Co-occuring and Dual Diagnosis Treatment and Recovery

Struggling with an addiction and a co-occurring disorder is like playing a frustrating game of whack-a-mole. When one illness seems to hide, another pops up to rear its ugly head. Often this dynamic continues until that person decides they’re ready to get sober and seek professional help.

At Hotel California by the Sea, we use a collection of effective co-occurring disorder treatment methods to identify and treat our clients’ mental illnesses while also caring for their addictions. This way, they can achieve ultimate and individualized healing for every part of themselves – not just the part that masked it all with mind-altering substances.

Drugs and alcohol tend to cover up what’s going on deep down. If you or a loved one is struggling with a co-occurring disorder, let this page be your resource for understanding more about what could be lying underneath of addiction – and why it matters.

We invite you to reach out to us when you are ready to rebuild your life free from the grips of addiction. Lasting freedom starts here.

co-occurring disorder treatment

What It Means to be Comorbid, And Why it Matters

A co-occurring disorder, also formerly known as a “dual diagnosis”, refers to a separate mental illness that exists alongside a substance abuse disorder. Dual diagnoses are officially characterized when someone meets the criteria for more than one mental illness according to the DSM-5, a manual used by mental health professionals to diagnose mental disorders nationwide.

Comorbidity has many “recipes”. For example, someone might develop a substance use disorder because using drugs masks some of their deepest fears (indicative of an anxiety disorder). Or, maybe someone strives to bury bothersome memories (reminiscent of Post-Traumatic Stress Disorder).

Or, sometimes mental illnesses and substance use disorders form with no correlation between one and the other. We’ll discuss more of the multiple combinations of co-occurring disorders below.

When two mental illnesses occur together, they work as catalysts for each others’ destructive natures. Like the cleverest partners in crime, comorbid mental illnesses can drag (and keep) someone in the depths of their darkness. Although crawling out of these depths isn’t easy, it is possible with the right course of treatment.

Why These Disorders Often Co-Occur

Despite the amount of research scientists have done over the past couple of decades, addiction remains an elusive disease with obvious consequences – but less apparent roots.

Some researchers will claim alcoholism stems from trauma and environmental factors, while some doctors claim it’s all due to genetic predisposition. The truth is, they’re probably both right.

However, we do know that when addiction exists with another mental illness, it can be that much harder to treat and overcome. Here are three points to consider about Co-Occurring disorders and their causes:

Mental illnesses are identified as “risk factors” for developing an addiction, and can directly lead to drug and alcohol abuse (many people call this “self-medicating”)

Both mental illnesses and addiction can stem from genetic vulnerability and exposure to trauma

Some regions of the brain that are affected by addiction, such as the circuitry responsible for regulating dopamine, are also affected by mental illnesses

Common Types of Co-Occurring Disorders

The compounding effects caused by having a mental illness and an addiction can be downright scary. Most professionals in the industry of addiction recovery will tell you simply that, to work on one, you must work on all. To work on something, though, you first have to identify it.

Some of the most common mental health conditions in the United States that can occur alongside of a Substance Use Disorder are:

Borderline Personality Disorder

Doctors characterize Borderline Personality Disorder by a deep and intense fear of abandonment or perceived abandonment. People with Borderline Personality Disorder also exhibit other distressing symptoms of their mental illness such as substance abuse, self-harm, severe mood swings, suspiciousness, irritability, self-destructive behaviors, chronic feelings of emptiness, and sometimes eating disorders.

Major Depressive Disorder

Major Depressive Disorder tends to take many forms depending on who it plagues. Sometimes, it manifests with intense sadness, hopelessness, or loneliness. Other times, its sufferers describe feeling numb, “flat”, and unmotivated. Many people who are depressed try to self medicate using drugs or alcohol.

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder is a mental health disorder on the anxiety spectrum. There are multiple forms of OCD, but in general, it’s symptoms can include an obsession with germs or cleaning, superstitious behavior, intrusive thoughts, “checking” behaviors, social isolation, and much more. Other official and unofficial subtypes of Obsessive-Compulsive Disorder Exist, such as ROCD (Relationship Obsessive Compulsive Disorder).

Generalized Anxiety Disorder (GAD)

War, crime, mass shootings, sexual abuse or assault, an abusive relationship, death of a loved one – all of these are events that can profoundly affect the circuitry in someone’s mind. PTSD causes actual lasting chemical changes in the brain, like memory changes, lessened ability to focus, and more. Post Traumatic Stress Disorder actually puts more people at risk for substance abuse disorders.

Post-Traumatic Stress Disorder

War, crime, mass shootings, sexual abuse or assault, an abusive relationship, death of a loved one – all of these are events that can profoundly affect the circuitry in someone’s mind. PTSD causes actual lasting chemical changes in the brain, like memory changes, lessened ability to focus, and more. Post Traumatic Stress Disorder actually puts more people at risk for substance abuse disorders.


Schizophrenia is a common mental illness that causes someone to feel out of touch with reality, sometimes hallucinate, and have disorganized speech or behavior. Although there is no cure for schizophrenia, there is a medication that can help lessen its frightening side effects.

