When one is struggling with a psychiatric disorders—such as PTSD, bipolar disorder, and depression— and a substance use disorder at the same time, these conditions are known as co-occurring mental health disorders. One who struggles with mental health conditions may be more likely to misuse substances, and people who misuse substances may be more likely to have mental health disorders.¹ Having at least one mental health disorder in the presence of at least one substance use disorder is known as co-occurring disorders. Since drug abuse and mental health issues can share common risk factors and influence the course of one another, it’s important to treat both disorders at the same time.¹

Dealing with co-occurring disorders can be challenging and can seriously impact your life. Drug and mental health rehab for co-occurring disorders, also known as dual diagnosis treatment, addresses symptoms of both problems to help you regain control and improve your quality of life.²

What Is Co-Occurring Mental Health and Drug Abuse?

The term co-occurring disorder, also referred to as a dual diagnosis, means that a person has a mental health disorder and an addiction at the same time.³ Mental health conditions can impact the way that addiction rehab takes place. Treatment providers should take not only the substance abuse, but also the mental health symptoms into account in order to improve the likelihood of successful long-term recovery.³

Many Americans are affected by mental illness and addiction. The 2020 National Survey on Drug Use and Health provides mental health and drug abuse statistics which report that 52.9 million people aged 18 and older had a past-year mental illness, and 17 million of these people had a co-occurring substance use disorder.⁹ NAMI reports that 1 in 5 American adults have a mental illness and 4% of American adults have a dual diagnosis.¹⁰

The Connection Between Mental Health and Substance Abuse

Mental illness and drug and alcohol addiction are often closely linked. People with mental illnesses can self-medicate with substances, but certain substances can also induce mental illness. A wide range of factors can play a role in the development of both disorders.^{1, 11}

The Substance Abuse and Mental Health Services Administration (SAMHSA) advises a comprehensive, individualized, and integrated approach to drug and mental health rehab or treatment.³ An integrated approach means treating the addiction and the mental health disorder together.

Your treatment plan should incorporate treatment methods that are designed to address both conditions. Providers may need to adapt these methods depending on your unique needs, which can include your symptoms, housing situation, gender, race, ethnicity, and other concerns.³ Your treatment plan should also take into account continuity of care, which means that treatment can occur in different settings over time as you progress in recovery. This can be inpatient or outpatient care, as well as aftercare, which happens after formal treatment is complete.⁴

What Is a Mental Health Condition?

The terms “mental health condition,” “mental illness,” and “mental disorder” are sometimes used interchangeably by different organizations to refer to conditions that affect your thinking, behavior, and mood.⁵ Mental health conditions include a wide range of disorders. They fall into categories based on symptoms and diagnostic criteria. While there are many mental health conditions, some of the most common disorders seen in those with co-occurring mental health and substance use disorders include:⁴

Anxiety disorders. These include conditions such as generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia. The key feature is excessive fear and worry.
Depressive disorders. These include major depressive disorder (MDD) and persistent depressive disorder. These disorders are characterized by low mood, excessive sadness, and cognitive changes that affect a person’s ability to function.
Bipolar disorder. This includes bipolar I and bipolar II. These disorders are characterized by mood shifts from depressive episodes to varying degrees of mania, which is the opposite of depression and includes symptoms like increased energy, little need for sleep, and impulsivity.
Post-traumatic stress disorder, or PTSD. This is an exaggerated fear response that can occur when people have been involved in or exposed to traumatic, life-threatening events.
Personality disorders. These include a range of usually lifelong disorders that affect a person’s inherent sense of self and impact their ability to form relationships with others. Examples of personality disorders that commonly occur with addiction include borderline personality disorder and antisocial personality disorder.
Schizophrenia and other psychotic disorders. These disorders cause severe incapacitation in areas of thinking, perception, and emotion and seriously impact a person’s mental and emotional state. They are characterized by symptoms like hallucinations (seeing, hearing, or feeling things that aren’t there) and delusions (believing things that aren’t true).
Attention-deficit hyperactivity disorder, or ADHD. This is characterized by a chronic inability to pay attention, hyperactivity, or a combination of both.

