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Predicting Alcohol Use and Drug Use Among Consumers of Community Mental Health Programs

Objective: The current study evaluated the demographic, clinical, and social support and service use predictors of alcohol and drug use disorders among a population of consumers of community mental health programs. Methods: The methodology is a secondary analysis of data collected from two randomized controlled trials that were part of the Community Mental Health Evaluation Initiative completed in Ontario, Canada. Participants included an inner-city population of persons with severe and persistent mental illness who had experienced housing instability. Participants were either randomly selected to receive Assertive Community Treatment or Intensive Case Management (Toronto) or Intensive Case Management or Standard Community Care (Ottawa). Data were collected from consumers at three time points (baseline, 9 months, and 18 months), and prospective and cross-sectional predictors of alcohol use disorders and drug use disorders at 9- and 18-month follow-up were examined. There were 232 participants at baseline, 203 at 9 months, and 179 at 18 months. Results: Approximately 32% of consumers had problematic substance use at 9 months and 28% of consumers had problematic substance use at 18 months. A sequential logistic regression analysis uncovered several significant predictors, which differed across the type of substance used and the two time points considered. The most salient and common predictors included nonadherence to medication and a decreased level of community functioning. Conclusions: Implications for treatment planning in community mental health programs to better address concurrent mental illness and substance use disorders are discussed.