Maximizing Effectiveness of Integrated Treatment Approaches

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DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic 05-DA-103: Integrated Versus Separate Treatment of Substance Abuse and Comorbid Conditions. Services research on promising strategies to improve the care of drug-dependent patients with comorbid psychiatric disorders remains a major priority for treatment providers and health care policymakers. This challenge grant application will make several substantial contributions to this work by using a well-controlled experimental design to evaluate the efficacy of contingency management for improving psychiatric service utilization and reducing psychiatric distress and impairment in opioid-dependent patients with any psychiatric disorder at a community-based drug abuse treatment program. The rationale and methodology of this study is based on a previously funded NIH-NIDA application (follow-up will be completed April 2009) that was then the first known controlled and randomized evaluation of a fully-integrated substance use and psychiatric service delivery model within a community-based drug abuse treatment program (Services Research: Psychiatric Comorbidity in Drug Abusers, R01 DA 016375). This study has revealed many benefits of integrated care, yet poor overall patient adherence to psychiatric services in the integrated condition (M = .32) clearly compromised the magnitude of these good findings, including the absence of a relationship between integrated care and drug use or retention. These results suggest that integrated approaches could be substantially improved by incorporating other strategies to improve adherence. The proposed study is the next logical step to this work. Male and female opioid-dependent patients at Addiction Treatment Services with any current psychiatric disorder (N = 70) will be randomly assigned to one of two psychiatric service conditions: 1) reinforced on-site integrated care (ROIC), with voucher incentives contingent on attending weekly psychiatric sessions; or 2) standard on-site integrated care (SOIC). Participants in both conditions will receive access to the same schedule and range of psychiatric and substance abuse treatment services. Participants will be assessed for 3-months post-randomization to determine rates of service utilization and adherence to psychiatric care, changes in scope and severity of psychiatric and psychosocial problems, and rates of drug use and treatment retention. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years. Services research on promising strategies to improve the care of drug-dependent patients with comorbid psychiatric disorders remains a major priority for treatment providers and health care policymakers. This challenge grant application will make several substantial contributions to this work by using a well-controlled experimental design to evaluate the efficacy of contingency management for improving psychiatric service utilization and reducing psychiatric distress and impairment in opioid-dependent patients with any psychiatric disorder at a community-based drug abuse treatment program. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years.