Abstract
Substance abuse treatment centers have been very slow to change program structures or to adopt new practices toward improving treatment outcomes for cooccurring disorder: substance abuse and mental health (COD) clients. This is despite several decades of COD practices research and development that make clear demands for making these changes and State and Federal monies tied to mandates for making changes toward system COD capability. Regardless of these powerful influences, recent studies have shown that a substantial research to practice (RPI) gap continues to exist in many substance abuse treatment centers across the United States in regard to COD treatment best practices. Using a formative evaluation survey as a springboard, this thesis discusses the history and recent developments in COD services and practices in the United States and then looks specifically at the progress in Sonoma County alcohol and drug treatment system toward COD capability. This was done by surveying addiction center floor staff on their knowledge, opinions and practices of COD services. The goal was to find which COD program components are currently not developed or undeveloped by contrasting survey findings with evidence-best practices for COD capable services. This thesis explores the current COD practices gap in Sonoma County, California's addiction treatment center by surveying treatment center floor staff on COD treatment best practices. The
survey is exploratory and is based on the Dartmouth DDCAT (2006) tool kit for assessing COD capacity in alcohol and drug treatment centers. By using the same DDCAT foci, this survey asks questions that covered at least one aspect of each of the 7 program areas of COD programming. These program areas are: program structure, program milieu, assessment, treatment, continuity of care, staffing and training. The results of this study are consistent with research findings of many other substance abuse treatment systems (Ducharme,
Knudsen, & Roman, 2006; Gamer, 2008). Which is that COD evidence-based knowledge and practices diffusion into the Sonoma County addiction treatment system has been fragmented and piece-meal with some COD service areas more developed and others hardly at all.