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Use of Integrated Dual Disorder Treatment Via Assertive Community Treatment Versus Clinical Case Management for Persons With Co-Occurring Disorders and Antisocial Personality Disorder

Frisman, Linda K. PhD*†; Mueser, Kim T. PhD‡§¶; Covell, Nancy H. PhD**†; Lin, Hsiu-Ju PhD*†; Crocker, Anne PhD††‡‡; Drake, Robert E. MD, PhD‡§; Essock, Susan M. PhD§§¶¶

The Journal of Nervous and Mental Disease: November 2009 - Volume 197 - Issue 11 - p 822-828
doi: 10.1097/NMD.0b013e3181beac52
Original Article
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We conducted secondary analyses of data from a randomized trial testing the effectiveness of Assertive Community Treatment (ACT) in delivery of integrated dual disorder treatment (IDDT) to explore the impact of IDDT delivered through ACT teams compared with standard clinical case management for dually-disordered persons with and without antisocial personality disorder (ASPD). This analysis included 36 individuals with ASPD and 88 individuals without ASPD. Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in standard clinical case management, whereas participants without ASPD did not differ between the 2 case management approaches. There were no significant differences for other substance use or criminal justice outcomes. This study provides preliminary evidence that persons with co-occurring serious mental illness, substance use disorders, and ASPD may benefit from delivery of IDDT through ACT teams.

*School of Social Work, University of Connecticut, West Hartford, CT; †Research Division, Connecticut Department of Mental Health and Addiction Services, Hartford, CT; Departments of ‡Psychiatry and §Community and Family Medicine, Dartmouth Medical School, Hanover, NH; ¶New Hampshire-Dartmouth Psychiatric Research Center, Lebanon, NH; **Department of Mental Health Services and Policy Research, Research Foundation for Mental Hygiene, Inc, New York, NY; ††Douglas Hospital Research Centre, Montreal, Quebec, Canada; ‡‡Department of Psychiatry, McGill University, Montreal, Quebec, Canada; §§Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY; and ¶¶Department of Mental Health Services and Policy Research, New York State Psychiatric Institute, New York, NY.

Supported by US Public Health Services grants R01 MH-52872 and R01-MH63463 from the National Institute of Mental Health, R01-AA-10265 from the National Institutes on Alcohol Abuse and Alcoholism, and UD3-SM51560, UD3-SM51802, and UD9-MH51958 from the Substance Abuse and Mental Health Services Administration.

Send reprint requests to Linda K. Frisman, PhD, CT-DMHAS Research Division, 410 Capitol Ave, MS 14RSD, Hartford, CT 06134. E-mail: Linda.frisman@po.state.ct.us.

© 2009 Lippincott Williams & Wilkins, Inc.