Table 3.

Comparative Balance of Comorbidity Treatment Models

Model	Description	Advantages	Disadvantages
Sequential	Treatment of one disorder followed by treatment of the second comorbid disorder	Can accommodate differential treatment interests among anxiety versus alcohol treatment seekers Allows for hypothesis testing of causal relationships among presenting symptoms If treatment of first disorder (e.g. alcohol use disorders (AUD) leads to reduction in symptoms of second disorder (e.g. anxiety reduction), unnecessary treatment of second disorder may be avoided	Case coordination can be complicated if different providers or treatment settings are involved Mutual maintenance pattern may compromise treatment gains for first disorder treated, leading to greater risk for relapse Implicit communication to clients that one disorder is more important than the other
Parallel/simultaneous	Specific treatment of both comorbid disorders at the same time but not necessarily by the same provider or in the same treatment facility	Roughly equivalent attention given to both disorders Both disorders are treated by experts in their respective areas Recognition that each comorbid disorder needs treatment attention, to reduce risk for relapse to each disorder being treated based on mutual maintenance pattern	Case coordination can be complicated if different providers or treatment settings are involved Clients may become overwhelmed by excessive demands of simultaneous treatment of two (or more) disorders Can ignore functional interrelationship among comorbid disorders
Integrated	Both disorders are treated, or at least monitored simultaneously, by a single qualified provider	Treatment addresses the functional interrelationship of comorbid disorders Both disorders are treated by the same provider at the same time, which eliminates case coordination difficulties associated with other treatment models Treatment efficiency is potentially maximized	Lack of professionals qualified to treat both disorders, especially considering the wide range of potential unique anxiety–AUD combinations Clients seeking treatment for one problem may have no interest in addressing the other comorbid disorder, which can compromise therapeutic alliance Assumption of functional interrelationship between comorbid disorders may not fit all cases