The IDDT Model In Dual Diagnosis Care

People in recovery for substance use disorder may also need support to manage their mental health. Though not everyone with a drug or alcohol addiction has a diagnosable mental illness, such is the case for nearly 40% of U.S. adults with addiction, according to the National Institute on Drug Abuse (NIDA).

The integrated dual disorder treatment (IDDT) model is an evidence-based practice used in some treatment centers. IDDT simultaneously provides recovery support for substance use and mental health disorders for people who need it.

Learn about the IDDT model in dual diagnosis care, how it works, and some of the key benefits.

The Intersection Of Mental Health And Substance Abuse

About four in 10 people with an alcohol or drug addiction also have a mental health disorder; this is referred to as co-occurring disorders. Many of them may be unaware of their mental health condition prior to entering treatment. In some cases, the mental health disorder precedes the substance use disorder and vice versa, and in other cases, they exist independently of each other.

Many people begin using alcohol and drugs experimentally. Over time, these people may inadvertently learn to use substances to cope with the symptoms of a mental illness they aren’t aware exists, otherwise known as self-medicating. Because they aren’t aware of their mental illness, they probably aren’t receiving treatment for it—and they don’t know that it’s contributing to their substance abuse. Substance use disorders are more common in accordance with certain mental health disorders, like depression, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), psychotic illness, borderline personality disorder, and antisocial personality disorder, according to NIDA. Self-medicating can worsen the symptoms of a mental health disorder and even trigger new ones.

In other cases, chronic drug and alcohol abuse can cause changes to the brain’s chemistry, thereby triggering mental illness. For example, the U.S. Department of Justice reports that long-term use of MDMA, also known as ecstasy, depletes serotonin levels, which can result in depression and anxiety. Research has also identified links between opioid abuse and depression, alcohol addiction and depression, heavy cannabis use and schizophrenia, prescription drug abuse and anxiety disorders, and cocaine abuse and bipolar disorder.

Still other people may have a mental illness and a substance use disorder that exist independently from each other. 

Long-Term Challenges Of Co-Occurring Disorders 

People with untreated co-occurring mental health and substance use disorders are more likely to experience negative outcomes.

Negative outcomes associated with untreated co-occurring disorders include:

• declines in physical and psychological health
• financial problems 
• homelessness 
• incarceration 
• increased risk of sexually transmitted diseases
• isolation 
• persisting substance abuse and relapse
• poverty 
• relationship problems
• self-harming behaviors
• suicidal ideation 
• unemployment
• violence
• worsening of chronic conditions, e.g., diabetes

What Is The IDDT Model?

The IDDT model is designed to treat people with a dual diagnosis, or with both a mental health disorder and a substance use disorder. The model uses a combination of educational, pharmacological, psychological, and social interventions to treat clients and provide support for their family members.

The IDDT model supports that long-term recovery is most effective when treatment is provided for both conditions. It suggests comorbidity, or the notion that mental illness and substance abuse affect each other. This model supports that people benefit from making small changes over time and enforces stage-based recovery.

Using the IDDT model, people can simultaneously learn the skills to support long-term recovery and manage their mental health. This model permits people to receive support for both conditions in the same facility, which is convenient in more ways than one. The IDDT model is always individualized to provide clients with the precise support they need. 

Throughout the course of treatment, there is ongoing communication and interaction between all teams involved, so as to ensure the cohesiveness and effectiveness of treatment. There is also a focus on factors that are not necessarily part of the treatment center experience, but are part of the client’s life, such as housing, employment, education, and more.

Components Of The IDDT Model

There are many components to the IDDT model that contribute to its effectiveness. 

Components of the IDDT model include:

• a multidisciplinary team, which includes an integrated substance abuse specialist
• stage-wise interventions
• access for IDDT model clients to comprehensive developmental disability services
• time-unlimited services
• outreach
• motivational interventions 
• substance abuse counseling 
• group developmental disability treatment 
• family education and support on developmental disability
• participation in alcohol and drug self-help groups
• pharmacological treatment 
• interventions to promote health
• secondary interventions for substance abuse treatment non-responders 
• high-intensity services

SAMHSA’s Support Of The IDDT Model

In 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a publication about the need for improvements to treat people with co-occuring mental health and substance use disorders. Much of this publication underscored the need for an integrative model that concurrently treated both conditions, as opposed to using parallel treatment.

SAMHSA suggests six guiding principles to treat people with co-occurring disorders, which include:

1. Use a recovery perspective.
2. Adopt a multi-problem viewpoint.
3. Develop a phased approach to treatment.
4. Address specific, real-life problems early in treatment.
5. Plan for the client’s cognitive and functional impairments.
6. Use supportive systems to maintain and extend treatment effectiveness.

Use A Recovery Perspective

The recovery perspective considers two factors: that recovery is a long-term undertaking of mental, emotional, and psychological changes, and that it occurs in stages. To provide the necessary support, treatment should be administered over time and in various settings, both in and out of care facilities, and should be specific to each phase of recovery.

Adopt A Multi-Problem Viewpoint

Because co-occurring disorders affect all areas of a person’s life, treatment should consider all affected areas. In addition to treating the mental illness and addiction itself, treatment should consider housing, health care, employment, and support networks.

Develop A Phased Approach To Treatment 

A phased approach to treatment allows healthcare providers to map a plan for all stages of recovery. Clients should learn a new toolkit of skills with each corresponding phase.

According to SAMHSA, general phases of treatment include:

• engagement 
• stabilization/persuasion
• active treatment
• continuing care/relapse prevention

Address Specific, Real-Life Problems Early In Treatment

Mental health disorders and substance abuse do not exist in a vacuum, and neither does recovery. These disorders are caused by and augment behavioral, social, and emotional problems, which, in turn, affect a person’s personal and social life. Using the IDDT model, the problems addressed are specific to each client and may include housing support, employment services, financial assistance, family support, and more. 

Not only is it important to address these factors to aid in stabilization, but improvements in these areas also contribute to self-esteem and self-identity, harness a sense of belonging, and help people to develop relationships with others.

Plan For The Client’s Cognitive And Functional Impairments

In some cases, people with co-occurring disorders may experience functional impairments. These impairments can affect their memory, their ability to learn, the capacity to perform tasks, and more. Consequently, interventions must be tailored to support the client’s level of functioning.

Use Supportive Systems To Maintain And Extend Treatment Effectiveness

A stable support network is imperative to long-term recovery for co-occurring disorders. It is also true that many people with mental health and substance use disorders did not have stable support systems for much of their lives, especially during active addiction. Mutual support networks are emphasized, where both parties involved help to benefit each other. Support networks may include family, friends, faith communities, peer services, and groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Dual Recovery Anonymous.

Benefits Of The IDDT Model

One of the greatest benefits to the IDDT model is the continuity of care for lasting recovery. Another benefit comes in terms of costs, with fewer duplicated services due to treatment happening at a single location, from a single team.

The development of a strong support network through the IDDT model can help reduce the risk of relapse and the need for a return to treatment, as can careful aftercare planning. The course of recovery changes for many people after they complete treatment. No longer required to attend therapy sessions at certain times or adhere to the rules of the treatment center, it can be easy to let recovery fall by the wayside. Some people begin a step-down method, during which they enter an outpatient program after completing residential treatment. Others harness the power of fellowships, like AA and NA or alumni programs, to maintain sobriety. 

Ark Behavioral Health And The IDDT Model

Call Ark Behavioral Health today to learn about the IDDT model and other evidence-based care provided at our treatment locations.