What Are the Most Common Co-occurring Disorders with Addiction?

When someone has a substance use disorder, it’s rarely the only problem. At least half of people with a substance use disorder also have another mental illness and many estimates are much higher, some as high as 80 percent. There are three possible reasons for this large overlap and none excludes the others. First, a mental health issue may lead to substance use, typically as a way of coping with the symptoms. Often, the mental health issue hasn’t been diagnosed, but someone learns through trial and error that drugs or alcohol relieves their symptoms. Second, substance use can lead to mental health issues. For example, excessive use of stimulants may lead to higher levels of anxiety or paranoia or even cause stimulant psychosis. Finally, both substance use and mental illness may share a common cause such as childhood abuse or genetic predisposition. Whatever the specific mechanism, here are some of the most common co-occurring mental health issues with addiction.

Anxiety Disorders

Anxiety disorders include a broad range of disorders, such as generalized anxiety disorder, obsessive-compulsive disorder, phobias, panic disorders, and social anxiety disorder. Because of the broad range of ways anxiety can get the better of you, anxiety disorders are among the most common mental health issues in the US. According to the Anxiety and Depression Association of America, about 18 percent of Americans have some kind of anxiety disorder and that number appears to be increasing. About 20 percent of people diagnosed with an anxiety disorder will also have some degree of substance use disorder; that’s about twice the rate of the general population. The number goes the other way too- about 20 percent of people with substance use disorders will also develop an anxiety disorder.

Substance use issues often develop from self-medicating the symptoms of an anxiety disorder. For example, a common path to alcohol use disorder is when someone with social anxiety disorder relies on alcohol to feel less anxious in social situations. Eventually, they need to drink to function normally and they fear going back to feeling socially anxious. Benzodiazepines such as Xanax are often prescribed for anxiety disorders. While they are effective when taken occasionally, they are extremely addictive when taken regularly. Quitting benzodiazepines may have severe side effects, including seizures and anxiety.


Technically, post-traumatic stress disorder, or PTSD, is an anxiety disorder, but it increases your addiction risk so much it deserves it’s own section. About half of people seeking treatment for substance use disorders meet the criteria for PTSD, which is about five times the rate of the general public. What’s more, people with PTSD tend to have worse substance treatment outcomes, experiencing more cravings and earlier relapses. This may require more intensive and prolonged treatment, and certainly requires a program that can specifically treat PTSD.

As with other anxiety disorders, people with PTSD often develop substance use issues self-medicating their symptoms. Symptoms of PTSD typically include flashbacks, nightmares, insomnia, irritability, depression, avoiding things associated with the trauma, inability to remember key features of the trauma, and being easily startled. Various substances, most commonly alcohol, may blunt some of these symptoms temporarily, but at a high long-term cost.


According to the CDC, more than eight percent of American adults experience depression in any given two-week period. That’s about 24 million people. Of people with recurrent major depression, more than 16 percent have an alcohol use disorder and 18 percent have another substance use disorder, and about a third of adults with a substance use disorder also suffer from depression. Symptoms of depression include loss of interest in things you used to enjoy, irritability, insomnia or sleeping too much, weight changes, physical aches, slow movements, trouble concentrating, low mood, and thoughts of suicide or death. Many of these symptoms overlap with symptoms of substance use disorders and it’s not always easy to tell them apart.

Depression is one of the most common mental health issues worldwide and many of the risk factors for depression are also risk factors for substance use. These include childhood abuse or neglect, domestic abuse, and genetic predisposition. As with anxiety disorders, substance use disorders often start as a way of self-medicating symptoms of depression.


Attention deficit/hyperactivity disorder, or ADHD, is another common disorder that significantly increases your risk of addiction. One study found that 15 percent of adults with ADHD have a substance use disorder. Depending on your baseline, that about two to three times the rate in the general population. The study found that only 30 percent used substances to get high, while 70 percent used substances to offset the effects of ADHD, either to improve their mood or sleep better.

People with ADHD, especially untreated ADHD, are often distracted by racing, disconnected thoughts and may use alcohol or other substances to slow things down a bit. Substance use issues often begin in adolescence. Teens with ADHD often feel ostracized in the classroom and may have low grades because they have difficulty paying attention. These are both risk factors for substance use, and they also may be more impulsive than their peers so they tend to think less about the consequences of their substance use. These problems often diminish as they get older, but people with undiagnosed ADHD may continue to have problems with racing thoughts, concentration, and insomnia. The good news is that the proper medication has been found to significantly decrease substance use. Teens with ADHD who are prescribed Ritalin or Adderall are about 50 percent less likely than their untreated peers to develop substance use issues.

Burning Tree provides programs specializing in long-term residential treatment for clients with a history of drug and alcohol relapse. Our long-term approach and extensive aftercare programs help clients break the cycle of relapse and transition to healthier, more fulfilling lives. Contact us for more information or visit the websites of our three locations: Renewal Lodge, which offers a 90-day treatment program, Burning Tree Ranch, which offers year-long treatment.


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