CO-MORBIDITY

CO-MORBIDITY

 

 

 

 

 

Introduction

 

 

            Co-morbidity is defined in medicine and psychiatry as the co-existence of one or more diseases in connection to a primary disease or illness diagnosed in a client.  There are three reasons as reported by  (2003) why co-morbidity occurs.  These are: (1) that there is a direct causal relationship between the two, with the presence of one disorder making another more likely to develop; (2) that there is an indirect causal relationship between the two, with one disorder affecting a third variable in a way that increases the likelihood of the second disorder; and (3) that there are common factors that increase the risk of both disorders (p. 15).

            Co-morbidity of mental disorders and substance or alcohol use disorders is common (2003, p.1).   (2004) stated that problems associated with alcohol and other substance abuse affect individuals and their families. They also have a wider economic impact on society, in terms of lost work days and increased burden on health systems, as well as the social impact of injuries, violence and crime.  Alcohol use contributes to a range of acute and chronic health consequences, from injuries resulting from traffic crashes to cancer and cardiovascular disease (2003).  In like manner, substance abuse has been a major source of health and social problems in developing societies as elsewhere ( 2004).

 

 

Co-morbidity of Psychiatric Disorders with Alcohol and Substance Misuse

 

 

 (2000) declared that approximately 50% of individuals with psychiatric disorders will meet the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for drug or alcohol abuse or dependence at some point during their lives.  Clinicians in mental health and addiction treatment services are frequently confronted with co-morbid substance abuse and psychiatric problems, often in seriously mentally ill persons.

Co-morbidity involving psycho-active drug misuse can often be present at the point of psychiatric clinical assessment, bringing with it a perceived enhanced risk of suicide or self harm.  By their very nature, all psychoactive drugs can affect mood and possibly be responsible for presenting psychiatric symptoms, such as delusions and/or hallucinations. Other presenting features may also be present such as anxiety irritability and restlessness                                                     ( 2001, p. 3).

Traditional treatment approaches have emphasized substance abuse in psychiatric patients as a secondary disorder i.e. self-medication in a primary psychiatric disorder (2000).   A central assumption of this “self-medication” hypothesis according to  (1985) is that substances are used to alleviate symptoms and that specific substances will be selected for their specific effects upon mood and cognition (cited in  2003, p. 15).  Furthermore, the common co-occurrence of alcohol use and anxiety disorders has suggested the “tension reduction” hypothesis.  (1987) said that this hypothesis proposes that persons with anxiety disorders use alcohol to relieve anxiety or distress, and that problematic use becomes more likely because alcohol becomes the means to control these negative mood states (cited in 2003, p. 15).

A recent multi-centre collaborative study of co-morbidity of substance misuse and mental illness found that: 75% of users of drugs services and 85% of users of alcohol services experienced mental health problems; approximately 30% of the drug treatment population and over 50% of those in treatment for alcohol problems experienced the co-occurrence of a number of psychiatric disorders in addition to substance misuse; and  44% of CMHT patients reported drug use and/or harmful alcohol use in the preceding 12 months                               (2005, p. 2).

 

Approaches in Treatment

 

 

            Co-morbidity             presents substantial treatment problems – standard interventions are complicated or even excluded in individuals with co-morbid disorders.  On the one hand co-morbid substance use disorders can pose difficulties for treatments that are narrowly defined for specific symptoms, or those treatments may have been developed on pure diagnostic groups and therefore of unknown benefit for co-morbid individuals (2003, p. 7).  Co-occurring mental health and substance use disorders will, most often, in any individual experiencing them, influence each other in their development, severity, response to treatment and relapse circumstances.  Because the disorders are so intimately intertwined failure to recognize and respond to either of the disorders will compromise the effectiveness of the response to the disorder being focused upon ( 2005).  According to (2005) there are six guiding principles in treating clients with co-occurring disorders.  These principles are: employment of a recovery perspective; adoption of a multi-problem viewpoint; development of a phased approach to treatment; addressing specific real-life problems early in treatment; planning for the client’s cognitive and functional impairments; and use of support systems to maintain and extend treatment effectiveness (p. 38). 

Conversely, anxiety and depression can complicate the treatment of substance use disorder ( 2003, p. 7).  People with co-occurring disorders have a range of medical and social problems – multidimensional problems that require comprehensive services.  In addition to treatment for their substance use and mental disorders, these clients often require a variety of other services to address other social problems and stabilize their living conditions.  Treatment providers should be prepared to help clients access a broad array of services, including life skills development, English as a second language, parenting, nutrition, and employment assistance                        (2005, p. 46). 

 

The Role of Client Engagement in Treatment

 

             (2000) wrote that in the treatment of co-morbid patients, engagement is the first step in developing a trusting alliance between the client and a service provider.  Successful engagement is critical to effective intervention or treatment and is dependent on a number of factors including a clear delineation of the interventions that can be offered and their potential value (p.8).

            However, engagement of individuals with co-morbid disorders may be difficult.  These clients are often in denial and difficult to enlist in treatment.  Other factors impacting on engagement include possible cognitive deficits within the client, amotivation and resistance.  Further, some authors suggest that the complications of both illnesses mean that the dually diagnosed individual is often unable to comply with treatment or to benefit from standard interventions             ( 2003, p. 15).

 

 

 

 

 

 

 

 

 

References

 

 

Credit:ivythesis.typepad.com