Co-occuring Disorders and Substance Abuse Across the U.S.

The world has changed since the early days of substance abuse treatment. Millions of dollars have been spent on research, measuring effective strategies to enhance outcome potentials, and working toward the magic that will give treatment professionals the edge that win will out over addiction.

The largest population being served, that of those who are beset with co-occurring diagnostic criteria is the toughest to treat. Part of the problem is that those who are trained to work with the mental illnesses present in co-occurring conditions are beyond the financial reach of many agencies, while those who are employed by most agencies are unskilled to work with that population. Counseling degrees require fewer credits that an associates' degree, which does not provide them the background necessary to recognize or diagnose mental illness. While they may have some training and personal experience in working with the addiction piece, their understanding and training does not give them tools to effectively treat their clients' presenting and complicated diagnosis.

Professionals who are trained to work with the diagnostic criteria of these clients are not fully acquainted with recognition and treatment of addictions. They receive, at best, one class during their educational process which focuses on with substance abuse. This is inadequate training for providers of mental health services, since it is widely recognized that they will work where it is the rule, not the exception, for their clients to have substance abuse issues that need to be rectified before their work will have beneficial outcomes.

Most treatment agencies are underfunded and cannot afford the professionals who are trained to assist these clients most effectively. While any number of agencies dealing with co-occurring disorders may range upward from $25,000 per month for treatment, this does not serve the majority of those who require treatment. For highest efficacy, co-occurring disorders must be treated simultaneously. Funding to train and operate agencies for maximum benefit to this population is scarce and in high demand.

This is population falls through the cracks. They do not qualify as severely impaired, yet they may become that population if left untreated long enough. Sadly, many of them can and do end up in the prison system due to their illegal drug habits, where they cost our social structure many dollars more to house and treat than they should.

This is a societal illness that needs to be rectified. These are people who are sick in need of healing. We need to train and educate those who would help them in order to save all the millions of dollars spent on prisons in this country. According to CASA (The National Center on Addiction and Substance Abuse at Columbia University) in February, 2010, 85 percent of imprisoned individuals nationwide were either appropriate for DSM-IV diagnostic criteria for substance abuse/addiction or under the influence at the time of their crimes for which they were incarcerated. If we were to offset the costs of imprisoning this number of persons with treating this number of persons, it would save enormous amounts of revenue nationwide. While many have raised this argument in the past, perhaps in light of today's financial woes, we can raise our voices again.


Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions' counselor.