Co-Occurring Treatment: Steps for Success

Co-Occurring Treatment: Steps for Success

Many individuals struggle with mental health disorders and substance use disorders (SUD), also known as co-occurring disorders. In cases with two or more conditions, integrated care is recommended.

Having two or more disorders can entangle the diagnosis and treatment process. Integrating screening and treatment for mental and SUD improves the quality of care and health outcomes for those living with co-occurring conditions by treating the whole person.

First Things First: Insurance Verification

Before the treatment process begins, the providing treatment facility should confirm the method of payment that will be used. Will insurance cover the cost, or will the customer be paying out-of-pocket? What about a deductible or copayment? The questions are never-ending.

Understanding insurance policies can be infuriating and unclear, but it doesn't have to be. To help you learn the process, Crownview Co-Occurring Institute has created a summary of the most common terms associated with insurance plans, including:

  • Deductible: The cost the client has to cover for their health care insurance yearly before the insurance provider takes accountability for any additional payment.
  • Coinsurance: If the coinsurance is 10% and the doctor's visit costs $1,000, the client must pay $100.
  • Copayment: This entails the established cost required to pay for a covered health care exam, including surgery, an ER visit, or a check-up. Depending on the specific insurance plan, the copay could be due before or after the deductible is paid.
  • Out-of-Pocket Maximum: The maximum amount of money the client will have to pay yearly for covered services.
  • Policy Effective Date: The date that the insurance company will begin to help the client pay for the treatment services.
  • Open Enrollment Period: A set period that usually transpires in December.
  • Special Enrollment Periods: Occurs after a special event such as a birth, new job, marriage, or losing health coverage.

Consultation and Clinical Assessment

Once resources for payment are verified, a trained clinician will begin a consultation where a clinical assessment is conducted to determine the best program for the client.

Screening and assessment are essential to identifying and treating clients with co-occurring disorders in a suitable, effective, and personalized manner to their needs. The assessment process helps fulfill a critical requirement, as most individuals with co-occurring disorders receive either treatment for only one condition or no treatment at all.

The assessment process is a "multifactor, biopsychosocial approach," which determines the symptoms and diagnoses present and how to customize conclusions about treatment and follow-up care based on assessment outcomes. Most counselors can initiate the screening process. Understanding why, whom, and when to screen validated tools to employ are the keys to success.

Treatment centers like Crownview Co-Occurring Institute formulate individualized treatment programs tailored to each client. After the assessment is complete, the treatment center may work through phases as part of the treatment process.

A standard structure would provide steps to follow, for example:

  • Acclimation: build a highly-structured, considerate, and safe environment to permit the clients to adjust to treatment.
  • Resocialization: maintain the structure as the clients rediscover their social values, beliefs, and norms.
  • Developing life skills: the clients exhibit the ability to start re-enforcing life skills for independence.
  • Independence: the clients begin to employ the skills from the previous phases to show independence with a substantial decrease in staff structure.

Diagnosing and Providing Integrated Treatments for Co-Occurring Disorders

Integrated treatment coordinates mental and substance use interventions by connecting individuals to other providers who can provide individualized and personalized services to treat all aspects of mental health disorders and SUD.

A complete recovery is possible with integrated care and improved quality of life. Integrated treatment leads to better outcomes for individuals with co-occurring disorders, including:

  • Decreased or discontinued substance use
  • Progress in psychiatric symptoms and functioning
  • Increased chance for successful treatment and recovery for both disorders
  • Enhanced quality of life
  • Decreased hospitalization
  • Reduced medication interactions
  • Increased housing stability
  • Fewer arrests

Until recently, many believed it was more helpful to treat an individual's SUD separately from their mental health issues until recently. The best option involves offering integrated care that treats co-occurring problems together.

Treatment for co-occurring disorders focuses on helping the client in many aspects and includes:

  • Appropriate medication
  • Medical detox
  • Individual or group counseling
  • Learning coping skills
  • Treatment for mental health
  • 12-step support groups for recovery
  • Residential or outpatient treatment

The "No Wrong Door" Policy

The "no wrong door" policy states that individuals will have access to care wherever they enter treatment. Effective systems must ensure that those who need treatment will be identified, assessed, and treated.

"No wrong door" means that people presenting for treatment for a mental disorder should be regularly screened for substance use disorder. Likewise, all people receiving treatment for substance use disorders should be screened for mental disorders.

Searching for help with co-occurring disorders and actually finding effective co-occurring disorder treatment can be challenging. Let Crownview Co-Occurring Institute help you in your quest. Crownview Co-Occurring Institute in Oceanside, CA, offers personalized psychiatric treatment for different levels of mental health disorders and co-occurring disorders, where we conduct the necessary assessments to determine and ensure you get the treatment needed for a successful recovery. Our customized approach assures that each client receives the best quality care with successful outcomes. CCI provides treatment programs to meet the physical and emotional needs for recovery. We want to support you from crisis to independence in a healing environment with a devoted team of professionals ready to help you regain control of your life. Let CCI help you with a successful long-term recovery. Call (760) 493-2887 today to learn about our effective treatment programs.

What Are Co-Occurring Disorders?

