title: Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.
abstract: OBJECTIVE
  Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.
  
  
  METHODS
  Participants at the Addiction Treatment Services (ATS) were assigned randomly to receive on-site and integrated substance abuse and psychiatric care (on-site: n = 160) versus off-site and non-integrated substance abuse and psychiatric care (off-site: n = 156), and observed for 1 year. On-site participants received all psychiatric care within the substance abuse program by the same group of treatment providers. The same type and schedule of psychiatric services were available to off-site participants at a community psychiatry program.
  
  
  METHODS
  All participants received routine methadone maintenance at the ATS program in Baltimore, Maryland, USA.
  
  
  METHODS
  Participants were opioid-dependent men and women with at least one comorbid psychiatric disorder, as assessed by the Structured Clinical Interview for DSM-IV and confirmed by expert clinical reappraisal.
  
  
  METHODS
  Outcomes included psychiatric service utilization and retention, Hopkins Symptom Checklist Global Severity Index (GSI) change scores and urinalysis test results.
  
  
  RESULTS
  On-site participants were more likely to initiate psychiatric care 96.9 to 79.5%; P < 0.001), remain in treatment longer (195.9 versus 101.9 days; P < 0.001), attend more psychiatrist appointments (12.9 versus 2.7; P < 0.001) and have greater reductions in GSI scores (4.2 versus 1.7; P = 0.003) than off-site participants; no differences were observed for drug use.
  
  
  CONCLUSIONS
  On-site and integrated psychiatric and substance misuse services in a methadone treatment setting might improve psychiatric outcomes compared with off-site and non-integrated substance misuse and psychiatric care. However, this might not translate into improved substance misuse outcomes.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Brooner
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kidorf
authors.forename: Van L
authors.initials: VL
authors.lastname: King
authors.forename: Jessica
authors.initials: J
authors.lastname: Peirce
authors.forename: Karin
authors.initials: K
authors.lastname: Neufeld
authors.forename: Ken
authors.initials: K
authors.lastname: Stoller
authors.forename: Ken
authors.initials: K
authors.lastname: Kolodner
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D015142:Baltimore / Q000453:epidemiology; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010045:Outpatients / Q000523:psychology; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: Drug use; integrated care; methadone maintenance; psychiatric care; psychiatric comorbidity; treatment response