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Morris DH, Davis AK, Lauritsen KJ, Rieth CM, Silvestri MM, Winters JJ, Chermack ST. Substance use consequences, mental health problems, and readiness to change among Veterans seeking substance use treatment. J Subst Abuse Treat 2018; 94:113-121. [PMID: 30243411 DOI: 10.1016/j.jsat.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 01/07/2023]
Abstract
Individuals seeking substance use treatment who have one or more co-occurring mental health problems tend to have lower treatment engagement, higher rates of attrition, and poorer treatment outcomes. Readiness to change (RTC) is an integral construct in the recovery process, with higher RTC associated with improved treatment outcomes. However, the impact of psychiatric symptoms on RTC is not fully understood, especially among specialty subpopulations, such as military Veterans. Therefore, the aim of the present study was to examine the associations of mental health problems with RTC in a sample of Veterans initiating outpatient substance use treatment. The present sample was comprised of 278 Veterans (12% women, Mage = 48.22, SD = 14.06) who completed self-report intake measures assessing past month substance use frequency, substance-related consequences, symptoms of insomnia, depression, and anxiety, and importance and confidence to change one's substance use. Four separate canonical correlation analyses focusing on RTC alcohol, opioid, cannabis, and nicotine use were conducted. Veterans' inclusion in each analysis was not mutually exclusive. Results indicated that greater depression, anxiety, consequences, and frequency of alcohol use corresponded with greater importance to change alcohol use. Likewise, greater depression, anxiety, and insomnia symptoms along with frequency of use and consequences related to greater importance and confidence to change one's opioid use. In contrast, greater anxiety, depression, insomnia, and frequency of use were associated with less confidence in one's ability to change cannabis use. None of these variables were related to one's RTC nicotine use. Findings highlight the importance of assessing mental health problems at outset of substance use treatment, as they may be an indication of RTC and could be used as a catalyst to advance Veterans forward in the process of behavior change.
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Affiliation(s)
- David H Morris
- Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Alan K Davis
- Department of Psychiatry, University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Kirstin J Lauritsen
- Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - C Martin Rieth
- Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Mark M Silvestri
- Cincinnati Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA
| | - Jamie J Winters
- Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Stephen T Chermack
- Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
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Bergman BG, Kelly JF, Nargiso JE, McKowen JW. "The Age of Feeling in-Between": Addressing Challenges in the Treatment of Emerging Adults With Substance Use Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Majer JM, Payne JC, Jason LA. Recovery resources and psychiatric severity among persons with substance use disorders. Community Ment Health J 2015; 51:437-44. [PMID: 25069418 PMCID: PMC4310816 DOI: 10.1007/s10597-014-9762-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/06/2014] [Indexed: 11/30/2022]
Abstract
A comparative analysis of recovery resources (abstinence social support, abstinence self-efficacy) was conducted among two groups exiting inpatient treatment for substance use disorders: persons with psychiatric comorbid substance use disorders and persons with substance use disorders. Both groups reported comparable levels of abstinence social support, but this resource was not significantly related to substance use among persons with psychiatric comorbid substance use disorders. Although abstinence self-efficacy was significantly related to substance use, persons with psychiatric comorbid substance use disorders reported significantly lower levels of abstinence self-efficacy than persons with substance use disorders. Findings suggest that persons with psychiatric comorbid substance use disorders exit alcohol/drug treatment with lower levels of abstinence self-efficacy compared to their substance use disorder peers.
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Affiliation(s)
- John M Majer
- Social Sciences Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA,
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Roush S, Monica C, Carpenter-Song E, Drake RE. First-Person Perspectives on Dual Diagnosis Anonymous (DDA): A Qualitative Study. J Dual Diagn 2015; 11:136-41. [PMID: 25781586 DOI: 10.1080/15504263.2015.1025215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE People with dually diagnosed substance abuse and mental illnesses often feel alienated at traditional 12-step meetings, yet they need the peer support provided by such groups. Dual Diagnosis Anonymous (DDA) is a peer-support program specifically for people with co-occurring disorders, which addresses many of the factors that members find alienating about traditional 12-step groups. This study aimed to elicit first-person perspectives on DDA. METHODS Occupational therapy students conducted 13 focus groups with 106 DDA members in three settings: the community (6 groups, n = 36), correctional facilities (5 groups, n = 53), and the state psychiatric hospital (2 groups, n = 17). Researchers inductively analyzed focus group transcripts to identify prominent themes. RESULTS The vast majority of participants were between the ages of 18 and 49 (n = 87, 82.1%) and were non-Hispanic/White (n = 82, 77.4%). Most participants had been using substances for more than 10 years and had a diagnosed mental illness for more than 10 years. The most common substance of choice among those in the community and corrections setting was multiple substances, while those in the state hospital identified alcohol most often. Bipolar disorder was the most common mental illness diagnosis among participants in the state hospital, but depression and anxiety were the two most common diagnoses in the community and corrections participants. Four primary themes emerged from the qualitative analysis: (1) feeling accepted by others in the group, (2) understanding the interactive nature of dual disorders, (3) the open discussions in DDA meetings, and (4) a focus on hope and recovery from both illnesses. CONCLUSIONS DDA provides a helpful alternative for individuals who do not feel comfortable at traditional 12-step groups due to their mental illness. Members value the acceptance, understanding, discussion, and hope in DDA meetings.
