How To Face Substance Use Disorder (SUD) With a Co-Occurring Diagnosis?

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How To Face Substance Use Disorder (SUD) With a Co-Occurring Diagnosis?

Working through substance use disorder (SUD) is a difficult battle. Sometimes, however, a pre-existing or new mental health condition can make an individual’s treatment and recovery that much more difficult. It’s fairly common for someone to have both SUD and a mental health condition. These conditions can interact with and affect each other in complex ways. However, both are treatable. Many resources are available to help you heal from both SUD and a co-occurring diagnosis.

What Is a Co-Occurring Diagnosis?

The diagnosis of a mental health condition alongside a diagnosis of SUD is often called a co-occurring diagnosis or disorder. It doesn’t matter which developed first or whether the disorders developed simultaneously. There is also no specific combination of mental health conditions and SUD that is typical. Some common co-occurring diagnoses found alongside SUD are:

  • Depression
  • Anxiety
  • Mood disorders (such as bipolar disorder)
  • Post-traumatic stress disorder (PTSD)
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Schizophrenia


People with pre-existing mental health conditions are more likely to develop SUD than those not affected by mental health conditions. In fact, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2021 National Survey on Drug Use and Health, about nine.2 million adults in the United States have a co-occurring disorder. Although it is unclear exactly why co-occurring diagnoses are so common, there are a few possible reasons:

  • SUD and many mental health conditions have common risk factors. For example, both SUD and depression can have a genetic component. Stress, trauma, and other environmental factors can increase the chance of SUD and mental health issues as well.
  • Mental health disorders can contribute to SUD. Individuals may turn to substance use as a way to cope with their mental health conditions. For example, someone struggling with PTSD may believe they’ll feel less anxious under the influence of alcohol. Additionally, people with mental health disorders may experience an enhanced reward effect when using substances, causing them to more easily become addicted.
  • SUD can contribute to mental health disorders. Substance use can potentially trigger chemical brain changes that affect brain function, which can make a person more likely to develop a mental health condition. Depression is an especially common mental health issue to develop after substance abuse.


Co-occurring disorders are a nuanced and complex issue. Though the interaction between substance use and mental health conditions isn’t fully understood, the correlation is very real. A co-occurring disorder can have devastating effects on a person’s mental and physical health, personal life, and general functionality.

Mental Health Conditions and SUD

Co-occurring disorders can also have a major impact on an individual’s SUD recovery. The added emotional and mental load of facing SUD along with another mental health condition can be debilitating. The disorders often feed into each other. An individual may use substances to cope with a mental health condition, and then that substance worsens the condition they’re trying to cope with. Damage to the body and mind can become cyclical. At the same time, the stress of a co-occurring diagnosis can lead to feelings of anger, guilt, shame, and low self-esteem. These emotions, while valid, are not conducive to personal growth or triumphing over SUD.

When facing this massive obstacle, it can feel like there’s no hope for a successful recovery. However, healing from both SUD and a co-occurring disorder is possible. As always, the first step is to ask for help.

SUD treatment programs offer clients treatment plans that often incorporate helpful techniques to treat both SUD and co-occurring disorders. These plans may include different types of therapy, many of which have been proven helpful in cases of co-occurring diagnoses. Cognitive-behavioral therapy (CBT), contingency management (CM), and dialectical behavior therapy (DBT) are just a few effective options. There are also medications available that can be effective in treating opioid and alcohol addictions while lessening the symptoms of other mental health conditions. A case manager or case management team should be consulted on the use of any medications during or after treatment.

Moving Forward With a Co-Occurring Diagnosis

If you are facing SUD and a co-occurring disorder, you are not alone. Millions of people experience the same struggles as you, and many are living healthy, substance-free lives. Receiving treatment for your SUD can be an invaluable first step, as substances may be worsening your mental health condition.

After treatment, it’s important to continue practicing the skills you learned as you transition back into everyday life. This may mean using mindfulness techniques, practicing yoga, exercising regularly, or doing outreach in your community.