title: Chronic care management for substance dependence in primary care among patients with co-occurring disorders.
abstract: OBJECTIVE
  Co-occurring mental and substance use disorders are associated with worse outcomes than a single disorder alone. In this exploratory subgroup analysis of a randomized trial, the authors hypothesized that providing chronic care management (CCM) for substance dependence in a primary care setting would have a beneficial effect among persons with substance dependence and major depressive disorder or posttraumatic stress disorder (PTSD).
  
  
  METHODS
  Adults (N=563) with alcohol dependence, drug dependence, or both were assigned to CCM or usual primary care. CCM was provided by a nurse care manager, social worker, internist, and psychiatrist. Clinical outcomes (any use of opioids or stimulants or heavy drinking and severity of depressive and anxiety symptoms) and treatment utilization (emergency department use and hospitalization) were measured at three, six, and 12 months after enrollment. Longitudinal regression models were used to compare randomized arms within the subgroups of participants with major depressive disorder or PTSD.
  
  
  RESULTS
  Among all participants, 79% met criteria for major depressive disorder and 36% met criteria for PTSD at baseline. No significant effect of CCM was observed within either subgroup for any outcome, including any use of opioids or stimulants or heavy drinking, depressive symptoms, anxiety symptoms, and any hospitalizations or number of nights hospitalized. Among participants with depression, those receiving CCM had fewer days in the emergency department compared with the control group, but the finding was of only borderline significance (p=.06).
  
  
  CONCLUSIONS
  Among patients with co-occurring substance dependence and mental disorders, CCM was not significantly more effective than usual care for improving clinical outcomes or treatment utilization.
authors.affiliation: Dr. Park is with the Warren Alpert Medical School of Brown University, Providence, Rhode Island (e-mail: tpark1@lifespan.org ). Dr. Cheng is with the Department of Biostatistics and Mr. Winter is with the Data Coordinating Center, Boston University School of Public Health, Boston. Dr. Samet is with the Section of General Internal Medicine, Boston Medical Center, Boston. Dr. Saitz is with the Department of Community Health Sciences, Boston University School of Public Health, Boston.
authors.forename: Tae Woo
authors.initials: TW
authors.lastname: Park
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D019468:Disease Management; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome