Co‐Occurring Disorders: Policy and Practice in Germany

The occurrence of substance use disorders (SUD) with other mental disorders-what is often referred to as co-occurring disorders (COD)-is a common phenomenon, but for a long time, little attention has been paid to this problem in Germany. During the last 25 years, however, COD awareness has increased due to a shift toward community-based services. Scientific research has also demonstrated the significance and clinical relevance of COD. High prevalence rates and evidence of poor clinical outcomes were found in German studies. Many practitioners as well as policymakers acknowledge that changes in systems of care are necessary to meet the requirements of COD patients. The traditional German system is currently divided into addiction services and mental health services (predominantly in inpatient settings), often resulting in ineffective sequential treatment for COD patients. Research demonstrates that integrative treatment models are more appropriate, and the division of services should be reorganized to help COD patients appropriately. Efforts have already been made to restructure healthcare systems toward a more flexible approach with improved networking between in- and outpatient services. A further issue is the general attitude toward SUD patients. Many practitioners continue to hold negative opinions (eg, "SUD patients are only weak-minded") or feel insecure when confronted with SUD. This results in SUD problems being frequently ignored or depreciated. Educational programs have been intensive over recent years to address this problem (eg, Fachkunde Sucht, an advanced training program on SUD). In general, treatment conditions for COD patients are improving, but further efforts are necessary. Guidelines and treatment strategies for COD patients have been recently published in Germany.