Robert E Drake

Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States

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Publications (423)1444.41 Total impact

  • Robert E Drake · Valerie A Noel · Patricia E Deegan
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    ABSTRACT: Background: As the concept of recovery has become increasingly popular in mental health treatment settings, professionals have attempted to measure recovery as an outcome. Aims: This article reviews the history of the concept of recovery and recent attempts to measure recovery as an outcome. Results: The concept of recovery, as developed by people who experienced mental health problems, emphasizes the process of learning to live a meaningful life in spite of vulnerabilities and symptoms. Traditional outcome studies assess recovery as cure or return to premorbid functioning, not in this new sense of developing quality of life. Newer measures attempt to assess the process and outcomes of recovery, but with minimal consistency, reflecting the heterogeneity of definitions, populations, and programs. Attempts to measure recovery may, nevertheless, move the mental health system, programs, and professionals closer to understanding and honoring the ideals of recovery that are so meaningful to service users.
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    ABSTRACT: A previous longitudinal study in rural New Hampshire showed that community mental health center clients with co-occurring schizophrenia-spectrum and substance use disorders (SZ/SUD) improved steadily and substantially over 10 years. The current study examined 7 years of prospective clinical and functional outcomes among inner-city Connecticut (CT) community mental health center clients with SZ/SUD. Participants were 150 adults with SZ/SUD, selected for high service needs, in 2 inner-city mental health centers in CT. Initially, all received integrated mental health and substance abuse treatments for at least the first 3 years as part of a clinical trial. Assessments at baseline and yearly over 7 years measured progress toward 6 target clinical and functional outcomes: absence of psychiatric symptoms, remission of substance abuse, independent housing, competitive employment, social contact with non-users of substances, and life satisfaction. The CT SZ/SUD participants improved significantly on 5 of the 6 main outcomes: absence of psychiatric symptoms (45%-70%), remission of substance use disorders (8%-61%), independent housing (33%-47%), competitive employment (14%-28%), and life satisfaction (35%-53%). Only social contact with nonusers of substances was unimproved (14%-17%). Many urban community mental health center clients with SZ/SUD and access to integrated treatment improve significantly on clinical, vocational, residential, and life satisfaction outcomes over time, similar to clients with SZ/SUD in rural areas, but a substantial group does not improve. Thus, the long-term course for people with SZ/SUD is variable but often quite positive. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email:
    Schizophrenia Bulletin 08/2015; DOI:10.1093/schbul/sbv110 · 8.45 Impact Factor
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    ABSTRACT: Employment is a key to participation in community life for people with severe mental illness, especially those who have been involved in the criminal justice system. Although the Individual Placement and Support (IPS) model of supported employment has been established as an evidence-based practice for helping people with severe mental illness attain competitive employment, little is known about whether IPS is effective for people with severe mental illness who have a history of arrest or incarceration. This study examined this question. A randomized controlled trial examined competitive employment outcomes for 85 participants with severe mental illness and justice involvement who were assigned to IPS or to a comparison group that offered a job club approach with peer support. At one-year follow-up, a greater proportion of participants in the IPS group than in the comparison group had obtained competitive employment (31% versus 7%; p<.01). The IPS and comparison groups did not differ significantly during follow-up in rates of hospitalization (51% versus 40%) or justice involvement-either arrests (24% versus 19%) or incarceration (2% for both groups). Although IPS was shown to be an effective model for helping justice-involved clients with severe mental illness achieve employment, the outcomes were modest compared with those in prior IPS studies. The IPS model provided a useful framework for employment services for this population, but augmentations may be needed.
    Psychiatric Services 06/2015; DOI:10.1176/ · 2.41 Impact Factor
  • Gary R. Bond · Robert E. Drake
    06/2015; 14(2). DOI:10.1002/wps.20234
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    ABSTRACT: Cognitive impairment presents a serious and common obstacle to competitive employment for people with severe mental illness, including those who receive supported employment. This study evaluated a cognitive enhancement program to improve cognition and competitive employment in people with mental illness who had not responded to supported employment. In a randomized controlled trial, 107 people with severe mental illness (46% with schizophrenia or schizoaffective disorder) who had not obtained or kept competitive work despite receiving high-fidelity supported employment were assigned to receive either enhanced supported employment (with specialized cognitive training of employment specialists) or enhanced supported employment plus the Thinking Skills for Work program, a standardized cognitive enhancement program that includes practice of computer cognitive exercises, strategy coaching, and teaching of coping and compensatory strategies. Research assistants tracked competitive employment weekly for 2 years, and assessors blind to treatment assignment evaluated cognitive functioning at baseline, at the end of cognitive enhancement training, and 12 and 24 months after baseline. Participants in the Thinking Skills for Work group improved more than those in the enhanced supported employment only group on measures of cognitive functioning and had consistently better competitive employment outcomes during the follow-up period, including in jobs obtained (60% compared with 36%), weeks worked (23.9 compared with 9.2), and wages earned ($3,421 compared with $1,728). The findings suggest that cognitive enhancement interventions can reduce cognitive impairments that are obstacles to work, thereby increasing the number of people who can benefit from supported employment and competitive work.
