Coordinated treatment between addiction and mental health services vs. uncoordinated treatment for patients with dual diagnosis: higher dropout rates but lower impairement of functional disability

Abstract

Background. Dual pathology is often found in addiction and mental health centers. Although there are integrated services for these patients, most countries have developed joint action protocols between addiction and mental health centers. The objective is to analyze the progress of patients diagnosed with dual pathology, comparing the therapeutic outcomes of those who exclusively attend either addiction or mental health centers with those patients who follow a program in which the two services are coordinated. It is hypothesized that patients assisted in coordinate manner will present a better evolution on psychopathological symptomatology, drug use and functional impairment.

Methods. The sample was 182 dual pathology patients treated in addictions centers (n=62), mental health centers (n=51) and treated in a coordinated manner (n=62). The instruments administered was WHODAS 2.0, BSI-18 and SDSS.

Results. In general, no statistically significant differences were found between baseline and follow up in WHODAS and BSI-18. More cocaine use was found in three groups but was statistically significant in patients attended by addictions center and mental health centers. High percentages of abandonment were found in patients attending coordinate services. In terms of reliable change, among those receiving the coordinated treatment, there were more patients who showed improvements in the WHODAS 2.0 dimensions.

Conclusions. The inconvenience caused by going to different treatment networks may partially explain these results related with abandonment. However, patients who remain in treatment in coordinated services, show lower functionality deterioration than patients in other modalities.