IntroductionIntroduction
Results and ConclusionsResults and Conclusions
On counselor background variables, no differences were found between the MH and SA COSPDspecialists on race/ethnicity, total years of counseling experience, or amount of COPSD training in thepast year. The provider groups did display differences in the areas of experience and education.Although the two groups were essentially equivalent in years of general counseling experience, MHproviders reported significantly more years of providing COPSD counseling services compared to SAspecialists. The SA providers had a significantly higher proportion of individuals with graduate degreesrelative to the MH providers. In the area of professional credentials, the two groups had approximatelyequal percentages of licensed chemical dependency counselors, other professional counselors, andparaprofessionals; however, the SA providers had a greater number of clinical interns providing services.
Analyses of the CODECAT results indicated that the MH counselors rated themselves as having lowercompetencies in knowledge and skills on two of the nine best practice principles: Principle 6: Diseaseand Recovery Model with Parallel Phases of Recovery and Stages of Change/Stages of Treatment, andPrinciple 7: Individualization of Treatment. These two principles emphasize the concepts of phases ofrecovery, stages of change, phases of treatment, and treatment matching.
Comparisons of COPSD client demographics by service setting revealed that clients in MH centers weremore likely to be male, non-Hispanic, older, and not in the labor force. In the area of psychiatricdiagnoses, MH clients were more often diagnosed with bipolar disorder and schizophrenia, whereas asclients in SA centers had the highest rates of depressive disorders (X2 = 77.31, p < .0001). Analyses ofsubstance abuse treatment history indicated that the MH group had a higher incidence of previous non-detox treatment and had attended AA meetings more frequently in the 30 days prior to admission.Substance use patterns also differed between the groups. Clients in SA centers had greater rates ofcocaine as the primary substance of abuse, had used their primary substance more days in the pastmonth, and were more likely to engage in daily substance use. MH clients were more likely to usemarijuana and engage in polysubstance use relative to SA clients.
A number of treatment characteristics were also found to be significantly different between clients in MHand SA centers. MH clients were predominantly treated in outpatient settings and had longer length ofstay in treatment. SA clients had higher rates of residential placement and more often completedtreatment relative to MH clients. At discharge, clients in SA centers were more likely to be abstinent, tohave attended AA in the past 30 days, and to have close people supporting their recovery. Clients in MHcenters were more often in living situations with exposure to alcohol or drugs at discharge.
Findings of this study suggest significant differences between MH and SA settings in Texas in both theclient population base and counselor perceptions of competency. The results of the COSPD specialistcounselor survey indicate that with the exception of the greater percentage of graduate degrees in the SAproviders, the counselors are generally similar in their training backgrounds, years of counselingexperience, and professional certifications. Despite the MH group’s greater length of experienceproviding COPSD services, the MH providers rated themselves lower in knowledge and skillcompetencies in the areas of stages of change, recovery models, and treatment matching concepts andmay benefit from enhanced training in these areas. Analyses of COPSD client characteristics alsosuggest differences in psychiatric diagnoses, substance use severity, and treatment environmentbetween the MH and SA settings. Identification of these types of distinctions in client base may informdevelopment of training in evidence-based practices tailored to each setting’s characteristics.
AcknowledgementsAcknowledgements
Presented at the Addiction Health Sciences Research Conference, SantaMonica, California, October 25, 2005
Psychiatric Diagnoses
CODECAT Scale Scores
Demographics
Treatment History and Substance Use
Numerous studies have documented the high incidence of co-occurring psychiatric andsubstance use disorders (COPSD) in clients presenting for either substance abuse ormental health treatment. Knowledge of this substantial prevalence has resulted in thedevelopment of a variety of treatment interventions designed to address both psychiatricand substance use issues. Adaptation of both the substance abuse and mental healthtreatment systems is an inherent and crucial element in the evolution of specializedCOPSD services. Few studies have examined features of these two service systemswithin the context of COPSD treatment.
The current study compares counselor, client, and substance abuse treatmentcharacteristics of state-funded programs in Texas providing treatment for COPSD ineither a mental health (MH) or substance abuse (SA) treatment setting. Identification ofunique features of these systems in the treatment of COSPD may assist in targetingdistinct training needs in MH versus SA programs.
Demographics and Training
The authors acknowledge the Texas Department of State Health Services (TDSHS),Mental Health and Substance Abuse Treatment Division for their assistance inproviding data for this study.
The findings and conclusions of this in this presentation are the opinions of the authorsand do not necessarily reflect the official position of TDSHS.
Counselor CharacteristicsCounselor Characteristics
Sample and MethodSample and Method
The counselor sample consisted of 96 COPSD specialists providing services in state-funded mental health and substance abuse treatment centers in Texas (MH: n = 42; SA:n = 54). Counselors completed a background survey and the Co-Occurring DisordersEducational Competency Assessment Tool (CODECAT; Minkoff, 1998). The CODECATis an assessment tool that measures self-perceived clinical competencies associatedwith nine best practice principles developed by the SAMHSA Managed Care InitiativePanel on Co-Occurring Disorders. The CODECAT was administered on-line for an 8-dayperiod. Participation in the survey was voluntary and anonymous, and resulted in aresponse rate of 67% of the statewide COPSD personnel. The survey results werecompared between COPSD specialists working in mental health versus substance abusetreatment centers.
The client sample consisted of 4,981 COPSD clients who were served in these programsduring the same fiscal year that the survey was conducted (MH: n = 2,038; SA: n =2,943). Clients were contrasted by service setting using data from BHIPS, themandatory data collection and outcomes monitoring system for state-funded substanceabuse treatment programs in Texas. Clients were compared on demographic,admission, treatment, and discharge characteristics to assess for potential differencesbetween mental health and substance abuse treatment settings. Continuous variableswere analyzed using between-groups t-tests and Chi-square analyses were used toexamine categorical variables.
Discharge Characteristics
COPSD Client CharacteristicsCOPSD Client Characteristics
Treatment Environment
Treatment of Co-Occurring Psychiatric and Substance Use DisordersinTreatment of Co-Occurring Psychiatric and Substance Use Disordersin
Mental Health Versus Substance Abuse Service SystemsMental Health Versus Substance Abuse Service Systems
Laurel Mangrum & Richard SpenceLaurel Mangrum & Richard Spence
University of Texas at Austin, Addiction Research InstituteUniversity of Texas at Austin, Addiction Research Institute
