Sketching out Potential Service Options
Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 49
Concurrent disorders, substance abuse coupled with another major mental illness, are a much discussed topic in the Okanagan Valley these days. Statistics vary depending on a number of factors, but it is estimated that as many as 50% of individuals seeking help for a mental health concern also have issues around substance use.1 These high numbers warrant finding an effective way to treat this population’s unique needs. Addiction services alone are not enough, nor are treatments for a mental health concern that don’t address the other issue.
As the Coordinator of Concurrent Disorders Services at the Okanagan Independent Living Society, I have spent the past three months researching this topic further, with the goal of developing a program specific to the treatment of concurrent disorders. The following is a brief synopsis of what I have discovered.
Currently, few services specific to concurrent disorders exist in the Kelowna area. Many government and nongovernment agencies recognize the need to better serve this population, but currently lack the specialization. Although some drug and alcohol treatment facilities do not exclude individuals who are diagnosed with a major mental illness, current programs may not adequately address the complex needs of these clients. On the flip-side, mental health services are structured to treat many mental disorders, but not substance abuse, which gets referred back to the alcohol and drug rehabilitation centres.
Further interviews with professionals and clients revealed the following needs:
Cross training: professionals working in the addiction field could benefit from more education on other major mental illnesses, while mental health workers could benefit from additional training on how drugs and alcohol affect someone with a mental illness. The complexity of concurrent disorders should be the primary focus of this training. Adding drugs and alcohol to a major mental illness can produce a number of impacts that may be difficult to separate. If someone has been abusing drugs and alcohol for years, it may be difficult to determine whether or not a major mental illness separate from the substance abuse even exists. Drugs and alcohol can mimic or mask a mental illness, while a mental illness can mimic or mask substance abuse.
Specialization: services need to be developed where both the substance abuse and other mental illness can be addressed concurrently. Aside from detoxification and the management of initial withdrawal symptoms, recovery needs to include addressing both disorders.
Client-centered treatment : harm reduction models are teaching us that we cannot use the same approach for everyone.2 This is especially true for concurrent disorders. Services need to be client-centred and recovery plans need to be individualized.
How the Community is Responding
Local mental health and addiction services are beginning to work more closely together, especially with the amalgamation of mental health and addiction services under one management structure. The Interior Health Authority is providing education around concurrent disorders, and there is talk of specialized services. Our largest addiction recovery centre is blending in a harm reduction model. Generally, there is greater awareness, and professionals are recognizing that concurrent disorders may be more of a rule than an exception. A lot of individuals who misuse drugs and alcohol, for example, also suffer from some degree of anxiety or depression. According to a University of British Columbia study, early onset of a major depression or an anxiety disorder doubles the risk for later drug use.
How the Okanagan Independent Living Society is Responding
We felt it was important to gain a clear understanding of our local community’s issues and plans around concurrent disorders. Armed with this information, we are now sketching out potential service options, which would:
facilitate a continuum of care focusing on the potential for permanent change, rather than band-aid solutions
provide flexibility in service delivery through individualized recovery plans
provide breadth in service to accommodate individuals at different stages of recovery
track success rates and provide aftercare services and relapse prevention
stress personal responsibility, resilience and re-integration into the community.
These goals tie in well with the latest research around harm reduction and new approaches. For example, one addiction task group report4 sketches out an intervention continuum showing a progression from saving lives, through stabilization, healing and eventual reintegration. This would be accomplished by providing services at the pre-contemplation and contemplation stages – stages where the consumer is either starting to consider or actively considering change – of recovery planning, through to maintenance and aftercare. We are not proposing to provide services along the entire continuum, but through collaboration and partnerships, we hope to provide a few links in the chain of recovery.
New concurrent disorders program in the North Okanagan
The Concurrent Disorders Program is new to the North Okanangan region of the interior Health Authority. It was started because there was a recognition that some clients were failing through the cracks because of the complex nature of their addiction and mental health issues.
To access the program, you must approach one of the professionals that is currently working with you. This may be a mental health worker or an addictions worker. This person may then request additional help from the program.
Help will be time limited and will be designed to help advocate for you, reduce the barriers you may be encountering and help you become healthier as soon as possible. The Concurrent Disorders Program is designed to help clients and professionals throughout the North Okanagan. You can access the program in the Salmon Arm or Vernon areas by calling (250) 549-5737. In the Revelstoke area, call (250) 837-6601.
About the Author
Carmen is the Coordinator of Concurrent Disorders Services at the Okanagan Independent Living Society. She has a background in social work and non-for profilt management
BC Partners for Mental Health and Addition Information (2003)The primer: Fact sheets on mental health and addiction issues.
Donald MacPherson (2001). A framework for action: A four-pilar approach to drug problems in Vancouver. City of Vancouver. See www.city.vancouver.bc.ca/fourpillars
Mental Health Evaluation and Community Consultation Unit, University of BC, (2001). Concurrent disorders: Substance use disorders and other mental disorders - Dimensions of policy and practice.Mheccu Bulletin, 2.
Addictions Task Group Report and Kaiser Youth Foundation (2001).Weaving threads together: A new approach to address addictions in BC. See healthservices.gov.bc.ca/addictions