OUTPATIENT QUALITY STUDY OF INTEGRATED TREATMENT OF MENTAL ILLNESS AND

SUBSTANCE ABUSE
A DISSERTATION SUBMITTED
Malachi Oledibe
January, 2013
School of Professional Psychology/School of Organizational Leadership
UNIVERSITY OF THE ROCKIES
Table of Contents
TOC o “1-3” h z u HYPERLINK l “_Toc347387511” CHAPTER ONE
PAGEREF _Toc347387511 h 3
HYPERLINK l “_Toc347387512” INTRODUCTION PAGEREF _Toc347387512 h
3
HYPERLINK l “_Toc347387513” 1.1. General statement PAGEREF
_Toc347387513 h 3
HYPERLINK l “_Toc347387514” 1.2. Purpose of the study PAGEREF
_Toc347387514 h 7
HYPERLINK l “_Toc347387515” 1.3. Importance of the study PAGEREF
_Toc347387515 h 10
HYPERLINK l “_Toc347387516” 1.4. Contribution to field of
specialization PAGEREF _Toc347387516 h 12
HYPERLINK l “_Toc347387517” 1.5. Research Implications PAGEREF
_Toc347387517 h 13
HYPERLINK l “_Toc347387518” 1.6. The Conceptual framework PAGEREF
_Toc347387518 h 14
HYPERLINK l “_Toc347387519” 1.6.1. Integrated treatment: a complex
definition PAGEREF _Toc347387519 h 14
HYPERLINK l “_Toc347387520” 1.6.2. Stages of an integrated treatment
plan PAGEREF _Toc347387520 h 14
HYPERLINK l “_Toc347387521” 1.6.3. Benefits of integrated treatment
PAGEREF _Toc347387521 h 15
HYPERLINK l “_Toc347387522” 1.7. Research questions and hypotheses
PAGEREF _Toc347387522 h 15
HYPERLINK l “_Toc347387523” 1.8. Overview of research design
PAGEREF _Toc347387523 h 17
HYPERLINK l “_Toc347387524” 1.9. Definition of terms PAGEREF
_Toc347387524 h 18
HYPERLINK l “_Toc347387525” 1.10. Assumptions and Limitations
PAGEREF _Toc347387525 h 19
HYPERLINK l “_Toc347387526” 1.11. Summary PAGEREF _Toc347387526 h
20
HYPERLINK l “_Toc347387527” Reference PAGEREF _Toc347387527 h 22
CHAPTER ONE
The term co-occurring disorders has a broad usage, but it is mostly used
to describe the co-occurrence of the mental health problem and substance
abuse. It can be used to describe minor situations such as the
co-occurrence of depression and alcoholism or severe condition such as
the co-occurrence of psychosis and cannabis abuse. In addition, the
terms can be used to explain the co-occurrence of intellectual
disability and mental illness. The dual diagnosis requires the
distinction between pre-existing mental illness and substance induced
psychiatric symptoms. The interventions require the same team of
clinicians working in one setting to address the two challenges in an
integrated fashion (Burnam & Watkins, 2012). According to Claus & Homer
(2011) the integrated treatment model eliminates the need for
negotiation with clinical teams and programs. This is because the
clinicians combine the interventions into single coherent package.
General statement
The comorbidity between the drug abuse and mental illness has been a
common phenomenon for many centuries. Several studies have tried to
establish the relationship between substance abuse and mental illness.
According to Frisher, Crome, Martino & Croft (2009) comorbidity between
the drug abuse and mental illness is a reflection of a high frequency of
psychopathology conditions and high risk for drug use in subjects with
mental illness. In addition, the study identified that the high rate of
comorbidity between the substance abuse and mental illness results from
the common contributing factors and brain substrates. The main
contributing factors include stress and posttraumatic stress disorders
(PTSD). However, the two main determinants of the relationship between
substance abuse and mental illness are highly entangled to each other.
