1
|
Giggie M, Boudreaux M, Harper E. Characteristics of a Southern Intensive Trauma- and Psychiatric-Focused Recovery Program. South Med J 2023; 116:776-781. [PMID: 37657788 DOI: 10.14423/smj.0000000000001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
OBJECTIVES Treatment of substance use disorders (SUDs) is complex, involving biological, psychological, and social factors to be considered when designing effective programs. Trauma-informed psychiatric care integrated with a developmentally appropriate intensive 12-step approach is being used at A Reprieve for Women (Reprieve), a long-term intensive residential recovery program for female emerging adults with SUDs located in Tuscaloosa, Alabama. The Reprieve treatment philosophy focuses on long-term intensive care, treatment of coexisting trauma and psychiatric disorders, and development of life skills. The purpose of this article is to outline Reprieve's programmatic features and report Reprieve's 1- and 2-year sobriety rates for women who completed the 6-month residential program and compare it with national sobriety rates for other residential SUD treatment programs. METHODS Reprieve provided 1- and 2-year sobriety rates and duration of treatment from 110 deidentified participants who completed Reprieve's 6-month residential program between September 2016 and November 2020. The researchers defined sobriety as complete abstinence from any addictive substances. Reprieve staff contacted program graduates to determine sobriety status following completion of the program. This research, approved by the University of Alabama's institutional review board, involved usable data points from 68 of the 110 participants. RESULTS We determined that Reprieve has a 75% 1-year sobriety rate and a 63% 2-year sobriety rate. The national average sobriety rate for people completing SUD treatment in residential programs is 40%. CONCLUSIONS Reprieve's higher-than-national sobriety rates make it a valuable program to study. Its emphasis on the treatment of coexisting psychiatric problems and past traumas, development of life skills, and the unique needs of female emerging adults may contribute to the program's success. It is hoped that this program description and preliminary analysis of outcomes will provide valuable information for future SUD treatment program development. More rigorous study is needed to delineate the effects of specific programmatic features on sobriety.
Collapse
Affiliation(s)
- Marisa Giggie
- From the College of Community Health Sciences, University of Alabama-Tuscaloosa, Tuscaloosa
| | - Madison Boudreaux
- From the College of Community Health Sciences, University of Alabama-Tuscaloosa, Tuscaloosa
| | - Emma Harper
- From the College of Community Health Sciences, University of Alabama-Tuscaloosa, Tuscaloosa
| |
Collapse
|
2
|
Zhang J, Slesnick N. Substance use and social stability of homeless youth: A comparison of three interventions. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:873-884. [PMID: 30556713 DOI: 10.1037/adb0000424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study identified subgroups of homeless youth and young adults that exhibited distinct co-occurring patterns of substance use and social stability (e.g., employment, school attendance, and housing), and evaluated the relative effectiveness of the Community Reinforcement Approach (CRA), Motivational Enhancement Therapy (MET), and case management (CM) in interrupting substance use and improving social stability. The differentiating effects of personal characteristics on the co-occurrence of substance use and social stability were also examined. Participants included 270 homeless youth and young adults who were randomly assigned to one of the three intervention conditions: CRA, n = 93, MET, n = 86, or CM, n = 91. Participants were assessed at baseline, 3, 6, and 12 months postbaseline. A dual trajectory latent class growth analysis identified four co-occurring patterns: low-stable substance use paired with low-increasing social stability, high-stable substance use paired with low-stable social stability, high-declining substance use paired with low-increasing social stability, and low-increasing substance use paired with high-stable social stability. Findings showed that CRA was superior in improving substance use and social stability simultaneously compared to MET and CM, and further, CM was more effective than MET. Personal factors including race, age, coping strategies, and behavior problems differentiated the co-occurring patterns of substance use and social stability. The findings underscore the significance in identifying subgroups of homeless youth that vary in problem severity in terms of their substance use and social stability, and offer evidence to help practitioners identify the most effective intervention that responds to the needs of homeless youth. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
|
3
|
Bromley E, Mikesell L, Whelan F, Hellemann G, Hunt M, Cuddeback G, Bradford DW, Young AS. Clinical Factors Associated with Successful Discharge from Assertive Community Treatment. Community Ment Health J 2017; 53:916-921. [PMID: 28116636 DOI: 10.1007/s10597-017-0083-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
We sought to explore clinical factors associated with successful transition from Assertive Community Treatment to less intensive clinical services. Mixed-method observational follow up study of veterans discharged from three VA-affiliated ACT teams to less intensive clinical services. Of the 240 veterans in ACT, 9% (n = 21) were discharged during the study period. Among the 11 of 21 discharged veterans who enrolled in the follow up study, reason for discharge, designated by the veteran's primary clinician at the time of discharge, predicted outcomes (p = 0.02) at 9 months, with "disengagement" as a reason for discharge predicting poorer outcomes. Six of 11 veterans experienced poor outcomes at 9 months, including incarceration and substance use relapse. ACT clinicians rarely discharge clients. Many clients may experience negative clinical events following ACT discharge, and clients may be difficult to follow post-discharge. Client disengagement from ACT may indicate higher likelihood of poor outcomes following discharge to less intensive clinical services.
