1
|
Orocio-Contreras M, Nieto-Caraveo A. Structured diagnosis and timely treatment of dual diagnosis: effect on the retention rate in outpatient treatment for substance use disorders. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1983046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marisol Orocio-Contreras
- Public Health Department at Faculty of Medicine, Autonomous University of San Luis Potosí, San Luis Potosí, Mexico
| | - Amado Nieto-Caraveo
- Public Health Department at Faculty of Medicine, Autonomous University of San Luis Potosí, San Luis Potosí, Mexico
| |
Collapse
|
2
|
Guerrero EG, Aarons GA, Palinkas LA. Organizational capacity for service integration in community-based addiction health services. Am J Public Health 2014; 104:e40-7. [PMID: 24524525 DOI: 10.2105/ajph.2013.301842] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined factors associated with readiness to coordinate mental health, public health, and HIV testing among community-based addiction health services programs. METHODS We analyzed client and program data collected in 2011 from publicly funded addiction health services treatment programs in Los Angeles County, California. We analyzed a sample of 14 379 clients nested in 104 programs by using logistic regressions examining odds of service coordination with mental health and public health providers. We conducted a separate analysis to examine the percentage of clients receiving HIV testing in each program. RESULTS Motivational readiness and organizational climate for change were associated with higher odds of coordination with mental health and public health services. Programs with professional accreditation had higher odds of coordinating with mental health services, whereas programs receiving public funding and methadone and residential programs (compared with outpatient) had a higher percentage of clients receiving coordinated HIV testing. CONCLUSIONS These findings provide an evidentiary base for the role of motivational readiness, organizational climate, and external regulation and funding in improving the capacity of addiction health services programs to develop integrated care.
Collapse
Affiliation(s)
- Erick G Guerrero
- Erick G. Guerrero and Lawrence A. Palinkas are with the School of Social Work, University of Southern California, Los Angeles. Gregory A. Aarons is with the Department of Psychiatry, University of California, San Diego
| | | | | |
Collapse
|
3
|
Guerrero EG, Marsh JC, Khachikian T, Amaro H, Vega WA. Disparities in Latino substance use, service use, and treatment: implications for culturally and evidence-based interventions under health care reform. Drug Alcohol Depend 2013; 133:805-13. [PMID: 23953657 DOI: 10.1016/j.drugalcdep.2013.07.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this systematic literature review was to enhance understanding of substance use, service use, and treatment among Latino subgroups to improve access to care and treatment outcomes in an era of health care reform. METHODS The authors used 13 electronic databases and manually searched the literature from January 1, 1978, to May 30, 2013. One hundred (69%) of 145 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus discussions and a content expert reconciled discrepancies. RESULTS Current rates of alcohol and substance abuse among Latinos are comparable to or surpass other U.S. ethnic groups. Disparities in access and quality of care are evident between Latinos and other ethnic groups. As a heterogeneous group, Latinos vary by geographic region in terms of substance of choice and their cultural identity takes precedence over general ethnic identity as a likely determinant of substance abuse behaviors. There is growing research interest in systems influencing treatment access and adherence among racial/ethnic and gender minority groups. However, studies on Latinos' service use and immediate treatment outcomes have been both limited in number and inconsistent in findings. CONCLUSIONS This review identified human capital, quality of care, and access to culturally responsive care as key strategies to eliminate disparities in health and treatment quality. Implications are discussed, including the need for effectiveness studies on Latinos served by systems of care that, under health care reform, are seeking to maximize resources, improve outcomes, and reduce variation in quality of care.
Collapse
Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, United States.
