7.3 What may happen: Sequential or parallel treatment

In many communities, treatments for substance use and mental health problems are still offered in isolation from one another. This may occur in one of two ways:

• treatment for one problem is only available after the other problem has stabilized (sequential treatment)
• both problems are treated at the same time, but there is little, if any, communication between the mental health and substance use service providers (parallel treatment).

Sequential treatment

In sequential treatment, a client with concurrent disorders is not eligible for treatment in one part of the system (e.g., in the mental health care system) until the other problem (e.g., alcohol or other drug use) is resolved or stabilized.

Drawbacks of sequential treatment include the following:

• The untreated problem continues to affect the problem that is being treated.
• Substance use and mental health providers may not agree about which problem (mental health or substance use) should be treated first.
• It is unclear when one problem has been “successfully treated” so that treatment of the other problem can begin.
• Often the client is not referred for treatment of the other problem.

Parallel treatment

In parallel treatment, mental health and substance use disorders are treated at the same time, but by different professionals or teams (often working for different agencies, but sometimes within the same agency).

Drawbacks of parallel treatment include the following:

• Mental health and substance use treatments are often not integrated into a cohesive treatment package. For example:
• Many addiction services agree that reducing or even monitoring substance use is a realistic goal for clients at the beginning of treatment. However, some mental health programs ask clients to stop all use of alcohol or other drugs before they can begin treatment.
• Many mental health problems benefit from treatment with medications. However, some substance use programs may want the client to stop taking all drugs, including those used to treat mental health problems.
• Treatment providers may not talk with each other.
• The job of pulling the substance use treatment plan and the mental health treatment plan together may fall on the client and his or her family.
• Clients may not meet eligibility criteria when trying to access one system or the other. This could mean the client receive no services at all.

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