How to treat coexistent mental illness and substance abuse

Unmet need for community-based mental health and substance use treatment among rural adolescents

This research assessed the extent of unmet service need for rural youth with mental health (MH) and/or substance use (SU) problems. All adolescents (12-18 years old) living in a three-county region of Iowa and discharged from outpatient MH or SU treatment were included (n = 177). Chart review was used to retrospectively assess service utilization and clinical characteristics at time of admission and discharge. Two-thirds (64%) of adolescents with co-occurring disorders did not receive treatment consistent with widely supported guidelines recommending that individuals with co-occurring disorders receive treatment for both their MH and SU problems. Higher severity of depression, more supports, prior MH service utilization and lower prevalence of prior abuse predicted the receipt of dual services. Finally, adolescents with co-occurring problems who received only MH treatment showed improvement on MH needs at discharge but no improvement on SU needs. Similarly, adolescents with co-occurring problems who received only SU treatment showed improvement on SU needs but not on MH needs. There is considerable unmet treatment need among rural adolescents with co-occurring disorders. Efforts to improve care must focus on adolescent, familial, program, funding and policy factors that act as barriers to unifying philosophies and practices needed to advance appropriate care.

Enhancing services for offenders: the impact on treatment completion

Because of high drop out rates, it is important to determine if enhancing standard substance treatment services will impact treatment completion rates among those in need of specialized services who are involved in the criminal justice system. The purpose of this research was to understand the impact of providing mental health services and gender-specific services for women in a modified therapeutic community setting. In the study, those who received mental health services and/or gender-specific treatment services, in additional to the substance abuse services, had similar rates of treatment completion as compared to those who received only substance abuse services. Logistic regression results indicated that controlling for other variables, age and length of time using one's primary drug were the only statistically significant predictors of treatment completion. The results suggest that the treatment model described in this article is a potentially cost-effective method of maximizing existing resources for treating substance abusing criminal offenders in community-based treatment settings.