Treating Comorbid Psychiatric and Substance Use Disorders

substance useComorbid psychiatric disorders and substance use disorders is commonly known as the rule, not the exception. In fact, 55 percent of patients with schizophrenia and 62 percent of patients with bipolar struggle with a lifetime substance use disorder.[1] In order for treatment of both the psychiatric disorder and the substance use disorder to be effective, an integrated treatment approach must be used.1 One usually acts upon the other, making it worse, and vice versa.1

The first step in treatment is to purposefully welcome these patients in order to begin engaging them in their care.1 This helps to facilitate a trustful relationship between the clinician and the patient. Treatment is often more successful and patients are more adherent when there is staff with whom they can feel safe and heard.1

Next, obtaining a detailed and accurate patient history is necessary.1 A close eye should be kept on the overlap between the two disorders so that triggers can be recognized.1 If there were periods of abstinence in substance use, find out why and note details.1 An accurate diagnosis should be able to be made from this detailed patient history in order for the patient to receive proper treatment.1

Treatment of both disorders should be integrated, as both the psychiatric and substance use disorder should be considered primary disorders.1 Medicines and 12 step programs are of the common treatments, as well as detoxification and maintenance programs.1 First, the best medication for each of the disorders must be prescribed to help the patient reach a stable point, when therapy may be best used.1 Clinicians should explain their choice of medicine and educate the patient as to the importance of adherence, what the adverse effects may be, and what to expect from taking this medicine.1 When the patient is stabilized, it may be necessary to use therapy as a second form of treatment.1

Overall, the psychiatric and the substance use disorder must be treated at the same time in order for either to improve.

[1] Minkoff, K. (2013, April 12). Treating Comorbid Psychiatric and Substance Use Disorders – Psychiatric Times. Psychiatric Times. Retrieved April 23, 2013, from http://www.psychiatrictimes.com/cme/content/article/10168/2137513

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