U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Building Bridges

Co-Occurring Mental Illness and Addiction: 

Consumers and 

Service Providers,

Policymakers, and Researchers

in Dialogue

Co-Occurring Mental Illness and Addiction: 

Consumers and 

Service Providers,

Policymakers, and Researchers

in Dialogue

Building Bridges

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Acknowledgments

Numerous people contributed to the development of this 

document (see Participant List). This document was prepared for 

the Substance Abuse and Mental Health Services Administration 

(SAMHSA), U.S. Department of Health and Human Services 

(DHHS), under contract number 280-01-8054 by Karpoff and 

Associates, Albuquerque, NM. Chris Marshall and Carole Schauer 

served as the Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are those 

of the conference participants and do not necessarily reflect the 

views, opinions, or policies of CMHS, SAMHSA, or DHHS. 

Public Domain Notice 

All material appearing in this document is in the public domain 

and may be reproduced without permission from SAMHSA. 

Citation of the source is appreciated. However, this publication 

may not be reproduced or distributed for a fee without the 

specific, written authorization of the Office of Communications, 

SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication can be accessed electronically through 

the following Internet World Wide Web connection: 

www.samhsa.gov. For additional free copies of this document, 

please call SAMHSA’s National Mental Health Information Center 

at 1-800-789-2647.

Recommended Citation

CMHS. Building Bridges: Co-Occurring Mental Illness and 

Addiction: Consumers and Service Providers, Policymakers, 

and Researchers in Dialogue. DHHS Pub. No. (SMA) 04-3892. 

Rockville, MD. Substance Abuse and Mental Health Services 

Administration, 2004.

Originating Office

Center for Mental Health Services, Substance Abuse and Mental 

Health Services Administration, 1 Choke Cherry Road, 

Rockville, MD 20857.

DHHS Publication No. (SMA) 04-3892

Printed 2004

iii
iv

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
v

Contents

Introduction ....................................................................................1

 Meeting Participants and Process ............................................3

Dialogue Themes and Findings .....................................................5

 Whole-Person Focus ................................................................5

Genuine Collaboration with Providers ...................................6

Training/Education ..................................................................7

Stigma/Public Image ................................................................7

Substance Abuse and Mental Health Systems Divisions ........8

Research ...................................................................................9

Nondiscrimination and Underserved Populations ...............11

Funding ..................................................................................13

Recommendations ........................................................................15

Dissemination Strategies ..............................................................27

Conclusion ....................................................................................31

References and Resources ...........................................................33

Participant List ..............................................................................35
vi

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
1

Introduction

The growing number of persons with co-occurring mental and 

substance use disorders in the United States has precipitated a 

crisis. In 2002, Charles G. Curie, Administrator of the Substance 

Abuse and Mental Health Services Administration (SAMHSA) 

within the U.S. Department of Health and Human Services 

(DHHS), announced that addressing the needs of persons with cooccurring disorders had become one of the highest priorities for 

the agency. The problems have not been easy to solve, however. 

The crisis has been exacerbated by previously established 

separate systems of care for mental health and addictions.

The two systems of care have different approaches to (1) 

identifying key symptoms, (2) making assessments or diagnoses, 

(3) deciding between quite disparate treatment approaches, and 

(4) figuring out which State block grant funding category should 

be used to obtain coverage and reimbursement for services. The 

systems, at Federal, State, and local levels, challenge consumers 

and service providers alike, and, in some cases, create divisions 

between providers and consumers, and between the providers 

themselves.

In addition to SAMHSA, many other agencies also are working 

on this issue. The Centers for Medicare and Medicaid Services 

(CMS) have pilot projects that demonstrate simpler ways of 

administering services for co-occurring disorders. Several States 

have found ways to integrate substance abuse and mental 

health funding, to improve access to services by mandating 

nondiscrimination of persons with co-occurring disorders, 

and to certify consumers to assist in service delivery. The 

National Association of State Alcohol and Drug Abuse Directors 

(NASADAD) and the National Association of State Mental 

Health Program Directors (NASMHPD) have jointly developed a 

conceptual framework for identifying and addressing the needs of 

persons with co-occurring disorders.

On December 2, 2002, U.S. Department of Health and 

Human Services Secretary Tommy G. Thompson sent Congress 

a comprehensive report on treatment and prevention of 

co-occurring substance use and mental disorders. This 

congressionally mandated report, developed by SAMHSA, 

emphasizes that people with co-occurring disorders can and 

do recover with appropriate treatment and support services. It 

identifies many longstanding systemic barriers to such treatment 

and services, and the need for various Federal agencies, State 
2

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

agencies, providers of services, researchers, recovering persons, 

families, and others to work together to create a system that 

addresses both disorders as primary conditions. It also outlines 

a 5-year blueprint for action to improve the opportunity for 

recovery by increasing the availability of quality prevention, 

diagnosis, and treatment services for people with co-occurring 

disorders.

In addition, SAMHSA awards large State infrastructure grants to 

address co-occurring disorders and awards multiple grants that 

focus on various target populations with co-occurring mental and 

substance use disorders.

SAMHSA is promoting other efforts to help individuals with cooccurring disorders. In fall 2003, SAMHSA created the National 

Co-Occurring Disorders Prevention and Treatment Cross-Training 

Center (COCE) to foster improvement in treatment and services 

to individuals with co-occurring mental and substance abuse 

disorders. In April 2004, SAMHSA sponsored the first National 

Policy Academy on Co-Occurring Mental and Substance Abuse 

Disorders in Baltimore, Maryland. Ten State teams and more than 

150 individuals participated. The policy academy was designed 

to assist States and local policymakers in developing an action 

plan to improve access to appropriate services for people with 

co-occurring substance abuse and mental disorders. SAMHSA 

anticipates conducting two additional policy academies in 

FY 2005.

SAMHSA has extensive resource information on co-occurring 

disorders on its Web site, including reports, publications, and 

documents, and maintains an electronic discussion list. Finally, 

SAMHSA is providing technical assistance on this issue through 

the convening of national conferences and other activities. 

