Barriers to comorbidity service delivery: the complexities of dual diagnosis and the need to agree on terminology and conceptual frameworks

Abstract

This paper draws from a literature review commissioned as part of a larger project evaluating comorbidity treatment service models, which was funded by the Australian Government Department of Health and Ageing as part of the National Comorbidity Initiative. The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. This paper outlines conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, particularly around the variable nature of comorbidity, and the impacts of the separation of the mental health (MH) and alcohol and other drug (AOD) sectors with their differing institutional cultures, aetiological concepts, philosophical underpinnings, educational requirements, administrative arrangements, and screening and treatment approaches. Issues pertaining to the lack of consistent definitions and conceptual frameworks for comorbidity are discussed, particularly in relation to the reported lack of communication, collaboration, and linkages between the sectors. It is suggested that the adoption of consistent terminology and conceptual frameworks may provide a valuable step towards consistency in service provision and research and could lead to improved capacity to address the many issues relating to comorbidity service provision and treatment efficacy.

Comorbidities of mental and behavioral disorders in chemically dependent patients in different periods of abstinence

“…In these cases, PAS could have been used as selfmedication. Psychotic disorders were more frequent in men, which is in agreement with what has been described in another study 2 .…”

“…Comorbidities of MBD range from "high-prevalence, low-impact" disorders such as depression and anxiety, to "low-prevalence, high-impact" severe mental illnesses such as psychosis and major mood disorders 2 . The causes of CMBD in SUD patients may include coincidence, common genetic vulnerability, common neural substrate, underlying shared origins, self-medication, and lifestyle 2,3 .…”

“…The causes of CMBD in SUD patients may include coincidence, common genetic vulnerability, common neural substrate, underlying shared origins, self-medication, and lifestyle 2,3 . Diagnosing CMBD in SUD patients is important because it enables both disorders to be treated.…”

Recovery From Comorbidity

“…How comorbidity is defined, measured, and estimated remains controversial and inconstant, despite the adoption of consistent terminology having been identified as a useful practical step in overcoming barriers to complex and fragmented services in Australia and elsewhere (Canaway & Merkes, 2010).…”

“…Traditional theories of etiology in comorbidity include the direct causal (one causes the other); the indirect causal (one disorder affects a separate variable that is a causative factor in the second disorder); bidirectionality, and the theory of shared common factors (Canaway & Merkes, 2010;Kessler, 2004a;Mueser et al, 1998). Hypotheses of underlying genetic etiology have yet to demonstrate conclusive scientific evidence and are unable to be proven on grounds of statistical inference by definition (Kessler, 2004a).…”