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BACKGROUND/RATIONALE:
Dual diagnosis (DD; psychiatric and substance use) patients' participation in 12-step dual-focused self-help groups (DF SHGs) is linked to lower relapse rates and less use of additional treatment services.
OBJECTIVE(S):
The first objective of this project is to implement and validate procedures to help counselors make effective referrals to DF SHGs for DD patients. It will assign DD outpatients to a standard or intensive referral to DF SHG condition, to determine whether and for how long intensive referral increases patients' group participation, compared to standard referral. The second objective is to determine whether patients who receive intensive referral have better substance use and psychiatric outcomes over the 2-year follow-up period, and less use of formal treatment services (reducing costs for VA). The long-term goal is to develop and implement guidelines to facilitate DD patients' involvement in DF SH and thereby improve their quality of life, and decrease their use of VA's specialized mental health services.
METHODS:
DD patients entering VA outpatient psychiatric or substance use treatment will be assigned to either standard or intensive referral to DF SH. Standard and intensive referral procedures were developed from our current HSR&D IIR project and in consultation with the QUERI Substance Use Disorder (QSUD) Module Providers Group. Standard referral will consist essentially of the counselor recommending DF SHG participation. The keys to intensive referral will include a pre-self-help orientation and the counselor facilitating direct contact between the patient and a member of the DF SHG and following up on the recommendation for self-help. Patients will be followed at 6 months, 1 year, and 2 years to determine whether intensive referral results in more DF SHG participation; better substance use and psychiatric outcomes; and less use of VA services and lower treatment costs. We will conduct analyses at each follow-up, and then hierarchical linear modeling to examine the benefits of intensive referral over time.
FINDINGS/RESULTS:
This study is collecting data and does not yet have findings.
IMPACT:
This project will help to specify clinical practices that enhance VA DD patients' chances of recovery. The intensive referral procedures to be validated in this project should be efficient, inexpensive, and generalizable for use by mental health clinicians in and outside the VA. Project team members serve on the QSUD, advise the VA Centers of Excellence in Substance Abuse Treatment and Education, direct the Program Evaluation and Resource Center (conducting nationwide evaluations of VA substance abuse programs under VA's Mental Health Strategic Healthcare Group), and have collaborated with and advise the QUERI Mental Health Module, VA MIRECCs (Mental Illness Research, Education, and Clinical Centers), VA SMITREC (Serious Mental Illness Treatment Research and Education Center), and NEPEC (the VA Northeast Program Evaluation Center) on VA mental health program evaluations. We will use these existing channels to report on and discuss project results regarding dual-focused self-help facilitation with the key planners of dual diagnosis services in VACO.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Mental Illness, Substance Abuse, Addictive Disorders
DRE:
Treatment, Resource Use and Cost, Quality of Care
Keywords:
Dual diagnosis – substance abuse and mental health, Utilization patterns, Outcomes
MeSH Terms:
none
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