| | | | | | | | | |
Collapse
|
4
|
Guerrero EG, Kao D. Racial/ethnic minority and low-income hotspots and their geographic proximity to integrated care providers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:34. [PMID: 24059252 PMCID: PMC3848872 DOI: 10.1186/1747-597x-8-34] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022]
Abstract
Background The high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care. However, access to integrated care is limited to certain communities. Racial and ethnic minority and low-income communities may not have access to needed integrated care in large urban areas. Because the main principle of health care reform is to expand health insurance to low-income individuals to improve access to care and reduce health disparities among minorities, it is necessary to understand the extent to which integrated care is geographically accessible in minority and low-income communities. Methods National Survey of Substance Abuse Treatment Services data from 2010 were used to examine geographic availability of facilities offering integration of mental health services in SAT programs in Los Angeles County, California. Using geographic information systems (GIS), service areas were constructed for each facility (N = 402 facilities; 104 offering integrated services) representing the surrounding area within a 10-minute drive. Spatial autocorrelation analyses were used to derive hot spots (or clusters) of census tracts with high concentrations of African American, Asian, Latino, and low-income households. Access to integrated care was reflected by the hot spot coverage of each facility, i.e., the proportion of its service area that overlapped with each type of hot spot. Results GIS analysis suggested that ethnic and low-income communities have limited access to facilities offering integrated care; only one fourth of SAT providers offered integrated care. Regression analysis showed facilities whose service areas overlapped more with Latino hot spots were less likely to offer integrated care, as well as a potential interaction effect between Latino and high-poverty hot spots. Conclusion Despite significant pressure to enhance access to integrated services, ethnic and racial minority communities are disadvantaged in terms of proximity to this type of care. These findings can inform health care policy to increase geographic access to integrated care for the increasing number of clients with public health insurance.
Collapse
Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
| | | |
Collapse
|
5
|
Stein JA, Zane JI, Grella CE. Impact of Abstinence Self-Efficacy and Treatment Services on Physical Health-Related Behaviors and Problems among Dually Diagnosed Patients. J Dual Diagn 2012; 8:64-73. [PMID: 22707922 PMCID: PMC3374344 DOI: 10.1080/15504263.2012.647470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE: Physical health problems are pervasive among patients with co-occurring substance use and mental disorders. Yet, drug treatment programs often ignore tobacco use and its association with health. Abstinence self-efficacy has been associated with improved outcomes for co-occurring disorders, which in turn may also impact physical health. This study had the goal of assessing whether abstinence self-efficacy for drugs and alcohol, and provision and use of services would influence tobacco use and other health-related outcomes among 351 individuals with co-occurring disorders in residential drug treatment. METHODS: Structural models tested the impact of baseline abstinence self-efficacy and treatment service characteristics on 6-month outcomes of health problems, functional limitations, health perceptions, and cigarette and heavy alcohol use. Demographics and baseline values for outcome variables were included as covariates. RESULTS: Correlations within time for poor health, cigarette use, and heavy alcohol use were substantial. A longer time in drug treatment was associated with less cigarette and heavy alcohol use at a 6-month follow-up. Baseline health problems were associated with more cigarette use and functional limitations at 6-months. Abstinence self-efficacy did not predict less cigarette use, but predicted less heavy alcohol use and fewer functional limitations. Availability of specialized dual-diagnosis groups and more on-site psychological services were not directly associated with outcomes, but had an impact through indirect effects on more psychological service utilization which predicted better subjective health. CONCLUSIONS: Improving overall treatment retention and services utilization among patients with co-occurring disorders may generalize to improved health perceptions, but specific health promotion and smoking-cessation interventions are warranted to improve health outcomes.
Collapse
Affiliation(s)
- Judith A. Stein
- Department of Psychology, University of California, Los Angeles, ()
| | | | - Christine E. Grella
- Integrated Substance Abuse Programs, Semel Institute for, Neuroscience and Human Behavior, University of California, Los Angeles, ()
| |
Collapse
|
6
|
Grella CE, Shi Y. Stability of Outcomes Following Residential Drug Treatment For Patients with Co-occurring Disorders. J Dual Diagn 2011; 7:103-112. [PMID: 21804769 PMCID: PMC3146302 DOI: 10.1080/15504263.2011.566067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE: Few studies have examined the stability of both substance use and mental health outcomes following residential drug abuse treatment for individuals with co-occurring disorders (COD). This study examines outcomes at 6 and 12 months for individuals with COD, in relationship to services received over the follow-up period. METHODS: Participants with COD (N=310) were sampled from 11 residential drug abuse treatment programs and completed in-depth assessments within 30 days of intake and at 6- and 12-month follow-ups. A path model was developed testing the relationships among treatment participation and services received, psychological status, and substance use outcomes across the two follow-up points. RESULTS: Retention for at least 90 days in residential drug treatment was associated with less inpatient mental health treatment and more mental health services received at 6 months; outpatient mental health treatment was associated with reduced substance use at 6 months. Substance use at 6 months was associated with more psychological distress at both 6 and 12 months and more inpatient mental health treatment at 12 months. CONCLUSIONS: Findings suggest that receipt of mental health services following residential drug abuse treatment for patients with COD is critical to improving their longer-term outcomes.
