It is typical that anywhere from 40 – 60% of those with serious mental illness have a co-occurring substance use diagnosis. In Assertive Community Treatment (ACT), this may be much higher. Substance use often makes many other symptoms and experiences worse. Although there is a great interest to fast-track people toward abstinence for their own good, confrontational and directive services can result in treatment drop-outs, which in turn loses out on opportunities to help people in the long-run and for a broader range of needs.
In the context of providing a full range of services, inclusive of engagement and outreach, ACT should be providing integrated treatment for co-occurring disorders. To this end, an ACT team should have at least one full-time team member with more specific training, experience, and licensure/certification as a Co-Occurring Disorder (COD) specialist, with all team members having training in the fundamentals of providing integrated treatment for CODs. Ideally, the psychiatric care provider also has specialist training in addiction.
Stage-wise treatment is delivered where there is systematic assessment and attention to each individuals’ stages of change readiness as it relates to the substance(s). Thus, for example, an ACT team is working very differently with someone who is actively using and does not recognize or acknowledge that their use is a problem (pre-contemplation stage) compared with how the team works with someone who does see their use as a problem and is currently attempting changes, or attempting abstinence (action stage). In addition to being skillful in substance abuse counseling and relapse prevention planning, the COD Specialist, along with the team, is skillful in using motivational interviewing strategies, as well as harm reduction techniques. The COD Specialist leads efforts to conduct ongoing COD assessments, which examine the interrelationship between mental health and substance use. In addition to individual contacts, groups are offered to meet the needs of individuals, as well as assistance connecting with self-help groups for those wishing for that service.
Learn More about the Integrated Treatment for Co-Occurring Disorders and the role of the COD Specialist through these resources.
- The free IDDT Toolkit on the SAMHSA
- Case Western Reserve University Center for Evidence Based Practices (EBP)
- The North Carolina Harm Reduction Coalition