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The Link Between Co-Occurring Disorders and Addiction

Addiction is a serious and chronic disease that seems to be growing in the United States across all demographics and a wide range of geographical areas. As the opioid crisis continues, more and more people need effective addiction treatment. Unfortunately, substance use disorders (SUDs) aren’t the only problem that people who are struggling with addiction need to address. Addiction often comes with co-occurring mental health and medical problems that can cause or complicate substance use disorders.

In the past, people who were seeking addiction treatment would be treated solely for their substance use disorder, and other issues would be treated separately or ignored altogether. Unfortunately, this approach would often lead to relapse.

Today, we’ve come to realize that addiction treatment needs to address multiple aspects of a person’s life and any issues they might have. Treatment should be tailored to you as an individual, and any medical, psychological, social, legal, or financial issues should be addressed as part of your treatment plan.

But why?

Wouldn’t it be easier to handle one issue at a time rather than treating everything at once? In one sense, it’s true that different issues have different priorities. If you enter treatment in the throes of a serious infectious disease, that disease would need to be stabilized before you start something like group therapy sessions. However, when you first enter treatment, all of your needs will be assessed and prioritized. The treatment plan you develop with your therapist will reflect an intention to address each issue that may affect your overall goal of lasting sobriety.

But what sort of diseases and disorders come with and complicate addictions, and how can they be effectively treated? Learn more about addiction treatment and how it can and should address co-occurring disorders.

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Common Co-Occurring Disorders

There’s a wide variety of potential physical and mental health problems that you may enter an addiction treatment program with, like everything from broken bones to cavities. But some disorders are more common than others, and many can significantly impact treatment. Here are a few common disorders people seeking treatment for a substance use disorder, may also have to overcome. 

Infectious Diseases

Certain drugs are closely associated with the contraction of serious infectious diseases like heroin, other illicit opioids, and any other drug that’s injected intravenously. Injecting heroin increases your risk of contracting diseases like HIV and hepatitis from contaminated needles. As your substance use disorder continues to progress, you may become more and more desperate for your drug of choice.

Safety concerns and even personal hygiene will take a back seat to your singular focus of finding drugs. You may reuse needles, use ones you’ve shared with others, and even use needles you found discarded. Many drugs have the effect of decreasing your inhibitions, causing you to engage in risky behavior like unprotected sex. This also raises your risk of contracting a sexually transmitted disease. 


According to a 2016 national survey, an estimated 16.2 million people had a major depressive episode within the past year, which constitutes 6.7 percent of adults in the United States. With such a significant portion of people with just one type of depressive disorder, it’s not hard to see why addiction has so much overlap with depression. Depression can lead to substance abuse through a phenomenon called self-medication, which is when people who are struggling with depression treat their symptoms with drugs or alcohol. However, most drugs will worsen depression outside the recommendation of a medical professional.

Substance use disorders and depression also have some similar risk factors like genetics, loss, personal conflict, and a history of abuse. If depression is left unaddressed through drug treatment, feelings of depression can trigger strong drug cravings after treatment. 

Anxiety Disorders

Anxiety disorders are another common mental health problem in the United States. According to the National Institute of Mental Health (NAMI), an estimated 19.1 percent of people struggle with anxiety problems. Like SUDs, anxiety disorders can also be caused by genetic and social factors. And like depression, anxiety problems can also cause or worsen substance use disorders. However, psychotherapy options such as cognitive behavioral therapy can help to treat anxiety disorders, and it also happens to be the most recommended treatment for addiction. 

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is another common mental health problem in the United States. It’s most common among military veterans, people who have experienced abuse or assault, and people who’ve been in automobile accidents. However, any traumatic event that pushes a person beyond their ability to cope with stress can cause PTSD. This disorder is often temporary, especially if it’s addressed quickly. However, PTSD that lasts longer than a month increases your likelihood for other issues like insomnia, anxiety disorders, and substance use disorders. Psychotherapies and behavioral therapies can also address PTSD alongside addiction treatment. Exposure therapy has also shown to help treat PTSD.

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 What Needs to Be Treated First?

As you go through addiction treatment, your needs will generally be met, according to Maslow’s Hierarchy of Needs. This hierarchy is based on the premise that a person will seek basic needs like food, water, and shelter before higher needs like healthy relationships or personal fulfillment. Someone who’s in active addiction will experience a disruption of this hierarchy as getting and using drugs becomes their most pressing need.

When you enter treatment, medical and clinical professionals will help you to establish a healthy hierarchy. For instance, if you’re cold, you will be given a sweater or a blanket before you are given an in-depth psychotherapy session. Your physiological needs will be met first. Otherwise, you may not be able to focus on other needs or therapeutic goals.

Addiction treatment practitioners will use a set of criteria to place you in the right level of care for your needs that has some similarities to Maslow’s hierarchy. This assessment is called the ASAM Criteria, which has been outlined by the American Society of Addiction Medicine (ASAM).  When you first enter treatment, the first two factors the criteria consider is your potential for experiencing dangerous withdrawal symptoms and any biomedical conditions or complications.

If you have pressing medical needs, you may be sent to a higher level of care like inpatient services or medical detox.

After physiological concerns, the criteria consider psychological conditions. If you enter treatment with serious mental health issues, you may be placed in an inpatient or residential program with 24-hour clinically managed or monitored services. Your mental health concerns may be addressed alongside your substance use disorder. As you make progress, you will move to less intensive levels of care.
Very severe mental health problems may require you to be referred to a specialist that is equipped to address high-level needs. For instance, schizophrenia often requires treatment from a psychiatrist who specializes in treating conditions that cause psychosis. However, it’s important that any substance use disorder is also addressed, as some drugs like psychedelics and stimulants can significantly worsen psychosis.


NIDA. (2018, January 17). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from from

National Institute of Mental Health. (2017, November). Any Anxiety Disorder. Retrieved from

Maslow’s Hierarchy of Needs Simply Psychology. (2018) Maslow's Hierarchy of Needs. McLeod, S. Retrieved from

National Institute of Mental Health. (2017, November). Major Depression. Retrieved from

Psycom. (2018 November 25) Substance Abuse and Depression. Smith, K. PhD., LPC Retrieved from

ASAM. (n.d.). What is the ASAM Criteria? Retrieved from

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