Severely and Persistently Mentally Ill Populations

Several investigators have examined integrated treatments for SPMI adults. Effectiveness trials by Drake and colleagues have obtained more success in decreasing substance use (Drake et al., 1998; McHugo, Drake, Teague, & Xie, 1999) and hospitalization (McHugo et al., 1999) than in diminishing psychiatric symptoms (Drake, Yovetich, Bebout, Harris, & McHugo, 1998; Drake et al., 1998) or improving functional status or quality of life (Drake et al., 1997). However, these interventions did not compare patients randomized to different treatments. Rather, treatment clinics were assigned to administer one intervention versus another. A recent review of the prospective, controlled trials of integrated treatment programs for SPMI dually diagnosed individuals (Jeffery, Ley, McLaren, & Siegfried, 2003) concluded that methodological flaws precluded determining whether one particular integrated treatment model is more effective than another, or whether integrated treatment in general is superior to nonintegrated treatment for this population. Despite this, much enthusiasm remains for integrated treatment in SPMI populations (Drake et al., 2001). Of note, a recent trial not included in the review approached integrating treatment for dually diagnosed SPMI patients from a different psychosocial treatment perspective and found positive results. Rather than integrating treatment from the perspective of intensive case management and/or housing (as in the studies discussed earlier), patient and caregiver dyads were randomized to routine care versus additional integrated treatment that included motivational interviewing, cognitive-behavioral therapy (CBT), and a family or caregiver intervention for dual-diagnosis patients with schizophrenia. The intervention was associated with improvements in general functioning, psychotic symptoms, and SUD outcomes (Barrowclough et al., 2001). Thus, this field continues to evolve and develop creative new treatments that are being tested with increasing methodological rigor.

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