Last Updated on September 26, 2025
An In-Depth Overview of Drug Use and Co-Occurring Disorders
At a Glance: Understanding Co-Occurring Disorders
- Co-occurring disorders involve the presence of both a substance use disorder and a mental health condition at the same time.
- These conditions often interact, with one worsening the symptoms of the other, making treatment more complex.
- Integrated treatment that addresses both addiction and mental health together is the most effective approach for long-term recovery.
- Professional support, individualized care plans, and evidence-based therapies are essential for managing co-occurring disorders.
Table of Contents
About 21.5 million adults in the United States were living with co-occurring mental health and substance use disorders in 2022, according to the latest National Survey on Drug Use and Health from SAMHSA. Despite the prevalence, treatment remains inadequate for many. In fact, in 2024, more than 41% of adults with co-occurring disorders received no treatment at all, while only 14.5% received care for both conditions. This gap in integrated treatment contributes to serious consequences, including medical complications, homelessness, incarceration, suicidal behaviors, and even premature death.
If depression is part of the picture, understanding the 6 types of depression (DSM‑5) can help you and your care team choose the right plan.
What Is a Co-Occurring Disorder?
A co-occurring disorder (previously referred to as dual diagnosis) is a clinical term that is used to describe the existence of a mental health and substance use disorder that exists simultaneously.2 For example, a person may be suffering from both alcohol addiction and depression. Or an individual may be addicted to methamphetamine and also have an eating disorder.
It’s not always clear which disorder developed first or which disorder caused the other. This is because substance abuse is often a form of self-medication. Conversely, the severity of an already-existing mood disorder may increase as a result of substance abuse. Regardless of which developed first, it’s important to understand that there is no single cause of addiction, but a person with a mental illness is certainly more likely to develop an addiction.
Drug Use and Co-Occurring Disorders: Most Common Co-Occurring Disorders with Addiction
There are several psychiatric disorders that may coexist alongside addiction, including:
- Clinical depression
- Social anxiety disorder
Mania - Borderline personality disorder
- Schizophrenia
- Panic disorder
- Bipolar disorder
Substance abuse and psychiatric disorders may also occur simultaneously because addictive substances change the way the brain works, impacting a person’s mood, thoughts, and behaviors.
Co-Occurring Eating Disorders and Addiction
Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, are also common among individuals with substance use disorders. Studies show that up to 50% of people with an eating disorder also misuse alcohol or illicit drugs, a rate that is several times higher than in the general population. Likewise, about 35% of individuals with alcohol or drug dependence have experienced an eating disorder, which is roughly 11 times greater than the general population rate. Research further indicates that bulimia has the strongest link to substance misuse, affecting about 36.8% of individuals, followed by anorexia at 27% and binge eating disorder at 23.3%. These statistics highlight the critical need for integrated treatment that addresses both conditions simultaneously to improve long-term recovery outcomes.
Clinical and epidemiological studies consistently show that women with eating disorders are at substantially higher risk for developing a substance use disorder (and vice versa).
Recent meta-analyses estimate that around 21.9 % of individuals with an eating disorder will experience a comorbid substance use disorder in their lifetime, with current rates lower (approximately 7–8 %) depending on methodology.
While earlier reports suggested rates as high as 14% for specific disorders like anorexia or bulimia among women with substance use disorders, newer research favors broader ranges and emphasizes variability across populations and diagnostic methods.
This underscores the importance of integrated screening and treatment approaches that address both eating disorders and substance use concurrently.
The relationship between substance use disorders and eating disorders is dynamic. People with eating disorders frequently misuse the same types of drugs or substances to achieve their goals regarding their appearance and weight or to help them cope. For example, a person in recovery from an eating disorder may abuse drugs or alcohol to cope with the triggers and stressors of recovery. Conversely, a person who is recovering from addiction, may severely restrict their diet or overeat to cope with the challenges of sobriety.
