Effects of treatment and social support measures in comorbidity

Background

Having a harmful use or dependence on alcohol or drugs and at the same time some other mental illness is a common form of comorbidity. According to the European Center for the Control of Drugs and Drug Addiction (EMCDDA), several studies indicate that between 50-80% of people involved in health care for harmful use or addiction also have at least one other mental illness [1]. In Sweden, the National Board of Health and Welfare's statistics show that 64% of women and 52% of men who were cared for for the use of addictive substances in 2017 were also cared for for one or more psychiatric diagnoses the year before or after addiction care [2]. It is also well known that harmful use / addiction is more common among people with mental illness than in the general population. Studies show that 20–30% of those who are involved in care for their mental illness also have a harmful use or addiction [3]. In co-morbidity, the disease states interact, which complicates the treatment and can impair the development of both conditions. Compared with people with one diagnos, people with comorbidity often show a higher degree of psychopathological difficulty and more psychosocial problems, e.g. unemployment, homelessness, social isolation and crime. Discontinuation of treatment is more common and fewer complete treatment. People with comorbidities also experience lower quality of life and are more likely to die early - including suicide [4]. Psychological, psychosocial and pharmacological treatments for comorbidities are available, but relatively few have been evaluated using safe scientific methods. Due to this, the National Board of Health and Welfare's recommendations on treatment and social support measures in the event of comorbidity contain relatively few concrete measures. However, the recommendations have not been updated since they were published in 2015. “Samsjuklighetsutredningens” report 2021 states that it is common for people with harmful use and addiction in combination with mental illness not to have access to the treatment they need and that the range of treatment interventions is insufficient and unevenly distributed across the country [5]. The Swedish Health and Care Inspectorate (IVO) has pointed out that collaboration between the health care and social services is lacking, which means that individuals with great care and nursing needs risk being caught between different care providers [6]. A number of studies have also shown that people with comorbidity make repeated visits to emergency care, primary care and social services, which indicates that existing treatment interventions are often unable to meet people's needs [7].

Aim

The purpose of SBU's project is to evaluate the effects of various treatments and social support measures for comorbidity. A sub-question is whether there are differences in clinical results when people with comorbidity receive coordinated interventions for both diseases compared with addiction treatment alone.

References

1. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2016, Perspectives on drugs; Comorbidity of substance use and mental health disorders in Europe.
2. Socialstyrelsen (2019), Kartläggning av samsjuklighet i form av psykisk ohälsa och beroendeproblematik, 2019-11-6481.
3. Bridget F. Grant, PhD, PhD; Frederick S. Stinson, PhD; Deborah A. Dawson, PhD et al. Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders. Results From the National Epidemiologic Survey on Alcohol and Related Conditions Arch Gen Psychiatry. 2004;61:807-816.
4. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2016, Perspectives on drugs; Comorbidity of substance use and mental health disorders in Europe.
5. SOU 2021:93 Från delar till helhet - En reform för samordnade, behovsanpassade och personcentrerade insatser till personer med samsjuklighet; Delbetänkande av samsjuklighetsutredningen.
6. Inspektionen för vård och omsorg, (IVO 2016-19). Samverkan för patienter och brukares välbefinnande - Missbruks- och beroendevården, 2016.
7. Eliasson B, Segerstedt E. FoU-Norrbotten, Rapport 77, 2013, Uppföljning av mångbesökare inom missbruks- och beroendevård.