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Illness Management and Recovery

Assertive Community Treatment

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Co-occuring Disorders: Integrated Dual Diagnosis Treatment

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Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Implementation Resource Kit User's Guide

Annotated Bibliography for Integrated Dual Disorders Treatment

Practice Manuals

Mueser, K. T., Noordsy, D. L., Drake, R. E., & Fox, L. (expected publication date: Spring, 2003). Integrated Treatment for Dual Disorders: Effective Intervention for Severe Mental Illness and Substance Abuse. New York: Guilford Publications.

Comprehensive clinical guide for the treatment of dual disorders from which some of the material in the implementation resource kit is drawn.
Information on assessment, including forms and instruments, is provided.
Ancillary treatment strategies described, such as residential and other housing approaches, involuntary intervention, vocational rehabilitation, and psychopharmacology.
Detailed guidelines and vignettes provided. Individual (including case management, motivational interviewing, and cognitive behavioral counseling), group (including persuasion, active treatment, social skills training, and self-help groups), and family (including individual family and multiple-family group) approaches are described.
Educational handouts covering different topics on mental illness, substance abuse, and their interactions are provided which can be duplicated for education with clients and family members.

Watkins, T. R., Lewellen, A., & Barrett, M. C. (2001). Dual Diagnosis: An Integrated Approach to Treatment. Thousand Oaks, CA: Sage Publications.

Discusses strategies for integrating substance abuse treatment with care for mental illness.
Separate chapters address different psychiatric disorders, including schizophrenia, bipolar disorder, depression, anxiety disorders, and severe personality disorders.

Ries, Richard and Consensus Panel (1994). Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse; Treatment Improvement Protocol (TIP) Series 9: DHHS Publication No. (SMA) 94-2078.

Provides practical information about the treatment of patients with dual disorders.
Separate chapters on treatment systems, linkages for mental health and substance abuse treatment, mood disorders, anxiety disorders, personality disorders, psychotic disorders and pharmacologic management.

Research and Conceptual Background
Reviews of the literature

Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589-608.

Comprehensive review of research on integrated treatment for dual disorders
Review covers a wide range of research, including early demonstration programs in establishing the feasibility of integrated treatment in community support service settings

Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., Lynde, D., Osher, F. C., Clark, R. E., & Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52, 469-476.

Update on research on integrated treatment of dual disorders

Mueser, K. T., & Kavanagh, D. (2001). Treating comorbidity of alcohol problems and psychiatric disorder. In N. Heather, T. J. Peters, & T. R. Stockwell (Eds.), Handbook of Alcohol Dependence and Related Problems (pp. 627-647). Chichester, England: John Wiley & Sons.

Provides an updated review of the epidemiology of dual disorders
Describes integrated treatment approaches for dual disorders, with specific recommendations for different types of psychiatric disorders, including schizophrenia, bipolar disorder, depression and anxiety disorders

Mueser, K., Drake, R., & Wallach, M. (1998). Dual diagnosis: A review of etiological theories. Addictive Behaviors, 23, 717-734.

Reviews the research literature on different theories accounting for the high rate of substance abuse in persons with severe mental illness
Challenges the prevailing hypothesis of high rates of substance abuse and severe mental illness could be explained by "self-medication" of distressful symptoms
Marshals evidence suggesting that some excess comorbidity is due to increased biological sensitivity to the effects of drugs and alcohol in persons with severe mental illness

Drake, R. E., & Brunette, M. F. (1998). Complications of severe mental illness related to alcohol and other drug use disorders. In M. Galanter (Ed.), Recent Developments in Alcoholism (Vol. XIV, Consequences of Alcoholism, pp. 285-299). New York: Plenum Publishing Company.

Summarizes research on the effects of alcohol and drug abuse on the course of severe mental illness

Selected research articles

Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S., Moring, J., O'Brien, R., Schofield, N., & McGovern, J. (2001). Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry, 158, 1706-1713.

Describes a randomized control trial of an integrated treatment for dual disorders, including motivational interviewing, cognitive behavioral counseling, and family intervention with services as usual.
Excellent outcomes were found for the integrated program, including substance abuse, relapse and rehospitalization.

Drake, R. E., McHugo, G. J., Clark, R. E., Teague, G. B., Xie, H., Miles, K., & Ackerson, T. H. (1998). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry, 68, 201-215.

