Outcomes of a Residential and Community-Based Co-occurring Disorders Treatment Program

Abstract

We evaluated an intensive, integrated treatment program for men with serious mental illness and co-occurring substance use disorder, which incorporated several evidence-based interventions. Independent researchers rated transcripts from quality improvement interviews to examine recovery in five key domains: housing, education/employment, family relationships, mental health, and substance use. The final sample comprised 82 participants; 60 (73.2%) had left the treatment program, and 22 (26.8%) remained engaged in services of varying intensity. Mean length of stay was 18.2 months (SD = 20.1). A large proportion of participants recovered on each domain (ranging from n = 40, 48.8% on education/employment to n = 55, 67.1% on substance use). Those who remained in treatment for at least a year (n = 37, 45.1%), compared with those who left earlier (n = 45, 54.9%), were significantly more likely to be in recovery in each of the five domains. Men with long-term dual disorders can achieve clinical and functional recovery when they receive intensive, integrated, evidence-based interventions for at least 1 year.

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References

  1. Ahrnsbrak, R., Bose, J., Hedden, S., Lipari, R., & Park-Lee, E. (2017). Key substance use and mental health indicators in the United States: results from the 2016 national survey on drug use and health. Rockville: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

    Google Scholar 

  2. Baker, A. L., Hides, L., & Lubman, D. I. (2010). Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review. The Journal of Clinical Psychiatry, 71(3), 247–254. https://doi.org/10.4088/JCP.09r05119gry.

    Article  PubMed  Google Scholar 

  3. Bruns, E. J., Kerns, S. E. U., Pullmann, M. D., Hensley, S. W., Lutterman, T., & Hoagwood, K. E. (2015). Research, data, and evidence-based treatment use in state behavioral health systems, 2001–2012. Psychiatric Services, 67(5), 496–503. https://doi.org/10.1176/appi.ps.201500014.

    Article  PubMed  Google Scholar 

  4. Dishion, T., Forgatch, M., Chamberlain, P., & Pelham 3rd., W. E. (2016). The Oregon model of behavior family therapy: from intervention design to promoting large-scale system change. Behavior Therapy, 47(6), 812–837. https://doi.org/10.1016/j.beth.2016.02.002.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dixon, L. (1999). Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophrenia Research, 35, S93–S100. https://doi.org/10.1016/S0920-9964(98)00161-3.

    Article  PubMed  Google Scholar 

  6. Drake, R. E., & Bond, G. R. (2010). Implementing integrated mental health and substance abuse services. Journal of Dual Diagnosis, 6(3–4), 251–262. https://doi.org/10.1080/15504263.2010.540772.

    Article  Google Scholar 

  7. Drake, R. E., Merrens, M. R., & Lynde, D. W. (2005). Evidence-based mental health practice: a textbook. WW Norton & Co.

  8. Drake, R. E., McHugo, G. J., Xie, H., Fox, M., Packard, J., & Helmstetter, B. (2006). Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. Schizophrenia Bulletin, 32(3), 464–473. https://doi.org/10.1093/schbul/sbj064.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Drake, R. E., O'Neal, E. L., & Wallach, M. A. (2008). A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. Journal of Substance Abuse Treatment, 34(1), 123–138. https://doi.org/10.1016/j.jsat.2007.01.011.

    Article  PubMed  Google Scholar 

  10. Drake, R. E., Luciano, A. E., Mueser, K. T., Covell, N. H., Essock, S. M., Xie, H., & McHugo, G. J. (2016). Longitudinal course of clients with co-occurring schizophrenia-spectrum and substance use disorders in urban mental health centers: a 7-year prospective study. Schizophrenia Bulletin, 42(1), 202–211. https://doi.org/10.1093/schbul/sbv110.

