A couple of decades ago, the terms "dual diagnosis," and "co-occurring
disorders" emerged, recognizing the significant percentage of individuals
who struggle with both substance abuse and mental illness.
Fragmentation of the existing public-sector treatment delivery system and
inadequacies in treatment approaches became apparent and were
identified as limiting the success of rehabilitation efforts.
In reaction, efforts were made to reduce fragmentation of treatment
delivery systems and improve treatment approaches (i.e., increase
dissemination of information about advances in treatment, efforts to
improve communication/coordination between substance abuse and
mental health providers, and the promotion of "parallel treatment").
More recent literature encourages progressing beyond parallel treatment to
the development of integrated treatment models and comprehensive treatment by one provider.
Numerous treatment models emerged integrating aspects of existing
substance abuse and mental health treatment (Carey 1996; Mercer et al.
1998; Minkoff 1996; Ziedonis & Trudeau 1997). Unfortunately, these
integrative approaches have not been widely adopted.
Several factors impede the adoption of integrated treatment (e.g.,
differences in clinical training among providers, restrictions from
licensing and governing bodies, billing practices and payment sources,
limited transfer of information between
research and treatment providers, etc.).
A salient factor limiting treatment integration is associated with how the
dual diagnosis population is viewed. Typically, dual diagnosed individuals
are seen as predominantly having a combination of mental health
and substance abuse problems that need to be addressed. Clinical
experience and research show this view to be narrow. The problems this
population experiences are far more complex and extend into a greater
variety of life areas.
Clinician training biases the clinician to focus on either
mental health or substance abuse treatment. This unilateral training focus,
not only impedes integration of substance abuse and mental health
approaches, but also is inconsistent with the development of a broader,
more holistic model.
This comprehensive, holistic model should outline the different life dimensions
constituting an individual's functioning, and the interconnectedness among
such dimensions. This model should organize current treatment
approaches and facilitate the development of future treatment
interventions. Integration of this model into one's practice should be
supported by assessment/treatment planning instruments consistent to the
model. The MTM achieves the above objectives.