Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Co-Occurring Disorders:
Integrated Dual Disorders Treatment
Information for Practitioners and Clinical Supervisors
What is meant by "dual disorders"?
This refers to the presence of both a severe mental illness and substance use disorder.
What is effective treatment?
Integrated dual disorders treatment has been shown to work effectively for both disorders. People with dual disorders have a better chance of recovery from both disorders when their mental health practitioners provide combined mental health and substance abuse treatments.
Why is information about integrated treatment for dual disorders important to mental health practitioners?
Dual disorders are common.
More than half of all adults with severe mental illness are further impaired by substance use disorders (abuse or dependence related to alcohol or other drugs).
Dual disorders lead to poor outcomes.
People with dual disorders are at high risk for many additional problems such as symptomatic relapses, hospitalizations, financial problems, family problems, homelessness, suicide, violence, sexual and physical victimization, incarceration, serious medical illnesses, such as HIV and hepatitis B and C, and early death.
Referral to separate substance abuse services is not effective treatment.
Sending people with dual disorders to substance abuse treatment programs or to self-help groups such as AA, without offering substance abuse treatment in the mental health setting, is not an effective approach.
What are the basic components of integrated dual disorders treatment?
Providing effective integrated dual disorders treatment involves the following:
Knowledge about alcohol and drug use, as well as mental illnesses
Clinicians know the effects of alcohol and drugs and their interactions with mental illness.
Integrated services
Clinicians provide services for both mental illness and substance use at the same time.
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.
How does one get effective training and information?
Learning dual disorders treatment skills requires knowledge, training, supervision, and practice.
Order an Integrated Dual Disorders Treatment Implementation Resource Kit.
This provides you information, training materials, annotated bibliography, and references to other training resources.
Explore implementation and training centers.
Since practitioners learn in different ways, implementation and training centers offer readings, workbooks, training videos, courses, job shadowing, supervision, and consultation.
Learn from consumers.
Many consumers will be in recovery from their substance abuse. Ask them what their recovery process was like, and what treatments were helpful. Read consumer writings about the dual disorder recovery process.
Attend AA, Al-Anon, or other self-help group meetings.
Many self-help meetings are open to nonmembers. You can learn about the process of recovery by attending these meetings.
Identify or hire an expert for your team.
One experienced team member can help others learn about integrated dual disorders treatment.
Visit an integrated dual disorders treatment team.
Arrange to visit and job shadow a program with a team that has experience providing integrated dual disorders treatment. Check the www.mentalhealthpractices.org website for a listing of available sites nationwide.
Co-lead a dual disorders group.
One way to learn skills while you are helping people work on their recovery process is to co-lead a group with an experienced dual disorders clinician.
Get supervision.
The proven way that clinicians acquire new skills is by working with people with dual disorders and discussing their work with an experienced supervisor. If you cannot get supervision in your agency, you may be able to obtain off-site supervision or consultation through a training center.
For more information
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.
The Integrated Dual Disorders Treatment Implementation Resource Kit contains an annotated bibliography in the User's Guide and copies of research articles.
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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