Co-occurring disorders were once called dual diagnosis. The combine a mental health disorder with a substance abuse disorder. In a 2014 report by SAMHSA, there were nearly 8 million adult in the U.S. with co-occurring disorders.
The reasons that people abuse substances can often be attributed to emotional reasons. Substances have the ability to numb pain from events in life that haven’t been dealt with.
A co-occurring disorder can be defined by two disorders such as:
- Alcoholism and depression.
- Cocaine addiction and anorexia.
- Post-traumatic stress disorder and heroin abuse.
Studies show that people who have mental health disorders are more likely to have a substance abuse disorder. The disorders have been proven to feed off one another. It’s challenging to diagnose co-occurring disorders as well. Each exacerbate one another, making it difficult to pinpoint the separate entities of the disorders.
For all addicts, it seems there is a perfect drug that can ease their suffering from mental health disorders. Co-occurring disorders are so common because substance abuse can ease the symptoms. In the end however, the drug or alcohol use makes the mental health disorder worse. The evil cycle will continue until a person gets treatment for the co-occurring problem.
The Connection of Substance Abuse and Mental Health Disorders
The Epidemiologic Catchment Area (ECA) conducted a study on patients with psychiatric disorders. They found that 44% of those patients also had an alcohol disorder. There were 64% of patients with drug-use disorders.
Mental disorders are more common in people that have been abusing substances for a long period of time. There is a definitive connection between mental health disorders and substance addiction. The following has been found in mental health disorder patients.
- 38 % consume alcohol
- 44 % consume cocaine
- 40 % smoke cigarettes
For those who have, at one point, been diagnosed with a mental health disorder, there is a separate set of statistics. They include substance consumption of:
- 69 % consumed alcohol
- 84 % consumed cocaine
- 68 % consumed cigarettes
Mental Health Disorders Cause Emotional Suffering Which Can Lead to Substance Abuse
There are a few reasons people become addicted to substances. Most of those reasons will fall into a deep emotional issue. When a person has a mental health disorder, they are suffering. They have come to a point where life is not manageable. They are given drugs, like heavy sedatives or mood altering medication, to function through daily life. These come with side effects that can make the person feel better, and even euphoric.
When you look to people who have suffered from trauma, they have a hard time coping with life. They can’t handle the memories, the feelings, or the pain. People use substance to self-medicate so they can numb themselves from the suffering.
They may feel depressed and anxious. Drugs and alcohol help soothe the pain so the person with a mental health disorder doesn’t have to deal with their emotions. They may spend their life trying to ensure they never have to.
Some People Will Develop Co-occurring Disorders because They Never Asked for Help
If a person has a mental health disorder, they may never seek help. Some people don’t want to ask for help because they have low self-esteem and a lack of self-worth. They have come to such a low point in their life, they feel worthless. So they self-medicate. This will include drugs like marijuana or heroin or they might rely on alcohol.
Someone with mental health problems may see it as their own problem. When the pain gets too much, they self-medicate. Once they begin to numb their feelings with euphoric drugs for example, the brain receives the message that the problem is solved. This creates the reward cycle in the brain that creates addiction.
Why Someone with Anti-Social Personality Disorder Reaches for Alcohol
A common co-occurring disorder is alcohol abuse and anti-social personality disorder (ASPD). The NIAAA has conducted studies that tell us ASPD has the most distinct connection with alcohol than other disorders. Statistics say that people who drink regularly are 21 times more likely to end up with ASPD.
This co-occurring disorder will often develop early on in life. Alcoholism essentially promotes the mental illness ASPD. People that have ASPD are more likely to drink because they’re overly nervous in social situations. The alcohol causes the person to exhibit their antisocial behaviors. This perpetuates the antisocial behavior over and over.
Why Anxious People Will Abuse Cocaine
People with anxiety disorders may turn to cocaine because it makes them feel confident. One of the afflictions anxious people have is an overwhelming feeling of insecurity. Cocaine can be like a band aid for a while. In the end however, use of cocaine will perpetuate insecurities a person tries to mask. They will also have more symptoms to deal with including;
For someone who has anxiety, these symptoms can be terrifying. Another issue is when someone attempts to stop using cocaine when they’ve become dependent on it. Cocaine is not an easy addiction to recover from. Stopping without help can bring on terrible feelings of insecurity and anxiety. This might cause someone to form an extreme dependency on it.
