Drug Treatment and Mental Health Services: Access and Outcomes

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Project Summary:

Background Individuals entering into substance abuse treatment programs often have co-occurring mental health problems. Because federal, state, and local infrastructures generally are organized to respond to either a substance abuse problem or a mental health disorder, not co-occurring disorders, access to either or both services has been problematic, and insufficient coordination between substance abuse and mental health systems has been criticized on both clinical and practical grounds. Although some progress has been made in recent years to improve the structure and delivery of services to individuals with co-occurring disorders, limited outcome data are available to assess the extent to which such changes have improved access to and utilization of mental health services, and how/what outcomes are associated with different patterns of service delivery. Specific Aims The goal of this project is to generate empirical information for policy-makers on how best to structure and deliver services for individuals with co-occurring substance abuse and mental health disorders. Based on the comprehensive data already collected from a large, diverse sample of substance abuse treatment patients, we will examine (a) the extent and characteristics of patients who received services for mental health, and whether program factors (for example, mental health services and structure, funding sources, staffing patterns, medication practices) influence access to and utilization of mental health services; and (b) how different structures of providing drug treatment and mental health services relate to short- and long-term outcomes. Methods We will conduct secondary analyses of data collected in the California Outcome Project (CalTOP), which included more than 14,000 patients recruited from 43 drug treatment facilities in 13 California counties. Ten of the CalTOP providers were dual-diagnosis programs (Integrated Program); 22 had partnerships with facilities that provided mental health services (Partnership Program); and 11 reported not providing any mental health services (Non-Mental Health Program). All patients were assessed at intake using the Addiction Severity Index (ASI), and their official records in mental health, substance abuse treatment, and criminal justice systems were obtained covering both pretreatment and posttreatment periods (one to two years). A subset of the sample (approximately 2,000) had also been interviewed at a three-month follow-up (using the Treatment Service Review, or TSR) and nine-month follow-up (using the ASI). The ASI is the most widely used instrument in the substance abuse field to provide assessment of problem severity in key life areas including drug use, alcohol use, mental health, employment, family and social relationships, and legal and medical status. The TSR collects information on services received during treatment in each of the seven problem areas of the ASI. We will conduct two sets of parallel analyses for the “intake” cohort (approximately 14,000 patients) and “follow-up” cohort (approximately 2,000 patients with both complete intake and follow-up interview data). Patients who have been identified to have mental health records (Dual Treatment Group) will be compared to those without mental health records (Drug Treatment Group), within the context of the program’s structure (Integrated, Partnership, and Non-Mental Health Program) in terms of pretreatment characteristics (for example, demographics, mental health history and needs, substance abuse history), during treatment (for example, services received), treatment retention and completion, and posttreatment outcomes (for example, readmission to substance abuse treatment, readmission to mental health treatment, arrest, and incarceration). A series of analyses including random-effects models will be applied to identify patient and program characteristics influencing access to mental health services and treatment outcomes.