This essay discusses the concept of co-morbidity with respect to the field of psychiatry and clinical psychology, and its relation to alcohol abuse and substance misuse. Moreover, the difficulties met by doctors in treating people with co-morbidity, proposed steps so to alleviate these, and the possible outcomes of having poor engagement from a co-morbid client group, are also discussed herewith.
Definition
In the term co-morbidity, co means jointly or together, while morbidity refers to ailment. Simply put, co-morbidity is defined as the simultaneous occurrence of two or more diseases, may it be psychiatric or physical in nature. ( 2006). The co-occurrence of schizophrenia, alcohol dependence, and depression is an example of co-morbidity. These correlations may reveal a causal connection between one disorder and another, or an underlying susceptibility to the other disorders. (1996).
Co-morbidity has become a vital issue with regard to psychiatry and clinical psychology. According to clinical and epidemiological results, co-morbidity that occurs among psychiatric disorders is greatly widespread. In addition, various types of co-morbidity are associated with more serious illnesses and worse clinical consequences (1996).
Co-morbidity and Substance Abuse
Co-morbidity between substance use disorders (SUDs) and other mental ailments have been widely acknowledged, more specifically in clinical and treatment samples of adolescents. According to studies, depression and alcohol abuse increase significantly during teenage years. When these problems jointly occur, they present challenges to doctors in the fields of evaluation, prioritization of treatment, and the handling of self-harmful actions. Regrettably, such a form of co-morbidity is relatively common (1996).
Numerous experts have conducted studies regarding the simultaneous occurrence of mental disorders and substance misuse. (1992) performed researches in treatment facilities for adolescents who misuse alcohol and other substances. As a result, they discovered that up to 50% of these youngsters have emotional illnesses, the majority of which are major depression and dysthymia. As for the investigation by Burkstein, et al., (1992) which focused on 156 adolescents on a dual diagnosis unit intended to cure substance abuse and other psychiatric ailments, 31% of the subjects experienced major depression. Lastly, a study conducted by Greenbaum, et al., (1991) noted that out of 547 tens who are in multiple mental health and special educational facilities, 48% had severe depression as well as. It has therefore been proven that alcohol use among depressed adolescents and depression among substance-abusing teens, do exist.
Alcohol abuse and depression tend to be recurring conditions that could result to impaired adaptive performance and when these conditions co-morbid, adaptive functioning is further damaged. In addition, h (1989) revealed that people with co-morbidity go through different unpleasant experiences such as increased mental symptoms, homelessness, higher possibility for relapse, institutionalization, and problems with handling their lives. (1995) found out that such patients also experience increasing hospitalization fees, lower satisfaction with familial relations and greater probability for mortality.
Also, such co-morbid circumstances have been related to increased occurrence and severity of suicidal actions and completed suicide. Evidently, depression and SUD, when taken together, aggravates each other, and could often lead to severely self-harmful actions (1996).
Difficulty in Treatment
Although it is clearly important to recognize and treat alcohol and other drug abuse of depressed teenagers, recognizing such abuse is not easy because some of the clinical symptoms of alcohol abuse are similar to those of depression. For example, loss of interest in formerly enjoyed activities can be apparent both in a depressed teenager and an adolescent who is alcohol dependent (2006).
Another difficulty in the treatment of patients with co-morbidity is the inadequate fit between such individuals and the traditional system of medication. One traditional method is the separate and parallel treatment. This occurs when two groups work with clinicians simultaneously, each healing one kind of sickness in a parallel approach. Unfortunately, many clinicians have difficulty in coordinating treatment and understanding co-morbidity. (2006). Consequently, the treatment of co-morbid patients is hindered.
Moreover, although there is enhanced information regarding the treatment of co-morbidity, obstacles still exist for the successful distribution of assistance. (1991) assessed the mental health service delivery in drug treatment programs in Los Angeles County and discovered that most of the addiction agenda restricted the admission of co-morbid patients and nearly half did not cater to co-morbid clients.
Another hindrance to the treatment of co-morbid individual occurs when doctors miss the second ailment of the patient. In fact, some patients who are mentally ill are not diagnosed by their psychiatrists to have SUDs, while individuals who have SUDs and attend to addiction treatment programs often do not get treated for their psychiatric ailments ( 2006). Lehman and colleagues (1995) reported that dually diagnosed people who have mental disorders were more likely to be referred for mental health treatment, and less likely to receive substance abuse treatment and follow-up.
Although proven that the treatment of co-morbid patients is a difficult task, adequate assessment and treatment can be provided to lessen this problem—assessment deals with the detailed history of psychiatric and substance abuse symptoms of the patient, while treatment goals are based on the severity of the symptoms and the leading needs of the client. In a nutshell, the level of combination of treatment is determined by the needs of the client, best determined through the assessment of the patient’s history, mental status, stage of substance abuse, and his psychosocial and cultural concerns. In effect, treatment that takes into account all the needs of co-morbid individuals has the possibility of improved results. (2006).
Poor engagement from co-morbid client group
To have a clear perspective of the effects of poor engagement from a client group with co-morbidity issues, it is best to examine how it occurs specifically in patients with co-morbid alcoholism and mental disorders.
Preliminary therapy for alcohol dependence mainly consists of detoxification and psychosocial approaches aimed at sustaining abstinence. Unfortunately, the presence of a co-morbid psychiatric illness can complicate this strategy. To illustrate, depressive indications can hinder a patient’s attendance at Alcoholics Anonymous (AA) assemblies or group therapy gatherings, two commonly used psychosocial interventions for alcoholism. As a result, they may miss learning ways for coping with circumstances that represent a great risk for alcoholic relapse. On the other hand, people with antisocial personality disorder may show hostile and manipulative deeds, which can result to interpersonal problems for themselves and for other co-morbid people in treatment. Thus, poor engagement with a client group with co-morbidity issues could lead to an inefficient therapy results for the patient himself and other clients as well. ( 1999)
Conclusion
Co-morbidity is the appearance of two or more psychiatric physical disorders, such as depression and alcohol dependence. Co-morbidity between mental disorders and substance misuse could lead to adverse and unproductive behaviours, such as suicide and impaired adaptive performance. Upon realizing the negative effects of co-morbidity on a person, treatment of multiple ailments should be performed. Unfortunately, difficulties in co-morbidity therapy exists, due to factors such as insufficient understanding of the multiple disorders of the patient, incompatibility of co-morbidity and the traditional method of medication, and a poor engagement from a client group with co-morbidity issues. Still, certain measures may be done so as to minimize these difficulties and deliver successful treatments to patients with co-morbidity.
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