Co-Occurring Disorders: How Drug Use and Mental Health Connect

Co-occurring disorders means having a substance use disorder and another mental health condition, such as depression, anxiety, PTSD or bipolar disorder, at the same time. Each can make the other worse, so care tends to work better when both are treated together. Recovery is possible, and reaching out early, without shame, is one of the most helpful steps a person can take.

This article is for adults who wonder whether their drinking or drug use is tied to how they feel, and for family members and friends who are worried about someone. It explains how substance use and mental health affect each other, signs to watch for, how to start a conversation and where to find help in Texas.

This article is general information, not a medical recommendation. Do not start, stop or change any medication without talking to your prescriber.

What are co-occurring disorders?

Co-occurring disorders are a substance use disorder and a mental disorder present in the same person. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes on its co-occurring disorders page that mental health problems and substance use disorders sometimes occur together.

The National Institute of Mental Health (NIMH) explains on its substance use and mental health page that substance use disorders affect the brain and behavior, can cause difficulties in work, school or relationships, range from mild to severe, and are treatable. You may also hear the older term "dual diagnosis."

How are drug use and mental health connected?

Drug use and mental health are connected in several directions at once. The NIMH describes three main links:

• Shared risk factors: stress, trauma and genetics can contribute to both substance use and other mental disorders.
• Using to cope: mental disorders can lead to risky behaviors, including using substances to cope with symptoms.
• Substances changing the brain: substance use can contribute to brain changes that increase the risk of other mental disorders.

The NIMH adds that people with mental disorders are at higher risk of developing substance use problems. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) similarly notes in its alcohol use disorder fact sheet that depression and anxiety commonly occur alongside alcohol use disorder.

Why can using substances to cope backfire?

Using substances to cope can backfire because short-term relief often leads to worse mood, sleep and anxiety over time. The NIMH notes that people can develop tolerance and experience withdrawal when they stop, which can feel like the original symptoms returning.

A hypothetical example: someone drinks in the evening to quiet anxiety. At first it helps them fall asleep. Over weeks, they wake up more at night, feel more anxious in the morning and need more to get the same effect. The original anxiety has not gone away, and now there is a second problem layered on top. This pattern is common and nothing to be ashamed of, and it is treatable.

What are the warning signs of co-occurring disorders?

Warning signs include using more than intended, struggling to cut back, and mood or anxiety symptoms that change with substance use. The NIAAA lists signs of alcohol use disorder such as drinking more or longer than intended, trying and failing to cut down, continuing despite problems and experiencing withdrawal.

Other signs to notice in yourself or someone else:

• using substances to get through the day, sleep or social situations
• mood swings, irritability or low mood that worsen after use
• losing interest in activities you used to enjoy
• problems at work, school or home linked to use
• hiding use from people close to you
• needing more of a substance to feel the same effect

How do you get help step by step?

Getting help starts with an honest conversation with a professional and a plan that addresses both conditions. The NIMH says that if you have concerns about your mental health, talking to a primary care provider is a good place to start.

1. Notice the pattern. For a week or two, jot down when you use, how much and how you feel before and after.
2. Tell one trusted person. Saying it out loud often makes the next step easier.
3. Call for guidance. SAMHSA's National Helpline, 1-800-662-HELP (4357), is a free, confidential treatment referral and information service available 24 hours a day, 365 days a year, in English and Spanish.
4. Search for treatment. FindTreatment.gov is a confidential, anonymous SAMHSA locator for substance use and mental health treatment.
5. Get an evaluation. A clinician can assess both conditions and how they interact.
6. Ask for an integrated plan. Ask how mental health and substance use care will be coordinated.
7. Plan for safety. Talk with a health care provider before stopping heavy, long-term use. MedlinePlus warns that alcohol withdrawal is a serious condition that may quickly become life-threatening, and that people with moderate-to-severe symptoms may need treatment at a hospital or other facility.

What does integrated treatment involve?

