Historically, the mental health and substance
abuse treatment systems in the
United States have been separate, and
traditional approaches to treating people
with co-occurring disorders have involved
parallel or sequential treatment in these
separate systems. In practice, patients
with co-occurring mental and substance
use disorders have rarely received needed
treatments (Watkins et al. 2001) and
have generally experienced poor outcomes
(Drake et al. 1996; Ridgely et al. 1987).
As a result, there has been widespread
endorsement by patients, clinicians,
administrators, and researchers for integrating
mental health and substance abuse services (Bellack and DiClemente
1999; Onken et al. 1997; Ries 1994).
There is also accumulating research
support for the effectiveness of the
integrated treatment approaches that
have evolved over the past two decades
(Drake et al. 1998).
Integrated approaches to treatment
for patients with schizophrenia and
AUD are generally offered through the
use of multidisciplinary treatment teams
that provide outreach, comprehensive
services, and stage-wise treatments
(described below). Outreach is needed
because these patients are often demoralized
and reluctant to engage in treatment.
Comprehensive services are vital
because recovery involves building skills
and supports to pursue a meaningful
life rather than just managing symptoms
or illnesses. Stage-wise treatment assumes
that patients recover from two serious
disorders over time, in stages, and with
help from treatment providers. Patients
with schizophrenia and AUD generally
pass through four stages of treatment:
1. Engagement, which involves building
a trusting treatment relationship
2. Persuasion, which entails developing
motivation to manage both illnesses
and pursue recovery
3. Active treatment, which encompasses
development of the skills and
supports needed for illness management
and recovery
4. Relapse prevention, which involves
strategies to avoid and minimize the effects
of relapses (Osher and Kofoed 1989).