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Han HR, Miller HN, Nkimbeng M, Budhathoki C, Mikhael T, Rivers E, Gray J, Trimble K, Chow S, Wilson P. Trauma informed interventions: A systematic review. PLoS One 2021; 16:e0252747. [PMID: 34157025 PMCID: PMC8219147 DOI: 10.1371/journal.pone.0252747] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. METHODS We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. RESULTS More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hailey N. Miller
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Manka Nkimbeng
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Chakra Budhathoki
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tanya Mikhael
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emerald Rivers
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ja’Lynn Gray
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kristen Trimble
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sotera Chow
- Medstar Good Samaritan Hospital, Baltimore, Maryland, United States of America
| | - Patty Wilson
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
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Sabri B, Greene C, Lucas GM. A systematic review of comprehensive interventions for substance abuse: Focus on victimization. AGGRESSION AND VIOLENT BEHAVIOR 2019; 48:46-59. [PMID: 33312052 PMCID: PMC7732018 DOI: 10.1016/j.avb.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Violence victimization is common among men and women who use substances and is associated with co-occurring health issues such as PTSD, depression and HIV. Substance use interventions, therefore, should include integrated components that are designed to address co-occurring health issues among victimized substance-using individuals. This systematic review synthesized the evidence on efficacy of comprehensive, integrated, multicomponent interventions for victimized substance-using individuals. The efficacy of integrated multicomponent intervention strategies was assessed for the following syndemic conditions: mental health, substance misuse, violence, and HIV risk. Seventeen studies were identified. Examples of effective components were empowerment strategies for violence, mindfulness-based stress reduction for mental health, social cognitive skill building for addressing HIV risk and psychoeducation for substance misuse. Although in this review, some components were found to be effective, we identified methodological limitations of included studies which calls for more rigorous research in this area. Further, there is lack of evidence base for multicomponent interventions for victimized substance-using individuals in developing countries. Additional studies are needed to establish rigorous evidence base for multicomponent interventions for victimized substance using individuals that help them cope effectively with their trauma of violence and address their needs.
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Affiliation(s)
- Bushra Sabri
- School of Nursing, 525 North Wolfe Street, Johns Hopkins
University, Baltimore, MD 21205, United States of America
| | - Claire Greene
- Johns Hopkins Bloomberg School of Public Health, 624 North
Broadway, Baltimore, MD 21205, United States of America
| | - Gregory M. Lucas
- Johns Hopkins University School of Medicine, 1830 E.
Monument St, Baltimore, MD 21205, United States of America
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Lotzin A, Buth S, Sehner S, Hiller P, Pawils S, Metzner F, Read J, Härter M, Schäfer I. Reducing barriers to trauma inquiry in substance use disorder treatment - a cluster-randomized controlled trial. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:23. [PMID: 31142336 PMCID: PMC6541998 DOI: 10.1186/s13011-019-0211-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite the high rate of traumatic events in clients with substance use disorders, trauma exposure often remains undetected in a majority of treatment-seeking clients. Improving health professionals' knowledge and skills in the inquiry of traumatic events is therefore of utmost importance for appropriately addressing trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to the inquiry about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings that aim to improve the systematic inquiry of traumatic events. METHODS Using a cluster-randomized trial, we examined whether a one-day training in trauma inquiry ('Learning How to Ask') would reduce professionals' perceived barriers to trauma inquiry. One hundred forty-eight professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals in the intervention group received a one-day training plus a refresher session 3 months later, the professionals in the control group received no training. At baseline, and at 3-month and 6-month follow-up, professionals rated on a four-point Likert scale regarding how strongly they agreed with statements about six common barriers to trauma inquiry, namely 'Feeling uncomfortable when asking about traumatic events', 'Fear of offending the client', 'Fear of retraumatizing the client', 'Fear that client may terminate treatment', 'Unsure whether authorities have to be informed when perpetrator is known', and 'No trauma-specific treatment available in my local area'. RESULTS The trained group experienced significant greater decreases in five of the six perceived barriers to the inquiry of traumatic events from baseline to 6-month follow-up than the control group ('Feeling uncomfortable when asking about traumatic events': b = - 0.32, 95% CI [- 0.52, - 0.12]; 'Fear of offending the client': b = - 0.33, 95% CI [- 0.56, - 0.09]); 'Fear of retraumatizing the client': b = - 0.45, 95% CI [- 0.69, - 0.22]; 'Fear that client may terminate treatment': b = - 0.28, 95% CI [- 0.49, 0.07]; 'No trauma-specific treatment available in my local area': b = - 0.25, 95% CI [- 0.51, - 0.01]). CONCLUSIONS Our findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may in turn improve detection of traumatic events.
