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

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on April 17, 2017

Program Summary

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 significantly reduced the number of reconvictions and incarcerations, it did not reduce the number of arrests, days in jail, felony convictions, or percent of reconvictions.

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

Program Description

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.

Evaluation Outcomes

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Study 1
Overall, Chandler and Spice (2006) found mixed results when examining the impact of the Integrated Dual Disorder Treatment (IDDT) Program on criminal justice measures. While the treatment group had significantly fewer reconvictions and incarcerations, there were no significant differences between the groups on numbers of arrests, percent of participants reconvicted, days in jail, and numbers of felony reconvictions. Overall, the preponderance of evidence suggests the program did not have the intended impact on the treatment group.
Number of Arrests
There was no significant difference in arrests between the IDDT treatment group and control group.
Percent Reconvicted
No significant difference was found in the percentage of IDDT treatment and control group participants being reconvicted.
Number of Reconvictions
However, the IDDT treatment group was significantly less likely to have multiple reconvictions (average of 2.0 convictions), compared with the control group (average of 2.6 convictions).
Number of Felony Reconvictions
No significant difference was found between treatment and control groups in the number of felony convictions. 
Number of Incarcerations
The treatment group also had significantly fewer incarcerations (average of 2.2 incarcerations), compared with the control group (average of 2.8 incarcerations).
Number of Days in Jail
No significant difference was found between the IDDT treatment and control groups in the number of days spent in jail.
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Evaluation Methodology

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Study 1
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.
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One goal of the Integrated Dual Disorder Treatment (IDDT) Program was to reduce inappropriate use of high-end services, while increasing participants’ engagement and use of community-based services. Chandler and Spice (2006) found that the average costs for IDDT program participants was $14,809, while the average costs for control group participants was $11,069. Thus, the IDDT program cost more than the services received by the control group.
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Evidence-Base (Studies Reviewed)

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

Study 1
Chandler, Daniel Williams, and Gary Spicer. 2006. “Integrated Treatment for Jail Recidivists with Co-occurring Psychiatric and Substance Use Disorders.” Community Mental Health Journal 42 (4):405–25.

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Related Practices

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Following are practices that are related to this program:

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:
Promising - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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Program Snapshot

Age: 18 - 78

Gender: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Urban

Setting (Delivery): Other Community Setting

Program Type: Alcohol and Drug Therapy/Treatment, Aftercare/Reentry, Crisis Intervention/Response, Group Therapy

Targeted Population: Mentally Ill Offenders, Alcohol and Other Drug (AOD) Offenders

Current Program Status: Not Active

Listed by Other Directories: National Reentry Resource Center