Describes large randomized controlled trial comparing two different case management approaches for the delivery of integrated dual disorder services: assertive community treatment versus standard case management.
Following three years of treatment, positive outcomes were found for both approaches to integrated treatment, with assertive community treatment showing modest advantages over standard case management.

Principles of Integrated Treatment for Dual Disorders

Mueser, K. T., Drake, R. E., & Noordsy, D. L. (1998). Integrated mental health and substance abuse treatment for severe psychiatric disorders. Practical Psychiatry and Behavioral Health, 4, 129-139.

Summarizes the fundamental ingredients of effective integrated dual disorder programs, including comprehensiveness, assertive outreach, assertive and protective living environment, motivation based intervention, and long-term perspective.
Provides an explanation of the stages of treatment (engagement, persuasion, active treatment, relapse prevention), which serve to guide clinicians in selecting interventions appropriate for our clients level of motivation to address substance use problems.

Carey, K. B. (1996). Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach. Community Mental Health Journal, 32, 291-306.

Describes conceptual foundation to a treatment approach based on motivational enhancement and the reduction of harmful consequences of substance abuse.

Minkoff, K. (1989). An integrated treatment model for dual diagnosis of psychosis and addiction. Hospital and Community Psychiatry, 40, 1031-1036.

Describes essential ingredients for an integrated service system for the treatment of severe mental illness and substance use disorders.

Ziedonis, D., & Fisher, W. (1996). Motivation-based assessment and treatment of substance abuse in patients with schizophrenia. Directions in Psychiatry, 16, 1-7.

Provides overview of motivation-based approach to assessment and treatment of dual disorders.

Historical context for Integrated Treatment for Dual Disorders

Ridgely, M. S., Goldman, H. H., & Willenbring, M. (1990). Barriers to the care of persons with dual diagnoses: Organizational and financing issues. Schizophrenia Bulletin, 16, 123-132.

Ridgely, M. S., Osher, F. C., Goldman, H. H., & Talbott, J. A. (1987). Executive summary: Chronic mentally ill young adults with substance abuse problems: A review of research, treatment, and training issues. Baltimore: Mental Health Services Research Center, University of Maryland School of Medicine.

These two publications summarize problems with traditional approaches to dual disorders, including administrative, clinical, and philosophical barriers to accessing intervention for both disorders.

Polcin, D. L. (1992). Issues in the treatment of dual diagnosis clients who have chronic mental illness. Professional Psychology: Research and Practice, 23, 30-37.

Describes obstacles in traditional treatment approaches to effective intervention for dual disorders.

Kushner, M. G., & Mueser, K. T. (1993). Psychiatric co-morbidity with alcohol use disorders. Eighth Special Report to the U.S. Congress on Alcohol and Health (Vol. NIH Pub. No. 94-3699, pp. 37-59). Rockville, MD: U.S. Department of Health and Human Services.

Early comprehensive review of the epidemiology, correlates, and outcome of dual disorders.
Summarizes research on the negative effects of psychiatric comorbidity on the course and outcome of treatment for substance abuse.

Consumer and Family Perspectives
Ethnographic and first person reports

Alverson, H., Alverson, M., & Drake, R. E. (2000). An ethnographic study of the longitudinal course of substance abuse among people with severe mental illness. Community Mental Health Journal, 36, 557-569.

Alverson, H., Alverson, M., & Drake, R.E. Social patterns of substance use among people with dual diagnoses. Mental Health Services Research, 3(1), 3-14, 2001.

Fox, L. (1999). Missing out on motherhood. Psychiatric Services, 50, 193-194.

Green, V.L. The resurrection and the life. American Journal of Orthopsychiatry, 66(1), 12-16, 1996.

Family perspectives

Clark, R. E. (2001). Family support and substance use outcomes for persons with mental illness and substance use disorders. Schizophrenia Bulletin, 27, 93-101.

Describes family members financial and time contributions to helping a relative with dual disorders, and the relationship between family assistance and improved outcomes.

Schwab, B., Clark, R. E., & Drake, R. E. (1991). An ethnographic note on clients as parents. Psychosocial Rehabilitation Journal, 15(2), 95-99.

Describes challenges faced by clients with dual disorders who are parents.

Practice Issues

See description of book under Practice Manuals section.
This book has chapters covering the specific topics listed below.

