Co-Occurring Conditions

Understand the Problem

Coast to Forest Web Library

Co-Occurring Mental Health and Substance Use Disorders

Research has found that roughly half of people with a substance use disorder (SUD) will experience a co-occurring mental health disorder at some point in their life and vice versa.

Some of the most common mental health disorders that co-occur with substance use include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, borderline personality disorder, antisocial personality disorder, and schizophrenia.

Importantly, while it is common for substance use disorders and mental health disorders to co-occur, it would be incorrect to assume that one caused the other. Rather, current research presents three major reasons for the connection between substance use disorders and mental health disorders:

  • Substance use disorders and mental health disorders share common risk factors.
  • Mental health disorders may contribute to substance use and addiction.
  • Substance use and addiction may contribute to the development of mental health disorders.

It is critical to treat both the substance use disorders and co-occurring mental health disorder. This treatment can include therapeutic interventions and medications.

Common therapeutic interventions include:

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Assertive community treatment (ACT)
  • Therapeutic communities (TC)
  • Contingency management (CM)

In terms of medications, there are currently medications approved for treating opioid, alcohol, and nicotine use disorders, with medications for other substance use disorders currently in development.


Around 1 in 4 individuals with serious mental illness also have a substance use disorder.

Deaths of Despair

The term “deaths of despair,” originally coined by Anne Case and Angus Deaton in 2015 and later expanded upon in their book Deaths of Despair and the Future of Capitalism, refers to deaths from suicide, drug overdose, and alcoholic liver disease.

These tragic deaths contributed to a decline in life expectancy for Americans for three consecutive years from 2015 to 2017. This decline is markedly contrasted by the increasing life expectancy of other wealthy countries.

Deaths of Despair have continued to rise during the pandemic to the present date.

To address this issue, researchers have proposed the following changes:

  • increasing regulations for prescription drugs
  • improving access to naloxone and safe injection sites
  • expanding recovery and mental health services
  • promoting resilience in children.