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Michael S. Kidorf — Effective Drug-Psychiatric Treatment

Men and women trying to shake their drug habits while also dealing with mental disorders pose difficult challenges for medical providers and health-care policymakers. And while combining psychiatric and addiction treatment services at one location holds great promise, the results so far have proved disappointing. Patients too often show up to get their medications at such centers, but don't stay around for the psychiatric counseling and other programs they need, resulting in poor outcomes and far greater costs.

Now Dr. Michael S. Kidorf of The Johns Hopkins University School of Medicine's Department of Psychiatry and Behavioral Sciences is using a $445,000 ARRA Challenge Grant from the NIH to evaluate an innovative incentive strategy for improving treatment outcomes.

A previous NIH-supported study by Drs. Robert Brooner and Michael Kidorf, and their colleagues at the Johns Hopkins' Bayview Medical Center's Addiction Treatment Services program, was one of the first known controlled and randomized evaluations of an integrated treatment delivery model for drug-dependent patients with other psychiatric disorders. While the delivery of psychiatric services in the drug abuse treatment program was associated with significantly better initial engagement in psychiatric care, the overall rate of adherence to psychiatric services was low and no different from the group of patients assigned to get their psychiatric care in a community psychiatry program on the same campus. These results strongly suggested the need for a more creative approach to the problem.

"Offering these patients integrated treatments in a single location will improve initial engagement in psychiatric care but by itself, is unlikely to produce the expected outcomes because of poor overall adherence," notes Dr. Kidorf. "The new study will determine if behaviorally reinforced attendance increases overall adherence to psychiatric treatment services and, second, if increased adherence results in improved outcomes."

So this time, their research team is randomly assigning drug-dependent patients to one of two groups of 42 men and women. The first group will receive the full range of psychiatric and drug treatment services. The second group will have access to the identical program with one difference – a $25 voucher each week. To earn the incentive, patients must attend all of their weekly scheduled psychiatric sessions.

Voucher earnings will escalate in value in response to successive weeks of attendance and accumulate over time in an account. Patients can use their voucher earnings for a wide range of consumer goods and services that are consistent with recovery, which will be purchased for them by the research team.

"We will measure if patients with vouchers are more likely to go to scheduled sessions and whether there are positive changes in their psychiatric and drug symptoms," says Dr. Kidorf. Progress will be assessed and compared for the study groups after three months, and the entire project, including a report at a national meeting, will be completed within the ARRA's two-year timetable.

The ARRA Challenge Grant enabled Dr. Kidorf, who is also Associate Director of Addiction Treatment Services at Johns Hopkins Bayview Medical Center, to create three new research jobs and retain two existing positions.

"This grant could lead to a lot of good things," according to Dr. Kidorf, such as more effective and shorter psychiatric treatment; cost savings; improved monitoring and adherence to drug regimens, and better patient outcomes.

Story attributed to The Johns Hopkins University School of Medicine

This article originally appeared on the Johns Hopkins University website. Reposted with permission.

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