Martinez Kaiser Medical Center Dept of Mental Hlth Chem Depend Servs
(925) 688-8910
www.kp.org
391 Taylor Boulevard
Suite 250
Pleasant Hill CA 94523

Rehab and Insurance Services

Mix of mental health and substance abuse services
Services Provided: Substance abuse treatment, Detoxification
Type of Care: Outpatient
Special Programs/Groups: Adolescents, Persons with co-occurring mental and substance abuse disorders, Women, Men

Comorbidity Diagnoses and Treatment

The high rate of comorbid substance abuse and mental illness points to the need for a comprehensive approach that identifies, evaluates and simultaneously treats both disorders. Patients with co-occurring disorders often exhibit more severe symptoms than either disorder alone, underscoring the need for integrated treatment. Careful diagnosis and monitoring helps ensure that doctors do not mistake symptoms related to drug abuse, like intoxication and withdrawal, for a discrete mental disorder. Even in people whose comorbidities do not occur simultaneously, research shows that mental disorders can increase vulnerability to subsequent drug abuse and that drug abuse constitutes a risk factor for subsequent mental disorders. Therefore, diagnosis and treatment of one disorder will likely reduce risk for the other or at least improve its prognosis. Many researchers strongly support the need to develop effective interventions to treat both conditions concurrently, but treatment has been difficult to implement in practice because the health care systems in place to treat substance abuse and mental illness are disjointed and inefficient. Physicians tend to treat patients with mental illnesses, whereas a mix of providers with varying backgrounds delivers drug abuse treatment. Some substance abuse treatment centers do not administer any medications, including those necessary to treat patients with severe mental disorders. Behavioral treatment options that doctors customize for a given age group or gender show promise for treating drug abuse and mental disorder comorbidities. Research is under way to identify medications that target both types of disorders. Clinicians and researchers generally agree that broad spectrum diagnosis and concurrent therapies, both pharmacological and behavioral, will lead to better outcomes for patients with comorbid disorders. The stigma attached to substance abuse and mental disorders often hinders early diagnosis and proper treatment. Greater understanding resulting from recent scientific findings that substance abuse and mental illness disrupt some of the same brain functions will reduce the social stigma that hinders treatment seeking, quality and access by patients with either or both conditions.

Treatment Needs for Women in the Criminal Justice System

Although women face incarceration at far lower rates than men, the number and percentage of incarcerated women have grown substantially in recent years. Between 1995 and 2005, the number of men in prisons and jails grew by about a third, while the number of incarcerated women more than doubled (Harrison and Beck, 2006). Women in prison are likely to have a different set of problems and needs than men, which present particular treatment challenges. For example, compared to incarcerated men, incarcerated women in treatment are significantly more likely to have severe substance abuse histories, as well as physical health and psychological problems (Messing, Burdon, Hagopian and Prendergast, 2006). Approximately 50 percent of female offenders are likely to have histories of physical or sexual abuse. Women are also more likely than men to be victims of domestic violence. Past or current victimization can contribute to drug or alcohol abuse, depression, post traumatic stress disorder and criminal activity.
Treatment programs serving both men and women offer effective treatment for female clients. However, programs specific to each gender may be more effective for female offenders, particularly those with histories of trauma and abuse. Female offenders are more likely to need medical and mental health services, childcare services and assistance in finding housing and employment. Following a comprehensive assessment, women with mental health disorders should receive appropriate treatment and case management, including victim services as needed. For female offenders with children, parental responsibilities can conflict with the ability to participate in drug treatment. Regaining or retaining custody of children can also motivate mothers to participate in treatment. Treatment programs may improve retention by offering childcare services and parenting classes.

Juveniles Abusers in the Criminal Justice System

In recent years, there number of juveniles with substance abuse problems involved in the criminal and juvenile justice systems is up. From 1986 to 1996, juvenile incarcerations related to drug use increased nearly threefold. In 2002, about 60 percent of detained boys and nearly half of the girls tested positive for drug use. One study found that about one-half of both male and female juvenile detainees met criteria for a substance use disorder (Teplin, Abram, McClelland, et al., 2002). Juveniles entering the criminal justice system can bring a number of serious issues with them including: substance abuse; academic failure; emotional disturbances; physical health issues; family problems and a history of physical or sexual abuse. Girls make up nearly a third of juvenile arrests, a high percentage report some form of emotional, physical or sexual abuse. Effectively addressing these issues requires the juvenile gaining access to comprehensive assessment, treatment, case management and support services that are age and developmentally appropriate. Assessment is particularly important, because not all adolescents who use drugs need treatment. For those who do, there are several points in the juvenile justice continuum where treatment is available, including juvenile drug courts, supervision within the community and juvenile detention.
Families play an important role in the recovery of substance abusing juveniles, but this influence can be positive or negative. Parental substance abuse or criminal involvement, physical or sexual abuse by family members and lack of parental involvement or supervision are all risk factors for adolescent substance abuse and delinquent behavior. Thus, the effective treatment of juvenile substance abusers often requires a treatment model that targets family functioning and the increased involvement of family members. Effective adolescent treatment approaches include multi-systemic therapy, multidimensional family therapy and functional family therapy. These interventions show promise in strengthening families and decreasing juvenile substance abuse and delinquent behavior.