COMPARATIVE EFFECTIVENESS OF 3 APPROACHES TO SERVING PEOPLE WITH SEVERE MENTAL-ILLNESS AND SUBSTANCE-ABUSE DISORDERS

This study examines the rationale for and relative effectiveness of th ree intervention models for treating people with severe mental illness and substance abuse disorders: Twelve Step recovery, behavioral skill s training, and intensive case management. Using clinical trial method s, 132 dually diagnosed clients were assigned to three service approac hes. Changes in client psychosocial outcomes, and psychiatric and subs tance abuse symptomatology were tracked over a 24-month period. Differ ential effectiveness was evident, with clients in the behavioral skill s group demonstrating the most positive and significant differences in psychosocial functioning and symptomatology, compared with the Twelve Step recovery approach. However, the case management intervention als o resulted in several positive and important differences compared with the Twelve Step recovery approach. We also found significant changes over time, not only at 6 months but increasingly positive changes in p sychosocial functioning at 12 and 18 months as well. These results und erscore the need for clinical trials to further examine the relative c ost effectiveness of treatment approaches for dually disordered client s and to incorporate means of assessing subgroup differences so that t he interventions being tested can be further refined and targeted to a broad set of needs among the dually diagnosed.