It’s not uncommon for people to experience a mental health disorder along with substance abuse; psychologists call this a “co-occurring disorder.” Typically, the mental health disorder triggers substance abuse, especially if the first condition is undiagnosed and untreated. However, substance abuse can also cause mental health disorders.

For many people, only one disorder or the other is treated. Treating both disorders simultaneously is crucial for healing. To live a more healthy life, it’s essential to get a proper diagnosis so each condition can be appropriately treated.

What Are the Symptoms of Co-Occurring Disorders?

Symptoms of a mental health disorder tend to overlap with symptoms of substance abuse. In both cases, these symptoms can include:

  • Social isolation
  • Difficulty concentrating at work or school
  • Strained relationships
  • Agitation or prolonged sadness
  • Anxiety

Left untreated, the most severe signs of co-occurring disorders could include hospitalization, financial strain, homelessness, and other serious medical conditions.

What Are the Causes of Co-Occurring Disorders?

There is no official consensus among psychologists on what causes mental health disorders, but multiple factors can contribute to their development. Some people may have a higher risk due to their genetics or environment. The distressing symptoms of mental health disorders can cause an individual to self-medicate with drugs or alcohol, ultimately leading to addiction. However, it is also possible to develop mental health disorders due to prolonged abuse of substances.

How Common Are Co-Occurring Disorders?

People with mental health disorders are more likely to experience addiction than those with no diagnosis. According to the Substance Abuse and Mental Health Services Administration's (SAMHSA) 2018 National Survey on Drug Use and Health, approximately 9.2 million adults in the United States have a co-occurring disorder.

Common Signs of Co-Occurring Disorders

There are many combinations of co-occurring disorders, meaning each person will exhibit different signs when they are struggling. However, common signs of co-occurring disorders include:

  • Sudden changes in behavior
  • Social isolation
  • Loss of control over how much substances are used
  • Risky behavior (driving under the influence, unprotected sex, etc.)
  • Problems with concentration
  • Suicidal ideation

The Most Common Co-Occurring Disorders

Substance abuse can occur with several different mental health disorders. The following disorders are the most commonly associated with drug or alcohol abuse.


People with depression may find it difficult to experience joy or pleasure, even during activities they normally enjoy. Alcohol or drugs can help recreate those feelings, albeit temporarily. However, once the elation wears off, the person with depression may feel the need to use again – perhaps at a higher dose to make the good feelings stronger, resulting in a worsened crash later. This can lead to a vicious cycle of dependence.


Substance abuse can offer temporary relief to the stress and burdens associated with prolonged anxious thoughts or feelings. For example, someone suffering from an anxiety disorder may feel compelled to drink in social situations to function as their “best self.” In reality, the anxiety relief from alcohol is temporary and can worsen anxiety symptoms when it wears off. Anxiety will worsen over time as the dependence on alcohol increases, making one vulnerable to developing an addiction.

Bipolar Disorder

The imbalance of chemicals in the brain caused by bipolar disorder can cause extreme feelings of sadness or anger, otherwise known as “mania" or “hypomania.” Substance abuse can temporarily relieve these symptoms at the expense of making brain activity more irregular. According to DualDiagnosis' article “Co-Occurring Disorders: The Most Popular," bipolar disorder is associated with substance abuse more often than other mental health disorders.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) isn’t just a diagnosis for war veterans; anyone who has experienced something traumatic can develop this mental health disorder. This may include survivors of severe storms or accidents, sexual assault, domestic violence, or other forms of abuse. It’s not uncommon for people living with PTSD to turn to drugs or alcohol as a means of escaping memories or flashbacks of the traumatic event.

Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by extreme restlessness and mood swings, along with unpredictable behaviors and difficulties forming relationships or connecting to the surrounding environment. People with BPD (roughly 1.6% of Americans) may use drugs or alcohol to help them adapt to their surroundings. Because the relief is short, the substance abuse likely aggravates the already existing symptoms of BPD.

How Are Co-Occurring Disorders Treated?

Co-occurring disorders are best treated by a team of professionals who understand both mental health disorders and substance abuse. This may involve an integrated approach with more than one treatment option so that both conditions can be treated together. Integrated treatment may involve cognitive-behavioral therapy (CBT) that helps patients develop healthier thought patterns and coping mechanisms for their mental health struggles. Many therapies can also be used alongside medication for the best treatment outcomes. Depending on the severity of the substance abuse, treatment at an inpatient facility may be recommended.

At Crownview Co-Occurring Institute, we understand the struggle of dealing with mental health disorders and substance abuse. The hardest part can be admitting that you have a problem; the next hardest step is reaching out for help. If that's where you are, we commend you for taking this critical step. When you're ready, our facility offers various treatment options for both disorders: the underlying mental health disorder and substance abuse. Depending on your diagnosis, we may recommend cognitive-behavioral therapy (CBT), medication, inpatient treatment, or a combination of these options. Our knowledgeable, compassionate staff will work with you at your pace to provide the best care possible so that you can live a healthy and productive life. To learn more about our treatment options and how we can help you, reach out to Crownview Co-Occurring Institute today by calling (760) 477-4754.