Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
Comorbidity or the co-occurrence of mental disorders and substance use disorders is common. The prevalence of comorbidity in the community and the complex interactions that occur between the two sets of disorders should raise doubts about the manner in which we continue to deal with each entity separately. Clinicians need to consider these problems as part of a whole complex of phenomena that are
closely linked to one another.
There are significant problems with the management of people with comorbidity. There is a dearth of evidence about best practice. Specialist mental health or alcohol and other drugs (AOD) services, where they are available, are usually separated physically, administratively and philosophically. Only recently has training for general practitioners (GPs) become adequate for the problems that are faced on a day to day
basis, either in the mental health field or the AOD field.
The original resource was developed as a result of work previously undertaken by PARC in 2001 with the development of a set of principles for the management of people with comorbidity.
The updating of these guidelines was undertaken in 2007–08 by Drug and Alcohol Services South Australia, through funding from the Australian Government under the National Comorbidity Initiative, to include the most current management principles obtained from the literature and clinical practice.
There is still a dearth of information available in the literature for some areas of comorbidity discussed in these guidelines. Therefore, management principles in these areas are based on what is currently thought to be reasonable clinical practice rather than on high levels of evidence. In addition, many people with comorbidity have more than one mental disorder and may have problematic use of several substances. This resource is a simple guide that provides a starting point for clinicians.
Andrea Gordon and Chris Holmwood
Drug and Alcohol Services South Australia