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Co-Occurring Disorders
Co-occurring disorders are a combination of a substance use disorder (abuse or dependence) and another mental disorder, as established in the fourth text revision edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) of the American Psychological Association. It is estimated that 50% to 70% of people diagnosed with either a mental disorder or a substance use disorder will have a co-occurring disorder of the other type; therefore, it is crucial to address the topic of co-occurring disorders. This entry discusses a brief history of co-occurring disorders, incidence and prevalence, screening, assessment, treatment planning, treatment interventions and programs, and evidence-based practices. A list of resources for further information is also included.
Definitions of Terms
A vast number of combinations of disorders have been labeled co-occurring disorders. These include co-occurring substance use disorders in combination with mental disorders, serious mental illnesses, developmental disabilities, health or physical diagnoses, or personality disorders. The term also refers to a combination of substance use disorders (e.g., cocaine dependence and alcohol dependence) or a combination of mental disorders (e.g., depression and schizophrenia or an anxiety disorder co-occurring with a personality disorder). For the purposes of this entry, co-occurring disorders is defined as co-occurring substance use disorders (abuse or dependence) and mental disorders, as established in the DSM-IV-TR. A diagnosis of co-occurring disorders can be made when at least one disorder of each type can be established independently of the other, when neither can be documented as a cluster of symptoms resulting from the other.
Substance Use Disorders
Substance abuse, as defined by the DSM-IV-TR, is a maladaptive pattern of substance use leading to clinically significant impairment or distress. Substance abuse is manifested by recurrent and significant negative or adverse consequences related to the recurrent use of substances. These negative consequences include repeated failure to fulfill major responsibilities at work, school, or home; repeated use in situations that are physically hazardous; and recurrent legal, social, or interpersonal problems related to the use of the substance.
According to the DSM-IV-TR, substance dependence is a maladaptive pattern of substance use, leading to clinically significant impairment or distress. It can be manifested by increased tolerance, a withdrawal syndrome, and/or a number of behavioral symptoms. These symptoms include having a desire to cut down or control the use of the substance; using the substance more than was intended; giving up important social, occupational, or recreational activities; or continuing to use despite knowledge that use affects a recurrent physical or mental health problem. The essential feature of substance dependence is impaired control over the use of the substance.
Mental Disorders
The DSM-IV-TR also provides the standard diagnostic criteria for mental disorders that comprise co-occurring disorders. Co-occurring mental disorders fall under a number of different categories. These include affective disorders, anxiety disorders, psychotic disorders, and personality disorders.
Affective disorders (also referred to as mood disorders) are characterized by persistent or episodic exaggerations of emotional states. Some examples of the emotional states include depression, mania, euphoria, dysphoria, anger, and irritability.
Anxiety disorders are characterized by felt anxiety at a frequency or intensity that causes impairment in functioning. Other symptoms may include affective flattening, alogia, apathy, avolition, and social withdrawal. Anxiety disorders include social phobia, panic disorder, and post-traumatic stress disorders.
