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What Is Common Comorbidity in Substance Abuse?

Comorbidity is co-occurring conditions that can be common in individuals with a substance use disorder.

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What Is Substance Abuse?

Substance abuse is when a person misuses and becomes dependent on drugs or alcohol. A person undergoing the effects of this disorder may face issues in their everyday lives physically, socially, and mentally.

What Causes Substance Abuse?

Substance abuse is often caused by a combination of factors such as genetics, mood disorders, and the environment. Within those broad strokes are several nuances that lead to dependency.1 For example, the child of a parent who has a substance use disorder has a higher chance of developing the dependency themselves.2 This occurs due to either a genetic predisposition to addiction or viewing substance abuse as a common practice after watching their parents partake in it for years. This is just one example of how dependency can take root.

Commonly Abused Substances

Commonly abused substances that lead to mental health and substance abuse followed by a comorbid disorder include:

There are dozens upon dozens of drugs and substances within each of these bullet points. Prescription drug addiction, for example, includes Xanax, Klonopin, and more.

Another prominent factor in substance abuse is comorbidity. Comorbid substance abuse occurs when two or more dependencies are present. For example, a person can be dependent on multiple drugs such as alcohol and opiates or any combination. Comorbidity can also mean having an underlying condition such as depression while harboring a dependency on alcohol. Thus, any combination of illness and dependency is comorbid substance abuse.

Comorbid conditions may complicate the treatment plan due to the variations of care needed for both disorders. Plus, comorbid conditions can increase the co-occurring issues.

How Common Is Comorbidity?

Comorbid substance abuse occurs in approximately half of all dependencies. Unfortunately, few people receive treatments for both illnesses, and without dual treatment, the chance for reoccurring addiction increases. As mentioned above, co-occurring disorders can be a mix of two conditions, and they could be caused by varying factors. For example, a dependency on alcohol that develops from depression to try to help with a negative mental state. Comparatively, someone that undergoes treatment for depression but not alcoholism risks developing worsened depression due to alcohol consumption. As such, the cycle continues.

Substance Use Disorders and Mental Illnesses

Mental illness is a leading cause of comorbid substance abuse. In modern times, mental health and substance abuse are widely discussed concepts. Moreover, treating them and their comorbid symptoms is slowly becoming easier. Historically, mental illness was treated with a certain level of shame that prevented many from seeking treatment. Thankfully, that is not as common, and individuals are able to seek help for mental health and substance use disorders openly.

Why Do These Disorders Often Co-Occur?

As previously stated, the cycle of recurring disorders begins and continues due to a lack of dual treatment. Much of the work towards making the journey to rehab easier is removing social stigmas and myths surrounding both mental illness and substance dependency. Comorbid disorders are nothing to be ashamed of; however, the fear of how they may be viewed keeps many people out of rehab. Help and treatment are vital during the road to recovery.

Common Risk Factors

Here’s the breakdown for each of the most common factors in developing mental health and substance abuse issues that lead to comorbidity.

Genetic Vulnerabilities

Genetic vulnerabilities to both addiction and mental illness create co-occurring disorders in a large percentage of the population. As one can’t change their genetics, sometimes the risk of dual disorders is heightened.

Epigenetic Influences

Epigenetic refers to how one’s genetics reflect environmental and habitual changes. Unlike genetics, epigenetics can be changed over time—substance abuse comorbidity is one example.

Environmental and Cultural Influences

Environmental or cultural influences impact how a person views their relationship to a substance. If a person is from a drinking culture such as binging alcohol on sports days, then they will view large consumption of alcohol as normal. Another example is when a person believes drinking is a healthy way to cope with stress or loss. If a person comes from an environment of binge drinking or casual drug use, they have a higher chance of developing co-occurring disorders.2


Physical and psychological trauma scar the brain and cause anxiety, depression, suicidal ideation, and other negative mental states. Each of these mental states can be a cause of dependency and prevent a person from asking for help. Mental health and substance abuse are inextricably linked, and without treating one, it will often lead to the other.

Substance Use Disorder and Physical Comorbid Conditions

There are many physical ailments that can lead to comorbid substance abuse. Here are common examples.

  • Chronic pain: Chronic pain like that from physical trauma or illness often spire the want to self-medicate. This, combined with a documented over-prescription of opioids from medical staff, cause chronic pain to lead to substance abuse.
  • Tobacco use: The risks associated with tobacco use is well-known, but many people substitute their tobacco cravings with a litany of other harmful drugs. Additionally, the pain caused by long-term complications of tobacco use can also be a cause for dependency.
  • Infectious disease transmission: The risk of infectious disease is increased with intravenous drugs like heroin, crack, and opium. Blood-borne illnesses are deadly and lead to comorbid substance abuse such as HIV and drug dependency.

