DUAL DISORDERS
Approximately
50 percent of the people in the State of Ohio who have been diagnosed with
a severe mental illness like schizophrenia or bipolar disorder have also
been diagnosed with a co-occurring substance use disorder. Persons with
dual disorders are more likely to experience higher rates of the following:
- psychiatric episode
- broken relationships (e.g., with family, friends, co-workers)
- relapse into alcohol and drug use
- hospitalization and emergency room visits
- suicide
- violence (as victims and witnesses)
- legal problems, including arrest, incarceration, and re-incarceration (i.e., recidivism)
- unemployment
- homelessness
- health problems, including chronic diseases like diabetes and infectious diseases like HIV and hepatitis
There are many unanswered questions about dual disorders.
For instance, researchers do not yet understand the causes of severe and
persistent mental illnesses nor do they completely understand the reasons
why the abuse of alcohol and other drugs is so prevalent among this population.
Despite these challenges, researchers have learned a great deal about
how to organize and deliver the social services and medical services that
help predict, prevent, and reduce the impact of symptoms.
EVIDENCED-BASED PRACTICES
For the last 20 years, researchers in the fields
of social work, medicine, social science, sociology, and anthropology
have inquired about and experimented with the organization and delivery
of supportive services to persons with mental and substance use disorders
in an effort to find the best service solutions. The researchers have
identified some best practices that consistently produce improved outcomes
for consumers, service organizations, and service systems. These are called
evidence-based practices (EBPs). EBPs
- prevent the most amount of relapse,
- promote the highest level of independent living skills among persons with mental illness and addictions,
- increase continuity of care,
- generate the highest level of consumer
and caregiver satisfaction, and
- reduce the cost of care.
Researchers have identified several EBPs that accomplish
the goals listed above. One of the EBPs is the New Hampshire-Dartmouth
Integrated Dual Disorder Treatment (IDDT) model. Another is the Supported
Employment (SE) model. We will discuss IDDT in more detail below. EBPs
are unique because they offer specific strategies for organizing and delivering
services. Research shows that EBPs consistently produce improved outcomes
when service organizations and systems implement these strategies as they
were originally designed. This is called fidelity. The Ohio SAMI
CCOE was created to help service providers, organizations, and systems
achieve and maintain fidelity and positive outcomes.
COMMUNITY LIVING
Throughout much of the history of the United States, persons with severe mental illnesses were required by law to live in hospitals (or institutions) with little or no contact with people who lived and worked in surrounding communities, including their own families. This practice was questioned and debated for many years, and in the 1960s, laws finally began to change, beginning what has been called the era of "deinstitutionalization."
Persons with mental illnesses are now encouraged to live in the community in their own housing, or with family or friends. They are encouraged to enter the mainstream of life, to work a part-time or full-time job, and perform many day-to-day tasks, like cooking, cleaning, balancing a checkbook, taking medication as needed, and scheduling and keeping appointments with doctors and other service providers. Because the symptoms of mental illness often inhibit a person’s ability to perform these tasks, state governments have mandated that service organizations provide assistance to them. As a result, many different service providers—such as case managers, counselors, nurses, and psychiatrists--work with mental health consumers and their families in the community to help them manage symptoms and to live as independently as possible. Service providers help consumers and caregivers with a multitude of life-management skills, including but not limited to the following:
- understanding symptoms of mental
and substance use disorders
- recognizing the signs of relapse
- managing medication use and side
effects
- accessing adequate and appropriate
mental health and addictions services, as well as medical care
- finding safe and affordable housing
- acquiring employment
- maintaining communication with family and friends who are supportive
- maintaining communication with professional service providers
NON-INTEGRATED TREATMENT
Living in the community has presented many challenges
to people with severe mental illnesses, especially those with a co-occurring
substance use disorder. Finding continuity of care has been one of the
biggest challenges. This has occurred because of the way in which services
are organized.
Many state governments in the United States fund and administer services
for substance abuse and mental illness separately. In Ohio, some counties
do have a combined mental health and substance abuse services board to
set policies and oversee the administration of both sets of services;
however, some do not. As a result, a large number of consumers with co-occurring
disorders and their caregivers must make separate appointments at separate
agencies that typically do not coordinate services, treatment plans, medical
records, and insurance billing. Research has shown this approach to be
inefficient for addressing the multiple and complex needs of consumers
with dual disorders. Consumers and caregivers report that the process
is often redundant, time-consuming, and discouraging, causing them to
miss appointments and to lose hope.
INTEGRATED DUAL DISORDER TREATMENT (IDDT)
The New Hampshire-Dartmouth Integrated Dual
Disorder Treatment (IDDT) model is unique because it integrates substance
abuse services with mental health services. IDDT utilizes biopsychosocial
treatments (which combine psychopharmacological, psychological, educational,
and social interventions) to address the needs of consumers and their
caregivers. It also promotes family involvement, stable housing, and employment.
Research has shown that IDDT’s unique integrated approach reduces
relapse, duplication of services and costs, and improves continuity of
care. IDDT promotes ongoing recovery from mental and substance use disorders
through four stages of interaction with consumers and caregivers:
- Stage 1: Engagement
- Stage 2: Persuasion
- Stage 3: Active Treatment
- Stage 4: Relapse Prevention
For more information about IDDT and integrated services, consult these publications and the CCOE Library :
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