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Author List:
DeBenedetti AF (CHCE)
Moos RH (CHCE)
Timko C (CHCE)
Objectives:
Despite the development of evidence-based, integrated treatment for dual diagnosis (DD; psychiatric and substance use disordered) patients, little is known about whether systems of care are providing the service components recommended for this patient group. This study described and compared the extent to which VA psychiatric and substance abuse programs treating DD patients in the residential and outpatient modalities provided recommended service components.
Methods:
Surveys were completed by managers of VA residential (96 substance abuse, 220 psychiatric) and outpatient (143 substance abuse, 294 psychiatric) programs nationwide (95% response rate) that had a treatment regimen oriented to DD patients. Managers reported on the program’s organization, management, services, and policies.
Results:
Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., counseling targeted at psychiatric and at substance use problems, family counseling and education), but substance abuse programs were more likely to offer some of these services and other critical care components (e.g., cognitive-behavioral treatment orientation, management practice of assigning a single case manager to each patient, continuity of care). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring and feedback for providers) and services (e.g., 12-step meetings).
Implications:
In light of the overall shift from inpatient to outpatient care, and findings that the proportion of DD patients is as high in outpatient as in inpatient programs (about 45%), outpatient psychiatric programs in particular need to provide more of the key components of integrated programs. More generally, the psychiatric and substance abuse systems’ difficulties in providing evidence-based care involve developing treatment that is fully oriented toward the co-occurring diagnosis.
Impacts:
Each system provides critical DD treatment components in an area in which the other system does so to a lesser extent (e.g., psychiatric programs were more likely to provide medical care; substance abuse programs were more likely to offer addiction-related services). Planners in each system should obtain and use knowledge from their counterparts in the other about how to overcome obstacles and facilitate implementation of enhanced integrated treatment.