Comorbid Substance Use Disorder and HIV

Anyone who shares needles, razors, etc., with multiple people, has a heightened risk of contracting HIV.

Over one million people per year admit to intravenous drug use. That’s countless needles being shared countless times, each with the risk of contracting a blood-borne illness. Increases in intravenous drug use correspond with rising levels of HIV in the general population.

Why Is HIV Screening Important?

HIV screening helps monitor and manage the number of HIV cases and treatments for individuals. It helps prevent the spread of HIV and educates visitors about how the virus works.

Diagnosis and Treatment When Comorbidity Exists

Finding the right team for a comorbid diagnosis and dual treatment takes time and research. This is because it takes specialized experience to differentiate the symptoms of mental illness and substance abuse.

Why It Is Difficult to Diagnose Comorbidities?

Mental illness and substance abuse share many of the same basic symptoms. Is a person suffering from sleep issues due to alcoholism or depression? Do their lungs hurt due to tobacco use, or is it cocaine use? While these are obvious examples, the nuances of comorbidity are far more complex. Correct diagnoses are crucial as a misdiagnosis delays proper treatment and could even hurt the individual.

Treatment for Substance Use Disorders and Mental Illnesses

These are the most common methods of comorbid substance abuse recovery:

  • Cognitive Behavioral Therapy (CBT): Cognitive behavioral therapy is centered around building better habits and coping mechanisms. CBT works by increasing the awareness one has of their mental state and implementing healthy techniques to stay positive. For co-occurring disorders, this means treating the cravings and urges that come with drug use. CBT is also used for comorbid psychiatric disorders.
  • Dialectical Behavior Therapy (DBT): Dialectical therapy helps teach social skills while increasing the awareness of one’s mental state. Much like CBT, it’s a multifaceted method. Plus, for co-occurring disorders, the focus on awareness helps uncover potential triggers that lead to drug use.
  • Therapeutic Communities (TC): Therapeutic communities contain people that have struggled with and gained control of their addiction and mental health. They live together and lean on each other as support. TCs limit the amount of negative exposure and influence a person has. This means a person with a co-occurring disorder can be surrounded by positive influence and resources. A therapeutic community isn’t just for dependencies, it can also help soothe the symptoms of comorbid psychiatric disorders.
  • Medications: Medication is required to manage the long-term symptoms of addiction and mental health. Some require more than others, but medication is essential to treating co-occurring disorders. Comorbidities in mental health can be managed with consistent treatment and therapy.

Prevention and Treatment for Substance Use Disorders and HIV

Because comorbid conditions and illnesses like HIV are so deadly, medication is key to managing symptoms and outbreaks. Other comorbid conditions and co-occurring disorders outside of HIV are also detrimental to recovery. Non-addictive medicine is often administered in a controlled medical environment to ensure the safety of the client.

Pre-exposure Prophylaxis (PrEP)

PrEP is a method where a person is given anti-HIV medicine before contracting the disease. It’s prescribed to people at risk for the illness due to lifestyle or underlying health conditions. Because it’s proactive, it helps prevent comorbid conditions from taking hold. Comorbidities in mental health play a large factor in preventing people from getting the treatment they need. It also gives the individual a chance to learn more about their mental health during treatment.3

STTR Model of Care

Seek, Test, Treat, and Retain, or STTR, is a proactive method of care used to find individuals with a high risk of comorbid conditions. Much like PrEP, it helps prevent a disease from spreading and cuts down on potential comorbid conditions. Addiction and mental health are the primary focus of an STTR program.4

Substance Use Disorder Treatment

Substance use disorder, or SUD, is used to treat addiction and can often include some form of dual treatment. Co-occurring disorders like multiple drug dependencies are uncovered and treated in SUD while guiding clients to the therapy they need to maintain sobriety. As mentioned, addiction and mental health go hand-in-hand. In the right environment, treating one leads to treating the other. That is why the staff of Great Oaks Recovery Center is trained in comorbid diagnoses and dual treatment options. 

Reach out to our team today to learn more about our recovery programs. Great Oaks Recovery Center can help you along every step of the recovery process, from detoxification to residential care and much more. Contact us today to learn more.



Questions About Treatment?

Our knowledgeable team is ready to discuss your situation and options. Your call is confidential with no obligation required.