    American Journal of Psychiatry 05/2015; 172(9):appiajp201514030374. DOI:10.1176/appi.ajp.2015.14030374 · 12.30 Impact Factor
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    ABSTRACT: People dually diagnosed with substance abuse and mental illnesses often feel alienated at traditional 12-step meetings, yet they need the peer support provided by such groups. Dual Diagnosis Anonymous (DDA) is a peer-support program specifically for people with co-occurring disorders, which addresses many of the factors that members find alienating about traditional 12-step groups. This study aimed to elicit first-person perspectives on DDA. Occupational therapy students conducted 13 focus groups with 106 DDA members in three settings: the community (6 groups, n = 36), correctional facilities (5 groups, n = 53), and the state psychiatric hospital (2 groups, n = 17). Researchers inductively analyzed focus group transcripts to identify prominent themes. The vast majority of participants were between the ages of 18 and 49 (n = 87, 82.1%) and were non-Hispanic/White (n = 82, 77.4%). Most participants had been using substances for more than 10 years and had been diagnosed with a mental illness for more than 10 years. The most common substance of choice among those in the community and corrections setting was multiple substances, while those in the state hospital identified alcohol most often. Bipolar disorder was the most common mental illness diagnosis among participants in the state hospital, but depression and anxiety were the two most common diagnoses in the community and corrections participants. Four primary themes emerged from the qualitative analysis: (1) feeling accepted by others in the group, (2) acceptance within the group of mental illness and substance abuse together, (3) the structure of DDA meetings compared to other 12-step meetings, and (4) a focus on hope and recovery from both illnesses. DDA provides a helpful alternative for individuals who do not feel comfortable at traditional 12-step groups due to their mental illness. Members value the acceptance, understanding, discussion, and hope in DDA meetings.
    Journal of Dual Diagnosis 03/2015; 11(2). DOI:10.1080/15504263.2015.1025215 · 0.80 Impact Factor
  • Robert E Drake · Alan I Green
    Journal of Dual Diagnosis 03/2015; 11(2). DOI:10.1080/15504263.2015.1027125 · 0.80 Impact Factor
  • Sean Roush · Corbett Monica · Danny Pavlovich · Robert E Drake
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    ABSTRACT: Community engagement research is widely discussed but rarely implemented. This paper describes the implementation of a community engagement research project on Dual Diagnosis Anonymous, a rapidly spreading peer support program in Oregon for people with co-occurring mental illness and substance use disorders. After three years of discussions, overcoming barriers, and involving several institutions, this grass-roots research project has been implemented and is expanding. Active participants in Dual Diagnosis Anonymous inspired and instructed policy makers, professionals, and students. Community engagement research requires front-line participants, community members, and professional collaborators to overcome multiple barriers with persistence and steadfastness. Building trust, collaboration, and structures for community engagement research takes time and a community effort.
    Journal of Dual Diagnosis 03/2015; 11(2). DOI:10.1080/15504263.2015.1025214 · 0.80 Impact Factor
  • Robert E. Drake · David A. Strickler · Gary R. Bond
    Psychiatric Annals 03/2015; 45(3):114-119. DOI:10.3928/00485713-20150304-05 · 0.71 Impact Factor
  • Dror Ben-Zeev · Robert Drake · Lisa Marsch
    BMJ Clinical Research 02/2015; 350(feb19 15):h945. DOI:10.1136/bmj.h945 · 14.09 Impact Factor
  • Alan I Green · Robert E Drake
    Journal of Dual Diagnosis 02/2015; 11(1):1-2. DOI:10.1080/15504263.2014.992557 · 0.80 Impact Factor
  • Robert E Drake · Rob Whitley
    World psychiatry: official journal of the World Psychiatric Association (WPA) 02/2015; 14(1):50-1. DOI:10.1002/wps.20183 · 14.23 Impact Factor
  • Psychiatric Services 01/2015; in press. · 2.41 Impact Factor
  • BMJ Clinical Research 11/2014; 349(nov25 8):g7086. DOI:10.1136/bmj.g7086 · 14.09 Impact Factor
  • Robert E Drake · Alan I Green
    Journal of Dual Diagnosis 10/2014; 10(4):175-6. DOI:10.1080/15504263.2014.969047 · 0.80 Impact Factor
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    Carol L M Caton · Haiyi Xie · Robert E Drake · Gregory McHugo
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    ABSTRACT: Objective: We conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses. Methods: A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardized research diagnostic assessment instrument, we classified patients at baseline into primary and substance-induced psychosis groups and analyzed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period. Results: Women had better premorbid adjustment, less misattribution of symptoms, and a later age at onset of regular drug use compared to men. Women, however, showed greater depression and histories of abuse compared to men. Men had greater arrest histories. No interactions between gender and diagnosis were significant. Both genders in the primary and substance-induced psychosis groups showed clinical and functional improvement over the follow-up period despite the overall minimal use of mental health and substance abuse treatment services. Conclusions: Women and men with psychosis and substance use differ on several dimensions. Our findings suggest the need for gender-specific treatment programming across both diagnostic groups.
    Journal of Dual Diagnosis 10/2014; 10(4):177-86. DOI:10.1080/15504263.2014.961882 · 0.80 Impact Factor
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    ABSTRACT: Objective: Roughly half of people with severe mental disorders also experience a co-occurring substance use disorder, and recovery from both is a critical objective for health care services. While understanding of abstinence initiation has grown, the strategies people with co-occurring disorders use to maintain sobriety are largely unknown. This article reports strategies for relapse prevention as described by men with co-occurring disorders who achieved one or more years of sobriety. Methods: We analyzed semi-structured interviews conducted with a sample of 12 men with co-occurring psychosis and substance use disorder who achieved and maintained sobriety for at least one year, supplemented with demographic and diagnostic clinical record data. These men were participating in residential or outpatient treatment at a private, nonprofit integrated treatment clinic. Results: The 12 men were primarily Caucasian (91.7%) and unmarried (100%), and their ages ranged from 23 to 42 years. The two most common psychiatric disorders were schizoaffective disorder (n = 4, 33.3%) and bipolar disorder (n = 4, 33.3%), while the two most commonly misused substances were alcohol and cannabis. Qualitative analyses showed that participants maintained sobriety for at least one year by building a supportive community, engaging in productive activities, and carefully monitoring their own attitudes toward substances, mental health, and responsibility. Alcoholics Anonymous might act as a catalyst for building skills. Conclusions: People with co-occurring disorders who achieve sobriety use a variety of self-management strategies to prevent relapse-seeking support, activities, and a healthy mindset. The findings suggest a relapse prevention model that focuses on social networks, role functioning, and self-monitoring and conceptualizes self-care as critical to extending periods of wellness.
    Journal of Dual Diagnosis 10/2014; 10(4):212-9. DOI:10.1080/15504263.2014.961884 · 0.80 Impact Factor
  • Alison Luciano · Gary R Bond · Robert E Drake
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    ABSTRACT: Introduction: This review synthesized prospective evidence to assess whether achieving employment alters the course of schizophrenia-spectrum disorder. Method: Researchers identified relevant analyses for review via PubMed, expert referral, and reference review and systematically applied two levels of screening to 1484 citations using seven a priori criteria. Results: A total of 12 analyses representing eight cohorts, or 6844 participants, compared illness course over time by employment status in majority schizophrenia-spectrum samples. Employment was consistently associated with reductions in outpatient psychiatric treatment (2 of 2 studies) as well as improved self-esteem (2 of 2 studies). Employment was inconsistently associated with positive outcomes in several other areas, including symptom severity, psychiatric hospitalization, life satisfaction, and global wellbeing. Employment was consistently unrelated to worsening outcomes. Discussion: Achieving employment does not cause harm among people with schizophrenia-spectrum disorder and other severe mental illnesses. Further detailed mechanistic analyses of adequately powered long-term follow-up studies using granular descriptions of employment are needed to clarify the nature of associations between employment and hypothesized benefit.
