Substance Use and Mental Health Treatment Must Go Hand in Hand

Across the nation, substance use disorders are devastating individuals, families, and communities. In 2021, the U.S. Centers for Disease Control and Prevention reported that annual overdose deaths in the U.S. had passed 100,000 for the first time. 

According to the Substance Abuse and Mental Health Services Administration’s 2021 National Survey on Drug Use and Health: 

• 46.3 million people aged 12 and older had a substance use disorder during the previous year. 
• Nearly half of young adults 18 to 25 had either a substance use disorder or a mental health disorder — or both.  

All too often, addiction and psychiatric disorders coincide. “There is significant overlap between substance use and mental illness. Addiction is a big piece of it, but it’s just one piece,” says Yakir Vaks, MD, service chief of the Adult Co-Occurring Disorders Unit at Sheppard Pratt’s Towson campus and lead physician at Sheppard Pratt’s Opioid Treatment Center. 

As the nation’s leading provider of mental health services, Sheppard Pratt provides comprehensive care for patients struggling with both challenges. “We integrate treatment for addiction and co-occurring psychiatric conditions at all levels of care,” Vaks says.

Treatment for Opioid Use Disorders

The opioid crisis has been at epidemic levels for years. But the situation only intensified during the pandemic, as people faced the stress of illness, job loss, and isolation — at the same time that mental health support and substance use treatment became harder to access. On top of those challenges, the dramatic increase of the synthetic opioid fentanyl into the drug supply has made opioid addiction more lethal than ever before. Of the 106,000 drug overdose deaths reported in 2021, 70,601 were due to synthetic opioids, according to the U.S. Centers for Disease Control and Prevention.  

To address this crisis, Sheppard Pratt offers the full spectrum of evidence-based treatments for opioid use disorder (OUD) and other substance use disorders. Treatment settings include:

• Outpatient treatment
• Intensive outpatient treatment
• Acute detoxification
• Inpatient treatment

The hospital also offers residential care at The Retreat, a private-pay treatment center that offers personalized residential psychiatric rehabilitation. 

Opioid Treatment Clinic

In 2021, Sheppard Pratt launched its new Opioid Treatment Center to increase access to comprehensive opioid addiction treatment and mental healthcare for residents in Baltimore County. The clinic provides methadone and other medications for OUD, serving as a hub for opioid treatment. That hub works closely with Sheppard Pratt’s community Outpatient Mental Health Centers across the state. 

As many as two-thirds of people with OUD have a co-occurring mental health disorder, and more than quarter have a serious mental illness. Yet clinics that provide OUD medications have traditionally been reluctant to treat patients with significant psychiatric issues, Vaks says. Sheppard Pratt’s program was designed, in part, to fill that need. 

“Our opioid treatment program actually welcomes these patients,” he says. “We monitor their progress and partner closely with their outpatient providers to make sure they are receiving necessary treatment.” 

Substance Use Treatment at The Retreat 

That commitment to addressing all of a patient’s mental health needs is echoed across Sheppard Pratt’s continuum of care, says Christoffel LeRoux, MD, a psychiatrist specializing in addiction and The Retreat’s service chief of group homes and outpatient services.  

The Retreat offers residential psychiatric rehabilitation to people with a range of behavioral health disorders, including mood and personality disorders, who have not been helped with outpatient treatment. For those patients, addiction is all too common. “We’re not a substance use rehab center,” LeRoux says. “But we have come to understand that we cannot do this work without containing addiction.”  

Unlike many other residential psychiatric rehabilitation programs, The Retreat is very psychiatrist-driven, says LeRoux, who is one of two psychiatrists on staff board-certified in addiction psychiatry. He and his colleagues focus on developing close therapeutic relationships with residents during their stays. In addition to frequent meetings with psychiatrists for individual treatment, residents have access to a daily group session for people with co-occurring psychiatric and substance use conditions. 

The Retreat also offers acute detoxification from alcohol or opioids on site, as well as the initiation of Suboxone® (buprenorphine/naloxone) treatment for OUD as needed. “The focus is on recovery, and we treat psychiatric conditions and addiction aggressively, side by side,” he says.

Well-Integrated Expertise

Continuity of care is an important element of treatment at Sheppard Pratt. Across the system’s inpatient, outpatient, and residential units, Sheppard Pratt can transfer patients from one setting to another as their needs become more or less acute. “It’s a very well-integrated system,” Vaks says. 

Patients who arrive at the hospital’s Psychiatric Urgent Care clinic are assessed by a licensed behavioral health professional and quickly connected to the appropriate level of care. The Opioid Treatment Program is also the hub of a “hub and spoke” model of consulting services. Through this service, staff psychiatrists act as expert consultants to providers across the state and within the Sheppard Pratt system, providing answers to any questions about managing substance use and co-occurring psychiatric disorders. 

“We’re unparalleled with a long institutional history and a deep bench of experts and consultants,” LeRoux adds. “That’s one of Sheppard Pratt’s great resources.”