co-occurring psychiatric and substance use disorders: what’s the fuss? richard a. rawson ph.d....

Co-occurring psychiatric and substance use

disorders: What’s the fuss?

Richard A. Rawson Ph.D.UCLA Integrated Substance Abuse Programs

San Diego, California

October 2004

What are we talking about?

An oversimplified picture of the behavioral healthcare service systems in the US

Mental Health Services • Leadership-psychiatrists

• Staffing-psychologists, social workers, nurses, MFTs

• Role of medications-Substantial

• Impact of behavioral therapies research-Substantial

• Knowledge of substance use disorders and their treatment Minimal

• Role of self-help-Minimal

Substance Abuse Services• Leadership-A mixture of

recovering addict/alcoholics, business people, professionals

• Staffing-paraprofessionals, with increasing role of professionals

• Role of medications and behavior therapies-Minimal

• Knowledge of psychiatric disorders-Minimal

• Role of self-help-Substantial

The prototype patients for the current service delivery systems

The mental health service system

• The uncomplicated schizophrenic

• The “simple” affective disordered individual

• The “pure” bi-polar patient

The substance abuse service system

• The “plain vanilla” alcoholic

• The addict who uses only heroin

• The stimulant dependent individual w/o other psych diagnoses

What’s the Problem?• Estimates of psychiatric co-morbidity among clinical

populations in substance abuse treatment settings range from 20-80%

• Estimates of substance use co-morbidity among clinical populations in mental health treatment settings range from 10-35%

* Differences in incidence due to: nature of population served (e.g.: homeless vs. middle class), sophistication of psychiatric diagnostic methods used (psychiatrist or DSM checklist) and severity of diagnoses included (major depression vs. dysthymia).

Why are substance use disorders treated in separate systems from other

psychiatric disorders?

How has the split occurred between substance use disorders and other psychiatric disorders?

• Before 1970 in the US, research and treatment for alcoholism and drug abuse were administered out of the National Institute of Mental Health.

• A number of factors prompted the separation of alcoholism/drug abuse into their own specialty areas, distinct and separate from general psychiatry.


psychiatric disorders?

• A pervasive perception existed among the public and policymakers that the professional fields of psychiatry, psychology and medicine were extraordinarily unsuccessful in providing treatment to addicts and alcoholics; and, that there was a tendency within much of organized psychiatry (and psychology) to avoid alcoholics and addicts as inherently untreatable individuals, incapable of insight.


psychiatric disorders?• Two major factors prompted the establishment of

new institutes in early 1970s:– Sen. Harold Hughes’ promotion of treatment for employees with alcohol

problems in the workplace was a major influence in the field of alcoholism. Health insurance began to include alcoholism treatment

benefits, EAPs began and NIAAA was created.

– Huge increases in drug experimentation in late 1960s and concerns about returning heroin addicted Vietnam Veterans, prompted public concern

about drug abuse and prompted the creation of NIDA.

Why are substance use disorders treated in separate systems from other psychiatric

disorders?

• The result was:– National Institute of Mental Health (NIMH) responsible for research on

and treatment of psychiatric disorders.

– National Institute on Alcoholism and Alcohol Abuse (NIAAA) responsible for research on and treatment for alcoholism and related issues.

– National Institute on Drug Abuse (NIDA) responsible for research on and treatment of illicit drug problems (and later nicotine).

– Each institute had its own experts, treatment systems, funding streams and each viewed the other as parochial, misinformed and naïve.

– Cooperation was uncommon.

Why are substance use disorders treated in separate systems from other psychiatric

disorders?

• Since early 1970s-– Within treatment settings, alcoholism and drug

abuse disorders are treated within the same treatment system; hence, there are now essentially two service delivery systems:

1. Alcoholism and Other Drug (AOD) system2. Mental health system

– Psychiatry has formally incorporated the study and treatment of substance use disorders as part of psychiatry.

