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Vinais T, Lacroix A, Gelle T, Nubukpo P. Effectiveness of the Therapeutic Community Model in Addiction Treatment: A Retrospective Pilot Study in French Prisons. Healthcare (Basel) 2023; 11:healthcare11111523. [PMID: 37297663 DOI: 10.3390/healthcare11111523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND In France, addiction care in prison usually consists of nurses' interventions, medical care and socio-educational programs, but new alternatives have arisen, namely the therapeutic community (TC) model. This pilot study aims to evaluate the effectiveness of this prison-based TC in comparison with classic and socio-educational care offered in French prisons. METHODS To compare these three types of prison-based care, two detention centers' files were screened for use of multiple drugs, willingness to participate and absence of psychiatric comorbidities incompatible with group therapy. A custom questionnaire was built based on the fifth version of the Addiction Severity Index. It investigates medical status, employment and support, primary addiction status, legal status, social/familial status and psychiatric status through various items. RESULTS Our sample only consisted of male repeat offenders with a mean age of 37.7 ± (9.1) years. Primary addiction status improvement was observed for all care studied but was more important in TC than in classic care. Self-esteem and social/familial status saw significant improvement throughout TC care. CONCLUSIONS The TC model represents an alternative to classic and socio-educational care in French prisons. More studies are needed to assess the extent of the benefits provided on both the medical side and economic side.
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Affiliation(s)
- Théodore Vinais
- Pôle Universitaire de Psychiatrie d'Adulte de la Personne Agée et d'Addictologie (PUP3A), Centre Hospitalier Esquirol, 87000 Limoges, France
| | - Aurélie Lacroix
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- Inserm U1094, IRD U270, EpiMaCT-Epidémiologie des Maladies Chroniques en Zone Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, CHU Limoges, 87042 Limoges, France
| | - Thibaut Gelle
- Inserm U1094, IRD U270, EpiMaCT-Epidémiologie des Maladies Chroniques en Zone Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, CHU Limoges, 87042 Limoges, France
| | - Philippe Nubukpo
- Pôle Universitaire de Psychiatrie d'Adulte de la Personne Agée et d'Addictologie (PUP3A), Centre Hospitalier Esquirol, 87000 Limoges, France
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- Inserm U1094, IRD U270, EpiMaCT-Epidémiologie des Maladies Chroniques en Zone Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, CHU Limoges, 87042 Limoges, France
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Sharp A, Carlson M, Vroom EB, Rigg K, Hills H, Harding C, Moore K, Schuman-Olivier Z. When a pandemic and epidemic collide: Lessons learned about how system barriers can interrupt implementation of addiction research. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231205890. [PMID: 37936966 PMCID: PMC10572032 DOI: 10.1177/26334895231205890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Telehealth technologies are now featured more prominently in addiction treatment services than prior to the COVID-19 pandemic, but system barriers should be carefully considered for the successful implementation of innovative remote solutions for medication management and recovery coaching support for people with opioid use disorder (OUD). Method The Centers for Disease Control and Prevention funded a telehealth trial prior to the COVID-19 pandemic with a multi-institution team who attempted to implement an innovative protocol during the height of the pandemic in 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, which integrated remote motivational recovery coaching with daily supervised dosing from secure pill dispensers via videoconference, on medication adherence during buprenorphine treatment. This paper provides a participant case example followed by a reflective evaluation of how the pandemic amplified both an existing research-to-practice gap and clinical system barriers during the implementation of telehealth clinical research intervention for patients with OUD. Findings Implementation challenges arose from academic institutional requirements, boundaries and role identity, clinical staff burnout and lack of buy-in, rigid clinical protocols, and limited clinical resources, which hampered recruitment and intervention engagement. Conclusions As the urgency for feasible and effective telehealth solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.
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Affiliation(s)
- Amanda Sharp
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Melissa Carlson
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Enya B. Vroom
- School of Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Khary Rigg
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Holly Hills
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Cassandra Harding
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Kathleen Moore
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
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Lee I, Lee M, Choi SSW. Therapeutic community-oriented day treatment program for Korean women with alcohol use disorder: a non-randomized pilot feasibility trial. Addict Sci Clin Pract 2022; 17:14. [PMID: 35189980 PMCID: PMC8862269 DOI: 10.1186/s13722-022-00297-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of alcohol use disorder (AUD) among women in South Korea has been rising, causing public health problems. Yet women's treatment needs are mostly unmet in South Korea due to the lack of women-focused treatment programs. This study evaluated the feasibility, acceptability, and clinical outcomes of a therapeutic community (TC)-oriented day treatment program for Korean women with AUD on alcohol abstinence self-efficacy, forgiveness, and spirituality. METHODS The current study employed a quasi-experimental, non-equivalent control group design with a pretest and posttest. Participants were assigned to 6-month TC-oriented day treatment program (n = 19) or usual treatment (n = 21). Feasibility (treatment completion rate) and acceptability (overall program satisfaction) were assessed. Alcohol abstinence was measured as a clinical outcome at baseline, 3 months, and 6 months. Repeated measures using Alcohol Abstinence Self-Efficacy (AASE), Enright Forgiveness Inventory-Korea (EFI-K), and Spiritual Assessment Scale (SAS) were also obtained from both conditions at those three time points. RESULTS Fifteen participants (78.9%) in the intervention group successfully completed the program. The overall program satisfaction ratings were very high (4.9 ± 0.2). Continuous abstinence rates at 6 months were significantly higher in the treatment group (78.9%) than in the control group (9.5%). Results of the two-way repeated measures ANOVA indicated that statistically significant two-way (group × time) interaction effects were found for the intervention group on AASE, EFI-K, and SAS but not for the control group on any of the outcomes. CONCLUSION The current study demonstrated the feasibility and acceptability of implementing a TC-oriented intensive day treatment program to promote recovery in Korean women with AUD. This intervention merits further investigation as a potential strategy to help address alcohol abstinence self-efficacy, forgiveness and spirituality. TRIAL REGISTRATION KCT0006386 (Cris.nih.go.kr).
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Affiliation(s)
- Insuk Lee
- Department of Nursing, College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea
| | - Mihyoung Lee
- Department of Nursing, College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea
| | - Scott Seung W Choi
- Department of Nursing, College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea.
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4
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De Leon G, Unterrainer HF. The Therapeutic Community: A Unique Social Psychological Approach to the Treatment of Addictions and Related Disorders. Front Psychiatry 2020; 11:786. [PMID: 32848950 PMCID: PMC7424041 DOI: 10.3389/fpsyt.2020.00786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/22/2020] [Indexed: 11/24/2022] Open
Abstract
The evolution of the contemporary Therapeutic Community (TC) for addictions over the past 50 years may be characterized as a movement from the marginal to the mainstream of substance abuse treatment and human services. TCs currently serve a wide array of clients and their diverse problems; through advances in research in treatment outcomes, the composition of staff has been reshaped, the duration of residential treatment has been reduced, the treatment goals have been reset and, to a considerable extent, the approach of therapy itself has been modified. An overview of the TC as a distinct social-psychological method for treating addiction and related disorders is provided by this paper. Included in this is a focus on the multifaceted psychological wounds that consistently show a strong association with addiction and thereby require initiating a recovery process characterized by life-style and identity changes.
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Affiliation(s)
- George De Leon
- Department of Psychiatry, NYU School of Medicine, New York City, NY, United States
| | - Human F Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria.,University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,Institute for Religious Studies, University of Vienna, Vienna, Austria
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5
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Snowdon N, Allan J, Shakeshaft A, Rickwood D, Stockings E, Boland VC, Courtney RJ. Outpatient psychosocial substance use treatments for young people: An overview of reviews. Drug Alcohol Depend 2019; 205:107582. [PMID: 31778903 DOI: 10.1016/j.drugalcdep.2019.107582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of reviews, synthesizes, and methodologically assesses reviews examining substance disorder interventions for YP in outpatient settings. METHODS Reviews published between 1990 and March 2018 were searched using EBM Reviews, PsycINFO, Embase, Ovid Medline, and Campbell Collaboration. Reviews investigating efficacy and/or feasibility of YP substance disorder treatments in outpatient settings were included. FORTY-THREE REVIEWS MET ALL INCLUSION CRITERIA To appraise methodological biases, 40 reviews were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and 3 were narratively assessed. One reviewer (NS) extracted study data and evaluated all 43 reviews. For inter-rater reliability, 13 (30%) reviews were extracted and appraised in duplicate by a second reviewer (JA, RC or ES). Agreement on AMSTAR2 ratings reached 100%. Agreement was moderate; κ = .52 (p < .05), 95% CI (.20, .84). RESULTS All high quality methodological reviews (n = 6) focused on intervention efficacy and none on treatment feasibility. One (n = 1) high quality review reported evidence for an intervention. Multidimensional Family Therapy (MDFT) has possible efficacy in reducing YP substance use when compared to treatment as usual, Cognitive Behavior Therapy, Adolescent Community Reinforcement Approach and Multifamily Educational Therapy. CONCLUSIONS Methodological and reporting quality of reviews require improvement. High quality reviews focused on intervention efficacy but treatments commonly lacked evidence. One high quality review found MDFT demonstrated promising outcomes. Reviews examining feasibility of interventions were of low methodological quality.
