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IIR 02-145 – HSR&D Study

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IIR 02-145
A Brief Community Linkage Intervention for Dually Diagnosed Individuals
David A. Smelson PsyD
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: February 2005 - June 2009

BACKGROUND/RATIONALE:
Surveys suggest that up to 80% of veterans with a persistent mental illness have a co-occurring substance abuse disorder. Substance abuse among this population is problematic and often results in poor engagement in treatment and thus frequent hospitalizations and unstable illness course. With regard to treatment engagement, local data from the VA New Jersey facility indicated that 50% of those veterans discharged from the acute psychiatric hospital unit to outpatient care did not attend their initial screening appointment and another 30% dropped out within six weeks. To assist with the transition from inpatient to outpatient care, we previously developed an eight-week augmentation intervention entitled, Time-Limited Case Management (TLC). TLC systematically integrates evidence-based interventions of 1) Dual Recovery Therapy; 2) Critical Time Intervention Case Management along with 3) Peer Support with the goal of assisting individuals with the transition from inpatient to outpatient care.

OBJECTIVE(S):
Objective # 1: To determine whether those in TLC have better attendance in inpatient sessions compared to those receiving Treatment-As-Usual Plus Attention (TAU+A).

Objective # 2: To determine whether those in TLC have better attendance in outpatient sessions compared to those receiving Treatment-As-Usual Plus Attention (TAU+A).

Objective # 3: To determine whether TLC, compared to Treatment-As-Usual Plus Attention (TAU+A) reduces rehospitalizations and has an effect on the use of the Emergency Room use.

Objective # 4: To determine whether TLC achieves a reduction in drug usage and related problems as compared to those receiving TAU+A.

METHODS:
This study involved a randomized attention controlled trial of 102 individuals recruited on the inpatient psychiatry service at the New Jersey VA with a substance abuse disorder and a severe and persistent mental illness. Subjects were randomly assigned to one of two conditions: 1) treatment-as-usual in inpatient and outpatient services plus 8 weeks of Time Limited Care-Coordination (TLC), a brief linkage augmentation intervention or 2) treatment-as-usual along with 8 weeks of matched attention in the form of health education sessions (TAU+A). The data analytic plan included descriptive and advanced statistical analysis.

FINDINGS/RESULTS:
This study found that individuals randomized to the TLC Intervention were more likely to stay in the study, receive inpatient and outpatient TLC as compared to TAU sessions, and participate in outpatient treatment. This study did not find significant differences in the reduction in rehospitalization or ER use, and while both groups showed improvement in substance abuse over time, it was not significantly different for those in TLC.

IMPACT:
There is a substantial need for brief interventions to assist with the transition from inpatient to outpatient care and reduce recidivism. This study tested and found that the TLC augmentation intervention assisted with the transition and improved engagement in outpatient services.

PUBLICATIONS:

Journal Articles

  1. Sussner B, Kline A, Smelson DA, Losonczy M, Salvatore S. The role of psychosocial characteristics in irregular discharge form residentioal services for homeless veterans. Psychological Services. 2008 May 1; 5(4):341-350.
  2. Smelson DA, Dixon L, Craig T, Remolina S, Batki SL, Niv N, Owen R. Pharmacological treatment of schizophrenia and co-occurring substance use disorders. CNS Drugs. 2008 Jan 1; 22(11):903-16.
  3. Ziedonis DM, Smelson D, Rosenthal RN, Batki SL, Green AI, Henry RJ, Montoya I, Parks J, Weiss RD. Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. Journal of psychiatric practice. 2005 Sep 1; 11(5):315-39.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction, Health Systems
DRE: none
Keywords: Dual diagnosis – substance abuse and mental health
MeSH Terms: none