What Is Common Comorbidity in Substance Abuse?

Learn here about common comorbidity and what it means when it comes to substance use disorder.


Table of Contents

What Is Comorbidity?

Comorbidity is a condition where a person has more than one health condition at the same time. Many times, it is a combination of a substance use disorder and another health condition. Comorbidity can lead to severe side effects if left untreated.

A person has comorbidity if they have “two or more health conditions at the same time, or if one condition occurs right after the other.” These tend to be chronic conditions that will last a lifetime. Sometimes, comorbidity is called co-occurring conditions or coexisting conditions.1

Burden Of Comorbid Disorders

A study done between 2010-12 found that 52.2% of adults had at least one of the following conditions: mental health disorder, substance use disorder, or chronic medical conditions.2 Approximately 1.2% of the people surveyed had all three conditions, which normally correlated with higher poverty rates.

When a person has comorbid disorders, each disorder may worsen the symptoms of the other. For example, alcohol use disorder can drastically increase a person’s chance of heart failure if mixed with obesity or diabetes. A person who has comorbid disorders may become overwhelmed in the treatment process, especially if they are only addressing one of the conditions.

Necessity Of Diagnosing Comorbid Disorders

Due to the high rates of comorbidity or dual diagnosis between substance use disorders and other conditions, it is crucial that “a comprehensive approach to intervention that identifies and evaluates each disorder concurrently” is used.3

If a person with substance use disorder never addresses the mental health condition that could be a potential trigger, they will not be able to fully recover. Moreover, if a person is struggling with mental health issues or physical health issues and they do not address each other, they might set themselves up for failure regarding long-term treatment.

Comorbidity Between Substance Use Disorders and Mental Illnesses

One of the most common comorbid disorder combinations is mental illnesses and drug addiction. Both issues can impact one another, and they both make symptoms for the other more severe. Substance use disorders and mental illnesses can lead to fatal consequences, and it is important to treat them comprehensively.

The Connection Between Substance Use Disorders and Mental Illness

One of the most significant connections between the two is the fact that substance abuse can lead to changes in the neurochemistry of the brain. When this happens, it can lead to the development of several different mental illnesses, such as schizophrenia, mood disorders, anxiety, or depression.4

Not only that, but mental illnesses can lead to chronic drug use. Several mental disorders are big risk factors when it comes to the development of substance use disorders. Many times, this type of use is through impulsiveness or a need to self-medicate. Finally, there is a link between the two due to common risk factors.

Common Risk Factors

Multiple overlapping factors can lead to mental health issues or drug addiction. It is essential to know the most common risk factors that lead to this common comorbidity.

Genetic Vulnerabilities

Studies show that somewhere between 40-60% of a person’s vulnerability to substance abuse is due to genetics.4 If a person develops either substance use disorder or a mental health condition, they are more likely to develop the other.

Many of the same genes that put a person more at-risk for substance abuse also put them at risk for mental health issues. Many of these genetic vulnerabilities deal with the neurotransmitters within the brain.4

Epigenetic Influences

Epigenetics is the study of “changes in the regulation of gene activity and expression that are not dependent on gene sequence.”4 Basically, it is how genes are read by cells throughout your body.

Different environmental influences including drug use can alter how the body reacts to genes. Many of these factors are determined during developmental stages within a human’s life including inside the womb. Aspects such as poor nutrition and high-stress rates can lead to a higher risk of comorbid disorders.

Brain Region Involvement

Addictive substances tend to impact the reward centers within the brain and the neurotransmitter systems, such as dopamine and serotonin. Specific mental illnesses such as depression and schizophrenia can also impact those areas of the brain or are a result of abnormalities within those sections. When mixed, comorbidity between substance use and mental illness can lead to a severe never-ending cycle.4

Environmental Influences

Trauma, stress, and adverse early life experiences can greatly increase a person’s risk for mental health conditions and substance abuse.4 If environmental influences occur during specific developmental periods, they could also impact the other factors listed previously.