Assessment and treatment planning

Carey, K. B., & Correia, C. J. (1998). Severe mental illness and addictions: Assessment considerations. Addictive Behaviors, 23, 735-748.

Discusses common issues faced by clinicians in assessing substance abuse in persons with severe mental illness, and provides solutions to those problems.

Connors, G. J., Donovan, D. M., & DiClemente, C. C. (2001). Substance Abuse Treatment and the Stages of Change. New York: Guilford Publications.

A helpful book on treatment planning based on clients' motivation to change their addictive behavior.

Donovan, D. D. and Alan Marlatt, G. A (Eds.) New York: Guilford Publications, (1988). Assessment of Addictive Behaviors.

The introductory chapter on assessment of addictive behaviors is outstanding.
This book also contains many chapters on specific drugs and approaches that are quite good.

Drake, R. E., Rosenberg, S. D., & Mueser, K. T. (1996). Assessing substance use disorder in persons with severe mental illness. In R. E. Drake & K. T. Mueser (Eds.), New Directions for Mental Health Services (Vol. 70, pp. 3-17). San Francisco: Jossey-Bass.

Describes many of the obstacles to accurate assessment of substance abuse in persons with dual disorders and strategies for overcoming these obstacles.

McHugo, G. J., Drake, R. E., Burton, H. L., & Ackerson, T. H. (1995). A scale for assessing the stage of substance abuse treatment in persons with severe mental illness. Journal of Nervous and Mental Disease, 183, 762-767.

Contains information regarding the assessment of stages of treatment for persons with dual disorders.

Mueser, K. T., Drake, R. E., Clark, R. E., McHugo, G. J., Mercer-McFadden, C., & Ackerson, T. (1995). Toolkit for Evaluating Substance Abuse in Persons with Severe Mental Illness. Cambridge, MA: Evaluation Center at HSRI.

Summarizes the Substance Abuse Treatment Scale for assessing clients' stage of treatment, and provides psychometric data on this scale.
Describes three clinician-administered scales for clients with dual disorders, including the Alcohol Use Scale, the Drug Use Scale, and the Substance Abuse Treatment Scale.
Includes software that contains the scales.
Information provided on training clinicians on the use of the scales, establishing and maintaining reliability, and validity.

Noordsy, D. L., McQuade, D. V., & Mueser, K. T. (2002). Assessment considerations. In H. L. Graham, A. Copello, M. J. Birchwood, & K. T. Mueser (Eds.), Substance Misuse in Psychosis: A Handbook of Approaches to Treatment and Service Delivery (pp. 159-180). Chichester, England: John Wiley & Sons.

Describes principles of assessment of substance abuse in persons with severe mental illness.
Explicates four steps of assessment: identification, classification, functional assessment and analysis, and treatment planning.
Specific methods for linking assessment to treatment are described.

Rosenberg, S. D., Drake, R. E., Wolford, G. L., Mueser, K. T., Oxman, T. E., Vidaver, R. M., Carrieri, K. L., & Luckoor, R. (1998). The Dartmouth Assessment of Lifestyle Instrument (DALI): A substance use disorder screen for people with severe mental illness. American Journal of Psychiatry, 155, 232-238.

Describes brief screening instrument (DALI) for identifying substance abuse in persons with severe mental illness.
Presents data showing that DALI outperforms other screening instruments in persons with dual disorders.

Engagement

Rapp, C. A. (1998). The Strengths Model: Case Management with People Suffering from Severe and Persistent Mental Illness. New York: Oxford University Press.

Excellent book that describes the engagement process in persons with severe mental illness.
Very helpful for anyone attempting to engage dual disorder clients in a treatment relationship.

Stages of treatment and motivational enhancement

Carey, K. B., Purnine, D. M., Maisto, S. A., Carey, M. P., & Barnes, K. L. (1999). Decisional balance regarding substance use among persons with schizophrenia. Community Mental Health Journal, 35, 289-299.

Describes use of decisional balance approach to helping persons with dual disorders weigh the advantages and disadvantages of continued substance abuse versus sobriety.

Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. (Second ed.). New York: Guilford Publications.

An outstanding book, a "classic" in the addiction field, about stages of change and recovery from substance abuse.
An excellent place to start; mandatory reading for all clinicians working with clients with dual disorders.

