Treatment and social support measures for people with comorbid substance use disorder and other psychiatric conditions

Background

Among people in contact with healthcare due to substance use disorder, it is estimated that 50–80 percent also have at least one other mental illness [1]. In individuals with dual diagnosis, the person’s substance use, and their mental health often influence each other, complicating treatment and worsening prognosis. Compared to those with a single diagnosis, individuals with dual diagnosis tend to experience a greater symptom burden, including lower functioning and reduced life expectancy. This population also faces more frequent social challenges, such as unemployment, homelessness, loneliness, and higher rates of criminal involvement. Overall, the combination of diagnosis significantly impairs health-related quality of life, leading to considerable suffering for the individual and high societal costs.

In Sweden, people with dual diagnosis usually face significant challenges in accessing necessary treatment, in part because the availability of treatment and social support measures is insufficient and unequally distributed across the country. National treatment recommendations for individuals with comorbid substance use disorder and other mental health diagnosis are incomplete, and the scientific data supporting the relevant guidelines from the National Board of Health and Welfare have not been updated since 2015.

Aim

The aim of this systematic review is to evaluate the effects of treatment and social support measures for adults who have dual diagnosis. We intend to investigate how treatments affect both substance use and psychiatric symptoms, as well as general function and quality of life. Ethical considerations relevant to the treatment of this population, as well as health economics will also be addressed.

The treatment evaluation will be carried out in two stages. In the first stage, we have assessed the effects of pharmaceutical treatments. An interim report was published on our website in February 2024. In the second stage, we will evaluate the effects of psychological and psychosocial interventions. The final report will cover both parts: an assessment of psychological and psychosocial interventions, and an updated assessment of pharmaceutical treatments.

Assignment

The evaluation was initiated by SBU after consulting the Swedish national network for Addiction and harmful use in Regions and Municipalities (Beroende och skadligt bruk i Regioner och Kommuner), which is coordinated by Swedish Association of Local Authorities and Regions (SKR).

Target groups

The evaluation is aimed at decision-makers for healthcare and social services who have the mandate to decide on the introduction and design of interventions for people with co-morbidities. Other target groups are researchers, professional organizations, idea-based organizations, business developers and not least people who have dual diagnoses, and their relatives.

[1] The European Monitoring Center for Drugs and Drug Addiction (EMCDDA) 2016, Perspectives on drugs; Comorbidity of substance use and mental health disorders in Europe.

References

1. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2016, Perspectives on drugs; Comorbidity of substance use and mental health disorders in Europe.
2. Socialstyrelsen (2019), Kartläggning av samsjuklighet i form av psykisk ohälsa och beroendeproblematik, 2019-11-6481.
3. Bridget F. Grant, PhD, PhD; Frederick S. Stinson, PhD; Deborah A. Dawson, PhD et al. Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders. Results From the National Epidemiologic Survey on Alcohol and Related Conditions Arch Gen Psychiatry. 2004;61:807-816.
4. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2016, Perspectives on drugs; Comorbidity of substance use and mental health disorders in Europe.
5. SOU 2021:93 Från delar till helhet - En reform för samordnade, behovsanpassade och personcentrerade insatser till personer med samsjuklighet; Delbetänkande av samsjuklighetsutredningen.
6. Inspektionen för vård och omsorg, (IVO 2016-19). Samverkan för patienter och brukares välbefinnande - Missbruks- och beroendevården, 2016.
7. Eliasson B, Segerstedt E. FoU-Norrbotten, Rapport 77, 2013, Uppföljning av mångbesökare inom missbruks- och beroendevård.