Because substance use disorders commonly occur in people with schizophrenia and other psychotic disorders, counselors should be aware of the needs of impacted individuals. Consequently, this chapter reviews the relevant Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria, prevalence rates and statistics, assessment strategies, diagnostic considerations, treatment modalities, and ethical considerations relevant for clients with co-occurring substance use and schizophrenia and other psychotic disorders.

Assessment is a process of gathering information to understand clients, learn their concerns, and develop a map for treatment and conclusion of services. Co-occurring disorder is the presence of at least one substance use disorder and another mental disorder(s). Approximately 17 million adults have a substance use disorder while concurrently experiencing any mental illness. Irrespective of the etiology of co-occurring disorders, a comprehensive integrated assessment is key to a successful treatment outcome. The concepts and processes of intake, therapeutic relationship, biopsychosocial assessment, screening and assessment tools, diagnosing and treatment planning, and ethical and legal issues related to co-occurring disorders are all reviewed within this chapter.

This chapter provides an overview of the interaction between mental health and substance use disorders, with an emphasis on anxiety, obsessive-compulsive, and substance use disorders. This overview focuses on general assessment and treatment approaches that can be used across clinical settings and populations as well as various disorders (e.g., anxiety, obsessive-compulsive, and substance use disorders). In addition, legal and ethical implications and considerations are discussed.

This chapter provides a general overview of psychopharmacology as it relates to working with co-occurring disorders. A brief overview of the general structure of the brain is provided for context about medications and how they affect the user. Behavioral health psychotropic medications such as antidepressants and antianxiety prescriptions are reviewed. In addition, medications used in medication-assisted treatment for addictive disorders are examined.

Military personnel and veterans are members of a unique and proud group within the overall culture of the United States. It is essential that counselors working with this population recognize high rates of alcohol use co-occur with traumatic brain injury as well as mental health issues such as posttraumatic stress, depression, and anxiety—especially among active-duty service members and veterans who were exposed to combat situations. With the withdrawal from Afghanistan, the deployment cycle of military unit rotations from the United States to overseas locations and back to stateside is slowing; however, the rotations that continue to occur places strain on individual service members and their families. Because military personnel and veterans are at risk of developing co-occurring mental and substance use disorders, counselors must be clinically astute and culturally aware when providing services to this population.

This chapter addresses a variety of topics that counselors should be knowledgeable of when working with clients at risk of experiencing difficulties related to mental health conditions and addictive disorders. First, the prevalence of co-occurring mental and substance use disorders (CODs) will be identified in order to establish the pervasiveness among client populations. Then, the etiological paradigms and risk factors will be examined so counselors have a better understanding of the potential origins and impact of CODs. Next, screening procedures will be distinguished from the assessment process when evaluating clients for CODs, which will be followed by a review of the treatment approaches, best practice guidelines, and levels of care that are available for CODs. Lastly, ethical and legal considerations related to counselor competencies when treating clients with CODs will be offered.

The brain is a complex, self-organizing system that both influences and is influenced by genetics, thoughts and behaviors, relationships, and the environment. This chapter reviews basic brain anatomy and functioning relevant to understanding the neuroscience of addiction and co-occurring disorders. A contemporary discussion of neuroscience principles underlying addiction and co-occurring disorders follows a review of basic principles. Implications and limitations for translational applications are addressed throughout.

This chapter provides a general overview of substance use and addictive disorders. Both substances of addiction as well as behavioral addiction are explored. Substances are introduced by detailing effects on the human body, common ingesting methods for the substances, and commonly used street names. Models of addiction such as the brain disease model and biopsychosocial model are described. Clinical information is presented, such as diagnostic categorization and a description of how addiction can present in clients’ clinical histories.

The co-occurrence of bipolar disorder (BD) and substance use disorders (SUD) is likely to impact presenting symptoms and risk factors related to each disorder. Persons who have co-existing BD and SUD typically experience more significant mood disturbance and more severe symptoms of substance misuse. Additionally, these co-occurring disorders contribute to increased risk for suicide and hospitalization and lower treatment utilization rates. Comorbidity of BD and SUD is also likely to increase the complexity of assessment and diagnostic procedures and pose additional treatment challenges. This chapter reviews diagnostic criteria, examines prevalence rates, explores assessment and screening procedures, and considers treatment implications.

This chapter provides information on co-occurring mental and substance use disorders among members of the LGBTQ+ community. LGBTQ+ individuals face greater mental health and substance use concerns than their heterosexual and cisgender counterparts; thus, relevant statistics regarding the prevalence of co-occurring mental and substance use disorders among this population are included. Importantly, the unique co-occurring treatment considerations for working with LGBTQ+ clients are also discussed, including the need for counselors to be cognizant that a higher occurrence of lifetime suicide attempts and nonsuicidal self-injury exists for this community. Because minority stressors impact the mental health of this population, an intersectional lens is important to use, which is examined. Additionally, counselors will be reminded to follow the core principles of counseling and focus on developing appropriate competencies, as well as be informed of a variety of affirmative, effective treatment options that are available for LGBTQ+ individuals with co-occurring disorders.