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August 3, 2026

Building a Plan for Co Occurring Disorders Treatment

Written and reviewed by the multidisciplinary leadership team at Coastal Recovery, including licensed medical and clinical professionals with a diverse background in addiction recovery and mental healthcare.

Key Takeaways

Integrated co-occurring care treats substance use and mental health conditions simultaneously through one team, one assessment, and one unified plan rather than sequencing or siloing treatment ¹.
Fragmented care leaves most people underserved—only 14.5% of U.S. adults with both conditions received treatment for both in 2024, while 41.2% received none ³.
A strong plan hinges on four decisions: a full dual-focused intake, the right ASAM-matched level of care, coordinated MAT and psychiatric prescribing, and trauma work that begins when clinically appropriate rather than after arbitrary sobriety ^{16, 17}.
When comparing programs, prioritize on-site prescribing for both psychiatric medication and MAT, organizational trauma-informed practice, and a written continuity plan for what happens after IOP ends ^{19, 21}.

What changes when both conditions sit at the same table

If you've experienced treatment before, you might recall being directed between different specialists. A therapist might insist that substance use must cease before addressing panic attacks, while a substance use counselor might identify anxiety as a relapse trigger but defer it to mental health specialists. This often leaves individuals feeling like they are solely responsible for connecting disparate pieces of their care.

A plan for co-occurring disorders treatment operates on a different principle: both conditions are addressed concurrently by a cohesive team. Federal clinical guidance from SAMHSA emphasizes that substance use disorders and mental disorders should be treated simultaneously, with a single integrated assessment informing one comprehensive plan ¹. This approach avoids sequencing or siloing, opting instead for concurrent treatment.

This integrated approach transforms nearly every aspect of treatment. Your intake process will cover mood, sleep, trauma, and medication alongside your substance use. Your therapist will be aware of any recent changes made by your prescriber. Relapse prevention strategies will consider factors like untreated PTSD symptoms contributing to cravings. This ensures that no aspect of your health is overlooked or passed between providers.

You are not overly complicated, nor do you need to be fragmented into separate cases. You are an individual whose treatment plan should be tailored to your life, history, and medications, all at once, by professionals who understand the daily interplay between your conditions ¹¹. Our services are designed to provide this holistic care, ensuring that all facets of your well-being are addressed in a unified manner.

Why the treatment gap keeps people stuck in one-sided care

If you've received treatment for depression without being asked about your alcohol consumption, or attended detox without exploring the underlying reasons for your substance use, you've experienced this gap firsthand. This is a common experience for most individuals with co-occurring conditions.

This treatment gap has significant repercussions. When only substance use is addressed, the underlying anxiety, panic, or trauma symptoms that fueled it often resurface, leading to relapse. Conversely, if only the mental health condition is treated, ongoing substance use can interfere with medication efficacy, sleep patterns, and treatment adherence. This creates a cycle where providers may refer you back and forth, leaving you to manage the burden of coordination.

This is why federal clinical guidance strongly advocates for integrated planning. SAMHSA's evidence-based practices emphasize that a single team, a unified assessment, and a coordinated plan lead to better engagement and outcomes compared to fragmented systems ^{11, 12}. Research indicates that integrated approaches generally outperform non-integrated ones in areas such as substance use reduction, mental illness symptom improvement, treatment retention, and client satisfaction ^{13, 15}.

The implication is not that previous treatment attempts failed due to your efforts. Instead, a plan that addresses only half of your needs will yield limited results, regardless of your dedication. If you've experienced repeated attempts and setbacks, it often points to a systemic issue in treatment design, which can be resolved when both conditions are addressed simultaneously. Our integrated care services are designed to overcome this challenge, offering comprehensive support that considers all aspects of your health.

How common this actually is (and why that matters for your plan)

If you've felt that your situation is uniquely complex, national statistics suggest otherwise. In 2024, 33.0% of U.S. adults reported having either a mental illness or a substance use disorder in the past year, and 20.6% had either a serious mental illness or an SUD ³. These figures represent past-year, self-reported data for adults aged 18 and older, not lifetime estimates. This means approximately one in three adults you encounter has experienced similar challenges.

The prevalence of co-occurring conditions significantly impacts how treatment should be structured. When a condition is this widespread, it should not be treated as an unusual case requiring a separate referral. Instead, it should be the foundational assumption upon which a program is built. If a clinic suggests addressing mental health "later" or treats co-occurring care as a specialized consultation, it reflects their system's design rather than the rarity of your situation.

The distinction between general mental illness with SUD and serious mental illness with SUD is also important for your individualized plan. This difference can determine whether you need consistent outpatient therapy with medication support or a higher level of structured care. Both are equally valid, but understanding where you fall helps tailor the intensity of care, session frequency, and the extent of wraparound support needed from the outset ¹. Our programs are designed to assess these nuances and provide the appropriate level of care for your specific needs.

The four decisions a real plan is built around

Screening and full assessment: what a good intake actually asks

An effective treatment plan begins with a thorough conversation, not just a checklist or a brief phone screening that leads to multiple referrals. A comprehensive intake for co-occurring care addresses both your substance use and mental health concerns in a single session, conducted by the same clinician, using consistent terminology.

SAMHSA's clinical advisory outlines the assessment process: screening for both conditions, a detailed evaluation of severity and history, identification of your strengths and support systems, and then the development of a plan tailored to your specific needs ¹. This means a good intake will inquire about your substance use patterns—what, how much, and how often—as well as the onset of anxiety, history of panic attacks, sleep quality, any undisclosed trauma, current medications, and past attempts to stop substance use.

You should also expect questions about safety, physical health, family history, and current positive aspects of your life. These seemingly small details—your job, children, pets, or supportive friends—are crucial as they form the foundation upon which your treatment plan is built. Our intake process is designed to gather this comprehensive information to create a truly personalized plan.

If an intake focuses solely on substances or mood, it indicates a screening for a single program rather than a holistic assessment for a comprehensive plan. It is appropriate to ask directly whether the clinician is trained to address both aspects of your health simultaneously.

Choosing a level of care that fits your life, not a brochure

Once your situation is thoroughly understood, the next step is determining the appropriate level of structure needed. This involves selecting a level of care, which in Maine, is guided by specific regulations.

Outpatient programs in Maine utilize ASAM criteria—a national framework—to match individuals with the correct level of care based on factors such as withdrawal risk, medical needs, mental health severity, and living situation ²¹. Intensive outpatient (IOP) in Maine requires a minimum of three hours per day, three days per week ²². Partial hospitalization (PHP) offers more hours and clinical support for those needing daytime structure without overnight care. Standard outpatient is less intensive, typically involving a few sessions per week, suitable for individuals stable enough to manage most aspects of their lives independently.

Licensing is also a critical factor. In Maine, a program offering medication management within an IOP must hold a mental health license. Similarly, a program providing MAT (medication for opioid or alcohol use disorder) must have a substance use disorder license ¹⁹. Some agencies, like ours, hold both licenses, enabling truly integrated co-occurring care under one roof ²⁰.

When comparing programs, ask two direct questions: "Can you manage my psychiatric medications here?" and "Can you prescribe or coordinate MAT here?" If the answer to either is "we refer that out," your care will likely be fragmented across different facilities from the start.

You don't need to choose the most intensive option unless it aligns with your clinical needs and lifestyle. If you are working full-time and relatively stable, an evening IOP might be sufficient. If you are transitioning from a higher level of care, PHP can provide a bridge. Your treatment plan should accommodate your schedule, not the other way around. Our programs offer flexible options to integrate care seamlessly into your daily life.

The medication conversation: MAT, psych meds, and who talks to whom

If medication is part of your treatment—as it is for many with co-occurring conditions—this aspect often becomes complicated when care is fragmented. You have every right to expect clear answers regarding medication management.

Regarding substance use, CDC guidance strongly recommends offering or arranging medication for opioid use disorder (buprenorphine, methadone, or naltrexone). These medications are proven to reduce cravings and withdrawal symptoms, improve treatment retention, and decrease overdose risk ^{7, 9}. The CDC also advises against detox alone for OUD, as it increases the risk of resumed use and overdose death ⁸. If a program suggests "just getting through detox" and addressing medication later, it contradicts current federal guidelines.

For mental health, if you are already taking antidepressants, mood stabilizers, ADHD medication, or anti-anxiety medication, a comprehensive co-occurring plan does not begin by asking you to discontinue them. Instead, it starts by understanding your current medications, who prescribes them, their effectiveness, and whether your prescriber is aware of your substance use. Your team can then make informed adjustments, if necessary, based on your evolving needs. Evidence supports combining medications with psychosocial treatment for co-occurring care, rather than choosing one over the other ¹⁴.

Integrated planning means your prescriber, therapist, and counselor communicate and share notes. Your buprenorphine dosage is known to your therapy group leader, and your antidepressant is considered by the person managing your MAT. This coordination allows the team to respond promptly—within days, not weeks—if your sleep deteriorates or cravings intensify, because they are already in communication ¹¹.

When you first contact a program, ask directly: "Who prescribes medication here, who manages psychiatric medications, and how do they coordinate?" A program that can answer clearly has established processes for integrated care. Our team includes prescribers and therapists who work collaboratively to manage all aspects of your medication and therapy.

