Co-Occurring Disorders: Addiction and Mental Health Together

Co-occurring disorders — also called dual diagnosis or co-morbid conditions — refer to the simultaneous presence of a substance use disorder and one or more mental health conditions. This is not unusual: research consistently shows that mental health conditions and substance use disorders co-occur at high rates, and that treating one without addressing the other significantly reduces the chances of long-term recovery.

Understanding co-occurring disorders is essential for anyone seeking recovery housing, behavioral health treatment, or recovery support services in Washington State. Hope & Chance Integrated Health serves adults with co-occurring disorders through our supportive recovery housing program in Seattle and Tacoma, in partnership with New Era Mental Health, which provides licensed clinical treatment for co-occurring conditions.

How Common Are Co-Occurring Disorders?

Co-occurring disorders are far more common than most people realize. According to SAMHSA:

• Approximately 9.2 million adults in the United States have co-occurring mental health and substance use disorders
• About half of people with a substance use disorder also have a mental health condition
• Mental health conditions are found in 50-75% of people with severe substance use disorders

The most commonly co-occurring mental health conditions with substance use disorders include:

• Depression and Major Depressive Disorder (MDD)
• Anxiety disorders (generalized anxiety, panic disorder, social anxiety)
• Post-Traumatic Stress Disorder (PTSD)
• Bipolar disorder
• Attention Deficit Hyperactivity Disorder (ADHD)
• Schizophrenia and other psychotic disorders
• Borderline Personality Disorder (BPD)

Why Do Addiction and Mental Health Often Occur Together?

There are several pathways through which substance use disorders and mental health conditions become intertwined:

Self-Medication

People with untreated or undertreated mental health conditions sometimes use alcohol or drugs to manage their symptoms — to quiet anxiety, to lift depression, to dull traumatic memories, or to achieve a sense of normalcy they do not have otherwise. This is called self-medication. While substances may provide temporary relief, they typically worsen mental health conditions over time while creating physical and psychological dependence.

Substance Use Causing Mental Health Symptoms

Sustained substance use can itself trigger mental health conditions in people who were not previously symptomatic. Alcohol is a depressant that can cause or worsen depression. Stimulants can trigger or worsen anxiety and psychosis. Cannabis use is associated with increased risk of psychotic episodes in susceptible individuals. The neurological damage of long-term substance use can have lasting effects on mood, cognition, and emotional regulation.

Shared Risk Factors

Many of the risk factors for substance use disorders are the same as those for mental health conditions — genetic predisposition, adverse childhood experiences (ACEs), trauma, poverty, social isolation, and exposure to violence. People who carry these risk factors may develop both conditions simultaneously or in close succession.

Why Integrated Treatment Matters

The research is clear: treating substance use disorders and mental health conditions separately — or treating one while ignoring the other — produces significantly worse outcomes than integrated treatment that addresses both simultaneously.

When someone's depression goes untreated during addiction treatment, the underlying condition that may have driven their substance use remains, making relapse more likely once treatment ends. When someone's substance use goes unaddressed during mental health treatment, intoxication and withdrawal interfere with the effectiveness of psychiatric care.

Integrated treatment means that the same care team — or closely coordinated care teams — address both the substance use disorder and the mental health condition together, with a coherent overall plan for recovery.

Co-Occurring Disorders and Housing

For people with co-occurring disorders, housing stability is even more critical than for those in recovery from substance use alone. Mental health conditions are significantly worsened by housing instability and the chronic stress of homelessness or unsafe living situations. Managing psychiatric medications consistently — a core requirement of mental health treatment — is extremely difficult without a stable, safe place to live.

Supportive recovery housing at Hope & Chance provides the stable environment that makes it possible for residents with co-occurring disorders to:

• Maintain consistent medication regimens
• Attend both substance use and mental health treatment appointments
• Avoid environmental triggers for both substance use and mental health crises
• Access care coordination that ensures both treatment streams are connected
• Receive peer support from specialists who understand the complexity of dual diagnosis recovery

Getting Help for Co-Occurring Disorders in Washington State

If you or a loved one has co-occurring disorders, you need treatment providers who specialize in integrated care. Our clinical partner, New Era Mental Health, provides licensed outpatient and IOP services that address both substance use and mental health conditions.

For housing support while in treatment, contact Hope & Chance to apply for our supportive recovery housing program in Seattle or Tacoma. We serve adults with co-occurring disorders and can connect you to the integrated clinical resources you need.

You can also browse our Washington State recovery resources directory for mental health, substance use, and dual diagnosis treatment options throughout the state.

Frequently Asked Questions