Recovery From Comorbidity

Abstract

Comorbidity among mood, anxiety, and alcohol disorders is common and burdensome, affecting individuals, families, and public health. A systematic and integrative review of the literature across disciplines and research methodologies was performed. Supradisciplinary approaches were applied to the review and the ensuing critical appraisal. Definitions, measurement, and estimation are controversial and inconstant. Recovery from comorbidity cannot be easily extricated from a sociocultural milieu. Methodological challenges in quantitative and qualitative research and across disciplines are many and are discussed. The evidence supporting current treatments is sparse and short-term, and modalities operating in isolation typically fail. People easily fall into the cracks between mental health and addiction services. Clinicians feel untrained and consumers bear the brunt of this: Judgmental and moralistic interactions persist and comorbidity is unrecognized in high-risk populations. Competing historical paradigms of mental illness and addiction present a barrier to progress and reductionism is an impediment to care and an obstacle to the integration and interpretation of research. What matters to consumers is challenging to quantify but worth considering: Finding employment, safe housing, and meaning are crucial to recovery. Complex social networks and peer support in recovery are important but poorly understood. The focus on modalities of limited evidence or generalizability persists in literature and practice. We need to consider different combinations of comorbidity, transitions as opposed to dichotomies of use or illness, and explore the long-term view and emic perspectives.

A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population- a meta-analysis of 31 studies

“…In support of this statement, our results show a trend towards a higher and more stable relationship between anxiety and cannabis use disorders that might eventually require treatment ( OR = 1.68, 95% CI : 1.23-2.31), than cannabis use alone ( OR = 1.24, 95% CI : 1.06-1.45; Table 4 ). Similarly, higher rates of comorbidity would be expected in vulnerable populations often not included in the population-based surveys due to being homeless, imprisoned, or inpatient in psychiatric or rehabilitation institutions [ 66 ].…”

The Meaning of Recovery from Co-Occurring Disorder: Views from Consumers and Staff Members Living and Working in Housing First Programming

“…As such, the findings described above are important because they demonstrate the overlap in the experiences of those living with a single disorder and those living with co-occurring disorder. The frequent overlap between serious mental illness and substance abuse suggests that a significant number of participants in previous recovery studies were likely living with a co-occurring disorder; however, recovery related specifically to co-occurring disorder has not been sufficiently investigated (Carter et al 2013). Additionally, our findings demonstrate significant overlap in consumer and staff definitions of recovery, which, as far as the authors are aware, has not been demonstrated within a single study.…”

“…Those with co-occurring disorder are at higher risk for a number of negative outcomes (e.g., poor treatment response, homelessness, incarceration, substance use relapse, re-hospitalization) than those with a single disorder (Abram and Teplin 1991; Carter et al 2013; Caton et al 2005; Drake et al 1989; Susser et al 1991). One reason proposed for these negative outcomes is a lack of understanding of recovery as it relates to co-occurring disorder, which is rooted in the separation between mental health and substance abuse treatment systems that ignores the complex realities of co-occurring disorder (Drake et al 2008; White et al 2005).…”

“…One reason proposed for these negative outcomes is a lack of understanding of recovery as it relates to co-occurring disorder, which is rooted in the separation between mental health and substance abuse treatment systems that ignores the complex realities of co-occurring disorder (Drake et al 2008; White et al 2005). Qualitative research that investigates understandings and lived experiences of recovery as it relates to those with co-occurring disorder has the potential to guide the integration of mental health and substance abuse treatment systems to better serve this group; however, a paucity of research in this area currently exists (Carter et al 2013; Cruce et al 2012). …”

Supporting recovery in social work with persons having co-occurring problems – clients’ and professionals’ perceptions

“…It sets out to analyse how central participants in the treatment processclients and professionalsperceive the relevance of treatment-related factors for the recovery process. Research focusing on the person's own experience of both AOD and mental health problems is scarce (Carter, Fisher, and Isaac 2013;Cruce, Öjehagen, and Norström 2012;Ness, Borg, and Davidson 2014) but is stressed as important for gaining knowledge of factors that are important in their recovery process (Beredsford 2000;Davidson et al 2001).…”