Collapse
Affiliation(s)
- Christine E Grella
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine at UCLA University of California, Los Angeles 1640 S. Sepulveda Blvd., Suite 200 Los Angeles, CA 90025 Phone (310) 267-5451 Fax (310) 473-7885
| | | |
Collapse
|
7
|
Siddiqui N, Astone-Twerell J, Hernitche T. Staff perspectives on modified therapeutic community services for homeless dually diagnosed clients: an exploratory pilot study. J Psychoactive Drugs 2010; 41:355-61. [PMID: 20235442 DOI: 10.1080/02791072.2009.10399773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The modified therapeutic community (MTC) is one treatment modality developed to meet the needs of the homeless dually diagnosed population. While studies have shown the effectiveness of the MTC, little is known regarding staff perspectives of this modality. Using data from in-depth qualitative interviews, this study examines key staff perspectives on treatment services offered at an MTC in New York for homeless, mentally ill substance abusers. Many staff members indicated that the services provided are innovative, state of the art, and comprehensive as compared to other programs that specifically treat only one need. The most beneficial aspects of the MTC modality noted were the number of social workers available and the introduction of art therapy groups. The MTC modality also fostered increases in communication and collaboration between staff to introduce more specialized clinical groups not outlined in MTC guidelines to better meet the needs of clients.
Collapse
|
8
|
Timko C, Chen S, Sempel J, Barnett P. Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs. J Ment Health 2009. [DOI: 10.1080/09638230600559631] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
9
|
Schulte SJ, Meier PS, Stirling J, Berry M. Treatment approaches for dual diagnosis clients in England. Drug Alcohol Rev 2008; 27:650-8. [PMID: 18830860 DOI: 10.1080/09595230802392816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dual diagnosis (DD, co-occurrence of substance use and mental health problems) prevalence data in England are limited to specific regions and reported rates vary widely. Reliable information on actual service provision for dual diagnosis clients has not been collated. Thus a national survey was carried out to estimate dual diagnosis prevalence in treatment populations and describe the service provision available for this client population in drug/alcohol (DAS) and mental health services (MHS). DESIGN A questionnaire was sent to managers of 706 DAS and 2374 MHS. Overall, 249 (39%) DAS and 493 (23%) MHS participated in the survey. RESULTS In both DAS and MHS, around 32% of clients were estimated to have dual diagnosis problems. However, fewer than 50% of services reported assessing clients for both problem areas. Regarding specific treatment approaches, most services (DAS: 88%, MHS: 87%) indicated working jointly with other agencies. Significantly fewer services used joint protocols (DAS: 55%, MHS: 48%) or shared care arrangements, including access to external drug/alcohol or mental health teams (DAS: 47%, MHS: 54%). Only 25% of DAS and 17% of MHS employed dual diagnosis specialists. CONCLUSIONS Dual diagnosis clients constitute a substantial proportion of clients in both DAS and MHS in England. Despite recent policy initiatives, joint working approaches tend to remain unstructured.
Collapse
Affiliation(s)
- Sabrina J Schulte
- Department of Psychology, Elizabeth Gaskell Campus, Manchester Metropolitan University, UK.
| | | | | | | |
Collapse
|
10
|
Pulling together: interagency coordination and HIV/STD prevention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2008; 14:E1-6. [PMID: 18091030 DOI: 10.1097/01.phh.0000303419.06389.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using multiple network comparisons, we determined whether sexually transmitted disease (STD) rates or black-white STD rate differences are related to how HIV prevention agencies interact through exchanges of information, clients, or funds. In 10 North Carolinian counties, we conducted a cross-sectional analysis, using each county's network as the unit of interest. Using data from face-to-face interviews, measures of the density (overall connectedness) and degree centralization (amount of centralized information hubs) were calculated with UCINET. Statistical significance of the associations between county characteristics and STD rates was assessed with exact Wilcoxon rank sum test. Syphilis rates were lower (P = .01) in counties with a high network density, on the basis of exchanges of information or clients. The effect on black-white rate differences was in the same direction but weaker. Where network degree centralization was high, syphilis rates were higher and the black-white rate differences were larger. Gonorrhea rates demonstrated similar but attenuated patterns of association with network characteristics. STD prevention is more effective when all agencies interact with each other (density) but less effective when interactions are predominantly with a few central agencies (degree centralization). The measures of network exchanges employed in this study may be appropriate for future assessment of service provision of funded prevention programs.
