Report to Congress - Nov 2002

REPORT TO CONGRESS ON THE PREVENTION AND TREATMENT OF
CO-OCCURRING SUBSTANCE ABUSE DISORDERS AND MENTAL DISORDERS

Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

• Foreword

Executive Summary

• What is Known about People with Co-Occurring Disorders, about the Disorders Themselves, and about Treatment 
• The Impact of Federal Block Grants
• Prevention of Co-Occurring Disorders
• Evidence-Based Practices for Treating Individuals with Co-Occurring Disorders
• Executive Summary References

Chapter 1: Characteristics and Needs of the Population 

Understanding Co-Occurring Disorders

• Using the Term “Co-Occurring Disorders”
• Defining “Co-Occurring Disorders”
• How Many People Have Co-Occurring Disorders?
• How Do People Develop Co-Occurring Disorders?
• How Are People with Co-Occurring Disorders Receiving Treatment?
  • Many Individuals Receive No Care or Inadequate Care  ( see Table 1.1 )
  • Individuals Who Receive Care in the Mental Health or Substance Abuse System
  • Individuals Who Receive Care Outside of the Mental Health or Substance Abuse System

Barriers to Providing Treatment for Co-Occurring Disorders

• Funding Barriers
  • Medicaid
  • Coverage Gaps
  • Lack of Resources
• Program Barriers
• Clinical Barriers
• Consumer and Family Barriers

The NASMHPD/NASADAD Conceptual Framework ( see Figure 1.1  )

• A Common Language
• Innovative Programs and Funding Strategies

Summary

Chapter 2: The States Respond: The Impact of Federal Block Grants

Background

• Services for Individuals with Co-Occurring Disorders
• Differences between the SAPT and CMHS Block Grants

The Substance Abuse Prevention and Treatment Block Grant

• Technical Assistance Activities in Support of Co-Occurring Disorder

The Community Mental Health Services Block Grant

• CMHS Block Grant Support for People with Co-Occurring Disorders
• State Plans
• Technical Assistance, Data Collection, and Evaluation

State Program Activities

• Arizona
• California
• Connecticut
• Maryland
• Michigan
• Minnesota
• Missouri
• New Jersey
• New Mexico
• New York
• Oregon
• Pennsylvania
• Texas
• Wisconsin
• Wyoming

Children’s Services

Summary

Chapter 3: Prevention of Co-Occurring Disorders

Understanding Prevention

• Prevention Is Necessary
• Defining Prevention

Prevention Can Be Cost-Effective

• Classifying Prevention Strategies  ( see Figure 3.1 )
• Understanding Risk and Protective Factors
• The Concept of Resilience
• The Need for a Developmental Approach

Prevention for Children and Adolescents

• The Window of Opportunity
• Risk and Protective Factors
• Common Risk and Protective Factors for Problem Behaviors
• Prevention Programs for Children and Adolescents
• Programs that Work
  • High-Risk Youth Demonstration Program
  • Starting Early Starting Smart  

Prevention for Adults

• Risk and Protective Factors

• Prevention Opportunities for Adults

Prevention for Older Adults

• Co-Occurring Disorders in Older Adults
• Risk and Protective Factors
• Prevention Opportunities for Older Adults

SAMHSA’s Leadership in Prevention

• State Incentive Grant Program
• Prevention Program Outcomes Monitoring System
• Mentoring and Family Strengthening Program
• Safe Schools/Healthy Students
• School Action Grant Program

Summary

Chapter 4: Evidence-Based Practices for Co-Occurring Disorders

Understanding Evidence-Based Practices

• Definition of Evidence-Based Practice
• Evidence-Based Integrated Treatment is Multifaceted.

Program Structures and Settings 

• The National Registry of Effective Prevention Programs

• Organizing Services: The Four Quadrant Framework 

The Evolution of Treatment for Co-Occurring Disorders

• The ADAMHA Reports
• Community Support Program
• Integrated Treatment
• Studies of Comprehensive, Integrated Treatment Programs 

Interventions for Adults with Co-Occurring Disorders

• Screening/Assessment
• Staged Interventions
• Establishing Therapeutic Relationships
• Psychopharmacological Interventions
• Motivational Interventions
• Cognitive/Behavioral Approaches
• Modified Therapeutic Communities
• Assertive Community Treatment (ACT)
• Housing and Employment Services
• Consumer Involvement
• Dual Recovery/Self-Help Programs

