Co-Occurring Disorders

A co-occurring disorder (formerly referred to as dual diagnosis) is when someone has a mental health disorder at the same time as a substance use disorder (e.g. alcoholism, drug addiction).  For instance, a person that abuses alcohol and is also schizophrenic would be said to have a co-occurring disorder.

Mental disorders that can co-occur with substances use disorders include:  major depression, bipolar disorder, schizophrenia and other psychotic disorders, eating disorders (although I personally would class those as a substance use disorder), general anxiety disorder, post-traumatic stress disorder, personality disorders, attention-deficit/hyperactivity disorder, and pathological gambling disorder.

Fifty to 75 percent of people in treatment for a substance use disorder also have a co-occurring mental health disorder.  And 20 to 50 percent of people that are treated for a mental health disorder also have a substance use disorder.  My favorite statistic is that 60 percent of people with three or more disorders (identified by survey) never received any treatment. Although, people with a co-occurring disorder are more likely to seek treatment than people with just one problem.

Coming from an alternative health perspective the idea of diagnosing and labeling people with disease names seems weird to me and somewhat funny.  People do not have diseases, they have a set of problems or issues that are interconnected and need to be considered as a whole.

The big thing in mainstream medicine is how we need to consider all disorders that co-occur when treating a person.  A step in the right direction, but it still seems bizarre to me that anyone would think about reducing a person to specific sets of symptoms so they can label and treat each condition separately. This reductionist approach is supported by the medical practitioners, drug companies and insurance companies that seem to feel it is necessary to have this system in order to communicate with each other.

I also imagine that this reductionist approach may be due to the limitation of humans to handle complexity.  It is simpler to label a disease and match it with a treatment than to understand what is happening with a person and create a unique treatment to address it.  We see this same reductionist approach applied by herbalists as well.  Often times a beginner or Western herbalist will just use a treatment that matches a disease name, unless they have training in a system that uses a constitutional approach (e.g. traditional Chinese medicine, etc.)

Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons with Co-Occurring Disorders. (2013). Treatment Improvement Protocol (TIP) Series, No. 42 (DHHS Publication No. (SMA) 13-3992). Rockville, MD: Substance Abuse and Mental Health Services Administration (US).


Denial means the act of declaring something is not true.  A simple enough word, but the way people use the word has become somewhat of a pet peeve for me.  I find that people use it in a derogatory way when they are judging another person’s actions and/or their stage of change level.  As commonly used, if I say you are in denial, what I am really saying is that I have the only truth.  And, perhaps, I know your truth better than you.

I’m not sure where our use of the word got off track.  It feels quite neutral to say that someone denies something, e.g. for many years I denied that eating saturated fats and eggs caused heart disease.  However, to say one is “in denial” feels charged, e.g. I was in denial that eating saturated fats and eggs caused heart disease.  “Being in denial”, inherently means I’m wrong, when it should just mean I don’t agree with something.

Consider the saturated fats and eggs example.  For many years, the mainstream thought that these items needed to be avoided for a healthy heart.  I denied this reality and, despite heart disease running in my family, continued to have the best cardiovascular system in my family.  Now, the mainstream has come around to my way of thinking.  Would I say they were in denial all those years?  Doesn’t that seem like a silly use of the term?  Perhaps they would have disagreed (denied) that my way is healthy, but it would seem strange to say they were in denial.

The “authorities” had taken all the available information and come to a different conclusion than me.  Then the mainstream had followed their advice. (I started to say they followed it “mindlessly” but realized that would be adding a judgement. Let’s just say they followed it without examining it further.)   In some traditions (Buddhism), this would not be called denial, but ignorance.  “Everybody” in my saturated fat example was simply ignorant of the truth.

The word ignorant rubs me wrong as well.  Inherent in the way it is commonly used, it suggests a mental deficiency, instead of just a simple and temporary not knowing. I prefer the term awareness.

Sometimes one is not aware that something is really a problem because no time has been taken to examine the situation objectively. This is the case when people accept things at face value, or accept information from people that they trust without examining it personally.

Other times people may be aware they are having a problem, but they ignore it because they cannot imagine an alternative or they think this is just how it is.  This is the case of the alcoholic/drug user that is surrounded by others that are drinking, using, getting DUIs and calling in sick to work due to hangovers.  It just doesn’t seem like a problem because it is normal.  I wouldn’t call that person in denial, they are just not aware of the alternative and/or aren’t looking for an alternative because they are already “normal”.

I think Socrates may sum it up best…

The unexamined life is not worth living.