Collapse
|
11
|
Mericle AA, Alvidrez J, Havassy BE. Mental health provider perspectives on co-occurring substance use among severely mentally ill clients. J Psychoactive Drugs 2007; 39:173-81. [PMID: 17703712 DOI: 10.1080/02791072.2007.10399876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This qualitative study explores strategies used by mental health providers (N = 17) to address substance use problems among seriously mentally ill (SMI) clients and their perspectives on barriers to treatment and how treatment can be improved. Providers identified numerous strategies, yet these were countered with perceptions of multiple obstacles, leaving them frustrated, helpless, and hopeless about their clients' substance use. Results suggest that, in addition to improving access to quality dual-diagnosis treatment, larger issues of poverty and social isolation must also be addressed. Not doing so limits what providers can do for SMI clients and could reduce the effect of larger system-level improvements.
Collapse
Affiliation(s)
- Amy A Mericle
- Department of Psychiatry, School of Medicine, University of California, San Francisco, USA.
| | | | | |
Collapse
|
12
|
Warren JI, Stein JA, Grella CE. Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders. Drug Alcohol Depend 2007; 89:267-74. [PMID: 17329040 PMCID: PMC2753536 DOI: 10.1016/j.drugalcdep.2007.01.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 01/12/2007] [Accepted: 01/17/2007] [Indexed: 11/15/2022]
Abstract
Individuals with co-occurring substance use and psychiatric disorders have a more severe clinical course and poorer outcomes than do individuals with one disorder. In an attempt to find intervening variables that may contribute to improvement in treatment outcomes among individuals with co-occurring disorders, we investigated the roles of social support and self-efficacy in a sample of 351 clients with co-occurring disorders in residential drug abuse treatment programs (53% male; 35% African American, 13% Hispanic). Given their demographic variability, we also explored how ethnicity and age influence self-efficacy and access to social support, as well as their relationships to the outcomes. Structural equation modeling was used to examine the impact of the demographics and baseline psychological status, substance use, social support, and self-efficacy on mental health and substance use outcomes 6 months after treatment entry. Time in treatment was included as a control. Greater social support at baseline predicted better mental health status and less heroin and cocaine use; greater self-efficacy predicted less alcohol and cocaine use. Older clients reported less social support. African-American ethnicity was associated with more cocaine use at baseline and follow-up; however, African Americans reported more self-efficacy, which moderated their cocaine use. The current study highlights the potential therapeutic importance of clients' personal resources, even among a sample of severely impaired individuals.
Collapse
Affiliation(s)
| | | | - Christine E. Grella
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, United States
| |
Collapse
|
13
|
Knudsen HK, Ducharme LJ, Roman PM. The use of antidepressant medications in substance abuse treatment: the public-private distinction, organizational compatibility, and the environment. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2007; 48:195-210. [PMID: 17583274 DOI: 10.1177/002214650704800207] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 363 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption.
Collapse
Affiliation(s)
- Hannah K Knudsen
- University of Georgia, Center for Research on Behavioral Health and Human Services Delivery, 101 Barrow Hall, Athens, GA 30602-2401, USA.
| | | | | |
Collapse
|
14
|
Ouimette P, Jemelka R, Hall J, Brimner K, Krupski A, Stark K. Services to patients with dual diagnoses: findings from Washington's mental health service system. Subst Use Misuse 2007; 42:113-27. [PMID: 17366128 DOI: 10.1080/10826080601096657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined how Washington State's (WA) mental health treatment system provided services to patients with substance use disorders or dual diagnoses at several stages of care: crisis commitment, hospitalization, and outpatient treatment. A total of 30 key informants from urban and rural areas were surveyed between February and July 2004 using semi-structured interviews. Key informants represented direct service providers to chief operating officers. Themes, consensus, and disagreements were summarized. Results indicated that best practices are not consistently implemented and administrative and provider barriers hinder provision of more effective care. Findings highlight that work on how to best implement evidence-based practices is critical to improving care of dual diagnosis patients. Limitations of the study are noted as well as future research directions.
