1. 1 Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings Session 6: Specific Population Groups

2. 2 Comorbidity Guidelines Refer to: Chapter 10

3. 3 Focus of this Session Indigenous Australians Culturally and linguistically diverse groups Gay, lesbian, bisexual and transgendered Rural/remote Homeless persons Specific gender issues Coerced clients Youth

4. 4 Meeting Specific Needs Treatments and services for AOD and comorbidity have arisen from research on dominant culture of city-dwelling westernised adults Can work for clients from different backgrounds, but approaches may need to be adapted depending on individual clients’ characteristics

5. 5 Cultural and Contextual Factors Cultural background Age Gender Sexual orientation Stability of accommodation Remote location Level of coercion into treatment

6. 6 Indigenous Australians Over-representation in mental health and AOD services High prevalence of comorbidity Increased risk of poor treatment outcomes Mainstream models may not be appropriate with some Indigenous Australians NB: not a homogenous group Refer to IRIS, Appendix P in Guidelines

7. 7 CALD Little research on CALD groups in AOD services (let alone comorbidity!) Under-represented in AOD treatment services Multiple barriers to AOD and MH treatment which need to be addressed Consider use of Trauma Screening Questionnaire, Appendix N in Guidelines

8. 8 GLBT Minimal research on GLBT and comorbidity; trends towards higher prevalence of higher distress and higher AOD use than general population Younger clients may be at greater risk of suicide Engagement and confidentiality are fundamental

9. 9 Rural/Remote Social, economic, geographic and community barriers to treatment May contribute to higher rates of suicide Limited specialist services Anonymity a challenge Alternatives need to be considered, such as on-line, self-guided and telephone services (eg: Moodgym)

10. 10 Homeless Persons Higher rates of comorbidity Up to 3 x more likely to have mental disorder Reduced access to services and resources Inconsistent involvement with services Lower levels of literacy Need to meet immediate needs

11. 11 Gender Patterns of comorbidity and needs of men and women differ Issues of stigma, DV and childcare with women Men less forthcoming in seeking treatment May need gender specific services, particularly family-oriented for women Men may need more concrete, action- oriented approach

12. 12 Coerced Clients Sources and level of coercion vary – family, judicial, employer, child protection Do not assume treatment will be less effective; can be important opportunity Requires high level of engagement and “rolling with reluctance” Confidentiality may be limited and needs to be clarified from start Harm reduction goal more realistic

13. 13 Youth Studies identify adolescents and young adults at particular risk of comorbidity High levels of mood and anxiety disorders among substance-abusing youth Time when first signs of psychosis may appear Need for “youth friendly”, flexible services Issues of confidentiality for minors

14. 14 In sum… Consider range of specific needs of individuals in assessment and treatment of co-existing AOD and MH issues Need for programs to be flexible to meet range of needs See Chapter 10 in Guidelines for further information