Stage-Wise Treatment: A Key Component in an Evidence-based Approach to Treating Co-occurring Disorders
For people with mental and substance use disorders, access to effective treatment can be the difference between a stable recovery and a prolonged struggle. Unfortunately, many individuals with co-occurring disorders receive fragmented or incomplete treatment. Some people receive no treatment at all.
Effective treatments exist for people with co-occurring disorders. Integrated Treatment for Co-occurring Disorders is an evidence-based approach to care, which recognizes that individuals go through different stages on their way to recovery. Treatment tailored to this process is called stage-wise treatment, and it is a key component of integrated treatment programs.
Stage-wise treatment can help people achieve recovery
Stage-wise treatment guides individuals with co-occurring disorders through four stages of treatment:
Integrated treatment specialists—practitioners trained to treat both substance use disorders and mental illness—work closely with individuals as they move through the stages. After establishing a trusting relationship with an individual, the integrated treatment specialist assesses the individual's stage and collaborates with him or her to tailor practical and intensive treatments.
Treating co-occurring disorders in this stage-wise fashion can help people achieve recovery. However, change is not an easy process. Some individuals with co-occurring disorders move through treatment stages one-by-one, while others go back and forth between stages before achieving stable remission from substance use.
Stage-wise treatment is designed to accommodate these differences. Integrated treatment specialists are prepared to adjust treatment on a continual basis. This flexibility helps individuals achieve their goals, wherever they are in the process.
Practitioners and individuals work together through the stages of treatment
Stage-wise treatment provides individuals with services specific to each stage of treatment. In the opening stage, integrated treatment specialists strive to establish a trusting relationship with the individuals they treat. Practitioners call this relationship a working alliance. By the final stage, both parties are working well together to achieve treatment goals and maintain abstinence.
The process begins in the engagement stage, before individuals are ready for treatment. In fact, sometimes people with co-occurring disorders do not believe they have a problem. In response, integrated treatment specialists seek to engage individuals in the treatment process. In this stage, practitioners:
- Reach out and listen to people
- Work to understand how they see their situation
- Help them with immediate needs
- Assess their co-occurring disorder
These tasks can be challenging, as engagement often begins in the context of a crisis.
In the persuasion stage, the individual and the integrated treatment specialist form a trusting relationship and start working together. The practitioner interviews and helps the individual think about substance use, mental illness, and life goals. The practitioner also continues to assess the individual, sometimes meeting with family and friends.
The third stage is active treatment, when individuals see their substance use as a problem and start making positive changes, such as stopping use, making new friends, or joining a self-help group. The integrated treatment specialist offers support and help with important social skills.
Individuals are in the fourth stage, relapse prevention, when they have been abstinent for six months or more. Here the individual and the practitioner work together to create a relapse prevention plan. They also build on positive behaviors and relationships going forward.
Stage-wise treatment is not a failure if a person relapses—even a person who achieves a long period of sobriety. Relapses are a natural part of behavior change. Practitioners are trained to work with individuals and continue treatment if they relapse.
Evidence-based practices are at the core of stage-wise treatment
From the earliest moments of the treatment process through sustained periods of remission, integrated treatment specialists use numerous evidence-based tools and practices that can help make treatment a success. Treatment includes:
- Integrated screening and assessment techniques
- Treatment planning strategies
- Motivational interviewing
- Cognitive behavioral therapy
- Peer support
Stage-wise treatment helps people build meaningful lives
Most people with co-occurring disorders want to recover and pursue meaningful goals. For many individuals, stage-wise treatment provides a path to recovery—a process that can drastically improve the quality of their lives.
Resources and Links
Resources and tools on implementing integrated COD treatment.
This Treatment Improvement Protocol (TIP) for practitioners provides consensus-based, field-reviewed guidelines and information on terminology, assessment, and treatment strategies and models related to treating people with co-occurring disorders.
Presentation reviews the Transtheoretical Model and Stages of Change, with a focus on matching mental health and substance use interventions to the Stages