viduals presenting with either condition. To facilitate the adoption of screening and treatment for comorbid mental and substance-use illnesses, the task force could include among its recommended guidelines screening for a co-occurring mental or substance-use problem at the time of an individual’s initial presentation with either condition.

As discussed earlier, however, when screening is done, it often is not performed effectively (Friedmann et al., 2000b; Saitz et al., 2002). Effectiveness can be increased by use of any of a broad range of available and reliable instruments for screening for mental illnesses and co-occurring substance-use problems and illnesses (NIAAA, 2002; Pignone et al., 2002; Williams et al., 2002). An example is the Patient Health Questionnaire, a self-administered instrument designed to screen for depression, anxiety disorders, alcohol abuse, and somatiform and eating disorders in primary care (Spitzer et al., 1999). Other very brief, single-question screens have been evaluated for use in screening for alcohol-use problems (Canagasaby and Vinson, 2005). NIAAA has developed a single question (one for men and one for women) for screening for alcohol-use problems in primary care and other settings (NIAAA, 2005).

Anticipation of Comorbidity and Formal Determination to Treat or Refer

Again because of the high prevalence of co-occurring conditions, especially among individuals seeking treatment, the congressionally mandated study of the prevention and treatment of co-occurring substance-use and mental conditions (SAMHSA, undated) stated that individuals with co-occurring disorders should be the expectation, not the exception, in the substance-use and mental health treatment systems. SAMHSA and others have concluded that substance-use treatment providers should expect and be prepared to treat patients with mental illnesses, and similarly that mental health care providers should be prepared to treat patients with substantial past and current drug problems (Havassy et al., 2004; SAMHSA, undated). In its report to Congress, SAMHSA stated that one of the principles for effective treatment of co-occurring disorders is that “any door is the right door”; that is, people with co-occurring disorders should be able to receive or be referred to appropriate services whenever they enter any agency for mental health or substance-use treatment.

This same principle is applicable to general health problems and illnesses as well. A review of innovative state practices for treating comorbid M/SU conditions found that agency staff expected their clients to present with co-occurring general health problems. They screened and assessed for related conditions, including HIV/AIDS, physical and sexual abuse, brain disorders, and physical disabilities. Staff were cross-trained in both mental health and substance-use disciplines (although they did not work outside of



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