Background

Individuals with co-occurring psychiatric and substance disorders are increasingly recognized as a population that is highly prevalent in both addiction and mental health service systems, associated with poor outcomes and higher costs in multiple domains. In addition, they have long been recognized to be “system misfits ” in systems of care that have been designed to treat one disorder only or only one disorder at a time. Thus, instead of being prioritized for attention, these individuals with challenging problems are made more challenging because the systems of care in which they present have significant regulatory, licensing, and reimbursement barriers to the implementation of successful treatment. In spite of these system barriers, there has been increasing accumulation of evidence supporting a range of “best practice ” treatment programs and interventions in this population, summarized recently in the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Report to Congress on Co-occurring Disorders [1] and in the Center for Substance Abuse Treatment’s (CSAT) soon to be released Treatment Improvement Protocol on Co-occurring Disorders. [2] There is less information availabl