Dual Treatment Best in Co-Occurring Disorders: Optimal Approach Is for Addiction Psychiatrists to Focus on Treatment, Leave Monitoring to Primary Care

Article excerpt

MIAMI -- In people with co-occurring substance use and mental health disorders, optimal treatment consists of brief screening and ongoing monitoring by primary care physicians, coupled with addiction psychiatry assessment and treatment, according to a presentation at the annual conference of the American Society of Addiction Medicine.

There are 14.9 million adults in the United States who meet criteria for a substance use disorder, and 19.4 million who meet criteria for serious psychological distress; 5.2 million meet criteria for both, according to the 2005 National Survey on Drug Use and Health.

"Of this 5.2 million, a remarkably small amount are coming into our treatment services," said Charlene E. Le Fauve, Ph.D., clinical psychologist and chief of the Co-Occurring and Homeless Activities Branch at the Substance Abuse and Mental Health Services Administration.

Almost half (48%) of this co-occurring disorder (COD) group gets no treatment at all. Approximately 5% get substance use treatment only, and about 6% get treatment for both substance use and a mental health disorder. Another 41% get treatment only for mental health problems, "but how many have positive, long-acting outcomes while treating one disorder and ignoring the other?" Dr. Le Fauve asked.

All individuals presenting for treatment for substance use should be screened for mental health problems and vice versa, Dr. Le Fauve said, because the presence of one type of disorder puts an individual at higher risk for developing the other type. For example, mood disorders, especially anxiety and depression, are very common in the addiction population.

Relationships between mental health and substance use disorders are often complex and challenging, Dr. Le Fauve said. Acute and chronic substance use can create psychiatric symptoms; substance withdrawal can cause psychiatric symptoms; and/or substance use can mask psychiatric symptoms. …