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SAMHSA News - September/October 2004, Volume 12, Number 5

Conference Panel: Improving Outcomes

A farm scene was probably the last thing conference participants expected to see at a session on "Improving Outcomes Through Organizational and Policy Change."

But to Harold Alan Pincus, M.D., a professor and Executive Vice Chair of the Psychiatry Department at the University of Pittsburgh School of Medicine, the image's depiction of silos perfectly illustrated the lack of integration between mental health and substance abuse systems. "Silo-ization" is one of the biggest barriers to integrating services for co-occurring disorders, said Dr. Pincus, who is also a senior scientist at the RAND Corporation and Director of the RAND-University of Pittsburgh Health Institute.

Harold Alan Pincus,
Harold Alan Pincus, M.D., of the University of Pittsburgh School of Medicine and RAND, compared the lack of integration among the mental health, substance abuse, and other systems to separate silos on a farm.

Administrative obstacles include separate funding streams, different licensing and credentialing requirements, and an overall scarcity of resources that leads to increased competition. Clinical obstacles include the dearth of empirical data, confusion about appropriate roles, and the fact that one condition can exacerbate the symptoms of another and prevent successful engagement in treatment.

Important philosophical differences also exist between the two communities. Substance abuse treatment providers are often reluctant to allow psychotherapeutic medications for individuals with mental illness. On the other hand, mental health treatment providers often require individuals to be both alcohol- and drug-free as a condition for entry into treatment.

But there is hope, said Dr. Pincus, citing SAMHSA's Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders, the Agency's State Incentive Grants for Treatment of Persons with Co-Occurring Substance Related and Mental Disorders, and the creation of a Co-Occurring Center for Excellence (see 4 Million Have Co-Occurring Serious Mental Illness, Substance Abuse).

Audrey Burnam, Ph.D., of RAND then described how state mental health, substance abuse, and Medicaid authorities are tackling the problem of co-occurring disorders.

Summarizing the results of a 23-state study, she said that all made broad efforts to build consensus and cross-train workforces. Some states already had changed regulations or policies to facilitate integration, such as adapting reimbursement rules, modifying licensing requirements, and setting standards for provider competence.

Katherine E. Watkins, M.D., M.S.H.S., a natural scientist in the health program at RAND, summarized a literature review of evidence-based practices for those with substance use disorders and affective or anxiety disorders.

Surveying documents produced between 1990 and 2002, the researchers noticed two broad shifts in thinking. While earlier publications urged providers to treat substance abuse before tackling any mental health problems, current guidelines emphasize the importance of simultaneous treatment. In addition, guidelines now view psychiatric medications as an important part of treatment for those with co-occurring conditions.

Robert Drake, M.D., Ph.D., Vice Chair for research in the psychiatry department at Dartmouth Medical School, then reviewed the data for people with more severe mental illness and less severe substance abuse, a category of co-occurring conditions that has been more extensively studied than others.

There is plenty of evidence—29 controlled studies so far—to show that integrated treatment does work, according to Dr. Drake.

Although it's still not clear which specific interventions work best, researchers have identified several key components of integrated treatment:

  • Persons should receive individualized treatment from a clinician or team able to address both mental health and substance abuse disorders.

  • Treatment should proceed in stages. Providers should first engage individuals in treatment, provide therapy designed to motivate them to change, and only then provide active treatment.

  • Treatment providers should also address other problems individuals face, such as housing, jobs, and family issues. End of Article

« See Also—Previous Article

« See Part 1: Complexities of Co-Occurring Conditions Conference: Experts Identify Problems, Examine Solutions

« See Part 2: Complexities of Co-Occurring Conditions Conference: Experts Identify Problems, Examine Solutions

« See Part 3: Complexities of Co-Occurring Conditions Conference: Experts Identify Problems, Examine Solutions

See Also—Next Article »

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Inside This Issue

Peer-to-Peer Program Promotes Recovery
  •  
  • Part 1
  •  
  • Part 2
    Related Content:
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  • From the Administrator: The Promise of Recovery
  •  
  • Examples of Peer Support Services

    Iowa Has Lowest Drug Use Rate
    Related Content:
  •  
  • Chart—Past-Month Use

    Youth in the Justice System: Improving Services

    Strategic Action Plans Clarify SAMHSA Matrix

    Complexities of Co-Occurring Conditions Conference - Special Report

    Complexities of Co-Occurring Conditions Conference:
  •  
  • Part 1
  •  
  • Part 2
  •  
  • Part 3

  •  
  • Conference Panels:
  •  
  • 4 Million Have Co-Occurring Serious Mental Illness, Substance Abuse
  •  
  • Center for Excellence
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  • Resources

    SAMHSA Appoints New Members to National Advisory Council

    President Announces $100 Million Award for Substance Abuse Treatment

    Resource Promotes Employment Despite Homelessness, Mental Illness

    SAMHSA "Short Reports" on Statistics

    In Brief…
  •  
  • Building Bridges
  •  
  • Mental Health, United States, 2002
  •  
  • 2003 Survey Released

    SAMHSA News

    SAMHSA News - September/October 2004, Volume 12, Number 5




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