Integrated Dual Disorder Treatment
The Integrated Dual Disorder Treatment (IDDT) model is an evidence-based practice that improves the 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 via 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.
IDDT is multidisciplinary and combines pharmacological (medication), psychological, educational, and social interventions to address the needs of consumers and their family members. IDDT also promotes consumer 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
Consumers experience incremental successes through stages of personal change & stages of treatment.
- Duplication of services
- Service costs
- Utilization of high-cost services
- Continuity of care
- Consumer quality-of-life outcomes
- Stable housing
- Independent living
MAKING THE CASE
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 (addiction to alcohol or other drugs) during their lifetimes.
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
IDDT promotes ongoing recovery from co-occurring disorders among consumers by providing service organizations with specific strategies for delivering services. The implementation of integrated treatment facilitates the following simultaneously: 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
There 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 SE achieve and sustain the best outcomes. IDDT has a fidelity scale that helps organizations implement and sustain the model (see "Related Resources" below).
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:
• 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.
• 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.
• D. 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 November, p2511-2518.
• IDDT Overview (Booklet)
• Implementing IDDT: A Step-By-Step Guide to Stages of Organizational Change (Booklet)
• IDDT Fidelity Scale
• More Resources & Tools
• Data analysis of Integrated Dual Disorder Treatment reveals cost savings for State of Ohio
• IDDT pioneer Bob Drake reflects upon the ongoing evolution of integrated treatment and the importance of supported employment