Trauma work: when to start, not just whether to start

Many older treatment models incorrectly advised delaying trauma work until sobriety was achieved. The prevailing wisdom was to stabilize first, then process trauma, waiting until an individual was "strong enough."

Current guidance has evolved significantly. The VA/DoD Clinical Practice Guideline for PTSD explicitly states that co-occurring substance use disorder should not preclude PTSD treatment, and delaying trauma-focused care solely due to SUD is not recommended ¹⁶. VA clinical guidance for co-occurring PTSD and SUD further advises offering evidence-based treatment for both conditions, ensuring one does not block treatment for the other ¹⁷. A review of evidence confirms that individual, manualized, trauma-focused psychotherapies are most effective for PTSD combined with SUD ¹⁸.

This means if trauma contributes to your substance use—which is common—you may not need to wait months to address it. The key question for your treatment team should be "when" and "in what form" trauma work should begin, rather than "whether" it belongs in your plan. Sometimes this starts immediately with grounding, stabilization, and safety planning. Trauma-focused therapy might begin a few weeks later once coping tools are in place, or it might run concurrently with substance use treatment from the outset. The timing is a clinical decision made collaboratively with you, not a rigid rule.

A trauma-informed program extends beyond a single therapeutic technique. It encompasses how you are greeted, how choices are presented, how staff respond when you are distressed, and the overall atmosphere of the physical space. SAMHSA's TIP 57 describes this as an organization-wide approach, not merely an add-on service ¹⁰. If past care felt punitive, shaming, or required you to earn safety, our trauma-informed approach offers a different experience, prioritizing your comfort and well-being.

Recovery Starts With a Conversation

Whether you’re exploring recovery for yourself or seeking guidance for someone you care about, Coastal Recovery Partners is here to help. Our team offers trauma-informed, evidence-based support grounded in structure, compassion, and real connection—without pressure or judgment.

When you’re ready, we’ll meet you where you are and help you take the next step forward.

Contact Now

What integrated care looks like in an ordinary week

It's helpful to visualize how integrated care functions in daily life. An integrated week is not overly dramatic; it's a consistent routine that addresses both aspects of your recovery without requiring you to navigate separate systems.

For example, if you're in an evening IOP, you might attend group sessions on Monday and Wednesday from six to nine—three hours each night, meeting Maine's minimum for IOP structure ²². One session might focus on relapse prevention, exploring triggers and alternative coping strategies. Another might be skills-based, utilizing CBT or DBT techniques to manage thought spirals or intense emotions that previously led to substance use.

Your individual therapy session might be on Friday. This is often where trauma work is integrated into your plan. Your therapist will be aware of discussions from your group sessions and any medication adjustments made by your prescriber, as the team communicates and shares notes—a core component of integrated practice ¹¹.

During the week, you'll also have a medication check-in. If you're on buprenorphine, this visit is coordinated with your treatment team, not at a separate clinic. If you also take psychiatric medication, the prescriber is either on staff or in regular contact with your therapist ¹⁹, eliminating the need for you to act as a messenger between providers.

Throughout this, you continue to live your life—working, caring for family, and maintaining other commitments. You might find yourself sleeping better than before, which itself is a significant improvement. This is the essence of integrated care: a plan for co-occurring conditions that fits into your existing life, rather than demanding its complete overhaul. Our programs are designed to support your recovery while respecting your daily responsibilities.

Capabilities to look for in any program you consider

When evaluating treatment programs, marketing materials often sound similar, with many claiming to treat co-occurring disorders and be trauma-informed. What truly matters is a program's ability to provide comprehensive care under one roof, without requiring you to coordinate services yourself.

Here's a checklist of essential capabilities to inquire about during your initial call:

Integrated Screening and Assessment: The program should conduct screening and assessment for both mental health and substance use conditions during the same intake process, ensuring neither is treated as a secondary concern ¹.
On-Staff or Coordinated Prescribers: Look for prescribers who can manage psychiatric medications and prescribe or coordinate MAT for opioid or alcohol use disorder ^{7, 19}.
Multiple Outpatient Levels of Care: The program should offer various levels of outpatient care, including PHP, IOP, and standard outpatient, allowing you to transition between levels without changing facilities or teams ²⁰.
Evidence-Based Therapies: Ensure the program utilizes evidence-based therapies such as CBT, DBT, and motivational interviewing, along with relapse prevention strategies that integrate your mental health needs.
Organizational Trauma-Informed Practice: The program should demonstrate a trauma-informed approach at an organizational level, reflected in how staff interact with clients, offer choices, and respond to distress, rather than just offering trauma therapy as an add-on service ¹⁰.
Access to Trauma-Focused Therapy: Trauma-focused therapy should be available when clinically appropriate, without requiring you to achieve an arbitrary sobriety milestone first ^{17, 18}.
Care Coordination with Outside Providers: The program should coordinate care with your external providers, such as your primary care doctor, existing prescriber, or therapist, and incorporate relevant medical information.
Flexible Scheduling: Availability of morning, afternoon, and evening options is crucial to ensure treatment can fit around your work, family, and other life commitments.
Aftercare and Alumni Support: A robust plan for aftercare and alumni support should be developed early in treatment, not just at discharge.

