Most simply stated, the vision is to create a welcoming, person centered, recovery oriented, culturally competent, trauma informed, co-occurring capable system that is created through stakeholder partnership reflecting the spirit and capacity of our shared values to serve consumers of the public mental health and substance abuse system. The vision holds the promise of creating, over time, creative, dynamic, enduring, and interrelated systems that:

• Welcome individuals with complex needs into hopeful, caring and integrated relationships,
• Support recovery through empowered partnerships focused on individualized goals,
• Organize all staff to deliver effectively matched services in every setting to help individuals with complex needs achieve their recovery goals.

In Michigan, funding for mental health services flows through Commmunity Mental Health Services Programs (CMHSPs) and Prepaid Inpatient Health Plans (PIHPs), which primarily serve people with serious mental illness. People who receive Medicaid and have a less serious mental illness are eligible for a limited outpatient mental health benefit through the Medicaid Health Plan.

Substance abuse funding, except for Medicaid, is contracted directly between MDCH and Substance Abuse Coordinating Agencies (CAs) which serve, through subcontract agencies, people with substance disorders. Medicaid funds for substance abuse services are contracted with PIHPs, which typically subcontract those funds with CAs (some PIHPs also serve as CAs).

Efforts are underway to improve the system of care for people who have both a mental illness and a substance disorder.

In Michigan, MDCH uses the principles of the Continuous, Comprehensive Integrated System of Care (CCISC) model developed by Dr. Ken Minkoff and Dr. Chris Cline to effectively change the systems. To develop a successful and sustainable change, PIHP must look at the entire system of care and develop a comprehensive plan that addresses co-occurring disorders and integrated treatment.

In June 2004, MDCH, together with the PIHPs, major universities, and other stakeholders, came together to discuss improving clinical practices in the mental health system. This group, the Practice Improvement Steering Committee, decided to implement federal Substance Abuse and Mental Health Administration (SAMHSA) approved Evidence-Based Practices (EBPs) in Michigan.

Co-occurring Disorders: Integrated Dual Disorder Treatment (COD:IDDT)model is for people who have serious mental illness and have a co-occurring substance use disorder in the mental health system. This treatment approach helps people recover by offering treatments that combine or integrate mental health and substance abuse interventions at the level of the clinical encounter. This means the same clinicians or teams of clinicians, working in one setting, provide appropriate mental health and substance abuse interventions in an integrated fashion.In other words, the caregivers take responsibility for combining the interventions into one coherent package. For the individual with a co-occurring disorder, the services appear seamless, with a consistent approach, philosophy, and set of recommendations. The need to negotiate with separate clinical teams, programs, or systems disappears. The goal of COD:IDDT, an Integrated Dual Diagnosis intervention is recovery from two serious illnesses.A wide variety of services are offered in a stage-wise fashion because some services are important early in treatment, while others are important later on. Individualized treatment is offered depending on what stage of recovery a person is in. Services are offered in a positive atmosphere and people are encouraged to believe that they can recover as many others have. Ultimately, the goal of Integrated Dual Disorders Treatment (IDDT) is to help people manage both their mental illness and substance disorders so that they can pursue their own meaningful life goals.

PIHP representatives, Substance Abuse Coordinating Agency representatives, MDCH staff, consumers, advocates, and educators have come together in a subcommittee to work toward the implementation of Integrated Treatment for Co-occurring Mental Health and Substance Use Disorder capability through out the public mental health and substance abuse system in the State of Michigan. 

MDCH Communications

• Clarification of Funding and Reporting Matters in Relation to Persons with Co-Occurring Disorders and the Provision of Substance Abuse and Mental Health Services, November 17, 2004.
• Internal Integrated Co-ordinating Committee December 18, 2006
• Providing Quality Coordinated Care for Medicaid Beneficiaries Additional Information Regarding Consent and Disclosure of Substance Abuse Information in Compliance with 42 CFR Part 2, March 19, 2007
• Use of Encounter Code Modifiers for Integrated Mental Health and Substance Use Disorders, February 16, 2007
• Additional Information on Reporting Integrated Mental Health and Substance Use Disorders, June 29, 2007  
• Responsibility for Mental Health Services for Medicaid Individuals with Mild to Moderate Mental Illness and a Co-occurring Substance Use Disorders enrolled in Medicaid Health Plans, November 13, 2007
• Statewide Integrated Treatment Committee (ITC), March 5, 2008
• Integrated Systems for People with Co-occurring Disorders update, June 24, 2008

For more information on Co-occurring Disorders, please visit:

Evidence-Based Practice: Co-occurring Disorders: Integrated Dual Disorders Treatment (COD:IDDT)

Co-occurring Disorder Resources

SAMHSA Co-Occurring Disorders: Integrated Dual Diagnosis Treatment Resource Kit 

SAMHSA Co-Occurring Center of Excellence

SAMHSA Co-Occurring Disorder Website

SAMHSA Co-occurring prodcuts/articles

For more information contact:  Tison Thomas MSW, LMSW at thomasti@michigan.gov