Addiction Medicine: Closing the Gap between Science and Practice

potentially addictive medications are considered
and monitored.^5

For example, patients treated with opioids for
pain may be at risk for developing addiction,
particularly if they do not take them as
prescribed.^6 Likewise, the frequent use of
addictive substances such as cocaine can result
in a range of gastrointestinal and cardiac
complications that can affect various organs in
the body; medications used in detoxification and
addiction treatment may further complicate these
medical conditions.^7

The efficacy of particular addiction treatment
approaches has not been examined
systematically in patient populations with co-
occurring medical conditions. However,
medical and other health professionals should
plan carefully the treatment protocols for
patients with co-occurring addiction and other
medical conditions, be prepared to monitor and
address emergent reactions that may arise in the
course of treating these patients and consult with
specialists in other medical sub-specialties when
necessary.^8

Co-occurring Mental Health Disorders ............................................................................

*

In the late 1970s, treatment professionals began
to recognize the effect that co-occurring mental
health disorders had on patients’ success in
addiction treatment. Around the same time,
treatment professionals and programs began to
document the large number of addiction and
mental health treatment seekers suffering from
both sets of problems.† 9

Traditionally, patients with co-occurring
addiction and mental health disorders were sent
to one treatment setting or another to address
their problems sequentially.^10 Patients have

• The treatment programs discussed in this section

represent the main evidence-based treatment
modalities for individuals with co-occurring
addiction and mental health disorders. It is not a
comprehensive list of available programs.
† See Chapter III for data on the prevalence of co-

occurring addiction and mental health disorders.

been advised either to “solve” their addiction

problems before entering mental health

treatment or stabilize their mental health

problems before entering addiction treatment.^11

This approach has not been effective since each

condition tends to exacerbate the other.^12

Current standards call for treatment programs

serving patients with addiction and mental

health disorders to provide integrated care that

treats both conditions simultaneously.^13

Treatment providers may coordinate addiction

and mental health treatment services by

combining therapies or by managing the care

while patients receive both types of treatments

concurrently.^14

Integrating addiction treatment and mental

health care for patients with co-occurring

disorders increases retention and yields positive

outcomes, including higher abstinence rates and

reduced hospitalization and arrest rates.^16

Integrated treatment also helps providers prevent

adverse drug interactions among their patients

and ensure that proper medication dosage is used

to treat both conditions.^17

Essential Program Components and

Principles for Treating Patients with

Co-occurring Disorders^15

 Coordinated treatment and recovery plan;

 Access to addiction and regular medical and

mental health services within the same

facility or through collaborating programs;

 Specialists to provide addiction treatment,

psychiatric services and other health care

services as needed;

 Patient information about the nature of the

disorders, the importance of lifestyle

changes and adherence to treatment

regimens and strategies for relapse

prevention;

 Comprehensive support services to address

issues such as housing and unemployment;

 Access to mutual support programming; and

 Reintegration of patients with their families

and communities.