The effects of residential dual diagnosis treatment on alcohol abuse.

Stephen J Schoenthaler,Rajendra Badgaiyan,Edward J Modestino,John Giordano,Lyle Fried,Marlene Oscar-Berman,Kenneth Blum

doi:10.15761/jsin.1000169

Abstract

This multi-center study of dual diagnosis (DD) programs involved 804 residential patients with co-occurring alcohol and mental health disorders. The Addiction Severity Index was administered at admission and at one, six, and 12 months after discharge. Repeated measures analysis showed the intoxication rate per month stabilized between months six and 12 with 68% still in remission and an 88% mean reduction from baseline (F = 519, p < .005). A comparison between patients with and without weekly relapse produced significant differences in hospitalization (odds ratio 11.3:1; 95% C.I., 5.5 to 23.2). Eight ANCOVAs used mean intoxication days per month after discharge as the outcome variable, pre-admission intoxication days per month as a covariate, and eight variables associated with relapse (e.g. depression) as factors. Patients with these factors at admission did not have significantly higher intoxication rates after discharge than patients without them. This suggests that these DD programs successfully integrated treatment of both disorders and explained their effectiveness. Co-occurring DSM IV mood disorders such as anxiety and depression as well as drug abuse involving opioids or cocaine fell between 66 and 95% at months one, six, and twelve.

Highlights

The 21st-century increase in dual diagnosis treatment of cooccurring drug and mental health disorders is, in part, a result of the recognition that they typically co-exist and difficulty in achieving longterm remission using treatment-as-usual
The American Society of Addiction Medicine (ASAM) has developed a three-tier taxonomy of addiction-only services (AOS), dual diagnosis capable (DDC), and dual diagnosis enhanced (DDE) services with the difference between the latter two being the capability of integrating treatment of all severities of both disorders [7]. This taxonomy does not imply that AOS or DDC programs are not desirable; some addicts do not have mental health disorders necessitating dual diagnosis treatment and others who might benefit from such treatment do not require DDE services due to low severity
We found no other study that has ever tested whether dual diagnosis centers can eliminate the association between co-occurring mental health problems at intake and post-discharge relapse

Summary

Introduction

The 21st-century increase in dual diagnosis treatment of cooccurring drug and mental health disorders is, in part, a result of the recognition that they typically co-exist and difficulty in achieving longterm remission using treatment-as-usual. The American Society of Addiction Medicine (ASAM) has developed a three-tier taxonomy of addiction-only services (AOS), dual diagnosis capable (DDC), and dual diagnosis enhanced (DDE) services with the difference between the latter two being the capability of integrating treatment of all severities of both disorders [7] This taxonomy does not imply that AOS or DDC programs are not desirable; some addicts do not have mental health disorders necessitating dual diagnosis treatment and others who might benefit from such treatment do not require DDE services due to low severity. Some have indicated [10,11,12] that there is a lack of well-designed dual diagnosis studies that consider the differences between effectiveness and efficacy The latter requires randomized controlled trials (RCTs) to determine causation that has high internal validity. The primary limitation of dual diagnosis RCTs is low external validity due to the use of extensive inclusion/exclusion criteria that hinder

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Conclusion