How to Identify a Co-Occurring Mental Health and Drug Abuse Problem

Co-occurring disorders can occur for a number of reasons, such as:^1,3,11

Common risk factors. Certain factors—such as genetics or environmental issues like stress and trauma—can play a role in the development of addiction and mental health disorders.
Mental disorders can impact addiction. As mentioned above, people who have mental illnesses may rely on substances to self-medicate, or ease their symptoms. Brain changes that occur with certain mental illnesses may increase the rewarding feelings associated with substance use.
Substance use and addiction can impact mental disorders. People who abuse substances can suffer from brain changes that may increase their chances of developing mental disorders.
Biological factors. Underlying medical problems or certain chemical imbalances in the brain can affect the development of addiction or mental illness.

Addiction isn’t always easy to spot, but there are certain behavioral, physical, and social changes that can indicate the presence of a problem. Signs of substance abuse can vary by substance and the individual. Common signs and symptoms can include:¹²

Frequently missing work or school.
Frequent fights, accidents, or problems with the law or other authorities.
Secretive or strange behaviors.
Appetite or sleep changes.
Mood swings, irritability, or angry outbursts.
Low motivation.
Seeming paranoid for no reason.
Bloodshot eyes.
Abnormally large pupils.
Tremors, a lack of coordination, or slurred speech.
Sudden changes in social circle.
Sudden financial problems.
Ongoing substance use despite the problems it causes.

All mental illnesses have their own set of symptoms and diagnostic criteria. Signs and symptoms can vary by individual and condition. However, some of the more common signs and symptoms that could indicate a possible mental illness can include:¹³

Excessive worry or fear.
Low mood.
Confusion or unclear thinking.
Rapid or extreme mood swings.
Unusual irritability or anger.
Appetite or sleep changes.
Social isolation.
Being unable to relate to others.
Problems perceiving reality, such as hallucinations or delusions.
Substance abuse.
Suicidal thoughts or behaviors.
Unexplained bodily aches and pains.
Inability to handle daily life stresses.

If you or someone you care about is struggling with a mental illness or addiction or both, it’s advisable to consult a doctor or another qualified professional to discuss your drug and mental health rehab options.

How to Treat a Mental Health and Drug Abuse Problem

Treatment for co-occurring disorders begins with a comprehensive intake and evaluation by a medical professional to assess the problem, your overall health, social factors, your living situation, and any other concerns. Depending on the substance you abuse, you might start with detox, which is a set of interventions designed to help your body cleanse itself from substances and address symptoms of drug or alcohol withdrawal.¹⁴ Detox prepares you for further treatment.¹⁴ While detox can take place on an inpatient or outpatient basis, inpatient detox tends to be more effective in helping people obtain initial sobriety and stabilization, according to NAMI.¹⁵

Co-occurring disorders are mainly treated with medication and behavioral therapies.¹ Different types of dual diagnosis rehab services are available for individuals seeking co-occurring disorder treatment. The proper treatment facility for you can vary depending on your needs, and different settings can work better for different people. Treatment settings include:^3,4,14

The time frame for treatment can vary. Treatment should be personalized based on individual factors, such as the level of addiction and your physical and mental health. Generally speaking, inpatient stays range from 28–30 days to 90 days or longer. Outpatient treatment might last for 2 months to 1 year.^3,14

Inpatient Treatment

NAMI explains that people with co-occurring disorders can benefit from the high level of support and care offered by inpatient rehabs.¹⁵ Inpatient care involves living onsite and receiving treatments, as well as medication, if necessary, and 24/7 monitoring.