Osher, F. C., & Kofoed, L. L. (1989). Treatment of patients with psychiatric and psychoactive substance use disorders. Hospital and Community Psychiatry, 40, 1025-1030.

Introduces and describes the concept of stages of treatment (engagement, persuasion, active treatment, relapse prevention) that help clinicians gear treatment interventions to clients' individual motivational states.

Rollnick, S. and others. (1999). Health Behavior Change: A Guide for Practitioners. Churchill Livingston.

Another helpful reference on the stages of change and recovery from substance abuse.
Describes substance abuse counseling and relapse prevention counseling.

D'Zurilla, T. and Nezu, A. (1999), Problem Solving Therapy (Second Edition). New York: Springer.

To learn more about problem solving therapy, which can be applied to substance abuse and/or mental illness problems in clients with dual disorders.

Graham, H., Copello, A., Birchwood, M. J., Orford, J., McGovern, D., Maslin, J., & Georgiou, G. (2002). Cognitive-behavioral integrated approach for psychosis and problem substance use. In H. L. Graham, A. Copello, M. J. Birchwood, & K. T. Mueser (Eds.), Substance Misuse in Psychosis: A Handbook of Approaches to Treatment and Service Delivery (pp. 181-206). Chichester, England: John Wiley & Sons.

Describes cognitive-behavioral approach to treating substance abuse in persons with severe mental illness.
Includes numerous useful clinical examples.

Marlatt, G. A., & Gordan, G. R. (1985). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guilford Publications.

Describes principles of substance abuse relapse prevention.
Written originally for work with the substance abuse population.
Much of the book applies to persons with severe mental illness who have achieved sobriety and are motivated to prevent relapses of their substance abuse.

Monti, P. M., Abrams, D. B., Kadden, R. M., & Cooney, N. L. (1989). Treating Alcohol Dependence. New York: Guilford Publications.

An excellent book on cognitive-behavioral treatment of substance abuse.
Offers a simple introduction to basic techniques that are effective with dual disorder clients in the active treatment stage.

Group treatment for dual disorders

Bellack, A. S., & DiClemente, C. C. (1999). Treating substance abuse among patients with schizophrenia. Psychiatric Services, 50, 75-79.

Describes social skills training approach to dual disorders treatment.

Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (1997). Social Skills Training for Schizophrenia: A Step-By-Step Guide. New York: Guilford Publications.

Addresses how to conduct social skills training groups for persons with severe mental illness.
Specific curriculum provided (steps of skills) for helping clients refuse substances and deal with substance abuse situations.

Mueser, K. T., & Noordsy, D. L. (1996). Group treatment for dually diagnosed clients. In R. E. Drake & K. T. Mueser (Eds.), Dual Diagnosis of Major Mental Illness and Substance Abuse Disorder II: Recent Research and Clinical Implications. New Directions for Mental Health Services (Vol. 70, pp. 33-51). San Francisco: Jossey-Bass.

Describes four different types of group interventions for dual disorders, including educational, stage-wise (persuasion and active treatment), social skills training, and self-help groups.
Brief clinical vignettes used to illustrate different group treatment methods.

Noordsy, D. L., Schwab, B., Fox, L., & Drake, R. E. (1996). The role of self-help programs in the rehabilitation of persons with severe mental illness and substance use disorders. Community Mental Health Journal, pp. 71-81.

Summarizes difficulties and solutions associated with using self-help groups, such as Alcoholics Anonymous, for persons with dual disorders.

Roberts, L. J., Shaner, A., & Eckman, T. A. (1999). Overcoming Addictions: Skills Training for People with Schizophrenia. New York: W.W. Norton.

Manual for providing social skills training to clients with dual disorders.

Weiss, R. D., Greenfield, S. F., & O'Leary, G. (2002). Relapse prevention for patients with bipolar and substance use disorders. In H. L. Graham, A. Copello, M. J. Birchwood, & K. T. Mueser (Eds.), Substance Misuse in Psychosis: A Handbook of Approaches to Treatment and Service Delivery (pp. 207-226). Chichester, England: John Wiley & Sons.

Describes group intervention program for bipolar disorder and substance abuse.
Useful clinical examples provided illustrating group treatment methods.

Self-help

Alcoholics Anonymous (1990). The AA Group: Where It All Begins (rev.). New York: Alcoholics Anonymous.

