Substance abuse treatment and psychiatric comorbidity: do benefits spill over? Analysis of data from a prospective trial among cocaine-dependent homeless persons.
BACKGROUND
Comorbid psychiatric illness can undermine outcomes among homeless persons undergoing addiction treatment, and psychiatric specialty care is not always readily available. The prognosis for nonsubstance abuse psychiatric diagnoses among homeless persons receiving behaviorally-based addiction treatment, however, is little studied.


RESULTS
Data from an addiction treatment trial for 95 cocaine-dependent homeless persons (1996-1998) were used to profile psychiatric diagnoses at baseline and 6 months, including mood-related disorders (e.g. depression) and anxiety-related disorders (e.g. post-traumatic stress disorder). Treatment interventions, including systematic reinforcement for goal attainment, were behavioral in orientation. There was a 32% reduction in the prevalence of comorbid non-addiction psychiatric disorder from baseline to 6 months, with similar reductions in the prevalence of mood (-32%) and anxiety-related disorders (-20%) (p = 0.12).


CONCLUSIONS
Among cocaine-dependent homeless persons with psychiatric comorbidity undergoing behavioral addiction treatment, a reduction in comorbid psychiatric disorder prevalence was observed over 6 months. Not all participants improved, suggesting that even evidence-based addiction treatment will prove insufficient for a meaningful proportion of the dually diagnosed homeless population.
Kertesz
Stefan G
SG
Div. of Preventive Med., Univ. of Alabama at Birmingham, School of Med. and the Deep South Center on Effectivenessat the Birmingham Veterans' Affairs Medical Center; 1530 3rd Ave South MT 608 Birmingham, Alabama 35294, USA. skertesz@uab.edu
Madan
Alok
A
Wallace
Dennis
D
Schumacher
Joseph E
JE
Milby
Jesse B
JB
D000328:Adult; D000407:Alabama / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D001521:Behavior Therapy; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome