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The Center for Policy, Advocacy and Education of The Mental Health Association of New York City. CO-OCCURRING SEVERE MENTAL ILLNESS AND SUBSTANCE ABUSE: A POLICY BACKGROUND BOOK. Mary Jane Alexander, Ph.D Gary Haugland, M.A. Nathan Kline Institute for Psychiatric Research
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The Center for Policy, Advocacy and Education of The Mental Health Association of New York City CO-OCCURRING SEVERE MENTAL ILLNESS AND SUBSTANCE ABUSE: A POLICY BACKGROUND BOOK Mary Jane Alexander, Ph.D Gary Haugland, M.A. Nathan Kline Institute for Psychiatric Research Michael B. Friedman, LMSW Center for Policy, Advocacy and Education of The Mental Health Association of NYC June 2007 Copyright: Center for Policy, Advocacy and Education of the Mental Health Association of NYC. All rights held.

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About This Briefing Book The issues went up against by individuals with psychiatric handicaps are amplified when they have co-happening substance mishandle clutters. The motivation behind this preparation book is to give a diagram of: the degree of co-happening mental and substance manhandle clutters, their effect on the lives of individuals with these scatters, their families, and on society, powerful mediations, seek after recuperation, obstructions to the utilization of successful intercessions, and suggestions in regards to beating hindrances. In spite of the fact that co-happening issue can be mellow or extreme, this instructions book concentrates essentially on individuals with genuine dysfunctional behaviors and substance manhandle issues (MICA). A lot of complex data is outlined quickly in this report. We have given a chose catalog to the individuals who need to grow better comprehension of the complexities of this field.

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Table of Contents

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People With Serious Mental Illness Are At High Risk For Co-happening Substance Use Problems In any given year, around 2.5 million US grown-ups have co-happening genuine emotional sickness and substance mishandle scatters. 40-60% of those in treatment for mental or substance manhandle disarranges have co-happening issue. ¼ of US young people get behavioral wellbeing administrations. Half of them have a substance utilize issue.

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Co-Occurring Mental and Substance Abuse Disorders Often Have Dire Consequences The real reason for long haul inability in ladies, second to cardiovascular sickness in men Increased dangers of coronary illness, diabetes, aspiratory ailment, HIV/AIDS, hepatitis, and all the more High expenses of restorative and behavioral human services because of high inpatient use Over $100 billion of lost efficiency every year

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Dire Consequences (proceeded with ) Increased dangers of: Suicide Being a wrongdoing casualty Homelessness Minor savagery Incarceration in prisons and jails Juvenile misconduct

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Recovery Is Possible For Most People With MICA If They Get Help The lion\'s share accomplish forbearance, or considerably lessen damage, and seek after dynamic, autonomous lives. Recuperation frequently happens after a few backslides. Backslide is activated by stretch, accessibility of medications and liquor, and the absence of option wellsprings of fulfillment. Scratch components of recuperation include: Stable lodging, not dependent upon restraint and consistence Accurate screening Integrated treatment Relapse anticipation Social and companion arranges that bolster recuperation and forbearance Employment openings Hope for a superior life

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Effective Interventions For MICA Integrated Dual Diagnosis Treatment Assertive Community Treatment (ACT) Case Management Treatment scratched to phases of progress Treatment that takes a man\'s way of life, injury history, family circumstance, and wellbeing status into record Peer upheld recuperation

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Vast Underservice Only 6% of People with MICA Receive Treatment for Both Disorders Almost Half of People with MICA don\'t Receive Services for Either Disorder

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Barriers To Recovery Shortages of lodging Shortages of clinically and socially able suppliers Unaffordable expenses and absence of protection scope Fragmentation of emotional wellness and substance manhandle frameworks Regulations that adequately disallow coordinated treatment Funding instruments that successfully forbid incorporated treatment Shortages of transportation Stigma Avoidance of treatment/Fear of intimidation Lack of learning about where to get help

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Ten Recommendations To Overcome Barriers To Recovery Increase access to stable & safe lodging Increase access to incorporated treatment and to associate support and self improvement Increase exceed and follow-up administer to the individuals who reject or float away from administrations Confront transinstitutionalization in prisons, jails, covers & grown-up homes Provide extra subsidizing and revamp financing models to bolster key intercessions (counting scope of coordinated treatment in wellbeing arranges)

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Ten Recommendations (proceeded with) Make lawful and administrative changes to bolster coordinated treatment including incorporated legislative arranging structures Develop quality change activities to bolster best in class hone in light of the best accessible research Build and maintain a clinically and socially able workforce Support government funded instruction to beat shame and to give data about compelling treatment and where to get it Ensure that authority – inside and outside of government - is resolved to change and quality

