Chronic Care Management for Substance Dependence in Primary Care Among Patients With Co-Occurring Disorders
- 1 January 2015
- journal article
- research article
- Published by American Psychiatric Association Publishing in Psychiatric Services
- Vol. 66 (1), 72-79
- https://doi.org/10.1176/appi.ps.201300414
Abstract
Objective: Co-occurring mental and substance use disorders are associated with worse outcomes than a single disorder alone. In this exploratory subgroup analysis of a randomized trial, the authors hypothesized that providing chronic care management (CCM) for substance dependence in a primary care setting would have a beneficial effect among persons with substance dependence and major depressive disorder or posttraumatic stress disorder (PTSD). Methods: Adults (N=563) with alcohol dependence, drug dependence, or both were assigned to CCM or usual primary care. CCM was provided by a nurse care manager, social worker, internist, and psychiatrist. Clinical outcomes (any use of opioids or stimulants or heavy drinking and severity of depressive and anxiety symptoms) and treatment utilization (emergency department use and hospitalization) were measured at three, six, and 12 months after enrollment. Longitudinal regression models were used to compare randomized arms within the subgroups of participants with major depressive disorder or PTSD. Results: Among all participants, 79% met criteria for major depressive disorder and 36% met criteria for PTSD at baseline. No significant effect of CCM was observed within either subgroup for any outcome, including any use of opioids or stimulants or heavy drinking, depressive symptoms, anxiety symptoms, and any hospitalizations or number of nights hospitalized. Among participants with depression, those receiving CCM had fewer days in the emergency department compared with the control group, but the finding was of only borderline significance (p=.06). Conclusions: Among patients with co-occurring substance dependence and mental disorders, CCM was not significantly more effective than usual care for improving clinical outcomes or treatment utilization.Keywords
This publication has 51 references indexed in Scilit:
- Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trialAddiction, 2010
- Delivery of Evidence-Based Treatment for Multiple Anxiety Disorders in Primary CareJAMA, 2010
- The Case for Chronic Disease Management for AddictionJournal of Addiction Medicine, 2008
- Incarceration Associated With Homelessness, Mental Disorder, and Co-occurring Substance AbusePsychiatric Services, 2005
- Does the Collaborative Model Improve Care for Chronic Heart Failure?Medical Care, 2005
- Design and Sample Characteristics of the PRISM-E Multisite Randomized Trial to Improve Behavioral Health Care for the ElderlyJournal of Aging and Health, 2004
- Comparisons of Patients With Comorbid Psychiatric and Substance Use Disorders: Implications for Treatment and Service DeliveryAmerican Journal of Psychiatry, 2004
- The PHQ-9Journal of General Internal Medicine, 2001
- Should depression be managed as a chronic disease?BMJ, 2001
- Co-occurring disorders among mentally ill jail detainees: Implications for public policy.American Psychologist, 1991