Dual Diagnosis Inpatients: Telephone Monitoring RCT to Improve Outcomes
Christine Timko PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: October 2010 - September 2014

BACKGROUND/RATIONALE:
Substance use disorders (SUDs) are highly prevalent among veteran psychiatry inpatients. Dual substance use and psychiatric disorders are related to poor outcomes and rehospitalizations, which are quite costly. However, relatively little is known about how to effectively help dually diagnosed psychiatry inpatients. Telephone Monitoring (TM) is effective among SUD patients at increasing SUD continuing care and self-help utilization and improving SUD outcomes. This study will build on these findings and contribute important new clinical knowledge by determining whether TM is similarly effective when adapted for dually diagnosed veteran psychiatry inpatients. It will evaluate the effectiveness of a manual-guided TM intervention.

OBJECTIVE(S):
Primary hypotheses are that patients in the TM condition, compared to patients in usual care (UC), will attend more SUD continuing care sessions and 12-step group meetings, and have better SUD and psychiatric outcomes. Secondary hypotheses are that TM patients will have fewer and delayed rehospitalizations, and their better outcomes will be mediated by SUD outpatient treatment and 12-step group participation.

METHODS:
This study will take place at two VAs: Palo Alto (VISN 21) and Ann Arbor (VISN 11). Dually diagnosed patients in psychiatry inpatient treatment will be randomly assigned to UC or TM. Patients in the TM condition will receive an in-person session while in treatment, followed by monitoring over the telephone for three months after discharge. The intervention will incorporate motivational interviewing to monitor patients' substance use, facilitate entry into outpatient treatment if a relapse occurs, and encourage 12-step self-help group participation. Patients will be assessed at baseline, end-of-intervention, and six months and one-year post-intervention for primary and secondary outcomes and non-VA health care; VA health care will be assessed with VA databases. GLMM analyses will be conducted to compare the UC and TM groups on course of primary and secondary outcomes over time; Cox regression models will compare groups on time to rehospitalization; and sequential regression analyses will examine whether outcomes associated with TM are mediated by more SUD continuing care and 12-step group participation.

FINDINGS/RESULTS:
We are collecting data at baseline and follow-ups and have no findings at this time.

IMPACT:
Given (a) the high prevalence of SUDs among psychiatry inpatients, (b) the established relationship of dual diagnoses with poorer outcomes and higher risks of rehospitalization, and (c) the high costs of hospital stays, psychiatry inpatient programs need to develop and implement successful strategies for treating dually diagnosed patients. Inpatient psychiatry treatment provides a unique opportunity to intervene to improve dually diagnosed patients' utilization of SUD services, participation in 12-step self-help groups, and SUD outcomes. However, for the most part, transitions to SUD formal treatment and informal help, which have been demonstrated to be effective for dually diagnosed patients, are not being successfully accomplished by inpatient psychiatry programs. This project has adapted an intervention demonstrated to be effective for SUD patients to improve care transitions and outcomes among dually diagnosed veterans receiving inpatient psychiatry treatment. Its expected impact is to improve outcomes for dually diagnosed psychiatry inpatients.

PUBLICATIONS:

Conference Presentations

1. Lin SL, Timko C, Cowden Hindash AH. Benefits of Mutual-Help Groups for Dually Diagnosed Patients. Poster session presented at: Research Society on Alcoholism Annual Scientific Meeting; 2012 Jun 23; San Francisco, CA.

DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction, Health Systems
DRE: Treatment - Observational
Keywords: Bipolar Disorder, Depression, PTSD, Substance Use and Abuse, Telemedicine/Telehealth
MeSH Terms: none