Concurrent Disorders
Co-ocurring Disorders
Last Updated (Saturday, 29 March 2008 20:12) Monday, 25 February 2008 06:50
Substance Abuse and Mental Illness
Individuals with co-occurring illnesses are a distinct group with specialized treatment requirements. Because of the differing perspectives on these groups of illnesses, neither the mental health nor the substance abuse systems of care are prepared to respond to these combined conditions. Individuals with co-occurring illnesses often fall between the cracks in these systems resulting in the over utilization of police and medical crisis services, homeless shelters and correctional facilities. There is growing recognition that individuals treated in either the mental health or substance abuse systems are likely to have elements of both types of illness.
Because of the complicated interaction between substance abuse disorders and mental illness, researchers are attempting to reorganize how we conceptualize these disease entities so that more appropriate treatment protocols can be developed. The term "concurrent" illness is preferred because it emphasizes that mental health and substance abuse constitute a plurality rather than a duality. Typically individuals presenting for treatment will have multiple mental illnesses and be abusive or dependent upon multiple substances.
http://www.hc-sc.gc.ca/ahc-asc/pubs/drugs-drogues/bp_disorder-mp_concomitants/disorders-troubles_e.html
Because of the complicated interaction between substance abuse disorders and mental illness, researchers are attempting to reorganize how we conceptualize these disease entities so that more appropriate treatment protocols can be developed. The term "concurrent" illness is preferred because it emphasizes that mental health and substance abuse constitute a plurality rather than a duality. Typically individuals presenting for treatment will have multiple mental illnesses and be abusive or dependent upon multiple substances.
http://www.hc-sc.gc.ca/ahc-asc/pubs/drugs-drogues/bp_disorder-mp_concomitants/disorders-troubles_e.html
Concurrent Disorders in the Adolescent Population
Concurrent or co-occurring illnesses are evident in the adolescent population where studies show that 75-80% of adolescents receiving inpatient care for substance abuse have a co-occurring mental disorder. Adolescents who demonstrate behavioral or emotional problems are nearly four times as likely to have a substance-use disorder than are children without these problems.
- Nearly two-thirds of incarcerated youth with substance use disorders have at least one other mental health disorder.
- A number of studies have shown an association between conduct disorder, attention deficit hyperactivity disorder (ADHD), and substance abuse. For example, as many as 50% of substance abusing juvenile offenders have ADHD.
- Youth who have co-occurring conduct problems, ADHD, and substance use disorders have higher than normal rates of anxiety and depressive disorders, and the presence of ADHD in particular worsens the prognosis of both the substance use disorder and the conduct disorder, increasing the likelihood of these persisting into adulthood.
- Among the juvenile justice population, mood disorders such as depression appear to co-occur with substance abuse problems more frequently than among youth generally.
- Among incarcerated youth with substance use disorders, nearly one-third have a mood or anxiety disorder.
- Delinquents with substance abuse and behavioral disorders such as conduct disorder and ADHD engage in higher rates of crime and exhibit more alcohol and illicit drug use than do youth with mood disorders and are at higher risk for out-of-home placement and other poor outcomes.
- Many incarcerated youth are exposed to high levels of traumatic violence which may result in symptoms of posttraumatic stress as well as increased rates of substance abuse.
Understanding Co-occurring Disorders
Science is working to understand the basis for the fact that mental illnesses and substance abuse disorders tend to occur in clusters. One theory is that individuals might use illicit drugs or alcohol in an attempt to medicate an underlying mental illness like anxiety or depression. Other researchers point to the fact that individuals who are likely to misuse substances are also inclined to engage in high-risk behaviors or to be impulsive. And still other research puts stress as the underlying causal factor in both disorders. Recent studies indicate that for adolescents who later develop substance-use disorders, 80% had a preexisting mental illness.
Treatment for Co-occurring Disorders
Research has repeatedly demonstrated that the most effective treatment occurs when mental health and substance abuse disorders are treated concurrently.
You will know if you are receiving integrated treatment because your clinician or treatment team will do several things at the same time, including:
- Help you think about the role that alcohol and other drugs play in your life. This should be done confidentially, without any negative consequences. People feel free to discuss these issues when the discussion is confidential and nonjudgmental.
- Offer you a chance to learn more about alcohol and drugs, to learn about how they interact with mental illnesses and with medications, and to discuss your own use of alcohol and drugs.
- Help you become involved with supported employment and other services that may help your process of recovery.
- Help you identify and develop your own recovery goals. If you decide that your use of alcohol or drugs may be a problem, a counselor trained in integrated dual disorders treatment can help you identify and develop your own recovery goals. This process includes learning about steps toward recovery from both illnesses.
- Provide special counseling specifically designed for people with dual disorders. If you decide that your use of alcohol or drugs may be a problem, a trained counselor can provide special counseling specifically designed for people with dual disorders. This can be done individually, with a group of peers, with your family, or with a combination of these.
The Link Between AD/HD and Substance Use Disorders
Dr. Brooke Molina addressed questions regarding the persistent risk of vulnerability to adult substance use for those diagnosed with ADHD in childhood. She reported results from her team’s longitudinal study on children with ADHD (Pittsburgh ADHD Longitudinal Study, Co-Pls Molina and William E. Pelham, Jr., Ph.D., funded by NIAAA/NIDA), in which they followed more than 350 children diagnosed with ADHD and 240 without ADHD through adolescence into early adulthood.