The 2 x 4 Model

Over a quarter century of studies have shown that addictions, mental illnesses, and their combinations (dual diagnoses) are pervasive in the general population. Meanwhile, emerging neuroscience is revealing that the neurodevelopmental basis of major mental illness and addiction diseases are tightly interconnected and often unified pathologies of the brain. This science calls into question the profound split between the addiction and mental health fields that define our fragmented research, professional training, and treatment delivery systems-a split that leaves most patients out of reach of adequate professional expertise and evidence-based standards of care. The 2 x 4 Model, as described in this translational textbook of Addiction Psychiatry, is the essential blueprint and operational manual for the fully integrated, expertly staffed, Dual Diagnosis clinic- a clinic that is maximally capable and efficient in treating the full spectrum of addictions, mental illness, and their comorbidities, through integration of psychotherapies and medications, by one team under one roof. Replication of 2 x 4 Model Clinics into a national system would allow widespread access to excellent, transparent standards of Addiction Psychiatry as a decisive measure against mass incarceration and the exploding health care crisis of untreated addictions, all while rebuilding brain health as a core public health, social and economic imperative of modern society.

R. Andrew Chambers, MD is Director of Addiction Psychiatry Training at Indiana University School of Medicine in Indianapolis. He is a graduate of Centre College (chemical physics/mathematics; 1991), Duke University School of Medicine (MD; 1996), and Yale University Psychiatry (2000) and Basic Neuroscience Programs (2002). After completing the IU Addiction Psychiatry Fellowship (2012) and earning certifications in Addiction Medicine (ABAM) and Addiction Psychiatry (ABPN), Andy has practiced and taught Addiction Psychiatry at Midtown Mental Health Center in Indianapolis. His research, supported by the Veterans Administration, the American Psychiatric Association, and the National Institutes on Drug Abuse (NIDA) and Alcohol Abuse and Alcoholism (NIAAA), has pioneered rodent models of dual diagnosis, contributing to our understanding of neurodevelopmental mechanisms that drive addiction disease in adolescence and mental illness. Andy's basic, neuro-computational, and health systems research aims to translate to a better future of integrated addiction and mental health care and professional training.

1. Introducing the 2 x 4 Model 2. Clinical and Neuroscience Basis for the 2 x 4 Model 3. The Illness Dimension: Integrating Equal Focus on Both Mental Illness and Addictions 4. The Treatment Dimension: Vertical Binding of Diagnostics, Psychotherapies, Medications, and Communications 5. Diagnostics 6. Psychotherapeutics 7. Medications 8. Communications 9. Professional Team Composition and Physical Infrastructure 10. All Together Now: Vertical and Horizontal Binding in the Functioning 2 x 4 Model Clinic 11. Professional Training and Research in the 2 x 4 Model Clinic 12. Building 2 x 4 Model Clinics and Systems: Local to International