Monday, December 02, 2002
USA TODAY - December 02, 2002
Mental disorders are common among alcoholics and drug abusers, but their mental illness and addictions are seldom treated at the same time, which prevents many from recovering from either, says a report sent to Congress today.
And the government must take the lead in tearing down the ''firewall'' between programs that treat addiction and those that treat mental illness, the report concludes.
People who have mental illness and are substance abusers have traditionally been considered exceptions, ''but it's time to get real,'' says Charles Curie of the Substance Abuse and Mental Health Services Administration, which wrote the report at Congress' request.
About one-third of drug and alcohol abusers have mental disorders, Curie says, and adults with mental illness are three times more likely than others to be substance abusers. An estimated 7 million to 10 million Americans have mental and addictive disorders, he says. There's strong evidence that integrated programs work best for them.
But that's going to take a major overhaul of the nation's treatment system. ''Virtually all programs are designed for one or the other,'' says psychiatrist Kenneth Minkoff, a clinical professor at Harvard. People with both problems ''have poor outcomes at higher cost, and they're more likely to end up in the corrections system.''
A recent study of the Pennsylvania state prison system found that 85% of inmates had addictions, and half of them had mental disorders as well. ''That's typical of prison systems nationally,'' Curie says. ''And we know if these inmates recover from the disorders, they're unlikely to repeat crimes.''
In the past few years, states have started some model integrated programs, but the pace needs to quicken, he says. The report lists several key steps the health services administration will take. Among them:
* Federal financial incentives that will spur states to try integrated programs.
* Incentives to combine therapy with medication in long-term treatment plans that help patients find employment and housing.
* A national summit next year for consumer advocates and experts in treatment and criminal justice.
* A ''tool kit'' to help local agencies replicate excellent programs.
In Connecticut, a Yale study showed that heroin addicts were far more likely to drop out of methadone treatment if they were depressed or had anxiety disorders. One-third of the state's methadone treatment programs have since added psychiatric screenings and treatment. That has kept more clients in the program and off heroin, says psychologist Tom Kirk, Connecticut's commissioner for mental health and addiction services.
''We have to change the programs to fit what people need, not try to fit the people into programs,'' he says. ''It's better value because patients are more likely to recover.''
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