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
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.
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:
- central assessment/intake unit with cross-trained staff and a single
assessment instrument that meets
all regulatory requirements;
- single point of assessment and services with agencies co-located in a single building; and/or
- multi-dimensional, holistic assessment and treatment process that
addresses each consumer’s needs
within the context of his/her individual biopsychosocial history.