Collapse
Affiliation(s)
- Elizabeth Bromley
- Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles VA Healthcare Center, Los Angeles, USA. .,Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA. .,Center for Health Services and Society, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA, 90024, USA.
| | - Lisa Mikesell
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Fiona Whelan
- Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA
| | - Gerhard Hellemann
- Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA
| | - Marcia Hunt
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, USA
| | - Gary Cuddeback
- Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Alexander S Young
- Desert Pacific VA Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles VA Healthcare Center, Los Angeles, USA.,Semel Institute for Neuroscience and Human Behavior, UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA
| |
Collapse
|
4
|
The cost savings of expanding Medicaid eligibility to include currently uninsured homeless adults with substance use disorders. J Behav Health Serv Res 2015; 41:110-24. [PMID: 24198085 DOI: 10.1007/s11414-013-9366-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Following the June 2012 Supreme Court ruling that states are no longer mandated to expand their Medicaid programs in 2014 as part of the Affordable Care Act, many states plan to opt out of the expansion, citing affordability as their primary concern. In response to this controversy, the present study evaluated the cost savings of expanding Medicaid coverage to include currently ineligible homeless adults with substance use disorders, a subset of the population that incurs some of the greatest societal costs and is disproportionately impacted by uninsurance. Using a time horizon of 7 years, separate analyses were conducted for state and federal governments, and then a final analysis evaluated the combined costs for the other two models. Results of the study demonstrate that, although the expansion will be associated with a net cost when combining state and federal expenses and savings, states will experience tremendous savings if they choose to participate.
Collapse
|
5
|
Waldbrook N. Exploring opportunities for healthy aging among older persons with a history of homelessness in Toronto, Canada. Soc Sci Med 2015; 128:126-33. [DOI: 10.1016/j.socscimed.2015.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Zur J, Mojtabai R. Medicaid expansion initiative in Massachusetts: enrollment among substance-abusing homeless adults. Am J Public Health 2013; 103:2007-13. [PMID: 24028262 DOI: 10.2105/ajph.2013.301283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether homeless adults entering substance abuse treatment in Massachusetts were less likely than others to enroll in Medicaid after implementation of the MassHealth Medicaid expansion program in 1997. METHODS We used interrupted time-series analysis in data on substance abuse treatment admissions from the Treatment 0Episode Data Set (1992-2009) to evaluate Medicaid coverage rates in Massachusetts and to identify whether trends differed between homeless and housed participants. We also compared Massachusetts data with data from 17 other states and the District of Columbia combined. RESULTS The percentage of both homeless and housed people entering treatment with Medicaid increased approximately 21% after expansion (P = .01), with an average increase of 5.4% per year over 12 years (P = .01). The increase in coverage was specific to Massachusetts, providing evidence that the MassHealth policy was the cause of this increase. CONCLUSIONS Findings provide evidence in favor of state participation in the Medicaid expansion in January 2014 under the Affordable Care Act and suggest that hard-to-reach vulnerable groups such as substance-abusing homeless adults are as likely as other population groups to benefit from this policy.