Collapse
Affiliation(s)
- Paige Ouimette
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York 13210, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Grella CE, Stein JA. Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2006. [PMID: 16816286 DOI: 10.1176/appi.ps.57.7.1007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up. METHODS Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up. RESULTS Individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services. CONCLUSIONS Study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans.
Collapse
|
16
|
Hser YI, Grella C, Evans E, Huang YC. Utilization and outcomes of mental health services among patients in drug treatment. J Addict Dis 2006; 25:73-85. [PMID: 16597575 DOI: 10.1300/j069v25n01_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined utilization of mental health services and treatment outcomes among 1,091 patients with mental health problems recruited from 39 treatment programs in 13 California counties. We compared three groups: one that received dual treatment from drug and mental health programs (N=294), one that received mental health services only within drug treatment programs (N=578), and one that received no mental health services (N=219). Individuals who received dual treatment had more severe substance use and mental health problems, followed in severity by those who received mental health services within drug treatment, and those who received no services. All groups significantly reduced their psychiatric severity at the follow-up, although there were no group differences in treatment retention and drug use outcomes. These findings suggest that individuals with mental health problems can be successfully treated within drug treatment programs and/or in conjunction with mental health providers.
Collapse
Affiliation(s)
- Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, 1640 S Sepulveda Boulevard, Suite 200, Los Angeles, CA 90025, USA.
| | | | | | | |
Collapse
|
17
|
McGovern MP, Xie H, Segal SR, Siembab L, Drake RE. Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. J Subst Abuse Treat 2006; 31:267-75. [PMID: 16996389 DOI: 10.1016/j.jsat.2006.05.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 05/02/2006] [Accepted: 05/05/2006] [Indexed: 11/23/2022]
Abstract
As the model for treating co-occurring disorders in addiction treatment settings becomes articulated, service systems need data on prevalence, current practice, and barriers to the implementation of evidence-based practices. A self-report survey was administered to 453 addiction treatment providers (43 agency directors, 110 clinical supervisors, and 300 clinicians) from a single state system of care. Data on prevalence estimates, treatment practices, and barriers to implementing services for co-occurring disorders were obtained. The three groups estimated that several co-occurring disorders were extremely common: mood disorders (40%-42%), anxiety disorders (24%-27%), posttraumatic stress disorder (24%-27%), severe mental illnesses (16%-21%), antisocial personality disorder (18%-20%), and borderline personality disorder (17%-18%). Practice patterns for patients with these co-occurring disorders differed widely, from referral to mental health programs to provision of integrated treatment. Common barriers to providing services to persons with co-occurring disorders were lack of psychiatric personnel and resources. Comprehensive surveys of an addiction treatment service system can rapidly and economically produce estimates of prevalence, current practices, and barriers to evidence-based practices. This objective information is critical for systems intending to enhance services to persons with co-occurring disorders.
Collapse
Affiliation(s)
- Mark P McGovern
- Department of Psychiatry, New Hampshire Dartmouth Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH, USA.
| | | | | | | | | |
Collapse
|
18
|
Messina N, Burdon W, Hagopian G, Prendergast M. Predictors of prison-based treatment outcomes: a comparison of men and women participants. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2006; 32:7-28. [PMID: 16450640 DOI: 10.1080/00952990500328463] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to examine differences between men and women entering prison-based therapeutic community (TC) treatment and to explore the relationship of those differences to posttreatment outcomes (i.e., aftercare participation and reincarceration rates). Extensive treatment-intake interview data for 4,386 women and 4,164 men from 16 prison-based TCs in California were compared using chi-square analyses and t-tests. Logistic regression analyses were then conducted separately for men and women to identify gender-specific factors associated with post-treatment outcomes. Prison intake data and treatment participation data come from a 5-year process and outcome evaluation of the California Department of Corrections' (CDC) Prison Treatment Expansion Initiative. The return-to-custody data came from the CDC's Offender Based Information System. Bivariate results showed that women were at a substantial disadvantage compared with their male counterparts with regard to histories of employment, substance abuse, psychological functioning, and sexual and physical abuse prior to incarceration. In contrast, men had more serious criminal justice involvement than women prior to incarceration. After controlling for these and other factors related to outcomes, regression findings showed that there were both similarities and differences with regard to gender-specific predictors of posttreatment outcomes. Time in treatment and motivation for treatment were similar predictors of aftercare participation for men and women. Psychological impairment was the strongest predictor of recidivism for both men and women. Substantial differences in background characteristics and the limited number of predictors related to posttreatment outcomes for women suggests the plausibility of gender-specific paths in the recovery process.
