The prevailing approach to addressing co-occurring mental-health and substance-use disorders has been to treat them separately. To determine whether an integrated approach improves outcomes, researchers implemented the Comprehensive Continuous Integrated System of Care (CCISC) treatment model in a residential program for homeless men and women with mental health and substance use disorders. The CCISC model combines several evidence-based treatments in one program. Comprehensive screening and assessment tools* were administered at the start of the program and at 6-month follow-up. Of the 96 patients who enrolled in the program, 76 completed follow-up assessments.

• Significant improvements were identified in mental health symptoms, frequency of past-month drug use, abstinence from alcohol or drug use, housing status, and employment from baseline to follow-up.
• Frequency of past-month alcohol use did not change significantly.

Comments by Michael Boyle, MA
The findings of this before-after observational study support the effectiveness of CCISC in treating co-occurring mental health and substance abuse disorders, but the study lacked a comparison group, and a randomized clinical trial is needed to provide stronger evidence. Such a study would be challenging to design and implement, but without one, it will be difficult to argue for challenging organizational inertia to change the current, usually segregated, approach to care.