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Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: A call to action

      Co-occurring diagnoses of substance abuse and mental disorders (e.g., schizophrenia, depression, or bipolar, anxiety, personality, conduct, or attention-deficit/hyperactivity disorders) are highly prevalent, often begin in youth, and place an immense burden on individuals, families, and society. Unchecked, co-occurring mental and substance use disorders represent a formula for troubled, unproductive, and foreshortened lives. Co-occurring mental and substance use disorders are associated with underachievement or failure at work and school, poor health, human immunodeficiency virus infection, hepatitis, difficulty fulfilling family responsibilities, abuse, violence, failed treatment attempts, incarceration, poverty, and homelessness (
      • Drake R.E.
      • Wallach M.A.
      Dual diagnosis 15 years of progress.
      ;
      • Drake R.E.
      • Essock S.M.
      • Shaner A.
      • Carey K.B.
      • Minkoff K.
      • Kola L.
      • et al.
      Implementing dual diagnosis services for clients with severe mental illness.
      ;
      • Gonzalez G.
      • Rosenheck R.A.
      Outcomes and service use among homeless persons with serious mental illness and substance abuse.
      ;
      • Mertens J.R.
      • Lu Y.W.
      • Parthasarathy S.
      • Moore C.
      • Weisner C.M.
      Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO. Comparison with matched controls.
      ). The risk of suicide is very high for persons with co-occurring mental and substance use disorders, especially for individuals with bipolar disorder (
      • Dalton E.J.
      • Cate-Carter T.D.
      • Mundo E.
      • Parikh S.V.
      • Kennedy J.L.
      Suicide risk in bipolar patients The role of co-morbid substance use disorders.
      ;
      • Kelly T.M.
      • Cornelius J.R.
      • Lynch K.G.
      Psychiatric and substance use disorders as risk factors for attempted suicide among adolescents a case control study.
      ) and those who are lesbian, gay, transgender, or bisexual (
      • Botnick M.R.
      • Heath K.V.
      • Cornelisse P.G.
      • Strathdee S.A.
      • Martindale S.L.
      • Hogg R.S.
      Correlates of suicide attempts in an open cohort of young men who have sex with men.
      ;
      • Lebson M.
      Suicide among homosexual youth.
      ;
      • Wichstrom L.
      • Hegna K.
      Sexual orientation and suicide attempt A longitudinal study of the general Norwegian adolescent population.
      ).
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