What is co-morbidity?
Introduction:
In particular, the paper will tackle on co – morbidity issues by giving an overview of the topic. The researcher will relate alcohol and substance misuse with co – morbidity by citing research studies that proves significant relationship such as the research study on co – morbidity of substance misuse and mental illness collaborative study (COSMIC). The paper will discuss why there is difficulty with treatment with co – morbidity disorders that result to poor engagement from client groups with co – morbidity issues.
Discussion:
Co – morbidity as defined by the Borderline Personality Disorder Resource Center (no date), is the presence of coexisting or additional diseases with reference to an initial diagnosis. Co – morbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. In addition, a research study on co – morbidity of substance misuse and mental illness collaborative study (COSMIC) headed by (2002) summarized their findings to the following data: (1) some 74.5% of users of drug services and 85.5% of users of alcohol services experienced mental health problems. Most have affective disorders (depression) and anxiety disorders. A relatively high rate of psychosis observed. (2) Almost 30% of the drug treatment population and over 50% of those treatment for alcohol problems experienced ‘multiple’ morbidity (co – occurrences of a number of psychiatric disorders or substance misuse. (3) Some 44% of mental health service users reported drug use and / or were assessed to have use alcohol at hazardous or harmful levels in the past year.
Evidence from the United States suggests that half of all patients with schizophrenia also have a substance misuse disorder ( 1990).This co – morbidity is associated with poor prognosis and heavy useof expensive inpatient care through recurrent “revolving door”admissions (1995). This high prevalence, the problems of clinical management (1995);and a continued rise in the general rate of drug misuse make co – morbiditya major public health issue
(2002) mentioned the characteristics of co – morbid service users; are the following: (1) significantly poorer social functioning and a greater need care interventions, (2) perceived to be more chaotic and more aggressive by key workers, while co – morbid users of alcohol services were perceived as being more difficult to manage, and (3) drug users with personality disorders were rated as having relatively poor engagement with services. The first characteristics could support the brief intervention on the treatment on alcohol dependence in the clinical review of (2002) that there should be daily supervision in order to allow early detection of complications such as delirium tremens, continuous vomiting, or deteriorationin mental state. This will not only result to time constraints but including financial constraints especially to individuals who does not have enough money unless there are agencies who would offer free services. Also, as stated by (2005) to reduce or stop substance misuse requirespatience, an open minded and non-judgmental approach, and anunderstanding of the stages of change in human behavior. Doctorscan help facilitate change, but only the individual can change his or her behavior. Positivereinforcement through comments on any change in substance misusebehavior, however small, can be valuable in continuing to motivatethe individual.This is particularly important in the context of relapses. Substance misuse usually follows a chronic relapsing course, yet relapsesare rarely anticipated. Meaning to say, health care providers must thoroughly explain that occurrences of relapses are normal and an expected course; in reassuring those of chronic relapses will reduce their sense of guilt or failure, thinking that they have not achieve anything which might lead to discontinue treatment. Services for drug misusers and mental health services have tended to develop in ways determined more by public anxiety andpolitical ideology than by research evidence (1998). Despite of higher levels of provision offered, higher levels of unmet need among co – morbid patients (2002). The few trials of assertive community treatment specifically targetedat co – morbidity have shown little benefit ( 1991). Hence a growingbody of opinion now argues that integrated treatment specificallyfor co – morbidity must underpin an approach based on assertive communitytreatment and that clinical teams must be able to implement motivationaltherapy and treatment for both types of disorder without crossreferral to other agencies (1995).
A study was conducted by (1997) at Durham prison, a typical male remandand short sentence prison. Before their reception into Durham prison over 70% of unconvicted remand prisoners reported the use of illicit drugs, regular consumption of excessive amounts of alcohol, or both. Amountsof drugs and alcohol consumed were often substantial, reflectedby 56% of the population having one or more current diagnosesof substance abuse or dependency. Multiple substance use wasalso common. Further, provision of detoxification programmes for prisoners identified by reception screening as having serious drug and alcohol related problems is inadequate; and prisoners who need help but think that asking for this is more likely to result in punishment than treatment are not likely be truthful about their substance use. The researchers concluded that few receive a detoxification programme,so that many are left with the option of continuing to use drugsin prison or facing untreated withdrawal.
Conclusion:
The paper concludes that there is no sufficient evidence that supports the efficiency of interventions with co – morbid individuals that there is a need to call to develop and tested for new mode of delivery services or enhancements of present health care services; since research based knowledge which can be applied to practice can limit errors thus, efficiency can be attained. In addition, there must be adequate supply of skilled health care professionals who are capable of dealing wholistically co – morbid patients which are tends to be aggressive and anxious especially in co – morbid prisoners who would prefer to misuse and abuse drugs rather seek treatment which is likely to face punishments.
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