Many people have heard the terms “dual diagnosis” and “co-occurring disorder.” However, not many people know what they mean. Furthermore, how they relate to addiction or substance use disorder. First, let’s understand what each term means and the slight different between the two.


Dual Diagnosis

“Dual diagnosis” is a term first identified in the 1980’s among individuals that had coexisting mental illness and substance use disorder. However, a dual diagnosis is when a person has been diagnosed with two or more conditions that occur simultaneously.


Co-Occurring Disorders

“Co-Occurring disorders” is a term that refers to an individual that also has two or more medical or health conditions occurring simultaneously, but often refers specially to mental illness and substance misuse, and that one condition contributed to the development of the other condition (meaning that the mental health condition contributed to the drug addiction or vice versa.)


Based on the latest numbers, surveys, and studies, almost 8 million Americans have a co-occurring mental health and substance use disorder. Of the almost 21 million American that meet criteria for a substance use disorder, almost 40% also have a mental illness or mental health condition. Among the over 42 million Americans with a diagnosable mental illness, just under 20% also have a substance use disorder.


So, with millions of Americans impacted by addiction, what are the common co-occurring disorders that accompany the substance use disorder? Here is a look at the 9 most common co-occurring disorders that accompany a substance use disorder or addiction to drugs and alcohol.


Anxiety Disorders

Anxiety disorders are a group of mental health disorders that cause constant and overwhelming anxiety, worry, and fear. Such disorders can interfere in regular life activities, like work, school, family, or social interactions and gathering. Several different types of anxiety disorders are generalized anxiety disorder, panic disorder, social anxiety disorders, agoraphobia, medication-induced anxiety disorder, separation anxiety, and other types of specific phobias.


Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)

Often first seen in children and adolescents or young adults, ADHD and ADD are common co-occurring disorders that can often accompany a substance use disorder diagnosis. ADHD stands for Attention Deficit Hyperactivity Disorder, which is a mental health condition that causes above-average or above-normal levels of hyperactive and impulsive behaviors. People with ADHD often may have difficulty focusing their attention on a single task or sitting still for too long. ADD stands for Attention Deficit Disorder and it a type of ADHD. ADD doesn’t necessarily involve constant movement and fidgeting, but it is a mental health condition that includes impulsivity and hyperactivity, as well as symptoms of inattention, distractibility, and poor working memory.


Bipolar Disorder

Bipolar Disorder is a mental health condition that is often referred to as manic depression. It is a mental illness that brings severe high moods and low moods, often quickly changing between the two. Symptoms include changes in sleep patterns or difficulty sleeping, high energy, hyperactivity in thought patterns and behaviors. Individuals often seem either extremely depressed or manic. Mood swings can be sudden or occur over long periods of time. There are several types of bipolar disorders, including Bipolar I disorder, Bipolar II disorder, cyclothymic disorder, and more. Bipolar disorder is a lifelong condition that can be managed with treatment and medication.



Everyone experiences depression at some point in one form or another. However, for certain people, they can be clinically diagnosed with depression or a depression disorder. There are several types of clinical depression that can be diagnosed, treated, and/or managed, including major depression, chronic depression, dysthymia, or season affective disorder (SAD.) Sometimes, due to symptoms, individuals with bipolar disorder will also fall into this category.


Eating Disorders

Eating disorders (or disordered eating) is more an umbrella term that includes many types of different eating disorders or disordered eating. Eating disorders are a range of psychological conditions that create unhealthy eating habits and relationships with food. Eating disorders can also be incredibly dangerous to the health of the individual. Some common examples of eating disorders are anorexia nervosa, bulimia nervosa, binge eating, pica (which involves eating things that are no food), rumination disorder, and avoidance or restrictive food intake disorder.


Mood Disorders

Mood disorders are mental health issues that primarily affect a person’s emotional state. For an individual that suffers from a mood disorder, they often experience long periods of extreme happiness, extreme sadness, or both. Both major depression and bipolar can fall into the category of being mood disorders, but other examples of mood disorders are dysthymia (dysthymic disorder),  substance-induced mood disorder, and a mood disorder that is linked to another health condition or general medical condition.


