Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Co-Occurring Disorders:
Integrated Dual Disorders Treatment
Information for Mental Health Program Leaders
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 co-occurring substance use disorders (abuse or dependence related to alcohol or other drugs).
Consumers with dual disorders are at high risk.
Risks include hospitalization, overdose, victimization, violence, legal problems, homelessness, HIV infection, and hepatitis.
Poor treatment for dual disorders is expensive.
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.
Integrated dual 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 team or program. Integrated treatment leads to dual recovery and reduces costs. Effective treatment is good public policy.
What is integrated dual disorders treatment?
Integration
Integrated dual disorders treatment differs from traditional approaches in several ways. The most important is integration of mental health and substance abuse treatments. One practitioner or one team in one agency provides both mental health and substance abuse treatments so that the consumer does not get lost, excluded, or confused going back and forth between two different programs.
Blending
Integrated dual disorders treatments also blend mental health and substance abuse treatments. For example, substance abuse treatments focus more on motivating people with two severe disorders to pursue abstinence, and mental health treatments are modified in light of the consumer's vulnerability to psychoactive substances.
Other features
- 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 mental health program leaders do?
Appoint a dual disorders program leader.
Implementation of a major program change requires that one person oversee planning, implementation, training, internal and external coordination, record keeping, and other sustaining activities.
Involve all stakeholders.
All stakeholders (consumers, families, clinicians, supervisors, program leaders, and policymakers) should be involved in planning, implementing, and sustaining an integrated service system for people with dual disorders.
Develop clinical skills.
Mental health practitioners often have not been trained to assess and treat substance abuse. Implementing an integrated dual disorders treatment program requires training staff to acquire new skills; it does not mean that additional staff must be hired.
There are four basic skills that all clinicians need:
- knowledge regarding substances of abuse and how they affect mental illness,
- substance abuse assessment skills,
- motivational interviewing skills, and
- substance abuse counseling skills.
Use established strategies for systems change.
Implementation of evidence-based practices entails a significant system change. Use well-known strategies, standardized models, and consultants.
Where can I get more information?
Integrated Dual Disorders Implementation Resource Kit.
See the Tips for Mental Health Program Leaders. 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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Integrated Dual Disorders Treatment
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