Comorbidity Guidelines for AOD Workers

Mills, K., Deady, M., Proudfoot, H., Sannibale, C., Teesson, M., Mattick, R. & Burns, L. (2010). Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: National Drug and Alcohol Research Centre, University of NSW. Available here

The Guidelines aim to:

  • Increase AOD workers’ knowledge and awareness of mental health conditions
  • Improve the confidence and skills of AOD workers working with clients with comorbid mental health conditions
  • Provide guiding principles for working with clients with comorbid mental health conditions
  • Improve AOD workers’ ability to identify mental health conditions
  • Provide practical information on the management of comorbid mental health conditions
  • Provide information regarding the treatment of comorbid mental health conditions.
  • Provide information regarding referral processes
  • Provide resources to help facilitate all the aims above
  • [Print copy of Contents & Chapter 10 on Specific Population Groups provided & PDF of full resource]

The Appendices in this Guideline include extensive resources such as a summary of Motivational Interviewing; a Mental State Examination; a Suicide Assessment checklist; screening tools (K10, IRIS, DASS); and client worksheets & exercises.

In a nutshell  (p.viii)....

Population estimates indicate that more than one-third of individuals with an AOD use disorder have at least one comorbid mental health disorder; however, the rate is even higher among those in AOD treatment programs. Additionally, there are a large number of people who present to AOD treatment who display symptoms of disorders while not meeting criteria for a diagnosis of a disorder.

The primary goal of AOD treatment services is to address clients’ AOD use. However, in order to do so effectively, AOD workers must take into account the broad range of issues clients present with, including their mental health. The high prevalence of comorbidity means that AOD workers are frequently faced with the need to manage complex psychiatric symptoms or problems, which may interfere with their ability to treat clients’ AOD use. As such, it is important that all AOD workers are aware of the mental health symptoms that clients commonly present with, and are aware of how to manage these symptoms.

The first step is being able to identify mental health symptoms (see Chapter 6). Despite high rates of comorbidity among clients of AOD services, it is not unusual for comorbid mental health conditions to go unnoticed by AOD workers. This is mostly because they are not routinely looking for them. It is a recommendation of these Guidelines that all clients of AOD treatment services should be screened and assessed for comorbidity as part of routine clinical care.

Once identified, these symptoms may be effectively managed while the person is undergoing AOD treatment (see Chapter 7). The goal of management is to allow AOD treatment to continue without mental health symptoms disrupting the treatment process, and to retain clients in treatment who might otherwise discontinue such treatment. Comorbidity is not an insurmountable barrier to treating people with AOD use disorders. Indeed, research has shown that clients with comorbid mental health conditions can benefit just as much as those without comorbid conditions from usual AOD treatment.

Some clients with comorbidity may require additional treatment for their mental health problems (see Chapter 8). Some interventions have been designed for the treatment of specific comorbidities; however, these interventions generally have not been well researched. In the absence of specific research on comorbid disorders, it is recommended that best practice is to use the most effective treatments for each disorder. Both psychosocial and pharmacological interventions have been found to have some benefit in the treatment of many comorbidities.

In addition to mental health services, AOD workers may need to engage with a range of other services to meet clients’ needs (see Chapter 9). Clients with comorbid mental health conditions often have a variety of other medical, family and social problems (e.g., housing, employment, welfare, legal problems). A broad, multifaceted and multidisciplinary approach is needed in order to address all of these issues effectively and it is important that AOD services and workers develop links with a range of local services. When referring clients to other services, active referral with assertive follow-up is recommended.

State of Queensland (Queensland Health) (2010). Queensland Health Dual Diagnosis Clinical Guidelines:  co-occurring mental health and alcohol and other drug problems. Brisbane: Qld Health.  

State of Queensland (Queensland Health) (2010). Queensland Health Dual Diagnosis Clinician Toolkit:  co-occurring mental health and alcohol and other drug problems. Brisbane: Qld Health. This kit provides various resource lists, assessment and intervention forms, and other tools for AOD workers. Some of the tools referred to are located on the Qld Health intranet web pages and not accessible to the general public.