ABSTRACT
Since the early 1950's, the mental health field has experienced persistent and, at times, dramatic changes. The introduction of psychotropic drugs, the enactment of the Mental Health Centers Act of 1963, the deinstitutionalization movement of the 1970's, the advocates, family and consumer movements of the 1980's, and the ongoing development of viable community alternatives have all added to the changes. Many observers in the field think that the rate of change is even likely to increase. Changes in national health care policy, results of services research, renewed interest in research on antipsychotic medications, and other factors will only serve to accelerate
266 Thomas S. Fox and Donald Shumway
changes. Therefore, to many who have worked in the mental health field for a number of years, it seems that the only durable reality is change. One area of significant change has been in the recognition that substance abuse is a common coexisting condition in severe mental illnesses (Ridgley, Goldman, & Willenbring, 1990; Minkoff & Drake, 1991) and that these coexisting conditions require a special workforce expertise in order to treat them.