DSM and ICD: The “Bibles”

Studies on Co-morbidity

Most widely cited studies:

•Epidemiologic Catchment Area (ECA) study

•National Comorbidity Study

ECA Study

•Epidemiologic Catchment Area (ECA) Study

•20,291 interviews at 5 sites

•Data Collected 1980 – 1984

•DSM – III Diagnoses

Regier, DA, et al. (1990). Comorbidity of Mental Disorders with Alcohol and other Drug Abuse: Results From the Epidemiologic Catchment Area (ECA) Study, JAMA, 264, 2511-2518

ECA DSM-III Diagnoses (rates per 100 people)

1 Month Lifetime

Any Alcohol, Drug or Mental Health Disorder

15.7 32.7

Any Mental 13.0 22.5

Alcohol Dependence 1.7 7.9

Drug Dependence 0.8 3.5

Regier, et al. (1990)

Lifetime Prevalence and Odds Ratios ECA Study

Alcohol OROtherDrug OR

Any mental 36.6% 2.3 53.1% 4.5

Schizophrenia 3.8% 3.3 6.8% 6.2

Any affective 13.4% 1.9 26.4% 4.7

Anti-social 14.3% 21.0 17.8% 13.4

Alcohol 47.3% 7.1

Regier, 1990

NC Study

•National Comorbidity Study

•8,098 interviews across the country

•Data collected 1990 – 1992

•DSM-III-R Diagnoses

Merikangas, KR, et al. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: Results o the international consortium in psychiatric epidemiology. Addictive Behavior, 23, 893-907.

NCS DSM-III Diagnoses

3641

45

55

37

44

0

10

20

30

40

50

60

Mood Anxiety Antisocial

Alc DepDrug Dep

Merikangas, KR, et al. (1998)

%

NCS DSM-III Diagnoses

1.82.2

2.6

3.0

3.74.0

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1 2 3

Alc DepDrug Dep

Merikangas, KR, et al. (1998)

OR

Number of mental disorders

Summary

• There is a problem

• We have documented it for a long time

• We need more information to figure out– The current state of affairs– What we do about it

Treatment of Co-occurring Disorders

• Treatment System Paradigms– Independent, disconnected– Sequential, disconnected – Parallel, connected– Integrated


• Independent, disconnected “model”

– Result of very different and somewhat antagonistic systems

– Contributed to by different funding streams– Fragmented, inappropriate and ineffective care


• Sequential Model– Treat SA Disorder, then MH disorder– Treat MH Disorder, then SA disorder– Urgency of needs often makes this approach

inadequate– Disorders are not completely independent– Diagnoses are often unclear and complex


• Parallel Model– Treat SA disorder in SA system, while

concurrently treating MH disorder in MH system. Connect treatments with ongoing communication

– Easier said than done– Languages, cultures, training differences

between systems– Compliance problems with patients


• Integrated Model– Model with best conceptual rationale– Treatment coordinated best– Challenges

• Funding streams• Staff integration• Threatens existing system• Short term cost increases (better long term cost

outcomes).

Elements of an integrated model

• Staffing– A true team approach including: Psychiatrist

(trained in addiction medicine/psychiatry); Nursing support; Psychologist; Social worker; Marriage and family therapist; Counselor with familiarity with self-help programs. (Others possible, vocational, recreational educational specialists).

Elements of an Integrated Model

• Preliminary assessment of mental health and substance use urgent conditions– Suicidality– Risk to self or others– Withdrawal potential– Medical risks associated with alcohol/drug use

Elements of an integrated model

• Diagnostic process that produces provisional diagnosis of psychiatric and substance use disorders using:

– Urine and breath alcohol tests

– Review of signs and symptoms (psychiatric and substance use)

– Personal history timeline of symptom emergence (what started when)

– Family history of psychiatric/substance use disorders

– Psychiatric/substance use treatment history

Elements of an integrated model• Initial treatment plan that includes (min- one day-max

ten days):

– Choice of a treatment setting appropriate to initially stabilize medical conditions, psychiatric symptom and drug/alcohol withdrawal symptoms

– Initiation of medications to control urgent psychiatric symptoms (psychotic, severe anxiety, etc)

– Implementation of medication protocol appropriate for treating withdrawal syndrome(s)

– Ongoing assessment and monitoring for safety, stabilization and withdrawal

Elements of an integrated model• Early stage treatment plan that includes ( min day 2-max

day 14)– Selection of treatment setting/housing with adequate supervision– Completion of withdrawal medication– Review of psychiatric medications– Completion of assessment in all domains (psychology, family,

educational, legal, vocational, recreational)– Initiation of individual therapy and counseling (extensive use of

motivational strategies and other techniques to reduce attrition)– Introduction to behavioral skills group and educational groups– Introduction to self help programs– Urine testing and breath alcohol testing

Elements of an integrated model• Intermediate treatment plan that includes (up to six

weeks):– Housing plan that addresses psychiatric and substance use

needs– Plan of ongoing medication for psychiatric and substance use

treatment with strategies to enhance compliance– Plan of individual and group therapies and psychoeducation

with attention to both psychiatric and substance use needs– Skills training for successful community participation and

relapse prevention– Family involvement in treatment processes– Self-help program participation– Process of monitoring treatment participation (attendance and

goal attainment– Urine and breath alcohol testing

Elements of an integrated model• Extended treatment plan that includes (up to 6 months):

– Housing plan

– Ongoing medication for psych and substance use treatment

– Plan of individual and group therapies and psychoeducation with attention to both psychiatric and substance use needs

– Ongoing participation in relapse prevention groups and appropriate behavioral skills groups and family involvement

– Initiation of new skill groups (e.g.; education, vocational, recreational skills)

– Self help involvement and ongoing testing

– Monitoring attendance and goal attainment

Elements of an integrated model• Ongoing plan of visits for review of:

– Medication needs

– Individual therapies

– Support groups for psych and substance use conditions

– Self help involvement

– Instructions to family to recognize relapse to psych and substance use

In short, a chronic care model is used to reduce relapse and if/when relapse (psychiatric or substance use) occurs, treatment intensity can be intensified.

Building integrated models• Challenges of building an integrated model

– Cost of staffing

– Training of staff

– Resistance from existing system

– Providing comprehensive, integrated care with efficient protocols

– The most likely strategy for moving toward this system is in increments

• Psychiatrist attend at AOD centers

• Relapse prevention groups introduced to mental health centers

• Staff exchanges; attending case conferences; joint trainings

• Gradual shifting of funding

Treatment of Co-occurring Disorders: Areas of Promise

• Integration of SA treatment and treatment of affective disorders– Depression

• Use of tricyclics and SSRIs produces excellent treatment response in SA patients with depression. Can be used with SA populations with minimal controversy.

• Good evidence of effectiveness with methadone patients, women with alcoholism and depression.


• Bipolar Disorder and SA Disorders– Medications for BPD often essential to stabilize

patients to allow SU treatment to be effective

– Challenges often occur in diagnosis• Cocaine/methamphetamine use disorders often mimic

BPD, medications for these disorders not yet with demonstrated efficacy and do not respond to medications for bipolar disorders


• Schizophrenia and SU Disorders

– Differential diagnosis with cocaine and methamphetamine psychosis can be difficult.

– Medication treatments frequently essential.– Knowledge about medication side effects and the

possibility that these side effects can trigger drug use is important.


• Understanding of neurobiological mechanisms and genetic foundations may provide key knowledge for both sets of disorders.

• Key issues in improving treatment effectiveness – Training, training, training– Increased contact between professionals from both

systems– Flexibility of funding streams– Training, training, training

Treatment of Co-occurring Disorders: Areas of Controversy

• Should the treatment of SUDs be fully incorporated within the mental health system(e.g.;Integrated Behavioral Health Agency)?

• If yes, will treatment protocols unique to substance abuse system be discarded?

• Will funding for SUDs be reduced?

Co-Occurring Disorders Center for Excellence (COCE)

Subcontractor’s Kick-Off Meeting

February 13, 2004

The CDM Group, Inc.