Alcoholics Anonymous (AA) is the largest self-help organization for addiction.
This book describes its history, traditions, and approach to recovery from addiction, base on the "12-Steps" of AA.

Hamilton, T., & Sample, P. (1994). The Twelve Steps and Dual Recovery: A Framework of Recovery for Those of Us with Addiction and an Emotional or Psychiatric Illness. Center City, MN: Hazeldon.

Explains 12-Step approach to self-help substance abuse treatment in persons with a mental illness.

The Dual Disorder Recovery Book (1993) Hazelden, Center City, Minnesota, 1993.

Discussion of 12-step self-help approach to recovery for persons with dual disorders.

Trimpey, J. (1996). Rational Recovery: The New Cure for Substance Addiction. New York: Pocket Books.

Discussion of 12-step self-help approach to recovery for persons with dual disorders. Trimpey, J. (1996). Rational Recovery: The New Cure for Substance Addiction. New York: Pocket Books.
Rational Recovery (RR) is a self-help alternative to 12-Step approaches (such as Alcoholics Anonymous).
RR is less spirituality oriented, and more focused on helping clients take control over their lives through accepting personal responsibility to themselves and others.

Vaillant, G. E. (1995). Natural History of Alcoholism Revisited. Cambridge, MA: Harvard University Press.

Offers a brilliant analysis of natural pathways to recovery and explains how self-help and treatment can enhance the process.

Family treatment

Barrowclough, C. (2002). Family intervention for substance misuse in psychosis. In H. L. Graham, A. Copello, M. J. Birchwood, & K. T. Mueser (Eds.), Substance Misuse in Psychosis: A Handbook of Approaches to Treatment and Service Delivery (pp. 227-243). Chichester: John Wiley & Sons.

Describes family intervention approach for dual disorders.

McFarlane, W. R. (2002). Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York: Guilford Publications.

Provides detailed guidance on formation and running of multi-family groups for persons with severe mental illness and their families.
Similar groups have been run for persons with dual disorders and their families (see Mueser & Fox, 2002, next reading).

Mueser, K. T., & Fox, L. (2002). A family intervention program for dual disorders. Community Mental Health Journal, 38, 253-270.

Describes family intervention program for dual disorders that includes single-family sessions and multiple-family group sessions.
Presents pilot data from study of family program.

Mueser, K. T., & Gingerich, S. L. (in press). Coping with Schizophrenia: A Guide for Families (Second Edition). New York: Guilford Publications.

Among many helpful books on family interventions, we recommend this book that is written for families.
Includes a chapter on how family members can help a relative with a dual disorder.

Mueser, K. T., & Glynn, S. M. (1999). Behavioral Family Therapy for Psychiatric Disorders (Second Edition). Oakland, CA: New Harbinger Publications.

Treatment manual for clinicians that describes family intervention model for severe mental illness, including strategies for addressing substance abuse in clients with dual disorders.
Includes educational handouts on different psychiatric disorders, medications, and the interactions between mental illness and substance abuse.

Psychopharmacological treatment

Day, E., Georgiou, G., & Crome, I. (2002). Pharmacological management of substance misuse in psychosis. In H. L. Graham, A. Copello, M. J. Birchwood, & K. T. Mueser (Eds.), Substance Misuse in Psychosis: A Handbook of Approaches to Treatment and Service Delivery (pp. 259-280). Chichester, England: John Wiley & Sons.

Detailed chapter that describes pharmacological management of substance use disorders, including stimulants, opioids, other drugs and alcohol.

Drake, R. E., Xie, H., McHugo, G. J., & Green, A. I. (2000). The effects of clozapine on alcohol and drug use disorders among schizophrenic patients. Schizophrenia Bulletin, 26, 441-449.

Summarizes positive effects of clozapine on alcoholism outcomes in persons with schizophrenia.

Green, A. I., Zimmet, S. V., Strous, R. D., & Schildkraut, J. J. (1999). Clozapine for comorbid substance use disorder and schizophrenia: Do patients with schizophrenia have a reward-deficiency syndrome that can be ameliorated by clozapine? Harvard Review of Psychiatry, 6, 287-296.

Theoretical paper in which authors suggest that the neurobiology of schizophrenia makes persons with this disorder more susceptible to substance abuse, and more likely to benefit from clozapine.

