1. Integrated Dual Disorders Treatment (IDDT) Mountain Manor Treatment Center Baltimore

2. IDDT Model Co-located integrated team treatment for SUD and co- occurring psychiatric disorders Aggressive use of psychiatric medications despite active substance use, with careful consideration of SUD vulnerability Cross-trained COD therapists with additional focus on medication compliance Use of relapse prevention medications Continuous engagement despite continued use and/or relapse Matching treatment expectations and goals with stage of readiness to change.

3. IDDT – Staged intervention matching Stage of changeIDDT intervention approach Focus Pre- Contemplation EngagementRelationship, working alliance, practical support, outreach Contemplation and Preparation PersuasionMotivation enhancement, assessment and feedback, reduce substance use ActionActive treatmentManage symptoms of both disorders, skills acquisition, emphasis on goals and function MaintenanceRelapse preventionRefinement, wellness, persistence of stable remission

4. Menu of services Primary therapist/case manager Psychiatric evaluation and treatment Buprenorphine + daily supervision (BBI) if needed Supervised psychiatric medications including injectables Group substance abuse counseling (OP and IOP) COD groups Medications for alcohol and cocaine

5. Initial barriers Differences in approach from SUD IOP Patients belonging to multiple programs Scheduling Team communication Finding best fit staffing

6. Strengths and successes Improvements in medication adherence Enduring institutional affiliation with return after dropout Support through lapse and relapse with “bouncing back” common Buprenorphine as contingency for other strategies IDDT staff as champions for culture change

7. Remaining hurdles and next steps More stagewise differentiation More integration of internal leadership Expand target population Expand menu of services – Links to vocational, housing, PRP Family engagement