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This study found that women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate the factors influencing length of stay differ for each gender, and include: type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. CONCLUSIONS/IMPORTANCE: These findings can be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.

Background: Trust in health care has been shown to influence health care utilization, perceptions of fair treatment, and health outcomes in the general population. The literature on trust in health care in individuals with a history of substance use disorder (SUD) is more limited, primarily examining the patient-provider relationship. Women seeking substance abuse treatment in community-based programs have higher rates of prior trauma and health disparities compared with male counterparts and the general population. With higher rates of prior trauma, this population is theoretically at high risk of decreased interpersonal trust and altered interpersonal relationships. Objective: This study sought to identify factors influencing trust in the health care system for women seeking substance abuse treatment in a community-based residential treatment program. Methods: Six client focus groups ( n = 30), 1 provider focus group ( n = 7), and 2 individual clinical administrator interviews ( n = 2) were conducted between November 2016 and August 2017. Focus groups and interviews were audio recorded and transcribed. Coding and coding reconciliation were conducted by 2 independent coders. Themes were extracted and analyzed from sorted and coded quotes. Results: Six themes emerged. Factors that influence trust in the health care system in this population include (1) prior experiences with diagnosis, treatment, and outcomes; (2) stigma of addiction; (3) payment and reimbursement structure; (4) patient rights and protections; (5) efficiency-driven care; and (6) the health care system's role in causing and/or enabling addiction. Conclusions: These themes demonstrate a general distrust of the health care system by women in this population. Distrust is influenced by a perception of a health care system providing care that is variable in quality, often stigmatizing, unaffordable, efficiency driven, and often influencing individuals’ SUD. This aligns with and extends prior literature around trust of health care in individuals with SUD. Future directions in research include formally assessing the impact of trust on health outcomes such as treatment entry and retention.

This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment.

The objective of this research was to evaluate the impact of Integrated Assertive Community Treatment (I-ACT) on psychiatric symptoms, drug use, housing status, and service utilization. A single-group repeated measures evaluation of outcome indicators at intake, 6 months, and 12 months examined changes over time with 555 respondents receiving outpatient treatment. While 555 received baseline interviews, figures vary on follow-up sample sizes and are listed as they are discussed in the paper. The study was implemented by a community treatment provider. The primary analyses used in this study were repeated measures ANOVA and the Friedman's twoway analysis test. Significant reductions in substance use (F(1.69, 553.02) = 94.30, p < .01) and psychiatric symptoms (F(1.98, 299.19) = 43.73, p = .0001) were found from baseline to 6 months and changes were sustained from the 6-to 12-month follow-up points. Similar results were found in housing status with the number of participants in stable housing rising significantly. Utilization of substance use and psychiatric treatment declined significantly across all three follow-up points, and physical health service use remained unchanged. I-ACT has demonstrated efficacy through controlled research studies, and this evaluation extends on these findings to demonstrate that I-ACT is effective in community service provision settings in reducing substance use and psychiatric symptoms. Further, the reduction in service use found across follow-up points indicates cost containment.

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Providers, including psychiatric advanced practice registered nurses, can use TMH to effectively address the growing need for mental health services, although regulatory, licensure, and clinical issues must be addressed prior to offering TMH services.