Co-Occurring Disorders: Do You Treat the Substance Use or the Mental Illness First?
- jameliahand
- Mar 24
- 3 min read
By Jamelia Hand MHS CADC CODP I
A Story That’s All Too Common…
When Ashley walked into the outpatient clinic for her intake, she looked exhausted, not just physically, but emotionally. She shared that she had been diagnosed with anxiety years ago and had been prescribed medication, but it hadn’t helped much. Over time, she began using pills and alcohol to self-soothe, then relied on them just to get through the day.
Eventually, the substances became a problem of their own. She tried to quit more than once, but each attempt left her feeling raw and overwhelmed. Her anxiety returned with a vengeance. “It feels like no matter what I treat, the other thing gets worse,” she told the intake specialist. “I don’t know where to start anymore.”
Ashley’s story isn’t unique. In fact, it’s more common than many realize.
Understanding Co-Occurring Disorders
Co-occurring disorders, also called dual diagnoses, refer to the presence of both a mental health disorder and a substance use disorder (SUD) at the same time. These conditions interact in complex and reinforcing ways. Mental illness can lead people to self-medicate with substances, and chronic substance use can exacerbate or even trigger psychiatric symptoms.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 1 in 4 adults with a serious mental illness also has a substance use disorder. Despite this, only a small percentage receive care for both conditions at the same time, a critical mistake that can prevent long-term recovery.
Which Comes First: Mental Illness or Addiction?
The answer is: it depends. For some, a mental health condition like depression, bipolar disorder, or PTSD may precede substance use. For others, heavy substance use over time can trigger or worsen symptoms of anxiety, psychosis, or mood disorders.
Trying to treat just one part of the problem is like removing half of a tumor and expecting it not to grow back. Successful outcomes depend on identifying and treating both disorders together.
The Case for Integrated Treatment
Historically, the addiction treatment field leaned toward addressing the SUD first. The logic was that mental health treatment couldn’t begin until the substance use stopped. But we now know this approach is outdated and often harmful.
Modern evidence supports integrated treatment, a coordinated, simultaneous approach to managing both substance use and mental health disorders. Integrated care recognizes that these conditions are not isolated but deeply intertwined, requiring a comprehensive treatment strategy that includes:
• Clinical Assessment that screens for both mental health and substance use disorders at intake.
• Medication-Assisted Treatment (MAT) for cravings or psychiatric stabilization, when appropriate.
• Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) to address distorted thinking, emotional regulation, and behavioral patterns.
• Trauma-Informed Care, which recognizes the high prevalence of trauma in this population.
• Peer Recovery Support and group therapies that build community and reduce isolation.
• Family Education to help loved ones understand the dual nature of these struggles and how to support recovery.
What Happens Without Integrated Treatment?
When only one part of a person’s experience is addressed, the risk of relapse and re-hospitalization increases. For example:
• A person with untreated bipolar disorder may continue to cycle through mania and depression, leading to substance use as a coping strategy, even if they’re actively in addiction treatment.
• Someone with an active opioid use disorder may skip mental health appointments or fail to adhere to psychiatric medications, making it difficult to stabilize their mood or anxiety.
In both scenarios, long-term recovery is nearly impossible without a plan that addresses the full picture.
How Vantage Clinical Consulting Can Help
At Vantage Clinical Consulting, we help treatment programs, healthcare providers, and community organizations build effective systems to serve individuals with co-occurring disorders. With decades of real-world experience in addiction and mental health, we understand the clinical, operational, and compliance challenges you face, and we know how to help you overcome them.
Here’s how we can support your team:
• Customized training on integrated care models, trauma-informed approaches, and motivational interviewing
• Implementation support for Medication-Assisted Treatment in behavioral health or primary care settings
• Technical assistance to meet state and national standards for co-occurring disorder treatment
• Workshops to increase your team’s confidence in working with complex client presentations
• Consultation for cross-sector partnerships, such as treatment courts, housing, and workforce reentry programs.
Co-occurring disorders require a coordinated response. Let Vantage help you create one. Because when we treat the whole person, we offer more than sobriety, we offer the chance at a full and meaningful life.
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