SERVICES FOR SMI ADULTS WITH SUBSTANCE ABUSE DISORDERS

严重精神疾病患者（SMI）的药物滥用导致 在过去的十年里，越来越多的关注。同时发生的药物滥用 加重症状，混淆诊断，使疾病复杂化， 导致昂贵的反复入院急性精神病护理。的 关于这个问题的越来越多的文献并没有确定一种治疗方法， 选择然而，它支持将药物滥用 全面和临床复杂的治疗方案， SMI个人。密集的个案管理模式显示， 实现这种整合，但控制研究有限。 这项随机临床试验的目的是比较一个密集的情况下， 管理模式转变为另一种全面的服务交付模式， 经常住院的重度精神病患者，同时伴有药物滥用障碍。 强化病例管理模式，临床病例管理（CCM）， 整合自信经纪与门诊治疗提供总， 通过单一供应商提供持续支持。临床病例管理将 与扩展经纪团队（EBT）相比， 住院后的关键时期。EBT成员不提供直接 治疗，但果断地将客户与社区服务联系起来。 我们将 同时检查这些模型的临床疗效和成本， 一体化设计 共400人，按存在分层 与无物质使用障碍相比，将从 在层内到CCM或到EBT，并随访18个月。的 将对干预措施进行监测，以提供有关治疗的精确数据 忠诚要检验的主要假设是， 干预措施与药物使用同时发生的相互作用 紊乱CCM将与更好的实质性成果相关 滥用SMI，将是他们成本较低的治疗方法。会有 对于无合并症的受试者，CCM和EBT之间的结局无差异。 发生药物滥用，但EBT将成本较低。成果 研究应增加对客户群体的了解， 从临床病例管理中受益，增加对 临床病例管理模式的具体优势，并有助于 为中小企业提供更好的综合服务， 发生物质使用障碍。

Substance abuse among persons with severe mental illness (SMI) has caused increasing concern over the past decade. Co-occurring substance abuse exacerbates symptoms, confuses diagnosis, and complicates illness, contributing to costly repeated admissions to acute psychiatric care. The growing literature on this problem does not identify a treatment of choice. Nevertheless, it supports integration of substance abuse treatments with comprehensive and clinically sophisticated programs for SMI individuals. Intensive case management models show promise as a means of achieving this integration, but controlled research has been limited. The aim of this randomized clinical trial is to compare an intensive case management model to another comprehensive service delivery model for frequently hospitalized SMI with co-occurring substance abuse disorders. The intensive case management model, Clinical Case Management (CCM), integrates assertive brokerage with outpatient therapy offering total, ongoing support through a single provider. Clinical Case Management will be compared to an Expanded Brokerage Team (EBT) that is available during critical periods following hospitalizations. EBT members provide no direct treatment, but assertively link clients to community services. We will examine clinical efficacy and cost of these models simultaneously In an integrated design. A total of 400 individuals, stratified by presence versus absence of substance use disorders, will be randomly assigned from within strata to CCM or to EBT and followed for 18 months. The interventions will be monitored to provide precise data about treatment fidelity. The main hypothesis to be tested is that there will be an interaction of the interventions with co-occurrence of substance use disorders. CCM will be associated with better outcomes for substance abusing SMI and will be the less costly treatment for them. There will be No difference in outcomes between CCM and EBT for subjeCts without co- occurring substance abuse, but EBT will be less costly. Results of this study should increase knowledge about the client groups who will most benefit from clinical case management, increase understanding of the specific advantages of clinical case management models, and contribute to development of improved Comprehensive services for the SMI with co- occurring substance use disorders.