Treating Co-Occurring Mental Illness and Substance Use Disorder

As the opioid epidemic continues to reach every corner of the US, physicians — particularly psychiatrists —have become increasingly familiar with substance use disorders among patients.

Jonathan Avery, MD, an addiction psychiatrist at New York-Presbyterian Hospital and associate professor at Weill Cornell Medical College, who has authored co-occurring mental illness and substance use disorder treatment guidelines, sat down with MD Magazine® at the 2019 Annual Meeting of the American Psychiatric Association (APA) to discuss comprehensive care and his takeaways from discussions at APA 2019.

MD Mag: What does comprehensive care look like for a patient experiencing both substance use and a psychiatric disorder?

Avery: I think comprehensive care for someone, looks different for every individual, I think in theory we should all be able to offer people menu of options and so comprehensive care for one person could look like you know time out in the rehab followed by treatment with psychiatrists and therapists, but for another person it could just be seeing someone periodically and being involved in and self-help groups to take up the bulk of their treatment. So, it really is providing a menu of options and letting people choose what feels right for them and meeting them where they're at and that can change over time and so comprehensive treatment one month could look different than next month based on how things evolved but you really want people to know they have options that and a range of evidence-based options that can get them to a better state.

MD Mag: In your opinion, what is the most important discussion to come out of APA this year?

Avery: There's been a lot of important discussions at the APA. We've talked a lot about the opiate epidemic and co-occurring disorders. I think a theme that runs through a lot is really being aware of the stigma that exists, not only in the community, but that doctors have towards patients with complicated presentations especially substance use disorder. As much knowledge as we can gain, I don't think will make an impact on improving quality of care unless we sort of — especially towards patients with substance use disorders — are aware of our attitudes and provide empathic evidence-based care to them.