Dual Diagnosis Capability in Addiction Treatment: A Comparison of Client Characteristics and Treatment Outcomes

1. Dual Diagnosis Capability in Addiction Treatment:A Comparison of Client Characteristics and Treatment Outcomes Laurel Mangrum, Ph.D. University of Texas at Austin Addiction Research Institute

2. DDCAT Index Provides a standardized measure of program capacity to serve clients with co-occurring psychiatric diagnoses (COD) Increased use across multiple states is providing data regarding system capacity to treat clients with COD

3. Research Question Do client characteristics and treatment outcomes differ based on addiction treatment programs’ dual diagnosis capability?

4. Texas COSIG Project The goal of the COSIG project is to improve the delivery of state-funded services for clients in Texas with COD The project consists of two components, including clinician training on COD issues and a voucher system that funds recovery support services The DDCAT is being used as part of the process evaluation of the project

5. DDCAT Results

6. Methodology • Data were available for 503 COD clients receiving addiction treatment from the five programs (AOS = 391; DDC = 112) • Clients were compared on demographic variables, psychiatric diagnoses, psychiatric severity, substance use characteristics, addiction treatment history, and treatment outcomes at discharge

7. Demographic Characteristics • AOS clients were more likely to be Hispanic and living with family • DDC clients were more often female, White, unemployed, and homeless or living in a group home

8. MINI Diagnostic Impressions

9. Brief Symptom Index Scores

10. Brief Derogatis Rating Scale Scores

11. Problem Days During Past Month in ASI Domains at Admission

12. Addiction Treatment History

13. Primary Substance of Abuse

14. Substance Use Patterns • DDC clients were more likely to engage in polysubstance use (60% vs. 40%) and to report daily primary substance use over the past 6 months • AOS clients had a greater history of IV drug use (40% vs. 25%) • No group differences were found in days of primary substance use during the month prior to admission

15. Length of Stay in Treatment

16. Discharge Characteristics

17. Reasons for Discharge

18. Conclusions • DDC clients had less successful outcomes at discharge relative to AOS clients • Although AOS clients demonstrated higher levels of psychiatric symptomatology at admission, DDC clients reported greater problems in multiple life domains, providing evidence of greater functional impairment

19. Conclusions • The higher incidence of bipolar and psychotic disorders suggests that DDC clients may have had more severe and persistent disorders • DDC clients had a lesser history of prior addiction treatment, indicating that many were experiencing their first exposure to addiction services

20. Conclusions • Findings suggest that DDC programs may be more open to accepting “difficult to treat” clients with relatively greater levels of chronic impairment • AOS programs may be more willing to admit COD clients with acute psychiatric symptoms relative to chronic conditions

21. Acknowledgements Texas Department of State Health Services Kwame Bruce, Psy.D. COSIG Project Manager Lesli San Jose Decision Support Research Specialist Substance Abuse and Mental Health Services Administration