Assess Effects of Co-Occurring Disorders
Assess Effects of Co-Occurring Disorders
Assess Effects of Co-Occurring Disorders
James E. McMullen
Bellevue University
Assessing the Effects of Co-Occurring Disorders 2
There is a high frequency of co-occurring mental disorders in those individuals who are
treated for substance use disorders (SUD). So, it is recommended that all new clients in SUD
treatment be screened and assessed for co-occurring mental disorders. It is also recommended
that mental health providers screen all new clients for any substance misuse and disorder.
Treatment outcomes for persons with multiple issues improve if each problem is addressed
specifically. So, clients entering treatment should be evaluated for all possible conditions that
Substance misuse screening in mental health service locations should screen for safety
risk related to serious intoxication or withdrawal. Clients should also be screened for past and
present substance use, and substance-related problems. Mental disorder screening should
evaluate for safety risk for the individual and others, past and present mental illness, learning
disabilities, and abuse and trauma. There is a recommended order to the steps that should be
followed in evaluating the effects of co-occurring disorders (Center for Substance Abuse
Treatment, 2005).
First, it is of most importance to assess the significance of the substance use disorder. It is
most helpful to develop a chronological history depicting the beginning of any mental disorder
and the SUD symptoms. It will help develop the proper treatment if it can be delineated what
mental disorder symptoms occur only in the presence of substance abuse. Work with the client
to determine whether abstaining from any substance leads to resolving any mental disorder
Second, assess from the client, and others if need be, the length of the current timeframe
of abstinence. This will assist in isolating symptoms from SUD and those from mental disorders.
Assessing the Effects of Co-Occurring Disorders 3
If there has not been at least a 4-6 week time of abstaining from substance use, work with the
client to obtain such a time period, and repeat assessment and diagnosis after such a period. This
will depend on the client’s individual status if they are able to go the needed period without use,
the mental disorder symptoms to determine what symptoms remain indicating mental disorder.
There are numerous instruments to evaluate for mental disorders and no single one can properly
screen for all disorders, but a proper combination of screening instruments can be used to best
evaluate the client (International Community Corrections Association, 1999). Some of the
recommended instruments are the Beck Depression Inventory II (BDI-II); Brief Symptom
Forth, if it is apparent that mental disorder symptoms are resolved, consider traditional
treatment for substance abuse. If evidence of mental disorders remains, consider referral for
facilities. This should be expected as the co-occurrence of mental disorders with SUDs is the
rule, and not the exception (Substance Abuse and Mental Health Services Administration, 2020).
Those professionals trained in addiction counseling should expect and be prepared to have such
clients cross their paths. As Addiction Counselors are not trained to provide full mental disorder
counseling, it is no slight on their ability, and they should refer them to someone with proper
continuing reevaluation of the client’s mental disorder symptoms and how their progress is going
in treatment. This should also include any progress made on SUD treatment, if it can be
Assessing the Effects of Co-Occurring Disorders 4
determined. This will continue until it is determined if their mental disorder symptoms are able
to be resolved to a point where their SUD symptoms are able to be adequately and independently
treated. Reevaluation will continue until treatment is no longer required or they need to be
References
Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment for Adults in the
Criminal Justice System. Treatment Improvement Protocol TIP 44. Rockville, MD:
Correctional Association.
Substance Abuse and Mental Health Services Administration. (2020). Substance Use Disorder
(TIP) Series, No. 42. SAMHSA Publication No. PEP20-02-01-004. Rockville, MD: