World renowned Delia Cimpean Hendrick, M.D. joins Virgil Stucker on a Mental Horizons podcast to discuss how to achieve excellence in the treatment of co-occurring mental illnesses and substance use disorders. Triple Boarded in psychiatry, addictions and internal medicine, Dr. Delia helps us to envision solutions, in which she has experience as the medical director of WestBridge.org.
Learn how she leads the field in integrating physical health care into their model of comprehensive treatment.”
Our podcast is now in its third season with over 10,000 views. Our objective is to bring you conversations with solution-oriented mental health leaders.
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Achieving Excellence in the Treatment of Co-Occurring Mental Health
and Substance Use Disorder
This podcast is sponsored by our friend and philanthropist Larry Gentile, who is dedicated to supporting and shining light on the good work of those who are dedicated to helping individuals with mental illness and substance use disorder.
Dr. Delia Cimpean Hendrick, a leader in the mental health field is triple board certified in Adult Psychiatry, Addiction Medicine, and Internal Medicine by the American Board of Psychiatry and Neurology, American Board of Preventive Medicine, and the American Board of Internal Medicine, respectively. She completed medical school at the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, studied psychiatry in France and trained in the US through the combined Psychiatry/Internal Medicine Residency Program at Geisel Medical School of Dartmouth College. She is fluent in English, Romanian, and French.
Dr. Delia Hendrick has extensive experience in treating individuals living with serious mental illnesses, substance use disorders, Post-Traumatic Stress Disorder and other anxiety disorders. She is dedicated to the utilization of evidence-based psychiatric and addiction treatments delivered in conjunction with collaborative medical care. A frequent presenter at both national and international conferences, Dr. Delia Hendrick also presented and was part of the United Nations International Panel of Experts on Medical and Psychiatric Care of People with Substance Use Disorders. Among her many publications, Dr. Hendrick is co-author of Addressing Chronic Diseases: Health Management Strategies for Use with Behavioral Health Clients.
Prior to joining the team at WestBridge full-time, Dr. Hendrick spent 15 years in academic and clinical psychiatry and internal medicine at Dartmouth-Hitchcock Medical Center.
First, Dr. Delia helps us to know how and what to look for when we are seeking co-occurring treatment for both mental illness and substance use disorder.
A co-occurring diagnosis really means that you live with two types of illnesses, in this instance, mental illnesses and substance use disorders. The relationship between them is complex and most often it is difficult to tell what came first. Usually, by the time treatment is sought, the two are so interrelated that they essentially make a third condition - the Co-Occurring Disorder (COD) is a different illness and it requires a complex treatment. For decades, treatment for co-occurring disorders has been separate – and has been seriously falling short of achieving recovery in either dimension, as people were told that they cannot be fully treated for their mental illness until “they stop using” (as if that was a choice and not an illness), and cannot be treated for the substance use disorder because they have symptoms of mental illness, especially when their mental illness was “serious,” which means disabling.
Common sense and then decades of research have shown that CODs need to be treated concomitantly, in an integrated manner, by one team able to address all aspects of co-occurring disorders, as well as their intricate interrelationship. WestBridge provides an example of excellence and those seeking excellence in the treatment of COD, should look closely at this treatment organization, which is based on a successful research model of integrated care. It treats men with COD.
First, one needs to make sure that the COD treatment program is able to address serious mental illnesses, such as schizophrenia, schizoaffective disorder, bipolar disorder, as well as substance use disorders concomitantly… Mood disorders and other mental illnesses can also be disabling, but many treatment programs are more familiar and comfortable with treating those, and not the mental illnesses accompanied by psychosis.
Other elements of success are having a multicomponent, evidence-based program offered by a multidisciplinary team, including a strong role for psychiatry. A continuum of care beginning with a residential component is needed, followed by assertive community treatment with a community integration focus. Ideally, the program should offer full time psychiatric care, with the willingness and the knowledge of prescribing psychiatric medications that are most effective, such as Clozaril and lithium as well as MAT (medication- assisted treatment) for substance use disorder. This includes medications like Suboxone, which can be life saving.
In seeking optimal treatment outcomes, one should also look for a medical component of the multidisciplinary team imparting awareness of the medical comorbidity that exists in people with COD. We must advocate on behalf of people with COD not only by offering wellness programming but by assuring that they have regular access to checkups with medical providers who will take their physical illnesses, risks and conditions seriously.
Additional solutions are found in programming that helps to include the family, offering education to them and encouraging their role as advocates. Individuals with COD also need access to supported employment, peer mentorship and support for obtaining housing.
WestBridge, which is celebrating its 20th anniversary of striving for excellence in the areas described, has recently had the honor of having its outcomes data analyzed by an independent research team, and the results were accepted for publication in “International Journal of Mental Health and Addiction”. You can read the article here:
https://www.westbridge.org/white-paper-and-publications. Their research shows that when staying with a program that combines several evidence-based strategies, including integrated treatment, community integration, family involvement, and obtaining employment, recovery outcomes after a year of treatment are and stay very high. Additional data shows that hospitalizations during or after the treatment may be reduced to near zero with the treatment elements described above. In regards to employment support, Dr. Delia encourages us to learn more about the IPS Model, which may be seen here: IPSWorks.org.
Moving beyond recovery from COD, Dr. Delia emphasizes the importance also of getting good, comprehensive care and treatment for physical health issues. Too often stigma stands in the way. Too often medical providers may think that someone’s symptom of a physical health issue is actually psychiatric in nature, leading to the physical issue being ignored. It is likely ‘not in their head’ and must be addressed, and the psychiatric factors, when present, need to be understood as a higher, not lower risk for a physical illness that is more severe is higher, not lower. For this reason, excellent programs must offer regular access to physical health care and family members must advocate for this.
In our conversation with Dr. Delia, we were pleased to hear her emphasize the importance of Self Management Support for individuals in recovery from COD. We are familiar with the WRAP plan which advocates self-management and offer an article her by Judith Cook which provides more information:
Readers are encouraged also to review: https://www.ahrq.gov/ncepcr/tools/self-mgmt/self.html
Dr. Delia covered a great deal in our conversation with her and we hope you will take time to listen to her podcast. She encourages to send any questions you may have to: email@example.com.
Visit our website to learn about Virgil's book,
A Family Guide to Mental Health Recovery