Integrated Treatmentfor Co-Occurring DisordersAn Evidence-Based Practice

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What Are Evidence-Based What Are Evidence-Based Practices?Practices?

Services that have consistently Services that have consistently demonstrated their demonstrated their effectivenesseffectiveness in helping people with mental in helping people with mental illnesses achieve their desired illnesses achieve their desired goals goals

Effectiveness was established by Effectiveness was established by different people who conducted different people who conducted rigorous studies and obtained rigorous studies and obtained similar outcomessimilar outcomes

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Examples of Evidence-Based Examples of Evidence-Based PracticesPractices

Integrated Treatment for Co-Integrated Treatment for Co-Occurring DisordersOccurring Disorders

Supported EmploymentSupported Employment

Assertive Community TreatmentAssertive Community Treatment

Family PsychoeducationFamily Psychoeducation

Illness Management and RecoveryIllness Management and Recovery

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Why Implement Evidence-Based Why Implement Evidence-Based Practices?Practices?

According to the President’s New Freedom According to the President’s New Freedom Commission on Mental Health:Commission on Mental Health:

State-of-the-art treatments, based State-of-the-art treatments, based on decades of research, are not on decades of research, are not being transferred from research to being transferred from research to community settingscommunity settings

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Why Implement Evidence-Based Why Implement Evidence-Based Practices?Practices?(continued)(continued)

According to the President’s New Freedom According to the President’s New Freedom Commission on Mental Health:Commission on Mental Health:

IIf effective treatments were more f effective treatments were more efficiently delivered through our efficiently delivered through our mental health services system . . . mental health services system . . . millions of Americans would be millions of Americans would be more successful in school, at work, more successful in school, at work, and in their communitiesand in their communities

——Michael Hogan, ChairmanMichael Hogan, Chairman

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What Is Integrated Treatment What Is Integrated Treatment for Co-Occurring Disorders?for Co-Occurring Disorders?

Integrated Treatment is a research-Integrated Treatment is a research-proven model of treatment for people proven model of treatment for people with serious mental illnesses and co-with serious mental illnesses and co-occurring substance occurring substance use disordersuse disorders

Consumers receive combined Consumers receive combined treatment for mental illnesses and treatment for mental illnesses and substance use disorders from the same substance use disorders from the same practitioner or treatment team. They practitioner or treatment team. They receive one consistent message about receive one consistent message about treatment and recoverytreatment and recovery

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Practice Principles for Integrated Practice Principles for Integrated Treatment for Co-Occurring DisordersTreatment for Co-Occurring Disorders

Mental health and Mental health and substance abuse substance abuse treatment are treatment are integrated to meet integrated to meet the needs of people the needs of people with co-occurring with co-occurring disordersdisorders

Integrated treatment Integrated treatment specialists are specialists are trained to treat both trained to treat both substance use and substance use and serious mental serious mental illnessesillnesses

Co-occurring disorders Co-occurring disorders

are treated in a stage-are treated in a stage-wise fashion with wise fashion with different services different services provided at different provided at different stagesstages

Motivational Motivational interventions are used interventions are used to treat consumers in to treat consumers in all stages, all stages, but especially in the but especially in the persuasion stagepersuasion stage

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Practice Principles for Integrated Practice Principles for Integrated Treatment for Co-Occurring DisordersTreatment for Co-Occurring Disorders

Substance abuse Substance abuse counseling, using a counseling, using a cognitive-behavioral cognitive-behavioral approach, is used to approach, is used to treat consumers in the treat consumers in the active treatment and active treatment and relapse prevention relapse prevention stagesstages

Multiple formats for Multiple formats for services are services are available, including available, including individual, individual, group, self-help, and group, self-help, and

familyfamily

Medication services Medication services are integrated and are integrated and coordinated with coordinated with psychosocial psychosocial services services

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Treatment is IntegratedTreatment is Integrated

Mental health and substance abuse Mental health and substance abuse treatment treatment are evaluated and addressed are evaluated and addressed

Same team Same team Same locationSame location Same timeSame time

Treatment targets the individual needs of Treatment targets the individual needs of people with co-occurring disorders and is people with co-occurring disorders and is integrated on organizational and clinical integrated on organizational and clinical levelslevels

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Treatment is in a Stage-Wise FashionTreatment is in a Stage-Wise Fashion

Precontemplation — Precontemplation — EngagementEngagement

Assertive outreach, practical Assertive outreach, practical help (housing, entitlements, help (housing, entitlements, other), and an introduction other), and an introduction to individual, family, group, to individual, family, group, and self-help treatment and self-help treatment formatsformats

Contemplation and Contemplation and Preparation — PersuasionPreparation — Persuasion

Education, goal setting, and Education, goal setting, and building awareness of building awareness of problem through problem through motivational counselingmotivational counseling

Action — Active Action — Active treatmenttreatment

Counseling and treatment Counseling and treatment based on cognitive-based on cognitive-behavioral techniques, skills behavioral techniques, skills training, training, and support from families and support from families and self-help groupsand self-help groups

Maintenance — Maintenance — Relapse preventionRelapse preventionContinued counseling and Continued counseling and treatment based on relapse treatment based on relapse prevention techniques, skill prevention techniques, skill building, and ongoing building, and ongoing support support to promote recoveryto promote recovery

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Integrated Treatment Recovery Integrated Treatment Recovery ModelModel

Hope is criticalHope is critical

Services and treatment goals are consumer-Services and treatment goals are consumer-drivendriven

Unconditional respect and compassion for Unconditional respect and compassion for consumers is essentialconsumers is essential

Integrated treatment specialists are Integrated treatment specialists are responsible responsible for engaging consumers and supporting for engaging consumers and supporting their recoverytheir recovery

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Integrated Treatment Recovery Integrated Treatment Recovery Model Model (continued)(continued)

Focus on consumers’ goals and Focus on consumers’ goals and functioning, not on adhering to functioning, not on adhering to treatmenttreatment

Consumer choice, shared Consumer choice, shared decisionmaking, and decisionmaking, and consumer/family education are consumer/family education are importantimportant

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Integrated Treatment Recovery Integrated Treatment Recovery ModelModel(continued)(continued)

Integrated treatment is associated with the Integrated treatment is associated with the following positive outcomes:following positive outcomes:

Reduced substance useReduced substance use Improvement in psychiatric symptoms Improvement in psychiatric symptoms

and functioning;and functioning; Decreased hospitalizationDecreased hospitalization

Increased housing stabilityIncreased housing stability

Fewer arrests andFewer arrests and

Improved quality of lifeImproved quality of life

-(Drake et al.,2001)

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SummarySummary

Integrated Treatment for Co-Occurring Disorders Integrated Treatment for Co-Occurring Disorders is effective in the recovery process for is effective in the recovery process for consumers with consumers with co-occurring disorders co-occurring disorders

The goal of this evidence-based practice is to The goal of this evidence-based practice is to support consumers in their recovery process support consumers in their recovery process

In Integrated Treatment programs, the same In Integrated Treatment programs, the same practitioners, working in one setting, provide practitioners, working in one setting, provide mental health and substance abuse mental health and substance abuse interventions in a coordinated fashion interventions in a coordinated fashion

Consumers receive one consistent message Consumers receive one consistent message about treatment and recovery about treatment and recovery

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Additional Resources Additional Resources

For more information about For more information about Integrated Treatment for Co-Integrated Treatment for Co-Occurring Disorders and other Occurring Disorders and other evidence-based practices, visitevidence-based practices, visit

www.samhsa.govwww.samhsa.gov