From Solitudes to Similitude?
Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 4
The recent Health Canada document, Best Practices: Concurrent Mental Health and Substance Use Disorders,1 defines concurrent disorders as any combination of mental health and substance use disorders that might affect an individual at the same time. The report emphasizes that many people experience overlapping mental health and substance use problems that require interventions that address both disorders concurrently. A concurrent disorders strategy should therefore include screening, assessment, treatment and aftercare interventions that target both types of disorders with equal emphasis and importance.
One particularly salient section in the Best Practices document includes a description of the historical separation of three distinct populations: mental health clients, people suffering from alcoholism, and people suffering from drug addiction. In the past, mental health clients were treated within a system of mental health clinics or institutions. Those suffering from alcoholism received assistance from informal support groups or, in some instances, specialized residential treatment facilities. Drug addiction tended to be managed from within a criminal justice context.
In British Columbia, an extreme example of this latter phenomenon was the Heroin Treatment Act passed into law by the provincial legislature in June 1978 but then repealed shortly thereafter in response to a court challenge. Under this legislation, heroin addicts who did not enroll voluntarily in a drug treatment or a methadone maintenance program could be taken into custody and compelled to attend a governmentsponsored heroin treatment program that could include up to six consecutive months detention at the Brandon Lake Treatment Centre near Nanaimo.2
Over time, and for a variety of reasons, both public and professional perception of persons with mental health and substance use disorders has shifted from viewing affected individuals as belonging to separate and distinct populations to being part of a larger group with overlapping mental health and substance use problems.
Many are by now familiar with the barriers to effective and comprehensive treatment inherent in the separation between the mental health and addiction treatment systems. One barrier is exclusion criteria – that is, persons with mental illness denied entry into drug rehab programs, or persons apparently suffering from the effects of drug use not being served by the mental health system. Others are the lack of co-existexist ing or connected expertise and resources to address both issues together, disagreement about treatment philosophy and lack of coordination of a continuum of services within the overall health care system.
A less common discussion, however, is about the similarities inherent to the two systems. These include:
the relevance of a biopsychosocialspiritual model for both mental health and substance use disorder
the need for a continuum of care that acknowledges and provides a range of services and interventions
a legitimate role for self-help organization
the importance of providing support for family of those suffering from both types of disorders
the significant impact of stigma in both populations
the existence of common clinical outcome goals that extend beyond cure or abstinence to reduction in risk and incremental improvement in health and social well-being
the fact that portions of both populations interact with the criminal justice system
In many ways, recent trends in the configuration of treatment resources and services for persons with concurrent disorders take advantage of these similarities in an attempt to reduce historical barriers and change entrenched attitudes and beliefs. Many articles included in this issue of Visions directly describe and discuss aspects of concurrent disorders from the perspective of commonality rather than difference. These include but are not restricted to:
how medications for mental disorders might worsen or create substance use disorders (e.g. in the case of benzodiazapines), thus highlighting the importance of considering concurrent disorders issues when prescribing medication
the increased impact of stigma and discrimination on persons suffering from concurrent disorders
recently emerging problems related to ‘drugs of choice’ such as crystal methamphetamine, which can lead to crystal meth psychosis
the role of police and the criminal justice system in managing offenders with concurrent disorders
the impact of government policy aimed at integrating mental health and addiction services at both the provincial and health authority level
the need to address concurrent disorders within special populations, such as young people, women and people of Aboriginal background
It is hoped that this issue of Visions will provide the reader with interesting and pertinent information about the management of concurrent disorders in British Columbia and also stimulate discussion and suggestions especially from the mental health and addictions consumer and advocacy community. Please join me in thanking the authors who have contributed their time and energy to this issue and who have given us all important information and insights into this emerging priority in mental health and addictions.
About the Author
John is an Adjunct Professor in the Department of Phychiatry, Faculty of Medicine, University of British Columbia, and Senior Medical Consultant, Mental Health and Addictions Division, Ministry of Health Services. He has worked as a physician for 27 years in various roles including family doctor, addictions agency physician, health services researcher and policy advisor. He can be reached at 1515 Blanshard Street, 6th floor Victoria, Brisitsh Columbia V8W 3C8; by phone at (250) 952-2301; or by email at John.Anderson@gems3.gov.bc.ca
Center for Addiction and Mental Health. (2002). Best practices: Concurrent mental health and substance use disordersOttawa: Health Canada. See www.cds-sca.com
Boisvert, A. (1995). Compulsory heroin treatment in BC. Cannabis Culture, I.