Co-Occurring Disorder Assessment

Co-occurring disorder assessment and treatment are essential when helping someone who has a substance use disorder coupled with a mental health disorder, something that is relatively common. Most dual diagnosis rehabilitation facilities focus on integrating all programming and treatment fully.

co-occurring disorderThe Substance Abuse and Mental Health Services Administration recommends that all patients entering rehabilitation or treatment centers for drug or alcohol abuse also be screened for mental disorders. In 2010, the Center for Behavioral Health Statistics and Quality estimated that there are 45.9 million adults in the United States with some type of mental illness.1

Substance abuse treatment facilities should also screen for patients who might present a safety risk, such as those prone to suicide or violence. They should screen for those who have experienced sexual or physical victimization and trauma and seek to identify any learning difficulties or cognitive deficits the patient might have.

Basic Co-Occurring Disorder Assessment

A basic assessment for co-occurring disorders seeks to fully understand the patient before making any rulings or diagnosis. A medical professional will first inquire about the patient’s background. A background assessment usually finds out about:2

  • Who the members of the patient’s family are and which ones live with them.
  • Any history of domestic violence.
  • Any history of other trauma.
  • The patient’s financial situation.
  • Overall physical health.
  • Housing status.
  • Employment.
  • Resources and other strengths.
  • Any previous criminal history.

The assessment may then cover substance-related topics, such as:

  • When substance abuse first occurred.
  • Primary drugs used, which may include alcohol.
  • Patterns of drug use.
  • Any past treatment episodes.
  • Family history of substance abuse.

Finally, a co-occurring disorder assessment will conclude with a discussion about any mental health problems including:

  • A family history of mental illness.
  • Client history of mental health problems.
  • Any previous diagnoses.
  • Any hospitalization for mental health problems.
  • Past mental health treatments.
  • Current mental illness symptoms.
  • Medications used to manage mental health.
  • Overall mental status.

Getting a complete assessment that fully addresses your substance abuse problems and mental health issues is an important first step toward sobriety.

Treatment Options

“Getting a complete assessment that fully addresses your substance abuse problems and mental health issues is an important first step toward sobriety.” Once a co-occurring disorder assessment has been completed, possible treatments will be discussed. While it is important to make sure no medications provided during the detoxification process could aggravate an existing mental illness, the real difference in dual diagnosis treatment lies in the therapy and support patients receive.

Most dual diagnosis addiction treatment facilities will include an on-site psychiatrist who understands co-occurring disorders and can prescribe medication for any mental illnesses. Employing an on-site psychiatrist has been shown to decrease substance use after detoxification and improve treatment retention. Many clients will require medication to address their psychiatric symptoms during treatment.

Dual diagnosis support groups are also essential during treatment. Through these support groups and the help of a therapist, many clients can begin to identify situations that trigger substance abuse or mental health problems. Their co-occurring disorder assessment can also help them understand how both issues affect their overall health.

Dual diagnosis groups allow patients who have a co-occurring disorder to talk about how their mental health issues contribute to their substance abuse problems. Mental health leaders encourage the group to talk about their psychiatric symptoms, such as hearing voices, as well as their desire to use drugs or alcohol.

Ongoing assessment as the patient begins co-occurring disorder treatment is also essential. Some symptoms that are traditionally associated with mental health issues, such as suicidal ideation and hallucinations, are also symptoms of substance abuse or withdrawal. In general, any symptoms that resolve themselves after 30 days of sobriety are usually considered to be symptoms of substance abuse.

Specialized Programs

We know that there are many Americans who have co-occurring disorders. In 2010, the Center for Behavioral Health Statistics and Quality estimated 9.2 million adults with mental health issues also met the criteria to be diagnosed with substance abuse issues.

Despite the commonality of co-occurring disorders, not all treatment programs offer treatment for both kinds of disorders. When searching for a rehab program, you may be more likely to find one that treats substance use disorders alone, which do not provide specific mental health programming. There can be different reasons for this, such as they do not want to offer co-occurring treatment, or because they simply do not have the necessary resources to competently do so.

Co-occurring treatment programs can accommodate patients who have completed the type of assessment described in this article that indicates the presence of both mental health and substance use disorders. Their assessments, treatment planning, and programs are all structured to appropriately accommodate patients who need both forms of treatment. Co-occurring disorder rehab programs employ staff members who are trained and able to address the interaction between these types of disorders, which can be essential when treating people who are not fully stable or functioning due to their mental illness.

Did You Know?

  • In 2010, the Center for Behavioral Health Statistics and Quality estimated that there are 45.9 million adults in the United States with some type of mental illness.
  • According to the Center for Behavioral Health Statistics and Quality, in 2010 there was an estimated 9.2 million adults with mental health issues who also met the diagnostic criteria for substance abuse issues.
  • A basic co-occurring disorder assessment asks questions about the patient’s background, substance abuse, and mental health.


  1. U.S. Department of Health and Human Services. (2012). Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings. Substance Abuse and Mental Health Services Administration; Center for Behavioral Health Statistics and Quality.
  2. Lichtenstein, D.P., Spirito, A., & Zimmermann, R.P. (2010). Assessing and Treating Co-occurring Disorders in Adolescents: Examining Typical Practice of Community-Based Mental Health and Substance Use Treatment Providers. Community Mental Health Journal, 46(3), 252–257.
  3. Harris, K. M. & Edlund, M. J. (2005). Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatric Services, 56(8), 954–959.
Last updated on November 12, 2018
2018-11-12T11:25:31+00:00 is operated by Recovery Brands LLC, a subsidiary of American Addiction Centers, Inc. Learn more about what this means here
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