Modified Therapeutic Community for Mentally Ill Chemical “Abusers”: Background; Influences; Program Description; Preliminary Findings
Center for Therapeutic Community Research, National Development and Research Institutes, Inc., New York, New York 10048, USA.Substance Use & Misuse (Impact Factor: 1.23). 08/1997; 32(9):1217-59. DOI: 10.3109/10826089709035472
This paper briefly surveys the literature that addresses the problem of co-occurring mental and "substance abuse disorders." It discusses several convergent influences on the development of modified therapeutic community (TC) approaches. The paper describes in some detail the modified TC program for mentally ill chemical "abusers" (MICAs). The paper also summarizes research data that establish positive retention rates and significant in-treatment change to support the effectiveness of the modified TC and to underscore the limited effect of treatment-as-usual approaches. Treatment approaches must be comprehensive, multidimensional, of relatively long duration, and must systematically address the interrelated problems of mental illness and substance use.
- "2-4,18 In addition to this, patients with this comorbidity show a lack of adherence to maintain1| themselves in and completing psychological and/or pharmacological treatments, which causes unsuccessful attention attempts in function of the high rate of relapse. 3,4,19,20 "
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- "In the last decade TCs have modified their approaches to accommodate a variety of special populations, including prisoners (Sacks et al., 2004), women and their children, adolescents (De Leon, 1997), people with HIV/AIDS (Sargent et al., 1999), homeless persons (De Leon et al., 2000; Skinner, 2005) and those with co-occurring mental illness requiring psychiatric medication (Sacks et al., 1997). A small number of TCs have also made modifications to allow clients on methadone maintenance treatment (MMT) into the TC. "
ABSTRACT: Residential therapeutic communities (TCs) have demonstrated effectiveness, yet for the most part they adhere to a drug-free ideology that is incompatible with the use of methadone. This study used equivalency testing to explore the consequences of admitting opioid-dependent clients currently on methadone maintenance treatment (MMT) into a TC. The study compared 24-month outcomes between 125 MMT patients and 106 opioid-dependent drug-free clients with similar psychiatric history, criminal justice pressure and expected length of stay who were all enrolled in a TC. Statistical equivalence was expected between groups on retention in the TC and illicit opioid use. Secondary hypotheses posited statistical equivalence in the use of stimulants, benzodiazepines, and alcohol, as well as in HIV risk behaviors. Mean number of days in treatment was statistically equivalent for the two groups (166.5 for the MMT group and 180.2 for the comparison group). At each assessment, the proportion of the MMT group testing positive for illicit opioids was indistinguishable from the proportion in the comparison group. The equivalence found for illicit opioid use was also found for stimulant and alcohol use. The groups were statistically equivalent for benzodiazepine use at all assessments except at 24 months where 7% of the MMT group and none in the comparison group tested positive. Regarding injection- and sex-risk behaviors the groups were equivalent at all observation points. Methadone patients fared as well as other opioid users in TC treatment. These findings provide additional evidence that TCs can be successfully modified to accommodate MMT patients.
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- "There is an increased prevalence of patients diagnosed with both psychiatric and substance use disorders , especially in publicly funded organizations (Drake & Mueser, 2000; Osher & Drake, 1996; Sacks et al., 1997). The increase has heightened recognition of the need for integrated treatment programs that yield better outcomes for dual diagnosis patients than sequential or parallel treatment in psychiatric or substance abuse programs (Drake, Mercer-McFadden, Mueser, McHugo, & Bond, 1998; Drake et al., 2001; Granholm, Anthenelli, Monteiro, Sevcik, & Stoler, 2003). "
ABSTRACT: The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., assessment and diagnosis, crisis intervention, counseling targeted at psychiatric and at substance use problems, medications, patient education, HIV screening and counseling, family counseling and education). However, compared to psychiatric programs, substance abuse programs were more likely to offer some of these services and other critical components (e.g., a cognitive-behavioral treatment orientation, assignment of a single case manager to each patient). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring of providers) and services (e.g., detoxification, 12-step meetings) of integrated treatment. Generally, differences between psychiatric and substance abuse programs appeared to involve difficulties in developing treatment that is fully oriented toward the co-occurring diagnosis. To improve the provision of high-quality dual-focused care, we recommend planners' use of cross-system teams and applications of recently produced tools designed to increase programs' ability to deliver integrated care to dually disordered individuals.
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