Review of integrated mental health and substance abuse treatment for patients with dual disorders

Patients with severe mental disorders such as schizophrenia and co-occurrin g substance use disorders traditionally received treatments for their two d isorders from two different sets of clinicians in parallel treatment system s. Dissatisfaction with this clinical tradition led to the development of i ntegrated treatment models in which the same clinicians or teams of clinici ans provide substance abuse treatment and mental health treatment in a coor dinated fashion. We reviewed 36 research studies on the effectiveness of in tegrated treatment for dually diagnosed patients. Studies of adding dual-di sorders groups to traditional services, studies of intensive integrated tre atments in controlled settings, and studies of demonstration projects have thus far yielded disappointing results. On the other hand, 10 recent studie s of comprehensive, integrated outpatient treatment programs provide encour aging evidence of the programs' potential to engage dually diagnosed patien ts in services and to help them reduce substance abuse and attain remission . Outcomes related to hospital use, psychiatric symptoms, and other domains are less consistent. Several program features appear to be associated with effectiveness: assertive outreach, case management, and a longitudinal, st age-wise, motivational approach to substance abuse treatment. Given the mag nitude and severity of the problem of dual disorders, more controlled resea rch on integrated treatment is needed.