Alcohol-Use Disorder and Severe Mental Illness PMC

To date, three medications have been approved by the FDA to help prevent a return to heavy drinking. You don’t need specialized training or licensing to prescribe these non-addicting medications, so they are no more complicated to prescribe than those for other common medical conditions. As with treatment for other mental health conditions, such as depression, if a patient does not respond well to one medication, it is often worthwhile to try another. Patients with less severe AUD may be able to receive treatment in primary care via brief interventions (see Core article on brief intervention) and FDA-approved AUD medications. For people with more severe AUD or with mental health comorbidities, it’s wise to seek evidence-based behavioral health treatment with a licensed professional therapist to set the stage for lasting change (see Core article on mental health issues).

aud mental health

Second, AUD may undermine a person’s psychological mechanisms to cope with traumatic events, by disrupting arousal, sleep, and cognition, thus increasing the likelihood of developing PTSD. Third, AUD and PTSD have shared risk factors, such as prior depressive symptoms and significant adverse childhood events. Anxiety disorders are the most prevalent psychiatric disorders in the United States. The prevalence of AUD among persons treated for anxiety disorders is in the range of 20% to 40%,2,15 so it is important to be alert to signs of anxiety disorders (see below) in patients with AUD and vice versa. It may also include medicines for detox (medical treatment for alcohol withdrawal) and/or for treating the AUD.

Is There a Cure for AUD?

Several recent studies indicate that integrated treatment programs combining AOD-abuse and mental health interventions within the same setting result in more positive outcomes than traditional, nonintegrated treatment systems (Drake et al. 1996a; Godley et al. 1994; Mueser et al. 1996). These studies show a steady reduction in AOD use, with the number of stably abstinent patients increasing with each year of consistent treatment. Other findings support the concept of treatment stages in the recovery process (McHugo et al. 1995). For example, in a recent study in New Hampshire, clients moved steadily through the stages of engagement, persuasion, active treatment, and relapse prevention, and approximately 50 percent of them achieved abstinence after 3 years of treatment (Mueser et al. 1996). Because of the ways in which AOD-use disorders complicate severe mental illness, comorbidity rates tend to be particularly high among young males and clients in high-risk settings, such as hospitals, emergency rooms, and homeless shelters. The high rates of AOD-use disorders, especially among young adults, may be due partly to changes in the United States’ mental health care system during the past few decades.

AUA is a potent proximal risk factor for suicidal behavior, and the risk increases with the amount of alcohol consumed, consistent with a dose-response relationship. Research indicates that AUA increases risk for suicidal behavior by lowering inhibition and promoting suicidal thoughts. There is support for policies that serve to reduce alcohol availability in populations with high rates of AUD and suicide, that promote AUD treatment, and that defer suicide risk assessments in intoxicated patients to allow the blood alcohol concentration to decrease. Numerous studies have shown that AOD-use disorders typically are underdiagnosed in acute-care psychiatric settings (Drake et al. 1993a). Several factors account for the high rates of nondetection, including mental health clinicians’ inattention to AOD abuse; patients’ denial, minimization, or inability to perceive the relationships between AOD use and their medical and social problems; and the lack of reliable and valid detection methods for this population.

Prevention and Risk Factors

In a comprehensive review, Fischer (1990) found that between 3.6 and 26 percent of homeless adults suffered from both a mental disorder and AUD. The rates of co-occurring mental and AOD-use disorders ranged from 8 to 31 percent. Other recent reviews also have determined that the rates of dual diagnoses among the homeless range from 10 to 20 percent (Drake et al. 1991). Unfortunately, many individuals with this disorder do not seek medical attention until they encounter health issues or become entangled in legal complications. The consequences of AUDs extend beyond mere addiction, profoundly impacting the lives of family members and friends and causing disruptions in interpersonal and professional relationships. Many people with AUD do recover, but setbacks are common among people in treatment.

  • For example, behaviors that may represent common adaptations to homeless living, such as intimidating or threatening other people, often are incompatible with participation in treatment and recovery programs (Weinberg and Koegel 1995).
  • Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.
  • Regardless of the treatment setting, behavioral therapy, pharmacotherapy, and recovery support in the patient’s community should be considered in treatment plans for patients with co-occurring AUD and MHCs.
  • The organization updated the terminology again in 2013 to “alcohol use disorder,” which fits under the umbrella of substance use disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

It requires great creativity by lawyers – and judges – to get people who are cycling through the system any morsel of support upon release, Ms. Bromberg said, which can be challenging in an overburdened court system. The revolving door of homelessness and incarceration is a pattern that Hamilton-based criminal lawyer Beth Bromberg has seen play out again and again. The data do not provide a breakdown of the types of offences the inmates are incarcerated for, or whether they were convicted or awaiting trial. The provincial jail system holds people who are either on remand – meaning they have not yet been convicted of a crime – or who have received a sentence of less than two years.

Alcohol Use Disorder (AUD)

Because of the heterogeneity among co-occurring AUD and MHCs, individualized treatment plans should account for the severity of each disorder and for patient preference regarding interventions. Also, although not typically assessed, the amount of available resources a person has for stabilization and recovery needs to be included in the assessment to inform the treatment plan. Until the increased recognition of co-occurring disorders in the 1980s and 1990s, patients who presented for SUD or mental health treatment often were not evaluated for a co-occurring disorder, or their treatment plan did not address the co-occurring disorder.


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