Personality Disorders

A personality disorder is a psychological or mental health condition where the individual experiences long-term patterns of behavior and inner experiences that differs significantly from what is expected. In short, a personality disorder is a way of thinking, feeling, and behaving that deviate from the typical expectations of the individual’s culture or societal norms. Individuals with a personality disorder often have difficulty coping with normal stress, trouble forming relationships, don’t enjoy social activities or interactions, and often do not see themselves as contributing to their own problems. Historically, there are ten different types of personality disorders: Antisocial personality disorder, avoidant personality disorder, borderline personality disorder, dependent personality disorder, histrionic personality disorder, narcissistic personality disorder, obsessive-compulsive personality disorder, paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.


Post-Traumatic Stress Disorder (PTSD) or Trauma

Trauma is an emotional response to an event in an individual’s life. It can be from a single event or small events that occur consistently over time. Trauma is typically divided into three main types: acute, chronic, and complex. Often, trauma is also divided into two main categories: Big “T” and little “t.” Big “T” trauma is often defined as an extraordinary and significant event that leaves an individual feeling powerless, helpless, and possessing little control in their environment. Examples of Big “T” trauma could be natural disasters, sexual assault, combat, or a major accident. Little “t” trauma is considered highly distressing events that affect individuals on a personal level and can often happen over time. Some examples could be ongoing emotional abuse, bullying or harassment, the loss of a significant relationship, or non-life-threatening injuries or events. Post-traumatic stress disorder, or PTSD, is a mental health condition typically associated with a Big “T” trauma. PTSD is a psychiatric disorder that often occurs in individuals who have experienced or witnessed traumatic events.



Schizophrenia is a long-term mental illness involving a breakdown in the relation between thought, emotion, and behavior which leads to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. Some symptoms of schizophrenia include delusions, hallucinations, disorganized thinking and/or speaking, being extremely disorganized or exhibiting abnormal motor behaviors, feeling a lack of please, or psychosis.


Treatment for Addiction and Co-Occurring Disorders


The difficulty in treating co-occurring disorders is that first, a determination must be made through a comprehensive evaluation which disorder is primary. Additionally, many patients seeking treatment for addiction have a co-occurring disorder without an accurate diagnosis. Unfortunately, there are many addiction treatment centers and rehab facilities that are not truly equipped to handle, manage, and treat a patient with co-occurring disorders, but will admit them anyway and attempt to treat them. What ultimately happens is the patient is not having their clinical needs met, has a poor experience, believes this experience is what treatment is, and becomes even more resistant to seeking help in the future.


What individuals, parents, family members, and loved ones should know is that quality addiction and co-occurring disorder treatment is available, and that substance use disorder and these common co-occurring disorders can be clinically treated appropriately at the same time. First, make sure the treatment center is adequately equipped to handle not only addiction issues, but mental health and co-occurring disorder issues. The clinical professionals (therapists and counselors) should be master’s level or doctorate level mental health clinicians with additional specialty training and education. There should be a robust psychiatric service offering, through the facilities psychiatrists and/or psych nurse practitioners. Recovery support staff should be able to identify and support patients when they are having emotional or behavioral issues related to both addiction and mental health. And a synergy should exist between all members of the staff to offer an appropriate diagnosis, treatment plan, and execution of patient goals and objectives.


Very rarely do addiction issues and mental health issues exist on their own. For most individuals suffering from addiction or suffering from mental health conditions, there is a cross relationship between substance use disorder and at least one mental health disorder. A high-quality, clinically sophisticated addiction treatment center or rehab that promotes itself as being dual diagnosis or able to treat common co-occurring disorders will effectively be able to do so in order to offer the best chance for the patient of recovery from all disorders.


If you or someone you know needs help for addiction or co-occurring disorder issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at For more information on all of our drug addiction, alcohol addiction and co-occurring disorder services and recovery resources, please visit our web site at