Collapse
Affiliation(s)
- Julia Zur
- At the time of the study, Julia Zur and Ramin Mojtabai were with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | |
Collapse
|
7
|
Benaiges I, Prat G, Adan A. Health-related quality of life in patients with dual diagnosis: clinical correlates. Health Qual Life Outcomes 2012; 10:106. [PMID: 22950596 PMCID: PMC3512505 DOI: 10.1186/1477-7525-10-106] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/31/2012] [Indexed: 12/04/2022] Open
Abstract
Background Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL) in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. Methods Cross-sectional assessment of three experimental groups was made through the Short Form – 36 Item Health Survey (SF-36). The sample consisted of a group with Dual Diagnosis (DD; N = 35), one with Severe Mental Illness alone (SMI; N = 35) and another one with Substance Use Dependence alone (SUD; N = 35). The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. Results The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. Conclusions The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.
Collapse
Affiliation(s)
- Irina Benaiges
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain
| | | | | |
Collapse
|
8
|
Routine outcomes monitoring to support improving care for schizophrenia: report from the VA Mental Health QUERI. Community Ment Health J 2011; 47:123-35. [PMID: 20658320 PMCID: PMC3058510 DOI: 10.1007/s10597-010-9328-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 06/03/2010] [Indexed: 11/16/2022]
Abstract
In schizophrenia, treatments that improve outcomes have not been reliably disseminated. A major barrier to improving care has been a lack of routinely collected outcomes data that identify patients who are failing to improve or not receiving effective treatments. To support high quality care, the VA Mental Health QUERI used literature review, expert interviews, and a national panel process to increase consensus regarding outcomes monitoring instruments and strategies that support quality improvement. There was very good consensus in the domains of psychotic symptoms, side-effects, drugs and alcohol, depression, caregivers, vocational functioning, and community tenure. There are validated instruments and assessment strategies that are feasible for quality improvement in routine practice.
Collapse
|
9
|
Tabol C, Drebing C, Rosenheck R. Studies of "supported" and "supportive" housing: a comprehensive review of model descriptions and measurement. EVALUATION AND PROGRAM PLANNING 2010; 33:446-56. [PMID: 20138365 DOI: 10.1016/j.evalprogplan.2009.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 05/05/2023]
Abstract
Supported housing is a service model that couples provision of independent housing with provision of community-based supports for individuals with psychiatric disabilities at risk of homelessness. Despite its promise as an alternative to traditional sequential residential rehabilitation programs, supported housing has not been evaluated to an extent that supports firm conclusions concerning the efficacy of specific program elements. We conducted a comprehensive review of the literature on supported housing and similarly labeled programs, to determine the degree of clarity in the supported housing model and the degree of fidelity to that model within the empirical literature, and to determine whether lack of clarity or fidelity are barriers to widespread, systematic program implementation and evaluation. We encountered a number of limitations in the literature, including conflicting use of program labels, inconsistent definitions of supported housing and its elements, and use of inadequate measurement indices in assessing adherence to program elements. Our findings suggest that greater model clarity, better specification of model elements, and greater standardization in measurement of program dimensions would aid in supported housing program implementation and evaluation. We present a number of recommendations for the field and suggestions for future research.
