Someone seeking help for substance use may also be struggling with anxiety, depression, chronic pain, or the lasting effects of trauma. These concerns can affect the same parts of daily life: sleep, relationships, work, and the ability to keep going when things feel overwhelming.
When treatment addresses only one concern, other needs can make recovery harder. Understanding how those needs connect helps care teams build a plan that fits the person.
In BrightView Health’s virtual forum, “More Than One Diagnosis: Treating SUD and Comorbidities Together,” Brianna Ramseur, MSN, NP, ACNPC-AG, Lead Advanced Practice Provider, and Katie Spencer, LISW-S, Behavioral Health Director for Ohio, explored how substance use, mental health, and physical health intersect. Their discussion emphasized a practical goal: help patients receive coordinated support without expecting them to navigate every part of care alone.
Watch: More Than One Diagnosis: Treating Substance Use & Co-Occurring Conditions
What Are Co-Occurring Disorders?
Co-occurring disorders refers to having both a substance use disorder and a mental health disorder. Examples include alcohol use disorder alongside depression or opioid use disorder alongside post-traumatic stress disorder (PTSD). The broader term “comorbidity” describes conditions that occur in the same person and can also include physical illnesses.
The Substance Abuse and Mental Health Services Administration (SAMHSA) explains that many combinations of mental health and substance use disorders can occur together. A thorough assessment helps identify which concerns need attention and how they may affect one another.
Having more than one diagnosis does not mean recovery is out of reach. It means treatment needs to account for more than one part of a person’s health.
Why Mental Health and Substance Use Can Overlap
There is no single explanation for why these conditions occur together. According to the National Institute of Mental Health (NIMH), shared risk factors can include genetics, stress, and trauma. Mental health symptoms may contribute to substance use, while substance use can also contribute to mental health problems.
During the forum, Spencer described how biology, life experiences, and social circumstances can interact. Housing instability, isolation, and financial stress may add to the challenges a person is already facing.
Understanding that context helps providers ask more useful questions: What is this person experiencing? What are they trying to cope with? What support would make treatment easier to access and continue?
Depression and Substance Use
Spencer explained that depression can interfere with motivation, relationships, and everyday responsibilities. Someone may withdraw from friends, struggle to get out of bed, or lose interest in activities they once enjoyed.
Alcohol or drugs may seem to offer relief from emotional pain, but that relief can be temporary. Substance use can add problems with sleep, mood, finances, and relationships, creating more distress.
The forum also highlighted grief. Patients may be coping with the loss of loved ones, relationships, or opportunities. Understanding those experiences helps a care team look beyond symptoms and recognize what the person needs support working through.
Anxiety and the Search for Relief
For someone living with anxiety, racing thoughts and constant worry can be exhausting. Spencer described how using a substance to feel calmer may become a repeating pattern: anxiety, substance use, temporary relief, and renewed distress.
Treatment can help patients develop ways to respond to anxiety while also addressing substance use. Providers also need to consider whether anxiety existed before substance use, worsened during it, or appeared during withdrawal.
Trauma and PTSD
Trauma can affect a person’s sense of safety and trust. Some people use substances to cope with intrusive memories, disrupted sleep, or overwhelming emotions. However, a history of trauma does not automatically mean someone has PTSD; diagnosis requires an appropriate assessment.
The VA National Center for PTSD explains that people with PTSD and substance use disorders can benefit from evidence-based treatment for both conditions. A substance use disorder should not automatically exclude someone from recommended PTSD treatment.
Spencer emphasized that trauma-informed care begins with everyday interactions: how someone is greeted, whether they feel respected, and how staff respond when they are struggling. Safety, consistency, and trust help patients participate in care.
Physical Health Matters in Recovery, Too
The forum also explored chronic pain, cardiovascular concerns, liver disease, and infections such as hepatitis C and HIV. Ramseur described how physical health needs can complicate recovery when they remain unaddressed.
For example, someone dealing with pain may have trouble sleeping, working, or attending appointments. A person referred to several specialists may struggle to arrange transportation or understand which appointment to schedule first.
Coordinated care can include screening, follow-up, and connections to primary care or specialists. It does not require every service to be provided by one organization. It requires a plan for helping patients reach the right services and keeping care connected.
What Does Integrated Treatment Look Like?
Integrated treatment brings substance use and mental health care into a coordinated plan. When physical health or practical needs also affect recovery, the team can help connect those pieces.
SAMHSA’s guidance on integrated care describes how coordinated treatment can improve symptoms, functioning, and quality of life for people with co-occurring disorders.
Depending on a person’s needs, care may include:
- Medical assessment and medication: Evaluating symptoms, reviewing medications, and offering treatment when clinically appropriate.
- Counseling: Helping patients understand patterns, build coping skills, and work toward personal goals.
- Mental health services: Addressing co-occurring conditions and arranging specialty care when needed.
- Care coordination: Helping patients schedule appointments and connect with other providers.
- Practical support: Addressing barriers such as transportation, housing, or insurance.
Ramseur offered a practical example during the forum: helping someone make an appointment can be more useful than handing them a phone number. The goal is to make the next step manageable.
Why Ongoing Assessment Is Important
Symptoms do not always point to a clear diagnosis at the first appointment. Withdrawal, substance effects, and mental health conditions can involve overlapping changes in sleep, mood, and behavior. NIMH emphasizes comprehensive assessment to help reduce missed diagnoses and guide treatment.
Ramseur and Spencer discussed the importance of reassessing symptoms over time. A care team may adjust its understanding as treatment progresses and more information becomes available.
Patients do not need to determine which condition came first before asking for help. They can describe what they are experiencing, and providers can work with them to identify needs, respond to urgent concerns, and refine the plan.
Recovery Goals Should Reflect the Person
During the forum, the speakers emphasized that progress can look different for each patient. Goals may include reducing substance use, attending appointments more consistently, managing symptoms, rebuilding relationships, or returning to meaningful activities.
BrightView’s discussion of harm reduction in addiction treatment explores how meeting people where they are can help them stay connected to support. Patients’ goals and needs can change, and treatment should make room for that ongoing work.
Finding Support at BrightView
If substance use and other health concerns are affecting your life, you can ask for help even if you are unsure where to start.
BrightView’s outpatient addiction treatment programs combine medical care, counseling, and social support. Treatment plans reflect individual needs, with coordination or referrals for additional services when appropriate. Same-day or next-day appointments are available, and weekday walk-ins are welcome.
Learn more about starting addiction treatment or visit BrightView’s website to connect with the team.
You deserve care that takes your full experience into account. Reaching out is a place to begin.
Explore More BrightView Virtual Forums
Sources
- BrightView. More Than One Diagnosis: Treating SUD and Comorbidities Together. Forum recording, supplied transcript, and presentation slides. Watch the recording.
- National Institute of Mental Health. Finding Help for Co-Occurring Substance Use and Mental Disorders.
- SAMHSA. Co-Occurring Disorders and Other Health Conditions.
- SAMHSA. Screening and Treatment of Co-Occurring Disorders.
- VA National Center for PTSD. Treatment of Co-Occurring PTSD and Substance Use Disorder in VA.
