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Many Patients Have Co-Occurring Mental
and Substance Abuse Disorders --
Both Must Be Addressed for Successful Treatment
Substance Abuse Mental Health Services Administration
News Release January 31, 2005
Co-occurring substance abuse and mental disorders are more common
than most professional counselors, medical personnel or the general
public realize. A new Treatment Improvement Protocol (TIP) released
today by the Substance Abuse and Mental Health Services Administration
(SAMHSA) estimates that 50-75 percent of patients in substance abuse
treatment programs have co-occurring mental illness while 20-50
percent of those treated in mental health settings have co-occurring
substance abuse. Most people with co-occurring disorders do not
receive treatment for both mental disorders and substance abuse.
Many receive no treatment of any kind.
The new Treatment Improvement Protocol is designed for substance
abuse treatment counselors and mental health providers who usually
treat one or the other of the two ailments, but it will also be
useful for administrators, primary care providers, criminal justice
staff and other health care and social service personnel who work
with people with co-occurring disorders.
Substance Abuse Treatment for Persons with Co-Occurring Disorders,
TIP 42, provides counselors with principles, assessment instruments,
strategies, settings and models for treating patients wherever they
show for treatment, whether it be in substance abuse treatment facilities,
mental health facilities or medical offices or clinics. TIP 42,
created by a panel of experts and reviewed in the field, also emphasizes
that outcomes for patients are enhanced when both illnesses are
addressed using an integrated approach.
"All too often individuals are treated only for one of the
two disorders, if they receive treatment at all," SAMHSA Administrator
Charles Curie said. "If one of the co-occurring disorders remains
untreated, both usually get worse. Additional complications often
arise, including the risk for other medical problems, suicide, unemployment,
homelessness, incarceration, and separation from families and friends."
"Since people with co-occurring disorders cannot separate
their addiction from their mental disorder, they should not have
to negotiate separate service delivery systems," Curie said.
"We know that with appropriate treatment and supportive services
people with co-occurring disorders can and do recover. This is the
premise of TIP 42. "
SAMHSA's 2003 National Survey on Drug Use and Health shows that
27.3 percent of persons 18 and older in the past year with serious
mental illness used an illicit drug. In 2003, the survey also found
that 5.7 million persons ages 18 and over with serious mental illness
engaged in binge alcohol use and 1.9 million were heavy drinkers.
Overall, the survey showed that about 4.2 million adults aged 18
and older met the medical criteria for both substance abuse and
mental illness.
The consensus panel that created the document is encouraging development
of a unified substance abuse and mental health approach. Emphasis
is placed on assisting substance abuse treatment systems to develop
the capacity to treat individuals with co-occurring disorders while
mental health systems develop similar capacities.
This Treatment Improvement Protocol is part of SAMHSA's promise
to Congress following the November 2002 Report to Congress on the
Prevention and Treatment of Co-Occurring Substance Abuse Disorders
and Mental Disorders to document state-of-the-art treatment for
individuals with co-occurring mental and substance abuse disorders.
Along with the TIP, SAMHSA has created a State Incentive Grant
for Co-Occurring Disorders to help states enhance their infrastructure
and treatment systems; established a national co-occurring disorders
prevention and treatment technical assistance and cross-training
center, the Co-Occurring Center for Excellence, to provide a broad
array of information on co-occurring disorders to states and community
providers in the substance abuse, mental health and related public
health fields; and increased federal agency collaboration within
HHS to enhance research attention to co-occurring disorders.
SAMHSA has also broadened the agency's efforts to identify and
disseminate known effective programs for prevention and treatment
of co-occurring disorders, including the development of a new tool
kit on treating co-occurring disorders; increased collaboration
between SAMHSA and the Centers for Medicare and Medicaid to explore
ways to use existing reimbursement mechanisms for services to people
with co-occurring disorders; and convened two National Policy Academies
on Co-Occurring Disorders to help states and communities enhance
service capacity.
The TIP panel was chaired by Stanley Sacks, Ph.D., of the National
Development and Research Institutes, Inc., New York and co-chaired
by Richard Ries, M.D., Professor of Psychiatry, University of Washington
.
TIP 42, inventory number BKD515, can be ordered through SAMHSA's
National Clearinghouse for Alcohol and Drug Information (NCADI),
P.O. Box 2345 , Rockville , MD 20847-2345 , or by calling 1-800-729-6686.
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