Kelly EversonKelly Eversonan American author.
She is contributing to Consumer Health Digest from 2011. Examiner from 2013, Epochtimes & Healthline from 2014.

Dual disorder or Co-occurring disease is a complex health condition that is characterised by the presence of substance use disorder (SUD) and mental illness. Patients with co-occurring disease suffer from substance abuse such as alcohol addiction, dependence on narcotics, prescription drug abuse along with any of the mental disorders such as severe depression, post traumatic stress disorder (PTSD), anxiety and more.

How many people are affected?

  • As per a survey conducted by SAMHSA approximately 8.9 million people are suffering from co-occurring disorder in United States.
  • Researchers opine that people with substance abuse issues are at a higher risk of developing or having an underlying mental disorder in comparison to those who are not addicted to drugs or alcohol.
  • In another survey conducted in 2013 by SAMHSA, it has been found that 17.3 million people who are above 12 years of age are suffering from alcohol abuse in United States.
  • A research on mental illness by The National Institute of Mental Illness (NAMI) states that over 13 million people have serious mental disorders in America.
  • A 2012 survey revealed that 20% of children who are under 18 years of age have serious mental illness in United States.
  • Most number of youth who are diagnosed with substance abuse issues have at least one mental disorder illness that is co-occurring (COD).


Adolescents exhibit certain behaviours that are:

  • Internalized- Low self esteem, depression, aloofness, paranoia, anxiety and sadness.
  • Externalised- 18-35% of people with COD show aggression, restlessness leading to destructiveness, difficult social relations, hyperactivity and antisocial tendencies among others.
  • 38-65% of people with COD exhibit both of these symptoms.

Gender specific symptoms of COD

Based on gender, the behavioural pattern differs for COD patients.

  • Girls who are suffering from substance abuse along with behavioural problems are more inclined toward delinquency than boys.
  • 83% of girls exhibit internalized as well as externalized characteristics.
  • Groups with poor outcomes have more number of girls than boys.
  • In comparison to boys (42%) 72% of girls are more prone to drug abuse.
  • Disruptive disorders related to ODD and CD are more prevalent in boys.
  • Approximately 80% of the boys with COD are seen in juvenile justice environment.
  • In instances of substance abuse, girls were found to be dependent on one drug while boys were dependent on combination of drugs.

Integrated treatment for co-occurring disease

Treating one health condition cannot solve the disease. Patients with COD often struggle to cope with every day activities. Their lifestyle is also partly to blame. Such patients are at a higher risk of early death or post traumatic stress disorder (PTSD). Hence, an integrated approach is much preferred to lower the health risks.

Dr. Melissa Racioppo, NIDA, Behavioural Branch Development Branch says that integrated treatments should be carefully planned to suit the needs of the patients as patients’ symptoms of COD differ  based on gender or age. However the symptom or characteristics of COD may not be of any relevance to the outcome of the treatment.

Clinical challenges in treating COD

There are some barriers in a clinical setting to treat co-occurring diseases. These barriers may not help in early diagnosis of the disease or treatment that is very crucial for positive outcomes.

  • SUD or substance use disorders are not considered as an important factor in “care mandate”
  • Patients with SUD are not treated with necessary medicines and treatments as doctors often show reluctance.
  • Such reluctance is partly due to the fact that most of the clinicians are not trained in SUD.
  • It is difficult to diagnose COD as patients try to minimize the symptoms.
  • Many doctors are not cross trained in mental health disorders.

COD can be diagnosed at an early stage when the above issues are addressed by respective departments.

Evidence based, integrated therapies to treat COD

The most common treatment methods used to treat COD are:

  1. Cognitive and behavioural therapy

Addressing behavioural issues and negative thinking patterns in patients to reduce negative outcome of COD is employed by trained doctors and counsellors. In this kind of therapy the patient is guided toward a healthy and positive lifestyle.

  1. Dialectical Behaviour therapy or DBT

DBT is based on acceptance and mindfulness regarding the health conditions of the patients especially those with suicidal tendencies are made to accept and train their thoughts to think positively.

  1. Interpersonal therapy

The aim of interpersonal therapy is to improve patient’s ability to communicate and interact with the society. Such approach is helpful in lowering the stress levels and increasing the confidence to overcome the disease.

  1. Family therapy

Patients’ family relations often get strained due to behavioural issues. Hence, this program aims at developing loving and nurturing relations with family and relatives that may help in substance abuse and relapse.


It is extremely difficult to pin point the root cause of co-occurring disorder. An underlying mental illness can lead to substance abuse in the pretext of feeling better or continuous substance abuse can lead to mental illness. Hence, it is imperative that the treatment plan should consider both the conditions in order to be effective.

With early detection of the disease and patient specific-integrated treatment plan, patients with COD can expect positive outcomes. However, in most of the instances the results are only achieved after many years of treatment. Hence, determination and perseverance is required from patients and medical professionals to combat COD.