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Maremmani AGI, Aglietti M, Intaschi G, Bacciardi S. Substance Use/Dependence in Psychiatric Emergency Setting Leading to Hospitalization: Predictors of Continuity of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020760. [PMID: 35055582 PMCID: PMC8775711 DOI: 10.3390/ijerph19020760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022]
Abstract
Background: Poor adherence to treatment is a common clinical problem in individuals affected by mental illness and substance use/dependence. In Italy, mental care is organized in a psychiatric service and addiction unit (SERD), characterized by dual independent assets of treatment. This difference, in the Emergency Room setting, leads to a risk of discontinuity of treatment in case of hospitalization. In this study we clinically characterized individuals who decided to attend hospital post-discharge appointments at SERD, in accordance with medical advice. Methods: This is a retrospective study, based on two years of discharged records of patients entering “Versilia Hospital” (Viareggio, Italy) emergency room, with urinalyses testing positive for substance use, and hospitalization after psychiatric consultation. The sample was divided according to the presence or absence of SERD consultation after discharge. Results: In the 2-year period of the present study, 1005 individuals were hospitalized. Considering the inclusion criterion of the study, the sample consisted of 264 individuals. Of these, 128 patients attended post-discharge appointments at SERD showing urinalyses positive to cocaine, opiates, and poly use; they were more frequently diagnosed as personality disorder and less frequently as bipolar disorder. The prediction was higher for patients that had already been treated at SERD, for patients who received SERD consultation during hospitalization, and for patients with positive urinalyses to cocaine and opiates at treatment entry. Conversely, patients who did not attend SERD consultation after discharge were affected by bipolar disorders. Limitations: Small sample size. Demographical data are limited to gender and age due to paucity of data in hospital information systems. SERD is located far from the hospital and is open only on weekdays; thus, it cannot ensure a consultation with all inpatients. Conclusions: Mental illness diagnosis, the set of substance use positivity at hospitalization, and having received SERD consultation during hospitalization appeared to have a critical role in promoting continuity of care. Moreover, to reduce the gap between the need and the provision of the treatment, a more effective personalized individual program of care should be implemented.
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Affiliation(s)
- Angelo Giovanni Icro Maremmani
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy;
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Lucca, Italy
- PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-328-8427217; Fax: +39-0584-6055242
| | - Mirella Aglietti
- SERD (Drug Addiction Service), Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, 55049 Viareggio, Italy; (M.A.); (G.I.)
| | - Guido Intaschi
- SERD (Drug Addiction Service), Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, 55049 Viareggio, Italy; (M.A.); (G.I.)
| | - Silvia Bacciardi
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy;
- PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy
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Watkins KE, Hunter SB, Cohen CC, Leamon I, Hurley B, McCreary M, Ober AJ. Organizational Capacity and Readiness to Provide Medication for Individuals with Co-Occurring Alcohol Use Disorders in Public Mental Health Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:707-717. [PMID: 33387128 PMCID: PMC8628547 DOI: 10.1007/s10488-020-01103-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Alcohol use disorders (AUD) in individuals with mental illness are largely untreated. The purpose of this study was to identify gaps in organizational capacity and readiness to provide medications for AUD in outpatient public mental health clinics. We selected a purposive sample of eight publicly funded outpatient mental health clinics operated by the Los Angeles County Department of Mental Health; clinics were chosen to maximize heterogeneity. Guided by theories of organizational capacity and readiness and research on the adoption of pharmacotherapy for AUD in primary and specialty care treatment settings, we conducted semi-structured interviews and focus groups with administrators, providers and staff, and a qualitative analysis of the results. Respondents described significant organizational capacity and behavioral readiness constraints to providing medication treatment for AUD. Both groups articulated a perception that mental health clinics were not designed to provide co-occurring AUD treatment because of large caseloads, staffing configurations, and time constraints that did not support the delivery of appropriate treatment, and a lack of protocols and workflow procedures. We documented organizational capacity and readiness constraints which impede the delivery of medication treatment for AUD in a large mental helth system. While some constraints have straightforward solutions, others require structural changes to the way care is delivered, and state-level funding and policy changes.
