1. Co-occurring Disorder Treatment: Understanding the Value of an Integrative Approach
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David Vecchio
GRC MSW Program
Abstract
Despite an increased awareness of co-occurring disorders, most current treatment models still take a silo approach focusing on one problem or the other, leaving much unassessed, unaddressed, or ignored. Individuals with co-occurring mental illness and substance use disorders encounter a number of challenges that significantly diminish their quality of life. Treatment facilities are often ill-equipped for detecting co-occurring disorders and clinicians may not be sufficiently trained to treat both disorders concurrently. This review will examine the impact of co-occurring disorders for individuals diagnosed with substance abuse and mental illness and review the best-suited treatment outcomes for those individuals according to current evidence-based research. An analysis of the different integrated models and the effectiveness of these approaches will offer insight into how the field could be improved for individuals seeking treatment for their co-occurring disorders. The field of social work plays a vital role in assessing and treating individuals with co-occurring disorders due to the varying areas of field work that social workers represent. Understanding the nature of treatment for co-occurring disorders, and the need for a more uniformed approach in addressing substance abuse and mental illness within the co-occurring population will be the focal point of this paper Mueser & Gingerich (2013)
Integrative Perspective Data Findings
Several different evidence-based approaches have been researched that have demonstrated efficacy in achieving improved functioning and quality of life, as well as reduced use of substances and psychiatric symptoms through integrated treatment. The resulting literature review of 36 relevant studies that were both peer-reviewed and published between 2012 and 2018 with the exception of two articles that highlighted the historical concepts of integrated treatment and the effects of that change on current treatment modalities. This data provided an understanding as to the corresponding changes needed for integrative treatment to overcome the systemic barriers identified in the literature. Developing one theoretical framework that can be adjusted to meet the needs within a community and their particular needs depending on the particular needs of the community population is an important aspect when developing an integrated treatment approach SAMSHA (2017)
Substance use and psychiatric problems frequently co-occur, but until recently the treatment of these co-occurring disorders was hampered by poor detection and separate, noninteracting treatment systems. In contrast to traditional approaches, integrated treatment models involve the treatment of both psychiatric and substance use disorders at the same time, by the same clinician(s) who assume the responsibility for integration. Other common features of effective integrated treatment programs include comprehensive assessment and treatment, motivation-based treatment, harm-reduction philosophy, minimization of treatment-related stress, and pharmacological treatment. A growing body of research supports the effectiveness of integrated treatment models over traditional approaches to treating co-occurring disorders. Mueser & Noordsy (2015)
SAMSHA (2017)
Treatment Recommendations Theoretical Framework Barriers To Service
The Integrated Dual Diagnosis Treatment (IDDT) model offers the most adaptability in comparison to other treatment models
Anticipate the presence of co-occurring disorders.
Assure staff are trained to assess for the presence of both disorders and a multidisciplinary treatment team trained to treat both conditions provides services.
Consumer choice is paramount.
Shared decision making and individualized, collaborative treatment planning includes consumer, family, and provider input.
Stage based treatment.
Spirituality and self-help groups are utilized.
Treatment is time unlimited.
Psychopharmacologic (medication) treatments are not dependent on total abstinence.
Community Reinforcement Approach
Motivation-Based Treatment (Integration of multiple Interventions)
Examples of these barriers would include:
Historical differences in alliance with the medical model and differences in the educational and experiential requirements to work in the two fields;
Low tolerance that still exists in some substance abuse programs for any psychoactive medication;
Lack of acceptance of harm reduction approaches in some substance abuse services and which may be necessary for effective engagement of this population in the care and support system;
Use of confrontational techniques that are too stress inducing or otherwise inappropriate with people with some combinations of concurrent disorders (e.g. substance use and severe and persistent mental illness);
Different policy, planning, funding and governance streams force reduced opportunities for new treatment modalities.
Federal, state and local infrastructures are generally organized to respond to single disorders
The stigma involved in obtaining services for both mental illness and substance abuse
Milrod, 2(015)
SAMSHA, (2017)
References
Mueser & Gingerich (2013)
SAMSHA (2017)
Substance Abuse and Mental Health Services Administration (SAMSHA). (2017). Key substance use and mental health indicators in the United States: Results from the 2016 national survey on drug use and health (HHS Publication No. SMA , NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from
Milrod, B. (2015). The iom framework for developing evidence-based standards in the field of psychosocial intervention for mental illness and substance abuse: A dynamic researcher’s perspective. Cause for concern. Depression and Anxiety, 32(11), doi: /da.22427
Mueser, K., & Gingerich, S. (2013). Treatment of co-occurring psychotic and substance use disorders. Social Work in Public Health, 28(3/4), doi: /
Mueser, K., & Noordsy, D. (2015). Integrated treatment for dual disorders: a guide to effective practice. Retrieved from