title: Longitudinal Course of Clients With Co-occurring Schizophrenia-Spectrum and Substance Use Disorders in Urban Mental Health Centers: A 7-Year Prospective Study.
abstract: OBJECTIVE
  A previous longitudinal study in rural New Hampshire showed that community mental health center clients with co-occurring schizophrenia-spectrum and substance use disorders (SZ/SUD) improved steadily and substantially over 10 years. The current study examined 7 years of prospective clinical and functional outcomes among inner-city Connecticut (CT) community mental health center clients with SZ/SUD.
  
  
  METHODS
  Participants were 150 adults with SZ/SUD, selected for high service needs, in 2 inner-city mental health centers in CT. Initially, all received integrated mental health and substance abuse treatments for at least the first 3 years as part of a clinical trial. Assessments at baseline and yearly over 7 years measured progress toward 6 target clinical and functional outcomes: absence of psychiatric symptoms, remission of substance abuse, independent housing, competitive employment, social contact with non-users of substances, and life satisfaction.
  
  
  RESULTS
  The CT SZ/SUD participants improved significantly on 5 of the 6 main outcomes: absence of psychiatric symptoms (45%-70%), remission of substance use disorders (8%-61%), independent housing (33%-47%), competitive employment (14%-28%), and life satisfaction (35%-53%). Only social contact with nonusers of substances was unimproved (14%-17%).
  
  
  CONCLUSIONS
  Many urban community mental health center clients with SZ/SUD and access to integrated treatment improve significantly on clinical, vocational, residential, and life satisfaction outcomes over time, similar to clients with SZ/SUD in rural areas. Thus, the long-term course for people with SZ/SUD is variable but often quite positive.
authors: Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH; Robert.E.Drake@dartmouth.edu.
authors: Robert E
authors: RE
authors: Drake
authors: Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH;
authors: Alison E
authors: AE
authors: Luciano
authors: Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston, MA;
authors: Kim T
authors: KT
authors: Mueser
authors: Department of Psychiatry, Columbia Medical School, New York, NY;
authors: Nancy H
authors: NH
authors: Covell
authors: Department of Psychiatry, Columbia Medical School, New York, NY;
authors: Susan M
authors: SM
authors: Essock
authors: Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH;
authors: Haiyi
authors: H
authors: Xie
authors: Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, NH.
authors: Gregory J
authors: GJ
authors: McHugo
mesh_terms: D000328:Adult; D000437:Alcoholism; D019970:Cocaine-Related Disorders; D003156:Community Mental Health Services; D003237:Connecticut; D017831:Diagnosis, Dual (Psychiatry); D018450:Disease Progression; D004651:Employment; D005260:Female; D006798:Housing; D006801:Humans; D057187:Independent Living; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse; D008875:Middle Aged; D010549:Personal Satisfaction; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000150:complications*; D012074:Remission Induction; D012559:Schizophrenia / Q000150:complications*; D058992:Social Participation; D019966:Substance-Related Disorders / Q000150:complications*; D014505:Urban Population; D055815:Young Adult
keywords: co-occurring substance disorders; long-term course; schizophrenia