Harm Reduction Therapy for Co-occurring Disorders

George A. Parks, Ph.D., Britt K. Anderson, Ph.D., G. Alan Marlatt, Ph.D.

Co-Occurring Disorders and the Practice of Psychology

Epidemiological research indicates psycho-active substance use is the most prevalent Axis I disorder. In addition, drug and alcohol problems are the most frequent comorbid condition associated with other mental disorders making accurate assessment and effective treatment of these psycho-logical problems more difficult. Axis I mental disorders and/or Axis II personality and developmental disorders co-occurring with psychoactive substance use disorders are referred to as dual diagnosis, dual disorders, Mentally Ill Chemical Abuser (MICA), etc. While there is no agreed upon label for these problems, we prefer the term co-occurring disorders specifying the mental disorders and substances involved. Developing more effective treatment for co-occurring disorders is essential because of their increasing prevalence and their threat to the health and well-being of our clients.Unfortunately, individuals suffering from co-occurring disorders generally encounter a treatment delivery system ill prepared to meet their needs (Marlatt and Roberts, 1998). High-thresholds for treatment entry in substance abuse programs may lead to denial of treatment altogether or treatment specific to alcohol and drug problems only. Conversely, clients presenting with co-occurring disorders may only be treated for mental disorders by psychotherapists who believe they cannot competently treat alcohol or drug problems. Even when co-occurring disorders are accurately assessed and diagnosed, they are often treated sequentially in the hope that the resolution of one will make treatment of the other easier. When the disorders are treated concurrently, it is usually by different providers with the burden of case management left to the client. Worse yet, an individual may become the focus of competition among providers in a dueling diagnostics over client ownership and the right theoretical approach to the client’s problems. Criminalizing drug use creates yet another barrier to treatment for those who abuse or are dependent on illicit drugs. Fortunately, more integrated approaches to the treatment of co-occurring disorders are emerging. Psychologists have a vital role to play in the continuing development, evaluation, dissemination, and implementation of these more integrated therapeutic approaches.

Developing more effective treatment for co-occurring disorders is essential because of their increasing prevalence and their threat to the health and well being of our clients.

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