UCSF

ABSTRACT

Approximately 20 million people suffer from substance abuse disorder in a given year and approximately 7-10 million of them will have co-occurring disorders (COD) of both mental illness and substance abuse. Moreover, 61 percent of those who have COD have not received treatment for either illness. To complicate matters, individuals with COD have higher rates of other chronic health problems (i.e. diabetes), multiple re-hospitalizations and over utilize emergent services. Despite their elevated risk for physical morbidities, there is a dearth of literature that focuses on the impact for those with COD of having multiple physical health disorders. Of concern is how this population copes with medical health issues while at the same time living with a psychiatric illness and substance abuse or dependence.

The purpose of this interpretive study was to understand: (a) the social and structural barriers that individuals with COD encounter in regards to their healthcare; and, (b) how individuals with co-occurring disorders of mental illness, substance abuse, and other chronic medical illnesses manage their illnesses. A purposive sampling of twenty individuals with COD (11 males; 9 females; 65% African American) were recruited from community treatment centers and supportive housing sites. Participants were interviewed for one hour on two occasions. Narrative interviews focused on meanings of health, management of illness and experiences with the healthcare system, were conducted. Thematic and paradigm case analyses were conducted on two occasions. Narrative interviews focused on meanings of health, management of illness and experiences with the healthcare system, were conducted. Thematic and paradigm case analyses were conducted.

Social and structural barriers to improving health included difficulties with interpersonal relationships with healthcare providers. Participants felt they were not heard and/or understood by providers. Additionally, informants described that limited or missing health insurance coverage, support, limited access to mental health services, frequent changes in Medicaid regulations, and increases in share of cost for medications as impasses to their health management. Unstable, unkempt, and crime-ridden housing and neighborhoods were barriers to improving and/or maintaining their health.

Additionally, three distinct patterns of coping with mental illnesses, drug and/or alcohol addiction, and physical chronic illnesses were observed, which included (a) interconnectedness, (b) ambivalence, and (c) waiting in defeat. The three patterns of coping describe the commonalities and differences in individuals' responses to living with COD. Implications for clinical care and social policies are included.