Key Points: 

  • Co-occurring disorders mean a person has both a substance use disorder and a mental health condition at the same time. 
  • Either condition can appear first, and each can make the other worse. 
  • The most common co-occurring disorders pair SUD with depression, anxiety, or PTSD, requiring integrated treatment to manage both together.

Co-occurring disorders occur when a person experiences a substance use disorder and a mental health condition at the same time. Many people entering treatment search for the right setting but may not know which questions to ask. 

A clear plan for recovery starts by understanding what a co-occurring disorder means and how rehab centers manage both issues in one approach. Careful evaluation reduces stress and helps you select a program prepared to meet complex needs.

Understand What a Co-Occurring Disorder Is

Co-occurring disorders, or dual diagnosis, mean one person has both a substance use disorder and another mental health condition.

Typical combinations include:

  • Alcohol use disorder with depression
  • Opioid use disorder with PTSD
  • Stimulant use disorder with bipolar disorder

These conditions interact, shaping mood, sleep, thinking, and relapse risk.

In 2023, about 20.4 million U.S. adults had both a mental illness and a substance use disorder. Yet 37.6% received no treatment, and only 18.6% got care for both. Most who sought help were treated only for mental health, not addiction.

Because access to integrated care is limited, confirm how a rehab defines and treats co-occurring disorders before enrolling. Here are the key questions to ask:

  • How does the facility define co-occurring disorders?
  • What tools are used to assess depression, anxiety, PTSD, bipolar disorder, psychosis, ADHD, and suicide risk under the DSM-5?
  • When will you meet a prescriber to review results and set an initial plan?

Check Staff Credentials and Experience

Recovery from co-occurring disorders works best when one team treats both conditions within the same plan.

Questions to ask about staff:

  • What licenses or certifications do therapists, psychiatrists, and nurses hold?
  • Are board-certified psychiatrists and addiction specialists available weekly during the first month?
  • How often does the team treat PTSD, bipolar disorder, psychosis, or ADHD, and how is supervision managed?

Staffing should cover medical detox, psychiatric medication management, and medications for alcohol, opioid, or nicotine use disorders when indicated. The program should explain policies for benzodiazepines and cannabis in people with misuse risk or psychosis risk and how labs, EKGs, drug levels, and primary care coordination are handled.

Clear communication is also crucial. Weekly team meetings, shared records, and sessions that include the prescriber show that mental health and addiction care work together instead of staying separate. That structure supports rapid adjustments when mood symptoms flare or cravings spike.

Examine Therapy and Treatment Models

A good program creates one plan that links mental health and substance goals.
The schedule should combine:

  • Individual therapy
  • Skills groups
  • Family sessions
  • Work on triggers, sleep, emotion control, and relapse prevention

For clients with PTSD and a substance use disorder, a recent individual-patient meta-analysis found combined approaches effective for reducing PTSD symptoms and substance use outcomes.

Ask which evidence-based therapies are used. Knowing how DBT vs CBT differ helps set expectations:

  • CBT for thoughts and behavior
  • DBT for emotion and distress skills
  • Contingency management for motivation
  • Trauma-focused care when stable

Also ask how sessions adjust if depression, panic, mania, or psychosis appears, and how family therapy and medication planning stay coordinated.

Questions to ask about therapy:

  • Does the program write one integrated plan rather than separate tracks?
  • How often will I have individual therapy, and what skills groups are standard for dual diagnosis?
  • When do you start trauma work, and what readiness criteria do you use?

Evaluate Detox and Medical Support

Some people with co-occurring disorders need medical support before therapy. Alcohol, opioid, and benzodiazepine withdrawal can be dangerous without supervision. 

For alcohol, untreated delirium tremens has an estimated 15% mortality, while care raises survival to about 95%. Broader alcohol withdrawal can lead to seizures or death if not treated, so guidelines recommend monitoring and symptom-based medications.

Detox should not delay co-occurring care. Programs should:

  • Continue safe psychiatric medicines
  • Start or adjust antidepressants or mood stabilizers as needed
  • Begin medications for alcohol or opioid use disorder as soon as appropriate

A smooth handoff from detox to residential, PHP, or IOP, with the same goals, prescriber, and therapy map, keeps recovery on track.

For opioid use disorder, medication-assisted treatment greatly improves outcomes. Large studies and meta-analyses show methadone and buprenorphine are associated with about 50% lower all-cause mortality while in treatment, compared with time out of treatment. If opioids are involved, ask:

Questions to ask about detox

  • Is nursing available 24/7 during withdrawal, and who is the onsite physician?
  • How do you coordinate detox with psychiatric stabilization and therapy so nothing drops?
  • Which medications for alcohol or opioid use disorder are started on site?

Consider Program Structure and Daily Schedule

Structure keeps people with co-occurring disorders engaged even when focus or energy shifts. Before admission, review the weekly schedule and the IOP program requirements if outpatient care is likely. It should include:

  • Individual therapy and skills groups
  • Medication checks
  • Wellness time (sleep, nutrition, movement)
  • Quiet recovery or reflection periods

Ask how the plan adjusts if symptoms change:

  • Depression: shorter blocks and more breaks
  • Mania: tighter structure, sleep protection, medication review
  • Panic: paced breathing and gradual exposure
  • Psychosis: calm spaces, steady routines, careful dosing

Check policies on phones, internet, and visitors. They should balance safety and family or work ties.

Many centers follow the ASAM Criteria, which review six areas, such as withdrawal, medical needs, psychiatric or cognitive issues, substance risks, recovery environment, and personal factors, and match them to the right care level. Ask how your intake feeds into these dimensions and guides the recommendation.

Explore Aftercare and Relapse Prevention

Recovery from co-occurring disorders improves with planned step-downs and steady follow-up. Before discharge, confirm:

  • Number of therapy and psychiatry visits already booked
  • Which skills groups will continue
  • How medications will be refilled on time
  • Evening IOP, telehealth in addiction treatment, recovery coaching, or family education options
  • Who coordinates with outside therapists or primary care and how updates are shared

Research shows longer, active continuing care, including check-ins, mobile tools, and incentives, helps maintain progress and cut relapse risk. Step-downs within days of discharge create a bridge between inpatient and outpatient care that raises retention.

Questions to ask about aftercare

  • How many psychiatry and therapy visits are pre-scheduled before discharge?
  • Do you offer evening or virtual groups for people working or in school?
  • How do you track continuing-care attendance and outcomes at 30, 60, and 90 days?

Ask About Insurance and Costs

Finances influence access and continuity. Request a written estimate that separates professional services (therapy hours, prescriber visits) from facility charges (room/board in residential, nursing). Before choosing a rehab, request a clear explanation of:

  • What insurance covers for co-occurring disorders treatment.
  • Extra fees for detox, lab tests, or medication.
  • Payment plans for those without coverage.

Transparent billing allows you to focus on healing instead of surprises.

Visit or Request a Virtual Tour

Seeing a facility can clarify whether it feels safe and organized. During a tour, check for:

  • Clean, calm spaces for therapy and relaxation.
  • Group rooms that support privacy and open discussion.
  • Housing arrangements that separate clients by need or gender when appropriate.

Many programs offer a virtual tour and live Q&A. Use them to meet the team, preview a typical day, and ask the hard questions from this article. If you’re attending virtually:

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  • Ask to see the therapy schedule.
  • Ask about the medication room (where appropriate).
  • Ask example for skills handouts. 
  • Ask how telehealth issues are handled so sessions stay consistent.

Frequently Asked Questions

What are the three most common co-occurring disorders?

Co-occurring disorders most often combine substance use disorder (SUD) with depression, anxiety disorders, or PTSD. These three conditions appear most frequently in clinical reviews and treatment samples, making them the most common psychiatric diagnoses found alongside SUD.

Which best describes co-occurring disorders?

Co-occurring disorders refer to the simultaneous presence of a mental health disorder and a substance use disorder in the same person. Either condition can appear first, and each can worsen the other. Diagnosis and treatment require integrated assessment and simultaneous care for both conditions.

Is ADHD a co-occurring disorder?

Yes, ADHD is a co-occurring disorder when it occurs with a substance use disorder. ADHD commonly overlaps with alcohol or drug addiction and often appears alongside mood, anxiety, or conduct disorders. Dual diagnosis care integrates medication and psychosocial therapies while monitoring risk of misuse.

Start Comprehensive Care Today

Choosing a rehab for co-occurring disorders shapes the foundation of recovery. Treatment for substance use and mental health in Ohio and Pennsylvania is available through structured programs designed to address both needs together.

New Horizons Recovery Centers offers evidence-based services and compassionate support for people living with co-occurring disorders. Contact us today to discuss your situation and start a treatment plan built to stabilize symptoms, develop coping skills, and support lasting change.