When addiction and mental health disorders co-occur, the statistics can be troubling. Researchers estimate that about 65 percent of patients in addiction treatment settings also suffer from a psychiatric disorder. These disorders are non-severe and severe, with the severe representing more debilitating and chronic mental health problems.

Most experts agree that having a co-occurring disorder leaves the patient at risk for a sub-par treatment experience. Examples of negative outcomes that researchers have identified for these patients include dropping out of treatment early, frequent transfer of the patient between clinicians, and recidivism or relapse.

The Substance Abuse and Mental Health Services Administration (SAMHSA) advocates an integrated system of mental health and addiction services. The continuity and quality of such a system is in the best interest of everyone, from patients to providers to funders. Hazelden has long agreed with this finding, being a provider of integrated treatment services as well as a publisher of resources that integrate treatment of addiction and mental health.

In September, Hazelden will publish a groundbreaking, multiformatted, manualized educational program for addiction and mental health programs that treat co-occurring disorders. The Hazelden Co-occurring Disorders Program (CDP) is the first evidence-based program to offer a truly integrated approach to address the non-severe mental disorders that often co-occur with addiction. Non-severe mental health disorders include mood, anxiety, adjustment and personality disorders. Severe mental health disorders include schizophrenia, severe bipolar disorder, and schizoaffective and major depressive disorders.

The most well-known program for severe mental health and substance use disorders is the evidence-based IDDT, or Integrated Dual Disorders Treatment model, which, like CDP, was created by faculty from the Dartmouth Medical School.

Dartmouth experts author program
CDP was developed and authored by national leaders in the research and treatment of co-occurring disorders. The program authors are faculty members of Dartmouth's Psychiatric Research Center, Department of Psychiatry, Community and Family Medicine Department, and Dartmouth Medical School. They include: Mark McGovern, PhD; Robert E. Drake, MD, PhD; Matthew Merrens, PhD; Kim Mueser, PhD; and Mary Brunette, MD.

CDP integrates evidence-based principles from the IDDT as well as best practices in cognitive-behavioral, motivational enhancement, and Twelve Step facilitation therapies.

While the IDDT was designed to treat severe mental illness, it wasn't designed for addiction treatment settings for patients with non-severe psychiatric disorders. An addiction treatment context is what CDP provides.

Improving outcomes
"Every addiction agency, just like every mental health treatment agency, is interested in improving outcomes," explains coauthor Kim Mueser. "We know that people with co-occurring disorders tend to have worse outcomes than those with only one disorder. For addiction treatment providers, their incentive for learning how to treat co-occurring disorders is that this knowledge will make them more effective in their primary mission in treating addiction."

"No other comprehensive manualized program that integrates evidence-based practices exists for people with non-severe mental health and substance use disorders," explains Richard Solly, a senior acquisitions editor at Hazelden.

Most addiction treatment providers recognize that patients with non-severe co-occurring disorders are already under their care. Whether you work in an addiction or a mental health setting, CDP provides you with the information and tools to develop program policy, practice and resources in order to deliver the best care possible to all patients with co-occurring disorders.

The seven components
The seven components of the program are designed to be used by agency directors, administrators, supervisors and clinicians. Each of the five curricula includes clinicians' materials and a CD-ROM of reproducible handouts for patients. The program is designed for adult patients, as well as their family members, who are participating in residential or outpatient programs. The materials have been developed within the context of addiction treatment programs, but are equally useful when applied in a mental health or criminal justice program that offers or seeks to offer integrated treatment for co-occurring disorders.

Clinical Administrator's Guidebook (item 2982, $85). Offers key stakeholders in your agency the tools to assess the seven key areas of organizational effectiveness in order to deliver the best possible services to persons with co-occurring disorders.

Curriculum 1: Screening and Assessment (item 2976, $195). Helps you detect, identify and treat mental health disorders in the context of substance use disorders. CD-ROM includes assessment forms and screening measures.

Curriculum 2: Integrating Combined Therapies (item 2977, $295). Helps you focus on the patient's relationship with substances as well as the mental health disorder. Motivational enhancement, cognitive-behavioral, and Twelve Step facilitation therapies help you engage change, assist change, and sustain change in clients.

Curriculum 3: Cognitive-Behavioral Therapy (item 2978, $265). Research shows that CBT is useful for treating non-severe co-occurring psychiatric disorders in an addiction treatment setting. This curriculum helps you use CBT to address common psychiatric problems such as depression, anxiety, bipolar disorder, social phobia, and post-traumatic stress disorder.

Curriculum 4: Medication Management (item 2979, $165). The component provides vital, current information for medical directors and clinicians about the psychiatric symptoms of intoxication and withdrawal, ways to collaborate with the patient, ongoing monitoring of co-occurring symptoms, and more.

Curriculum 5: Family Program (item 2980, $495). Research shows that treatment is more effective when family members are involved. This curriculum includes a 15-week family educational program.

A 90-minute DVD, A Guide for Living with Co-occurring Disorders: Help and Hope for Clients and Their Families (item 2981). This DVD, considered the seventh component of the program, also offers a summary overview of the full program and features interviews with some of the CDP authors and patient testimonials.

For outcome fidelity and consistency of delivery, it is recommended that customers use the complete program (item 2999, $1,295). However, if you are already delivering integrated treatment of co-occurring disorders but need to fill in gaps or enhance areas, components can be purchased separately. Comprehensive training and ongoing support for the program will be provided by Hazelden and the faculty of the Dartmouth Medical School.

The Co-occurring Disorders Program will be available for ordering in September. For more information or to order, call 800-328-9000 or visit www.hazelden.org/cooccurring.

--by Susan Maricle, Hazelden

Published Summer 2008, The Voice