Identifying comorbidity

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Key Points

  • Given the high rates of co-occurring mental health conditions among clients of AOD treatment services, it is essential that routine screening and assessment be undertaken for these conditions as part of case formulation.
  • Screening and assessment set the scene for the future client- worker relationship and need to be conducted in a friendly and empathic manner.
  • It is important to consider a range of aspects in the process of case formulation, not only AOD and mental health issues (e.g., sociocultural factors, motivation, living situation, and medical and personal history).
  • Full assessment should ideally occur subsequent to a period of abstinence, or at least when not withdrawing or intoxicated.
  • Multiple assessments should be conducted throughout a person’s treatment as symptoms may change over time.
  • It is important to provide assessment feedback to the client in a positive, easily understood manner.

Identifying comorbidity

Despite high rates of mental health conditions among clients of AOD services, it is not unusual for these comorbid conditions to go unnoticed by AOD workers [100, 260]. This is mostly because they are not routinely looking for these conditions. Many of the signs and symptoms of common mental health conditions (e.g., depression) are not immediately obvious or visible, and may be overlooked if not specifically asked about. As mentioned in Chapter A3, all clients should be screened and assessed for comorbidity as part of routine clinical care. This chapter describes methods of screening and assessing for mental health conditions, which should form part of the case formulation process for all clients.

Assessing and identifying the client’s needs is the first step. It is important to recognise whatever needs the client may have as they will undoubtedly impact upon AOD treatment. Early diagnosis and treatment of mental health disorders can improve treatment outcomes [261-263]. Identification does not necessarily mean that the AOD worker has to personally treat the difficulty the client is experiencing; however, they do need to consider the impact of these difficulties, manage them accordingly, and engage other services where necessary. It is often difficult to determine which symptoms are attributable to which disorders. Once symptoms are identified, more specialised assessment may be required by mental health providers, psychologists, or psychiatrists to determine whether the person has a diagnosable disorder (care coordination is discussed further in Chapter B4). It is equally important that other issues identified (e.g., problems involving employment, housing, medical care) are dealt with appropriately, which may also require consultation with other services.