Mental Health and substance abuse care refers to an integrated approach to helping people who experience psychological or psychiatric/medical problems:(please, consult with a medical doctor/psychiatrist) together with problematic alcohol or drug use. When both occur, the term co-occurring disorders or dual diagnosis may often be used.
Key components
- Comprehensive assessment
- Mental health symptoms and diagnoses
- Alcohol and drug use patterns
- Trauma and adverse experiences
- Medical conditions and medications: (please, consult with a medical doctor/psychiatrist)
- Suicide and violence risk: Get Immediate emergency care.
- Social, family, housing, employment, and legal circumstances
Integrated treatment
Rather than treating substance abuse and mental health problems as completely separate issues, treatment addresses them together when appropriate.
Evidence based interventions
- Depending on the person’s needs, these may include:
- Motivational interviewing (MI)
- Cognitive behavioral therapy (CBT)
- Relapse prevention approaches
- Trauma informed care
- Contingency management
- Medication treatment when indicated: (please, consult with a medical doctor/psychiatrist)
- Peer/recovery support
- Family therapy
- Psychiatric treatment: (please, consult with a psychiatrist)
Relapse prevention
Treatment helps identify triggers, cravings, high risk situations, emotional states, and thinking patterns that may contribute to renewed substance abuse.
Harm reduction
Recovery may not always begin with complete abstinence. Harm reduction approaches may reduce immediate risks while helping the person move toward healthier patterns and, when desired and appropriate, abstinence.
Continuity of care
Effective care may involve coordination among therapists, psychiatrists, primary care providers, addiction specialists, social workers, peer support programs, and other professionals.
An important clinical principle
A useful framework may be:
Treat the person, not merely the diagnosis.
For example, depression may contribute to alcohol drinking, while heavy alcohol drinking may worsen depression. Anxiety may lead someone to use and abuse cannabis or abuse alcohol for short term relief, while substance abuse may subsequently increase anxiety. The relationship may therefore become a self-reinforcing cycle.
Mental health and substance use cycle
Psychological distress…substance abuse…temporary relief…consequences/withdrawal…increased distress…increased risk of further abuse
Treatment attempts to interrupt that cycle while developing healthier coping skills, emotional regulation, social support, and recovery resources.
In short: Mental Health and substance abuse care may increasingly understood as integrated, person centered, trauma informed, and recovery oriented care, rather than two completely separate treatment systems.
Shervan K Shahhian