Treatment usually combines therapy, support and sometimes medication, coordinated so both conditions are addressed together. The NIMH explains that integrated care combines mental health and substance use treatment so people can receive coordinated care, and that behavioral therapies such as cognitive behavioral therapy, contingency management and motivational interviewing can help people build coping skills.

The NIMH also notes that medications can effectively treat opioid and alcohol addictions and ease symptoms of many other mental disorders. Any medication decision belongs with a prescriber who knows your full history. Support groups, family involvement and help with sleep, stress and daily routines are often part of the plan too. Our article on substance use recovery covers the recovery process in more depth.

What can you say to someone you are worried about? A checklist

Calm, specific and caring words make it more likely a person will listen. Lyte Psychiatry suggests focusing on what you have noticed and how you feel, rather than labels.

• Choose a private moment when the person is sober and you are calm.
• Start with care: "I care about you, and I have been worried lately."
• Name specifics: "I have noticed you seem down after weekends, and you have missed work twice."
• Avoid labels like "addict" or "alcoholic."
• Ask, do not lecture: "How have you been feeling? Would you be open to talking to someone?"
• Offer concrete help: "I can sit with you while you call the helpline."
• Take care of yourself too, and expect that it may take more than one conversation.

For more on alcohol specifically, see how alcohol affects mental health.

How can families take care of themselves too?

Families coping with a loved one's substance use and mental health struggles often carry worry, anger, guilt and exhaustion, and their own well-being matters. The SAMHSA National Helpline serves families as well as individuals, so you can call for information even if your loved one is not ready.

• Set clear, kind limits about what you will and will not do, such as not providing money for substances.
• Avoid covering up consequences, which can delay change.
• Look for family support groups or your own therapy.
• Keep up your own sleep, meals, movement and friendships.
• Celebrate small steps, such as attending one appointment.

A hypothetical example: a parent stops calling in sick for an adult child after nights of heavy drinking, while still offering to drive them to an evaluation. The message becomes "I love you and I will help you get care," rather than "I will make this problem disappear." Read more in alcohol and mental health recovery.

When should you get help right away?

Get emergency help for signs of overdose, severe withdrawal, or thoughts of suicide. MedlinePlus advises going to the emergency room or calling 911 for seizures, fever, severe confusion or hallucinations during alcohol withdrawal. For a mental health crisis, call or text 988.

• trouble breathing, unresponsiveness or blue lips
• seizures, severe confusion or hallucinations during withdrawal
• talk of suicide or wanting to die
• mixing substances and being unable to stay awake
• chest pain or a racing heartbeat that does not settle

What should Texans know about substance use and mental health support?

Texans can reach a 24/7 crisis line through their county's local mental health authority. Texas Health and Human Services lists these crisis lines by county, and local authorities can also help connect people to community mental health and substance use services.

Laws about substances, including which products are legal and how they are regulated, vary by state and change over time. If you have questions about a specific product, ask a health care provider or pharmacist rather than relying on store labels or online claims.

Getting support in Texas

Lyte Psychiatry offers therapy, psychiatric evaluation and medication management in Texas. In-person visits are available at Lyte Psychiatry's clinic in Pantego, in the Dallas–Fort Worth area. Lyte Psychiatry offers telehealth visits to patients who are physically located in Texas at the time of the visit. All Lyte Psychiatry services are available in Spanish.

Lyte Psychiatry is an outpatient practice. It does not provide inpatient care, crisis or after-hours coverage, medically supervised detox, or intensive outpatient or partial hospitalization programs. If you need detox or a higher level of care, the SAMHSA helpline or FindTreatment.gov can help you locate it. Availability, insurance and clinician fit require confirmation.

Learn about coordinated therapy and psychiatry, or read about holiday substance use and gambling addiction and mental health.

If you are in a mental-health crisis in the United States, call or text 988. Call 911 for immediate danger.

Educational information, not a diagnosis or individual treatment plan.