Alcohol Use Disorders and Co-Occurring Conditions
Ting-Kai Li, M.D.
Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism, presented an overview of alcohol use disorders and co-occurring conditions, the onset of alcohol use and alcohol use disorders,
and screening and brief interventions. Currently, 18 million Americans are suffering from alcohol use or dependence (100,000 die annually) and alcohol problems
in the U.S. cost an estimated $185 billion per year. Li outlined some of the reinforcing effects, aversive effects, and peer/cultural influences that encourage or do not encourage people to drink, and covered the rate of co-occurrence of alcohol dependence with nicotine dependence, other drug dependencies, mood and anxiety disorders, and personality disorders. Li then presented information on two important public health issues—age of onset of alcohol use and family history of alcoholism and their influences on lifetime alcohol dependence. Li also discussed age of onset for cannabis use disorders, tobacco dependence, and major depression; a developmental perspective on age of onset of brain disorders (ADHD, antisocial behavior, obsessive compulsive disorders, eating disorders, panic disorders, bipolar, etc.); screening protocols for high-risk drinking; and counseling interventions.
Preventing Co-Occurring Disorders: Prospects and Opportunities
J. David Hawkins, Ph.D.
Dr. David Hawkins, director of the Social Development Research Group at the University of Washington, discussed the prevention of co-occurring disorders. He explained that such prevention requires the identification of malleable risk and protective factors that predict comorbidity. Risk factors occur in a number of domains—the individual, the community, the family, and the school—and predict a broad set of behavior and health outcomes in young adults.
Some of these outcomes are substance abuse, teen pregnancy, violence, depression and anxiety, and school drop-out. Hawkins segued into a discussion of protective and promotive factors that appear to buffer exposure to risk and reduce the likelihood of health
and behavior problems. Some of these factors are individual characteristics while others exist in the neighborhood, school, family, and peer group. The overarching question was, “Can predictors of comorbidity be identified in early adolescence, and if so, would addressing these predictors prevent comorbid disorders in early adolescence? Hawkins presented data on the Seattle Social Development Project, a longitudinal study of the etiology of prosocial and antisocial behaviors in 808 5th grade students that examined four treatment designs: full treatment, late treatment, parent-training only, and a control sample. Hawkins concluded by outlining intervention strategies and their results on bonding to school, violent delinquent behavior, heavy alcohol use, high school graduation, and depressive symptomatology.
Complexities of Co-Occurring Disorders: State Agency Perspective
Renata J. Henry, M.Ed.
Dr. Renata Henry, director of the Division of Substance Abuse and Mental Health in the Delaware Department of Health and Social Services, spoke about the development of a state infrastructure of services and systems to treat individuals with co-occurring disorders. Henry discussed the barriers and challenges that exist to creating a truly integrated system, some of which include the existence of separate and uncoordinated state mental health and substance abuse systems, disparate insurance coverage, categorical funding streams, few staff bridges between programs, and little connection between providers and programs. She also presented solutions that Delaware has introduced for breaking some of these barriers. In addition, Henry addressed action items at the administrative, Federal, and research levels to improve services for individuals with co-occurring disorders.
Access to Best Practices for Co-Occurring Disorders: Research and Practice Partnerships
Constance Weisner, Dr.P.H., M.S.W.
Dr. Constance Weisner, professor of psychiatry at the University of California at San Francisco and investigator in the Division of Research at Kaiser Permanente Medical
Systems, spoke about the importance of practice—research collaborations and studying access to services when treating co-occurring disorders. She presented a framework for broadening the research focus—posing new and different research questions, moving away from the traditional paradigm of reaching the next step in a research agenda, collaborating with clinicians, and putting far more emphasis on the implementation process. Weisner also covered the importance of access to screening, assessment, and integrated services. She presented data from four cities in California on adolescent chemical dependency (CD), psychiatric conditions of adolescents entering CD treatment, and characteristics of adolescents with suicidal behavior diagnoses. Additional data also addressed whether psychiatric services and medical services are related to outcome in treating co-occurring disorders.