The Center for Mental Health Services (CMHS), within SAMHSA, 

has been given the lead in implementing the policies to improve 

the coordination of treatment and services identified by President 

George Bush’s New Freedom Commission on Mental Health. The 

Commission’s Final Report highlights the importance of convening 

participatory dialogues—a process that CMHS has used since 

1997 to bring together consumers of mental health services and 

professional service providers. In 2003, the crisis level of cooccurring disorders made it clear that CMHS should convene a 

dialogue between consumers with co-occurring mental health 

and substance use concerns and service providers, policymakers, 

and researchers. This report summarizes the meeting and the 

recommendations made by the participants.
3

Meeting Participants and Process

Twenty-three people gathered in May 2003 for the dialogue. 

Paolo del Vecchio and Chris Marshall of the SAMHSA Center for 

Mental Health Services welcomed the group and emphasized the 

importance that SAMHSA places on promoting interaction and 

dialogue between consumers and other stakeholders in mental 

health and substance use policies and programs. 

The process of the dialogue, designed by a planning committee 

of several participants and CMHS staff, and the meeting objectives 

were straightforward and supportive of participants. After the 

participants introduced themselves, the discussion focused on 

three topics: 

 Person-centered factors that hinder or promote recovery. These 

included personal experiences, values, and beliefs; consumer 

and provider expectations; and concerns related to age, 

ethnicity, and culture. 

 System-level factors that hinder or promote recovery. These 

included administrative structures and services coordination; 

research knowledge about models and best practices; funding 

and regulatory issues; and core competencies and training. 

 Recommendations for improved understanding and service 

delivery. These covered nine different areas and focused on 

themes such as consumer-driven policymaking, research, and 

services delivery; the whole-person focus; public awareness 

and education; and coalition building. 

The dialogue was conducted as a roundtable discussion. At 

the close of each discussion topic, participants offered summary 

comments to help pull together the group’s thinking to that point.
4

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
5

Dialogue Themes and Findings

Whole-Person Focus

A principal theme—one that participants returned to several 

times, from several perspectives—is that any and every individual 

seeking services must be considered in the context of his or her 

entire background—as a whole person—rather than as a set of 

individual problems to solve or resolve. Each person develops 

uniquely and has individual physical, mental, and spiritual 

concerns; all of these factors must be considered if the process of 

recovery is to be successful. Above all is the need to treat people 

with dignity. A whole-person focus represents a commonsense 

approach to understanding how best to design effective methods 

for assessment, treatment, and recovery. A symptom, even if 

severe, cannot be treated effectively in isolation from other 

aspects of a person’s being.

Several participants noted that during the assessment process 

in the service delivery system, questions related to the whole 

person rarely are asked. A person seeking services, in addition 

to exhibiting symptoms, may have a spouse or partner, a parent, 

child, or sibling; may have experienced trauma; may have legal, 

employment, or housing problems; may have concerns related to 

his or her sexual life; and may have important, rich background 

information to share, but this information is rarely discovered 

or taken into account. Other participants noted that sometimes 

background questions are asked only in the narrow context 

of filling out an assessment or intake form, or within narrow 

guidelines of a research project or program. 

The context within which assessments are conducted is a 

crucial issue. “Assessments based on the medical model focus on 

what’s wrong with the person; in recovery, it’s more important 

to focus on what’s right with the person,” said one participant. 

However, working with strengths-based approaches that focus 

on the whole person and ask questions sensitively and fully, may 

require increased interaction between a provider and a consumer. 

This may be difficult, not only because of time constraints, but 

also because focusing on these areas may expose the need for a 

long-term commitment to the process by both the consumer and 

provider, or may stretch beyond the current limits of any single 

provider’s expertise. 
6

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

Working with the whole person also requires attention to 

the internal process of recovery. Hope and community—one’s 

personal dreams and expectations, and one’s network of 

relationships—play key roles in recovery. A person’s spirituality 

also is crucial to a person’s recovery because it helps an 

individual develop his or her perspective on the world. Yet, these 

topics are difficult for consumers and providers to talk about or to 

really understand, let alone measure for efficacy.

Adopting a whole-person focus will require a basic shift in how 

services are developed, structured, and funded. Services must 

become more person-centered, rather than symptom-centered. An 

individualized, holistic approach to recovery may include services 

related to housing, employment, and other needs, as well as to 

the specific symptoms of one or more co-occurring disorders. 

One participant, emphasizing the need for an integrated, 

holistic approach, said that “it’s more than co-occurring, it’s ‘alloccurring.’”

Genuine Collaboration with Providers

Closely related to the theme of focusing on the whole person is 

the importance of involving people with co-occurring disorders 

in the design, implementation, and evaluation of all processes 

that affect them. Obtaining consumer “input” is not enough; those 

who are affected by the treatment system must be invited to 

help create the system. This is not only an issue of fairness and 

inclusiveness; it is directly related to making improvements in 

service delivery systems. Consumers have a distinctive and crucial 

role in determining appropriate, effective approaches precisely 

because recovery is an internal as well as an external process—

because it involves the whole person—and because of their 

firsthand knowledge of what works. People with co-occurring 

disorders should be regarded as peers throughout every aspect of 

the system, and partnerships based on peer relationships should 

be established in building reimbursement systems, research 

design, program implementation and evaluation, training, service 

provision, and policy development.

Forming respectful, personal relationships between providers 

and consumers becomes a priority with this orientation. An 

approach that integrates services focused on the whole person 

and based on collaboration between providers and consumers, 

requires more respectful and involved relationships—getting to 

know each other and “not hiding behind our systems or labels.” 

Although progress has been made, more needs to be done. 
7

Training/Education

In response to the need for basic shifts in the service delivery 

system, training/education was a key theme with several different 

components: 

 Changes in professional and clinical health care education and 

requirements for State licensure will be needed to support a 

collaborative model of care that considers the whole person. 

Several participants spoke of key gaps in their education and 

training—for example, few or no classes on mental health or 

substance abuse, or on the differences in medication. 

 Peer-based approaches to treatment need to be seen as basic 

components of a whole-person, collaborative approach to 

services. Peer support is critical to help people in recovery 

become engaged in the community; the firsthand experience of 

other consumers can provide tools and wisdom on a person’s 

path to recovery. One participant asked, “How [else] do we 

learn the personal interventions, techniques, and affirmations 

that are powerful in a person’s recovery?” and stated that the 

principle of “each one teach one” is crucial.

 Another participant noted that the State of Georgia has trained 

peers to serve as certified peer support specialists who can 

help consumers set recovery goals, teach self-directed recovery 

skills and social skills, and provide assistance with obtaining 

decent and affordable housing. Georgia has been able to 

obtain reimbursement for such services provided by certified 

peer support specialists through the Medicaid Rehabilitiation 

Option. 

 People with co-occurring disorders need to be trained how to 

discover what services are available and how to assist in their 

own recovery. They need to learn what is possible for them 

to achieve. One participant spoke of the need for vocational 

programs to get beyond the idea that the four “F’s”—food, 

flowers, filth, and filing—are the only kind of jobs people with 

mental disorders can handle. These types of jobs are fine, but 

they are not the only jobs people with mental or co-occurring 

disorders may be qualified to perform. 

Stigma/Public Image

The media continue to reinforce negative stereotypes of people 

with co-occurring disorders. To change these stereotypes, basic 

changes in relating to the media are required. One participant 

stated, “Until we change the images of people with psychiatric 
8

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

conditions and of drugs in Hollywood, and portray people with 

these conditions as real people, we will not see major change. 

We need different images and different stories.” It was noted 

that even supposedly sympathetic portrayals rely on mistaken 

implications and images; for instance, a few participants noted 

that the film “A Beautiful Mind” contained several inaccurate 

depictions of John Nash’s disorder and treatment. 

A different context, with different terms and definitions, is 

required to understand illness. Several participants stated:

 “We perpetuate the perception barrier of dual disorders by 

focusing on crisis interventions and more severe disorders,” 

said one participant. The term “wellness diversity” is a better 

way to describe the continuum of wellness and illness that is 

mental health.

 The term “family” should be defined according to the 

individual’s circumstances to ensure that services are not 

limited, especially during crisis situations.

 Even the term “recovery” should be better defined, as 

it encompasses both growth (emotional recovery) and 

development (skill-building).

Participants challenged each other to become more involved 

in changing images. One participant suggested a series of public 

service announcements showing “recovered faces in high places” 

and “the many faces of mental illness.” Another stated that it is 

crucial for consumers and consumer advocates to develop more 

media contacts, in order to engage in direct dialogue with media 

representatives and to become more visible in the media. Still 

another participant noted that “we do too much ‘preaching to 

the choir’ in anti-stigma campaigns,” and conduct such events in 

remote places. “We need to get out to other groups and into the 

center of the community with such efforts.” 

Substance Abuse and Mental Health Systems 

Divisions

Participants noted a number of examples of how the 

mental health and substance abuse treatment systems are 

narrowly focused and ineffective. “Our programs, systems, and 

organizations operate in ‘silos,’” said one participant, noting that 

“when real silos don’t get air, they explode.” It is difficult to find 

or obtain resources because of the narrow focus of treatment 

systems. In addition to the difficulties in obtaining services 
9

through different systems, consumers find that each system places 

a different value on specific types of behavior, so they constantly 

must conform their behavior to particular treatment approaches. 

(For instance, in treatment for substance use disorders, you might 

be allowed to get angry, but in treatment for mental disorders, 

you should never get angry.)

The meeting participants discussed the problems associated 

with the exisitng mental health and substance use treatment and 

service delivery systems that focus too heavily on crisis-oriented 

services and give relatively little priority to the promotion of 

recovery. Although it is important to be able to access services at 

a time of dire need resulting from acute exacerbation of illness, 

participants expressed their preference to see these systems focus 

more on teaching individuals how to maintain and promote 

their own health. The goal is to promote recovery and prevent a 

crisis at which time individuals may not only experience severe 

symptoms of mental illness, but may also experience preventable 

losses of personal relationships, housing, and employment. 

While noting these shortcomings and divisions within the 

present system of delivering services, participants chose to focus 

on how to build relationships between the substance abuse and 

mental health systems. It was suggested that cultural diversity 

approaches be used to bridge differences. “We must realize that 

the mental health and substance abuse systems have different 

cultures,” stated one participant. The systems have different 

mandates, histories, language, and rationales for funding. “What 

is needed is cultural competency in working with each system, to 

help stop the prejudice and blame about the respective fields and 

language.”

Research

A good deal of attention was given to the perceptions and 

possibilities surrounding research into co-occurring disorders. 

Many participants voiced concern about three major questions: 

First, what qualifies as research? Second, how should research be 

designed and conducted? Third, how do learning and innovation 

get broadly applied?

On the first question, several participants were concerned 

about the increased emphasis on “evidence-based” research. 

Very little research actually qualifies as “evidence-based,” since 

the term refers to “a large body of research in a particular field 

with a particular population.” However, many requests for 
10

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

research proposals require or prefer programs that are “evidencebased.” As one participant stated, “Having ‘evidence-based’ as a 

prerequisite for funding knocks out many proposals in certain 

populations,” including older adults, gender and sexual minority 

persons, and persons with eating disorders. Very little research 

has been done with these populations, and an “evidencebased” preference continues to lock them out of further possible 

research.

On the second question, participants strongly objected to 

research programs that do not involve people with co-occurring 

mental and substance use disorders in a meaningful way. 

Evidence-based research shifts power to institutions and academic 

researchers, and cuts into innovation. “Laboratory,” “top-down,” 

or “medical-model” research keeps consumers in the role of test 

subjects. Also, research and evaluation too often focus on the 

program, rather than on the recovery process—on how people 

integrate their own recovery with programs. It looks at the 

system dynamics, not the personal dynamics. The conventional 

view of research, with a bias toward institutions and programs, 

regarding people as test subjects, and using a narrow definition of 

“evidence-based,” reinforces an adversarial relationship between 

the researcher-observer and those being observed or tested.

On the third question, participants agreed that getting research 

results out to the field happens too slowly. There is a “literature 

lag” between formal research and what is happening in the 

field. At times, the research and academic literature do not even 

recognize current terms and approaches being used in the field. 

For instance, you cannot find references linking “dual disorders” 

with “marriage counseling” or “employee assistance programs.” 