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Affiliation(s)
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Michael McCreary
- Health Services and Society, UCLA Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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Searby A, Maude P, McGrath I. Improving Care Provision to Older Adults with Dual Diagnosis: Recommendations from a Mixed-Methods Study. Issues Ment Health Nurs 2020; 41:229-234. [PMID: 31661654 DOI: 10.1080/01612840.2019.1648618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Older adults with dual diagnosis remain an under-diagnosed population in mental health services, with complex needs and high rates of medical comorbidity. Dual diagnosis is a significant challenge to contemporary mental health services, with recognition of the increased rate of relapse and costs of care of poorly managed dual diagnosis identified through comprehensive research. Unfortunately, the research attention paid to those with dual diagnosis in younger age groups has not been replicated in the older adult cohort, with few studies specifically exploring the treatment needs of these individuals. Of the studies that do exist, many identify poor screening and assessment, clinician frustration and a lack of cohesive treatment for co-occurring alcohol and other drug use disorders for older adults. We draw from a mixed methods exploratory study conducted in an inner Melbourne community older adult mental health service providing care to consumers with dual diagnosis to formulate recommendations to improve the care provision to this cohort. We discuss changes to the way older adult mental health services operate that are essential to improve the care and response to consumers presenting with dual diagnosis. Ultimately, we aim to discuss how older adult mental health services can improve to provide timely, responsive care to those with dual diagnosis.
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Affiliation(s)
- Adam Searby
- School of Health and Biomedical Sciences-Nursing, RMIT University, Bundoora, Australia
| | - Phillip Maude
- School of Health and Biomedical Sciences-Nursing, RMIT University, Bundoora, Australia.,University of Tasmania, School of Health Sciences (Nursing), RMIT University, Hobart, Australia
| | - Ian McGrath
- School of Health and Biomedical Sciences-Nursing, RMIT University, Bundoora, Australia
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4
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Mauro PM, Furr-Holden CD, Strain EC, Crum RM, Mojtabai R. Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach. Drug Alcohol Depend 2016; 163:108-15. [PMID: 27106113 PMCID: PMC4880516 DOI: 10.1016/j.drugalcdep.2016.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities. METHODS We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes. RESULTS A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs. CONCLUSIONS Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.
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Affiliation(s)
- Pia M. Mauro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore MD 21205 USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 Street, New York NY 10032 USA,Address correspondence to Pia M. Mauro: Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 Street #R228D, New York NY 10032
| | - C. Debra Furr-Holden
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore MD 21205 USA
| | - Eric C. Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore MD 21205 USA
| | - Rosa M. Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore MD 21205 USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore MD 21205 USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
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Carrà G, Bartoli F, Brambilla G, Crocamo C, Clerici M. Comorbid Addiction and Major Mental Illness in Europe: A Narrative Review. Subst Abus 2014; 36:75-81. [DOI: 10.1080/08897077.2014.960551] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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McGovern MP, Lambert-Harris C, Gotham HJ, Claus RE, Xie H. Dual diagnosis capability in mental health and addiction treatment services: an assessment of programs across multiple state systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:205-14. [PMID: 23183873 PMCID: PMC3594447 DOI: 10.1007/s10488-012-0449-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the dual diagnosis capability in addiction treatment and dual diagnosis capability in mental health treatment indexes, and sampled 256 programs across the United States. Approximately 18 % of addiction treatment and 9 % of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures.
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Affiliation(s)
- Mark P McGovern
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA,
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Assessing the co-occurring capability of mental health treatment programs: the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index. J Behav Health Serv Res 2014; 40:234-41. [PMID: 23334656 DOI: 10.1007/s11414-012-9317-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index was developed to assess the capability of mental health programs to provide substance abuse and co-occurring treatment services. The DDCMHT is an objective scale rated following a site visit that includes semi-structured interviews with staff at all levels, review of program documents and client charts, and ethnographic observation of the milieu and setting. Using data from 67 mental health programs across six states, this study found that the DDCMHT had excellent total score reliability, variable subscale reliability, high inter-rater reliability (n = 18), and moderate construct validity (n = 22). Results also suggest that many mental health programs are at a relatively low level of capability for the delivery of care to individuals with co-occurring disorders. Results from this important new benchmark measure, the DDCMHT, can be used with programs in implementation planning and with treatment systems, states, or national organizations to guide policy change.
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8
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Abstract
Clinical management of HIV must account for the "triple diagnosis" of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990s, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention.
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Laudet AB, Humphreys K. Promoting recovery in an evolving policy context: what do we know and what do we need to know about recovery support services? J Subst Abuse Treat 2013; 45:126-33. [PMID: 23506781 PMCID: PMC3642237 DOI: 10.1016/j.jsat.2013.01.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/23/2012] [Accepted: 01/28/2013] [Indexed: 11/23/2022]
Abstract
As both a concept and a movement, "recovery" is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40years, recovery research and the lived experience of recovery from addiction should be central to reform.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery at National Development and Research Institutes, Inc., (NDRI), 71 West 23rd Street, 8th floor, NYC, NY 10010, USA.
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10
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Boden MT, Moos R. Predictors of substance use disorder treatment outcomes among patients with psychotic disorders. Schizophr Res 2013; 146:28-33. [PMID: 23453585 DOI: 10.1016/j.schres.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 12/01/2022]
Abstract
Although integrated approaches are recommended and effective for treating patients with co-occurring substance use and psychotic disorders (SUD-PSY), many patients receive standard, nonintegrated substance use disorder (SUD) treatment. Research has yet to investigate how patients with co-occurring substance use and psychotic disorders respond to standard SUD treatment, an issue we address here. In a naturalistic follow-up of 236 male SUD-PSY patients receiving 12-step facilitation or cognitive-behavioral-oriented SUD treatment, we found that patients (1) demonstrated significant improvements in proximal outcomes (e.g., approach coping) from treatment intake to discharge, and in distal outcomes (e.g., psychiatric symptoms, substance use frequency) from treatment intake to 1- and 5-year follow-ups, and (2) tended to have similar outcomes whether they received 12-step facilitation or cognitive-behavioral SUD treatment. Patients who (3) were more involved in treatment, as reflected by more positive perceptions of and more satisfaction, tended to experience better proximal outcomes and engage in more continuing care, and those who (4) experienced better proximal outcomes tended to have better psychiatric and substance use outcomes in the years following treatment. Our results suggest that SUD-PSY patients can benefit from standard SUD treatments, even though it may not directly address their psychiatric disorders.
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Affiliation(s)
- Matthew Tyler Boden
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, United States.
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Padwa H, Larkins S, Crevecoeur-Macphail DA, Grella CE. Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs. J Dual Diagn 2013; 9:179-186. [PMID: 23687469 PMCID: PMC3655772 DOI: 10.1080/15504263.2013.778441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Improved understanding of the relative strengths and weaknesses of treatment organizations' dual diagnosis capability is critical in order to guide efforts to improve services. This study assesses programs' capacity to meet the needs of clients with dual diagnosis, identifies areas where they are well equipped to serve these clients, and determines where programmatic improvement is needed. The study also undertakes an initial exploration of the potential impact that funding sources have on dual diagnosis capability. METHODS We administered Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments at 30 treatment programs in two California counties. Seven of the programs received funding to provide both mental health and substance use disorder services, 13 received funding to provide mental health services, and 10 received funding to provide substance use disorder services. RESULTS The mean DDCAT/DDCMHT score of programs in the sample was 2.83, and just over 43% of the sample met or exceeded DDCAT/DDCMHT criteria for dual diagnosis capability. Programs scored highest and had the highest rates of dual diagnosis capability in domains related to assessment, training, and staffing, whereas scores were weakest and rates of dual diagnosis capability were lowest in the program structure, treatment, and continuity of care domains. Programs that received funding to provide both mental health and substance use disorder services consistently scored higher than the other programs in the sample, and mental health programs scored higher than substance use disorder treatment programs both on the overall assessments and in most domains. CONCLUSIONS Findings suggest that programs in the sample are functioning at a nearly dual diagnosis capable level. However, structural barriers continue to limit providers' capacity to serve clients with co-occurring mental health and substance use disorders, and many organizations have not yet translated their potential to deliver dual diagnosis capable services into practice. By enhancing their program structure, treatment services, and continuity of care services, these treatment organizations should be able to deliver fully dual diagnosis capable services. Observed differences in dual diagnosis capability based on funding source indicate a need for further research to better understand the impact that funding streams have on dual diagnosis capability.
