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Summary: New data from the National Institutes of Health (NIH) show that over 18 million people had co-occurring mental health and addiction disorders in the U.S. in 2025.

Key Points:

  • Co-occurring disorders means when a person has a clinical diagnosis for a mental health disorder and a substance use disorder (SUD) – a.k.a. addiction – at the same time.
  • When a person has co-occurring mental health and addiction disorders, accurate diagnosis is essential.
  • After an accurate diagnosis, treating both types of disorder simultaneously – or in a deliberate, stepwise fashion determined by individual needs– leads to the best outcomes.
  • Treating one without treating the other can lead to unsuccessful outcomes for both and can exacerbate both.

When Mental Health and Addiction Disorders Co-Occur, Integrated Treatment Improves Outcomes

In the report “National Institute on Drug Abuse (NIDA): Common Comorbidities with Substance Use Disorders,” mental health and addiction experts identify three primary reasons many people with mental health disorder or substance use disorders develop or have co-occurring menta health and addiction disorders.

These reasons include, but are not limited to:

  1. The risk factors for mental health disorders and addiction often overlap.
  2. The symptoms of mental health disorders can increase risk of developing addiction.
  3. Misuse and disordered use of substances can increase risk of developing mental health disorders.

One of the most common reasons people with mental health disorders develop addiction disorders is the practice of self-medication. This occurs when a person uses alcohol or substances to manage, decrease, or reduce the negative, disruptive, painful/uncomfortable/overwhelming thoughts and emotions associated with mental health disorders.

However, self-medication is an ineffective long-term strategy, and can make mental health disorders worse, i.e. exacerbate symptoms and associated disruption.

In addition, experts indicate the use of substances can trigger the onset of mental health disorders, including psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, obsessive-compulsive disorders.

The mental health disorders that most commonly co-occur with mental health disorders include:

Mental disorders that commonly co-occur with substance use disorders include

  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Bipolar disorder
  • Disorders with psychosis
  • Borderline personality disorder
  • Antisocial personality disorder
  • Schizophrenia and schizophreniform disorder

The consequences of untreated co-occurring disorders include:

  • Problems in peer, family, social, and partner relationships
  • Impairment in vocational ability and achievement
  • Impairment in academic achievement
  • Decreased cognitive performance in executive functioning, attention, memory, decision-making
  • Increased risk of non-suicidal self-injury (NSSI)
  • Increased risk of suicidality: thinking about, talking about, planning, and/or attempting suicide.

Those are the basic facts about co-occurring mental health and addiction disorders. It’s clear they develop for reasons we can all understand: in most cases, to protect oneself from painful, unwanted thoughts, and emotions, with genetics, family history, and personal circumstances all contributing factors.

Now let’s look at the latest data from the NIH and learn how many people had co-occurring mental health and addiction disorders in the U.S. in 2025.

The Prevalence of Co-Occurring Mental Health and Addiction Disorders

In the U.S., one of our most important resources for mental health and addiction information is the National Survey on Drug Use and Health (NSDUH). It’s an annual survey that includes data from over 70,000 people in the U.S. That’s a sample size large enough to make population-level generalizations and conclusions about the current state of drug use and mental health in the U.S. It’s a powerful tool for policymakers, providers, and community members, which allows them to best understand who needs what kind of support, and allocate resources accordingly.

Let’s review their latest report, the 2025 National Survey on Drug Use and Health (2025 NSDUH), and learn the facts and figures about co-occurring mental health and addiction disorders in the U.S. in 2025.

We’ll start with the big picture: co-occurring addiction (SUD) and any mental illness (AMI).

SUD and AMI: By Age Group

SUD or AMI:

  • 18+: 78.8 million
  • 18-25: 14.8 million: 41.2%, highest.
  • 26-49: 39.4 million
  • 50+: 24.5 million

Only SUD:

  • 18+: 24.2 million
  • 18-25: 4.5 million: 12.6%, highest
  • 26-49: 10.9 million
  • 50+: 8.7 million

AMI only:

  • 18+: 36.1 million
  • 18-25: 6.3 million: 17.5%, highest
  • 26-49: 17.9 million
  • 50+: 11.8 million

Co-Occurring SUD and AMI:

  • 18+: 18.4 million
  • 18-25: 4.0 million: 11.1%, highest.
  • 26-49: 10.5 million
  • 50+: 3.9 million

These data indicate that tens of millions of people in the U.S. have co-occurring mental health disorders and addiction, with more people reporting mental illness than addiction. The highest rates of both mental health disorders and addiction appear among people ages 18-25. Keep in mind that rates refer to percentage within the specified group, rather than raw numeric totals.

Trends show that over the past five years, these rates – also across all age groups – have remained relatively stable, i.e. without a statistically significant increase or decrease since 2021.

Next, the data on co-occurring addiction (SUD) and serious mental illness (SMI).

SUD and SMI: By Age Group

SUD or SMI:

  • 18+: 53.1 million
  • 18-25: 10.9 million: 30.5%, highest
  • 26-49: 26.9 million
  • 50+: 15.1 million

Only SUD:

  • 18+: 34.8 million
  • 18-25: 6.6 million: 18.4%, highest
  • 26-49: 16.8 million
  • 50+: 11.4 million

SMI only:

  • 18+: 10.3 million
  • 18-25: 2.4 million: 6.7%, highest
  • 26-49: 5.5 million
  • 50+: 2.4 million

Co-Occurring SUD and SMI:

  • 18+: 7.8 million
  • 18-25: 1.9 million: 5.4%, highest
  • 26-49: 4.6 million
  • 50+: 1.2 million

These data indicate that millions of people in the U.S. have co-occurring serious mental illness and addiction. However, in contrast to the data and SUD and AMI, more people reported SUD than reported serious mental illness (SMI). This raises questions about the relative levels of stigma attached to addiction and mental illness:

Does the data reflect actual numbers, or indicate that there’s less stigma attached to moderate mental illness than addiction, but more stigma attached to serious mental illness than addiction? We don’t have an answer, but rather, report that to reflect that the presence of stigma is difficult to predict and is determined by a variety of factors.