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Affiliation(s)
- Nicole Snowdon
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia; National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia.
| | - Julaine Allan
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Debra Rickwood
- Research and Evaluation, headspace, The National Youth Mental Health Foundation, South Tower, Level 2, 485 La Trobe St, Melbourne VIC 3000, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Veronica C Boland
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
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Ramos SDA. The recovery-oriented therapeutic community for addictions (ROTC): a response to contemporary substance use disorder treatments in the Philippines. THERAPEUTIC COMMUNITIES 2019. [DOI: 10.1108/tc-12-2017-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The Philippines’ nationwide campaign on drugs has been under the limelight due to its controversial approaches in dealing with the problem of addiction. Despite the government’s current efforts, substance use disorders continue to persist within the population. The purpose of this paper is to provide recommendations for addressing the issue of substance use disorder treatment through a modification of the therapeutic community (TC) in the Philippine context.
Design/methodology/approach
This conceptual paper reviews the existing facts about the Philippines’ campaign against drugs, the approaches implemented by the government, current state and research developments of TCs, and its resulting impact on contemporary evidence-based treatment for addiction in the country.
Findings
A treatment framework outlining a recovery-oriented therapeutic community (ROTC) is presented. The ROTC aims to address addiction as a chronic, relapsing disease. This alternative approach for addiction treatment in the Philippines is based on the concept of recovery, principles of effective substance use disorder treatment, and recent developments in TC best practices from the international community.
Originality/value
This paper discusses different recommendations for policy development, interventions and research, aimed at improving the odds of securing recovery for people suffering from addiction.
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Araos P, Vergara-Moragues E, González-Saiz F, Pedraz M, García-Marchena N, Romero-Sanchiz P, Ruiz JJ, Campos-Cloute R, Serrano A, Pavón FJ, Torrens M, Rodriguez De Fonseca F. Differences in the Rates of Drug Polyconsumption and Psychiatric Comorbidity among Patients with Cocaine Use Disorders According to the Mental Health Service. J Psychoactive Drugs 2017; 49:306-315. [PMID: 28682218 DOI: 10.1080/02791072.2017.1342151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cocaine continues to be a worldwide public health concern in Europe. To improve prognosis and intervention, it is necessary to understand the characteristics of the patients who depend on the services where they receive care. The objective is to analyze the differences among patients who use cocaine and between ambulatory and residential resources to better adapt treatment. This is a descriptive, observational study of two populations of cocaine users in treatment: the ambulatory therapeutic community (ATC) and the therapeutic community (TC). The PRISM diagnostic interview was used for both groups. An analysis of both populations indicates a high prevalence of cocaine, heroin, cannabis, sedative, psychostimulant, and hallucinogen use disorders in the TC population compared to the ATC. In alcohol use disorder, differences between both mental health services were not observed. The degree of severity of cocaine use disorders (CUD) is greater in the TC population. The prevalence of psychiatric comorbidity is not statistically significant between the two populations, except for primary psychotic disorders, which are more prevalent in the TC population. This difference in the prevalence of psychotic disorders may be related to the high prevalence of cannabis use disorders in TC patients. Differences in the prevalence of substance use disorders, severity of CUD, and psychiatric comorbidity may limit the efficiency of mental health services involved in substance use disorder therapeutics. These results suggest the need for careful and extensive phenotyping of patients to improve intervention and prognosis in a clinical resource-dependent manner.
