General Principles 

for the Use of 

Pharmacological 

Agents to Treat Individuals 

with Co-Occurring Mental

and Substance Use Disorders
General Principles 

for the Use of 

Pharmacological 

Agents to Treat Individuals 

with Co-Occurring Mental

and Substance Use Disorders

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration
General Principles for the Use of Pharmacological Agents to Treat Individuals with 

Co-Occurring Mental and Substance Use Disorders

Acknowledgments

This document was produced for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by Westat under the Co-Occurring Mental Health and Substance Abuse Disorder (COD) 

Knowledge Synthesis, Product Development, and Technical Assistance (CODI) contract (reference number 

283-07-0610). Charlene E. Le Fauve, Ph.D.; Tison Thomas, M.S.W.; Onaje Salim, M.A., L.P.C.; Jayme S. 

Marshall, M.S.; and Deborah Stone, Ph.D. served as the Government Project Officers. 

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors 

and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. 

Public Domain Notice

All material appearing in this publication is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source is appreciated. However, this publication 

may not be reproduced or distributed for a fee without specific, written authorization from the Office 

of Communications, SAMHSA, HHS.

Electronic Access

This publication may be downloaded at http://store.samhsa.gov. 

Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). 

Recommended Citation

Substance Abuse and Mental Health Services Administration, General Principles for the Use of Pharmacological 

Agents to Treat Individuals with Co-Occuring Mental and Substance Use Disorders. HHS Publication No. SMA12-4689, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. 

Originating Office

Centers for Substance Abuse Treatment and Mental Health Services (CSAT and CMHS), SAMHSA

1 Choke Cherry Road

Rockville, MD 20857

HHS Publication No. SMA-12-4689. 

Printed 2012 

SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 1

Individuals with co-occurring mental and substance use 

disorders (COD) are common in behavioral and primary 

health settings (Grant et al., 2004; Hasin et al., 2007; 

Kessler, Chiu, et al., 2005; Kessler, Nelson, et al., 1996). 

These individuals frequently benefit from pharmacologic 

interventions, whether for mental disorders, substance 

use disorders, or both conditions.

While some research is available on prescribing 

pharmacologic agents to individuals diagnosed with 

COD, this information is not available in a brief, 

easy-to-use format that provides guidance to both 

frontline practitioners, as well as to system or program 

policymakers. This document provides general principles 

to assist in the planning, delivery, and evaluation of 

pharmacologic approaches to support the recovery of 

individuals with COD.

Development of

the General Principles

The Pharmacotherapy Principles were assembled by a 

task order work group, which included federal Substance 

Abuse and Mental Health Services Administration 

(SAMHSA) staff and contractors. These principles are 

drawn from a number of reputable resources and edited 

to be applicable. Each of the principles is supported by an 

evidence base—a reference list accompanies each.

The principles were reviewed and rated (i.e., on a 5-point 

scale, “How much do you agree or disagree that each 

statement should be included in the final principles 

document?”) by an expert Consensus Panel. The role of 

the Consensus Panel was to provide guidance based on 

up-to-date research, their experiences, and expertise. The 

panel was made up of 33 individuals who are identified 

as experts in psychiatry, pharmacotherapy, COD, mental 

health, addictions, health center administration, and 

health reform. All panelists were nominated by national 

professional organizations or SAMHSA federal staff.

The Consensus Panel process is discussed in more

detail in a separate summary report. 

Definition of COD

A diagnosis of COD requires that individuals have one or 

more disorders relating to the use of alcohol and/or other 

drugs of abuse, as well as one or more mental disorders.

A diagnosis of COD can be made when at least one 

disorder of each type can be established independent 

of the other, and is not simply a cluster of symptoms 

resulting from one disorder (Substance Abuse and Mental 

Health Services Administration, 2005b).COD may 

include alcohol, other drugs, and non-substance related 

DSM-IV-TR Axis I & II mental disorders.

Target Audience

The primary target audience for these principles is 

providers who prescribe medication for adults with COD. 

This includes psychiatrists, primary care physicians, 

nurse practitioners and other nurse prescribers, physician 

assistants, and other licensed prescribers. In the 

document, the term “prescribers” is used to describe this 

audience.

The secondary target audience is individuals who work 

in administrative and leadership roles at the program, 

agency, or system level. This may include medical 

directors, clinical directors, executives, quality managers, 

and regulators. These principles provide guidance for the 

design of policies and protocols to support best practice 

pharmacologic interventions for individuals with COD

in all settings. They are intended to support the 

attainment of valued recovery outcomes and the more 

efficient and effective use of resources for individuals 

with complex challenges.

Structure of the Document

The principles are organized in the sequence in which a 

prescriber will likely meet, engage, and intervene with 

an individual with COD. This sequence begins with 

welcoming and engagement, proceeds through screening 

and assessment, followed by treatment planning that 

includes pharmacologic interventions, and continuation 

of care and collaboration with the individual and other 

team members. The principles are tied together with 

attention to continuous quality improvement processes.
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 2

Introduction

Pharmacotherapy alone is not an adequate treatment plan 

for individuals with COD (Power et al., 2005; Substance 

Abuse and Mental Health Services Administration, 

2005b, 2008). Pharmacotherapy for individuals with 

COD is optimally delivered by prescribers in a context 

of a broad range of treatment and services to address the 

needs of individuals with multiple types of issues and 

priorities in a system of care. These may include a range 

of specific types of services such as health, housing, 

employment, childcare, eldercare, and parenting, as 

well as a range of program types, provider networks, 

and funding streams (American Psychiatric Association, 

2004; Blanco et al., 2010; Brady et al., 2010; Minkoff & 

Cline, 2004; Rosenthal & Ries, 2009; Substance Abuse 

and Mental Health Services Administration, 2004, 2005b, 

2008). It is generally recognized that untreated COD 

complicates and reduces the effectiveness of treatment 

of either disorder (Minkoff & Ajilore, 1998; Minkoff & 

Cline, 2004; Substance Abuse and Mental Health Services 

Administration, 2005a,b, 2008).

Because not all programs will have the capacity to 

prescribe medications for mental and/or substance use 

disorders to individuals with COD who may benefit 

from such medication, prescribers should develop 

opportunities for routine and consistent partnerships 

with such programs to facilitate timely access to necessary 

pharmacologic interventions so that individuals in 

need can more easily receive these essential treatments 

(American Psychiatric Association, 2004; Blanco et al., 

2010; Brady et al., 2010; Substance Abuse and Mental 

Health Services Administration, 2005b, 2008).

Given the evolving empirical evidence for COD 

pharmacotherapy effectiveness, prescribers should be 

engaged in continuous learning as new information 

emerges (Khalsa & Elkashef, 2009; Litten et al., 

2005; McCance-Katz et al., 2009). The objective is to 

determine the best pharmacologic strategy in a context 

of ongoing psychosocial, behavioral, cognitive, and 

other interventions, including peer support, to help the 

individual address mental health and/or substance use 

disorders to achieve his or her recovery goals (Minkoff & 

Ajilore, 1998; Minkoff & Cline, 2004; Substance Abuse 

and Mental Health Services Administration, 2005a,b).

Principles

1 Engagement As part of usual practice, prescribers should be prepared to:

•	 welcome and engage individuals with COD;

•	 anticipate the need to screen, assess, and diagnose COD;

•	 promote access to medications and other psychosocial, behavioral, and cognitive 

interventions; and

•	 provide medication and treatment education for individuals with COD (American 

Psychiatric Association, 2004; Minkoff & Ajilore, 1998; Minkoff & Cline, 2004; 

Power et al., 2005; Substance Abuse and Mental Health Services Administration, 

2005b, 2007c, 2008).

2 Relationship

Building

Successful pharmacologic interventions for individuals with COD are most likely 

to occur in the context of a relationship in which the prescriber positions himself 

or herself as a collaborator in the recovery process, with the goal of helping the 

individual achieve his or her life goals. The relationship should be empathetic, 

hopeful, and strength-based, and the prescribing clinician should be prepared to work 

with the individual in a continuing process of assessment and reassessment (Minkoff 

& Ajilore, 1998; Minkoff & Cline, 2004; Power et al., 2005; Substance Abuse and 

Mental Health Services Administration, 2005b, 2007c, 2008).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 3

3 Shared

DecisionMaking

Shared decision-making between the prescriber and individuals receiving services 

(and, where appropriate, their families or other support individuals of their choosing) 

should be incorporated into standard treatment practice (unless the individual is 

deemed to lack capacity). Prescribers should:

•	communicate likely outcomes of various treatment options (including 

pharmacologic strategies) for both mental and substance use disorders;

•	ascertain the individual’s understanding of the information being conveyed;

•	work in partnership with the individual to consider risks and benefits for

each option in relation to the individual’s personal recovery goals;

•	decide collaboratively on a course of treatment within this partnership,

based on discussion between the prescriber and the individual;

•	request individual consent to obtain prior medical records (review again with the 

individual if consent is initially refused); and

•	document the individual’s participation in the shared decision-making

process (Blanco et al., 2010; Brady et al., 2010; Minkoff & Ajilore, 1998; Minkoff & 

Cline, 2004; Substance Abuse and Mental Health Services Administration, 2005b, 

2006b, 2008).

4 Screening &

Assessment

Individuals presenting for service in any behavioral or primary health setting 

should be screened for both mental and substance use disorders, as well as physical 

conditions that may present as behavioral health conditions (e.g., brain tumor, 

subdural hematoma). There should be no requirements related to blood alcohol levels, 

length of abstinence from psychoactive substances, or length of medication adherence 

as a precondition for access to evaluations and appropriate acute care (Minkoff & 

Ajilore, 1998; Minkoff & Cline, 2004; Substance Abuse and Mental Health Services 

Administration, 2005b). Ongoing alcohol and/or drug use, however, warrants 

increased caution when prescribing medications. Medication adherence should 

be assessed initially and monitored on an ongoing basis as poor adherence might 

increase the risks associated with medications and undermine treatment success. 

Prescribers should recognize the need to screen, assess, and treat an intoxicated 

individual, but appreciate that an accurate diagnosis cannot be made, and non-urgent 

interventions should be delayed until the person is not intoxicated and is capable 

of understanding and participating in decision making regarding treatment options 

(Minkoff & Ajilore, 1998; Minkoff & Cline, 2004; Substance Abuse and Mental 

Health Services Administration, 2005b, 2007a). Laboratory studies, drug screening, 

electrocardiography (EKG), and imaging studies should all be considered as part of 

the assessment. Positive screenings should lead to further integrated assessment and 

treatment planning (American Psychiatric Association, 2004; Blanco et al., 2010; 

Brady et al., 2010; Minkoff & Ajilore, 1998; Minkoff & Cline, 2004; Power et al., 

2005; Substance Abuse and Mental Health Services Administration, 2005b, 2007a, 

2008).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 4

5 Assessment of

Co-Occurring

Disorders

Symptoms of mental disorders can be either temporary or permanent, and continuing 

re-evaluation in partnership with the individual receiving care is required (Minkoff & 

Ajilore, 1998; Minkoff & Cline, 2004; Substance Abuse and Mental Health Services 

Administration, 2005a,b). Psychiatric syndromes diagnosable as mental disorders that 

originate during periods of active substance use may persist once substance use is 

discontinued and may require ongoing intervention. Assessment of individuals with 

COD should occur over time (American Psychiatric Association, 2004; Blanco et al., 

2010; Brady et al., 2010; Minkoff & Ajilore, 1998; Minkoff & Cline, 2004; Substance 

Abuse and Mental Health Services Administration, 2005b, 2008) and should:

•	include a review of chronologic history, including time frames for onset and 

continuation of both mental and substance use disorders;

•	differentiate between substance-induced disorders that resolve when substance 

use stops and independent, co-occurring mental disorders that require 

ongoing intervention (American Psychiatric Association, 2004; McCance-Katz, 

2009; Rosenthal & Ries, 2009; Substance Abuse and Mental Health Services 

Administration, 2004);

•	include a review of current and previous pharmacotherapy for behavioral disorders 

effectiveness and problems encountered; and

•	include a review of family history of both mental and substance use disorders.

6 Integrated

Interventions

When a determination has been made that both a mental and substance use disorder 

are present, the prescriber should consider both disorders to be “primary.” Treatment 

plans should integrate best practice interventions—including both psychosocial 

interventions and pharmacotherapy—to address each of the CODs (American 

Psychiatric Association, 2004; Blanco et al., 2010; Brady et al., 2010; Minkoff & 

Ajilore, 1998; Minkoff & Cline, 2004; Power et al., 2005; Rosenthal & Ries, 2009; 

Substance Abuse and Mental Health Services Administration, 2005b, 2008).

7 Treatment

Readiness

In keeping with the Stages of Change Model (Substance Abuse and Mental Health 

Services Administration, 2005b), the individual may be less motivated to address 

one of the disorders, and may benefit from other interventions to facilitate treatment 

readiness (e.g., Motivational Interviewing) (Minkoff & Ajilore, 1998; Minkoff & 

Cline, 2004; Power et al., 2005; Substance Abuse and Mental Health Services 

Administration, 2004, 2005a, 2005b, 2008). Prescribers should monitor individuals 

for ongoing alcohol or drug use due to the risks involved.

8 Interdisciplinary

Communication

Prescribers may provide non-pharmacologic interventions, such as Motivational

Interviewing, in the context of the pharmacologic relationship and/or work in

collaboration with a treatment team that provides ongoing psychosocial, behavioral, 

cognitive, and other interventions. Improved outcomes occur through regular

communication and coordination of care. It is important for the individual to receive 

an integrated and consistent message from all providers. (Arias & Kranzler, 2008; 

National Institutes of Health, 1997; Substance Abuse and Mental Health Services 

Administration, 2005b, 2006b, 2007b, 2008).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 5

9 Integrated

Treatment

Individualized treatment plans that include pharmacologic strategies should be 

developed through a person-centered planning process and should integrate 

interventions to respond to multiple factors identified in the assessment, including:

•	immediate risk and safety

•	recovery goals

•	cognitive functioning

•	social and physical functioning and disability

•	other medical conditions and medications prescribed to treat them

•	strengths, skills, and periods of success

•	history of treatment response

•	motivation and stage of change

•	phase/stage of treatment

•	age and gender

•	culture and background (Blanco et al., 2010; Brady et al., 2010; Minkoff & Ajilore, 

1998; Minkoff & Cline, 2004; Rosenthal & Ries, 2009; Substance Abuse and 

Mental Health Services Administration, 2004, 2005b, 2008).

10 Pharmacologic

Strategies

& Drug

Interaction/

Toxicity

Prescribers should be familiar with the full range of pharmacologic strategies available 

for both the mental and substance use disorders. Prescribers should not be limited 

to a single model, approach, category, or formulation of medications. In populations 

with COD, additional consideration should be given to the potential for abuse of 

prescribed medication (American Psychiatric Association, 2004; Blanco et al., 2010; 

Brady et al., 2010; Minkoff & Ajilore, 1998; Minkoff & Cline, 2004; Substance 

Abuse and Mental Health Services Administration, 2005b, 2008). Side effects should 

be monitored carefully and differentiated from the effect of ongoing alcohol and/or 

drug use. Prescribers must also consider potential toxicities and drug interactions 

that may occur between medications prescribed, medications being considered, and 

tobacco, alcohol, and/or drug use to treat individuals with COD (e.g., the combination 

of opiates and benzodiazepines carries a particularly high risk, and tobacco can 

lower antipsychotics blood levels) (Blanco et al., 2010; Brady et al., 2010; Khalsa & 

Elkashef, 2009; Lintzeris & Nielsen, 2009; McCance-Katz et al., 2009; Substance 

Abuse and Mental Health Services Administration, 2004, 2005b).

11 Medications

& Crossover

Benefits

In general, the most appropriate medication for addressing an individual’s mental 

disorder is likely to be the same medication for addressing these symptoms when the 

individual is diagnosed with a co-occurring substance use disorder. Likewise, the most 

appropriate medication for addressing an individual’s substance use disorder is likely 

to be the same one when they are diagnosed with a co-occurring mental disorder 

(Blanco et al., 2010; Brady et al., 2010; Substance Abuse and Mental Health Services 

Administration, 2004, 2005a, 2005b). Be aware that certain medications that are 

effective for one condition may have a crossover benefit for the other co-occurring 

condition (e.g., Valproate for the treatment of bipolar disorder may also benefit a cooccurring substance use disorder [Green et al., 2007; Salloum et al., 2005]).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 6

12 Risk/Benefit

Assessment

Within the shared decision-making partnership, the selection of pharmacologic 

interventions should move from low risk to higher risk strategies, dependent on 

clinical response. The use of medications with the potential for abuse is risky 

in individuals with COD, and requires careful risk/benefit assessment within a 

prescribing relationship prior to initiation. However, these categories of medication 

should not be arbitrarily denied to individuals who have substance use disorders if the 

medications may be medically beneficial or indicated. In such cases, the risks involved 

with using substances while on medications should be reviewed with the individual 

and close monitoring is required (Minkoff & Ajilore, 1998; Minkoff & Cline, 2004).

13 Coordinated

Treatment

Approach

It is essential that prescribers, with client consent, routinely communicate with 

other providers regarding an individual’s medical conditions, test results, and 

prescribed medications (Manubay & Horton, 2010). Individuals with COD are 

at high risk for concurrent medical problems due to substance toxicities, lifestyle 

factors (e.g., injection drug use and homelessness), lack of regular medical 

attention, and medication side effects. There is also concern that commonly used 

medications can interfere with the metabolism of substance abuse and psychiatric 

medication, and vice versa, and may cause increased or decreased drug levels and

potency (e.g., fluoxetine and fluvoxamine decreases the metabolism of methadone 

and buprenorphine; methadone decreases the metabolism of zidovudine) (Khalsa 

& Elkashef, 2009; McCance-Katz et al., 2009). Coordinated treatment of COD

and concurrent medical conditions benefits overall recovery (Manubay & Horton, 

2010).

14 Relapse

Prevention

An essential component of relapse prevention and relapse management is close

monitoring of individuals for signs of relapse, with the goals of:

•	identification of the relapse signs,

•	identification of the causes of relapse, and

•	assisting individuals to anticipate early warning signs of relapse and developing 

strategies to interrupt the relapse process (Substance Abuse and Mental Health 

Services Administration, 2005b).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 7

15 Continuity

of Treatment

Medications that are used for symptom management and stabilization of known 

mental disorders or medical conditions should generally be maintained even when 

the individual continues to abuse substances. Individuals should be closely monitored 

and discontinuation of treatment should only occur when the risk of prescribing 

outweighs the benefits of continued therapy (Blanco et al., 2010; Manubay & Horton, 

2010; Minkoff & Ajilore, 1998; Minkoff & Cline, 2004).

16 Quality

Improvement

Prescribers should develop a quality improvement approach to address the needs of 

individuals with COD. This involves monitoring the effect of treatment decisions and 

keeping up to date on new medications, research on drug use, and revised standards 

of practice (Khalsa & Elkashef, 2009; Litten et al., 2005; McCance-Katz et al., 2009; 

Minkoff & Ajilore, 1998; Minkoff & Cline, 2004).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 8

Glossary

Assessment – The process of gathering information and engaging with a client to establish (or rule out) the existence of 

a co-occurring disorder or service need, determine the client’s readiness for change, identify the client’s strengths and 

problem areas that may affect treatment and recovery, and work with the client to develop a treatment and service plan 

(Substance Abuse and Mental Health Services Administration, 2005b).

Behavioral interventions – A therapeutic approach that targets changes in behavior without necessarily exploring 

the cognitive/thinking processes that underlie feelings or behavior (Substance Abuse and Mental Health Services 

Administration, 2006a).

Cognitive-behavioral interventions – A therapeutic approach that targets both thought and behavior change (i.e., 

thinking differently about substance abuse and coping in ways that do not involve substance use) (Substance Abuse and 

Mental Health Services Administration, 2005b).

Co-occurring disorders – A diagnosis of co-occurring disorders requires that clients have one or more disorders 

relating to the use of alcohol and/or other drugs of abuse as well as one or more mental health disorders. A diagnosis of 

co-occurring disorders can be made when at least one disorder of each type can be established independent of the other 

and is not simply a cluster of symptoms resulting from one disorder. Co-occurring disorders may include alcohol, other 

drugs, and non-substance related DSM-IV Axis I & II mental health disorders (Substance Abuse and Mental Health 

Services Administration, 2005b).

DSM-IV-TR – Diagnostic and Statistical Manual of Mental Disorders, 4th edition (revised). The DSM-IV-TR organizes 

mental health disorders into five dimensions (axes). Those germane to these Principles include:

•	 Axis I: Clinical disorders and conditions that need clinical attention;

•	 Axis II: Personality disorders and intellectual disabilities; and

•	 Axis IV: Psychosocial and environmental problems (American Psychiatric Association, 2000).

