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Substance Abuse and Mental Health Services Administration - SAMHSA News - Volume X, No. 4 - Fall 2002

Report on Co-Occurring Disorders Recommends Integrated Treatment

U.S. Health and Human Services Secretary Tommy G. Thompson provided Congress with a comprehensive Report to Congress on the Treatment and Prevention of Co-Occurring Substance Abuse and Mental Disorders this fall. SAMHSA developed the congressionally mandated report for the Secretary.

The report emphasizes that people with co-occurring disorders can and do recover with appropriate treatment and support services. It also finds there are many longstanding systemic barriers to appropriate treatment and support services for people with co-occurring disorders, including separate administrative structures, different eligibility criteria and funding streams, and limited resources for both mental health services and substance abuse treatment.

The report identifies the need for various Federal agencies, state agencies, providers of services, researchers, recovering persons, families, and others to work together to create a system in which both disorders are addressed and treated simultaneously and with equal priority.

"This report tells us that individuals with co-occurring disorders should be the expectation, not the exception in the substance abuse treatment and mental health service systems," Secretary Thompson said. "The blueprint for action outlines how we will work in partnership with the states and local community providers to improve access to integrated services and treatments and find ways to pay for this care."

"I hope that this report will help more people understand the connection between drug use and mental illness," said John Walters, director of National Drug Control Policy. "Recovery from the disease of addiction is a lifelong challenge. Treating co-occurring disorders appropriately can significantly improve the chances of recovery."

"All too often individuals are treated only for one of the two disorders—if they receive treatment at all. If one of the co-occurring disorders goes untreated, both usually get worse and additional complications often arise, including the risk for other serious medical problems, suicide, unemployment, homelessness, incarceration, and separation from families and friends," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "People with co-occurring disorders cannot separate their addiction from their mental illness, so they should not have to negotiate separate service delivery systems."

According to the report, 7 to 10 million individuals in the United States have at least one mental disorder as well as an alcohol or drug use disorder. From studies and firsthand experiences in the substance abuse and mental health fields, many researchers and clinicians believe that both disorders must be addressed as primary and treated as such. The report discusses a number of evidence-based interventions and programs that demonstrate improved outcomes with integrated services and treatments.

The report shows there are an increasing number of states and communities throughout the country that are initiating system-level changes and developing innovative programs that overcome barriers to providing services for individuals of all ages who have co-occurring disorders. In fact, many make use of their funds from Substance Abuse Prevention and Treatment and Community Mental Health Service Block Grants. States and communities that are successful build consensus around the need for an integrated response to co-occurring disorders, develop aggregated financing mechanisms, cross-train their staffs, and measure their improvements in terms of client functioning and quality of life.

Mr. Curie noted, "Our goal is to create a system that allows any door to be the right door for the services an individual needs. It is the right thing to do. Any person entering mental health care, substance abuse treatment, or primary health care should be screened for mental illness and for substance abuse, and then provided appropriate treatment."

To help move the Nation to such a system, the report laid out a 5-year action plan that includes:

  • Creating a new SAMHSA-funded State Incentive Grant for Co-Occurring Disorders to help enhance state infrastructure and treatment systems
  • Establishing a national co-occurring disorders prevention and treatment technical assistance and cross-training center
  • Increasing Federal agency collaboration within the U.S. Department of Health and Human Services to enhance research attention to co-occurring disorders and the field's research needs
  • Increasing collaboration between SAMHSA and the Centers for Medicare & Medicaid Services in conjunction with the Agency for Healthcare Research and Quality to explore ways to use existing reimbursement mechanisms for services for people with co-occurring disorders
  • Convening a national summit on co-occurring disorders to share practices and lessons learned, and to discuss initiatives and cross-funding opportunities with Federal partners and key stakeholders
  • Continuing work to improve, refine, test, and apply consistent outcome measures for co-occurring disorders
  • Disseminating successful strategies for appropriate use of the Substance Abuse Prevention and Treatment and Community Mental Health Services Block Grants to serve individuals with co-occurring disorders.

To obtain a copy of the report, visit SAMHSA's Web site at, click on Hot Topics. End of Article

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