Co-occurring disorders are among the greatest challenges that the medical community face today. It is common for patients to receive treatment for one disorder while the other disorder receives little attention (Goodman et al., 2015). For instance, a patient suffering from depression and substance addiction may receive treatment for the substance addiction while they continue to endure depression. To ensure the successful treatment of co-occurring disorders, practitioners require cultural competence. Through cultural competence, they are able to integrate cultural and social dynamics into the administration of treatment.
Cultural differences in treatment of co-occurring disorders
Culture plays a defining role in determining the success of treatment for co-occurring disorders. While individuals from a certain culture welcome treatment, others may distrust the medical community and therefore fail to seek treatment for the disorders. Cultural differences affect the treatment of co-occurring disorders in different ways. Culture shapes such issues as the coping mechanisms that patients adopt, the social support systems that are available to the patients and the attitudes that individuals hold regarding healthcare (Forman & Nagy, 2006). Culture also determines whether patients suffer stigma for substance abuse and mental illness. If a culture encourages the adoption of healthy coping mechanisms, embraces those battling with substance abuse and has established strong support systems, individuals from this culture are more likely to seek treatment. On the other hand, if the members of a particular culture face stigma, distrust healthcare providers and lack support systems, treatment for co-occurring disorders will be ineffective. Culture also shapes the perspectives of the practitioner administering treatment (Sacks & Ries, 2005). For the treatment to be effective, the practitioner needs to abandon biases and maintain objectivity.
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Disparities and limitations in assessment and diagnosis in multicultural society
Despite the efforts of the medical community, various disparities and limitations exist in the assessment and diagnosis of co-occurring disorders in a multicultural society. It has been observed that patients from certain communities struggle in their efforts to access medical services. For example, ethnic and racial minorities face barriers when they attempt to seek treatment (Priester et al., 2016). Age also appears to be responsible for the limitations and disparities. Older adults are hugely disadvantaged as they encounter hurdles (Priester et al., 2016). Sexual orientation is another cultural factor that shapes assessment and diagnosis of co-occurring disorders. Non-heterosexual individuals do not enjoy the same level of access that their heterosexual counterparts do (Priester et al., 2016). Overall, it appears that belonging to the majority enhances assessment and diagnosis. On the other hand, members of minority groups grapple with challenges.
Cultural competence as a continuum
Cultural competence is among the elements of practice that facilitates the effective delivery of treatment. This element exists in the form of a continuum. The continuum is composed of different levels which represents varying levels of cultural competence. At the lowest end of the continuum is cultural destructiveness (“Cultural Competence Continuum”, n.d). Cultural incapacity, cultural blindness and cultural pre-competence follow cultural destructiveness in this order. Cultural competence and cultural proficiency are at the highest level of the continuum (“Cultural Competence Continuum”, n.d). Practitioners on the lower level of the continuum lack the skills and insights needed to deliver treatment to diverse cultural groups. On the other hand, professionals who are culturally competent and culturally proficiency are able to integrate cultural considerations into the delivery of care.
Cultural identity and impact on treatment
Cultural identity has been identified as among the factors that shape human health. Individuals who identify and feel that they belong in a certain culture receive the social protections that the culture offers (Abbott & Chase, 2008). The protections that the culture offers enhance the effectiveness of treatment for co-occurring disorders. For example, members of the LGBT community who have accepted their identity and seek the safe spaces that this community provides have better outcomes (Yarbrough, 2017). Another aspect of cultural identity that affects treatment concerns substance abuse. A drug culture that brings together individuals with shared values, beliefs and perspectives is emerging. This culture poses a threat to treatment as it persuades individuals to reject any efforts to rid them of drug dependency (“A Treatment Improvement” 2014). Individuals who subscribe to the drug culture are therefore less likely to seek treatment or derive any meaningful benefit after being provided with treatment. Other cultures which are destructive have a similar effect as the drug culture.
