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Randomized Controlled Trial
. 2013 Nov;108(11):1942-51.
doi: 10.1111/add.12269. Epub 2013 Jul 19.

Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation

Robert K Brooner  1 , Michael S Kidorf, Van L King, Jessica Peirce, Karin Neufeld, Ken Stoller, Ken Kolodner
Affiliations
Randomized Controlled Trial

Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation

Robert K Brooner et al. Addiction. 2013 Nov.

Abstract

Background and aims: Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.

Design: Participants at the Addiction Treatment Services (ATS) were assigned randomly to receive on-site and integrated substance abuse and psychiatric care (on-site: n = 160) versus off-site and non-integrated substance abuse and psychiatric care (off-site: n = 156), and observed for 1 year. On-site participants received all psychiatric care within the substance abuse program by the same group of treatment providers. The same type and schedule of psychiatric services were available to off-site participants at a community psychiatry program.

Setting: All participants received routine methadone maintenance at the ATS program in Baltimore, Maryland, USA.

Participants: Participants were opioid-dependent men and women with at least one comorbid psychiatric disorder, as assessed by the Structured Clinical Interview for DSM-IV and confirmed by expert clinical reappraisal.

Measurements: Outcomes included psychiatric service utilization and retention, Hopkins Symptom Checklist Global Severity Index (GSI) change scores and urinalysis test results.

Findings: On-site participants were more likely to initiate psychiatric care 96.9 to 79.5%; P < 0.001), remain in treatment longer (195.9 versus 101.9 days; P < 0.001), attend more psychiatrist appointments (12.9 versus 2.7; P < 0.001) and have greater reductions in GSI scores (4.2 versus 1.7; P = 0.003) than off-site participants; no differences were observed for drug use.

Conclusions: On-site and integrated psychiatric and substance misuse services in a methadone treatment setting might improve psychiatric outcomes compared with off-site and non-integrated substance misuse and psychiatric care. However, this might not translate into improved substance misuse outcomes.

Keywords: Drug use; integrated care; methadone maintenance; psychiatric care; psychiatric comorbidity; treatment response.

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Figures

Figure 1
Figure 1. Consort Diagram
Figure 2
Figure 2
Standardized psychiatric treatment protocol used at the Addiction Treatment Services (ONSITE) and Community Psychiatry Program (OFFSITE) treatment settings.
Figure 3
Figure 3
Mean Global Severity Index (GSI) scores at baseline and Months 1-12 across study conditions (on-site: n=157 vs. off-site: n=156), with baseline GSI scores imputed at follow-up for participants with no GSI follow-up scores (on-site: n = 14; off-site: n=10). Three on-site participants with no baseline GSI scores were excluded from these analyses. Both conditions demonstrated significant reductions in GSI scores (on-site: p < .001; off-site: p = .005), with on-site participants having larger change scores (p = .003). 1ONSITE: Onsite Integrated Substance Abuse and Psychiatric Care; OFFSITE: Off-site Non-integrated Substance Abuse and Psychiatric Care
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