The Substance Abuse and Mental Health Services Administration (SAMHSA) states that more than half of the adults with severe mental illness in public mental health systems are have co-occurring substance use disorders. SAMHSA further indicates that 50% - 75% of clients in substance abuse treatment programs have co-occurring disorders.
Co-occurring disorders occur on a biaxial continuum where the severity of substance abuse and mental disorders vary from mild to severe. The four quadrant model is well known and is a useful conceptual tool for illustrating the interplay of substance abuse and mental disorders. However, it is limited as a schema for the clinical or systems response to co-occurring disorders.
In California, persons receiving publicly funded mental health treatment must meet a medical necessity threshold of severe mental illness. As a result, substance abuse treatment programs are more likely to see persons with severe AOD dependence combined with mild- to moderate-severity mental disorders, most commonly depressive, bipolar, panic and anxiety disorders. In addition, PTSD, borderline personality and antisocial personality disorders are not uncommon.
Effective treatment of co-occurring disorders can be both a clinical and organizational challenge. ADPI works to advance the field in both domains.
ADPI Reports and Analysis
Report on Co-Occurring Disorders Prepared for The California Co-Occurring Joint Action Council (COJAC).
This document is a discussion of systems level issues and recommendations for addressing the needs of individuals with co-occurring substance abuse and mental illness.
Advancing California's Continuum of Care for Persons With Co-Occurring Substance Use and Mental Health Disorders: A Statement of CADPAAC-Supported Positions.
In California and throughout the nation, there is a high prevalence of co-occurring disorders. Yet coordinated, integrated treatment remains largely unavailable. The County Alcohol and Drug Program Administrators Association of California (CADPAAC) commissioned ADPI to produce this paper which identifies nine positions that county alcohol and drug programs can jointly assert to persons influencing state and local policy as well as to persons influencing the operational/service-delivery (practice) side of addressing co-occurring disorders. This paper also begins to outline specific roles for CADPAAC and counties as they work to overcome barriers that prevent advancement.
The Treatment of Depression with Co-Morbid Alcohol and/or Drug Disorders
Epidemiological data indicate that Major Depressive Disorder (MDD) impacts a significant minority of individuals in the United States general population. Further, having an MDD is associated with increased risk for Substance Use Disorders (SUD). These data also indicate that among individuals seeking treatment the rates of co-occurring SUD and MDD are notably higher than among the general public. Those at highest risk for co-occurring MDD and SUD are likely male, younger, unmarried, and White. Research evidence supports the use of motivational interviewing, cognitive behavioral therapy and contingency management in the treatment of co-occurring SUD and MDD.
An Exemplary Program For Women Offenders With Co-Occurring Disorders: Key Recommendations For Implementation And Replication
This report provides a detailed review of the key issues relevant to treating drug dependent women offenders in the community and outlines recommendations for service delivery. Women in the criminal justice system have more complex treatment needs than their male counterpart. They typically present with extensive histories of sexual and physical abuse; severe trauma; chronic addiction; and mental health problems. Moreover, histories of abuse, addiction, and mental illness are the most common predictors of recidivism for women offenders. Achieving successful outcomes for this population requires multi-agency collaborations, primarily between criminal justice agencies, community agencies, and researchers in order to reduce the number of women offenders returning to prison and to facilitate the successful reintegration of women offenders back into our communities.
Older Adults and Co-Occurring Disorders
Substance use among the elderly may exacerbate preexisting mental health problems as well as complicate treatment for physical health problems. Conversely, mental health disorders among older adults, particularly depression, are a risk factor for substance misuse. This paper provides an overview of current research and an assessment of key issues relevant to COD among older adults based on a review of published literature. Topics covered include the following in relation to older adults: (1) prevalence of substance use disorders, with specific attention to use of alcohol, heroin/opioids, and prescription drugs; (2) prevalence of mental health disorders; (3) treatment seeking and utilization; (4) treatment processes; (5) treatment outcomes, including findings from long-term outcome studies; and (6) recommendations for future directions in treatment planning and policy development.
Trauma and Co-Occurring Disorders Among Youth
Trauma is a major contributing factor to the development of co-occurring disorders in young people. In addition, young people who use drugs and alcohol put themselves at risk for further trauma and complicate assessment and treatment. This report provides a discussion of the complex interplay of trauma, mental illness, substance use and adolescent development. Effective treatment strategies for youth require trauma informed systems of care that not only integrate both substance abuse and mental health services, but offer a range of innovative and comprehensive services. In order to engage and retain these youth in our services we must stop using adult models to treat them, offer developmentally appropriate services, and be open to harm reduction and alternative strategies of proven effectiveness.
Links to Other Resources on Co-Occurring Disorders
