Alcohol-dependent adults with serious mental illness who receive medication-assisted treatment experience less frequent mental health hospitalization and emergency department visitation and also have improved psychotropic medication adherence, according to research published in The American Journal of Psychiatry.
Adults with serious mental illness and comorbid alcohol dependence are at elevated risk for crisis-driven healthcare use and criminal justice involvement. To determine whether a medication-assisted treatment solution might abate these outcomes, researchers evaluated data on 5743 alcohol-dependent adults who had a mental illness such as bipolar disorder or schizophrenia spectrum disorder and who received medication-assisted treatment. Included individuals had to have spent at least 1 night in jail or prison during the study period (2002-2009).
Of the total population, 896 received medication-assisted treatment. Effects and outcomes of the intervention treatment were compared with those of common outpatient treatment options.
With regard to healthcare utilization, medicine-assisted treatment demonstrated strong benefits following the treatment period, including significantly lower odds for mental health hospitalization and fewer emergency department/crisis visits. Furthermore, medicine-assisted treatment was associated with better adherence with psychotropic medication than comparison treatments.
Medication-assisted treatment was also found not to be associated with reduced criminal recidivism, with no statistically significant difference in odds for arrest. However, after treatment and during months without hospitalization, the number of days in jail remained relatively stable among patients who received medicine-assisted treatment (pretreatment mean: 2.78 days; posttreatment mean: 2.84 days). For comparison treatment groups, this rate decreased (pretreatment mean: 4.61 days; posttreatment: 3.40 days).
Researchers noted several limitations to the study, including the unbalanced nature of the 2 groups and a lack of data on alcohol consumption and other functional status measures.
Despite these and other limitations, researchers said, “Significant reductions in psychiatric hospitalizations and emergency department visits, along with improvements in psychiatric medication adherence…suggest that evidence-based medications for treating alcohol dependence among adults with serious mental illness can significantly improve their clinical functioning.”
Robertson A, Easter M, Lin HJ, Frisman LK, Swanson J, Swartz M. Medication-assisted treatment for alcohol-dependent adults with serious mental illness and criminal justice involvement: effects on treatment utilization and outcomes. Am J Psychiatry. 2018;175:665-673.