(January 15, 2019) Patients with co-occurring substance use and mental health disorders are disproportionately likely to experience a host of negative outcomes—such as poor management of the psychiatric condition and increased likelihood of using additional costly health services—associated with non-treatment of their diseases. Providing treatment to these patients is particularly important during the period immediately following a psychiatric inpatient stay, during which research has shown there is a significant high-risk of suicide.
Due to this risk, innovative approaches to follow-up and monitoring of patients after an inpatient stay are needed, especially for patients with co-occurring disorders. Although telephone monitoring resulted in reduced substance for patients with substance use disorders, a new randomized control trial led by Dr. Christine Timko shows that administering telephone monitoring post-discharge did not result in reduced substance use or psychological symptoms for psychiatric patients, nor did it result in an increase in seeking and utilizing continued treatment.
Patients participating in Dr. Timko's randomized control trial entered inpatient psychiatric treatment health care facilities under the Veterans Health Administration. In the study, licensed clinical social workers contacted the experimental group of patients by telephone once a week for three months, in addition to administering what researchers called "usual care" for the non-experimental group. Usual care included biopsychosocial inpatient treatments such as comprehensive assessments, psychopharmacology, individual and group psychotherapy, and other behavioral interventions.
Though the effects of telephone monitoring in this study were insignificant, both experimental and non-experimental groups showed an overall reduction in substance use and psychiatric distress over the 15-month study period. This is likely due to the sufficient levels of care administered through the usual care that patients of both groups received.
As noted above, findings from previous studies of telephone monitoring in patients with substance use disorders have shown positive results. One study showed that emergency room visits for patients with alcohol use disorders were reduced by nearly two-thirds due to telephone monitoring patients after their discharge. Another study found that telephone monitoring was more effective or more favorable than usual care among women with alcohol dependence.
However, Dr. Timko's findings are consistent with previous studies that have assessed the telephone monitoring intervention in veteran patients with co-occurring disorders. A co-occurring mental illness, especially if the individual lack's insight into their disease, makes telephone monitoring treatment programs difficult.
Given the fact that most veterans are men, it is possible that the telephone monitoring intervention could be successful among female patients with co-occurring disorders. Dr. Timko and her co-authors authors propose further research and potential targeting for future telephone monitoring interventions along these lines.
Grace Lim
Research Intern
Treatment Advocacy Center
References
• Timko, Christine et al. (2019). Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders. Drug and Alcohol Dependence.