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state seal VASIP/COSIG Virginia Service Integration Program/Co-occurring State Infrastructure Grant

Treatment of Co-Occurring Disorders

One of the goals of the Virginia COSIG project (now VASIP, see above) is to promote state-of-the-art,“evidence-based” practices for the treatment of CODs. Evidence-based practices, or EBPs, are services or treatment regimens that have been shown through independent research to be effective at addressing a given problem. To date, a major challenge in the treatment of CODs has been adapting the traditional treatment models for mental illness and substance abuse to the special needs of persons with CODs.

Traditionally, substance abuse treatments have been intense and confrontational, while methods for the treatment of mental illness have been supportive and non-threatening. In order to address the challenges of treating co-occurring disorders, some EBPs for the treatment of CODs have been developed and implemented. Recent research indicates that practices such as motivational interviewing, cognitive-behavioral therapy, assertive community treatment and modified therapeutic communities – delivered in a setting that welcomes the consumer with a COD – have achieved positive outcomes with these individuals. More information on these and other EBPs for co-occurring disorders can be accessed by visiting the SAMHSA Evidence-Based Practices Web site.

The Virginia COSIG project supports the SAMHSA-approved New York Model of treatment for co-occurring disorders. The basic premise of this model is that consumers with CODs fall into one of four major categories, or quadrants, based on the severity of their mental illness and substance abuse. Individuals at various stages of recovery from mental illness and substance abuse may move back and forth between the four quadrants during the course of their treatment, so matching the consumer to the service level that is appropriate to the severity of his or her symptoms is essential for positive outcomes.

 View the four-quadrant model and the corresponding levels of care.

Service coordination in the New York Model occurs at three levels, depending upon the severity of the consumer’s symptoms. In Quadrant I, in which consumers have a low incidence of both substance use and mental health issues, consultation consists of informal relationships among providers that ensure both MH and SA problems are addressed. Prevention and early intervention are appropriate strategies for this quadrant; similar strategies can also be applied to other quadrants to prevent increases in mental illness or substance abuse severity. In Quadrants II and III, in which services are provided in either the substance abuse or mental health treatment system, collaboration describes more formal relationships among providers that ensure both MH and SA problems are addressed in the treatment regimen. 

For consumers in Quadrant IV -- those with the highest severity of both mental health and substance abuse problems -- the goal is integration of services, in which the contributions of professionals in both fields are merged into a single treatment setting and regimen. Some examples of service structures that support an integrated treatment model include a: 

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