A blog by Dr Constant Mouton
MBChB, FCPsychSA, KNMG Psychiatrist
Psychiatrist and Medical Director at Triora
The science of addiction is developing rapidly. We are continuously learning more about the brain, behaviour, neural pathways and treatment methodologies. Around the globe we see improved treatment modalities and we are able to treat addiction even better than before. The variety of different settings and treatment modals available ensures everyone’s specific needs are met. In many ways these shifts towards professionalising the field of addiction care are in the right direction, but are we truly moving away from the one-size-fits-all treatments? Or are we getting stuck on new islands in the my-treatment-modality-can-heal-all mentality?
One exciting driver, shifting the thinking in both psychiatry and addictionology, is the field of dual disorders. Even though there is no consensus on the term "dual disorder", it basically refers to the co-occurrence of addiction, and another mental health problem in one person, often referred to as co-occurring disorders. In the original definition, only severe mental illness, such as schizophrenia, bipolar mood disorder, severe depression and so on were included. Currently, it is also acceptable to include other psychiatric co-morbidities and also focusing on medical and psychosocial problems. Depending on how broad one takes the term, one might argue that all patients with addiction have one, or more, other (mental) health problem; either now or in the past.
Regardless of the causal relation between the other illness and addiction, the effect of one disorder on the other is evident - they impact each other negatively . Yes, addiction as comorbidity impairs the outcome of a psychiatric disorder. Similarly, the presence of a mental disorder worsens the outcome and course of the addiction.
Complicating the clinical picture is that dual disorders lead to complex psycho-social problems. Dual diagnosis are associated with higher likelihood of homelessness, incarceration, relationship problems, other medical illnesses, suicide, unemployment or even early death. Lastly, people with dual disorders have poorer access to health care due to stigma within the health sector, low availability of trained staff and reduced availability of facilities able to treat dual disorders.
Integrated Dual Disorder Treatment (IDDT) is considered to be the gold standard in assessing and treating patients with dual disorders. The model implies that the same team, in the same setting evaluates and manages all aspects of the addiction and other mental health problem. This model has been found to be more effective than parallel treatment (where different teams treat the patient at the same time) or the sequential treatment model (where one problem gets addressed after the other, often by different specialists).
IDDT excels because it approaches all problems simultaneously, regardless of causal relation, helping the patient to start the process of recovery from all issues at the same time. This prevents the negative impact on other problems and helps prevent frequent relapsing. It is also a patient centred approach, allowing for individualised treatment plans and shared decision making, further improving outcomes and patient satisfaction.
A recent meta-analysis done on what patients with dual disorders found helpful in their recovery process revealed four main themes. 
Remarkably the process of IDDT resembles what patients found helpful in their experience. Or maybe IDDT merely satisfies the needs of the patients? Whichever way you look at it, the model of IDDT does answer many needs of our patients, and a collaborative approach improves outcomes dramatically.
For IDDT, or any other integrative model, to succeed, there is one essential ingredient: collaboration.
The first level of collaboration is with the patient. By making the patient part of the decision-making process, right from the start, the strengths of the patient can be accessed and utilised towards recovery. This process, also referred to as shared decision making improves autonomy and commitment to treatment and leads to patients taking ownership of their lives and recovery sooner.
The next level of collaboration is between the different healthcare professionals within the team. The traditional IDDT model allows for specific professionals to be involved. The original model suggested the following professional be part of the team: a team leader, case manager, substance abuse specialist, counsellor, physician/psychiatrist, nurse, employment specialist, housing specialist and criminal justice specialist.
However, the model could further be improved by extending the collaboration beyond the conventional team, especially in cases where the team can insufficiently address a problem. The team can broaden its own strengths base by incorporating help from outside to resolve all issues adequately and in a sustainable manner.
Expanding the collaboration outside the traditional multidisciplinary team with other “newer” care professions can improve the effectivity of the team itself.
Some examples of professionals working in more modern teams:
Collaborating even further than professionals and including the family from a very early stage will additionally improve outcomes. Utilising family strengths by integrating evidence-based, best practice family programs which are invitational, such as ARISE® comprehensive care with intervention will allow access to family strength and resilience. Several studies support ARISE® as an effective method to engage patients in treatment, help the family and person with addiction to recover, and improve outcomes overall. 
The combination of these actions could increase sustainable recovery by adding the process of spirituality, connectedness, regaining ownership over one’s life, autonomy and participating in meaningful activities to the treatment goals.
The main prerequisite to adding these professions to a team is a shared commitment to the same core values, ethics and vision on recovery. If this is adhered to, extensive integrated treatment will allow for the individual problems of the patient to be sufficiently addressed.
Even though there are many different models of collaboration, the key benefits are similar across models. Collaboration leads to
Extensive integrative models of collaboration in addiction care are indeed not new, but unquestionably the future when it comes to addiction care and co-occurring disorders. We need, however, to broaden our view on the topic and be more inclusive in our healthcare teams and think more laterally when developing new models, as long as we stick to solid core values and ethical principles.
The old African saying “If you want to go fast go alone; if you want to go far, go together” has never been more accurate.
Triora’s addiction care is one of the most successful ways to overcome addiction. Using the unique Triora Model, we treat body, mind and soul to help you and your loved ones regain a meaningful life. Our professional staff provide discrete inpatient and outpatient rehabilitation to people like you from the pleasant surroundings of our private recovery clinics in Alicante and Malaga, Spain.