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- Behavioral Addictions
- Classifications of Drugs of Abuse
- Alcohol
- Amphetamines
- Amyl Nitrite
- Anabolic Steroids
- Anxiolytic Drugs
- Barbiturates
- Benzodiazepines
- Buprenorphine
- Caffeine
- Central Nervous System Depressants
- Central Nervous System Stimulants
- Club Drugs
- Cocaine and Crack
- Drugs, Classification of
- Ecstasy
- Fentanyl
- Hallucinogens
- Heroin
- Illicit and Illegal Drugs
- Inhalants
- Levo-Alpha Acetyl Methadol
- Marijuana
- Methadone
- Methamphetamine
- Methods of Drug Administration
- Morphine
- Naltrexone
- Opioids
- Over-the-Counter Drugs
- OxyContin
- Prescription Drugs
- Tobacco
- Criminal Justice System and Substance Abuse
- Engagement and Intervention
- Family and Community Issues
- Adult Children of Alcoholics
- Al-Anon
- Alateen
- Behavioral Couples Therapy
- Binge Drinking
- Brief Strategic Family Therapy
- Children of Alcoholics
- Codependency
- Community Reinforcement and Family Training
- Community Reinforcement Approach
- Enabling
- Experimental Substance Use
- Family Behavior Therapy
- Family Therapy
- Fetal Alcohol Syndrome
- Fetal Effects of Alcohol and Other Drugs
- Multidimensional Family Therapy
- Violence, Intimate Partner and Substance Abuse Treatment
- Models of Addiction
- Neurobiology of Addiction
- Prevention Theories, Research, Techniques, Strategies, and Effectiveness
- Alcohol Marketing
- Alternative Activities
- Behavioral Risk Factor Surveillance System
- Community-Based Processes
- Drug Abuse Resistance Education
- Environmental Approaches
- Evidence-Based Prevention
- Evidence-Based Prevention and Treatment, Dissemination and Adoption of
- Expectancies
- Fidelity of Prevention Programs
- Gateway Drugs Theory
- High-Risk Behaviors
- Information Dissemination
- Institute of Medicine Classification System
- Mentoring
- Monitoring the Future
- National Clearinghouse for Alcohol and Drug Information
- National Media Campaign
- National Outcome Measures
- National Registry of Evidence-based Programs and Practices
- National Survey on Drug Use and Health
- Prevention Education
- Prevention Evaluation
- Prevention Populations
- Prevention Resources
- Prevention Strategies
- Problem Identification and Referral
- Public Policy, Prevention
- Racial and Ethnic Minorities, Issues in Prevention
- Refusal Skills
- Risk and Protective Factor Theory
- Risk Factors for Addiction
- School-Based Prevention Programs
- Social Norms Marketing
- Social Skills Training
- Tobacco Marketing and Countermarketing
- Tobacco Master Settlement Agreement
- Underage Drinking
- Violence Prevention
- Professional Issues in Addictions
- Addiction Technology Transfer Centers
- American Society of Addiction Medicine
- Business Improvement Practices
- Centers for the Application of Prevention Technologies
- Certification and Licensing
- Clinical Supervision of Addiction Counselors
- College on Problems of Drug Dependence
- Confidentiality
- Dual Relationships
- Electronic Health Records
- Ethical Standards for Addiction Professionals
- Ethics
- Health Insurance Portability and Accountability Act
- Impaired Professionals
- Informed Consent
- International Coalition for Addiction Studies Education
- NAADAC, the Association for Addiction Professionals
- Network for the Improvement of Addiction Treatment
- Qualified Services Organization Agreements
- Single State Authorities
- State Provider Associations
- Public Policy Development
- Access to Recovery
- Center for Substance Abuse Prevention
- Center for Substance Abuse Treatment
- Comprehensive Drug Abuse Prevention and Control Act
- Decriminalization
- Demand Reduction
- Discrimination, Addicted and Recovering Individuals
- Drug Testing
- Drug-Free Schools and Communities Act
- Economic Costs of Alcohol and Drug Abuse
- Harm Reduction, Public Health
- Indian Health Services
- Insurance Parity
- Join Together
- Legal Action Center
- Legalization of Drugs
- Medical Use of Marijuana
- Moderation Approaches to Alcohol Problems
- National Council on Alcoholism and Drug Dependence
- National Drug Control Strategy
- National Epidemiologie Survey on Alcohol and Related Conditions
- National Institute of Mental Health
- National Registry of Evidence-based Programs and Practices
- Needle Exchange Programs
- Office of National Drug Control Policy
- Public Policy, Alcohol
- Public Policy, Drugs
- Public Policy, Prevention
- Public Policy, Treatment
- pulse Check
- Single State Authorities
- State Provider Associations
- Substance Abuse and Mental Health Services Administration
- Supply Reduction
- Synar Amendment
- Tobacco Master Settlement Agreement
- War on Drugs
- Recovery
- Al-Anon
- Alateen
- Alcoholics Anonymous
- Big Book, The
- Bill W.
