Across Iowa, communities are facing rising challenges related to both mental health and substance use. While these issues are often discussed separately, they frequently occur together — creating complex and deeply intertwined struggles for individuals, families, and the professionals who support them. Yet despite this growing need, too few therapists are trained to effectively treat both conditions at the same time.

Understanding the connection between mental health and substance use is essential for effective care. These conditions often influence one another in powerful ways. Individuals experiencing depression, anxiety, or trauma may turn to alcohol or drugs to cope with emotional pain. At the same time, ongoing substance use can worsen mental health symptoms, disrupt sleep, alter mood and thinking, and interfere with daily functioning, making any underlying mental health condition worse. In many cases, substance use can also reduce the effectiveness of medications used to treat mental health conditions.

When mental health and substance use disorders occur together, they are known as co-occurring disorders. These conditions can be difficult to identify and even harder to treat without specialized training. Substance use can mimic or mask mental health symptoms — alcohol use may appear as depression, withdrawal can resemble anxiety, and stimulants may present as mania. Cannabis and its CBD derivatives and other substances may trigger symptoms similar to psychosis. These are called substance induced mental health disorders in which symptoms persist even after the substance use is stopped.

Clinical guidelines, including those in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), often recommend a period of abstinence from substances — typically around 30 days — before determining whether symptoms are substance-induced or part of an underlying mental health condition. However, this is not always practical or safe. Withdrawal from certain substances can be severe and, in some cases, life-threatening, requiring medical supervision. In other situations, the severity of substance use may need to be addressed before a clear diagnostic picture can emerge.

The growing presence of newer substances adds another layer of complexity. Synthetic drugs and high-potency concentrates can produce unpredictable and sometimes severe symptoms, making accurate diagnosis even more challenging. Substances sold legally in vape shops, gas stations, or online may carry significant mental health risks that are not always well understood. For providers, staying informed about evolving drug trends is critical–but not all clinicians receive this level of training.

Because of these challenges, effective treatment is oftentimes best using an integrated approach. Clinicians trained in co-occurring disorders are better equipped to assess the whole person, identify underlying causes, and develop treatment plans that address both mental health and substance use simultaneously. This model — known as integrated treatment — has been shown to improve outcomes, reduce relapse rates, and support long-term recovery.

Integrated treatment may include:

• Teaching healthier coping strategies

• Identifying triggers and patterns of substance use

• Coordinating care with medical and psychiatric providers

• Incorporating medication-assisted treatment (MAT) when appropriate

• Referring individuals to higher levels of care, such as residential treatment

• Monitoring progress and preventing relapse

• Providing education and support for individuals and families

The need for this level of care is significant. Nationally, nearly one in four adults experiences a mental health condition each year, and tens of millions live with a substance use disorder. More than 20 million individuals experience both at the same time — yet fewer than 15 percent receive treatment that addresses both conditions together.

The need for integrated mental health and substance use treatment in Iowa is backed by clear data. Nearly 600,000 Iowans experience a mental health condition each year, and more than 42% of adults report symptoms of anxiety or depression. At the same time, substance use continues to rise, with 172 opioid-related deaths in 2024 — 73% involving fentanyl — and growing impacts from methamphetamine and high-potency cannabis. More than 1.8 million Iowans live in areas with a shortage of mental health professionals, and only a fraction of patients receive substance use treatment compared to mental health services. As demand increase, evidenced by over 47,000 annual contacts to Iowa’s mental health and addiction helpline, the gap between need and available, integrated care continues to widen. Demand for mental health and addiction support is rising faster than the workforce can keep up.

Without access to integrated treatment, individuals may receive care for one condition while the other remains unaddressed, making recovery more difficult and increasing the risk of relapse, hospitalization, and long-term instability.

Research consistently shows that integrated care leads to better outcomes, including:

• Reduced or discontinued substance use

• Improved mental health symptoms and daily functioning

• Higher rates of sustained recovery

• Fewer hospitalizations and crises

• Greater housing stability

• Reduced involvement with the criminal justice system

Organizations like Prairie Ridge Integrated Behavioral Healthcare are working to close this gap. As a Certified Community Behavioral Health Clinic (CCBHC), Prairie Ridge provides comprehensive, evidence-based care for both mental health and substance use disorders. This model ensures that individuals can access coordinated services regardless of their ability to pay, following a “no wrong door” approach to care.

Prairie Ridge merged with former SATUCI in October 2024 and we are now covering 12 counties with offices in Mason City, Marshalltown, Tama, Grinnell, Eldora, Algona, Charles City, Forest City and Hampton offering a full continuum of services, outpatient Mental Health services, substance use treatment, residential substance use treatment services, medication-assisted treatment, family practice and psychiatric care for both children and adults. By integrating these services, we are able to treat the whole person, addressing both mental health, physical health and substance use needs in a coordinated and effective way.

A key part of this mission is building a workforce trained in integrated care. Prairie Ridge is actively hiring therapists and supporting clinicians in developing the skills needed to assess and treat co-occurring disorders. This includes providing supervision for professionals seeking certification in alcohol and drug counseling (CADC) alongside their mental health credentials. For counselors, social workers, and mental health professionals, this represents an opportunity to grow professionally while making a meaningful impact. Training in co-occurring treatment not only expands clinical expertise but also allows providers to deliver more effective, life-changing care.

As Iowa continues to confront the growing challenges of mental health and substance use, the need for trained professionals has never been greater. Integrated treatment is not just a best practice, it is essential.

For those considering a career in behavioral health, or looking to expand their skills, now is the time to step into this critical field.

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Amy R. Nova Sinclaire is a co-occurring

outpatient therapist. She is a licensed social worker (LMSW) and is an international advanced alcohol and drug counselor (IAADC) and

Substance Abuse Professional (SAP) who

practices in the Marshalltown office while

offering remote services as well.