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Affiliation(s)
- P Araos
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Esperanza Vergara-Moragues
- b Researcher, Facultad de Ciencias Jurídicas, Sociales y Humanidades , Universidad Internacional de la Rioja , Logroño , La Rioja , Spain.,c Researcher, Addictive Disorders Network, Grupo de Investigación en Neurociencias Traslacional en Adicciones , Universidad de Granada , Andalucía , Spain
| | - Francisco González-Saiz
- c Researcher, Addictive Disorders Network, Grupo de Investigación en Neurociencias Traslacional en Adicciones , Universidad de Granada , Andalucía , Spain.,d Researcher, Community Mental Health Unit of Villamartín , Hospital de Salud Mental de Cádiz , Andalucía , Spain
| | - María Pedraz
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Nuria García-Marchena
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Pablo Romero-Sanchiz
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Juan Jesus Ruiz
- f Researcher, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques and Department of Psychiatry , Universitat Autònoma de Barcelona , Barcelona , Spain
| | | | - Antonia Serrano
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Francisco Javier Pavón
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Marta Torrens
- f Researcher, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques and Department of Psychiatry , Universitat Autònoma de Barcelona , Barcelona , Spain.,g Researcher, School of Medicine , Universitat Autónoma de Barcelona, Barcelona , Spain
| | - Fernando Rodriguez De Fonseca
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
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Co-Occurrence of Substance use Disorders with other Psychiatric Disorders: Implications for Treatment Services. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/nsad-2014-0002] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction This paper critically evaluates the literature on the co-occurrence of substance-use disorders (SUDs) with other psychiatric conditions. Our review considers the variety of different associations between the two, and suggests the implications of the literature for the design of treatment services that address both types of disorders. Methods: A narrative review of research and theory was conducted, covering epidemiology of co-occurring psychiatric disorders worldwide, mechanisms underlying co-occurrence, and treatment models. Results: Epidemiological research has documented a high prevalence of co-occurring disorders in both clinical samples and the general population, although the literature is based primarily on studies in high-income countries and some of the overlap might be due to the co-occurrence of milder forms of both types of disorders. Consistent with what has been reported in other reviews, we conclude that clients with co-occurring disorders tend to have a more severe course of illness, more severe health and social consequences, more difficulties in treatment, and worse treatment outcomes than clients with a single disorder; we address the implications of these findings for the design of treatment services. Conclusions: Much of the evidence shows that separately, treatments for both SUD and other psychiatric disorders are effective in reducing substance use and in improving behavioral, familial, and psychosocial outcomes. The evidence further suggests that these outcomes might be improved when treatment modalities are offered in combination within an integrated treatment plan that simultaneously addresses substance abuse and psychiatric problems. It is concluded that there is potentially more to be gained from taking a public health perspective and working on efforts to implement existing evidence-based practices at the systems level, than from the current tendency to look for ever more powerful individual-level interventions at the clinical level.
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Peters RH, Young MS, Rojas EC, Gorey CM. Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:475-488. [PMID: 28375656 DOI: 10.1080/00952990.2017.1303838] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system. OBJECTIVES To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system. METHODS We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings. RESULTS Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs). CONCLUSION Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.
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Affiliation(s)
- Roger H Peters
- a Department of Mental Health Law and Policy , Louis de la Parte Florida Mental Health Institute, University of South Florida , Tampa , FL , USA
| | - M Scott Young
- a Department of Mental Health Law and Policy , Louis de la Parte Florida Mental Health Institute, University of South Florida , Tampa , FL , USA
| | - Elizabeth C Rojas
- b Department of Psychology , University of South Florida , Tampa , FL , USA
| | - Claire M Gorey
- b Department of Psychology , University of South Florida , Tampa , FL , USA
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Demographic and clinical characteristics of current comorbid psychiatric disorders in a randomized clinical trial for adults with stimulant use disorders. Psychiatry Res 2016; 246:136-141. [PMID: 27693866 PMCID: PMC5437704 DOI: 10.1016/j.psychres.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/18/2016] [Accepted: 09/07/2016] [Indexed: 11/21/2022]
Abstract
This study aimed to determine if current comorbid psychiatric disorders differ in adults with cocaine use disorder, other stimulant (primarily methamphetamine) use disorder, or both, and identify demographic and clinical characteristics in those with increasing numbers of comorbid disorders. Baseline data from a randomized controlled trial beginning in residential settings (N=302) was used. Mood disorders were present in 33.6%, and anxiety disorders in 29.6%, with no differences among stimulant use disorder groups. Panic disorder was more frequently present with other stimulant use disorder. Those with two or more comorbid psychiatric disorders were more often female, White, had more symptoms of depression, greater propensity and risk for suicidal behavior, lower functioning in psychiatric and family domains, lower quality of life, more symptoms with stimulant abstinence and greater likelihood of marijuana dependence. Those with one or more comorbid disorders had more medical disorder burden, lower cognitive and physical functioning, greater pain, and higher rates of other drug dependence. With current comorbid psychiatric disorders, the morbidity of stimulant use disorders increases. Use of validated assessments near treatment entry, and a treatment plan targeting not only substance use and comorbid psychiatric disorders, but functional impairments, medical disorder burden and pain, may be useful.
