What is comorbidity?
Comorbidity means that a person has two or more diagnoses at the same time, usually a combination of mental health conditions (e.g., depression, anxiety, ADHD) and harmful use or dependence on alcohol/drugs. These conditions often interact negatively, requiring coordinated care for both diagnoses at the same time.
- Research shows that people with substance use disorders often have a co-occurring mental illness – and vice versa – which affects both prognosis and treatment outcomes.
- The Swedish National Board of Health and Welfare’s data indicates that a large proportion of patients treated for addiction also had a psychiatric diagnosis.
- Comorbidity is linked to poorer quality of life, higher risk of relapse and greater need for coordinated interventions.
Brief definition of comorbidity and why it is clinically relevant:
- Two or more concurrent diseases can interact and worsen both symptoms and functional impairment.
- Treatment that focuses only on one diagnosis is often insufficient. Integrated interventions improve the chances of better outcomes.
Addiction care in change – from divided responsibility to comprehensive reform
n recent years, it has become increasingly clear that Sweden’s addiction care system faces major challenges. Research, investigations and political initiatives all point in the same direction: the system is fragmented, coordination is lacking and people with both addiction and mental illness risk being left behind. At the same time, extensive reform work is underway and is now starting to take shape.
A clear connection that has long been ignored
Several years ago, surveys from the National Board of Health and Welfare showed that there is a strong connection between addiction and mental illness. A majority of those treated for addiction also have some form of psychiatric diagnosis. Despite this, care has historically been divided between different authorities, with the municipal social services responsible for parts of addiction care and the regions for health and medical care and psychiatry. The consequence has often been a lack of a holistic view and unclear responsibility for the individual.
The comorbidity investigation points to a new direction
In 2021, the so-called comorbidity inquiry was presented, which concluded that the current division of responsibility is a fundamental problem. The inquiry therefore proposed that the regions should take over the main responsibility for care and treatment for harmful use and addiction. By bringing addiction care and psychiatric care together under the same legislation – the Health and Medical Services Act – care would become more cohesive, equal and accessible.
The investigation also emphasized the importance of early intervention, increased user influence, reduced stigmatization, and better support for relatives. The goal was clear: no one should fall through the cracks.
Willingness to reform – but also warning signs
Despite broad agreement on the problems, the path to reform has proven to be complex. The Swedish Association of Local Authorities and Regions (SKR) has expressed support for many of the proposals, but at the same time warned that major changes require the right conditions. According to SKR, the division of responsibilities, financing and collaboration must first work in practice before further reforms can be fully implemented.
SKR has also highlighted the importance of preventive work and effective contact channels for healthcare, especially for people with serious problems. The reform must not lead to people losing important access to support and treatment.
A new delegation will drive the work forward
The next step was taken in the spring of 2025 when the government appointed a delegation for initiatives against addiction and mental illness. The delegation is tasked with driving forward the work of implementing the co-morbidity inquiry’s proposals for three years, analyzing obstacles and proposing concrete solutions for more cohesive care.
The Minister of Social Affairs has been clear about the ambition: healthcare should be based on the needs of the individual, not on organizational boundaries. The regions are expected to take greater responsibility, while collaboration with the municipalities will continue to be central.
From words to action
Overall, the development shows that Sweden is in the midst of a crucial shift for addiction care. The knowledge about comorbidity exists, the problems are well documented and the will to reform is expressed. The big challenge now lies in implementation.
If the reform work is successful, it could mean a health care where people with addictions and mental illness are met by a comprehensive, respectful and effective structure – where help is available in the right place, at the right time.
Previct Care – support within comorbidity
- Comprehensive picture and better coordination
When comorbidity occurs, it is easy to have “two parallel care plans”. A platform can bring together:
– monitoring of substance use/relapse risk
– mental health (well-being, sleep, stress)
– motivation and treatment adherence
This makes it easier for the team to work towards a common plan and reduce misunderstandings. - Early detection of deterioration and relapse risk
Comorbidity often means faster fluctuations. Continuous data points (e.g. self-assessments, behavioral data, bladder checks/breathalyzer, eye monitoring (drug testing) if relevant) can provide:
– early warning signals (sleep decline, stress increases, aberrant patterns)
– opportunity to act before a relapse or an emergency safety situation arises. - Personalized interventions – the right support at the right time
If you can see patterns (e.g. anxiety peaks → increased cravings) it is possible to:
– trigger targeted support interventions (contact, extra session, coping exercises, follow-up)
– adapt the frequency of checks and check-ins according to risk, instead of “one size fits all”. - Better adherence to treatment and structure in everyday life
Many with comorbidities have cognitive difficulties, low energy or chaos in routines. Digital support can simplify:
– reminders and micro-goals
– tasks and follow-up between visits
– simple reporting that reduces friction and makes the patient “have the energy” to participate. - Support for multi-professional teamwork
Comorbidity often requires a psychologist/therapist, doctor, nurse, social support. A shared space can:
– reduce duplication
– clarify responsibilities (who does what)
– provide faster feedback when something deviates. - Objectivity and security in difficult situations
When the patient is feeling worse, self-reporting sometimes becomes difficult. Objective/semi-objective measures (where appropriate) can:
– reduce conflict and “word for word”
– create security for both patient and therapist
– facilitate motivational conversations with clear data. - The effect of monitoring over time
In the case of comorbidity, one often wants to be able to show: “What helps – and for whom?” Structure in data can make it easier to:
– follow treatment response
– adjust efforts in the event of lack of effect
– report outcomes at the individual and organizational level.
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