Addiction Treatment Services Research

This section of the Dartmouth Psychiatric Research Center focuses on research with co-occurring substance use and psychiatric disorders in addiction treatment settings. Our goal is to improve the chances for successful recovery among those with these disorders.

Cognitive behavioral therapy for posttraumatic stress disorder in community addiction treatment

In NIDA-funded research, a cognitive behavioral therapy (CBT) has been developed for persons with co-occurring substance use and posttraumatic stress disorder (PTSD) in community addiction treatment programs. Within the stage model of behavioral therapy development, Stage I Phase I (Safety and Practicality) and Stage I Phase II (Feasibility Study) studies have been completed. Thus far, CBT for PTSD has shown promise for its positive effects on PTSD symptoms, substance use and treatment retention. In the study presently underway, Stage I Phase III Randomized Pilot Trial, CBT for PTSD is being compared with an adaptation of Individual Drug Counseling (IDC). Patients are being recruited from 4 community intensive outpatient programs and 2 methadone maintenance clinics and randomized to CBT or Individual Addiction Counseling (IAC).

For information about the Cognitive Behavioral Therapy for PTSD in Addiction Treatment Programs: Therapist Manual, Client Workbook, and Adherence and Competence Index Manual, please contact Chantal.A.Lambert@Dartmouth.edu

The following materials are available for downloading:

For more information contact: Chantal.A.Lambert@Dartmouth.edu

Assessing the capacity of addiction and mental health treatment services to address co-occurring substance use and psychiatric disorders: DDCAT Index and DDCMHT Index

In research funded by the Robert Wood Johnson Foundation Substance Abuse Policy Research Program and by SAMHSA Co-Occurring State Incentive Grants, a measure designed to assess addiction treatment services capacity for co-occurring disorders has been developed. This measure, the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index, is being used to assess public and private sector addiction treatment services at agency, regional and state system levels. The DDCAT method is based on observational, interview and material review data gathered during a site visit. These data are then used to complete ratings on 35 benchmarks regarding policy, clinical practice and workforce domains. There are seven dimensional or scale scores derived on the measure: Program Structure; Program Milieu; Clinical Practice: Assessment; Clinical Practice: Treatment; Continuity of Care; Staffing; and, Training. Programs receive scores and a graphic profile on these dimensions, and based upon overall performance are categorized as: Addiction Only Services (AOS), Dual Diagnosis Capable (DDC) or Dual Diagnosis Enhanced (DDE). The index was developed and tested in community addiction treatment programs and systems. Psychometric studies have also been conducted. Presently, applications of the DDCAT are in progress in at least 20 state systems and internationally, and the index is also being used to assess private treatment programs and systems. Current research is focused on: 1) refining the instrument for content, scoring and interpretation; 2) linking DDCAT scores with patient and program level outcomes; and 3) adapting the index for mental health (DDCMH) and general healthcare (DDCHS) settings.

The following materials, pertaining to the DDCAT, are available for downloading:

The following materials are available upon request:

McGovern, M.P., Matzkin, A.L., Giard, J.A. (2007). Assessing the Dual Diagnosis Capability of Addiction Treatment Services: The Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index. Journal of Dual Diagnosis, 3: 111-123.

Developed by Heather Gotham, Jessica Brown, Joseph Comaty and Mark McGovern, the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) is an adaptation of the DDCAT for application in mental health settings. The DDCMHT framework and method are identical to the DDCAT, but it is intended for use to evaluate the capacity of mental health services policy, practice and workforce to address persons with co-occurring disorders. Programs receive scores and a graphic profile on the seven dimensions, and based upon overall performance are categorized as: Mental Health Only Services (MHOS), Dual Diagnosis Capable (DDC) or Dual Diagnosis Enhanced (DDE).

