Intensive community-focused treatment of veterans with dual diagnoses.

Abstract

This case presentation follows two veterans through a 5-year course of intensive outpatient care as they made the transition from lives centered on repeated cycles of crisis and hospitalization to lives that are stably centered in the community. The veterans have both major psychiatric disorders and severe substance abuse, and their outpatient treatment demanded intensive, highly individualized care. The treatment programs in which these patients participated were costly, and their development required a substantial shift of inpatient staffing and resources to the outpatient sector (1‐4). These clinical histories illustrate the need for both flexibility and close coordination of the efforts of multiple providers, programs, and agencies. Since these patients were participants in national Veterans Affairs (VA) demonstration programs that include built-in program evaluation and outcome-monitoring efforts, the care they received was an example of the new evidencebased medicine in which the tools of empirical science are used to inform clinical decision making and in which high levels of accountability become a standard part of the everyday practice of medicine (5‐7). CASE PRESENTATION