Preliminary Outcomes from a Community Linkage Intervention for Individuals with Co-Occurring Substance Abuse and Serious Mental Illness

UMMS Affiliation

Department of Psychiatry



Document Type



Mental Disorders | Psychiatry | Substance Abuse and Addiction


Objective: Few interventions assist individuals with a mental illness and a co-occurring substance abuse disorder in the transition from hospitalization to outpatient treatment. This change in care is often abrupt, resulting in fragmented treatment that jeopardizes recovery. This article reports on the preliminary outcomes from a new eight-week linkage intervention entitled “Time-Limited Case Management (TLC)” that integrates intensive outreach, Dual Recovery Therapy (DRT), and peer support to facilitate outpatient treatment engagement following discharge from Acute Psychiatry.

Method: This eight-week naturalistic feasibility study included 59 recently hospitalized subjects with a mental illness and substance abuse disorder who were offered the new service. The individuals who agreed to receive TLC (n = 26) formed the treatment group and those who refused (n = 33) made up the comparison group.

Results: The TLC service was successfully implemented into the system and improved the transition from inpatient to outpatient care. The individuals who received the TLC intervention had a higher show rate at the Day Treatment Center intake appointment, attended more days of treatment at the Day Center, had greater pharmacy refill compliance, and were less likely to be lost to follow-up at eight weeks than the comparison group.

Conclusion: TLC represents a promising new approach to maintaining continuity in care following psychiatric hospitalization that may be easily implemented in other systems. We are currently in the process of developing an implementation manual and doing a large randomized controlled trial to determine whether the intervention improves substance abuse and psychiatric outcomes in addition to facilitating treatment engagement.


Citation: Smelson, D. A., Losonczy, M. F., Castles-Fonseca, K., Sussner, B. D., Rodrigues, S., Kaune, M., Ziedonis, D. (2005). Preliminary outcomes from a community linkage intervention for individuals with co-occurring substance abuse and serious mental illness. Journal of Dual Diagnosis, 1(3), 47-59. doi:10.1300/J374v01n03_05.

At the time of publication, David Smelson, Stephanie Rodrigues and Douglas Ziendonis were not yet affiliated with the University of Massachusetts Medical School.


Dual diagnosis, case management, peer support, discharge, transition, linkage, hospitalization, day treatment