Extension and Enhancement of Davidson County’s Dual Diagnosis Services

Details of The Contract

  • Served from October 2001 through September 30, 2004.
  • Grantee Federal
  • Identifier: T1-12720
  • Project Name: Expansion and Enhancement of Davidson County Dual Diagnosis Service Capabilities
  • Principal Investigator: Scott Orman
  • Nashville, Tennessee; Foundations Associates: Project Location
  • Nashville, Tennessee: Dual Diagnosis Management.
  • Executive Director Michael Cartwright

Purpose of The Project

Foundations Associates launched a Dual Diagnosis Service in Davidson County as a part of a dual diagnosis program designed to provide integrative front end services to consumers with co-occurring disorders. The project had a three-year lifespan, modelled on an existing program. The expansion component of the facility makes it possible for it to accommodate up to 28 step-down beds and for case management services to be provided by the American Society of Addiction Medicine’s Patient Placement Criteria (ASAM PPC)-2.

Expansion of the sector started in 2013. Ninety-two consumers will now receive ASAM outpatient services covering all levels I to II, all through the ASAM PPC-2 program, representing an expansion of the program by 100%. FA saw the opportunity within that model to modify its existing outpatient program in a way that amplifies and expands upon the principles that have been demonstrated to work through empirical evidence. In addition to various factors, FA’s decision to redesign their intensive outpatient program is influenced by other more important factors. In addition to filling a void between outpatient and inpatient treatment, the intensive outpatient program demonstrates a commitment to managed care objectives.

We examined the Intensive Outpatient Program of the Addiction Recovery Center of America (FA) and its existing residential program in this study. The project’s stated objective was to establish a community-based method of dual diagnosis service treatment that was more flexible than that of FA’s residential model and, at the same time, less resource-intensive. Our study evaluated FA’s highly acclaimed residential program against a more intensive community-based program over a longer term.

This study, the purpose of this study was to determine whether intensive outpatient treatment would yield similar efficacy to a residential program. Among the project’s development objectives was to improve sobriety and behavioral stability, as reflected in measures of reduced crime, decreased substance use, and enhanced dependency with family and friends, as well as the local level. Also included in our proposal is the expansion of the scope and duration of Dual Diagnosis Services to mirror those offered in residential care settings. There is currently no clinically effective treatment for symptom management among outpatient treatment models of integrated care.

Description of The Program

A custom-designed, recovery-centered integrated program provided consumers with deeper, more accurate insight into specific consumer needs and wants. Patients with a dual diagnosis should receive treatment plans that incorporate improvement principles. This publication is intended to strengthen relationships with clients and improve their quality of life and their families. A leading team at the University of Pittsburgh’s Center of Research Science has developed enhanced IOP strategies with a long-term perspective to reduce long-term societal costs while improving health care outcomes across the board.

An Overview of Baseline Findings

Substance Use Severity

Foundations Associates, a leading integrated treatment provider, treated 816 patients with co-occurring disorders/Dual Diagnosis Service in this study. There are many levels of dependency, many levels of substance abuse and a significant level of depression within the individual committing substance abuse, and significant levels of dependence upon a client.
It was understood that TAAD interviews were carried out to evaluate alcohol and other drug abuse and dependence amongst each participant. In the TAAD dataset, there are 16 pieces of information relating to substance abuse, 19 pieces about alcohol abuse, and 39 additional insights that may provide greater depth of information about substance abuse. The test measures both the consumer’s patterns of behavior and the consumer’s actual consumption of products and services since both patterns of consumption and the behaviors may be inferred from these patterns of consumption.

The requirement to be classified as a dependent is to have items from at least two different DSM-IV dependency categories present and display your behavior, thoughts, and feelings. The dependence models created by the independent component analysts must have at least five different relationships between them positively measured to form a more robust dependency model. A total of two distinct indications of abuse in any of the four abuse categories, along with more than one instance of abuse, are required, as well as more than one indication of abuse in any of these categories. As a result, we use a more rigorous standard of measurement than what is normally observed for determining if a man/woman’s dependency is a direct result of abuse by someone else or a result of the man/woman himself.


On this page depicts several behaviors attributed to the presence of multiple dependence patterns in the human brain, as participant responses illustrate. Many more people are dependent on drugs than alcohol, and more people abuse and abuse and are dependent on drugs than people are dependent and addicted to alcohol. The data collected in this study indicate that thousands of people categories themselves as addicts (see Figure 2) instead of being with other types of alcoholism (see Table).


The study employs the GPRA measures, which are usually administered as a supplement with the Treatment Addictions Assessment Design (TAAD) to evaluate substance abuse patterns through Dual Diagnosis Service in patients who have been referred for treatment. The results are depicted in the figure below. Many studies have demonstrated the increased percentage of people who have reported using drugs illegally compared to those who have been reported to be consuming alcohol of any type (50.7%), including alcohol to the point of intoxication (38.2%).

