title: Intensity of acute services, self-help attendance and one-year outcomes among dual diagnosis patients.
abstract: OBJECTIVE
  This study of dual diagnosis patients examined the associations of the intensity of acute care services and 12-step self-help group attendance with substance use and mental health outcomes.
  
  
  METHODS
  Participants (n = 230; 96% men) received treatment in one of 14 residential programs and were evaluated with the Addiction Severity Index at discharge (98%) and at 1-year follow-up (80%).
  
  
  RESULTS
  High service intensity in acute treatment was associated with better substance use and family/social outcomes both at discharge and at 1 year when patients' intake status was controlled. More attendance at 12-step self-help groups was also associated with better patient substance use and psychiatric outcomes, both during and following treatment. The benefits of more 12-step group attendance, however, depended on whether acute treatment was of low or high service intensity. More 12-step group attendance during treatment was associated with better alcohol and drug outcomes at discharge only among patients treated in low-service-intensity programs; and more attendance postdischarge was associated with better psychiatric and family/social functioning at 1 year only among patients receiving low-service-intensity care.
  
  
  CONCLUSIONS
  We suggest potential means by which high-service-intensity acute care programs might better facilitate patients' postdischarge use of 12-step self-help groups to benefit outcomes.
authors.affiliation: Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, California, USA. ctimko@stanford.edu
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.forename: Jill M
authors.initials: JM
authors.lastname: Sempel
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology*; D002391:Catchment Area, Health; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012114:Residential Treatment; D012657:Self-Help Groups / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology