Understanding Evidence-Based

Practices for Co-Occurring Disorders

OVERVIEW PAPER 5
Acknowledgments

COCE Overview Papers are produced by The CDM Group, Inc.

(CDM) under Co-Occurring Center for Excellence (COCE)

Contract Number 270-2003-00004, Task Order Number 270-

2003-00004-0001 with the Substance Abuse and Mental

Health Services Administration (SAMHSA), U.S. Department of

Health and Human Services (DHHS). Jorielle R. Brown, Ph.D.,

Center for Substance Abuse Treatment (CSAT), serves as COCE’s

Task Order Officer and Lawrence Rickards, Ph.D., Center for

Mental Health Services (CMHS), serves as the Alternate Task

Order Officer. George Kanuck, COCE’s Task Order Officer with

CSAT from September 2003 through November 2005, provided

the initial Federal guidance and support for these products.

COCE Overview Papers follow a rigorous development process,

including peer review. They incorporate contributions from COCE

Senior Staff, Senior Fellows, consultants, and the CDM production

team. Senior Staff members Michael D. Klitzner, Ph.D., Fred C.

Osher, M.D., and Rose M. Urban, LCSW, J.D., co-led the content

and development process. Senior Staff member Stanley Sacks,

Ph.D., made major writing contributions. Other major

contributions were made by Project Director Jill G. Hensley, M.A.;

Senior Staff Member Sheldon R. Weinberg, Ph.D.; and Senior

Fellows Barry S. Brown, M.S., Ph.D., Michael Kirby, Ph.D., Kenneth

Minkoff, M.D., Richard K. Ries, M.D., and Joan E. Zweben, Ph.D.

Editorial support was provided by CDM staff J. Max Gilbert, Jason

Merritt, Michelle Myers, and Darlene Colbert.

Disclaimer

The contents of this overview paper do not necessarily reflect

the views or policies of CSAT, CMHS, SAMHSA, or DHHS. The

guidelines in this paper should not be considered substitutes

for individualized client care and treatment decisions.

Public Domain Notice

All materials appearing in COCE Overview Papers, except those

taken directly from copyrighted sources, are in the public

domain and may be reproduced or copied without permission

from SAMHSA/CSAT/CMHS or the authors.

About COCE and COCE Overview Papers

The Co-Occurring Center for Excellence (COCE), funded through the Substance Abuse and Mental Health

Services Administration (SAMHSA), is a leading national resource for the field of co-occurring mental health and

substance use disorders (COD). The mission of COCE is threefold: (1) to receive and transmit advances in

treatment for all levels of COD severity, (2) to guide enhancements in the infrastructure and clinical capacities of

service systems, and (3) to foster the infusion and adoption of evidence- and consensus-based COD treatment

and program innovations into clinical practice. COCE consists of national and regional experts including COCE

Senior Staff, Senior Fellows, Steering Council, affiliated organizations (see inside back cover), and a network of

more than 200 senior consultants, all of whom join service recipients in shaping COCE’s mission, guiding

principles, and approaches. COCE accomplishes its mission through technical assistance and training, delivered

through curriculums and materials on-line, by telephone, and through in-person consultation.

COCE Overview Papers are concise and easy-to-read introductions to state-of-the-art knowledge in COD. They are

anchored in current science, research, and practices. The intended audiences for these OPs are mental health

and substance abuse administrators and policymakers at State and local levels, their counterparts in American

Indian tribes, clinical providers, other providers, and agencies and systems through which clients might enter the

COD treatment system. For a complete list of available overview papers, see the back cover.

For more information on COCE, including eligibility requirements and processes for receiving training or technical

assistance, direct your e-mail to coce@samhsa.hhs.gov, call (301) 951-3369, or visit COCE’s Web site at

www.coce.samhsa.gov.

