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Introduction to New Edition of Integrated Dual Disorders Treatment

Integrated Dual Disorders Treatment (IDDT) can assist addiction and mental health practitioners in their work with clients with severe mental illnesses and addiction in important ways. It aims to improve clinicians' skills, encourage clinicians in various tasks, and provide resources for the successful practice of those skills and tasks.

This expanded and updated edition of the original widely disseminated IDDT contains nearly a decade of new research since the first version appeared on the SAMHSA Web site in 2002. This edition brings the most comprehensive research and information available today to the mental health field. It teaches clinicians about substances of abuse and the basic skills needed to help people with a substance use disorder and a mental illness (dual disorders) recover from both disorders.

New version has major differences

This new version of IDDT differs significantly from the original version. It comes packaged in a three-ring binder with a CD-ROM, and it contains handouts and worksheets for clients and clinicians. The three-ring binder provides easy access to the handouts and worksheets, while the CD-ROM creates a more permanent record for photocopying. Other major differences between this updated version and the 2002 version include the following:

  • This version is written in everyday language as opposed to academic, journal language. It is our expectation that practitioners, supervisors, clinical leadership, and clients will find the curriculum to be approachable and much easier to use.
  • This version clearly sets out tasks and skills for administrators, senior organizational leaders, clinical leaders, and practitioners to facilitate the best possible implementation.
  • It deals with how to conduct group treatment, and the material in the chapter on group treatment has been updated based on recent research.
  • Supported housing is incorporated in this manual as a component of integrated treatment. Material in this chapter has also been updated based on recent research.
  • Issues regarding criminal justice and dual disorders are discussed in this manual.
  • Physical and medical health care issues are discussed in this manual, as well as trauma treatment and recovery.
  • The topics of training and consultation are also discussed and appear in a unique chapter, not found in other publications.
  • This manual includes many clinical vignettes that illustrate aspects of treatment and serve to motivate readers.

In this manual, the word recovery means that the client is learning to master both illnesses-substance use and mental health disorders-in order to pursue personally meaningful life goals. A primary purpose of Integrated Dual Disorders Treatment is to educate, train, and assist mental health clinicians to motivate and inspire their clients to strive for and attain recovery goals as listed in chapter 2, "Recovery-oriented Treatment."

Manual accommodates different learning styles

This manual also assumes that because co-occurring disorders are so common, all clinicians need to learn basic skills to foster recovery. We also assume that clinicians, like others, learn in different ways. Some read textbooks, some prefer training videotapes or online webinars, some rely on supervision, and some like practical manuals such as this one with worksheets and handouts.

The curriculum covers the basic information needed to treat persons with co-occurring disorders. Most mental health clinicians will need to acquire basic skills to address co-occurring substance use disorders. If mental health clients are not treated for their addictions at the same time they are receiving mental health treatment, they are not likely to sustain and stabilize themselves in recovery. This manual will help clinicians learn practical substance abuse treatment skills, as well as provide guidance in how clinicians can get additional training.

For this purpose, we assume that every clinician needs four basic skills:

1. Working knowledge of common substances of abuse and how they affect mental illnesses

2. Ability to assess substance abuse and dependence

3. Skills to provide motivational counseling for clients who are not ready to acknowledge substance abuse and pursue recovery

4. Skills to provide integrated substance abuse counseling for clients who are motivated to address their problems with substance use

Integrated treatment for people with dual disorders is more effective if the same clinician or clinical team helps the client with both substance abuse and mental illness. That way the client gets one consistent, integrated message about treatment and recovery. This manual will help you learn the skills to provide effective integrated dual disorders treatment.

How to use this curriculum

Use this curriculum in any way that fits your learning style!

  • Supervisors may want to use the manual and handouts to teach skills to clinicians or to review the basic skills for themselves and then teach them without using the book.
  • Organizational leaders wanting to provide integrated treatment will find direction and resources in this manual.
  • Some clinicians may want to read the entire manual at once, but most prefer to read one chapter at a time and discuss it with their treatment team members or colleagues.
  • Some will seek out the worksheets and handouts on the CD-ROM and in the three-ring binder for use with clients. Most of the handouts are for clients, but clinicians will find handouts, such as screening and assessment tools, for themselves.

Hard copies of all the handouts and worksheets mentioned in the curriculum can be found in the three-ring binder. PDFs of the handouts and worksheets are located on the CD-ROM. All documents in the three-ring binder and on the CD-ROM can be reproduced or copied without worry of copyright infringement. The handouts are organized by the chapter or appendix where they are first identified. Also in the three-ring binder and on the CD-ROM you will find tabs/folders for "Alcohol and Drug Fact Sheets" and "Psychiatric Disorders Fact Sheets." On the CD-ROM only you will find an additional folder for "Screening and Assessment Measures."

Case studies illustrate chapter topics

Nearly every chapter in the manual begins with a vignette, or case study, that illustrates the chapter's topic. These are offered to stimulate thinking about the many special issues and unique situations that arise in doing this work.
One way to use the manual is to read the vignette and discuss it before you read the chapter. Information in each chapter comes from experts in the field who have been providing integrated dual disorders treatment for years, so you can examine your own ideas in relation to theirs.

The preface to the manual by clinician and researcher Lindy Fox raises an important issue and challenge for today's mental health practitioners. Ms. Fox reminds the reader that, unlike the addiction profession, "mental health has traditionally not valued the experience of recovery in the workforce. Hence, mental health professionals tended not to disclose their personal histories of recovery." She encourages all clinicians to consider their personal experiences with mental illness or addiction as valuable to their work and their clients, as well as to their colleagues.

Chapter summaries

Chapters 1 and 2 provide a short introduction to integrated treatment and dual or co-occurring disorders.

Chapters 3 and 4 identify tasks for senior organizational leadership and the clinical leader in establishing an IDDT program.

Chapters 5 through 10 present tasks and skills for direct treatment, whether individually or in groups, as well as important issues for screening, assessment, and stagewise treatment.

Chapter 11 addresses the effects of substances of abuse and how they impact a person with mental illness.

Chapters 12 and 13 focus on new research in housing, supported employment, and education for people with severe mental illness.

Chapter 14 addresses one of the most critical factors in a client's recovery: the family. Readers will also find a curriculum and a wealth of resources for conducting family psychoeducation.

Chapters 15 through 20 address special issues, such as criminal justice, physical and medical health care, medications, elders with co-occurring disorders, and trauma treatment and recovery.

In the unique chapter 21, readers can learn more about specific training and consultation.

Finally, in the appendices, readers will find abundant information and resources, such as the IDDT Fidelity Scale and the General Organizational Index (GOI).

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