COMORBIDITY

COMORBIDITY

 

What is Comorbidity?

Comorbidity or dual diagnosis is the coexistence of substance abuse and mental health disorders in the same individual ( 2003). The term dual diagnosis is a common, broad term that indicates the simultaneous presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and alcohol and other drug (AOD) problems. The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an AOD disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not depreciatory ( 1990).

 

Common examples of dual disorders include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse. The combinations of AOD (alcohol and other drug) problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, the two disorders may each be severe or mild, or one may be more severe than the other. Indeed, the severity of both disorders may change over time. Levels of disability and impairment in functioning may also vary ( 1990).

 

Relationship with Alcohol and Substance Misuse

Compared to patients with mental health disorder or an AOD use problem alone, patients with dual disorders often experience more severe and chronic medical, social, and emotional problems. Research findings indicate the people with comorbidity conditions generally have (a) limited and inadequate social relationships and support networks (2000; 1999), (b) unstable housing, employment, and income histories (2000;  2000), and (c) are usually younger with lower levels of educational attainment ( 1996; 1995). Generally, this client group has criminal or legal problems (1999; 2000) with poorer functional skills ( 1998; 2000). These conditions increase the tendency among mentally ill individuals to resort to alcohol and drug abuse to make up for the social incapacity they have.

 

Patients with mental disorders have an increased risk for AOD disorders, and patients with AOD disorders have an increased risk for mental disorders as about one-third of patients who have a psychiatric disorder also experience AOD abuse at some point which is about twice the rate among people without psychiatric disorders (1990). This population are reported to have high levels of risky drug-taking behaviors, including sharing of injection equipment ( 1994; 1998) as well as sexually risky behaviors, such as trading sex for money or drugs and having unprotected sex (1998). They likewise experience high rates of depression (1995; 1998) and general psychopathology (1996).

 

Difficulty with Treatment

As a result of the social and physical conditions that clients with comorbidity experience, clinical researches have found out that mentally ill chemical abusers have more difficulty gaining access to treatment, have a poorer course of treatment, have less successful treatment outcomes, and incur more treatment costs than clients with only mental health or substance abuse symptoms (2000; 2000; 1999).

 

Substance abuse complicates care for the person with mental illness. Diagnosis is difficult because it takes time to unravel the interacting effects of substance abuse and the mental illness (1987). Because they have two disorders, they are vulnerable to both AOD relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation, and worsening of psychiatric problems often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with dual disorders. Compared with patients who have a single disorder, patients with dual disorders often require longer treatment, have more crises, and progress more gradually in treatment (1990).

 

Mental health services are provided by a variety of mental health professionals including psychiatrists, psychologists, clinical social workers, clinical nurse specialists, other therapists and counselors including marriage, family, and child counselors, and paraprofessionals. Services offered by mental health professionals include: case management, partial hospitalization, inpatient treatment, vocational rehabilitation, and a variety of residential programs. On the other hand, addiction treatment is provided by a diverse group of practitioners, including physicians, psychiatrists, psychologists, certified addiction counselors, other therapists, counselors, and recovering paraprofessionals. In typical addiction treatment, medications are used to treat the complications of addiction, such as overdose and withdrawal (1993).

 

Patients with combinations of dual disorders are often encountered in certain treatment settings. For instance, some methadone treatment programs treat a high percentage of opiate-addicted patients with personality disorders. Patients with schizophrenia and alcohol addiction are frequently encountered in psychiatric units, mental health centers, and programs that provide treatment to homeless patients (1990). Large numbers of mentally ill chemical abusers counted in hospital, drug rehabilitation centers, city streets, andgeneral population surveys are challenging traditional approachesto the delivery of psychiatric care. Historically, majormental illness and substance abuse have been treated in separatesystems with differing and sometimes contradictory orientations Due to structural divisions in the delivery of psychiatricand substance abuse treatment, mentally ill chemical abusers,who need both types of help, are not likely to find it in eithersystem ().

 

Expected Outcomes of Poor Engagement from Client Group with Comorbidity Issues

Individuals with comorbidity conditions may have difficulty being accommodated at home and may not be tolerated in community residences of rehabilitation programs. They lose their support systems and suffer frequent relapses and hospitalizations. Violence is more prevalent among the dually diagnosed population. Both domestic violence and suicide attempts are more common, and of the mentally ill who wind up in jails and prisons, there is a high percentage of drug abusers (1987). As such, high levels of risk-taking behaviors have been documented among client groups with comorbidity conditions (2003).

 

According to (1994), chemical abusers are very sensitive to criticism and tend to cut their noses off to spite their faces by picking up. Treatment staff should give far more positive than negative feedback, and when giving corrective feedback, should try to provide it in a non-punitive, understated way.  Staff should really listen to patients, be real with them, including shared feelings, have a sense of humor, and not to take them too seriously. Those who are providing services to MICA patients should try to avoid making the same mistakes made by overly critical, bossy family members. Over-criticalness and bossiness could trigger self-medication.

 

The mentally ill chemical abusers were severelyimpaired initially in terms of both mental illness and chemical abuse, but marked reductions in these afflictions were observed during the course of treatment at both the community residencesand the therapeutic community. Many professionals believe that confrontational approaches are counterproductive with MICAs because these patients are more fragile than non-MICAs (1994).

 

 

 

 

 

 

 

 

 

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