And while research may be very good, “we don’t teach the 

people in our programs what we’re finding out,” one participant 

said. “We don’t let people in programs understand what is being 

discovered.”

What is needed, participants agreed, is a more collaborative and 

field-based approach to research. “In our field, a lot of change 

happens in the field, through trial and error,” said one participant. 

“The research doesn’t have to be evidence-based,” said another. 

“There is a need for research on innovative techniques, because 

that tells us about what’s really happening in the field.”

One of the most critical elements is to have consumer advice 

and involvement at every step, from program design through 

research implementation and evaluation. “Consumers need to be 

trained to do research, and to be on Federal [and other] advisory 
11

boards,” said one participant. This will lead to improvements 

in data quality and increased innovation, as well as to a better 

image of research. One participant stated, “I go around and 

ask researchers questions they’re not asking, because they only 

ask questions defined in the study—yet they know a lot more 

information that is very useful.” 

Also, as one participant reminded the group, research findings 

can help change policymakers’ minds, leading to legislative 

changes and funding for improved services. Cost-benefit analyses 

help legislators understand not only that treatment works, but that 

investment in research results in more effective and less expensive 

care.

SAMHSA can play a leadership role in this area. Participants 

recommended a closer relationship between SAMHSA and the 

National Institutes of Health (NIH) in order to move science to 

services more quickly.

Research can be a partner, if researchers are concerned about 

practice in the field and see consumers as collaborators in 

innovation, and if research funding is not limited to overly narrow 

definitions of “evidence-based.” Research is needed to identify 

practices that will actually influence training competence, service 

guidelines, and funding directions; that focus on the whole 

person; that rely on consumer input at every stage of research; 

and that include cost/benefit considerations about research and 

co-occurring issues.

Nondiscrimination and Underserved Populations

Another theme was the importance of serving all persons 

affected by co-occurring disorders. This involves ensuring that 

access is not denied because of discrimination, and focusing 

attention on those groups that have been historically underserved. 

The State of Texas was held up as a model for establishing 

regulatory language and an administrative system to ensure 

nondiscrimination in access to care. In Texas, although there 

are parallel systems, people seeking treatment are assumed to 

have co-occurring disorders. The State has established rules and 

used language of nondiscrimination in the regulations to support 

this assumption, and has also established minimum standards of 

competence. To help mitigate the silo effect of separate funding 

streams, the State has placed engagement strategy specialists 
12

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

throughout the service system, to assist people who have not 

been helped in the existing system. The State has adopted the 

following regulatory language:

State of Texas

Standards for Services to Individuals with Co-Occurring 

Psychiatric and Substance Use Disorders (COPSD), Chapter 411, 

Subchapter N, Section 411.657:

(a) In determining an individual’s initial and ongoing eligibility 

for any service, an entity may not exclude an individual 

based on the following factors:

(1) the individual’s past or present mental illness or 

substance use diagnosis or services;

(2) medications prescribed to the individual in the past or 

present;

(3) the presumption of the individual’s inability to benefi t 

from treatment;

(4) the specifi c substance used by the individual;

(5) the individual’s continued substance use; or 

(6) the individual’s level of success in prior treatment 

episodes.

(b) Entities must ensure that an individual’s refusal of a 

particular service does not preclude the individual from 

accessing other needed mental health or substance abuse 

services.

(c) Entities must ensure that individuals have access to staff 

who meet specialty competencies described in Section 

411.658 of this title (relating to Specialty Competencies of 

Staff Providing Services to Individuals with COPSD).

(d) Entities must establish and implement procedures to ensure 

the continuity of screening, assessment, and treatment 

services provided to individuals. 

While most participants were impressed with the explicit 

regulatory language the State has adopted, several participants 

urged caution when using statutory and regulatory strategies. 

There is some risk, especially at State levels, of legislation that 
13

places more restrictions and allows fewer community-based 

approaches, thus causing more problems than might be solved. 

Participants also expressed concern that several populations 

have been significantly underserved, including older adults, 

youth, persons with eating disorders, gender and sexual minority 

persons, Native Americans, and ex-inmates.

Older adults are at risk for late-life mental illness and 

addiction, particularly depression and alcoholism, and 

dependence on or overuse of medication, because physiology 

changes with age. Yet service providers do not respond 

adequately to these issues, especially because many people 

suffer at home and may also suffer from dementia and physical 

disability. Youth are usually not viewed as being at risk for cooccuuring mental illness and addiction.

Persons with eating disorders also suffer from, or are 

at risk of, co-occurring disorders, but are usually left out of 

consideration, while sexual minority persons have particular 

issues that may affect mental and substance use disorders.

Native Americans historically have been underserved for cooccurring disorders as well as for many other medical, social, and 

economic issues, while ex-inmates are perceived by providers as 

being difficult to work with and have a high occurrence of both 

substance use and mental disorders.

Not only are these populations traditionally underserved for 

co-occurring disorders, but more information also is needed to 

understand the risk or extent of co-occurring disorders among 

them. Participants advocated that more attention be paid to 

these populations in terms of both services and research, at 

the same time recognizing the tension, or balance, between 

focusing on underserved populations and integrating everyone 

with co-occurring disorders into the community-at-large. As one 

participant said, “We sometimes ‘ghetto-ize’ people by putting 

them into special population groups.” The group understood 

that both sides of this balance need to be emphasized: the need 

to focus attention on those who have been neglected or denied 

access, and the need to make sure that all community members 

are genuinely integrated into the life of the community.

Funding

Woven throughout the discussion on the themes above was 

recognition that a new system of reimbursement for services to 

persons with co-occurring disorders is a critical need. “We need 
14

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

to dismantle the silo effect of separate funding systems,” said one 

participant. Participants discussed the importance of: 

 Establishing new billing codes for co-occurring.

 Reimbursing multidisciplinary team approaches to service 

delivery.

 Using simpler documentation for billing.

 Providing certification and funding for peer specialists.

 Including incentives for building coalitions, for serving 

underserved populations, and for funding innovations in block 

grants.

 Ensuring adequate technology for data sharing across systems.

Participants also noted that the present methods for financing 

services for mental health and substance use disorders promote 

dependency and are provider-focused. Once again, the key 

strategy is to ensure much greater consumer involvement in the 

design of appropriate and effective policies and mechanisms. 

This includes exploring consumer-directed or self-determination 

models of financing. 
15

Recommendations

The second day of the dialogue focused on consolidating the 

themes and individual ideas into specific recommendations. 

Participants outlined specific, action-oriented steps under 

each of nine major recommendations. These are the nine 

recommendations: 

1. Form and maintain healthy, consumer-driven partnerships in 

policymaking, research, and service delivery. 

2. Embed a whole-person focus in research and service 

delivery.

3. Transform workforce development, emphasizing peer-based 

approaches.

4. Expand programs to reduce stigma and discrimination 

against underserved populations. 

5. Create incentives for coalition building.

6. Engage actively in public awareness and education.

7. Support appropriate policy for systems change.

8. Support collaborative research.

9. Redesign the reimbursement system.

Many recommendations were directed to SAMHSA in particular. 

However, a number of recommendations were directed to 

providers and consumers, and to the field in general.

1. Form and Maintain Healthy, Consumer-Driven 

Partnerships in Policymaking, Research, and Service 

Delivery. 

1.1. Include consumers as partners in the development, 

implementation, and evaluation of programs. Move 

beyond getting “consumer input” to using actual 

consumer-driven approaches. 

1.1.1. Develop accountability mechanisms that 

track consumer involvement. Mandate 

use of these mechanisms in requests for 

proposals for research and programs funded 

by SAMHSA, NIH, NIDA, and other Federal 

agencies. 
16

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

1.1.2. Use the Ryan White Act as a model to assure 

consumer participation when allocating 

funds.

1.2. Increase the number of consumers/survivors 

participating on advisory councils and panels. 

1.2.1. Review the guidelines for consumer 

participation on advisory panels and councils 

during SAMHSA’s reauthorization process

1.2.2. Include at least two consumer/survivor 

representatives on the SAMHSA and CMHS 

National Advisory Council (in addition to 

participation on any subcommittees that 

have been formed). 

1.3. Increase consumer involvement at State and local 

levels in the design and conduct of research, in the 

development of toolkits, in participation on boards 

of mental health centers, in working with local 

providers, and in other areas.

1.4. Train and support consumers asked to serve on 

advisory groups and participate in partnerships. 

Consumers may be inexperienced with these kinds 

of jobs; do not support tokenism, or set people up 

for failure. Mentors, orientation programs, and other 

supports should be available for those asked to 

participate. 

1.5. Include consumers as grant reviewers to help in the 

scoring of SAMHSA grant applications. Ask grantees 

to demonstrate, account for, and evaluate consumer 

involvement in grants. 

1.6. Clarify the definition of “consumer.” Assume that 

most people have a disorder, and ask people to 

disclose that they are a non-consumer. The thinking 

should be changed to “we’re all co-occurring until 

proven otherwise.”

2. Embed a Whole-Person Focus in Research and Service 

Delivery.

2.1. Create a resource pool of effective screening 

and assessment tools, particularly those that help 

providers and consumers understand the whole 

person. 
17

2.2. Use a treatment team approach; encourage providers 

to assess a person’s strengths as well as weaknesses, 

and to follow up with each other and the consumer 

about how strengths are being reinforced and 

weaknesses are being addressed.

2.3. Ask research questions and clinical questions about 

the inner dynamics and personal experience of 

recovery that drive the recovery itself.

2.4. Require data sharing across systems.

2.5. Train consumers in the Wellness Recovery Action 

Plan (WRAP) program, and train them to become 

facilitators and trainers, so consumers can teach 

other consumers about these tools.

2.6. Improve general medical health care coordination 

with substance abuse and mental health issues.

2.6.1. Incorporate ceremony and ritual into 

treatment.

2.6.2. Recognize people as “multiply-abled” and 

not “multiply-disabled.”

2.6.3. Include vocational rehabilitation in the 

continuum of care—not as a collateral or 

extra type of service.

2.7. Use advance directives in all co-occurring treatment 

and services programs, and develop national 

standards for advance directives.

2.8. In vocational rehabilitation service programs, focus 

on the development of careers.

2.9. Create “one-stop shopping” for co-occurring services.

2.10. Create incentives for communities/neighborhoods 

to allow housing programs for persons in recovery 

from co-occurring illnesses.

3. Transform Workforce Development, Emphasizing 

Peer-Based Approaches.

3.1. Initiate a 10-year SAMHSA workforce development 

plan. The plan would include scholarships and loan 

forgiveness programs for serving in the field. The 

plan would also call on SAMHSA to demonstrate 

leadership in changing accreditation requirements of 
18

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

the Joint Commission on Accreditation of Healthcare 

Organizations (JCAHO) and other accrediting 

organizations to ensure that co-occurring disorders 

are included in service delivery. 

3.2. Design and support a recruitment campaign for 

peer support specialists. Actively recruit people with 

addictions and psychiatric conditions to work in the 

field. Create specialized training and certification for 

people in recovery to work in the field.

3.3. Place a strong emphasis on new curriculum 

development on co-occurring disorders across 

academic social work, psychology, psychiatry, 

nursing, and other programs at colleges and 

universities. 

3.4. Develop licensure requirements for behavioral health 

and substance abuse treatment in collaboration with 

university graduate programs.

3.5. Establish credentials for specialists in substance 

abuse/mental health fields, that is, for professionals 

who work with special populations. 

3.5.1. Increase education about special 

populations, particularly older adults. 

3.5.2. Support gender minority and sexual minority 

sensitivity training.

3.6. Increase block grant flexibility to add workforce 

development plans; rely on incentives rather than 

sanctions in proposed plans. Design incentives 

to look beyond Quadrant IV (of the National 

Association of State Alcohol and Drug Abuse 

Directors (NASADAD)/National Association of State 

Mental Health Program Directors (NASMHPD) 

conceptual framework), e.g., early identification/

prevention and marital counseling.

3.7. Assure that workforce development programs 

apply to rural areas. Base workforce development 

initiatives regionally.
19

4. Expand Programs to Reduce Stigma and 

Discrimination Against Underserved Populations. 

