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Elison-Davies S, Wardell JD, Quilty LC, Ward J, Davies G. Examining correlates of cannabis users' engagement with a digital intervention for substance use disorder: An observational study of clients in UK services delivering Breaking Free Online. J Subst Abuse Treat 2021; 123:108261. [PMID: 33612195 DOI: 10.1016/j.jsat.2020.108261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cannabis is among the most widely used drugs, with the literature demonstrating that cannabis use disorder (CUD) may be more prevalent than previously thought. Research should explore novel approaches to behavioral support to meet treatment need, including computer-assisted therapies such as Breaking Free Online (BFO). This study aimed to understand how participants' baseline sociodemographic and clinical characteristics are associated with engagement with BFO, and how both participants' characteristics and their engagement may be associated with cannabis use and biopsychosocial functioning at follow-up. METHODS An observational study with 1830 individuals presenting to UK-based publicly funded treatment services who reported cannabis as their primary problem substance and engaged with BFO as a self-directed intervention. RESULTS Moderate-severe depression/anxiety (51%) and elevated severity of cannabis dependence scores (39%) characterized the baseline sample. Women demonstrated greater clinical complexity at baseline than men. Baseline mental health and biopsychosocial functioning were associated with whether participants completed a follow-up assessment. Among 460 participants who completed a follow-up assessment, intervention engagement was positively associated with self-reported quality of life and biopsychosocial functioning at follow-up. CONCLUSIONS Cannabis users demonstrated substantial clinical complexity at baseline, with depression/anxiety and biopsychosocial functioning being associated with BFO engagement. Greater BFO engagement was also associated with better quality of life and biopsychosocial functioning at follow-up. Some groups, including those with greater mental health and biopsychosocial impairment at baseline and women, may require support to engage with BFO to maximize clinical benefits.
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Affiliation(s)
- Sarah Elison-Davies
- Breaking Free Group, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK.
| | - Jeffrey D Wardell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1L8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1L8, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1L8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1L8, Canada
| | - Jonathan Ward
- Breaking Free Group, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
| | - Glyn Davies
- Breaking Free Group, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
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Saban A, Morojele N, London L. A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa. BMC Health Serv Res 2017; 17:740. [PMID: 29219083 PMCID: PMC5773865 DOI: 10.1186/s12913-017-2643-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town. METHODS Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted. RESULTS Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital. DISCUSSION The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers. CONCLUSIONS Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.
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Affiliation(s)
- Amina Saban
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Neo Morojele
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Leslie London
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Schoenthaler SJ, Blum K, Fried L, Oscar-Berman M, Giordano J, Modestino EJ, Badgaiyan R. The effects of residential dual diagnosis treatment on alcohol abuse. ACTA ACUST UNITED AC 2017; 3. [PMID: 28868159 PMCID: PMC5576155 DOI: 10.15761/jsin.1000169] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This multi-center study of dual diagnosis (DD) programs involved 804 residential patients with co-occurring alcohol and mental health disorders. The Addiction Severity Index was administered at admission and at one, six, and 12 months after discharge. Repeated measures analysis showed the intoxication rate per month stabilized between months six and 12 with 68% still in remission and an 88% mean reduction from baseline (F = 519, p < .005). A comparison between patients with and without weekly relapse produced significant differences in hospitalization (odds ratio 11.3:1; 95% C.I., 5.5 to 23.2). Eight ANCOVAs used mean intoxication days per month after discharge as the outcome variable, pre-admission intoxication days per month as a covariate, and eight variables associated with relapse (e.g. depression) as factors. Patients with these factors at admission did not have significantly higher intoxication rates after discharge than patients without them. This suggests that these DD programs successfully integrated treatment of both disorders and explained their effectiveness. Co-occurring DSM IV mood disorders such as anxiety and depression as well as drug abuse involving opioids or cocaine fell between 66 and 95% at months one, six, and twelve.
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Affiliation(s)
| | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.,Dominion Diagnostics, LLC North Kingstown, RI, USA.,National Institute of Holistic Studies, North Miami Beach, FL, USA.,Department of Psychiatry, Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine Burlington, VT, USA.,Department of Addiction Research & Therapy, Nupathways, Innsbrook, MO, USA.,Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton OH, USA.,Department of Psychiatry, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.,Division of Addition Research & Therapy, The Shores Treatment & Recovery Center, Port St. Lucie, FL, USA.,Division of Precision Medicine, Geneus Health, LLC, San Antonio, TX, USA
| | - Lyle Fried
- Division of Addition Research & Therapy, The Shores Treatment & Recovery Center, Port St. Lucie, FL, USA
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, 02118, USA
| | - John Giordano
- National Institute of Holistic Studies, North Miami Beach, FL, USA
| | | | - Rajendra Badgaiyan
- Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton OH, USA
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Roncero C, Szerman N, Terán A, Pino C, Vázquez JM, Velasco E, García-Dorado M, Casas M. Professionals' perception on the management of patients with dual disorders. Patient Prefer Adherence 2016; 10:1855-1868. [PMID: 27698553 PMCID: PMC5034926 DOI: 10.2147/ppa.s108678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.
