Understanding Comorbid Substance Use Disorders and Serious Mental Illness-View Presentation Slides

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This 2019 American Psychiatric Association webinar presentation addresses the complex issue of comorbid substance use disorders (SUDs) and serious mental illness (SMI). It highlights the prevalence, diagnostic criteria, screening, treatment options, and recovery approaches for individuals facing these dual challenges.<br /><br />SUDs are defined as chronic brain diseases involving impaired reward, motivation, and memory circuits, leading to compulsive substance use despite harmful consequences. Nearly 20 million Americans have SUDs, with opioids and alcohol being the most common. Comorbidity is significant: about 3.1 million adults experience both SMI and SUD yearly. The relationship is bidirectional, with shared risk factors and reciprocal influences between substance use and mental illness.<br /><br />Diagnostic criteria for SUDs in DSM-5 categorize severity along a continuum, based on 11 criteria encompassing impaired control, social impairment, risky use, and pharmacological symptoms like tolerance and withdrawal. Risky drinking, including binge and heavy drinking, is prevalent and linked to diverse negative health outcomes.<br /><br />Screening tools such as CAGE-AID, AUDIT, CRAFFT, and DAST help identify risky substance use. Motivational interviewing (MI) is emphasized for engaging patients ambivalent about change, using core skills (OARS) to evoke “change talk,” and addressing patient goals including abstinence or harm reduction.<br /><br />Pharmacological treatments include FDA-approved medications for alcohol use disorder (acamprosate, disulfiram, naltrexone) and opioid use disorder (methadone, buprenorphine, naltrexone). Medication-assisted treatment (MAT), combined with behavioral therapy, is considered first-line. The 2016 Comprehensive Addiction and Recovery Act expanded MAT access, allowing more providers to prescribe buprenorphine.<br /><br />Providers play a critical role in recognizing SUDs, managing withdrawal, referring to specialty services, and addressing stigma through clinical language. Relapse is understood as a common feature of chronic diseases, highlighting the need for ongoing support across recovery episodes.<br /><br />Overall, the presentation calls for integrated, evidence-based approaches combining assessment, motivational strategies, pharmacotherapy, and referral to improve outcomes for individuals with co-occurring SMI and SUD.

Keywords

Comorbid substance use disorders

Serious mental illness

DSM-5 diagnostic criteria

Screening tools for SUD

Motivational interviewing

Pharmacological treatments

Medication-assisted treatment

Addiction and Recovery Act

Relapse management

Integrated treatment approaches