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Four Quadrant Model

The Four Quadrant Model is a way in which we can categorize those we serve with co-occurring disorders for the purpose of service planning and providing the most appropriate and effective treatment possible. Treatment success is a result of providing empathic, hopeful, continuous treatment within the therapeutic relationship through the course of multiple treatment episodes. When an individual experiences both a substance disorder and psychiatric disorder, each should be considered primary and integrated treatment is recommended. There is no one type of treatment for co-occurring disorders. For each person the correct treatment is individualized. This individualized treatment depends on the level of functioning, diagnosis, stage of change, skills and goals. Those in Quadrant I are usually presenting in an outpatient setting with different symptoms for example: depression, anxiety, family conflict and patterns of substance misuse but not clear cut dependence. Those in Quadrant II are those with serious and persistent mental illness, for example: Schizophrenia or Serious PTSD which is complicated by substance use whether or not the person sees substances as a problem. Those in Quadrant III experience addiction and significant mental health symptoms, but are not persistently and seriously mentally ill. This quadrant includes both substance-induced and substanceexacerbated psychiatric disorders. Those in Quadrant IV experience serious and persistent mental illness and also have alcoholism or drug addiction and are in need of treatment for addiction, for mental illness, or for both.


Treatment Matching Example Quadrant IV

- Continuity

- Acute Stabilization

- Motivational Enhancement

- Active Treatment

- Relapse Prevention/Rehabilitation


Remember that someone with COD can use recurrent episodes of treatment, everything from screening, to assessment, to self-help meetings, to dual recovery groups (see John French!), to MI, to medications, to hospitalization. It is so important to see that one may need a series of treatment episodes because progress could be obtained through repeated involvement in treatment. This is progress.

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