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Section 1 Prevalence and Demographics of Co-happening Disorders Prevalence: Severe Mental Illness and Substance Use Disorders Elevated Risk of SUD among individuals with SMI MICA Rates Substances Used Gender and MICA Adolescence and MICA

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Almost Half The Adult Population Has Had a Mental and additionally Substance Abuse Disorder In Their Lifetime, and More Than Quarter In Any Given Year. * Note: Due to co-event of disarranges "any turmoil" is not the entirety of sorts of scatters * Note: Due to co-event of clutters "any confusion" is not the whole of sorts of clutters Source: Kessler et al, 2005

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People With Mental Illness Have An Elevated Risk For Also Having a Substance Use Disorder. Individuals with any maladjustment are more than 2x as likely as others to have a liquor utilize clutter, and right around 5x as liable to have a medication utilize scatter. Among those with a dysfunctional behavior, those with SMI are at most elevated hazard for co-happening unlawful medication utilize. Source: Kessler 1996; NSDUH 2005

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SAMHSA Identifies 4 Different Combinations Of Co-Occurring Mental Illness and Substance Use Disorders : Mild dysfunctional behavior and mellow substance manhandle Severe emotional sickness and gentle substance mishandle Mild maladjustment and serious substance mishandle Severe dysfunctional behavior and extreme substance manhandle MICA alludes to the seriousness of states of people in II and IV. Source: NASMHPD/NASADAD 1998

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Each Year, 6.75 Million Adult Americans Have Co-Occurring Disorders. Around 2.5 Million Have MICA. Rates are about equivalent among men and ladies . Sources: Kessler, McGonagle, Zhao, et. al, 1994; Center for Substance Abuse Treatment, 2005

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MICA Prevalence Rates Vary By Diagnosis. Generally Half of Those with Bipolar Disorder or Schizophrenia, And a Quarter of Those with Major Depression, Have a Substance Use Disorder in Their Lifetime. Source: Regier et al, 1990 bipolar issue schizophrenia significant gloom

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Substances Used People with serious dysfunctional behavior utilize substances that are most accessible and reasonable – liquor, cannabis and break/cocaine. Poly-substance utilize is basic. Source: Mueser, Essock, Drake, et al., 2001

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Mental and Substance Use Disorders Usually First Appear In Adolescence and Early Adulthood. Fitting in with companions is the most well-known explanation behind beginning to utilize liquor or medications. Sources: Kessler, 2004; Kessler, 2005; Laudet et al, 2004

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In 2004, Almost One Quarter of US Adolescents (5.7 Million) Were Treated For Behavioral or Emotional Problems. About 43% Met Criteria For Substance Abuse/Dependence. . Source: NSDUH 2004

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Section 2 MICA: Disability and Distress Disability Poor Health Family Burden School Failure Victimization; Trauma Homelessness Violence Criminal Justice/Incarceration Treatment Costs

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Prevalence In Developed Economies In 1990, in created economies all through the world, significant dejection and liquor utilize were among the main five driving reasons for inability. Schizophrenia and bipolar issue were additionally among the main 10 reasons for handicap for ladies. Percent of Total Disability Adjusted Life Years (DALYs*) Accounted for by Each Illness Category *DALYs - Disability Adjusted Life Years – Years of life lost because of untimely mortality and inability - make it conceivable to assess the relative weight of significant ailments, wounds and dangers crosswise over populace gatherings or regions . Source: Murray and Lopez, 1996

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1/3 to 1/2 of US Adolescents and Adults With Major Depression Experience Severe Impairment In Their Home Life, School, or potentially Intimate and Social Relationships. Percent teenagers and grown-ups with an earlier year significant depressive scene encountering serious/exceptionally extreme part impedances Source: NSDUH 2004

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Indirect Costs Of Major Mental Disorders Disability or sudden passing because of major mental issue costs the economy over $100 billion in lost profitability. Barring schizophrenia, individuals incapacitated because of major mental issue lose 88 days of ordinary movement every year. Source: Murray and Lopez, 1998

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People With MICA Are At Higher Risk For Serious Medical Conditions Than Other Poor People Odds Ratios - contrasted with people without emotional sickness or substance utilize clutters Source: Dickey, Normand, Weiss et al., 2002

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People With MICA Are At Higher Risk For Death From External Causes Than People Without Co-Occurring Disorders Distribution of Causes of Death of Medicaid Beneficiaries Source: Dickey et al, 2004

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People With MICA Are At Higher Risk For Infectious Diseases Than The General Population Rates Per 100,000 General Population* MICA HBV (Hepatitis B) 0.6 19.0 HCV (Hepatitis C) 1.9

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