Chevy Chase, MarylandRose M. Urban, M.S.W., J.D., LCSW

COCE Executive Project Director The CDM Group,

Inc.

Co-Occurring Disorders -Advances in the Field

• Better definitions

• Treatment needs better understood

• Improved screening and assessment

• Improved systems and processes

• Evidence-based practices exist

Key COD Products and Technology Transfer Initiatives

• CSAT’s National Treatment Plan, Changing the Conversation;

• CSAT’s Substance Abuse Treatment for Persons with Co-Occurring Disorders TIP;

• CMHS’s Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit;

• SAMHSA’s Report to Congress on the Prevention and Treatment of Co-Occurring Disorders and Mental Disorders;

• SAMHSA’s Strategies for Developing Treatment Programs for People with Co-Occurring Substance Abuse and Mental Disorders

Contributors to Knowledge Base

• Federal agencies• Grantees (Including COSIG grantees)• States • Service providers• Consumers• Researchers• Addiction Technology Transfer Centers (ATTCs)• Centers for the Application of Prevention

Technologies (CAPTs)• National Mental Health Information Center (NMHIC)

SAMHSA’S VISION FOR COD

PROVIDE LEADERSHIP AND DIRECTION IN DEFINING AND TRANSFERRING THE LATEST EVIDENCE-BASED PRACTICES/ SYSTEMS, SERVICES, & INFRASTRUCTURE TO ALL LEVELS OF THE COD SERVICE SYSTEM

OPERATIONALIZING THE VISION:

SAMHSA’S CO-OCCURRING CENTER

FOR EXCELLENCE (COCE)

COCE APPROACH

COCE will:

• Advance a unified substance abuse and mental health approach;

• Address all levels of client disorder severity; and

• Adapt solutions to the unique needs of each service recipient

What is the COCE?CRITICAL INPUTS

COCE:Analysis Integration Priorities

State/Local Experience &

Innovation

Consumer Needs And

Perspectives

Mental Health,Substance

Abuse,& CODResearch

Federal Policy WORK OF THE COCE

COCE GOALS

SAMHSA’sMission &Priorities

LEADERSHIP IN CLARIFYING

Definitions

Nosology

Measurement

Evidence & Consensus-Based Practices

Unified Approach

AGENDA SETTING

Professional Education

Practice Improvement

Research

Policy

Workforce Development

RESOURCE TO SAMHSA

Logistical/Operational

Execution/Implementation

Informational

ACTIVITIESTraining

Technical AssistanceTraining of Trainers

InstitutesCoordination with other

SAMHSA Centers

PRODUCTSTemplates for Product

DevelopmentTechnical Reports

ArticlesLiterature ReviewsModels of Change

Technology Transfer Principles and Practices

StatePolicy

THE COD SERVICE SYSTEM

Who is the COCE?

CONTENT IMPLEMENTATION

SENIOR FELLOWSe.g.,

Richard Ries, MD

FELLOWSCONSULTANT AND

SUBCONTRACTOR POOL

PLANNING, MANAGEMENT, & ACCOUNTABILITY

EXPERT LEADERSHIP GROUP

SENIOR MANAGEMENT TEAM

Insures accuracy and integrity of scientific and clinical content

Plans and oversees COCE activities

Advises and assists Expert Leaders in developing overall COCE content

Provides expert input on specific COD content areas

Conducts technical assistance, cross-training, and assists in

development of materials

STEERING COUNCIL

Advises SAMHSA and COCE on planning and

conduct of COCE activities

VISION & LEADERSHIP

SAMHSA

CMHSCSAT CSAP

The COCE Team• Awarded as a 5-year contract to The CDM

Group, Inc. (CDM) on September 29, 2003 in association with:– The National Development Research Institutes

