Date of Graduation

Spring 5-17-2019

Document Type


Degree Name

Doctor of Psychology in Clinical Psychology (PsyD)


School of Nursing and Health Professions




Clinical Psychology (PsyD)

First Advisor

Dr. Brent Ferm

Second Advisor

Dr. Michelle Montagno

Third Advisor

Dr. Christine Wright


Historically, patients with dual diagnosis have been subjected to ineffective treatment and negative attitudes from healthcare providers. Further, these patients are plagued with myriad afflictions that exist beyond substance abuse and mental illness. The treatments and collateral damage associated with the diagnosis impose excessive healthcare costs and can be of significant detriment to society. Largely, patients suffering from dual diagnosis do not receive adequate treatment. As such, psychiatric emergency services are frequently utilized as an alternate treatment, wherein the main focus of care is on the substance abuse alone. This study argues that solely treating the substance abuse is not sufficient for positive outcomes because the substance use, in most cases, is merely a self-discovered treatment for an underlying mental illness. This study proposes an integrative model that involves both substance abuse counseling and mental health counseling in order to treat this suffering population more effectively.

Using archival data from the years 2014–2017, this study examined the effectiveness of integrative care among dual diagnosis patients at a methadone clinic in San Francisco, California. The study measured whether patients with dual diagnosis, who were assigned to both Substance Abuse Counseling (SAC) and Mental Health Counseling (MHC), differ in the mean number of Psychiatric Emergency Services (PES) visits from patients with dual diagnosis receiving SAC alone. Additionally, this study measured whether females and males differ in the mean number of PES visits and whether age positively or negatively correlates with the number of PES visits. Independent samples t-tests were used to measure mean differences of PES visits between treatment groups (MHC+SAC vs. SAC only) and mean difference of PES visits between gender. Pearson correlation was used to measure correlation between age and PES visits.

Results revealed that patients receiving integrative care (MHC+SAC) had fewer PES visits than those receiving SAC only, suggesting that integrative care is a more effective treatment model than SAC only when treating patients with dual diagnosis. Additionally, although females accessed PES less than males, there were no statistically significant differences found. Lastly, there was no correlation found between age and number of PES visits.