ASSERTIVE COMMUNITY TREATMENT FOR PATIENTS WITH CO‐OCCURRING SEVERE MENTAL ILLNESS AND SUBSTANCE USE DISORDER
ABSTRACT Integrated mental health and substance abuse treatment within an assertive community treatment (ACT) approach was compared to that within a standard case management approach for 223 patients with dual disorders over three years. ACT patients showed greater improvements on some measures of substance abuse and quality of life, but the groups were equivalent on most measures, including stable community days, hospital days, psychiatric symptoms, and remission of substance use disorder.
Full-textDOI: · Available from: Gregory J Mchugo, Dec 23, 2014
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ABSTRACT: Objective: Persons with comorbid severe mental illness and substance use disorder (dual diagnosis) are often referred to intensive case management. There has been little evaluation in real-world settings of the process and outcomes of intensive case management for such clients. Methods: This study used evaluation data on 3422 clients of the Veterans Health Administration treated in rural and urban intensive case management programs to compare veterans with and without dual diagnosis on characteristics at program entry, service delivery, and 6-month outcomes, adjusting for baseline differences. Results: At treatment entry, participants with dual diagnosis had more severe symptoms, more indicators of suicidality, poorer quality of life, more hospitalizations, and more arrests than those without dual diagnosis. They were also younger and more likely to be male. After 6 months of treatment, 2584 participants were still attending the treatment program. A higher proportion of those with dual diagnosis had received rehabilitation, housing, substance abuse, and supportive vocational services, but not other services. The rate of treatment dropout was higher for veterans with dual diagnosis and clinicians rated their alliance with these clients lower than their clients without dual diagnosis. With regard to outcomes, improvement was observed for both groups on almost all measures. The only significant difference in 6-month outcomes was that veterans with dual diagnosis had slightly higher violence index scores than veterans without dual diagnosis. Conclusions: These data suggest practical feasibility and potential effectiveness of intensive case management for veterans with, and those without, dual diagnosis.Journal of Dual Diagnosis 11/2013; 9(4):311-321. DOI:10.1080/15504263.2013.835162 · 0.80 Impact Factor
Journal of Gay & Lesbian Social Services 08/2014; 26(3):303-317. DOI:10.1080/10538720.2014.924459
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ABSTRACT: Assertive community treatment (ACT) is an evidence-based practice that consists of a multidisciplinary team of professionals who provide intensive and comprehensive services to people with serious mental disorders living in the community. ACT has been shown to be effective in reducing hospital days and increasing housing stability for service recipients. However, more than half of the people in these programs typically have a co-occurring substance use disorder, and evidence for the model's effectiveness in treating dual disorders is less consistent. One reason cited for this shortcoming is the apparent failure to provide care consistent with the principles and practices of integrated dual disorders treatment, itself an evidence-based practice with demonstrated effectiveness. This is a problem of treatment fidelity, one that is addressed in a new ACT fidelity measure, the Tool for Measurement of Assertive Community Treatment (TMACT), which assesses not only the structural features of ACT but also the quality of clinical processes and services. With the TMACT, evaluators assess particular aspects of staff roles and team functioning as well as integration of critical elements of other evidence-based services, including integrated dual disorders treatment and recovery-oriented, person-centered practices. The measure is described, with particular detail provided for items that assess integrated dual disorders treatment, and a case example is presented to illustrate how the TMACT is used to guide consultation for ensuring effective integrated dual disorders treatment implementation within ACT.Journal of Dual Diagnosis 05/2013; 9(2):187-194. DOI:10.1080/15504263.2013.779480 · 0.80 Impact Factor