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Co-Occurring Disorders in Teens

More often that not, addiction is accompanied by co-occurring mental illnesses such as depression or anxiety. A good treatment center focuses not only on your teen’s substance abuse, but also on any underlying dual disorders. With the right help, long-term recovery is possible. Seek treatment options now.


6 min read

What Is A Co-Occurring Disorder?

A co-occurring disorder is the diagnosis given to people who have a concurrent mental disorder and a substance use disorder.

A substance use disorder includes:

  • substance abuse
  • using alcohol or drugs enough to impact daily life in social relationships, school and work
  • substance dependence
  • the brain adapts to habitual drug use and exposure, which can eventually lead it to perform its expected functions by responding only to administration of the substance
  • in cases of stronger dependence, physiological side effects may include powerful withdrawal symptoms whenever the user stops using the substance

Co-occurring disorders and substance use disorder each amplify the other’s effects. In many cases, it’s difficult to judge which came first. For some, an alcohol or drug habit forms as a response to a mental disorder they’re battling. For others, the substance use disorder causes a mental disorder to develop.

Co-occurring disorders are complex and require a lot of attention. Nearly 9 million adults have co-occurring disorders and 51% of people with a mental disorder — also referred to as psychological disorders — also have a substance use disorder. The tumultuous teenage years can be an especially potent breeding ground, as kids struggling with depression or anxiety issues may turn to substance use as a method of coping.

What Are Common Co-Occurring Disorders?

teen on bench from afar

Co-occurring disorders can encompass a number of combined issues. Some may be more manageable than others. Anyone living with co-occurring disorders requires a unique diagnosis, because the problems are often complex and need to be treated as such. Complications arise when patients may even suffer from multiple mental disorders.

The most commonly diagnosed mental disorders in teens are mood-related disorders:

  • Major depression
  • Dysthymia (mild but chronic form of depression)
  • Bipolar disorder

Also common among teens are anxiety-related disorders:

In certain cases, more severe disorders take hold, including:

Once a teen with a drug or alcohol problem also exhibits signs of any of these disorders, they can be diagnosed as a dual disorder patient. Some of the more common examples of co-occurring disorders are major depression with cocaine addiction, alcoholism paired with panic disorder and borderline personality disorder with episodic polydrug abuse (i.e. using multiple drugs at a time).

In some cases, mood disorders and anxiety disorders can cause alterations in neurotransmitters in the brain that promote emotional stability (e.g. serotonin). These alterations often trigger eating disorders like anorexia, bulimia or binge eating.

On their own, any one of these disorders can throw major hurdles at a teenager. When multiple disorders co-exist, they demand even more attention and, often, professional treatment is the only viable solution. The sad truth is that only 7.4% of individuals receive dual diagnosis treatment, with 55.8% receiving no treatment at all.

What Causes Co-Occurring Disorders?

At the core, both psychological disorders and substance use disorders are biological issues, which can result from a variety of causes:

  • Genetics (what’s ingrained in DNA or stemming from a family history of problems)\Environmental factors (neighborhood, school, home life)
  • Birth defects
  • Pharmacologic influences

Sometimes substance abuse begets a mental illness to develop. Other times, it’s the other way around — when somebody battling a mental or emotional problem turns to drugs or alcohol for self-medication.

There’s no exact rhyme or reason for why dual disorders develop. Sometimes, the best way to determine the causes is for you and your teen’s doctor to trace the issues back to their roots. This can involve both physical and psychological testing. Once you understand the history, sequence and severity of the problems, you can begin to address the illnesses holistically and help your teen towards recovery.

Would My Teen Have A Co-Occurring Disorder?

It’s hard enough being a teenager — feeling misunderstood and constantly trying to fit in drives their decision-making. Around the world, teenagers live with mental health problems that often go by untreated. In fact, 21% of children in the U.S. between the ages of 9 and 17 have a diagnosable mental disorder. Almost three-fourths don’t receive the necessary treatment for it.

In the grips of a debilitating mental disorder, self-medication may present itself as a reasonable option. What can start off as a casual use of drugs or alcohol can develop into a dependence — and even addiction, which is a disease that drives the user to crave or compulsively use the substance despite the apparent damage it’s inflicting on them. At that point, the co-occurring disorders present complications, which set many up for failure as they attempt to balance school, work and a social life with their slowly-worsening health.

For others, heavy substance use can trigger the onset of mental health disorders. Once a teen is diagnosed with co-occurring disorders, their recovery path becomes immensely more rocky and unclear. One study of teens in drug abuse treatment revealed that 64% had at least one co-occurring mental illness, with 59% meeting criteria for conduct disorder.