The effects of stress are prominent when the victim of substance abuse
is suffering from posttraumatic stress disorder because the stressors
trigger the disorder. The accentuated stress response to PTSD triggers
the sedative hypnotics as the means to relieve the PTSD symptoms. Both
drug abuse and PTSD activate the stress circuit in the human brain. The
two contributing factors have common process such as sensitization and
conditioned response. The sensitization makes the drug abuser sensitive
to drug while conditioning makes the drug abuser suffering from PTSD
develop aversive stimuli. The high correlation between the two
contributing factors further complicates their co-treatment. The
results of the study conducted by Birks (2012) indicated that a mental
illness increases the use of addictive substances by 20 % for alcohol,
27 % cocaine, and 27 % cigarettes. To arrive at these figures, the study
defined the mental illness as the abnormality, emotion, and social
function, which is at the severe level. The study identified that the
total of 38 % of the amount of alcohol, 43 % of the total cocaine, and
40 % of all cigarettes are consumed by individuals with existing mental
illness. In addition, Birks (2012) suggested that the co-occurrence of
the mental illness and drug abuse has been known for decades, but the
development of integrated treatment option under one roof has been
lacking for long.
Despite the high demand for effective treatment of the co-occurring
disorders, researchers who advocate for the combined therapy for mental
disorders and drug addiction have faced several challenges. According to
Cherry (2011) the key to success of the combined therapy of drug abuse
and mental illness of co-occurring disorders is to overcome its
resistance, which occurs at different levels of administration. In
addition, the scientific-based evidence of the benefits ensuring the
combined therapy approach as compared to the fragmented approaches has
been used for a long time. The main resistance is faced at the provider
level as a result of the eligibility requirements. Clayton, Bennett &
Bellack (2012) identified that most of the mental health care provider
find it difficult to verify the patient’s mental illness diagnosis
until the problem of active substance abuse is put under control.
Moreover, lack of scientifically proven benefits of the collaborative
treatment of the co-occurring disorders has limited the administration
of medical drugs because of the fear that medical treatment might
co-interact with the abused drugs. According to Burnam & Watkins (2012),
failure to recognize the benefits of integrated treatment of
co-occurring disorders have resulted in delayed establishment of
collaborative efforts to counter the challenge in the United States of
America. Health facilities in many states still apply the systematic
split between the mental health and substance addiction services.
The fragmented treatment models face several challenges, which limit
their effectiveness in delivering healthcare to patients with
co-occurring disorders. According to Bukstein, (2009) the fragmentation
of the two services results mainly from organizational barriers, which
pose significant barriers to the integration of the health care services
related to the co-occurring disorders. The patients suffering from
co-occurring disorders are forced to visit separate systems in both
public and private institutions of health, contacting different
agencies, and multiple providers. In addition, lack of suitable linkages
between providers and organizations force the patients to coordinate
their own care, which pose a significant challenge to the patients
experiencing functional impairment resulting from co-occurring disorders
(Sciacca, 2011). The fragmented system of care for the co-occurring
disorders is ineffective and in both the clinical set up and in relation
to the cost involved. The alternative to counter these challenges is the
integration of the two streams to improve the health care services of
patients with both mental disorders and substantive disorders. The
available studies have focused on the relationship between mental
illness resulting from schizophrenia and psychosis with commonly abused
substances such as alcohol and cocaine. However, the limitation of many
studies is that they have failed to address the benefits of integrating
the treatment for these co-occurring disorders in a vivid and convincing
way. This have resulted in the persistence of the fragmented health
care, which is expensive and inefficient (Frisher, Crome, Martino &
Croft, 2009). This study will address this shortage of information on
the benefits of integrated health care system for the co-occurring
mental and substance addiction disorders. This will be achieved by
conducting an investigation on the patients suffering from the
co-occurring disorders in an outpatient set up.
Purpose of the study
The purpose of this study is to evaluate the effectiveness of the
integrated model in treatment of co-occurring substance abuse disorders
and mental illness in Kansas City. This research aims at measuring the
effectiveness of outpatient therapeutic services of Individual Therapy
(IT), Medication Management (MM) & Substance Abuse Treatment (SAT) on
individuals with co-occurring disorders. The study will also investigate
the potential benefits of an integrated model for treating patients
suffering from co-occurring disorders of mental illness and substance
addiction in an outpatient setting of Swope Health Services located in
Kansas City, MO. In addition, this study targets at creating awareness
of an integrated model and stimulating the interests of the stakeholders
in the healthcare sector including the administrators, psychologists,
social workers, nurses, families, and communities. This will agitate the
responsible authorities in the health dockets and arouse their will to
replace the parallel health plan with an integrated model. This will
consequently improve efficiency and reduce the cost of treating the
co-occurring disorders (Braude & Niki, 2011). Additionally, the study
will document the benefits of an integrated model in a stunning manner
to overcome the organizational barriers of integrated health care
system, which have resulted in the persistence of the fragmented
healthcare plan (Sterling, Chi, & Hinman, 2011).
