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

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.