Efficacy of Dual Focus Mutual Aid for Persons With Co-occurring Disorders
Condition: Substance Abuse; Mental Disorders
MeSH terms: Substance-Related Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The purpose of the study is to determine whether adding "dual focus" mutual aid groups to
      formal treatment for people dually diagnosed with substance abuse and mental illness is
      effective in improving treatment outcomes.

      NO VOLUNTEERS ARE ACCEPTED. ENROLLMENT IS LIMITED TO CLIENTS OF THE PARTICIPATING TREATMENT
      PROGRAMS.
    

Detailed description: 
      This study builds on two previous studies by the principal investigator, which found that
      participation in an established and growing "dual-focus" mutual aid model (Double Trouble in
      Recovery; DTR) by persons with co-occurring substance use and psychiatric disorders was
      associated with drug/alcohol abstinence and improved psychiatric outcomes. However, these
      findings are limited as they are based on studies using an observational design with existing
      DTR groups and a pre-post design with a historical control. This new application seeks to
      confirm and significantly extend this research by conducting a randomized clinical trial
      (RCT) of DTR at multiple treatment sites.

      The specific study aims are:

        1. To conduct a multi-site RCT to determine the efficacy of "dual focus" 12-step mutual aid
           groups for persons with co-occurring substance use and mental disorders. Substance-using
           patients who are admitted to psychiatric outpatient clinics will be randomly assigned
           within each clinic to (i) DTR group participation plus standard treatment, or (ii)
           standard treatment as usual (wait list for DTR). The primary outcome is drug/alcohol
           use. The secondary outcomes are psychiatric medication adherence; quality of life;
           treatment retention; and traditional 12 step group participation. Major assessments will
           occur at baseline and 6 months later.

        2. To determine the therapeutic mechanisms mediating between DTR participation and
           behavioral outcomes. Hypothesized mediating variables will include both "common process"
           factors across treatments, e.g., coping, self-efficacy and social support; and factors
           relatively unique to mutual aid, e.g., mutual aid group processes, 12-step attitudes and
           spirituality.

        3. To determine the personal, social/environmental and treatment-related variables which
           predict DTR affiliation.

        4. To describe the development of DTR groups and the conditions needed to sustain them.

      Federal substance abuse and mental health policy encourages the use of evidence-based
      interventions, yet rigorous evaluation data are scant for mutual aid groups. In particular,
      this research will lead to recommendations for improving the integration of formal treatment
      with mutual aid for persons with co-occurring disorders. Moreover, by conducting the proposed
      RCT, the study will substantially raise the standard by which mutual aid is evaluated.
    

Intervention name(s): Double Trouble in Recovery; Treatment as usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): DTR is a 12 Step-based fellowship for individuals with co-occurring problems of substance abuse and mental illness; Receive usual treatment at the programs
Other intervention name(s): 12 Step groups
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment