Research provides practical insights to inform policy and practice for addiction, mental illness and co-occurring disorders

—by Paul M. Kubek

Advances in brain-imaging technologies have helped researchers in the biological sciences gain a better understanding of neural anatomy and neural processes, including those associated with addictions to alcohol and other drugs and those associated with severe mental illnesses such as schizophrenia, bipolar disorder, and severe depression.

Yet, despite this growing body of knowledge, the causes of addiction and mental illness still elude investigators, leaving communities everywhere with some very practical questions for public policy and public-health initiatives. So, as brain researchers continue to look for biological causes and cures, other researchers, such as those affiliated with the Center on Substance Abuse and Mental Illness (SAMI Center) at the Mandel School of Applied Social Sciences, continue to examine social and psychological factors of the disorders, gaining insight into the consequences of the illnesses and facilitators of recovery.

SAMI Center Co-Directors David E. Biegel, PhD, Henry L. Zucker Professor of Social Work Practice at the Mandel School, and Mark I. Singer, PhD, Leonard W. Mayo Professor in Family and Child Welfare, are among these researchers. They explain that the SAMI Center brings together faculty of the Mandel School whose interests and expertise address substance abuse or mental illness or the intersection of both, what is called dual disorders or co-occurring disorders. They note that, this past year, faculty members continued to make progress on important funded-research and training initiatives described below.


funded by the National Institute on Drug Abuse (NIDA), titled "Role of Personal Social Networks in Post-Treatment Functioning,” which is commonly called the "Women's Network Project.” The study is being conducted in collaboration with three service organizations in Cleveland—Hitchcock Center for Women, Recovery Resources, and Women's Center of Greater Cleveland—where many of the research interviews are conducted.
The study is following 377 women in the Cleveland area who are 18 years of age or older, who have recently begun substance-abuse treatment, and have been diagnosed with substance dependence.

The study is examining the characteristics of social networks that help these women build upon advances they make in treatment. Approximately 6.5 million adult women in the United States have been diagnosed with substance use disorders.

Because recovery from addiction typically occurs in stages over time, Tracy’s research is measuring social support and composition of the social networks at four different times: at the onset of treatment, then at one month, six months, and 12 months after onset. To date, researchers have conducted over 1,000 interviews. Most of the women have reached the six month mark, so Tracy’s team has been analyzing data through this time interval and has begun to identify some characteristics of the women:

  • Over four-fifths (86 percent) have been in jail or prison at some time in their lives
  • Over three-fourths (75 percent) have been in substance-abuse treatment in the past (for abuse of cocaine, marijuana, or alcohol)
  • Over two-fifths (42 percent) have been homeless
  • They have used alcohol or other drugs, on average, with over one-fourth (28 percent) of people in their social networks.
  • Over one-third (36 percent) of people in their social networks also use alcohol or other drugs.

Preliminary Findings

Data analyses are also beginning to uncover some other findings. For instance, after one month in treatment, women in residential treatment report having a social network that is more supportive of recovery than women in outpatient treatment. Those in residential programs have more professional support, more emotional support, and more concrete support, which means they have access to people who are able to help with day-to-day tasks, for instance, with providing transportation to doctors’ appointments, watching children, and getting mail and checking-in upon apartments or homes while the women are away. For women in both residential and outpatient treatment, the support for abstinence and recovery from social networks is predicting quality of life at the six-month follow-up.

Tracy also notes that data collected during focus-group interviews with participants in both residential and outpatient treatment show that women in recovery acknowledge the importance of being connected to "the right people” who have a "healthy lifestyle.” They explain that these are individuals who support recovery, even if they are not sober themselves.


Sonia Minnes, PhD, is an assistant professor of social work at the Mandel School and is principal investigator of a longitudinal study of children who were exposed to cocaine and other drugs prenatally. The study began in 1994 and has been funded by the National Institute on Drug Abuse (NIDA) in several phases. The study has followed almost 400 children and their parents (or primary caregivers) since birth. It boasts a retention rate of over 90 percent.

The project is now in its fourth phase and is currently supported by a $4.9 million NIDA grant. This phase of the study is titled "The Effects of Prenatal Cocaine Exposure in Adolescence” and is taking place in Cleveland for five years. There are 382 adolescents and their primary caregivers (e.g., parents, grandparents, foster parents) in the current study. Most are African-American and live in low income urban neighborhoods. There are two comparison groups: 194 cocaine-exposed adolescents and their primary caregivers; and 188 non-cocaine exposed adolescents and their primary caregivers (control group).

