This is a heavier article than most of our self-help and life coaching topics. However, we thought it was well done (Provided by Ryan Neace of The Change Group, Lynchburg, VA).


Geoff has been drinking and drugging since high school.  As a matter of fact, he stays up most nights these days “partying”, or at least that’s what he calls it.  He drinks at the bar till about 1 or 2 in the morning, then comes home and smokes marijuana until he falls asleep.  He dabbles in prescription drugs as well.  By his own estimation, Geoff has been depressed most of his life.  He never really recovered from all of the turmoil he experienced with his father growing up, and the older he got, the more regular “the blues” became.  In some senses, partying is a welcome relief to the depression he’s been experiencing.

Karen was always a “worry wort” as a kid – everyone could see it.  She was anxious, backwards, and socially akward.  But when she hit puberty, boys started noticing her and other girls seemed to accept her more.  She started going to parties and hanging out with the “in” crowd, but she never really felt like she fit in.  By high school, Karen felt more anxious than ever because of the radical change in her social life, and started drinking at parties to relax and have fun.  Now in college, both the anxiety and the drinking have clearly become problematic.  Her anxiety increases with each new social situation she encounters, and her drinking isn’t helping like it used to because of her increased tolerance.


A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a co-occurring disorder.  In order for full recovery to take place, treatment is required for both issues.

Although co-occurring disorders have only been recognized in recent years, they are pervasive.  It is estimated that 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.  Conversely, it is estimated that 29 percent of all people diagnosed as mentally ill abuse either alcohol or drugs.

People with mental illness are 3 to 6 times more likely to abuse substances than those without. However, some mental illnesses co-occur with substance abuse more frequently than others:

  • depressive disorders, such as depression and bipolar disorder;
  • anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and other phobias; and
  • other psychiatric disorders, such as schizophrenia and personality disorders.

It is often difficult to know whether the mental illness or substance abuse problem occurred first. Someone with a psychiatric problem may drink or use drugs in an attempt to feel calmer, more peppy,  or more cheerful.  Doctors call this “self-medication.”  Frequent self-medication may lead a person to become physically or psychologically dependent on alcohol or drugs. On the other hand, a person whose substance abuse problem has become severe may develop symptoms of a psychiatric disorder, including depression, rage, hallucinations, delusions or attempts at suicide.


If you are suffering from co-occurring disorders, here are a few thoughts:

  • Make sure you immediately seek the help of a licensed professional.
  • Make sure treatment addresses both the substance abuse problem and the mental health problem.
  • Share in the decision-making process and are actively involved in setting goals and developing strategies for change.
  • Make sure your treatment includes basic education about each disorder and related problems.
  • Endeavor to learn healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships.
  • Follow doctor’s orders. Once you are sober and you feel better, you might think you no longer need medication or treatment. But arbitrarily stopping medication or treatment is a common reason for relapse in people with co-occurring disorders. Always talk with your doctor before making any changes to your medication or treatment routine.

If someone you know or love is suffering from co-occurring disorders, here are some thoughts for you:

  • Seek support. Dealing with a loved one’s mental illness and substance abuse problem can be painful and isolating. Make sure you’re getting the emotional support you need to cope. Talk to someone you trust about what you’re going through. It can also help to get your own therapy or join a support group.
  • Set boundaries. Be realistic about the amount of care you’re able to provide without feeling overwhelmed and resentful. Set limits on disruptive behaviors, and stick to them. Letting the substance abuse problem or mental illness take over your life isn’t healthy for you or your loved one.
  • Educate yourself. Learn all you can about your loved one’s mental health problem, as well as substance abuse treatment and recovery. The more you understand what your loved one is going through, the better able you’ll be to support recovery.
  • Be patient. Recovering from addiction and mental health problems doesn’t happen overnight. Recovery is an ongoing process that can take months or years, and relapse is common. Ongoing support for both you and your loved one is crucial as you work toward recovery.

Author: Ryan Neace, Therapist with Lynchburg Counseling Center, The Change Group.