SERVICES FOR SMI ADULTS WITH SUBSTANCE ABUSE DISORDERS

严重精神疾病(SMI)患者的药物滥用导致 在过去的十年里，人们越来越关注这个问题。共同发生的药物滥用 加剧症状，混淆诊断，使疾病复杂化， 增加了反复接受急性精神护理的昂贵费用。这个 关于这个问题的越来越多的文献并没有确定一种治疗 选择。尽管如此，它支持整合药物滥用 通过全面和临床复杂的计划进行治疗 SMI个人。密集的病例管理模式显示出作为一种手段的前景 实现这种整合，但受控研究一直有限。 这项随机临床试验的目的是比较一个重症病例。 管理模式转变为另一种全面的服务交付模式 经常住院的SMI伴发药物滥用障碍。 集约化病例管理模式--临床病例管理(CCM)、 将自信的经纪服务与门诊治疗相结合， 通过单一提供商提供持续支持。临床病例管理将 可与扩展的经纪团队(EBT)相提并论 住院后的关键时期。EBT会员不提供直接 治疗，但果断地将客户与社区服务联系起来。我们会 同时检查这些模型的临床疗效和成本 一体化设计。总共有400个人，按存在情况分层 与无物质使用障碍的对比，将从 层内至CCM或EBT，并随访18个月。这个 将对干预措施进行监测，以提供有关治疗的准确数据 富达。需要检验的主要假设是，将会有一个 干预措施与同时发生的药物使用的相互作用 精神错乱。CCM将与物质的更好结果相关 滥用SMI，对他们来说将是成本更低的治疗方法。会有 CCM和EBT在没有联合治疗的受试者中的结局没有差异 发生药物滥用，但EBT的成本将较低。这样做的结果是 学习应该增加对客户群体的了解，这些客户群体 受益于临床病例管理，提高对临床病例管理的认识 临床病例管理模式的特定优势，并有助于 与合作伙伴共同为SMI开发更完善的综合服务 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.