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Substance Abuse and Mental Health

Co-occurring Disorders / Dual Diagnosis

In the United States, as many as one in five people live with a mental health disorder such as depression, anxiety, or a trauma-related illness. In addition to these illnesses, people also live with alcohol or substance use disorders. Some live with both; in fact, research shows that in 2019, 9.5 million adults had both a mental illness and a substance use disorder. This is called a dual diagnosis or co-occurring disorder.

At Singer Island Health, we are experts in the diagnosis and treatment of co-occurring disorders. We utilize evidence-based practices in our integrated treatment program. Our treatment program is designed to address both your substance use and mental health disorders at the same time. Research shows that the most effective way to recover is by treating both conditions simultaneously.

What does it mean to have a co-occurring disorder or dual diagnosis?

One way to understand what having a co-occurring disorder means is to imagine if you have high blood pressure and a heart condition. It’s not always clear which came first; what is clear, however, is that treating one condition will help improve the other. So, treating your substance use disorder can help you unmask the underlying causes of your addiction and improve your mental health at the same time and vice versa.

You are not alone. Among US adults, over 7.5% aged 18 – 25 are diagnosed with a substance use and a co-occurring disorder. For adults 26 – 49, that number is over five percent. Co-occurring disorders are prevalent in the population and happen across the lifespan, and there is help available.

What are mental health disorders?

Mental health disorders can be grouped into categories, followed by a specific diagnosis.

Anxiety Disorders

An anxiety disorder causes intense feelings of panic and fear for seemingly no reason. They can impact your daily life as the emotions, frequency, and intensity can vary.  Anxiety disorder can be divided into three specific diagnoses.

Generalized Anxiety Disorder

A condition where you experience chronic and unrealistic anxiety about at least two areas of your life, such as family, relationships, finances, etc. Some symptoms include:

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  • Feeling nervous
  • Irritability or feeling on edge
  • Trouble concentrating
  • Difficulty sleeping

Social Anxiety Disorder

Causes intense anxiety and fear about social situations, such as speaking in public or being visibly uncomfortable in social situations. Other symptoms include:

  • Feeling afraid of social situations.
  • Fear of meeting new people even though you want to get to know them.
  • Extreme fear of being judged
  • Avoiding places with people

Panic Disorder

Characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms. These episodes will happen randomly and are not connected with a known fear or stressor. When having a panic attack, you may have:

  • Difficulty breathing
  • Excessive sweating
  • Chest pain
  • Rapid heartbeat
  • Dizziness, lightheadedness or faintness

Mood Disorders

Mood disorders are disruptive, distorted emotional moods that seem unrelated to your life circumstances. They can include depression, a persistent feeling of sadness, or mania, which is a state of extreme good feelings to the exclusion of others. Both extremes can impact your daily life.

Major Depressive Disorder

Characterized by symptoms such as:

  • Mild to severe sadness
  • Little pleasure in activities you usually enjoy
  • Weight loss or gain
  • Irregular sleeping patterns
  • Poor self-care
  • Trouble concentrating
  • Suicidal thinking

Bipolar Disorder

This disorder means that you cycle between two states: mania and depression.


  • Extreme sadness
  • Trouble making decisions or concentrating
  • Inconsistent sleep patterns


  • Racing thoughts
  • Inability to make decisions
  • Impulsivity
  • Overly confident, inflated sense of self
  • Decreased need for sleep

Persistent Depressive Disorder

means that you have a depression that persists for at least two years. This disorder usually impacts you if you have early-onset depression, with symptoms that started in your teens or young adulthood. While depressed, you may experience:

  • Low energy and chronic fatigue
  • Poor self-esteem
  • Constant feelings of hopelessness
  • Anhedonia, which is an inability to experience pleasure.

Personality Disorders

Personality disorders are characterized by very rigid and distorted ways of thinking, impacting your behavior and interpersonal relationships. In one study, 14.3% of people diagnosed with an alcohol use disorder also met the diagnostic criteria for Borderline Personality Disorder.

Borderline Personality Disorder (BPD)

Usually begins in early adulthood and is diagnosed in both women and men. Symptoms of BPD include:

  • Intense irrational fear of abandonment
  • Impulsivity, such as reckless spending, sexual behavior, and substance use
  • A pattern of pushing people away while wanting them to stay around you
  • Unstable and intense relationships
  • Feeling empty and an unstable self-image
  • Rapid mood swings occurring within hours or over several days.
  • Suicidality and/or self-harm


Trauma can occur when you witness or experience a deeply disturbing event and your ability to cope is overwhelmed. Some examples of traumatic events include:

  • Childhood neglect or abuse
  • War or other violent events
  • Witnessing violence
  • Being a victim of violence, including a crime committed against you
  • Physical, emotional, sexual abuse
  • Grief
  • Natural disasters and other events or accidents.

While you may think of trauma related to veterans, the National Council for Behavioral Health reports that 70% of adults in the US have experienced trauma. There are three kinds of trauma:

  1. Acute trauma is the result of a single event, such as a physical attack or witnessing an auto accident.
  2. Chronic trauma occurs when you are repeatedly exposed to a traumatic event, such as prolonged childhood neglect and/or abuse or being bullied and/or harassed.
  3. Complex trauma occurs when you’ve been exposed to multiple, separate traumatic events.

Post Traumatic Stress Disorder (PTSD)

PTSD may develop after a traumatic event. There are four categories of symptoms that can interrupt your daily life:

  1. Intrusion – Experiencing intrusive thoughts, memories, flashbacks of the event, or disturbing dreams. You may even feel at times as though you are reliving the event.
  2. Avoidance – You may avoid people, places, and events that remind you of the event
  3. Altered memory and moods – It may be difficult for you to remember the traumatic event’s details. You may experience chronic shame and self-blame surrounding the situation and struggle to feel positive emotions.
  4. Arousal and Reactions – These symptoms may mean you behave dangerously, you are hypervigilant of your surroundings, and you have unpredictable bursts of anger. It may also be difficult to sleep or concentrate.

Complex Post Traumatic Stress Disorder (C-PTSD)

C-PTSD caused by prolonged exposure to trauma. While sharing the above symptoms with PTSD, the following additional symptoms mark a difference between the two conditions. These include:

  • Difficulty maintaining relationships
  • Avoidance of other people
  • Lack of connection

Substance use can feed into mental health disorders, and each one can make the other worse. Thus it is vital to treat both simultaneously. At Singer Island Health, we are experts in the diagnosis and treatment of co-occurring disorders. Our trauma-informed, integrated treatment program can help you develop new ways to cope with a mental health disorder without turning to drugs or alcohol.

What causes a co-occurring disorder?

It’s difficult to say exactly what causes mental health disorders. Much like a substance use disorder, genetics, environment, trauma, and early childhood exposure can determine whether you are diagnosed with a psychiatric disorder.


Your genetic makeup can be an essential factor for specific mental health diagnoses. In 2013, researchers at the University of North Carolina linked genetics to five major psychiatric disorders, schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorder.

Environmental Concerns

Being raised in a stressful environment or having an abusive homelife are significant risk factors. Watching someone in your family struggle with mental illness, witnessing violence, or being subjected to violence in your environment all increases the odds that you may develop a mental health disorder. Other environmental influences that can occur at any time in your life can include financial stress, chronic medical conditions, deaths, or divorce.

Traumatic Experiences

It’s estimated that 80% of individuals diagnosed with Post-Traumatic Stress Disorder usually have at least one other diagnosis.

Early Exposure and Brain Development

Evidence suggests that exposure to some of the environmental concerns above at an early age can influence if you are likely to develop a co-occurring disorder. Exposure to drugs or alcohol in utero can play a significant role in mental health disorders.

None of these causes exist in isolation, and all likely influence each other. If you have a dual diagnosis, it’s difficult to say it’s due to genetics or environment. Most would agree that it’s likely that all of the above factors play a role.

Symptoms of a Co-occurring Disorder

The symptoms of a co-occurring disorder are different for everyone. However, there are some symptoms that you may have experienced that are related to having a dual diagnosis. These include:

  • Sudden, noticeable changes in your behavior or social life
  • Becoming secretive about your behavior, including where you are going, who you are with, and how you spend your time.

Physical changes include:

  • Changes in sleep pattern.
  • Weight gain or loss.
  • Sudden, rapid changes in hygiene.
  • Increasing isolation and withdrawing from the important relationships in your life.
  • Intense emotional reactions to situations you previously were able to cope with
  • Rapid mood swings that are noticeable to those around you

Not everyone will experience the same symptoms or even all the symptoms listed. At Singer Island, we are aware that you are an individual, and your symptoms and recovery won’t be the same as another person. We strive to personalize your treatment experience to ensure your success.

What comes first: Addiction or Mental Illness?

To some extent, this is a chicken and an egg problem. The truth is that both disorders impact each other. Since your experiences and circumstances are unique to you, it’s impossible to make a definitive statement about what came first for you. We can say, though, co-occurring disorders are treatable with the right combination of therapy and medications (if needed).

We know mental illness causes emotional pain and, you may try self-medicating, which is using drugs or alcohol to feel better. This is usually a temporary solution and often leads to more problems in the long run. Substances can cause physical changes in the body and brain, which can intensify the underlying mental illness.

Integrated Treatment Overview

Treating a co-occurring disorder is best addressed in a program that simultaneously treats both mental illness and substance use conditions. This is called integrated treatment, and at Singer Island, we utilize this approach for its proven effectiveness. Our program is designed to:

  • Ensure therapy addresses both the mental health and substance abuse components together
  • Provide therapy to support both diagnoses, and make adjustments to your treatment plan based on your progress.
  • Approach treatment in stages which involve trust-building, increasing motivation and controlling the disorders’ symptoms.
  • Offer a holistic recovery program that involves social support, family relationships, coping skills, potential medication, and more.

At Singer Island Health, our clinicians provide expert, evidence-based integrated treatment for your dual diagnosis. Our compassionate and skilled therapists can help you understand your diagnosis and learn how to reclaim your life. Our comprehensive, holistic program will provide you with the therapy, support, and education you need because we know recovery is not only possible, it’s a reality. Call or chat with us today; we are here for you 24/7.