TREATMENT FOR HOMELESS, DUALLY DIAGNOSED CLIENTS

描述（改编自申请人摘要）： 滥用酒精和 其他药物是一种常见的诊断之间的人有严重的精神 疾病（SMD），尤其是无家可归者。 一 很大一部分，通常是50%或更多的人， SMD滥用酒精或其他非处方精神活性物质。 他们的药物滥用与临床 残疾、无家可归、收容和治疗 困难 为了解决这一问题，康涅狄格州政府 心理健康已经建立了一个ACT团队， 治疗药物滥用和SMD无家可归，双重诊断 客户在康涅狄格州最大也是最穷的城市布里奇波特。 的 拟议的项目将是康涅狄格州之间的合作 达特茅斯医学院精神卫生系和 大布里奇波特社区精神卫生中心：（1）监测 在两个ACT团队中对药物滥用和SMD进行综合治疗， 在治疗中规定的标准病例管理服务中 在本项目第一阶段开发的手册。 (2)进行 严格评估ACT的相对有效性和成本 为城市中无家可归的双重诊断客户设计方案 可卡因和其他毒品很容易获得， 采用研究将仔细记录提供的干预措施 在ACT和标准的案件管理条件下， 记录实际发生的干预措施和成本 干预措施，以便临床结果和 成本可以归因于在 护理过程。 (3)确定社区的有效性 对双重诊断的病人进行强化治疗。 半年 ACT和标准病例中的知情同意研究参与者 达到积极治疗阶段的管理条件将是 随机分配到应急管理干预， 基于社区强化方法的奖励禁欲。（四） 确定家庭如何为客户成果做出贡献，以及ACT如何 团队影响家庭支持。 该项目将利用 一项正在进行的随机临床试验（ACT与标准病例 管理，N = 150）。 因此，该项目提供了一个强有力的比较 ACT在无家可归的双重诊断客户中的有效性 在一个贫困的城市地区。

DESCRIPTION (Adapted from applicant's abstract): Abuse of alcohol and other drugs is a frequent diagnosis among people with severe mental disorders (SMD), particularly among those who are homeless. A significant proportion, typically 50 percent or more, of people with SMD abuse alcohol or other non- prescribed psychoactive substances. Their substance abuse is strongly associated with clinical disability, homelessness, institutionalization, and treatment difficulty. To address this problem, the Connecticut Department of Mental Health has established an ACT team to provide integrated treatment for substance abuse and SMD to homeless, dually-diagnosed clients in Connecticut's largest and poorest city, Bridgeport. The proposed project will be a collaboration among the Connecticut Department of Mental Health, the Dartmouth Medical School, and the Greater Bridgeport Community Mental Health Center to: (1) Monitor the integrated treatment of substance abuse and SMD in both ACT teams and in standard case management services as set forth in the treatment manual developed during Phase 1 of this project. (2) Conduct a rigorous evaluation of the relative effectiveness and costs of the ACT program design for homeless, dually diagnosed clients in an urban area where cocaine and other drugs are readily available and widely used. The research will carefully document the interventions provided to clients in the ACT and standard case management conditions to document both what interventions actually occurred and the costs of the interventions so that any differences in clinical outcomes and costs can be attributed to differences identified in the processes of care. (3) Determine the effectiveness of community reinforcement treatment for dually diagnosed clients. Half of the consenting study participants in both the ACT and standard case management condition who reach the active treatment phase will be randomly assigned to a contingency management intervention which will reward abstinence based on the community reinforcement approach. (4) Determine how families contribute to client outcomes and how ACT teams influence family support. The project will capitalize upon an ongoing randomized clinical trial (ACT versus standard case management, N = 150). Hence the project offers a powerful comparison of the effectiveness of ACT among homeless, dually-diagnosed clients in a distressed urban area.