Many addicts and alcoholics also suffer from mental health problems. Here are 12 suggestions to guide a treatment strategy.

People who suffer from both mental health and substance use disorders present the clinician with a unique set of challenges. Only in recent decades have we begun to accurately identify and effectively treat such co-occurring conditions. But after a slow start, progress is finally being made.

In the mid-1990s mental health agencies and treatment providers for addiction recognized that patients presenting with co-occurring disorders required clinical services beyond their existing capabilities. At the point of entry to public and private facilities, many patients were literally “falling through the cracks.” On the one hand, mental health services were challenged by patients whose primary disorders were schizophrenia, bipolar disorder, and major depressive disorders at the “high end” and adjustment disorders at the “low end.” However, the clinical presentations of many patients suffering from these problems were compounded by secondary—and equally serious—substance use disorders that mental health facilities were ill equipped to treat. On the other hand, facilities for alcoholism and addiction treatment found that entry-level patients met their criteria for admission, but mental health issues were interfering with accurate assessment and “best practices” therapy.

The research and literature were literally in their “infancy.” Evidenced-based treatment was just beginning to show results. An effort to bridge the gap between mental health treatment and substance abuse treatment was in order. Collaboration between the clinical and the administrative components of agencies providing services to these two distinct medical conditions was necessary.

Over the next decade both types of agencies slowly began to change in order to meet the needs of patients with co-occurring disorders. Now there is widespread recognition that this challenging population requires its own tailored treatment. Yet some “hard-liners” still resist these changes, holding onto old practices or not fully implementing new guidelines. They fail to accept the evidence of many epidemiological studies that mental health disorders and substance use disorders are not separate issues but “co-exist” in a large segment of the population that we treat.

The following list condenses my long experience assessing and treating people with co-occurring mental health and substance use disorders into 12 principles that every clinician needs to know. Read More…