Electronic Access and Copies of Publication

Copies may be obtained free of charge from SAMHSA’s National

Clearinghouse for Alcohol and Drug Information (NCADI),

(800) 729-6686 or (301) 468-2600; TDD (for hearing

impaired), (800) 487-4889, or electronically through the

following Internet World Wide Web sites:

www.nacadi.samhsa.gov or www.coce.samhsa.gov.

Recommended Citation

Center for Substance Abuse Treatment. Understanding EvidenceBased Practices for Co-Occurring Disorders. COCE Overview Paper

5. DHHS Publication No. (SMA) 07-4278. Rockville, MD:

Substance Abuse and Mental Health Services Administration, and

Center for Mental Health Services, 2007.

Originating Offices

Co-Occurring and Homeless Activities Branch, Division of State

and Community Assistance, Center for Substance Abuse

Treatment, Substance Abuse and Mental Health Services

Administration, 1 Choke Cherry Road, Rockville, MD 20857.

Homeless Programs Branch, Division of Service and Systems

Improvement, Center for Mental Health Services, Substance

Abuse and Mental Health Services Administration, 1 Choke

Cherry Road, Rockville, MD 20857.

Publication History

COCE Overview Papers are revised as the need arises. For a

summary of all changes made in each version, go to COCE’s

Web site at: coce.samhsa.gov/cod_resources/papers.htm. Printed

copies of this paper may not be as current as the versions

posted on the Web site.

DHHS Publication No. (SMA) 07-4278

Printed 2007.
Understanding Evidence-Based Practices for Co-Occurring Disorders 1

LITERATURE HIGHLIGHTS

Both researchers and practitioners increasingly perceive EBPs as

essential for improving treatment effectiveness in the medical,

SA, and MH fields. The use of EBPs permits clinicians and

programs to more reliably improve services and achieve

optimal outcomes. In substance abuse treatment, EBPs have

influenced service delivery in areas ranging from initial

engagement (e.g., in the use of motivational enhancement

strategies) to community re-entry (e.g., in the focus on

cognitive-behavioral strategies for relapse prevention). The

National EBP Project (e.g., Torrey et al., 2001) exemplifies the

focused attention on translating science to service that is

taking place for the treatment of persons with serious mental

illnesses in mental health systems.

The earliest definitions of EBPs emphasized scientific research

and contrasted scientific evidence with approaches based on

“global subjective judgment,“ consensus, preference, and

other forms of “nonrigorous“ assessment (Eddy, 2005). This

“research only“ approach was recently rearticulated for the

field of mental health by Kihlstrom (2005): “Scientific

research is the only process by which clinical psychologists

and mental health practitioners should determine what

evidence guides EBPs“ (p. 23).

Critics of the “research only“ approach note that the true

performance of an intervention often remains uncertain even

when research evidence is available (Claxton et al., 2005), that

certain types of interventions are more amenable to research

than are others and are therefore more likely to be supported

by research evidence (Reed, 2005), and that definitions of

successful outcomes are not universally shared, especially in

behavioral health (Messer, 2005). Reed (2005) suggests that

the dichotomy between research and “everything else“ in

defining EBPs unnecessarily restricts the definition of evidence

and precludes important knowledge based on nonexperimental research (e.g., case studies) and clinical and patient

SUMMARY

The advantages of employing evidence-based practices (EBPs) (see Table 1, Key Definitions) are now widely acknowledged across the medical, substance abuse (SA), and mental health (MH) fields. This overview paper discusses EBPs and their role in the treatment of co-occurring disorders (COD).

Practitioners seldom have as much evidence as they would like about the best clinical approach to use in any given

clinical situation. To choose the optimal approach for each client, clinicians must draw on research, theory, practical experience, and a consideration of client perspectives. Picking the best option at the moment using the best

information available has been termed “evidence-based thinking” (Hyde et al., 2003) (see Table 1, Key Definitions).

This paper discusses EBPs and their use in treating persons with COD, discusses how evidence (see Table 1, Key

Definitions) is used to determine if a given practice should be labeled as evidence based, and gives some brief

examples of EBPs for COD.

