An Integrated Treatment Approach for Severely Mentally Ill Individuals withSubstance Disorders
(As printed in Chapter 6 of
New Directions For Mental Health Services
, No. 50, Summer 1991: Jossey-Bass,Publishers.)
The author, Kathleen Sciacca can be reached at: 212-866-5935.
The step-by-step approach to integrated treatment for multiple disorders described in this chaptercan be replicated at minimal cost in any type of mental health treatment program or service.According to the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) (Talbott,1987), at least 50 percent of the 1.5 to 2 million Americans with severe mental illness abuseillicit drugs or alcohol, compared to 15 percent of the general population. This finding isconsistent with earlier epidemiological studies reporting that 25 to 50 percent of newly admittedpsychiatric patients have concomitant drug and/or alcohol abuse problems (Simon, Epstein andReynolds, 1968; Crowley, Chesluk, Dilts, and Hart, 1974; Davis, 1984; Kofoed, Kania, Walsh,and Atkinson, 1986). Similarly, in New York State, the Commission on Quality of Care for theMentally Disabled (1986) found that 50 percent of the patients admitted for psychiatric care hadalcohol or drug abuse that required treatment. Despite this high prevalence of combined mentalillness and substance abuse, treatment resources are scarce. This author's review (1989a) of 100clients in psychiatric outpatient services in New York State who had received extensivepsychiatric care and who were known substance abusers revealed that 61 of the clients had neverreceived substance abuse treatment. The remaining clients received minimal attention to theirsubstance abuse, and had never been in any form of sustained substance abuse treatment. Manyof these clients accepted the lack of availability of substance abuse services, and kept theirsubstance abuse problems to themselves. Clearly, in many patients, mental illness, drug addictionand alcoholism are not encountered as discrete disorders. Yet, those services that are availablefor these patients are divided by funding sources, admission criteria, treatment methods, and staff training and philosophy (Ridgely, Goldman, and Willenbring, 1990).Rectifying the lack of treatment resources for multiply diagnosed patients requires acomprehensive approach, integrating mental health and addiction treatment in a single programdesign. Multiple disorders are often undiagnosed by professionals who specialize in servingdistinct populations (Ridgely, Goldman and Willenbring, 1990). Addiction professionals maybelieve that mental illness is a symptom or manifestation of substance abuse; mental healthprofessionals may believe that substance abuse is a symptom of mental illness. Neither group istherefore likely to provide effective treatment for multiply diagnosed patients in their usualtreatment setting.The purpose of this chapter is to describe an integrated treatment model that the author hasdeveloped, and that has been applied successfully to the treatment of mental illness, chemicalabuse and addiction (MICAA) throughout New York State, and in other states across thecountry. The first step in describing this model is to clarify diagnostic terminology. Next, we willidentify the limitations of traditional substance abuse and mental health treatment approaches,followed by an in-depth discussion of the MICAA treatment model itself.