ASSERTIVE COMMUNITY TREATMENT AND CONTINGENCY MANAGEMENT

酒精滥用是一种常见的诊断中的人有严重的精神 疾病（SMD），尤其是无家可归者。显著 比例，通常为50%或更多的SMD患者滥用酒精。 他们的酗酒与临床残疾密切相关， 无家可归、机构收容和治疗困难。解决 关于这个问题，康涅狄格州精神卫生部已经提供了 资助建立一个新的自信社区治疗（ACT）团队 为药物滥用和SMD提供综合治疗， 康涅狄格州最大也是最穷的城市布里奇波特的确诊病人。 这项拟议中的研究将是康涅狄格州 精神卫生部和达特茅斯医学院进行了一次 对ACT计划的有效性和成本进行严格评估 为城市地区的双重诊断客户设计， 可卡因和其他毒品很容易获得并被广泛使用。半年 ACT和标准病例中的知情同意研究参与者- 将对达到积极治疗阶段的管理状况进行随机 分配到一个应急管理干预， 基于社区强化方法的行为治疗。的 研究将仔细记录提供给客户的干预措施， 每种治疗条件，以记录实际干预措施 发生和干预措施的成本，使任何差异， 临床结果和成本可归因于以下方面的差异： 护理的过程。 该项目的第一个目标是尽量减少问题 双重诊断客户的特征：酗酒，住房 不稳定和无家可归，以及在医院的机构化， 监狱第二个目标是确定这些项目的良好结果是否 主要领域将与更普遍的改进相关联， 症状、功能状态和生活质量。第三个目标是 确定与以下方面相关的案例管理质量： 成功的参与和治疗。独立的数据分析策略 将适用于这些目标中的每一个。 研究设计为随机临床试验，2x2析因 设计（社区强化服务组织）。共有150 同意，双重诊断的客户将被随机分配到 ACT或标准病例管理，一半参与者来自 参加积极治疗的每个服务条件 社区强化干预。研究参与者将 在基线和6个月时使用定量工具进行访谈 随访3年。

Abuse of alcohol is a frequent diagnosis among people with severe mental disorders (SMD), particularly among those who are homeless. A significant proportion, typically 50% or more, of people with SMD abuse alcohol. Their alcohol abuse is strongly associated with clinical disability, homelessness, institutionalization, and treatment difficulty. To address this problem, the Connecticut Department of Mental Health has provided funding for the creation of a new assertive community treatment (ACT) team to provide integrated treatment for substance abuse and SMD to dually diagnosed clients in Connecticut's largest and poorest city, Bridgeport. The proposed research will be a collaboration between the Connecticut Department of Mental Health and the Dartmouth Medical School to conduct a rigorous evaluation of the effectiveness and costs of the ACT program design for dually diagnosed clients in an urban area where alcohol, cocaine, and other drugs are readily available and widely used. 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 employ behavioral treatment based on the community reinforcement approach. The research will carefully document the interventions provided to clients in each treatment condition 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. The first objective of the project is to decrease the problems most characteristic of dually diagnosed clients: alcohol abuse, housing instability and homelessness, and institutionalization in hospitals and jails. A second objective is to determine whether good outcomes in these primary domains will be associated with more general improvements in symptoms, functional status, and quality of life. A third objective is to identify the qualities of case management that are associated with successful engagement and treatment. Separate data analysis strategies will be applied to each of these objectives. The research design is a randomized clinical trial with a 2x2 factorial design (service organization by community reinforcement). A total of 150 consenting, dually diagnosed clients will be randomly assigned to either ACT or to standard case management, with half of the participants from each service condition who enter active treatment participating in the community reinforcement intervention. Study participants will be interviewed with quantitative instruments at baseline and at 6-month followup intervals for 3 years.