There is still considerable debate concerning how EBPs should be defined. This paper presents various points of

view and offers COCE’s perspective as a starting point for further discussion by the field.

Table 1: Key Definitions

Evidence-Based A practice which, based on research findings and expert or consensus opinion about available evidence,

Practice is expected to produce a specific clinical outcome (measurable change in client status).

Evidence-Based A process by which diverse sources of information (research, theory, practice principles, practice

Thinking guidelines, and clinical experience) are synthesized by a clinician, expert, or group of experts in

order to identify or choose the optimal clinical approach for a given clinical situation.

Evidence Facts, theory, or subject matter that support or refute the claim that a given practice produces a

specific clinical outcome. Evidence may include research findings and expert or consensus

opinions.

Expert Opinion A determination by an expert, through a process of evidence-based thinking, that a given

practice should or should not be labeled “evidence based.”

Consensus Opinion A determination reached collectively by more than one expert, through a process of evidencebased thinking, that a given practice should or should not be labeled “evidence based.”

Strength of Evidence A statement concerning the certainty that a given practice produces a specific clinical outcome.
2 Understanding Evidence-Based Practices for Co-Occurring Disorders

experiences. It has also been argued that clinical

decisionmaking (Messer, 2005) and health policy (Atkins et

al., 2005) involve factors and trade-offs related to patient and

community values, culture, and competing priorities that are

not generally informed by research. An alternative to the

“research only“ approach that addresses these concerns is the

“multiple streams of evidence“ approach (Reed, 2005).

The Institute of Medicine (IOM; 2001) suggests a definition

of EBPs that reflects the “multiple streams of evidence“

approach. The IOM argues for three components of EBPs:

1. Best research evidence—the support of clinically

relevant research, especially that which is patient centered

2. Clinician expertise—the ability to use clinical skills and

past experience to identify and treat the individual client

3. Patient values—the integration into treatment planning

of the preferences, concerns, and expectations that each

client brings to the clinical encounter

These “streams of evidence” can be integrated through

“evidence-based thinking“ (see Table 1, Key Definitions).

Evidence-based thinking may be undertaken to designate

practices as evidence based or in day-to-day clinical

decisionmaking. See Messer (2005) for two case-based

examples of evidence-based thinking in clinical practice; see

Atkins and colleagues (2005) for examples related to health

policy.

KEY QUESTIONS AND ANSWERS

1. What do we mean by evidence-based practices for

co-occurring disorders?

COCE has adopted the “multiple streams of evidence“

approach to EBPs discussed above. COCE also takes the

position that the integration of multiple streams of evidence

requires the application of evidence-based thinking. Accordingly, EBPs are defined by COCE as practices which, based

on expert or consensus opinion about available evidence, are

expected to produce a specific clinical outcome (i.e.,

measurable change in client status). Figure 1 illustrates the

process by which streams of evidence (i.e., research and

scholarship, client factors, and clinical experience) are

combined using evidence-based thinking to arrive at recommendations concerning EBPs. The systems, practitioners, and

clients who use these EBPs contribute to the evidence base

for future evidence-based thinking.

2. How much evidence is needed before a practice

can be called an EBP?

There is no simple answer to this question. In general, the

designation of a practice as an EBP derives from a review of

research and other evidence by experts in the field (see Question 1). Different organizations use different processes and

standards to determine whether or not practices are evidence

based.

The key question in determining whether a practice is

evidence based is: What is the strength of evidence indicating that the practice leads to a specific clinical outcome?

There is no gold standard for assessing strength of evidence,

especially evidence derived from clinical experience. However, COCE has developed a pyramid to represent the level or

strength of evidence derived from various research activities.

As can be seen in Figure 2, evidence may be obtained from a

range of studies including preliminary pilot investigations

and/or case studies through rigorous clinical trials that

employ experimental designs. Higher levels of research

evidence derive from literature reviews that analyze studies

selected for their scientific merit in a particular treatment

area, clinical trial replications with different populations, and

meta-analytic studies of a body of research literature. At the

highest level of the pyramid are expert panel reviews of the

research literature.

Figure 2: Pyramid of Evidence-Based Practices

Figure 1: Evidence-Based Thinking
Understanding Evidence-Based Practices for Co-Occurring Disorders 3

In evaluating evidence, it is important to understand the

distinction between efficacy and effectiveness. Efficacy

means that a treatment or intervention produces positive

results in a controlled experimental research trial. Effectiveness means that treatment or intervention produces positive

results in a usual or routine care setting (i.e., in the real

world). Efficacy established in controlled research does not

necessarily equate with effectiveness in real world settings.

For example, it may be impractical to provide real world

clinicians with the level of training and supervision provided

to clinicians in research studies, or real world target populations and community contexts may differ from those used in

the research.

3. Why should EBPs be used?

There are several reasons to use EBPs. Foremost, when services

are informed by the best available evidence, the quality of care

is improved. Second, using EBPs increases the likelihood that

desired outcomes will be obtained. EBPs that are based upon

research typically have carefully described service components,

and many have manuals to guide their implementation. This

supports consistent delivery of the practice and high fidelity to

the model. Third, by employing these practices, providers will

often more efficiently use available resources.

4. What are the differences among EBPs, “consensusbased practices,“ “science-based practices,“ “best

practices,“ “promising practices,“ “emerging

practices,“ “effective programs,“ and “model

programs“?

A number of terms have been used at different times, and by

different groups, to describe practices that are expected to

produce a specific clinical outcome. These terms are somewhat interchangeable. The terms “promising“ and “emerging“ are consistent with the notion that the strength of

evidence varies among practices deemed likely to produce

specific clinical outcomes. COCE avoids descriptors like

“best“ and “model“ because they may imply that there is a

single best approach to treating all persons with COD. COCE

also avoids the term “effective“ because no hard criterion

exists for the level of evidence by which “effectiveness“ is

established.

The term “consensus based“ refers to a process by which

evidence is commonly evaluated and synthesized to determine if a given practice is an EBP. Other common processes

include evaluation of evidence using standardized criteria and

numerical scores, meta-analysis, and synthesis by a single

scholar. COCE views the consensus process as the best way

to identify and evaluate EBPs.

5. Is all manualized treatment evidence-based

treatment? Have all EBPs been manualized?

Just because a practice is documented in manual form does

not mean it has risen to the level of an EBP. Manual development can be an early step in outcome research, and that

research may show the manualized treatment to be ineffective. Moreover, manuals are sometimes developed as

marketing tools for treatments that have undergone little

research.

However, once an EBP is established, the development of

treatment manuals and practice guidelines are an important

part of the dissemination process and help make the EBP

accessible to providers. Manuals can minimize the need for

costly trainings and often contain fidelity measures and

outcome assessment strategies. They can also improve

clinical decisionmaking by laying out guidelines for critical

circumstances. Practice manuals vary in their level of detail

and may not be useful as stand-alone products. Not all EBPs

have manuals, but many do.

6. What is EBP fidelity and why does it matter?

Fidelity is the extent to which a treatment approach as

actually implemented corresponds to the treatment strategy

as designed. Following the initial design with high fidelity is

expected to result in greater success in achieving desired

client outcomes than deviating from the design (i.e., having

low fidelity).

7. What are some evidence-based practices for cooccurring disorders?

Because the treatment of COD is a relatively new field, there

has not been time for the development and testing of a large

number of EBPs specifically for clients with COD. Clearly,

EBPs developed solely for MH or SA should be considered in

the treatment of people with COD.

EBPs for COD should combine both treatment elements

(e.g., the use of motivational strategies) and programmatic

elements (e.g., composition of multidisciplinary teams).

COCE has outlined the critical components of COD practices

(see Overview Paper 3, Overarching Principles) that should

guide the selection of these elements.

At the treatment level, interventions that have their own

evidence to support them as EBPs are frequently a part of a

comprehensive and integrated response to persons with COD.

These interventions include:

• Psychopharmacological Interventions (e.g., desipramine

and bupropion for people with cocaine dependence and

depression [Rounsaville, 2004])

• Motivational Interventions (e.g., motivational enhancement therapy [Miller, 1996; Miller & Rollnick, 2002])

• Behavioral Interventions (e.g., contingency management

[Roth et al., 2005; Shaner et al., 1997])

At the program level, the following models have an evidence

base for producing positive clinical outcomes for persons

with COD:

• Modified Therapeutic Communities (CSAT, 2005; De Leon

et al., 2000; Sacks et al., 1998, 1999)
4 Understanding Evidence-Based Practices for Co-Occurring Disorders

• Integrated Dual Disorders Treatment (CMHS, 2003; Drake

et al., 1998b, 2004; Mueser et al., 2003)

• Assertive Community Treatment (Drake et al., 1998a;

Essock et al., 2006; Morse et al., 1997; Wingerson &

Ries, 1999)

The current state of the science highlights the need for

evidence-based thinking in making both programmatic and

clinical decisions in the treatment of people with COD.

8. How can I learn about new developments in EBPs?

At SAMHSA, the National Registry of Effective Programs and

Practices (NREPP) is a decision-support tool that assesses the

strength of evidence and readiness for dissemination of a

variety of mental health and substance abuse prevention and

treatment interventions. The NREPP system is available

through a new Web site (www.nationalregistry.samhsa.gov).

In Great Britain, the Cochrane Collaborative maintains

the Cochrane Library, which contains regularly updated

evidence-based healthcare databases (see

www.cochrane.org) on a comprehensive array of health

practices. Relevant specialty organizations (e.g., American

Psychological Association) also publish lists of evidencebased practices. These compilations of programs and

interventions may be generalizable to persons with COD,

and the reader should look for specific reference to COD

populations.

9. What issues should be considered in the use of

EBPs?

Most EBPs are not universally applicable to all communities,

treatment settings, and clients. If communities, treatment

settings, and/or clients vary from those for which the EPB is

designed, or if the human and facilities resources needed for

the EBP are not available, effectiveness may be reduced. The

various issues that must be considered in the use of an

evidence-based practice include:

• Client population characteristics including culture,

socioeconomic status, and the existence of other health

and social issues that may complicate service delivery

(e.g., pregnancy, incarceration, disabilities)

• Staff attitudes and skills required by the EBP

• Facilities and resources required by the EBP

• Agency policies and administrative procedures needed to

support the EBP

• Interagency linkages or networks to provide needed

additional services (e.g., vocational, educational, housing

assistance, etc.)

• State and local regulations

• Reimbursement for the specific services to be provided

under the EBP

10. Are there financial incentives to use EBPs?

Are there components of EBPs that are not

reimbursable?

The financing of EBPs for COD varies greatly by State. Some

States (e.g., New York) have included evidence-based

practice language in their licensing and regulation standards

to create an incentive for providers receiving State support

to use EBPs (New York State Office of Mental Health, 2005).

Other States now require that programs demonstrate the use

of EBPs in order to receive funding. In Oregon, for example,

programs that receive State funds must show that a percentage of those funds are used to pay for EBPs (Oregon

Department of Human Services, 2005).

For evidence-based program model EBPs, like assertive

community treatment, some States will use Medicaid dollars

to support a case rate, and other States use a fee-for-service

methodology to reimburse providers.

11. What should be done to facilitate/enable program administrators and staff to adopt EBPs?

The implementation of EBPs will present both psychological challenges (e.g., resistance to change, commitment to

current practices) and practice challenges (e.g., need for

training and supervision, need for organizational changes,

new licensures or certifications). Several practical guides

to facilitating adoption of new practices are available,

including sections from SAMHSA’s Evidence-Based

Practice Implementation Resource Kits available at

www.mentalhealth.samhsa.gov/cmhs/communitysupport/

toolkits/cooccurring/default.asp and Module 6 of COCE’s

Evidence- and Consensus-Based Practice curriculum (CSAT,

in development)

12. How can one bridge the gap between the diverse

needs of people with COD and the limited number of EBPs?

The reality is that the number of EBPs available to the

clinician is insufficient to the task of treating COD. Clients

with COD present a variety of disorders, and appropriate

treatment covers a wide spectrum of services—screening,

assessment, engagement, intensive treatment, and re-entry.

The clinician will need to use evidence-based thinking to

determine the optimal course of action for each patient. As

discussed earlier, inputs to evidence-based thinking include

research, theory, practice principles, practice guidelines, and

clinical experience.

Two documents provide substantial information to inform

evidence-based thinking: TIP 42, Substance Abuse

Treatment for Persons With Co-Occurring Disorders (CSAT,

2005) and Service Planning Guidelines: Co-Occurring

Psychiatric and Substance Disorders (Minkoff, 2001). These
Understanding Evidence-Based Practices for Co-Occurring Disorders 5

documents incorporate EBPs where appropriate and

emphasize recommended treatment interventions for people

with COD in substance abuse treatment settings.

FUTURE DIRECTIONS

Much has been accomplished in the field of COD over the

last 10 years, and a body of knowledge has been acquired

that is appropriate for broad dissemination and application.

There are now several well-articulated, evidence-based

practices that are ready for application in clinical programs.

Despite this considerable progress, far more research is

needed to answer the host of questions that surround the

treatment of persons with COD. Research is needed that

will:

• Survey typical treatment facilities to understand their

capabilities (with particular regard to staffing) and current

activities (regarding identifying and serving clients with

COD)

• Clarify the characteristics of those clients with COD for

whom substance abuse treatment alone is not sufficient

to achieve significant improvement in their substance use

and mental disorders

• Develop and test strategies to engage clients with COD

of different degrees of severity

• Develop and test strategies to maximize adherence to

substance abuse and mental health counseling services,

medication, and medical regimens

• Clarify the optimum length of treatment for clients with

COD who manifest different severities of disorders

• Develop and test strategies and techniques for ensuring

successful transition to continuing care (also known as

aftercare) and for determining the effectiveness of

different aftercare service models

• Evaluate the dual recovery mutual self-help approaches

that are emerging nationally

• Study the principles, practices, and processes of

technology transfer in the field of COD treatment

• Facilitate integrated treatment through policies and

workforce development strategies that overcome legal

and other barriers to the provision of a full spectrum of

behavioral health services by the substance abuse

treatment workforce

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Torrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Flynn, L.,

Rush, A. J., Clark, R. E., & Klatzker, D. (2001).

Implementing evidence-based practices for persons with

severe mental illnesses. Psychiatric Services, 52, 45–50.

Wingerson, D., & Ries, R. K. (1999). Assertive Community

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COCE National Steering Council

Richard K. Ries, M.D., Chair, Research Community

Representative

Richard N. Rosenthal, M.A., M.D., Co-Chair,

Department of Psychiatry, St. Luke’s Roosevelt

Hospital Center; American Academy of Addiction

Psychiatry

Ellen L. Bassuk, M.D., Homelessness Community

Representative

Pat Bridgman, M.A., CCDCIII-E, State Associations of

Addiction Services

Michael Cartwright, B.A., Foundations Associates,

Consumer/Survivor/Recovery Community

Representative

Redonna K. Chandler, Ph.D., Ex-Officio Member,

National Institute on Drug Abuse

Joseph J. Cocozza, Ph.D., Juvenile Justice

Representative

Gail Daumit, M.D., Primary Care Community

Representative

Raymond Daw, M.A., Tribal/Rural Community

Representative

Lewis E. Gallant, Ph.D., National Association of State

Alcohol and Drug Abuse Directors

Andrew L. Homer, Ph.D., Missouri Co-Occurring State

Incentive Grant (COSIG)

COCE Senior Staff Members

The CDM Group, Inc.

