history and background

To read the Co-Occurring Psychiatric and Substance Abuse Disorders Consensus Document issued by the County of San Diego Health and Human Services Agency Behavioral Health Services, please click here. 


  • The County of San Diego convened the Dual Diagnosis Workgroup and developed a Dual Diagnosis Strategic Plan (2000-2002).
  • Dr. Ken Minkoff and Dr. Christie Cline designed a "Train the Trainer" implementation program and trained the first 30 CADRE members in CCISC in January 2003 over an 18 month period.
  • These 30 CADRE members were charged with creating an environmental shift in each of their own organizations by developing strategic plans, action plans and staff trainings.
  • Knowledge of the CADRE and the County's plan to provide integrated treatment grew through regional meetings and in-house service provider trainings.
  • By 2004, the CADRE had become self-sufficient, with regular meetings, established by-laws and members of the original "Train the Trainer" group began training the 2nd generation of CADRE members.
  • In 2009, San Diego CADRE hosted the first ever Un-Convention, providing a lively forum, extensive presentations and training, and networking opportunities for organizations from around the country.
  • The practice continues. New generations of Change Agents and CADRE members are graduating every year, bringing the total number of members to well over 300. 


  • The San Diego Change Agents Developing Recovery Excellence (CADRE) developed as a result of two key initiating events that evolved over a period of time. The first event was the county's Dual Diagnosis Strategic Plan developed between 2000-2002. The plan was developed to support clients and their families who were the highest utilizers of both the mental health and alcohol and drug systems with the poorest outcomes.
  • The second event occurred when Drs. Ken Minkoff and Christie Cline, authors of the CCISC model, were contracted by the County of San Diego as consultants. Their task was to train the first 30 CADRE members in this model, beginning in January 2003, for the following 18 months.