The Dual Diagnosis Physician-infrastructure Assessment Tool: Examining Physician Attributes and Dual Diagnosis Capacity

Abstract

Objective: Inadequate physician training and involvement in addictions treatment are barriers to integrating mental health and addiction services in public behavioral health care. The authors designed and implemented the Dual Diagnosis Physician-infrastructure Assessment Tool (DDPAT) to quantify statewide dimensions of this workforce problem. Methods: The DDPAT examined institutional dual diagnosis capability and physician workforce, training backgrounds, and clinical roles across Indiana's 30 community mental health centers (CMHCs), six psychiatric hospitals, and 13 addiction treatment centers. Results: All treatment centers and 75% of physicians responded. Sixty-nine percent of all treatment centers and 97% of CMHCs reported dual diagnosis capability. However, 29% of physicians treated both mental illness and addictions, and only 8% had certification in an addiction specialty. Overall workforce shortages, particularly of younger psychiatrists, contextualized these findings. Conclusions: The DDPAT identified multiple deficiencies in the physician workforce with respect to dual diagnosis and addictions care in Indiana. The DDPAT may be useful for characterizing similar trends in other states.