SUD 101 Module 15 - Primary Care Management of Co-Occurring Psychiatric Disorders in Those with Substance Use Disorders-Presentation

Video Transcription

Video Summary

This presentation by Kevin Severino from Yale School of Medicine addresses the primary care management of co-occurring psychiatric disorders in individuals with substance use disorders (SUD), emphasizing their common co-occurrence and complexity. It highlights that over half of those with SUDs have concurrent non-substance psychiatric disorders such as depression, bipolar disorder, PTSD, anxiety, ADHD, and personality disorders. The presentation underscores the critical need for comprehensive screening—particularly for suicidality and homicidality—using tools like the Columbia Suicide Severity Rating Scale (C-SSRS).<br /><br />Distinguishing between substance-induced psychiatric symptoms and independent psychiatric disorders is vital; symptoms persisting beyond four weeks of sobriety usually indicate independent disorders requiring integrated treatment. The case of Anna, a 25-year-old veteran with opioid use disorder, PTSD, and depression, illustrates assessment and treatment challenges, reinforcing the importance of addressing pain management, motivation, and trauma.<br /><br />Primary care providers are encouraged to use evidence-based screening tools such as PHQ-9 for depression, GAD-7 for anxiety, and ASRS for ADHD to identify comorbid conditions. Treatment principles include stabilizing substance use disorders first (often with medications like buprenorphine or naltrexone), then addressing psychiatric symptoms with appropriate pharmacotherapy and psychotherapy, including CBT and trauma-focused therapies. Benzodiazepines and cannabis are generally discouraged due to risks and lack of efficacy.<br /><br />Collaborative care models that integrate behavioral and medical treatment improve outcomes, especially where mental health specialists are limited. Medication choices should avoid abuse liability, and treatment plans must be individualized considering patient goals (e.g., abstinence versus reduced use). Ongoing monitoring for relapse, suicidality, and treatment adherence is essential. The presentation concludes by encouraging clinicians to utilize mentorship, online resources, and support networks to enhance care for this complex population.

Keywords

primary care

substance use disorders

psychiatric comorbidity

depression

PTSD

suicide screening

integrated treatment

buprenorphine

cognitive behavioral therapy

collaborative care