IN THIS ISSUE

Behavioral Health Disorders and Treatment Gaps, Cont'd

Co-Occurring Disorders and Treatment Gaps
In 2015, roughly 8.1 million U.S. adults age 18 or older reported co-occurring disorders (CODs) in the past year (CBHSQ, 2016). Among the 43.4 million adults who reported any mental illness in the past year, about 19 percent met criteria for a substance use disorder (CBHSQ, 2016). Including people with any lifetime substance use disorder and mental health disorder, the U.S. population with CODs is even higher.

Ten percent of the population 18 and older had lifetime substance use disorders.¹ The likelihood of a co-occurring psychiatric disorder is higher for someone with a lifetime substance use disorder than for someone without it, according to recent data from NESARC (Grant et al., 2016).

Among the U.S. adult population in 2012–13, individuals with 12-month substance use disorders were 30 to 80 percent more likely to have major depressive disorder, dysthymia, bipolar disorder, PTSD, and antisocial, borderline, or schizophrenic personality disorder (Grant et al., 2016). People with lifetime substance use disorders are 30 percent more likely to have generalized anxiety disorder, panic disorder, or social phobia (Grant et al., 2016).

Co-occurring disorders require more complex treatments than are traditionally provided in separate mental health and substance use treatment centers (Mangrum et al., 2006). In 2015, less than 7 percent of people who reported having CODs received treatment for both disorders, despite high rates of comorbidity associated with mental health and substance use disorders (CBHSQ, 2016). Nearly half of those 12 and older with CODs received no treatment at all, based on 2015 data (CBHSQ, 2016).

Researchers and practitioners consider integrated treatment to be most effective for individuals with co-occurring disorders, compared with separate, fragmented, or nonconcurrent treatment (Kelly et al., 2012; Mueser et al., 2003). Integrated treatment may involve coordinated service delivery among providers in different agencies, bundling interventions, or coordinated treatment delivered by one team of providers in one setting.

However, evidence of the effectiveness of integrated treatment is mixed (e.g., Babowitch & Antshel, 2016; Hunt et al., 2013). Persistent disparities remain in access to concurrent, integrated treatment for CODs. For example, African Americans and Latinos are less likely than whites to receive concurrent integrated treatment, according to 2009–13 data from NSDUH (Nam et al., 2017). Types of co-occurring disorders also vary by race and ethnicity, necessitating culturally and clinically competent integrated treatments (Pacek et al., 2012; Mericle et al., 2012). SAMHSA offers guidelines for building and delivering integrated treatment programs for people with CODs.

Call to Action for MFP Fellows. Given the complexity and severity of co-occurring disorders for a significant proportion of the population, MFP Fellows have an important role to play in understanding, implementing, and evaluating effective treatments.

In a study of 256 substance use and mental health treatment programs across eight states, McGovern and colleagues (2014) found only 18 percent of addiction treatment programs and 9 percent of mental health treatment programs met the criteria for delivery of integrated services according to practice guidelines for people with CODs.

Structural, organizational, and managerial changes are also required to reduce treatment barriers experienced by individuals with co-occurring disorders (Priester et al., 2016).

MFP Fellows have many new opportunities to develop, implement, study, and expand access to effective care for individuals with CODs, particularly racial and ethnic minorities.

¹Substance use disorders included misuse of sedatives/tranquilizers, cannabis, amphetamines, cocaine, nonheroin opioids, heroin, hallucinogens, club drugs (e.g., ecstasy), and solvents/inhalants. For lifetime disorders, individuals must meet 2 or more of 11 criteria in the DSM–5 arising from use of the same substance in the prior year or before the last year.

References
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Bush, D. M., & Lipari, R. N. (2015). Substance use and substance use disorder by industry. Rockville, Md.: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

CBHSQ. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. Rockville, Md.: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

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Kelly, T. M., Daley, D. C., & Douaihy, A. B. (2012). Treatment of substance abusing patients with comorbid psychiatric disorders. Addictive Behaviors, 37, 11–24.

Lipari, R. N., & Hughes, A. (2017). How people obtain the prescription pain relievers they misuse. Rockville, Md.: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

Lipari, R. N., Park–Lee, E., & Van Horn, S. (2016). America's need for and receipt of substance use treatment in 2015. Rockville, Md.: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

Lipari, R. N., & Van Horn, S. (2017). Smoking and mental illness among adults in the United States. Rockville, Md.: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

Mangrum, L. F., Spence, R. T., & Lopez, M. (2006). Integrated versus parallel treatment of co-occurring psychiatric and substance use disorders. Journal of Substance Abuse Treatment, 30(1), 79–84.

Mays, V. M., Jones, A. L., Delany–Brumsey, A. D., Coles, C., & Cochran, S. (2017). Perceived discrimination in health care and mental health/substance abuse treatment among blacks, Latinos, and whites. Medical Care, 55(2), 173–181.

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News and Views

In Recovery, Relationships Can Make the Difference
September is National Recovery Month, and this year's theme is "Join the Voices for Recovery: Strengthen Families and Communities." Family and community support is indispensable to people recovering from mental health or substance use disorders, and SAMHSA is inviting those individuals and their families to share personal stories and successes. A wealth of tools and materials is available on SAMHSA's website for spreading the message.

McCance–Katz Confirmed as Mental Health and Substance Use Assistant Secretary
Last month, the U.S. Senate confirmed Elinore McCance–Katz as the first Health and Human Services assistant secretary for mental health and substance use. The position was created by the Helping Families in Mental Health Crisis Act of 2016. McCance–Katz was previously SAMHSA's first chief medical officer.

