A Comprehensive Peer Mentor-based Disease Management Program for Medically Complex Substance Users

Substance-using adults are admitted to hospital for medical complication from their drug and
alcohol use at very high rates; yet, their care is often defined by low rates of referral to
addiction treatment programs and recidivism. In 1997, we instituted an integrated
medical-substance use treatment program at Johns Hopkins, the First Step Day Hospital,
designed for intensive post-acute care of previously hospitalized substance using adults. We
have shown that patients with dual diagnoses admitted to First Step more often complete their
course of medical care and stay in recovery longer than patients not admitted to First
Step.(1;2) On discharge from First Step, patients are medically stable and drug-free. Their
substance abuse care is transferred to an out-patient substance abuse treatment facility and
their medical care is transferred to their primary care provider. Unfortunately, many
patients are lost to follow-up during this transition. We believe that a peer mentor-based
disease management program (PM) can provide continuity of care that begins in First Step and
continues after discharge thereby increasing the proportion of patients who remain in
treatment for their addiction and medical conditions. Peer mentors are persons from the
target community who have been in recovery for 5 or more years. In cooperation with patients
and providers, peer mentors improve the integration of care, quality of care, and access to
healthcare services. This pilot study will test the effectiveness of a peer mentor-based
disease management program. The specific aims are to compare the impact of the PM
intervention verses enhanced usual care on outcomes in three domains (1) medical/psychiatric
health status, (2) addiction recovery, and (3) social resource acquisition. If successful,
this study will provide evidence supporting a larger randomized controlled trial of the
impact of field workers on post-acute care among patients with dual diagnoses.