Motivational interviewing – A therapeutic approach that helps clients enhance their motivation to reduce substance 

use or to become abstinent in order to reach their personal goals. The approach fosters change by helping clients explore 

and clarify their goals, and then make the commitment to change in order to reach their desired goals (Substance Abuse 

and Mental Health Services Administration, 2005b, 2008).

Psychosocial interventions – A therapeutic approach that helps clients with concerns such as housing, entitlements, 

vocational assistance, legal services, and access to food, clothing, and medication (Substance Abuse and Mental Health 

Services Administration, 2005b).

Recovery from Mental Disorders and Substance Use Disorders – A process of change through which individuals 

improve their health and wellness, live a self-directed life, and strive to reach their full potential (http://www.samhsa.

gov/recovery/).

Relapse – The return to active substance use in a person with a diagnosed substance use disorder or the return of 

disabling psychiatric symptoms after a period of remission related to a non-addictive mental health disorder (Substance 

Abuse and Mental Health Services Administration, 2006a).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 9

Screening – The process to determine the likelihood that a person has a co-occurring disorder and whether there is a 

need to conduct an in-depth assessment (Substance Abuse and Mental Health Services Administration, 2006a).

Shared decision making – An approach where prescribers and the client discuss together the making of decisions 

regarding medications and treatments, where the client is supported in considering the best attributes and options, to 

arrive at informed preferences regarding care (Gafni & Whelan, 1997).

Stages of change – A six-stage model that assesses an individual’s readiness to act on new healthier behavior, and 

provides strategies, or processes of change to guide the individual through the stages to action, maintenance, and 

recovery (Substance Abuse and Mental Health Services Administration, 2005b).
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 10

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SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 13

Acknowledgments

We wish to acknowledge the many people who contributed to all aspects of this project. In particular, we wish to 

acknowledge the following contributors and consultants.

PLANNING COMMITTEE MEMBERS

H. Westley Clark, M.D., J.D., M.P.H., C.A.S., F.A.S.A.M.

Director of the Center for Substance Abuse Treatment 

SAMHSA

Rockville, Maryland

Dulari Gandhi

Co-Occurring Disorders Integration and

Innovation (CODI) Research Assistant

Westat

Rockville, Maryland

Shoma Ghose, Ph.D.

Co-Occurring Disorders Integration and

Innovation (CODI) Task Lead

Westat

Appleton, WI

Nina Hamburg, M.B.A.

Project Manager, Co-Occurring Disorders 

Integration and Innovation (CODI)

Westat

Rockville, Maryland

Charlene Le Fauve, Ph.D.

Chief, Co-Occurring and Homeless Activities Branch 

Center for Substance Abuse Treatment

SAMHSA 

Rockville, Maryland

Robert Lubran, M.S., M.P.A.

Director, Division of Community Programs

Center for Substance Abuse Treatment 

SAMHSA

Rockville, Maryland

Mary Anne Myers, Ph.D.

Project Director, Co-Occurring Disorders 

Integration and Innovation (CODI)

Westat

Rockville, Maryland

Fred Osher, M.D.

Director, Health Systems and Services Policy

Council of State Governments Justice Center

Johns Island, South Carolina

Dr. Lawrence D. Rickards

Consultant to Westat

Washington, DC 

Onaje Salim, M.A., L.P.C.

Public Health Advisor

Center for Substance Abuse Treatment 

SAMHSA 

Rockville, Maryland

Deborah Stone, Ph.D.

Social Science Analyst

Center for Mental Health Services

SAMHSA

Rockville, Maryland
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 14

SAMHSA’S PHARMACOTHERAPY EXPERT CONSENSUS PANEL MEMBERS

J. Craig Allen, M.D.

Chief Medical Officer

National Council of Community Behavioral Healthcare

Rushford Center, Inc.

Meriden, Connecticut

John Paul Allen, Ph.D., M.P.A.

National Mental Health Director, Addictive Disorders

Office of Mental Health Services

Veterans Health Administration

Washington, DC

Michael H. Allen, M.D.

Trustee and Past President

American Association of Emergency Psychiatry

Director of Research

University of Colorado Depression Center

Aurora, Colorado

Tony B. Campbell, R.Ph., D.O.

