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IIR 05-014 – HSR&D Study

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IIR 05-014
Dual Diagnosis Self-Help Group Referral: Outcomes and Services Use
Christine Timko PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: April 2006 - September 2010

BACKGROUND/RATIONALE:
Dual diagnosis (psychiatric and substance use) patients' (DDPs) participation in 12-step mutual-help groups is linked to lower relapse and treatment utilization rates. However, under usual referral, many DDPs do not attend, or sustain attendance of, substance-focused groups (SFG). DDPs may benefit from dual-focused groups (DFGs).

OBJECTIVE(S):
(1) Implement and validate procedures to help counselors make effective referrals to DFGs. DDPs were assigned to a standard- or intensive-referral to DFG condition to determine the extent to which intensive referral, compared to standard referral, increased patients' mutual-help group participation. (2) Determine whether DDPs who received intensive referral had better substance use and psychiatric outcomes.

METHODS:
DDPs entering VA outpatient mental health treatment received either standard (N=145) or intensive (N=142) referral. Standard referral consisted essentially of the counselor recommending DFG participation. The keys to intensive referral were a DFG orientation and the counselor facilitating direct contact between the patient and a DFG member, and following up on recommendations for mutual help. Patients were followed at six months (80%), one year (81%) and two years (80%) to determine whether intensive referral resulted in more DFG and SFG participation, and better substance use and psychiatric outcomes.

FINDINGS/RESULTS:
To date, analyses have focused on six-month follow-up results. Compared to patients in the standard condition, those in the intensive referral intervention were more likely to attend and be involved in DFGs and SFGs, and had better psychiatric outcomes at follow-up. Attending more intensive-referral sessions was associated with more DFG and SFG meeting attendance. More need fulfillment in DFGs, and more readiness to participate in SFGs, were associated with better alcohol and psychiatric outcomes at six months.

IMPACT:
This project is helping to specify clinical practices to enhance dually diagnosed veteran patients' chances of recovery. The intensive referral procedures validated in this project should be efficient, inexpensive, and generalizable for use by mental health clinicians in and outside the VA.

PUBLICATIONS:

Journal Articles

  1. Timko C, Ilgen M, Haverfield M, Shelley A, Breland JY. Polysubstance use by psychiatry inpatients with co-occurring mental health and substance use disorders. Drug and Alcohol Dependence. 2017 Nov 1; 180:319-322.
  2. Timko C, Cronkite RC, McKellar J, Zemore S, Moos RH. Dually diagnosed patients' benefits of mutual-help groups and the role of social anxiety. Journal of substance abuse treatment. 2013 Feb 1; 44(2):216-23.
  3. Makin-Byrd K, Cronkite RC, Timko C. The influence of abuse victimization on attendance and involvement in mutual-help groups among dually diagnosed male veterans. Journal of substance abuse treatment. 2011 Jul 1; 41(1):78-87.
  4. Timko C, Sutkowi A, Moos R. Patients with dual diagnoses or substance use disorders only: 12-step group participation and 1-year outcomes. Substance use & misuse. 2010 Mar 1; 45(4):613-27.
Conference Presentations

  1. Makin-Byrd K, Cronkite RC, Timko C. The Influence of Abuse Victimization on Health Outcomes in Dually Diagnosed Men. Presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2010 Nov 21; San Francisco, CA.
  2. Makin-Byrd K, Cronkite RC, Timko C. The influence of abuse victimization on health outcomes in dually diagnosed men. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 28; Little Rock, AR.
  3. Weaver C, Crawford E, DeBenedetti A, Rosen C, McKellar J, Timko C, Trafton JA, Kimerling R. Preventing chronicity and relapse in SUD/PTSD: Research issues. Paper presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction, Health Systems
DRE: Treatment - Observational, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Dual diagnosis – substance abuse and mental health, Outcomes, Utilization patterns
MeSH Terms: none