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Affiliation(s)
- Howard Padwa
- UCLA Integrated Substance Abuse Programs, UCLA Center for Health Services and Society
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12
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Laudet AB. Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery. J Addict Dis 2012; 31:288-302. [PMID: 22873190 DOI: 10.1080/10550887.2012.694604] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Employment is a key functioning index in addiction services and consistently emerges as a goal among individuals in recovery. Research on the employment status in the addiction field has focused on treatment populations or welfare recipients; little is known of employment rates or their predictors among individuals in recovery. This study seeks to fill this gap, capitalizing on a sample (N = 311) of urban individuals at various stages of recovery. Fewer than half (44.5%) of participants were employed; in logistic regressions, male gender and Caucasian race enhanced the odds of employment, whereas having a comorbid chronic physical or mental health condition decreased the odds by half. Implications center on the need to identify effective strategies to enhance employability among women and minorities and for integrated care for individuals with multiple chronic conditions.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery, National Development and Research Institutes, Inc., New York, New York 10010, USA.
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Enderby P. How much therapy is enough? The impossible question! INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:432-437. [PMID: 22708975 DOI: 10.3109/17549507.2012.686118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There is sufficient evidence in the literature related to speech-language pathology, physiotherapy, occupational therapy, and psychology to indicate that intensive therapy is required in order to influence the neurophysiological basis of various impairments. Conversely, the influence of therapy on reducing communication restriction, psychosocial impact, and well-being is less well documented in speech-language pathology, but research in related areas indicates that the amount of therapy required to have a positive influence on these areas is associated with a broad range of individual and social factors. Intensive therapy takes considerable commitment on the part of the therapist, patient, and family members, and is not always achievable or acceptable. Therapists can incorporate a broad range of approaches to increase the amount of therapy available to individuals which may include expanding self-management, computerized therapy, use of the family members and volunteers, and improving skill mix. Most importantly it is essential to consider the objectives of the therapy when determining the intensity.
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Reupert A, Goodyear M, Maybery D. Engaging with, and understanding children whose parents have a dual diagnosis. Child Adolesc Ment Health 2012; 17:153-160. [PMID: 32847265 DOI: 10.1111/j.1475-3588.2011.00622.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The perspective of children whose parents have a mental health and a substance use disorder (dual diagnosis) are rarely considered in either research or clinical practice. This study sought to (i) identify the issues when engaging children whose parents have a dual diagnosis into research, and (ii) present their needs and preferred supports. METHOD Semi-structured, qualitative interviews were conducted with 12 children whose parent had a dual diagnosis. Analyses involved thematic analysis, inter-rater reliability and respondent validation. RESULTS Building trust with parents was crucial to gain access to children. Children described the importance of family, the secrecy around their parent's substance abuse, and various maladaptive coping strategies. Children requested more positive times in their families and specific support for their parent's substance abuse. CONCLUSION The primacy of family in the child's life is highlighted. The need to acknowledge and work with the individual needs of children and parents, as well as family dynamics, is indicated.
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Affiliation(s)
- Andrea Reupert
- Monash University, Faculty of Education, PO Box 6, Clayton, Victoria 3800, Australia. e-mail:
| | - Melinda Goodyear
- Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, VIC, Australia.,The Bouverie Centre, La Trobe University, Brunswick, VIC, Australia
| | - Darryl Maybery
- Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, VIC, Australia
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Matusow H, Rosenblum A, Fong C, Laudet A, Uttaro T, Magura S. Factors associated with mental health clinicians' referrals to 12-Step groups. J Addict Dis 2012; 31:303-12. [PMID: 22873191 PMCID: PMC3425942 DOI: 10.1080/10550887.2012.694605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually diagnosed clients to 12-Step groups. This study examined the relationships among clinicians' 12-Step experiences, attitudes, and referral practices in 6 mental health clinics in New York, New York. A path analysis model showed that greater interest in learning about 12-Step groups directly predicted 12-Step referral practices and that 12-Step interest was predicted by clinicians' perception of the helpfulness of 12-Step groups and the severity of their patients' problems with substance abuse. Clinicians' responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-Step groups.
