This study will continue the effort to identify the necessary and sufficient features of treatment services for patients with co-occurring addictive and psychiatric disorders. This heterogeneous group is understudied and little is known about what combinations of alcohol, drug abuse, and mental health services are most appropriate. We have begun to characterize a subgroup of patients with concurrent DSMIII-R psychoactive substance use disorders and schizophrenia (PSUD/S). We have developed an outpatient program of integrated psychiatric and substance abuse treatment (Combined Outpatient Psychiatric and Addictive Disorders program, or COPAD). With the COPAD model, we successfully retained 69.7% of PSUD/S patients in treatment at 4 months and 60.6% at 8 months, significantly more than those retained in a standard, non-integrated treatment program. Despite better treatment retention, the COPAD program had a considerable number of treatment non-starters. We now propose a prospective, randomized clinical trial that tests the efficacy of two manual-driven modes of integrated substance abuse and psychiatric outpatient treatment In a component control design,we propose to l) to develop a model of Targeted Assertive Outreach (TAO) particularly designed for the needs of PSUD/S patients, and to integrate TAO into the COPAD program (COPAD+TAO); 2) to enroll new PSUD/S patients in this enhanced program via random assignment, and to compare outcome between COPAD and COPAD+TAO across 5 assessment domains: treatment retention, psychoactive substance use severity, psychiatric severity, rehospitalization and target complaints; 3) to collect data on longitudinal clinical status and service use on PSUD/S patients, both those retained in the study and drop-outs, through the use of patient tracking, community outreach, and serial evaluations by trained raters; 4) to develop a useful clinical model for treatment of persons with alcohol and/or psychoactive substance abuse disorders and severe mental illness, a model which can be adopted by other general outpatient clinics. This hospital Outpatient project will treat predominantly unemployed Black and Hispanic patients who have concurrent diagnoses of Psychoactive Substance Use Disorder (PSUD) and Schizophrenia. If integrated treatment with assertive outreach is more effective than integrated treatment alone, then we can expect , decreased abuse of drugs and alcohol, and improved psychosocial functioning over the study period as demonstrated by clinical and evaluation team ratings.
| Hellerstein, D J; Rosenthal, R N; Miner, C R (2001) Integrating services for schizophrenia and substance abuse. Psychiatr Q 72:291-306 |
| Galynker, I I; Watras-Ganz, S; Miner, C et al. (2000) Cerebral metabolism in opiate-dependent subjects: effects of methadone maintenance. Mt Sinai J Med 67:381-7 |
