Mixing Oil and Water: Developing Integrated Treatment for People with the Co-Occurring Disorders of Mental Illness and Addiction

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This chapter chronicles the shift in scientific assumptions and the ensuing consensus on treating people with a co-occurring mental illness and a substance misuse problem. In this chapter, the term co-occurring disorder refers to a person with both a mental illness and a substance use disorder. The paradigm shift and subsequent technology transfer in the fields of addictions and mental health is extremely important for the lessons learned in the effort to integrate the two modalities. There are lessons from the process of moving new ideas based on science into practice. These lessons give us direction for treatment and knowledge transfer in the future. And, finally there is a need to examine critically the underlying flaws that were exposed in the philosophy and practice tradition of both models when they were integrated. Fundamentally, the attempt to develop and deliver appropriate treatment to persons with a co-occurring disorder illustrates one of the self-correcting mechanisms of science. Unchallenged, clinicians in mental health and substance abuse treatment would have had little motivation to examine the science underlying their practice. In the history of mental health and substance abuse treatment there have been few revolutionary changes in care and treatment that have made life better for people suffering from an addiction or mental illness. Based on a rapidly evolving science and a better understanding of the treatment needs of people with co-occurring disorders, the expectation at the turn of the 21st century was that by integrating the two models, effective treatment could be provided for people with a co-occurring disorder. Driven by the growing number of persons identified with a co-occurring mental health and substance misuse disorder the tipping point had been reached by the mid 1990s. Declared a crisis in the United States, the number of people being identified as having a co-occurring disorder was estimated to be much higher than thought. The higher rates of failure in treatment and repeated treatment episodes were an unnecessary burden on the treatment community, individuals, families of people with co-occurring disorders, and the community in general. In 2002, Charles G. Curie, Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that “addressing the needs of