These Guidelines aim to provide alcohol and other drug (AOD) workers with evidence-based information to assist with the management of co-occurring AOD and mental health conditions. They represent an update and revision of the second edition of these Guidelines, published in 2016.
Population estimates indicate that more than one-third of people with an AOD use disorder have at least one co-occurring mental disorder; however, the rate is even higher among those in AOD treatment programs. Additionally, there are a large number of people who present to AOD treatment who display symptoms of disorders while not meeting criteria for a diagnosis of a disorder.
The high prevalence of co-occurring AOD and mental health conditions means that AOD workers are frequently faced with the need to manage complex psychiatric symptoms whilst treating clients’ AOD use. Furthermore, clients with co-occurring mental health conditions often have extensive trauma histories, and a variety of other medical, family, and social problems (e.g., housing, employment, welfare, legal problems). As such, it is important that AOD workers adopt a holistic and trauma-informed approach to the management and treatment of co-occurring conditions that is based on treating the person, not the illness (see Chapter B1 and Chapter B2).
The first step in responding to co-occurring AOD and mental health conditions is being able to identify the person’s needs (see Chapter B3 and Chapter B4). Despite high rates of co-occurring mental disorders among clients of AOD services, it is not unusual for these co-occurring conditions to go unnoticed, mostly because AOD workers are not routinely looking for them. It is a recommendation of these Guidelines that all clients of AOD treatment services be screened and assessed for co-occurring mental disorders as part of routine clinical care.
Once identified, symptoms of mental health conditions may be effectively managed while the person is undergoing AOD treatment (see Chapter B6 and Chapter B7). The goal of management is to allow AOD treatment to continue without mental health symptoms disrupting the treatment process, and to retain clients in treatment who might otherwise discontinue such treatment. Co-occurring conditions are not an insurmountable barrier to treating people with AOD use disorders. Indeed, research has shown that clients with co-occurring mental health conditions can benefit just as much as those without co-occurring conditions from usual AOD treatment.
Some clients with co-occurring conditions may require additional treatment for their mental health problems (see Chapter B7). The evidence base regarding interventions designed for the treatment of specific co-occurring conditions is growing, but still in its infancy. Where there is an absence of specific research on co-occurring AOD and mental disorders, it is recommended that best practice is to use the most effective treatments for single disorders. Both psychosocial and pharmacological interventions have been found to have some benefit in the treatment of many co-occurring disorders. Consideration should also be given to the use of e-health interventions, physical activity, and complementary and alternative therapies, as an adjunct to traditional treatments.
In addition to mental health services, AOD workers may need to engage with a range of other services to meet clients’ needs, including housing, employment, education, training, community, justice, and other support services. A broad, multifaceted, and coordinated approach is needed in order to address all of these issues effectively, and it is important that AOD services and workers develop links with a range of local services (see Chapter B5). Worker self-care and the provision of training and support for AOD workers are also essential to the provision of effective care for co-occurring conditions (see Chapter B8).