Despite the enormous studies conducted on the treatment of the
co-occurring disorders, there are several reasons, which justify the
pursuance of this theme. First, the separate plans for treatment of
mental illness and substance use disorders does not provide an
appropriate condition for engagement of patients in the treatment
procedure. The fragmented treatment often limits the engagement of the
in individuals with both serious mental illness and substance use
disorders. This is because this category of patients shows high levels
of functional impairment and often dropout the treatment (Daley &
Douaihy, 2011). In addition, the increase in the rate of development of
psychotic disorders among the patients suffering from co-occurring
serious mental illness and substance use disorders contribute to poor
engagement in the treatment process. This resulted from the
disintegration of point of services and the need for contacting
different health care providers. Secondly, people suffering from the
co-occurring disorders are often neglected at the mental health
facilities. Plapinger (2011) identified that most of the health
facilities have the capacity to handle one disorder because of
limitations such as inadequate personnel and the high rigidity of the
health systems. To illustrate the outcome of these limitations, Braude &
Niki (2011) reported that patients with co-occurring disorders are first
referred to the drug rehabilitation programs for detoxification before
commencing the mental treatment. Most of the patients under such
treatment plans easily relapsed to the drug abuse because of the
worsening mental illness. Consequently, this triggers the development of
psychiatric decomposition. The consumers suffering from co-occurring
serious mental illness and substance use disorders face many social and
economic challenges. This necessitates the research that identified the
benefits of combined therapy for the two conditions.
The pursuance of the theme of treatment of the benefits of co-occurring
disorders is timely and necessary to answer the most intriguing
questions among the stakeholders in the health sector. This study
answered the two research questions after carrying out an assessment of
the health recovery progress of 240 patients undertaking the initial
therapy treatment. First, the most frequently asked question among the
researchers is whether the integrated treatment for the co-occurring
disorders has the capacity to enhance the treatment outcomes. This study
clears the queries raised in the previous research works as to whether
the amalgamation of the two treatment processes can speed up the
recovery process and improve the treatment outcome for consumers with
co-occurring disorders. The integrated system facilitates dual recovery
and reduces the cost treatment of the co-occurring disorders (Suter,
Nelly, Carol & Gail, 2009). Secondly, this research answers the
questions as to whether the fragmented treatment plan for the
co-occurring disorders impedes the treatment for consumers suffering
from co-occurring disorders. In response to this, it is evident that the
fragmented treatment plan is inefficient and often results to relapse as
the patients pursue the treatment for one disorder at a time. In
addition, the fragmented treatment procedure reduces the motivational
aspect that is most necessary for individuals with functional
impairment, who are likely to dropout the treatment (Clayton, Bennett, &
Bellack 2012). The study is important because it seeks to encourage the
stakeholders to integrate the treatment processes for the co-occurring
serious mental illness and substance use disorders. The effectiveness of
the integrated treatment program will identified by analyzing the data
collected on the improvement of the recovery process and expressed as a
percentage of clients who give positive response at different stages
treatment.
The theme of integrated treatment of co-occurring disorders lay squarely
within the discipline of social science. Qualitative research is the
most suitable technique to help in the enquiry of the controversial
issues regarding the integrated treatment for the co-occurring
disorders. This approach helped in gathering the in-depth understanding
the impact of the integrated treatment in relation to the fragmented
treatment. The main methods employed in this qualitative study include
observation, interview, and documentary analysis (Vanclay, 2012). The
qualitative method provided valuable information, which other method may
not provide. The flexibility of qualitative methods allows its
appropriation in different paradigms including positivism, critical
theories, participatory, and constructivism. The critical,
participatory, and constructivist paradigms are commensurable on certain
issues such as textual representation and intended action (Daley &
Douaihy, 2011). There are several means of establishing for the validity
in qualitative methodology. The most common ones include the peer
debriefing, member check, conformability, prolonged engagement,
negative case analysis, and interviewer collaboration (Cherry, 2011).