Opioid Addiction and PTSD
Post-traumatic stress disorder (PTSD) is a mental illness that occurs when someone goes through major trauma. This can be anything from a near death experience to watching somebody die. During the time of the trauma, they will feel powerless. This feeling of powerlessness often stays with them. Coincidently, people who survive a serious injury in a traumatic situation will be treated with prescription painkillers.
When someone goes through a traumatic experience, they will often experience terrible side effects. This includes:
- Flashbacks of the traumatic experience.
- Avoidance of things that happened during the event. This leads to repressed emotions which are the cause of clinical depression.
- Severe anxiety with a feeling that something terribly wrong may happen again.
- Aggressive behavior and angry outbursts.
Symptoms may happen anytime, usually by a trigger that reminds the person of the traumatic events. People that fall into this category will often have a mental health disorder that manifests such as depression, A.D.D., or chronic pain. These afflictions will often cause a person to remain on opioid pain killers for a long duration.
In cases where people have experienced true PTSD, they will turn to substances to numb their emotional pain. In a highly traumatic experience, it feels as though a person will lose all control. The constant substance abuse creates a complex co-occurring disorder. It becomes difficult to diagnose what the real problem is as both disorders criss-cross over each other.
Common causes of the PTSD include:
- Combat in the military.
- A violent assault.
- Natural disasters like an earthquake.
- A violent sexual assault.
- Childhood abuse.
Endorphin Withdrawal May Be the Answer to Co-occurring Disorder
In a traumatic situation, the fight-or-flight response can cause dysregulation in the body.
Research has found that neurobiological abnormalities occur in PTSD patients. People who have gone through trauma or have experienced stress for a long time, will have depleted endorphins. This is what brings us joy and makes us feel happy.
Endorphin withdrawal plays a large part in drug or alcohol abuse in order to control symptoms of PTSD. When the moment of trauma occurs, neurotransmitters help a person cope with the moment so they can survive. Once the moment is over, the body will go through endorphin withdrawal. It actually comes with some of the same withdrawal symptoms as alcohol does.
- A craving for drugs and alcohol
Heroin Addiction and Depression
Studies have shown that nearly 50% of opiate users have experienced depression. For people suffering from depression, heroin may seem like a solution. The high of heroin includes a rush of euphoria along with a total sense of relaxation. For someone who battles depression, this brief feeling will create dependency quickly.
Side effects will perpetuate the feelings of depression once the heroin high wears off. The feelings of sadness, guilt, and hopelessness will worsen. They will continue to abuse heroin to avoid the feelings. The cycle in this co-occurring disorder exists daily. The two become deeply intertwined and it’s easy to lose someone completely.
Heroin alters the brain’s chemistry which causes mood changes. In the very short-term, these mood changes are good. A welcoming relief from a user’s mood disorder. In the long-run however, they can cause suicidal behavior and heroin addiction in the mind and body. The two disorders are so similar and each can cause the other to grow stronger. Heroin can lead to brain damage that causes severe depression. In the end, what a person thought was the solution makes their condition much worse.
Does Addiction Lead to Co-occurring Disorder?
The disorders within co-occurring disorders trigger one another. Someone’s path in life will define what comes first with co-occurrence. They may have experienced trauma that caused addiction. Alternatively, addiction may cause the mental health disorder. Everyone’s experience is different when it comes to addiction and mental illness.
Heroin can cause depression in someone who hadn’t been depressed prior. Someone who is anxious may become addicted to cocaine. The chances of becoming addicted when you have a mental health disorder are greater. The chances are also higher for someone with a mental health disorder to become addicted to a substance. As the two feed off each other, it’s common that someone suffering from one disorder will experience the other.
SAMHSA, Substance Abuse and Mental Health Services Administration. Co-Occurring Disorders. Retrieved from,
The National Bureau of Economic Research. Mental Illness and Substance Abuse. Retrieved from,
NCBI, Addiction Science and Clinical Practice (Dec. 2005) Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Retrieved from,
NCBI, World Psychiatry. (Oct, 2004) Concurrent substance-related disorders and mental illness: the North American experience. Retrieved from,
NCBI, Dialogues Clinical Neuroscience (Sept. 2011) Post-Traumatic Stress Disorder, the neurobiological impact of psychological traumaPost-traumatic stress disorder: the neurobiological impact of psychological trauma
Post-traumatic stress disorder: the neurobiological impact of psychological trauma