Stress is one of the most significant risk factors that connect these two disorders. Studies show that stress is one of the biggest risk factors that can lead to relapse. Many times, people will turn to substances as a coping mechanism for stress, which can lead to dependency. Many treatment plans focus on teaching new ways to cope with stress because of this.

Trauma And Adverse Childhood Experiences

Finally, people who went through severe trauma in childhood are at a higher risk of drug use. People that struggle with things such as Complex PTSD or PTSD might attempt to self-medicate to avoid dealing with the memories, trauma, and the consequences. Studies done by the VA show a strong comorbidity link between PTSD and substance use disorder.4

dual diagnosis treatment center

Treatment Options

There are several treatment options for people struggling with comorbid disorders. Depending on the specifics of what disorders a person is struggling with and the severity of them will determine the best treatment course of action.

Multi-Systemic Therapy (MST)

MST is a type of therapy that focuses on how a person behaves within the outside world, including at places like home, work, neighborhood, or school. MST will use the strengths inside of each realm for an individual to better support them. It may involve sessions with family inside of the home environment.

Brief Strategic Family Therapy (BSFT)

BSFT specifically looks at how family interactions directly impact a patient’s behaviors. Normally, it is used with adolescents or children. However, it can be used with adults. These sessions focus on the individuals within a family and the interaction patterns between those individuals.

This intervention normally only lasts about three months, and it focuses on engaging the family, overcoming resistance, diagnosing the issue, and developing a plan for the future, especially one focused on boundaries.5

Multidimensional Family Therapy (MDFT)

MDFT focuses on “a collaborative approach that is comprehensive, family-centered, and scientifically proven.”6 This style of therapy focuses on the fact that the issues that an adolescent or young adult face are complex. The goal of MDFT is to help families communicate more effectively with their children and to function better on a day-to-day basis.

During MDFT, you will notice four types of meetings: individual therapy sessions, individual sessions with the family/parents, joint sessions with the family and individual, and sessions with family, the individual, and other influences. The goal of MDFT is to use family to help people overcome their substance use disorders and to help the individual and family work through mental health issues.6


Finally, most treatment centers will use medication to help with comorbid disorders. One of the biggest reasons why comorbidity can develop is due to a need to self-medicate. Several medications can be used to help treat mental health issues. Some of these are antidepressants, stimulants, mood regulators, or anti-anxiety medications. For specific addictions, a doctor might also prescribe medication to help with withdrawal effects.

Comorbidity Between Substance Use Disorders and Infectious Diseases

Sadly, there is a strong link between substance use disorders and infectious diseases. Activities such as sharing personal possessions, unprotected sex, and sharing of needles can lead to the increase of diseases such as HIV, tuberculosis, and hepatitis spreading.7 Studies have found a statistically significant difference in infectious disease comorbidities among people that abuse substances.

The Connection Between Substance Use Disorders And HIV

Substance use disorders play a huge role in every stage of HIV development. Substance abuse s a cofactor in the transmission of this disease.8 Drug addiction can make HIV progress quicker in the body. Drugs allow HIV to attack the brain, leading to serious consequences. Comorbidity of drug abuse and HIV is also linked with a lack of medical treatment for HIV.

Importance Of HIV Screening

The CDC recommends that people who are at risk for HIV get tested a minimum of once per year and everyone gets tested at least once in their lifetime. If HIV goes untreated for too long, it can cause adverse health issues that could be hard to reverse. Moreover, it can cause the spread of the disease to others. If a person is struggling with substance use disorder, not only should they be tested regularly, but they should also be precautious of some of the risk factors.9

Methods Of Prevention

Unlike the late twentieth century, we have many ways to prevent the spread of HIV today. There are obvious aspects such as abstinence, refraining from sharing needles, or using condoms during sexual encounters.10

Pre-Exposure Prophylaxis (Prep)

There are currently two HIV prevention medications that are very effective in lowering the risk of transmission. Pre-exposure prophylaxis is taken regularly to prevent getting HIV during sexual encounters or injections. Post-exposure prophylaxis is a medication for someone that has already been exposed to HIV.10

STTR Model of Care

STTR stands for seek, test, treat, and retain. It is when places reach out to high-risk groups that struggle with drug abuse. They then seek them out for HIV testing, test them, and then continue to monitor for symptoms.11 This type of care helps lower transmission and identifies people with HIV to begin treatment.