Minnes explains that analyses of data from earlier phases of her research have found that cocaine exposure has negatively affected brain development and related cognitive development of infants and children. So in this phase of the study, researchers are examining if prenatal cocaine exposure continues to interfere with development during adolescence, particularly in four areas: executive function of the brain (e.g., attention, motivation, self-regulation, organizing, planning); cognitive function (e.g., language, non-verbal problem solving); risk-taking behavior; and mental health (e.g., problems with attention and delinquency). The researchers are also exploring if cocaine exposure may increase these risk-taking behaviors:

  • Use of alcohol, tobacco, and other drugs
  • Risky sexual activity
  • Delinquent and violent behaviors
  • Current Activities

Minnes and her team are currently analyzing data they collected from 15-year old subjects. Preliminary results suggest that adolescents exposed prenatally to cocaine are twice as likely to use an addictive substance at this age. 

Also, heavy exposure to cocaine prenatally appears to predict use of any addictive substance (e.g., alcohol, marijuana). In addition, prenatally-exposed females tend to exhibit more delinquent behavior than those females not exposed prenatally. Examples include stealing, fighting, disobedience, lying, cheating, and destructive behavior, among others. These results were recently published in Neurotoxicology and Teratology.

This past year, Minnes and researchers from the School of Medicine at Case Western Reserve received an alliance grant from the university. The grant will support cross-disciplinary initiatives for existing and proposed research to enhance understanding of the impact of addiction on the course of infectious disease.


While Minnes and Tracy are investigating experiences of substance abuse, SAMI Center Co-Director David Biegel, PhD, is investigating experiences of severe mental illness. He is the principal investigator of a two-year study, titled "Strengthening the Social Networks of Clubhouse Members,” which is funded by the Woodruff Foundation of Cleveland and The Cleveland Foundation.

Biegel’s study is being conducted at the Magnolia Clubhouse, a community-based program of psychosocial rehabilitation located in Cleveland. It primarily serves people diagnosed with schizophrenia, bipolar spectrum disorder, and major depression. It currently serves approximately 380 people (members), with an average of 80 people attending each day. Psychosocial rehabilitation is important, because symptoms of severe mental illness often impair a person's cognition (e.g., memory, thinking) and social cognition (e.g., ability to interpret social cues accurately and to respond appropriately), making them more vulnerable to social isolation and loneliness.

Magnolia is one of only 200 Clubhouses in the United States accredited by the International Center for Clubhouse Development Model. The Clubhouse model was recently recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice. Research shows that social networks and social connectedness are important for helping individuals maintain physical health and mental health and for recovering from episodes of illness. Biegel’s study is filling a gap in the research literature, because there have been few studies of the impact of the Clubhouse model upon members' social networks and social isolation. The study looks closely at the following:
Size, composition, and quality (e.g., amount of social support) of social networks of Clubhouse members

  • Relationship between social network size, quality, and composition to Clubhouse members’ quality of life, recovery, social functioning, and loneliness
  • Relationship of Clubhouse participation to members’ social networks, quality of life, functioning, and loneliness

The research team recently finished interviews with 135 members of Magnolia and will soon conduct qualitative interviews with relatives of Clubhouse members. The team is also conducting a national survey of Clubhouses throughout the country to examine the role and degree of family involvement in Clubhouse activities and operations. Analyses of current data have revealed these preliminary results:

  • Average age of participants in the study is 44.2 years.
  • Over half are African American (53.8 percent) and predominately male (70 percent).
  • Almost three-fifths (58.8 percent) have a diagnosis of schizophrenia.
  • Higher number of Clubhouse visits is associated with lower levels of loneliness (social isolation).
  • Higher satisfaction with relationships is also associated with lower levels of loneliness (social isolation).

Biegel explains that previous studies have shown that Clubhouses can positively impact members’ employment status and recovery. This study’s preliminary data suggests that participation in the socially-oriented Clubhouse model can be a helpful resource to reduce loneliness and social isolation.

"The Clubhouse model has been an important resource in Cleveland and communities throughout the nation for a long time,” Biegel says. "We anticipate this project will provide valuable information to help shape its course for the future.”


In discussing the SAMI Center, Biegel notes that faculty members Lenore A. Kola, PhD, and Gerald A. Strom, MSW, continued the successful implementation of the "Cuyahoga County Behavioral Health Training and Intern Program.”  

Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at Case Western Reserve University, a partnership between the Mandel School of Applied Social Sciences and Department of Psychiatry at the Case Western Reserve School of Medicine.