The following materials, pertaining to the DDCMHT, are available for downloading:

The following materials, pertaining to both the DDCAT and DDCMHT, are available for downloading:

Below are recent presentations of DDCAT or DDCMHT findings at national addiction or psychiatric services research conferences:

Addiction Health Services Research Meeting (San Francisco, California, October 2009):

Claus, R., Riedel, E., Homan, M.E., & Winton, S. Co-Occurring Capability and Collaborative Partnerships: Understanding the Service Linkages of Substance Abuse and Mental Health Programs
Claus, R., Winton, S., Homan, M.E., & Riedel, E. Staff Turnover and Change in Co-Occurring Capability
De Lu, D., Using an Assessment Tool as a Way to Improve Treatment for Co-Occurring Disorders
Gotham, H.J., Brown, J.L., Comaty, J.E., McGovern, M.P., & Claus, R.E. The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index
McGovern, M.P. Addiction Treatment Services Research and Co-Occurring Psychiatric and Substance Use Disorders: National and State Systems Perspectives

Addiction Health Services Research Meeting (Boston, Massachusetts, October 2008):

Giard, J.A., Morton, F., McGovern, M.P. The Connecticut Co-Occurring Practice Improvement Collaborative: Implementing Quality using the DDCAT Index

60th Institute on Psychiatric Services (Chicago, Illinois, October 2008):

Claus, R. The Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index: A nine state collaborative to enhance policy and implement evidence-based practices for persons with co-occurring disorders

Annual Meeting of the College on Problems of Drug Dependence (San Juan Puerto Rico, June 2008):

Lee, N., Cameron J., Harney, A. Improving capacity of drug treatment workers to manage co-occurring mental health disorders among AOD clients

5th Annual COSIG Grantee Meeting (Bethesda, Maryland, May 2008):

McGee, T.M. Louisiana COSIG Data Warehouse & Decision Support System
McGee, T.M. From Assessment to Planning to Implementation: Louisiana's Utilization of the DDCAT

Louisiana Integrated Treatment Services (LITS) Leadership Summit (Lafayette Louisiana, May 2008):

Brown, J., Comaty, J.E., McGovern, M.P. DDCAT State Collaborative & Research Opportunities

Addiction Health Services Research Meeting (Athens, Georgia, October 2007):

McGovern, M.P. & Giard, J.A. Services Research on Co-Occurring Disorders: Application of the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index
Brown, J.L. & Comaty, J.C. Statewide Utilization of the DDCAT: Reliability and Feasibility
Claus, R., Gotham, H., Harper-Chang, L., Selig, K. & Homer, L. Leadership Style in Dual Diagnosis Capability Does Transformational Leadership Make a Difference?
Gotham, H., Claus, R., Selig, K. & Homer, L. A. Predictors of Change in Capability to Provide Treatment Services for Clients with Co-Occurring Substance Use Disorders and Mental Illness

Mangrum, L. Dual Diagnosis Capability in Addiction Treatment: A Comparison of Client Characteristics and Treatment Outcomes

The Robert Wood Johnson Foundation Substance Abuse Policy Research Program
Annual Meeting (Amelia Island, Florida, December 2007):

McGovern, M.P., Becker, K., Lambert-Harris, C. The Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index: A Six State Collaborative to Enhance Policy and Implement Evidence-Based Practices for Persons with Co-Occurring Disorders

For more information contact: Chantal.A.Lambert@Dartmouth.edu

Addiction treatment services research focused on youth with co-occurring disorders

These research studies are funded through sub-contracts on grants from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (Effective Adolescent Treatment Services; Treatment Infrastructure Grant), the New Hampshire Charitable Foundation (New Futures' Adolescent Treatment Initiative), and the Robert Wood Johnson Foundation (Reclaiming Futures). These studies involve an analysis of data gathered nationally, and in the states of New Hampshire and Vermont, using the Global Appraisal of Individual Needs (GAIN) scale. The GAIN is a structured clinical interview designed to assess substance use and related problems, and is widely implemented across the United States. Our research specifically focuses on an analysis of data collected within these studies, and in examining the characteristics and outcomes of youth with co-occurring disorders. Current research studies the differential response of youth to an evidence-based practice (Motivational Enhancement Therapy/Cognitive Behavioral Therapy-5 session version) by co-occurring problem type: No problem; Internalizing psychiatric problems; Externalizing behavior problems; or, both internalizing and externalizing problems.