Eating Disorders

Eating disorders come in many different forms, such as Bulimia, Anorexia, Orthorexia, and Eating Disorder Not Otherwise Specified (EDNOS). Perhaps surprisingly to those who work in the field of addiction, eating disorders have the highest death rate of any mental illness.

Bipolar Disorder

Bipolar Disorder is a mental illness that was once called “manic depression”. Hence its old name, Bipolar Disorder involves a lot of mood swings, ranging from “highs” of mania to “lows” of depression. Those who suffer from both Bipolar Disorder often attempt to level out their moods with substances, or, substances sometimes aggravate the Bipolar’s moods even more.

It is evident that many of the symptoms of these mental illnesses either overlap with each other, or overlap with common indicators of addiction.

Why Does it Help to Know if You’re Comorbid in Rehab?

Unfortunately, the effects of using drugs and alcohol can mimic many of the mental illness symptoms mentioned above, making it hard to make a proper diagnosis while an addict isn’t sober.

To make the right diagnosis, Hotel California by the Sea’s treatment program involves meeting 1-on-1 with a trained psychiatric physician for an initial consultation. However, throughout the client’s entire journey here, routine follow-ups are necessary to monitor their recovery and progress.

Understanding whether someone is comorbid while still in treatment can allow them to address their destructive internal processes adequately free from the effects of substances. Clients will also come to understand how their mental illness might relate to their addiction and determine what specific therapies might be best for them.

For example, medication might be right for the treatment of some mental illnesses (and some individuals), but it might not be the best course of action for others. Either way, understanding if you have another mental illness can help you deal with your addiction with more insight, allow you to understand your biggest triggers better, and ideally prevent relapse.

The Difficulties of Assessing Co-occuring Mental Illnesses

As if the brain weren’t complicated enough, withdrawing from drugs and alcohol can cause a lot of brain chemicals to fluctuate abnormally. This can make it confusing to understand which came first – the co-occuring disorder, or the substance abuse disorder.

With proper psychiatric evaluation and medical oversight, Hotel California by the Sea’s clinical team can successfully distinguish what mental illness might lie under the veil of addiction and how to properly treat both.

That’s why it’s best for clients to be monitored for an agreed upon amount of time after getting sober by mental health professionals.

Sometimes the following can occur, creating barriers for those in need of treatment for both their addiction and their co-occurring disorder:

  • Some United States treatment systems prefer to only treat one disorder at a time.
  • Sometimes, due to the potentially lasting effects of drug and alcohol, it can be difficult to tell whether certain symptoms are for more organic reasons or whether they stem directly from drug usage.
  • Sometimes insurance companies don’t take mental illnesses as seriously as they need to. Or, perhaps they decide someone is ready to be discharged from treatment too early.
  • Often people believe that dual diagnoses are purely for insurance companies to get more money – this couldn’t be further from the truth. If two mental disorders exist, it is crucial to diagnose and treat both of them for a better chance at sustainable recovery.

Co-occurring Disorder Treatment

Many people ask us at HCBTS: “Which should we treat first, the substance abuse disorder or the other mental illness?” And our answer is almost always the same:

Both. Treating the whole person is never more crucial than in the case of someone with a dual diagnosis.

If one disorder is not adequately addressed in treatment, it can potentially lead to a relapse in the other later on. Dual Diagnosis residential treatment is recommended for most of our beginning clients, followed up by thorough aftercare planning.

Types of Therapy For Co-Occurring Disorders


Cognitive Behavioral Therapy assists in changing someone’s thought patterns, thus leading to a change in their behavior. It can be helpful for identifying someone’s triggers and alter someone’s self-limiting belief systems. CBT is one of the most widely-used therapies in the United States – and for good reason!


Dialectical Behavioral Therapy is not as well known as CBT, but it’s especially effective for certain types of mental illnesses, like Borderline Personality Disorder. Where CBT might not be as effective for some clients, DBT offers an alternative. DBT has also been shown to be extremely helpful for drug-related disorders, as it focuses on mindfulness and becoming more aware of the feelings that

Integrative Group Therapy, or IGT

Group therapy is especially helpful in treating co-occurring disorders, since it shows our dual diagnosed clients they are not alone! Clients can interact openly with others who share their struggles and develop trusting, meaningful relationships with people who resonate with their experiences.

Psychotropic Medication

Medication isn’t for everyone, nor is it mandatory in treatment, but it can be extremely helpful for many people suffering from an addiction and a seperate mental illness. SSRIs and SNRIs have been clinically proven to help some forms of depression and anxiety, while mood stabilizers often positively influence mood disorders. In tandem with our psychiatrist, our clients can decide for themselves what course of treatment is right for them.

Having more than one mental illness is complicated – we know.

Comorbid addicts and alcoholics face a tough journey full of hard work, but that doesn’t mean recovery is hopeless. Seeking treatment for comorbid disorders and addiction can be even more rewarding for those who set their hearts to embracing an all-encompassing recovery process with a caring treatment team.

If you or someone you know is struggling with drug or alcohol addiction, Hotel California by The Sea provides integrated treatment for addiction and co-occurring disorders. Reach out to get help today:

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The road to recovery is full of uncertainty, leave your worries behind…
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Every member of our admissions team has been where you are today – be sure to ask them about their journey!