Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
2. Management of people with comorbidity of mental disorders and substance use
Mental disorders and substance use occur together very frequently and can interact negatively on one another.
Little evidence is available to allow advice about safe levels of substance use in people with mental disorders. Safe levels of consumption in the general population may cause severe adverse effects in people with mental disorders1,2. The assumption should be that any substance use has the potential to cause deleterious effects on the comorbid mental disorder.
The management of comorbid mental disorders and substance use requires a long-term perspective. Actual clinician interventions may be brief or extended over a period of time. A doctor-patient relationship based on honesty, trust and respect will form the basis for effective therapy. Active listening skills and a patient-centred clinical method should be used to establish rapport and develop a common understanding of the problems and an agreed management plan.
1Substance use: is intended to be a non-quantitative term for the consumption of a substance. The risk associated with the use may range from low tohigh. It does not necessarily imply dependent use.
2Substance misuse: is a term for the consumption of a substance where the risk associated with the use is moderate or high, or where a substance is notbeing used for its intended therapeutic purpose, or use exceeds recommended therapeutic quantities.