ASSERTIVE COMMUNITY TREATMENT AND CONTINGENCY MANAGEMENT

酗酒是严重精神疾病患者的常见诊断 精神障碍(SMD)，特别是在无家可归者中。一个重要的 SMD患者中有50%或更多的人酗酒。 他们的酗酒与临床残疾密切相关， 无家可归、制度化和治疗困难。致信地址 这个问题，康涅狄格州心理健康部门已经提供了 为创建一个新的自信的社区治疗(ACT)小组提供资金 为药物滥用和SMD提供综合治疗 被诊断为康涅狄格州最大和最贫穷城市布里奇波特的客户。 这项拟议的研究将是康涅狄格州 精神卫生部和达特茅斯医学院开展一项 对ACT方案的有效性和成本进行严格评估 为城市地区被诊断为双重诊断的客户设计， 可卡因等毒品随处可得，用途广泛。一半的人 ACT和标准案例中同意的研究参与者- 达到积极治疗阶段的管理情况将是随机的 分配给应急管理干预，将采用 基于社区强化方法的行为治疗。这个 研究将仔细记录向客户提供的干预措施 每种治疗条件都记录了实际的干预措施 发生的情况和干预的成本，因此 临床结果和成本可归因于 护理的过程。 该项目的第一个目标是最大限度地减少问题 双重诊断患者的特征：酗酒、住房 不稳定和无家可归，以及医院和医院的制度化 监狱。第二个目标是确定这些项目的良好结果 主域将与以下方面的更一般改进相关联 症状、功能状态和生活质量。第三个目标是 确定与以下各项相关的案例管理质量 成功的介入和治疗。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，因子为2x2 设计(通过社区加固的服务组织)。总共150个 同意的，双重诊断的客户将被随机分配到 行动或标准的案例管理，一半的参与者来自 参加积极治疗的每一位服役条件 社区强化干预。研究参与者将是 在基线和6个月时使用量化工具进行访谈 随访间隔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.