SUBSTANCE MISUE

UK Policy on Substance Misue, Mental Health, Dual Diagnosis

UK Policy on Substance Misue, Mental Health, Dual Diagnosis

Introduction

Substance abuse disorders develop within a complex constellation of biological, psychosocial, and structural factors, and comprehensive treatment tailored to the patient's unique constellation may increase the likelihood of stable recovery: the continuum of patient care for substance abuse and dependency facilitates such comprehensive treatment. The array of treatment options available may be used sequentially or episodically as appropriate for an individual patient and may be described as ranging from less to more intensive in the nature of the intervention and from brief to long term in their duration. A structured patient assessment allows providers to determine the appropriate level of care and define specific treatment goals. Patient assessment includes signs and symptoms of withdrawal; treatment history; Diagnostic and Statistical Manual of Mental Disorders criteria for substance abuse disorders; the Global Assessment of Functioning, which measures social, psychological, and occupational function and level of impairment; general assessment of need, willingness, and cognitive ability to engage in treatment; the presence or absence of family and social support for treatment; and other diagnoses that may impact on the individual's response to substance abuse treatment.

Substance Abuse

It is often difficult to make precise estimates of prevalence of different problems within the homeless population. With this in mind, Robert Huebner and colleagues estimated that 45% of people who are homeless are alcohol abusive or dependent and an additional 30% are drug abusive. Often these individuals are poly drug users, using more than one drug at a time.

In addition, the National Coalition for the Homeless estimated that as many as 22% to 50% of the population of people who are homeless in the United Kingdom are mentally ill. Many individuals who are homeless are dually diagnosed; that is, they have been diagnosed as having a substance abuse disorder and a psychiatric disorder. Even more alarming are the high rates of people who are homeless and drug abusers with HIV infection. Those people who are dually diagnosed and homeless face many obstacles to recovery, including increased risk for victimization and violence; frequent cycling between the streets, jails, emergency rooms, and hospitals; and rarely showing improvement in their symptoms or functioning. Also, many of the agencies working with substance abusers who are homeless will not take those with psychiatric problems, and many who work with individuals who are homeless and mentally ill will not accept those who are substance abusing.

Contributing Causal Factors

There are many theories of the etiology of homelessness. One of the primary causes of homelessness is poverty, and contributing to poverty is unemployment. This causal relationship has become especially evident after the events of September 11, 2001, and more recently, Hurricanes Katrina and Rita. Many companies have experienced severe cutbacks and layoffs. Many people are homeless or on the verge of homelessness as a result of these events. Low-paying jobs also contribute to poverty and homelessness. A report from the U.S. Council of Mayors suggested that having a job ...