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Affiliation(s)
| | | | - Chunki Fong
- NDRI, 71 W 23 St., New York, NY 10010, Ph: 212-845-4522
| | | | - Thomas Uttaro
- South Beach Psychiatric Center, 777 Seaview Avenue, Staten Island, NY 10305, Ph: 718-667-2742
| | - Stephen Magura
- Western Michigan University, 1903 W. Michigan Ave., 4405 Ellsworth, Kalamazoo, MI 49008-5237, Ph: 269-387-5895
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Kola LA, Kruszynski R. Adapting the Integrated Dual-Disorder Treatment Model for Addiction Services. ALCOHOLISM TREATMENT QUARTERLY 2010. [DOI: 10.1080/07347324.2010.511067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sterling S, Weisner C, Hinman A, Parthasarathy S. Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities. J Am Acad Child Adolesc Psychiatry 2010; 49:637-46; quiz 725-6. [PMID: 20610133 PMCID: PMC3045032 DOI: 10.1016/j.jaac.2010.03.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 03/23/2010] [Accepted: 03/31/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the research on economic and systemic barriers faced by adolescents needing treatment for alcohol and drug problems, particularly those with co-occurring conditions. METHOD We reviewed the literature on adolescent access to alcohol and drug services, including early intervention, and integrated and specialty mental health treatment for those with co-occurring disorders, examining the role of health care systems, public policy (health reform), treatment financing and reimbursement systems (public and private), implementation of evidence-based practices, confidentiality practices, and treatment costs and cost/benefits. RESULTS Barriers to treatment, particularly integrated treatment, are largely rooted in our organizationally fragmented health care system, which encompasses public and private, carved-out and integrated systems, and different funding mechanisms (Medicaid versus block grants versus private insurance that include "high deductible" plans and other cost controls.) In both systems, carved-out programs de-link services from other mental health and general health care. Barriers are also rooted in disciplinary differences and weak clinical linkages between psychiatry, primary care and substance use, and in confidentiality policies that inhibit communication and coordination, while protecting patient privacy. CONCLUSION In this era of health care reform, we have the opportunity to increase access for adolescents and develop new models of integrated services for those with co-occurring conditions. We discuss opportunities for improving treatment access and implementation of evidence-based practices, examine implications of health reform and parity legislation for psychiatric and substance use treatment, and comment on key unanswered questions and future research opportunities.
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Affiliation(s)
- Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, USA.
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Greenfield L, Wolf-Branigin M. Mental Health Indicator Interaction in Predicting Substance Abuse Treatment Outcomes in Nevada. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 35:350-7. [DOI: 10.1080/00952990903108223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gotham HJ, Claus RE, Selig K, Homer AL. Increasing program capability to provide treatment for co-occurring substance use and mental disorders: organizational characteristics. J Subst Abuse Treat 2009; 38:160-9. [PMID: 19717273 DOI: 10.1016/j.jsat.2009.07.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 06/12/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
Abstract
The Dual Diagnosis Capability in Addiction Treatment and the Dual Diagnosis Capability in Mental Health Treatment indexes were used to document change in the capability of 14 substance abuse and mental health agencies to provide services to clients with co-occurring substance use and mental disorders (COD). COD capability significantly increased over 2 years, with the largest improvements seen in client assessment and staff training for COD. The role of agency structural characteristics and organizational readiness for change was also investigated. The study found modest evidence that some structural characteristics (e.g., agency size) and organizational readiness for change were related to increased COD capability. Further study is needed of how these factors affect implementation and fidelity to evidence-based practices, including how programs might compensate for or modify the effects of organizational factors to enhance implementation efforts.
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Affiliation(s)
- Heather J Gotham
- Mid-America Addiction Technology Transfer Center, University of Missouri-Kansas City, Kansas City, MO 64110-2499, USA.
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20
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Boden MT, Moos R. Dually diagnosed patients' responses to substance use disorder treatment. J Subst Abuse Treat 2009; 37:335-45. [PMID: 19540699 DOI: 10.1016/j.jsat.2009.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/19/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
Abstract
Few studies have investigated whether dually diagnosed patients with co-occurring substance use and psychiatric disorders (DD) respond as well to substance use disorder (SUD) treatments as patients with SUD do. Here we assessed whether male veteran DD and SUD patients with alcohol dependence diagnoses differed in the process and outcomes of residential SUD treatment. The main findings showed that (a) DD patients did not perceive SUD programs as positively as patients with SUD did and had worse proximal outcomes at discharge from treatment; (b) DD patients did as well as SUD patients on 1- and 5-year substance use outcomes but had worse psychiatric outcomes; and (c) patients who perceived treatment more positively and had better outcomes at discharge had better longer term outcomes. Thus, residential SUD programs are relatively effective in reducing DD patients' substance use problems; however, they are less successful in engaging DD patients in treatment and addressing their psychiatric problems.
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Affiliation(s)
- M Tyler Boden
- Department of Veterans Affairs Health Care System, Center for Health Care Evaluation, Health Services Research and Development Service, Stanford University School of Medicine, Palo Alto, CA, USA.
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21
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Chi FW, Weisner CM. Nine-year psychiatric trajectories and substance use outcomes: an application of the group-based modeling approach. EVALUATION REVIEW 2008; 32:39-58. [PMID: 18198170 PMCID: PMC2946827 DOI: 10.1177/0193841x07307317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study identifies longitudinal psychiatric trajectories of 934 adult individuals entering chemical dependency treatment in a private, managed care health plan and examines the relationship of these trajectories with substance use (SU) outcomes. The authors apply a group-based modeling approach to identify trajectory groups based on repeated measures of psychiatric severity for 9 years and identify four distinct groups. Results of multivariate logistic generalized estimating equation models find an association between psychiatric trajectories and long-term SU. Older cohorts and life course measures of marital status and employment status as individuals changed over time are related to drug and some alcohol outcomes.
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Affiliation(s)
- Felicia W Chi
- Kaiser Permanente Northern California, Oakland, CA 94612-2403, USA.
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Clark HW, Power AK, Le Fauve CE, Lopez EI. Policy and practice implications of epidemiological surveys on co-occurring mental and substance use disorders. J Subst Abuse Treat 2008; 34:3-13. [PMID: 17574794 DOI: 10.1016/j.jsat.2006.12.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 12/05/2006] [Accepted: 12/06/2006] [Indexed: 10/23/2022]
Abstract
This article describes factors that influence national policy and practice, with particular focus on the implications of epidemiological survey research. Examples of areas of concern to policymakers include treatment-seeking patterns, access to care at points of service in public health and social service systems, evidence-based practices, workforce development, and the complexities of reimbursement. In responding to data on systemic barriers to care, the Substance Abuse and Mental Health Services Administration (SAMHSA) has sought to promote a no wrong door strategy to address the needs of persons with co-occurring disorders (CODs) involving their mental health and substance use. Examples of SAMHSA programs and policies addressing CODs discussed in this article include targeted partnerships with the states, mechanisms to enhance system infrastructure, technical assistance, and initiatives with special populations.
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Affiliation(s)
- H Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, MD 20857, USA.
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No-Show for Treatment in Substance Abuse Patients with Comorbid Symptomatology: Validity Results from a Controlled Trial of the ASAM Patient Placement Criteria. J Addict Med 2007; 1:79-87. [DOI: 10.1097/adm.0b013e3180634c1d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grella CE, Greenwell L, Prendergast M, Farabee D, Hall E, Cartier J, Burdon W. Organizational characteristics of drug abuse treatment programs for offenders. J Subst Abuse Treat 2007; 32:291-300. [PMID: 17383553 PMCID: PMC1941644 DOI: 10.1016/j.jsat.2007.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 01/02/2007] [Accepted: 01/08/2007] [Indexed: 11/19/2022]
Abstract
This article examines the association between the organizational characteristics of drug abuse treatment programs for offenders and the provision of wraparound services and three types of treatment orientations. Data are from the National Criminal Justice Treatment Practices Survey, which was conducted with program directors (N = 217). A greater number of wraparound services provided were associated with inpatient treatment, specialized treatment facilities, community setting (vs. correctional), services provided for more types of client populations, college-educated staff, and planned treatment for > 180 days. Therapeutic community orientation was associated with prison-based treatment and specialized treatment facilities. Cognitive-behavioral therapy orientation was associated with higher perceived importance of community treatment, more perceived staff influence on treatment, and treatment for 91-180 days. The 12-step orientation was most strongly associated with having staff specialized in substance abuse. Study findings have implications for developing effective reentry programs for offenders that bridge correctional and community treatment.
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Affiliation(s)
- Christine E Grella
- UCLA Integrated Substance Abuse Programs, NPI-Semel Institute for Neuroscience, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90025, USA.
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