Essock 2006.

Methods	Allocation: randomised. Design: multi‐centre, 2 urban sites. Duration: 36 months. Setting: community (two sites). Location: Bridgeport and Hartford, Connecticut, USA.
Participants	Diagnosis: 76% DSM‐III‐R schizophrenia, 17% mood disorder with co‐occurring DSM‐III‐R substance use disorder ( 74% alcohol abuse, 81% other substances).* N = 198. Age: mean ˜ 37 years. Sex: 142 M, 56 F. Ethnicity: 55%, African American, 27% White, 14% Hispanic, 4% other. Inclusion criteria: major psychotic disorder and active substance use disorder within past 6 months, high service use in the past two years, homelessness or unstable housing, poor independent living skills, no pending legal charges, no medical conditions or mental retardation that would preclude participation, if inpatient, discharge scheduled.
Interventions	1. Psychosocial intervention: integrated ACT with a direct substance use component. N = 99. 2. Standard care: standard case management.** N = 99.
Outcomes	Leaving the study early: lost to treatment, lost to evaluation. Adverse event: death. Service use: relapse (number of patients hospitalised during study). Global state: GAS (see GAF). Quality of life/life satisfaction: QOLI (General Life Satisfaction Scale). Homelessness: number of days living in stable community residences. Unable to use Substance use: AUS, DUS, SATS, number of days using in the past 6 months (skewed data). Mental state: Expanded BPRS Hospitalisation: days in hospital and days in hospital or in jail (skewed data).
Notes	Not ITT analysis. * Some participants had more than one dependence. *Participants paid US $15 for each interview and additional $5 for each urine and saliva sample. ** Refer to correspondence regarding clinical case management team (Kanter 2006). Authors kindly provided additional data.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomised using separate computer‐generated randomisation stream for each site.
Allocation concealment (selection bias)	Unclear risk	No details.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Clinician‐/participant‐mediated and participants and personnel not blinded. It is not possible to blind a psychosocial intervention.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Raters were blind to allocation.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Lost to follow‐up: 14% (27/198) 3 years. Insufficient reporting of missing data (numbers and reasons for missing data are reported for the total sample, not for each intervention group). Seven randomised participants were lost for administrative reasons, but their intervention allocation was not reported.
Selective reporting (reporting bias)	Unclear risk	Listed outcomes of interest are fully reported for each site, one site had better outcomes than the other. Author provided further data of combined sites for each treatment.
Other bias	Low risk	Public funded. No further details. No evidence other biases are occurring.