Inpatient or residential care may be well-suited to those who require a higher level of care and support. This can include individuals with co-occurring medical or mental health disorders, as well as those with a prior history of relapse or withdrawal seizures, people who need medical supervision, those without supportive home environments, and people who require withdrawal management. Inpatient care removes the distractions of daily life so that you can focus on recovery.^4,14,15,17

Outpatient Treatment

Outpatient treatment means you live at home but travel to a treatment facility between 1 and several times per week. Treatment may begin at a high level of intensity and transition to less supportive levels of care. High-intensity programs offer treatment for several hours per day, most days of the week, while others may offer fewer services and lower levels of intensity.⁴ Some of the settings where outpatient care takes place include:^3,18

Partial hospitalization. This is highly supportive and usually involves attending treatment for 4 to 6 hours per day, most days of the week.
Intensive outpatient. This involves attending treatment more than twice a week for at least 3 hours per day.
Standard outpatient. This can involve attending treatment sessions at a rehab 1 to 2 times per week.
Outpatient visits with counselor/therapist/clinician. This may be helpful as a form of aftercare for individuals who have completed a treatment program or can be useful as a brief intervention to receive referrals to other forms of care.

Behavioral Therapy

Behavioral therapy typically takes place in groups or on an individual basis.¹⁹ Some of the behavioral therapies you may receive include:^1,6,19,20

Cognitive behavioral therapy (CBT), which helps you address unhelpful thoughts and behaviors related to addiction and mental illness.
Dialectical behavior therapy (DBT), which helps you develop mindfulness and acceptance of the situation and your emotions. It teaches you skills such as self-regulation and stress management and helps prevent self-harm.
Assertive community treatment (ACT), which focuses on outreach, long-term support, and an individualized treatment approach.
Mindfulness-based cognitive therapy, which combines elements of CBT and mindfulness (such as meditation).

Medication-Assisted Therapy

Medication-assisted therapy, or pharmacotherapy, may be a part of your treatment plan.³ You may receive different medications based on your diagnosis and unique needs. Common mental health medications include:²¹

Antidepressants. These medications treat depression. They can include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and bupropion.
Anti-anxiety medication. This helps reduce anxiety symptoms. The most common anxiety medications are benzodiazepines.
Stimulants. These are primarily used to treat ADHD.
Antipsychotics. These are used to manage psychosis, such as in cases of schizophrenia and bipolar disorder.
Mood stabilizers. These can help stabilize your mood and are mainly used to treat bipolar disorder or other conditions that cause mood swings.

What Happens After Treatment?

Recovery is a lifelong process that continues after treatment has been completed. Aftercare involves ongoing support or treatment that helps prevent relapse and increases your chances of long-term recovery success.²²

Aftercare can be any form of relapse prevention support that works for your needs. This can include options like:^3,8,15,16

Mutual support groups, like Alcoholics Anonymous and Narcotics Anonymous.
Sober living homes, which provide a supportive, substance-free environment for people in recovery.
Individual therapy, where you have weekly sessions with a therapist to obtain recovery support.
Group therapy, where you meet in a group, led by a therapist, with others who are also in recovery.
Mindfulness-based relapse prevention, which combines self-care and relaxation strategies with relapse prevention techniques.

Find Dual Diagnosis Facilities for Addiction Treatment

Rehab centers are located throughout the U.S., and a variety of treatment types is available. The only way to determine which treatment options are best for you is to talk with your medical or mental health provider. You can speak with them about programs that suit your priorities and goals.

American Addiction Centers (AAC) is a leading treatment provider and has trusted rehab facilities across the country. Start your path to recovery today by verifying your insurance coverage for treatment to see what and how much will be covered. You can contact AAC free at at any time, day or night.

Using Health Insurance to Pay for Treatment

Visit the links below to find out more about your health insurance coverage levels, how to get your insurance company to pay for drug and alcohol rehab, and how to pay if you don’t have insurance.

Substance Abuse and Mental Health Treatment Programs