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Affiliation(s)
- Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.
| | - Sven Buth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Institute for Interdisciplinary Addiction and Drug Research, Hamburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Institute for Interdisciplinary Addiction and Drug Research, Hamburg, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franka Metzner
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John Read
- School of Psychology, University of East London, London, UK
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
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Bailey K, Trevillion K, Gilchrist G. What works for whom and why: A narrative systematic review of interventions for reducing post-traumatic stress disorder and problematic substance use among women with experiences of interpersonal violence. J Subst Abuse Treat 2019; 99:88-103. [DOI: 10.1016/j.jsat.2018.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/13/2022]
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Bailey KA, Baker AL, McElduff P, Jones MA, Oldmeadow C, Kavanagh DJ. Effects of Assault Type on Cognitive Behaviour Therapy for Coexisting Depression and Alcohol Misuse. J Clin Med 2017; 6:jcm6070072. [PMID: 28753976 PMCID: PMC5532580 DOI: 10.3390/jcm6070072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022] Open
Abstract
Although assault exposure is common in mental health and substance misusing populations, screening for assaults in treatment settings is frequently overlooked. This secondary analysis explored the effects of past sexual (SA) and physical (PA) assault on depression, alcohol misuse, global functioning and attrition in the Depression and Alcohol Integrated and Single focussed Intervention (DAISI) project, whose participants (N = 278) received cognitive behaviour therapy (CBT) for their depression and/or alcohol misuse. Of the 278 DAISI participants, 220 consented to screening for past assault (either by a stranger or non-stranger) at baseline. Depression, alcohol, and global functioning assessments were administered at baseline and 3, 12, 24, and 36 months post baseline. A between-group analysis was used to assess differences between SA and No SA, and PA and No PA groupings, on adjusted mean treatment outcomes across all assessment periods. SA and PA participants had similar mean symptom reductions compared to No SA and No PA participants except for lower depression and global functioning change scores at the 12-month follow-up. People with coexisting depression and alcohol misuse reporting SA or PA can respond well to CBT for depression and alcohol misuse. However, follow-up is recommended in order to monitor fluctuations in outcomes.
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Affiliation(s)
- Kylie A Bailey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
| | - Mark A Jones
- Hunter Medical Research Institute, 1/1 Kookaburra circuit, New Lambton Heights NSW 2305, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
- Hunter Medical Research Institute, 1/1 Kookaburra circuit, New Lambton Heights NSW 2305, Australia.
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4000, Australia.
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Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2017; 3:CD011618. [PMID: 28358173 PMCID: PMC6464073 DOI: 10.1002/14651858.cd011618.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability. OBJECTIVES To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence. MAIN RESULTS We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID). AUTHORS' CONCLUSIONS Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.
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Affiliation(s)
- Nicole Vogel
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
- Hirslanden Klinik BirshofLeonardoReinacherstrasse 28MünchensteinSwitzerland4142
| | - Stefan Schandelmaier
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonONCanadaL8S4L8
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchSpitalstrasse 12BaselSwitzerland4031
| | - Thomas Zumbrunn
- University of Basel HospitalClinical Trial UnitSchanzenstrasse 55BaselSwitzerland4031
| | | | - Wout EL de Boer
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
| | - Jason W Busse
- McMaster UniversityDepartment of Anesthesia1280 Main Street West, Rm. 2C12HamiltonONCanadaL8S 4K1
| | - Regina Kunz
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
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Moyes HCA, Heath JJ, Dean LV. What can be done to improve outcomes for prisoners with a dual diagnosis? ADVANCES IN DUAL DIAGNOSIS 2016. [DOI: 10.1108/add-07-2015-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to review the literature on offenders with a dual diagnosis and discuss how prison-based services can improve to better meet the needs of prisoners with co-occurring substance misuse and mental health disorders.
