Community Mental Health Journal

, Volume 48, Issue 2, pp 127–132 | Cite as

A Brief Treatment Engagement Intervention for Individuals with Co-occurring Mental Illness and Substance Use Disorders: Results of a Randomized Clinical Trial

  • David SmelsonEmail author
  • David Kalman
  • Miklos F. Losonczy
  • Anna Kline
  • Usha Sambamoorthi
  • Lauren St. Hill
  • Kathy Castles-Fonseca
  • Douglas Ziedonis
Brief Report


Study objectives were to evaluate a brief intervention designed to facilitate outpatient engagement following an inpatient psychiatric stay for individuals with mental illness and substance use. A total of 102 veterans were randomly assigned to one of two conditions: (1) Time Limited Care-Coordination (TLC), an eight-week co-occurring disorders intervention or (2) a matched attention (MA) control condition in the form of health education sessions. Both groups also received treatment as usual in inpatient and outpatient settings. Sixty-nine percent of TLC participants attended an outpatient appointment within 14 days of discharge, compared to only 33% of MA participants (P < 0.01). TLC participants were also more likely to be engaged in outpatient services at the end of the intervention period (44 vs. 22%, P < 0.01). This study provided evidence that an eight-week intervention could improve treatment engagement. Research is currently underway to examine impact of TLC intervention beyond the 8 week study period.


Substance abuse Mental illness Behavioral therapy Case management Peer support Treatment engagement 



This research was supported by grants from the Department of Veterans Affairs-Health Services Research and Development Service: IIR-020-145 (Dr. Smelson). The authors wish to acknowledge the support by veterans who participated in this research.


