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Introduction

Addiction treatment providers are continually challenged to improve services. Often, these challenges occur in a fiscal growth environment that is not only flat, but in most instances, declining. Over the past 15 years, there has been an increased awareness of the common presentation of persons with co-occurring mental health disorders in routine addiction treatment settings. Research results suggest that sequential treatment (treating one disorder first, then the other) and purely parallel treatment (treatment for both disorders provided by separate clinicians or teams who do not coordinate services) are not as effective as integrated treatment (Drake, O’Neal, & Wallach, 2008). National and state initiatives related to co-occurring disorders have been significant, stimulating considerable interest in providing better services for people with these challenges. Although clearly interested in improving existing services, addiction treatment providers have lacked pragmatic guidance on how to change. In 2005, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) published Treatment Improvement Protocol 42 (or TIP 42) to respond to this need. However, providers continue to identify the need for specific benchmarks and related practical direction with which to plan and develop services.

In 2003 the Dual Diagnosis Capability in Addiction Treatment (DDCAT) index was created and field tested. Since 2004, we have been developing and implementing the index. The DDCAT, based on the American Society of Addiction Medicine’s (ASAM) taxonomy of program dual diagnosis capability, has been subjected to a series of psychometric studies. The map below reflects the widespread implementation in various stages of the DDCAT as well as two parallel instruments, the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) and Dual Diagnosis Capability in Health Care Settings (DDCHCS). The DDCAT, defined more fully below, guides both programs and system authorities in assessing and developing the dual diagnosis capacity of addiction treatment services (McGovern, Matzkin, & Giard, 2007).

States Using Dual Diagnosis Capability Assessment Measures, as of April 2011. The 32 States, District of Columbia, and Navajo Nation are shown in the map image using DDCAT/DDCMHT/DDCHCS in 2011 are: Alaska, Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Navajo Nation, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, and Washington.

This toolkit emerges from these efforts. It is a response to numerous requests by community treatment providers for more specific guidance on how to enhance services based upon their current status. For programs that the DDCAT determines to offer services at an Addiction Only Services (AOS) level, this toolkit provides specific suggestions and examples from the field on how to reach Dual Diagnosis Capable (DDC) level services. Likewise, programs already assessed at the DDC level have asked for specific guidance on how to attain the Dual Diagnosis Enhanced (DDE) level. This toolkit responds to that request as well.

The motivation among addiction treatment providers to improve the quality of care offered to their patients is impressive if not inspirational. This toolkit was developed in direct response to addiction treatment programs at the “action” stage of readiness. The toolkit is designed to immediately offer practical tools and useable materials that will rapidly improve services to those programs with co-occurring disorders entrusted to their care.