Commonwealth Research Center

Family Intervention for Severe Mental Illness (SMI) and Substance Use Disorders (FIDD)

Rationale - Research Objective and Specific Aims

Principal Investigator

Kim Mueser, Ph.D.

New Hampshire-Dartmouth Psychiatric Research Center

Main Bldg., State Office Park South

105 Pleasant Street

Concord, NH 03301

Tel: (603) 271-5226

Fax: (603) 271-5265

Email: kim.t.mueser@dartmouth.edu

Other Investigators     

James Feldman, M.D. (MMHC site PI)

Medical Director

Massachusetts Mental Health Center

MMHC at the LSH Campus

180 Morton Street

Jamaica Plain, MA 02130

Tel: (617) 626-9483

Email: James.Feldman@dmh.state.ma.us

Margaret Guyer, Ph.D.

Outpatient Services Director

Massachusetts Mental Health Center 

MMHC at the LSH Campus

180 Morton Street

Jamaica Plain, MA 02130

Tel: (617) 626-9338

Email: Margaret.Guyer@dmh.state.ma.us

Daniel Beck, LICSW (Clinician)

North Suffolk Mental Health Association

Freedom Trail Clinic

25 Staniford Street

Boston, MA 02114

Tel: (617) 470-3900

Corinne Cather, Ph.D. (NSMHA Site PI)

North Suffolk Mental Health Association

Freedom Trail Clinic

25 Staniford Street

Boston, MA 02114

Tel: (617) 912-7891

Email: ccather@partners.org

Michelle Friedman-Yakoobian, Ph.D.

North Suffolk Mental Health Association

Freedom Trail Clinic

25 Staniford Street

Boston, MA 02114

Tel: (617) 912-7848

Email: mfriedmanyakoobian@partners.org

Ken Park, Ph.D.

North Suffolk Mental Health Association

Freedom Trail Clinic

25 Staniford Street

Boston, MA 02114

Tel: (617) 724-6300 #1340237

Email: kpark3@partners.org

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Rationale

Alcohol and drug use disorders are the most common comorbid condition in persons with severe mental illness (i.e., dual disorders), afflicting upwards of 50% of this population.  Substance use disorders have a profound impact on worsening the course of psychiatric illness, including increased relapses and rehospitalizations, housing instability and homelessness, family burden, treatment noncompliance, violence and aggression, and increased vulnerability to infectious diseases.  Although there have been some advances in integrating mental health and substance abuse treatment services, substance use disorders continue to be relatively stable and persistent over time, and take a heavy toll on clients, relatives, and providers.  No specific, manualized interventions, including individual, group, or family modalities, have been demonstrated to be effective in treating dual disorders.  There is a pressing need for more effective treatments to address this problem.  This study will take an important step towards evaluating a recently developed program for collaborating with families who have a member with a dual disorder.

Family intervention for dual disorders is a promising but neglected treatment modality.  Most dually diagnosed clients continue to have contact with their families, with substance abuse contributing to increased family burden and stress.  Aggression in dual disorder clients is most likely to be directed at family members, and the loss of family support is a major cause of housing instability and homelessness.  Finally, there is ample support for the effects of family collaboration in the treatment of severe mental illness, and for primary substance use disorders, but no research addressing its effects on dual disorders.  The proposed research will be a randomized controlled trial of a family collaboration program for dual disorders, conducted at three community mental health centers to ensure replicability of the intervention.  The family program was developed based on a model of the interactions between family factors and the course of dual disorders.  The program has been manualized and pilot tested in a typical community mental health center setting.

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Research Objective and Specific Aims

The proposed research is a randomized controlled trial to evaluate the Family Intervention for Severe Mental Illness (SMI) and Substance Use Disorders (FIDD) program for dually diagnosed clients with SMI, a recently developed program for collaborating with families who have a member with a dual disorder.  We expect that the intervention will improve outcomes in several different areas.  The effectiveness of this intervention will be tested with respect to the following specific aims and hypotheses:

Specific Aim 1 - To help client gain improvement in substance use remission. 

We hypothesize that participants in the FIDD Intervention group, as opposed to those in the Psychoeducation group, will:

a) Demonstrate greater improvement in substance use diagnoses (SUD)

b) Demonstrate greater improvement in severity of substance abuse

c) Demonstrate greater improvement in motivational stage of treatment.

Specific Aim 2 - To reduce the number of hospitalizations clients experience.

We hypothesize that that participants in the FIDD Intervention group, as opposed to those in the Psychoeducation group will have:

a) Significantly fewer hospitalizations

b) Significantly fewer days in the hospital.

Specific Aim 3 - Demonstrate a positive effect on the family members involved in the study.

We hypothesize that the family members in the FIDD Intervention group, as opposed to those in the Psychoeducation group, will:

a) Report a significantly lower burden of care

b) Report more satisfaction with their relationship with the client

c) Report higher levels of social support.

The study is still recruiting.  For more information, call Margaret Guyer at (617) 626-9338.

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