Integrated Dual Disorder Treatment
The Integrated Dual Disorder Treatment (IDDT) model is an evidence-based practice that improves quality of life for people with co-occurring severe mental illness and substance use disorders by combining substance abuse services with mental health services. It helps people address both disorders at the same time—in the same service organization by the same team of treatment providers.
IDDT emphasizes that individuals achieve big changes like sobriety, symptom management, and an increase in independent living through a series of small, overlapping, incremental changes that occur over time. Therefore, IDDT takes a stages-of-change approach to treatment, which is individualized to address the unique circumstances of each person’s life.
MAKING THE CASE
Integrated Dual Disorder Treatment (IDDT) is multidisciplinary and combines pharmacological (medication), psychological, educational, and social interventions to address the needs of clients and their family members. IDDT also promotes client and family involvement in service delivery, stable housing as a necessary condition for recovery, and employment as an expectation for many.
- Relapse of substance abuse and mental illness
- Duplication of services
- Service costs
- Utilization of high-cost services
- Continuity of care
- Consumer quality-of-life outcomes
- Stable housing
- Independent living
NEED FOR SYSTEMS CHANGE
Research shows that over 50 percent
of people in the
United States who have been diagnosed with a severe mental illness will
also have a diagnosable co-occurring substance use disorder (alcohol or
other drugs) during their lifetimes (see Regier in "Sources" below).
Historically, people with co-occurring disorders have been excluded from mental health treatment because of their substance use disorder. Likewise, they have been excluded from substance abuse treatment because of their severe mental health symptoms. As a result, they frequently have not gotten the help they need.
Negative Life Outcomes
Individuals with co-occurring disorders are more likely to experience the following:
- Psychiatric episodes
- Use, abuse, and relapse to alcohol and other drugs
- Hospitalization and emergency room visits
- Relationship difficulties
- Arrest and incarceration
- Infectious diseases, such as HIV, hepatitis, and sexually transmitted diseases
- Complications resulting from chronic illnesses such as diabetes and cancer
To address these negative outcomes, IDDT is often integrated with Assertive Community Treatment (ACT). Learn more about integrated IDDT-ACT (click here).
IDDT promotes recovery among people with co-occurring disorders by providing service organizations with specific strategies for delivering services. The implementation of integrated treatment facilitates service system change, organizational change, and clinical change. IDDT is built upon the following core treatment components:
- Multidisciplinary Team
- Stage-Wise Interventions (stages of change, stages of treatment)
- Access to Comprehensive Services (e.g., residential, employment, etc.)
- Time-Unlimited Services
- Assertive Outreach
- Motivational Interventions
- Substance Abuse Counseling
- Group Treatment
- Family Psychoeducation
- Participation in Alcohol & Drug Self-Help Groups
- Pharmacological Treatment
- Interventions to Promote Health
- Secondary Interventions for Treatment of Non- Responders
FIDELITY & OUTCOMES
are treatment characteristics (components) and organizational
characteristics of the IDDT model that are called fidelity domains.
These domains encourage service systems and organizations to develop
holistic integrated program structures and treatments. These domains
also provide a structure for a continuous quality-improvement process
that addresses multiple outcomes.
IDDT facilitates systems
change, organizational change, and clinical change when it is
implemented with fidelity. Research shows that organizations which
maintain fidelity to the original design of IDDT achieve and sustain the
best outcomes. IDDT has a fidelity scale that helps organizations implement and sustain the model (see "Related Resources" below).
STATE OF OHIO
The Center for Evidence-Based Practices at Case Western Reserve University provides technical-assistance services for IDDT and integrated IDDT-ACT (Assertive Community Treatment) to behavioral healthcare organizations in Ohio through our Centers of
Excellence, two of which are supported by the State of Ohio.
More information about the integration of IDDT and ACT (click here)
RESOURCES & TOOLS
Recommended IDDT resources produced by our Center:
Organizational Change & Systems Change
More IDDT resources in our database, including fidelity scales (click here).
RELATED RESOURCES & TOOLS
Resources from our Center to integrate with IDDT:
Resources from our Center to build dual-diagnosis capacity at organizations:
SOURCES & RECOMMENDED READING
1.) Robert E. Drake, Kim T. Mueser, Mary F. Brunette, Gregory J. McHugo
(2006). A Review of Treatments for People with Severe Mental Illnesses
and Co-Occurring Substance Use Disorders. Psychiatric Rehabilitation
Journal, v27, n4 Spring, p360-374.
2.) Robert E. Drake E., Susan M.
Essock, Andrew Shaner, Kate B. Carey, Kenneth Minkoff, Lenore Kola,
David Lynde, Fred C. Osher, Robin E. Clark, and Lawrence Rickards
(2001). Implementing Dual Diagnosis Services for Clients with Severe
Mental Illness. Psychiatric Services, v52, April, p469-476.
A. Regier, M. E. Farmer, D. S. Rae, B. Z. Locke, S. J. Keith, L. L.
Judd, and F. K. Goodwin (1990). Comorbidity of Mental Disorders with
Alcohol and other Drug Abuse. Results from the Epidemiologic Catchment
Area (ECA) Study. Journal of the American Medical Association, v264, n19
RESEARCH & DEVELOPMENT
Integrated Dual Disorder Treatment (IDDT), the evidence-based practice, was developed and continues to be studied by researchers at the Dartmouth Psychiatric Research Center of Dartmouth Medical School in Lebanon, New Hampshire. The researchers include Robert E. Drake, MD, PhD; Kim T. Mueser, PhD; and their colleagues.
The Dartmouth PRC has provided leadership for national implementation of IDDT via the Substance Abuse and Mental Health Services Administration. The State of Ohio and the Center for Evidence-Based Practices at Case Western Reserve University—through its Ohio SAMI Coordinating Center of Excellence (CCOE)—participate in these national initiatives, making significant contributions to the advancement and enhancement of the IDDT model.
Track #6 from our 2008 conversation with IDDT pionoeer Bob Drake, MD, PhD: