New report examines treatments for people who have both mental health and substance-use disorders

It is common for people to have both substance-use and psychiatric disorders, especially among those with more severe symptoms. When concomitant, the symptoms of each diagnosis often aggravates the other. Therefore people with these comorbidities often have more psychosocial problems, a lower quality of life, and are at increased risk of premature death, compared to individuals with a single diagnosis.
“This group has a high mortality and suffers enormously, so we really need to find out more about how we can help them,” says Sara Wallhed Finn, clinical psychologist and PhD at Stockholm Center for Dependency Disorders (Beroendecentrum Stockholm), and an expert in the ongoing project in which SBU is evaluating the effects of treatments and social support interventions for people who have comorbid substance use and mental health disorders.

The difficulties have long been recognized. Nevertheless, people in Sweden with these comorbidities often do not receive the treatment and social interventions that they need, according to the 2021 interim report from the Comorbidity Inquiry (Samsjuklighetsutredningen). Treatment options and interventions are inadequate, and coordination of care is often insufficient between the those who provide specialist addiction care, psychiatric care, and social services, so people risk falling between the cracks.
“Treatment is still often aimed at only one of these problems at a time, even though there is consensus that both disorders should be addressed simultaneously. For example, if a patient who is in treatment for depression is also found to have a substance use disorder, the patient may be referred to addiction care or social services, which can interrupt their current mental health treatment and lead to a worse prognosis. Awareness of this dilemma has increased, but we have not yet found out how to effectively com- bine treatments” says Agneta Öjehagen, a social worker and professor emerita at the Department of Psychiatry, Lund University, and an expert in the project.

The initiative for the evaluation comes from SBU, which has received consistent signals from representatives of both social services and health care that a better knowledge base is needed for this group of patients. The fact that the National Board of Health and Welfare’s national guidelines pertaining to this area are meager and have not been updated since they were initially published in 2015 underscores this need.
The work spans the whole range of sub- stance use disorders combined with a wide range of mental disorders. The studies under review also evaluate many different types of interventions: pharmacological treatments, psychological and psychosocial, as well as social support. 

This broad approach is important, according to Nils Stenström, project manager at SBU. “We hope that this review will be relevant for many professionals from both the social services and health care settings. That is why we chose to take such a broad approach,” he says.

Sara Wallhed Finn believes that the results will become a valuable tool in daily work with patients.
“This report has the potential to improve care and social support for this group of patients. Current guidelines are insufficient to guide everyday clinical practice in treating both conditions.
We hope this assessment will be able to provide more concrete guidance to those working in the clinical setting – that would be a great help,” she says.
“Even if the results show that there is not enough evidence to make certain pronouncements, it will still provide
important information about where more research is needed,” she says.

The report also draws attention to this important area, according to Agneta Öjehagen. Another important feature, she notes, is that the review includes groups with mild or moderate conditions:
“In the past, most attention has been to those with severe illness, which is reasonable. But this has the consequence that we know less about effective treatment interventions for the group with less severe problems, who may still have a stable life with a job and a family. I hope we can direct more attention to this latter group now,” says Agneta Öjehagen.
Nils Stenström agrees with these expectations and adds that he hopes the report will result in a wider range of treatment options. 
“There are few facilities today that can offer patients a multifaceted range of treatments. We hope that our report will
contribute to finding more effective treatment interventions so that the possibilities for health care and social services to meet patients’ needs can improve.” 

“We hope that this review will be relevant for many professionals from both the social services
and health care settings.”

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