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Co-occurring Disorders


Co-occurring disorders are defined as a person having one or more disorders relating to the use of alcohol and or other drugs as well as one or more mental disorder. Both drug use disorders and other mental illnesses are caused by over-lapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma. Certain mental disorders are established risk factors for subsequent drug abuse and vice versa. Co-occurring disorders also implies interactions between the illnesses that affect the course and prognosis of both.

Population surveys show a high rate of co-occurrence between drug addiction and other mental illnesses. Adults with both substance use and severe mental health disorders is approximately 23% of the population or 69,000 people adjusted for Oregon population. The lifetime prevalence of substance use problems in people with severe mental illness is between 40 and 60%. They are more likely to be hospitalized and use emergency services, are highly vulnerable to housing instability, have high rates for homelessness, and in Oregon, people with COD die at an average age of 45.1 compared to 76.6. for the general population. In Oregon, 10,760 people received services in 2005 for both substance use and mental health.

AMH along with partners is improving services to Oregonians with co-occurring substance use and mental health disorders by:

  • Developing funding strategies
  • Developing competencies
  • Providing training and technical assistance to staff on program integration and evidence based practices
  • Conducting fidelity reviews of evidence based practices for the COD population
  • Revising the Integrated Services and Supports Oregon Administrative Rule

The high rate of co-occurrence between drug abuse and addiction and other mental disorders argues for a comprehensive approach to intervention that identifies, evaluates, and treats each disorder concurrently. Co-occurring substance use and mental health disorders is considered the expectation for both the addictions and mental health service providers.

Oregon Co-occurring Disorders Services Resource Directory

Co-occurring Disorders Clinical Competencies

In May, 2000, The Final Report and Recommendations of the Department of Human Services Statewide Task Force on Dual Diagnosis was issued. An important recommendation was to develop core competencies for all staff working in mental health and chemical dependency treatment programs. The Addictions and Mental Health Division worked with providers and representatives from state facilities, educators and experts in the field to develop guidelines and a core competency checklist tool. With the Integrated Services and Supports Rule (ISSR) implementation in March 2010, AMH believes it is the right time to provide guidance that outlines basic, intermediate and advanced clinical competencies. When staff members are competent in providing integrated treatment services to people struggling with co-occurring disorders (COD), better outcomes can be realized.

View and copy of the Co-occurring Disorder Competency Checklist Guidelines.

Competency Checklist Tool

Score Sheets

COD Resources

COD-related Web links

DDCAT-NIATx Project: A promising practice for improving integrated care - Two project phases were conducted by professionals familiar with DDCAT and experience in COD treatment. The results were reviewed and a plan was developed identifying targets and objectives for improving integration.

Washington State NIATx/DDCAT Pilot 2008-10 - A presentation of Washington State's pilot project.

Co-occurring Disorders Center of Excellence (COCE) - A project of the Substance Abuse and Mental Health Services Administration (SAMHSA) administered by Center for Substance Abuse Treatment and Center for Mental Health Services. Co-occurring disorders (COD) are identified by SAMHSA as one of "11 priority program areas to ensure that the Agency's work addresses the elements that people with substance use and mental disorders need to live a full rewarding life in the community." COCE provides technical assistance, training, products and resources to support the dissemination and adoption of best practices in systems and programs that serve people with COD. Find more information and COCE overview papers

Substance Abuse Treatment for Persons with Co-occurring Disorders, Treatment Improvement Protocol (TIP 42) - TIPs are developed by the Center for Substance Abuse Treatment (CSAT), are best practice guidelines for the treatment of substance use disorders (PDF). CSAT draws on the experience and knowledge of clinical, research, and administrative experts.

Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery (Tip 48) - This Tip provides the answers that substance abuse treatment counselors need when working with clients with depressive symptoms and substance use disorders. Request a report from the AMH Resource center by calling 503-945-7814.

Integrated Dual Disorders Treatment Toolkit (IDDT) - This resource kit is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and emphasizes strengthening the consensus-building process, expanding the involvement of consumers and families, includes practical orientation to issues involving service organization and financing, and insists on paying careful attention to issues of ethnic and cultural sensitivity and overall cultural competence.

Dual Diagnosis Capability Assessment Tool (DDCAT) - A fidelity instrument for measuring alcohol and other drug treatment services for people with co-occurring substance use and mental health disorders(PDF). It has served to guide services in assessing and developing the dual diagnosis capacity of alcohol and other drug treatment services. The DDCAT index has been subjected to a series of research studies, and has been implemented in a number of different jurisdictions.

Comorbidity Program Audit and Self-Survey for Behavioral Health Services, Adult and Adolescent Program Audit Tool for Dual Diagnosis Capability (COMPASS) - A tool that can be used by behavioral health care systems to assess a program's competency in multiple areas that reflect standards for Dual Diagnosis Capable substance use and mental health disorder services. This tool is designed for either substance use or mental health programs seeking to improve or enhance integration of services, supporting an array of behavioral health programs. info@ziologic.org


Dual Diagnosis Anonymous of Oregon (DDA) - A peer support group based on an authorized version of the 12 Steps of Alcoholics Anonymous plus an additional five steps that focus on Dual Diagnosis (mental illness and substance abuse).DDA's unique 12 Steps Plus 5 Program offers hope for achieving the promise of recovery.

Older Adults - Older Americans Substance Abuse and Mental Health Technical Assistance Center promotes the physical and mental well-being of older Americans through partnerships with state and federal agencies and community health care providers, the Center serves as a national repository to disse​minate information, training, and direct assistance in the prevention and early intervention of substance abuse and mental health problems.

Washington and Oregon State Pilot Test (PDF)

Adolescents and Youth - Working with Youth with Co-occurring Disorders (PowerPoint)

​​Program Contact - Ralph Summers​