Design/methodology/approach
– A comprehensive literature search of PsycINFO, JSTOR, PubMed and Google Scholar, reviewing international studies on dual diagnosis amongst offender and community samples spanning the last three decades, supplemented by international policy, guidance papers and reports was conducted to explore how services can be improved.
Findings
– It was found that research into dual diagnosis amongst prisoners internationally was scarce. However, from the evidence available, several consistent factors emerged that led to the following recommendations: integrated treatment needs to be coordinated and holistic, staged and gender-responsive; increased availability of “low level”, flexible interventions; transitional support and continuity of care upon release with the utilisation of peer mentors; comprehensive assessments in conducive settings; mandatory dual diagnosis training for staff; and increased funding for female/gender-responsive services.
Practical implications
– The recommendations can inform commissioners, funders and service providers of areas where support must be improved to address the needs of prisoners with a dual diagnosis.
Social implications
– Improved outcomes for prisoners with a dual diagnosis would likely have a positive effect on society, with improvements in mental health and substance misuse treatment impacting on rates of reoffending.
Originality/value
– This paper brings originality and value to the sector because it reviews relevant research on dual diagnosis and translates it into practical implications for policy makers.
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Melchior M, Prokofyeva E, Younès N, Surkan PJ, Martins SS. Treatment for illegal drug use disorders: the role of comorbid mood and anxiety disorders. BMC Psychiatry 2014; 14:89. [PMID: 24670230 PMCID: PMC3986906 DOI: 10.1186/1471-244x-14-89] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 03/17/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Our aim was to examine whether comorbid mood and anxiety disorders influence patterns of treatment or the perceived unmet need for treatment among those not receiving treatment for illegal drug use disorders. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001-2002 and 2004-2005, n = 34,653). Lifetime DSM-IV illegal drug use disorder (abuse and dependence), as well as comorbid mood (major depression, dysthymia, manic disorder, hypomanic disorder) and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety) were ascertained by a standardized psychiatric interview. Treatment for illegal drug use disorders and perceived unmet need for treatment were assessed among individuals with illegal drug use disorder. Odds of treatment and odds of perceived unmet need for treatment were assessed using logistic regression, adjusting for socio-demographic characteristics, treatment for mood and anxiety disorders, and comorbid alcohol use disorder. RESULTS Out of 34,653 participants, 1114 (3.2%) had a diagnosis of lifetime illegal drug use disorder: 21.2% had a comorbid mood disorder only, 11.8% a comorbid anxiety disorder only, and 45.9% comorbid mood and anxiety disorders. Comorbid mood and anxiety disorders were not related to treatment for illegal drug use disorders but were associated with an elevated likelihood of unmet need for treatment: compared to participants with no comorbidities, multivariate ORs were 2.21 (95% CI: 1.23- 4.10) for mood disorder only, 2.38 (95% CI: 1.27-4.45) for anxiety disorder only, and 2.90 (95% CI: 1.71-4.94) for both mood and anxiety disorders. CONCLUSIONS Individuals with an illegal drug use disorder and comorbid mood or anxiety disorders are disproportionately likely to report unmet need for treatment. Integrated mental health and substance use programs could prove effective in addressing their treatment needs.
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Affiliation(s)
- Maria Melchior
- Inserm, U1018, Centre for Research in Epidemiology & Population Health (CESP), Epidemiology of occupational and social determinants of health, F-94807 Villejuif, France.
| | - Elena Prokofyeva
- Inserm, U1018, Centre for Research in Epidemiology & Population Health (CESP), Epidemiology of occupational and social determinants of health, F-94807 Villejuif, France,University of Versailles Saint-Quentin, UMRS 1018, F-94807 Villejuif, France
| | - Nadia Younès
- Université de Versailles Saint-Quentin EA 4047, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 10032 New York, NY, USA
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Kidorf M, Brooner RK, Gandotra N, Antoine D, King VL, Peirce J, Ghazarian S. Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial. Drug Alcohol Depend 2013; 133:30-6. [PMID: 23866988 PMCID: PMC3786041 DOI: 10.1016/j.drugalcdep.2013.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program. METHODS Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks. RESULTS ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed. CONCLUSIONS These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States.
