Substance Use and Co-Occurring Mental Disorders

When someone has a SUD and another mental health disorder, it is usually better to treat them at the same time rather than separately. People who need help for a SUD and other mental disorders should see a health care provider for each disorder. It can be challenging to make an accurate diagnosis because some symptoms are the same for both disorders, so the provider should use comprehensive assessment tools to reduce the chance of a missed diagnosis and provide the right treatment.

It also is essential that the provider tailor treatment, which may include behavioral therapies and medications, to an individual’s specific combination of disorders and symptoms. It should also take into account the person’s age, the misused substance, and the specific mental disorder(s). Talk to your health care provider to determine what treatment may be best for you and give the treatment time to work.

Behavioral therapies

Research has found several behavioral therapies that have promise for treating individuals with co-occurring substance use and mental disorders. Health care providers may recommend behavioral therapies alone or in combination with medications.

Some examples of effective behavioral therapies for adults with SUDs and different co-occurring mental disorders include:

• Cognitive behavioral therapy (CBT) is a type of talk therapy aimed at helping people learn how to cope with difficult situations by challenging irrational thoughts and changing behaviors.
• Dialectical behavior therapy (DBT) uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help control intense emotions, reduce self-destructive behaviors (such as suicide attempts, thoughts, or urges; self-harm; and drug use), and improve relationships.
• Assertive community treatment (ACT) is a form of community-based mental health care that emphasizes outreach to the community and an individualized treatment approach.
• Therapeutic communities (TC)  are a common form of long-term residential treatment that focuses on helping people develop new and healthier values, attitudes, and behaviors.
• Contingency management (CM) principles encourage healthy behaviors by offering vouchers or rewards for desired behaviors.

Behavioral therapies for children and adolescents

Some effective behavioral treatments for children and adolescents include:

• Brief strategic family therapy (BSFT) therapy targets family interactions thought to maintain or worsen adolescent SUDs and other co-occurring problem behaviors.
• Multidimensional family therapy (MDFT) works with the whole family to simultaneously address multiple and interacting adolescent problem behaviors, such as substance use, mental disorders, school problems, delinquency, and others.
• Multisystemic therapy (MST) targets key factors associated with serious antisocial behavior in children and adolescents with SUDs.

Medications

There are effective medications that treat opioid , alcohol , and nicotine addiction  and lessen the symptoms of many other mental disorders. Some medications may be useful in treating multiple disorders. For more information on behavioral treatments and medications for SUDs, visit NIDA’s Drug Facts  and Treatment  webpages. For more information about treatment for mental disorders, visit NIMH's Health Topics webpages.

To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), visit the SAMHSA online treatment locator , or text your ZIP code to 435748.

For additional resources about finding help, visit:

NIMH's Help for Mental Illnesses page

National Cancer Institute’s Smokefree.gov  website, or call their smoking quitline at 1-877-44U-QUIT (1-877-448-7848)

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage: Information about participating in clinical trials related to mental disorders
• Clinicaltrials.gov: Current studies on mental illness and substance misuse : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country

Brochures and other educational resources

• National Institute on Alcohol Abuse and Alcoholism (NIAAA) Publications Order Form 
• NIDA: Parents and Educators 
• SAMHSA Publications and Digital Products 
• MedlinePlus:
  • Alcohol Use Disorder  (also en español )
  • Drug Use and Addiction  (also en español )
  • Mental Health and Behavior  (also en español )
  • Opioids and Opioid Use Disorder   (also en español )
  • Risks of tobacco  (also en español )

Multimedia

• NIH Experts Discuss the Intersection of Suicide and Substance Use: Learn about common risk factors, populations at elevated risk, suicides by drug overdose, treatments, prevention, and resources for finding help.

Research

• NIDA Co-Occurring Disorders and Health Conditions 
• NIDA Tobacco, Nicotine, and E-Cigarettes Research Report 
• SAMHSA National Survey on Drug Use and Health 
• NIMH Director’s Messages:
  • Suicide Deaths Are a Major Component of the Opioid Crisis that Must Be Addressed
  • NIMH and the NIH HEAL Initiative: Collaborating to address the opioid epidemic
• NIMH’s Role in the NIH HEAL Initiative

Last reviewed: March 2024