Table 7 Summary of evidence-based drug abuse disorders and co-occurring psychiatric problems group treatment for adults

Compton et al., 2000 [91]

996 recruited outpatient cocaine users with and without antisocial personality disorder (ASPD) and major depression (DIS). Mean age 39 years, 39% female, 92% African American.

Two 15-min sessions, plus 4 peer-administered 2-h sessions:

1. Standard Intervention (SI; developed by NIDA Cooperative Agreement Final Cohort sites; 2 15-min sessions)

2. Enhanced Intervention (EI; SI plus 4-peer administered 2-h sessions)

1. Yes

2. Yes

RAAT; 3-month follow-up. 88%, f/u rate, 100% participation in SI, 69% tx completion in EI.

All groups improved significantly in: crack cocaine use, injection drug use (IDU), number of IDU sex partners and overall number of sex partners. Stratified by psychiatric status, ASPD was associated with significantly less improvement in crack cocaine use. When

examining the standard and peer groups separately, no consistent differences in the association of psychiatric comorbidity with outcome were evidenced.

DiNitto et al., 2002 [92]

97 recruited inpatients at chemical dependency treatment program, with Axis I disorder (ASI, Addiction Severity Index). Mean age 33 years, 53% female, 28% African American.

28-days of treatment:

1. Treatment as usual (TAU; Inpatient chemical dependency services)

2. Good Chemistry Group (GCG; TAU plus psychoeducational group therapy; 9 60-min sessions; 3 times a week; repeated for 15 months)

1. No

2. Yes

RAWC; 1-. 2- and 3-month f/u. 86% f/u rate. Average treatment 25.6 days for GCG and 26.3 days for TAU.

No significant differences between groups.

Fisher & Bentley (1996) [18]

38 referred inpatient and outpatient with SUD and personality disorder (SCID). Mean age 37 years, 24% female, 61% African American.

45-min sessions, 3x per week, for 4 weeks:

1. Disease-recovery group (DRG; acceptance of substance abuse as a chronic and progressive disease)

2. CBT-group

3. Group treatment as usual (Control)

1. Yes

2. Yes

3. No

RAWC; Full sample completed pre and post-test assessments (e.g., 100% tx completion and f/u rate).

DRG and CBT evidenced improved social/family relations compared to control. CBT more effective than DRG group in reducing alcohol and improving social/family function and enhancing psychological function.

Jerrell et al., 1995 [93];

Jerrell et al., 1997 [94]

132 recruited outpatients with psychotic or Axis I disorder and SUD (DIS) and poor work history; eligibility for public assistance, poor basic living skills, poor social support, or poor social skills. Excluded based on cognitive impairment, personality disorder and medical disabilities. Ages 28–59, 23% female, no ethnicity data provided.

1. Twelve-step group (TS; one to several meetings per week; structured)

2. Behavioral Skills group (BS; Social and Independent Skills program; one group per week)

3. Intensive case management (Program for Assertive Community Treatment; as needed 5 day/week)

1. Yes

2. Yes

3. Yes

RAAT. 18-month f/u. No data provided on f/u rate or tx completion rate.

BS and ICM evidenced significant decreases in schizophrenia, depression and mania symptoms compared to TS. BS also evidenced significant decreases in drug and alcohol use compared to TS. Compared to men, women had higher functioning scores, more psychiatric symptomatology, and greater reductions in use of acute treatment services used over the 6-month f/u.

Lehman et al., 1993 [95]

54 patients with SUD and schizophrenia or affective disorder (SCID). Mean age 30 years, 26% female, 79% African American.

5 1-h sessions and 2 months of intensive case management:

1. Treatment as usual (Control; Community mental health center and rehabilitation services)

2. Being sober group, plus group and intensive case-management (ICM-G)

1. No

2. Yes

RAWC; 1 year f/u, No f/u rate reported. 20% average tx attendance.

One-year follow-ups detected no significant differences between ICM-G and Control (treatment as usual).

Linehan et al. 1999 [96]

27 referred from community care, with borderline personality disorder and SUD (opiates, cocaine, amphetamines, sedatives, hypnotics, anxiolytics, or polysubstance use; SCID and International Personality Disorders Exam). Mean age 30 years, 100% female, 78% Caucasian.

Weekly 1-h individual sessions; 2-h group sessions; coaching as needed for 12 months:

1. Treatment as usual (TAU; outpatient psychotherapy or community care).

2. Dialectical Behavior Therapy Group modified for substance use (DBT).

1. No

2. Yes

RAWC; 16-month f/u; 66% f/u rate, 70% tx completion rate.

DBT evidenced greater reductions in drug use compared to TAU throughout treatment and at f/u. DBT evidenced significantly higher tx retention compared to TAU, and greater global adjustment at follow-up compared to TAU.

Milby et al., 2004 [97]

141recruited cocaine-dependent homeless individuals and co-occurring non-psychotic mental disorder (DSM-III-R checklist). Mean age 38, 72% male, 83% African American.

All participants received: Phase I (8 weeks day treatment, 5 days per week, 5.5 h per day; highly structured) and Phase II (16 weeks of weekly group therapy, individual counseling 1 time per week).

1. Day treatment only (DT)

2. Day treatment plus abstinent-contingent housing

and work (DT+)

1. Yes

2. Yes

RAAT; 2-, 6-, and 12-month f/u. At 2-months, 76.3% f/u, at 6-months, 74.5% f/u. 37% tx completion in DT, 77% of DT+ tx completion.

Compared with DT, more DT+ participants established abstinence, maintained abstinence for longer durations, were marginally significantly more likely to lapse, and significantly less likely to relapse. Of all participants who established abstinence and then relapsed, DT+participants relapsed later and were more likely to reestablish abstinence.

Petry et al. (2010) [98]

170 HIV+ patients with cocaine or opioid abuse or dependence over past year (via SCID). Mean age 43 years, 39% female, 44% African American, 32% Hispanic.

Weekly groups for 24 weeks:

1.Contingency management (CM)

2.Twelve step groups (TS)

1. Yes

2. Yes

RAAT; 1-, 3-, 6-, 9- and 12-month f/u; mean attendance 10.8 for CM and 9 for TS.

Compared to TS, CM participants submitted more consecutive drug-free urine specimens; whereas negative urine samples did not vary between groups during treatment or follow-up; CM participants reported fewer HIV-risk behaviors compared to TS during treatment.

Zlotnick et al. (2009) [99]

49 incarcerated women with SUD and full/subthreshold posttraumatic stress disorder (SCID and Clinician Assisted Posttraumatic Stress Disorder Scale-I) without psychotic or organic brain impairment. Mean age 35 years, 100% female, 32.7% African American, 14.2% Hispanic.

6–8-week intervention:

1. Treatment as usual (TAU; 180–240 h of individual and group treatment)

2. Seeking Safety Group (90-min sessions, 3x per week)

1. No

2. Yes

RAWC; 12-week, 3-, and 6-month f/u. 97% 12-week f/u rate, 85% 6-month f/u rate for SS, and 95% 6-month f/u rate for TAU. Women attended average of 15.6 of 25 SS sessions.

Consistent main effects for time but not group by time interaction on key variables (e.g., PTSD, substance use, legal problems). 6 months after release from prison, 53% of the women in both groups reported a remission of PTSD. Some advantages for Seeking Safety were found over TAU during the f/u period (e.g., improvement in psychopathology and recidivism rates).