Effects of substance dependence on outcomes of patients in a randomized. Trial of two case management models

Objective: The effectiveness of a community-based intensive clinical case m anagement program was compared with that of a hospital-based expanded broke rage case management program for seriously mentally ill adults with and wit hout substance dependence, Methods: The sample of 268 frequently hospitaliz ed psychiatric patients was recruited during acute psychiatric hospitalizat ion. More than half of the sample (53 percent) was diagnosed as having at l east one current DSM-III-R substance dependence disorder co-occurring with their primary major mental disorder. Subjects were stratified by substance dependence status and randomly assigned to one of the case management progr ams, They were interviewed before hospital discharge and at one, two, and s ix months after discharge to assess psychosocial and drug use variables. Su bjects' service use was examined for the six months before and after hospit alization. Results: The hypothesis that substance-dependent subjects would benefit more from intensive clinical case management was not supported. Sub stance dependence predicted negative outcomes independent of the case manag ement intervention. The hypothesis that the two case management approaches would be equally effective for subjects not dependent on substances was als o not borne out, Intensive clinical case management was the superior treatm ent for subjects who were not dependent on substances, Fewer of them requir ed psychiatric hospitalization in the six-month postdischarge period than i n the six-month period before hospital admission. Conclusions: The negative outcomes for substance-dependent subjects in both programs suggest that th e two case management models were relatively ineffective for these patients , Results suggest that intensive clinical case management can be effective within the first six months for nondependent adults with serious mental ill ness.