What are Co-Occurring Disorders?

Teens with a mental health condition are more likely to have a drug or alcohol addiction than those who do not experience symptoms of a mental health condition or have a diagnosed mental illness. Unfortunately, most people (teens and adults alike) with a co-occurring disorder do not get treatment for both disorders as part of a simultaneous treatment program. They tend to seek help for just one condition or the other.


 Typically, they seek help for the condition or illness with the symptoms that present the most acute and unpleasant distress. Not so many years ago, treatment for a behavioral or substance addiction was a separate treatment process from the treatment for a mental health condition. Treatment and care to address addiction and mental health were often provided at different rehabs, ensuring the delivery of co-occurring disorder treatment was all but impossible. 


Consequently, many people who suffered from depression, schizophrenia, obsessive-compulsive disorder, bipolar disorder, or other severe mental health condition never received treatment for their substance use disorder or substance addiction. Conversely, many people who completed treatment for substance use disorders or substance addictions may never receive or seek treatment for a preexisting mental health condition. For many, the failure to address both conditions likely likes at the root of symptom relapse. 


What is a Co-Occurring Disorder?

The term co-occurring disorder is used by medical and mental health professionals to describe a condition that occurs when someone experiences symptoms from two illnesses at the same time. When someone has a co-occurring disorder, they simultaneously experience the symptoms of a mental health condition and a substance use disorder. Because there are many different mental health diagnoses and several types of substance addiction, there are many possible co-occurring disorder combinations. 


It is also essential to remember that mental health conditions and addiction share several similar symptoms. As a result, it can be challenging for parents and treatment providers to separate the symptoms of each disorder. Because addiction and mental illness are highly intertwined, and one often lies at the root of the other, simultaneous treatment is the only safe and effective way to overcome symptoms and achieve lasting physical, psychological, and spiritual wellness. 


Co-Occurring Disorders vs. Dual Diagnosis

Often, when medical or mental health community members discuss circumstances where a teen experiences alcohol or drug addiction symptoms and a mental health diagnosis, they refer to it as a co-occurring disorder. However, you may also hear providers call your teen’s illness a dual diagnosis condition. It is important to mention that while these terms describe similar things and are frequently used interchangeably, their meanings are slightly different. 


A dual diagnosis is a condition that occurs when someone experiences two distinct illnesses simultaneously. A dual diagnosis condition can be any combination of two physical or mental health conditions. Examples of a dual diagnosis may include heart disease and bipolar disorder, generalized anxiety disorder, and major depressive disorder. This differs from a co-occurring disorder where the two conditions include a mental health condition and a substance use disorder. 


Common Co-occurring Disorders

As previously mentioned, there are hundreds of diagnosable mental health conditions as detailed in the Diagnostic and Statistical Manual of Mental Health Disorders. Of those hundreds, a handful occurs alongside substance use disorders with greater frequency than others. They include: 



Anxiety is a mental health condition characterized by excessive worry and intense fear that interferes with your teen’s ability to carry out daily obligations and responsibilities. Data provided by the Anxiety and Depression Association of America suggests as many as 20% of people diagnosed with anxiety also have a co-occurring disorder.



The symptoms of depression (also called major depression or major depressive disorder) include intense and sometimes feelings of sadness, hopelessness, or irritability that can last for two weeks or more. According to the Pew Research center, between 13% and 15% of teens between ages twelve and seventeen experienced at least one episode of major depression in the last year. 


Post-Traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, is often associated with adults, especially those with particular employment functions that lead to frequent trauma exposure. Many do not realize the extent to which youth and teens also experience trauma and resulting PTSD symptoms. Some studies suggest up to 43% of teens will experience at least one traumatic event in their childhood. 


PTSD is generally diagnosed following a traumatic experience such as an act of terrorism, natural disaster, neglect, severe illness or injury, abuse, or being the victim of a violent crime. The most common symptoms of PTSD include nightmares, flashbacks, hyper-vigilance, and avoidance of situations that could trigger symptoms.


Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder (ADD/ADHD)

Attention deficit disorder or ADD is characterized by chronic inattention and impulsiveness, which commonly interferes with daily functioning. In some cases, hyperactivity is also present. In this case, the individual is diagnosed with attention deficit hyperactivity disorder or ADHD. ADD affects approximately 10% (2.5 million) youth between ages 6 and 11 and another 14% (3.3 million) teens ages twelve to seventeen. 


