WASHINGTON—Mental illnesses and addiction disorders are chronic illnesses with significant burden, disability and mortality, according to officials who spoke at the Centers for Disease Control and Prevention’s 20th National Conference on Chronic Disease Prevention and Control held in February.

“We are really trying to make the case here for the importance of really expanding the understanding of chronic and co-existing diseases if we are going to be promoting health and well being for whole populations,” said Ruth Perou, Ph.D., acting mental health coordinator at CDC, during a presentation. “So we really need to make a better effort of recognizing both mental illness and addiction disorders as chronic diseases and as coexisting diseases with other chronic diseases.”

Larke Huang, Ph.D., a senior advisor at Substance Abuse and Mental Health Services Administration who is currently detailed at CDC, said that statistics indicate that in any given year 26.2 percent of Americans aged 18 and older have a diagnosable mental disorder, and 45 percent of those have a comorbid, co-existing disorder.

Mental disorders are costly, accounting for lost earnings of $193.2 billion dollars annually in the U.S. “This becomes even more important now that we are looking at the impact of economic stress and what is going on in the economy that even exacerbates some of the issues around mental disorders and mental illness,” she said. “As our nation moves forward and tries to do better with the economy, we really have to be cognizant of the role that mental disorders play in the whole economic picture.”

Expanding Understanding of Chronic Diseases

Dr. Perou noted that drug addiction should be viewed as both a mental illness and a chronic disease. “It is really a very complex brain disease with compulsive and uncontrollable drug cravings,” she said.

Recent studies have shown that drug addiction actually leads to structural and functional changes within the brain. “[In] some of the MRI studies, you can see the changes within the brain. Some of the changes in the brain are actually the same areas disrupted for other mental disorders such as depression, anxiety and schizophrenia,” she said.

In addition, drug addiction is similar to other diseases, such as cardiovascular disease, in that it disrupts the function of an organ. “Both disrupt the normal function of the underlying organ, in this case the brain, and they have serious consequences and they are preventable, treatable and if left untreated can last a lifetime,” Dr. Perou said.

Mental Health Important to Overall Health

Mental illnesses have a major impact on overall health. A 2006 study found that people with severe mental illnesses die, on average, 25 years earlier than the general population. “They are not dying of their mental health disorders and they are not dying of their addiction disorders, but they are dying of other kinds of chronic diseases. The early mortality is really linked to a lack of focus or negligence of their physical health disorders.” Dr. Huang said.

The role that mental health plays in causing poorer outcomes with co-existing conditions should be considered by the medical establishment. Dr. Huang pointed to one study published in the Journal of the American College of Cardiology on women with cardiovascular disease that found that depression was associated with 15 percent to 53 percent increases in 5-year cardiovascular expenditures compared to nondepressed women with cardiovascular disease. The study concluded that these results “reinforce the importance of assessing depression in clinical populations and support the hypothesis that improved management of depression in women with suspected myocardial ischemia could reduce medical costs.”

Integrating Mental Heath and Substance Abuse into Primary Care

Dr. Huang said that one of the problems when it comes to drug and mental health disorders is that while there is treatment available, many people do not seek it.

In a 2007 SAMHSA study, 24.3 million adults age 18 or older experienced serious psychological distress but only about 44.6 percent of these received mental health services. Among adolescents who needed treatment for alcohol use, the percentage who received treatment at a specialty facility fluctuated between 5.9 and 8.1 percent from 2002 through 2007, according to SAMHSA.

“One of the reasons I am doing detail at CDC from SAMHSA is when we look at this treatment gap that has persisted over the years, we don’t seem to be closing the treatment gap. We thought, ‘okay we need to figure out how to move more upstream. How do we get more into the prevention arena for mental health and addiction disorders?’We know that they are preventable and treatable,” Dr. Huang said.

Because substance abuse disorders and mental health have an impact on the trajectory of other chronic health illnesses, one question is whether a substance abuse assessment should a part of a primary care assessment.

“When we think about when people go for primary care, is assessment of substance abuse a part of that examination? Should it be a part of that when we know there is a high rate of prevalence of these disorders and a high rate of co-occurrence and that they actually interfere with the positive outcomes for those other disorders?” Dr. Huang said.

Dr. Huang said that federal offi cials are looking more at the importance of incorporating mental health and drug addiction services in primary care settings, and vice versa, as a way of making sure that people receive treatment.

“How do you take care of both the physical and behavioral aspects? We are looking at this conceptual framework for not just putting behavioral health care or mental health and addictions in to primary care, but also when would it is necessary to put physical and primary care health services into, say, community mental health services? That hasn’t been done traditionally. We have seen more of the other way, where we see more into primary care and actually we are really two separate healthcare delivery systems,” Dr. Huang said.

Dr. Perou said that it is important to think about how primary care and public health approaches can be linked with mental health and substance abuse help.

“We need to have a much more comprehensive system of care and we have that opportunity now with health care reform. Mental health is essential to overall health. We need to keep saying that message and making sure that everybody knows that,” she concluded.