Impact of a 12-step facilitation intervention on tobacco smoking outcomes in community treatment programs

Abstract

Methods: Opioid abusers with at least one co-occurring psychiatric disorder were randomly assigned to Integrated Substance Abuse and Psychiatric Care (ISAP: n=160) or Parallel Substance Abuse and Psychiatric Care (PSAP: n=156), and observed for oneyear. All participants received methadone maintenance at the substance abuse program. ISAP participants received all psychiatric care at the substance abuse program; PSAP participants received a similar scope and frequency of psychiatric services at a community psychiatry program on the same campus. Psychiatric care included psychiatrist appointments, individual and group therapy sessions, and good access to psychiatric medications. Primary outcomes included psychiatric service utilization and retention, changes in psychiatric distress (using the SCL-90-RGlobal Severity Index-GSI), and urinalysis results. Results: ISAP participants were more likely to initiate psychiatric care (97% vs. 79%, p< .001), remained in psychiatric treatment longer (M=196 vs. 102 days; p< .001), utilized more psychiatric services (M=24 vs. 15 sessions; p< .001), and enjoyed greater reductions in psychiatric distress (difference in GSI change scores =2.80; p= .002) than PSAP participants. No differences were observed for drug use outcomes. Conclusions: Integrated psychiatric and substance abuse care in a community opioid agonist setting improved psychiatric, but not substance abuse, outcomes. These findings provide evidence to support the efficacy of integrated care for opioid abusers, demonstrate limitations of this treatment model, and suggest clinical research opportunities for improving outcomes for more participants. Financial support: NIDA grant R01DA016375.