Mueser, K. T., & Lewis, S. (2000). Treatment of substance misuse in schizophrenia. In P. Buckley & J. Waddington (Eds.), Schizophrenia and Mood Disorders: The New Drug Therapies in Clinical Practice (pp. 286-296). Oxford: Butterworth & Heinemann.

Brief chapter that includes recommendations for pharmacological treatment of clients with dual disorders.

Mueser, K. T., Noordsy, D. L., Fox, L., & Wolfe, R. (in press). Disulfiram treatment for alcoholism in severe mental illness. American Journal on the Addictions.

Quantitatively describes positive long-term outcomes of 30 persons with severe mental illness and alcoholism treated with disulfiram (Antabuse).

Infectious diseases

Bartlett, J. and others (1998). Guide to Living with HIV Infection. Baltimore: John Hopkins U. Press.

Coping with HIV and hepatitis.

Eversen G. and Weinberg, H. L (1999). Living with Hepatitis C. Hatherleigh.

Coping with HIV and hepatitis.

Razzano, L. (2002). Issues in comorbidity and HIV/AIDS. In H. L. Graham, A. Copello, M. J. Birchwood, & K. T. Mueser (Eds.), Substance Misuse in Psychosis: A Handbook of Approaches to Treatment and Service Delivery (pp. 332-346). Chichester, England: John Wiley & Sons.

Practical chapter on the nature of HIV/AIDS in persons with dual disorders and treatment approaches.

Implementation, Administration, and Cost
Implementation and administrative issues

Covers issues related to the implementation and dissemination of integrated programs for dual disorders.

Fox, T., Fox, L., & Drake, R. E. (1992). Developing a statewide service system for people with co-occurring severe mental illness and substance use disorders. Innovations and Research, 1(4), 9-13.

Describes the development of integrated dual disorder services in the state of New Hampshire.

Torrey WC, Drake RE, Cohen M, et al. "The Challenge of Implementing and Sustaining Integrated Dual Disorders Treatment Programs" Community Mental Health Journal (in press 2002).

State and local administrative perspectives

Fox, T., & Shumway, D. (1995). Human resource development. In A. F. Lehman & L. Dixon (Eds.), Double Jeopardy: Chronic Mental Illness and Substance Abuse (pp. 265-276). New York: Harwood Academic Publishers.

Describes how to cultivate clinicians and administrators in developing integrated programs for dual disorders.

Mercer-McFadden, C., Drake, R. E., Clark, R. E., Verven, N., Noordsy, D. L., & Fox, T. S. (1998). Substance Abuse Treatment for People with Severe Mental Disorders: A Program Manager's Guide. Concord, NH: New Hampshire-Dartmouth Psychiatric Research Center.

Useful guide for program managers and anyone else with administrative responsibility for establishing and maintaining high quality integrated programs for dual disorders.

Financing and cost-effectiveness of integrated dual disorders treatment

Clark, R. E., Teague, G. B., Ricketts, S. K., Bush, P. W., Xie, H., McGuire, T. G., Drake, R. E., McHugo, G. J., Keller, A. M., & Zubkoff, M. (1998). Cost-effectiveness of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Health Services Research, 33, 1285-1307.

Describes cost-effectiveness analysis of study comparing assertive community treatment (ACT) with standard case management for dual disorders.

Clark, R. E., Ricketts, S. K., & McHugo, G. J. (1999). Legal system involvement and costs for persons in treatment for severe mental illness and substance use disorders. Psychiatric Services, 50, 641-647.

Addresses cost of legal system involvement in persons with dual disorders.

Dickey, B., & Azeni, H. (1996). Persons with dual diagnoses of substance abuse and major mental illness: Their excess costs of psychiatric care. American Journal of Public Health, 86, 973-977.

Documents the high cost of standard (non-integrated) treatment approaches to substance abuse in persons with severe mental illness.

Fidelity measures for integrated dual disorders treatment

Jerrell, J. M., & Ridgely, M. S. (1999). Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs. Psychiatric Services, 50, 109-112.

Documents that better substance abuse outcomes in persons with dual disorders are associated with higher program fidelity to integrated treatment model.

McHugo, G. J., Drake, R. E., Teague, G. B., & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818-824.

Shows that clients in assertive community treatment (ACT) programs that implemented dual disorders treatment with high fidelity to the integrated treatment model had better substance abuse outcomes than low fidelity programs.

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