Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Co-Occurring Disorders:
Integrated Dual Disorders Treatment

Information for Public Mental Health Authorities

Why are dual disorders important?
Dual disorders are common.
More than half of the adults with severe mental illness in public mental health systems are further impaired by the presence of co-occurring substance use disorders (abuse or dependence related to alcohol or other drugs).

Consumers with dual disorders are at high risk.
Consumers are at risk for negative outcomes, including hospitalization, overdose, violence, legal problems, homelessness, victimization, HIV infection, and hepatitis.

Poor treatment for dual disorders is expensive.
Often people with dual disorders have been forced into a parallel method of treatment, where substance abuse treatment was provided separately and independently of treatment for mental illness. This has proven to be an ineffective method of treatment. Additionally, mental health systems spend most of their resources on a small percentage of individuals with difficult problems, often consumers with dual disorders. Mental health services for these consumers cost, on average, nearly twice as much as for clients with single disorders.

Treatment works.
Consumers with dual disorders have high rates of recovery when provided integrated dual disorders treatment, which means combining mental health and substance abuse treatments within the same system of care. Integrated treatment leads to dual recovery and reduces costs. Effective treatment is good public policy.

What are the basic components of integrated dual disorders treatment?
Providing effective integrated dual disorders treatment involves the following:

Knowledge about alcohol and drug use, as well as mental illnesses
Clinicians know the effects of alcohol and drugs and their interactions with mental illness.

Integrated services
Clinicians provide services for both mental illness and substance use at the same time.

Stage-wise treatment
People go through a process over time to recover and different services are helpful at different stages of recovery.

Assessment
Consumers collaborate with clinicians to develop an individualized treatment plan for both substance use disorder and mental illness.

Motivational treatment
Clinicians use specific listening and counseling skills to help consumers develop awareness, hopefulness, and motivation for recovery. This is important for consumers who are demoralized and not ready for substance abuse treatment.

Substance abuse counseling
Substance abuse counseling helps people with dual disorders to develop the skills and find the supports needed to pursue recovery from substance use disorder.

What can public mental health authorities do?
Articulate a vision.
Describe your vision for integrated dual disorders treatment facilitating the dual recovery process for people with dual disorders.

Involve all stakeholders.
All stakeholders, including practitioners, consumers, and family members are critical partners for effective planning, implementing, and sustaining an integrated dual disorders treatment model in your system.

Collaborate with the public substance abuse authority.
Involve a variety of stakeholders from the substance abuse services; discuss how your public mental health authority can integrate treatments, and how your colleagues from substance abuse can provide expertise, training, and other help.

Address financing and organizational issues.
Financial structures and organizational processes must be aligned at the top administrative levels to support local mental health programs in their efforts to implement integrated dual disorders treatment.

Standardize training.
Mental health authorities can facilitate and standardize training by establishing training centers or enhancing existing education and training centers. These institutions should offer education, training, and ongoing supervision for evidence-based integrated dual disorders treatments.

Use established strategies for system change.
The implementation of evidence-based practices entails a significant system change. The collaboration and consultation of an evidence-based practice implementation center can help. Explore and choose resources that embody well-known change strategies and trained consultants. Examine policies and procedures that can be modified or developed to provide incentives for local programs to provide integrated dual disorders treatment.

Where can I get more information?
Order an Integrated Dual Disorders Treatment Implementation Resource Kit.
See Implementation Tips for Public Mental Health Authorities. This document identifies specific strategies, recommendations for reading, consultants, and implementation centers.

Contact national organizations.
We recommend the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration: (www.samhsa.gov), and the National Association of State Mental Health Program Directors Research Institute, Inc. (http://nri.rdmc.org).

Visit our website.
Information about integrated dual disorders treatment, as well as other evidence-based practices for the treatment of mental illness in the community, can be found at www.mentalhealthpractices.org.

This document is part of an evidence-based practice implementation resource kit developed through a contract (no. 280-00-8049) from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) and a grant from The Robert Wood Johnson Foundation (RWJF), and support from the West Family Foundation. These materials are in draft form for use in a pilot study. No one may reproduce, reprint, or distribute this publication for a fee without specific authorization from SAMHSA.

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