Academic journal article Alcohol Research

Integrating Care for People with Co-Occurring Alcohol and Other Drug, Medical, and Mental Health Conditions

Academic journal article Alcohol Research

Integrating Care for People with Co-Occurring Alcohol and Other Drug, Medical, and Mental Health Conditions

Article excerpt

Most people with alcohol and other drug (AOD) use disorders suffer from cooccurring disorders (CODs), including mental health and medical problems, which complicate treatment and may contribute to poorer outcomes. However, care for the patients' AOD, mental health, and medical problems primarily is provided in separate treatment systems, and integrated care addressing all of a patient's CODs in a coordinated fashion is the exception in most settings. A variety of barriers impede further integration of care for patients with CODs. These include differences in education and training of providers in the different fields, organizational factors, existing financing mechanisms, and the stigma still often associated with AOD use disorders and CODs. However, many programs are recognizing the disadvantages of separate treatment systems and are attempting to increase integrative approaches. Although few studies have been done in this field, findings suggest that patients receiving integrated treatment may have improved outcomes. However, the optimal degree of integration to ensure that patients with all types and degrees of severity of CODs receive appropriate care still remains to be determined, and barriers to the implementation of integrative models, such as one proposed by the Institute of Medicine, remain. KEY WORDS: Alcohol and other drug use (AODU) disorders; comorbidity; cooccurring disorders; mental health; health care; treatment; treatment outcomes; integrated treatment; combined treatment

It is widely recognized that the majority of patients with alcohol use problems also suffer from cooccurring mental health and medical problems. Cooccurring disorders (CODs) complicate the treatment process and, in many cases, contribute to poorer outcomes (Drake et al. 1996; Rosenthal andWestreich 1999) as well as higher service utilization and costs over time (Curran et al. 2008; Lennox et al. 1993). In the past, clinicians within each treatment setting-alcohol treatment, mental health, and general medicine-frequently treated COD patients as they would patients with only one of these disorders; however, such treatment is not well suited to the special needs of patients with CODs (Rosenthal andWestreich 1999). Extensive research has documented the need to treat all conditions from which patients suffer and has identified many key components of the best practices for achieving this goal (Goldman et al. 2000; Minkoff 1991; Minkoff and Ajilore 1998;Osher 1996).Moreover, a growing body of research suggests that integrated approaches to treatment may improve the outcomes of patients with alcohol problems (Craig et al. 2008; Drake et al. 2004, 2008; Goldman et al. 2000; Minkoff and Ajilore 1998; Osher 1996). Although optimally integrated care still is the exception in most treatment settings, interest in this approach is mounting, and many programs are attempting to incorporate integrated models of care.

This articles draws from the framework established in the Institute of Medicine (IOM) (2006) report, Improving the Quality of Health Care for Mental and SubstanceUse Conditions, and other literature to consider the state of integrated care for people with alcohol problems and CODs. It examines how integrated approaches can make treatment more attractive to patients and contribute to higher retention rates and better outcomes, and discusses strategies and mechanisms that facilitate greater integration. It also considers barriers that impede optimal coordination of care for CODs, including organizational fragmentation; stigma; financing mechanisms; and the complex issues of confidentiality, patient safety, and the free flow of information necessary to implement integrated treatment approaches. Throughout the article, the term "disorder" refers to alcohol or other drug (AOD) use problems that meet the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for abuse or dependence. The term "unhealthy use" describes less severe but problematical AOD use. …

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