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The purpose of this paper is to report on the success of an initiative involving the transformation of a group of small substance use treatment only or mental health treatment only provider agencies serving uninsured adults into providers of co-occurring disorder treatment.

The paper uses a case study narrative to describe the initiative and the transformation of the participant agencies from being providers of mental health or substance use treatment to providers of co-occurring disorders.

Six agencies serving uninsured adults expanded their scope of patient treatment services to include the capacity to treat adults with co-occurring disorders. This was achieved with modest support funding from a local foundation. The initiative has been ongoing for five years.

The outcome of this initiative demonstrates the financial and practical feasibility of improving and expanding treatment services to low-resourced patient populations. The participating agencies were able to improve their capacity to treat patients with substance use or mental health issues that previously they were not prepared to treat and thus increased their ability to provide integrated care.

The initiative described here shows that the treatment of concomitant substance use and mental health disorders is within the range of many small-scale treatment providers, if provided the leadership and support. Delivery of effective treatments to populations experiencing co-occurring disorders that are underserved and undertreated are achievable in community-based clinical practices. This has implications for developing treatment capacity outside of hospital settings to enable treatment of co-occurring disorders to become more accessible.

Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.

This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.

Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.

Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.

Integrated care approaches have been recommended for co-occurring substance use and mental health disorders. The purpose of this study is to explore and map the research literature regarding social work and its intersection with co-occurring substance use and mental health disorders.

An iterative and systematic search of five electronic databases CINAHL, Scopus, PsycINFO, Social Science Database and Medline was conducted to identify studies published between 2002 and 2022. Two reviewers independently screened publications in two successive stages of title and abstract screening, followed by a full-text screening of eligible studies. Data from each included publication were screened and extracted using Covidence.

A total of 38 eligible studies were included in the final scoping review. The included studies were conducted in eight different counties, including a range of study designs (e.g. cross-sectional, RCT, pilot studies). Only 8 of the 38 studies included people with co-occurring disorders as participants. Study settings were broad, for example, dual-diagnosis, military, homeless, substance use and community-based settings.

A review of the literature surrounding social work practice and its intersection with co-occurring mental health and Alcohol and other drug was warranted to document the evidence on this largely unexplored area of research. This review found that there was a paucity of literature that focused specifically on the role of social work practice in relation to individuals with co-occurring disorders, with a limited number of studies focusing on dual diagnoses.

This paper describes the development of a novel integrative self-directed treatment tool which uses cognitive behavioural therapy techniques to reduce anxiety symptoms in patients presenting to treatment for alcohol-related problems. More specifically, the purpose of this paper is to explore patient and health practitioner perceptions of the booklet, in order to determine its suitability and utility in the context of existing alcohol treatment services. The extent of cross-informant agreement between patient and health practitioner responses is also examined.

This research utilises a cross-sectional qualitative research design using semi-structured interview methods with patients presenting to hospital for alcohol-related diseases/illnesses/accidents/injuries (n=15) and practitioners (n=10) working at inpatient, outpatient and residential substance treatment facilities.

The present study found that the majority of patients (80 per cent) and practitioners (90 per cent) expressed a motivation to utilise the proposed booklet, agreeing that the booklet was a practical, achievable and educational resource for patients suffering from co-occurring anxiety symptoms in substance abuse facilities. Participants outlined limitations of the resource, suggesting that the booklet would be most suitable for patients with moderate to high cognitive ability, who also exhibit a motivation to change alcohol consumption and have access to additional support.

Findings from the present study suggest that the booklet may be most effective in improving treatment accessibility and patient treatment seeking behaviours; rather than reducing practitioner-patient contact.

This paper focuses on the development and utility of a novel resource suitable for substance abuse treatment facilities. The findings and feedback produced from the present study can assist with modifications of the intervention and in improving the effectiveness of future trials.

Many individuals in drug treatment courts (DTCs) have co-occurring mental health and substance use disorders (COD), which can negatively impact treatment engagement, behavioral health and criminal justice outcomes. This paper aims to report results of DTC participants with a COD, who received a 12-month wraparound treatment intervention called MISSION-Criminal Justice (MISSION-CJ) alongside DTC to improve treatment engagement and behavioral health outcomes and reduce reincarcerations.

In this pre-post, single-group pilot, 48 clients enrolled and 81% completed 12-month follow-up assessments (N = 39) and weekly MISSION-CJ fidelity for type and intensity of services delivered. Generalized linear mixed models (GLMMs) were computed with a fixed term for fidelity (e.g. high or low MISSION-CJ), time and a fidelity x time interaction term.

Among participants, at 12 months, 81% of the participants remained engaged in treatment at study completion, and 89% had high MISSON-CJ fidelity. Clients demonstrated significant reductions from baseline to 12 months in average nights in jail (B = −0.1849511, p < 0.0344), mental health symptoms via the Behavior and Symptom Identification Scale (BASIS) total and subscale scores (B = −0.121613, p < 0.0186) and trauma symptoms on the PTSD Checklist-5 (PCL-5) (B = −0.928791, p < 0.0138). High MISSION-CJ fidelity further improved criminal justice, and behavioral health outcomes.

This was the first reported 12-month MISSION-CJ trial. While feasible to implement, given the design limitations, future research should include a large randomized controlled trial.

Despite the prevalence of co-occurring mental health and substance use disorders, the assessment and placement processes for each often remain separate. The purpose of this paper is to describe an expanded use of the American Society of Addiction Medicine (ASAM) Criteria^TM to make placements into substance use, co-occurring, and mental health treatment.

A rationale for the development of two new domains (Domain 7, substance use and Domain 8, independent living skills) and preliminary data supporting the use of the ASAM Criteria^TM as a placement process for all types of behavioral health issues will be provided.

Dimension 3 and Domains 7 and 8 were correlated with selected clinical indices in the expected direction (Dimension 3: depression (F (4, 4650)=202.092, p<0.001), medication usage (F (4, 4,637)=174.254, p<0.001), and psychotic symptoms (F (4, 4,561)=62.954, p<0.001); Domain 7: alcohol use (F (4, 4,458)=213.786, p<0.001) and drug use (F (4, 4,471)=611.491, p<0.001); and Domain 8: functional impairment (F (4, 3,927)=815.646, p<0.001) and number of “high needs” (F (4, 3,927)=737.568, p<0.001).

The limitations of this research included a lack of inter-rater reliability data and less established intake assessments.

This single placement approach for clients seeking behavioral health services can create a more efficient, person-centered intake experience.

This paper suggests that it is possible to deploy a single assessment and placement approach for all types of behavioral health issues.

The co-occurrence of mental health and substance use problems is prevalent, and has been problematic both in terms of its complexity for the person and of the challenges it poses to health care practitioners. Recovery in co-occurring mental health and substance use problems is viewed as with multiple challenges embedded in it. As most of the existing literature on recovery tends to treat recovery in mental health and substance use problems separately, it is critical to assess the nature of our current understanding of what has been described as “complex” or “dual” recovery. The purpose of this paper is to identify and discuss what persons with co-occurring mental health and substance use problems describe as facilitators and barriers in their recovery process as revealed in the literature.

The method used for this study was a small-scale review of the literature gleaned from a wider general view. Searches were conducted in CINAHL, Psych info, Medline, Embase, SweMed+, and NORART.

Three overarching themes were identified as facilitators of dual recovery: first, meaningful everyday life; second, focus on strengths and future orientation; and third, re-establishing a social life and supportive relationships. Two overarching themes were identified as barriers to dual recovery: first, lack of tailored help and second, complex systems and uncoordinated services.

The recovery literature mostly focuses on recovery in mental health and substance use problems separately, with less attention being paid in the first-person literature to what helps and what hinders dual recovery.

Drug Treatment Courts (DTCs) offer a form of alternative sentencing for people who have been convicted of a crime related to drug or alcohol abuse. The work of rehabilitation in DTCs is client-centered, meaning that it takes into account all of the client’s needs that affect their life in regards to completion of the program and rehabilitation. DTCs employ teams of people made up of judges, lawyers, educators, clinicians, and community supervisors. There are specific ways that librarians might become involved with DTCs regarding both literacy and, more specifically, health literacy. Existing programs could be adapted to solve common health literacy problems of participants, and librarians could also forge relationships with DTCs. Training for librarians should include education about the health and literacy problems faced by this population so they can successfully connect DTC participants with people and information that will contribute to their success completing the program and building healthier lives. This chapter looks to established best practices within DTCs and to some current related programs within public libraries to find grounds for expanding services to this population.

The purpose of this paper is to explore addiction service users’ experiences of psychological interventions for depression symptoms, with an emphasis on understanding obstacles to engage with treatment.

This was a thematic analysis of semi-structured interviews with ten people who took part in a randomised controlled trial of cognitive and behavioural interventions; four of whom never engaged with treatment.

Five prominent obstacles to access therapy were: memory deficits, becoming overwhelmed by multiple demands and appointments, being housebound due to fluctuations in mental health problems, tendency to avoid the unfamiliar, and contextual life problems related to deprivation and social conflict.

The authors note some possible limitations related to overreliance on telephone interviews and interviewers’ field notes. The authors discuss the findings in light of epidemiological research, cognitive, behavioural and motivational enhancement theories.

The authors propose it is important to recognise and address multiple obstacles to therapy. Offering therapy appointments that are co-located within addiction services and time-contingent to other social/medical interventions may help to address some of these obstacles.

The present qualitative results complement the prior experimental research and enrich the understanding of how to maximise engagement with psychological interventions.