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4/24/20131

Tennessee Co-Occurring Disorders Collaborative

STRENGTHENING INDIVIDUALS, FAMILIES, AND COMMUNITIES THROUGH EDUCATION AND AWARENESS

MAKING CONNECTIONSFOR RECOVERY

Integrating Treatment

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SAMHSA’s 2002 report to Congress defines co-occurring disorders as:

Individuals who have at least one mental disorder as well as an alcohol or drug use disorder. While these disorders may interact differently in any one person

(e.g.,

an episode of depression may trigger a relapse into alcohol abuse, or cocaine use may exacerbate schizophrenic symptoms

)

, at least one disorder of each type can be diagnosed independently of the other.

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The term “co-occurring disorders” typically refers to having one or more diagnosed mental illness coupled with one or more addictive disorder.

Simply put,



Are Co-Occurring Disorders Common?

As a matter of fact,

YES



41% to 65.5% with Substance Use Disorder (SUD) have at least one Mental Health (MH) disorder; 51% with a MH disorder also have at least one SUD (Kessler et al).



10 million U.S. residents each year.

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As a matter of fact,

YES

Are Co-Occurring Disorders Common?



10% account for 71% of our nation’s healthcare costs. Two-thirds of that 10% are diagnosed with co-occurring MH/SUD (Buck, 2001, CMHS Office of Managed Care).



It is estimated that 196,000 Tennesseans suffer from co-occurring disorders. (National Household Survey, 2008 noted that 393,000 Tennesseans reported dependence or abuse of illicit drugs or alcohol. This estimate is based on NHS and national COD prevalence data.)

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Parallels (Minkoff)

1.

Biological (no fault) illness

2.

Hereditary (in part)

3.

Chronicity

4.

Incurability

5.

Leads to lack of control of behavior and emotions

6.

+ and –symptoms

7.

Affects the whole family

8.

Disease progresses without treatment

9.

Symptoms can be controlled with proper treatment

10.

Disease of denial, (both disease & its chronicity)

11.

Facing the disease can lead to depression & despair

12.

Disease is often seen as a “

moral issue

” & personal weakness rather than biological

13.

Feelings of guilt & failure

14.

Feelings of shame & stigma

15.

Physical, mental and spiritual disease

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Mental IllnessAddiction

Which came first . . .

There are several hypotheses regarding the onset and direction of co-occurring disorders. Science has not settled on one specific explanation and there may be multiple causal factors. The prevalence of co-occurring mental illness and addiction does not necessarily prove causation.

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Drug abuse may bring about symptoms of another mental illness

. Increased risk of psychosis in vulnerable marijuana users suggests this possibility.

Mental disorders can lead to drug abuse

, possibly as a means of “self-medication.” Patients suffering from anxiety or depression may rely on alcohol, tobacco, and other drugs to temporarily alleviate their symptoms.

These disorders could also be caused by shared risk factors, such as—

Overlapping genetic vulnerabilities

. Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.

Overlapping environmental triggers

. Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common environmental factors that can lead to addiction and other mental illnesses.

National Institute of Health, 2010

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Involvement of similar brain regions

.Brain systems that respond to reward and stress, for example, are affected by drugs of abuse and may show abnormalities in patients with certain mental disorders.

Drug use disorders and other mental illnesses are developmental disorders

.That means they often begin in the teen years or even younger—periods when the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. Also, early symptoms of a mental disorder may indicate an increased risk for later drug use.

National Institute on Drug Abuse, 2010

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Early Occurrence Increases Later Risk

. Strong evidence has emerged showing early drug use to be a risk factor for later substance abuse problems; additional findings suggest that it may also be a risk factor for the later occurrence of other mental illnesses. However, there are several factors at play: genetic vulnerability, psychosocial experiences, and/or general environmental influences. A 2005 study highlights this complexity, with the finding that frequent marijuana use during adolescence can increase the risk of psychosis in adulthood, but only in individuals who carry a particular gene variant.


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It is also true that

having a mental disorder in childhood or adolescence can increase the risk of later drug abuse problems

, as frequently occurs with conduct disorder and untreated attention-deficit hyperactivity disorder (ADHD). This presents a challenge when treating children with ADHD, since effective treatment often involves prescribing stimulant medications with abuse potential. This issue has generated strong interest from the research community, and although the results are not yet conclusive, most studies suggest that ADHD medications do not increase the risk of drug abuse among children with ADHD.Regardless of how comorbiditydevelops, it is common in youth as well as adults. Given the high prevalence of comorbidmental disorders and their likely adverse impact on substance abuse treatment outcomes, drug abuse programs for adolescents should include screening and, as needed, treatment for comorbidmental disorders.


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Poorer functioning and outcomesHigher rates of relapse

Significantly higher physical healthcare costs and more severe and chronic medial conditions

At least 50% of individuals who are homeless have COD (SAMHSA, 2011)

Increased emergency service use

Increased criminal justice involvement and arrests

The Impacts of Co-OccurringDisorders

Higher risk for HIV and higher rates of HIV infection

Slower treatment progress

More likely to be refused admission or to be prematurely discharged from A&D and MH treatment

59% more inpatient psychiatric admissionsPrimary predictor of readmissionMajor predictors of excessive inpatient utilization