Abuse of alcohol and other drugs is a frequent diagnosis among people with severe mental disorders (SMD) particularly among those who are homeless. A significant proportion, typically 50% or more, of people with SMD abuse alcohol or other non-prescribed psychoactive substances. Their substance abuse is strongly associated with clinical disability, homelessness, institutionalization, and treatment difficulty. To address this problem, the Connecticut Department of Mental Health has provided 'funding for the creation of a new assertive community treatment (ACT) team to provide integrated treatment for substance abuse and SMD to dually diagnosed clients in Connecticut's largest and poorest city, Bridgeport. The proposed research will be a collaboration between the Connecticut Department of Mental Health and the Dartmouth Medical School to conduct a rigorous evaluation of the effectiveness and costs of the ACT program design for dually diagnosed clients in an urban area where cocaine and other drugs are readily available and widely used. The research will carefully document the interventions provided to clients in the ACT and control conditions to document both what interventions actually occurred and the costs of the interventions so that any differences in clinical outcomes and costs can be attributed to differences identified in the processes of care. The first objective of the project is to decrease the problems most characteristic of dually diagnosed clients: alcohol and drug abuse, housing instability and homelessness, and institutionalization in hospitals and jails. A second objective is to determine whether good outcomes in these primary domains will be associated with more general improvements in symptoms, functional status, and quality of life. A third objective is to identify the qualities of case management that are associated with successful engagement and treatment of dually diagnosed clients. Separate data analysis strategies will be applied to each of these objectives. The research design is a randomized clinical trial. A total of 200 consenting, dually diagnosed clients will be randomly assigned to either ACT or to standard case management. Study participants will be interviewed with standard quantitative instruments at baseline and at six-month followup intervals for three years.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH052872-04
Application #
2675251
Study Section
Special Emphasis Panel (SRCM (02))
Project Start
1994-09-30
Project End
2000-04-30
Budget Start
1998-05-01
Budget End
1999-04-30
Support Year
4
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Connecticut State Department of MH/Addiction Services
Department
Type
DUNS #
City
Hartford
State
CT
Country
United States
Zip Code
06134
Drake, Robert E; Luciano, Alison E; Mueser, Kim T et al. (2016) Longitudinal Course of Clients With Co-occurring Schizophrenia-Spectrum and Substance Use Disorders in Urban Mental Health Centers: A 7-Year Prospective Study. Schizophr Bull 42:202-11
Luciano, Alison; Belstock, Johannes; Malmberg, Per et al. (2014) Predictors of incarceration among urban adults with co-occurring severe mental illness and a substance use disorder. Psychiatr Serv 65:1325-31
Manuel, Jennifer I; Covell, Nancy H; Jackson, Carlos T et al. (2011) Does assertive community treatment increase medication adherence for people with co-occurring psychotic and substance use disorders? J Am Psychiatr Nurses Assoc 17:51-6
Frisman, Linda K; Mueser, Kim T; Covell, Nancy H et al. (2009) Use of integrated dual disorder treatment via assertive community treatment versus clinical case management for persons with co-occurring disorders and antisocial personality disorder. J Nerv Ment Dis 197:822-8
Lu, Weili; Mueser, Kim T; Rosenberg, Stanley D et al. (2008) Correlates of adverse childhood experiences among adults with severe mood disorders. Psychiatr Serv 59:1018-26
Elbogen, Eric B; Beckham, Jean C; Butterfield, Marian I et al. (2008) Assessing risk of violent behavior among veterans with severe mental illness. J Trauma Stress 21:113-7
Rosenberg, Stanley D; Lu, Weili; Mueser, Kim T et al. (2007) Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatr Serv 58:245-53
Jackson, Carlos T; Covell, Nancy H; Drake, Robert E et al. (2007) Relationship between diabetes and mortality among persons with co-occurring psychotic and substance use disorders. Psychiatr Serv 58:270-2
Essock, Susan M; Mueser, Kim T; Drake, Robert E et al. (2006) Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatr Serv 57:185-96
Mueser, Kim T; Crocker, Anne G; Frisman, Linda B et al. (2006) Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders. Schizophr Bull 32:626-36

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