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ABSTRACT: This study evaluated the impact of an integrated (mental health/substance abuse) assertive community treatment program on homeless persons with serious mental and substance use disorders. High rates of retention in treatment, housing stability, and community tenure were attained, and all but the most severe substance users appeared to gain these benefits. While the intervention appears to be an effective means of retaining in services and monitoring such difficult-to-treat and costly populations, it did not yield high rates of abstinence and social benefits in severe users.
Substance use among persons with serious mental illness contributes to chaotic lifestyles, recurrent crises, and anti-social behavior (Safer, 1987; Gelberg, Linn and Leake, 1988; Drake & Wallach, 1989; Abram and Teplin, 1991; Drake, Alterman and Rosenberg, 1993). The prevailing hospital-based mental health and substance abuse service system, which provides services during crisis episodes for persons with co-occurring serious mental and substance use disorders (hereafter referred to as dually diagnosed), has not demonstrated effective longterm outcomes (Minkoff and Drake, 1992; Mercer-McFadden and Drake, 1992). More promising approaches integrate mental health and substance abuse treatment into a long-term service package that can include assertive outreach, intensive case management, individual and group counseling and mutual self-help, and social control (Knoedler, 1987; Hellerstein and Meehan, 1987; Osher and Koefed, 1989; Fariello and Scheidt, 1989; Blankertz and Cnaan, 1991; Detrick and Steipock, 1992; Drake, McHugo, and Noordsy, 1993). The results of studies on such integrative approaches have only recently begun to appear in the professional literature. For example, Drake and colleagues (1993) in a study of the effectiveness of an integrated mental health substance abuse intervention in a rural mental health center (CMHC) reported abstinence in 11 of 18 subjects (61%) after four years of treatment and a mean period of abstinence of 26.5 months for the 11 subjects. Detrick & Steipock (1992) reported reductions of 50% in psychiatric hospital admissions, 75% in detoxification facility admissions, and 65% in arrests for 17 dually diagnosed clients with histories of criminal justice involvement treated through an integrated mobile treatment team in an urban setting. Blankertz and Cnaan (1991) found favorable rates of abstinence in an integrated, urban-based, mostly African American, and homeless sample served in a residential treatment program based on the tenets of psychosocial...