SUBSTANCE-ABUSE AND PSYCHIATRIC-ILLNESS - TREATMENT EXPERIENCE

The purpose of this paper is to describe an outpatient dual-diagnosis treatment program and 1-year clinical outcome and hospital utilization data. Subjects were 118 consecutive admissions to the Seattle Veteran s Affairs (VA) Medical Center's Dual Disorders program over the period from June 1, 1992, to August 31, 1994. Program eligibility requiremen ts included having a current substance use disorder and an active non- substance-related major Axis I disorder (typically major depression, p ost-traumatic stress disorder [PTSD], bipolar disorder, or schizoaffec tive disorder). The treatment frame involved group-based programming ( including support, medications management, and psychoeducation), routi ne urine drug screening, and crisis interventions. Results showed that subjects averaged 1.5 non-substance-related Axis I psychiatric disord ers (54% involving psychotic symptoms) and 1.8 active substance use di sorders. Patients stayed engaged in treatment for a median of 217 days , with 60% of patients having no positive drug screens, and the overal l sample having a 40% reduction in the number of inpatient bed days in the year after intake. Conclusions were that, for a number of patient s with comorbid disorders, psychiatric stabilization and cessation of substance use can be ac complished within an outpatient treatment fram e that averages two completed clinical contacts per week.