Co-Occurring Disorders (CODs)

(Also known as “dually diagnosed disorders)

At Milwaukee Women’s Recovery Center, Inc., all our licensed clinical staff are trained to screen and assess clients for co-occurring (i.e., dually diagnosed) mental disorders.

Incidence of CODs

According to SAMHSA:

People with SUDs are more likely than those without SUDs to have co-occurring mental disorders. Addiction counselors encounter clients with CODs as a rule, not an exception. (Emphasis in the original.)

Mental disorders likely to co-occur with addiction include depressive disorders, bipolar I disorder, posttraumatic stress disorder (PTSD), personality disorders (PDs), anxiety disorders, schizophrenia and other psychotic disorders, ADHD, and eating and feeding disorders.

Serious gaps exist between the treatment and service needs of people with CODs and the actual care they receive. (Emphasis in the original.)

Many factors contribute to the gap, such as lack of awareness about and training in CODs by addiction counselors, as well as workforce factors like labor shortages and professional burnout.

Failure to routinely screen clients receiving behavioral health services for mental disorders and SUDs creates a problematic domino effect. A lack of screening means a lack of assessment, which results in a lack of diagnosis, which leads to a lack of treatment, which then reduces a person’s chances of achieving long-term recovery for either or both disorders.

Counselors and other providers can prevent this cascade of negative events by understanding how and why to screen, how to perform a full assessment, and how to recognize diagnostic symptoms of mental disorders and SUDs.

CODs are treatable conditions, and a range of treatment modalities exists that can be implemented across numerous inpatient and outpatient settings. Counselors may need to adapt interventions based on the treatment setting as well as the unique needs and characteristics of clients (emphasis in the original), including their gender, race/ethnicity, life circumstance (e.g., homelessness, involvement in the criminal justice system), symptoms, functioning, stage of change, risk of suicidality, and trauma history.

People with CODs are at an elevated risk for self-harm, especially if they have a history of trauma. Counselors, other providers, supervisors, and administrators should make client safety a priority and ensure that providers have the necessary training to detect and respond to suicidal thoughts, gestures, and attempts in COD clientele. (Emphasis in the original.)

Essential services for people with CODs are person centered, trauma informed, culturally responsive, recovery oriented, comprehensive, and continuously offered across all levels of care and disease course. There is no “wrong door” by which people with CODs arrive at treatment. Counselors and programs should have a range of interventions and services in their “toolbox” with which they can help all clients.

SAMHSA – Substance Use Disorder Treatment for People with Co-Occurring Disorders UPDATED 2020.  Retrieved from Substance Use Disorder Treatment for People With Co-Occurring Disorders TIP 42 ( on April 27, 2021.

Researchers have found that about half of individuals who experience a SUD during their lives will also experience a co-occurring mental disorder and vice versa. Co-occurring disorders can include anxiety disordersdepressionattention-deficit hyperactivity disorder (ADHD)bipolar disorderpersonality disorders, and schizophrenia (emphasis added), among others.

Data from a large nationally representative sample suggested that people with mental, personality, and substance use disorders were at increased risk for nonmedical use of prescription opioids. Research indicates that 43 percent of people in SUD treatment for nonmedical use of prescription painkillers have a diagnosis or symptoms of mental health disorders, particularly depression and anxiety.


NIDA. 2021, April 13. Part 1: The Connection Between Substance Use Disorders and Mental Illness. Retrieved from on 2021, April 26.

NIMH. Substance Use and Co-Occurring Mental Disorders.  Retrieved from: on 2021, April 26.