Collapse
Affiliation(s)
- Charity Tabol
- Mental Illness, Research and Education Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA.
| | | | | |
Collapse
|
10
|
Tsai J, Bond GR, Davis KE. Housing Preferences among Adults with Dual Diagnoses in Different Stages of Treatment and Housing Types. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2010; 13:258-275. [PMID: 21415937 PMCID: PMC3057217 DOI: 10.1080/15487768.2010.523357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Housing is an essential component of psychiatric rehabilitation, particularly for consumers with dual diagnoses. Research has not clearly examined why and when consumers prefer different types of housing. This exploratory study examined 1) whether housing preferences differ between stage of treatment for substance abuse, 2) whether consumers who prefer certain housing types have preferences for certain characteristics, and 3) whether consumers living in different types of housing report differences in social support, choice, and housing satisfaction. A total of 103 participants living in supervised housing (n= 65), independent apartment housing (n= 22), single room occupancy hotels (n= 11), and with family (n= 5) completed self-report questionnaires. Results showed that 1) the majority of participants preferred their own apartment or house across different stages of treatment, 2) preference for supervised housing was associated with on-site staff and peer support while preference for apartment housing was associated with autonomy and privacy, and 3) consumers in single room occupancies reported the least choice and lowest satisfaction. These findings contribute to the understanding of consumers' housing preferences and the differences consumers perceive between certain housing types.
Collapse
Affiliation(s)
- Jack Tsai
- Department of Psychiatry, Yale University, New Haven, CT 06516
| | - Gary R. Bond
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH 03766
| | | |
Collapse
|
11
|
De Maeyer J, Vanderplasschen W, Lammertyn J, van Nieuwenhuizen C, Sabbe B, Broekaert E. Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment. Qual Life Res 2010; 20:139-50. [PMID: 20740316 PMCID: PMC3023858 DOI: 10.1007/s11136-010-9732-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 11/16/2022]
Abstract
Purpose This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals’ QoL. Methods Participants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis. Results Five years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change one’s living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL. Conclusions Opiate-dependent individuals’ QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence.
Collapse
Affiliation(s)
- Jessica De Maeyer
- Department of Orthopedagogics, Ghent University, H Dunantlaan 2, 9000 Ghent, Belgium.
| | | | | | | | | | | |
Collapse
|
12
|
Crawford V, Crome IB, Clancy C. Co-existing Problems of Mental Health and Substance Misuse (Dual Diagnosis): a literature review. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000072990] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vanessa Crawford
- Consultant in General Adult Psychiatry, Homerton Hospital, Homerton Row, London E9 6SR, UK
| | - Ilana B. Crome
- Professor of Addiction Psychiatry/Academic Director of Psychiatry, Academic Psychiatry Unit, Keele University Medical School (Harplands Campus), Academic Suite, Harplands Hospital, Hilton Road, Harpfields, Stoke on Trent ST4 6TH, UK
| | - Carmel Clancy
- Senior Lecturer--Mental Health and Addictions, Department of Mental Health, School of Health and Social Sciences, Middlesex University, Highgate Hill, London N19 3UA, UK
| |
Collapse
|
13
|
Sylvestre J, Ollenberg M, Trainor J. A Model of Housing Stability for People With Serious Mental Illness. ACTA ACUST UNITED AC 2009. [DOI: 10.7870/cjcmh-2009-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- John Sylvestre
- School of Psychology, and Centre for Research on Educational and Community Services, University of Ottawa
| | | | - John Trainor
- Community Support and Research Unit Centre for Addiction and Mental Health, Toronto
| |
Collapse
|
14
|
Rickards LD, McGraw SA, Araki L, Casey RJ, High CW, Hombs ME, Raysor RS. Collaborative initiative to help end chronic homelessness: introduction. J Behav Health Serv Res 2009; 37:149-66. [PMID: 19337841 DOI: 10.1007/s11414-009-9175-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 02/08/2009] [Indexed: 11/30/2022]
Abstract
The Collaborative Initiative to Help End Chronic Homelessness was a coordinated effort by the US Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), and Veterans Affairs (VA), and the US Interagency Council on Homelessness to house and provide comprehensive supportive services to individuals with serious psychiatric, substance use, health, and related disabilities who were experiencing long-term chronic homelessness. Eleven communities received 3-year grants from HHS and VA (2003-2006) and up to 5-year grants from HUD (2003-2008) to implement the initiative. This article provides background on chronic homelessness, describes the federal collaboration to comprehensively address chronic homelessness, and introduces the seven articles in this special issue that describe the findings and lessons learned from the participating communities in addressing chronic homelessness. Collectively, these articles offer insight into the challenges and benefits of providing housing and services to individuals experiencing chronic homelessness.
