Metamorphosis Centre for Change
Concurrent substance use and mental health disorders means a person is living with both at the same time. The two conditions can start in either order, influence each other, and change in severity over time. Treatment works best when both are addressed together through one coordinated plan. This guide explains common signs, causes, risks, and treatment approaches, and it outlines how to ask for help for yourself or someone you love.
What the Term Means
Concurrent disorder is the term used for co-occurring substance use and mental health problems. You may also see the terms dual disorder, dual diagnosis, or co-occurring disorders. In Ontario, dual diagnosis is sometimes used to describe a person who has both an intellectual or learning disability and a mental health problem, so it is worth asking a provider what a term means in their setting.
The combinations are wide. Someone may have an eating disorder and an alcohol problem, schizophrenia and cannabis use, borderline personality disorder and nicotine dependence, or depression with opioid use. There is no single profile that fits everyone.
Some people describe a sense that substances quieted a problem they could not name for years, and only later learned what was underneath. Others describe the reverse, with symptoms that developed gradually during heavy use. Both experiences are real, and both deserve careful attention.
Many people ask whether the mental health problem or the substance use started first. That question is often hard to answer. Some people use substances to cope with symptoms of anxiety, depression, or trauma. Others develop mental health symptoms after a long period of substance use. In some cases both are present at once, and each may have been active at different points in life.
It helps to think of them as separate problems that interact. Treating them as linked, rather than trying to decide which one caused the other, is usually more useful for planning care.
Signs can also change over time. A person who was managing well may have a sudden shift after a loss, a stressful event, or a change in medication. Keeping a simple record of substance use, mood, and sleep can help a clinician see patterns that are easy to miss in a single appointment.
Common Signs and Combinations
Concurrent disorders are often grouped into a few broad patterns:
- Substance use together with a mood or anxiety disorder, such as bipolar disorder or obsessive-compulsive disorder.
- Substance use together with a severe and persistent mental illness, such as schizophrenia.
- Substance use together with a personality disorder.
- Substance use together with an eating disorder, such as anorexia nervosa or binge-eating disorder.
- Substance use together with other behaviours or conditions, such as problem gambling or compulsive sexual behaviour.
Signs that a substance use problem may be present include using more than intended, repeated failed attempts to cut back, cravings, withdrawal symptoms when stopping, and continuing to use despite harm. Signs of a mental health problem may include persistent low mood, worry that interferes with daily life, changes in sleep or appetite, or hearing or seeing things others do not. Because the severity of each problem shapes treatment, a clinician needs to assess both.
Living with concurrent disorders can increase the risk of other problems. People may face relapse, hospital stays, involvement with the justice system, homelessness, social isolation, financial strain, and declining physical health. These risks are a reason to reach out early rather than waiting for a crisis. Reaching out early can give people more options and more time to plan.
How Each Problem Affects the Other
A substance use problem and a mental health problem can affect each other in several ways:
- Substance use can hide or mimic mental health symptoms.
- Substance use can make mental health symptoms worse.
- Some people use substances to relieve symptoms, at least for a short time.
- Substance use can reduce the effectiveness of prescribed medication or lead to missed doses.
- A relapse in one area can trigger symptoms in the other.
- Both problems can strain relationships, housing, income, and physical health.
Some symptoms that appear during substance use improve with time and abstinence, while others persist. That is one reason a clinician should reassess mental health once a person has been stable for a while, rather than assuming every symptom came from the substance.
Treatment That Addresses Both
Integrated treatment means that substance use and mental health are addressed together, by a team that talks to each other. A typical plan may include a thorough assessment, individual and group therapy such as cognitive behavioural therapy (CBT) or dialectical behavioural therapy (DBT), family involvement where it is helpful, and medication when a physician decides it is appropriate. Plans also address practical needs such as housing, income, and relationships, because those affect recovery directly.
Some people need to stabilize one problem before the other can be addressed in depth. For example, a person in the early stage of withdrawal may need medical care before they can take part in therapy. The order of care is a clinical decision, and it should be explained clearly. If depression is part of the picture, you can learn more about our depression treatment approach, and if alcohol is involved, see our information on alcohol addiction.
Progress is easier to sustain when a person has a consistent, trusting relationship with one lead clinician, such as a therapist or case manager, who keeps track of the whole plan. When care happens in several places, the team can coordinate by sharing progress and updating the plan together. Ongoing support in areas like employment, housing, and relationships helps people keep their gains and lowers the risk of relapse.
Frequently Asked Questions
Does the mental health problem always come first?
No. The sequence differs from person to person. Some people have a mental health problem before any substance use, some develop it later, and some experience both at the same time. A careful history helps a clinician understand the pattern in each case.
Will symptoms disappear once substance use stops?
Not always. Some symptoms improve as the body recovers, but others remain and need their own treatment. Stopping substance use often makes underlying symptoms easier to see, which is one reason a reassessment after stabilization matters.
Can a person get treatment without a formal diagnosis of both?
Yes. Many people start care because they are struggling with one problem and later discover the other. A good program looks at the whole person, not only the label on a form.
What happens during an assessment?
An assessment usually includes a conversation about substance use, mental health history, family history, sleep, housing, and daily functioning. Clinicians may also ask about trauma and about any medications a person is taking. The goal is to understand each problem and how they interact, so the plan is built around the person rather than around a single diagnosis.
Get Support
If you are not sure whether your symptoms and substance use are connected, you do not need to answer that question before you reach out. Call 705-429-3870 or contact us online. Our team can explain our programs and help you decide what kind of support fits your situation.
Written by Dr. Leonard Bienenstock, Medical Director and Addictions Doctor, M.D., CCFP
Dr. Bienenstock completed medical school at McGill University and his family medicine residency at Toronto Western Hospital. He has further training in addictions medicine and psychotherapy and serves as Medical Director at Metamorphosis Centre for Change.