Implementation of Integrated Dual Disorder Treatment in Routine Veterans Health Administration Settings

Integrated dual disorder treatment is an evidence-based practice for coordinating complex care for people with severe mental illnesses and comorbid substance use disorders in a single program. Despite its effectiveness, the program can be difficult to implement and is not routinely implemented in Veterans Health Administration settings. This study sought to better understand factors in implementation of this model using. We evaluated the model in four different programs at two Veterans Health Administration medical centers and documented costs associated with implementation efforts at one site. We used interviews and observations to characterize factors (with initial coding based on the Consolidated Framework for Implementation Research) impacting implementation. Critical factors included the perceived usefulness of the model for patients served by the program, the need for ongoing case-based coaching after initial training, staff openness to stage-wise approaches as opposed to abstinence-only interventions, leadership at both the team and upper-level manager levels, and the need for model adaptation within varied program settings. Costs for implementation were relatively modest for both programs observed. These results should inform future efforts to implement the model in the Veterans Health Administration and are also relevant to implementation challenges in other mental health service settings.