The following recommendations recognize the importance of 

balancing the need for focusing on specific needs of underserved 

populations, while at the same time moving toward genuinely 

including all special populations in the community-at-large. 

4.1. Adopt, at Federal and State levels, through legislation 

or regulation, the language on nondiscrimination 

adopted by the State of Texas.

4.2. Improve access for underserved populations by 

encouraging multidisciplinary team approaches 

to outreach, evaluation, and treatment, including 

training of gatekeepers to obtain access to these 

specialized services.

4.3. Address the needs of special populations in the 

publication of co-occurring toolkits.

4.4. Recognize older adults as a special population. 

The differences between the needs of older adults 

and the regular population are as significant as 

the differences between children and the regular 

population. “Nondiscrimination” is not sufficient; 

older adults must be identified as a special 

population.

4.5. Compile data on sexual minority and gender 

minority discrimination. Gender and sexual 

minorities experience discrimination “in all four 

quadrants,” yet sufficient information has not been 

collected about this issue.

4.6. Increase training, education, and outreach for Native 

Americans. 

4.7. Reduce the stigma of being an ex-inmate. 

Professionals may prefer not to deal with, or may not 

trust many ex-inmates. 

4.7.1. Allocate funding for housing and provide 

training for ex-inmates. 

4.7.2. Implement life skills and other training 

programs for incarcerated persons while they 

are still in jail/prison.
20

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

4.8. Train agency and program staff in “Therapeutic 

Community,” “Milieu Management,” and other 

approaches that welcome persons with co-occurring 

disorders and support consumer-driven programs. 

4.9. Ensure that persons with co-occurring disorders are 

represented in all SAMHSA activities and groups, 

rather than seeing them as a sub-specialty group. 

4.10. Support interpretation of the Americans with 

Disabilities Act (ADA) as covering mental and 

substance abuse disabilities. 

5. Create Incentives for Coalition Building.

5.1. Include coalition building as a grant incentive or 

requirement.

5.2. Create incentive grants, like the State Incentive 

Grants (SIGs), for national substance abuse and 

mental health advocacy organizations to work 

together on co-occurring issues.

5.3. Form coalitions with the vocational rehabilitation 

disability community.

5.4. Create a resource pool of materials that relate what 

organizations and agencies in other States are doing 

in regard to policy, training, and curriculum.

5.5. Ensure that the requests for proposals for SAMHSA/

CMHS funded Consumer and Consumer Supporter 

Technical Assistance Centers require these centers 

to focus on co-occurring issues and cultural 

competence.

6. Engage Actively in Public Awareness and Education.

6.1. Enter into direct dialogues with media 

representatives. Develop more contacts to change 

media stereotypes. 

6.2. Emphasize the message that “recovery is possible,” 

and show the face of co-occurring in public 

awareness campaigns, using media and the arts. 

6.2.1. Create campaigns such as “Recovered Faces 

in High Places.”

6.2.2. Encourage the pharmaceutical companies’ 

advertising campaigns to place a softer, 
21

gentler face on psychiatric and co-occurring 

issues.

6.3. Become more visible and assertive in the 

community. Avoid “preaching to the choir” in antistigma campaigns; go to other groups and into the 

center of the community.

6.4. Think strategically about the use and impact of 

language. 

6.4.1. Distinguish “recovery,” which is a personal, 

individual process, from “wellness,” which 

involves families and the whole community. 

The community must buy into wellness for 

appropriate policy to be adopted.

6.4.2. Think in terms of three simultaneous 

levels of impact—individual, family, and 

community/society.

6.4.3. Make sure that the language we use, and 

the way we phrase things, does not get us 

into a box. For example, “substance abuse” 

has become merely a catch-all phrase for all 

addictions and reinforces an image of willful 

misconduct, while “substance dependence” 

is more strongly associated with mental 

illness in co-occurring disorders.

6.4.4. Define “family” according to the individual’s 

circumstances to ensure that services are not 

limited, especially during crisis situations.

6.5. Apply a co-occurring agenda to the Emergency 

Medical System.

6.6. Conduct assessments of co-occurring disorders to get 

an adequate picture of the situation across society—

the incidence of co-occurring is much greater than 

what is normally portrayed.

6.7. Identify appropriate Web sites and develop a process 

to efficiently exchange links and get information to 

organizations.

6.8. Encourage local efforts that integrate people with cooccurring issues into the community and encourage 
22

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

direct interaction with others to help increase their 

quality of life. 

6.8.1. Conduct all community outreach alongside 

people with co-occurring illnesses.

6.8.2. Have professionals and people in recovery 

jointly make presentations to community 

groups and others. 

7. Support Appropriate Policy for Systems Change.

7.1. Include language in Federal policy proposals that 

supports or requires co-occurring approaches, 

including SAMHSA’s reauthorization, as well as 

authorization for the National Institutes of Health 

(NIH) and the Centers for Medicare and Medicaid 

Services (CMS). 

7.1.1. Look for opportunities to include appropriate 

language in Federal and State policy similar 

to that used in Texas. Use caution, because 

there is some risk, especially at State levels, 

of policy that places more restrictions and 

allows fewer community-based approaches. 

7.1.2. Become more proactive in reviewing and 

developing policy in general.

7.2. Encourage substance abuse/mental health planning 

committees to work together in developing block 

grant proposals. Develop guidelines that allow 

States flexibility in designing specific mechanisms 

that support co-occurring approaches, and that take 

differences in substance abuse and mental health 

funding into account. Specific ideas to consider:

7.2.1. Have block grant proposals reviewed by a 

consumer committee.

7.2.2. Allocate the same amount of funding for 

older adults as for children.

7.2.3. Establish an advisory and planning council 

when designing a State’s substance abuse 

Performance Partnership Grant (PPG), or 

add substance abuse to the mental health 

planning council. 
23

7.3. Advocate for Medicaid guidelines on co-occurring 

that do not support the mental health/substance 

abuse departmental split at the State level—to reduce 

the administrative nightmare of working with two 

systems.

7.4. Examine the need for paramedics to be able to 

petition for involuntary treatment.

7.5. Develop guidelines within SAMHSA for encouraging 

consumer advocate input on policy.