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Lindahl ML, Berglund M, Tönnesen H. Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial. Nord J Psychiatry 2013; 67:197-203. [PMID: 22853707 DOI: 10.3109/08039488.2012.704068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care. METHODS Court-ordered patients with substance abuse ( n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%. RESULTS Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems. CONCLUSIONS Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population. CLINICAL IMPLICATIONS The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence.
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Pitt V, Lowe D, Hill S, Prictor M, Hetrick SE, Ryan R, Berends L. Consumer-providers of care for adult clients of statutory mental health services. Cochrane Database Syst Rev 2013; 2013:CD004807. [PMID: 23543537 PMCID: PMC9750934 DOI: 10.1002/14651858.cd004807.pub2] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND In mental health services, the past several decades has seen a slow but steady trend towards employment of past or present consumers of the service to work alongside mental health professionals in providing services. However the effects of this employment on clients (service recipients) and services has remained unclear.We conducted a systematic review of randomised trials assessing the effects of employing consumers of mental health services as providers of statutory mental health services to clients. In this review this role is called 'consumer-provider' and the term 'statutory mental health services' refers to public services, those required by statute or law, or public services involving statutory duties. The consumer-provider's role can encompass peer support, coaching, advocacy, case management or outreach, crisis worker or assertive community treatment worker, or providing social support programmes. OBJECTIVES To assess the effects of employing current or past adult consumers of mental health services as providers of statutory mental health services. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 3), MEDLINE (OvidSP) (1950 to March 2012), EMBASE (OvidSP) (1988 to March 2012), PsycINFO (OvidSP) (1806 to March 2012), CINAHL (EBSCOhost) (1981 to March 2009), Current Contents (OvidSP) (1993 to March 2012), and reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials of current or past consumers of mental health services employed as providers ('consumer-providers') in statutory mental health services, comparing either: 1) consumers versus professionals employed to do the same role within a mental health service, or 2) mental health services with and without consumer-providers as an adjunct to the service. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data. We contacted trialists for additional information. We conducted analyses using a random-effects model, pooling studies that measured the same outcome to provide a summary estimate of the effect across studies. We describe findings for each outcome in the text of the review with considerations of the potential impact of bias and the clinical importance of results, with input from a clinical expert. MAIN RESULTS We included 11 randomised controlled trials involving 2796 people. The quality of these studies was moderate to low, with most of the studies at unclear risk of bias in terms of random sequence generation and allocation concealment, and high risk of bias for blinded outcome assessment and selective outcome reporting.Five trials involving 581 people compared consumer-providers to professionals in similar roles within mental health services (case management roles (4 trials), facilitating group therapy (1 trial)). There were no significant differences in client quality of life (mean difference (MD) -0.30, 95% confidence interval (CI) -0.80 to 0.20); depression (data not pooled), general mental health symptoms (standardised mean difference (SMD) -0.24, 95% CI -0.52 to 0.05); client satisfaction with treatment (SMD -0.22, 95% CI -0.69 to 0.25), client or professional ratings of client-manager relationship; use of mental health services, hospital admissions and length of stay; or attrition (risk ratio 0.80, 95% CI 0.58 to 1.09) between mental health teams involving consumer-providers or professional staff in similar roles.There was a small reduction in crisis and emergency service use for clients receiving care involving consumer-providers (SMD -0.34 (95%CI -0.60 to -0.07). Past or present consumers who provided mental health services did so differently than professionals; they spent more time face-to-face with clients, and less time in the office, on the telephone, with clients' friends and family, or at provider agencies.Six trials involving 2215 people compared mental health services with or without the addition of consumer-providers. There were no significant differences in psychosocial outcomes (quality of life, empowerment, function, social relations), client satisfaction with service provision (SMD 0.76, 95% CI -0.59 to 2.10) and with staff (SMD 0.18, 95% CI -0.43 to 0.79), attendance rates (SMD 0.52 (95% CI -0.07 to 1.11), hospital admissions and length of stay, or attrition (risk ratio 1.29, 95% CI 0.72 to 2.31) between groups with consumer-providers as an adjunct to professional-led care and those receiving usual care from health professionals alone. One study found a small difference favouring the intervention group for both client and staff ratings of clients' needs having been met, although detection bias may have affected the latter. None of the six studies in this comparison reported client mental health outcomes.No studies in either comparison group reported data on adverse outcomes for clients, or the financial costs of service provision. AUTHORS' CONCLUSIONS Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management services.There is low quality evidence that involving consumer-providers in mental health teams results in a small reduction in clients' use of crisis or emergency services. The nature of the consumer-providers' involvement differs compared to professionals, as do the resources required to support their involvement. The overall quality of the evidence is moderate to low. There is no evidence of harm associated with involving consumer-providers in mental health teams.Future randomised controlled trials of consumer-providers in mental health services should minimise bias through the use of adequate randomisation and concealment of allocation, blinding of outcome assessment where possible, the comprehensive reporting of outcome data, and the avoidance of contamination between treatment groups. Researchers should adhere to SPIRIT and CONSORT reporting standards for clinical trials.Future trials should further evaluate standardised measures of clients' mental health, adverse outcomes for clients, the potential benefits and harms to the consumer-providers themselves (including need to return to treatment), and the financial costs of the intervention. They should utilise consistent, validated measurement tools and include a clear description of the consumer-provider role (eg specific tasks, responsibilities and expected deliverables of the role) and relevant training for the role so that it can be readily implemented. The weight of evidence being strongly based in the United States, future research should be located in diverse settings including in low- and middle-income countries.
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Affiliation(s)
- Veronica Pitt
- National Trauma Research Institute, The Alfred Hospital, Monash UniversityLevel 4, 89 Commercial RoadMelbourneVictoriaAustralia3004
| | - Dianne Lowe
- Australian Institute for Primary Care & Ageing, La Trobe UniversityCentre for Health Communication and ParticipationBundooraVICAustralia3086
| | - Sophie Hill
- La Trobe UniversityCentre for Health Communication and Participation, Australian Institute for Primary Care & AgeingBundooraVICAustralia3086
| | - Megan Prictor
- Australian Institute for Primary Care & Ageing, La Trobe UniversityCochrane Consumers and Communication Review GroupBundooraVICAustralia3086
| | - Sarah E Hetrick
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, Australian Institute for Primary Care & AgeingBundooraVICAustralia3086
| | - Lynda Berends
- Turning Point Alcohol & Drug Centre54‐62 Gertrude StFitzroyVICAustralia3065
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12
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Sacks S, Chaple M, Sirikantraporn J, Sacks JY, Knickman J, Martinez J. Improving the capability to provide integrated mental health and substance abuse services in a state system of outpatient care. J Subst Abuse Treat 2013; 44:488-93. [PMID: 23317513 DOI: 10.1016/j.jsat.2012.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 10/29/2012] [Accepted: 11/05/2012] [Indexed: 11/17/2022]
Abstract
The paper reports on the capability of New York State (NYS) outpatient programs to provide integrated services for co-occurring disorders (COD). Assessments of 447 outpatient clinics, using two dual diagnosis capability indices (one used in addiction settings, the other in mental health settings), produced an overall score of 2.70, interpreted to position NYS clinics closer to "capable" (3.0 = Dual Diagnosis Capable) than to "basic" (1.0 = Alcohol [Mental Health] Only Services). "Assessment" and "Staffing" received the highest scores; i.e., clients with COD were usually identified, and staff (with some additional training and supervision) could treat both disorders effectively. While programs were generally prepared for clients with COD (e.g., welcoming such clients into the program, employing staff with competencies in both disorders, and having established routine screening and assessment to identify COD), results showed that the actual delivery of effective treatment was less satisfactory. The project demonstrated that COD capability can be assessed system-wide, using direct observation.
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Affiliation(s)
- Stanley Sacks
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), New York, NY 10010, USA.
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13
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Torrens M, Rossi PC, Martinez-Riera R, Martinez-Sanvisens D, Bulbena A. Psychiatric co-morbidity and substance use disorders: treatment in parallel systems or in one integrated system? Subst Use Misuse 2012; 47:1005-14. [PMID: 22676568 DOI: 10.3109/10826084.2012.663296] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psychiatric co-morbidity among substance users refers to the simultaneous presence of at least another psychiatric disorder in a person diagnosed with a substance use disorder. Co-morbid patients represent a substantial number of people in treatment and present greater disorder severity from both the clinical and social perspectives than those people diagnosed with only one type of disorder. We present an overview of the current state of the art concerning the choice of site of treatment, the kind of intervention, the length of such treatment, and future goals, aiming to establish a more effective intervention, and finally so as to further improve clinical outcomes.
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Affiliation(s)
- Marta Torrens
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar-IMIM, Parc de Salut Mar, Passeig Marítim 25–29, Barcelona, Spain.
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14
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Torchalla I, Nosen L, Rostam H, Allen P. Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis. J Subst Abuse Treat 2012; 42:65-77. [DOI: 10.1016/j.jsat.2011.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/23/2011] [Accepted: 09/15/2011] [Indexed: 01/08/2023]
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15
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Timko C, Sutkowi A, Cronkite RC, Makin-Byrd K, Moos RH. Intensive referral to 12-step dual-focused mutual-help groups. Drug Alcohol Depend 2011; 118:194-201. [PMID: 21515004 DOI: 10.1016/j.drugalcdep.2011.03.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 03/15/2011] [Accepted: 03/24/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study implemented and evaluated procedures to help clinicians effectively refer dually diagnosed (substance use and psychiatric disorders) patients to dual-focused mutual-help groups (DFGs). METHODS Using a cohort cyclical turnover design, individuals with dual diagnoses beginning a new outpatient mental health treatment episode (N=287) entered a standard- or an intensive-referral condition. Participants provided self-reports of 12-step mutual-help (DFG and substance-focused group [SFG]) attendance and involvement and substance use and psychiatric symptoms at baseline and six-month follow-up. The intensive referral intervention focused on encouraging patients to attend DFG meetings. RESULTS Compared to patients in the standard condition, those in the intensive referral intervention were more likely to attend and be involved in DFGs and SFGs, and had less drug use and better psychiatric outcomes at follow-up. Attending more intensive-referral sessions was associated with more DFG and SFG meeting attendance. More need fulfillment in DFGs, and more readiness to participate in SFGs, were associated with better alcohol and psychiatric outcomes at six months. However, only 23% of patients in the intensive-referral group attended a DFG meeting during the six-month follow-up period. CONCLUSIONS The intensive referral intervention enhanced participation in both DFGs and SFGs and was associated with better six-month outcomes. The findings suggest that intensive referral to mutual-help groups focus on its key components (e.g., linking patients to 12-step volunteers) rather than type of group.
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Affiliation(s)
- Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, and Stanford University Medical Center, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
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16
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Dye MH, Roman PM, Knudsen HK, Johnson JA. The availability of integrated care in a national sample of therapeutic communities. J Behav Health Serv Res 2011; 39:17-27. [PMID: 21744180 DOI: 10.1007/s11414-011-9251-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Therapeutic communities (TCs) for substance abusers are oriented toward changing the entire person as a means for facilitating a drug-free future. This vision parallels ideas such as integrated care for the treatment of co-occurring substance abuse and psychiatric conditions. The extent to which integrated services are available in TCs has not been documented. Using data from a national sample of 345 TCs, this paper examines the availability of integrated care in TCs and the structural and cultural characteristics of TCs that offer integrated care. The results indicate that a substantial portion of TCs in this sample admit clients with co-occurring disorders (70.7%), and as many as half of the TCs offer integrated care. TCs that offer integrated care show increased use of professional staff, individual psychotherapy, and a less confrontational milieu, but notably, retain many of the "essential elements" of the traditional TC model.
