What are concurrent disorders?

Concurrent Substance Use and Mental Health Disorders: An Information Guide

A person with a mental health problem has a higher risk of having a substance use problem, just as a person with a substance use problem has an increased chance of having a mental health problem. People who have combined, or concurrent, substance use and mental health problems are said to have concurrent disorders.

Concurrent disorders can include combinations such as:

• an anxiety disorder and a drinking problem
• schizophrenia and cannabis dependence
• borderline personality disorder and heroin dependence
• depression and dependence on sleeping pills.

Many other concurrent disorders are possible, because there are many types of mental health and substance use problems. A note about language In this information guide, we use the phrases “substance use problem” or “mental health problem” to describe the broad range of situations, from mild to severe, that a person with concurrent disorders may experience. We use the phrases “substance use disorder” or “mental health disorder” only where the text refers to a specific diagnosis.

Concurrent disorders are also sometimes called:

• dual disorders
• dual diagnosis
• co-occurring substance use and mental health problems.

In Ontario, the term dual diagnosis is used when a person has an intellectual disability and a mental health problem.

How common are concurrent disorders?

A large American study¹ found the following rates:

• 30 per cent of people diagnosed with a mental health disorder will also have a substance use disorder at some time in their lives. This is close to twice the rate found in people who do not have a lifetime history of a mental health disorder.
• 37 per cent of people diagnosed with an alcohol disorder will have a mental health disorder at some point in their lives. This is close to twice the rate found in people who do not have a lifetime history of a substance use disorder.
• 53 per cent of people diagnosed with a substance use disorder (other than alcohol) will also have a mental health disorder at some point in their lives. This is close to four times the rate found in people who do not have a lifetime history of a substance use disorder.

The most common combinations are:

• substance use disorders + anxiety disorders
• substance use disorders + mood disorders.

Anxiety disorders

• In general, 10 to 25 per cent of all people will have an anxiety disorder in their lifetime.
• Among people who have had an anxiety disorder in their lifetime, 24 per cent will have a substance use disorder in their lifetime.

Major depression

• In general, 15 to 20 per cent of all people will have major depression in their lifetime.
• Among people who have had major depression in their lifetime, 27 per cent will have a substance use disorder in their lifetime.

Bipolar disorder

• In general, one to two per cent of all people will have bipolar disorder in their lifetime.
• Among people who have had bipolar disorder in their lifetime, 56 per cent will have a substance use disorder in their lifetime.

Schizophrenia

• In general, one per cent of all people will have schizophrenia in their lifetime.
• Among people who have had schizophrenia in their lifetime, 47 per cent will have a substance use disorder in their lifetime.

When do concurrent disorders begin?

Mental health and substance use problems can begin at any time: from childhood to old age. When problems begin early and are severe, recovery will probably take longer, and the person will need to work harder and have more support. On the other hand, if the problem is caught and treated early, the person has a better chance of a quicker and fuller recovery.

People often ask, “Which came first: the mental health problem or the substance use problem?” This is a hard question to answer. Often it is more useful to think of them as independent problems that interact with each other.

Notes:

1. Reiger, D.A., Farmer, M.E. & Rae, D.S. (1990). Co-morbidity of mental disorders with alcohol and other drug abuse, Results from the Epidemiological Catchment Area (ECA) study. Journal of the American Medical Association, 264, 2511–2518.

 

 

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