Co-Occurring Disorders in Recovery

By Steve K.

I would describe the relationship between mental illness or disorder, and alcohol or other drug dependency, as a strong one. However, it is important not to consider them as the same condition. In the fellowship of Alcoholics Anonymous (AA), it is very common for members in recovery from alcoholism to still suffer from other mental illnesses and disorders.

There is a common, but complex cause and effect relationship between mental illness and addiction, 1) the sufferer drinking to escape the symptoms of their depression, anxiety etc resulting in substance dependency, 2) addiction to alcohol/drugs resulting in or exacerbating mental health problems and 3) genetic/environmental factors resulting in a common origin for both the mental disorder and addiction.

My concern in relation to the Twelve-Step philosophy of AA, is with the tendency of some to consider the Twelve Steps as a ‘cure all’. Sufferers of clinical mental health difficulties would be wise to seek help professionally for their mental health problems, and not assume, as some do, that their alcoholism is the primary problem and that the solution is the program.  The good news is that it’s possible to recover from alcoholism, developing spiritually and morally, despite still suffering from mental health difficulties, episodically or chronically.

The co-founder of AA, Bill Wilson, is a good example of someone who suffered from depression well into his recovery from alcoholism. It is well documented that he suffered from episodes of depression as a young man, well before the onset of his alcoholism, during his alcoholism, and for at least 20 years into his recovery from alcoholism. Wilson engaged in extensive psychoanalytical therapy for his depression from approximately 1943 – 1949, and insights gained from his therapy influenced the writing of the ‘Twelve Steps & Twelve traditions’.

Wilson was subjected to accusations from other members of AA of not working the steps due to his depression, and of even secretly drinking. Unfortunately, some members of AA today can still make prejudiced assumptions about others suffering mental health problems in the fellowship, unfairly blaming them for not practising the program.

Wilson himself felt at times that he was not practising the Twelve Steps properly due to his depression, and my own personal experience is that depression can prevent me from practising a healthy relationship with the Steps and the fellowship. However, suffering and unhappiness can serve as motivation for spiritual and personal growth, and this was the attitude adopted by Father Ed Dowling, who was Bill Wilson’s spiritual mentor. Father Dowling suffered from arthritis and wrote an article for a magazine entitled, ‘How to enjoy being miserable’.

My view is that some of the misunderstanding in relation to depression that often happens within AA, is a result of being too literal when interpreting the ‘promises’ in the Big Book (p 83-84 3rd edition), which refer to having a spiritual awakening as the result of practising the Steps.


I think some individuals are more capable of being happy than others, and that some AA’s don’t suffer from any mental health difficulties, but many do, which affects their ability to be happy. I also doubt that the ‘promises’ in the Big Book were written with members suffering from clinical mental health difficulties in mind.

My observations of AA members who stop drinking, and genuinely practice the Twelve Steps, attending regular meetings on a long-term basis, are that they lead better, happier, and more fulfilling lives. However, this is relative to the individual’s circumstances and capabilities, and doesn’t mean that they don’t suffer from illnesses and other life difficulties, which can cause unhappiness and harsh realities.

What the program and fellowship does do, is support the recovering alcoholic to get the best out of the good, beautiful, and wonderful aspects of life, as well as cope with the suffering and difficult realities that we all experience to some degree.

First of the Buddha’s four noble truths “life is suffering”.

“Life is difficult”. Scott Peck, The Road less Travelled.

The focus within AA is on developing a positive attitude towards life and sobriety, which I very much agree with, as it helps people cope with and get the best out of life, but it’s important not to deny people’s suffering. I think that in general AA gets this balance right.




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