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Affiliation(s)
- Meredith Huey Dye
- Department of Sociology/Anthropology, Middle Tennessee State University, Murfreesboro, 37132, USA.
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17
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Sacks S, McKendrick K, Sacks JY, Cleland CM. Modified therapeutic community for co-occurring disorders: single investigator meta analysis. Subst Abus 2010; 31:146-61. [PMID: 20687003 DOI: 10.1080/08897077.2010.495662] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper presents the results of a meta-analysis for a single investigator examining the effectiveness of the modified therapeutic community (MTC) for clients with co-occurring substance use and mental disorders (COD). The flexibility and utility of meta-analytic tools are described, although their application in this context is atypical. The analysis includes 4 comparisons from 3 studies (retrieved N = 569) for various groups of clients with COD (homeless persons, offenders, and outpatients) in substance abuse treatment, comparing clients assigned either to an MTC or a control condition of standard services. An additional study is included in a series of sensitivity tests. The overall findings increase the research base of support for the MTC program for clients with COD, as results of the meta-analysis indicate significant MTC treatment effects for 5 of the 6 outcome domains across the 4 comparisons. Limitations of the approach are discussed. Independent replications, clinical trials, multiple outcome domains, and additional meta-analyses should be emphasized in future research. Given the need for research-based approaches, program and policy planners should consider the MTC when designing programs for co-occurring disorders.
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Affiliation(s)
- Stanley Sacks
- National Development & Research Institutes, Inc. (NDRI), New York, New York 10010, USA.
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18
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Baldacchino A, Greacen T, Hodges CL, Charzynska K, Sorsa M, Saias T, Clancy C, Lack C, Hyldager E, Merinder LB, Meder J, Henderson Z, Laijarvi H, Baeck-Moller K. Nature, level and type of networking for individuals with dual diagnosis: A European perspective. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687637.2010.520171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Perron BE, Bunger A, Bender K, Vaughn MG, Howard MO. Treatment guidelines for substance use disorders and serious mental illnesses: do they address co-occurring disorders? Subst Use Misuse 2010; 45:1262-78. [PMID: 20441462 PMCID: PMC3285548 DOI: 10.3109/10826080903442836] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Practice guidelines are important tools for improving the delivery of evidence-based practices and reducing inappropriate variation in current treatment approaches. This study examined the degree to which guidelines targeted to the treatment of substance use disorders or serious mental illness address treatment of co-occurring disorders. Guidelines archived by the National Guideline Clearinghouse (NGC) were retrieved in December 2007 and content analyzed. Nineteen pertinent guidelines were identified, and 11 included recommendations regarding the assessment and/or treatment of co-occurring disorders. None of the guidelines making recommendations for treatment of co-occurring disorders included outcomes that clearly targeted both substance use and mental health disorders. Limitations and implications of this study are noted.
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Affiliation(s)
- Brian E Perron
- University of Michigan, School of Social Work, Ann Arbor, MI, USA.
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20
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Prendergast M, Greenwell L, Cartier J, Sacks J, Frisman L, Rodis E, Havens JR. Adherence to Scheduled Sessions in a Randomized Field Trial of Case Management: The Criminal Justice-Drug Abuse Treatment Studies Transitional Case Management Study. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2009; 5:273-297. [PMID: 20157623 PMCID: PMC2820393 DOI: 10.1007/s11292-009-9077-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Transitional Case Management (TCM) study, one of the projects of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative, was a multi-site randomized test of whether a strengths-based case management intervention provided during an inmate's transition from incarceration to the community increases participation in community substance abuse treatment, enhances access to needed social services, and improves drug use and crime outcomes. As in many intervention studies, TCM experienced a relatively large percentage of treatment-group participants who attended few or no scheduled sessions. The paper discusses issues with regard to participation in community case management sessions, examines patterns of session attendance among TCM participants, and analyzes client and case manager characteristics that are associated with number of sessions attended and with patterns of attendance. The average number of sessions (out of 12) attended was 5.7. Few client or case manager characteristics were found to be significantly related to session attendance. Clinical and research implications of the findings and of adherence in case management generally are discussed.
