Dr. Darryl Inaba, Paul Steinbroner, and myself just returned from the 22^nd Annual Co-Occurring Disorders Conference in Yakima, Washington, put on by the State of Washington Department of Social & Health Services. The themes of the conference were “Transforming Systems, Transforming lives – Integrating Care to Support Recovery. The audience of more than 400 treatment professionals, whose focus was primarily mental health and dual diagnosis treatment, spent the two days of the conference learning from 8 plenary sessions and dozens of workshops.

In one of the plenary sessions, Dr. Inaba discussed how the rapidly evolving science of addictionology provides a better understanding of compulsive behaviors and of those who are vulnerable to develop substance use disorders (SUD). The presentation explored the basic neurochemical, neurocellular, and neurofunctional anomalies that result from a “diathesis” which hijacks the brain’s control of its normal “more” and “stop” mechanisms.

In the afternoon, Dr. Inaba’s workshop focused on how recent advances in the understanding of  addiction have led to an explosive growth in medical interventions for substance use disorders (SUD). A good number of medications have already been approved to treat SUD. A much larger number are being used “off-label,” and an even greater number of medications are in the FDA New Drug Development process to treat SUD. The presentation and discussion explored some of theses medications, evaluated what is known about their current efficacy, and provided a rationale for their development.

Since mental health disorders involve the same neurotransmitters involved in substance abuse, any research involving co-occurring needs to look at how a psychotropic medications, prescribed for mental illness, will affect the client’s relationship with their drug craving. There has been more integration of mental health and substance abuse treatment for co-occurring disorders than at any time in the past but there are still many barriers to overcome.

William E. Cohen

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