While these findings indicate that several psychological, pharmacological, and alternative approaches for the treatment of co-occurring depression and AOD use disorders appear promising, further research is required to establish which therapeutic approaches are particularly effective. It is suggested that clinical efforts be focused on the provision of client-centred, evidence-based treatment, taking into account the client’s needs and preferences, in a collaborative partnership.
Box 16 illustrates the continuation of case study D, following Jack after the identification of his comorbid depressive and AOD use disorder.
Box 16: Case study D: Treating comorbid depression and AOD use: Jack’s story continued
Jack’s revelations about his use of cannabis and alcohol led to a change in his treatment plan, and he realised for the first time that both alcohol and cannabis – alone or in combination – made his depression much worse. Jack said that there was a strong family history of depression; his father, one paternal uncle and his paternal grandfather, all experienced severe depression over the course of their lives, and his grandfather committed suicide in his early sixties. Jack went on to say that he had now realised that both he and his doctors had accepted a genetic causation of his recurrent depressive illness, without much thought being given to other factors such as AOD use.
With Jack’s consent, the AOD worker spoke with his GP, psychologist, and psychiatrist to devise some treatment options for Jack. After presenting various options to Jack, it was decided that he would continue with his current antidepressant medication (which was working well so far), continue to see his psychologist weekly, and try attending some outpatient AOD group sessions for additional support. Jack was also made aware of the possibility of pharmacological therapies to help reduce his drinking, bu the decided that he did not want to try medications at this stage. Jack continued with his antidepressant medication and seeing his psychologist, but decided after trying a few different support groups that it wasn’t for him. Jack received regular ongoing monitoring of his physical health from his GP, who paid particular attention to Jack’s liver function, respiratory health and blood pressure.
Despite a few lapses, Jack progressed through treatment very well. Initially, he had some trouble abstaining from both alcohol and cannabis, but eventually stopped drinking and used cannabis only once per week. In planning his treatment, Jack had decided that he would take some time off work to concentrate on his mental health. After discussing his options with his psychologist, Jack decided to disclose the details of his condition, in confidence, to his employer who he had known for many years. Jack’s manager was understanding and supportive, but he was also naturally concerned about Jack’s return to work as several of the firm’s clients were somewhat reliant on him.
In consultation with Jack’s team of health care providers, it was agreed that he would have a short time off work and then return to work part-time, which in itself might be helpful to Jack in respect to improving his confidence and self-esteem.
- People with comorbid disorders do not necessarily present in any obvious way. There is higher prevalence of older people who have continued to use AOD since cannabis and stimulants became more readily available in the 1960s and 1970s. The need for careful history taking regarding AOD use cannot be overemphasised.
- In some cases, mental health conditions may quickly respond to appropriate treatments. However, comorbid mental health and AOD use disorders present a numbers of challenges – in particular the need to address the need to maintain treatment gains in the long term (years rather than days or weeks).