Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs

Abstract

Objective Improved understanding of the relative strengths and weaknesses of treatment organizations’ dual diagnosis capability is critical in order to guide efforts to improve services. This study assesses programs’ capacity to meet the needs of clients with dual diagnosis, identifies areas where they are well equipped to serve these clients, and determines where programmatic improvement is needed. The study also undertakes an initial exploration of the potential impact that funding sources have on dual diagnosis capability. Methods We administered Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments at 30 treatment programs in two California counties. Seven of the programs received funding to provide both mental health and substance use disorder services, 13 received funding to provide mental health services, and 10 received funding to provide substance use disorder services. Results The mean DDCAT/DDCMHT score of programs in the sample was 2.83, and just over 43% of the sample met or exceeded DDCAT/DDCMHT criteria for dual diagnosis capability. Programs scored highest and had the highest rates of dual diagnosis capability in domains related to assessment, training, and staffing, whereas scores were weakest and rates of dual diagnosis capability were lowest in the program structure, treatment, and continuity of care domains. Programs that received funding to provide both mental health and substance use disorder services consistently scored higher than the other programs in the sample, and mental health programs scored higher than substance use disorder treatment programs both on the overall assessments and in most domains. Conclusions Findings suggest that programs in the sample are functioning at a nearly dual diagnosis capable level. However, structural barriers continue to limit providers’ capacity to serve clients with co-occurring mental health and substance use disorders, and many organizations have not yet translated their potential to deliver dual diagnosis capable services into practice. By enhancing their program structure, treatment services, and continuity of care services, these treatment organizations should be able to deliver fully dual diagnosis capable services. Observed differences in dual diagnosis capability based on funding source indicate a need for further research to better understand the impact that funding streams have on dual diagnosis capability.

A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services

“…The co-occurrence of the abovementioned disorders increases the severity of symptoms and difficulty of treatment, with worse physical, psychological, and social outcomes 10. The clinical and rehabilitative needs of dual-diagnosis patients can be extremely different and polymorphic, depending on the level of their functioning, which is usually conditioned by pathological behavior and poor therapeutic compliance 11,12…”

Leadership and Licensure for Drug Treatment and the Implementation of Co-Occurring Disorder Treatment in Community Mental Health Centers

“…Previous studies have highlighted the importance of training and supervision (Drake et al, 2001), program structure and program milieu (McGovern et al, 2010; Padwa et al, 2013), assessment and treatment protocols (Drake et al, 2004; McGovern et al, 2010; Minkoff, 2001; Padwa et al, 2013), and continuity-of- care approaches (Drake et al, 2004; McGovern et al, 2010; Padwa et al, 2013) to mental health organizations’ capacity to serve clients with COD. This study indicates that in addition to these factors, directorial leadership and program licensure to deliver COD services may be key factors associated with mental health programs’ dual-diagnosis capability.…”

“…Yet the multiple treatment components (e.g., appropriate program structure, program milieu, clinical processes, continuity-of-care procedures, staffing, and training) needed to provide quality care to individuals with CODs are unavailable in many mental health treatment settings across the nation (Chandler, 2009; Gotham, Claus, Selig, & Homer, 2010; McGovern, Lambert-Harris, McHugo, Giard, & Mangrum, 2010; Padwa, Larkins, Crevecoeur-MacPhail, & Grella, 2013; Sacks et al, 2013). Only about 4% of individuals with CODs receive integrated evidence-based interventions designed to address both mental health and substance use conditions (Drake & Bond, 2010), and on the rare occasions that such services are delivered, it is usually with low fidelity (Chandler, 2009).…”

“…Studies have also underscored the importance of improvements in domains related to program structure, program milieu, assessment, treatment, and continuity of care (McGovern et al, 2010; Padwa et al, 2013) and delivering brief dual-disorder treatment via a continuing-care approach at the community level (Drake, Mueser, Brunette, & McHugo, 2004). Experts have also suggested that programs can improve their COD treatment capacity by restructuring treatment processes to give equal weight to both substance abuse and mental health issues (Drake et al, 2004; Grella & Stein, 2006).…”

Mujeres con patología dual: características clínicas y de tratamiento

“…La evidencia existente recomienda que la atención de la PD incluya esquemas de tratamiento farmacológi-co (Pettinati et al, 2010), sin embargo, existen barreras para que hombres y mujeres logren recibir atención adecuada, entre las que se pueden mencionar: la limitada oferta de servicios públicos con infraestructura suficiente (Padwa, Larkins, Crevecoeur-MacPhail, & Grella, 2013) y la ausencia de personal calificado para la atención de la PD (Padwa et al, 2013), aspectos que se complejizan en países de bajos y medianos ingresos (LMIC, por sus siglas en inglés) por carencias presupuestales en los programas públicos de salud (Marín-Navarrete & Medina Mora, 2015).…”