OverlapWhen Addiction and Mental Health Overlap: Co-Occurring Disorders. What it means when both are present, and how to find care that treats the whole person.

This is common. Federal health agencies, including SAMHSA and the National Institute on Drug Abuse, describe mental health conditions and substance use problems as often showing up together. If your family is facing both, you are not alone, and it is not a sign that someone is beyond help.

The two conditions can affect each other in either direction. Sometimes the mental health condition comes first and drinking or drug use follows. Sometimes heavy use comes first and brings on or worsens anxiety, low mood or other symptoms. Often they share roots, such as family history, long-term stress or trauma. In many cases nobody can say for sure which came first, and that is okay. What matters is treating both.

• Depression with alcohol or other drugs. Alcohol can feel like relief in the moment but tends to deepen low mood over time.
• Anxiety with alcohol, cannabis or sedatives. Substances can quiet worry for a few hours, then leave it stronger.
• Trauma and PTSD with many kinds of substance use. Using can be a way to numb memories, block nightmares or get to sleep.
• ADHD with stimulants, cannabis or alcohol. Some people use to focus, and some use to slow down a busy mind.
• Bipolar disorder with alcohol or drugs. Use can show up during highs, during lows, or both, and can make mood swings harder to manage.

These are general patterns, not a way to diagnose anyone. Only a qualified clinician can sort out what is going on for a specific person.

A person who cannot sleep, cannot calm down, or cannot shake a heavy mood may find that a drink or a pill takes the edge off. It works, at first. Over time the body adjusts, the relief gets shorter, and the original problem usually comes back stronger. Now there are two problems instead of one.

Seeing use as self-medication can help families respond with less anger and more curiosity. A useful question is not only why are you using, but what is the using helping you avoid or manage? The answer often points to the mental health side of the picture.

Here is a general example. A young adult drinks most nights and the family focuses on the drinking. Later it becomes clear he has had panic attacks for years and drinking was the only thing that helped. Treating only the drinking would leave the panic in place, and the urge to drink with it.

If someone stops drinking but their depression goes untreated, the low mood can make a return to drinking feel like the only way out. If someone starts treatment for anxiety but keeps using heavily, the substance can blur symptoms, interfere with medication and make progress hard to see.

Families also run into a frustrating loop. One provider says to stop using first, then come back for mental health care. Another says the mental health condition is driving everything. The person bounces between them, and nobody looks at the whole picture. SAMHSA and other public health guidance support screening for both conditions and treating them together whenever possible.

It does not have to mean one building or one person doing everything. It means the psychiatrist, therapist and other supports share the same goals, know what the others are doing, and adjust together when something changes. Different roles usually make up the team:

• Psychiatry. A psychiatric evaluation looks at symptoms, history and substance use together. Psychiatric care can include medication management, with attention to how medications and substances interact. See what happens at a psychiatric evaluation.
• Therapy. Individual therapy helps a person understand what drives their use, build coping skills, and work through anxiety, low mood or trauma at a safe pace.
• Case management. A case manager helps coordinate the pieces: appointments, communication between providers, practical problems and the plan for what comes next.
• Monitoring. Regular drug and alcohol testing, with the person’s consent, can give everyone clear information and help rebuild trust. Our guide on how drug and alcohol monitoring works explains more.

At The Blackburn Group, Blackburn Clinical Services offers psychiatric evaluation, medication management and individual therapy for adolescents and adults. Blackburn Recovery Services provides case management that helps keep the different parts of a plan connected.

• Do you screen for both mental health and substance use at the start?
• Will you treat both at the same time, or do you need one handled first?
• Who prescribes medication, and how do you account for alcohol or drug use when you do?
• How do the psychiatrist, therapist and any case manager share information?
• How will we know if the plan is working, and what happens if it is not?
• How can family be involved, and what will you share with us with consent?
• What is the plan if symptoms get worse or there is a return to use?

If you are weighing different kinds of support, our guide to case management, mentoring or therapy may help.

Learning about the mental health condition helps you see some behavior as symptoms rather than choices made to hurt you. Learning about substance use helps you spot warning signs and avoid patterns that keep the problem going. Both take time.

• Ask, with your loved one’s consent, to be part of family sessions or planning meetings.
• Keep your own boundaries clear and calm. You can be loving and still say no.
• Notice changes in sleep, mood and routine, not only in use. Our guide on relapse warning signs can help.
• Get support for yourself. See our guide on support for families.

Safety comes first. Stopping alcohol or benzodiazepines suddenly can be medically dangerous. If your loved one wants to stop, encourage them to talk to a doctor first. If someone is struggling to accept help at all, our guide on helping a loved one who won’t accept help walks through options.

• NIDA: Comorbidity
• NIMH: Co-Occurring Substance Use and Mental Disorders
• SAMHSA: Co-Occurring Disorders
• NAMI: Substance Use Disorders
• MedlinePlus: Dual Diagnosis

If you are not sure where to begin, visit Where to start, call us at (888) 305-5422, or email info@theblackburngroup.org. Families may also find our families page useful.

If you or someone you love is thinking about suicide or is in crisis, call or text 988 to reach the 988 Suicide and Crisis Lifeline. In an emergency, call 911.

Related help in Los Angeles: Help for families in Los Angeles, Case management in Los Angeles. Or call (888) 305-5422.

• What Happens at a Psychiatric Evaluation
• Relapse Warning Signs and What to Do
• Support for Families

All guides →