Importance of integrated approaches
In an earlier section of this discussion, it was noted that one of the challenges that co-occurring disorders present is that it is difficult to treat all the disorders that patients grapple with. Evidence-based integrated approaches seek to address this challenge. These approaches focus on all the disorders that a patient has developed (SAMHSA, 2009). There are a number of approaches that practitioners rely on for treatment. These approaches include cognitive behavioral interventions, motivational interventions, psychopharmacological initiatives, assertive community treatment and therapeutic relationships, among others (Skinstad, n.d). These integrated approaches serve a number of important roles. One, they treat both substance abuse and mental health disorders. These approaches also help to reduce the cost of treatment and prevent relapses (SAMHSA, 2009). Furthermore, thanks to integrative approaches, practitioners are able to help address such challenges as crime and homelessness. Overall, the integrated approaches have a holistic impact on the wellbeing of patients.
Strategies for assessment, diagnosis and treatment
Working with patients with co-occurring disorders can be a complex task. To aid practitioners in addressing the needs of these patients, a number of strategies have been developed. Creating a therapeutic alliance is among these strategies (Sacks & Ries, 2005). Practitioners should establish relationships that are based on respect and cultural considerations. It is also vital for the practitioner to maintain a perspective that focuses on recovery while keeping an eye on the patient for any psychiatric symptoms (Sacks & Ries, 2005). Adopting an empathetic counseling style that leverages support structures is another strategy that practitioners can use. Perhaps the most important strategy involves practitioners integrating the cultural profile of the patient into assessment, diagnosis and treatment. For instance, the practitioner should adopt approaches that account for the sex, race, ethnicity, sexual orientation and the social status of the patient.
In conclusion, co-occurring disorders continue to receive focus from the medical community. These disorders are notoriously difficult to treat. If a practitioner is to achieve success in the treatment of the disorders, they must embrace cultural competence. The practitioner should examine the cultural profile of the patient to determine the approaches that will the most effective. It is also vital for practitioners to identify the resources within the patient’s community that can be used to enhance the effectiveness of treatment.
References
Abbott, P. & Chase, D. M. (2008). Culture and Substance Abuse: Impact of Culture Affects
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Cultural Competence Continuum. (n.d). Retrieved 24 th February 2018 from http://webtutorials.ucsd.edu/ccmp/01_02_005.html
Forman, R. F. & Nagy, P. D. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Retrieved 24 th February 2018 from
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Goodman, D. J., Milliken, C. U., Theiler, R. N., Nordstrom, B. R. & Akerman, S. C. (2015). A Multidisciplinary Approach to the Treatment of Co-Occurring Opioid Use Disorder And Posttraumatic Stress Disorder in Pregnancy: A Case Report. Journal of Dual Diagnosis, 11 (3-4), 248-257.
Priester, M. A., Browne, T., Iachini, A., Clone, S., DeHart, D., & Seay, K. D. (2016). Treatment Access Barriers and Disparities among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review. Journal of Substance Abuse and Treatment, 61, 47-59.
Sacks, S. & Ries, R. K. (2005). Substance Abuse Treatment for Persons with Co-Occurring Disorders. Retrieved 24 th February 2018 from https://www.ncbi.nlm.nih.gov/books/NBK64197/pdf/Bookshelf_NBK64197.pdf
Substance Abuse and Mental Health Services Administration (SAMHSA). (2009). Integrated Treatment for Co-Occurring Disorders. Retrieved 24 th February 2018 from https://store.samhsa.gov/shin/content/SMA08-4367/BuildingYourProgram-ITC.pdf
Skinstad, A. H. (n.d). Double Trouble: Co-Occurring Disorders: Cultural Considerations.Retrieved 24 th February 2018 from
https://peerta.acf.hhs.gov/sites/default/files/public/uploaded_files/Denver%20Co-occuring%20disorders.pdf
A Treatment Improvement Protocol. Improving Cultural Competence. (2014). Retrieved 24 th February 2018 from https://www.ncbi.nlm.nih.gov/books/NBK248428/pdf/Bookshelf_NBK248428.pdf
Yarbrough, E. (2017). LGBTQ Population. In Avery, J. D. & Barnhill, J. W. Co-Occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment. Washington, DC: American Psychiatric Pub.
