SAMHSA logo Report to Congress - Nov 2002








Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

Chapter 3 - Prevention of Co-Occurring Disorders - Prevention for Adults


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Prevention for Adults

Serious mental illnesses, such as schizophrenia and bipolar disorder generally arise and are first diagnosed in youth and young adults. Because these individuals are at increased risk for developing co-occurring substance abuse disorders and mental disorders (Mueser et al., 1998), the opportunity is available to clinicians and others in the caregiving system to intervene to prevent the co-occurrence. Intervention can reduce the likelihood of a host negative outcomes, increased rates of relapse and rehospitalization, homelessness, legal problems, violence, treatment noncompliance, HIV infection, and family stress (Drake and Brunette, 1998, in Mueser, et al., 1998).

The results from a study integrating data from State mental health, substance abuse, and Medicaid agencies found that individuals with a single diagnosis (substance abuse or mental disorder) were not likely to be hospitalized. In 1996 there were 87 hospital stays per 1,000 for individuals with a mental disorder only and 23 stays per 1,000 for individuals with substance abuse only in 1996. In contrast, individuals with co-occurring substance abuse disorders and mental disorders were considerably more likely to be hospitalized, at a rate of 457 hospitalizations per 1,000 (SAMHSA, 2001a).

Youth in transition to adulthood who experience serious emotional disturbance are at special risk (Davis and Stoep, 1996). Many leave institutions in the child mental health system or foster care settings with few skills and little social support. They remain largely unclaimed by either the child or the adult mental health systems and are at significant risk for developing co-occurring substance abuse disorders, as well as for suicide, arrest, and homelessness (Lezak and MacBeth, 2002; Davis and Stoep, 1996).

Risk and Protective Factors

Common psychological and social stressors in adult life - the breakup of intimate relations, death of a family member or friend, economic hardship, racism and discrimination, trauma and poor physical health - may precipitate mental disorders in adults with particular biological, social or psychological vulnerabilities (U.S. DHHS, 1999b). For example, adult survivors of past trauma, childhood sexual abuse and/or domestic violence are at increased risk for post traumatic stress disorder (PTSD), depression, anxiety, substance abuse, eating disorders, and suicide. Family history - including genetics - may act as biological risk factors for some forms of mental disorders and substance abuse disorders.

Protective factors are at work in adulthood, as well. Mrazek and Haggerty (1994) have suggested that problem-solving skills, the availability of responsive social and medical services, and support from friends, family, and others act as protective factors. Additional protective factors include the ability to cope with one's emotions, to control the demands of work and mobilize supportive co-workers, to use job-seeking skills, and to nurture spouse and family support.

Prevention Opportunities for Adults

Following on a 1996 report that identified depression as an important issue in health care, the U.S. Preventive Services Task Force (2000) recently recommended that primary care physicians be encouraged to screen their adult patients for depression. Based on a broad corpus of research that shows improvements in overall health status when depression is recognized and treated, the Task Force, further recommended that primary care physicians should have or gain the skills necessary to diagnose, treat, and provide follow-up to their patients who have depression.

Some new evidence suggests that early intervention by primary care providers also can help lower the onset and severity of depressive symptoms and depression-related impairment in adults. A randomized, controlled trial tested the effect of education about depression and controlling mood on 150 primary care patients who did not meet diagnostic criteria for depression but who were considered to be at high risk. A year after receiving the intervention, participants had developed significantly fewer symptoms associated with depression than members of the control group (Munoz et al., 1995).


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