Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders.
OBJECTIVE
This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up.


METHODS
Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up.


RESULTS
Individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services.


CONCLUSIONS
Study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans.
Grella
Christine E
CE
Department of Psychology, UCLA, Los Angeles, CA 90025, USA. grella@ucla.edu
Stein
Judith A
JA
D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006556:Heroin Dependence / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D015141:Los Angeles; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010555:Personality Inventory; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data