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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
Integrated Treatment for Co-Occurring Disorders
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
Integrated Treatment for Co-Occurring Disorders
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
Integrated Treatment for Co-Occurring Disorders
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
The Evidence 3 Review of Research Literature
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
Review of Research Literature 4 The Evidence
Dual diagnosis services
Research on dual diagnosis practices
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4470
Editor’s note:
The Evidence 5 Review of Research Literature
Critical components
Staged interventions
Assertive outreach
Motivational interventions
Counseling
Social support interventions
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4 471
Review of Research Literature 6 The Evidence
Long-term perspective
Comprehensiveness
Cultural sensitivity and competence
Limitations of the research
Implementation barriers
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4472
The Evidence 7 Review of Research Literature
Policy barriers
Program barriers
Clinical barriers
Consumer and family barriers
Implementation strategies
Policy strategies
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4 473
Review of Research Literature 8 The Evidence
Program strategies
Clinical strategies
Consumer- and family-level strategies
Conclusions
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4474
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.
The Evidence 9 Review of Research Literature
Acknowledgments
References
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4 475
PSYCHIATRIC SERVICES April 2001 Vol. 52 No. 4476
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.
The Evidence 13 Selected Bibliography
Principles of Integrated Treatment for Co-Occurring Disorders
n
n
Implementation and administrative issues
Selected Bibliography 14 The Evidence
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
The Evidence 15 Selected Bibliography
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
The Evidence 17 Selected Bibliography
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
Selected Bibliography 18 The Evidence
n
n
n
n
n
n
n
n
n
n
n
Group treatment for co-occurring disorders
n
n fi
n
n
The Evidence 19 Selected Bibliography
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
Selected Bibliography 20 The Evidence
n
n
n
n
n
n
Psychopharmacological treatment
fi
substance abuse and more likely to benefit
The Evidence 21 Selected Bibliography
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
The Evidence 29 Acknowledgments
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
Acknowledgments 30 The Evidence
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
The Evidence 31 Acknowledgments
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
Acknowledgments 32 The Evidence
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
The Evidence 33 Acknowledgments
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
Acknowledgments 34 The Evidence
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