Changing a Culture: Helping Substance Use Disorder Treatment Settings Implement Integrated Care

Catherine Iacuzzi (2010)

The co-occurrence of substance use and mental health disorders is increasingly being recognized by researchers and providers alike. Studies have solidly demonstrated that co-occurring disorders are prevalent and present in the substance use disorder treatment system. As such, there are widespread calls for an increase in the availability of effective, integrated treatments for this population. Yet, integrated care is not readily available in community treatment settings and most individuals with co-occurring disorders do not receive integrated treatment. This dissertation sought to identify the challenges to and develop a program for implementing integrated treatment in substance use disorder treatment settings. Following a thorough review of the literature on co-occurring disorders and technology transfer, I identified the professional and organizational culture within substance use disorder treatment as a critical unaddressed barrier to implementing integrated treatment. In order to develop a program to implement integrated treatment that addressed this barrier, I reviewed the organizational development literature and identified Schein's (2004) model of organizational culture change as an appropriate framework. This dissertation presents the literature review on co-occurring disorders and technology transfer, followed by a review of organizational culture and Schein's model of culture change. I then present a program design for implementing integrated co-occurring disorder treatment within substance use disorder treatment settings, including a logic model, implementation guidelines, and a preliminary evaluation plan.