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The Climb

Co-Occurring Mental Health and Substance Use Disorders

Mar 6, 2019 8:00:00 AM / by Ascension Recovery Services

Is drug addiction considered a mental illness? Addiction disturbs the brain, which then challenges an individual's needs and desires replacing them with new priorities like procuring substances to use. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, lists criteria for SUDs, as well as distinguishes the differences of severity levels of substance misuse.

Criteria for SUD include:

  1. Substance is often taken in larger amounts and/or over a longer period than intended.
  2. Persistent attempts or one or more unsuccessful efforts made to cut down or control substance use.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from effects.
  4. Craving or strong desire or urge to use the substance
  5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued substance use despite having persistent or recurrent social or interpersonal problem caused or exacerbated by the effects of the substance.
  7. Important social, occupational or recreational activities given up or reduced because of substance use.
  8. Recurrent substance use in situations in which it is physically hazardous.
  9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance
  11. Withdrawal 

The severity of the SUD is determined by the number of criteria the person meets:

  • Mild: two to three of the criteria
  • Moderate: four to five of the criteria
  • Severe: six to 11 of the criteria

According to Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, “Mild substance use disorders can be identified quickly and reliably in many medical and social settings. These common but less severe disorders often respond to brief motivational interventions and/or supportive monitoring, referred to as guided self-change. In contrast, severe, complex, and chronic substance use disorders often require specialty substance use disorder treatment and continued post-treatment support to achieve full remission and recovery. To address the spectrum of substance use problems and disorders, a continuum of care provides individuals an array of service options based on need, including prevention, early intervention, treatment, and recovery support “ 

How common is it to have co-occurring (comorbidity) disorders? According to the Substance Abuse and Mental health Services Administration(SAMHSA), almost eight million Americans struggle with co-occurring disorders: substance use disorder (SUD) and mental health disorder. Of the eight million Americans who had co-occurring disorders, only 48 percent received treatment for either their mental health or SUD.

The Center for Substance Abuse Treatment recommends that all individuals at risk for co-occurring disorders go through a 12-step assessment performed by a trained professional:

The Assessment Process

  • Assessment Step 1: Engage the Client
  • Assessment Step 2: Identify and Contact Collaterals (Family, Friends, Other Providers) To Gather Additional Information
  • Assessment Step 3: Screen for and Detect Co-Occurring Disorders
  • Assessment Step 4: Determine Quadrant and Locus of Responsibility
  • Assessment Step 5: Determine Level of Care
  • Assessment Step 6: Determine Diagnosis
  • Assessment Step 7: Determine Disability and Functional Impairment
  • Assessment Step 8: Identify Strengths and Supports
  • Assessment Step 9: Identify Cultural and Linguistic Needs and Supports
  • Assessment Step 10: Identify Problem Domains
  • Assessment Step 11: Determine Stage of Change
  • Assessment Step 12: Plan Treatment 

In one study[1], Mood Disorders and Substance Use Disorder: A Complex Comorbidity, it’s cited that mood disorders, which include depression and bipolar disorder, are the most common psychiatric comorbidities among patients with SUD.

In a 1990 Epidemiologic Catchment Area (EAC) study[2], it was noted:

*Epidemiologic Catchment Area: geographic areas with populations of 75,000 to 250,000

  • Among individuals with a mood disorder, 32 percent had a co-occurring SUD.
  • Of the individuals who had major depression, 16.5 percent had alcohol use disorder and 18 percent had a SUD.
  • Fifty-six percent of individuals with bipolar disorder had a lifetime SUD.

Why are co-occurring (comorbidity) disorders so common? In the A Complex Comorbidity study we discussed earlier, three theories are discussed as to why there is such as high co-occurrence of SUDs and mood disorders.

Disorder Fostering Disorder (Self-Medication)

This theory suggests that the pathways of one disorder can increase the risk of the other disorder. Meaning, an individual uses substance to minimize the unwanted feelings/moods they may have.

Overlapping Neurobiological Pathways (Kindling)

*Kindling is typically referred to when discussing epilepsy and means repeated disruptions in the brain can lead to sensitized brain cells. The more this happens, the more seizures happen.

Substances like cocaine and alcohol sensitize neurons, which can lead to the frequent use of the substances.

Genetic Factors

substance use disorder and mental health disorders

SUD and mental health disorders both carry genetic risks. Scientists believe that genes may make an individual more vulnerable to mental health disorders, promote chronic use of substances and foster both co-occurring disorders.




Mental health disorders and co-occurring SUDs can be treated through cognitive behavioral therapy (CBT), dialectical behavior therapy, mindfulness based cognitive behavioral therapy (MBCBT) and other treatments in conjunction with addiction treatment.

The first step towards recovery is knowing that help is needed. Does your loved one struggle from a SUD, and need an intervention? Contact us below.


If you aren’t sure if your loved one needs and intervention, download our in-depth guidebook below.



[1]"Mood Disorders and Substance Use Disorder: A Complex Comorbidity." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/. Accessed 12 Feb. 2019.

[2]"Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse ...." https://jamanetwork.com/journals/jama/fullarticle/383975. Accessed 12 Feb. 2019.

Assessment Process Summary

Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.) 4 Assessment. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64196/

Topics: Addiction Recovery, intervention

Ascension Recovery Services

Written by Ascension Recovery Services

Ascension Recovery Services is a team of experts and specialists with years of experience working to support individuals struggling with addiction and their families.

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