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Co-Occurring Disorders


Co-occurring disorders (previously called dual disorder or dual diagnosis) describe the existence of two or more than two disorders at the very same point in time. An example is when someone suffers from drug abuse and bipolar disorder.

While the scope of treatment for drug dependency and mental conditions has emerged to be rather specific, the same thing goes as well for the terms used to refer to individuals who both have problems with drug dependency and mental conditions.


Dual disorder and dual diagnosis terms are replaced by the term co-occurring disorders. These latter terms, though used commonly to point to the mixture of substance abuse and mental disorders, are confusing in that they also point to other mixtures of disorders (like mental retardation and mental disorders).

Besides, these terms imply that only two disorders occur at the very same time when in reality there can be more than two disorders. People who suffer from co-occurring disorders (COD) have one or more disorders that have to do with mental disorders and one or more disorders that have to do with the use of drugs and/or alcohol. An identification of co-existing condition is made when there is an existence of at least one disorder of each type which is also separate from the other, not just a series of indications stemming from a particular disorder.

Even though the term co-occurring disorder is the most up to date term that is used by professionals, the term dual disorders will be used interchangeably for the objectives of this article.


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For people that suffer from COD, another term is commonly used and it is MICA, which means Mentally Ill Chemical Abusers in cases where patients suffer from an extreme and constant mental disorder like bipolar disorder or schizophrenia. Mentally ill chemically affected people is the phrase that is preferred because the word affected is not pejorative and it designates their condition in a better way. Some of the other acronyms are: CAMI (chemical abuse and mental illness), MISU (mentally ill substance using), MISA (mentally ill substance abusers), SAMI (substance abuse and mental illness), ICO PSD (individuals with co-occurring psychiatric and substance disorders) and MIC'D (mentally ill chemically dependent).

Some typical examples of co-occurring disorders are the combinations of cocaine addiction with major depression, occasional polydrug abuse with borderline personality disorder, panic disorder with alcohol addiction and polydrug addiction and alcoholism with schizophrenia. Some patients have more than two disorders even if the focus of this is on dual disorders. The concept that applies to dual disorders normally applies also to multiple disorders.

Extremity, chronicity, disability and the level of impairment in functioning are some differing extents in which combinations of COD issues and mental disorders vary. As an example, both disorders can be mild or serious or one disorder can be more serious than the other disorder. How severe the disorders are also varies with time and is not constant. Other factors that may also vary include the level or degree of disability or impairment in day to day functions.

Thus, there is no single mixture of dual disorders; in fact, there is huge variability among them. Specific treatment environments are, however, set up for patients that have alike combinations of dual disorders.


Further damage is inflicted in more than 50 % of all adults that have severe mental disorder as well as substance abuse disorders (abuse or addiction to alcohol or illicit drugs).


Patients with dual disorders go through much more emotional, social and chronic medical problems in comparison to patients who only have a mental health disorder or a co-occurring disorder caused by substance abuse or dependence only. They are vulnerable to both COD relapse and a worsening of the psychiatric disorder because they have two disorders. Further, worsening of psychiatric problems often leads to addiction relapse and addiction relapse often leads to psychiatric decompensation. Thus, for patients with dual disorders relapse prevention must be specially designed. Unlike patients who only have one disorder, those with dual disorders would mostly need prolonged treatment, have more difficulties and have slow progress in treatment.

Psychiatric disorders most prevalent among dually diagnosed patients include personality disorders, mood disorders, psychotic disorders, and anxiety disorders.