Dual Diagnosis Model
For more than two decades, researchers have recognized the importance of screening individuals who need addiction treatment for mental illness. The Substance Abuse and Mental Health Services Administration (SAMHSA), the World Health Organization (WHO) and other public health entities consider Dual Diagnosis treatment a best practice therapy (McGovern, Lambert-Harris, Gotham, Claus, & Xie, 2012). Despite wide recognition and promotion of Dual Diagnosis programs, very few treatment centers achieve the enhanced capability to treat patients with co-occurring disorders effectively.
(Note: The terms “substance use disorder” and “addiction” are used interchangeably throughout this document.)
Top-Tier Dual Diagnosis Treatment
In the United States, an independent assessment of addiction treatment programs found that only 18% of addiction treatment centers and 9% of mental health programs meet the standards of a “Dual Diagnosis Capable” program (McGovern, Lambert-Harris, Gotham, Claus, & Xie, 2012).
SAMHSA is working with states and organizations to improve the availability of Dual Diagnosis treatment. The goal is to provide the best possible treatment to the more than 8.9 million people with co-occurring conditions—only 7.4 percent receive treatment for both conditions and 55.8 percent receive no treatment at all (SAMHSA, 2010).
Furthermore, 68 percent of patients with a mental health disorder also suffer from one or more medical conditions. Medical conditions (including hypertension and diabetes) may lead to mental health disorders, such as depression; or a mental health disorder may lead to a medical condition (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005).
With adequate treatment for all co-occurring conditions, patients experience improved quality of life and the future financial burden on the medical system is eased.
Foundations Recovery Network’s Commitment to Dual Diagnosis Treatment
Foundations offers Dual Diagnosis treatment across all of its programs. In fact, the organization and its centers annually meet the criteria for “Dual Diagnosis Enhanced” (DDE) services, a standard only achieved by the top 5% of addiction treatment programs. [Eligibility for DDE services is determined annually by the Dual Diagnosis Capability in Addiction Treatment (DDCAT) index assessment.]
The DDCAT Index and Addiction Treatment Evaluation
The DDCAT index is designed to determine how effectively substance use treatment programs provide services for patients with co-occurring mental health disorders. Independent rating consultants visit facilities and use a series of interviews as well as a 35-item rating scale to determine how well a facility meets the pre-defined standards. The index is recognized as a reliable and valid tool for assessing outpatient, residential and hospital-based treatment programs (Gotham, Brown, Comaty, Joseph E., McGovern, & Claus, 2013).
Once an addiction treatment program is evaluated with the DDCAT index, it receives one of three rankings along a continuum: “Addiction or Mental Health Only Services,” “Dual Diagnosis Capable,” and “Dual Diagnosis Enhanced” (SAMHSA). Dual Diagnosis Capable facilities are qualified to treat less severe mental illnesses in conjunction with addiction, while Dual Diagnosis Enhanced facilities are qualified to treat a wide range of mental illnesses, including severe mental illness.
An important purpose of the DDCAT evaluation process is to encourage treatment programs to improve every aspect of their care.
Chart: Seven Dimensions Measured by DDCAT
The Canyon at Peace Park
Overall DDCAT Score, 2013: 4.76 out of 5
Michael’s House Treatment Center
Overall DDCAT Score, 2013: 4.76 out of 5
La Paloma Treatment Center
Overall DDCAT Score, 2013: 4.9 out of 5
Efficacy of Dual Diagnosis Treatment
Integrated treatment approaches, such as the model used by Foundations, are more likely to be effective and to produce positive long-term outcomes. While some treatment centers may treat a substance use disorder first and then move to treating a mental illness, studies show this method is not as beneficial: Treatment programs that offer an uncoordinated approach to mental illness and addiction, through different clinicians or at different points of care are also not as effective (Drake, O’Neal, & Wallach, 2008).
A study of the five variables researchers believe impact long-term sobriety also showed the advantage of Dual Diagnosis treatment. The five factors—social background, intake functioning, Dual Diagnosis treatment orientation, patients’ change on proximal outcomes and aftercare participation—were measured for a total population of 981 male Dual Diagnosis patients. The study found treatment programs that carefully followed the principles of Dual Diagnosis treatment produced better outcomes, especially for patients with milder mental health disorders (Moggi, Ouimette, Finney, & Moos, 1999).
The study showed the following results for patients in Dual Diagnosis treatment:
- Higher abstinence rate at follow-up (39% vs. 2% at intake)
- Freedom from mental illness symptoms (60% to 68%)
- Higher employment (20% to 29%)
Patients in strong Dual Diagnosis treatment programs produced the following results at follow-up:
- Higher freedom from mental illness symptoms (71%)
- Even higher employment (35%)
Efficacy of Dual Diagnosis Treatment
A crucial part of the Dual Diagnosis model is the patient. The best care is possible when patients direct their care and are offered choices about treatment services and caregivers. SAMHSA outlines the following strategies that show effective methods of involving patients in the addiction treatment process:
- Self-directed care that allows informed consumers to assess needs, determine how and by whom needs
should be met, and monitor the quality of the services
- Consumer-operated services that generally emphasize self-help
- Peer support services delivered by consumers that may or may not be consumer-operated
- Mutual support groups, such as12-Step programs
- Consumer advocacy, involvement in policy and planning activities at all levels
Patient-directed care is an important part of Foundations’ treatment philosophy. In a 2007 letter offering explanation about Foundations’ DDCAT rating, Mark P. McGovern, Ph.D., of Dartmouth Psychiatric Research Center, a developer of the Dual Diagnosis Capability Assessment Toolkit, noted that Foundations’ patients had significant input in every step of the treatment process. He wrote, “Patients learn their diagnosis, they learn what they need to do to treat their illnesses, and they talk about it with a measure of acceptance and openness atypical of addiction treatment settings.”