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People who suffer from both substance use disorders and eating disorders frequently misuse the following substances:
- Alcohol
- Laxatives
- Diuretics
- Emetics
- Amphetamines (methamphetamine, MDMA/Ecstasy, Cocaine)
- Heroin
Although more women experience eating disorders than men, both genders can suffer from them. The two types of disorders frequently occur simultaneously because they share many of the same risk factors.
Risk factors for both substance abuse and eating disorders include:
- Genetics
- Brain chemistry
- Family history
- Depression
- Anxiety
- Social anxiety/peer pressure
- Low self-esteem
- Compulsive behavior
- Social isolation
- Risk for suicide
According to the Substance Abuse and Mental Health Services Administration, both eating disorders and substance use disorders share the same primary characteristics: compulsive behaviors, a loss of control, and continuing the behavior despite the negative consequences that occur as a result.
Symptoms and Signs of Co-Occurring Disorders
Because there are so many different combinations of co-occurring disorders, the symptoms and signs are vastly varied. This may make it difficult to diagnose all disorders that are affecting an individual. In addition, many of the signs and symptoms are overlapping.
If a person is struggling with coexisting substance abuse and psychiatric disorders, they may exhibit the following signs and symptoms:
- Deliberate isolation
- Severe mood swings
- Trouble at school or work
- Strained relationships
- Hallucinations
- Extreme sadness or hopelessness for weeks at a time
- Lying about whereabouts or activities
- Sudden changes in appearance or hygiene
- Withdrawal symptoms during attempts to quit drugs or alcohol
- Loss of control over drug/alcohol usage
Assessment of Addiction and Co-Occurring Disorders
Screening for the presence of both substance use disorders and eating disorders is complex, as signs and symptoms of both can overlap. However, it is very important that drug rehab centers and programs repeat the screening process several times over the course of a client’s treatment, as the nature of the client’s overall health and well-being will fluctuate.
- Family history and background: This should include any history of trauma, domestic violence, housing status, education and employment, health, financial status, marital status, and any legal problems.
- Substance use history: This usually includes the age the client first started using drugs or alcohol, primary drugs of use, and family history of substance use, abuse, or addiction.
- Mental health problems: It’s also important to collect details about the client’s mental health history, his or her family’s mental health history, and the client’s current mental health status (including medications and medication adherence).
Co-Occurring Disorders in Recovery from Addiction
In the past, many people struggling with substance abuse disorders and psychiatric disorders simultaneously were denied treatment until they were sober. Today, the standard for high-quality treatment regarding co-occurring disorders has changed.
Research has shown that treatment is much more effective when mental and substance use disorders are addressed at the same time. This is called integrated treatment. Not only is this approach more affordable, but it is also more effective in treating all co-occurring disorders.
Effective integrated treatment and care for co-occurring disorders should include the following characteristics:
- Balanced use of psychotherapeutic medications and evidence-based therapies
- Parallel treatment of psychiatric disorders and substance abuse disorders
- Individual, group and family counseling
Although every person’s treatment plan should be individualized based on their circumstances and needs, the above characteristics of integrated treatment for co-occurring disorders can be met with a continuum of care plan that incorporates the following:
- Comprehensive assessment
- Multidisciplinary treatment approach
- Medically assisted detox
- Therapeutic services (individual, group and family)
- Aftercare support services
Increasing your own awareness of dual diagnosis and co-occurring disorders may help you understand your own struggle with addiction or be more compassionate towards the struggle of a loved one. In addition, education on the topic may also aid in finding the best type of treatment.
If you are searching for integrated treatment for yourself or a loved one, please contact Nova Recovery Center today to learn more about our long-term drug and alcohol rehab programs.
FAQ: Co‑Occurring Disorders (Dual Diagnosis)
What are co‑occurring disorders?
Co‑occurring disorders (also called dual diagnosis) means a person has a substance use disorder and a mental health disorder at the same time. Treating both together is essential for better outcomes.
How common are co‑occurring disorders?
In 2024, an estimated 21.2 million U.S. adults had both a mental illness and a substance use disorder in the past year.
What mental health conditions most often co‑occur with addiction?
