Program Profile: Alameda County (Calif.) Integrated Dual Disorders Treatment Program

This is a post-custody, community-based intervention for individuals with co-occurring mental illness and substance use disorders. The program is rated No Effects. While the program statistically significantly reduced the number of reconvictions and incarcerations, it did not impact the number of arrests, days in jail, felony convictions, or percent of reconvictions.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

The Integrated Dual Disorder Treatment (IDDT) Program in Alameda County (Calif.) was a post-custody, community-based intervention for individuals with co-occurring mental illness and substance use disorders. The objective of the program was to reduce recidivism rates (including rearrests, reconvictions, and reincarcerations) of program participants following release from jail.  

Target Population/Eligibility

Eligibility requirements for participants included 1) having a serious mental illness and substance use disorder; 2) not being imprisoned, on parole, or a resident of another county outside of Alameda; 3) not enrolled in another treatment program; 4) Global Assessment of Functioning (GAF) score of 50 or below; 5) fluency in English or Spanish; and 6) at least two jail stays in the 2 years prior to admission or alternatively having spent at least 90 days in jail within the past 2 years.

Program Components

The IDDT program offered participants stage-wise interventions, meaning that the program progressed consistent with the participant’s readiness to change, with unlimited access to supportive services. These services included outreach, motivational intervention, substance-abuse counseling, dual-disorder group treatment, family education on dual disorders, self-help groups, pharmacological treatment, health interventions, and secondary interventions for those who did not respond to treatment.

IDDT participants also had access to the usual pre- and post-release services. These services included intensive assessment, medications, discharge planning, individual counseling, and crisis intervention for the pre-release component and case-management referral, medication services, grant-funded case management, and housing assistance for up to 60 days as the post-release component.

Study

Chandler and Spicer (2006) conducted a randomized controlled trial in the large urban county of Alameda in the San Francisco Bay Area to study the impact of the Integrated Dual Disorder Treatment (IDDT) Program. Eligibility was determined by research associates, who then randomly assigned two individuals to the treatment group for every one individual randomly assigned to the control group. Assignment was then reversed with two members of the control group assigned for each one treatment member. The result was 79 participants in the control group and 103 in the experimental group. Both groups received in-custody services. The experimental group received the IDDT program while the control group received treatment-as-usual post-custody, which included case management and medications. Control group members also received an additional 60 days of case management and housing assistance.

Over half of the IDDT program sample (51.5 percent) was between 36 and 50. Male participants made up 71.8 percent of IDDT participants. The program sample was 66 percent African American, 23.3 percent white, 7.8 percent Latino, and 2.9 percent other race/ethnicity. The most frequently reported primary diagnosis of IDDT participants was major depressive disorder (28.2 percent), followed by schizophrenia (25.2 percent) and psychotic disorder (23.3 percent). A little over 60 percent of the control group was between 36 to 50 years old, and males also made up 71.8 percent of the sample. The control group was 67.1 percent African American, 19.0 percent white, 10.1 percent Latino, and 3.8 percent other race/ethnicity. The most frequently reported primary diagnosis of control group members was psychotic disorder (34.2 percent), followed by major depressive disorder (22.8 percent) and schizophrenia (17.7 percent). There were no significant characteristic differences between treatment and control groups at baseline.

The outcomes of interest included number of arrests, having any reconvictions, number of reconvictions, number of incarcerations, number of days in jail, and felony reconvictions. Administrative data from local jurisdictions was used to assess the outcomes of interest in the study. Binomial and logistical regression models were used.

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Adult Reentry Programs

This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Rehabilitation Programs for Adults Convicted of a Crime

This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adults who have been convicted of an offense.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?