Abstract
The comorbidity of mental and addiction disorders is increasingly apparent. Such comorbidity increases overall client morbidity substantially, and reduces the success rate in treating either type of disorder. In addiction treatment settings, the challenge is twofold: first, to develop a method for detecting mental disorders that is valid and practical, and second, to identify treatment approaches that are appropriate to that setting. Simple referral away of the patient with a mental disorder is rarely successful. Difficulties often arise in finding appropriate mental health treatments in a timely fashion; furthermore client resistance to being referred out poses an additional barrier. This article identifies strategies to improve practical detection of mental health disorders through the use of simple but validated patient self-reports. In addition, this commentary proposes a stepped care approach to the provision of mental health treatments that allows for some universally effective ‘wellness treatments’ to be initiated for all individuals in addiction treatment settings; those with persistent high psychiatric symptoms related to the most common disorders such as depression or anxiety would then receive some additional mental health treatment in the addiction setting. Referral out would be reserved for those individuals with more severe psychiatric illnesses or those with comparatively rarer disorders. This pragmatic approach to screening and stepped care increases the likelihood of success in treating the addictive disorder, as well as providing care for the mental disorder.
Similar content being viewed by others
References
Brown, R. P., & Gerbarg, P. L (2005). Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II—clinical applications and guidelines. Journal of Alternative and Complementary Medicine, 11(4), 711–717.
Buckley, P. F., & Brown, E. S. (2006). Prevalence and consequences of dual diagnosis. Journal of Clinical Psychiatry, 67(7), e01.
Castel, S., Rush, B., Kennedy, S., Fulton, K., Toneatto, T. (2007). Screening for mental health problems among patients with substance use disorders: Preliminary findings on the validation of a self-assessment instrument. Canadian Journal of Psychiatry, 52, 22–27.
Castel, S., Rush, B., Urbanoski, K., Toneattto T, et al. (2006). Overlap of clusters of psychiatric symptoms among clients of a comprehensive addictions treatment service. Psychology of Addictive Behaviors, 20(1), 28–35.
Goldberg, D., & Gask, L. (1992). Primary care and psychiatric epidemiology: the psychiatrist’s perspective. In B. Cooper, & R. Eastwood (Eds.), Primary care and psychiatric epidemiology (pp. 44–56). London: Tavistock/Routledge.
Greenberger, D., & Padesky, C. A. (1995). Mind over mood: Changing how you feel by changing the way you think. New York: Guildford.
Hillier, D., Fewell, F., Cann, W., & Shephard, V. (2005). Wellness at work: Enhancing the quality of our working lives. International Review of Psychiatry, 17(5), 419–431.
Jin, P. (1992). Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. Journal of Psychosomatic Research, 36(4), 361–370.
Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56(10), 730–737.
Kuramoto, A. M. (2006). Therapeutic benefits of Tai Chi exercise: Research review. Wisconsin Medical Journal, 105(7), 42–46.
Lam, R. W., Michalak, E. E., & Swinson, R. P. (2005). Assessment scales in depression, mania, and anxiety. Taylor & Francis: London.
Larun, L., Nordhein, L. V., Ekeland, E., Hagen, E. B., & Heian, F. (2006). Exercise in the prevention and treatment of anxiety and depression among children and young people. Cochrane Database Systematic Reviews, 3, CD004691.
Parikh, S. V., & Baudoin, F. (2002) (Eds.). Mental disorders in primary care: A World Health Organization Toolkit, Canadian edition. Geneva: WHO.
Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005.) Yoga for depression: the research evidence. Journal of Affective Disorders, 89(1–3), 13–24.
Staab, J. P., Datto, C. J., Weinrieb, R. M., Gariti, P., Rynn, M., & Evans, D. L. (2001). Detection and diagnosis of psychiatric disorders in primary care medical settings. Medical Clinics of North America, 85(3), 579–596.
Zimmerman, M, & Mattia, J. I. (2001). The psychiatric diagnostic screening questionnaire: development, reliability, and validity. Comprehensive Psychiatry, 42, 175–189.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Parikh, S.V. Screening and Treating Mental Disorders in Addiction Treatment Settings: A Stepped Care Model. Int J Ment Health Addiction 6, 137–140 (2008). https://doi.org/10.1007/s11469-007-9095-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-007-9095-3