The Benefits of Intergrated Care for AOD and Co-Occurring Disorders

DisordersThe greater part of persons with alcohol and other drug use (AOD) disorders are also affected by a co-occurring mental health or medical problem which can complicate the treatment of either, leading to an increased percentage of relapse.[1] Formerly, patients with AOD disorders and co-occurring disorders (CODs) have been treated separately for each; however, more frequently, patients with AOD disorders and CODs have been treated for only one disorder, a proven ineffective approach.[2]

To begin, persons with co-occurring disorders often do not fit perfectly into the treatments offered through the fields of mental health or AOD, as would patients who suffer from a singular disorder.[3] Therefore, persons with co-occurring disorders must participate in two separate treatment systems, frequently under the care of multiple providers, leaving the responsibility of care-coordination up to the patient. Regularly, many patients discontinue at least one of their treatment schedules.3

More often, programs are recognizing the flaws with separate treatments for persons with co-occurring disorders and adding to their current treatment models to better include those persons.3 According to Sterling and colleagues, there are currently four treatment categories for patients with AOD disorders and CODs: serial treatment, simultaneous/parallel treatment, coordinated/parallel treatment, and integrated care.3 With serial treatment, care is provided in sequential episodes, in non-coordinated treatment systems; simultaneous/parallel treatment is provided for all disorders at the same time, but in non-coordinated treatment systems; coordinated/parallel treatment is provided for all disorders at the same time in closely-linked treatment systems; and integrated care is provided for all disorders by the same clinicians at the same treatment center. While research regarding the most effective model of treatment is limited, recent studies have found that integrated systems more often improve the success of the patient post-treatment.[4]

A 2006 study conducted by Grella and Stein found that patients with co-occurring AOD and mental disorders had improved AOD and psychological outcomes after six months when treated by a program that integrated care for their co-occurring disorders.[5] In 2008, Craig and colleagues conducted a study which examined patient outcomes after receiving integrated treatment that included motivational interviewing and relapse prevention techniques.[6] After 18 months, the patients resulted in better psychological outcomes than those who used serial or simultaneous treatment.6

However, a barrier to providing simultaneous and coordinated care to patients with co-occurring disorders is the movement of confidential patient information between treatment providers. With strict regulations rightfully protecting patient information, obtaining consent from a person with a severe co-occurring disorder to release the information to several providers may be difficult.3 Without full disclosure of information, treatment routes cannot be effectively determined. This may also affect integrated care if past records cannot be obtained.3 Therefore, the Institute of Medicine suggests that the movement of confidential information become smoother, perhaps through discussing the importance of information-sharing with the patient.8

A nationwide survey conducted by Mojtabai in 2004 found only half of AOD programs offered treatment for co-occurring AOD and mental health disorders, and less offered treatment for co-occurring AOD disorders and medical conditions.[7] According to Sterling and colleagues, integrating all treatment systems for the use of patients with co-occurring disorders is not feasible for most, due to the barriers of staff education and training.3 However, AOD disorder treatment programs are more likely to offer treatment for co-occurring AOD and mental health disorders than mental health programs.3 Sterling and colleagues also state that taking the approach of offering treatment for AOD and mental health disorders in primary care settings would be beneficial to those with co-occurring disorders, as a greater number of persons suffering from AOD and co-occurring disorders could be reached through a less “stigmatized” setting.3 Still, integrated care often allows the patients the greatest amount of treatment and a higher success rate of overcoming AOD disorders.[8] While the most effective level of integrated care is still unclear, Friedmann and colleagues report that the more formal the integrated care, the better the outcome for the patient.[9]



[1] Drake, RE.; Mueser, KT.; Clark, RE; and Wauach, MA The course, treatment, and outcome of substance disorder in persons with severe mental illness. American Journal of Orthoprychiatry 66:42-51, 1996. PMID: 8720640

[2] Rosenthal RN., and Westreich, L. Treatment of persons with dual diagnoses of substance use disorder and other psychological problems. In: McCrady, B. S. and Epstein, E. E. (Eds.) Addictions: A Comprehensive Guidebook, New York Oxford University Press, 1999, pp. 439-476.

[3] Sterling, S. M.P.H., M.S.W.; Chi, F., M.P.H.; and Hinman, A. (2011). Integrating Care for People With Co-Occurring Alcohol and Other Drug, Medical, and Mental Health Conditions. Alcohol Research & Health, 33(4), 338-348.

[4] Drake, RE.; O’Neal, E.L; and Wauach, M.A. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. Journal of Substance Abuse Treatment 34:123-138, 2008. PMID: 17574803

[5] Grella, C.E., and Stein, J.A. Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders. Psychiatric Services 57:1007-1015, 2006. PMID: 16816286

[6] Craig, T.K; Johnson, S.; McCrone, P.; et al. Integrated care for co-occurring disorders: Psychiatric symptoms, social functioning, and service costs at 18 months. Psychiatric Serinirs 59:276-282, 2008. PMID: 18308908

[7] Mojtabai, R. Which substance abuse treatment facilities offer dual diagnosis programs? American Journal of Drug and Alcohol Abuse 30:525-536, 2004. PMID: 15540491

[8] Institute of Medicine. Improving the Quality of Health Car efor Mental and Substance-Use Conditions: Quality Chasm Series, Washington, DC: National Academies Press, 2006.

[9] Friedmann, P.D.; D’Aunno, T.A.; Jin, L; and Alexander, J.A. Medical and psychosocial services in drug abuse treatment Do stronger linkages promote client utilization? Health Services Research 35:443-465, 2000a. PMID: 10857471

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