Co-occurring Substance Use

About Co-occurring Disorders

Substance use disorders often can occur simultaneously with mental health disorders, which is referred to as "co-occurring disorders."

According to the National Institute of Mental Health, although mental health and substance use disorders often co-occur, that does not mean that one causes the other. Either disorder can develop first. Many people who develop substance use disorder are also diagnosed with mental health disorders, and many people with mental health disorders will develop an substance use disorder.

Co-occurring disorders may include any combination of two or more mental health disorders and substance use disorders identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).  

About Co-occurring Mental Health and Substance Use Disorders

According to the National Institute of Mental Health, although mental health and substance use disorders often co-occur, that does not mean that one causes the other. Either disorder can develop first. Many people who develop substance use disorder are also diagnosed with mental health disorders, and many people with mental health disorders will develop an substance use disorder.

Co-occurring disorders may include any combination of two or more mental health disorders and substance use disorders identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

How Common Are Co-occurring Disorders?

Millions of people in the United States are affected by mental health and substance use disorders:

Why Do Mental Health and Substance Use Disorders Co-occur?

Research suggests three possible reasons why these disorders often occur together:

Diagnosing and Treating Co-occurring Disorders

Because co-occurring mental health and substance use disorders may interact with each other, and some symptoms are the same for both disorders, diagnosis and treatment can be complex. People who have co-occurring disorders often have symptoms that are more persistent, severe, and resistant to treatment compared with patients who have either disorder alone.

Since substance use and mental health disorders frequently co-occur, integrating screening and treatment for both disorders leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person.

Learn more about integrated diagnosis and treatment for co-occurring disorders at SAMHSA.gov.

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About Substance Use Disorder

Substance use disorder occurs when the repeated use or misuse of substances – like legal or illegal drugs, alcohol, or medications – changes a person’s brain and behavior, making it difficult for them to control their use of the substance even when it causes harm.

Substance use disorder is a chronic but treatable medical condition.

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What Is a “Substance?"

Substances are chemicals that can change how a person’s body and mind work. According to MedlinePlus.gov, substance use, or misuse, includes:

How Substance Use Affects the Brain

Drugs target the brain's reward system, flooding it with dopamine and creating feelings of pleasure. Normally, this system motivates healthy behaviors like eating or spending time with loved ones, but substance use hijacks it, reinforcing unhealthy behaviors.

Over time, the brain adapts by reducing its response to dopamine, leading to tolerance – needing more of the substance to achieve the same feelings of pleasure. This often diminishes the ability to enjoy other activities as well.

Substance use also disrupts areas of the brain involved in:

  • Learning
  • Judgment
  • Memory
  • Behavior
  • Stress management
  • Decision making

Learn more at SAMHSA.gov.

Other Effects of Substance Use

People with a substance use disorder have an increased likelihood of developing primary conditions or chronic diseases like cancer, chronic pain, heart disease, sleep problems, and HIV and other infectious diseases.

Learn more about health conditions that can co-occur with substance use disorders at NIDA.gov.

Substance use disorders can influence a person’s treatment for medical conditions, and substance use also can lessen the effectiveness of medications for some conditions.


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Who Does Substance Use Disorder Affect?

According to SAMHSA’s National Survey on Drug Use and Health, in 2023:

1 in 6
people
(age 12 or older) had a substance use disorder in the past year. That's 48.5 million people.
  • Of these 48.5 million people:
  • 28.9 million had an alcohol use disorder.
  • 27.2 million had a drug use disorder.
  • 7.5 million people had both alcohol and drug use disorders.
The highest percentage of people with a substance use disorder in the past year:
27.1%
were young adults age 18 to 25
— 9.2 million people.
16.6%
were adults age 26 or older
— 37.0 million people.
8.5%
were adolescents age 12 to 17
— 2.2 million people.
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Stages of Substance Use

There are several stages of substance use that may lead to addiction, according to MedlinePlus. Young people seem to move more quickly through the stages than adults do. These stages are:

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About Addiction

Addiction Is a Complex Disease

Many people mistakenly believe that addiction results from a lack of willpower or moral principles.

