Why Patients Should Be Screened for Substance Use Disorder and Vice Versa

Patients with a psychiatric disorder should be screened for substance use disorders upon admission into treatment, while patients seeking treatment for alcohol use disorder (SUD) should be screened for other mental illnesses. This is so because comorbidities among the disorders are highly prevalent and complicate the mode of treatment applied. Interactions between co-occurring disorders are magnified in symptoms and challenge recovery. For this reason, early identification and simultaneous treatment become absolutely necessary to improve patient outcomes (Bethesda, 2020). For example, a fictional patient suffering from major depressive disorder (MDD) with AUD comorbidity. This is undoubtedly a prevalent comorbidity: long-term ethanol usage may exacerbate depressive symptoms, while depression itself may be exacerbated by alcohol addiction. Genetic predispositions, such as polymorphisms in serotonin transporter genes, confer vulnerability to MDD and AUD. Neural-level dysregulation within the brain’s reward system, especially in dopamine pathways, underpins both conditions. Environmental factors, such as childhood trauma, social isolation, or even precipitating stressors, also constitute an overlap in triggering events regarding the development of mental health and substance use problems.

Integrated Approach to Treatment for this Patient

Instead of treating either the substance use or mental health disorder independently, the approach to treating co-occurring disorders is to provide treatment for both conditions simultaneously. This helps because these paired disorders can feed into one another and might make a recovery from either condition more difficult if just one is addressed. Integrated treatment often differs in its inclusion of pharmacotherapy might include medications like antidepressants for psychiatric disorders, substances such as naltrexone, and psychotherapeutic interventions like CBT (Leichsenring et al., 2022). Support structures, ranging from group therapy to peer support, are some of the mainstays. With the integrated approach to treating both the underlying factors that contribute to both problems, the possibility of relapse can be minimized while enhancing functioning and quality of life. This treatment modality, through comprehensive care, heightens the possibility of recovery that is long-lasting and thus is important in clinical practice. Also, feedback provision and motivation toward peer support in the process instills a sense of sharing and belonging, which could be quite crucial for long-term recovery.

References

Bethesda. (2020). Common Comorbidities with Substance Use Disorders Research Report. In PubMed. National Institutes on Drug Abuse (US). https://www.ncbi.nlm.nih.gov/books/NBK571451/

Leichsenring, F., Steinert, C., Rabung, S., & Ioannidis, J. P. A. (2022). The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses. World Psychiatry, 21(1), 133–145. https://doi.org/10.1002/wps.20941

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Discussion Board—Addiction co-morbidities

Explain why patients entering treatment for a psychiatric/mental illness should be screened for substance use disorder and vice versa. Provide a clear example (hypothetical) of a substance use disorder and a specific mental health disorder. In your example, explain genetic, neural, and environmental underpinnings for the co-morbid disorder(s). Explain the integrated approach to treatment for this patient and why this is important. As usual, provide feedback to your peers.

Why Patients Should Be Screened for Substance Use Disorder and Vice Versa