AETC-NMC
   

Substance Abuse and Mental Health Issues

The co-occurrence of a mental disorder and substance abuse is a common phenomenon and presents a particularly challenging situation for treatment of either condition as well as for the prevention of HIV transmission in HIV-negative individuals and for antiretroviral treatment in HIV-positive individuals.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2002, 17.5 million adults ≥ 18 years of age—approximately 8% of all adults—were estimated to have a serious mental illness (SMI) in the past year. (SMI is defined as having had a diagnosable mental, behavioral, or emotional disorder according to DSM-IV criteria that resulted in functional impairment that substantially interfered with or limited ≥ 1 major life activities.) Approximately 23% (4 million) of adults with an SMI in 2002 also were dependent on or abused alcohol or an illicit drug—ie, had a co-occurring SMI and a substance use disorder. Among adults who did not have an SMI, the rate of substance dependence or abuse was only approximately 8%.

More than half of adults with co-occurring SMI and a substance use disorder (a total of 2 million persons) had not received treatment for either their SMI or specialty substance use during the past year. Among adults with co-occurring disorders, 34% received mental health treatment only, 2% received specialty substance use treatment only, and 12% received both mental health and specialty substance use treatment during the past year. Furthermore, approximately 61% of adults with co-occurring SMI and a substance use disorder who had not received treatment perceived no unmet need for either specialty substance use treatment or mental health treatment in the past year. [SAMHSA, Adults with co-occurring] With the known risks for HIV transmission and antiretroviral adherence that are associated with mental disorders and substance abuse, the potential concerns for African Americans and others in populations with such comorbidities are considerable.

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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center