2026-2027 | Live Session | Co-Occurring Psychiatric and Substance Use Disorders | October 2026-Co-Occurring Psychiatric and Substance Use Disorders Presentation

Co-Occurring Psychiatric and Substance Use Disorders Presentation

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The presentation reviews the prevalence, diagnosis, and treatment of co-occurring psychiatric and substance use disorders (SUDs). These conditions are common: substantial proportions of people with either a mental illness or an SUD experience both. Co-occurrence is associated with greater relapse risk, hospitalization, suicide, social and medical harms, and difficulties with treatment adherence.<br /><br />Diagnosis requires a careful, longitudinal history rather than relying on symptoms alone. Clinicians should establish when symptoms began relative to substance use, intoxication, withdrawal, and periods of abstinence; identify the substances involved; assess symptom severity and treatment response; and consider overlapping conditions and incomplete information. Substances can cause or worsen depression, mania, anxiety, and psychosis, while independent psychiatric disorders can also increase vulnerability to substance use. Early recovery mood instability and distress should not automatically be classified as a psychiatric disorder.<br /><br />Treatment should address both conditions together and be tailored to the person. Combine appropriate psychiatric medication and evidence-based SUD treatment—including medications for opioid or alcohol use disorders—with psychotherapy, recovery supports, and coordinated interdisciplinary care. Medication decisions should account for diagnosis, side effects, interactions, safety, adherence, and substance-related risks. Psychosocial approaches such as cognitive behavioral therapy, motivational interventions, and relapse-prevention skills are essential.<br /><br />A case study illustrates the challenges of distinguishing bipolar disorder from substance-induced mood symptoms and other diagnoses. The patient’s mood episodes, medication discontinuation, and substance use repeatedly interacted, contributing to relapse and crises. Her course highlights the importance of ongoing reassessment, medication adherence, continued buprenorphine, attention to cannabis-related harms, and maintaining engagement after return to use.<br /><br />Key recommendations include promoting retention rather than discharging patients for relapse, addressing practical barriers such as scheduling and medication side effects, and using harm-reduction goals when abstinence is not immediately achievable. Detailed assessment, integrated care, and sustained patient engagement are central to improving outcomes.

Keywords

co-occurring disorders

psychiatric disorders

substance use disorders

dual diagnosis

diagnosis history

integrated treatment

relapse prevention

bipolar disorder

buprenorphine

harm reduction