    Article  PubMed  Google Scholar 

  11. Epstein, J., Barker, P., Vorburger, M., & Murtha, C. (2004). Serious mental illness and its co-occurrence with substance use disorders, 2002. (DHHS Publication o. SMA 04-3905, Analytic Series A-24). Rockville: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

    Google Scholar 

  12. Hartz, S. M., Pato, C. N., Medeiros, H., Cavazos-Rehg, P., Sobell, J. L., Knowles, J. A., et al. (2014). Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry, 71(3), 248–254. https://doi.org/10.1001/jamapsychiatry.2013.3726.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kelly, T. M., Daley, D. C., & Douaihy, A. B. (2012). Treatment of substance abusing patients with comorbid psychiatric disorders. Addictive Behaviors, 37(1), 11–24. https://doi.org/10.1016/j.addbeh.2011.09.010.

    Article  PubMed  Google Scholar 

  14. Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56(10), 730–737. https://doi.org/10.1016/j.biopsych.2004.06.034.

    Article  PubMed  Google Scholar 

  15. Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. The American Journal of Orthopsychiatry, 66(1), 17–31. https://doi.org/10.1037/h0080151.

    CAS  Article  PubMed  Google Scholar 

  16. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month dsm-iv disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 617–627. https://doi.org/10.1001/archpsyc.62.6.617.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kreyenbuhl, J., Buchanan, R. W., Dickerson, F. B., & Dixon, L. B. (2009). The schizophrenia patient outcomes research team (port): updated treatment recommendations 2009. Schizophrenia Bulletin, 36(1), 94–103. https://doi.org/10.1093/schbul/sbp130.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Luciano, A. E., Bryan, E. L., Carpenter-Song, E. A., Woods, M. R., Armstrong, K., & Drake, R. E. (2014). Long-term sobriety strategies for men with co-occurring disorders. Journal of Dual Diagnosis, 10(4), 212–219. https://doi.org/10.1080/15504263.2014.961884.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McGovern, M. P., Lambert-Harris, C., Gotham, H. J., Claus, R. E., & Xie, H. (2014). Dual diagnosis capability in mental health and addiction treatment services: an assessment of programs across multiple state systems. Administration and Policy in Mental Health and Mental Health Services Research, 41(2), 205–214. https://doi.org/10.1007/s10488-012-0449-1.

    Article  PubMed  Google Scholar 

  20. McHugo, G. J., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., et al. (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services, 58(10), 1279–1284. https://doi.org/10.1176/ps.2007.58.10.1279.

    Article  PubMed  Google Scholar 

  21. Morin, L., & Franck, N. (2017). Rehabilitation interventions to promote recovery from schizophrenia: a systematic review. Frontiers in Psychiatry, 8, 100. https://doi.org/10.3389/fpsyt.2017.00100.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mueser, K. T., & Gingerich, S. (2013). Treatment of co-occurring psychotic and substance use disorders. Social Work in Public Health, 28(3–4), 424–439. https://doi.org/10.1080/19371918.2013.774676.

    Article  PubMed  Google Scholar 

  23. New Freedom Commission on Mental Health. (2003). Achieving the promise: transforming mental health care in america. Final report (Pub No. SMA-03-3832). Bethesda: US Department of Health and Human Services.

    Google Scholar 

  24. Noel, V. A., Woods, M. R., Routhier, J., & Drake, R. E. (2016). Planning treatment and assessing recovery in participants with dual diagnosis: preliminary evaluation of a new clinical tool. Journal of Dual Diagnosis, 12(1), 55–62. https://doi.org/10.1080/15504263.2016.1146555.

    Article  PubMed  Google Scholar 

  25. Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for good. New York: Avon Books.

    Google Scholar 

  26. Reeves, W. C., Strine, T. W., Pratt, L. A., Thompson, W., Ahluwalia, I., Dhingra, S. S., et al. (2011). Mental illness surveillance among adults in the United States. Morbidity and Mortality Weekly Report: Surveillance Summaries, 60(Suppl 3), 1–29.

