Comparative analysis of treatment conditions upon psychiatric severity levels at two years among justice involved persons

Abstract

The aim of this investigation was to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n = 39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions. Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally-run residential integrated treatments for justice involved persons who have dual diagnoses. Results support the utilization of low-cost, community-based treatments for a highly marginalized population. Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.