Commonly co‑occurring conditions include depression, anxiety disorders, PTSD, bipolar disorder, schizophrenia, ADHD, personality disorders, and eating disorders.
What causes co‑occurring disorders?
There’s no single cause. Shared risk factors (genetics, brain changes, environment, trauma) mean either disorder can increase risk for the other, and each can worsen the other over time.
How are co‑occurring disorders diagnosed?
Clinicians use comprehensive assessments to untangle overlapping symptoms and create an integrated care plan, ideally by providers trained in both SUD and mental health.
How are co‑occurring disorders treated?
Integrated treatment—addressing mental health and substance use together—consistently shows better outcomes than treating them separately.
Which therapies work best?
Evidence‑based options include cognitive behavioral therapy, motivational interviewing, contingency management, and family‑based interventions, often combined with medications as appropriate.
Do medications help?
Yes. Depending on diagnosis, FDA‑approved medications can treat SUDs (e.g., methadone, buprenorphine, naltrexone for OUD) and mental health symptoms—always coordinated by a licensed prescriber within an integrated plan.
What happens if only one condition is treated?
Outcomes are poorer and relapse risk is higher when only one disorder is addressed. Integrated care improves engagement and recovery.
Is inpatient or outpatient better for dual diagnosis?
It depends on severity, safety, support, and co‑morbidities. Programs “co‑occurring capable/enhanced” integrate SUD and mental health services across inpatient, residential, PHP, IOP, and outpatient levels.
How long does treatment take?
Duration varies by condition severity and response. Treatment is often ongoing, with step‑downs (e.g., residential → IOP → outpatient) plus continuing care to sustain recovery.
Does insurance cover dual diagnosis treatment?
Marketplace health plans must cover mental health and SUD services as essential health benefits, and parity rules require comparable coverage to medical/surgical care; specifics vary by plan and setting.
How often do eating disorders co‑occur with substance use disorders?
Meta‑analyses suggest a ~21.9% lifetime SUD comorbidity among people with eating disorders overall, with higher rates in binge‑purge presentations (e.g., bulimia).
Are co‑occurring disorders common in teens?
They occur in adolescents as well; early identification and family‑involved, evidence‑based care are important.
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Medical Disclaimer
The information on this page is intended for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Prescription medications and treatment decisions should always be made under the guidance of a licensed healthcare provider. Do not begin, adjust, or discontinue any medication or treatment without first consulting your doctor. If you are experiencing severe symptoms, withdrawal complications, or thoughts of self-harm, call 911 immediately in the United States or seek emergency medical assistance. For mental health support, you can also dial 988 to connect with the Suicide & Crisis Lifeline, available 24/7.
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- Devoe, D. J., et al. (2021). The prevalence of substance use disorders and eating disorders. PMC. https://www.ncbi.nlm.nih.gov/articles/PMC8666057/
Accessed September 26, 2025. - Mellentin, A. I., et al. (2022). The impact of alcohol and other substance use disorders on mortality risk among people with eating disorders. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21030274
Accessed September 26, 2025. - National Institute on Drug Abuse. (2024, September 30). Co-occurring disorders and health conditions. NIDA. https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions
Accessed September 26, 2025. - Substance Abuse and Mental Health Services Administration. (2024, March 29). Co-Occurring Disorders and Other Health Conditions. SAMHSA. https://www.samhsa.gov/substance-use/treatment/co-occurring-disorders
Accessed September 26, 2025. - Substance Abuse and Mental Health Services Administration. (2025, July 28). Release of the 2024 National Survey on Drug Use and Health: Leveraging the latest substance use & mental health data to make America healthy again. SAMHSA Blog. https://www.samhsa.gov/blog/release-2024-nsduh-leveraging-latest-substance-use-mental-health-data-make-america-healthy-again
Accessed September 26, 2025. - Tapoi, C., et al. (2022). Comorbidity of substance use disorders and eating disorders. PMC. https://www.ncbi.nlm.nih.gov/articles/PMC9567808/
Accessed September 26, 2025.
