We included 25 RCTs and found no compelling evidence to support any one psychosocial treatment over another to reduce substance use (or improve mental state) by people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results; high drop out rates, varying fidelity of interventions, varying outcome measures, settings and samples and comparison groups may have received higher levels of treatment than standard care. Further studies are required which address these concerns and improve the evidence in this important area.
Integrated treatment for jail recidivists with co-occurring psychiatric and substance use disorders.
Jail recidivists with serious mental illness and substance use disorders were treated in an in-custody setting and then randomly assigned to either a high fidelity Integrated Dual Disorders Treatment program (103 participants) or to service as usual (79 participants). Outcomes were tracked an average of 18 months from program entry at the termination of the initial incarceration. A reduction in jail days from baseline to study period was significant for both groups. The pre to post reduction for arrests and total convictions was significant in the experimental group but not the control group. However, during the study period, differences between experimental and control groups in arrests, convictions and jail days were not statistically significant. Experimental participants had lower study period psychiatric inpatient and crisis utilization and greater outpatient utilization than did control group participants. The groups did not differ with regard to total institutional days. Experimental group attrition was relatively high.