Co-occurring disorders in substance abuse treatment: Issues and prospects

Abstract

This paper explores the epidemiology of co-occurring disorders with an emphasis on the implications of study findings for the functioning and potential of substance abuse treatment. Severity of disorder is discussed as an issue that may have particular significance for the selection of specialized as opposed to traditional substance abuse treatment forms. Exploration is made, as well, of the resources currently available to substance abuse treatment, especially the human resources available, and the implications of resource availability for undertaking initiatives specific to co-occurring disorder. Findings from standard and enhanced treatment for comorbid individuals are examined in an effort to clarify areas of need for specialized and typical treatment personnel. Issues are raised for consideration by the clinical research and treatment provider communities in terms of assessment and diagnosis, manpower and training, and response to the challenge of relapse in this population.

Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings

“…(Flynn & Brown, 2008). The same studies, however, show that those with moderate to severe mental disorder comorbidity do not respond positively and require specialized treatment (Flynn & Brown, 2008).…”

“…Despite the release of guidelines, government initiatives, and increasing awareness of the poor outcomes associated with COD, the ongoing failure to identify and thereafter treat co-occurring mental disorders in substance misuse treatment is well documented (Flynn & Brown, 2008). In one large 3-year study that assessed the rates of detection of CODs in the New Jersey addiction treatment system, CODs were only detected in 22% of actual cases (N = 47,379;Hu, Kline, Huang, & Ziedonis, 2006).…”

“…In a review of a number of studies that surveyed current access to specialised psychiatric staff in the substance misuse treatment services in America, Flynn and Brown (2008) conclude that although evidence exists for an association between on site psychiatric staff and better treatment outcomes, such as retention and reduced substance use, the utility of such staff is moot because of their limited availability to public treatment programs. The research relied upon by these authors included research that reported a current dearth of postgraduate specialist mental health staff in the industry, a level of staff turnover so high that it jeopardized treatment program stability, and an inability to fill existing positions with staff competent to fill them due to an inability to offer appropriate remuneration.…”

“…The research relied upon by these authors included research that reported a current dearth of postgraduate specialist mental health staff in the industry, a level of staff turnover so high that it jeopardized treatment program stability, and an inability to fill existing positions with staff competent to fill them due to an inability to offer appropriate remuneration. These authors reported results indicating that substance misuse treatment services do not have adequate access to specialised mental health services (Flynn & Brown, 2008). Flynn and Brown conclude:…”

“…This research noted the poorer treatment response and outcomes experienced by those who suffer COD in treatment settings compared to those diagnosed with one disorder alone in such settings, (as noted above). Researchers also investigated whether sequential, parallel or integrated treatment produced better outcomes for the COD population -a question still the subject of debate although commentators favour integrated treatment (Flynn & Brown, 2008). Twenty-five years of COD research in treatment populations later, what has not improved is research into the screening, prevalence and nature of comorbidity in the treatment/clinical population.…”