|
RESEARCH WEEKLY: ACT programs decrease substance use for people with SMI
By Shanti Silver
(June 21, 2023) Substance use disorders are estimated to be present in 45% of people with serious mental illness. People with serious mental illness who use substances such as tobacco, alcohol, or drugs are more likely to have more frequent hospitalizations, more severe symptoms, poorer medication adherence, and a higher death rate. Decreasing the frequency and severity of substance use among people with serious mental illness is crucial.
A recent review of literature from the “International Journal of Mental Health Nursing” examined the impact of assertive community treatment on substance use among people with serious mental illness. This review suggests that participating in ACT results in less substance use for people with serious mental illness.
Methods
ACT is an evidence-based intervention for people with serious mental illness. In ACT, a person with a serious mental illness is assigned a team of healthcare professionals who can provide them with intensive services in the community at any time of day, any day of the week. This research article examined results from 29 different studies that investigated changes in substance use for participants in ACT.
Key Findings
Overall, results from this review suggest that participating in ACT can decrease the severity of substance use for people with serious mental illness. Results also suggest that ACT is not more effective than typical treatments at improving substance use outcomes for people with serious mental illness. However, the authors note that many of the studies included in this review were of “low quality,” meaning that they had experimental designs that make it difficult to determine if their results are representative of most people who receive ACT.
Implications
The finding that ACT programs were not more effective than typical treatments at reducing substance use is somewhat surprising, because ACT programs have been shown to be more effective than typical treatments at reducing hospitalizations and symptom severity for people with serious mental illness. ACT’s comparatively smaller impact on substance use may be caused by a lack of specific substance use treatment in ACT. While some ACT teams provide substance use treatment directly, others rely on community providers. The authors note that only a few studies in this review reported that their ACT program included treatment specifically for substance use. Accordingly, the authors recommend expanding the capacity of ACT to treat substance use through including certified substance use treatment specialists in ACT teams, among other things.
Another surprising finding from this review is that no published studies have examined the impact of ACT on tobacco use. Tobacco smoking is more common among people with serious mental illness than the general population and causes many diseases, damage to organs, and a lower life expectancy. Accordingly, it is very important to connect people with serious mental illness to treatments that can reduce tobacco use. As a result, the authors recommend a special focus on including and studying tobacco treatment in ACT.
| 
