- Dual diagnosis is an expectation, not an exception.
- All ICOPSD (Individuals with co-occurring psychiatric and substance
disorders) are not the same; the national consensus four quadrant model
for categorizing co-occurring disorders (NASMHPD, 1998) can be used as a
guide for service planning on the system level.
- Empathic, hopeful, integrated treatment relationships are one of the
most important contributors to treatment success in any setting;
provision of continuous integrated treatment relationships is an
evidence based best practice for individuals with the most severe
combinations of psychiatric and substance difficulties.
- Case management and care must be balanced with empathic detachment,
expectation, contracting, consequences, and contingent learning for each
client, and in each service setting.
- When psychiatric and substance disorders coexist, both disorders
should be considered primary, and integrated dual (or multiple) primary
diagnosis-specific treatment is recommended.
- Both mental illness and addiction can be treated within the
philosophical framework of a "disease and recovery model" (Minkoff,
1989) with parallel phases of recovery (acute stabilization,
motivational enhancement, active treatment, relapse prevention, and
rehabilitation/recovery), in which interventions are not only
diagnosis-specific, but also specific to phase of recovery and stage of
change.
- There is no single correct intervention for ICOPSD; for each
individual interventions must be individualized according to quadrant,
diagnoses, level of functioning, external constraints or supports, phase
of recovery/stage of change, and (in a managed care system)
multidimensional assessment of level of care requirements.
- Clinical outcomes for ICOPSD must also be individualized, based on
similar parameters for individualizing treatment interventions.
- The system of care operates in partnership with consumers, family
members and concerned significant others and a continuous effort is made
to involve the individual and the family at the system, program and
individual levels.
