Original ArticlesAlgorithm-Driven Substance Use Disorder Treatment for Inner-City Clients With Serious Mental Illness and Multiple ImpairmentsMcHugo, Gregory J. PhD∗; Drake, Robert E. MD, PhD†; Haslett, William R. PhD‡; Krassenbaum, Sarah R. MSW§; Mueser, Kim T. PhD∥; Sweeney, Mary Ann MA¶; Kline, John#; Harris, Maxine PhD∗∗ Author Information ∗The Dartmouth Institute for Health Policy and Clinical Practice †IPS Employment Center, Westat ‡Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire §New York State Office of Addiction Services and Supports (NYS OASAS), Albany, New York ∥Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts ¶Formerly Dartmouth Psychiatric Research Center, Dartmouth Medical School, Lebanon, New Hampshire #Volunteers of America Chesapeake & Carolinas, Lanham, Maryland ∗∗Community Connections DC, Washington, DC. Send reprint requests to Robert E. Drake, MD, PhD, IPS Employment Center, Westat, 85 Mechanic St, Lebanon, NH 03766. E-mail: [email protected]. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonmd.com). The Journal of Nervous and Mental Disease: February 2021 - Volume 209 - Issue 2 - p 92-99 doi: 10.1097/NMD.0000000000001296 Buy SDC Metrics Abstract Mental health clients with serious mental illness in urban settings experience multiple chronic stresses related to poverty, unemployment, discrimination, homelessness, incarceration, hospitalization, posttraumatic stress disorder, pain syndromes, traumatic brain injury, and other problems. Substance use disorder exacerbates these difficulties. This study examined the efficacy of algorithm-driven substance use disorder treatments for 305 inner-city mental health clients with multiple challenges. Researchers assessed substance use quarterly using a combination of standardized self-reports and case manager ratings. Of the 305 multiply impaired clients who began treatment, 200 (66%) completed 2 years of treatment. One fourth (n = 53) of the completers were responders who developed abstinence and improved community function; one half (n = 97) were partial responders, who reduced substance use but did not become abstinent; and one fourth (n = 50) were nonresponders. Evidence-based interventions for substance use disorder can be effective for multiply impaired, inner-city clients, but numerous complications may hinder recovery. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.