Bipolar Disorder

Approximately 35% of American teens ages thirteen to eighteen are affected by the symptoms of bipolar disorder. These symptoms include manic moods (highly impulsive and sometimes dangerous behaviors that impact social functioning) and depressive episodes (intense hopelessness and sadness). People with bipolar disorder often cycle through these phases of depression and mania. In some cases, mixed episodes occur where manic and depressive symptoms occur together. 



Schizophrenia is a mental health disorder that affects approximately 0.25% of teens. Hallucinations and delusions characterize this mental health condition. The symptoms of schizophrenia are difficult to recognize in young children; however, the average age of onset for adolescent schizophrenia is age twelve. 


Treatment for Co-Occurring Disorders at Hillcrest

Experiencing symptoms of both a substance use disorder and a mental health condition means your teen has a co-occurring disorder or dual diagnosis condition. In some cases, mental health and addiction treatment providers experience difficulty treating co-occurring conditions because the symptoms of the conditions overlap. As mentioned above, past treatment processes for teens and adults required mental health conditions and substance use disorders to be addressed as part of separate treatment programs at different rehab facilities. 


Separating treatment in this way frequently meant that many people did not receive the help they needed to address their mental and physical health needs thoroughly. Additionally, one illness would be left untreated or undertreated, leading to future symptom relapse and the need for additional treatment. Fortunately, the way treatment providers address co-occurring disorders, and dual diagnosis conditions has changed. 


Today, the unique needs of teens with substance use disorders and co-occurring mental health conditions are better understood. While current research has yet to provide evidence that proves mental illness causes addiction or vice versa, science clearly shows that the symptoms one experiences when they have a co-occurring disorder can lead to the use of harmful coping mechanisms like using drugs and alcohol to dull the pain of mental (or physical) health symptoms. 


If your teen has a co-occurring disorder or a dual diagnosis condition, the best opportunity to safely and successfully overcome their symptoms is choosing treatment at a treatment center where staff is experienced in the treatment of co-occurring conditions. It is essential to remember that not all mental health or addiction treatment programs are equipped to manage the needs of co-occurring disorder treatment. Therefore, it is important to do your research before selecting a treatment program for your teen.


At a co-occurring disorder treatment program like Hillcrest, you can expect a multifaceted treatment program explicitly designed to address your teen’s physical and psychological health needs. Our teen-focused treatment programs start with an intake interview or assessment. Intake is followed by detox, addiction and mental health therapy, and aftercare planning. The intake process is an essential first step in treatment as it allows your teen’s treatment team to learn more about their current mental and physical health. It also helps provide a better understanding of their current relationship with drugs or alcohol. An intake interview is a vital first step for treatment providers as they work with your teen and family to develop a comprehensive treatment plan focused on your teen’s specific needs. 


The following step in dual diagnosis treatment is detox. During detox, your teen will safely and successfully wean off drugs or alcohol with the guidance of medical and mental health providers. Depending on the severity of your teen’s addiction, detox can take a few days or up to several weeks. Throughout all stages of detox, a team of experienced and compassionate treatment professionals will monitor your teen’s physical and emotional health to ensure safety and success. 


Once detox is complete and the influence of drugs and alcohol reduced, your teen will transition into the therapeutic portion of a treatment program. Depending on their specific therapy needs, they will engage in various therapies designed to teach them about their mental health and how to manage their symptoms in healthier, safer ways that do not involve substances. They will also learn about trigger management and relapse prevention tools they can use after their primary treatment program ends. 


If your teen has a co-occurring mental health condition and substance use disorder seeking help at a teen treatment program specializing in co-occurring disorder treatment is a vital first step on their recovery journey. While seeking help of any kind is crucial to learning how to address and safely manage symptoms, a treatment that fails to address all aspects of your teen’s mental and physical health may not lead to positive, lasting outcomes. Not all treatment programs are designed to treat co-occurring disorders, and therefore, it is vital to find one where your teen’s treatment needs will be met. If you would like to learn more about co-occurring disorder treatment at our California teen treatment center, contact a member of our admissions team today

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