For more information contact: Chantal.A.Lambert@Dartmouth.edu

Community addiction treatment provider surveys

In order for research findings to translate from "bench to bedside", a better understanding of the needs and motivations of the addiction treatment community is essential. These studies involve completed research in two areas: 1) A survey of addiction treatment providers' readiness to adopt evidence-based practices, and 2) Surveys of addiction treatment providers' current practices and perceived barriers to offering effective treatments for persons with co-occurring disorders.

The following materials are available upon request:

McGovern, M.P., Fox, T.S., Xie, H., Drake, R.E. (2004). A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system. Journal of Substance Abuse Treatment, 26: 305-312.
McGovern, M.P., Xie, H., Segal, S.R., Siembab, L., Drake, R.E. (2006). Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices and barriers. Journal of Substance Abuse Treatment, 31: 267-275.
McGovern, M.P., Xie, H., Acquilano, S., Segal, S.R., Siembab, L., Drake, R.E. (2007). Addiction treatment services and co-occurring disorders: The ASAM-PPC-2R taxonomy of program dual diagnosis capability. Journal of Addictive Diseases, 26(3): 27-37.

The quadrant model of co-occurring substance use and psychiatric disorders

This research, funded by the Robert Wood Johnson Foundation Substance Abuse Policy Research Program (Robin Clark, PI), involved an analysis of Medicaid data across six state systems during 1999. Claims data were categorized by co-occurring disorder status for exploration of service utilization patterns. Co-occurring disorder status was further grouped according to the quadrant model and tested for reliability (consistency across six states) and validity (correspondence with treatment utilization). This research highlighted the need to engage providers, such as emergency departments, hospitals and courts, where many patients with co-occurring disorders are most likely to obtain services. This research also found high rates of persons in quadrant III (high substance severity, low psychiatric severity) among Medicaid recipients, and in particular among persons below the age of 25. In the second study, the reliability and validity of the quadrant model was also supported.

The following materials are available for downloading:

Clark, R.E., Samnaliev, M., McGovern, M.P. (2007). Treatment for co-occurring mental illness and substance use disorders in five state Medicaid programs. Psychiatric Services, 58(7): 942-948.
McGovern, M.P., Clark, R.E., Samnaliev, M. (2007). Medicaid beneficiaries with co-occurring substance use and psychiatric disorders: A multi-state application of the quadrant model. Psychiatric Services, 58(7) 949-954.

Co-occurring substance use and psychiatric disorders in addiction treatment: Reviews and critical analyses

The following materials are available for downloading:

McGovern, M.P., Wrisley, B.R., Drake, R.E. (2005). Relapse of substance use disorder and its prevention among persons with co-occurring disorders. Psychiatric Services, 58(7): 1270-1273.

The following materials are available upon request:

McGovern, M.P., Carroll, K.M. (2003). Evidence-based practices for substance use disorders. Psychiatric Clinics of North America, 26: 991-1010.
McGovern, M.P., Wrisley, B.R., Drake, R.E. (2005). Substance use relapse and it prevention: Implications for persons with co-occurring substance use and psychiatric disorders. Psychiatric Services, 56(10): 1270-1273.
Mueser K.T., Drake, R.E., Turner, W., McGovern, M.P. (2006). Comorbid substance use disorders and psychiatric disorders. In W.R. Miller, K.M. Carroll. (Eds.). Substance Abuse: What Science Tells Us, and What We Should Do About It. NY: Guilford Press, pp. 115-133.
Crouse E., Drake K.M., McGovern, M.P. (2007). Co-existing substance use and Axis II Personality disorders. In A. Baker, R. Velleman (Eds.). Clinical handbook of co-existing mental health and drug and alcohol problems. London UK: Brunner Rouledge, pp. 309-328.