Dual Diagnosis
Conditions
Keywords
self-help groups, referral and consultation
Brief summary
This project will help counselors in substance abuse treatment programs make effective referrals of dually diagnosed patients (those with a co-occurring psychiatric disorder) to self-help groups.
Detailed description
Background: 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). Objectives: (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. Status: Completed.
Interventions
BEHAVIORALIntensive referral to dual-focused self-help
4 group sessions to introduce patients to dual focused groups
Sponsors
VA Office of Research and Development
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Dually diagnosed veterans entering outpatient mental health treatment
Exclusion criteria
* Unable to correctly answer the Orientation and Registration questions of the Mini-Mental State Examination
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Psychiatric Functioning at 6 Months | 6 months | Addiction Severity Index psychiatric composite ranges from 0 to 1, with 1 indicating more severe problems. |
Secondary
| Measure | Time frame |
|---|---|
| Mental Health Services Use and Costs at 6 Months, 1 Year, and 2 Years | 6 months, 1 year, 2 years |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 Intensive Referral Intensive referral to dual-focused self-help groups
Intensive referral to dual-focused self-help: 4 group sessions to introduce patients to dual focused groups | 142 |
| Arm 2 Usual Care Usual care | 145 |
| Total | 287 |
Baseline characteristics
| Characteristic | Arm 1 Intensive Referral | Arm 2 Usual Care | Total |
|---|---|---|---|
| Age, Continuous | 50.9 years STANDARD_DEVIATION 9 | 51.2 years STANDARD_DEVIATION 8.8 | 51.0 years STANDARD_DEVIATION 8.9 |
| Region of Enrollment United States | 142 participants | 145 participants | 287 participants |
| Sex: Female, Male Female | 11 Participants | 15 Participants | 26 Participants |
| Sex: Female, Male Male | 131 Participants | 130 Participants | 261 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 142 | 0 / 145 |
| serious Total, serious adverse events | 4 / 142 | 5 / 145 |
Outcome results
Primary
Psychiatric Functioning at 6 Months
Addiction Severity Index psychiatric composite ranges from 0 to 1, with 1 indicating more severe problems.
Time frame: 6 months
Population: Explanation of Ns discrepant with patient flow: Ns with psychiatric severity scores at 6 months differ from those having completed the study at 2 years.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm 1 Intensive Referral | Psychiatric Functioning at 6 Months | .333 units on a scale | Standard Deviation 0.199 |
| Arm 2 Usual Care | Psychiatric Functioning at 6 Months | .387 units on a scale | Standard Deviation 0.228 |
Secondary
Mental Health Services Use and Costs at 6 Months, 1 Year, and 2 Years
Time frame: 6 months, 1 year, 2 years
Population: Access to data is no longer available.