Integrated Dual Disorders Treatment(IDDT)

Mountain Manor Treatment CenterBaltimore

IDDTModel

• Co-located integrated team treatment for SUD and co-occurring psychiatric disorders

• Aggressive use of psychiatric medications despite active substance use, with careful consideration of SUD vulnerability

• Cross-trained COD therapists with additional focus on medication compliance

• Use of relapse prevention medications• Continuous engagement despite continued use and/or relapse • Matching treatment expectations and goals with stage of

readiness to change.

IDDT – Staged intervention matchingStage of change IDDT intervention

approachFocus

Pre-Contemplation

Engagement Relationship, working alliance, practical support, outreach

Contemplation and Preparation

Persuasion Motivation enhancement, assessment and feedback, reduce substance use

Action Active treatment Manage symptoms of both disorders, skills acquisition, emphasis on goals and function

Maintenance Relapse prevention Refinement, wellness, persistence of stable remission

Menu of services

• Primary therapist/case manager• Psychiatric evaluation and treatment• Buprenorphine + daily supervision (BBI) if needed• Supervised psychiatric medications including

injectables• Group substance abuse counseling (OP and IOP)• COD groups• Medications for alcohol and cocaine

Initial barriers

• Differences in approach from SUD IOP• Patients belonging to multiple programs• Scheduling • Team communication• Finding best fit staffing

Strengths and successes

• Improvements in medication adherence• Enduring institutional affiliation with return

after dropout• Support through lapse and relapse with

“bouncing back” common• Buprenorphine as contingency for other

strategies• IDDT staff as champions for culture change

Remaining hurdles and next steps

• More stagewise differentiation• More integration of internal leadership• Expand target population• Expand menu of services – Links to vocational,

housing, PRP• Family engagement