These methods of testing for validity make the qualitative methodologies
more reliable for this study than others methods of research.
Importance of the study
The importance of integrated care for individuals with co-occurring
conditions of mental illness and substance abuse cannot be
under-estimated. For example, people with co-occurring disorders rarely
receive treatment in one setting, and they are often referred to other
facilities to negotiate in separate service systems. Plapinger (2011)
reported that the fragmented health care plan is complicated
bureaucratic, and service delivery is often delayed. The complications
of the fragmented health care system for the co-occurring disorders
overwhelm the patients suffering from cognitive impairment, therefore,
hampering their ability to participate in the treatment process. In this
respect, this study is significant because it emphasized on the
importance of translating the available and emerging information on the
advantages of the integrated treatment plan into action. The successful
implementation of the integrated treatment plan will result in reduced
cost of treating the co-occurring serious mental illness and substance
use addiction improve the efficiency, and outcome of the treatment
process (The US Department of Health and Human Services, 2009).
This research evaluated the effectiveness of combined therapy and
promotion of holistic treatment modality among healthcare providers,
psychologists, social workers, healthcare administrators and treatment
facilities. Increased awareness and the collaborative practice of
integrated treatment of drug and mental illness will be served from the
same place by the same providers. The consumers with co-occurring
disorders will enjoy quality of life, better treatment outcomes,
decreased drug abuse, mental health problems, live productive lives in a
safer environment, decreased burden of health problems, and improved
social and coping skills. Additionally, the study outlines the
integrated health care system as a stage-wise process, meaning that it
is a process and not an event. The main stages of implementation include
motivational, cognitive-behavioral therapy, relapse prevention, and
self-help groups (Braude & Niki, 2011). The clear outline of the
treatment strategy will ease the implementation process.
Contribution to field of specialization
The successful completion of this study will provide an appropriate
ground in advocating for the replacement of the fragmented treatment
with an integrated treatment plan. This was achieved by the
establishment of the benefits of the integrated treatment plan for the
co-occurring disorders compared to the parallel treatment plan. The
information contained in the findings of this research provides the
psychologists and healthcare providers with suitable grounds to advocate
for the holistic treatment of the co-occurring disorders. In addition,
the findings will assist the providers to prepare for additional
challenges and receive more training in both substance abuse and mental
problems so that the problems can be assessed and treated holistically.
This will minimize the barriers in seeking for treatment as the case of
parallel treatment. In describing some of the barriers of lack of
integrated treatment, Sterling et al (2011) reported that health care
providers have different training, skills, experience, and educational
levels. Mental health providers often do not provide treatment for
individuals with substance abuse. On the other hand, substance abuse
counselors do not treat mental health problems. The psychologists and
healthcare providers must be aware that when both conditions are
addressed together, the clients have better treatment outcomes and
improved quality of life.
Currently, there are knowledge gaps in the treatment of co-occurring
disorders. Frisher, Crome, Martino & Croft (2009), identified that the
available studies fail to establish a casual relationship between the
integrated treatment and the improved treatment outcome. This study
provided background information, which contributed to the available
information on the improvement of the treatment of co-occurring
disorders. Moreover, the study established the basis for further
research towards the establishment of the benefits of integrated
treatment as opposed to the fragmented health care plan.
Research Implications
The co-occurrence of serious mental illness and substance use disorders
is currently a significant health challenge in different parts of the
world. The large number of individuals affected by the co-occurring
disorders and complex nature of the disorders seems to overwhelm the
psychologists and health attendants. According to Clayton, Bennett &
Bellack (2012) in 2011, the United States had the largest number of
individuals with co-occurring disorders in the world. It was estimated
that 5.4 million adults suffered from the co-occurring disorders in the
United States alone. The study indicated that the rate of co-occurring
disorders had an increasing trend despite the measures taken to promote
resilience and prevention.
Review of available information and case studies indicate that
comprehensive, quality integrated treatment of co-occurring disorders,
combined with the key principles of integration care have better
treatment outcomes and quality of life of consumers with co-occurring
disorders (Grella, 2009, & Sterl, 2011). The results of this research
provide sufficient information to create awareness about the importance
of integrated treatment as opposed to the parallel treatment among the
health care providers, hospitals, community mental and substance abuse
centers, clients and families, the local and state communities.
