The two main obstacles to addiction and mental health treatment for people with co-occurring disorders are personal characteristic barriers, such as psychosis, and structural barriers, such as finances, an integrative review published in the Journal of Substance Abuse Treatment found.

Researchers from the College of Social Work, DeSaussure College and University of South Carolina studied 10 different databases, 24 experiential articles and 9 theoretical articles before they identified the two broad categories of treatment access obstacles faced by people with a diagnosed co-occurring disorder, which is where a patient has met medical requirements for at least one substance use disorder and one mental health disorder.

Out of the 36 articles included in the review, 15 mentioned personal characteristics as an impediment to substance abuse treatment for individuals with co-occurring disorders.

The review separated personal characteristic barriers into two groups: personal vulnerabilities and beliefs.

Symptoms related to either the coexisting substance use disorder or the mental illness — such as psychosis or debilitated social abilities — were defined as personal vulnerabilities, as they tend to aggravate general vulnerabilities of a person.

Individual beliefs were described essentially as opinions about treatment providers, cultural beliefs, attitudes and stigmas regarding mental illness or substance abuse disorder.

Structural barriers were reported by 30 of the articles as obstacles to substance abuse treatment among populations suffering from co-occurring disorders. The review determined that availability of services was the most prominent structural barrier. Other structural barriers included service location, disorder determination, financial factors such as insurance coverage or settlements, and racial disparities.

Researchers emphasized that there are “notable racial and ethnic disparities” in addiction treatment access for individuals with co-occurring disorders.

A 2014 study that looked at thousands of inmates with substance use disorders in 286 different prisons found that white individuals were more likely to be diagnosed with a co-occurring disorder and also more likely to have access to counseling during addiction treatment.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 9 million people who had co-occurring disorders were living in the U.S. in 2015. Although the problem affects millions of Americans, several minority groups remain disenfranchised from the clinical literature.

The review highlighted that existing research on impediments to addiction treatment has not included older populations, non-white individuals and people who do not identify as heterosexual.

This analysis was the first to ever integrate clinical research and literature currently available on the subject. Lead author Mary Ann Priester, a researcher from the College of Social Work at the University of South Carolina, stated the goal of her research was to not only find out what prevents people with co-occurring disorders from receiving treatment but to identify the most underrepresented populations who need to access tailored addiction treatment.

SAMHSA’s latest estimations show that about 20 percent of people who have a serious mental illness also end up developing a substance use disorder, yet less than 10 percent are treated for both conditions and more than 50 percent are not treated at all.

“Universal screening across service setting for both [mental health and substance use disorders] may decrease inconsistent and biased referrals, and increase identification of dual disorders among minority populations,” concluded Priester.