What are the most common co-occurring disorders diagnosed alongside substance abuse?

Jun 30, 2021

When it comes to substance abuse, you’re often looking at a complex diagnosis that includes many other factors, including co-occurring mental and physical disorders and past trauma, just to name a few. Addiction specialists shared with us some of the more prevalent conditions that are often linked with substance use disorders.

Dr. Scott Giacomucci

Dr. Scott Giacomucci

Dr. Scott Giacomucci, DSW, LCSW, BCD, FAAETS, PAT, Director and Founder of the Phoenix Center for Experiential Trauma Therapy.

PTSD Most Common and Overlooked Co-Occurring Disorder

One of the most common, while also frequently overlooked, co-occurring disorder alongside substance abuse is PTSD. Research indicates that an overwhelming majority (70%-80%) of folks in treatment for substance use report a history of trauma and they are 7-12 times more likely to meet the criteria for PTSD than someone without a substance use disorder.

PTSD is the most common co-occurring disorder for those already diagnosed with alcohol use disorder. About half of those struggling with PTSD also struggle with substance abuse. Addictions and trauma exist in a cyclical relationship fueling each other and often consuming one’s life.

Substance Abuse Commonly Linked with Depression, Anxiety, PTSD

Though statistics from research vary, it has been consistently found that at least 20 percent of individuals with a substance use disorder are concurrently diagnosed with a mental health disorder. In some cases the mental health disorder precedes the substance use disorder or vice versa; however, regardless of which came first, one may continually serve to reinforce the other until both come to resolve.

This often requires treatment. Among the most common co-occurring diagnoses include:

  • Major Depressive Disorder
  • Anxiety Disorder
  • Post-traumatic stress disorder (PTSD)
  • Bipolar Disorder (among others)

Given the severity of these conditions, many begin using [substances] as a “quick fix” to cope. Such symptoms may include feeling down, withdrawing socially, amotivation, performance issues, impulsive behaviors, difficulty thinking clearly, and so on.

Depending on the individual, such symptoms may become quite severe, which leads to one becoming desperate for relief. This immediate relief does pose a substantial risk, particularly for those who currently struggle with addiction or have addictive personalities.

In the cases where the substance use disorder came first, how symptoms and side effects negatively impact the lives of self and others tend to lead toward substance-induced mental health disorders.

Matt Glowiak

Matt Glowiak

Dr. Matthew Glowiak, PhD, LCPC, CAADC, NCC, Substance Abuse Counselor and Writer for Choosing Therapy.

Joanne Ketch

Joanne Ketch

Joanne Ketch, an LPC, LMFT, SAP, and LCDC, Recovery Therapist at Chrysalis Counseling.

Simultaneous Treatment Increases Recovery Success

Substance abuse, misuse, overuse, and addiction are common and occur on a continuum. That means that a person can have problematic use ranging from “misuse” to “dependency.”

What informs that relationship includes heritable factors, histories such as trauma, situational circumstances such as developmental stages (when it may be common to binge drink or over-consume party drugs), or the misuse of painkillers after a medical event.

Another factor is the presence of a co-occurring issue. “Co-occurring” is the term used by professionals to describe when a client or patient has both a substance use disorder and an additional mental health concern. It’s important, if not imperative, to identify and treat these co-occurring issues simultaneously with the substance use disorder because there is often a bidirectional impact: the substance use disorder often makes the co-occurring issue worse (though it may have helped at the beginning) and the co-occurring issue, if not treated, will constantly challenge the management of the substance use disorder. Clinicians need to work with clients on building skills without substance use to replace what the substance helped to alleviate.

Common co-occurring issues are anxiety and depression. Another quite common issue is trauma. Addiction research has shown in the last 20 years that trauma, particularly developmental (childhood) trauma, is correlated with predisposing that person with a greater likelihood of developing a substance use disorder. Another common, but often unmentioned co-occurring issue is intimate partner violence and substance use disorder. The presentation of these together requires a professional who is knowledgeable and skilled because the privileging of safety while motivating sobriety requires specific information.

The good news is that often the changes needed, the skills acquired, and the habits of the thought and behavior used for substance abuse recovery are multidimensional and assist with many co-occurring presentations as well.

Recovery Progress Is Dim Without Addressing Co-Occuring Conditions

According to SAMHSA (Substance Abuse and Mental Health Services Administration), the most common co-occurring disorders diagnosed alongside substance abuse are:

  • Depression
  • Anxiety
  • Schizophrenia
  • Bipolar disorder
  • ADHD
  • Post-Traumatic Stress Disorder.

Those struggling with substance abuse issues report their use of substances commonly began as a way to cope with mental health issues. Addiction followed thereafter, compounding an already compromised emotional state because of mental health struggles. Addiction usually brings with it physiological and/or mental dependence that keeps an addict bound to continued use to ward off withdrawal.

A person’s mental illness is then exacerbated by the addiction; many addicts report depression and anxiety linked to addictive behaviors. For example, veterans who suffer from Post-Traumatic Stress Disorder report using substances as a way to cope with the symptoms associated with PTSD, such as flashbacks, anxiety, and hypervigilance (hyperawareness). Then, as their substance use continues and a physical dependence develops, anxiety surrounding needing more of a substance to maintain a sense of wellbeing develops.

Thus, their anxiety is increased. A biopsychosocial cycle of despair becomes the norm for people suffering from co-occurring disorders. Effective treatment involves professionals who are well versed in treating those with co-occurring disorders. Assessing and determining how to best proceed concerning substance abuse and co-occurring disorders is of paramount importance in having a positive prognosis for recovery.

Keischa Pruden

Keischa Pruden

Keischa Pruden, LCMHC, LCAS, CCS, SAE, Owner and Therapist at Pruden Counseling Concepts.

Monty Ghosh

Monty Ghosh

Monty Ghosh, Addiction Specialist and Physician. Find him at Monty Ghosh.

Consider Mental, Physical, and Socio-Economic Health

Most individuals with substance use disorders who have concurrent disorders typically have a coexisting mental health condition. Whether it is depression, anxiety, or PTSD, it is important to address these when you examine substance use disorders. These diagnoses not only worsen a patient’s chance for recovery, but also increase their risk of relapse if they are in recovery.

Other diagnoses to examine include concurrent pain concerns which need to be managed on top of substance use issues, as well as an examination of a client’s social determinants of health, such as homelessness, which also worsens substance use states.

This is a crowdsourced article. Contributors' statements do not necessarily reflect the opinion of this website, other people, businesses, or other contributors.