RESEARCH ON INTEGRATED TREATMENT

Studies of integrated treatment programs have been limited by small sample sizes, brief followup periods, measurement problems (e.g., failure

TABLE 1. Common ingredients of integrated mental health and

substance abuse treatment programs. Ingredient Function

The same professionals provide mental health and substance abuse treatment

Coordinating mental health and substance abuse treatments; avoiding sending "mixed messages" or failing to treat relevant problem areas

Case management

Attending to the range of clinical, housing, social, and other needs that may be affected by either substance abuse or mental health problems

Assertive outreach

Providing services directly in the community to engage patients, address pressing needs, followup and reengage relapsing patients

Group interventions

Providing peer support, persuading patients to address substance use behavior, promoting sharing of coping strategies for managing urges to use substances and for social situations

Education about substance abuse and mental illness

Informing patients about the nature of their psychiatric disorders and the effects of substance abuse to highlight negative effects of drugs and alcohol

Motivational techniques

Engaging patients in working towards substance use reduction and abstinence by identifying personally relevant goals that become a focus of treatment

TABLE 1. Common ingredients of integrated mental health and

substance abuse treatment programs (continued). Ingredient Function

Behavioral strategies

Using techniques such as social skills training, training in coping skills to manage symptoms and high risk situations, and relapse prevention to reduce substance use and vulnerability to relapses

Family/social network factors Working with members of patient's social networks to reduce factors that may maintain substance use behavior, help patients progress towards personal goals, and bolster resistance to relapses

Stage-wise treatment

Providing specific interventions based on the patient's specific stage of recovery: engagement, persuasion, active treatment, or relapse prevention

Long-term perspective

Recognizing that dual disorders are chronic conditions that require longterm, not time-limited, intervention

to employ standardized instruments to assess diagnosis or substance abuse), and lack of experimental design. While a comprehensive survey of the integrated treatment research is beyond the scope of this chapter (for a review, see Drake et al., in press), a brief synopsis of progress in this area can be provided. Early uncontrolled studies of integrated treatment showed decreased hospital use and substance abuse among clients who remained in treatment. Hellerstein and Meehan (1987) found that 10 men with