- Cocaine Anonymous
- Double Trouble
- Dry Drunk Syndrome
- Gamblers Anonymous
- Moderation in Use
- Moderation Management
- Narcotics Anonymous
- Natural Recovery
- Peer Recovery Support Services
- Rational Recovery
- Recovery
- Recovery Community Organizations
- Recovery Community Services Program
- Recovery Schools
- Recovery Support Services
- Secular Organizations for Sobriety/Save Our Selves
- Sobriety
- Social Drinking
- Spiritual Issues
- Stigma
- Support Groups
- Twelve Steps
- Twelve-Step Recovery Programs
- Women for Sobriety
- Relapse Prevention
- Research and Evaluation Issues in Substance Abuse Prevention and Treatment
- Cannabis Youth Treatment Study
- College on Problems of Drug Dependence
- COMBINE Study
- Drug Abuse Treatment Outcome Studies
- Evidence-Based Prevention
- Evidence-Based Prevention and Treatment, Dissemination and Adoption of
- Evidence-Based Treatment
- Fidelity of Prevention Programs
- National Institute on Alcohol Abuse and Alcoholism
- National Institute on Drug Abuse
- National Institute on Drug Abuse Clinical Trials Network
- National Treatment Improvement Evaluation Study
- Prevention Evaluation
- Project MATCH
- Research Issues in Prevention
- Research Issues in Treatment
- Screening, Assessment, and Diagnosis
- Addiction Severity Index
- Alcohol Testing
- Alcohol Use Disorders Identification Test
- Alcohol-Induced Disorders
- Alcoholism
- Antisocial Personality Disorder
- Anxiety Disorders
- Assessment
- Assessment Instruments
- Borderline Personality Disorder
- CAGE Screening Instrument
- Co-Occurring Disorders
- Denial
- Depression
- Diagnosis
- Diagnostic and Statistical Manual of Mental Disorders
- Drug Abuse Screening Test
- Drug Testing
- Experimental Substance Use
- Inventory of Drinking Situations
- Michigan Alcohol Screening Test
- Post-Traumatic Stress Disorder
- Problem Oriented Screening Instrument for Teenagers
- Psychosocial History
- Screening
- Screening Instruments
- Self-Report Inventories
- Substance Abuse
- Substance Abuse Subtle Screening Inventory-3
- Substance Dependence
- Substance Use Disorders
- Substance-Induced Disorders
- Substance-Induced Withdrawal Delirium
- Timeline Followback
- Tolerance
- Urine Toxicology Testing
- Withdrawal
- Sociocultural and Historical Perspectives on Drug use
- Special Populations: Etiology, Prevention, and Treatment
- Adolescents, Substance Abuse and Treatment
- Antisocial Personality Disorder
- Anxiety Disorders
- Athletes and Drug Use
- Borderline Personality Disorder
- Children of Alcoholics
- Co-Occurring Disorders
- College Students, Alcohol Use and Abuse
- College Students, Drug Use and Abuse
- Criminal Justice Populations
- Depression
- Disabilities, Issues in Prevention and Treatment
- Elderly Populations, Treatment Issues
- Fetal Alcohol Syndrome
- Fetal Effects of Alcohol and Other Drugs
- Gay, Lesbian, Bisexual, and Transgender Issues
- Gender Issues
- Homeless, Substance Abuse and Treatment
- Maternal Drug Use
- Multiculturalism
- Post-Traumatic Stress Disorder
- Racial and Ethnic Minorities, Issues in Alcohol and Other Drug Use
- Racial and Ethnic Minorities, Issues in Prevention
- Racial and Ethnic Minorities, Issues in Treatment
- Special Populations
- Veterans, Substance Abuse and Treatment
- Welfare Reform and Substance Abuse
- Substance Abuse Health-Related Issues
