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The new paradigm of recovery has highlighted the importance of positive social relationships, but little is known about their role in recovery among homeless individuals with serious mental illness and comorbid substance abuse. This study used within- and across-case analyses of longitudinal data from qualitative interviews with 41 dually diagnosed individuals entering residential programs to exit homelessness and receive needed services. Thematic findings include (a) 'loner talk' and the need for privacy; (b) family ties as 'good news, bad news'; (c) when it comes to a partner, other things come first; and (d) in search of positive people. Analyses of change in individual trajectories revealed that stronger social relationships did not coincide exactly with positive outcomes. Although positive life changes were gradual, negative changes could be precipitous. Social relationships were threatened by concentrated disadvantage, that is, a lack of social and economic currency. Findings are discussed with implications for improving services for the most vulnerable individuals who stand to benefit from the era of recovery. Keywords: serious mental illness, substance abuse, social relationships, recovery

Integrated mental health and substance abuse treatment within an assertive community treatment (ACT) approach was compared to that within a standard case management approach for 223 patients with dual disorders over three years. ACT patients showed greater improvements on some measures of substance abuse and quality of life, but the groups were equivalent on most measures, including stable community days, hospital days, psychiatric symptoms, and remission of substance use disorder.

Assertive community treatment (ACT) is a complex community-based service approach to helping people with severe mental disorders live successfully in the community. Effective replication of the model and research on critical elements require explicit criteria and measurement. A measure of program fidelity to ACT and the results of its application to fifty diverse programs are presented.

Recent evaluations of ACT programs have produced equivocal findings, often leading to the invocation of methodological problems as responsible for the lack of positive results. This paper discusses issues of theory and methodology as they pertain to improving research of ACT, with particular attention paid to issues of sampling, process evaluation, measurement, and data analysis.

Assertive community treatment is a novel mental health service approach that employs a multidisciplinary group composed of case managers, vocational rehabilitation specialists, social workers, nurses and psychiatrists. It intends to make sure that every patient gets all the required services to maintain the highest achievable quality of life. Its future is dependent on how certain issues, including financing, integration within existing mental health programs, identification of key service components, training of clinicians and quality assurance, are addressed.

Individuals with co-occurring substance abuse and severe mental illness are particularly vulnerable to negative outcomes. This paper reviews findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance-abuse programs; describes the movement toward programs that integrate both types of treatment at the clinical level; reviews evidence related to outcomes in integrated treatment programs; and discusses health-care policy changes that would encourage effective treatments.

Individuals with co-occurring addictive and mental disorders are particularly vulnerable to negative outcomes. Historically, they have been treated either in mental health or addiction service settings and sometimes excluded from receiving any services at all. This article presents an overview of the prevalence and clinical correlates of co-occurring disorders, and of the historical development of separate care systems for mental and addictive disorders. The articles that follow address future treatment and service system development.