    Schizophrenia Research 09/2014; 159(2-3). DOI:10.1016/j.schres.2014.09.010 · 3.92 Impact Factor
  • Gary R. Bond · Robert E. Drake · Kikuko Campbell
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    ABSTRACT: AimThe individual placement and support (IPS) model of supported employment was first developed in community mental health centres for adults with severe mental illness. While IPS is an established evidence-based practice in this broad population, evidence on its effectiveness focused specifically on young adults has been limited. The current study aimed to address this gap.Methods To investigate the effects of IPS on young adults, the authors conducted a secondary analysis on a pooled sample of 109 unemployed young adults (under age 30) from four randomized controlled trials employing a common research protocol that included a standardized measurement battery and rigorous fidelity monitoring. Researchers assessed these participants over 18 months on nine competitive employment outcome measures.ResultsOn all measures, the IPS group had significantly better employment outcomes. Overall, 40 (82%) of IPS participants obtained employment during follow-up compared with 25 (42%) of control participants, χ2 = 17.9, P < .001. IPS participants averaged 25.0 weeks of employment, compared with 7.0 weeks for control participants, t = 4.50, P < .001.Conclusions The current analysis supports a small number of previous studies in showing that IPS is highly effective in helping young adults with severe mental illness to attain competitive employment. When young adults acquire competitive jobs and initiate a path towards normal adult roles, they may avoid the cycle of disability and psychiatric patient roles that are demeaning and demoralizing.
    Early Intervention in Psychiatry 09/2014; DOI:10.1111/eip.12175 · 1.95 Impact Factor
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    ABSTRACT: Objective: People with severe mental illness and a co-occurring substance use disorder (co-occurring disorders) who live in urban areas experience high rates of incarceration. This study examined sociodemographic, clinical, economic, and community integration factors as predictors of incarceration among people with co-occurring disorders. Methods: This secondary analysis used data from a randomized controlled trial of assertive community treatment versus standard case management. In the parent study, researchers interviewed 198 people with co-occurring disorders from two urban mental health centers in Connecticut at baseline and every six months for three years. Researchers tracked incarceration, clinical engagement and status, employment, living situation, social relationships, and substance use. The study reported here used bivariate analyses and logistic regression analyses to compare individuals who were incarcerated during the study period with those who were not. Results: The overall incarceration rate was 38% during the study period. In multivariate analyses, prior incarceration predicted incarceration during the study period (odds ratio [OR]=3.26). Two factors were associated with a reduced likelihood of incarceration: friendships with individuals who did not use substances (OR=.19) and substance use treatment engagement (OR=.60). Conclusions: Positive social relationships and engagement in substance use treatment are promising service and policy targets to prevent incarceration in this high-risk population.
    Psychiatric services (Washington, D.C.) 07/2014; 65(11). DOI:10.1176/ · 2.41 Impact Factor

Publication Stats

18k Citations
1,444.41 Total Impact Points


  • 1990–2015
    • Geisel School of Medicine at Dartmouth
      • • Department of Psychiatry
      • • Psychiatric Research Center
      • • Department of Community and Family Medicine
      Hanover, New Hampshire, United States
  • 1999–2014
    • Dartmouth College
      • • Department of Psychiatry
      • • Dartmouth Psychiatric Research Center (PRC)
      • • Department of Anthropology
      • • Department of Community and Family Medicine
      Hanover, New Hampshire, United States
  • 2011
    • Ministry of Health (Israel)
      • Mental Health Services
      Yerushalayim, Jerusalem District, Israel
    • New York State Psychiatric Institute
      New York City, New York, United States
  • 2004–2011
    • McGill University
      • • Douglas Research Centre
      • • Division of Social and Transcultural Psychiatry
      • • Department of Psychiatry
      Montréal, Quebec, Canada
    • University of California, San Francisco
      • Department of Psychiatry
      San Francisco, California, United States
  • 2009
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 2008
    • University of Birmingham
      Birmingham, England, United Kingdom
  • 1998–2008
    • Indiana University-Purdue University Indianapolis
      • Department of Psychology
      Indianapolis, IN, United States
  • 2007
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 2006
    • University of Kansas
      Lawrence, Kansas, United States
  • 2001–2006
    • University of Maryland, Baltimore
      • Department of Psychiatry
      Baltimore, Maryland, United States
  • 1989–2005
    • Duke University
      • Department of Psychology and Neuroscience
      Durham, North Carolina, United States
  • 2003
    • St George's, University of London
      Londinium, England, United Kingdom
  • 1984–2001
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1993
    • Concord Hospital
      Concord, New Hampshire, United States
  • 1986–1991
    • Berkeley Geochronology Center
      Berkeley, California, United States
  • 1984–1990
    • Tufts University
      • Department of Psychiatry
      Georgia, United States
  • 1988
    • Mass General Hospital
      Cambridge, Massachusetts, United States
  • 1979–1987
    • University of California, Berkeley
      Berkeley, California, United States