What are the key factors in effective integrated treatment? There are a number of key factors in an integrated treatment program.
Treatment must be approached in stages. First, a trust is established between the consumer and the caregiver. This helps motivate the consumer to learn the skills for actively controlling their illnesses and focus on goals. This helps keep the consumer on track, preventing relapse. Treatment can begin at any one of these stages; the program is tailored to the individual.
Assertive outreach has been shown to engage and retain clients at a high rate, while those that fail to include outreach lose clients. Therefore, effective programs, through intensive case management, meeting at the consumer’s residence, and other methods of developing a dependable relationship with the client, ensure that more consumers are consistently monitored and counseled.
Effective treatment includes motivational interventions, which, through education, support and counseling, help empower deeply demoralized clients to recognize the importance of their goals and illness self-management.
Of course, counseling is a fundamental component of dual diagnosis services. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills. Counseling can be in the form of individual, group, or family therapy or a combination of these.
A consumer’s social support is critical. Their immediate environment has a direct impact on their choices and moods; therefore consumers need help strengthening positive relationships and jettisoning those that encourage negative behavior.
Effective integrated treatment programs view recovery as a long-term, community-based process, one that can take months or, more likely, years to undergo. Improvement is slow even with a consistent treatment program. However, such an approach prevents relapses and enhances a consumer’s gains.
To be effective, a dual diagnosis program must be comprehensive, taking into account a number of life’s aspects: stress management, social networks, jobs, housing and activities. These programs view substance abuse as intertwined with mental illness, not a separate issue, and therefore provide solutions to both illnesses together at the same time.
Finally, effective integrated treatment programs must contain elements of cultural sensitivity and competence to even lure consumers, much less retain them. Various groups such as African-Americans, homeless, women with children, Hispanics and others can benefit from services tailored to their particular racial and cultural needs.
Reviewed by Robert Drake, MD September 2003