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Dr. Richard L. Grant is right on target in the June 20 issue, except for his use of the term "parallel treatment."
Parallel treatment - or coordinated treatment, serial treatment, or sequential treatment - for persons with co-occurring mental and substance abuse disorders places the burden on the patient to access two separate treatment facilities. As a result, people with co-occurring disorders have the highest treatment dropout rate.
As Robert E. Drake, M.D., Ph.D., and his associates stated in the June 1990 edition of Addiction and Recovery: "Shunting back and forth between the mental health and substance abuse systems, sometimes termed parallel or sequential treatment, has been ineffective for these clients. Not surprisingly, homelessness and institutionalization have been frequent outcomes." Dr. Drake is recognized as one of the nation’s leading authorities on treatment of persons with a dual diagnosis.
On November 13 and 14, 1995, in Washington, D.C., the Substance Abuse and Mental Health Services Administration (SAMHSA) convened 140 experts in the fields of mental health and substance abuse, who were trying to contend with the ever-growing problem of comorbidity, to formulate recommendations to Health and Human Services Secretary Donna Shalala in six areas of concern. (I chaired that conference.) The "Best Practices" group of experts agreed, "Treating both disorders simultaneously, in the same facility with cross-trained professional staff, produced far better clinical and more cost-effective short- and long-term results."
I am sure that Dr. Grant would agree that "simultaneous treatment" was what he intended to say, not "parallel treatment." His fine article, read in its entirety, could lead to no other conclusion.
Max Schneier, J.D.
Chair
Subcommittee on Services Integration
SAMHSA National Advisory Council