• Effective Interventions
• Case Management
• Family Therapy
• Multisystemic Therapy
• Therapeutic Communities
• The Comprehensive Community Mental Health Services for Children and Their Families Program
• Circles of Care

Interventions for Older Adults with Co-Occurring Disorders 

• Effective Intervention

High-Risk Populations 

• People with Co-Occurring Disorders Who Have Other Concurrent Medical Conditions
• People with Co-Occurring Disorders Who Are Homeless
• Women with Co-Occurring Disorders
• Co-Occurring Disorders and Trauma
• People with Co-Occurring Disorders in the Criminal Justice System
• Youth with Co-Occurring Disorders in the Justice System  
• Individuals with Co-Occurring Disorders in Rural Areas
• Co-Occurring Disorders in Racial and Ethnic Minorities

System-Level Approaches 

• A Conceptual Framework for System Development and Financing ( see Table 4.1 )
• Identify Resources/Secure Financing
• Train Staff
• Measure Outcomes
• Systems Integration in Practice
• Special Programs and Demonstrations of Systems Change  
  • The Clinical Standards and Workforce Competencies Project
  • Comprehensive Continuous Integrated System of Care (CCISC)

SAMHSA’s Leadership in Evidence-Based Practices 

• The National Evidence-Based Practices Project
• NASMHPD/NASADAD Joint Task Force on Co-Occurring Disorders
• The National GAINS Center for People with Co-Occurring Disorders in the Justice System
• The Women, Co-Occurring Disorders, and Violence Study
• The Primary Care Research Study in Substance Abuse and Mental Health Services for the Elderly (PRISMe)
• The Targeted Capacity Expansion Program
• The Co-Occurring Disorders Study
• Community Action Grants for Service System Change
• Recovery Community Services Program
• Projects for Assistance in Transition from Homelessness (PATH)
• The Homeless Families Initiative
• Addiction Technology Transfer Centers (ATTCs) and Centers for Application of Prevention Technology (CAPTs)
• SAMHSA Education and Training Tools 

Summary

Chapter 5: Five-Year Blueprint for Action

Accountability

• Co-Occurring Performance Partnership Measures

Capacity 

• Use of Block Grant and Other Funds
• SAMHSA State Capacity Building Goals  
• Capacity Building Grants for Co-Occurring Disorders
• The Science-to-Services Agenda: Closing the Gap from Research to Practice
• Technical Assistance
• Workforce Development
• Prevention, Early Identification, and Early Intervention

Effectiveness 

• Key Partnership Activities 
• National Summit on Co-Occurring Disorders

Summary

References

Appendices

I.  Legislative Requirement for the Report to Congress on Co-occurring Disorders

II.  NASADAD Reports: SAPT Block Grant Expenditures in Support of Co-occurring Substance Abuse and Mental Health Treatment Services ( MS Word Document)

III. NASMHPD/NASADAD Task Force Report on Co-Occurring Mental Health and Substance Use Disorders: Exemplary Methods of Financing Integrated Service Programs for Persons with Co-Occurring Mental Health and Substance Use Disorders Report on Financing Integrated Services. (PDF File)

IV. Substance Abuse Treatment Programs Targeted to those with Co-Occurring Substance Abuse and Mental Health Disorders Receiving Funding from the State AOD Agency, and Numbers of Clients Admitted ( MS Word Document)

V. Overview of Mental Health Block Grant Data Collected on Mental Health and Substance Abuse Co-Occurrence ( MS Word Document)

VI. Federal Register Notice: Request for Comments Regarding the Prevention, Identification, and Treatment of Co-Occurring Disorders ( MS Word Document)

VII. Co-Occurring Subcommittee and Ad Hoc Representatives and SAMHSA Co-Occurring Writers, Facilitator and Workgroup ( MS Word Document)

Tables and Figures

Table 1.1: Rates of Treatment by Type (Mental Health, Substance Abuse Disorders) and by Severity Level of the Disorder (NCS-R) 

Figure 1.1: Co-Occurring Substance Abuse Disorder and Mental Disorder Conceptual Framework

Figure 3.1: The mental health intervention spectrum for mental disorders (Mrazek and Haggerty, 1994)

Table 4.1: Organizing and Financing a Comprehensive System of Care for People with Co-Occurring Disorders

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