Double Trouble

According to the Department of Health and Human Services, in any given year seven to 10 million individuals in the US have at least one mental disorder as well as an alcohol or drug abuse disorder. The Surgeon General in his 1999 Report on Mental Health estimated 51 percent of those with lifetime mental illness also have a lifetime history of at least one substance abuse disorder.

Unfortunately, "individuals experiencing these disorders simultaneously ... have particular difficulty seeking and receiving diagnostic and treatment services, even though, separately, these disorders often are as treatable as other chronic illnesses."

The above is from a timely and comprehensive Report to Congress on the Treatment and Prevention of Co-Occurring Substance Abuse and Mental Disorders by the Substance Abuse and and Mental Health Services Administration (SAMHSA), part of the US Department of Health and Human Services. Sadly, SAMHSA notes, one type of disorder or the other tends to go untreated, resulting in worsened outcomes for both, with tragically predicable results - of the mentally ill in prison, for example, 72 percent of them also have a substance abuse disorder, and of the mentally ill who are homeless, 50 percent have a substance abuse disorder.

To summarize SAMHSA's Report:

"Dual diagnosis" is an "unfortunate misnomer," as rarely do people experience ONLY two disorders. SAMHSA favors the term, "co-occurring disorders." One type of disorder may trigger the other, but 90 percent of the time, according to National Comorbidity Survey (NCS) data, mental illness precedes substance abuse. On average, mental illness occurs at around age 11 followed by substance abuse five to 10 years later. On the other side of the coin, drug abuse can produce psychotic symptoms, result in a relapse of a psychotic illness, or create a need for meds adjustments.

Regardless of which disorder an individual experiences first, SAMHSA emphasizes that "both disorders must be considered as primary and treated as such." Unfortunately, according to NCS findings, of those with co-occurring disorders, only 49 percent are treated for serious mental illness, 29 percent for substance abuse, and a mere 19 percent for both. Putting it another way, citing other studies, of an estimated prevalence rate of 4.8 percent for co-occurring disorders, only 0.2 to 0.9 percent are getting the full range of treatment.

Those who do get treated generally wind up in the hospital. In 1996 there were 87 hospital stays per 1,000 for individuals with mental illness only and 23 hospital stays for those with substance abuse only. Having both disorders, however, resulted in a rate of 457 (no typo) hospitalizations per 1,000. Meanwhile, those with co-occurring disorders comprise 10 percent of the homeless population but use nearly half of all homeless emergency assistance resources.

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