Eight-year follow-up of severe mentally ill drug abusers undergoing integrated, case-managed treatment.

Objectives: To know the retention in a specific program for patients with severe mental illness and substance use disorder, the reasons for discharge and their clinical (severity, relapses, hospital admissions) and functional (disability) improvement.

Method: Eight-year prospective, observational study of patients with severe mental illness (GCI-S=> 5) undergoing treatment in an integrated program, "case managed" (N = 320). Reasons for discharge, medications and consumed substances were recorded. The CGI-S and the WHO-DAS disability scale were administered. Admissions in Hospital Psychiatric ward and detoxifications were the eight years prior to treatment and during follow-up.

Results: Most of patients had schizophrenia (55%), with an initial GCI-S of 5.72(0.8). After eight years, remained in treatment 33.6% (GCI-S=4.1(0.9); p<0.01); 42% were medical discharges (GCI-S=3.1(1.3); p<0.001). In patients who continued treatment and those who were medical discharged, the WHO-DAS decreased in the four areas (p<0.01). 14.1% were voluntary discharges (55% of them personality disorders). There was a decrease in abuse of alcohol (p < 0.01) and in the use of illegal drugs (p<0.005). 66,2% received long-acting medication, with high tolerance and few drops (4.2%). There were significantly less psychiatric hospital admissions (p<0.001) and less hospital detoxifications (p<0.001) than in the eight previous years.

Conclusions: People with severe mental illness and substance abuse treated in a comprehensive specific program reached high retention and clinical (less severity and hospital admissions by psychopathological worsening or drug use relapse) and functional (decreased disability) improvement. The integrated approach with methodology of "case management" of the programme, and the routine use of long-acting medication could explain these results.