- Alcohol-Related Birth Defects
- Amotivational Syndrome
- Antidepressant Drugs
- Antipsychotic Drugs
- Antiseizure Drugs
- Anxiolytic Drugs
- Attention Deficit Hyperactivity Disorder
- Blood Alcohol Concentration
- Drug Abuse Warning Network
- Fetal Alcohol Syndrome
- Fetal Effects of Alcohol and Other Drugs
- Grief, Loss, and Substance Abuse
- Health Care System and Substance Abuse
- Hepatitis C
- HIV/AIDS
- Injection Drug Use
- Insurance Parity
- Maternal Drug Use
- Medical Consequences
- Medical Use of Marijuana
- Methods of Drug Administration
- Pain Management
- Sexually Transmitted Diseases
- Suicide
- Tuberculosis
- Substance Abuse in the Workplace and School
- Treatment Theories, Research, Techniques, Strategies, and Effectiveness
- Abstinence Violation Effect
- Acamprosate
- Acceptance and Commitment Therapy
- Antabuse (Disulfiram)
- Antisocial Personality Disorder
- Anxiety Disorders
- Aversive Therapy
- Behavioral Couples Therapy
- Borderline Personality Disorder
- Brief Interventions
- Brief Strategic Family Therapy
- Buprenorphine
- Cannabis Youth Treatment Study
- CENAPS Model
- Client Engagement
- Client/Treatment Matching
- Co-Occurring Disorders
- Cognitive Behavioral Therapy
- Cognitive-Social Learning Model
- COMBINE Study
- Community Reinforcement and Family Training
- Community Reinforcement Approach
- Contingency Management
- Continuum of Care
- Counseling Approaches
- Court-Mandated Treatment
- Covert Sensitization
- Craving
- Depression
- Detoxification
- Drug Abuse Treatment Outcome Studies
- Evidence-Based Prevention and Treatment, Dissemination and Adoption of
- Evidence-Based Treatment
- Family Behavior Therapy
- Family Therapy
- Gender Issues
- Grief, Loss, and Substance Abuse
- Group Therapy and Counseling
- Harm Reduction Psychotherapy
- Inventory of Drinking Situations
- Levo-Alpha Acetyl Methadol
- Matrix Model
- Methadone Maintenance Treatment
- Minnesota Model
- Moderation Approaches to Alcohol Problems
- Moderation in Use
- Motivational Enhancement Therapy
- Motivational Interviewing
- Multidimensional Family Therapy
- Naloxone
- Naltrexone
- National Outcome Measures
- National Treatment Improvement Evaluation Study
- Nicotine Replacement Therapy
- Outpatient Treatment
- Patient Placement Criteria
- Pharmacological Approaches to Treatment
- Post-Traumatic Stress Disorder
- Project MATCH
- Public Policy, Treatment
- Qualified Services Organization Agreements
- Racial and Ethnic Minorities, Issues in Treatment
- Rapid Opioid Detoxification
- Relapse
- Relapse Prevention
- Residential Treatment
- Resistance in Treatment
- Solution-Focused Therapy
- Stages of Change Model
- Substitute Addictions
- Support Groups
- Synanon
- Therapeutic Communities
- Tobacco Cessation Programs and Treatments
- Treatment Access and Retention
- Treatment Approaches and Strategies
- Treatment Effectiveness
- Treatment Facilities
- Treatment in Jails and Prisons
- Treatment of Alcohol and Drug Use Disorders
- Treatment Plans and Treatment Planning
- Treatment Programs for Alcohol or Drug Abuse
- Treatment Settings
- Treatment, Nontraditional Approaches
- Twelve-Step Facilitation
- Veterans, Substance Abuse and Treatment
- Violence, Intimate Partner and Substance Abuse Treatment
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