BACKGROUND/RATIONALE:
Individuals with a persistent mental illness and co-occurring substance abuse disorder often have difficulty transitioning across levels of care. This difficulty transitioning is consistent with our previous local New Jersey VA data indicating that 50% of veterans discharged from the acute psychiatric hospital unit to outpatient care failed to attend their initial screening appointment and another 30% dropped out of the outpatient treatment within six weeks. To assist dually diagnosed veterans with the transition from inpatient to outpatient care, we developed an eight-week outreach intervention entitled Time-Limited Case management (TLC). TLC is composed of three evidence-based interventions: 1) Dual Recovery Therapy, an integrated mental health and substance abuse treatment; 2) Critical Time Intervention, a case management approach focused on discharge planning and establishing community linkages; and 3) Peer Support. Preliminary data from a non-randomized study comparing TLC participants to a comparison group of service refusers suggested that the program substantially reduced re-hospitalizations, increased treatment attendance, and improved psychiatric and substance abuse outcomes. The current study is being undertaken to more rigorously evaluate this promising new TLC intervention.
OBJECTIVE(S):
Objective # 1: To determine whether TLC, compared to Treatment-As-Usual Plus Attention (TAU+A), improves the transition from Acute Psychiatry to outpatient day treatment by promoting better day treatment engagement and fewer re-hospitalization days.
Objective # 2: To examine whether TLC, compared to TAU+A, improves general functioning as measured by the Global Assessment of Functioning (GAF).
Objective # 3: To determine whether TLC achieves a reduction in drug usage and substance abuse relapses greater than that achieved by TAU+A.
Objective #4: To determine whether TLC promotes better improvement than TAU+A in other life domains, including medical status, family and social adjustment, employment and legal involvement as measured by the Addiction Severity Index (ASI) and sub-scales of the Quality of Life Interview (QOLI).
Objective #5: To determine the cost effectiveness of implementing TLC relative to TAU+A.
METHODS:
This randomized study with a matched attention control condition will enroll 170 veterans with a severe mental illness and co-occurring substance abuse disorder. Subjects in acute psychiatry are randomly assigned to one of two treatment conditions: 1) treatment-as-usual in acute psychiatry and outpatient treatment plus matched attention in the form of health education sessions (TAU+A); or 2) treatment-as-usual plus the TLC community linkage intervention (TLC). Subjects will undergo 2-month, 6-month and 12-month follow-up assessments.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
There is a substantial need for brief transitional interventions targeting at-risk populations during vulnerable times in recovery. This study addresses critical clinical issues of effective treatments, integrated care and acute phase management that have all been a national VA focus. We believe the TLC program could complement existing VA Mental Health Intensive Case Management (MHICM) services by offering different levels or intensities of care to meet the diverse needs of more veterans.
PUBLICATIONS:
Journal Articles
- Smelson D, Losonczy MF, Castles_Fonseca K, Stewart P, Kaune M, Ziedonis D. 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. 2005; 1(3): 47-59.
- Ziedonis DM, Smelson D, Rosenthal RN, Batki SL, Green AI, Henry RJ, Montoya I, Parks J, Weiss RD. Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. Journal of Psychiatric Practice. 2005; 11(5): 315-39.
