Andrea B. Burns

Improved Treatment Outcome Associated With the Shift to Empirically Supported Treatments in a Graduate Training Clinic

There has been an increase in recent years in the use of empirically supported treatments (ESTs) for a variety of mental disorders. This study was an investigation of the impact of standardized use of ESTs in an outpatient community clinic. Clients treated prior to and those treated after the implementation of this policy were compared. The results indicate significant group differences, with the improvement ratings of the group receiving ESTs surpassing those of the group receiving unsupported treatment. Support for the use of ESTs indicates that patients may be best served if therapists rely primarily on these treatments.

Alcohol use and other psychiatric disorders in the formerly homeless and never homeless: prevalence, age of onset, comorbidity, temporal sequencing, and service utilization.

Interview survey data were collected on a large (n = 4730) general population sample of adults subsequently classified as “never homeless” (NH) or “formerly homeless” (FH), with the latter group consisting of persons who had past experience of at least a one-month period with no regular place to live. The objective was to analyze differences, as a function of this classification, in the prevalence, age of onset, comorbidity, temporal sequencing, and service utilization pertinent to alcohol-use and other psychiatric disorders. Almost half of the FH group were found to have a one-year DSM diagnosis, nearly twice the rate seen in the NH group. Moreover, at 15.1%, the prevalence of alcohol-use disorder (AUD) comorbid with one or more other psychiatric disorders was five times that reported by NH participants. Subsequent analyses addressed differences between the FH (n = 167) and NH (n = 1031) groups within the subset who met criteria for one or more psychiatric diagnoses. Focusing on drinking behavior, we found that among the FH, dual-diagnosis was associated with elevated rates of alcohol-use problem symptoms and with greater alcohol consumption than were evident in the FH with AUD alone. Also, among the FH with comorbid AUD, as well as among those with two or more psychiatric disorders unrelated to alcohol, there was an earlier onset of psychiatric disorders than in the NH. This earlier onset may have placed these individuals at greater risk for later homelessness and AUD, and may also be indicative of a more severe course of illness. Differences between the FH and the NH suggest the importance of devoting special attention to this unique sample.