Quick Summary
A co-occurring disorder means someone has a mental health condition and a substance use disorder at the same time. It is common: SAMHSA estimates 21.2 million U.S. adults had both in 2024, and about 2 in 5 of them got no treatment for either. The two conditions can affect each other, which is why the recommended approach is to assess and treat them together. This guide explains what co-occurring disorders are, why they overlap, what integrated care includes, and the questions to ask before picking a program.
Key Takeaways
- About 21.2 million U.S. adults had both a mental illness and a substance use disorder in 2024, slightly less than half of all adults with a substance use disorder.
- About 2 in 5 adults with both conditions got no treatment for either one that year.
- Shared risk factors, using substances to cope, and the effects of substances on the brain all help explain the overlap.
- Integrated care treats both conditions together with a coordinated team, and it is the model federal health agencies recommend.
- Not every program can treat both. Ask about psychiatric care before you start.
What a Co-Occurring Disorder Is
SAMHSA’s treatment guide on co-occurring disorders defines the term as having at least one mental disorder and at least one substance use disorder. You will also hear it called dual diagnosis. Any combination counts, from depression and alcohol use to PTSD and opioid use, and severity ranges from mild to severe.
How Common It Is
SAMHSA’s 2024 National Survey on Drug Use and Health puts the numbers this way:
- 21.2 million adults had both any mental illness and a substance use disorder in the past year.
- That is about a third of adults with a mental illness, and slightly less than half of the 46.3 million adults with a substance use disorder.
- About 58.8% got some kind of treatment, either mental health or substance use treatment, and about 41.2%, or 8.8 million people, got neither.
That last number is the real problem. A lot of people with both conditions are not getting care for either one.
Pairings Clinicians See Often
Any combination is possible. The examples below are patterns clinicians often describe, not rules for any one person:
- Depression and alcohol. Alcohol can bring short relief and then deepen low mood. Our post on anxiety and alcohol covers a similar loop.
- Anxiety and sedatives or alcohol. These can calm anxiety in the moment while making it harder to manage over time.
- PTSD and alcohol or opioids. Substances can become a way to numb trauma symptoms. See our page on trauma and PTSD.
- Bipolar disorder and several substances. Use can shift with mood episodes.
- Schizophrenia and cannabis or stimulants. These can worsen psychotic symptoms. Our guide on schizophrenia and substance use goes deeper.
Each person’s situation needs its own assessment.
Why the Two Overlap
The National Institute on Drug Abuse (NIDA) describes several reasons substance use and mental illness overlap, and usually more than one applies:
- Shared risk factors. Genetics, stress, trauma and early-life experiences can raise the risk of both. Our post on whether addiction is genetic covers the family-history piece.
- Using substances to cope. Alcohol or drugs may ease symptoms for a while, which reinforces using again.
- Effects of substances on the brain. Substance use can affect the brain systems that handle mood, stress and reward, and may worsen symptoms for some people. How much depends on the substance, the amount, how long, and the person.
Which came first matters less than treating what is in front of you now.
We’re here to make treatment as accessible and affordable as possible — and are in network with many insurance providers. Not sure about your coverage? We can help.
Why Treating Both Together Is Recommended
When only one condition gets treated, the other can keep complicating things. Depression and drinking, for example, can make each other harder to manage, so treating both gives the care team the full picture. That is the basic case for integrated care.
The National Institute of Mental Health (NIMH) describes integrated care as combining mental health and substance use treatment so people get coordinated care, often in one place. SAMHSA’s co-occurring disorders guide recommends the same approach. How well it works varies by condition and by person, so a good program measures progress on both fronts and adjusts.
What Integrated Care Includes
- An assessment that looks at mental health, substance use, physical health and safety together.
- One treatment plan that covers both conditions, built with the person.
- Medication management when it is needed for either condition, handled by a qualified prescriber.
- Therapies that work on both, such as cognitive behavioral therapy, motivational interviewing, dialectical behavior therapy and trauma-focused approaches.
- Peer and family support.
- A plan for ongoing care after the intensive part ends, since both conditions can need long-term attention.
Questions to Ask Before Choosing a Program
- Do you have psychiatric prescribers who can manage mental health medications alongside substance use treatment?
- Which mental health conditions do you treat, and which would you refer elsewhere?
- What therapies do you use for trauma, depression and anxiety?
- How do you coordinate with a psychiatrist or therapist I already see?
- What happens if mental health symptoms get worse during treatment?
- What does follow-up care look like for both conditions after discharge?
Clear, specific answers are a good sign. Vague ones are a reason to keep asking. Our page on co-occurring mental health conditions gives general information about dual diagnosis care. Ask admissions which services are available for your situation.
When to Reach Out for Help
Reach out when substance use and mental health symptoms are showing up together, even if it is not clear which one is driving things. If you drink heavily or take benzodiazepines every day, do not stop suddenly on your own, because withdrawal can be dangerous. Talk to a medical professional first. If you are having thoughts of suicide, call or text 988. If someone may act on those thoughts, cannot stay safe, has rapidly worsening hallucinations or severe confusion, or is having a medical emergency, call 911.
Talking With a Professional
An assessment that covers both conditions is the right starting point. Bring a list of current medications, what you use and how often, past diagnoses, and what has or has not helped before. The admissions team at Discovery Point Retreat can walk you through what an assessment involves and what options exist.
FAQ
What is the difference between a co-occurring disorder and a dual diagnosis?
They mean the same thing: having a mental health condition and a substance use disorder at the same time.
Which comes first, the mental illness or the substance use?
It varies. Sometimes the mental health condition comes first, sometimes the substance use does, and sometimes they develop together. Treatment focuses on both either way.
Can medication help with both conditions?
Medication can play a role for many mental health conditions and some substance use disorders. Decisions about which medication and dose are made with a qualified prescriber.
Is integrated care always better than treating one condition at a time?
It is the recommended approach, and coordinated care avoids one condition undermining treatment of the other. Results vary by person and condition, so ongoing reassessment matters.
What if a program only treats substance use?
Ask how it coordinates with outside mental health care. If it cannot, a program with psychiatric care on site may be a better fit.
References
- Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health. Accessed October 2026. samhsa.gov
- Substance Abuse and Mental Health Services Administration. TIP 42: Substance Use Disorder Treatment for People With Co-Occurring Disorders. Accessed October 2026. samhsa.gov
- National Institute on Drug Abuse. Comorbidity: Substance Use and Other Mental Disorders. Accessed October 2026. nida.nih.gov
- National Institute of Mental Health. Substance Use and Co-Occurring Mental Disorders. Accessed October 2026. nimh.nih.gov
Related Reading
- Co-Occurring Mental Health Conditions
- Schizophrenia and Substance Use
- Anxiety and Alcohol
- Trauma and PTSD
Resources
- 988 Suicide and Crisis Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential support 24/7.
- SAMHSA National Helpline. Call 1-800-662-HELP (4357) or visit the SAMHSA National Helpline page for free, confidential referrals to local treatment.
- 911. For any medical emergency, call 911 immediately.
This article is general education and is not medical advice.
If you are dealing with both mental health and substance use, call Discovery Point Retreat at (855) 245-7133 to talk with our admissions team.
