Addiction to drugs or alcohol is a difficult problem for anyone to overcome. But imagine how hard it would be to successfully conquer a substance abuse problem if you were also struggling to deal with a psychiatric disorder or mental illness. A person trying to beat an addiction to intoxicants requires all of the inner strength and focus they can generate, but mental illness robs its victims of the resources they need just to cope with daily living, let alone any other kind of serious health problem or medical condition that might be present.

Unfortunately, those who are suffering from the co-occurrence of substance abuse and psychiatric disorders are living examples of the psychological reality behind the Rorschach test. Because people have a tendency to see what they want to see or expect to see, victims of co-occurrence are often believed by family or friends to be either addicted or mentally ill, but not both at the same time. Even psychiatrists and professional counselors are often fooled, since trained experts on human behavior also bring their expectations and backgrounds into the equation.

But in order to find their way back to good health and a sound mind and body, mentally ill substance abusers will need to be diagnosed and treated for any and all conditions they might be suffering from, and they will need to be treated for everything at the same time, in a carefully controlled and coordinated manner.

The Facts about Co-occurrence

The connection between substance abuse and psychiatric disorders is neither rare nor tenuous. Approximately 20% of all who are suffering from a psychiatric disorder also have substance abuse issues, while 50% of all drug addicts and alcoholics are also coping with some kind of serious mental illness. The rates of co-occurrence are especially high for those who have been diagnosed with either bipolar disorder or schizophrenia, as about half of all victims of these disorders are also addicted to drugs or alcohol.

Life can be an uphill struggle for any substance abuser, and obviously for anyone trying to cope with a psychiatric condition as well. But things tend to spiral out of control for the men and women who are forced to cope with addiction and mental illness at the same time. Those diagnosed with both have:


  • Higher levels of involvement in violent incidents or crimes
  • Much higher rates of dropout from addiction treatment facilities
  • Higher levels of relapse
  • More episodes of psychosis
  • More problems with chronic physical illness
  • A greatly increased likelihood of ending up homeless
  • Higher incarceration rates

    Because the complicated nature of their problems are seldom acknowledged or understood, mentally ill addicts or alcoholics do not usually receive the kind of comprehensive integrated treatment they truly require, and they too often end up cast off and adrift without an effective support net to help them out or look after them. Family members may try to help for awhile, but they are frequently overwhelmed by the depth and complexity of the problems their loved ones face, and they tend to reach a point where they no longer know what to do or where to turn.

    Finding Hope for the Hopeless

    While the question of which came first is not really all that important in the final analysis, it seems likely that mental illness is more often a cause of addiction than addiction is a cause of mental illness. Drugs and alcohol are seductive because they help people bear the unbearable, which is why addiction is so often seen as a symptom of some deeper underlying conflict or dysfunction. For this reason, family caretakers would be well advised to do everything they can to keep their mentally ill loved ones away from drugs and alcohol, since exposure to addictive substances in this case can only make things worse.

    Once addiction and mental illness are present together they will inevitably feed and reinforce each other, so in this situation it is critical that both problems be treated aggressively and simultaneously. Studies have proven that co-occurrence treatment plans work better than an approach that tackles one problem at a time, and there is really no clear way that the effects of one can be differentiated from the other anyway. So after someone struggling to overcome a mental illness has started using drugs or alcohol, at that point it would be foolish to pretend the substance abuse issue does not exist, just as it would be foolish for those concerned with the welfare of an addict to ignore any psychiatric conditions that might also be present.

    As previously mentioned, the common experience for most mentally ill addicts has been limited and inadequate treatment. However, over the last decade in particular, understanding of the connection between substance abuse and mental illness has deepened considerably, and there are now many treatment options available for people who are suffering from a psychiatric disorder and an addiction at the same time. But in order for the victims to get help, it is up to family members and friends to accurately assess what is going on so they can let the professionals know what is really happening with their loved ones. When addiction counselors, psychiatrists, and co-occurrence specialists (there are some around now) are in possession of a full history on their patients, they will be in a much better position to develop a treatment regimen that actually has a chance of working.


    Choose a better life. Choose recovery.