Dual Diagnosis Capability inDual Diagnosis Capability in Addiction Treatment: Addiction Treatment:

A Comparison of Client Characteristics A Comparison of Client Characteristics and Treatment Outcomesand Treatment Outcomes

Laurel Mangrum, Ph.D.Laurel Mangrum, Ph.D.

University of Texas at AustinUniversity of Texas at Austin

Addiction Research InstituteAddiction Research Institute

DDCAT IndexDDCAT Index

Provides a standardized measure of Provides a standardized measure of program capacity to serve clients with co-program capacity to serve clients with co-occurring psychiatric diagnoses (COD)occurring psychiatric diagnoses (COD)

Increased use across multiple states is Increased use across multiple states is providing data regarding system capacity providing data regarding system capacity to treat clients with CODto treat clients with COD

Research QuestionResearch Question

Do client characteristics and treatmentDo client characteristics and treatment

outcomes differ based on outcomes differ based on

addiction treatment programs’addiction treatment programs’

dual diagnosis capability?dual diagnosis capability?

Texas COSIG ProjectTexas COSIG Project

The goal of the COSIG project is to improve the The goal of the COSIG project is to improve the delivery of state-funded services for clients in delivery of state-funded services for clients in Texas with CODTexas with COD

The project consists of two components, The project consists of two components, including clinician training on COD issues and a including clinician training on COD issues and a voucher system that funds recovery support voucher system that funds recovery support servicesservices

The DDCAT is being used as part of the process The DDCAT is being used as part of the process evaluation of the projectevaluation of the project

DDCAT ResultsDDCAT Results

Addiction Only Services

(AOS)3

Dual Diagnosis Capable(DDC)

2

MethodologyMethodology

Data were available for 503 COD clients Data were available for 503 COD clients receiving addiction treatment from the five receiving addiction treatment from the five programs (AOS = 391; DDC = 112)programs (AOS = 391; DDC = 112)

Clients were compared on demographic Clients were compared on demographic variables, psychiatric diagnoses, variables, psychiatric diagnoses, psychiatric severity, substance use psychiatric severity, substance use characteristics, addiction treatment history, characteristics, addiction treatment history, and treatment outcomes at dischargeand treatment outcomes at discharge

Demographic CharacteristicsDemographic Characteristics

AOS clients were more likely to be AOS clients were more likely to be Hispanic and living with familyHispanic and living with family

DDC clients were more often female, DDC clients were more often female, White, unemployed, and homeless or White, unemployed, and homeless or living in a group homeliving in a group home

MINI Diagnostic ImpressionsMINI Diagnostic Impressions

0%

10%

20%

30%

40%

50%

60%

70%

Bipolar Depression Hypomania Dysthymia Panic OCD Psychotic GAD PTSD

AOS DDC

*

*

*

*

*

*

*

Brief Symptom Index ScoresBrief Symptom Index Scores

45

50

55

60

65

SOM OC IS DEP ANX HOS PHOB PAR PSY GSI

AOS DDC

Brief Derogatis Rating Scale ScoresBrief Derogatis Rating Scale Scores

0

1

2

3

4

5

SOM OC IS DEP ANX HOS PHOB PAR PSY GPI

AOS DDC

Problem Days During Past Month Problem Days During Past Month in ASI Domains at Admissionin ASI Domains at Admission

0

5

10

15

20

25

Medical Employment Family Social Psychological Substance Use

AOS DDC

*

** * * *

Addiction Treatment HistoryAddiction Treatment History

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Prior Detox Prior Non-Detox

AOS DDC

**

Primary Substance of AbusePrimary Substance of Abuse

0%

10%

20%

30%

40%

Alcohol Cocaine Heroin Crack Marijuana Meth

AOS DDC

Substance Use PatternsSubstance Use Patterns

DDC clients were more likely to engage in DDC clients were more likely to engage in polysubstance use (60% vs. 40%) and to report polysubstance use (60% vs. 40%) and to report daily primary substance use over the past 6 daily primary substance use over the past 6 monthsmonths

AOS clients had a greater history of IV drug use AOS clients had a greater history of IV drug use (40% vs. 25%)(40% vs. 25%)

No group differences were found in days of No group differences were found in days of primary substance use during the month prior to primary substance use during the month prior to admissionadmission

Length of Stay in TreatmentLength of Stay in Treatment

AOS DDC

57.2 Days

86.8 Days*

Discharge CharacteristicsDischarge Characteristics

0%

20%

40%

60%

80%

100%

Completed Treatment Abstinent Past 30 Days

AOS DDC

*

*

Reasons for DischargeReasons for Discharge

0%

5%

10%

15%

20%

25%

Against Medical Advice Program Decision

AOS DDC

**

ConclusionsConclusions

DDC clients had less successful outcomes DDC clients had less successful outcomes at discharge relative to AOS clientsat discharge relative to AOS clients

Although AOS clients demonstrated higher Although AOS clients demonstrated higher levels of psychiatric symptomatology at levels of psychiatric symptomatology at admission, DDC clients reported greater admission, DDC clients reported greater problems in multiple life domains, problems in multiple life domains, providing evidence of greater functional providing evidence of greater functional impairmentimpairment

ConclusionsConclusions

The higher incidence of bipolar and The higher incidence of bipolar and psychotic disorders suggests that DDC psychotic disorders suggests that DDC clients may have had more severe and clients may have had more severe and persistent disorderspersistent disorders

DDC clients had a lesser history of prior DDC clients had a lesser history of prior addiction treatment, indicating that many addiction treatment, indicating that many were experiencing their first exposure to were experiencing their first exposure to addiction servicesaddiction services

ConclusionsConclusions

Findings suggest that DDC programs may Findings suggest that DDC programs may be more open to accepting “difficult to be more open to accepting “difficult to treat” clients with relatively greater levels treat” clients with relatively greater levels of chronic impairmentof chronic impairment

AOS programs may be more willing to AOS programs may be more willing to admit COD clients with acute psychiatric admit COD clients with acute psychiatric symptoms relative to chronic conditionssymptoms relative to chronic conditions

AcknowledgementsAcknowledgements

Texas Department of State Health ServicesTexas Department of State Health Services

Kwame Bruce, Psy.D.Kwame Bruce, Psy.D.

COSIG Project ManagerCOSIG Project Manager

Lesli San JoseLesli San Jose

Decision Support Research SpecialistDecision Support Research Specialist

Substance Abuse and Mental Health Substance Abuse and Mental Health

Services AdministrationServices Administration