Substance Use Disorder Treatment

A patient with HIV or other infectious diseases alongside a substance use disorder should also seek treatment. By focusing on both comorbid conditions, a patient can receive specified care that will lower their risk of transmission and lower the adverse effects of the infectious disease.12 SUD treatment normally involves a treatment plan with a medical professional.

Co-occurring Substance Use Disorder and Other Physical Comorbidities

People that have physical health conditions may develop substance use comorbidities. Many times, people will use substances to self-medicate their symptoms.13

Chronic Pain

Chronic pain is strongly associated with opioid use disorder. It is believed that 10% of people that struggle with chronic pain have a substance comorbidity.13 Because chronic pain can be debilitating, the cycle between these comorbidities can be very difficult to treat.


Schizophrenia can also coincide with substance use disorder. Many times, people will try to use substances to self-medicate. This type of use normally backfires and can lead to worse hallucinations and delusions. Drug use and schizophrenia do not cause one another, but they greatly impact each other when there are comorbidities.

Tobacco Use

Tobacco usage is one of the biggest reasons for physical health comorbidities.13 Tobacco use can lead to a lot of different issues such as cancers, immune system issues, diabetes, and heart problems. Tobacco use can also coincide with other substance use disorders.

Treatment Adherence

When a person is struggling with a physical or mental health condition, there is normally a treatment plan that they are supposed to adhere to. Someone who is struggling with a substance addiction might be less likely to follow that treatment plan the way they are supposed to.13 Moreover, the substances could negate the effectiveness of any other medications a person might be taking.

Implications for Health Care Delivery

Comorbid conditions tend to lead to higher healthcare costs and can cause greater impairment for the individual. Because of this fact, it is vital to seek out a comprehensive treatment plan that would be most likely to be successful.

Frequently Asked Questions

Comorbidity can be a difficult topic to process, and it can lead to several questions. If you have inquiries, feel free to reach out to our team at The PAC Program.

Is High Blood Pressure a Comorbidity?

High blood pressure can be a comorbidity. High blood pressure can cause issues with the cardiovascular system. If this issue is mixed with other comorbidities such as alcohol use disorder, it can lead to fatal consequences. For high blood pressure to be a comorbidity, it must co-exist or come shortly after another comorbidity.

What Are the Symptoms of Comorbidity?

Symptoms can vary when it comes to comorbidity. Normally, a person that is struggling with two disorders will experience side effects of both simultaneously. Many times, a person might know of one thing they are struggling with (substance use disorder, obesity, depression, etc.) and will learn they have a comorbidity when they seek medical attention or treatment.

Who Are Persons with Comorbidities?

A person with comorbidities can be anyone that is struggling with two or more health conditions. If you believe you or a loved one might be struggling with comorbidity, it would be best to seek out advice from a doctor or medical professional.

Is Diabetes A Comorbidity?

Like high blood pressure, diabetes can be a comorbidity if it coincides with another disorder or condition. Diabetes by itself is not a comorbidity, but it does normally coincide with other health problems.

Comorbidity should be taken seriously because it can have severe, possibly fatal consequences. If you or a loved one are struggling with substance use disorder alongside physical or mental comorbidity, please seek advice from a medical professional to begin a treatment plan.


If you or a loved one needs help, please call us at
623-523-4748 and our team at Blueprints For Recovery in Arizona will help.

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