(NDRI)– The Center for Behavioral Health, Justice & Public

Policy (CBHJPP) at The University of Maryland– The National Opinion Research Center (NORC) at

the University of Chicago

The COCE Senior Team

• Directed by CDM– Rose M. Urban, J.D., M.S.W., Executive

Project Director– Jill G. Hensley, M.A., Project Director

The COCE Senior TeamCDM

• Michael Klitzner, Ph.D. – Senior Social Scientist

• William Reidy, Jr., M.S.W. – TA/CT Specialist

• Sheldon Weinberg, Ph.D. – TA/CT Specialist

• Robert O’Brien, Ph.D. – Evaluation Adviser

The COCE Senior TeamNDRI• Stan Sacks, Ph.D. – Expert Adviser on Co-Occurring Disorders• JoAnn Sacks, Ph.D. - Director of State Technical Assistance

(TA) • John Challis, B.A., B.S.W. – Project DirectorCBHJPP, University of Maryland• Fred Osher, M.D. – Expert Medical Adviser on Co-Occurring

Disorders NORC• Sam Schildhaus, Ph.D. – Director of the PPG Pilot Evaluation

Other COCE Subcontractors• 52 other staff from key subcontractors:

• Policy Research Associates, Inc. (PRA)• National Addiction Technology Transfer Center;• Regional ATTCs (Northeast/IRETA, Northwest Frontier,

and Pacific Southwest)• National Center on Family Homelessness• The George Washington University• New England Research Institutes, Inc.• Foundations Associates

• Potential Collaboration with:• National Association of State Mental Health Program

Directors (NASMHPD)• National Association of State Alcohol and Drug Abuse

Directors (NASADAD)

The COCE Consultants• 227 expert consultants with a range of expertise

across disciplines, populations, and service settings, including:– Thomas Backer, Ph.D.

– Carlo DiClemente, Ph.D.

– Alan Marlatt, Ph.D.

– Tom McLellan, Ph.D.

– Richard K. Ries, M.D.

– Steven Schinke, Ph.D.

– Douglas M. Ziedonis, M.D.

Providing Guidance: The COCE National Steering Council

• National Association of State Mental Health Program Directors (NASMHPD) – Andrew Hyman, J.D.

• National Association of State Alcohol and Drug Abuse Directors (NASADAD)• State Associations of Addiction Services (SAAS)• National Council of Community Behavioral Health (NCCBH) – Jennifer

Michaels, M.D.• American Association of Addiction Psychiatry (AAAP) – Richard Rosenthal,

M.D.• National Association of Alcohol and Drug Abuse Counselors (NAADAC)• National Mental Health Association (NMHA)• Research Community – Richard Ries, M.D.• Primary Care Community• Consumer/Survivor/Recovery Community – Michael Cartwright• Homelessness Community – Ellen Bassuk, M.D.• Criminal Justice/Drug Court Community – Joe Coccoza, Ph.D.• Tribal/Rural Community – Raymond Daw• Trauma/Violence Prevention Community – Lisa Najavits, Ph.D.

THE COCE AS A CENTER FOR EXCELLENCE

COCE WILL:

• Address the wide range of clinical, administrative and systems issues that impact the quality and accessibility of care for persons with COD

• Address the needs of a broad range of individuals and organizations including practitioners, researchers and scholars, policy makers, administrators, affected populations, and concerned citizens

• Have a multidisciplinary staff who have a common interest in COD and science-to-service

• Emphasize knowledge synthesis, research-to-practice, and dissemination

• Model its message through the application of management, communications, and dissemination science in its own work

• Be responsive to the field’s changing needs and priorities

• Take a long term view of system change and system improvement

THE COCE AS A CENTER FOR EXCELLENCE

COCE IS COMMITTED TO:

• Advancing a unified substance abuse and mental health approach;

• Addressing all levels of client disorder severity; and

• Adapting solutions to the unique needs of each service recipient

THE FOUNDATIONS OF COCE’S WORK ARE

• Evidence-based treatment models and strategies

• Comprehensive and integrated services and systems

• Client/consumer focus and cultural competence

• Quality improvement process

TOOLS FOR EXCELLENCE:

Services and Service Systems

Infrastructure Special Populations

Prevention Principles of Care Children and Adolescents

Screening Legislation and Regulation

Children of Individuals with COD

Assessment Standards (Federal, State, Other)

Women

Treatment Planning Credentialing Gay, Lesbian, Bi-Sexual, Transgendered

Treatment Service Staff Development and Training

Geriatric

Support Services System Coordination Supports

Ethnic/ Linguistic Minorities

Service Integration Information Systems Homeless

System Integration Health Care Finance Criminal Justice Involved

Evaluation/Research Persons with Medical Comorbidity

Resources

* Each category contains several subcategories, allowing greater specificity

COCE Conceptual Framework


COCE Conceptual Framework

COD SCIENTIFIC BASE – e.g.

