Coexisting Disorders Addiction Treatment

Drug addiction frequently occurs along with other mental disorders. As many as 6 out of 10 people with an illicit substance abuse disorder also suffer from another mental illness. The rate of coexisting addiction and mental disorders are similar for users of licit drugs like tobacco and alcohol. For these individuals, any one condition becomes more difficult to treat as another condition presents itself. Thus, doctors should assess patients entering treatment for a substance use disorder or for another mental disorder, to determine the presence of an already occurring condition. Research indicates that treating both substance abuse and mental illnesses simultaneously in an integrated fashion is the best treatment approach for these patients.

Substance Abuse Treatment Center

The Center for Substance Abuse Treatment is a part of the Substance Abuse and Mental Health Services Administration. The Center for Substance Abuse Treatment is responsible for supporting treatment services through a block grant program, as well as for disseminating findings to the field and promoting the adoption of new research. The Center operates the 24-hour National Treatment Referral Hotline (1-800-662- HELP), which offers information and referral services to people seeking treatment programs and other assistance.

Offender Relapse

Because addiction is a chronic disease, drug relapses and returns to treatment are common features of the path to recovery, so treatment should extend over a long period of time and across multiple episodes of care. Individuals with the most severe problems can participate in treatment and achieve positive outcomes.

Rewards and Sanctions in Offender Treatment

The systematic application of behavioral management principles that underscore reward and punishment can help individuals reduce drug use and criminal behavior. Rewards and sanctions change behavior when they follow targeted behavior, swiftly and fairly. It is important to recognize and force progress toward abstinent behavior. Rewarding positively toward responsible, behavior is more effective in producing abstinent behavior. Long term positive change is better than punishing negative behavior. Nonmonetary rewards such as social recognition can be as effective as monetary rewards. A graduated range of rewards given for meeting predetermined goals can be an effective strategy.
In recovery treatments in the community, contingency management strategies use incentives or rewards, like vouchers or bus tokens, to reinforce abstinence measured by negative drug tests or to shape progress toward other treatment goals, such as program session attendance or compliance with medication regimens. Contingency management is most effective when the contingent reward closely follows the behavior monitored. Graduated sanctions, which invoke less punitive responses for early and less serious noncompliance and increasingly severe sanctions for more serious or continuing problems, are effective tools in conjunction with drug testing. The effective use of graduated sanctions involves consistent, predictable and clear responses to noncompliant behavior.

Drug Testing

Drug testing can determine when an individual is having difficulties with recovery. The first response to drug use is clinical and detected through urinalysis and results in an increase in treatment intensity or a change to an alternative treatment. This often requires coordination between the criminal justice staff and the treatment provider. A more intensive treatment approach should not be a sanction, but rather a routine progression in healthcare practice when a treatment appears less effective than expected.
Behavioral contracting can employ both rewards and sanctions. A behavioral contract is an explicit agreement between the participant and the treatment provider or criminal justice monitor or among all three. A behavioral contract specifies proscribed behaviors and associated sanctions, as well as positive goals and rewards for success. Behavioral contracting can instill a sense of procedural justice because both the necessary steps toward progress and the sanctions for violating the contract are specific and understood in advance.