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I A. Primary focus of agency as stated in the mission statement. (If program has mission, consider program mission)

Element Details


Programs that offer treatment for individuals with co-occurring disorders should have this philosophy reflected in their mission statements.


Observation of milieu and physical settings, review of documentation of patient handouts, videos, brochures, posters and materials for clients and families that are available and/or used in groups.

Item Response Coding

Coding this item depends on examination of the clinic environment and waiting areas. Specifically, the different types and displays of educational materials and public notices are under consideration.

Coding of this item requires an understanding and review of the program’s mission statement, specifically as it reflects a co-occurring disorders orientation.

  • Addiction Only Services = (SCORE-1): Addiction only. The program has a mission statement that outlines its mission to be the treatment of a primary target population who are defined as individuals with substance use disorders only.

  • Dual Diagnosis Capable = (SCORE-3): Primary focus is addiction, co-occurring disorders are treated. The program has a mission statement that identifies a primary target population as being individuals with substance use disorders, but the statement also indicates an expectation and willingness to admit individuals with a co-occurring mental health disorder and to address that disorder, at least within the context of addiction treatment. The term “co-occurring disorders” does not need to be used specifically in the mission statement.

  • An example of a mission statement that meets the DDC level would be one similar to the following. Note that a specific population is identified, but it also incorporates a willingness to treat the person comprehensively and provide the necessary arrays of services.

    “The mission of the Addiction Board is to improve the quality of life for adults and adolescent with addictive disorders. This is accomplished by ensuring access to an integrated network of effective and culturally competent behavioral health services that are matched to persons’ needs and preferences; thus promoting consumer rights, responsibilities, rehabilitation, and recovery.”

  • Dual Diagnosis Enhanced = (SCORE-5): Primary focus on persons with co-occurring disorders.The program has a mission statement that identifies the program as being one that is designed to treat individuals with co-occurring disorders. The statement notes that the program has the combined capacity to treat both mental health and substance use disorders equally.

    “The Behavioral Health Unit is a private, non-profit organization dedicated to providing services that support the recovery of families and individuals who experience co-occurring mental health and substance use disorders.”

Enhancing AOS Programs

Programs scoring a 1 for this item likely have a more traditional mission statement, such as: “The North Side Alcohol and Drug Treatment Center is dedicated to assisting persons with alcohol and drug problems regain control over their lives.”

Revising a mission statement is emblematic of a “sea change” in leadership philosophy and commitment even though the new mission statement may not directly or immediately affect the clinical practices at a program. Consider this subtle shift in the last phrase of the mission statement: “The North Side Alcohol and Drug Treatment Center is dedicated to assisting persons initiate a process of recovery from substance use and its associated problems.”

A DDC mission statement is characterized by a clear willingness to treat individuals with COD. Often this is communicated in overarching terminology, such as “behavioral health” or “recovery.” Here is an example: “The City Clinic is committed to offering a full range of behavioral health services to promote well-being and lifelong recovery.”

Enhancing DDC Programs

Programs at the AOS level often face legitimate certification or licensure restrictions. This restriction encumbers a program to provide treatment solely to persons who meet criteria for a substance use disorder. Even though many patients will have an active co-occurring mental health disorder, the program must declare the substance use disorder as primary if not singular.

Several practical strategies are possible to elevate a program to the DDC level. Some programs cite long-standing agency traditions to assert their inability to treat persons with co-occurring disorders. Regional, state, and funder policies must be verified so that restrictions, if they do exist, can be clearly determined. Some state authorities have made special allocations for persons with co-occurring disorders (i.e., substance use disorders with complications). Other programs have sought joint mental health licensure or hired licensed staff to bill for unbundled services. Finally, it is common and realistic for a program to provide services that generically target mental health problems within the context and scope of addiction treatment licensure.