Homelessness predicts attrition but not alcohol abstinence in outpatients experiencing co-occurring alcohol dependence and serious mental illness.

BACKGROUND: Adults experiencing homelessness and serious mental illnesses (SMI) are at an increased risk of poor mental health and treatment outcomes compared with stably housed adults with SMI. The additional issue of alcohol misuse further complicates the difficulties of those living with homelessness and SMI. In this secondary data analysis, the authors investigated the impact of homelessness on attrition and alcohol use in a contingency management (CM) intervention that rewarded alcohol abstinence in outpatients with SMI. METHODS: The associations between housing status and attrition and alcohol abstinence during treatment, as assessed by ethyl glucuronide (EtG) urine tests, were evaluated in 79 adults diagnosed with alcohol dependence and SMI. RESULTS: Thirty-nine percent (n = 31) of participants reported being homeless at baseline. Individuals who were homeless were more likely to drop out of CM (n = 10, 62.5%) than those who were housed (n = 4, 16.7%), χ CONCLUSIONS: Individuals experiencing homelessness and co-occurring alcohol dependence and SMI receiving CM had higher rates of attrition, relative to those who were housed. Homelessness was not associated with differences in biologically assessed alcohol abstinence

Prevalence and Correlates of Cannabis Use in Outpatients with Serious Mental Illness Receiving Treatment for Alcohol Use Disorders.

Introduction: People with serious mental illness (SMI) use cannabis more than any other illicit drug. Cannabis use is associated with increased psychotic symptoms and is highly comorbid with alcohol use disorders (AUDs). Despite the national trend toward decriminalization, little is known about the prevalence, correlates, and impact of cannabis use on those with SMI receiving treatment for substance use disorders, a group at high risk for the negative effects of cannabis use. Methods: In this secondary data analysis, cannabis use prevalence, correlates, and impact on treatment outcomes were examined in 121 adults with cooccurring SMI and AUDs receiving outpatient addiction treatment in a randomized trial of contingency management (CM) for alcohol. Prevalence and frequency of cannabis use were calculated across the 7-month study period using self-report and urine tests. Cannabis users were compared with nonusers by SMI diagnosis, psychiatric symptoms, medical problems, legal problems, and HIV-risk behavior. The relationship between cannabis use and longest duration of alcohol abstinence in participants randomized to CM (n=40) was assessed. Results: Fifty-seven (47%) of participants submitted at least one cannabis-positive urine sample during the study. Out of the 2834 total samples submitted, 751 (27%) were positive for cannabis. Cannabis users were 2.2 times more likely to submit an alcohol-positive sample, and 2.5 times more likely to submit a cocaine-positive sample at baseline, relative to noncannabis users (p=0.01). Cannabis users were more likely to engage in risky sexual behavior (p=0.01) and to report being homeless (p=0.03) than nonusers. When controlling for pretreatment alcohol use, the relationship between comorbid cannabis use and alcohol abstinence during CM was not significant (p=0.77). Conclusion: Rates of comorbid cannabis use were high in this sample of adults with SMI and AUDs. Cannabis use was correlated with recent alcohol and cocaine use, risky sexual behavior, and homelessness, but not with alcohol abstinence during CM

Pretreatment ethyl glucuronide levels predict response to a contingency management intervention for alcohol use disorders among adults with serious mental illness.

BACKGROUND AND OBJECTIVES: This study investigated if pretreatment ethyl glucuronide (EtG) levels corresponding to light (100 ng/mL), heavy (500 ng/mL), and very heavy (1,000 ng/mL) drinking predicted longest duration of alcohol abstinence (LDA) and proportion of EtG-negative urine tests in outpatients receiving a 12-week EtG-based contingency management (CM) intervention for alcohol dependence. METHODS: Participants were 40 adults diagnosed with alcohol use disorders and serious mental illness who submitted up to 12 urine samples for EtG analysis during a 4-week observation period and were then randomized to 12-weeks of CM for alcohol abstinence and addiction treatment attendance. Alcohol use outcomes during CM as assessed by EtG and self-report were compared across those who did and did not attain a pre-treatment average EtG level of 500 ng/mL-a level that equates to frequent heavy drinking. RESULTS: Only the 500 ng/mL cutoff was associated with significant differences in LDA and proportion of EtG-negative samples during CM. Those with a pre-treatment EtG \u3c 500 ng/mL attained a LDA 2.3 (alcohol) to 2.9 (drugs) weeks longer than pre-treatment heavy drinkers. DISCUSSION AND CONCLUSIONS: The EtG biomarker can be used to determine who will respond to a CM intervention for alcohol use disorders and could inform future trials that are designed to be tailored to individual patients. SCIENTIFIC SIGNIFICANCE: Results suggest pre-treatment EtG cutoffs equivalent to heavy and very heavy drinking predict outcomes in CM. (Am J Addict 2017;26:673-675)

Interaction between pre-treatment drug use and heterogeneity of psychiatric diagnosis predicts outcomes in outpatients with co-occurring disorders.