Medical Officer, Division of Pharmacologic Therapies

Center for Substance Abuse Treatment 

SAMHSA 

Rockville, Maryland

Jason Carter, Pharm.D.

Chief Pharmacist, Tennessee Department 

of Mental Health and Developmental Disabilities

State Opioid Treatment Authority

Associate Professor, Clinical Pharmacy

University of Tennessee College of Pharmacy

Nashville, Tennessee

Anthony Dekker, D.O., F.A.O.A.A.M.

Hospital Vice President for Medical Affairs 

and Chief Medical Officer Brighton Hospital

Brighton, Michigan

Walter Ginter, C.M.A.

Project Director, Medication Assisted 

Recovery Support (MARS) Project

Port Morris Wellness Center

Bronx, New York

Janice Kauffman, R.N., M.P.H., C.A.S.

Vice President, Addiction Treatment Services

North Charles Foundation, Inc.

Somerville, Massachusetts

Jeffrey A. Kelman, M.D., M.M.Sc.

Chief Medical Officer, Center for Beneficiary Choices

Centers for Medicare and Medicaid Services

Baltimore, Maryland

Jag H. Khalsa, Ph.D.

Chief, Medical Consequences of Drug Abuse 

and Co-Occurring Infections Branch

Division of Pharmacotherapies and Medical 

Consequences of Drug Abuse

National Institute on Drug Abuse, NIH

Bethesda, Maryland

R. Gregory Lande, D.O., F.A.C.N.

Clinical Consultant, Department of Psychiatry

Walter Reed Army Medical Center

Army Substance Abuse Program

Washington, DC 

Raye Z. Litten, Ph.D.

Associate Director, Division of Treatment 

and Recovery Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland
SAMHSA • General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental and Substance Use Disorders • May 2012 15

SAMHSA’S PHARMACOTHERAPY EXPERT CONSENSUS PANEL MEMBERS (cont.)

Elinore McCance-Katz, M.D., Ph.D.

Director, Addiction Medicine Research

San Francisco General Hospital

Adjunct Professor, Psychiatry

University of California, San Francisco

San Francisco, California

Laura McNicholas, M.D., Ph.D.

American Psychiatric Association 

Philadelphia, Pennsylvania

Fran Randolph, Dr.P.H.

Director of the Division of Pharmacologic Therapies

Center for Substance Abuse Treatment

SAMHSA

Rockville, Maryland

Bob Rappaport, M.D.

Director, Division of Anesthesia and Analgesia Products

Food And Drug Administration

Silver Spring, Maryland

Nicholas Reuter, M.P.H.

Senior Public Health Analyst, Division 

of Pharmacologic Therapy

Center for Substance Abuse Treatment

SAMHSA 

Rockville, Maryland

Deidra Roach, M.D.

Medical Director, Division of Treatment 

and Recovery Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland

Richard N. Rosenthal, M.D.

Senior Associate Dean 

Arthur J. Antenucci Professor of Clinical Psychiatry

Columbia University College of Physicians and Surgeons

Chairman, Department of Psychiatry 

St. Luke’s Roosevelt Hospital Center

New York, New York

Matthew Rudorfer, M.D.

Associate Director for Treatment and Research

Division of Services and Intervention Research

National Institute of Mental Health

Bethesda, Maryland

Steven Samra, M.P.A.

Recovery Specialist

Center for Social Innovation

Newton Center, Massachusetts

Tison Thomas, M.S.W.

Public Health Advisor 

Center for Substance Abuse Treatment

SAMHSA

Rockville, Maryland

Douglas Ziedonis, M.D., M.P.H.

Professor and Chairman of the Department of Psychiatry

University of Massachusetts Medical School and

University of Massachusetts Memorial Health Care

Worcester, Massachusetts 

Penelope P. Ziegler, M.D., F.A.S.A.M.

Medical Director, Virginia Health Practitioners

American Society of Addiction Medicine

Richmond, Virginia

A special thank you to Dr. Elinore McCance-Katz and Dr. Lawrence D. Rickards for providing the first drafts of 

the Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use 

Disorders and General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental 

and Substance Use Disorders, respectively.
35291.0512.87770501

SMA-12-4689. First printed 2012.

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