Collapse
Affiliation(s)
- Nena Messina
- UCLA Integrated Substance Abuse Programs, Criminal Justice Research Group, Los Angeles, CA 90025, USA.
| | | | | | | |
Collapse
|
19
|
Carter WC, Lee SYD, Thomas KC, Morrissey J. Managed Care, Inter-agency Linkages, and Outpatient Substance Abuse Treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006; 33:122-31. [PMID: 16416037 DOI: 10.1007/s10488-005-0010-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
: Although treatment of co-occurring behavioral and physical health problems could be facilitated by the linkages between health care providers, it is uncertain how such inter-agency linkages are affected by managed care. We used a sample of 167 service linkages to examine the effects of managed care arrangements on inter-agency communication, coordination, and perceived effectiveness. These linkages were identified based on interviews with 62 outpatient substance abuse treatment units in 2000. Results indicate that frequency of communication and inter-agency coordination are positively related to several managed care arrangements and may moderate the relationships between managed care arrangements and perceived effectiveness.
Collapse
Affiliation(s)
- W Craig Carter
- Department of Sociology and Anthropology, Middle Tennessee State University, Murfreesboro, TN 37132-0001, USA.
| | | | | | | |
Collapse
|
20
|
Gil-Rivas V, Grella CE. Treatment services and service delivery models for dually diagnosed clients: variations across mental health and substance abuse providers. Community Ment Health J 2005; 41:251-66. [PMID: 16131005 DOI: 10.1007/s10597-005-5000-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper reports on a survey of administrators (n = 26) and staff (n = 248) in 10 mental health and 16 substance abuse programs in Los Angeles County providing services to individuals with co-occurring disorders. Although half or more of the administrators and staff reported that their programs had some degree of on-site service integration, there was a lack of agreement within most programs as to the extent of integration. Characteristics of services provided and interactions with other service providers are also examined. Future research is needed regarding the divergent perceptions of administrators and staff and their relationship to treatment outcomes.
Collapse
Affiliation(s)
- Virginia Gil-Rivas
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC 28273, USA.
| | | |
Collapse
|
21
|
O'Brien CP, Charney DS, Lewis L, Cornish JW, Post RM, Woody GE, Zubieta JK, Anthony JC, Blaine JD, Bowden CL, Calabrese JR, Carroll K, Kosten T, Rounsaville B, Childress AR, Oslin DW, Pettinati HM, Davis MA, Demartino R, Drake RE, Fleming MF, Fricks L, Glassman AH, Levin FR, Nunes EV, Johnson RL, Jordan C, Kessler RC, Laden SK, Regier DA, Renner JA, Ries RK, Sklar-Blake T, Weisner C. Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: a call to action. Biol Psychiatry 2004; 56:703-13. [PMID: 15556110 DOI: 10.1016/j.biopsych.2004.10.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Charles P O'Brien
- Department of Psychiatry, University of Pennsylvania School of Medicine, 3900 Chestnut Street, Philadelphia, PA 19104-6178, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Grant LP, Haughton B, Sachan DS. Nutrition education is positively associated with substance abuse treatment program outcomes. ACTA ACUST UNITED AC 2004; 104:604-10. [PMID: 15054346 DOI: 10.1016/j.jada.2004.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The scope and types of nutrition services provided in substance abuse treatment programs has not been well defined nor has there been an attempt to determine if associations exist between the provision of nutrition services and substance abuse treatment outcomes. The objectives of this study were to assess the provision (use and extent) of nutrition education in substance abuse treatment programs in facilities that provide a single or two or more substance abuse treatment programs, and to determine the possible association between nutrition intervention and substance abuse treatment program outcome measures (defined as changes in Addiction Severity Index [ASI] composite scores). A descriptive, single, cross-sectional survey of registered dietitians with clinical nutrition program management responsibility (n=152) was used to define the use and extent of nutrition services in substance abuse treatment programs. Positive associations between nutrition services provided, particularly nutrition education services and substance abuse treatment program outcome measures, were detected. When group nutrition/substance abuse education was offered, ASI psychological and medical domain scores improved by 68% and 56%, respectively (P<.05). Individual nutrition/substance abuse education was a predictor of ASI family/social domain change scores improving by 99% (P<.05). In those programs where group nutrition/substance abuse education was offered, moderate to strong correlations with various nutrition education services were observed, specifically in individual nutrition/substance abuse education (r=0.51; P<.05), group normal/nutrition education (r=0.64; P<.01), and individual normal/nutrition education (r=0.46; P<.05). Substance abuse treatment programs offering group nutrition/substance abuse education offered significantly (P<.05) more nutrition services overall. Findings support the position that nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. Dietitians should promote and encourage the inclusion of nutrition education into substance abuse treatment programs.
