How to Assess a Client for Co-Occurring Disorders


Examine the client's mental health history and substance abuse problems. Evaluate the client's present and past symptoms such as suicidal tendencies, depression, anxiety, paranoia, impulsivity and so on. A report by the University of South Florida's Department of Mental Health Law and Policy recommends evaluating a client's past treatment history along with "patterns of denial and manipulation" (See Reference 2).

When examining a client's drug use, learn about their substance of choice, other drugs used (including prescription drugs), how and when drugs are abuse and their treatment history. Also, ask the patient why they use drugs and/or alcohol, the age they started using, frequency of use, frequency of abstinence and about patterns of substance use.


Assess the full spectrum of psychological problems to address during treatment. The University of South Florida report states that clinicians should look into the client's symptoms of mental health problems and substance abuse. Evaluate how the mental health symptoms effect substance abuse, and vice versa, and take into account the patient's timeline of mental health disorders and substance abuse. The report also suggests asking a client about their interpersonal relationships, medical status, social and family relationships, family history of mental health and substance abuse and developmental disabilities. When considering a client's psychological problems to address during treatment, take into consideration the client's criminal justice status and history as well.


Provide a foundation for treatment planning. The University of South Florida report states that there are common problems among each specific mental health co-occurring disorder. Those with affective disorders are likely to have a long history of drinking and have may experienced physical and social problems as a result. These clients are also more likely to remain sober for up to a month after treatment. Individuals with psychotic disorders are more likely to be disruptive in group settings. Clients with attention-deficit hyperactivity disorder do not respond as well to alcohol treatments, according to the report. They also state individuals in this group fall into two different categories: those with psychopathic personalities and those with psychopathic behavior. Those with psychopathic behavior generally respond better to treatment.

Tips and Warnings

  • Assessing a client for co-occurring disorders occurs after a mental health screening.
  • A patient has a co-occurring disorder when they are dependent upon drugs and/or alcohol alongside having an emotional or psychiatric problem. The New York State Office of Alcoholism and Substance Abuse Services reports that 37 percent of alcohol abusers and 53 percent of drug abusers are diagnosed with a minimum of one mental disorder. Patients who abuse substances may have psychiatric problems in the following categories: mood disorders, anxiety disorders, psychotic disorders and personality disorders. Assessing a client for co-occurring disorders is important, as not addressing a psychiatric problem could hinder a client's recovery from chemical dependence.