1.2 How common are concurrent disorders?

A Family Guide to Concurrent Disorders - Part I: What are concurrent disorders?

On this page:

• Understanding the terminology
• Mental disorders

Having either a substance use or a mental health problem significantly increases the likelihood of having the other. The results of the Epidemiologic Catchment Area Study (Regier et al., 1990) indicate that a person who has a mental health disorder is almost three times more likely to have a substance use disorder at some time in his or her life than is a person who does not have a mental health disorder. A person who has a substance (other than alcohol) use disorder is about 4.5 times more likely to have a mental health disorder at some point in his or her life than a person who does not have a substance use disorder.

The prevalence of combinations of substance use and mental health disorders varies depending on the disorder:

• Among people who have had an anxiety disorder in their lifetime, 24 per cent will have a substance use disorder 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.
• Among people who have had bipolar disorder in their lifetime, 56 per cent will have a substance use disorder in their lifetime. This is more than three times the average rate.
• Among people who have had schizophrenia in their lifetime, 47 per cent will have a substance use disorder in their lifetime. This is nearly three times the average rate.

People who work in substance use agencies should assume that someone who comes for help with a substance use problem might also have a mental health problem, until they have information that indicates that this is not the case. Similarly, mental health workers should assume that clients might also have a substance use problem, until they have information that rules out this possibility.

Understanding the terminology

People often have substance use and mental health problems that have a significant impact on their daily lives, but are not severe enough or do not last long enough to meet the criteria for a diagnosis of any disorder. So, we will usually use the broader term “mental health and substance use problems,” unless we are talking about a specific DSM IV-based (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) diagnosis of a disorder.

These are terms you will probably hear used in some parts of the substance use and mental health systems.

Mental disorders

Mental disorders (including substance use disorders) are health conditions that are characterized by changes in thinking, mood or behaviour (or some combination of the three) associated with distress and/or impaired functioning (American Psychiatric Association, 1994).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used in North America to diagnose mental health disorders. The fourth and most recent edition, the DSM-IV, organizes mental disorders into 16 major diagnostic classes—for example, mood disorders and substance-related disorders. Within these diagnostic classes, disorders are further broken down—for example, depressive disorders and bipolar disorders are included in the mood disorders class. For each disorder, the DSM-IV lists specific criteria for making a diagnosis.

While we will use the terms co-occurring problems and concurrent disorders in this manual, there are other terms that you may have heard:

• Dual diagnosis is often used in the United States. It implies that a person has just two problems. However, evidence suggests that there may well be more. In Ontario, this term is used to refer to people with serious developmental delay and severe, persistent mental illness.
• Co-occurring disorders (COD) is another way of describing a situation where someone has one or more mental health disorders and one or more substance use disorders.

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