Objective: Adults with serious mental illness and comorbid alcohol dependence are at high risk for both high utilization of crisis-driven health care services and criminal justice involvement. Evidence-based medication-assisted treatment (MAT) for alcohol dependence may reduce both crisis service utilization and criminal recidivism. The authors estimated the effect of MAT on behavioral health treatment utilization and criminal justice outcomes for this population.
Method: Relevant administrative data were merged from several public agencies in Connecticut for 5,743 adults $18 years old who had schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder comorbid with moderate to severe alcohol dependence and who were incarcerated for at least one night during the study window (2002–2009). Longitudinal multivariable regression models were used to estimate the effect of MAT compared with other outpatient substance abuse treatments on inpatient mental health and substance abuse hospitalizations, emergency department visits, criminal convictions, and incarcerations.
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The participant will explain how medications for the treatment of alcohol use disorder can affect treatment and criminal justice outcomes among adults with co-occurring serious mental illness.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Duration: 1 hour
Begin Date: July 1, 2018
End Date: June 30, 2020
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Title: Medication-Assisted Treatment for Alcohol-Dependent Adults With Serious Mental Illness and Criminal Justice Involvement: Effects on Treatment Utilization and Outcomes
Authors: Allison G. Robertson, Ph.D., M.P.H., Michele M. Easter, Ph.D., HsiuJu Lin, Ph.D., Linda K. Frisman, Ph.D., Jeffrey W. Swanson, Ph.D., Marvin S. Swartz, M.D.
Affiliations: From the Department of Psychiatry and Behavioral Sciences, Duke University, Durham, N.C. (A.G.R., M.M.E., J.W.S., M.S.S.); Connecticut State Government, Hartford, Conn. (H.J.L.); and the Connecticut Department of Mental Health and Addiction, Hartford, Conn. (L.K.F.).
Disclosures: Drs. Robertson, Easter, Swanson, and Swartz receive research grant support from the Laura and John Arnold Foundation for a study on extended-release naltrexone, and the medication for that study is donated by Alkermes. All other authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).
Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.
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