Prevalence of co‐occurring alcohol and other drug use in an Australian older adult mental health service

Abstract

Co-occurring mental illness and substance use disorder, known as dual diagnosis, is a significant challenge to mental health services. Few older adult specific alcohol and other drug treatment services exist, meaning older adult mental health services may become the default treatment option for many. Evidence suggests that dual diagnosis leads to substandard treatment outcomes, including higher rates of psychiatric relapse, higher costs of care and poorer treatment engagement. This paper explores the prevalence of co-occurring alcohol and other drug (AOD) use in an older adult community mental health service in inner Melbourne, Australia. This aim was accomplished by using a retrospective file audit of clinical intake assessments (n = 593) performed on consumers presenting to the service over a two-year period, June 2012-2014. Of consumers presenting to the service, 15.5% (n = 92) were assessed by clinicians as having co-occurring AOD use. Depression predominated in the dual diagnosis group as the primary mental health disorder. Dual diagnosis consumers in this sample were statistically more likely to be male and younger than their non-dual diagnosis counterparts. A limitation of this audit was the lack of implementation of screening tools, leaving assessment to clinical judgement or the interest of the clinician. This may also explain the discrepancy between the results of this study and previous work. Although appearing to be a relatively small percentage of assessments, the results accounted for 92 individuals with complex mental health, AOD and medical issues. Poor screening procedures in a population that is traditionally difficult to assess need to be rectified to meet the future challenges inherent in the ageing baby boomer generation, changing drug use trends and extended lifespans through harm reduction initiatives and medical advancements.

Point Prevalence and Patterns of Mental Health Comorbidity Among People Accessing Australia's First Older Adult–Specific Alcohol and Other Drug Treatment Service

“…These results show a significantly higher prevalence of dual diagnosis among older adults accessing AOD treatment than past audits of mental health services (Blixen et al, 1997;Searby et al, 2016).…”

“…Lower rates have been reported in Australia. Searby, Maude and McGrath (2016) found up to 16% of patients within an Australian Aged Psychiatry Unit had a co-morbid substance use disorder. These findings were limited by the study methodology.…”

“…These findings were limited by the study methodology. The audit-recording template was designed to monitor performance indicators and contained minimal information about previous Alcohol and Other Drug (AOD) use (Searby et al, 2016). Only one study has examined the prevalence of dual diagnosis among older patients (M=53.9, SD=4.01 years) accessing AOD services.…”

Connections between specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder and primary substance use

“…This paper has intentionally focused on the connection between a PMHD and primary problematic substance use, with the exception of nicotine. As demonstrated by the examination of the DDCSCM data, there continues to be a need for further exploration of the impact of multiple substances on treatment for mental health disorders (Searby et al , 2016).…”

Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study

“…Bright et al (2018) undertook a 12‐month medical chart audit and found the point prevalence of comorbidity among older Australians accessing the first specialist inpatient alcohol and drug service for older people was 89% ( n = 79). Others have identified comorbidity in 15.5% of 593 consumers that presented to a community mental health service for older adults (Searby et al, 2016). The clinical significance of comorbidity was identified by Reilly et al (2019) who found that 57.6% of 2118 people admitted over a five‐year period had clinically significant Health of the Nation Outcome Scale (HoNOS) scores in the drug and alcohol domain that indicated the need for intervention or monitoring.…”