Screening and Treating Mental Disorders in Addiction Treatment Settings: A Stepped Care Model

The comorbidity of mental and addiction disorders is increasingly apparent. Such comorbidity increases overall client morbidity substantially, and reduces the success rate in treating either type of disorder. In addiction treatment settings, the challenge is twofold: first, to develop a method for detecting mental disorders that is valid and practical, and second, to identify treatment approaches that are appropriate to that setting. Simple referral away of the patient with a mental disorder is rarely successful. Difficulties often arise in finding appropriate mental health treatments in a timely fashion; furthermore client resistance to being referred out poses an additional barrier. This article identifies strategies to improve practical detection of mental health disorders through the use of simple but validated patient self-reports. In addition, this commentary proposes a stepped care approach to the provision of mental health treatments that allows for some universally effective ‘wellness treatments’ to be initiated for all individuals in addiction treatment settings; those with persistent high psychiatric symptoms related to the most common disorders such as depression or anxiety would then receive some additional mental health treatment in the addiction setting. Referral out would be reserved for those individuals with more severe psychiatric illnesses or those with comparatively rarer disorders. This pragmatic approach to screening and stepped care increases the likelihood of success in treating the addictive disorder, as well as providing care for the mental disorder.