Predicting Alcohol Use and Drug Use Among Consumers of Community Mental Health Programs

Abstract

Objective: The current study evaluated the demographic, clinical, and social support and service use predictors of alcohol and drug use disorders among a population of consumers of community mental health programs. Methods: The methodology is a secondary analysis of data collected from two randomized controlled trials that were part of the Community Mental Health Evaluation Initiative completed in Ontario, Canada. Participants included an inner-city population of persons with severe and persistent mental illness who had experienced housing instability. Participants were either randomly selected to receive Assertive Community Treatment or Intensive Case Management (Toronto) or Intensive Case Management or Standard Community Care (Ottawa). Data were collected from consumers at three time points (baseline, 9 months, and 18 months), and prospective and cross-sectional predictors of alcohol use disorders and drug use disorders at 9- and 18-month follow-up were examined. There were 232 participants at baseline, 203 at 9 months, and 179 at 18 months. Results: Approximately 32% of consumers had problematic substance use at 9 months and 28% of consumers had problematic substance use at 18 months. A sequential logistic regression analysis uncovered several significant predictors, which differed across the type of substance used and the two time points considered. The most salient and common predictors included nonadherence to medication and a decreased level of community functioning. Conclusions: Implications for treatment planning in community mental health programs to better address concurrent mental illness and substance use disorders are discussed.

Keywords:

• concurrent disorders
• community mental health
• alcohol use
• drug use
• mental health
• co-occurring disorders

ACKNOWLEDGMENTS

The study was conducted with data collected as part of the Community Mental Health Initiative that was supported by a grant from the Ontario Mental Health Foundation.

Notes

1. The six programs included Assertive Community Treatment, Intensive Case Management, Consumer/ Survivor Initiatives, and family support organizations. For the current analysis, the Consumer/Survivor Initiatives and family support program projects were excluded as they did not collect data on substance use. One site with Assertive Community Treatment services was removed from the analysis, as it did not include “true” baseline scores in that participants may have been involved with program services for years before the evaluation was conducted.

2. Two sets of analyses were run, since the data were at an ordinal level. The first set of analyses involved comparing consumers not receiving medication to those receiving medication. These analyses yielded no significant results. The second set of analyses involved consumers who adhered to their medication half or less than half of the time compared to those who were not receiving medication or adhered more than half of the time. These results are reported throughout the remainder of the paper.

3. As listwise deletion is used within logistic regression analyses, the final number of participants used at nine months was 158. This was due to the removal of individuals with both a diagnosis of schizophrenia and a mood disorder and individuals with neither diagnosis.

4. As above, the final number of participants at 18 months was 115.