Co-Occurring Disorders and How to Identify Them

Co-occurring disorders refers to when an individual has both a mental health diagnosis and a substance use diagnosis. Members with co-occurring disorders and co-occurring needs respond better when they are offered a whole-person care approach and integrated treatment.

Integrated treatment is the preferred method of treating co-occurring disorders, and is defined as a means of actively combining interventions intended to address substance use and mental health disorders in order to treat both disorders, related problems, and the whole person effectively. ("Substance Use Disorder Treatment for People With Co-Occurring Disorders: TIP 42 (PDF)," Substance Abuse and Mental Health Services Administration, 2020, p. 216.)

In order to identify members who may have co-occurring needs, mental health providers are expected to screen for substance use, and substance use providers are expected to screen for mental health issues. Screening tools are used to identify individuals who may be at increased risk of a specific behavioral health concern, such as depression, anxiety, or a substance use diagnosis. These tools can be administered by staff or self-administered. Generally, screening tools have a scoring guide and are not diagnostic, instead they indicate if further assessment or evaluation would be beneficial to identify potential treatment needs.

Assessment tools are more comprehensive than screening tools, and are administered by staff who are trained and/or qualified to administer them. Assessment tools can assist clinicians in determining an appropriate diagnosis. They can also determine the severity of identified conditions and aid in treatment and discharge plan development. Assessment tools can be used as part of a clinician's assessment process, which may also include psychological evaluations, testing, clinical interviewing, and a comprehensive review of other records or previous treatment experiences.

In order to assist providers in this clinical task, PerformCare created a toolkit of some appropriate screening and assessment tools. If providers identify needs beyond their ability to treat, such as an individual who may need trauma-informed treatment, providers are encouraged to assist members by locating a provider who can address the identified treatment need. As a part of evidence-based substance use treatment, some individuals may need medication-assisted treatment (MAT). Identifying a provider who can offer MAT is essential. Providers can use the PerformCare website provider directory to find an in-network provider or contact Provider Services for assistance.

PerformCare is providing examples of screening and assessment tools at the following links, on documents available for download, making it easy for clinicians to access in their daily practice. Please note that this list is not exhaustive, and there are multiple other screening and assessment tools that can be utilized based on the individual's treatment needs.

Evidence-based treatments for mental health and substance use

The most effective treatment modalities for mental health and substance use diagnoses are known as evidence-based treatments. Evidence-based treatments are those that have been proven to be effective based on data and efficacy. Many treatment options are available to treat the symptoms of mental health and substance use. However, it is highly recommended that providers use evidence-based treatments. Members should have access to treatment providers who offer evidence-based treatments to meet specific treatment needs and concerns. Below you will find a list of some common diagnoses and conditions, and the corresponding evidence-based treatments that are available within the provider network.