Research
Substance abuse treatment and psychiatric comorbidity: do benefits spill over? analysis of data from a prospective trial among cocaine-dependent homeless persons
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* Corresponding author: Stefan G Kertesz skertesz@uab.edu
1 Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine and the Deep South Center on Effectiveness at the Birmingham Veterans' Affairs Medical Center; 1530 3rd Ave South MT 608 Birmingham, Alabama 35294, USA
2 Department of Psychiatry, University of North Carolina School of Medicine, Medical School Wing E, CB#7205 Chapel Hill, North Carolina 27599-7205, USA
3 Rho Federal Systems, Inc., Chapel Hill, North Carolina 27517, USA
4 Division of Preventive Medicine, The University of Alabama at Birmingham, School of Medicine. 1530 3rd Ave South MT 616 Birmingham, Alabama 35294, USA
5 Department of Psychology, The University of Alabama at Birmingham, Division of Preventive Medicine, The University of Alabama at Birmingham, 1530 3rd Ave South CH 415 Birmingham, Alabama 35294, USA
Substance Abuse Treatment, Prevention, and Policy 2006, 1:27 doi:10.1186/1747-597X-1-27
Published: 11 September 2006Abstract
Background
Comorbid psychiatric illness can undermine outcomes among homeless persons undergoing addiction treatment, and psychiatric specialty care is not always readily available. The prognosis for nonsubstance abuse psychiatric diagnoses among homeless persons receiving behaviorally-based addiction treatment, however, is little studied.
Results
Data from an addiction treatment trial for 95 cocaine-dependent homeless persons (1996–1998) were used to profile psychiatric diagnoses at baseline and 6 months, including mood-related disorders (e.g. depression) and anxiety-related disorders (e.g. post-traumatic stress disorder). Treatment interventions, including systematic reinforcement for goal attainment, were behavioral in orientation. There was a 32% reduction in the prevalence of comorbid non-addiction psychiatric disorder from baseline to 6 months, with similar reductions in the prevalence of mood (-32%) and anxiety-related disorders (-20%) (p = 0.12).
Conclusion
Among cocaine-dependent homeless persons with psychiatric comorbidity undergoing behavioral addiction treatment, a reduction in comorbid psychiatric disorder prevalence was observed over 6 months. Not all participants improved, suggesting that even evidence-based addiction treatment will prove insufficient for a meaningful proportion of the dually diagnosed homeless population.