Achieving effective treatment of patients with chronic psychotic illness and comorbid substance dependence

Objective: The changing effectiveness of a treatment program for dual-diagn osis patients was evaluated over a 2-year period with the use of a sequenti al study group design. Method: The treatment outcome of 179 consecutively e nrolled patients with chronic psychotic illness and comorbid substance depe ndence who entered a specialized day hospital dual-diagnosis treatment prog ram from Sept. 1, 1994, to Aug. 31, 1996, was evaluated. The 24 months were divided into four successive 6-month periods for comparing the evolving ef fectiveness of the program for groups of patients entering the day hospital during these four periods. Treatment attendance, hospital utilization, and twice weekly urine toxicology analyses were used as outcome measures. Resu lts: The initial treatment engagement rate, defined as at least 2 days of a ttendance in the first month, increased significantly from group 1 to group 4, more than doubling. Thirty-day and 90-day treatment retention rates als o substantially increased from group 1 to group 4. More patients had no hos pitalization in the 6 months after entering the day hospital program than i n the 6 months before entering the day hospital program. Urine toxicology m onitoring indicated that the patients in group 4 were more likely than thos e in group 1 to remain abstinent at follow-up. Conclusions: The evolving cl inical effectiveness of a developing program can be quantified by using a s equential group comparison design. The sequential outcome improvements may be related to the incremental contributions of assertive case management an d skills training for relapse prevention.