Additionally, it will sensitize the psychologists and health care
providers on negative effects, shame and rejections associated with
mental illness and substance abuse treatment and assist the providers to
make a diligent effort to accommodate individual problems in a single
setting. The study also makes it clear that the separate appointments
for consumers with co-occurring disorders do not work. This is because
clients have difficulty keeping and following up with different
appointments and healthcare providers. This reduces the efficiency and
effectiveness of a parallel treatment plan.
The Conceptual framework
In this dissertation, the concept of evidence-based integrated treatment
is understood as the plan, which provides treatment for two co-occurring
disorders from the same practitioner and at the same point of services
delivery. The concept can be applied in different aspects, but the
approach adopted in this research is focusing on the treatment of
co-occurring serious mental illness and substance use addition. The key
idea of this research is to establish the benefits associated with the
integrated treatment for the co-occurring disorders. This will create
the grounds for an informed shift from the fragmented treatment into an
integrated treatment plan.
Integrated treatment: a complex definition
Some authors state that the integrated treatment of co-occurring
disorders is a process that goes beyond the mere merging of two services
(Clayton, Bennett & Bellack, 2012). According to Claus & Homer (2011)
the integrated treatment of the co-occurring disorders targets at the
improved quality of life and high quality of services delivery for both
disorders. The key beneficiaries of the integrated treatment plan are
the individuals suffering from the co-occurring disorders. This is
because the integrated plan reduces their confusion, exclusion, and
their movements from one service point to the other. The treatment
specialists are trained to handle both disorders concurrently, and thus
providing an integrated message to patients. This is achieved by
equipping the health specialists with significant understanding of
substances that are commonly abused by consumers, their mechanism of
action, and both the short and long-term effects of abuse and addiction.
Stages of an integrated treatment plan
In 2010, the Substance Abuse and Mental Health Services Administration
(SAMHSA) developed a standard evidence-based kit for integrated
treatment for co-occurring disorders. The kit entailed the key elements
of integrated treatment, which include integrated services,
cross-trained practitioners, stage-wise treatment, motivational
interventions, cognitive-behavioral approach, multiple formats, and
integrated medication services (The US Department of Health and Human
Services, 2009). In addition, the kit outlined the key steps of stages
of an integrated treatment of co-occurring disorders. The four stages
include the client engagement, persuasion, active treatment, and
prevention of relapse. The stage wise treat allows the specialist to
assess the progress of the consumer and tailor the services according
the needs of the consumers accordingly. Motivational interventions are
applied at all stages in order to assist demoralized consumers, who at
times have functional impairment.
Benefits of integrated treatment
Studies have shown that most of fatalities of the serious mental
illness and substance use disorders are the youths aged 18-35 (The US
Department of Health and Human Services, 2009). However, the disorders
also present a significant challenge to individuals of up to 65 years of
age. The key beneficiaries of the integrated medication management
system, individual treatment and substance abuse treatment include
improved quality use of medicines, reduced drug events, better
management of medicines, improved care coordination, and contained cost
of treatment. Several authors have documented the benefits of the
integrated treatment system as to include the reduced chances of
relapse, improved recovery, better quality of life, minimized conflicts
with law enforcers, reduced cost of health, and time saving (Braude &
Niki, 2011).
Research questions and hypotheses
Research hypotheses refer to specific testable predications about the
variables used in the study. Appropriate hypotheses are couched in terms
of dependent and independent variables that are going to be used in the
research (Moriarty, 2011). This study derives its research questions
from the fact that the benefits of integrated treatment of co-occurring
disorders especially mental illness and drug abuse have long been
underestimated and utilized in outpatient treatment facilities across
the nation. In the current research, the research questions helped in
identification of the benefits of an integrated treatment model compared
to a fragmented treatment models. SANHSA (2012) defined the integrated
treatment model as a system in which patients receive concurrent
treatment for co-occurring disorders from the same setting and the same
healthcare providers. Identification of the benefits associated with
integrated treatment of co-occurring substance use disorders and mental
illness is necessary for the implementation of effective care plan. The
research questions used to achieve the objectives of this study include
the following:
How does integrated treatment of co-occurring disorders enhance
treatment outcomes and improve the quality of life?