According to the National Survey on Drug Use and Health, almost one quarter (43.4%) of college students (students in grades in K-12) are reported to have consumed cocaine or marijuana last year. The prevalence of cocaine use, intoxication with cocaine has not increased significantly over the last few years. Still, any study on adult drinking patterns will show that overall cocaine use figures are much higher than alcohol consumption, which is surprising, according to peer-reviewed studies with samples from 17 countries. The Substance Abuse and Dual Diagnosis Services Administration conducted a study on problematic behavior that revealed alcohol and drugs contributed to both high rates. The majority of findings, at the time, were in line with those of the project.


Although most DAAD information concentrates on symptoms related to dependence, abuse or mental health complications, this information can still serve as a valuable resource for identifying signs of substance abuse or dependence. The used TAAD instrument has been identified as one of the most reliable tests to evaluate the substance abuse of specific substance abusers. I think being able to assess the extent of substance abuse is important because it can help researchers better understand what to do and how to behave when dealing with a problem. Here, the graph further illustrates the extent of substance abuse as revealed by the fact that the graph is based on a single substance being consumed. There should also be a note that the number of days reported by the average person for each category is an average based on the number of days reported by individuals who belong to that category only, and only those individuals who meet that requirement can fill out the report.

This was found to be less true in groups using these categories as we observed a decrease of 25 substance abuse cases (or 3.2%) in comparison to groups using comparable measures. A single in three individuals reported they had been using alcohol on average on an average day. A survey conducted on substance abuse topics found that most respondents to the Dual Diagnosis Service reported moderate levels of substance abuse across a wide range of demographic groups.


A consumer sample surveyed by Foundations Associates included people who had been receiving substance abuse treatment within the past 30 days and who reported increased use of substances during the same period. The treatment of FA should consider several factors, particularly for co-occurring disorders that require prolonged treatments and those with co-occurring disorders that are a predisposing factor.

Dual Diagnosis Service Provided the Participants with Access to Other Services Related to Addiction and Life Skills Training in Those

  • 12% of the patients referred by substance abuse treatment facilities were referred from inpatient treatment facilities.
  • In this study, 8 % of patients were referred by outpatient programs to undergo substance abuse treatment.
  • 29% were referred to the facility after receiving substance abuse treatment at homes or in residential treatment facilities.

Psychological Severity

Symptoms differ across contexts based on people entering the Foundations Associates Program and within contexts based on their age and financial status. There has been a consistent finding of a pattern of behavior displayed by clients originating from the five major areas of mental health. The most consistent finding is the symptomatology of symptomatology. The Brief Symptom Inventory (BSI), a validated quality measure of depression, is the main tool used to assess participants’ levels of psychiatric severity compared to normative data.

Based on a normative survey conducted by the British Society for Integrative Medicine (BSI), most people surveyed score somewhere in the middle of the severity range on mental health assessments rendered at outpatient treatment programs; these results have been demonstrated in a BSI normative survey. As a general total, consumers with psychiatric symptoms reported percentage ranges between 95th and 99th percentiles in terms of their overall rates of mental health symptoms to be similar to non-psychiatric demographic norms in general. There were no differences in BSI scores between the FA participants and those at the corresponding outpatient facilities in the BSI study. In contrast, the BSI scores obtained from the outpatient facilities matched those from the FA participants.


SymptomsBSI Outpatient NormsBSI Census Norms
Interpersonal Sensitivity59.7%96.5%
Global Severity69.3%98.7%

According to Figure 5, whereas program participants were less likely to be severely disorganized by psychiatric diagnosis, the population at large had a more elevated rate of attention disorders. The severity of psychiatric symptoms experienced by FA participants and the outpatient control over various symptom levels and psychiatric domains is greater than that of the normative control groups across all symptom levels and psychiatric domains. The study noted that more than 70% of patients who sought help for minor psychiatric problems as outpatients reported worse symptoms than FA participants regarding the severity of symptoms and clinical significance.


Additional to a participant’s baseline scores on the BSI, tests done on the Mental Component Summary of the Short-Form 12-Hour Interview indicate that the participant also exhibits higher levels of psychiatric impairment than is the case for the normal control population. A survey of a general population sample obtained an average score of 42.4 points, while 71 employees in the same company received an average of 41. However, the standard deviation was 10 points, which means scores with significant subjective differences. A graph shows this mental health condition’s relationship to mental health and how that health affects participants. It illustrates the burden mental health has on participants two standard deviations below the national average for that condition and shows how participants used the program. It was estimated that the health status of Foundation Partners clients might be more greatly affected by health factors derived from the BMI and a 12-item questionnaire as compared to their outpatient counterparts from a list of six factors derived from the BMI and short questionnaires.

Problems Associated with Medical, Family/Social, Economic, and Housing Issues

One way to help consumers better understand their Dual Diagnosis situations is to make them aware of the various social problems they may come across once they are diagnosed with a serious health condition. The Lehman’s Quality of Life Questionnaire helps to identify these social issues. I find it difficult to eliminate any of the major groupings based on the qualitative consistency of their ratings, except that ratings of financial success seem to differ a great deal. Respondents at a lower satisfaction level with their items were at a lower level of satisfaction than the respondents who were choosing the other dual diagnosis service.