Previously published in 4 SOCIAL WORK PRACTICE 531-545 (July 2003). Republished with permission.
Director of Clinical Training, Ohio SAMI CCOE.
This is the nineteenth article from the Supreme Court of Ohio Advisory Committee on Mentally Ill in the Courts about effectively dealing with offenders with mental illness. Persons with co-occurring (dual) mental illness and substance abuse disorders have complex problems and face many service challenges. The Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE) facilitates the implementation and maintenance of faithfulness to the Integrated Dual Disorders Treatment (IDDT) model for this population in Ohio's mental health system.
Mental health and chemical dependency providers, administrators, policy makers, and advocates across the country have become increasingly aware of the challenges related to the needs of clients dually diagnosed with non-addictive and addictive psychiatric disorders. Co-occurring alcohol and other drug abuse (AODA) problems represent the most frequent and significant disorders among clients with mental illness.
The Epidemiological Catchment Area (ECA) study (Regier, et al., 1990), the most comprehensive study of the prevalence of other disorders with mental illness to date, showed that the lifetime rate of substance abuse disorders for persons with severe mental illness was approximately half, with 48% of persons with schizophrenia and 56% of persons with bipolar disorder affected. ECA study data showed, as well, that all psychiatric disorders were associated with higher rates of substance abuse and that persons with severe mental illness were most at risk. Additionally, studies have suggested that 25-35% of persons with a severe mental illness have an active or recent (within the last 6 months) substance abuse disorder.
Persons with co-occurring mental illness and substance abuse disorders have complex problems and face many service challenges. These Page 1094 consumers are more likely to experience psychiatric decline, relapse, and hospitalization; emergency room visits; legal problems including incarceration, suicide, and violence; unemployment; homelessness; infectious diseases such as HIV and...