COD TIP

OTHER TIPS

COD TOOL KIT

REPORT TO CONGRESS

NEW FREEDOM INITIATIVE

POSITION PAPERS & TECHNICAL

REPORTS – e.g.

Screening Assessment & Treatment Planning

Definitions

Training and Workforce Development

PRODUCTS – e.g.

Training

Technical Assistance

Monographs

Curricula

Fact Sheets

Treatment Services

SCIENCE-BASED COD PRINCIPLES

Etc.

COCE SCIENCE TO SERVICE PROCESS

Etc.


THE COCE BRAIN TRUST

SENIOR FELLOWS

e.g.,

Richard Ries, M.D.

FELLOWS

EXPERT LEADERSHIP GROUP

Stan Sacks, Ph.D.

Fred Osher, M.D.

Rose Urban, J.D., MSW

STEERING

COUNCIL

COCE’s Target Audiences• States that have received Incentive Grants for

Treatment of Persons with Co-Occurring Substance Related and Mental Disorders (COSIGs)

• States selected for the COD Policy Academy• Selected Data Incentive Grant (DIG) States and State

Data Infrastructure (SDI) Grants • Sub-State entities including cities, counties, tribes and

tribal organizations• Providers (community-based, educational

establishments, homelessness system, criminal justice, other social and public health)

The COCE Technology Transfer Approach

Technology Transfer

Principles:• Relevance• Credibility• Clarity• Feasibility• Psychosocial factors

Practices:• Matching goals to

readiness• Interpersonal

strategies• Organizational

support• Use of:

– Translators– Early adopters– Champions

• Peer networking• Follow-up and

support

CRITICAL INPUTS

State/Local Experience &

Innovation

Consumer Needs And

Perspectives

Mental Health,Substance

Abuse, & CODResearch

Federal Policy

SAMHSA’sMission &Priorities

StatePolicy

COCE Technology Transfer Mechanisms

• Provide technical assistance • Provide training• Prepare and distribute state-of-the-art materials on COD• Analyze materials and develop taxonomies • Design and manage a co-occurring disorders Web site• Support regional and National meetings• Develop and conduct a pilot evaluation of the co-occurring

Performance Partnership Grant (PPG) measures• Sustain technical assistance and cross-training through

coordination with SAMHSA’s existing TA/CT sources

Technical Assistance• Individual and Group• On-Site • Off-Site

– Telephone– Literature Reviews– Networking– Web sites– General Information– Materials, reports, etc.

Select TA/CTProviders

Field Requestsand Assess

Needs

Develop TA/CTPlan

Off-SiteCOCE Staff

and/or Consultant TA/CT Provider(s)

perform TA/CT activities:TelephoneLit ReviewsNetworking

Web site

On-Site

DevelopConsultation

Plan

Plan and ManageLogistics

Evaluation andReporting

Pre-Delivery Phase

Post-Delivery Phase

Follow-up

On-Site TA/CT

Delivery

COCE TA Coordinator

Support

On SiteOff-SiteBoth

MaintainFiles

To Inform SimilarTA Events

Off-Site

COCE Technical Assistance Delivery Process

Interim TA Plan

• Pilot of TA Plans and Procedures• Federal Project Officer Reviews and Approves TA

Plan Before Services are Provided• Pilot Findings used to Refine Process for Full-

Scale Rollout

Training

• Training of Trainers (TOT)– Addiction Technology Transfer Centers (ATTCs)– Centers for the Application of Prevention Technology

