Although evidence indicates the need for comprehensive and integrated therapy to address comorbidity,3,22,82,83 research shows that only about 18 percent of SUD treatment programs and 9 percent of mental health treatment organizations have the capacity to serve dually diagnosed patients.162 Provision of such treatment can be problematic for several reasons:
- In the United States, SUD treatment is often siloed from the general health care system.23,163 Primary care physicians are most often the front line of treatment for mental disorders. The specialty mental health treatment system typically addresses only severe mental illness, while drug treatment is typically provided by a separate SUD treatment system. Typically, none of these systems have sufficiently broad expertise to address the full range of problems presented by dually diagnosed patients.
- A lingering bias remains in some SUD treatment centers against using any medications, including those necessary to treat serious mental illnesses including depression, although this is slowly changing.164 Additionally, many SUD treatment programs do not employ clinicians who can prescribe, dispense, and monitor medications.162
- Many individuals who would benefit from treatment are in the criminal justice system. It is estimated that about 45 percent of individuals in state and local prisons and jails have a mental health problem comorbid with substance use or addiction.165 However, adequate treatment services for both drug use disorders and other mental illnesses are often not available within these settings. Treatment of comorbid disorders can reduce not only medical comorbidities, but also negative social outcomes by mitigating against a return to criminal behavior and re-incarceration.166
While these barriers loom large, changes to the U.S. health care system can help improve care for people with comorbidities.167 The Mental Health Parity and Addiction Equity Act of 2008 (also known as the Parity Act) and the Patient Protection and Affordable Care Act of 2010 (also known as the Affordable Care Act or ACA) have increased the number of people with insurance that covers addiction and mental health treatment. The Parity Act mandates that health care plans that cover behavioral health treatments do so to the same extent as treatments for physical health conditions.168 The ACA requires that addiction and mental health treatment be covered as one of the ten Essential Benefit categories. With healthcare reform’s other provisions to increase the quality of care, clinicians now have greater support and incentives to implement evidence-based practices23,169 and to collaborate in teams that provide integrated care for physical and mental disorders.23,163,168,169