Recognizing the individual and overlapping needs of those with severe psychotic illnesses, addictions and concurrent disorders
Background:
Severe psychotic illnesses and substance abuse disorders are both serious conditions on the mental illness spectrum. Each requires completely different treatment options and support mechanisms, as do concurrent disorders (having both psychotic illness and addiction). However, this distinction is often lost in the current public debate over how best to help people suffering from one or both conditions.
Treating psychotic illnesses and substance abuse disorders as one and the same has led to significant challenges in providing effective and tailored support to all three groups.
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Given the current opioid crisis and the tragic toll of overdose deaths, public policy is increasingly focussed on addictions. As a result, a larger share of resources are being taken from the common budget to go towards treatment for substance use disorders alone. Rather than adequately funding resources to help all those with a psychotic illness and/or addiction, the already-strained budgets for treating severe mental illnesses falls further behind. Additionally, housing options are increasingly combined, which leads to concerns that treatment centres and harm-reduction housing will introduce new problems for those with mental illness alone.
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Front line workers (nurses, social workers, police and others) are expected to know how best to communicate with those in their care. More and more, language and expectations appropriate to addictions are being applied to all those with psychotic illness. For example, expecting someone with a psychotic illness to admit to their illness as the first step to recovery will lead to failure for a patient with lack of insight, or anosognosia.
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It is imperative that both psychotic illnesses and substance abuse disorders be approached in a way that prioritizes the safe treatment and support of each within distinct and separate settings. We hear from many families that those who have concurrent disorders (both a psychotic illness and a substance use disorder) are often refused treatment for either condition until they have received treatment for the other – making it impossible to get help. Consequently, there needs to be comprehensive, integrated treatment for those with concurrent disorders.
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Position:
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Psychotic illness and addiction are two quite different conditions, with different origins and requiring distinct treatment methods. Concurrent disorders require their own form of comprehensive, integrated treatment. By recognizing and addressing each of these conditions, we can pave the way for more effective, targeted, and compassionate support for individuals grappling with severe mental illness in Canada.
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There must be separation of psychotic illness, addiction and concurrent disorders in the realms of treatment, resource allocation, and legislation within the Canadian healthcare system. Everyone living with a psychotic illness, a substance use disorder, or both, must be given adequate treatment that is appropriate to their situation.
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Supporting Research:
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Mental Illness and Addiction: Facts and Statistics – Centre for Addiction and Mental Health (CAMH)
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Concurrent Disorders – Centre for Addiction and Mental Health (CAMH)
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Concurrent (dual mental health and substance use) disorders – Fraser Health
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A Family Guide to Concurrent Disorders (PDF) – CAMH
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Prevalence and Consequences of the Dual Diagnosis of Substance Abuse and Severe Mental Illness - Peter F. Buckley, MD, 2006