Moreover, general medical practitioners only treat a small proportion of their patients’ AOD use problems.1 Stigma and societal attitudes about addictions affect physicians as well as the general public. Accordingly, many treatment providers are uncomfortable about discussing AOD use with their patients, and few are trained in assessment and treatment. The proliferation of “carve-outs”—arrangements whereby health plans contract with managed behavioral health care companies to provide AOD and mental health care services rather than reimbursing the providers—has reduced financial incentives for providers to is alcoholism considered a mental illness treat patients rather than referring them (IOM 2006). As a result of all these factors, general medical practitioners are not commonly considered the appropriate health care professional to handle treatment for AOD use problems. It is widely recognized that the majority of patients with alcohol use problems also suffer from co-occurring mental health and medical problems. Co-occurring disorders (CODs) complicate the treatment process and, in many cases, contribute to poorer outcomes (Drake et al. 1996; Rosenthal and Westreich 1999) as well as higher service utilization and costs over time (Curran et al. 2008; Lennox et al. 1993).
Health Topics
Depression and anxiety disorder were highly comorbid with other psychiatric disorders in our sample; however, Sober living house when we adjusted for them in sensitivity analyses, the results did not meaningfully change. Therefore, the associations we observed between psychiatric disorders and alcohol consumption levels do not appear to be biased due to confounding by depression and anxiety disorder. Unhealthy alcohol use frequently co‐occurs with psychiatric disorders; however, little is known about the relationship between psychiatric disorders and alcohol consumption levels.
- While establishing this chronological history, it is important for the clinician to probe for any periods of stable abstinence that a patient may have had, noting how this period of sobriety affected the patient’s psychiatric problems.
- This difference could be explained by the types of CMDs included in our review in which we included MDD, dysthymia, GAD, panic disorder, phobias, PTSD, OCD or SAD, whereas Lai and colleagues 11 included agoraphobia, GAD, panic disorder, social phobia, bipolar disorder, dysthymia and MDD.
- Public Health Service grant MH–46072 from the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration; National Institute on Alcohol Abuse and Alcoholism grants AA–08341, AA–08840, and AA–10265; and NIMH grants MH–00839 and MH–52822.
- People who experience AUD and mental health conditions can speak with a healthcare professional for support in treating and managing both.
TDS Mental Health: Navigating Trauma, Depression, and Suicidal Thoughts
The FDA recently announced a new tool through which investigators can determine if proposed treatments for alcohol use disorder (AUD) work based on whether they reduce “risk drinking” levels. The new tool can be used as an acceptable primary endpoint in studies of medications to treat adults with moderate to severe AUD. However, complete clinical integration does not seem feasible for most programs in the short term, if only for logistical reasons, particularly with regard to integrating medical care and AOD treatment. A recent survey estimates that only half of AOD programs nationwide offer dual AOD and mental health treatment (Mojtabai 2004), and even fewer offer integrated medical services. There is no evidence in the literature that mental health programs are more likely to coordinate services for patients with CODs. In fact, a survey of AOD and psychiatric treatment programs found that AOD programs were more likely to provide services for CODs than were psychiatric programs (Timko et al. 2005).
Integrating the Treatment of Co-Occurring AOD and Other Health Problems
Understanding varying levels of unhealthy alcohol use among individuals with a variety of psychiatric disorders in primary care would provide valuable insight for tailoring interventions. It is very important to get treatment for such disorders if they are contributing to the problem. As mentioned in this article, you can support recovery by offering patients AUD medication in primary care, referring to healthcare professional specialists as needed, and promoting mutual support groups. See the Core article on recovery for additional, effective strategies that can help your patients prevent or recover from a relapse to heavy drinking, including managing stress and negative moods, handling urges to drink, and building drink refusal skills. Making a correct diagnosis of both an addiction and a mental health issue is vitally important to a patient’s success. As the recognition and treatment for co-existing conditions improves, this will help reduce the social stigma that makes people so reluctant to pursue the treatment that they need.
Many researchers and clinicians in the addictions field welcomed the separation because of concern that AOD problems had been given short shrift under the mental health system. The two separate public systems of care became largely funded by the Federal Government via separate block grants, further reinforcing the separation of services. Unfortunately, however, the separation also created a system in which most programs and providers do not have the resources, training, or inclination to treat patients with CODs and instead reinforced differences in provider attitudes toward specific disorders and in overall treatment philosophy.
After detoxification, various forms of individual or group therapy or support groups can help keep a person from returning to drinking. The medications acamprosate, disulfiram, or naltrexone may also be used to help prevent further drinking. In the Western world, about 15% of people have problems with alcoholism at some point in time.
