Interview with Kenneth Minkoff, MD
Athealth.com: Welcome Dr. Minkoff. I would like to start by inviting you to talk a little about the work that you do.
Dr. Minkoff: Apart from doing a little clinical work, I primarily consult with systems of care of all different sizes ranging from individual programs to state agencies. Actually, I also do some consultation with the Substance Abuse and Mental Health Services Administration on national projects regarding the implementation of strategies for developing integrated treatment systems within the context of existing treatment resources. This involves using a number of different strategies in both managed care and non-managed care systems. I also conduct training at all different levels for clinicians, managers, programs, agencies, and so on.
Athealth.com: What have been the most important developments in the areas co-occurring substance use and mental illness disorders research and treatment?
Dr. Minkoff: While there are a number of recent developments, probably the most important are
- The recognition of the high prevalence of comorbidity, and
- The realization for the need to design interventions for people with co-occurring disorders throughout the entire service system.
It is important that these interventions be built on evidence-based best practices and that integrated interventions be provided in all kinds of service settings for treating people with comorbidity.
Athealth.com: Can you speak more to the high prevalence of comorbidity?
Dr. Minkoff: Whatever service setting you are in, whether it is a mental health setting, an addictions setting, an inpatient setting, an outpatient setting, or a residential
setting, you are going to find people with co-occurring disorders. You won't necessarily find the same combinations of disorders in each setting, but you are going to find comorbidity everywhere.
The essential challenge is building appropriate screening, assessment,
diagnosis specific, and stage specific treatment interventions into each setting as part of broad system design - and to do that based on what we are learning from the available research.
Athealth.com: Do you see any positive trends in the area of treatment outcomes, prevention, and intervention?
Dr. Minkoff: Although actual outcomes research data remains somewhat limited and cautious, evidence-based best practices have been developed; these generally indicate that people
who receive proper treatment will get better. This means that we need to provide integrated treatment interventions where the individual has a primary treatment relationship in which interventions for the substance use disorder and interventions for the mental illness are brought
together and coordinated in a person-centered, coherent whole appropriate to the level of the person's impairment and incapacity to meet these problems on his/her own. It is important that those relationships are maintained over time, through course of individual treatment
programs and also through the course of multiple treatment interventions. Ultimately, over time, as people develop incremental learning around each disease, they will get better.
What is important to remember is that neither integrated treatment nor dual diagnosis is
a "thing." If you think about it, dual diagnosis means that a person has more than one disorder, so the outcome of the combined problem is not going to be any better than the outcome of either of the single problems taken separately. Most of the people have separate disorders that
are in and of themselves chronic, relapsing conditions that don't get better through any single intervention. So, the challenge of providing appropriate treatment for people with co-occurring disorders is to take the specific diagnosis-based best practices for each disorder, and
the outcomes attendant to each disorder, and combine them. Then, you get outcomes that are related to the combination of both disorders. That is essentially what we are beginning to learn about how this process works.
Page last modified or reviewed on March 8, 2009
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