Diagnoses, Opioid-dependent and Methadone Treated Patients With Other Psychiatric, Study Focusing on Integrated Versus Non-integrated Psychiatric Care in
Conditions
Brief summary
This research is being done to: * identify any emotional, behavioral or other troubling psychological problems that some people have who are seeking and receiving treatment for heroin or other drug use problems, * learn if providing additional psychiatric treatment services in the ATS drug abuse treatment program is as beneficial for and acceptable to patients as referring them to the Bayview Community Psychiatry Program to get help for their emotional, behavioral and other psychological problems.
Detailed description
This study will rigorously and systematically evaluate an integrated service delivery approach using a design that reduces many of the methodological limitations in earlier work. Study participants will include opioid abusers with a current psychiatric disorder. All study participants will receive comprehensive drug abuse treatment that includes adequate daily doses of methadone. Study participants will be randomly assigned to either an onsite and fully Integrated Substance Abuse and Psychiatric Care condition (ISAP-Integrated) or an offsite and non-integrated Parallel Substance Abuse and Psychiatric Care condition (PSAP-Parallel). Patients assigned to the ISAP condition will receive all of their ambulatory psychiatric care in the ATS treatment program; those assigned to the PSAP condition will be referred for matched doses of psychiatric care to the Community Psychiatry Program, which is located on the same campus as the ATS program. All drug abuse treatment services will be provided in the ATS program. Patients will be evaluated for 12 months on a range of outcome measures, including psychiatric medication and therapy adherence, drug abuse treatment adherence, changes in psychiatric symptoms, including posttraumatic stress disorder (PTSD), drug use, exposure to traumatic events, psychosocial functioning, and retention in both psychiatric and drug abuse treatment.
Interventions
BEHAVIORALCounseling compliance
Rates of attendance to call counseling session over specific time points
Sponsors
National Institute on Drug Abuse (NIDA)
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* DSM-IV criteria for current opioid physical dependence * SAMSA Center for Substance Abuse Treatment - CSAT guidelines for maintenance on methadone or another approved opioid agonist * have a current DSM-IV psychiatric disorder that is eligible for reimbursement in the Health Choice, Public Mental Health System (e.g., schizophrenia, mood disorders, anxiety disorders, personality disorders, adjustment disorder) * express an interest in receiving psychiatric treatment for the problem.
Exclusion criteria
* pregnant * acute medical problem that requires immediate and intense management (e.g., AIDS defining illness, tuberculosis, other serious and unstable medical disorder) * delirium, dementia or mental retardation * already receiving standard outpatient psychiatric care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Psychiatrist session attendance compliance rate | 90, 180, and up to 365 days | — |
| Individual and group psychiatric session attendance compliance rate | 90, 180, and up to 365 days | — |
| Days to first psychiatric appointment | within first 90 days of randomized care | — |
| Overall psychiatric counseling attendance compliance rate | 90, 180, and up to 365 days | Includes attendance to all of the following sessions: psychiatrist, individual psychiatric counseling, and group psychiatric counseling. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Level of psychiatric distress | 90, 180, and up to 365 days | Measured monthly using the Symptom Checklist 90-Revised (SCL90) |
| Urinalysis results | 90, 180, and up to 365 days | Urinalysis tests are collected weekly. Results include tests for opioids, cocaine, benzodiazepines, and cannabis. |
Countries
United States
Outcome results
None listed