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Organizational Capacity to Address Co-occurring Substance Use and Psychiatric Disorders: Assessing Variation by Level of Care

Lambert-Harris, Chantal MA; Saunders, Elizabeth C. BA; McGovern, Mark P. PhD; Xie, Haiyi PhD

doi: 10.1097/ADM.0b013e318276e7a4
Original Research

Objectives: There is widespread recognition that services to persons with co-occurring substance use and psychiatric disorders should be accessible, yet most persons with these disorders do not receive care for both problems. Estimates of available services vary widely and have not examined potential variation by level of care.

Methods: The present study samples 180 community addiction treatment programs and utilizes a standardized observational assessment of these programs using the dual diagnosis capability of addiction treatment (DDCAT) index. By level of care, the sample consisted of 53 outpatient programs, 50 intensive outpatient programs, and 77 residential programs.

Results: Overall, approximately 81.1% of programs across levels of care offered addiction-only services, 18.3% dual diagnosis capable services, and less than 1% dual diagnosis enhanced services. Relative to residential and intensive outpatient programs, outpatient programs were more likely to have greater dual diagnosis capability (dual diagnosis capable services). Outpatient programs scored significantly higher on the DDCAT dimensions associated with program policies and continuity of care. Specific DDCAT benchmark items revealing detailed differences were found in these dimensions and specific assessment and treatment practices. Access to physician-prescriber or to psychotropic medications did not differ by level of care.

Conclusions: The findings suggest that across levels of care, addiction-treatment systems and programs must continue to improve capacity for patients with co-occurring disorders. The application of a standardized, objective, and observational instrument may be useful to guide and measure the effectiveness of these efforts.

From the Department of Psychiatry (CL-H, MPM), Dartmouth Psychiatric Research Center (ECS), and Department of Community and Family Medicine (HX), Geisel School of Medicine at Dartmouth, Lebanon, NH.

Send correspondence and reprint requests to Mark P. McGovern, PhD, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, 85 Mechanic St, Ste B4-1, Lebanon, NH 03766. E-mail:

Supported by a Robert Wood Johnson Foundation Substance Abuse Policy Research Program grant (Grant no. 63110) and by the Substance Abuse and Mental Health Services Administration Co-Occurring Disorder Implementation and Innovation (8732).

The authors declare no conflicts of interest.

Received February 17, 2012

Accepted September 30, 2012

© 2013 American Society of Addiction Medicine