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Affiliation(s)
- Michael Prendergast
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 20025 USA
| | - Lisa Greenwell
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 20025 USA
| | - Jerome Cartier
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 20025 USA
| | - JoAnn Sacks
- Center for the Integration of Research & Practice, National Development & Research Institutes, Inc., New York, NY USA
| | - Linda Frisman
- Research Division, Connecticut Department of Mental Health & Addiction Services, Hartford, CT USA
| | - Eleni Rodis
- Research Division, Connecticut Department of Mental Health & Addiction Services, Hartford, CT USA
| | - Jennifer R. Havens
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY USA
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Cleary M, Hunt GE, Matheson S, Walter G. Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review. J Adv Nurs 2009; 65:238-58. [DOI: 10.1111/j.1365-2648.2008.04879.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Sacks JY, McKendrick K, Hamilton Z, Cleland CM, Pearson FS, Banks S. Treatment outcomes for female offenders: relationship to number of Axis I diagnoses. BEHAVIORAL SCIENCES & THE LAW 2008; 26:413-434. [PMID: 18683197 DOI: 10.1002/bsl.828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.
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Affiliation(s)
- Joann Y Sacks
- Center for the Integration of Research and Practice, National Development and Research Institutes, Inc, New York, NY 10010, USA.
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23
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Sacks S, Melnick G, Grella CE. Synthesis of studies of co-occurring disorder(s) in criminal justice and a research agenda. BEHAVIORAL SCIENCES & THE LAW 2008; 26:475-486. [PMID: 18683198 DOI: 10.1002/bsl.835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The studies reported in this special issue were designed to take advantage of the unique opportunity that the Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative provides to the systematic study of several key issues in programming for co-occurring disorder(s) (COD) in the criminal justice system. These papers present findings from CJDATS studies pertaining to co-occurring disorder(s), identify clinical initiatives to strengthen efforts to treat the population with co-occurring disorder(s), and point to a direction for the elaboration of a future research agenda. Four key areas of investigation are presented: Screening and Diagnosis; the Relationship of Co-Occurring Disorder(s) to Violence; Gender Differences; and the Delivery of Services for Co-Occurring Disorder(s). The first section of this article summarizes the studies included in this special issue within the context of the research literature already available. The second section suggests a future research agenda for the study of offender populations with co-occurring disorder(s), and concludes with a broad statement of clinical advancements to date.
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Affiliation(s)
- Stanley Sacks
- Center for the Integration of Research and Practice, National Development and Research Institutes, Inc, York, NY 10010, USA.
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Sacks S, Banks S, McKendrick K, Sacks JY. Modified therapeutic community for co-occurring disorders: a summary of four studies. J Subst Abuse Treat 2007; 34:112-22. [PMID: 17574792 PMCID: PMC2572263 DOI: 10.1016/j.jsat.2007.02.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 02/01/2007] [Accepted: 02/02/2007] [Indexed: 11/29/2022]
Abstract
This article summarizes results from four research studies (n = 902) that examined the effectiveness of the modified therapeutic community (MTC) for clients with co-occurring disorders (most with severe mental disorders). Significantly better outcomes for MTC were found across four experimental versus control comparisons on 23.1% (12 of 52) of primary outcome measures of substance use, mental health, crime, HIV risk, employment, and housing. Study limitations included the potential for selection bias, limited measurement of program fidelity, and insufficient examination of the relationship between treatment dose and outcome. Future research should emphasize clinical trial replications, multiple outcome domains, and further development of continuing care models. Given the need for research-based approaches, the MTC warrants consideration when program and policy planners are designing programs for co-occurring disorders.
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Affiliation(s)
- Stanley Sacks
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010, tel 212.845.4400 • fax 212.845.4650 •
| | - Steven Banks
- University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, tel 508.856.1784 •
| | - Karen McKendrick
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010, tel 212.845.4400 • fax 212.845.4650 •
| | - Joann Y Sacks
- Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), 71 W 23 Street, 8 Floor, New York, NY 10010, tel 212.845.4400 • fax 212.845.4650 •
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