Co-occurring disorders exist when an individual has at least one mental disorder accompanied by (1) an alcohol or drug use disorder, (2) developmental or intellectual disability, or (3) acquired brain injury, or a combination of those three things. Co-occurring disorders in individuals have a significant impact on the citizens of Kentucky.

Examples of co-occurring disorders are:

• Major depression with cocaine dependence.
• Alcohol abuse with panic disorder.
• Dependence on more than one drug ("poly-dependence") with schizophrenia.
• Borderline personality disorder with dependence on prescription pain medication.
• Acquired brain injury with alcohol dependence and depression.
• Mental retardation with depression and/or anxiety.

Co-occurring disorders vary widely among individuals, based on severity, whether the disorders are chronic, and the degree of impairment in functioning. Approximately 4.2 million people in the nation have a diagnosis of at least two disorders. In Kentucky less than 12 percent of all mental health clients receive a secondary diagnosis of substance-related disorder. This is five times less than the national average. Many people in Kentucky with co-occurring disorders are simply not being diagnosed.

The best practice for people with co-occurring disorders is integrated treatment. With integrated treatment, the client receives treatment for two or more disorders by the same clinician in one setting. Treatment includes an array of services to meet a person's needs over a lifetime.

Principles of integrated treatment include:

• Dual diagnosis is the expectation, not an exception.
• Treatment can be organized into four subgroups for planning purposes, based on the severity of each disorder.
• Integrated treatment provides for interventions for both disorders continuously at each visit.
• Treatment success depends on establishing empathic, hopeful, integrated treatment relationships.
• Integrated dual primary diagnosis-specific treatment interventions are recommended.
• Interventions need to be matched not only to diagnosis, but also to phase of recovery, stage of treatment, and stage of change.
• Interventions need to be matched according to level of care and/or service intensity requirements, utilizing well-established level-of-care assessment methods.
• Based on the above, there is no single correct dual diagnosis intervention or single correct program. For each individual, at any point in time, the correct intervention must be individualized according to subgroup, diagnosis, stage of treatment or stage of change, phase of recovery, need for continuity, extent of disability, availability of external contingencies (legal, for instance), and level-of-care assessment.
• Outcomes of treatment are also individualized based upon the above variables and the nature and purpose of the intervention. Outcome variables include not only abstinence, but also amount and frequency of substance use, reduction in psychiatric symptoms, stage of change, level of functioning, utilization of acute care services, and reduction of harm.

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