Module 2

HOME

MODULES

GLOSSARY

--> -->Module 2

Module 2: Screening and Assessment

5F. Assessment of Co-occurring Disorders

If symptoms of both mental health and substance use disorders are detected during screening, all follow-up assessments should explore both disorders. Symptoms of mental health and substance use disorders can mimic, mask, precipitate, or exacerbate each other. Understanding the interactive effects of these disorders is critical to the development of a successful treatment plan. Clarifying the chronology of substance use and mental health symptoms is important as is continued reassesment and rediagnosis.

Chronology

Whenever possible, it is important to clarify the chronology of the relationship between co-occurring mental health and substance use disorders. Use the checkboxes below to indicate which steps your agency typically does.

1.	Assess the significance of each disorder
		Obtain a longitudinal history of the onset of mental illness and substance abuse
		Analyze whether mental health symptoms occur only in the context of substance abuse
		Determine whether sustained abstinence from drug of alcohol use leads to rapid and full remission of mental health symptoms
		Determine whether improvements in mental health status result in reduction of substance-abusing behaviors
2.	Determine the length of current abstinence from drugs or alcohol.
3.	Reassess mental health symptoms at the end of 4 to 6 weeks of abstinence
4.	If mental health symptoms remit fully, then refer the youth to substance abuse or co-occurring services. If mental health symptoms do not remit, refer the youth to mental health or co-occurring services.

If significant psychiatric symptoms continue after a detoxification period (how long depends on the pattern and type of substance used), treatment planning must consider explanations other than substance-induced causes.

How Important Is the Issue of "Primary" Versus "Secondary" Diagnosis?

This has been a prominent issue in the history and treatment of youth with co-occurring disorders. One school of thought was that treating the "primary" disorder of mental illness would be enough to resolve the youth’s substance use disorder. This strategy has been found to be both simplistic and futile, with most youth with co-occurring disorders failing to make expected treatment gains or achieve symptom remission because their continued abuse of substances remained unaddressed.

Historically, this distinction has been used to deny services and shift youth from one system to another. Currently, most experts feel the distinction is not very useful in making treatment decisions.

Continual Reassessment and Rediagnosis

The wide variation in co-occurring disorders and the impact of adolescent development create a need to continually assess symptoms, the course of the disorders, and the effectiveness of the treatment being provided. In addition, substance use in one environment does not predict substance use in the next setting. Only with continual reassessment and rediagnosis are we able to monitor the disorders closely and work to prevent relapse.