continues to be seen as an intractable condition
largely resistant to treatment.
Interventions Do Not Adequately Address
Co-occurring Conditions. In standard medical
practice, it is recommended that health
professionals assess the presence of co-occurring
conditions in order to develop an effective
treatment plan and tailor treatment
accordingly.^116 Although such assessments are
critical in addiction treatment given the very
high rate of co-occurring conditions in people
with addiction, treatment programs frequently
do not address co-occurring health conditions or
do so in a suboptimal way.^117
Implementing a one-size-fits-all approach to
treatment based solely on a clinical diagnosis
without consideration of co-occurring health
conditions often amounts to a waste of time and
resources. CASA Columbia’s survey of
directors of addiction treatment programs in
New York State found that less than half (48.2
percent) of the program directors indicated that
treatment for co-occurring mental and physical
health disorders is offered in their programs.^118
A recent study of patients in residential
treatment for addiction who had co-occurring
mental health conditions underscores the
importance of tailoring treatment to the needs of
the patient population. In this study, those with
co-occurring mental health conditions reported
less satisfaction with treatment, saw fewer
benefits to stopping their substance use, had less
belief in their efforts to control their substance
use to maintain abstinence and were less likely
to employ positive coping skills than patients
with addiction who did not have co-occurring
mental health conditions.^119Although people with mental illness smoke at
significantly higher rates than the general
population, smoking cessation services rarely
are provided by mental health treatment
professionals.^121 Generally psychiatrists are less
likely than family physicians to inquire about
smoking, offer advice on quitting or assess
patients’ willingness to quit.^122 Yet, because
individuals with severe mental illness interact
with psychiatrists to a greater extent than with
primary care physicians (who typically are the
main referral source or provider of smoking
cessation interventions), patients in mentalWe are treating these folks with severe and
persistent addiction with a time limited-treatment
of three or four weeks, maybe six or eight, maybe
at the most three months, if you want to include
what’s called aftercare. Now, why would we think
that treating a chronic disorder for a few weeks
would lead to improvement 10 years later or five
years later or even a year later? It doesn’t make
any sense.^115--Mark Willenbring, MD
Director, Division of Treatment and Recovery
National Institute on Alcohol
Abuse and Alcoholism
(currently, Associate Professor of Psychiatry,
University of Minnesota)I lost my son to addiction and ultimately suicide.
From the time I knew he had a problem until the
day he died, I tried everything at my disposal to
help him get quality care. He went to eight
different programs and they all had a different
approach; many offered conflicting advice.
Only four of them looked at Brian as a whole
person; the other four only looked at his
addiction. Only five included a comprehensive
medical assessment; in fact, only three even had
a full-time doctor on the premises. And
although they each viewed his condition as a
chronic disease requiring effective aftercare and
long term management, none of them had an
effective recommendation for this, nor any
follow up from that program. In a letter to me
during one of his stays in a residential program,
he offered the insight that much of his previous
rounds of treatment had addressed his addiction
in isolation--as if it were unrelated to any
underlying emotional problems. In the last
weeks of his life, Brian was suffering from
severe depression. On the day before he died,
his aftercare program made the decision,
without consulting Brian’s therapist, or his
parents, to terminate their relationship with him.
At the time Brian most needed help, he was left
alone. And so was I.^120--Gary Mendell, father
Lost his son Brian, age 25,
to addiction and suicide