Integrated Treatment for Co-Occurring Disorders: The Evidence...Integrated Treatment for...

Integrated Treatment for Co-Occurring Disorders

The Evidence

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationCenter for Mental Health Serviceswww.samhsa.gov


The Evidence

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Acknowledgments

This document was produced for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the New Hampshire-Dartmouth Psychiatric Research Center under contract number 280-00-8049 and Westat under contract number 270-03-6005, with SAMHSA, U.S. Department of Health and Human Services (HHS). Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as the Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors and do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), SAMHSA, or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization from the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at www.samhsa.gov/shin. Or, please call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Recommended Citation

Substance Abuse and Mental Health Services Administration. Integrated Treatment for Co-Occurring Disorders: The Evidence. DHHS Pub. No. SMA-08-4366, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009.

Originating Office Center for Mental Health Services Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Rockville, MD 20857 DHHS Publication No. SMA-08-4366 Printed 2009


The Evidence

The Evidence introduces all stakeholders to the research literature and other resources on Integrated Treatment for Co-Occurring Disorders. This booklet includes the following:

n Two key resources included in the KIT;

n Additional resources for further reading; and

n References for the citations presented throughout the KIT.

This KIT is part of a series of Evidence-Based Practices KITs created by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

This booklet is part of the Integrated Treatment for Co-Occurring Disorders KIT that includes a DVD, CD-ROM, and seven booklets:

How to Use the Evidence-Based Practices KITs

Getting Started with Evidence-Based Practices

Building Your Program

Training Frontline Staff

Evaluating Your Program

The Evidence

Using Multimedia to Introduce Your EBP


What’s in The Evidence

Review of Research Literature . . . . . . . . . . . . . . . . . . . . 1

Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . 11

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

The Evidence

Review of Research Literature

The Evidence 1 Review of Research Literature

are based on definitive research, empirical support,

specific

n

n

n

n

www.ncadi.samhsa.gov

Review of Research Literature 2 The Evidence


PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4 469

Implementing Dual DiagnosisServices for Clients With Severe Mental IllnessRobert E. Drake, M.D., Ph.D.Susan M. Essock, Ph.D.Andrew Shaner, M.D.Kate B. Carey, Ph.D.Kenneth Minkoff, M.D.Lenore Kola, Ph.D.David Lynde, M.S.W.Fred C. Osher, M.D.Robin E. Clark, Ph.D.Lawrence Rickards, Ph.D.

After 20 years of development and research, dual diagnosis servicesfor clients with severe mental illness are emerging as an evidence-based practice. Effective dual diagnosis programs combine mentalhealth and substance abuse interventions that are tailored for thecomplex needs of clients with comorbid disorders. The authors de-scribe the critical components of effective programs, which include acomprehensive, long-term, staged approach to recovery; assertive out-reach; motivational interventions; provision of help to clients in ac-quiring skills and supports to manage both illnesses and to pursuefunctional goals; and cultural sensitivity and competence. Many statemental health systems are implementing dual diagnosis services, buthigh-quality services are rare. The authors provide an overview of thenumerous barriers to implementation and describe implementationstrategies to overcome the barriers. Current approaches to imple-menting dual diagnosis programs involve organizational and financingchanges at the policy level, clarity of program mission with structuralchanges to support dual diagnosis services, training and supervisionfor clinicians, and dissemination of accurate information to consumersand families to support understanding, demand, and advocacy. (Psy-chiatric Services 52:469–476, 2001)

Dr. Drake Dr. Clark

Dr. EssockDr. Shaner

Dr. Carey Dr. MinkoffDr. Kola

Mr. Lynde Dr. OsherDr. Rickards


Dual diagnosis services

Research on dual diagnosis practices

PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4470

Editor’s note:


Critical components

Staged interventions

Assertive outreach

Motivational interventions

Counseling

Social support interventions



Long-term perspective

Comprehensiveness

Cultural sensitivity and competence

Limitations of the research

Implementation barriers



Policy barriers

Program barriers

Clinical barriers

Consumer and family barriers

Implementation strategies

Policy strategies



Program strategies

Clinical strategies

Consumer- and family-level strategies

Conclusions


Recent

research

offers evidence

that integrated dual

diagnosis treatments

are effective, but basic

interventions are rarely

incorporated into the

mental health programs

in which these

clients receive

care.


Acknowledgments

References


The Evidence

Selected Bibliography

Literature reviews

n

n

The Evidence 11 Selected Bibliography

Selected Bibliography 12 The Evidence

n

n

for co-occurring disorders with specific

n

n

n

Historical context for Integrated Treatment for Co-Occurring Disorders

n

n

diagnoses: Organizational and financing issues.


Principles of Integrated Treatment for Co-Occurring Disorders

n

n

Implementation and administrative issues


State and local administrative perspectives

Financing and cost-effectiveness of Integrated Treatment for Co-Occurring Disorders

Additional readings for program leaders and public mental health authorities


Fidelity measures for Integrated Treatment for Co-Occurring Disorders

associated with higher program fidelity to the

reatment with high fidelity to the

those in low-fidelity programs.

Practice manuals

n

n

n

n

n Includes a chapter for each of five

n

n

n

n

n

n

n

n

Substance abuse

Assessment and treatment planning

n

n This book also has many chapters on specific

16 The Evidence


n

n

n

n

n

identification, classification, functional

n Describes specific methods for linking

n

n

Engagement

n

n

Stages of treatment and motivational enhancement


n

n

n

n

n

n

n

n

n

n

n

Group treatment for co-occurring disorders

n

n fi

n

n


Summarizes difficulties and solutions

eiss, R. D., Greenfield, S. F

n

n

Self-help

http://www.aa.org/

en_pdfs/p-16_theaagroup.pdf

n

n

Family treatment


n

n

n

n

n

n

Psychopharmacological treatment

fi

substance abuse and more likely to benefit


R. (2003). Disulfiram treatment for alcoholism

with disulfiram (Antabuse).

Infectious diseases

First-person accounts

Family perspectives

Describes family members’ financial and time

The Evidence

ReferencesThe following list includes the references for all citations in the KIT.

The Evidence 23 References

http://www.tacinc.org

http://www.acmha.org

References 24 The Evidence

The Evidence 25 References

http://www.nimh.nih.gov

The Evidence

Acknowledgments

The materials included in the Integrated Treatment KIT were developed through the National Implementing Evidence-Based Practices Project. The Project’s Coordinating Center—the New Hampshire-Dartmouth Psychiatric Research Center—in partnership with many other collaborators, including clinicians, researchers, consumers, family members, and administrators and operating under the direction of the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, developed, evaluated, and revised these materials.

We wish to acknowledge the many people who contributed to all aspects of this project. In particular, we wish to acknowledge the contributors and consultants on the next few pages.

The Evidence 27 Acknowledgments

SAMHSA Center for Mental Health Services, Oversight Committee

Michael English

Neal B. Brown

Sandra Black

Crystal R. Blyler

Pamela J. Fischer

Sushmita Shoma Ghose

Patricia Gratton

Betsy McDonel Herr

Larry D. Rickards

Mary Brunette

Robert E. Drake

Co-Leaders

David W. Lynde

Acknowledgments 28 The Evidence


Contributors

Stephen T. Baron

Gary R. Bond

John S. Caswell

Kevin Curdie

Michael J. Cohen

Cathy Donahue

Kana Enomoto

Carol Furlong

Paul G. Gorman

Pablo R. Hernandez

Marta J. Hopkinson

Lenore A. Kola

Charlene LeFauve

Doug Marty

Gregory J. McHugo

Alan C. McNabb

Matthew Merrens

Gary Morse

Kim T. Mueser

Fred C. Osher

Ernest Quimby

Charles A. Rapp

Lawrence D. Rickards


Dennis RossMarshfield, V

Marian Scheinholtz

Karin Swain

William Torrey

Loralee West

Consultants to the National Implementing Evidence-Based Practices Project

Dan Adams

Diane C. Aldenfi

Lindy Fox Amadio

Diane Asher

Stephen R. Baker

Stephen T. Baron

Deborah R. Becker

Nancy L. Bolton

Patrick E. Boyle

Mike Brady

Ken Braiterman

Janice Braithwaite

Michael Brody

Mary Brunette

Sharon Bryson

Barbara J. Burns

Jennifer Callaghan


Kikuko Campbell

Linda Carlson

Diana Chambers

Alice Claggett

Marilyn Cloud

Melinda Coffman

Jon CollinsOffice of Mental Health and Addiction Services

Laurie Coots

Judy Coxork State Office of Mental Health

Harry Cunningham

Gene Deegan

Natalie DeLuca

Robert E. Drake

Molly Finnerty ork State Office of Mental Health

Laura Flint

Vijay Ganju

Susan Gingerich

Phillip Glasgow

Howard H. Goldman

Paul G. Gorman

Gretchen Grappone

Eileen B. Hansen

Kathy Hardy

Joyce Hedstrom

Lon Herman

Lia Hicks

Debra Hrouda


Bruce Jensen

Clark Johnson

Amanda M. Jones

Joyce Jorgensen

Hea-Won Kim

David A. Kime

Dale Klatzker

Kristine Knoll

Bill Krenek

Rick Kruszynski

H. Stephen Leff

Treva E. Lichti

Wilma J. Lutz

Anthony D. Mancinifi

Paul Margolies

Tina Marshall

Ann McBride (deceased)

William R. McFarlane

Mike McKasson

Alan C. McNabb

Meka McNeal

Ken Minkoff

Michael W. Moore Office of Mental Health and Addiction Services

Roger Morin

Lorna Moser

Kim T. Mueser


Britt J. Myrholfi

Bill Naughton

Nick Nichols

Bernard F. Norman

Linda O’Malia

Ruth O. Ralph

Angela L. Rollins

Tony Salernofi

Diana C. Seybolt

Patricia W. Singer

Mary Kay Smith

Diane Sterenbuch

Bette Stewart

Steve Stone

Maureen Sullivan

Beth Tanzman

Greg Teague

Boyd J. Tracy

Laura Van Tosh

Joseph A. Vero

Barbara L. Wieder

Mary Woods


Special thanks to

Production, editorial, and graphics support

Carolyn Boccella Bagin

Sushmita Shoma Ghose

Julien Hofberg

Glynis Jones

Chandria Jones

Tina Marshall

Mary Anne Myers

Robin Ritter

26443.0409.7765020404

DHHS Publication No. SMA-08-4366Printed 2009

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