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Factors That Affect Treatment Initiation Among Individuals With Serious Mental Illness and Substance Abuse Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2014. [DOI: 10.1097/adt.0b013e31827914b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aase DM, Jason LA, Ferrari JR, Li Y, Scott G. Comorbid mental health and substance abuse issues among individuals in recovery homes: Prospective environmental mediators. MENTAL HEALTH AND SUBSTANCE USE : DUAL DIAGNOSIS 2014; 7:170-183. [PMID: 24678342 DOI: 10.1080/17523281.2013.806342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Individuals with comorbid internalizing psychological symptoms and substance abuse issues often have more negative outcomes and evidence a relative disparity in treatment gains compared to those with only substance abuse issues. The present study examined social mechanisms over time for individuals living in self-governed recovery homes (Oxford Houses) such as 12-step group activities and social support, which likely influence both abstinence and psychological outcomes. Participants (n = 567) from a national United States sample of Oxford Houses completed baseline and multiple follow-up self-report assessments over a one-year period. A structural equation model was utilized to evaluate predicted relationships among baseline symptoms, 12-step activities, social support, and outcome variables. Results indicated that internalizing symptoms were associated with subsequent mutual help activities, but not directly with social support. Living in an Oxford House for six months and number of 12-step meetings attended were partially mediated by social support variables in predicting abstinence outcomes, but not psychological outcomes. Environments such as Oxford Houses may be viable options for recovering individuals with comorbid internalizing psychological problems, although social support mechanisms primarily promote abstinence. Implications for future research and for Oxford House policies are discussed.
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Affiliation(s)
- Darrin M Aase
- Governors State University, Department of Addictions Studies and Behavioral Health, 1 University Parkway, University Park, IL, USA 60484
| | - Leonard A Jason
- DePaul University, Center for Community Research, 990 W. Fullerton Ave. Suite 3100, Chicago, IL, USA 60614
| | - Joseph R Ferrari
- DePaul University, Department of Psychology, 2219 N. Kenmore Ave., Chicago, IL, USA 60614
| | - Yan Li
- DePaul University, Department of Psychology, 2219 N. Kenmore Ave., Chicago, IL, USA 60614
| | - Greg Scott
- DePaul University, Department of Sociology, 990 W. Fullerton Ave. Suite 3100, Chicago, IL, USA 60614
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Chi FW, Sterling S, Campbell CI, Weisner C. 12-step participation and outcomes over 7 years among adolescent substance use patients with and without psychiatric comorbidity. Subst Abus 2013; 34:33-42. [PMID: 23327502 PMCID: PMC3558833 DOI: 10.1080/08897077.2012.691780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examines the associations between 12-step participation and outcomes over 7 years among 419 adolescent substance use patients with and without psychiatric comorbidities. Although level of participation decreased over time for both groups, comorbid adolescents participated in 12-step groups at comparable or higher levels across time points. Results from mixed-effects logistic regression models indicated that for both groups, 12-step participation was associated with both alcohol and drug abstinence at follow-ups, increasing the likelihood of either by at least 3 times. Findings highlight the potential benefits of 12-step participation in maintaining long-term recovery for adolescents with and without psychiatric disorders.
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Affiliation(s)
- Felicia W Chi
- Divisionof Research, Kaiser Permanente Northern California, 2000 Broadway,Oakland, CA 94612–2403, USA.
