When someone with substance use disorders enters the recovery system, it is very often on a one-to-one basis. For example, they arrive at the emergency room experiencing an overdose, are treated, and then released as soon as possible.

Or they get pulled over for driving under the influence, leading to one-on-one interactions with police, with a judge, and then with a mandated addiction treatment program.

As these examples illustrate, the road to a substance use disorder — or other behavioral disorders — is built on a series of one-on-one interactions that fail to take into consideration a person’s whole life. The interventions involved at every step often fail to endure due to other factors, such as comorbidities, that complicate treatment.

Comorbidities is a lousy term for multiple disorders experienced at the same time. None of them are likely “morbidities.” Most people are going to die from cancer or heart disease, not overdose or self-inflicted harm. Let’s call them co-occurring disorders, then, and explain a little of what that means.

Co-occurring disorders means two or more mental health disorders occurring at the same time in one individual. A mental health disorder is defined in DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. It includes both substance use disorders and behavioral disorders.

Substance use disorders include nicotine use disorder, alcohol use disorder (AUD), cannabis use disorder, opioid use disorder, and many other compulsive use disorders. Behavioral disorders include anxiety disorders, eating disorders, obsessive/compulsive disorders, and numerous other emotional disorders.

Treating these disorders individually is like trying to drive coast-to-coast on cul-de-sacs. Each one of these disorders is itself a constellation of symptoms and causes. When connected with other disorders, they make an accurate but confusing map of insults and urges interconnecting mind, body and spirit with a complexity that is impervious to simple solutions.

Enter the Collaborative Care Model (CoCM) developed at the University of Washington in Seattle. CoCM takes the linear, one-on-one interaction between patient and caregiver, and turns it into a triangle that involves mental health, behavioral health, and physical health. The result? How about a 47% improvement in abstinence rates for people being treated for opioid use disorder (OUD)?

That excellent statistic comes from a randomized controlled trial involving 377 patients being treated for OUD and/or AUD. Measured six months after the initiation of treatment, researchers found:

• 22.3% abstinence for the conventional treatment group
• 32.8% abstinence for the CoCM group
• 47.0% increase in abstinence for CoCM vs. conventional treatment

What’s in CoCM that is capable of delivering those sorts of results in a randomized, controlled trial? Here’s a description of collaborative care from the University of Washington’s department of psychiatry and behavioral sciences:

CoCM requires a team of providers. Trained Primary Care Providers work with embedded Behavioral Health Care Managers to provide evidence-based medication or psychosocial treatments. They are supported by a Psychiatric Consultant who meets regularly with the Behavioral Health Care Manager for systematic caseload review where they consult on patients and adjust treatment for those who are not improving as expected.

In short: Teamwork! The triangle between physical, mental and behavioral health experts is buttressed by the systematic caseload review: a data-driven caseload scan conducted every week by University of Washington data scientists. Every single case is tracked every single week, and anything unusual flags a case for closer review.

Systematic case review is a critical feature of the CoCM process. Researchers report, “If the Systematic Caseload Review is not functioning optimally, it will undermine the effectiveness of your entire Collaborative Care program.” The main driver is the weekly meeting between the behavioral health specialist and the mental health specialist to review flagged cases.

As we have pointed out here many times at AddictionNews, the majority of people seeking treatment for substance use disorders were abused as children. Addiction is downstream of pain, including physical, emotional, and mental anguish. You cannot effectively treat addiction without addressing the underlying pain driving self-abuse.

In a recent review of CoCM programs, Newsweek summarized the benefits of a multidisciplinary approach to addiction treatment:

The collaborative care model is a highly evidence-based and adaptable form of treatment. The behavioral health clinician in the model will typically utilize evidence-based therapy modalities, including cognitive behavioral therapy and behavioral activation. The typical progression for these programs is six to eight sessions with a therapist over three to four months.

Addiction treatment providers stress the need to act quickly when someone presents themselves for care, most often through a primary care physician. Activating the CoCM triangle and initiating systematic case review helps ensure patients do not fall through the cracks and that anything flagged by one member of the team is shared promptly with the rest of the team.

The triangle of care initiated with CoCM recognizes that addiction almost always involves co-occurring disorders. Solutions need to quickly involve behavioral health, mental health, and physical health providers in order to supercharge six-month sobriety results. Providing collaborative care could soon become standard care for treating addiction and other behavioral disorders.

Written by Steve O’Keefe. First published August 27, 2025.

Sources:

“Medicaid cuts threaten to stall a breakthrough in addiction care,” Newsweek, August 18, 2025.

“Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial,” JAMA Internal Medicine, October 1, 2017.

“Best Practices for Systematic Case Review in Collaborative Care,” Psychiatric Services, November 1, 2019.

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