Despite our increased understanding of the determinants of substance abuse the treatment of addictive disorders continues to be a major public health problem. Even powerful treatments such as methadone maintenance for opiate dependence have high failure rates and, when patients stay in treatment, they often continue to use psychoactive substances. One reason for this poor outcome may be the high prevalence of comorbid psychiatric disorders in this population. Fortunately, a number of studies have shown the outcome of these patients can improve when their comorbidity is treated, Therefore, increasing the diagnostic accuracy and referral for treatment of this group of patients represents a promising strategy for the treatment of substance abuse disorders. The goal of the present application is to start to address this problem. The focus of this Stage I proposal is the development and initial testing of a brief intervention to increase the successful referral of treatable psychiatric disorders frequently comorbid in substance abuse populations. The intervention, called Systematic Motivation for Assessment, Referral and Treatment (SMART), will address three key barriers to the treatment of co-occurring disorders: identification of the disorders, improvement of the referral process, and adherence to the recommendations on the part of patients who are referred for psychiatric care. In addition, we will provide the treating psychiatrist with algorithms, includingthe use of medication combined with manualized medication management, to treat the co-occurring disorders.It is hoped that this intervention could become a tool for counselors and other frontline staff to identify patients who could benefit from referral for psychiatric care. Data from this study, which will be conducted in a large methadone maintenance clinic, will help plan future intervention studies that will use our increased ability to diagnose comorbidity to provide appropriate referral and treatment strategies for substance abuse patients in more diverse community-based treatment settings.
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