Integrated Treatment for Homeless Clients With Dual Disorders: A Quasi-Experimental Evaluation

ABSTRACT

The purpose of this study was to compare the effectiveness of four interventions in providing services to homeless clients with dual disorders: standard care (SC), assertive community treatment only (ACTO), integrated assertive community treatment (IACT), and new integrated assertive community treatment (NIACT). Participants had to be homeless, have a substance use disorder, and have a severe mental illness to be eligible for the study. One hundred ninety-six individuals were randomly assigned to SC, ACTO, or IACT. Approximately two years later, 85 participants were assigned to NIACT. A quasi-experimental design was employed to analyze the data. Clients in the NIACT program had better outcomes on consumer satisfaction than clients in the other conditions. Clients in NIACT, IACT, and ACTO groups had better housing outcomes than clients in SC. Clients in NIACT reduced their use of drugs more than clients in the other programs, but there was no difference between conditions on the other substance abuse variables. There was no difference between conditions on psychiatric symptoms. IACT may need to be augmented with other services to reduce substance use and produce better psychiatric outcomes for dual-disorder homeless individuals.

KEYWORDS:

• Dual diagnosis
• homeless
• integrated treatment
• assertive community treatment

The authors thank the study participants for their cooperation in this study; we hope that their lives have improved as a result of their participation. We also appreciated the cooperation of the many agencies that provided services to the study participants, particularly the City of St. Louis Mental Health Board, Community Alternatives, Inc., Places for People, and Peter and Paul Community Services. The following individuals were critical to the execution of this project: Dawn Mahoney, Mary Blegen, Don Shipp, Ruth Smith, Mary Maguire, Bill Tourville, Joris Miller, Gretchen Gerteis, Gail Saulnier, Bonnie Barbareck, Kecia Smith, Dorothy Gano, Melinda Bowen, and Jean Mayo. The authors also appreciate the consultation provided by Dr. Robert E. Drake, Dartmouth University, throughout the project. Financial assistance was provided by the National Institute of Mental Health (MH 57154), the Center for Mental Health Services (1 U79 TI12907), and the University of Missouri-St. Louis. However, the views expressed in this paper are the sole responsibility of the authors.