Optimizing Treatment for Co-occurring Psychiatric and Substance Use Disorders

In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Smita Das discuss co-occurring psychiatric and substance use disorders (SUD). They explore the most common psychiatric conditions seen alongside addiction, share strategies for distinguishing primary psychiatric disorders from substance-induced symptoms, and review approaches to screening, treatment planning, and integrated care. The conversation highlights practical screening tools, medication considerations, and populations with unique clinical needs, emphasizing the importance of treating both conditions concurrently.

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Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Smita Das, MD, PhD, MPH  

Dr. Smita Das is board-certified in psychiatry, addiction psychiatry, and addiction medicine. She studied chemistry and statistics at Stanford University, earned her Master’s in Public Health at Dartmouth College, and completed her MD/PhD in Community Health at the University of Illinois at Urbana-Champaign. Dr. Das completed her psychiatry residency and served as chief resident at Stanford, followed by an addiction psychiatry fellowship at UCSF. She has over two decades of research experience in healthcare quality and addiction. Dr. Das is a former chair of the APA Council on Addiction Psychiatry, a past president of an APA District Branch, and a member of the APA Advisory Council for Workplace Mental Health. She previously served as Director of Addiction Treatment Services at the Palo Alto VA and as Vice President of Psychiatry at Lyra Health. Currently, Dr. Das practices in addictions at Stanford School of Medicine as a Clinical Associate Professor.

📖 Show Segments

• 00:05 - Introduction 
• 03:58 - Common Co-occurring Psychiatric Conditions 
• 05:37 - Prevalence and Substance-Specific Co-occurrences
• 08:35 - Distinguishing Primary vs Substance-Induced Symptoms
• 11:33 - Screening Tools and Measurement-Based Care
• 14:25 - Pharmacological Management Challenges
• 18:11 - Breaking Through Treatment Barriers
• 21:46 - Special Populations: Adolescents, Older Adults, and Peripartum Patients
• 25:12 - Key Takeaways
• 26:45 - Conclusion and Additional Learning Opportunity 

📋 Key Takeaways

• Co-occurrence is the rule, not the exception - Approximately half of people with substance use disorders also have another mental health condition, making integrated treatment essential. 
• Screen for both conditions routinely - Use validated screening tools, such as PHQ-9 for depression, GAD-7 for anxiety, NIDA screeners for substance use, and the Columbia scale for suicidality to identify co-occurring conditions early. 
• Treat both conditions together - Research consistently shows that integrated, concurrent treatment of psychiatric and substance use disorders leads to better outcomes. 
• Take a thorough history - Understanding the relationship between psychiatric symptoms and substance use is important for proper diagnosis and treatment planning. 
• Know the most common co-occurring conditions - Depression, generalized anxiety disorder, ADHD, psychotic disorders, and trauma-related disorders such as PTSD are the most common co-occurring psychiatric conditions with SUDs. There are also specific substance-disorder pairings to be aware of, such as alcohol and depression, opioids and chronic pain/PTSD/d