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Integrated Treatment is Most Effective Approach

Research shows that an integrated approach to treating co-occurring disorders results in the best possible patient outcomes.

The integrated treatment model addresses the problem of access by ensuring that one visit, in one setting, is sufficient to receive treatment for both disorders. It addresses the problem of combining messages and philosophies by giving this responsibility clearly to the treatment provider instead of the client.

Key features

Integrated treatment is now considered an evidence-based practice because it has been shown through multiple randomized controlled trials to be more effective than other approaches. There are several key features of integrated treatment services:  

Shared Decision Making
Shared decision making is a systematic approach to client-centered care that involves the client explicitly in the treatment process. In this approach, clients with co-occurring disorders decide what goals they want to pursue, how they want to proceed with treatment, and what their path to dual recovery will be.

Integration of Services
When both mental health and substance use services are provided by the same person or team, the client has one treatment plan, one set of goals, and one relapse plan. The need for communication across agencies disappears.

People with co-occurring disorders typically have multiple needs. Having two illnesses can be demoralizing and can reduce a person's basic psychosocial supports. Co-occurring disorders programs, therefore, must have access to an array of services. These include, among others:

  • Housing
  • Case management
  • Supported employment
  • Family psychoeducation
  • Social skills training 
  •  Illness management
  • Pharmacological treatment

Assertive Community Outreach
Many people with co-occurring disorders do not come into mental health centers to seek treatment on their own. They might be on the streets, in homeless shelters, in police custody, or in jail or prison. Assertive community outreach that uses specific engagement strategies is necessary to connect them to the help they need.

Reduction of Negative Consequences
Before people are ready to completely stop using substances, they are often willing to take some smaller steps to reduce some of the harmful consequences of their use.

When people make progress on some of these [harm reduction] goals, they become more motivated to control their substance and mental health disorders. Some professionals argue that this approach enables an addicted person to continue to use and add that, because of this enabling, addicted persons will never experience the pain of their use and "hit bottom" so they can truly recover. For people with co-occurring disorders, however, not attending to the negative consequences of addiction often leads to death. Taking positive steps often increases motivation for recovery.

Long-term Perspective
People with co-occurring disorders recover at varying rates. Research shows that some begin to manage their illnesses in a matter of months. Unfortunately, many people enter recovery gradually, over many years. This long-term perspective means that we must be accepting of different paths. We must never give up. We must accept that recovery can be a life-long journey.

Motivation-based Treatment
To effectively address a client's co-occurring disorders, treatment must target the client's stage of motivation for recovery. The idea of stages of treatment means that there are different interventions for different stages. The stages of motivation-based treatment are engagement, persuasion, active treatment, and relapse prevention.

Multiple Psychotherapeutic Interventions
People with co-occurring disorders typically have multiple needs. Like everyone, they also have their own unique preferences and values. Needs, preferences, and values all influence their goals. Interventions, therefore, must be highly individualized and tailored to each client. Most clients engage in multiple interventions at the same time. For example, two young clients with schizophrenia and cocaine abuse could easily have different interventions. Person A might be bothered more by the interaction of schizophrenia and cocaine abuse and require residential dual diagnosis treatment plus attendance in Narcotics Anonymous. Person B might be bothered more by family problems and past trauma and need trauma intervention and family psychoeducation. Both might need supported employment.

Excerpted from Integrated Dual Disorders Treatment: Best Practices, Skills, and Resources for Client Care, by faculty of Dartmouth Psychiatric Research Center, Hazelden, 2010.

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