Providing treatment with persons with co-occurring disorders has been a state and national dilemma for many years.
The National Survey on Drug Use and Health (NSDUH) includes questions for adults aged 18 or older to assess serious mental illness (SMI) during the year prior to the survey interview. SMI is defined for this report as having had at some time during the past year a diagnosable mental, behavioral, or emotional disorder that met criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV),1 and resulted in functional impairment that substantially interfered with or limited one or more major life activities. NSDUH measures SMI using the K-6 distress questions.2,3 NSDUH also includes a series of questions to assess dependence on or abuse of alcohol or an illicit drug. Illicit drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically. These questions are designed to measure dependence and abuse based on criteria specified in the DSM-IV. For the purpose of this report, individuals with either alcohol or drug dependence or abuse are said to have a substance use disorder, and individuals with both SMI and a substance use disorder are said to have co-occurring SMI and a substance use disorder.4
NSDUH respondents also were asked about their experiences with mental health or specialty substance use treatment during the past year. Mental health treatment is defined as the receipt of treatment or counseling for any problem with emotions, "nerves", or mental health in the 12 months prior to the interview in any inpatient or outpatient setting; it also includes the use of prescription medication for treatment of a mental or emotional condition.5 Specialty substance use treatment is defined as treatment received at alcohol or drug rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), or mental health centers.6
Prevalence of Co-Occurring Disorders
In 2002, 17.5 million adults aged 18 or older were estimated to have SMI in the past year. This represents about 8 percent of all adults. About 23 percent (4 million) of adults with SMI in 2002 also were dependent on or abused alcohol or an illicit drug (had co-occurring SMI and a substance use disorder). Among adults without SMI, the rate of dependence or abuse was only about 8 percent (Figure 1).
More than half of adults (a total of 2 million persons) with co-occurring SMI and a substance use disorder received neither mental health nor specialty substance use treatment during the past year (Figure 2). Among adults with co-occurring disorders, 34 percent received mental health treatment only, 2 percent received specialty substance use treatment only, and 12 percent received both mental health and specialty substance use treatment during the past year.
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Figure 1. Percentages with Substance Dependence or Abuse in the Past Year, among Adults Aged 18 or Older, by Past Year SMI: 2002 |
Figure 2. Receipt of Mental Health or Substance Use Treatment in the Past Year among Adults Aged 18 or Older with Co-Occurring SMI and a Substance Use Disorder: 2002 |
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Receipt of Mental Health Treatment
Among adults with co-occurring SMI and a substance use disorder, the following persons were more likely to have received mental health treatment during the past year: females were more likely than males (54 vs. 39 percent, Figure 3) and adults aged 26 to 49 were more likely than young adults aged 18 to 25 (53 vs. 36 percent). 7 The rate of mental health treatment received during the past year among adults with co-occurring disorders was similar in metropolitan counties (47 percent) and in non-metropolitan counties (44 percent).
Receipt of Specialty Substance Use Treatment
Among adults with co-occurring SMI and a substance use disorder, the rate of specialty substance use treatment received during the past year was similar among males (16 percent) and females (11 percent). Adults aged 26 to 49 with co-occurring disorders were more likely to have received specialty substance use treatment during the past year than those aged 18 to 25 (18 vs. 6 percent). The rate of specialty substance use treatment during the past year among adults with co-occurring disorders was higher in metropolitan counties than in non-metropolitan counties (15 vs. 8 percent).
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Figure 3. Percentages Who Received Mental Health Treatment in the Past Year among Adults Aged 18 or Older with Co-Occurring SMI and a Substance Use Disorder, by Gender: 2002 |
Figure 4. Perceived Unmet Need for Past Year Mental Health and Substance Use Treatment among Untreated Adults Aged 18 or Older with Co-Occurring SMI and a Substance Use Disorder: 2002 |
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Perceived Unmet Treatment Need
In 2002, among the 2 million adults with co-occurring SMI and a substance use disorder who had not received treatment, 24 percent perceived an unmet need for mental health treatment in the past year, only 6 percent perceived an unmet need for specialty substance use treatment in the past year, and only 9 percent perceived an unmet need for both specialty substance use treatment and mental health treatment in the past year (Figure 4). About 61 percent of adults with co-occurring SMI and a substance use disorder who had not received treatment perceived no unmet need for either specialty substance use treatment or mental health treatment in the past year.
Co-Occurring Disorders at the Mental Health Cooperative
The Mental Health Cooperative (MHC) has been a state and national leader in the treatment of consumers with severe and persistent mental illness (SPMI) since 1993. Due to the increasing numbers of these consumers having comorbid alcohol and/or drug dependence, MHC has developed a state of the art out-patient treatment program for this population. MHC has based their model of care for treating consumers at “point of service” and incorporates a case management system of delivering care coupled with evidence based medical treatment of both disorders simultaneously. Research has shown that treating both disorders at one place has better outcomes.
Additionally, MHC offers 24 hours, 7 day a week crisis services. The Mental Health Cooperative has a certified addictionologist as the medical director and all case managers and providers are trained in both addiction treatment and other psychiatric illnesses. Treatment is integrated and on going. Each consumer has an individualized treatment plan. MHC offers both adult and adolescent services. Our philosophy---“There IS Life after Diagnosis”