Setting the Context

Excerpted from the Preface to Treating Concurrent Disorders: A Guide for Counsellors - Approaching Concurrent Disorders

Much of the research in concurrent disorders has focused on people with severe mental illness—in particular, on people with psychotic disorders. The excellent work of Drake, Mueser, Minkoff and others has provided a solid base for work with this population. Their work tends to follow the disease model of addiction, which emphasizes an abstinence-based treatment approach.

Despite the clear value of abstinence as an ideal goal, most experts in the field acknowledge that a relapse to drug use and, in some cases, not even being able to interrupt or reduce drug use, are realities with this client population, and that there is a need to continue to work with these clients even (or especially) when they are not abstinent. Looking at concurrent disorders in this way has helped people realize that these are chronic, recurring problems, and that there usually are no quick remedies. Across North America, this approach has led to the development of integrated treatment approaches and community-based care, and to a greater emphasis on open-ended case management and psychosocial rehabilitation of these clients.

When we look at people whose co-occurring substance use and mental health problems are mild to moderate, there is much less research to draw from. However, we know that, while 2.4 per cent of people in general have severe, persistent mental illness (Standing Senate Committee on Social Affairs, Science and Technology, 2002), mild to moderate mental health issues, especially depression and anxiety, are over-represented among people with substance use problems. Substance use problems also range widely in severity, with the majority of problems falling into the mild to moderate range of the spectrum. For example, it is estimated that there are four times as many people with a “drinking problem” as there are people with severe “alcohol dependence” (Institute of Medicine, 1990).

By including people whose problems fit within the mild to moderate range in our approach to concurrent disorders, our goal is not to take attention away from those with severe mental illness or addiction, but rather to extend the scope of our concern to the full set of people affected by co-occurring substance use and mental health problems. Even when problems are less severe, they still have a profound effect on the person, and on families, friends and colleagues. A benefit of working with people whose problems are mild to moderate is that there is a greater chance of improved outcome. Less severe problems are often easier to treat. And while building social support and hopefulness about positive change is often a primary challenge when working with people with severe addiction and mental health problems, people whose problems are mild to moderate generally have higher levels of support and motivation. The presence of such factors is predictive of more positive results.

In the Preface: Approaching Concurrent Disorders:

Setting the Context

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