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11
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Vasilev G, Milcheva S, Vassileva J. Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2016; 3:293-305. [PMID: 27493878 PMCID: PMC4968876 DOI: 10.1007/s40501-016-0089-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The global prevalence in the use of opiates and opioids has remained stable, though there were some unprecedented recent increases in opioid use and associated mortality and morbidity in the United States. Internationally, there is a strong tendency for consolidation of drug treatment strategies in favor of more systematic, structured and balanced approaches to regional and national drug policies. However, there are considerable differences in the scope, focus, and implementation of national drug policies and the political context is shaping drug prevention, treatment and rehabilitation efforts to an extent not typically observed in other public health domains. As a result, though in theory, there is a considerable multi-national agreement about the efficacy and effectiveness of different treatment modalities for opioid dependence, in practice, there are striking differences among different world regions and countries in the degree of implementation of these treatment modalities into clinical practice. Such discrepancies between theory and practice are observed even in high-income countries such as the United States and European Union member states, where evidence-based treatment modalities are still not well implemented into clinical practice. Despite the lack of evidence-based support for the role of detoxification as a stand-alone treatment for opioid use disorders, it appears to be the most widely used intervention for opioid use across the world.
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Affiliation(s)
- Georgi Vasilev
- Bulgarian Addictions Institute, 93 Antim I, Sofia 1303, Bulgaria, Tel: 00359 885 000 533
| | - Svetla Milcheva
- University Hospital Sveta Marina, 1 Hristo Smirnenski blvd, Varna 9100, Bulgaria, Tel: 00359 889 317 293
| | - Jasmin Vassileva
- Department of Psychiatry, Virginia Commonwealth University, 203 E. Cary Street, Richmond VA 23219, USA, Tel: 804 828 5807
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Meshberg-Cohen S, Presseau C, Thacker LR, Hefner K, Svikis D. Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. J Womens Health (Larchmt) 2016; 25:729-37. [PMID: 27387193 DOI: 10.1089/jwh.2015.5328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) are high among women seeking treatment for substance use disorders (SUDs). Minority women, in particular, experience high rates of trauma and may be less likely to disclose trauma history. This article identifies items from pre-existing screening measures that can be used across settings to sensitively but noninvasively identify women with likely PTSD. METHOD For a sample of 104 African American women in residential SUD treatment who provided informed consent as a part of a larger randomized clinical trial, the prevalence of trauma and PTSD, as well as the relationships between trauma, health, depression, and distress, was examined. Measures included Posttraumatic Stress Diagnostic Scale (PDS), Center for Epidemiologic Studies-Depression Scale (CES-D), Pennebaker Inventory of Limbic Languidness (PILL), and Brief Symptom Inventory (BSI). Additional analyses were undertaken to determine if a subset of noninvasive items could serve to identify the presence of a probable PTSD diagnosis. RESULTS Most women (94.2%) reported at least one lifetime trauma, with over half (51.0%) meeting DSM-IV criteria for PTSD. Women with greater trauma symptom severity reported more health problems and higher levels of depression and distress. Five BSI items and one CES-D item were significantly associated with a probable PTSD diagnosis with a sensitivity of 88.7%, a specificity of 66.7%, a positive predictive value of 73.4%, a negative predictive value of 85.0%, and an accuracy of 77.9%. CONCLUSION Findings affirm that African American women with SUDs present for residential treatment with comorbid psychiatric and emotional conditions that warrant assessment and treatment. Results highlight potential benefits of brief screening with routine measures and coordinated access to ancillary psychiatric and medical services, in conjunction with substance treatment, such as in residential or primary care.
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Affiliation(s)
- Sarah Meshberg-Cohen
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Candice Presseau
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut
| | - Leroy R Thacker
- 3 Department of Family and Community Health Nursing, Virginia Commonwealth University , Richmond, Virginia
| | - Kathryn Hefner
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Dace Svikis
- 4 Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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13
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Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review. J Subst Abuse Treat 2015; 61:47-59. [PMID: 26531892 DOI: 10.1016/j.jsat.2015.09.006] [Citation(s) in RCA: 284] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
The purpose of this integrative review is to examine and synthesize extant literature pertaining to barriers to substance abuse and mental health treatment for persons with co-occurring substance use and mental health disorders (COD). Electronic searches were conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were examined for this review. Narrative review of these articles resulted in the identification of two primary barriers to treatment access for individuals with COD: personal characteristics barriers and structural barriers. Clinical implications and directions for future research are discussed. In particular, additional studies on marginalized sub-populations are needed, specifically those that examine barriers to treatment access among older, non-White, non-heterosexual populations.
