Outcomes and service use among homeless persons with serious mental illness and substance abuse
Outcomes and service use among homeless persons with serious mental illness and substance abuse
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DOI：
10.1176/appi.ps.53.4.437
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发表时间：
2002-04-01
影响因子：
3.8
通讯作者：
Rosenheck, RA
中科院分区：
文献类型：
--
作者：
Gonzalez, G;Rosenheck, RA
目的：这项研究比较了基线特征和临床改善12个月后，无家可归的人诊断为严重的精神疾病，并没有共病物质使用障碍。研究方法：研究对象是5，432名无家可归的精神疾病患者，他们参加了精神卫生服务中心的社区护理和有效服务和支持（ACCESS）计划。协方差分析被用来比较客户谁有双重诊断和那些谁没有，并确定服务使用和临床改善之间的任何关联。结果：4，415名客户（81%）的随访数据可用。在基线时，在大多数临床和社会适应措施方面，双重诊断的客户比没有双重诊断的客户更糟糕。双重诊断的客户在24项结果指标中的15项（62%）的随访结果也较差。然而，在有双重诊断的客户中，那些报告广泛参与药物滥用治疗的客户的临床改善与没有双重诊断的客户相当或更好。在酒精问题的措施，客户与双重诊断谁在自助团体的参与率高的结果上级的其他客户与双重诊断。接受高水平专业服务的双重诊断的客户在社会支持和参与刑事司法系统方面也有上级成果。结论：无家可归的人与双重诊断有较差的调整，对大多数基线措施，并经历了显着较少的临床改善比那些没有双重诊断。然而，那些接受广泛药物滥用治疗的双重诊断者，在12个月时表现出与没有治疗者相似的改善。
Objective: This study compared baseline characteristics and clinical improvement after 12 months among homeless persons with a diagnosis of serious mental illness with and without a comorbid substance use disorder. Methods: The study subjects were 5,432 homeless persons with mental illness who were participating in the Center for Mental Health Services' Access to Community Care and Effective Services and Supports (ACCESS) program. Analysis of covariance was used to compare clients who had dual diagnoses and those who did not and to identify any association between service use and clinical improvement. Results: Followup data were available for 4,415 clients (81 percent). At baseline, clients with dual diagnoses were worse off than those without dual diagnoses on most clinical and social adjustment measures. Clients with dual diagnoses also had poorer outcomes at follow-up on 15 (62 percent) of 24 outcome measures. However, among clients with dual diagnoses, those who reported extensive participation in substance abuse treatment showed clinical improvement comparable to or better than that of clients without dual diagnoses. On measures of alcohol problems, clients with dual diagnoses who had a high rate of participation in self-help groups had outcomes superior to those of other clients with dual diagnoses. Clients with dual diagnoses who received high levels of professional services also had superior outcomes in terms of social support and involvement in the criminal justice system. Conclusions: Homeless persons with dual diagnoses had poorer adjustment on most baseline measures and experienced significantly less clinical improvement than those without dual diagnoses. However, those,,with dual diagnoses who received extensive substance abuse treatment showed improvement similar to those without at 12 months.