Abstract
BackgroundAn estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders.MethodsThis study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not?ResultsFrom baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen’s d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen’s d = 0.91) and Continuity of Care (p = 0.026, Cohen’s d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen’s d = 0.51) were found.ConclusionsOverall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders.Trail registrationClinicalTrials.gov, NCT03007940. Retrospectively registered January 2017
Highlights
An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders
The addiction treatment agencies were located across the State of Washington in 21 of the 39 counties, located predominantly in cities with medium sized populations (i.e., 26,000 – 249,000)
Improvements in Diagnosis in Addiction Treatment (DDCAT) Index total and dimension scores at one-year post active implementation may indicate that even the audit and feedback of DDCAT Index scores alone, which were provided to both the active Network for the Improvement of addiction treatment (NIATx) and the waitlist control group, were useful to initiate important and significant changes in both study arms
Summary
An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. The benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Research evidence supports the effectiveness of integrated treatment: both substance use and mental health disorders are treated at the same time, during the same treatment episode, and by the same providers [6,7,8,9,10,11]. The current state of access to adequate treatment for co-occurring disorders remains profoundly limited, and the percentage of specialty addiction programs and mental health programs offering integrated services remain low and highly variable [1, 10, 16,17,18,19,20]
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