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 percent 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 established an ACT team to provide integrated treatment for substance abuse and SMD to homeless, dually-diagnosed clients in Connecticut's largest and poorest city, Bridgeport. The proposed project will be a collaboration among the Connecticut Department of Mental Health, the Dartmouth Medical School, and the Greater Bridgeport Community Mental Health Center to: (1) Monitor the integrated treatment of substance abuse and SMD in both ACT teams and in standard case management services as set forth in the treatment manual developed during Phase 1 of this project. (2) Conduct a rigorous evaluation of the relative effectiveness and costs of the ACT program design for homeless, 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 standard case management 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. (3) Determine the effectiveness of community reinforcement treatment for dually diagnosed clients. Half of the consenting study participants in both the ACT and standard case management condition who reach the active treatment phase will be randomly assigned to a contingency management intervention which will reward abstinence based on the community reinforcement approach. (4) Determine how families contribute to client outcomes and how ACT teams influence family support. The project will capitalize upon an ongoing randomized clinical trial (ACT versus standard case management, N = 150). Hence the project offers a powerful comparison of the effectiveness of ACT among homeless, dually-diagnosed clients in a distressed urban area.

Agency
National Institute of Health (NIH)
Institute
Center for Mental Health Services (CMHS)
Type
Unknown (UD3)
Project #
5UD3SM051802-02
Application #
2288642
Study Section
Special Emphasis Panel (SRC (06))
Project Start
1994-09-30
Project End
1996-08-31
Budget Start
1995-09-01
Budget End
1996-08-31
Support Year
2
Fiscal Year
1995
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
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
Covell, Nancy H; Frisman, Linda K; Essock, Susan M (2003) Rates of refusal to participate in research studies among men and women. Psychiatr Serv 54:1541-4