    Google Scholar 

  27. Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the epidemiologic catchment area (eca) study. Jama, 264(19), 2511–2518.

    CAS  Article  Google Scholar 

  28. Ridgely, M. S., Goldman, H. H., & Willenbring, M. (1990). Barriers to the care of persons with dual diagnoses: organizational and financing issues. Schizophrenia Bulletin, 16(1), 123–132. https://doi.org/10.1093/schbul/16.1.123.

    CAS  Article  PubMed  Google Scholar 

  29. Substance Abuse and Mental Health Services Administration. (2017). 2017 uniform reporting system (urs) output tables. Available from https://www.samhsa.gov/data/report/2017-uniform-reporting-system-urs-output-tables. Accessed 20 Aug 2018.

  30. Vaillant, G. E. (1995). The natural history of alcoholism revisited. Cambridge: Harvard University Press.

    Google Scholar 

  31. Vandevelde, S., Vander Laenen, F., De Ruysscher, C., Bryssinck, D., De Maeyer, J., Meesen, D., & Broekaert, E. (2018). Reflections on a service user perspective in supporting persons with dual diagnosis: the case of Villa Voortman. International Journal of Mental Health and Addiction, 16(5), 1189–1192. https://doi.org/10.1007/s11469-017-9840-1.

    Article  Google Scholar 

  32. Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Watson, D. P., & Rollins, A. L. (2015). The meaning of recovery from co-occurring disorder: views from consumers and staff members living and working in housing first programming. International Journal of Mental Health and Addiction, 13(5), 635–649. https://doi.org/10.1007/s11469-015-9549-y.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Woods, M. R., & Drake, R. E. (2011). Treatment of a young man with psychosis and polysubstance abuse. Journal of Dual Diagnosis, 7(3), 175–185. https://doi.org/10.1080/15504263.2011.593418.

    Article  Google Scholar 

  35. World Health Organization. (2009). Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization.

    Google Scholar 

  36. World Health Organization. (2013). Mental health action plan 2013–2020. Geneva: WHO Document Production Services.

    Google Scholar 

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Acknowledgments

We wish to thank the staff at WestBridge for their hard work on data aggregation and verification, particularly Sarah White, who also took great care in going through records to locate missing data and helping to verify information when in question.

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Affiliations

Authors

Contributions

Acquilano co-designed the study; had primary responsibility for validating, managing, and analyzing the data; contributed to interpreting findings; and led the writing of the manuscript. Noel was involved in data validation and analyses, and contributed to the interpretation of findings and writing the manuscript. Gamache conducted the quality improvement initiative at the treatment program and contributed to writing the manuscript. Drake co-designed the study and contributed to the interpretation of findings and writing the manuscript. Hendrick assisted with interpretation of results and writing the manuscript. Gamache, Hendrick, and other program staff had no role in data analyses or reporting of results.

Corresponding author

Correspondence to Stephanie C. Acquilano.

Ethics declarations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Conflict of Interest

Authors Acquilano, Noel, and Drake declare that they have no conflict of interest. Author Hendrick is employed by WestBridge, Inc.; Author Gamache was employed by Westbridge, Inc. while the study was being conducted.

Informed Consent

Because we analyzed de-identified data that were already collected as part of the treatment program’s quality improvement efforts, the institutional review board waived the requirement for informed consent and deemed that this study was exempt from further review.

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Appendix

Appendix

Table 4 Five Recovery Domains and Rating Anchors

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Acquilano, S.C., Noel, V.A., Gamache, J. et al. Outcomes of a Residential and Community-Based Co-occurring Disorders Treatment Program. Int J Ment Health Addiction (2020). https://doi.org/10.1007/s11469-020-00251-x

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Keywords

  • Co-occurring disorders
  • Dual disorders
  • Dual diagnosis
  • Program evaluation
  • Evidence-based treatment
  • Integrated treatment
  • Recovery