Integrated Treatment of Co-Occurring Mental Illness and Substance Use Disorders Lecture Outline

Krishna Balachandra MD, University of Western Ontario (Slide 1)

 

I.                    Introduction

A.     Co-Occurring disorders (COD) are important:  (Slide 2)

1.      ~50% Of serious mental disorders (d/o) have substance use disorders (SUD)1 vs 15-20% in general population

2.      Physicians inadequately trained about SUD2

3.      Patients (Pts) with COD receive suboptimal care3

4.      Pts with COD at ­ risk for:

a.       Relapse and re-hospitalization4

b.      Suicide5

c.       Financial stress6

d.      Violence7

e.       Medical illness8

B.     Definitions (Slide 3)

1.      Independent mental disorders i.e. not substance induced:

a.       Syndrome of behaviors or thinking problems

b.      Associated with:

1)      Psychological distress

2)      Occupational or functional disability

3)      ­ Risk of physical or emotional suffering9

c.       Not due to:

1)      General medical condition

2)      Substances

2.      Substance use disorders (SUD)9

a.       Substance abuse ≥ 1 criteria repeatedly:

1)      Fail role obligations

2)      Physically hazardous use

3)      Legal problems

4)      Social/interpersonal problems

5)      Not dependent

b.      Substance dependence ≥ 3 criteria:

1)      Tolerance

2)      Withdrawal

3)      Taken in larger amounts/longer period

4)      Desire to cut down

5)      Excessive time spent on getting substance

6)      Activities given up

7)      Use despite physical/psychological problems

3.      Co-Occurring disorders (COD) (Slide 4)

a.       Independent mental illness (MI) combined with SUD10

b.      Not substance-induced mental disorders9 which are:

1)      Not true independent disorders11

2)      Require brief (several wks) symptomatic treatment

3)      Defined as syndrome only in context of substances or medical illness

C.     This lecture reviews co-occurring disorder:  (Slide 5)

1.      Epidemiology

2.      Etiology

3.      Treatment (Rx) overall

4.      Relevance of integrated treatment

II.                 Epidemiology of co-occurring disorders12 (Slide 6)

A.     ­ Lifetime prevalence of SUD > in mental illness populations

B.     General population12:

1.      Any SUD →17%

2.      Alcohol use disorder (AUD) →14%

3.      Drug use disorder (DUD) → 6%

C.     Schizophrenia12:

1.      SUD ↑ 3 X’s

2.      AUD ↑ 2.5 X’s

3.      DUD ↑ 4 X’s

D.     Bipolar disorder12:  (Slide 7)

1.      SUD ↑ 3 X’s

2.      AUD ↑ 3 X’s

3.      DUD ↑ 5 X’s

E.      Panic disorder12:

1.      SUD ­ 2 X’s

2.      AUD ­ 2 X’s

3.      DUD ­ 2.5 X’s

F.      Post traumatic stress disorder13,14:

1.      SUD ­ 2 X’s

2.      AUD ­ 1.5 X’s

3.      DUD ­ 2 X’s

G.     Borderline personality disorder