What are the main challenges that patients suffering from co-occurring
substance abuse disorders and mental illness?
What are the key reasons for high prevalence of the co-occurring
substance abuse disorders and mental illness?
Which are the key barriers for the adoption of the integrated model for
treatment of co-occurring substance abuse disorders and mental illness?
According to Pratt (2009) hypothesis and the literature review provide
the background material to justify the pursuance of a given theme in
research. Currently, there are several studies, which have supported the
integrated treatment plan, as opposed to the fragmented treatment plan
based on its efficiency, reduced cost, and treatment outcome (Braude, &
Niki, 2011). Bukstein (2009) suggested that definitional problems such
as philosophical differences in the fields of mental health and
substance abuse and lack of prevalence data as the main barriers towards
the adoption of the integrated treatment of co-occurring disorders. The
two fields need an atmosphere for collaboration in order to achieve
effective integration. The in-depth research on the benefits of
effective collaboration in an integrated system aids in finding the
solution to the complex and multiple challenges faced by people with
co-occurring disorders in the fragmented treatment plan.
Overview of research design
The qualitative research is the most appropriate design for this
research. The research relied on three methods of data collections
(including direct observation, in-depth interviews, and review of
records). The nature of the data collected was behavioral response of
the clients under the simultaneous treatment of co-occurring disorders.
The study will relied on the tested and verified tool kit, which have
the capacity to save money time and improve reliability (Pierce, 2009).
The main instrument used in recording the data about the patients’
recovery was the Psychological General Well-Being Index (PGWBI)
questionnaire.
A sample of 86 patients from a total population of 214 male and female
patients aged between 18-65 years using simple random technique. The
patients had been enrolled for treatment of co-occurring disorders at
Swope Health Services (a drug rehabilitation center located in Kansas
City with primary focus on treatment of individuals with substance use
disorders and mental illness). More than 40,000 patients are served at
Swope`s 11 medical, behavioral and dental centers located throughout
Kansas City, MO., Independence, MO., Wyandotte Kansas, North Kansas City
and South Kansas City, MO. All the subjects in the study had DMS-1V axis
1 dual diagnosis of co-occurring substance abuse disorders and mental
illness. Simple random sampling was used in selection of the study
subjects because it is the easiest sampling technique that eliminates
the bias by offering every subject in the study population an
opportunity of being selected (Couwenberg, Gaag, Koeter & Brink, 2009).
The collected data will then be analyzed to measure variability of
different characteristics in the study subjects.
The selection of this design is based on the capacity to conduct an
inquiry into the selected theme, and its capacity to provide a profound
understanding of the human behavior and the factors governing the human
actions. In addition, the research design focuses on patterns and
themes, not on hypothetical testing. The qualitative research is
achieved through approaches that seek to explore the theme in an
unobtrusive manner to ensure that the presence of the research does not
disturb the situation (Bapir, 2011). The main strategies employed in the
realization of the key objectives of the qualitative design include
observation, documentary analysis, and interviews.
Definition of terms
Parallel treatment model– a treatment model in which the treatment of
both mental and substance use disorders occurs simultaneously, but by
different professionals (Center for Addiction and Mental Health, 2012).
Sequential treatment model- A treatment model in which a consumer with
co-occurring disorders is not eligible for treatment in one system until
the other disorder is solved or stabilized (Center for Addiction and
Mental Health, 2012).
Co-concurrent disorders- these are conditions in which a person suffers
both the mental illness and substance use disorders at the same time
(Braude & Niki, 2011).
Relapse to drug use- A situation in which a person is not able to
drug-free or sober over time (Medicine Health, 2012).
Qualitative research- refers to a form of systematic empirical enquiry
into a meaning (Pratt, 2009).
Comorbidity- refers to a situation in which two disorders or illnesses
occur simultaneously in one person (National Institute on Drug Abuse,
2012).
Motivational interventions- clinical approach designed to enhance the
client’s motivation for a positive change from the given behavior
(National Center for Biotechnology Information, 2011).
Multidisciplinary team – a team of professionals from diverse
disciplines who come together to provide a comprehensive assessment,
treatment and consultation services especially in the abuse cases
(Birks, 2012).
Evidence-based practice – a thorough integration of the best available
evidence coupled with clinical expertise in order to address a given
health care question with an evaluative and qualitative approach
(Grella, 2009).
