Information about NICE clinical guideline 120

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To download the full document, please click here.

Also see:

Psychosis with coexisting substance misuse

New NICE Guidance To Help Manage Psychosis With Co-Existing Substance Misuse

The Cost of Mental Health and Substance Abuse Services in Canada

From the Institute of Health Economics, Edmonton, Alberta:



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To download the entire report (PDF), please click here.

National Call to Action: Identifying the Need for Specialized Treatment and Care of Concurrent Mental Health and Substance Use Disorders

An April 9th news release from the Canadian Centre on Substance Abuse:

Ottawa, April 9, 2010 – The Canadian Centre on Substance Abuse (CCSA) — Canada’s non-governmental organization dedicated to reducing the harms associated with alcohol and drugs — today announced the release of Substance Abuse in Canada: Concurrent Disorders, the third in a series of biennial publications that highlight key contemporary substance abuse issues in Canada and identifies areas where action is needed.

Written by members of CCSA’s Scientific Advisory Council — a group of Canada’s leading biomedical, neuroscience and clinical experts — and other leading clinicians and academics in the field, Concurrent Disorders takes an in-depth look at the state of concurrent disorders and provides a call to action to address this significant health issue.

Concurrent disorders — cases in which individuals have both a mental health problem and a substance use problem — are currently poorly understood by the public and inadequately addressed by either Canada’s primary healthcare system or specialized mental health and addiction services.

"Concurrent disorders are generally seen as unlinked and separate as a result of mental health and addiction systems that are compartmentalized and largely independent of each other. The result is that clients are often being treated for one of their disorders but not the other," said Rita Notarandrea, CCSA’s Deputy Chief Executive Officer. "As this report indicates, treating each problem separately leads to poor client outcomes that are characterized by frequent relapses and crises, placing undue strain on the healthcare system and its professionals. Concurrent Disorders is a significant first step towards identifying the actions we must take to effectively address this public health issue."

The publication takes an in-depth look at six areas within the field of concurrent disorders, including the interplay between substance use and anxiety, stress and trauma, impulsivity, mood, and psychosis.

"The rationale for considering concurrent disorders a topic of special significance is in many ways self-evident: the two disorders frequently coexist; they often share common biological, psychological and social roots; and these co-occurring disorders represent a major health challenge," said Dr. Franco Vaccarino, Professor of Psychology and Psychiatry at the University of Toronto and Chair of CCSA’s Scientific Advisory Council. "The limited ability of our parallel substance use and mental health clinical and community programs to approach concurrent disorders in a coordinated, integrated manner represents a significant barrier to effectively treating those affected."

The cost of substance abuse and mental health to Canadians is considerable. In a 2002 study by CCSA, substance abuse disorders were estimated to cost Canada more than $40 billion annually. In addition, a 2001 Public Health Agency of Canada study estimated the price tag of mental health problems in Canada to be $14.4 billion annually. Collectively, substance abuse and mental health issues account for more than $54 billion in costs to Canadian society each year and exact an immeasurable toll on individuals, their family and friends.

The percentage of costs that can be attributed to those with concurrent disorders is currently unknown. However, findings within Concurrent Disorders suggest that these individuals likely account for a large portion of the total, as they have a limited ability to cope with everyday challenges, experience higher unemployment, and at the extreme, can become homeless, socially marginalized or criminally involved.

A Call to Action

Concurrent Disorders identifies the critical need for Canada to address the issue of concurrent disorders through:

• Policy makers, educators, researchers and health professionals acknowledging that specialized treatment for those with concurrent disorders is a major priority for Canada;

• Increased scientific programs that provide a better understanding of the processes and mechanisms underlying concurrent disorders, and that address current gaps in research and research funding;

• Increased community addiction programs that are better equipped to deal with clients with concurrent disorders;

• Integration of clinical practice guidelines in the substance use disorder and mental health fields that reflects a unified national approach to treatment and care;

• An educational platform that increases the number of trained professionals with a common understanding of concurrent disorders and treatment practices;

• A focus on youth and early detection, as concurrent disorders often have an onset during adolescence and are best treated early; and

• The development of prevention and treatment strategies that focus on life stressors and trauma as significant risk factors in the development and recurrence of concurrent disorders.

To read the full Concurrent Disorders publication or the Highlights report, please click here.

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About CCSA:

With a legislated mandate to reduce alcohol- and other drug-related harms, the Canadian Centre on Substance Abuse (CCSA) provides leadership on national priorities, fosters knowledge translation within the field and creates sustainable partnerships that maximize collective efforts. CCSA receives funding support from Health Canada.


For further information, please contact:

Annie Boucher, Fuse Communications
Tel.: (613) 863-3702
Email: boucher@fusecommunications.ca

Also see:

National approach needed on care for mentally ill who abuse substances: report

Dual diagnosis: Why treat one and not the other?

An article published in today's edition of The Chronicle Herald:

By Christine Stapleton [pictured]

I HOPE we can put an end to the pesky debate about alcoholism.

Alcoholism is an illness — a real illness. The American Medical Association accepted alcoholism as an illness in 1957 and for about as long the American Psychiatric Association has included alcoholism in its Diagnostic and Statistical Manual — the Bible for diagnosing mental disorders.