Which Topical Areas Do Federal Agencies Fund?
Dr. Michael Lauer, NIH's Deputy Director for Extramural Research, blogs on the agency's RePORTER tool. The RePORTER is a resource for understanding the research areas NIH supports, designed especially for scientists developing new programs or applying for funding. Even more expansive is the Federal RePORTER, which searches more than 800,000 projects across 17 federal agencies. It's an easy-to-use, topic-organized system, with plenty of tips for new users.

A Measure for the Nation's Behavioral Health
Volume 4 of SAMHSA's Behavioral Health Barometer breaks down key trends in America's mental wellness. With tables, charts, and bullets, the Barometer tracks ups and downs in substance use, mental illness, suicidal thoughts, and treatment, grouping data by age, gender, race and ethnicity, poverty level, and health insurance coverage. The Barometer shows an increase in major depressive episodes among teenagers, from 8.2 percent in 2011 to 12.5 percent in 2015. Only 39 percent of those adolescents received treatment for depression.

Psychotherapy Gets Centered
In parts of the country where mental health care is less accessible and often less understood, integrated behavioral health care is finding its niche. Here, psychologists work out of doctors' offices and medical centers, in tandem with physicians. Along with providing care, these psychologists train medical residents to use their techniques in therapy. Integrated psychologists help patients manage their pain at home and offer alternatives to long-term pill prescriptions, like breathing exercises and meditation. Having an in-house psychologist also takes some of the burden off primary care physicians to address mental health issues. Many clinics will work with uninsured patients, billing them on an income-based sliding scale.

Study Connects Opioid Use and Mental Health Disorders
People with two common mental health disorders are consuming a disproportionate amount of prescription pain medicine, say researchers at Dartmouth College and the University of Michigan. Their study found nearly 19 percent of the estimated 38.6 million people with anxiety and depression received at least two prescriptions for opioids over a year's time. More than half the prescriptions for the powerful, highly addictive pain meds went to people in that group. Although many of these patients authentically suffer from physical ailments, poor coping skills and a distraught mental state could exacerbate their pain. But while opioids may dilute the symptoms of depression temporarily, patients will eventually return for more drugs. Brian Sites, the study leader, says doctors are in a difficult position, acknowledging the overprescribing epidemic. "We're in an independent crisis of mental health as well, the under-treatment of it," he said. "These two things collide."

New SAMHSA Committee Will Organize SMI Efforts
SAMHSA will manage a new committee dedicated to addressing serious mental illness in America. The Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) was created under the 21st Century Cures Act to coordinate federal efforts around SMI and convey progress in research on serious mental illness among adults and children. The committee will also explore how SMI may be related to unemployment, homelessness, criminal justice involvement, emergency hospitalization, drug overdose, and suicide and recommend actions for agencies to improve the administration of mental health services.

Marriage and Family Therapy Partners With Behavioral Health Center
As a result of a SAMSHA–Health Resources and Services Administration joint initiative, the American Association for Marriage and Family Therapy (AAMFT) has entered a research partnership with the Behavioral Health and Workforce Research Center (BHWRC), which is based at the University of Michigan School of Public Health. BHWRC will work with AAMFT to glean information about current marriage and family therapists. Among the topics of research will be demographic composition, practice characteristics, job functions, and service settings.

Veterans Initiative Makes Mental Wellness Part of Healthy Lifestyle
Walgreens is partnering with the Veterans of Foreign Wars and the Department of Veterans Affairs (VA) to raise awareness about mental health among veterans and their families. The collaboration seeks to change the way people think about behavioral health and encourage veterans to find help when they need it. Walgreens supports the VA's Make the Connection campaign, which shares veterans' stories of treatment and recovery. There is also an opioid overdose prevention effort that will circulate information about naloxone, and a potential training initiative where Walgreens pharmacists would learn to address the specific needs of veterans.

As College Nears, Keep Talking With Kids About Mental Health
This guide for college students and their parents invites an open conversation on mental wellness to prepare for a healthy school experience. It describes the early signs of depression and other mental health conditions that college kids may experience with separation from family and mounting academic and peer pressure, and points to places where students can find help.

SAMHSA Backs Bigger Behavioral Healthcare Workforce
SAMHSA will provide up to $44.6 million to support an expanded healthcare workforce that can effectively treat substance use disorders and promote recovery. Through the Addiction Technology Transfer Centers Cooperative Agreements, grantees will establish a network in which to work with each other and SAMHSA to improve treatment and advance recovery. The new network will feature a National Coordinating Office and 10 regional centers around the country.

NIH Seeks to Strengthen Biomedical Field
The Next Generation Researchers Initiative came about to ensure the long-term stability of biomedical research. With this investment, the National Institutes of Health (NIH) will work to extend the payline for scientists about to lose NIH funding and prioritize financing a concurrent award for particularly promising mid-career investigators. The effort will help progressive researchers get the funding they need to pursue their studies without excessive financial or time constraints.

APA Issues New Guidelines for PTSD Treatment
Early this year, the APA Council of Representatives approved a clinical practice guideline for treating post-traumatic stress disorder (PTSD) in adults. The guidance is based on empirical evidence, summarizing existing research and elaborating on the efficacy of psychological and pharmacological interventions. An accompanying report addresses not only standard treatment issues, but also the quality of the patient–therapist relationship and sensitivity to diversity, with recommendations for cognitive–behavioral therapy, cognitive processing therapy, and prolonged exposure therapy for adults with PTSD.