SUD Program Implementation Considerations for People with Co-Occurring Conditions

People with co-occurring conditions, also known as comorbidities, experience two or more illnesses or disorders simultaneously, which can impact their overall health and recovery. Among individuals with substance use disorder (SUD), co-occurring conditions are particularly prevalent. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 35% of U.S. adults who have another mental health disorder also have SUD, yet more than one third of them do not receive treatment for either condition. These co-occurring conditions can exacerbate one another, complicating both diagnosis and treatment. Effective care requires an integrated, holistic approach that addresses the complex interplay of substance use, mental health, and physical health challenges.

Mental Health and Suicide Risk
Mental health conditions such as depression, anxiety, bipolar, and personality disorders are common among individuals with SUD. These conditions may share overlapping risk factors, such as environmental stressors or exposure to trauma. Mental health symptoms can drive substance misuse as individuals attempt to self-medicate, while prolonged substance use can worsen mental health symptoms. Screening for mental health conditions in SUD treatment programs can help identify and address these challenges early. Evidence-based interventions, such as cognitive-behavioral therapy (CBT), trauma-informed care, and medications for opioid use disorder (MOUD), can support individuals with co-occurring mental health disorders in achieving long-term recovery.

Risk of suicide is an important consideration for individuals with co-occurring SUD and mental health disorders. People struggling with these conditions are at an elevated risk for suicidal ideation and behaviors due to the compounded effects associated with SUD and mental health issues. In addition, people who use drugs may not have an explicit intent to die but may experience a low motivation to live, associated with reckless substance use where they do not care about the consequences. Suicides are also often misclassified as unintentional overdoses, highlighting the complex overlap between overdose deaths and suicide. Incorporating suicide risk assessments into SUD treatment protocols, providing crisis intervention resources, and creating strong connections to mental health services are important for comprehensive care in rural areas.

Physical Health Conditions
Physical health conditions also frequently co-occur with SUD and mental health disorders. Substance misuse can lead to risky behaviors, such as unprotected sex or needle sharing among people who inject drugs, increasing the risk of infections like HIV and hepatitis. In rural areas, individuals may face barriers to accessing testing and treatment for these infections due to stigma, lack of specialty healthcare, and high associated costs. SUD treatment programs in rural settings can mitigate these challenges by incorporating routine screening for HIV and viral hepatitis, providing education to reduce the risk of negative health outcomes, and connecting patients with specialized care.

Resources to Learn More

Integrated Dual Disorder Treatment
Website
Provides information on the evidence-based Integrated Dual Disorder Treatment model that combines severe mental health services with SUD services for people living with comorbid conditions.
Organization(s): Case Western Reserve University, Center for Evidence-Based Practices

Substance Use Disorders in the Zero Suicide Framework
Presentation Slides
Discusses innovative ways that organizations can provide improved care for patients with SUD at high risk for suicide.
Organization(s): Zero Suicide
Date: 7/2018