Collapse
Affiliation(s)
- Lawrence D Rickards
- Homeless Programs Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, MD 20420, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
Research on treatment outcome for addictive disorders indicates that a variety of interventions are effective. However, the progress clients make in treatment frequently is undermined by the lack of an alcohol and drug free living environment supporting sustained recovery. This introduction to a special edition on Oxford Houses suggests that treatment providers have not paid sufficient attention to the social environments where clients live after residential treatment or while attending outpatient programs. The paper begins with a description of the need for alcohol and drug free living environments. The history of communal living for recovering addicts and alcoholics is then reviewed and the Oxford House model emphasized as a recent and widespread communal living option for recovering persons. The structure and philosophy of Oxford Houses are presented along with recent outcome studies providing support for their effectiveness. Three different perspectives are presented as ways of conceptualizing how residents in Oxford Houses benefit: social context theory, self governance/self care, and peer affiliation/identification.
Collapse
|
16
|
Abstract
ABSTRACTOlder people who become homeless have attracted increasing attention in North America, Western Europe and Australia over the last 20 years, but there have been few projects dedicated to their support, and even fewer studies of the outcomes. This paper reports a longitudinal study of the resettlement of 64 older people who were rehoused into permanent accommodation from homeless people's hostels in England. Their progress was monitored for two years by face-to-face interviews. The theoretical model was that the outcomes of rehousing are a function of personal factors and behaviour, the support that people receive, and the characteristics of the new home. After 24 months, 28 respondents were housed and ‘settled’, 10 were housed but ‘unsettled’, 11 had abandoned their accommodation, and six had been evicted (nine had died or ceased contact). The factors that significantly associated with remaining housed and settled included: previous stable accommodation histories, revived contacts with relatives, taking up activities, and regular help from housing-support workers. Unsettledness and tenancy failure associated with prolonged prior homelessness, worries about living independently, and continuing contacts with homeless people. Rehousing older homeless people successfully is difficult, particularly among those with long histories of homelessness and instability, and more needs to be known about the types of accommodation and the types of support that promote tenancy sustainment.
Collapse
|
17
|
LePage JP, Bluitt M, McAdams H, Merrell C, House-Hatfield T, Garcia-Rea E. Effects of increased social support and lifestyle behaviors in a domiciliary for homeless veterans. Psychol Serv 2006. [DOI: 10.1037/1541-1559.3.1.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
Xie H, McHugo GJ, Helmstetter BS, Drake RE. Three-year recovery outcomes for long-term patients with co-occurring schizophrenic and substance use disorders. Schizophr Res 2005; 75:337-48. [PMID: 15885525 DOI: 10.1016/j.schres.2004.07.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Revised: 07/14/2004] [Accepted: 07/21/2004] [Indexed: 11/22/2022]
Abstract
Little is known about the expected treatment outcomes of patients with co-occurring schizophrenic and substance use disorders. This paper reports 3-year outcomes for 152 patients with schizophrenia or schizoaffective disorder and substance use disorders, all of whom received integrated dual disorders treatments in the New Hampshire Dual Diagnosis Study. Outcomes are defined as positive coping behaviors identified by consumers as indicators of recovery. Participants improved steadily in terms of controlling symptoms of schizophrenia, actively attaining remissions from substance abuse, increasing competitive employment, increasing social contacts with non-substance abusers, and improving life satisfaction. Though successful in reducing hospitalization and homelessness, they did not increase time in independent living situations. Outcomes were only weakly interrelated, suggesting that recovery is a multidimensional concept. Neither psychotic diagnosis (schizophrenia vs. schizoaffective disorder) nor substance abuse diagnosis (alcohol vs. other drug disorder vs. both) was related to outcomes. However, these patients with co-occurring schizophrenic and substance use disorders did significantly less well than patients with co-occurring bipolar and substance use disorders in terms of hospitalization, independent living, and quality of life. Overall, the findings provide a hopeful long-term perspective for dual diagnosis patients.
Collapse
Affiliation(s)
- Haiyi Xie
- Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, NH 03766, USA.
| | | | | | | |
Collapse
|
19
|
Lemaire GS, Mallik K, Rever K. Factors Influencing Community-Based Rehabilitation for Persons with Co-Occurring Psychiatric and Substance Abuse Disorders. J Addict Nurs 2004. [DOI: 10.1080/jan.15.1.15.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
Sacks JAY, Drake RE, Williams VF, Banks SM, Herrell JM. Utility of the Time-Line Follow-Back to assess substance use among homeless adults. J Nerv Ment Dis 2003; 191:145-53. [PMID: 12637840 DOI: 10.1097/01.nmd.0000054930.03048.64] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Assessing substance use of homeless persons is a critical task. This study examines the test-retest reliability, concurrent validity, and sensitivity to change of the Time-Line Follow-Back interview, a calendar instrument used to assess days and quantities of alcohol use and days of illicit drug use, in the multisite Collaborative Program to Prevent Homelessness (CPPH). The Time-Line Follow-Back was reliable for assessing use during the past month and the recent 6 months. Results from the Time-Line Follow-Back were correlated with other self-reports of use, with research diagnoses of substance use disorder, and with clinician ratings of severity of substance abuse. The Time-Line Follow-Back detected changes in clients with severe mental illness and in those with less severe psychiatric problems.
Collapse
Affiliation(s)
- Jo Ann Y Sacks
- National Development and Research Institutes, Inc. (NDRI), 71 West 23 Street-Fl. 8, New York, New York 10010, USA
| | | | | | | | | |
Collapse
|
21
|
Gulcur L, Stefancic A, Shinn M, Tsemberis S, Fischer SN. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2003. [DOI: 10.1002/casp.723] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Franskoviak P, Segal SP. Substance use and mental disorder diagnostic profiles in a sample of long-term self-help agency users. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2002; 72:232-240. [PMID: 15792062 PMCID: PMC7575409 DOI: 10.1037/0002-9432.72.2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study examined the prevalence of substance use and mental disorder profiles in a sample of mental health self-help attendees. Findings demonstrate that the rates of these disorders are equivalent to or exceed those found in clinical and community samples. Implications for the role that self-help agencies play in the lives of vulnerable individuals, as well as the justification for increased funding from drug and alcohol treatment sources, are discussed.
Collapse
Affiliation(s)
- Perri Franskoviak
- San Francisco Department of Public Health, San Francisco, California 94103, USA.
| | | |
Collapse
|
23
|
Drake RE, Wallach MA, Alverson HS, Mueser KT. Psychosocial aspects of substance abuse by clients with severe mental illness. J Nerv Ment Dis 2002; 190:100-6. [PMID: 11889363 DOI: 10.1097/00005053-200202000-00006] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the literature on co-occurring substance abuse in persons with severe mental illnesses has evolved, emphasis on biologic and pharmacologic factors has diverted attention from important psychosocial issues. The authors review recent research showing that a) psychosocial risk factors may explain consistently high rates of substance abuse by these persons, b) substance abuse is for most clients a socio-environmental phenomenon embedded in interpersonal activities, and c) both natural recovery processes and effective treatments rely on developing new relationships, activities, coping strategies, and identities. Thus, psychosocial issues are critical in our attempts to understand and address substance abuse in this population.