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Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:388-406. [PMID: 23731427 PMCID: PMC3753025 DOI: 10.1080/19371918.2013.774673] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Epidemiological studies find that psychiatric disorders, including mental disorders and substance use disorders, are common among adults and highly comorbid. Integrated treatment refers to the focus of treatment on two or more conditions and to the use of multiple treatments such as the combination of psychotherapy and pharmacotherapy. Integrated treatment for comorbidity has been found to be consistently superior compared to treatment of individual disorders with separate treatment plans. This article focuses on a review of the risks for developing comorbid disorders and the combinations of treatments that appear to be most effective for clients with particular comorbid disorders.
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Affiliation(s)
- Thomas M Kelly
- The Center for Psychiatric and Chemical Dependency Services, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Ullman SE, Najdowski CJ, Adams EB. Women, Alcoholics Anonymous, and Related Mutual Aid Groups: Review and Recommendations for Research. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.718969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Unlicensed Boarding House Managers’ Experiences and Perceptions of Need in Residents with Mental Health and Substance Use Problems. Int J Ment Health Addict 2012. [DOI: 10.1007/s11469-012-9381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Definitions of cultural competence often refer to the need to be aware and attentive to the religious and spiritual needs and orientations of patients. However, the institution of psychiatry maintains an ambivalent attitude to the incorporation of religion and spirituality into psychiatric practice. This is despite the fact that many patients, especially those from underserved and underprivileged minority backgrounds, are devotedly religious and find much solace and support in their religiosity. I use the case of mental health of African Americans as an extended example to support the argument that psychiatric services must become more closely attuned to religious matters. I suggest ways in which this can be achieved. Attention to religion can aid in the development of culturally competent and accessible services, which in turn, may increase engagement and service satisfaction among religious populations.
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Affiliation(s)
- Rob Whitley
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
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Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav 2012; 37:11-24. [PMID: 21981788 DOI: 10.1016/j.addbeh.2011.09.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/29/2011] [Accepted: 09/06/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients. METHOD Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity. RESULTS Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions. CONCLUSIONS Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.
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Kadden RM, Litt MD. The role of self-efficacy in the treatment of substance use disorders. Addict Behav 2011; 36:1120-6. [PMID: 21849232 DOI: 10.1016/j.addbeh.2011.07.032] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 05/26/2011] [Accepted: 07/21/2011] [Indexed: 11/18/2022]
Abstract
Self-efficacy is the belief that one has the ability to implement the behaviors needed to produce a desired effect. There has been growing interest in the role of self-efficacy as a predictor and/or mediator of treatment outcome in a number of domains. The present paper reviews the recent literature on self-efficacy in the substance abuse field. In numerous studies of substance abuse treatment, self-efficacy has emerged as an important predictor of outcome, or as a mediator of treatment effects. Despite these repeated positive findings, the self-efficacy concept has had little impact on the design of treatments. Since the concept was first introduced, there have been numerous suggestions regarding the means by which self-efficacy may be enhanced in clinical settings, but very little by way of empirical tests of those suggestions. This review concludes with a number of recommendations for further research to improve understanding of this potentially valuable concept and its interactions with other variables, and to develop effective strategies for enhancing self-efficacy.
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Affiliation(s)
- Ronald M Kadden
- Department of Psychiatry, School of Medicine, University of Connecticut Health Center, Farmington, CT 06030-3944, USA.
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Dere-Meyer C, Bender B, Metzl E, Diaz K. Psychotropic medication and art therapy: Overview of literature and clinical considerations. ARTS IN PSYCHOTHERAPY 2011. [DOI: 10.1016/j.aip.2010.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Russell-Mayhew S, von Ranson KM, Masson PC. How does overeaters anonymous help its members? A qualitative analysis. EUROPEAN EATING DISORDERS REVIEW 2010; 18:33-42. [PMID: 19827021 DOI: 10.1002/erv.966] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Overeaters Anonymous (OA) is a 12-step, self-help group for individuals who perceive themselves to have problems with compulsive overeating. Despite the popularity of OA and the frequent use of addictions-based treatments for eating disorders, little is known about how OA is helpful. The purpose of this qualitative study was to explore members' experiences with and perceptions of OA. We conducted three focus groups with self-selected members of OA (N = 20). We present three primary themes that emerged from the analysis of the focus groups' discussions, which emphasize why individuals entered OA, OA's 'tools', and how individuals perceived OA to 'work'. Overall, although participants agreed OA was helpful to them, there was no consensus regarding how OA 'works'.
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Affiliation(s)
- Shelly Russell-Mayhew
- Division of Applied Psychology, Faculty of Education, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada.
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