Co-occurring disorders means that a person has both a mental disorder and a substance use disorder. The relationship can be complex, so assessment should address both concerns rather than assuming one explains everything. Coordinated treatment asks how the professionals involved will share relevant information and work toward a coherent plan.
This general guide is for adults and families trying to understand assessment and care coordination. Having distress and using a substance does not, by itself, establish two diagnoses. Only an appropriately qualified professional can assess the individual situation. Support resources. NIMH’s help guidance.
What the term explains, and what it leaves open
NIMH describes several possible connections between mental disorders and substance use: shared risk factors, substance use related to coping, and substance-related changes that can contribute to mental-health problems. It does not describe one universal sequence.
The term “co-occurring” tells you two conditions are present; it does not tell you which came first, which treatment to use or what someone’s future will be. A program’s use of “dual diagnosis” likewise needs a concrete explanation of whom it assesses and what services it actually provides.
Avoid turning the label into a summary of a person. They may also be dealing with housing, pain, work, family relationships or other concerns that need to be heard. Write the person’s own priorities alongside any professional terminology so that the practical purpose of care remains visible.
Why the assessment should hear about both concerns
NIMH recommends comprehensive assessment by providers experienced with these overlapping concerns. That is different from using an online questionnaire to decide that a particular symptom belongs to a particular diagnosis.
Bring observations in a sequence: what changed, roughly when it changed and what else was happening. Mention alcohol, other substances, prescribed medicines and prior care accurately. You do not need to produce a theory of causation to ask for help.
In a fictional example, someone reports sleep problems during a stressful period and a change in drinking around the same time. The useful next step is to describe both to the assessor. Concluding “it is only stress” or “it is only drinking” would add an explanation that the example does not establish.
What coordinated, co-located and integrated care can mean
SAMHSA recommends integrated care and distinguishes coordinated, co-located and fully integrated approaches. It describes integrated treatment as linking mental-health and substance-use interventions around the person’s needs. The practical question is how that coordination works at the service you are considering.
A shared address is useful logistical information, but it does not answer who makes decisions together. Separate organizations can also communicate. Ask for an explanation of responsibility, communication and review instead of deciding from the building or the label alone.
The following questions are our editorial way to examine a proposed arrangement; they are not a certification standard.
| Part of care | A concrete question |
|---|---|
| Assessment | Who evaluates each concern and discusses the findings with me? |
| Treatment plan | How do the professionals agree on goals and resolve conflicting instructions? |
| Medication review | Who reviews the full medication and substance-use information? |
| Communication | How is information shared with my involvement and appropriate permissions? |
| Change in needs | Who reassesses the plan, and how do I reach that person? |
Ask what the service can actually provide
A website may list several conditions without explaining the depth of its services. Ask whether the program conducts assessment, provides ongoing treatment, coordinates with outside professionals or refers elsewhere. Those are different capabilities.
If a service refers out for part of your care, ask whether the receiving professional has been identified and how the first appointment is arranged. If a psychiatrist or another prescriber is described as “available,” ask how access works rather than assuming it is included in every schedule.
It is reasonable for a service to explain limits. A clear statement about what it cannot provide can be more useful than a broad promise. Take those limits to the professional helping you compare options, especially if the proposed plan leaves one concern without a responsible clinician.
- Which needs can this specific location assess and treat?
- What is handled elsewhere, and who arranges that connection?
- Will I have one shared explanation of the plan, or several plans to reconcile?
- Who answers questions if the recommendations appear inconsistent?
Keep one accurate medication picture
NIMH advises discussing prescription medicines, nonprescription products, supplements and other substances with the treating professional. Different professionals seeing incomplete lists can leave important questions unresolved. Do not stop or change a medicine on your own because a second service has entered the picture.
Use a current list and show it to the professionals involved. Record the actual medicine name and the prescribing contact rather than a vague description such as “the anxiety pill.” Ask the prescriber or pharmacist to help resolve names you are unsure about.
If two sets of instructions appear to conflict, contact the professionals for clarification before deciding which one to follow. The coordination task belongs with the care team; a family member should not have to interpret competing prescriptions.
How a family member can help without making the diagnosis
Offer specific observations with the person’s agreement where possible. “I noticed you stopped joining our usual Sunday meal” is an observation. “You definitely have a particular disorder” is a conclusion the family member may not be qualified to make.
Ask the person what kind of help they want: a ride, help organizing questions or company while contacting a service. Agree on what information can be shared and ask the team how family participation works. The person may want some conversations to remain private.
Keep your own capacity visible. Offering to help with one appointment is different from agreeing to coordinate every service indefinitely. Clear boundaries make practical help easier to sustain and reduce confusion about who is responsible for clinical decisions.
What to do with conflicting or incomplete answers
Write the unresolved issue in one sentence. For example: “The first service says the second service will manage medication, but the second has not accepted that responsibility.” Bring that precise gap to the current treating professional or care coordinator.
Ask for the next action, who will take it and how you will know it happened. If the answer is a new referral, clarify whether you are starting another assessment or arranging a specific ongoing service. You can ask for explanations without having to choose a diagnosis yourself.
If symptoms or safety concerns change while arrangements are pending, contact an appropriate clinical or crisis service. The general support routes linked with this guide explain where to seek help; an unresolved administrative question should not delay emergency assistance.
A shared-care question record
This is an invented coordination example. It does not describe a patient, a verified provider arrangement or a clinical recommendation.
| Part of the record | Example entry |
|---|---|
| Concern to assess | Mental-health symptoms and substance-use concerns both need to be discussed. |
| Known | First assessment arranged with one service. |
| Unknown | Whether that service provides both kinds of ongoing care or refers out. |
| Question | Who will explain the combined plan and the role of each professional? |
| Follow-up | Record the receiving service and appointment status if another provider is involved. |
Download the co-occurring care coordination record (CSV). Open it in a spreadsheet or print it. Keep your completed copy privately; this site does not collect your answers.
Continue with the next question
- What to ask before choosing a treatment program
- What happens during a mental-health or addiction assessment?
- Planning your next steps after treatment
For public contacts and geographic questions, browse our local care guides.
Sources and editorial scope
This guide combines published source guidance with original preparation examples. No named clinician has reviewed this guide. The worksheets are not diagnostic tests, validated measures or assessments of a provider. No interviews or individual care arrangements were verified.
- NIMH: Finding help for mental illnesses
- NIMH: co-occurring substance use and mental disorders
- SAMHSA: screening and treatment of co-occurring disorders
- NIMH: mental-health medication questions
Sources checked September 8, 2026. Read our editorial standards.