Cost effectiveness – the outcome of a given treatment model exceeds it
relative cost (Claus & Homer, 2011).
Assumptions and Limitations
The scope of this research is to evaluate and make the data on the
effectiveness of the integrated treatment of co-occurring disorders
available. However, it is the role of the stakeholders in health sector
to utilize the findings of this research in integration of the two
settings. This study was subject to three major limitations. First, the
data collection process relied on the feedback of the patients during
the direct interviews. The subjects were interviewed and their response
about how they felt at different points in time during the treatment and
recovery recorded. The limitation arises because some patients could
give positive feedback about their recovery in order to impress the
interviewer. Secondly, given that the subjects had the mental illness it
could be difficult to get the correct data either through the direct
observation or in-depth interview. Third, data on the patients’
recovery during the simultaneous treatment of the two disorders was
collected at intervals. It could be possible that the subjects gave the
information only about how they felt at the time of feeling in the PGWBI
questionnaires. This eliminated the opportunity for the researcher to
collect the valuable data that could have helped in monitoring the
progress of the subjects in between the intervals for filling PGWBI
questionnaires.
Qualitative research is one of the most difficult approaches of inquiry.
It consists of many components, whose explanation is mainly aided by
interpretative frameworks and general assumptions. On the other hand,
the interpretative frameworks and assumptions are described using the
qualitative approaches of inquiry (Moriarty, 2011). The qualitative
case studies are exposed to a number of assumptions, and this research
is not an exemption. Similar to other qualitative case studies, this
research was based on three main assumptions. First, the researcher
assumed that the treatment and the recovery process could be similar to
all the subjects recruited in the study. It was assumed that the
feedback could be similar to all the subjects despite the fact that they
suffered from different disorder in both categories of substance use
addiction and mental illness. Secondly, it was assumed that study
population in Kansas City could act as a representative of the other
parts of the world. The study was confined within the Kansas City, while
the researcher expected that the findings could be applied in any health
system irrespective of their geographical location. The main weakness of
this research is that the data analysis process involved behavioral
coding. This could be response from the subjects was assigned three
digit codes. The behavioral analysis was also conducted in digits. This
could make it difficult for the readers to understand and derive the
meaning from the research findings, thus limiting the impact of the
research in the society.
Currently, the co-occurring serious mental illness and substance use
disorders are key challenges in different parts of the word. Most of
the scholarly and research works agree to the fact that the fragmented
treatment plan for the co-occurring disorders is inefficient and
requires drastic reforms. (Sciacca, 2011).The main challenges presented
by the parallel treatment model for the two co-occurring disorders
include frustration of the consumers as they seek for medical services
from different providers, high cost of treatment, and increased chances
for relapse (Grella, 2009). According to Claus & Homer (2011), the
consumers with the functional impairment are most likely to give up the
treatment process under the sequential or parallel model because they
are referred to different departments for treatment. The studies
reviewed in this chapter suggest that the integration of the mental
treatment services for the drug abuse disorder as the most viable
solution (Daley & Douaihy, 2011) & Cherry, 2011). These studies have
suggested several advantages that make the integrated treatment model
the best alternative. The identified benefits include the reduced cost
of treatment, effectiveness, enhanced outcome of the treatment process,
and improved quality of life of the consumer (Claus, & Homer, 2011). The
current research aimed at identification of the benefits of an
integrated treatment model. The findings will aid the stakeholders in
the medical sector include the policy makers, physicians, healthcare
providers, nurses, and administrative bodies to make an informed
decision of integrating the treatment services for the two co-occurring
disorders. However, this study limits itself within the identification
of the benefits of the integrated treatment model, and does not provide
much on the means of integrating the two treatment models.
An effective research aims at improving the current scenario, which is
better understood through a thorough review of the literature. Chapter
II of this research identifies the limitation of the sequential and
parallel treatment models. It will also establish the benefits of
individual treatment, medication management system, and substance abuse
treatment in an integrated model as identified in the few cases where it
has been tested. The chapter reviews the social economic benefits of an
integrated treatment model as well as its key principles. The data to be
used in this research will be collected using detailed interviews and
direct observation as outlined in chapter III. Chapter IV contains the
findings of the research while Chapter V provides the discussion for the
results.
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