Robert E Drake

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

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Publications (462)1513.78 Total impact

  • Gary R. Bond · Robert E. Drake · Deborah R. Becker · Valerie Noel

    No preview · Article · Feb 2016 · World psychiatry: official journal of the World Psychiatric Association (WPA)
  • Valerie Noel · Mary Woods · Jonathan Routhier · Robert Drake
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    ABSTRACT: Objective: Integrated treatment for people with co-occurring mental illness and substance use disorder would be enhanced by a simple, recovery-oriented instrument to plan treatment and monitor progress toward dual recovery. This paper describes the development of a clinical instrument, the WestBridge Dual Recovery Inventory, and presents a preliminary evaluation of its usability. Methods: In collaboration with participants in treatment, family members, clinicians, and program leaders, we developed an inventory on dual recovery and then examined its utility through a series of iterative steps. First, we tested the inventory for inter-rater reliability among 10 program participants (rated independently by the first and last author). Second, we examined concordance by having a separate group of 10 program participants and their care managers complete the inventory independently. Third, we observed three care managers and 10 participants work together to complete the inventory as part of routine care during the quarterly assessment; we evaluated shared decision making based on the process they used to resolve differences and on a brief survey completed by program participants as the end of the session. Finally, to measure the inventory's capacity to detect change over time, we analyzed the ratings from admission to one year for 43 participants with quarterly assessments available for that time period. Results: The WestBridge Dual Recovery Inventory assesses 14 domains of recovery, each rated on five-point scales. Inter-rater reliability was high (Kappa = .82 to 1.00); agreement between independent ratings by care managers and participants varied considerably (Kendall's tau = -.83 to +.87); and collaborative ratings demonstrated high scores on shared decision making. Participants improved significantly on 11 of 14 domains during the initial residential treatment phase (admission to six months) and sustained gains during outpatient assertive community treatment (six to 12 months). Conclusions: This preliminary assessment of the WestBridge Dual Recovery Inventory suggests it reliably assesses dual recovery, facilitates shared decision making, and captures changes over time. The inventory appears to be usable, well received by participants and care managers, specific for program goals, and sensitive to changes in our participants. Recovery measures may need to be program-specific.
    No preview · Article · Jan 2016 · Journal of Dual Diagnosis
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    Robert E. Drake · Alan I. Green

    Preview · Article · Jan 2016 · Journal of Dual Diagnosis
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    Haiyi Xie · Robert E. Drake · Sunny Jung Kim · Gregory J. McHugo
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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
  • Robert E. Drake · Alan I. Green

    No preview · Article · Oct 2015 · Journal of Dual Diagnosis
  • 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.
    No preview · Article · Sep 2015
  • Roline Milfort · Gary R Bond · Susan R McGurk · Robert E Drake
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    ABSTRACT: Objective: This study examined barriers to employment among Social Security Disability Insurance (SSDI) beneficiaries who received comprehensive vocational and mental health services but were not successful in returning to work. Methods: This study examined barriers to employment among 430 SSDI beneficiaries with mental disorders who received evidence-based vocational and mental health services for two years but worked less than one month or not at all. Comprehensive care teams, which included employment specialists, made consensus judgments for each participant, identifying the top three barriers to employment from a checklist of 14 common barriers. Results: Teams most frequently identified three barriers to employment: poorly controlled symptoms of mental illness (55%), nonengagement in supported employment (44%), and poorly controlled general medical problems (33%). Other factors were identified much less frequently. Conclusions: Some SSDI beneficiaries, despite having access to comprehensive services, continued to experience psychiatric impairments, difficulty engaging in vocational services, and general medical problems that limited their success in employment.
    No preview · Article · Sep 2015 · Psychiatric services (Washington, D.C.)
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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:
    Full-text · Article · Aug 2015 · Schizophrenia Bulletin
  • David Roe · Robert E. Drake · Mike Slade

    No preview · Article · Aug 2015 · International Review of Psychiatry
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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.
    No preview · Article · Jun 2015 · Psychiatric Services
  • Gary R. Bond · Robert E. Drake

    No preview · Article · Jun 2015
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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.
    Full-text · Article · May 2015 · American Journal of Psychiatry
  • 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.
    No preview · Article · Mar 2015 · Journal of Dual Diagnosis
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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.
    No preview · Article · Mar 2015 · Journal of Dual Diagnosis
  • Robert E Drake · Alan I Green

    No preview · Article · Mar 2015 · Journal of Dual Diagnosis
  • Robert E. Drake · David A. Strickler · Gary R. Bond
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    ABSTRACT: Residential treatment settings can provide safety, stabilization, and treatment. Many also provide psychiatric rehabilitation, defined here as enhancement of supports and skills. Long-term residential treatment must balance potential benefits and harms. Critical issues include dependence, community inclusion, transfer of skills, supported employment and education, psychiatric medications, and perverse incentives. Guidelines to address each of these issues include emphasis on independence, recovery, living in the community, informed decision-making, developing skills and supports in real-world settings, pursuing education and employment in normal school and work settings, developing healthy relationships outside of professional staff, minimizing medication exposure, and minimizing time in segregated residential programs.
    No preview · Article · Mar 2015 · Psychiatric Annals
  • Dror Ben-Zeev · Robert Drake · Lisa Marsch

    No preview · Article · Feb 2015 · BMJ Clinical Research
  • Alan I Green · Robert E Drake

    No preview · Article · Feb 2015 · Journal of Dual Diagnosis
  • Robert E Drake · Rob Whitley

    No preview · Article · Feb 2015 · World psychiatry: official journal of the World Psychiatric Association (WPA)

  • No preview · Article · Jan 2015 · Psychiatric Services

Publication Stats

22k Citations
1,513.78 Total Impact Points


  • 1988-2016
    • Geisel School of Medicine at Dartmouth
      • • Department of Psychiatry
      • • Psychiatric Research Center
      • • Department of Community and Family Medicine
      Hanover, New Hampshire, United States
  • 2015
    • Boston University
      • Center for Psychiatric Rehabilitation
      Boston, Massachusetts, United States
  • 2000-2015
    • Dartmouth College
      • • Department of Psychiatry
      • • Department of Community and Family Medicine
      • • Department of Anthropology
      Hanover, New Hampshire, United States
  • 2011
    • Ministry of Health (Israel)
      • Mental Health Services
      Yerushalayim, Jerusalem District, Israel
  • 2006-2010
    • McGill University
      • • Division of Social and Transcultural Psychiatry
      • • Department of Psychiatry
      Montréal, Quebec, Canada
    • University of Kansas
      Lawrence, Kansas, United States
    • New Hampshire College
      Concord, New Hampshire, United States
  • 2009
    • Yale University
      New Haven, Connecticut, United States
  • 2008
    • University of Birmingham
      Birmingham, England, United Kingdom
  • 2007
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 1991-2005
    • Duke University
      Durham, North Carolina, United States
  • 2004
    • University of California, San Francisco
      • Department of Psychiatry
      San Francisco, California, United States
  • 1985-2003
    • Harvard Medical School
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 1999-2001
    • University of Maryland, Baltimore
      • Department of Psychiatry
      Baltimore, Maryland, United States
  • 1984-2001
    • Harvard University
      Cambridge, Massachusetts, United States
    • Cambridge College
      Cambridge, Massachusetts, United States
  • 1998-1999
    • Indiana University-Purdue University Indianapolis
      • Department of Psychology
      Indianapolis, Indiana, 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
  • 1979-1987
    • University of California, Berkeley
      Berkeley, California, United States