We examined whether the interaction of baseline stimulant use, assessed by urine drug tests, and type of serious mental illness (SMI) diagnosis predicted stimulant use in a trial of contingency management (CM). The interaction between baseline stimulant use and SMI diagnoses was significant in the overall sample (p=0.002) when controlling for the main effects of treatment condition, baseline stimulant use, and SMI diagnosis. Similar results were also found within the CM sample. Individuals with bipolar disorder were more or less likely, depending on their baseline stimulant-drug test results, to use stimulants during treatment compared to those with other SMI diagnoses

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.

OBJECTIVE: The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior. METHOD: Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement prize draw procedure contingent on EtG-negative samples (/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods. RESULTS: Contingency management participants were 3.1 times (95% CI=2.2-4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up. CONCLUSIONS: This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness

Portland Street Response: Six-Month Evaluation: A Report Prepared for the City of Portland Bureau of Fire and Rescue

Overview of the Program: Portland Street Response (PSR) is a new first responder program for non-emergency calls involving people experiencing homelessness or mental health crisis. The program launched on February 16, 2021 in the Lents neighborhood in Portland, OR and operates Monday to Friday from 10 AM to 6 PM. The pilot is coordinated by Portland Fire & Rescue (PF&R), and the founding team consists of a firefighter paramedic, a licensed mental health crisis therapist, and two community health workers

Kenton Women’s Village Update and Survey

Homeless shelters can be chaotic and sometimes not much better than living on the streets. Sleeping pod villages, such as Kenton Women’s Village, provide opportunities for community development while still allowing privacy and security. The village model provides a more incremental transition into permanent housing from the streets rather than a sudden transition. This report provides an update on the village and results of a survey that explored physical health, mental health, demographic information, and level of satisfaction with village living

Urbanicity as a Moderator of the Relationship Between Stigma and Well-being Outcomes for Individuals with Serious Mental Illnesses

During the deinstitutionalization movement in the 1960s, community mental health centers and supportive and affordable housing for people with serious mental illnesses (SMI) was concentrated in economically disadvantaged urban centers. Today, these urban centers are becoming increasingly gentrified and unaffordable for people with SMI. Affordability is no longer synonymous with urban living, and supportive housing for people with SMI is increasingly found in non-urban areas. Given this shift, it is important to understand the potential impacts of non-urban living on people with SMI. Non-urban environments provide potential benefits for the general population, including reduced traffic and increased proximity to the outdoors. However, people with SMI living in non-urban areas may perceive higher levels of mental illness stigma than their urban counterparts, leading to negative outcomes. I hypothesized that the relationships between perceived stigma and psychological distress and perceived stigma and sense of community would be moderated by urbanicity, such that these relationships would be stronger in non-urban settings. Data collected from 300 adults with SMI living in a range of urban and non-urban areas were analyzed using a moderated regression design. Correlations were found between primary study variables, but the moderation by urbanicity hypotheses were not supported. The broad construct of urbanicity needs to be explored further to understand which components impact perceived stigma and outcomes. The associations between urbanicity, perceived stigma, sense of community, and psychological distress support the need to address mental illness stigma across all settings

Experiences of People with Serious Mental Illness Seeking Services at Community Mental Health Centers During the COVID-19 Pandemic

Community mental health centers (CMHCs) have been underfunded and overburdened since Reagan-era disinvestment and the United States\u27 move toward neoliberalism. Rates of mental illness have been rising consistently, particularly in Oregon, as CMHCs face continuing financial pressures and staff retention issues. This was before the COVID-19 pandemic. Today, we are still trying to understand the ongoing pandemic\u27s impact on people with serious mental illnesses (SMI). Most of the studies in this area thus far are quantitative, and first-hand accounts of the pandemic from people with SMI are largely absent. Additionally, research in this area fails to draw on critical alternative models for mental illness found in social movements and disciplines such as the consumer/survivor/ex-patient movement, Mad Studies, and Disability Studies. In this study, I used a narrative inquiry approach to qualitatively interview 15 CMHC clients with SMI. I also interviewed five staff members and six members of leadership to contextualize the impact of the pandemic on clients. Drawing on thematic narrative analysis and other approaches, I generated richly detailed themes, paying special attention to recurring ideas and metaphors, how the interviews unfolded, and the emotional significance of the themes. Client themes included feeling left behind as a person with disabilities; the impact of staff turnover; difficulty accessing resources; negative experiences including racism, exhaustion, depression, and isolation; the pandemic as a time for self-work; the potential of the pandemic to create empathy for people with SMI; and a critique of the pandemic as a great equalizer Staff themes included burnout and struggle at work; perceptions of clients\u27 independence and coping skills; and whether CMHCs would be able to return to their pre-pandemic functioning. Leadership themes included team cohesion; tensions with staff; and organizational changes that were prompted by the pandemic. This study adds new perspectives to the growing literature on the COVID-19 pandemic and encourages further investigation into changes in policy and practice that were implemented during the pandemic. It also highlights potential avenues for improvement at CMHCs. Additionally, these CMHC clients offer counternarratives to dominant narratives in the literature and among CMHC staff and leadership about how people with SMI have experienced the pandemic. Reading these narratives may challenge the way CMHC staff and leadership think about people with SMI, and allowing their stories to relate to our own lives may create empathy for people with SMI