  1. Appleby, L., Luchins, D. J., & Dyson, V. (2001). Predischarge linkage and aftercare contact among dually-diagnosed public psychiatric patients. The Journal of Nervous and Mental Disease, 189, 265–267.PubMedCrossRefGoogle Scholar
  2. Bellack, A. et al. (2009). Behavioral therapy along with critical time intervention for co-occurring disorders. Presented at NIAAA R 13 Conference, Fairlee, VT.Google Scholar
  3. Bellack, A., Bennett, M. E., Gearon, J. S., Brown, C. H., & Yang, Y. (2006). A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. Archives of General Psychiatry, 63, 426–432.PubMedCrossRefGoogle Scholar
  4. Bennett, M. E., Bellack, A. S., & Gearon, J. S. (2001). Treating substance abuse in schizophrenia: An initial report. Journal of substance abuse treatment, 20, 163–175.PubMedCrossRefGoogle Scholar
  5. Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management & Health Outcomes, 9, 141–159.CrossRefGoogle Scholar
  6. Brunette, M. F., Drake, R. E., Woods, M., & Hartnett, T. (2001). A comparison of long-term and short-term residential treatment programs for dual diagnosis patients. Psychiatric Services, 52, 526–528.PubMedCrossRefGoogle Scholar
  7. Burnam, M. A., Morton, S. C., McGlynn, E. A., Petersen, L. P., Stecher, B. M., Hayes, C., et al. (1995). An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults. Journal of Addictive Diseases, 14, 111–134.PubMedCrossRefGoogle Scholar
  8. Carey, K. B. (1996). Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational harm reduction approach. Community Mental Health Journal, 32, 291–306.PubMedCrossRefGoogle Scholar
  9. Dixon, L., Goldberg, R., Iannone, V., Lucksted, A., Brown, C., Kreyenbuhl, J., et al. (2009). Use of a brief critical time intervention approach to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Services, 60, 451–458.PubMedCrossRefGoogle Scholar
  10. Drake, R. E., McHugo, G. J., Clark, R. E., Teague, G. B., Xie, H., Miles, K., et al. (1998). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry, 68, 201–215.PubMedCrossRefGoogle Scholar
  11. Drake, R. E., Yovetich, N. A., Bebout, R. R., Harris, M., & McHugo, G. J. (1997). Integrated treatment for dually diagnosed homeless adults. Journal of Nervous and Mental Disease, 185, 298–305.PubMedCrossRefGoogle Scholar
  12. Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35, 696–703.Google Scholar
  13. Latimer, E. (1999). Economic impacts of assertive community treatment: A review of the literature. Canadian Journal of Psychiatry, 44, 443–454.Google Scholar
  14. McLellan, A. T., Luborsky, L., Woody, G., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The addiction severity index. Journal of Nervous and Mental Diseases, 168, 26–33.CrossRefGoogle Scholar
  15. Morgenstern, J., Hogue, A., Dauber, S., Dasaro, C., & McKay, J. R. (2009a). A practical clinical trial of coordinated care management to treat substance use disorders among public assistance beneficiaries. Journal of Consulting and Clinical Psychology, 77, 257–269.PubMedCrossRefGoogle Scholar
  16. Morgenstern, J., Neighbors, C. J., Kuerbis, A., Riordan, A., Blanchard, K. A., McVeigh, K. H., et al. (2009b). Improving 24-month abstinence and employment outcomes for substance-dependent women receiving temporary assistance for needy families with intensive case management. American Journal of Public Health, 99, 328–333.PubMedCrossRefGoogle Scholar
  17. Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24, 37–74.PubMedGoogle Scholar
  18. Nidecker, M., DiClemente, C. C., Bennett, M. E., & Bellack, A. S. (2008). Application of the transtheoretical model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness. Addictive Behaviors, 33, 1021–1030.PubMedCrossRefGoogle Scholar
  19. Owen, C., Rutherford, V., Jones, M., Tennant, C., & Smallman, A. (1997). Non-compliance in psychiatric aftercare. Community Mental Health Journal, 31, 25–34.CrossRefGoogle Scholar
  20. Pantalon, M. V., & Swanson, A. J. (2003). Use of the university of Rhode Island change assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals. Psychology of Addictive Behaviors, 17, 91–97.PubMedCrossRefGoogle Scholar
  21. Rahav, M., Rivera, J. J., Nuttbrock, L., Ng-Mak, D., Sturz, E. L., Link, B. G., et al. (1995). Characteristics and treatment of homeless, mentally ill, chemical-abusing men. Journal of Psychoactive Drugs, 27, 93–103.PubMedCrossRefGoogle Scholar
  22. Smelson, D. A., Kline, A., Hills, S., Mizzeli, A., & Trip, J. (2007a). The MISSION consumer workbook. Substance Abuse and Mental Health Service Administration.Google Scholar
  23. Smelson, D.A., Kline, A., Hills, S., & Ziedonis, D. (2007b). The MISSION treatment manual. Substance Abuse and Mental Health Service Administration.Google Scholar
  24. Smelson, D. A., Losonczy, M., Castles-Fonseca, K., Stewart, P., Kaune, M., & Ziedonis, D. (2005). Preliminary outcomes from a booster case management program for individuals with a co-occuring substance abuse and a persistent psychiatric disorder. Journal of Dual Diagnosis, 3, 47–59.CrossRefGoogle Scholar
  25. Smelson, D. A., Losonczy, M., Ziedonis, D., Castles-Fonseca, K., & Kaune, M. (2007b). Six month outcomes from a booster case management program for individuals with a co-occuring substance abuse and a persistent psychiatric disorder. European Journal of Psychiatry, 21, 143–152.Google Scholar
  26. Susser, E., Betne, P., Valencia, E., Goldfinger, S. M., & Lehman, A. F. (1997). Injection drug use among homeless adults with severe mental illness. American Journal of Public Health, 5, 854–856.CrossRefGoogle Scholar
  27. Swindle, R. W., Phibbs, C. S., Paradise, M. J., Recine, B. P., & Moos, R. H. (1995). Inpatient treatment for substance abuse patients with psychiatric disorders: A national study of determinants of readmission. Journal of Substance Abuse, 7, 79–97.PubMedCrossRefGoogle Scholar
  28. Tenhula, W. N., Bennett, M. E., & Strong Kinnaman, J. E. (2009). Behavioral treatment of substance abuse in schizophrenia. Journal of Clinical Psychology, 65, 831–841.PubMedCrossRefGoogle Scholar
  29. Yanos, P. T., Primavera, L. H., & Knight, E. L. (2001). Consumer-run service participation, recovery of social functioning, and the mediating role of psychological factors. Psychiatric Services, 52, 493–500.PubMedCrossRefGoogle Scholar
  30. Ziedonis, D. M., Smelson, D., Rosenthal, R. N., Batki, S. L., Green, A. I., Henry, R. J., et al. (2005). Improving the care of individuals with schizophrenia and substance use disorders: Consensus recommendations. Journal of psychiatric practice, 11, 315–339.PubMedCrossRefGoogle Scholar
  31. Ziedonis, D., & Stern, R. (2001). Dual recovery therapy for schizophrenia and substance abuse. Psychiatric Annals, 31, 255–264.Google Scholar
  32. Ziedonis, D. M., & Trudeau, K. (1997). Motivation to quit using substances among individuals with schizophrenia: Implications for a motivation-based treatment model. Schizophrenia Bulletin, 23, 229–238.PubMedGoogle Scholar
  33. Ziedonis, D., Yanos, P. T., & Silverstein, S. M. (2007). Relapse prevention for schizophrenia. In K. Witkiewitz & G. A. Marlatt (Eds.), Therapist’s guide to evidence-based relapse prevention (pp. 117–215). Oxford, UK: Elsevier Inc.CrossRefGoogle Scholar

Copyright information

© US Government 2010

Authors and Affiliations

  • David Smelson
    • 1
    • 2
    Email author
  • David Kalman
    • 1
    • 2
  • Miklos F. Losonczy
    • 3
  • Anna Kline
    • 3
  • Usha Sambamoorthi
    • 2
    • 4
  • Lauren St. Hill
    • 3
  • Kathy Castles-Fonseca
    • 3
  • Douglas Ziedonis
    • 5
  1. 1.Center for Health, Quality, Outcomes and Economic ResearchEdith Norse Rogers VA Medical CenterBedfordUSA
  2. 2.Department PsychiatryUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.VA New Jersey Healthcare SystemLyonsUSA
  4. 4.Center for Healthcare Knowledge ManagementVA New Jersey Healthcare SystemEast OrangeUSA
  5. 5.Department PsychiatryUniversity of Massachusetts Medical School/UMass Memorial Health CareWorcesterUSA

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