The Difference that FRN Makes
FRN’s commitment to providing quality treatment is unique for many reasons, including the following:
- FRN’s integrated treatment model has national recognition for meeting best practice standards in TIP 42, a leading SAMHSA publication for treating persons with co-occurring disorders.
- FRN’s participation in 11 federally funded research grants focusing on Dual Diagnosis and addiction.
- FRN’s alumni programs and mutual support groups encourage discussion and offer hope for both addiction and mental health disorders.
- The Heroes in Recovery movement begun by FRN emphasizes breaking down barriers to treatment in the following ways: encouraging those in recovery to share their stories, celebrating the cause of recovery by hosting events such as races and athletic competitions that invite community involvement, and promoting awareness of addiction and mental health conditions to remove the social stigma surrounding them that often discourages people with those issues from seeking the treatment they need.
- FRN’s fully staffed “arm’s-length” research department is committed to developing and communicating reliable, valid and timely information necessary to providing the best treatment available.
- FRN uses independent third party verification of research findings.
Careful tracking of the follow-up data show that Foundations is exceeding industry abstinence rates. Third party validation and independent analyses of research data conducted by Stephen Schoenthaler, professor at the University of California at Stanislaus, has shown that FRN patients’ abstinence rates at one-year were significantly higher than average.
Figure 1: Change in Use Patterns One Year After Treatment at Foundations Recovery Network
Source: 2012 report, Stephen Schoenthaler, Professor, University of California at Stanislaus
According to Dr. Schoenthaler and analysis of the scientific literature:
- Abstinence from illegal drug use 12 months after discharge from treatment at Foundations occurred in over 80% of research respondents. Two thirds of respondents were abstinent from alcohol as well.
- No program (reviewed in the literature) produced two-thirds abstinence at 12 months regardless of the type of drug misuse or the type or combination of interventions utilized.
Although not all Foundations’ former patients were available for follow-up at one year, further analysis revealed that there were very few differences between those who answered the survey at one year and those who answered only at earlier time points, thus supporting the reliability of the reported data.
The figure shows that patients who reported alcohol use to the point of intoxication before admission were intoxicated, on average, 16 of the 30 days before admission, but only two out of 30 days one year after discharge. This represents an 88% decrease in the use of alcohol to intoxication.
The results of all illegal drug use show similar rates of reduction. Patients showed a 90% decrease in misuse and an 83% abstinence rate one year after discharge. In addition, the high rates of abstinence are consistent for every type of illegal drug assessed.
Dual Diagnosis treatment produces better outcomes and improved quality of life for Foundations’ patients. Foundations ranks among the top 5% and has been featured as a “Best Practices” organization in treating co-occurring disorders. Outcomes at Foundations are determined using valid, scientific processes and are further checked by independent, third-party validation. One year abstinence rates of former patients at Foundations far exceed those reported in the literature.
If you would like to speak with an admissions coordinator today or if you would like to learn more about our research methods and programs, please call us directly at 615-490-9376.
Drake, R., O’Neal, E., & Wallach, M. (2008). A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. Journal of Substance Abuse Treatment, 34 (1), 123-138.
Gotham, H. J., Brown, J., Comaty, Joseph E., McGovern, M., & Claus, R. (2013). Assessing the co-occurring capability of mental health treatment programs: The dual diagnosis capability in mental health treatment (CCDMHT) index. Journal of Behavioral Services & Research, 40 (2), 234-241.
Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-4 disorders in the national comorbodity survey replication (NCS-R). Archives of General Psychiatry, 62 (6), 593-602.
Kessler, R., Chiu, W., Demler, O., Merikangas, K., & Walters, E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-4 disorders in the national comorbidity survey replication (NCS-R). Archives of General Psychiatry, 62 (6), 617-627.
McGovern, M. P., Lambert-Harris, C., Gotham, H., Claus, R., & Xie, H. (2012). Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems. Administration and Policy in Mental Health and Mental Health Services Research. Published online.
Moggi, F., Ouimette, P., Finney, J., & Moos, R. (1999). Effectiveness of treatment for substance abuse and dependence for dua diagnosis patients: A model of treatment factors associated with one-year outcomes. Journal of Studies on Alcohol and Drugs, 60 (6), 856-866.
Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Mental health findings. Office of Applied Studies, NSDUH Series H-39, No. SMA 10-4609. Retrieved August 11, 2011, from http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf
SAMHSA. (n.d.). Dual Diagnosis Capability in Addiction and Mental Health Treatment Measures. Retrieved June 27, 2013, from Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov/co-occurring/news-and-features/ddcat.aspx
SAMHSA. (2011). Dual Diagnosis Capability in Addiction Treatment Toolkit Version 4.0. Rockville, MD: Substance Abuse and Mental Health Services Administration.