Co-occurring addiction and mental health care in NYC

Co-occurring disorders and mixed substance use

Mental-health symptoms and substance-use problems can occur together. A useful evaluation looks at both, including how symptoms and use changed over time. Using several substances also creates treatment and safety needs that cannot be handled by choosing one medicine from a general list. The plan should coordinate the relevant clinicians and address immediate risk before longer-term goals.

How co-occurring disorders and mixed substance use works

Substances can cause, worsen or mask mental-health symptoms, and a separate disorder may also be present. Anxiety, low mood, trauma symptoms, ADHD, bipolar disorder or psychosis require careful assessment. Treating substance use does not guarantee that every psychiatric symptom resolves, and treating anxiety alone does not address every substance-use disorder.

Eligibility: Co-occurring disorders and mixed substance use

Bring details of each substance and prescribed medicine, including alcohol, opioids, stimulants, cannabis and sedatives. The assessment reviews current symptoms, prior diagnoses, treatment response and safety. Having more than one condition is not a reason to give up on care. Severe intoxication, withdrawal, psychosis or inability to stay safe may require urgent treatment in a more monitored setting.

What to expect: Co-occurring disorders and mixed substance use

Build a shared timeline

Describe which symptoms began before substance use, which change during intoxication or withdrawal and what persists between episodes. Bring psychiatric and addiction-treatment records if available. This helps the clinician avoid attributing every symptom to one cause without enough information.

Review combinations and withdrawal risks

Give an accurate list of sedating medicines, alcohol and opioids. Some combinations raise breathing and overdose risk; suddenly stopping alcohol or benzodiazepines can also be dangerous. The clinician chooses a safe sequence and setting rather than advising you to stop everything at once.

Coordinate treatment for the actual disorders

Discuss which clinician manages each prescription and how records will be shared with appropriate consent. Medication for OUD or AUD has a specific role and does not treat every other substance-use disorder. Psychiatric treatment may continue or change based on assessment. Behavioral care can address triggers shared by both conditions.

Agree on follow-up and escalation

Set goals for use, sleep, mood and daily function. Clarify whom to call for side effects, worsening symptoms or an access gap. If the first plan does not adequately control risk, another level of care may be needed. Coordination should include a definite next appointment rather than only a referral list.

Preparing for your appointment

Bring medication bottles, recent changes, prior discharge instructions and the contact details of existing clinicians. Describe nonprescribed products and substances without assuming they are irrelevant because they are legal or natural. Ask how family can participate if you want support and what consent is needed. Explain housing, work and caregiving barriers that may affect the plan.

Risks and when to seek help

Call 911 or seek emergency care for overdose, severe breathing problems, seizure, severe confusion or an inability to remain safe. Dangerous mania, psychosis or major psychiatric worsening needs urgent assessment. Do not abruptly stop prescribed sedatives or OUD medication to simplify the medicine list. FDA supports careful management rather than automatically withholding buprenorphine solely because benzodiazepines are used.

Follow-up and treatment review

Review the course of symptoms and substance use together. A positive or negative test does not explain the whole picture. The clinician may revise diagnoses or medicines as the history becomes clearer. Ask whether the clinicians have exchanged the information needed for safe prescribing. If coordination breaks down, raise the specific missing step, prescription or appointment.

Appointments, costs and coverage

Ask whether the service provides integrated care, coordinated referral or separate appointments. Ask which model the service provides. Confirm who manages ongoing prescriptions and urgent concerns, which therapies are available and how fees and coverage work across services. Do not assume one provider’s addiction webpage verifies every psychiatric specialty or program.

Medical sources

• SAMHSA: co-occurring disorders and other health conditions
• SAMHSA: screening and integrated treatment for co-occurring disorders
• FDA: benzodiazepine precautions, including use with opioid addiction medicines
• Joint clinical practice guideline on benzodiazepine tapering
• ASAM/AAAP clinical practice guideline on stimulant use disorder
• CDC: five things to know about naloxone
• NIMH: substance use and mental health