In reality, addiction is a complex disease. Repeated substance use alters the brain, making people compulsively seek and use substances despite harmful consequences, and making it hard to quit – even for those who want to stop.

These changes to the brain can persist, which is why addiction is considered a "relapsing" disease – people may return to substance use even after long periods of sobriety.

Relapse is common, but it doesn’t mean treatment failed. Like other chronic illnesses, addiction treatment must be ongoing and adapted to fit a person’s needs.

Why Do Some People Become Addicted While Others Don’t?

Addiction risk varies based on three key factors:

Biology: Genetics account for about half of a person’s risk. Other factors like gender, ethnicity, and mental health also play a role.

Environment: Family, friends, economic conditions, and life experiences, such as peer pressure, abuse, or early exposure to drugs, can influence addiction risk.

Development: Drug use during key stages of life, especially adolescence, increases the risk. Teen brains are still developing in areas that control decision-making and self-control, making them more likely to engage in risky behaviors like drug use.

Learn more about substance use and addiction on SAMHSA.gov.

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Symptoms and Behaviors of Substance Use Disorder

Symptoms and behaviors of a substance use disorder may include:

  • Withdrawal from friends and family; no longer taking part in usual activities.
  • Sudden changes in behavior, engaging in risky behaviors.
  • Neglecting to eat, not caring about physical appearance.
  • Missing work or school, or a decrease in performance.
  • Developing a high tolerance and withdrawal symptoms.
  • Feeling the need for daily or regular substance use to function.
  • Lack of control over substance use, being unable to stop or reduce use.
  • Continuing to use, even when it causes harm to health, work, or family.
  • Hostility when confronted about substance dependence.
  • Using substances even when alone.
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Diagnosing Substance Use Disorder

This information is only an overview, and should not be used as a substitute for professional medical care or advice. If you have concerns about substance use, talk to your health care provider.

The most commonly used system in the United States for diagnosing mental health and substance use disorders is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

A substance use disorder diagnosis is usually made along a continuum — mild, moderate, or severe — based on the number and severity of the symptoms a person has.

According to the DSM-5, the symptoms include:

If you think that you -- or someone you know -- may have a substance use problem, talk to a health care provider.

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Treating Substance Use Disorders

Treatment for substance use disorder begins with recognizing and acknowledging the problem.

Treatment plans will be different for everyone, and depend on the needs of the individual and the substance or substances involved. The goal of most SUD treatments is to change thoughts and behaviors, and, if needed, manage physical dependence and withdrawal symptoms.

There are different treatment approaches, and they each work indifferent ways. Effective SUD treatments address the whole person, often combining multiple approaches tailored to each individual. It is important to work with a treatment provider to determine the most effective treatment plan.

Learn more about treatment and recovery at NIDA.gov.

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Common Treatment Elements for Substance Use Disorders

Treatment plans will not be the same for everyone, but there are common elements of treatment:

  • Twelve-Step programs for individuals include:
  • Alcoholics Anonymous (AA): a Twelve-Step abstinence-based recovery program for people who are addicted to alcohol.
  • AA Home Group hosts online open Alcoholics Anonymous meetings 24 hours a day, 7 days a week.
  • Narcotics Anonymous (NA): a Twelve-Step abstinence-based recovery program for people who are addicted to drugs or alcohol.
  • Twelve-Step-based support programs for family members and friends affected by someone else’s substance use include:
  • Al-Anon Family Groups: a Twelve-Step program for anyone who is affected by someone else’s drinking. 
  • Nar‑Anon Family Groups: a Twelve-Step program for people affected by a loved one's drug addiction.
  • For teens and young adults:
  • Alateen – Al-Anon Meetings for Teens: caters to teens and young adults affected by alcoholism in their family.
  • Narateen: part of the Nar-Anon program, provides support to teens affected by a family member or friend’s addiction.
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Substance Use Disorder Treatment Settings

SUD treatment can take place in different settings, depending on the substance and the severity of the disorder.

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For More Information About Substance Use Disorders

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Substance Use Resources

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In crisis? Call or text 988.   For non-emergency guidance, contact the NAMI Jacksonville Helpline: 904-323-4723 or email Helpline@namijax.org

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