Assertive Community Treatment for Patients with Co-Occurring Severe Mental Illness and Substance Use Disorder

Department of Community Mental Health, Florida Mental Health Institute, Tampa
American Journal of Orthopsychiatry (Impact Factor: 1.36). 03/1998; 68(2):201 - 215. DOI: 10.1037/h0080330


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.

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Available from: Gregory J Mchugo, Dec 23, 2014
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    • "Services may be provided directly by the ACT team or by referral to other resources. ACT case management is frequently used with persons who have coexisting substance abuse and mental health problems (Drake et al., 1998). Generalist case management provides the traditional functions of case management— assessment, planning, linking, monitoring, and advocacy—and is usually characterized by a close involvement between case manager and client. "
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    ABSTRACT: Objective: Case management has been widely used as an intervention in the treatment of substance abuse problems. Its effectiveness has been associated with over 450 outcomes, some consistent with case management's traditional functions of linking (treatment tasks) and others typical of treatment outcomes such as substance use (personal functioning). Method: Meta-analyses were conducted on 21 randomized clinical trials in which we compared the efficacy of case management with standard-of-care conditions and active interventions. Characteristics of case management-including targeted outcomes, case management model, location on the treatment continuum, and intervention quality-were treated as moderators, as were 2 study features, length of follow-up, and methodological quality. Results: RESULTS showed that case management was efficacious across all targeted outcomes when compared with standard of care (δ = 0.15, SE = 0.037), although the overall effect was weak. There was a significant difference, F(1, 429) = 25.26, p < .0001, between case management's effect on treatment task outcomes such as linking with and staying in treatment (δ₂ = .29, p = .001) and improving individuals' functioning of persons with substance abuse problems in areas such as substance use and HIV risk behaviors (δ₁ = 0.06, p = .05). Moderator analyses demonstrated that (a) 4 case management models were more effective than standard of care in improving treatment task outcomes and (b) case management was effective either in or out of treatment. Conclusions: Our results demonstrate that case management is effective across a wide range of treatment task outcomes, but more limited in its effectiveness with personal functioning outcomes.
    Journal of Consulting and Clinical Psychology 05/2014; 82(4). DOI:10.1037/a0036750 · 4.85 Impact Factor
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    • "The team encourages all clients to participate in community employment and directly provides many vocational rehabilitation services. Collaboration in the interdisciplinary team is crucial (Drake et al., 1998 "
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    ABSTRACT: Background: Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. Methods: The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. Results: Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. Conclusion: It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.
    Substance Abuse 03/2014; 35(1):3-6. DOI:10.1080/08897077.2013.792313 · 1.62 Impact Factor
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    • "K. A. Moore e-mail: management approaches (Drake et al. 1998a "
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    ABSTRACT: Assertive community treatment (ACT) and integrated dual disorders treatment (IDDT) have individually proven effective for treatment of adults with complex behavioral health and housing needs. This study evaluated the effectiveness of an ACT team that delivered integrated care consistent with IDDT principles. Participants included 60 adults with a history of chronic homelessness and co-occurring mental health and substance use disorders. Measures assessing mental health, substance use, and residential stability were completed at intake to the program and then 6 months later. Participants reported statistically significant improvements in mental health symptomatology and residential stability over time, although there were no changes in substance use. Findings support the effectiveness of the intervention for improving mental health and housing stability among adults with complex behavioral health and housing needs. Fidelity data support the notion that multiple evidence-based interventions can be integrated while still maintaining adequate fidelity to individual components.
    Community Mental Health Journal 12/2013; 50(4). DOI:10.1007/s10597-013-9692-5 · 1.03 Impact Factor
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