(CAPTs)– States– Provider Organizations (e.g., NCCBH, SAAS)

• Cross-Training (CT)• Curriculum Development

Materials Development and Analysis

• Position Papers

• Monographs

• Training Curricula

• Brochures

• Newsletter

• Fact Sheets

• Program Briefs

CLINICAL CAPACITY BUILDING

INFRASTRUCTURE DEVELOPMENT

Screening, Assessment, and Treatment Planning

Financing Mechanisms

Treatment Services Certification and Licensure

Terminology, Nosology, Definitions

System Integration

Training and Workforce Development

Services Integration

Evaluation and Monitoring

Information Sharing

COCE Web Site

Will be designed to:

• Motivate exploration of COD;

• Clarify users’ interests and concerns;

• Guide users to relevant information; and

• Provide users with support in understanding and using information.

Regional and National Meetings

• Annual National meeting• Three regional meetings in year 1, four regional

meetings in years 2-5– Increase awareness of recent research– Bridge the gaps between research, practice, and policy– Form and sustain relationships among providers across

constituencies– Create peer networks – Provide cross-training of providers

The COCE Contract Emphasizes Sustainability

Early and substantive linkages with:– CSAT’s Addiction Technology Transfer Centers (ATTCs)– CSAP’s Centers for the Application of Prevention

Technology (CAPTs) (6 regional centers)– CMHS’s National Mental Health Information Center

(NMHIC) Development of sustainable systems of technology

transfer Establishment of science-based practices as the norm Impact on agendas of knowledge producers to better

meet the needs of a science-to-service model

Role of the Subcontractors• Policy Research Associates (PRA) – Criminal Justice

Expertise• National Center on Family Homelessness –

Homelessness Expertise• George Washington University – Treatment Systems

Finance and Organization; Cross-Systems Infrastructure Expertise

• New England Research Institutes, Inc. (NERI) – Financial Strategy Development and Analysis Expertise

• Foundations Associates (FA) – Consumer/Recovery Community Expertise

Role of the ATTCsCURRENT PARTNERS

National ATTC

NE ATTC NW ATTC SW ATTC

• Coordinate ATTC activities with COCE activities

• Logistical support for NE ATTC TOTs

• Plan for marketing & dissemination of COCE products through ATTCs

• Convene an ATTC COD Workgroup to collaborate with COCE

• Work with COCE to design and implement a TOT for ATTCs

• Adapt COCE products and services to meet specific ATTC needs

• Assist in convening ATTC COD Workgroup

• Provide advice and planning concerning dissemination of COCE knowledge throughout the ATTC system

• inventory existing COD-related ATTC materials/databases; assess these for suitability for COCE efforts; and assist in revising for SAMHSA content clearance, if necessary

• Assist in convening ATTC COD Workgroup

• provide consultation to COCE staff on developing and/or revising curricula and training materials on COD for use by the ATTCs, particularly with respect to evaluating treatment outcomes

MAXIMUMIMPACT

MotivateOrientTrain

Role of the ATTCs

CURRENT ATTC

PARTNERS

OTHERATTCs

THE COD FIELD

COCE TimetableSep 29 – Dec 30, 2003• Conceptualize Approach and Develop Plans• Initial COSIG Meeting December 15-17Jan 1 – Mar 31, 2004• Provide Interim TA• Establish Coordination Mechanisms• Convene National Steering Council• Convene COSIG, DIG, and SDI Grants Involved in the PPG Pilot

EvaluationApril 1, 2004• Full TA services• Continued development of

– COCE infrastructure– Linkages– TIP– Curricula– Other materials– Web site

How to Request COCE Services• Requests for services must be in writing• Direct requests to:

– [email protected] or– COCE Phone Line: 301-951-3369

• Questions?– Jill Hensley, COCE Project Director

301-654-6740 (x 201)

– George Kanuck, Federal Project Officer301-443-8642

co-occurring psychiatric and substance use disorders: what’s the fuss? richard a. rawson ph.d....

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