What Are Co-Occurring Disorders?

Co-occurring disorders exist when someone has a substance use disorder (SUD) such as alcohol use disorder (AUD) and a co-existing mental health disorder, such as depression or anxiety. It can also be the case when someone has a mental health disorder and an intellectual disability. 

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Dual diagnosis or dual disorder were initially used interchangeably, but there is a difference between the two terms.

People with co-occurring disorders experience varying levels of severity in their disorders that change over time. Many experience more severe challenges and might require longer, more intensive treatment to manage their disorders.

The most common types of disorders to exist when someone also has alcohol use disorder (AUD), more commonly known as alcoholism, include:


Approximately a third of all people who struggle with alcohol consumption have major depression. In most people, depression appears first, and the person consumes alcohol to improve the symptoms of depression, but this isn’t always the case. Alcohol is a depressant and tends to exacerbate an existing depression disorder and increase the risk of suicide.


People with anxiety sometimes use alcohol to feel calmer. No longer drinking after misusing alcohol might trigger panic and insomnia, which increases a person’s risk of creating a cycle of overdrinking to ease anxious feelings. Anxiety disorders with an increased risk for AUD include:

  • Generalized anxiety disorder
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Social anxiety disorder
  • Agoraphobia and other phobias

Bipolar Disorder

Bipolar disorder, disorder formerly known as manic depression, causes extreme mood swings that include emotional highs, mania or hypomania, and lows, depression. Some people self-medicate these mood swings with alcohol. Alcohol moderates manic phases because it is a depressant and eases the low feeling of depression, at least temporarily. People with bipolar disorder and a co-occurring AUD or SUD have a higher risk of unsuccessful treatment.


Schizophrenia triggers delusions, hallucinations, disorganized thoughts, speech, and behavior, lack of motivation, and absence of emotional expression. 

One study found that people with schizophrenia experience a 33 percent higher risk of developing AUD. 

In some cases, people with schizophrenia use alcohol to self-medicate, while in others the alcohol abuse existed before schizophrenia developed.


Dual Diagnosis vs. Co-Occurring Disorders

Dual diagnosis and co-occurring disorders are somewhat similar. Dual diagnosis occurs when someone has two or more disorders simultaneously. 

It’s often used in reference to mental illness and substance addiction. It also applies to all combinations of physical conditions, whether or not they are linked with alcoholism or other substance use issues. For example, someone can have a dual diagnosis of diabetes and high blood pressure.

Co-occurring disorders are a type of dual diagnosis. The term is most often used in reference to mental health disorders linked to substance use.

The difference between the terms is the relationship between the disorders. In a dual diagnosis, the cause of the medical issues might be substance abuse, but they are two separate diagnoses. 

In the case of a co-occurring disorder, mental illness and drug and alcohol addiction are directly linked. The effect of alcohol on the brain leads to or worsens a mental health disorder. A mental health disorder can also lead to the development of an alcohol use disorder (alcoholism).


Treatment for Co-Occurring Disorders

Treatment for co-occurring disorders is more intensive and requires more attention than when drug addiction occurs on its own. It is also essential that people with co-occurring disorders receive treatment for both disorders simultaneously. Failing to diagnose or treat a co-occurring disorder reduces the effectiveness of treatment for alcoholism.

Integrated treatment approaches are best for people with co-occurring disorders. Integrated care includes a combination of the following:

  • Medical detox
  • Medications
  • Therapy and counseling
  • Support groups
  • Aftercare support

One of the challenges of treating co-occurring disorders is medication. Alcohol interferes with many different prescription medications, and the problem is especially severe with psychiatric medications. This means if someone consumes alcohol while taking medication to manage a mental health disorder, potentially fatal symptoms can occur.

It also means detox is especially important before the administration of medication for a mental health disorder. Medications are still effective for treating anxiety, depression, schizophrenia, and bipolar disorder, but staying abstinent from alcohol and other substances is essential.

Behavioral therapy is one of the most effective treatments for alcoholism. It is especially helpful for those with co-occurring disorders. This therapy is also useful long-term and reduces the risk of relapse. 

Working with a therapist who has experience with a specific mental illness improves a person’s ability to focus on sobriety and improve their overall mental health.

Treatment for Depression and Alcohol Use Disorder

Treatment for depression and AUD begins with detox, ideally in a medically-supervised environment. Once the person’s body is clear of alcohol, he or she will receive a mix of treatment options, including:

  • Behavioral therapy
  • Group counseling
  • Individual counseling
  • Peer support groups
  • Long-term care planning
  • Medication for depression and AUD

Treatment for Anxiety and Alcohol Use Disorder

Once a medically supervised detox is complete, a person struggling with anxiety and alcoholism can receive a combination of treatment options, including:

  • Medication to ease AUD and anxiety symptoms
  • Individual counseling
  • Group counseling
  • Behavioral therapies
  • Peer support group
  • Long-term care planning

Treatment for Bipolar and Alcohol Use Disorder

Following a medically supervised detox, people struggling with bipolar disorder and alcoholism benefit from an integrated treatment approach that includes:

  • Medications such as antidepressants, antipsychotics, and mood stabilizers
  • Individual therapy
  • Group therapy
  • Behavioral therapy
  • Long-term care planning that includes relapse prevention
  • Family therapy

Treatment for Schizophrenia and Alcohol Use Disorder

Treating co-occurring schizophrenia and alcoholism is best done with an inpatient treatment program, at least during the early stages of treatment. Inpatient programs provide round-the-clock medical supervision in a secure and stable environment away from temptations to use alcohol. 

For those with less severe symptoms or who have completed an inpatient program, partial hospitalization programs offer a bridge between inpatient treatment and a return to regular life. Long-term treatment for schizophrenia and alcoholism includes:

  • Medication
  • Ongoing therapy
  • Peer support group attendance
  • Long-term care planning and relapse prevention

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“Co-Occurring Disorders | Psychology Today.” Psychology Today, 2019, www.psychologytoday.com/us/conditions/co-occurring-disorders.

“NIAAA Publications.” Nih.Gov, 2017, pubs.niaaa.nih.gov/publications/arh312/155-167.htm.

Yule, M.D., Amy M., and John F. Kelly, Ph.D. “Integrating Treatment for Co-Occurring Mental Health Conditions.” Alcohol Research Current Reviews, NIH, 24 Oct. 2019, www.arcr.niaaa.nih.gov/arcr401/article07.htm?utm_source=niaaa.nih.gov&utm_medium=referral&utm_campaign=Issue-401-Article-7. 

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Updated on: January 21, 2021
Kelly Jamrozy
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Medically Reviewed
Annamarie Coy,
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