Alcoholism and drug addiction are more than just a lack of self-restraint and discipline. Just ask anyone who knows me. I have run marathons and countless triathlons. I have held the same job for 23 years, and I contribute to my company pension plan. I have resisted doughnut-day-Friday and the lure of expensive high-heeled, pointy-toed shoes, which certainly would have improved my love life.

I am not an aberration. In fact, many, many alcoholics are like me. We are high-functioning alcoholics who managed to hang on to our careers, cars and homes. We did not live under bridges and we did not panhandle.

Why is this important? Because I believe that dual-diagnosis is the biggest mental health problem today, yet most people do not even know what it is. Dual diagnosis is the coupling of substance abuse with another mental illness. I am talking about people like me who have alcoholism and depression or are addicted to crack and have bipolar disorder.

As I see it, the problem is that we — including the medical community and criminal justice system — do not accept and treat alcoholism as a real illness. Nor do they understand and appreciate how futile it is to treat one illness but not the other. Everyday addicts and alcoholics seek treatment for substance abuse but no one bothers to screen them for a companion mental illness. Likewise, doctors prescribe antidepressants to their patients without screening them for substance abuse.

The addict/alcoholic whose depression is not treated will continue to self-medicate with drugs and alcohol or fail at the attempt to get clean and sober. Those with depression whose substance abuse is not detected will get sicker because alcohol is a depressant and with every sip they are throwing gasoline on their simmering depression or bipolar.

No one knows how many dual-diagnosed alcoholics/addicts are out there but experts believe at least one of every three alcoholics/addicts has another mental illness. They are the most tragic and costliest of the mentally ill. Very often they commit crimes or suicide. They abuse their wives/husbands and children. Police answer their 911 calls and foster parents take in their kids. The dual diagnosed often become homeless and clog our emergency rooms.

So if you want to go on believing that addicts and alcoholics are weak-willed and you have no compassion for them, please have mercy on your wallet. Your ignorance is costing all of us.

Christine Stapleton writes for The Palm Beach Post, West Palm Beach, Fla.

I have changed the headline of this story to the one that appeared in the The Palm Beach Post.

Also see:

Schizophrenia and Substance Use

Concurrent Disorder

Understanding Complex Interactions Key to Preventing Alcohol Abuse

An article published in the July 17th edition of Psychiatric News:

A genetically associated characteristic — the level of response to alcohol — connects genetic vulnerabilities with the environment to reveal the complicated process through which alcohol use disorders develop.

By Jun Yan

Like other mental illnesses, alcohol use disorders (AUDs) develop through interactions of multiple genetic vulnerabilities and environmental factors over a long period. By understanding these interactions, psychiatrists can devise and apply targeted, effective, and efficient prevention methods.

These were the messages of Marc Schuckit, M.D. [pictured], in his Adolf Meyer Award lecture at APA's 2009 annual meeting in May in San Francisco. Schuckit is a professor of psychiatry at the University of California, San Diego, and director of the Alcohol and Drug Treatment Program and Alcohol Research Center at the Veterans Affairs San Diego Healthcare System.

His lecture, "How Alcoholism Develops: Identification of Genetic and Environmental Influences in a 25-Year Longitudinal Study," examined groundbreaking research by him and his colleagues on the intricate dynamics between genes and environment that reveal much about AUDs as well as other mental illnesses.

To read the entire article, please click here.

Photograph by David Hathcox

Admit you have an illness

An article published in today's edition of The Chronicle Herald:

By Christine Stapleton {pictured]

IN 1957, the American Medical Association accepted alcoholism as an illness. At about the same time, alcoholism found a place in the American Psychiatric Association’s Diagnostic and Statistical Manual — the hallowed handbook that doctors use to diagnose mental illness (and that insurance companies use to deny your claim).

In other words, alcoholism is an illness. It is a mental illness. People who have alcoholism, like me, are not weak or lacking discipline. In fact, most of the alcoholics I know — in recovery and still drinking — are very strong and very disciplined. That’s how we convince ourselves that we are in control and what makes us so annoying.

Learning that alcoholism is a legitimate illness helped me immensely. It gave me some self-esteem, hope and the final word in conversations with know-it-alls who believe we could quit drinking if we really, really tried: "Well I guess you know more than the American Medical Association because the AMA decided that alcoholism is an illness 50 years ago."

Depression is different. There are a lot of people who admit that depression is a real illness. They feign sympathy and tell you about someone else’s struggle with depression.

But you can tell by their zealous enthusiasm that they don’t really believe it. I hate to admit this: I was among them.

I knew that Hippocrates declared depression a real illness several thousand years before the American Psychiatric Association.

Folks that I admired — Michelangelo, Eric Clapton and the guy who played Beaver’s brother, Wally — all suffered from depression. But when dealing with someone with depression, I privately thought: "Get a grip already, will ya?"

When I was diagnosed with a depression — a major clinical depression — what helped me more than the manuals and medical endorsements were the aw-shucks comments from friends: "I’ve been on antidepressants for years." Or, "Actually, I am on two antidepressants." Or, "I have to be on either antidepressants or hormones or I’m a mess."

Really? Who would have guessed?

The moral is simple: Do whatever it takes to accept and forgive yourself for being mentally ill.

Also see:

Accepting problems hard, but worth it