Collapse
Affiliation(s)
- Robert E Drake
- New Hampshire-Dartmouth Psychiatric Research Center, 2 Whipple Place, Lebanon, New Hampshire 03766, USA
| | | | | | | |
Collapse
|
24
|
McNamara C, Schumacher JE, Milby JB, Wallace D, Usdan S. Prevalence of nonpsychotic mental disorders does not affect treatment outcome in a homeless cocaine-dependent sample. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2001; 27:91-106. [PMID: 11373038 DOI: 10.1081/ada-100103120] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study presents the prevalence and treatment outcome of DUAL diagnoses (psychoactive substance use disorders [PSUD] plus other nonpsychotic mental disorders) among a population of homeless persons participating in a behavioral day treatment and contingency management drug abuse treatment program. Participants were 128 persons: 76.6% male, 23.4% female; 82.2% African-American, 17.2% Caucasian. There were 46 (35.9%) PSUDs and 82 (64.1%) DUAL participants. Cocaine (96.9%) and alcohol disorders (57.8%) were most prevalent overall, and 60.2% of participants had two or more psychoactive substance use disorders. DUAL participants had significantly more alcohol disorders than PSUDs (62.2% versus 50.0%). The most prevalent mental disorders (other than substance use) for the total and DUAL samples were, respectively, mood (51.6% and 80.5%) and anxiety (35.9% and 56.1%), and 31.3% and 48.8% had more than two mental disorders. The DUAL group had more severe problems than the PSUD group at baseline in alcohol, medical condition, employment/support, and psychiatric status areas on the ASI. Both groups showed treatment improvements at 6-months follow-up with the DUAL group showing greater mean changes than the PSUD group in five of the seven ASI areas. These findings are discussed in terms of effect of dual diagnoses on treatment outcome and study limitations related to a retrospective design and select sample of nonpsychotic mental disorders.
Collapse
Affiliation(s)
- C McNamara
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, 35205, USA.
| | | | | | | | | |
Collapse
|
25
|
Abstract
OBJECTIVES To evaluate the differences between two cohorts of patients with severe mental illness (schizophrenia-spectrum or bipolar disorder) and co-occurring substance-use disorders, living in either predominantly rural areas or urban areas. METHODS Two study groups of patients with a dual diagnosis, recruited using the same criteria, were evaluated, including 225 patients from New Hampshire and 166 patients from two cities in Connecticut. The two study groups were compared on demographic characteristics, housing, legal problems, psychiatric and substance use diagnoses, substance use and abuse, psychiatric symptoms, and quality of life. RESULTS Patients in the Connecticut study group had higher rates of cocaine-use disorder, more involvement in the criminal justice system, more homelessness, and were more likely to be from minority backgrounds. The Connecticut group also had a higher proportion of patients with schizophrenia and more severe symptoms, as well as lower rates of marriage, educational attainment, and work than the New Hampshire study group. Alcohol-use disorder was higher in the New Hampshire group. Subsequent analyses within the Connecticut group indicated that although African American patients had higher rates of cocaine-use disorder than white patients, cocaine disorder and not minority status was most strongly related to criminal involvement and homelessness. CONCLUSIONS Because of the substances abused and the greater degree of psychiatric illness severity, patients with a dual diagnosis who are living in urban areas may require greater ancillary services, such as residential programs, Assertive Community Treatment, and jail diversion programs in order to treat their disorders successfully.
Collapse
Affiliation(s)
- K T Mueser
- New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH 03301, USA.
| | | | | | | | | |
Collapse
|
26
|
Primm AB, Gomez MB, Tzolova-Iontchev I, Perry W, Vu HT, Crum RM. Mental health versus substance abuse treatment programs for dually diagnosed patients. J Subst Abuse Treat 2000; 19:285-90. [PMID: 11027899 DOI: 10.1016/s0740-5472(00)00112-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the similarities and differences of patients with co-existing psychiatric and substance use disorders attending treatment in either a mental health setting or a substance abuse treatment setting. A total of 129 patients were assessed, including 65 individuals from the substance abuse treatment center and 64 individuals from the mental health program. Treatment records were reviewed for diagnoses and sociodemographic data. While the two groups were highly similar with regard to age and ethnicity, there were significant differences in psychiatric profile, with the substance abuse treatment group having less severe diagnoses and no patients with schizophrenia, while the mental health treatment group had a majority of patients with schizophrenia. Other differences in the two groups, such as marital and parental status, disability status, and medical problems appeared to be directly linked with the aforementioned diagnostic profile. These data suggest important differences in characteristics of patients with comorbid disorders that appear to be dependent on the type of treatment program they attend. For the most effective management, integrated treatment programs should be aware of these differences and tailor service provision accordingly.
