The Guidelines have been designed primarily for AOD workers. When referring to AOD workers, we are referring to all those who work in AOD treatment settings in a clinical capacity. This includes nurses, medical practitioners, psychiatrists, psychologists, counsellors, social workers, and other AOD workers.
AOD treatment settings are those specialised services that are specifically designed for the treatment of AOD problems and include, but are not limited to, facilities providing inpatient or outpatient detoxification, residential rehabilitation, substitution therapies (e.g., methadone or buprenorphine for opiate dependence), and outpatient counselling services. These services may be in the government or non-government sector.
Although these Guidelines focus on AOD workers, a range of other health professionals may find them useful. However, it should be noted that comorbidity is not homogenous, and different patterns of comorbidity are seen across different health services . For example, AOD treatment services are most likely to see comorbid mood, anxiety, and personality disorders; mental health services, on the other hand, are more likely to see individuals with schizophrenia and bipolar disorder comorbid with AOD use disorders .
These Guidelines have been developed with the assumption that the management and treatment of comorbid AOD and mental health conditions will be provided by trained practitioners. AOD workers differ in their job descriptions, education, training, and experience. This may range from those who are highly educated with little experience to those with little education but much experience . The amount of time that AOD workers spend with clients also varies widely depending on the type of service provided, and the presentation of the client. For example, AOD workers may have very brief contact with clients who present in medical or psychiatric crisis (who may then be referred to other services); they may work with them for one week if they are entering detoxification, or they may work with them for several months or years if they present for substitution therapy, residential rehabilitation, or outpatient counselling.
Given these differences in AOD workers’ roles, education, training, and experience, it is not expected that all AOD workers will be able to address comorbid conditions to the same extent. Each AOD worker should use these Guidelines within the context of his/her role and scope of practice. At a minimum, however, it is suggested that all AOD workers should be ‘comorbidity informed’. That is, all AOD workers should be knowledgeable about the symptoms of the common mental health conditions that clients present with (see Chapter A4) and how to manage these symptoms (see Chapter B6). The provision of opportunities for continuing professional development for AOD staff in the area of comorbidity should be a high priority for AOD services.