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

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

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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

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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