This study reports on associations among symptom severity, amount of treatment, and 1-year outcomes in a national sample of 8,622 dual diagnosis patients, who were classified at treatment entry into low-, moderate-, and high-severity groups. Patients with more severe symptoms at intake had poorer 1-year outcomes. Higher severity patients did not receive adequate “doses” of care: Compared with low-severity patients, they had a shorter duration of care, although a longer duration was associated with improved outcomes; they also were less likely to receive outpatient substance abuse treatment, although more intensive treatment was associated with better drug outcomes. High-severity patients improved more on drug and legal outcomes, but less on psychiatric and family/social outcomes, than low-severity patients did when treatment was of longer duration or higher intensity. Dual diagnosis patients with highly severe symptoms would likely benefit from a longer episode of care that includes substance abuse and psychiatric outpatient treatment.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Alterman, A.I., & Cacciola, J.S. (1991). The antisocial personality disorder diagnosis in substance abusers: Problems and issues. Journal of Nervous and Mental Disease, 179, 401-409.
Alterman, A.I., McLellan, A.T., & Shifman, R.B. (1993). Do substance abuse patients with more psychopathology receive more treatment? Journal of Nervous and Mental Disease, 181, 576-582.
Barkham, M., Rees, A., Stiles, W.B., Shapiro, D.A., Hardy, G.E., & Reynolds, S. (1996). Dose-effect relations in time-limited psychotherapy for depression. Journal of Consulting and Clinical Psychology, 64, 927-935.
Brown, V.B., Melchior, L.A., & Huba, G.J. (1999). Level of burden among women diagnosed with severe mental illness and substance abuse. Journal of Psychoactive Drugs, 31, 31-40.
Drake, R.E., Mercer-McFadden, C., Mueser, K.T., McHugo, G.J., & Bond, G.R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589-609.
Fontana, A., & Rosenheck, R. (1996). Improving the efficiency of outpatient treatment for posttraumatic stress disorders. Administration and Policy in Mental Health, 23, 197-210.
Gastfriend, D.R., & McLellan, A.T. (1997). Treatment matching: Theoretic basis and practical implications. Medical Clinics of North America, 81, 945-966.
Gerstley, L.J., Alterman, A.J., McLellan, A.T., & Woody, G.E. (1990). Antisocial personality disorder in patients with substance abuse disorders: A problematic diagnosis? American Journal of Psychiatry, 147, 173-178.
Gordon, R.E., & Gordon, K.K. (1987). Relating Axes IV and V of DSM-III to clinical severity of psychiatric disorders. Canadian Journal of Psychiatry, 32, 423-424.
Hoffman, G.W., DiRito, D.C., & McGill, E.C. (1993). Three-month follow-up of 28 dual diagnosis inpatients. American Journal of Drug and Alcohol Abuse, 19, 79-88.
Howard, K.I., Lueger, R.J., Maling, M.S., & Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology, 61, 678-685.
Huff, E.D. (2000). Outpatient utilization patterns and quality outcomes after first acute episode of mental health hospitalization. Evaluation and the Health Professions, 23, 441-456.
Humphreys, K., Huebsch, P.D., Moos, R.H., & Suchinsky, R.T. (1999). The transformation of the Veterans Affairs substance abuse treatment system. Psychiatric Services, 50, 1399-1401.
Ito, J.R., & Donovan, D.M. (1990). Predicting drinking outcome: Demography, chronicity, coping, and aftercare. Addictive Behavior, 15, 553-559.
Kasprow, W.J., Rosenheck, R., Frisman, L., & DiLella, D. (1999). Residential treatment for dually diagnosed homeless veterans: A comparison of program types. American Journal on Addictions, 8, 34-43.
Kopta, S.M., Howard, K.I., Lowry, J.L., & Beutler, L.E. (1994). Patterns of symptomatic recovery in psychotherapy. Journal of Consulting and Clinical Psychology, 62, 1009-1016.
Kurtz, L.F., Garvin, C.D., Hill, E.M., Pollio, D., McPherson, S., & Powell, T.J. (1995). Involvement in Alcoholics Anonymous by persons with dual disorders. Alcoholism Treatment Quarterly, 12, 1-18.
Lehman, A.F., Myers, C.P., Johnson, J., & Dixon, L.B. (1995). Service needs and utilization for dualdiagnosis patients. American Journal on Addictions, 4, 163-169.
Luke, D.A., Mowbray, C.T., Klump, K., Herman, S.E., & BootsMiller, B. (1999). Exploring the diversity of dual diagnosis: Utility of cluster analysis for program planning. Journal of Mental Health Administration, 23, 298-316.
McKay, J.R., Alterman, A.I., McLellan, A.T., & Snider, E.C. (1994). Treatment goals, continuity of care, and outcome in a day hospital substance abuse rehabilitation program. American Journal of Psychiatry, 151, 254-259.
McLellan, A.T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., Pettinati, H., & Argeriou, M. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 461-480.
