Co-morbidity can be defined generally as the occurrence of more than two mental health problems. Co-morbidity results from drugs abuse and other psychological disorders is becoming a common clinical problem. Co-morbidity happens when on disorder causes another disorder to appear. For instance, people may develop depression due to alcohol dependency.
Co-Morbidity is a common health condition in the clinical medicine filed. In a recent study of 8000 people, aged between 15-54 years, conducted to show the extent of current prevalence of co-morbidity and substance abuse, shocking results were found. The research assessed the lifetime and today’s occurrence of mental disorders. The result showed that 29.5% had recent mental disorder. 36% of those identified with substance abuse disorder. Among the substance abusers, 25% at least more than one affective disorder. Among the respondents with mental disorder diagnosis, 15% had at least one co-occurring substance use disorder. These results show that there is a high degree of co-morbidity among people with mental disorders and those who abuse substances. At least one person in every four people with substance abuse disorder also has at least one mental disorder like anxiety and affective mental disorder. This reveals that this condition is very common among the substance abusers and people with mental disorders. It is a cause for concern sine many people are likely to suffer from the condition as indicated by the statistics above.
In working with people with co-morbidity disorders, it is important to consider the following principles
- Do not harm them. AOD workers must first think of the actions they are about to undertake and consider the potential benefits and risks. They should avoid actions which might to hurt the clients.
- Working within one’s capacity- Every AOD worker should work within their capacity to deal with the co-morbidity problems. All AOD workers cannot be able to deal with co-morbidity problems to the same extent.
- Participate in continuous professional development- AOD workers should keep themselves updated on all the symptoms off mental health problems and how to manage them. Professional development should be provided to ensure that the workers are competent enough to deal with clients. They should also update themselves with current research and methodologies to remain knowledgeable on what is new.
- Equal access to care- all clients with comorbid problems have equal access to care in spite of of their mental health conditions.
- Adoption of a ‘no wrong door policy”- under this principle, no patient should be sent away from health care institutions. When a client visits a facility with no relevant facilities, they should be referred to centres with the appropriate services.
- Monitor and assess the symptoms of the clients continuously-assessing the clients mental health is an ongoing process, and it is, therefore, important for the AOD staff to monitor a client’s symptoms and health over a long period of time. The staff should also provide feedback to patients with relation to their progress or otherwise.
- Adoption of a holistic approach- the main aim of AOD treatment is to ensure that all clients’ issues are addressed. It is necessary that the AOD staff adopt a holistic approach, where they take into account all issues surrounding the client’s mental health. It is important to consider other issues like family and social issues likely to affect the mental health of a client.
- Adoption of client-centred approach- it is important that the AOD staff listen to the clients so that they can accept and achieve the best treatment. This assists to develop an effective treatment plan and identify other services, which might be, necessary.
- Emphasis on collaborative treatment-it is important that the AOD staff explain to the clients that they have full control of their lives. Collaborative treatment is the most effective way of treating the clients.
Despite the fact that comorbids are very common, it is usually unnoticed by AOD workers. It is, therefore, important to assess and screen clients for co-morbidity as a regular routine. Identifying the needs of the clients is the first step in identifying whether one is comorbid or not. Then screening and assessment follows to identify the extent of the condition. This involves identifying and monitoring the mental health of a client to determine the type and extent of the disorder. Assessment can take the form of formal or informal assessment. In informal assessment, the AOD staff conducts semi structured interview on the client to establish the mental state, the current situation, family, personal and medical history, trauma and psychiatry history, risks and criminal history and willingness and readiness to change. The formal assessment, on the other hand, entails the use of standardized tools to gather information on the clients’ current life conditions and difficulties. After the screening and assessment, the AOD staffs are able to tell if the patient has comorbid disorders.
Managing clients with co-morbidity
There are different ways of managing clients with co-morbidity effectively. The aim of managing the client is to ensure that the client goes through the treatment process without the symptoms interfering with it. The following techniques can be used to manage the clients.
- Open discussions and anxiety management programs can help to manage symptoms of loss, anxiety, grief and trauma.
- Motivational enhancement, relaxation, and grounding strategies can also help to manage the mental disorder symptoms.
- Acute withdrawal management is helpful in managing clients with alcohol and other substances dependences.
- Ensuring a safe environment and setting boundaries is useful in rapport building and ensuring that the client participate in the assessment process.
- Cognitive therapy can also be used to manage clients who have symptoms of substance and alcohol abuse.
Treating clients with co-morbidity
Effective treatment demands good therapeutic corporations. There are several methods of treating co-morbidity.
- Sequential treatment- in this type of treatment one mental condition is treated at a time. After the first condition is treated, then the next one is treated. In many cases, AOD problem is first addressed and then the other problems. In other cases, the primary symptom is first treated then followed by the other symptoms.
- Parallel treatment- under this approach, the AOD use and mental disorder problems are treated simultaneously though medication is given independently. AOD use treatment is usually offered by a separate service or provider from the one offering treatment for the mental disorders.
- Integrated treatment- under this approach, the AOD use treatment and the mental disorder problems are treated at the same time by the same provider. This approach is useful in identifying the connection between the clients’ AOD use and mental health.
- Steeped care- under this approach, treatment is offered depending on the severity of each case. Intensity of treatment depends on the severity of the disorders.
- Motivational interviewing- this entails non-judgemental discussions with regard to specific effects of AOD use has on the clients life. This strategy aims at encouraging and motivating the client to change.
- Cognitive behavioural therapy- under this strategy, importance of thinking about how the client feels about their condition is greatly emphasized. This is one of the most effective treatments for conditions like anxiety and depression.
- Relapse prevention- this is a strategy aimed at reducing the likelihood of a relapse happening. Examples include normalising the relapse issue and enhancing the clients’ commitment to change.
- Use of psychosocial groups and self help groups-the former entails appreciations by people with co-morbid problems. They share their experiences and discuss on group interventions. The latter entails clients joining groups with people who have the same conditions. AOD services are provided in such groups.
Attending to referral and discharge planning
When attending to a referral case, the first thing is to communicate with the referring agent so that AOD can get information on the nature of the services needed by the client. The AOD also gets information on the extent of the services already provided to the client and then the AOD staffs carries out their own assessment and diagnosis to determine the best treatment.
When planning to discharge a client, it is important to prepare them in advance for treatment stoppage. The clients should be equipped with the necessary information on how to maintain with the positive progress. Plan for follow-up consultations to ensure that the client have a relapse. Also, discuss relapse prevention strategies with the client before discharge. Consider issues like social support and accommodation stability of the client before discharge.