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Affiliation(s)
- Mary Ann Priester
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208.
| | - Teri Browne
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Aidyn Iachini
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Stephanie Clone
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Dana DeHart
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Kristen D Seay
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
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14
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Speirs V, Johnson M, Jirojwong S. A systematic review of interventions for homeless women. J Clin Nurs 2013; 22:1080-93. [DOI: 10.1111/jocn.12056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 01/30/2023]
Affiliation(s)
| | - Maree Johnson
- School of Nursing and Midwifery; University of Western Sydney; Penrith South DC NSW
- Centre for Applied Nursing Research (venture between South-Western Sydney Local Health District and the University of Western Sydney); University of Western Sydney; Penrith South DC NSW Australia
| | - Sansnee Jirojwong
- School of Nursing and Midwifery; University of Western Sydney; Penrith South DC NSW
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15
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Vergara-Moragues E, González-Saiz F, Lozano OM, Betanzos Espinosa P, Fernández Calderón F, Bilbao-Acebos I, Pérez García M, Verdejo García A. Psychiatric comorbidity in cocaine users treated in therapeutic community: substance-induced versus independent disorders. Psychiatry Res 2012; 200:734-41. [PMID: 22910475 DOI: 10.1016/j.psychres.2012.07.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 07/05/2012] [Accepted: 07/29/2012] [Indexed: 11/15/2022]
Abstract
This is a cross-sectional study of 227 cocaine dependent individuals in six different therapeutic communities (TCs) within a single treatment network in Andalusia (Spain). The primary aim of the study is to examine the prevalence of lifetime psychiatric comorbidity in this sample using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Diagnoses were assessed 15-20 days after admission. The data indicate that more than 65% of the sample experienced a lifetime co-occurring psychiatric comorbidity. Substance-induced mood (21.6%) and psychotic (11.5%) disorders were more prevalent in this population than independent mood (12.3%) and psychotic (7.5%) disorders. These data suggest the need to introduce changes in these centers, both in the diagnostic aspects and in the treatment programs.
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16
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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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17
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Samuel DB, LaPaglia DM, Maccarelli LM, Moore BA, Ball SA. Personality disorders and retention in a therapeutic community for substance dependence. Am J Addict 2011; 20:555-62. [PMID: 21999502 PMCID: PMC3856923 DOI: 10.1111/j.1521-0391.2011.00174.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Although therapeutic community (TC) treatment is a promising intervention for substance use disorders, a primary obstacle to successful treatment is premature attrition. Because of their prevalence within substance use treatment facilities, personality disorder (PD) diagnoses have been examined as predictors of treatment completion. Prior research on TC outcomes has focused almost exclusively on antisocial personality disorder (ASPD), and the results have been mixed. This study extends previous research by examining the impact of the 10 Axis II PDs on early (first 30 days) attrition as well as overall time to dropout in a 9-month residential TC. Survival analyses indicated that borderline was the only PD negatively related to overall program retention. In contrast, ASPD, as well as histrionic PD, were related to very early attrition, but not to overall program retention. Early assessment and identification of at-risk individuals may improve treatment retention and outcome for TC treatment.
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Affiliation(s)
- Douglas B Samuel
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
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18
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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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19
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Tuchman E, Sarasohn MK. Implementation of an evidence-based modified therapeutic community: staff and resident perspectives. EVALUATION AND PROGRAM PLANNING 2011; 34:105-112. [PMID: 20800284 DOI: 10.1016/j.evalprogplan.2010.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 07/14/2010] [Accepted: 08/03/2010] [Indexed: 05/29/2023]
Abstract
The widespread successful implementation of evidence-based practices (EBPs) into community substance abuse settings require a thorough understanding of practitioner and client attitudes toward these approaches. This paper presents the first that we know of a qualitative study that explores staff and resident experience of the change process of a therapeutic community to an evidence-based modified therapeutic community for homeless individuals with co-occurring substance abuse and mental illness disorders. The sample consists of 20 participants; 10 staff and 10 residents. Interviews were conducted at the agency, recorded and transcribed verbatim. Transcripts were organized and coded from a grounded theory perspective. Themes and patterns of staff and resident experience were identified. The change in program structure from TC to MTC were perceived by staff as efforts to accommodate the particular needs of the homeless individuals with mental and substance abuse disorders and feeling they were inadequately prepared with inadequate resources to facilitate a successful transition. Participant descriptions were described in terms of loss of structure, loss of peers and being helped. Findings have potential to shape implementation of evidence-based practices in community substance abuse treatment.
