Program Profile: Alameda County (California) Integrated Dual Disorders Treatment

Study Title: Integrated Treatment for Jail Recidivists With Co-occurring Psychiatric and Substance Use Disorders (which is associated with outcomes Rearrests, Reconvictions, Felony reconvictions , Time to re-arrest, and Days in a psychiatric hospital)

Research Design/Sample 

Chandler and Spicer (2006) conducted a randomized controlled trial in Alameda County, California, to assess the effects of the Integrated Dual Disorders Treatment program on participants’ rearrest, reconviction, and days in a psychiatric hospital. 

Participants were eligible if they had both a current serious mental illness and a current substance use disorder; were not sentenced to prison and were not on parole; were not a resident of another county; were not currently enrolled in another Alameda County treatment program; had a Global Assessment of Functioning score of 50 or less; were fluent in English or Spanish; and had at least two jail episodes in the two years prior to the index admission (or had spent at least 90 days in jail in the prior two years). Potentially eligible individuals were interviewed and randomly assigned by research staff resulting in 79 participants in the control group and 103 in the treatment group. Both groups received in-custody services. The treatment group received the Integrated Dual Disorders Treatment program as described in the Program Description, while the control group received treatment-as-usual post-custody, which included referral to a county-operated service team for case management and medications. Control group members also had access to 60 days of case management and housing assistance.

There were no statistically significant differences between the treatment group’s characteristics and those of the control group at baseline. Over half of the Integrated Dual Disorders Treatment program group (51.5 percent) was between 36 and 50 years old. Male participants made up 71.8 percent of treatment group participants. The treatment group was 66 percent Black, 23.3 percent white, 7.8 percent Latino, and 2.9 percent another race/ethnicity. The most frequently reported primary diagnosis of the Integrated Dual Disorders Treatment program group participants was major depressive disorder (28.2 percent), followed by schizophrenia (25.2 percent) and psychotic disorder (23.3 percent). A little over 60 percent of the control group was between 36 and 50 years old, and the majority were male (71.8 percent). The control group was 67.1 percent Black, 19.0 percent white, 10.1 percent Latino, and 3.8 percent another race/ethnicity. The most frequently reported primary diagnosis of control group members was psychotic disorder (34.2 percent), followed by major depressive disorder (22.8 percent) and schizophrenia (17.7 percent). 

Data Collection/Outcome Measures

The outcomes included the number of rearrests and time to rearrest, total reconvictions (which included the number of reconvictions and the percent who were reconvicted), felony reconvictions, and days spent in psychiatric hospital. Arrests and convictions data were obtained from the Alameda County Information Services Department. Arrests included only “original” arrests and not subsequent arrests related to the original, which was primarily due to failure to appear in court. Information on acute hospitalization days was provided by Alameda County Behavioral Health Care Services. 

Statistical Analysis

Binomial and logistical regression models were used to examine the effect of participation in the Integrated Dual Disorders Treatment program on the outcomes. No subgroup analysis was conducted. 

Citation:

Chandler, Daniel Williams, and Gary Spicer. 2006. “Integrated Treatment for Jail Recidivists with Co-Occurring Psychiatric and Substance Use Disorders.” Community Mental Health Journal 42(4):405–425.

This study is a high-quality randomized controlled trial.