Collapse
Affiliation(s)
- A B Primm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Primm AB, Gomez MP, Tzolova-Iontchev I, Perry W, Crum RM. Chronically mentally ill patients with and without substance use disorders: a pilot study. Psychiatry Res 2000; 95:261-70. [PMID: 10974365 DOI: 10.1016/s0165-1781(00)00180-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The study was designed to assess characteristics of chronic mentally ill patients with and without a substance use disorder. Study patients (n=48) had either psychiatric illness alone (they received conventional psychiatric rehabilitation) or dual diagnoses (they received mental illness and substance abuse services). All patients were administered the Brief Symptom Inventory (BSI), the Client Satisfaction Questionnaire, the Perceived Social Support Scales, and the Composite International Diagnostic Interview. Higher proportions of dually diagnosed patients had schizophrenia, had higher scores on the BSI, and were less satisfied with treatment.
Collapse
Affiliation(s)
- A B Primm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | | | | | | | |
Collapse
|
28
|
Primm AB, Tzolova-Iontchev I, Taylor CM. An Integrated Approach for Dually Diagnosed Patients in a Substance Abuse Treatment Program: Case Presentation. Subst Abus 2000; 21:121-126. [PMID: 12466652 DOI: 10.1080/08897070009511424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with co-occurring psychiatric and substance use disorders experience worse social and clinical outcomes and are in need of adequate and simultaneous treatment for both disorders. The case presented illustrates the diversity of psychosocial, health, and behavioral problems and the complexity of treatment of a dually diagnosed patient. The authors discuss the benefits of using an integrated approach in an addiction treatment setting. The authors also review the importance of an integrated treatment model for populations with inadequate health care resources who are at high risk for medical and psychiatric complications.
Collapse
Affiliation(s)
- Annelle B. Primm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Johns Hopkins Hospital Community Psychiatry Program, Baltimore, Maryland
| | | | | |
Collapse
|
29
|
Maynard C, Cox GB, Krupski A, Stark K. Utilization of services for mentally ill chemically abusing patients discharged from residential treatment. J Behav Health Serv Res 1999; 26:219-28. [PMID: 10230149 DOI: 10.1007/bf02287493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Little is known about outcomes of treatment for individuals with mental illness and chemical dependencies. This article compares services utilization preadmission and postdischarge in 534 patients discharged from a residential treatment program in Washington State. A number of services, including chemical dependency detoxification, mental health crisis, inpatient psychiatric, medical emergency, and general medical inpatient hospitalization, were used less frequently in the period after discharge. The total reimbursement for all Medicaid services decreased by 44% from $5 million in the year prior to discharge to $2.8 million in the year after discharge. Also, individuals (32%) who completed the program were less likely to use costly, acute care services. This study was limited by the absence of a control group and posttreatment alcohol and drug use data. In addition, other unmeasured factors could have explained the association between program completion and better outcomes.
Collapse
Affiliation(s)
- C Maynard
- Department of Medicine, University of Washington, Seattle 98105, USA.
| | | | | | | |
Collapse
|
30
|
Carr S, Murray R, Harrington Z, Oge J. Discharged Residents' Satisfaction With Transitional Housing for the Homeless. J Psychosoc Nurs Ment Health Serv 1998; 36:27-33. [PMID: 9670118 DOI: 10.3928/0279-3695-19980701-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One year following discharge from a transitional residential program, homeless women, some of whom were chemically dependent or mentally ill, indicated that they were satisfied with the program and that it had met their needs. Suggestions for improvement related primarily to greater flexibility of rules in the transitional residence. Most of the women had improved their housing situation since discharge; all of the women continued to maintain a home for their children.
Collapse
Affiliation(s)
- S Carr
- Thomas Nursing Service, Inc., St. Louis, MO, USA
| | | | | | | |
Collapse
|