What the results of the Center for Health Innovation Poll on addiction and treatment trends demonstrate is what we have also seen in our mental health clinics and private practices since the 1990s: That is, an alarming increase in patients presenting with anxiety, depression or some other clinical condition comorbid with some substance abuse.
Such comorbidity poses significant demands on clinicians and challenges with regard to their relationships with these patients and the roles they need to play in effecting change. For example, working with these patients often involves negotiating deception, emotional avoidance, confrontation, and other forms of interpersonal hostility. It can also require that the clinicians take a more active-directive role in their relationships with these patients, which is a challenge to certain theoretical orientations, like some humanistic and psychoanalytic models.
As the psychotherapy research suggests, so much depends on the nature and quality of the relationship between clinician and patient. And of course, this marked trend in comorbidity with substance abuse has important implications for how we train and prepare future clinicians.
For example, our approach to psychopathology should concentrate more on the nature of various comorbid conditions, and our approach to psychotherapy should emphasize how clinicians can more effectively negotiate their relationships with these patients.
written by J. Christopher Muran, Ph.D., Associate Dean & Professor, Derner Institute (former Chief Psychologist, Beth Israel Medical Center)