Like the data on SUD and AMI, the highest rates for co-occurring serious mental illness and addiction appeared among people age 18-25 across all age groups.

Next, we’ll share the data on treatment for co-occurring mental health and addiction disorders.

Treatment for Co-Occurring Mental Health and Addiction Disorders in 2025

Given the significant disruption, functional impairment, and disability associated with co-occurring mental health and addiction disorders, it’s important for people with co-occurring mental health and addiction disorders to understand this fact:

Treatment for co-occurring mental illness and addiction works. The best approach is the integrated care model, which addresses mental health and addiction problems simultaneously.

Let’s take a look at the prevalence data, also from the 2025 NSDUH.

Co-Occurring SUD and AMI: Treatment Facts and Figures, By Age Group

  • 18+:
    • No treatment: 42.6%
    • SUD or MH treatment: 57.4%
    • SUD treatment only: 2.8%
    • MH treatment only: 41.8%
    • Both SUD and MH treatment: 12.7%
  • 18-25:
    • No treatment: 43.9%
    • SUD or MH treatment: 56.1%
    • SUD treatment only: 1.6%
    • MH treatment only: 44.6%
    • Both SUD and MH treatment: 9.9%
  • 26-49:
    • No treatment: 41.5%
    • SUD or MH treatment: 58.5%
    • SUD treatment only: 3.4%
    • MH treatment only: 41.9%
    • Both SUD and MH treatment: 13.2%
  • 50+:
    • No treatment: 44.3%
    • SUD or MH treatment: 55.7%
    • SUD treatment only: 2.5%
    • MH treatment only: 39.0%
    • Both SUD and MH treatment: 14.2%

In these two datasets, the numbers begin to shift. We can see similar rates for 4/5 metrics, but the oldest the age group – 50+a – showed the highest the rates of treatment for both SUD and mental health.

Co-Occurring SUD and SMI: Treatment Facts and Figures, By Age Group

  • 18+:
    • No treatment: 28.7%
    • SUD or MH treatment: 71.3%
    • SUD treatment only: 3.0%
    • MH treatment only: 51.9%
    • Both SUD and MH treatment: 16.4%
  • 18-25:
    • No treatment: 34.5%
    • SUD or MH treatment: 65.5%
    • SUD treatment only: 1.7%
    • MH treatment only: 51.5%
    • Both SUD and MH treatment: 12.3%
  • 26-49:
    • No treatment: 26.2%
    • SUD or MH treatment: 73.8%
    • SUD treatment only: 3.9%
    • MH treatment only: 52.6%
    • Both SUD and MH treatment: 17.3
  • 50+:

[incomplete data/final estimates unavailable]

In this last dataset, we see that trend continue. Similar rates for 4/5 metrics, but the oldest age group showed he highest rate of treatment for both SUD and mental illness. Unfortunately, data were insufficient for estimates for people over age 50 for co-occurring SUD and serious mental illness.

We’ll close this article with a brief discussion of effective, evidence-based treatment for co-occurring disorders.

Integrated Treatment, Whole Person, Patient-Centered Approach

The most effective treatment for co-occurring mental health and addiction disorders is integrated, holistic, and addresses all aspect of mental health and addiction that prevent a patient from living the life they want to lead. Treatment involves a combination of individual psychotherapy, medication if needed, individual and group counseling, which may include family therapy, peer support, lifestyle changes, and complementary/supporting therapies

The most common psychotherapeutic approaches for the integrated treatment for co-occurring disorders in particular:

  • Cognitive-Behavioral Therapy (CBT)
  • Dialectical Behavior Therapy (DBT)
  • Acceptance and Commitment Therapy (ACT)
  • Motivational Interviewing (MI)
  • Mindfulness-Based Cognitive Therapy (MBCT)
  • Trauma-informed Therapy: CBT, DBT, ACT, MI, and MBCBT

All of those approaches may occur one-on-one, in specialized invite-only groups, in family therapy, and in general process groups.

Medications for co-occurring disorders may include:

  • Antidepressants
  • Anxiolytics
  • Antipsychotics
  • New and emerging medications such as ketamine and Spravato

Lifestyle changes may include:

  • Healthy eating
  • Exercise and activity
  • Sleep hygiene
  • Stress management/self-care

Complementary supports may include:

  • Mindfulness
  • Meditation
  • Acupuncture
  • Yoga
  • Education
  • Expressive therapies – art, writing, music
  • Outdoor, experiential therapies

To learn more about integrated treatment for co-occurring disorders, please read the following article on our blog:

What Type of Mental Health Therapy Helps People With Co-Occurring Disorders?

Here’s the message we want anyone reading this article to take away:

Treatment for co-occurring mental health and addiction disorders works. The sooner a person diagnosed with co-occurring disorders gets the treatment they need, the better the outcome.

Finding Help: Resources

If you or someone you know needs professional treatment for co-occurring mental health and addiction disorders, please contact us here at Crownview Co-Occurring Institute. We can help. In addition, you can find support through the following online resources: