Co-occurring Disorder Toolkit

This toolkit is a compilation of resources for individuals and organizations who treat clients with co-occurring mental health and substance use disorders.

Co-occurring Disorder Toolkit

Co-Occurring Disorders

The term co-occurring disorder refers to the condition in which an individual has a co-existing mental illness and substance use disorder. While commonly used to refer to the combination of substance use and mental disorders, the term also refers to other combinations of disorders, such a mental disorder and an intellectual disability. (The terms dual disorder and dual diagnosis were previously used to describe the same condition.)

When a substance use disorder and a psychiatric disorder co-occur, they may differ in severity, and the severity of each can change over time. Compared to individuals who have a single disorder, those with a combination of disorders may experience more severe medical and mental health challenges and may also require longer periods of treatment.


The symptoms of co-occurring disorders include those associated with the particular substance-abuse and/or mental health conditions affecting an individual. People with co-occurring disorders are at high risk for many additional problems such as symptomatic relapses, hospitalizations, financial problems, social isolation, family problems, homelessness, sexual and physical victimization, incarceration, and serious medical illnesses.


Mental health and substance use disorders result from a combination of factors. Certain people have a high genetic risk for such disorders, but one’s environment can also contribute to the risk.

People with mental health disorders are more likely to have a substance use disorder than those who do not. Roughly half of individuals who have either a mental illness or a substance use disorder will have the other at some point in their lives, according to the National Institute on Drug Abuse.

According to the DSM-5, an increased risk of alcohol use disorder, for example, is associated with conditions including bipolar disordersschizophrenia, and antisocial personality disorder, and alcohol use disorder may also be related to certain anxiety and depressive disorders. Other substance-related disorders also commonly co-occur with distinct psychiatric conditions. As in the case of opioiduse disorder and depressive disorders, it is possible that a substance use problem leads to the development of other mental health challenges or that it worsens a preexisting disorder.


To provide appropriate treatment for co-occurring disorders, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends an integrated treatment approach. Integrated treatment involves coordinating substance-abuse and mental health interventions, rather than treating each disorder separately without consideration for the other.

Integrated treatment often involves forms of behavioral treatment, such as cognitive behavioral therapy or dialectical behavior therapy, that can help improve coping skills and reduce maladaptive behaviors. These may be used in combination with medication. Treatment may also entail a collaboration between clinicians and organizations that offer support to handle issues related to housing, health, and work.

As a part of programs that treat co-occurring disorders, psychoeducational classes can help increase awareness of the symptoms of disorders and the relationship between mental disorders and substance abuse. Relapse-prevention education can help clients become aware of cues that make them more likely to abuse substances and help them develop alternative responses.

Dual-recovery groups located on treatment sites or offsite can also play a role in recovery by offering a supportive forum for the discussion of psychiatric symptoms, medication, substance-related impulses, and coping strategies.

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