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SAMHSA News - September/October 2007, Volume 15, Number 5

Co-Occurring Disorders: Integrating Services

For a person with co-occurring mental health and substance use disorders, obtaining treatment services can be a challenge.

The process may involve navigating the often complicated shuffle between providers in separate service systems and needed referrals. Also, treatment providers may be saddled with overwhelming client loads, which sometimes compromise quality care.

To provide strategies to ease these burdens and show the benefits of combining services for mental and substance use disorders, SAMHSA’s Co-Occurring Center for Excellence (COCE) recently released Services Integration: Overview Paper 6. Presented in question-and-answer format, the overview paper examines issues concerning the context, content, approaches, and processes that promote and inhibit services integration.

What Is Services Integration?

Services integration is the process of combining mental health and substance abuse services—as well as other health and social services—to meet the needs of persons with co-occurring disorders.

Individual providers, teams of providers, or entire programs can combine their services to offer integrated substance abuse and mental health screening, assessment, treatment planning, treatment delivery, and continuing care.

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Benefits and Challenges

Mental health issues and substance use disorders often go hand in hand. For example, in 2006, adults age 18 or older with a major depressive episode (MDE) in the past year were more likely than those without an MDE to have used an illicit drug in the past year (27.7 percent versus 12.9 percent), according to SAMHSA’s 2006 National Survey on Drug Use and Health.

Providing integrated services is fundamental to providing quality care. Failure to address co-occurring disorders in either substance abuse or mental health programs is tantamount to ignoring the needs of the majority of participants.

Clients receiving integrated services in addiction counseling settings are more likely to complete treatment and have better post-treatment outcomes, according to research findings. Additional benefits to consumers include:

  • Better, integrated information rather than conflicting advice from several sources

  • Improved access to services through “one-stop shopping.”

Benefits to programs and care providers include:

  • Opportunities for agency and professional growth

  • Workforce development

  • Less frustration and increased job satisfaction.

Services integration presents very few drawbacks for the consumer. However, the use of integrated services—as with any organizational change—can introduce challenges for clinicians and programs, which may be required to:

  • Identify and respond to gaps in workforce competencies, certifications, and licensure.

  • Modify record-keeping practices to accommodate co-occurring disorders.

  • Modify facilities to meet additional needs (e.g., space for counseling).

  • Reconcile differences in confidentiality regulations, policies, and practices between the substance abuse and mental health treatment fields.

Ultimately, the treatment benefits for consumers receiving integrated services greatly outweigh the moderate organizational challenges for programs or care providers.

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COCE Overview Papers

This COCE series is intended to keep mental health and substance abuse administrators and policymakers up to date on the most current research and treatment practices. These papers offer concise introductions to state-of-the-art knowledge about co-occurring disorders and are anchored in current science, research, and practices.

Overview Paper 6 may be obtained free of charge by calling SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number SMA07-4294. Online, Overview Paper 6 is available at

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Overview Papers Available Online

The following COCE overview papers are available for free download on SAMHSA’s Web site at

Paper 1: Definitions and Terms Relating to Co-Occurring Disorders

Paper 2: Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders

Paper 3: Overarching Principles To Address the Needs of Persons With Co-Occurring Disorders

Paper 4: Addressing Co-Occurring Disorders in Non-Traditional Service Settings

Paper 5: Understanding Evidence-Based Practices for Co-Occurring Disorders

Paper 6: Services Integration

Paper 7: Systems Integration

Paper 8: The Epidemiology of Co-Occurring Disorders

For more information about other recent COCE overview papers, see SAMHSA News, July/August 2007.


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