A Clinician-Researcher Tackling the Overlooked Crisis of Co-Occurring Disorders

Orrin D. Ware, PhD, MPH, MSW, has spent his career on the front lines of overdose, addiction and mental health care. The through line is clear: Co-occurring disorders are everywhere, but coordinated treatment still isn’t.

“What I’ve often found, especially working in the clinical setting, is that folks may be experiencing a mental health disorder, and they may use a substance to cope,” he said. “And that can ultimately cause someone to develop a substance use disorder.”

For Ware, this isn’t just a clinical observation. It’s a systems problem — one shaped by trauma, housing insecurity, employment instability and other stressors that compound over time.

“It’s not just that one condition,” he said. “It’s often a constellation of different factors that are impacting that person’s life.”

That understanding is personal. Ware grew up in Oxon Hill, Maryland, just outside Washington, D.C., an area that experienced the impacts of the crack epidemic. He watched as people who needed support and treatment were instead incarcerated and pushed deeper into the criminal justice system.

Today, living in Baltimore — a city long impacted by heroin and opioids — he sees how widespread the crisis remains.

“So many people are struggling,” he said. “If it’s not you, it’s your family member, it’s your friend, it’s your neighbor, it’s your co-worker.”

In crisis stabilization settings, Ware worked with people who had been revived by emergency medical services after overdosing — sometimes just hours earlier. In those moments, he heard what many people outside those settings never hear: the domestic violence, the grief, the trauma and the deep desire to get better.

He also saw how often people didn’t know where to go or who to trust.

“Oftentimes just being there to listen to their stories seemed to have an immense benefit,” he said, especially when paired with concrete help navigating services.

When Ware talks about why people fall through the cracks, he doesn’t blame individuals. He points to barriers built into the system: wait lists, lack of insurance coverage, child care needs, language access and transportation.

One of the most persistent challenges, he said, is the siloed structure of care. Mental health and substance use treatment are often separated into different facilities, leaving people with co-occurring needs forced to treat one condition at a time.

“There’s a minority of facilities that can specialize in treating these co-occurring conditions,” he said, “which leads me to having to receive treatment from the mental health facility first or the substance use facility first.”

That’s where implementation science comes in. Ware describes it as central to his work: identifying where the gaps are, learning what treatment sites need to provide coordinated care, and partnering with clinicians, administrators and people with lived experience to implement real-world improvements — then measuring what changes.

Before joining the C-DIAS fellowship, Ware worked as a licensed clinical social worker and public health practitioner. While he had firsthand experience in the field, he said the fellowship has helped him build a deeper foundation in implementation science — and connect with a national network of mentors and colleagues.

He learned about the opportunity through Dr. Maggie Sweeney, who was a mentor during his postdoctoral fellowship and knew immediately it was the right fit.

“The moment she sent it to me, I thought, this looks perfect,” he said.

Outside of work, Ware stays grounded through running, strength training and reading widely — driven by curiosity about the human experience.

His path reflects a clear commitment: building systems that treat co-occurring mental health and substance use needs as the intertwined realities they are, and making it easier for people to access the coordinated care they deserve.