175036 Use of IDDT via ACT vs. clinical case management for persons with co-occurring disorders and Anti-Social Personality Disorder

Monday, October 27, 2008

Linda K. Frisman, PhD , CT Dept Mental Health & Addiction Services, Research Division MS # 14 RSD, Hartford, CT
Kim Mueser, PhD , Psychiatry Research Center, Dartmouth Medical School, Concord, NH
Nancy Covell, PhD , CT Dept Mental Health & Addiction Services, Research Division MS # 14 RSD, Hartford, CT
Hsiu-Ju Lin, PhD , Research Division, CT DMHAS, Hartford, CT
Anne Crocker, PhD , Douglas Hospital Research Centre, McGill University, Montreal, QC, Canada
Susan Essock, PhD , Dept of Mental Health Services & Policy Research, Columbia University, New York, NY
Robert Drake, MD , Community and Family Medicine, Dartmouth College, Hanover, NH
Objective: Persons with serious mental disorders who have co-occurring substance use problems are also more likely to have Antisocial Personality Disorder (ASPD). We examined the impact of Integrated Dual Disorder Treatment (IDDT) delivered through Assertive Community Treatment (ACT) teams compared to Standard Clinical Case Management (SCCM) for dually disordered persons with and without ASPD. Method: We conducted secondary analyses of data from a randomized controlled trial testing the effectiveness of ACT in delivery of IDDT over a 3-year period. The present analysis included 36 individuals meeting the criteria for ASPD and 88 individuals without ASPD. We hypothesized that individuals with ASPD would show greater improvements in substance use and criminal justice outcomes when treated with IDDT by the ACT team compared to SCM. Results: Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in SCM, whereas participants without ASPD did differ between the two case management approaches. There were no significant differences for the other substance use or criminal justice outcomes. Conclusions: This study provides preliminary evidence that persons with co-occurring serious mental illness, substance use disorders and ASPD may benefit from delivery of IDDT through ACT teams.

Learning Objectives:
1. At the end of this presentation, attendees will be able to describe important treatment outcomes for persons with co-occurring disorders who also have ASPD. 2. Attendees will be able to identify advantages in using Assertive Community Treatment for persons with co-occurring disorders who also have ASPD.

Keywords: Co-morbid, Personality Disorder

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I served as the Project Director and co-Investigator for the parent study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.