Close to one in every five Americans suffer from mental illness each year, and four percent of American adults over the age of 18, suffer from a serious mental illness that disrupts their everyday life, as reported in Newsweek.

The National Survey on Drug Use and Health (NSDUH) reports that 21.6 million, or 8.2 percent of the American population over the age of 12, battled a substance abuse or dependence in 2013.

Both substance abuse disorder and mental illness are brain diseases, and they often occur at the same time in the same person, called co-occurring disorders. The National Alliance on Mental Illness (NAMI) publishes that one-third of all alcohol abusers and one-half of drug abusers also suffer from a mental illness, while one-third of those battling mental illness also abuse substances and one-half of those with a serious mental illness abuse substances such as drugs or alcohol.

Mental illnesses that commonly occur with substance abuse include:

  • Depression: About 21 percent of those suffering from a major depressive episode also abused substances in 2010, as published by Everyday Health.
  • Mood and anxiety disorders: Approximately 20 percent of those with a substance abuse disorder also battle an anxiety or mood disorder, reports the Anxiety and Depression Association of America (ADAA)
  • Post-traumatic stress disorder (PTSD): One in three US veterans seeking treatment for a substance abuse disorder also suffers from PTSD, and two out of every 10 veterans diagnosed with PTSD also suffer from substance a abuse disorder, according to theS. Department of Veterans Affairs.
  • Bipolar disorder: About 60.7 percent of those studied under the Epidemiological Catchment Area (ECA) study, published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), suffering from bipolar I disorder also battled a substance abuse disorder, and 48 percent of those with bipolar II disorder also suffered from a substance abuse disorder at the time of the ECA study.

These disorders may co-occur for a variety of reasons and may be an attempt to self-medicate mental illness symptoms or may be due to overlapping genetic or environmental vulnerabilities or triggers. Sometimes, substance abuse can cause mental illness symptoms to appear for the first time.

Both mental illness and substance abuse may be developmental disorders, meaning that they may first occur during adolescence or young adulthood. Initiating substance abuse early may increase the odds for developing a substance abuse disorder. The 2013 NSDUH reported that beginning marijuana abuse before age 14 correlated with future substance abuse disorders; 11.5 percent of those who abused marijuana before age 14 were classified with a substance abuse or dependence, while only 2.6 percent of adults who waited until age 18 were classified as such. Substance abuse exacerbates mental illness symptoms and may interfere with medications and the treatment for mental health disorders, and increase the risks for developing a substance abuse disorder.

Specialized Treatment

An undiagnosed mental health disorder can disrupt substance abuse or addiction treatment as well. Regardless of the reason these disorders co-occur, specialized treatment, often called dual diagnosis treatment, is necessary to provide the best results.

Parallel, Sequential and Integrated Treatment

The three main models of treatment for co-occurring disorders are sequential, parallel and integrated treatment models. Sequential models generally require that either the substance abuse disorder be treated and stabilized or resolved first before the mental illness can be managed or vice versa. Different parts of the health care system may be involved in completely separate treatments (e.g., mental health providers and substance abuse counselors). The medical professionals involved may not converse about the recovery process with each other or agree on which disorder should be treated first. It may also be difficult to ascertain when one disorder has been resolved so that the other disorder may be treated. Parallel treatment methods have similar limitations with both disorders being treated simultaneously, although not by the same medical professionals and potentially by completely different agencies.

The Substance Abuse and Mental Health Administration (SAMHSA) supports and approves the use of integrated treatment models for co-occurring mental health and substance abuse disorders. Integrated treatment models consider both the substance abuse and mental health disorder as primary disorders and treat both simultaneously. Teams of medical professionals work together to create and implement a comprehensive care plan that addresses both disorders. Integrated treatment methods modify traditional treatment models that may have been parallel or sequential, and instead find workable ways to combine mental health care and substance abuse counseling and care. Integrated treatment is considered the most successful model for dual diagnosis treatment of substance abuse and mental health disorders.

Screening and Assessment

The first step in integrated treatment models is a comprehensive screening and assessment in order to diagnose any potential mental health issues or substance abuse dependencies. The screening process is used to determine what, if any, co-occurring disorders may be present and often uses a series of yes-or-no questions and answers. The assessment gathers all the necessary information through a battery of oral and written tests as well as a clinical and physical examination by a medical health professional in order to develop a comprehensive and unique care plan tailored to the individual’s specific circumstances and needs. Problem areas, strengths, and weaknesses are assessed, and one’s readiness and willingness to change are also addressed. One’s background, patterns, and initiation of substance abuse as well as family history will be explored to provide a complete picture.

Mental health professionals may perform the initial assessment, and results are shared with all members of the care team. Assessments may be performed throughout treatment in order to ensure that specific needs are still being met, and the care plan can be modified accordingly.


Talk therapy, or psychotherapy, is an important aspect of both mental health care and the treatment of a substance abuse disorder. Cognitive Behavioral Therapy (CBT) can help to identify potential emotional or environmental triggers that may induce a mental health episode or encourage a return to substance abuse. CBT also works to modify any and all negative views of the self, and self-destructive behaviors and thoughts, into more positive ones, bolstering self-esteem and self-confidence. CBT can help to ascertain what may have caused the desire to abuse substances in the first place and work to overcome these obstacles to prevent relapse in the future. CBT may actually make positive changes in the brain, improving neurological and central nervous system function, as reported by the Journal of Neuropsychiatry.

Another form of psychotherapy that is related to CBT is Dialectical Behavior Therapy (DBT), which is commonly used in the treatment of bipolar disorder. DBT differs from CBT in that it focuses more on validation and coming to terms with difficult emotions or behaviors and accepting them. DBT helps the individual to find a balance between acceptance and change that works best during recovery. By focusing on strengths, DBT influences positive changes through motivational methods. Certain anxiety and mood disorders, as well as PTSD, may be treated with exposure therapy wherein stressors are confronted in a safe and controlled manner.

Group and individual therapy and counseling sessions based on individualized care are a part of both mental health and substance abuse treatment. Educational opportunities providing insight into both mental illness and substance abuse are vital tools in order to understand potential triggers that may induce relapse and promote enlightenment in regard to what to expect during recovery. Therapy and training sessions will also include the teaching of new life skills and coping mechanisms to provide lasting success throughout recovery.


Detox from drugs or alcohol may need to occur before psychotherapy can be initiated in order to promote physical stabilization. Withdrawal from some drugs and alcohol may be tough, and even dangerous, if not managed properly. Many times, medical professionals will set up a gradual tapering schedule during which the individual will wean off drugs or alcohol in a slow and controlled manner under direct medical supervision. Adjunct medications are also sometimes necessary during detox to help manage withdrawal symptoms as well. Some medications may not be tolerable for certain mental illnesses, and in integrated treatment models, medical professionals will work together to determine the right course of action and medication required.

Similarly, medications are often needed for the management of mental illness symptoms long-term, and certain medications with addictive or habit-forming properties should be avoided in someone who also suffers from substance abuse. Some may argue that someone in recovery from a substance abuse disorder should not use any medications, but this is something to be discussed with one’s doctor and medical care team. Sometimes medications are necessary to manage mental illness symptoms successfully, and many programs allow for the use of medications that are not mind-altering. An integrated care plan will consider all of the potential side effects and risk factors, and then weigh them against the potential positive results when administering medications during dual diagnosis treatment. Medications will also be constantly assessed and modified on an as-needed basis.

Long-Term Support

Aftercare Support GroupWhen it comes to co-occurring disorders, recovery is real and attainable with the right diagnosis and comprehensive integrated treatment model. Support groups and 12-Step programs are great ways to maintain sobriety and keep the incidence of relapse and its severity and duration low. Dual diagnosis support groups exist for those battling both a substance abuse disorder and mental illness, which can help to build up a positive support network and keep individuals on the right track.

Family counseling sessions can help repair relationships and provide a better understanding of both diseases and their treatment. Many dual diagnosis programs will also provide the necessary tools to reintegrate seamlessly back into life after a residential rehabilitation period. Counseling may continue long-term in order to support emotional well-being and mental health, especially if medications will be taken for an extended period of time.

Selecting the right treatment facility with dual diagnosis and comprehensive integrated care models is the first step toward a healthy recovery. Black Bear Lodge is a premier dual diagnosis treatment facility where teams of medical professionals are trained in the most current and scientifically based, integrated treatment models. All aspects of mind and body are explored while ensconced in a serene and private environment. Contact Black Bear Lodge today for a free and confidential assessment.