The purpose of this 3 year randomized clinical trial project is to implement and test innovative social security representative payee strategies as they are integrated into long-term dual disorder treatment for substance abusing severely mentally ill outpatients in order to decrease substance abuse. The project targets subjects who 1) receive SSI or SSDI disability benefits for severe mental illness, 2) have an alcohol/other duty disorder, and 3) have assigned representative payee status to their Community Mental Health Center (CMHC). Two different CMHC's (urban/rural) will be used as study sites. After six months of baseline preintervention study, subjects will be randomized (stratified by baseline substance use) into either contingent or non-contingent payee management and compared over six months [randomized cohorts of subjects will be """"""""signed to one of two treatment orders, both Or which include 12 -month contingent and 6-month non contingent phases Of payee management]. In the contingent phase substance avoidance, regular treatment attendance, [clinical stability] and responsible money management will earn subjects increasing levels of autonomy in terms of the form (cash verses vouchers) and frequency (monthly/weekly/daily) of benefit disbursement by their representative payee case managers. The case managers will use a carefully described payee log with built-in disbursement plan [and decision tree] to tighten or loosen form and frequency (not overall amount) of benefit disbursement according to the above [defined] subject behaviors. In the non-contingent phase, disbursements are made once weekly without any behavioral contingencies. While the primary outcome will be comparative substance abstinence, other key multi-dimensional outcomes will be assessed. [By using a staggered phase, cross-over design, multi-dimensional outcomes will be compared across and within subjects.] It is hypothesized that contingent management will be associated with significantly more abstinence from substance, better treatment adherence and money management; improved psychiatric symptomatology and quality of life, and decreased homelessness, hospitalization and incarcerations than noncontingent management in this high risk-high cost population. [fewer adverse outcomes (hospitalization, incarceration, homelessness) and increased positive outcomes ([decreased substance use] greater treatment involvement, stability, quality Of life) than baseline or non-contingent management practices, in this high-risk/high-cost population. The findings of this study should be immediately relevant for providers and applicable for the approximately half-million similarly affected individuals nationwide.
| Ries, Richard K; Short, Robert A; Dyck, Dennis G et al. (2004) Unlinking disability income, substance use and adverse outcomes in dually diagnosed, severely mentally ill outpatients. Am J Addict 13:390-7 |
| Ries, Richard K; Dyck, Dennis G; Short, Robert et al. (2002) Use of case manager ratings and weekly urine toxicology tests among outpatients with dual diagnoses. Psychiatr Serv 53:764-6 |
