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Levels of Co-Occurring Disorders Treatment: Where is Your Program?

Mark Sanders, LCSW, CADC


Mental illness and substance use disorders co-occur at the rate of 50 to 70%. Therefore, to be effective, it is essential to address both disorders in treatment (Atkins, 2021). To increase effectiveness, programs can analyze their current level in addressing co-occurring disorders and plan for programmatic improvements. Below is a description of four levels of co-occurring disorders treatment. Take a moment to evaluate your program's current level of effectiveness in working with clients with co-occurring disorders.

Level One

Single diagnosis focus. Our program primarily focuses on treating substance use disorders or mental illness.

Level Two

Co-occurring disorders capable. We have had some training in co-occurring disorders treatment. One or two of our staff has worked in both fields.

Level Three

Co-occurring disorders competent. All of our staff have been trained in integrated co-occurring disorders treatment. We have demonstrated the capacity to treat co-occurring disorders effectively. Our program effectively utilizes peers as a part of our approach to treatment and recovery. We use evidence-based approaches to co-occurring disorders treatment and recovery.

Level Four

Complexity proficient. In addition to addressing co-occurring disorders effectively, our program also has proficiency in addressing other co-occurring conditions/complexities common among clients with co-occurring disorders, including homelessness, HIV, diabetes and other medical complications, nicotine dependence, cognitive impairments, and disabilities.

Next Steps

Evaluating your program’s current ability to address co-occurring disorders can occur individually or in a staff meeting. To improve services for clients with co-occurring disorders, you can address the following questions.

  • Using the criteria above, what is our current level of effectiveness in addressing co-occurring disorders?
  • What are our plans to move to the next level of effectiveness in addressing co-occurring disorders? What new information will we need? What training will we need? What new skills will we need? Who can help us reach the next level?

Substance use disorders and mental health treatment have operated in separate silos for years. However, as programs improve their effectiveness in addressing co-occurring disorders, clients will achieve greater outcomes, and fewer will slip through the cracks.

Learn more about co-occurring disorders:

The ATTC and MHTTC Networks offer an array of training resources on co-occurring disorders. An example is the five-part webinar series on integrated care:

Webinar 1: Defining and Assessing Integrated Behavioral Health Capacity
Webinar 2: Organizational Structure and Service Environment
Webinar 3: Staffing and Training
Webinar 4: Intake, Screening and Assessment
Webinar 5: Integrated Treatment Planning, Service Provision, and Continuity of Care

SAMHSA also offers many resources on co-occurring disorders, including the TIP 42: Substance Use Treatment for Persons with Co-Occurring Disorders.


Atkins, C. Co-Occurring Disorders. (2021). Pesi Publishing, INC. Eau Claire, WI.

About the Author: 

Mark Sanders, LCSW, CADC, is the Illinois State Program Manager for the Great Lakes ATTC, MHTTC, and PTTC. Mark has more than 30 years of experience as a counselor, trainer, international speaker, and author. He is also the founder of the Online Museum of African American Addictions, Treatment, and Recovery. Mark has received numerous awards, including the 2021 NAADAC Enlightenment Award for his career contributions to NAADAC and the field.