Rose M. Urban, LCSW, J.D., Executive Project Director

Jill G. Hensley, M.A., Project Director

Anthony J. Ernst, Ph.D.

Fred C. Osher, M.D.

Michael D. Klitzner, Ph.D.

Sheldon R. Weinberg, Ph.D.

Debbie Tate, M.S.W., LCSW

National Development & Research Institutes, Inc.

Stanley Sacks, Ph.D.

John Challis, B.A., B.S.W.

JoAnn Sacks, Ph.D.

National Opinion Research Center at the University

of Chicago

Sam Schildhaus, Ph.D.

Andrew D. Hyman, J.D., National Association of

State Mental Health Program Directors

Denise Juliano-Bult, M.S.W., National Institute of

Mental Health

Deborah McLean Leow, M.S., Northeast Center for

the Application of Prevention Technologies

Jennifer Michaels, M.D., National Council for

Community Behavioral Healthcare

Lisa M. Najavits, Ph.D., Trauma/Violence Community

Representative

Annelle B. Primm, M.D., M.P.H., Cultural/Racial/

Ethnic Populations Representative

Deidra Roach, M.D., Ex-Officio Member, National

Institute on Alcohol Abuse and Alcoholism

Marcia Starbecker, R.N., M.S.N., CCI, Ex-Officio

Member, Health Resources and Services

Administration

Sara Thompson, M.S.W., National Mental Health

Association

Pamela Waters, M.Ed., Addiction Technology

Transfer Center

Mary R. Woods, RNC, LADAC, MSHS, National

Association of Alcohol and Drug Abuse

Counselors

COCE Senior Fellows

Barry S. Brown, M.S., Ph.D., University of North

Carolina at Wilmington

Carlo C. DiClemente, M.A., Ph.D., University of

Maryland, Baltimore County

Robert E. Drake, M.D., Ph.D., New HampshireDartmouth Psychiatric Research Center

Michael Kirby, Ph.D., Independent Consultant

David Mee-Lee, M.S., M.D., DML Training and

Consulting

Kenneth Minkoff, M.D., ZiaLogic

Bert Pepper, M.S., M.D., Private Practice in Psychiatry

Stephanie Perry, M.D., Bureau of Alcohol and Drug

Services, State of Tennessee

Richard K. Ries, M.D., Dual Disorder Program,

Harborview Medical Center

Linda Rosenberg, M.S.W., CSW, National Council for

Community Behavioral Healthcare

Richard N. Rosenthal M.A., M.D., Department of

Psychiatry, St. Luke’s Roosevelt Hospital Center

Douglas M. Ziedonis, M.D., Ph.D., Division of

Psychiatry, Robert Wood Johnson Medical School

Joan E. Zweben, Ph.D., University of California -

San Francisco

Affiliated Organizations

Foundations Associates

National Addiction Technology Transfer Center

New England Research Institutes, Inc.

Northeast/IRETA Addiction Technology Transfer Center

Northwest Frontier Addiction Technology Transfer Center

Pacific Southwest Addiction Technology Transfer Center

Policy Research Associates, Inc.

The National Center on Family Homelessness

The George Washington University
COCE Overview Papers*

“Anchored in current science, research, and practices in the field of co-occurring disorders”

y Paper 1: Definitions and Terms Relating to Co-Occurring Disorders

y Paper 2: Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders

y Paper 3: Overarching Principles To Address the Needs of Persons With Co-Occurring Disorders

y Paper 4: Addressing Co-Occurring Disorders in Non-Traditional Service Settings

y Paper 5: Understanding Evidence-Based Practices for Co-Occurring Disorders

*Check the COCE Web site at www.coce.samhsa.gov for up-to-date information on the status of overview papers in

development.

For technical assistance:

visit www.coce.samhsa.gov, e-mail coce@samhsa.hhs.gov, or call (301) 951-3369

A project funded by the

Substance Abuse and Mental Health Services Administration’s

Center for Mental Health Services and Center for Substance Abuse Treatment