Community Mental Health Journal

, Volume 33, Issue 2, pp 113–122 | Cite as

Impact of Assertive Community Treatment on Homeless Persons with Co-Occurring Severe Psychiatric and Substance Use Disorders

  • Neil Meisler
  • Laura Blankertz
  • Alberto B. Santos
  • Catherine McKay


This study evaluated the impact of an integrated (mental health/substance abuse) assertive community treatment program on homeless persons with serious mental and substance use disorders. High rates of retention in treatment, housing stability, and community tenure were attained, and all but the most severe substance users appeared to gain these benefits. While the intervention appears to be an effective means of retaining in services and monitoring such difficult-to-treat and costly populations, it did not yield high rates of abstinence and social benefits in severe users.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abram, K.M. & Teplin, L.A. (1991). Co-occurring disorders among mentally ill jail detainees. American Psychologist, 46:1036-1045.Google Scholar
  2. Anthony, W.A. & Blanch, A. (1987). Supported employment for persons who are psychiatrically disabled: A historical and conceptual perspective. Psychosocial Rehabilitation Journal, 11:5-23.Google Scholar
  3. Blankertz, L. & Cnaan R. (1992). Principles of care for dually diagnosed homeless persons: findings from a demonstration project. Research on Social Work Practice. 2:448-464.Google Scholar
  4. Detrick, A. & Stiepock, V. (1992). Treating persons with mental illness, substance abuse, and legal problems: The Rhode Island experience. In L.I. Stein, (Ed.), Innovative Community Mental Health Programs. New Directions for Mental Health Services, 56. San Francisco: Jossey-Bass.Google Scholar
  5. Drake, R.E., Osher, F.C., Noordsy, D.L. Hurlbut, S.M., Teague, C.B. & Deaudett, M.S. (1990). The case manager rating scale for alcohol use disorder. In G.B. Teague, B. Schwab & R.E. Drake, Evaluation of Services for Young Adults with Severe Mental Illness and Substance Use Disorders, Alexandria, VA: National Association of State Mental Health Program Directors.Google Scholar
  6. Drake, R.E., McHugo, G.J. & Noordsy, D.L. (1993). Treatment of alcoholism among schizophrenic outpatients 4-year outcomes. American Journal of Psychiatry, 150:328-329.Google Scholar
  7. Drake, R.E. & Wallach, M.S. (1989). Substance abuse among the chronic mentally ill. Hospital and Community Psychiatry, 40:1041-1046.Google Scholar
  8. Drake, R.E., Alterman, A.I. & Rosenberg, S.R. (1993). Detection of substance use disorders in severely mentally ill patients. Community Mental Health Journal, 29:175-192.Google Scholar
  9. Fariello, D. & Scheidt, S. (1989). Clinical case management of the dually diagnosed patient. Hospital and Community Psychiatry, 40:1065-1067.Google Scholar
  10. Gelberg, L., Linn, L.S. & Leake, B.D. (1988). Mental health, alcohol and drug use, and criminal history among homeless adults. American Journal of Psychiatry, 145:191-196.Google Scholar
  11. Hellerstein, D.J. & Meehan, B. (1987). Outpatient group therapy for schizophrenic substance abusers. American Journal of Psychiatry, 144:1337-1339.Google Scholar
  12. Hoult, J. & Reynolds, J. (1984). Schizophrenia: A comparative trial of community oriented and hospital oriented psychiatric care. Acta Psychiatrica, 69:359-372.Google Scholar
  13. Knoedler, W.H. (1987). The treatment of substance abuse in the training in community living (TCL) model: principles. Mendota Mental Health Institute, Madison, Wisconsin. Unpublished manuscript.Google Scholar
  14. Knoedler, W.H. (1979). How the training in community living program helps patients work. New Directions for Mental Health Services, 2:57-66.Google Scholar
  15. Marx, A.J., Test, M.A. & Stein L.I. (1973). Extrahospital management of severe mental illness: feasibility and effects of social functioning. Arch Gen Psychiatry, 29:505.Google Scholar
  16. Meisler, N. (1991). State mental health agency responsibility for outreach. In N.L. Cohen (Ed.), Psychiatric Outreach to the Mentally Ill. New Directions for Mealth Health Services. San Francisco: Jossey-Bass.Google Scholar
  17. Meisler, N., Detrick, A. & Tremper, R. (1995). Statewide dissemination of the Training in Community Living program. Administration and Policy in Mental Health, 23:71-76.Google Scholar
  18. Mercer-McFadden, C. & Drake, R.E. (1992). A Review of Outcome Measures for Assessing Homeless Populations with Severe Mental Illness and Co-Occurring Substance Abuse. National Institute of Mental Health.Google Scholar
  19. Minkoff, K. & Drake, R.E. (1992). Homelessness and dual diagnosis. In H.R. Lamb, L.L. Bachrach & F.l. Kass (Eds.), Treating the Homeless Mentally Ill. Washington, DC: American Psychiatric Press.Google Scholar
  20. Muijen, M., Marks, I., Conolly, J. & Audini, B. (1992). Home based care and standard hospital care for patients with severe mental illness: A randomized controlled trial. British Medical Journal, 304:749-54.Google Scholar
  21. Mulder, R. (1982). Final Evaluation of the Harbinger Program as a Demonstration Project. Michigan Department of Mental Health. Unpublished manuscript.Google Scholar
  22. Osher, F.C. & Kofoed, L.L. (1989). Treatment of patients with psychiatric and psychoactive substance abuse disorders. Hospital and Community Psychiatry, 40:1025-1030.Google Scholar
  23. Russert, M.G. & Frey, J.L. (1991), “The PACT vocational model: a step into the future. Psychosocial Rehabilitation Journal, 14(4), 11-17.Google Scholar
  24. Safer, Daniel J. (1987). Substance abuse by young adult chronic patients. Hospital and Community Psychiatry, 38:511-514.Google Scholar
  25. Stein, L.I. & Test, M.A. (1980). Alternative to mental hospital treatment: I. conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry, 37:392-397.Google Scholar
  26. Tessler, R. & Goldman, H.H. (1982). The Chronically Mentally Ill: Assessing Community Support Programs. Cambridge, MA: Bollinger.Google Scholar
  27. Test, M.A. (1992). Training in community living. In R. P. Liberman (Ed.) Handbook of Psychiatric Rehabilitation. New York: MacMillan.Google Scholar
  28. Test, M.A., Knoedler, W.H., Allness, D.J., & Burke, S.S. (1992). Training in community living (TCL) model: Two decades of research. Outlook 2:5-8.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1997

Authors and Affiliations

  • Neil Meisler
    • 1
  • Laura Blankertz
    • 2
  • Alberto B. Santos
    • 3
  • Catherine McKay
    • 4
  1. 1.Medical University of South CarolinaUSA
  2. 2.Matrix Research, Inc.Philadelphia
  3. 3.Medical University of South CarolinaUSA
  4. 4.Connections Community Support Program, Inc.Wilmington

Personalised recommendations