Rehabilitation for adults with severe mental illness and substance use disorders. A clinical trial.
Faced with many patients with comorbid severe mental illness and substance use disorders, a university-affiliated, inner-city community mental health center and a psychosocial rehabilitation center initiated this clinical trial assessing a program to care for these patients. Fifty-four patients, age 18 to 40, with either schizophrenia or major affective disorder and a substance use disorder were randomly assigned to usual community mental health center and rehabilitation services with or without an innovative group and intensive case management program. One-year follow-ups detected no significant advantages on patient outcomes for adding the innovative program to usual services. Failure to engage patients in the experimental program posed a major and enduring barrier to treatment, despite intensive case management. Future efforts must give greater consideration to effective engagement techniques and patients' readiness for active treatment.
Lehman
A F
AF
Department of Psychiatry, University of Maryland, Baltimore 21201.
Herron
J D
JD
Schwartz
R P
RP
Myers
C P
CP
D000293:Adolescent; D000328:Adult; D003155:Community Mental Health Centers; D015897:Comorbidity; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D015995:Prevalence; D015397:Program Evaluation; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome