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Co-Occurring Disorders Training & Development

Co-occurring disorders – defined as “where an individual has at least one mental-health disorder, as well as an alcohol or drug-use disorder” (Center for Substance Abuse Treatment [CSAT], in press) – affect millions of Americans each year. According to SAMHSA’s 2020 National Survey on Drug Use and Health, approximately 17 million adults in the United States had co-occurring disorders.

Individuals with co-occurring mental-health and substance-use disorders in Anne Arundel County are recognized as a population with poorer outcomes and higher costs in multiple clinical domains. They are commonly underserved in both mental-health and substance-use treatment settings, with resulting over-utilization of resources in the criminal-justice system, the primary healthcare system, the homeless-shelter system, and the child protective system. In addition to having poorer outcomes and higher costs, individuals with co-occurring disorders are sufficiently prevalent in all healthcare settings, including behavioral, medical, and primary care, that they can be considered an expectation, rather than an exception.

People with co-occurring disorders can and do recover. To provide more welcoming, accessible, integrated, continuous, and comprehensive services to these individuals, a coalition of clinical behavioral-health and non-clinical human-services entities led by the Anne Arundel County Local Behavioral Health Authority (LBHA) have agreed to adopt the Comprehensive, Continuous, Integrated System of Care (CCISC) model for designing systems change to improve outcomes.

The Anne Arundel County LBHA is committed to promoting high-quality, integrated behavioral healthcare through various initiatives:

Comprehensive, Continuous, Integrated System of Care (CCISC) Model

  1. Is a model for the implementation of best-practice principles of practice for persons with co-occurring mental-illness and substance-use issues. It was developed and copyrighted by Kenneth Minkoff, M.D. A “Train the Trainers” Curriculum was developed by Christie Cline, M.D., MBA, for use with this model.
  2. The basic characteristics of the model emphasize the need to continuously and simultaneously:
    1. Focus on three levels:
      1. Systems-level change (Collaboration and Partnerships)
      2. Program-level change (Co-Occurring Steering Committee)
      3. Workforce-level change (Change Agent Committees and ROSC)
    2. Use existing resources efficiently
    3. Incorporate Evidence Based Practices (EBP)
    4. Use:
      1. An integrated service philosophy
      2. Motivational enhancements of rolling with resistance, developing empathy, developing discrepancies, avoiding argumentation, and supporting self-efficacy.
      3. Stages of Change:
        1. Pre-contemplation
        2. Contemplation
        3. Preparation
        4. Action
        5. Maintenance
    5. System Standards:
      1. Welcoming
      2. Accessible
      3. Integrated
      4. Continuous
      5. Comprehensive
  3. The model uses eight principles:
    1. Co-occurring is an expectation, not an exception.
    2. Treatment should be based on empathetic, hopeful, integrated, and continuous relationships.
    3. Use of the Four Quadrants for assessment, treatment matching, and individualization of treatment and recovery plans.
    4. Use of case management and ongoing coordination of care.
    5. When both disorders are present, both should be considered Primary.
    6. As bio-psychological disorders, treatment and recovery strategies should be within the context of “disease and recovery” models.
    7. Treatment must be individualized.
    8. Individualized treatment in turn facilitates the availability of continuing, empathetic, supportive treatment approaches and recovery supports.

Read ZiaPartners’ overview of the Comprehensive, Continuous, Integrated System of Care (CCISC) Model.