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Affiliation(s)
- Ellen Tuchman
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA.
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20
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Goethals I, Soyez V, Melnick G, De Leon G, Broekaert E. Essential elements of treatment: a comparative study between European and American therapeutic communities for addiction. Subst Use Misuse 2011; 46:1023-31. [PMID: 21235341 DOI: 10.3109/10826084.2010.544358] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to investigate whether European and American therapeutic communities (TCs) for addiction, both traditional and modified, share a common perspective on what is essential in treatment using the Survey of Essential Elements Questionnaire (SEEQ). The European sample (N = 19) was gathered in 2009. For the American sample (N = 19), we used previously published research data. Despite comparable perspectives, European traditional TCs (N = 11) scored significantly higher than their American predecessors (N = 11) on four SEEQ domains. Cluster differences were more pronounced in Europe than in America.
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Affiliation(s)
- Ilse Goethals
- Department of Special Education, Ghent University, Belgium.
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21
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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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22
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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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23
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Dye MH, Ducharme LJ, Johnson JA, Knudsen HK, Roman PM. Modified therapeutic communities and adherence to traditional elements. J Psychoactive Drugs 2010; 41:275-83. [PMID: 19999681 DOI: 10.1080/02791072.2009.10400538] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Traditional therapeutic communities (TCs) are characterized by confrontational group therapy, treatment phases, a tenure-based resident hierarchy, and long-term residential care. Many TCs have modified the structure and intensity of the traditional model, tailored services for specific client populations, and hired more professionally trained staff. This study examines the extent to which modified TCs are able to retain the underlying core technology of the TC. Using data from a nationally representative sample of 380 self-identified TCs, six traditional TC elements are identified. Results from a structural equation model indicate that offering services for specific populations and professionalization of staff has limited impact on the six TC elements. Modifications to structure and intensity of TC programming evidenced the strongest effect. Specifically, outpatient-only TCs showed significantly lower adherence to five of the six elements. Short-term residential programs showed a similar negative trend. Findings suggest selected modifications are possible without significantly impacting the TC model's core technology.
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Affiliation(s)
- Meredith Huey Dye
- Department of Sociology/Anthropology, Middle Tennessee State University, P.O. Box 10, Murfreesboro, TN 37132, USA.
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24
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Hoxmark EM, Wynn R. Health Providers' Descriptions of the Significance of the Therapeutic Relationship in Treatment of Patients with Dual Diagnoses. J Addict Nurs 2010. [DOI: 10.3109/10884602.2010.520170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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CHANDLER DANIEL. Implementation of Integrated Dual Disorders Treatment in Eight California Programs. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2009. [DOI: 10.1080/15487760903248473] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Magura S, Rosenblum A, Betzler T. Substance Use and Mental Health Outcomes for Comorbid Patients in Psychiatric Day Treatment. Subst Abuse 2009; 3:71-78. [PMID: 20333262 PMCID: PMC2843434 DOI: 10.4137/sart.s3462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The study's purpose was to determine treatment outcomes for patients who present with drug use vs. those presenting with no drug use at admission to a psychiatric day treatment program. Consecutively admitted patients completed confidential interviews which included psychological distress and quality of life measures and provided urine specimens for toxicology at admission and six month follow-up. Subjects positive by past 30 day self-report or urinalysis were categorized as drug users. Major psychiatric diagnoses were: major depression 25%; bipolar, 13%; other mood 13%; schizoaffective 13%; schizophrenia 13%. Drug use at admission was: cocaine 35%; marijuana 33%; opiates 18%, (meth)amphetamines, 6% For each of these drugs, the percentage of patients positive at admission who remitted from using the drug significantly exceeded the percentage negative at baseline who initiated using the drug. Overall, there were significant decreases in psychological distress and significant improvement on quality of life, but no change on positive affect. There were no significant differences between drug users and non-drug users on symptom reduction and improvement in quality of life. Psychiatric day treatment appears to benefit comorbid patients by reducing the net number of patients who actively use certain common drugs and by improving psychological status and quality of life to the same degree as for non-drug using patients.
