Treatment Setting and Outcomes of Patients With Co-Occurring Disorders

Abstract

This study examined the potential differential benefits for patients with co-occurring psychiatric and substance use disorders (SUDs) entering treatment at one of three types of treatment programs: dual-diagnosis, SUD, and psychiatric treatment programs. This quasiexperimental study compared 6-month substance use and psychiatric symptom outcomes of 257 adults with co-occurring substance use and psychiatric disorders who had sought treatment at one of four outpatient treatment programs that used group treatment as the main treatment modality: a dual diagnosis, a psychiatric, or one of two SUD treatment programs. At treatment initiation, patients received a structured diagnostic interview and a survey assessing SUD and psychiatric symptoms; the survey was readministered 6 months later. Multiple and logistic regression analyses examined patient SUD and psychiatric outcome indicators to compare potential benefits of initiating treatment at a dual-diagnosis treatment program. At treatment entry, patients who entered the dual-diagnosis treatment program had a lower rate of abstinence for both alcohol and illicit drug use and had a higher rate of suicide attempt in the past 30 days than patients who entered SUD or psychiatric treatment programs. At 6-month follow-up, controlling for differences at treatment initiation, patients who initiated treatment at the dual-diagnosis treatment program no longer had a lower rate of abstinence for both alcohol and illicit drug use as compared with patients who entered SUD or psychiatric treatment programs; however, among subgroups of patients who continued to use substances, patients who initiated treatment at the dual-diagnosis treatment program had more days of heavy alcohol use and more days of illicit drug use. In addition, patients who initiated treatment at the dual-diagnosis treatment program were no longer characterized by a higher suicide attempt rate. There may be advantages for patients with co-occurring disorders to enter a dual-diagnosis treatment program rather than initiating treatment at an SUD or psychiatric program, especially in regard to managing suicidal behavior. Future studies are necessary to identify patient subgroups that might benefit most from initiating treatment at programs with a dual-diagnosis focus and to explore the key characteristics of effective dual-diagnosis programs. Furthermore, it may be important for dual-diagnosis treatment programs to monitor patient outcomes and focus resources on treating SUD issues among nonabstainers.

KEYWORDS:

• substance use disorder
• psychiatric disorder
• dual diagnosis
• treatment setting
• patient outcomes

Acknowledgments

This article not subject to US copyright law.

This work was supported by Department of Veterans’ Affairs (VA) Program Evaluation and Resource Center/Mental Health Strategic Health Care Group Grant No. XVA 62-004. The opinions expressed in this article are those of the authors and do not necessarily reflect those of the VA.

We wish to thank the staff and patients of the VA treatment programs who participated in this project and Valerie Jackson, Leah McKechnie, Dr. Michele Stefan, Dr. Joseph Liberto, Dr. Mark Mann, and Allison Davis for their contributions.