What Are the Risks of Co-Occurring Disorders?

tteen in introspective state

Studies have shown that, when compared to teens with only substance use disorders, those diagnosed with co-occurring disorders start using substances earlier, use substances more frequently and for longer periods and have greater potential for school, family and legal problems.

Common outcomes of dual disorders include, but are not limited to:

  • Employment and housing instability
  • Difficulty budgeting funds
  • Social isolation and repeated social difficulties
  • Prostitution or sexual deviance
  • Sudden unexplained mood shifts
  • Hygiene and health problems
  • Violent behavior and suicidal ideation
  • Cognitive impairments

The outcomes are more prevalent than you may think. For example, of the estimated 600,000 people who are homeless on a given day, around 25–30% have a mental illness. Around half of these people also have substance use disorder. More than 2 million teens under 18 years old are arrested in the U.S. each year and many of these teens are battling co-occurring disorders.

A substance habit or mental disorder alone can each snowball at debilitating rates. Left untreated, they can evolve into co-occurring disorders that can severely impact your teen.

How Can I Tell If My Teen Has Co-Occurring Disorders?

frustrated teen with head in hands

Ideally, you can identify a single disorder in your teen before a second one develops. At the first signs of any problem — whether psychological or substance-related — you should research the symptoms and try to determine what may be wrong, before approaching your teen and trying your best to resolve the issue with them.

While symptoms can vary greatly, depending on the substance or psychological disorder involved, the most common ones — in any combination — to look for include:

  • Depression
  • Introversion
  • Irritability or mood swings
  • Trouble in school
  • Change in appearance, weight, or overall health
  • Suspicious behavior, such as lying or secrecy
  • Changing friend groups or becoming distant
  • Unpredictable or erratic behaviors
  • Money problems
  • Conflicts with teachers, administrators or police
  • Appearing sick or unwell
  • Lethargy or strange sleep schedule

Of course, the symptoms are more complex than your teen having trouble waking up on an off day and getting chores done on time. The symptoms of co-occurring disorders dramatically affect the everyday functioning of your teen, the results of which often play out in an almost systematic deterioration of sense of responsibility and quality of relationships.

As the signs stack up, don’t assume they’ll be okay on their own or that their problems will work themselves out. If your teen is struggling with co-occurring disorders — or an individual disorder of any sort — they need your help.

Can You Test for These Disorders?

Taking your teen to a primary care physician should be the first step. Often, their doctor may refer them to a specialist for integrated screening for co-occurring disorders. Integrated screening will assess your teen’s health, both mentally and physically, along with their habits and behaviors to determine if they have at least one diagnosable substance use disorder and mental health disorder. If they find signs of co-occurring disorders, their next step is to determine how these disorders are related given the individual’s unique contexts. This integrated screening is different from a standard assessment for a single problem, as it’s designed to assess the two problems in the context of each other.

  • Establish or rule out a co-occurring disorder
  • Educate you and your family on the problem
  • Determine the teen’s willingness and readiness for change
  • Identify his or her strengths and problem areas going into treatment
  • Begin developing a promising treatment relationship and recovery path
  • Recommend your teen to the best treatment options to suit their needs

Is Treatment A Viable Option?

It absolutely can be. In an ideal situation, your teen would be getting treated before their problem ever grew into more complex co-occurring disorders. Unfortunately, that’s not always the case. Countless mental disorders — and emotional disorders — fly under the radar for years, only to get noticed once a substance habit manifests. Once a teen qualifies as a co-occurring disorder patient, they need to be treated as such. Rather than receive separate treatments for each disorder, their treatment needs to be integrated. This means understanding their disorders holistically, making all the disorders a priority and solving the problem as a whole.

Certain clinics specialize in handling these complex cases. It may take months or even years to help them get their situation under control. The sooner they get started, the easier it will be.

Does My Child Need Treatment?

If you notice signs that your teen may have a substance abuse problem, now is the time to act. Get in touch with a professional such as your teen’s school guidance counselor, who can help you sort through the confusion of the situation and figure out what is happening with your child. If they agree that signs of addiction are present, they will probably direct you to your family doctor or to a treatment center for rehab. Especially when a co-occurring disorder is at play, specialized treatment is crucial.

We at are available to speak with you about your family’s problem, free of charge. Our compassionate addiction specialists have years of experience in helping parents like you. We understand your distress at the thought that your child may be suffering from addiction, and we can help point you towards the path of recovery for your child. Whether you need help finding the right treatment center for your teenager, or simply have some questions about addiction, we are here for you. Don’t let this issue continue any longer — you can start by calling us.


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