7.6. Change SAMHSA’s Center for Substance Abuse 

Prevention’s (CSAP’s) authorization to include 

prevention of behavioral health disorders.

8. Support Collaborative Research.

8.1. Promote research as an active, accountable 

partnership between providers and consumers, and 

create funding mechanisms that support this concept. 

Research and evaluation should be an ongoing, 

building process, integrating what is being learned 

with training of personnel.

8.2. Establish a “toward evidence-based research” 

funding track to discover where innovation is 

happening, so that research is not limited to 

traditional, academic approaches. 

8.3. Provide funding or other support for demonstration 

projects so that they can be sustained after the 

research/demonstration phase.

8.4. Encourage NIH to develop its own “blueprint,” a 

5-year plan to respond to co-occurring disorders as 

SAMHSA has done.

8.5. Create a mechanism to support collaboration 

between NIH research funding and SAMHSA service 

funding. 

8.6. Set up projects with and through the Veterans 

Administration (VA). 

8.7. Focus research efforts on ways to understand 

the process of treatment—what is happening to a 

person’s self-esteem and personal growth during the 

treatment process—as well as treatment outcomes. 

What are appropriate personal growth indicators?
24

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

8.8. Demonstrate how cost—and cost savings resulting 

from research and service delivery innovations—

influences policy and planning.

8.9. Disseminate research findings to a wider audience 

beyond professionals to consumers, to be more 

relevant and inform practice more quickly. 

8.9.1. Present research results at conferences 

interactively to allow more dialogue between 

consumers and providers. 

8.9.2. Write, publish, and present research results 

in plain language.

9. Redesign the Reimbursement System.

9.1. Convene a SAMHSA Work Group—including 

provider and consumer stakeholders—to 

comprehensively review the reimbursement structure 

for co-occurring disorders and to develop a funding 

plan that supports the blueprint in the SAMHSA 

Report to Congress (RTC).

9.1.1. Review the list of recommendations from 

this meeting and construct a model of a 

system that focuses on the whole person, is 

multidisciplinary, and is consumer-driven in 

approach.

9.1.2. Determine the principal bottlenecks in the 

present system and then assess the cost 

factor/waste of maintaining the present 

system. Make it possible to say, “Because of 

the various Federal and State requirements, 

in each State, to provide $1 of service, it is 

costing us $X.”

9.2. Support some level of reimbursement of substance 

abuse services as well as expand mental health 

services through Medicaid and Medicare reform. 

9.3. Do not change Medicaid into a block grant. 

9.4. Establish a new billing code, a new rate, and new 

program certification for co-occurring services.

9.5. Permit SAMHSA and CMS reimbursement for 

multidisciplinary treatment planning.
25

9.6. Fund SAMHSA demonstration projects that make use 

of both private and State treatment funds.

9.7. Construct a data system that can track funding across 

the various “silo” agencies and systems. Make better 

use of technology.
26

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
27

Dissemination Strategies

Dialogue participants suggested that the “Co-Occurring 

Mental Illness and Addiction: Consumers and Service Providers, 

Policymakers, and Researchers in Dialogue” and “Mental Health 

Consumers and Members of Faith-Based and Community 

Organizations in Dialogue” monographs be disseminated to the 

groups listed below. The list also can serve as a checklist of 

groups to involve in future co-occurring initiatives at the State and 

local levels. 

Public Sector

 Department of Health and Human Services leadership and 

relevant agencies

 Department of Housing and Urban Development leadership 

and relevant agencies

 Department of Veterans Affairs leadership and relevant 

agencies

 National Institutes of Health leadership and relevant 

institutes

 Tribal communities

 Bureau of Indian Health

 Elected officials at all levels of government

 State mental health and substance abuse agencies

Faith-Based Organizations

 National leadership of faith organizations 

 American Association of Pastoral Counselors 

 Faith-based media outlets

Providers/Associations

 First responder groups (Red Cross, Salvation Army) 

 Guilds for psychiatrists, psychologists, social workers, and 

nurses

 Consumer and family member organizations, CONTAC, the 

Self Help Clearinghouse, DBSA, NAMI, NMHA, and others

 International Association of Psychosocial Rehabilitation 

Services 

 Law enforcement/criminal justice systems
28

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

 Community-based social service providers

 Immigrant services

 Rosalynn Carter Institute for Human Development

 Housing advocates

 Homeless support groups

 Social service systems that address substance abuse issues 

 Minority mental health organizations (e.g., National Asian 

American Pacific Islander Mental Health Association)

 Associations of medical schools

 Vocational workers

 Self-help consumer groups and consumer-operated services

 Community support programs, including drop-in programs 

 SAMHSA/CMHS Consumer and Consumer Supporter 

Technical Assistance Centers

 American Medical Association

 Organizations that advocate for the Americans with 

Disabilities Act

 Recovery support programs

 SAMHSA ATTCs

 National Association of State Mental Health Directors 

(NASMHD) and National Association of State Alcohol and 

Drug Abuse Directors (NASADAD)

 SAAS Therapeutic Communities of America 

 American Psychological Association

 American Psychiatric Association

 Eating disorders associations

 LGBT (Lesbian, gay, bisexual, and transgender) groups

 HIV and AIDs-related organizations

 American Public Health Associaton

 Disability organizations
29

Schools

Academic training programs for mental health care providers

Residency training programs 

Media

General media 

Ethnic media
30

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
31

Conclusion

The dialogue on co-occurring issues provided an opportunity 

for consumers to engage service providers, policymakers, and 

researchers on the topic of co-occurring mental health and 

addiction disorders. All groups learned from hearing firsthand 

experiences of living with disorders and receiving services, 

of providing services, and of studying the issue. The dialogue 

format provided a level playing field for all participants to freely 

exchange ideas, knowledge, and solutions that promote recovery.