Collapse
Affiliation(s)
- Louise P Grant
- Nutrition and Food Service, James H Quillen VA Medical Center, Mountain Home, TN, USA.
| | | | | |
Collapse
|
23
|
Perceptions of Mental Health and Substance Abuse Program Administrators and Staff on Service Delivery to Persons With Co-occurring Substance Abuse and Mental Disorders. J Behav Health Serv Res 2004. [DOI: 10.1097/00075484-200401000-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Grella CE, Gil-Rivas V, Cooper L. Perceptions of mental health and substance abuse program administrators and staff on service delivery to persons with co-occurring substance abuse and mental disorders. J Behav Health Serv Res 2004; 31:38-49. [PMID: 14722479 DOI: 10.1007/bf02287337] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several initiatives in the past 20 years have been implemented in Los Angeles County to improve service delivery across the mental health and substance abuse treatment systems, with the goal of increasing access to and coordination of services for individuals with co-occurring substance abuse and mental disorders. To examine the current status of service delivery to this population, a survey was conducted with administrators of mental health and substance abuse programs that provide services to dually diagnosed patients and with the treatment staff in those programs. Administrators (n = 15) and staff (n = 99) in substance abuse programs rated the accessibility and coordination of services to dually diagnosed patients significantly lower than the mental health administrators (n = 10) and staff (n = 136). Efforts to coordinate service delivery across the two systems need to address these divergent perceptions between staff in programs that are increasingly called upon to work together to jointly deliver services.
Collapse
Affiliation(s)
- Christine E Grella
- UCLA Drug Abuse Research Center/Integrated Substance Abuse Programs, 1640 S Sepulveda Blvd, Suite 200, Los Angeles, CA 90025, USA.
| | | | | |
Collapse
|
25
|
Grella CE. Effects of gender and diagnosis on addiction history, treatment utilization, and psychosocial functioning among a dually-diagnosed sample in drug treatment. J Psychoactive Drugs 2003; 35 Suppl 1:169-79. [PMID: 12825760 DOI: 10.1080/02791072.2003.10400512] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
There has been increased recognition of the clinical treatment needs of patients with co-occurring mental and substance use disorders and the heterogeneity of this group with regard to types of substances used and mental disorders. This article examines differences between men and women diagnosed with mood or psychotic disorders at admission to residential drug treatment, specifically regarding their addiction history, treatment history, perceived service needs, and psychosocial functioning. Males initiated drug use at a younger age and had higher levels of dependence on alcohol, cannabis, and opioids. There were no differences among groups in treatment history, motivation, or initiation. Males had higher rates of being under legal supervision and engaging in property crime, whereas females had higher rates of prostitution. Females had greater needs for family- and trauma-related services, and females with psychotic disorders had the highest needs for basic services. There were no differences among groups in barriers to treatment, quality of life, self-efficacy, or family support. Individuals with psychotic disorders had more symptoms of psychological distress; females had higher rates of posttraumatic stress disorder. Differences among dually-diagnosed individuals related to gender and diagnosis need to be considered in treatment planning and in matching services to patient needs.
Collapse
Affiliation(s)
- Christine E Grella
- UCLA Integrated Substance Abuse Programs, Neuropsychiatric Institute and Hospital, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Cailfornia 90025, USA.
| |
Collapse
|