The Government Just Confirmed the Co-Occurring Disorder Treatment Gap, and Trauma Is Often the Missing Piece
Every summer, a quiet but consequential report lands on the desks of policymakers, insurers, and treatment providers across the country. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health, the largest and most detailed look at addiction and mental health in America, tends to tell us more about where the system is failing than almost anything else published all year.
This year’s edition, covering 2025 data and released in July 2026, has a clear message for anyone treating co-occurring disorders: the gap between people who need integrated care and people who actually get it isn’t closing. For adults managing both a substance use disorder and a mental health condition, often rooted in trauma that’s never been properly addressed, it’s getting wider.
That population, people navigating a substance use disorder and a mental health condition, and very often trauma underneath both, is exactly who Windmill Wellness Ranch was built to treat. So, when a report like this comes out, we don’t just skim it. We study it, because it tells us how well the country is doing the work we’ve centered our entire program around.
Key Takeaways
- Among adults with both a substance use disorder and a mental illness, 42.6% received no treatment at all in 2025, up from 41.2% in 2024, according to SAMHSA.
- Only 12.7% of adults with a co-occurring SUD and mental illness received integrated care for both conditions together in 2025.
- Overall, 84% of the 47.2 million Americans aged 12 and older who needed SUD treatment in 2025 did not receive it.
- Substance use is frequently a symptom of unresolved trauma, anxiety, or depression, which is why treating addiction in isolation often fails to prevent relapse.
- Windmill Wellness Ranch is a licensed dual-diagnosis treatment center in Canyon Lake, Texas, built specifically to treat trauma and mental health conditions alongside substance use.
The Co-Occurring Numbers: Where the Gap Is Widening
This is the part of the report that stops us in our tracks every year, because it’s the one that describes the people we see walk through our doors every week.
Among the 18.5 million adults in 2025 who had both a substance use disorder and a mental illness:
- 42.6% received no treatment at all. Not for the addiction. Not for the mental health condition. Nothing. That’s up from 41.2% the year before, meaning the problem is getting worse, not better.
- Only 12.7% received care for both conditions together. The rest either got partial help or none at all.
Zoom in further, to the group facing the most severe combination, a substance use disorder alongside a serious mental illness like schizophrenia or bipolar disorder, and the numbers are just as sobering: 28.7% received no treatment of any kind, and only 16.4% received integrated care for both conditions, a drop from 19.2% the year before.
Sit with that for a second. Among the people whose need is arguably the most urgent, the share getting truly integrated care is shrinking.
The Bigger Picture: Progress, With an Asterisk
Zooming out, there’s genuine good news. According to SAMHSA’s 2025 survey, an estimated 44.6 million people aged 12 and older had a substance use disorder in the past year, a meaningful drop from 46.8 million in 2021. Alcohol use disorder alone fell from 29.7 million people to 25.7 million over that same span. Fewer Americans are struggling with addiction than four years ago, and fewer are dying from it.
Here’s the asterisk: fewer people needing help hasn’t translated into more people getting it.
Of the 47.2 million people aged 12 and older who needed SUD treatment in 2025, a staggering 84% did not receive it. The treatment gap for adults barely budged, inching from 95.6% untreated in 2024 to 94.5% untreated in 2025. Among younger people, the picture is worse: roughly 1 in 10 who needed care actually received it, a decline from the year before. (A quick note: SAMHSA’s survey covers ages 12 and up, while Windmill Wellness Ranch’s program serves adults 18 and older.)
Progress on prevalence is real. Progress on access, especially integrated access, is not.
Why “Just Treat the Addiction” Doesn’t Work
It’s worth asking why this gap exists in the first place, and the answer isn’t a lack of good intentions. It’s structural.
Mental health care and addiction treatment have historically lived in separate systems: separate providers, separate intake processes, separate insurance codes. A person walks into a program built to address substance use, and the trauma or depression underneath it never gets properly diagnosed. Or they land in therapy for anxiety, and nobody addresses the drinking that’s quietly making everything worse.
Substance use is very often a symptom, not the root cause. It’s frequently a way of self-medicating pain, trauma, or an underlying mental health condition that’s gone unidentified or untreated. Of the two, trauma is one of the most common drivers and one of the most consistently missed in standard addiction treatment, because most programs simply aren’t built to diagnose it. Address the substance use alone, without touching what’s driving it, and relapse becomes far more likely. That’s not a theory. It’s the exact pattern this year’s SAMHSA data is showing at a national scale.
How Windmill Wellness Ranch Was Built to Close This Exact Gap
Windmill Wellness Ranch exists because we believe substance use is a symptom, not the whole story. We’re a licensed dual-diagnosis, co-occurring treatment center on a 75-acre ranch in the Texas Hill Country outside Canyon Lake, and integrated care isn’t something we bolt onto our program. It’s the foundation of it.
Trauma, in particular, is where our clinical team’s expertise stands out. Among clients managing a co-occurring SUD and mental health condition, unresolved trauma is one of the most common, and most frequently missed, underlying drivers. Identifying and treating it directly, rather than around it, is central to how we approach every case.
Here’s what that looks like in practice:
We diagnose and treat the whole person, not just the addiction. Depression and anxiety are the most common co-occurring conditions we see, but our clinical team is also equipped to properly diagnose and treat PTSD, trauma and stress disorders, bipolar disorder, personality disorders, and chronic pain alongside substance use, using the right combination of therapy and medication management for each individual.
We use data, not guesswork, to guide treatment. Every client’s plan draws on genetic testing and ongoing psychometric assessment, and clients also have the option to add our Brain Frequency™ technology, a quantitative EEG (q-EEG), or brain map, to their treatment. Progress is formally reviewed multiple times a week, and our outcomes are independently measured by Trac9, resulting in some of the top outcomes in the nation for three years running.
We don’t discharge on a calendar; we discharge on goals. A standard 30-day model simply isn’t built to fully address a co-occurring mental health condition. Our length of stay is based on individual clinical progress, not an arbitrary number of days.
We take trauma seriously, including for veterans and first responders. Our Founder, Shannon Malish, is the wife of a veteran and an active police officer, and treating PTSD in veterans and first responders is personal to our team, not just a program checkbox.
We stand behind our model. Through the Windmill Guarantee, clients who complete our program and post-treatment protocol and still need to return within a year can come back at no additional cost, backed by lifetime access to aftercare and a personal recovery coach.
Only 12.7% of adults with a co-occurring SUD and mental illness receive truly integrated care, according to this year’s data. Closing that gap, especially where trauma is the root cause, is the entire reason our program exists.
If Any of This Sounds Familiar
If you recognize your own situation, or a loved one’s, in these numbers (a substance use problem tangled up with anxiety, depression, trauma, or another mental health condition), don’t try to sort out on your own whether Windmill is the right fit. Call our admissions team first. They can walk through your specific situation, insurance, and level-of-care needs at no obligation, and help you understand what integrated treatment could actually look like. Explore our insurance and admissions process online. Windmill Wellness Ranch serves adults aged 18 and older.
Contact Our Admissions Team Today
Frequently Asked Questions
What is a co-occurring disorder, or dual diagnosis?
A co-occurring disorder, also called a dual diagnosis, is when someone has both a substance use disorder and a mental health condition, such as depression, anxiety, PTSD, or bipolar disorder, at the same time. According to SAMHSA’s 2025 data, an estimated 18.5 million adults fall into this category.
Why is treating co-occurring disorders together more effective than treating them separately?
Integrated treatment is more effective because it addresses the root cause, often trauma or an unmanaged mental health condition, alongside the substance use itself, rather than treating one and leaving the other to drive relapse. A coordinated care team treats both conditions together instead of routing a person through separate, disconnected systems.
What percentage of people with a substance use disorder get treatment?
According to SAMHSA’s 2025 National Survey on Drug Use and Health, 84% of the 47.2 million Americans aged 12 and older who needed SUD treatment did not receive it that year.
Does Windmill Wellness Ranch treat mental health conditions in addition to addiction?
Yes. Windmill Wellness Ranch is a dual-diagnosis, co-occurring treatment center. Our clinical team diagnoses and treats depression, anxiety, PTSD and trauma, bipolar disorder, personality disorders, and other mental health conditions alongside substance use disorders, using individualized therapy, medication management, and data-driven tools like Brain Frequency™ technology.
Where is Windmill Wellness Ranch located, and who does it serve?
Windmill Wellness Ranch is located on a 75-acre ranch in Canyon Lake, Texas, in the Hill Country near San Antonio, Austin, New Braunfels, and Boerne. We serve clients from those surrounding areas as well as clients traveling from across the country for our residential dual-diagnosis program.
How do I know if I need treatment for a co-occurring disorder?
If substance use is accompanied by ongoing symptoms of anxiety, depression, trauma, mood swings, or other mental health concerns, especially if one seems to fuel the other, it’s worth a professional evaluation. Windmill Wellness Ranch’s admissions team is available around the clock to talk through symptoms and next steps at no obligation.
Does Windmill Wellness Ranch treat teens or minors?
Windmill Wellness Ranch is an adult treatment program, serving clients aged 18 and older. If you’re looking for care for a child or adolescent, our admissions team is still happy to take your call and help point you toward the right next step.
Sources: Substance Abuse and Mental Health Services Administration (SAMHSA), 2025 National Survey on Drug Use and Health, released July 2026. Additional reporting via Behavioral Health Business, “3 Takeaways from SAMHSA’s Annual Report for SUD Treatment Pros” (July 2026).