McLellan, A.T., Luborsky, L., Cacciola, J., Griffith, J., Evans, F., Barr, H.L., & O'Brien, C.P. (1985). New data from the Addiction Severity Index: Reliability and validity in three centers. Journal of Nervous and Mental Disease, 173, 412-423.
McLellan, A.T., Luborsky, L., Woody, G.E., & O'Brien, C.P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26-33.
McLellan, A.T., Woody, G.E., Luborsky, L., O'Brien, C.P., & Druley, K.A. (1983). Increased effectiveness of substance abuse treatment: A prospective study of patient-treatment “matching.” Journal of Nervous and Mental Disease, 171, 597-605.
Meissen, G., Powell, T.J., Wituk, S.A., Girrens, K., & Arteaga, S. (1999). Attitudes of AA contact persons toward group participation by persons with a mental illness. Psychiatric Services, 50, 1079-1081.
Moggi, F., Ouimette, P.C., Finney, J.W., & Moos, R.H. (1999). Effectiveness of treatment for substance abuse and dependence for dual diagnosis patients: A model of treatment factors associated with one-year outcomes. Journal of Studies on Alcohol, 60, 856-866.
Moos, R.H., Finney, J.W., Cannon, D., Finkelstein, A., McNicholas, L., McLellan, A.T., & Suchinsky, R. (1998). Outcomes monitoring for substance abuse patients: I. Patients' characteristics and treatment at baseline. Palo Alto, CA: Department of Veterans Affairs Health Care System.
Moos, R.H., Finney, J.W., Federman, E.B., & Suchinsky, R. (2000). Specialty mental health care improves patients' outcomes: Findings from a nationwide program to monitor the quality of care for patients with substance use disorders. Journal of Studies on Alcohol, 61, 704-713.
Moos, R.H., Humphreys, K., Ouimette, P.C., & Finney, J. (1999). Evaluating and improving VA substance abuse patients' care. American Journal of Medical Quality, 14, 45-54.
Moos, R.H., Schaefer, J., Andrassy, J., & Moos, B. (2001). Outpatient mental health care, self-help groups, and patients' one-year treatment outcomes. Journal of Clinical Psychology, 57, 273-287.
Ouimette, P.C., Finney, J.W., & Moos, R.H. (1997). Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology, 65, 230-240.
Ouimette, P.C., Finney, J.W., & Moos, R.H. (in press). Two year posttreatment functioning and coping of patients with substance use and posttraumatic stress disorder. Psychology of Addictive Behavior.
Ouimette, P.C., Gima, K., Moos, R.H., & Finney, J.W. (1999). A comparative evaluation of substance abuse treatment. IV. The effect of comorbid psychiatric diagnoses on amount of treatment, continuing care, and 1-year outcomes. Alcoholism: Clinical and Experimental Research, 23, 552-557.
Pristach, C.A., & Smith, C.M. (1999). Attitudes towards Alcoholics Anonymous by dually diagnosed psychiatric inpatients. Journal of Addictive Diseases, 18, 69-76.
Rabinowitz, J., Massad, A., & Finnig, S. (1995). Factors influencing disposition decisions for patients seen in a psychiatric emergency service. Psychiatric Services, 46, 712-718.
Rabinowitz, J., Slyuzberg, M., Salamon, I., Dupler, S., Kennedy, R.S., & Steinmuller, R. (1995). A method for understanding admission decision making in a psychiatric emergency room. Psychiatric Services, 46, 1055-1060.
Rounsaville, B.J., Kosten, T.R., Weissman, M.M., & Kleber, H.D. (1986). Prognostic significance of psychopathology in treated opiate addicts. Archives of General Psychiatry, 43, 739-745.
Rychtarik, R.G., Connors, G.J., Dermen, K.H., & Stasiewicz, P.R. (2000). Alcoholics Anonymous and the use of medications to prevent relapse: An anonymous survey of member attitudes. Journal of Studies on Alcohol, 61, 134-138.
Stoffelmayr, B.E., Mavis, B.E., & Kasim, R.M. (1994). The longitudinal stability of the Addiction Severity Index. Journal of Substance Abuse Treatment, 11, 373-378.
Tucker, L., Bauer, S.F., Wagner, S., Harlam, D., & Sher, I. (1987). Long-term hospital treatment of borderline patients: A descriptive outcome study. American Journal of Psychiatry, 144, 1443-1448.
Turner, W.M., Turner, K.H., Reif, S., Gutowski, W.E., Gastfriend, D.R. (1999). Feasibility of multidimensional substance abuse treatment matching. Drug and Alcohol Dependence, 55, 35-43.
About this article
Cite this article
Timko, C., Moos, R.H. Symptom Severity, Amount of Treatment, and 1-Year Outcomes Among Dual Diagnosis Patients. Adm Policy Ment Health 30, 35–54 (2002). https://doi.org/10.1023/A:1021275516753
- dual diagnosis
- functioning outcomes
- substance use outcomes
- symptom severity
- treatment duration and intensity