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NIDA. (2004, December 1). "No Wrong Door" for People with Co-Occurring Disorders. Retrieved from

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December 01, 2004
Lori Whitten

More than 450 behavioral health professionals have committed to creating a system in which people with coexisting mental health and substance abuse problems as well as physical disorders find "no wrong door" when they seek help. Participants at the "Complexities of Co-Occurring Conditions: Harnessing Services Research To Improve Care for Mental, Substance Use, and Medical/Physical Disorders" conference, which was sponsored by NIDA and five Federal partners, acknowledged that system reform is challenging but necessary to ensure appropriate care. Achieving a service delivery system that addresses the complex needs of people with cooccurring disorders requires significant changes at the conceptual, organizational, and provider levels. One meeting cannot achieve such a major reform, but the conference brought together diverse professionals in a first step toward the goal.

Photo of a depressed woman receiving comfort

"Co-occurring disorders challenge traditional care, which addresses one disease and immediately apparent symptoms even though most patients have multiple, chronic, and compounding problems that often relapse," explained Dr. Jack Stein, chief of NIDA's Services Research Branch, in welcoming the participants to the conference held June 23 through 25 in Washington, D.C.

Conference participants—researchers, clinicians, treatment evaluation experts, advocates and policymakers, service coordinators, and representatives from Federal health agencies.

The group overwhelmingly agreed that individuals with co-occurring disorders are the "expectation rather than the exception" across all service delivery systems. Acknowledging the high prevalence and severe consequences of co-occurring conditions, the participants advocated treatment that cuts across multiple systems of care. Reshaping treatment must involve the criminal justice system—often the point of first contact for people with co-occurring disorders—and address the higher probability of homelessness, HIV, and domestic violence in this population. Coordinating or integrating care is a major challenge, however, because parallel service systems have different funding, rules, policies, and traditions. Professionals increasingly acknowledge that integrated care for co-occurring disorders is appropriate, but they need guidance on the most effective forms of integrated treatment and how to bring them to communities with limited resources.

"It is imperative that we break through the 'translational bottleneck' to get evidence-based practices in prevention, treatment, and aftercare services for coexisting disorders into the community," said NIDA Director Dr. Nora D. Volkow. "NIDA and its partners are developing standards for evidence-based practice, which is an essential step toward a goal we must achieve—ensuring reimbursement for addiction treatment services," she said, drawing applause.

"The Department organized this collaborative conference to accelerate the translation of research into practice and build the knowledge base in the area of co-occurring disorders," Dr. Stein explained. Plenary session speakers discussed the role of health services research in the effort to improve access, quality, and costeffectiveness of prevention and treatment.

Attendees participated in small-group panel sessions on specific topics, including research on particular co-occurring conditions, diagnostic tools, and integrated treatment strategies and outcomes. Interactive poster sessions encouraged collaborations and development of a research agenda.

In the panel discussions, behavioral health professionals agreed that substance abuse and mental health services are at a critical juncture, facing pressure from limited resources, changing infrastructure, rapid scientific advancements, and political and cultural shifts. In such a dynamic and complex environment, reforming systems of care to ensure "no wrong door" for people with co-occurring disorders will be challenging. Participants called on professional societies to guide clinicians on simultaneous treatment and to recognize the inappropriateness of excluding people with co-occurring conditions from treatment (see "Adults with Co-Occurring Depression and Substance Abuse Benefit from Treatment of Depression"). They called on professional groups and educational institutions to promote integrated, comprehensive services by reforming curricula, licensure and certification, and facility accreditation. Participants encouraged the Federal agencies sponsoring the conference to continue collaborative initiatives that support appropriate care for people with co-occurring disorders.