If a program can address most of these points clearly, it indicates a system designed for individuals with co-occurring conditions. Vague responses or frequent referrals to outside services suggest a fragmented approach, which could complicate your treatment journey. Our programs are built to meet these criteria, providing comprehensive and integrated care.

Continuity: the part of the plan most people underestimate

While initial focus often centers on the first ninety days of treatment, the long-term success of recovery largely depends on what happens after the intensive phase concludes. This crucial aspect, continuity of care, is frequently underestimated.

Maine's outpatient regulations mandate that programs have written admission criteria linked to ASAM placement and actively connect clients to community providers as they transition to lower levels of care ²¹. Federal guidance considers continuity of care a fundamental component of co-occurring treatment, not an afterthought once discharge paperwork is completed ¹. A comprehensive plan should outline, in advance, who will manage your prescriptions after IOP, where your therapy will continue, how your MAT will be refilled without interruption, and what relapse prevention support will be available months down the line.

During your initial inquiry, ask about aftercare and alumni support, rather than waiting until your final week of treatment. Inquire if you can transition from IOP to standard outpatient within the same team. Ask what happens if you encounter challenges three months post-treatment—can you return for a tune-up, or do you have to start over elsewhere? Continuity is what transforms a successful period of treatment into sustainable, long-term recovery ¹¹. Our programs prioritize seamless transitions and ongoing support to ensure lasting well-being.

References

Substance Use Disorder Treatment for People With Co-Occurring Disorders. https://library.samhsa.gov/sites/default/files/pep20-06-04-006.pdf
Co-Occurring Disorders and Other Health Conditions. https://www.samhsa.gov/substance-use/treatment/co-occurring-disorders
Results from the 2024 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt56287/2024-nsduh-annual-national-report.pdf
Highlights for the 2024 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH%202024%20Annual%20Release/2024-nsduh-nnr-highlights.pdf
2024 NSDUH Detailed Tables. https://www.samhsa.gov/data/report/2024-nsduh-detailed-tables
State Data Tables and Reports from the 2023-2024 NSDUH. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/state-releases/2023-2024
Opioid Use Disorder: Treating. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html
Guideline Recommendations and Guiding Principles. https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/recommendations-and-principles.html
Treatment of Substance Use Disorders. https://www.cdc.gov/overdose-prevention/treatment/index.html
TIP 57: Trauma-Informed Care in Behavioral Health Services. https://library.samhsa.gov/product/tip-57-trauma-informed-care-behavioral-health-services/sma14-4816
Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices KIT. https://www.samhsa.gov/resource/ebp/integrated-treatment-co-occurring-disorders-evidence-based-practices-ebp-kit
Integrated Treatment for Co-Occurring Disorders: Building Your Program. https://library.samhsa.gov/sites/default/files/ebp-kit-building-your-program-10112019.pdf
Chapter 7—Treatment Models and Settings for People With Co-Occurring Disorders. https://www.ncbi.nlm.nih.gov/sites/books/NBK571024/?report=reader
Treatment for Substance Use Disorder With Co-Occurring Mental Illness. https://pubmed.ncbi.nlm.nih.gov/31975963/
Integrating Treatment for Co-Occurring Mental Health Conditions. https://pmc.ncbi.nlm.nih.gov/articles/PMC6799972/
VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder. https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/MH/ptsd/VA-DoD-CPG-PTSD-Full-CPG-Edited-111624-V5-81825.pdf
Treatment of Co-Occurring PTSD and Substance Use Disorder in VA. https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp
State of the Science: Treatment of comorbid posttraumatic stress disorder and substance use disorder. https://www.ptsd.va.gov/professional/articles/article-pdf/id1635224.pdf
Licensing Requirements for Intensive Outpatient Program (IOP) Providers. https://www.maine.gov/dhhs/oms/providers/provider-bulletins/licensing-requirements-intensive-outpatient-program-iop-providers-2025-06-06
Behavioral Health | Department of Health and Human Services. https://www.maine.gov/dhhs/dlc/licensing-certification/behavioral-health
10-144 C.M.R. ch. 123, § 23 - Substance Use Disorder Treatment Organization Standards. https://www.law.cornell.edu/regulations/maine/10-144-C-M-R-ch-123-SS-23
c2s065-2026-037 (ACK).docx. https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c2s065-2026-037%20(ACK).docx

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