Dialogue participants identified and discussed the many 

longstanding systemic barriers to appropriate treatment and 

support services for people with co-occurring disorders, including 

separate administrative structures, eligibility criteria, and funding 

streams, as well as limited resources for both mental health 

services and substance abuse treatment. In addition, participants 

provided recommendations that support successful partnerships 

between the two groups, address the barriers to effective services, 

and promote recovery. The dialogue recommendations represent 

the united voice of those who receive services and those who 

provide them, build on the findings of the SAMHSA Report to 

Congress, and emphasize that people with co-occurring disorders 

can and do recover.
32

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
33

References and Resources

Publications

National Association of State Mental Health Program Directors 

and National Association of State Alcohol and Drug Abuse 

Directors. (2002). Exemplary Methods of Financing a Service 

Program for Persons with Co-occurring Mental Health and 

Substance Use Disorders. Alexandria, VA, and Washington, DC: 

NASMHPD/NASADAD.

New Freedom Commission on Mental Health. (2003). Achieving 

the Promise: Transforming Mental Health Care in America. Final 

Report. DHHS Pub. No. SMA-03-3832. Rockville, MD.

U.S. Department of Health and Human Services. (2002). Report 

to Congress on the Prevention and Treatment of Co-Occurring 

Substance Abuse Disorders and Mental Disorders. Rockville, MD: 

SAMHSA. Online: www.samhsa.gov/reports/congress2002/index.

html

Federal Resources

The National GAINS Center

http://gainscenter.samhsa.gov

Substance Abuse and Mental Health Services Administration

www.samhsa.gov/reports/co_occur_home.htm

SAMHSA’s National Mental Health Information Center

www.mentalhealth.samhsa.gov

SAMHSA’s Center for Substance Abuse Treatment

Treatment Improvement Exchange

http://tie.samhsa.gov
34

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue
35

Participant List

 Moe Armstrong

 Peer Educators Project

 P.O. Box 391467

Cambridge, MA 02139

 moeA@shore.net

 (617) 864-7203

Raymond Brown

 D.C. Department of Mental Health

 420 4th Street, NE

 Washington, DC 20002

 ray.brown@dc.gov

 (202) 669-9590

 Michael Cartwright

 Foundations Associates

 220 Venture Circle

 Nashville, TN 37228

 Mcartwright@dualdiagnosis.org

 (615) 256-9002

 Mark Davis

 Philadelphia DPH/OMH/PMHCC

 123 S. Broad Street, 22nd Floor

 Philadelphia, PA 19109

mark.davis@phila.gov

 (215) 546-0300 x3301

A. J. Ernst

 Texas Commission on Alcohol and Drug Abuse

 Texas Department of Mental Health and Mental Retardation

 P.O. Box 80529

 Austin, TX 78708

 aj.ernst@tcada.state.tx.us

 (512) 349-6658

 Jane Fleming 

 The Renfrew Center Foundation for Eating Disorders

 475 Spring Lane

 Philadelphia, PA 19128

 jfleming@renfrew.org

 (215) 254-1609
36

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

 Melinda Fox

 New Hampshire – Dartmouth Psychiatric Research Center

 105 Pleasant Street, Main Building

 Concord, NH 03301

 melinda.b.fox@dartmouth.edu

 (603) 271-5747

 Sonia Gonzales

 Pima Prevention Partnership (PWRD)

 330 North Commerce Park Loop, Suite 160

Tucson, AZ 85745

 sgonzales@pimaprevention.org

 (520) 884-1300

Tim Hamilton

 Dual Recovery Empowerment Foundation

P.O. Box 8708

 Prairie Village, KS 66208

 rwth@kc.rr.com

 (866) 297-8584

 Michael Harle

Gaudenzia, Inc.

 106 West Main Street

 Norristown, PA 19401

 Mharle@gaudenzia.org

 (610) 239-9600 x201

 Donald Hume

 Office of Consumer Affairs and Double Trouble in Recovery

 1100 Alvarado Street, SE #214

 Albuquerque, NM 87108

 dhume@nm.net

 (505) 256-4995

 Timothy Karpoff 

 Karpoff and Associates

 1811 Tapia Blvd., SW

 Albuquerque, NM 87105

 timkarpoff@aol.com

 (505) 877-6041

 Chris Kelly

 Advocates for Recovering Through Medicine

 P.O. Box 26377

 Washington, DC 20001

 DCREARDON@aol.com

 (202) 246-6850
37

 Ric Kruszynski

 Ohio Substance Abuse and Mental Illness Coordinating 

 Center of Excellence

 1756 Sagamore Road c/o NBH

 P.O. Box 305z

 Northfield, OH 44067

 tomapoc99@yahoo.com

 (216) 287-3430

 Paula Lafferty

 Hearts and Ears, Inc.

 11 E. Chase Street, Suite 7B

 Baltimore, MD 21202

 Paula@Heartsandears.org

 (410) 837-7778

 Pamela Martin

 NM Behavioral Health Services Division

 1190 St. Francis Drive, N3300

 Santa Fe, NM 87502

 pam.martin@doh.state.nm.us

 (505) 827-2658

 Charlene Moore

 The Philadelphia AIDS Consortium

 112 N. Broad Street, 11th Floor

 Philadelphia, PA 19133

 Cmoore8300@yahoo.com

 (215) 988-9970 x302

 John Piacitelli

 Older Adult Consumers Mental Health Alliance

 12515 Vine Maple Drive, SW

 Lakewood, WA 98499

jdpia@harbornet.com

 (253) 582-2789

 Gilberto Romero

 De Sol a Sol

 P.O. Box 459

 Santa Cruz, NM 87567

 (505) 753-8906
38

Co-Occurring Mental Illness and Addiction:

Consumers and Service Providers, Policymakers, and Researchers in Dialogue

 Joann Sacks

 Center for the Integration of Research and Practice at the 

 National Development and Research Institutes

 70 W. 23rd St., 8th Floor

 New York, NY 10010

 jysacks@hotmail.com

 (212) 845-4648

Federal Representatives

 Paolo del Vecchio

Center for Mental Health Services

 1 Choke Cherry Road, Room 6-1069

Rockville, MD 20857

 pdelvecco@samhsa.gov

 (240) 276-1946

 Chris Marshall

 Center for Mental Health Services

 1 Choke Cherry Road, Room 6-1071

 Rockville, MD 20857

 cmarshal@samhsa.gov

 (240) 276-1947

 Larry Rickards

 Center for Mental Health Services

 1 Choke Cherry Road, Room 6-1027

 Rockville, MD 20857

 (240) 276-1920

SMA 04-3892

2004