Diagnosis, Dual (Psychiatry)
Conditions
Brief summary
This research program will improve the care and treatment outcomes of dually diagnosed veterans who receive inpatient psychiatry care, and decrease their use of VA inpatient mental health services. It will increase the use of substance abuse outpatient care and 12-step groups to benefit recovery, reduce rehospitalizations, and reduce costs for VA.
Detailed description
Background: Substance use disorders (SUDs) are highly prevalent among veteran psychiatry inpatients. Dual substance use and psychiatric disorders are related to poor outcomes and rehospitalizations, which are quite costly. However, relatively little is known about how to effectively help dually diagnosed psychiatry inpatients. Telephone Monitoring (TM) is effective among SUD patients at increasing SUD continuing care and self-help utilization and improving SUD outcomes. This study will build on these findings and contribute important new clinical knowledge by determining whether TM is similarly effective when adapted for dually diagnosed veteran psychiatry inpatients. It will evaluate the effectiveness of a manual-guided TM intervention. Objectives: Primary hypotheses are that patients in the TM condition, compared to patients in usual care (UC), will attend more SUD continuing care sessions and 12-step group meetings, and have better SUD and psychiatric outcomes. Secondary hypotheses are that TM patients will have fewer and delayed rehospitalizations, and their better outcomes will be mediated by SUD outpatient treatment and 12-step group participation. Methods: This study will take place at two VAs: Palo Alto (VISN 21) and Ann Arbor (VISN 11). Dually diagnosed patients in psychiatry inpatient treatment will be randomly assigned to UC or TM. Patients in the TM condition will receive an in-person session while in treatment, followed by monitoring over the telephone for three months after discharge. The intervention will incorporate motivational interviewing to monitor patients' substance use, facilitate entry into outpatient treatment if a relapse occurs, and encourage 12-step self-help group participation. Patients will be assessed at baseline, end-of-intervention, and six months and one-year post-intervention for primary and secondary outcomes and non-VA health care; VA health care will be assessed with VA databases. GLMM analyses will be conducted to compare the UC and TM groups on course of primary and secondary outcomes over time; Cox regression models will compare groups on time to rehospitalization; and sequential regression analyses will examine whether outcomes associated with TM are mediated by more SUD continuing care and 12-step group participation. Status: As of this time, this project is in the follow-up data collection phase.
Interventions
BEHAVIORALTelephone Monitoring (TM) with Motivational Interviewing
Patients in the TM condition will receive an in-person session while in the inpatient psychiatry program, followed by monitoring delivered over the telephone for three months after discharge. The TM intervention will have a motivational interviewing component to address patients' motivation to obtain help for and reduce their substance abuse. The purpose of the intervention condition is to monitor patients' substance use, facilitate patients' entry into outpatient substance use disorder (SUD) treatment, and encourage ongoing 12-step selfhelp group participation to support sobriety.
OTHERUsual care
All patients in the trial will receive usual care (i.e., the care they would have received in the absence of a study).
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Dually diagnosed veteran in VA inpatient psychiatry treatment
Exclusion criteria
* Current diagnosis of schizophrenia or schizoaffective disorder * too psychiatrically unstable or cognitively impaired to understand informed consent and other study procedures * does not have ongoing telephone access
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Readiness to Attend Substance Use Disorder Continuing Care | 3 months post-intervention | Readiness to attend substance use disorder continuing care; scale range=0-4, with 0=not ready to do; 4=already doing; higher scores indicate a better outcome. |
Countries
United States
Participant flow
Recruitment details
Patients were recruited from inpatient psychiatry settings.
Participants by arm
| Arm | Count |
|---|---|
| Usual Care Psychiatry inpatient usual care
Usual care: All patients in the trial will receive usual care (i.e., the care they would have received in the absence of a study). | 199 |
| Telephone Monitoring Patients in the TM condition received an in-person session while in treatment, followed by monitoring over the telephone for three months after discharge. The intervention will incorporate motivational interviewing to monitor patients' substance use, facilitate entry into outpatient treatment, and encourage 12-step self-help group participation.
Telephone Monitoring (TM) with Motivational Interviewing: Patients in the TM condition will receive an in-person session while in the inpatient psychiatry program, followed by monitoring delivered over the telephone for three months after discharge. The TM intervention will have a motivational interviewing component to address patients' motivation to obtain help for and reduce their substance abuse. The purpose of the intervention condition is to monitor patients' substance use, facilitate patients' entry into outpatient substance use disorder (SUD) treatment, and encourage ongoing 12-step selfhelp group participation to support sobriety | 207 |
| Total | 406 |
Baseline characteristics
| Characteristic | Usual Care | Telephone Monitoring | Total |
|---|---|---|---|
| Age, Continuous | 45 Years STANDARD_DEVIATION 13 | 45 Years STANDARD_DEVIATION 13 | 45 Years STANDARD_DEVIATION 13 |
| Gender Female | 16 Participants | 18 Participants | 34 Participants |
| Gender Male | 183 Participants | 189 Participants | 372 Participants |
| Region of Enrollment United States | 199 participants | 207 participants | 406 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 3 / 199 | 4 / 207 |
| serious Total, serious adverse events | 3 / 199 | 4 / 207 |
Outcome results
Primary
Readiness to Attend Substance Use Disorder Continuing Care
Readiness to attend substance use disorder continuing care; scale range=0-4, with 0=not ready to do; 4=already doing; higher scores indicate a better outcome.
Time frame: 3 months post-intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Usual Care | Readiness to Attend Substance Use Disorder Continuing Care | 1.8 units on a scale | Standard Deviation 1.1 |
| Telephone Monitoring | Readiness to Attend Substance Use Disorder Continuing Care | 2.2 units on a scale | Standard Deviation 1.3 |
p-value: <0.05ANCOVA