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Concurrent Disorders & Mental Health

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What is a Concurrent Disorder?

The term “concurrent disorder” refers to a person’s experience with coexisting mental health disorder(s) and substance abuse issues, both requiring specialized treatment. Symptoms of mental health and substance abuse can occur at any point in a person’s lifetime (Bartha et al., 2004) and more than one mental health disorder may exist at the same time as multiple substance use problems (Distress and Crisis Ontario, 2019).

People with a mental health disorder are substantially more likely to develop a substance abuse disorder. The inverse is also true, however; it is important to understand that this does not mean that one condition caused the other, even if one was experienced first (National Institute of Drug Abuse, 2008). Researchers suggest that it is most beneficial to consider each issue as separate and interacting (Bartha et al., 2004).

A concurrent disorder may include the following dual diagnoses:

  • Anxiety disorder and alcohol abuse
  • Schizophrenia and cannabis addiction
  • Borderline Personality Disorder and addiction to heroin
  • Depression and abusing sleep aid medication
  • Impulse control disorder (e.g. gambling or Attention Deficit Hyperactivity Disorder) and cocaine dependence
  • Post Traumatic Stress Symptoms (PTSS) and Post Traumatic Stress Disorder (PTSD) and opioid abuse

This is not an exhaustive list of concurrent disorders; many more co-occurring issues are possible due to the number of mental health disorders and substances (Bartha et al., 2004)

Those who have concurrent disorders most commonly depend on alcohol (60%). Approximately 29% of the population with a concurrent disorder abuses cocaine, with crack cocaine being most prevalent.

Furthermore, research indicates that 15% of those with concurrent disorders are dependent on marijuana, with the smallest number of people with a concurrent disorder being addicted to opioids (Distress and Crisis Ontario, 2019).

Relationship Between Mental Health Disorders and Addiction

The relationship between a mental health disorder and concurrent substance abuse is complex.

It can be difficult to properly identify a concurrent disorder, both for the person in question and those around them.

Symptoms will be different for every person dealing with a concurrent disorder.

Substance use impacts a person’s state of mental health and one’s experience with mental health may impact the substances that they choose to use (Distress and Crisis Ontario, 2019).

Substance use can exacerbate symptoms of mental health in a manner that is more severe than if the person did not use illicit drugs.

Substances may also trigger/produce symptoms of mental health that a person otherwise would not have experienced. An example of this is demonstrated when a person smokes marijuana and develops a psychotic episode they may not have otherwise experienced (Distress and Crisis Ontario, 2019).

It is known that withdrawal from substances also contributes to a person’s exacerbation of mental health symptoms. An example of this occurring is when a person is withdrawing from a stimulant dependence (e.g. cocaine, methamphetamine) and experiences an intense “comedown,” distinguished with intense symptoms of depression (Distress and Crisis Ontario, 2019).

It is common for states of substance use and withdrawal to both mimic and mask symptoms of mental health. As an example, a person’s intoxication from a stimulant (e.g. cocaine) may present as similar to that of a manic episode (Distress and Crisis Ontario, 2019).

Additionally, a person who experiences unbearable symptoms of depression may rely on a substance (e.g. alcohol) to disguise how they are truly feeling, giving the illusion that they are “normal” under the influence of their drug of choice (Distress and Crisis Ontario, 2019).

Similarly, a person with symptoms of social anxiety may self medicate with a substance to provide them with the comfort of engaging in the context of their relationships and social settings.

As a central nervous depressent, alcohol is often used as a means to reduce symptoms of physiological arousal that accompany anxiety and panic disorders (shortness of breath, excessive sweating, sense of impending doom, etc.).

It is important to consider that over time alcohol can create permanent changes in the brain because it reduces levels of serotonin, thereby bringing about symptoms of depression that may not have otherwise existed or have been exacerbated (Distress and Crisis Ontario, 2019).

It is far too often that people with mental health problems and addiction experience stigma and discrimination. It is of importance to understand the relationship between addiction and mental health, and for you to be able to ask any questions you have in order to increase your awareness and sensitivity to the reasons why people depend on substances to cope and what might be contributing to one’s challenges with mental health.

Research in the field of concurrent disorders indicates that there is a high prevalence of drug abuse and dependence among individuals with mood and anxiety disorders.

More research in the field indicates that:

– For those with a dependence on alcohol, 44% will develop mental illness in their lifetime, and with all other substance use disorders, 64.4% will also experience a mental health disorder at some point (El-Guabaly, N., 2004).

– The prevalence of people with an anxiety disorder developing a substance abuse issue is 24% (Bartha et al., 2004).

– Approximately 27% of those with a diagnosis of major depression will experience a substance use disorder at one point (Bartha et al., 2004).

– The percentage of those who have been diagnosed with schizophrenia to develop a substance use disorder over their lifetime is 47% (Bartha et al., 2004).

– 56% of individuals who have bi-polar disorder will encounter a substance use disorder (Bartha et al., 2004).

Relationship Between Trauma and Addiction

People may use substances as a means to cope with Post Traumatic Stress symptoms (Van Dam, D. et al., 2013).

In the context of treatment for trauma and addiction, the outcome of reduced symptomatology of Post Traumatic Stress Disorder (PTSD) is associated with recovery from dependence on substances (Van Dam, D. et al., 2013).

Treatment for Concurrent Disorders at Trafalgar

At Trafalgar’s rehab programs, we are committed to ensuring that you are being treated for both conditions.

Upon the first week of your treatment you will participate in a consultation with a Psychologist, in order to assess your psychological state and recovery needs.

This information is communicated to your assigned Clinical Therapist in order to inform the therapeutic interventions and recovery goals that will treat your conditions.

At the beginning and throughout your virtual treatment, you will also be required to complete instruments (e.g. GAD-7, PHQ-9, PCL-5) that measure severity of symptoms pertaining to mental health disorders (including anxiety, depression, PTSD).

Depending on your diagnoses, you will be administered other relevant instruments.

Over the duration of your treatment, your symptoms will be monitored and treated using evidence-based therapies.

Your substance use addiction and/or compulsive behaviours will be treated with additional therapeutic interventions such as Motivational Interviewing, with consideration to other contributing factors, otherwise known as the “root of the issue,” and strategies for preventing relapse.

At Trafalgar we take pride in our specialized group programming options for gambling, sex and love addiction, and Post Traumatic Stress Disorder with First Responders.

We use a number of client centered treatment methods in the context of individual therapy and group counselling. We design our treatment programs to treat the whole person, not just their disorders.

Integrated, evidence-based services of the kind Trafalgar Addiction Treatment Centres provide are a proven, effective way of treating those dealing with concurrent disorders.


Distress and Crisis Ontario (2019, May). Concurrent Disorders (Part 1) [Audio podcast episode] In Distress and Crisis Ontario on Spotify.

Bartha, C., O’Grady, C.P., Parker, C. & Skinner, W.W.J. (2004). Concurrent substance use and mental health disorders: An information guide. (Retrieved April 21, 2021)

Van Dam, D., Ehring, T., Emmelkamp, P. MG. & Vedel, E. Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: a randomized control trial. BMC Psychiatry 13 (172), 1-13.


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