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For those in straight addiction treatment, multiple relapse episodes may lead to their treatment coverage being limited or canceled. For more severe dually diagnosed persons, multiple relapse episodes during the engagement phase of treatment are probably the norm.
When treating acute or episodic conditions, managed care often identifies decreased utilization of services as being a positive outcome. However, this may not be the goal for many dually disordered persons. In fact, for more severely ill individuals, low participation in outpatient treatment often leads to their use of expensive acute emergency room, inpatient, and jail services. A drop-off in participation may lead to the client’s stopping of medications or loss of sobriety. For many dually disordered persons, whose conditions will be chronic and relapsing, the first positive outcome might be higher utilization of outpatient treatment. After participation, the problem of finding a common measure for symptoms and functions emerges. (See above, What instruments and criteria will be used?)