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Co-occurring disorders draw a crowd

April 1, 2010
by Lindsay Barba, Associate Editor
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1,400 providers log in to learn how to integrate care for co-occurring disorders

With the recent passage of the healthcare reform bill that will establish a link between the divided sectors of health services in the U.S., integration is on everyone’s mind. This was especially clear yesterday afternoon as 1,400 addictions, behavioral health, and developmental disability professionals logged in to Addiction Professional’s latest webinar, “Integrating Treatment for Co-occurring Disorders.” The webinar was sponsored by NAADAC, Hazelden, and WestBridge Community Services, and was led by four prominent figures in addiction treatment:

• Cynthia Moreno Tuohy, Executive Director, NAADAC
• Marty Harding, Director of Training and Consultation, Hazelden Publishing
• Tim Sheehan, PhD, Dean and Director of Institutional Effectiveness, Hazelden Graduate School of Addiction Studies
• Mary Woods, RNC, LADC, MSHS, CEO, WestBridge Community Services

According to Sheehan, 50 to 75 percent of clients receiving treatment for a substance abuse disorder also have a diagnosable mental health disorder, while 25 to 50 percent of clients receiving psychiatric treatment also have or have had a substance use disorder. “Co-occurrence is not the exception, but the rule,” he said.

Of the attendees, 50 percent reported they were currently treating clients with a high substance use severity and a low mental health severity, while about 30 percent reported treating clients with a high substance use severity and a high mental health severity.

Despite the prevalence of co-occurring disorders, providers reported that submitting co-occurring diagnosis claims to payers for reimbursement remains difficult, since every state and payer requires something different. “The challenge is that co-occurring disorder can mean almost anything—it’s relative to where you are and how your state defines it,” Woods said. “You have to understand your state and payers and their requirements for reimbursement.”

The screening, assessment, and diagnosis of these co-occurring disorders are also difficult, especially within organizations that aren’t trained in treating co-occurring disorders. “There is a greater level of complexity in screening and assessment for co-occurring disorders,” Sheehan said. “Symptoms can mimic or mask psychiatric disorders. Intoxication, withdrawal, substance-induced disorders, motivational factors, and the processing of feelings, management of symptoms, and diagnosis of disorders contribute to these complexities.”

To address the complexity of treatment, Sheehan and Woods outlined seven components for an effective integrated treatment model.

1. Integration: Both disorders are viewed as primary disorders.
2. Comprehensiveness: The availability of wraparound services is ensured.
3. Assertiveness: “The bottom for these folks is death,” Sheehan said, “so it’s important to be assertive.”
4. Reduction of negative consequences: Clinicians instead provide positive reinforcements, like housing or employment assistance.
5. Long-term perspective: Illnesses are viewed as chronic, and recovery as a goal-in-progress.
6. Motivation-based treatment: Clinicians use evidence-based practices in treatment, such as motivational interviewing.
7. Multiple psycho-therapeutic modalities: A well-thought out approach is taken to treatment planning, and treatment plans vary from client to client.

Woods also cited the recruitment of a multi-disciplinary treatment team and the capacity to prescribe medication as essential components of integrated co-occurring disorder treatment. Sheehan agreed, adding that “research is showing that the more we are able to treat both [disorders] at the same time with the same staff, the more successful outcomes we’ll have.”

For clients, the benefits of integrated care for co-occurring disorders include not having to travel between treatment facilities, reduced frustration, greater transparency throughout the treatment process, and a greater sense of empowerment.

NAADAC and Hazelden came together in sponsoring the webinar because of a new training program—Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know—which educates counselors through case studies, videos, interactive exercises, and written resources. To find trainings in your area, visit, or to host a training session, contact Diana Kamp ( or Cynthia Moreno Tuohy (

Hazelden also offers another resource for administrators and clinicians: the “Co-occurring Disorders Program” written by Dartmouth Medical School. The five curriculum guides in this toolkit provide information on the implementation of a co-occurring disorders treatment program. A “Clinical Administrator’s Guide” is also included. For more information, contact To view the free webinar, visit Vendome Group's webinar division by clicking here. Registration is required.