Running head: Assessing the Effects of Co-Occurring Disorders 1

Assessing the Effects of Co-Occurring Disorders

James E. McMullen

Bellevue University
Assessing the Effects of Co-Occurring Disorders 2

Assessing the Effects of Co-Occurring Disorders

There is a high frequency of co-occurring mental disorders in those individuals who are

treated for substance use disorders (SUD). So, it is recommended that all new clients in SUD

treatment be screened and assessed for co-occurring mental disorders. It is also recommended

that mental health providers screen all new clients for any substance misuse and disorder.

Treatment outcomes for persons with multiple issues improve if each problem is addressed

specifically. So, clients entering treatment should be evaluated for all possible conditions that

can be causing their issues.

Substance misuse screening in mental health service locations should screen for safety

risk related to serious intoxication or withdrawal. Clients should also be screened for past and

present substance use, and substance-related problems. Mental disorder screening should

evaluate for safety risk for the individual and others, past and present mental illness, learning

disabilities, and abuse and trauma. There is a recommended order to the steps that should be

followed in evaluating the effects of co-occurring disorders (Center for Substance Abuse

Treatment, 2005).

First, it is of most importance to assess the significance of the substance use disorder. It is

most helpful to develop a chronological history depicting the beginning of any mental disorder

and the SUD symptoms. It will help develop the proper treatment if it can be delineated what

mental disorder symptoms occur only in the presence of substance abuse. Work with the client

to determine whether abstaining from any substance leads to resolving any mental disorder

symptoms to isolate what, if any, mental disorders remain.

Second, assess from the client, and others if need be, the length of the current timeframe

of abstinence. This will assist in isolating symptoms from SUD and those from mental disorders.
Assessing the Effects of Co-Occurring Disorders 3

If there has not been at least a 4-6 week time of abstaining from substance use, work with the

client to obtain such a time period, and repeat assessment and diagnosis after such a period. This

will depend on the client’s individual status if they are able to go the needed period without use,

or if they will need aid from withdrawal symptoms.

Third, after successful completion of 4-6 weeks of abstinence perform a reassessment of

the mental disorder symptoms to determine what symptoms remain indicating mental disorder.

There are numerous instruments to evaluate for mental disorders and no single one can properly

screen for all disorders, but a proper combination of screening instruments can be used to best

evaluate the client (International Community Corrections Association, 1999). Some of the

recommended instruments are the Beck Depression Inventory II (BDI-II); Brief Symptom

Inventory (BSI); and the General Behavior Inventory (GBI).

Forth, if it is apparent that mental disorder symptoms are resolved, consider traditional

treatment for substance abuse. If evidence of mental disorders remains, consider referral for

treatment by a mental health professional, or treatment within specialized co-occurring disorders

facilities. This should be expected as the co-occurrence of mental disorders with SUDs is the

rule, and not the exception (Substance Abuse and Mental Health Services Administration, 2020).

Those professionals trained in addiction counseling should expect and be prepared to have such

clients cross their paths. As Addiction Counselors are not trained to provide full mental disorder

counseling, it is no slight on their ability, and they should refer them to someone with proper

training, if need be.

Fifth, as is the case in any treatment or treatment setting it is necessary to provide

continuing reevaluation of the client’s mental disorder symptoms and how their progress is going

in treatment. This should also include any progress made on SUD treatment, if it can be
Assessing the Effects of Co-Occurring Disorders 4

determined. This will continue until it is determined if their mental disorder symptoms are able

to be resolved to a point where their SUD symptoms are able to be adequately and independently

treated. Reevaluation will continue until treatment is no longer required or they need to be

referred to another provider, as discussed in the fourth step.

Assessing the Effects of Co-Occurring Disorders 5

References

Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment for Adults in the

Criminal Justice System. Treatment Improvement Protocol TIP 44. Rockville, MD:

Substance Abuse and Mental Health Services Administration.

International Community Corrections Association. Conference (1997: Cleveland, O., Latessa, E.

J., American Correctional Association. (1999). Strategic solutions: The International

Community Corrections Association examines substance abuse. Lanham, MD: American

Correctional Association.

Substance Abuse and Mental Health Services Administration. (2020). Substance Use Disorder

Treatment for People with Co-Occurring Disorders. Treatment Improvement Protocol

(TIP) Series, No. 42. SAMHSA Publication No. PEP20-02-01-004. Rockville, MD:

Substance Abuse and Mental Health Services Administration.