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Chapter 9 - Comorbid Substance Use and Mental Illness

Published online by Cambridge University Press:  02 November 2021

By
Michael Kelleher  and
Luke Mitcheson
Edited by
Ed Day
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Summary

Psychiatric disorders are much more prevalent in the population with substance use disorders than they are in the general population. The co-existence of mental health and substance use disorders is associated with high levels of mortality and morbidity, linked to exclusion from mainstream services and unmet need. This chapter explores current policy guidance for services in England, focusing on the key themes of ‘no wrong door’ and ‘everyone’s job’. The elements of service organisation and delivery are considered at all levels, including the importance of care planning, communication, engagement, crisis services and training and support for staff. Interventions for co-occurring disorders are reviewed, including psychoeducation, pharmacology and mutual aid approaches. The chapter ends on a note of optimism that greater understanding of comorbid conditions will bring a more rational and equitable approach to this complex issue.

Keywords

comorbidityprevalenceexclusionunmet needpolicyservice organisationengagementcare planning
Type
Chapter
Information
Seminars in Addiction Psychiatry , pp. 163 - 174
Publisher: Cambridge University Press
Print publication year: 2021

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References

National Institute for Health and Care Excellence. Coexisting Severe Mental Illness and Substance Misuse: Community Health and Social Care Services. London: NICE; 2016.Google Scholar
Public Health England. Better Care for People with Co-Occurring Mental Health and Alcohol/Drug Use Conditions: A Guide for Commissioners and Service Providers. London: PHE; 2017.Google Scholar
Farrell, M., Howes, S., Bebbington, P., Brugha, T., Jenkins, R., Lewis, G. et al. Nicotine, alcohol and drug dependence and psychiatric comorbidity: Results of the national household survey. British Journal of Psychiatry. 2001; 179: 432–7.Google Scholar
Drummond, C., McBride, O., Fear, N., Fuller, E. Alcohol Dependence (chapter 10). In: McManus, S., Bebbington, P., Jenkins, R, Brugha, T., eds. Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital; 2016. p. 238–64.Google Scholar
Lai, H. M. X., Cleary, M., Sitharthan, T., Hunt, G. E. Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: A systematic review and meta-analysis. Drug and Alcohol Dependence. 2015; 154: 1–13.Google Scholar
Weaver, T., Madden, P., Charles, V., Timso, G. S., Renton, A., Tyrer, P. et al. Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry. 2003; 183: 304–13.Google Scholar
Carrà, G., Johnson, S., Crocamo, C., Angermeyer, M. C., Brugha, T., Azorin, J. M. et al. Psychosocial functioning, quality of life and clinical correlates of comorbid alcohol and drug dependence syndromes in people with schizophrenia across Europe. Psychiatry Research. 2016; 239: 301–7.CrossRefGoogle ScholarPubMed
Senior, J., Birmingham, L., Harty, M. A., Hassan, L., Hayes, A. J., Kendall, K. et al. Identification and management of prisoners with severe psychiatric illness by specialist mental health services. Psychological Medicine. 2013; 43 (7): 1511–20.Google Scholar
Fazel, S., Geddes, J. R., Kushel, M. The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet. 2014; 384 (9953): 1529–40.Google Scholar
Department of Health. Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. London: Department of Health; April 2002.Google Scholar
NHS England, National Collaborating Centre for Mental Health, National Institute for Health and Care Excellence. Achieving Better Access to 24/7 Urgent and Emergency Mental Health Care. Part 2: Implementing the Evidence-based Treatment Pathway for Urgent and Emergency Liaison Mental Health Services for Adults and Older Adults: Guidance. 2016.Google Scholar
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction. 1993; 88 (6): 791–804.Google Scholar
WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002; 97: 1183–94.Google Scholar
Independent Expert Working Group. Drug Misuse and Dependence: UK Guidelines on Clinical Management. London: Department of Health; 2017.Google Scholar
National Collaborating Centre for Mental Health. Drug Misuse: Psychosocial Interventions. London: British Psychological Society and The Royal College of Psychiatrists; 2008.Google Scholar
Buckman, J. E. J., Naismith, I., Saunders, R., Morrison, T., Linke, S., Leibowitz, J. et al.The impact of alcohol use on drop-out and psychological treatment outcomes in improving access to psychological therapies services: An audit. Behavioural and Cognitive Psychotherapy. 2018; 46 (5): 513–27.CrossRefGoogle ScholarPubMed
Improving Access to Psychological Therapies. IAPT positive practice guide for working with people who use drugs and alcohol. London: IAPT, Drugscope, NTA; 2012.Google Scholar
Hunt, G. E., Siegfried, N., Morley, K., Brooke‐Sumner, C., Cleary, M. Psychosocial Interventions for People with Both Severe Mental Illness and Substance Misuse. Cochrane Database of Systematic Reviews. 2019(12).Google ScholarPubMed
Agabio, R., Trogu, E., Pani, P. P. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database of Systematic Reviews. 2018(4).Google ScholarPubMed
Temmingh, H. S., Williams, T., Siegfried, N., Stein, D. J. Risperidone versus other antipsychotics for people with severe mental illness and co‐occurring substance misuse. Cochrane Database of Systematic Reviews. 2018(1).Google ScholarPubMed
Gossop, M. Living with Drugs, 7th ed. Abingdon: Routledge: 2016.CrossRefGoogle Scholar

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