Prevention and early intervention
The strong relationship between mental health and alcohol and other drugs has implications for how we prevent and address the burden these disorders place on individuals and on our community.
We can best do this by:
- strengthening common protective factors to reduce the frequency of problems occurring with mental health or AOD use, working to prevent one to - in turn - prevent the other
- providing appropriate treatment for people with dual diagnosis, including steps to ensure accurate diagnoses
- improving capacity for services to deliver effective treatment for mental health and substance use problems, preventing individuals falling between the gaps22
- reducing stigma to ensure people are seeking help when they need it and receiving appropriate and quality care22.
Effective primary prevention acknowledges the prevalence and impacts caused by co-occurring disorders and focuses on reducing risk factors and strengthening the protective factors that are most closely related to the problem being addressed. This approach helps practitioners provide appropriate advice and treatment.
Because of the bi-directional nature of these conditions, efforts that prevent AOD use will reduce the prevalence of mental health conditions and vice versa.
Find further information on risk factors and strengthening protective factors.
Primary prevention strategies aim to shift the focus ‘upstream’ by helping people to avoid, reduce or modify drug use; rather than reacting to a subsequent ‘downstream’ problem that requires acute treatment, and often an emergency response.
For example, encouraging people to avoid early or heavy alcohol and other drug use can help reduce personal and social dysfunction, mental and physical health problems and the need for complex interventions through the health, legal and justice systems.
By strengthening and supporting personal and social protective factors the likelihood that people, particularly young people, will engage in problematic AOD use is reduced, thus promoting mental and physical health and improving their life chances.11
Protective factors for young people include:
- maintaining positive relations with parents and other family members
- enjoying school
- completing school or leaving to take up employment pathways
- having a firm attachment to adult role models outside the home (such as teachers, sporting coaches and/or youth leaders)
- developing future-oriented recreational pursuits
- living in communities with lower levels of drug use.
Secondary and Tertiary prevention
Health practitioners play an important role in reducing the harms associated with dual diagnosis and comorbidity through effective secondary and tertiary prevention.
Secondary prevention seeks to identify risk factors and early warning signs through screening for early detection and treatment, resulting in a decrease in the number of cases of a disorder or illness.23
Tertiary prevention focusses on effectively treating conditions and preventing their reoccurrence, as well as addressing the reciprocal and compounding effect of self-medication or under-treatment.24
‘No wrong door’ approach
Another key priority for specialist AOD and mental health practitioners and services is to take a ‘no wrong door’ approach.
This ensures that individuals who present for support or treatment to one specialist can also be treated for their dual diagnosis condition by another specialist, or multiple specialists, sometimes across a number of organisations.
Services that adopt a ‘no wrong door’ approach are committed to ensuring any door into the health care system will lead a person to the treatment that is appropriate for them.
This helps prevent people with a dual diagnosis and other complex needs from falling through the cracks.
Learn more about working together with other services to adopt a ‘no wrong door’ approach.
- Marel C, Mills K, Kingston R, Gournay K, Deady M, Kay-Lambkin F, et al. Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: Centre of Research Excellence in Mental Health and Substance Use, Centre NDaAR; 2016.
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- Victorian Government Department of Human Services. Dual diagnosis: key directions and priorities for service development. Melbourne: Government of Victoria; 2007.
- National Academies of Sciences E, and Medicine,. Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. Washington (DC): National Academies Press; 2016.
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- Hall W, Degenhardt L, Teesson M. Reprint of “Understanding comorbidity between substance use, anxiety and affective disorders: Broadening the research base”. Addictive Behaviors. 2009;34(10):795-9.
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- Mortlock KS, Deane FP, Crowe TP. Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings. Journal of Substance Abuse Treatment. 2011;40(4):397-404.
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- Kay-Lambkin F, Baker A, Lewin T. The'co-morbidity roundabout': a framework to guide assessment and intervention strategies and engineer change among people with co-morbid problems. Drug and Alcohol Review. 2004;23(4):407-23.
- Kingston R, Marel C, Mills K. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug and Alcohol review. 2016;36(4):527-39.
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- Deady M, Barrett E, Mills K, Kay-Lambkin F, Haber P, Shand F, et al. Effective models of care for comorbid mental illness and illicit substance use: An Evidence Check review brokered by the Sax Institute for the NSW Mental Health and Drug and Alcohol Office. 2014.
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