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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    • "Data for this illustrative study are from the New Hampshire Dual Diagnosis Study, a prospective 16-year study of clients with severe mental illnesses and co-occurring substance use disorders (Drake et al. 1998). Participants were 223 clients from seven of New Hampshire's 10 community mental health centers recruited between 1989 and 1992. "
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    ABSTRACT: With the rapid development of methods for electronic data capture, longitudinal data sets with many assessment points have become common in mental health services and addiction research. These data typically exhibit complex and irregular patterns of change, and the relationship between variables may also change over time. Existing statistical methods are not flexible enough to capture this complexity, but a new method, the time-varying effect model (TVEM), permits modeling nearly any shape of change, and allows the effect of an independent variable on outcome to change over time. This paper introduces TVEM and illustrates its application using data from a 16-year study of 223 participants with serious mental illness and substance abuse.
    Full-text · Article · Jan 2016 · Administration and Policy in Mental Health and Mental Health Services Research
    • "The high rates of SUDs among individuals with SMI, and the consequences of this comorbidity, directly contribute to the high economic cost of SMI in the U.S., which is estimated to be well over $400 billion (2013 USD) annually (Insel, 2008). Many people with comorbid SUD and SMI do not receive concurrent treatment for the disorders (Substance Abuse and Mental Health Services Administration, 2002; Watkins et al., 2001a), although integrated treatments have been shown to reduce drug use (Baker et al., 2006; Barrowclough et al., 2010; Bellack et al., 2006; Drake et al., 1998; Epstein et al., 2004; Watkins et al., 2001b; Weiss et al., 2009). While the results pertaining to reductions in psychiatric severity associated with many integrated treatments are mixed (Drake et al., 2008), two randomized, controlled trials (RCTs) have shown that CM alone (McDonell et al., 2013), or as part of a cognitive behavioral treatment (Bellack et al., 2006) can reduce drug and alcohol use, improve psychiatric symptoms, and reduce inpatient hospitalizations in adults who suffer from co-occurring SUDs and SMI. "

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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.
    Full-text · Article · May 2014 · Journal of Consulting and Clinical Psychology
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