By Robert J. Budsock and Cheryl Ann Kennedy
Gov. Phil Murphy recently announced the preliminary 2019 year-end opioid statistics for 2019. Although the data suggests a 3% decrease in the number of individuals who died in compared to 2018, the numbers are still staggering: more people in New Jersey died of drug overdoses in 2019 than were killed in the 9/11 terrorist attacks. Let that sink in.
The numbers are both stark and daunting and remind us that New Jersey remains in the throes of a complex, multifaceted public health crisis. It is a crisis with no easy answers and no panaceas. It is one that must be addressed with proven, evidence-based tactics that provide the best opportunities to better treat those struggling with addiction – particularly those coping with co-occurring disorders, that can often make addiction treatment even more challenging.
A co-occurring disorder, or dual diagnosis, is when someone experiences mental illness and substance use disorder simultaneously. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health for 2018, an estimated 9.2 million adults aged 18 or older had both a mental illness and a substance use disorder.
In addition, 37% of those with an alcohol use disorder and 53% of those with a substance use disorder have at least one serious mental illness, according to the Journal of the American Medical Association. And similarly, of those diagnosed with a mental illness, 29% abuse alcohol or drugs. Despite the obvious prevalence of co-occurring disorders, they can be difficult to diagnose because a substance use disorder can often conceal mental illness warning signs and symptoms.
For too long, the substance use disorder treatment and mental health communities have viewed substance use disorders and mental health issues as a classic “chicken and egg” equation – determine which “came first” and treat them sequentially. However, we now know that, ultimately, if a mental health issue is not concurrently addressed, it is difficult to properly and effectively treat an individual’s substance use disorder, and vice versa.
Upon being admitted into care at a recovery facility, it is essential that individuals receive a comprehensive interview and evaluation to determine if any signs or symptoms of co-occurring disorders exist. Those with symptoms suggestive of co-occurring disorders require additional psychiatric evaluation, specialized individual and group counseling as well as a greater medication management regimen, and more.
The idea that a mental illness cannot be treated until a substance use disorder is addressed is antiquated and ultimately detrimental to the well-being of the individual. It does not represent Best Practices. When a mental illness goes untreated, a substance use disorder can often get worse. Individuals with a substance use disorder who do not get treatment for a co-occurring mental illness may feel that they have no choice but to turn to “self-treatment,” or continued drug or alcohol abuse. Similarly, an increase in substance abuse can exacerbate symptoms of a mental illness, creating a dangerous and vicious cycle for the individual.
As we look to new solutions to the opioid crisis, we need to focus our energy and resources on proven, evidenced-based approaches that address the issues for those struggling with the disease of addiction. Integrated treatment, like those offered at Integrity House, is the proven, effective route. Treating substance use disorders in conjunction with mental healthcare is an essential component of long-term recovery and gives individuals the greatest chance for lasting recovery and mental wellness. This must become the industry model.
Robert J. Budsock is president and CEO of Integrity House, one of the largest non-profit providers of substance use disorder treatment in New Jersey.
Cheryl Ann Kennedy MD, DLFAPA, FASAM, is a Professor of Psychiatry for the Rutgers New Jersey Medical School.