Level of burden among women diagnosed with severe mental illness and substance abuse.

Women diagnosed with severe mental illness and substance abuse may face a variety of associated difficulties that require intervention, including other health-related problems, housing instability or homelessness, and a history of or current physical or sexual abuse. This article expands upon the concept of "level of burden" by specifically examining issues for women with multiple vulnerabilities in a sample of 577 women participating in a residential substance abuse treatment program. Two types of outcomes were examined for the women. In Study 1, the effects of severe mental illness as well as overall level of burden on retention in treatment were examined. Cox regression analyses revealed that severe mental illness was significantly related negatively to retention in treatment; those women diagnosed with severe mental illness tended to stay in treatment less time than those without such a diagnosis. In Study 2, staff ratings of the women's status at departure from residential treatment for a subsample of 311 women were examined with respect to overall retention in treatment and severe mental illness. Ratings of client status at program exit were significantly related to time in program but were not related to having a severe mental illness diagnosis. For a few indicators (e.g., leaving treatment against advice, having scattered or disorganized thoughts, and having no specific plans for life outside of treatment), there was an interaction between time in program and severe mental illness such that women with severe mental illness who were retained for less than 180 days were more likely to demonstrate negative outcomes. Implications for the treatment of multiply-diagnosed women are discussed.