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Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.

ABSTRACT: Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.Participants at the Addiction Treatment Services (ATS) were assigned randomly to receive on-site and integrated substance abuse and psychiatric care (on-site: n?=?160) versus off-site and non-integrated substance abuse and psychiatric care (off-site: n?=?156), and observed for 1 year. On-site participants received all psychiatric care within the substance abuse program by the same group of treatment providers. The same type and schedule of psychiatric services were available to off-site participants at a community psychiatry program.All participants received routine methadone maintenance at the ATS program in Baltimore, Maryland, USA.Participants were opioid-dependent men and women with at least one comorbid psychiatric disorder, as assessed by the Structured Clinical Interview for DSM-IV and confirmed by expert clinical reappraisal.Outcomes included psychiatric service utilization and retention, Hopkins Symptom Checklist Global Severity Index (GSI) change scores and urinalysis test results.On-site participants were more likely to initiate psychiatric care 96.9 to 79.5%; P?

SUBMITTER: Brooner RK

PROVIDER: S-EPMC3833440 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.

Brooner Robert K RK Kidorf Michael S MS King Van L VL Peirce Jessica J Neufeld Karin K Stoller Ken K Kolodner Ken K

Addiction (Abingdon, England) 20130719 11

<h4>Background and aims</h4>Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.<h4>Design</h4>Participants at the Addiction Treatment Serv ...[more]

PMID: 23734943

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Project description:ObjectiveTo compare the effect of intramuscular olanzapine with intramuscular haloperidol plus promethazine on rapid tranquillisation of agitated or violent people with mental illness.DesignPragmatic, allocation concealed, randomised controlled trial.SettingEmergency services of a general hospital psychiatry department in Vellore, south India.Participants300 adults with agitated or violent behaviour as a result of mental illness; 150 randomised to intramuscular olanzapine and 150 randomised to intramuscular haloperidol plus promethazine.InterventionsOpen treatment with intramuscular olanzapine or intramuscular haloperidol plus promethazine.Main outcome measuresPrimary outcome was proportion of patients who were tranquil or asleep at 15 minutes and 240 minutes. Secondary outcomes were proportion of patients who were tranquil, asleep, restrained, absconding, or clinically improved at 15, 30, 60, 120, and 240 minutes; additional medical interventions and adverse effects over four hours; and compliance with oral drugs and adverse effects over two weeks.ResultsOf 300 people randomised to receive either intramuscular olanzapine or intramuscular haloperidol plus promethazine, follow-up data were available for primary outcomes for 298 (99%). Both treatments resulted in similar proportions of people being tranquil or asleep at 15 minutes (olanzapine 131/150 (87%), haloperidol plus promethazine 136/150 (91%); relative risk 0.96, 95% confidence interval 0.34 to 1.47) and 240 minutes (olanzapine 144/150 (96%), haloperidol plus promethazine 145/150 (97%); relative risk 0.99, 0.95 to 1.03). However, more people given olanzapine than those given haloperidol plus promethazine required additional drugs over four hours (65/150 (43%) v 31/150 (21%); relative risk 2.07, 1.43 to 2.97). Adverse effects were uncommon with both treatments.ConclusionsIntramuscular olanzapine and intramuscular haloperidol plus promethazine were effective at rapidly tranquillising or sedating agitated or violent patients with mental illness but the combination resulted in fewer additional medical interventions within four hours of intervention.Trial registrationClinical trials NCT00455234 [ClinicalTrials.gov].

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Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.

Publications

Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.

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