Ron Manderscheid, PhD, executive director of the National Association of County Behavioral Health & Developmental Disability Directors, recently wrote about an emerging complex health problem involving people who have serious mental illness (SMI), using or who are dependent on opioids. Anecdotal reports from the field suggest that up to half of adults with SMI in urban areas, particularly those with schizophrenia or bipolar disorder, have this comorbidity.

 

Dr. Manderscheid argues that "these linkages should not be surprising to anyone. Opioid use or other drug use is principally a 'disease of despair.' The disease is an addiction. The despair is a psychological comorbidity reflected in the depression. Both must be addressed." He further argues, "Clearly, we must develop the capacity to offer integrated mental health and substance use care to this population. We also must make integrated primary care available at the same time and in the same encounters, with appropriate social supports linked to all of these services."