Evidence-based practices (EBPs) are interventions proven to help improve the lives of people experiencing homelessness, mental illness, or substance use issues. This includes individuals who are experiencing both mental health and substance use issues, known as co-occurring disorders. However, there has been little time for the development of EBPs specifically designed for clients with co-occurring disorders. By using what works in mental health and substance use treatment, you can improve lives.

Working in homeless service delivery you hear a lot about “evidence-based practices” or EBPs. This is for a good reason. An EBP is based on expert or consensus opinion about available evidence. It is expected to produce a measurable change in client status. EBPs have been shown to help improve the lives of some of the most vulnerable people experiencing homelessness. This includes individuals who are experiencing both mental health and substance use issues, known as co-occurring disorders.

The treatment of co-occurring disorders is a relatively new field. There has not been enough time to develop and test a large number of EBPs specifically designed for clients with co-occurring disorders. Still, there are some EBPs available to treat mental illness or substance use. SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) is a searchable online database of mental health and substance use interventions that have been reviewed and rated by independent reviewers.

EBPs for co-occurring disorders should combine both treatment elements (for example, the use of motivational strategies) and programmatic elements (for example, programs that offer multidisciplinary teams). Some of the practices identified specifically for the treatment of co-occurring disorders include:

Treatment-Level Evidence-Based Practices

At the individual treatment level, EBPs include:

• Psychopharmacological interventions, like medications such as desipramine and bupropion for people with cocaine use disorders and depression.
• Motivational interventions, like motivational enhancement therapy. This includes one or more conversational sessions between consumer and provider where progress is discussed in a non-confrontational manner.
• Cognitive-behavioral interventions, such as contingency management, which offers rewards for adherence to program rules.

Program-Level Evidence-Based Practices

At the program level, some intervention models have proven effective in producing positive clinical outcomes for individuals with co-occurring disorders. These include:

• Modified Therapeutic Communities: a comprehensive treatment model developed specifically for individuals with co-occurring disorders. The 12- to 18-month residential treatment program is structured and active. Staff members function as role models, rational authorities, and guides.
• Integrated Dual Disorders Treatment: where clinicians provide services for both mental illness and substance use at the same time.
• Assertive Community Treatment: a team treatment approach designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support.

While these models have proven effective in some settings, most EBPs are not universally applicable to all communities, treatment settings, or clients. Your clients might have health, cultural, socioeconomic, or other issues that complicate service delivery.

EBPs may require that staff are trained in specific skills, and may require certain facilities, and resources. Integrating new treatment approaches requires support from all levels of an agency, including leaders, administrators, and direct service staff. Agencies must ensure that their environments and staff are well equipped to provide the EBP and evaluate its effectiveness.

The information in this article is drawn from “COCE Overview Paper No. 5 – Understanding Evidence-Based Practices for Co-Occurring Disorders.”

Visit SAMHSA’s Co-Occurring Center for Excellence to learn more about evidence-based practices for about co-occurring disorders.