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Affiliation(s)
- Stephen Magura
- The Evaluation Center, Western Michigan University, Kalamazoo, MI
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27
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Mangrum LF. Client and service characteristics associated with addiction treatment completion of clients with co-occurring disorders. Addict Behav 2009; 34:898-904. [PMID: 19303219 DOI: 10.1016/j.addbeh.2009.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 10/21/2022]
Abstract
The study examines client and service characteristics of addiction treatment completers and non-completers with co-occurring disorders (COD). On demographic variables, completers were more likely to be male and homeless. In the psychiatric domain, a greater proportion of completers received diagnoses of depression and generalized anxiety disorder, whereas non-completers were more often diagnosed with bipolar disorder and posttraumatic stress disorder. No group differences were found in client-reported psychiatric symptom severity; however, non-completers were rated by clinicians as having more severe symptoms in the areas of interpersonal sensitivity, depression, and hostility. In the area of substance use patterns, no differences were found in primary substance of abuse but completers reported more days of use during the month prior to treatment. Completers also had a greater history of both prior detox and non-detox treatment. At discharge, completers achieved higher rates of past month abstinence and AA attendance, but no differences were found in length of stay in treatment. Examination of recovery support services utilization revealed that completers more often received peer mentoring services. Greater proportions of the non-completer group received educational support, clothing, medical care, and employment assistance. These results suggest that future studies are needed in examining possible differential treatment response by diagnostic category and the potential role of peer mentoring in enhancing addiction treatment completion of COD clients.
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28
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Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing first for homeless persons with active addiction: are we overreaching? Milbank Q 2009; 87:495-534. [PMID: 19523126 PMCID: PMC2881444 DOI: 10.1111/j.1468-0009.2009.00565.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT More than 350 communities in the United States have committed to ending chronic homelessness. One nationally prominent approach, Housing First, offers early access to permanent housing without requiring completion of treatment or, for clients with addiction, proof of sobriety. METHODS This article reviews studies of Housing First and more traditional rehabilitative (e.g., "linear") recovery interventions, focusing on the outcomes obtained by both approaches for homeless individuals with addictive disorders. FINDINGS According to reviews of comparative trials and case series reports, Housing First reports document excellent housing retention, despite the limited amount of data pertaining to homeless clients with active and severe addiction. Several linear programs cite reductions in addiction severity but have shortcomings in long-term housing success and retention. CONCLUSIONS This article suggests that the current research data are not sufficient to identify an optimal housing and rehabilitation approach for an important homeless subgroup. The research regarding Housing First and linear approaches can be strengthened in several ways, and policymakers should be cautious about generalizing the results of available Housing First studies to persons with active addiction when they enter housing programs.
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Affiliation(s)
- Stefan G Kertesz
- Center for Surgical, Medical Acute Care Research and Transitions at the Birmingham Veterans Affairs Medical Center, University of Alabama, Birmingham, AL 35294, USA.
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29
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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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30
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SACKS STANLEY, CHANDLER REDONNA, GONZALES JUNIUS. Responding to the challenge of co-occurring disorders: suggestions for future research. J Subst Abuse Treat 2008; 34:139-46. [PMID: 17574790 PMCID: PMC2215390 DOI: 10.1016/j.jsat.2007.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 03/22/2007] [Accepted: 03/30/2007] [Indexed: 11/19/2022]
Abstract
This special issue consolidates some recent research findings and scientific thought on co-occurring disorders from both the substance abuse and mental health fields. This summary article recaps and synthesizes the main findings and themes, then considers additional issues in the field today to arrive at an agenda for future co-occurring disorders research. Plans must: (1) encourage and assist further development of treatment programs that respond to an array of types and severities of co-occurring disorders while taking into account the limited resources typically available; (2) continue the development and testing of continuing care models by exploring strategies that will sustain the recovery of treated individuals who remain vulnerable to relapse; and (3) contribute to our understanding of the mechanisms and processes that enable new interventions and practices to be adopted, implemented, and sustained. "Co-occurring disorders" is a relatively new area of research; this special issue illustrates the productivity of work to date and indicates the potential for advances to come.
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Affiliation(s)
- STANLEY SACKS
- Director, 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,
| | - REDONNA CHANDLER
- Branch Chief, Services Research Branch, National Institute on Drug Abuse, 6001 Executive Blvd. Room 5185, Bethesda, MD 20892, tel 301.443.6504, fax 301.443.6815,
| | - JUNIUS GONZALES
- Principal Associate, Healthcare Policy and Clinical Research Division, Abt Associates, Inc., 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD, 20814, tel 301.634-1700, fax 301.634.1801,
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31
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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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