We examined patterns of changes in psychiatric symptoms among mentally ill chemical abusers (MICAs) in long-term residential treatment. Clients were evaluated with various measures of psychopathology, referred to a therapeutic community (TC) or community residence, and reassessed after 2, 6, and 12 months of treatment with regard to anxiety, depressive symptoms, and psychotic ideation. Reductions in mean values of psychopathology were found only for anxiety and depressive symptoms at the TC during the first 2 months of treatment. However, an examination of changing patterns of symptoms revealed a more complex set of findings. At both programs, a significant number of MICAs showed reductions in psychopathology during treatment, a significant minority exhibited no improvements in psychiatric symptoms, and a few reported new symptoms of anxiety, depression, and psychotic ideation. We conclude that the symptoms of the vast majority of MICAs are highly labile during treatment.
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