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Affiliation(s)
- Carlos Roncero
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
- Correspondence: Carlos Roncero, Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain, Tel +34 93 489 4294, Fax +34 93 489 4587, Email
| | - Néstor Szerman
- Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Terán
- Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain
| | - Carlos Pino
- Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain
| | - José María Vázquez
- Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain
| | - Elena Velasco
- Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain
| | | | - Miguel Casas
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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Kolliakou A, Castle D, Sallis H, Joseph C, O'Connor J, Wiffen B, Gayer-Anderson C, McQueen G, Taylor H, Bonaccorso S, Gaughran F, Smith S, Greenwood K, Murray RM, Di Forti M, Atakan Z, Ismail K. Reasons for cannabis use in first-episode psychosis: does strength of endorsement change over 12 months? Eur Psychiatry 2014; 30:152-9. [PMID: 25541346 DOI: 10.1016/j.eurpsy.2014.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time. METHODS FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point. RESULTS Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive. CONCLUSIONS Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use.
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Affiliation(s)
- A Kolliakou
- Department of Psychological Medicine, PO92, Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF London, UK.
| | - D Castle
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - H Sallis
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C Joseph
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - J O'Connor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - B Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - C Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - G McQueen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - H Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - S Bonaccorso
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - F Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - S Smith
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
| | - K Greenwood
- School of Psychology, University of Sussex, Sussex, UK
| | - R M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - M Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Z Atakan
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - K Ismail
- Department of Psychological Medicine, PO92, Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF London, UK
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Elison S, Ward J, Davies G, Lidbetter N, Hulme D, Dagley M. An outcomes study of eTherapy for dual diagnosis using Breaking Free Online. ADVANCES IN DUAL DIAGNOSIS 2014. [DOI: 10.1108/add-11-2013-0025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service.
Design/methodology/approach
– A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74.
Findings
– Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant.
Research limitations/implications
– These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach.
Originality/value
– This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.
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Bahorik AL, Newhill CE, Queen CC, Eack SM. Letter to the editor: Critique of Bahorik et al. (2013)--'Underreporting of drug use among individuals with schizophrenia: prevalence and predictors'--a reply. Psychol Med 2014; 44:670-671. [PMID: 24524169 DOI: 10.1017/s0033291713002560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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White SM, Riley A, Flom P. Assessment of Time Management Skills (ATMS): A Practice-Based Outcome Questionnaire. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/0164212x.2013.819481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Anne Riley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Peter Flom
- Scientific Computing Center, SUNY Downstate Medical Center, Brooklyn, New York
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Pereiro C, Pino C, Flórez G, Arrojo M, Becoña E. Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study. PLoS One 2013; 8:e66451. [PMID: 23823135 PMCID: PMC3688915 DOI: 10.1371/journal.pone.0066451] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/04/2013] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED The objective of this study is to assess the prevalence of psychiatric comorbidity in patients under treatment within the addictive disorders assistance units of Galicia (Spain). MATERIAL AND METHODS A total of 64 healthcare professionals performed clinical diagnosis of mental disorders (on DSM IV-TR criteria) in 2300 patients treated throughout March 2010 in 21 addictive disorders assistance units. RESULTS 56.3% of patients with substance abuse/dependency also showed some other mental disorder, 42.2% of patients suffering from at least an Axis I condition and 20.2% from some Axis II condition. Mood and anxiety disorders and borderline and antisocial personality disorders were the most frequent disorders in both axes. CONCLUSIONS A high comorbidity was found between mental and substance use disorders (SUD) in patients seen at the addictive disorders assistance units of Galicia.
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Affiliation(s)
| | | | | | - Manuel Arrojo
- Mental Health and Drug Dependency Assistance Service, Direction of Sanitary Assistance, Galician Health Service, Galicia, Spain
| | - Elisardo Becoña
- Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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11
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Boden MT, Moos R. Predictors of substance use disorder treatment outcomes among patients with psychotic disorders. Schizophr Res 2013; 146:28-33. [PMID: 23453585 DOI: 10.1016/j.schres.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 12/01/2022]
Abstract
Although integrated approaches are recommended and effective for treating patients with co-occurring substance use and psychotic disorders (SUD-PSY), many patients receive standard, nonintegrated substance use disorder (SUD) treatment. Research has yet to investigate how patients with co-occurring substance use and psychotic disorders respond to standard SUD treatment, an issue we address here. In a naturalistic follow-up of 236 male SUD-PSY patients receiving 12-step facilitation or cognitive-behavioral-oriented SUD treatment, we found that patients (1) demonstrated significant improvements in proximal outcomes (e.g., approach coping) from treatment intake to discharge, and in distal outcomes (e.g., psychiatric symptoms, substance use frequency) from treatment intake to 1- and 5-year follow-ups, and (2) tended to have similar outcomes whether they received 12-step facilitation or cognitive-behavioral SUD treatment. Patients who (3) were more involved in treatment, as reflected by more positive perceptions of and more satisfaction, tended to experience better proximal outcomes and engage in more continuing care, and those who (4) experienced better proximal outcomes tended to have better psychiatric and substance use outcomes in the years following treatment. Our results suggest that SUD-PSY patients can benefit from standard SUD treatments, even though it may not directly address their psychiatric disorders.
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Affiliation(s)
- Matthew Tyler Boden
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, United States.
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12
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Nuijten M, Blanken P, van der Hoorn B, van den Brink W, Hendriks V. A randomised controlled trial of outpatientversusinpatient integrated treatment of dual diagnosis patients: a failed but informative study. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17523281.2011.628947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing Housing First with Treatment First programs. Community Ment Health J 2011; 47:227-32. [PMID: 20063061 PMCID: PMC2916946 DOI: 10.1007/s10597-009-9283-7] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 12/28/2009] [Indexed: 11/29/2022]
Abstract
The Housing First (HF) approach for homeless adults with serious mental illness has gained support as an alternative to the mainstream "Treatment First" (TF) approach. In this study, group differences were assessed using qualitative data from 27 HF and 48 TF clients. Dichotomous variables for substance use and substance abuse treatment utilization were created and examined using bivariate and logistic regression analyses. The HF group had significantly lower rates of substance use and substance abuse treatment utilization; they were also significantly less likely to leave their program. Housing First's positive impact is contrasted with the difficulties Treatment First programs have in retaining clients and helping them avoid substance use and possible relapse.
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Affiliation(s)
- Deborah K Padgett
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA.
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Doering BK, Conrad N, Rief W, Exner C. Living with acquired brain injury: Self-concept as mediating variable in the adjustment process. Neuropsychol Rehabil 2011; 21:42-63. [DOI: 10.1080/09602011.2010.525947] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Canaway R, Merkes M. Barriers to comorbidity service delivery: the complexities of dual diagnosis and the need to agree on terminology and conceptual frameworks. AUST HEALTH REV 2010; 34:262-8. [PMID: 20797355 DOI: 10.1071/ah08723] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 04/22/2009] [Indexed: 11/23/2022]
Abstract
This paper draws from a literature review commissioned as part of a larger project evaluating comorbidity treatment service models, which was funded by the Australian Government Department of Health and Ageing as part of the National Comorbidity Initiative. The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. This paper outlines conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, particularly around the variable nature of comorbidity, and the impacts of the separation of the mental health (MH) and alcohol and other drug (AOD) sectors with their differing institutional cultures, aetiological concepts, philosophical underpinnings, educational requirements, administrative arrangements, and screening and treatment approaches. Issues pertaining to the lack of consistent definitions and conceptual frameworks for comorbidity are discussed, particularly in relation to the reported lack of communication, collaboration, and linkages between the sectors. It is suggested that the adoption of consistent terminology and conceptual frameworks may provide a valuable step towards consistency in service provision and research and could lead to improved capacity to address the many issues relating to comorbidity service provision and treatment efficacy.
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Affiliation(s)
- Rachel Canaway
- School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Caulfield, VIC 3145, Australia
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Kola LA, Kruszynski R. Adapting the Integrated Dual-Disorder Treatment Model for Addiction Services. ALCOHOLISM TREATMENT QUARTERLY 2010. [DOI: 10.1080/07347324.2010.511067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boden MT, Moos R. Dually diagnosed patients' responses to substance use disorder treatment. J Subst Abuse Treat 2009; 37:335-45. [PMID: 19540699 DOI: 10.1016/j.jsat.2009.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/19/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
Abstract
Few studies have investigated whether dually diagnosed patients with co-occurring substance use and psychiatric disorders (DD) respond as well to substance use disorder (SUD) treatments as patients with SUD do. Here we assessed whether male veteran DD and SUD patients with alcohol dependence diagnoses differed in the process and outcomes of residential SUD treatment. The main findings showed that (a) DD patients did not perceive SUD programs as positively as patients with SUD did and had worse proximal outcomes at discharge from treatment; (b) DD patients did as well as SUD patients on 1- and 5-year substance use outcomes but had worse psychiatric outcomes; and (c) patients who perceived treatment more positively and had better outcomes at discharge had better longer term outcomes. Thus, residential SUD programs are relatively effective in reducing DD patients' substance use problems; however, they are less successful in engaging DD patients in treatment and addressing their psychiatric problems.
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Affiliation(s)
- M Tyler Boden
- Department of Veterans Affairs Health Care System, Center for Health Care Evaluation, Health Services Research and Development Service, Stanford University School of Medicine, Palo Alto, CA, USA.
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18
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Reedy AR, Hall JA. Treatment issues with substance use disorder clients who have mood or anxiety disorders. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701741738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Drake RE, O'Neal EL, Wallach MA. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. J Subst Abuse Treat 2008; 34:123-38. [PMID: 17574803 DOI: 10.1016/j.jsat.2007.01.011] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 12/22/2006] [Accepted: 01/02/2007] [Indexed: 11/19/2022]
Abstract
This report reviews studies of psychosocial interventions for people with co-occurring substance use disorder and severe mental illness. We identified 45 controlled studies (22 experimental and 23 quasi-experimental) of psychosocial dual diagnosis interventions through several search strategies. Three types of interventions (group counseling, contingency management, and residential dual diagnosis treatment) show consistent positive effects on substance use disorder, whereas other interventions have significant impacts on other areas of adjustment (e.g., case management enhances community tenure and legal interventions increase treatment participation). Current studies are limited by heterogeneity of interventions, participants, methods, outcomes, and measures. Treatment of co-occurring severe mental illness and substance use disorder now has a large but heterogeneous evidence base that nevertheless supports several types of interventions. Future research will need to address methodological standardization, longitudinal perspectives, interventions for subgroups and stages, sequenced interventions, and the changing realities of treatment systems.
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Affiliation(s)
- Robert E Drake
- Department of Psychiatry, Dartmouth Medical School, Lebanon, NH 03766, USA.
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Perron BE, Bright CL. The influence of legal coercion on dropout from substance abuse treatment: results from a national survey. Drug Alcohol Depend 2008; 92:123-31. [PMID: 17869030 PMCID: PMC2265782 DOI: 10.1016/j.drugalcdep.2007.07.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 07/10/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
Abstract
Legal coercion is frequently used to leverage substance abuse treatment upon persons who would otherwise not seek it voluntarily. Various methodological and conceptual problems of the existing research have prevented a clear understanding of its effectiveness. The influence of legal coercion on retention in substance abuse treatment was examined using a national survey of programs in the public sector of care and three different treatment modalities including short-term residential (N=756), long-term residential (N=757), and outpatient treatment (N=1181). Legal coercion was found to reduce the risk of dropout across all three treatment modalities. The greatest effect was among persons in short-term residential treatment. The smallest effect was observed in outpatient treatment. This study shows that legal coercion significantly reduces the risk of dropout in substance abuse treatment. However, the differential effects across treatment conditions must be carefully considered when using coercion to involve individuals in treatment.
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Affiliation(s)
- Brian E Perron
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA.
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21
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Dawson R, Green AI, Drake RE, McGlashan TH, Schanzer B, Lavori PW. Developing and testing adaptive treatment strategies using substance-induced psychosis as an example. PSYCHOPHARMACOLOGY BULLETIN 2008; 41:51-67. [PMID: 18779776 PMCID: PMC2615414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Decisions concerning treatment changes pervade the management of chronic psychiatric disorders that resist definitive cure, yet empirical evidence for the comparative clinical effectiveness of treatment strategies remains underdeveloped. In this paper we exploit the example of psychosis following substance use to illustrate some new developments in clinical trials design that can provide the most solid evidence base for defining successful strategies. The intent is to explore the strengths and limitations of the methodological approach through a meaningful clinical example, with an emphasis on concepts and issues. Both methodology and clinical science are overviewed.
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Affiliation(s)
- Ree Dawson
- Frontier Science & Technology Research Foundation, Boston, MA, USA.
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DRAKE ROBERTE, MUESER KIMT, BRUNETTE MARYF. Management of persons with co-occurring severe mental illness and substance use disorder: program implications. World Psychiatry 2007; 6:131-6. [PMID: 18188429 PMCID: PMC2174596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Adults with severe mental illness have extraordinarily high rates of co-occurring substance use disorders, typically around 50% or more, which adversely affect their current adjustment, course, and outcome. Separate and parallel mental health and substance abuse treatment systems do not offer interventions that are accessible, integrated, and tailored for the presence of co-occurrence. Recent integrated interventions for this population have the specific goal of ameliorating substance use disorder and the general goal of improving adjustment and quality of life. The authors overview the current research and offer guidelines related to mission and philosophy, leadership, comprehensive reorganization, training, specific programs, and quality improvement.
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Affiliation(s)
- ROBERT E DRAKE
- Psychiatric Research Center, Dartmouth Medical
School, 2 Whipple Place, Suite 202, Lebanon, NH 03766, USA
| | - KIM T MUESER
- Psychiatric Research Center, Dartmouth Medical
School, 2 Whipple Place, Suite 202, Lebanon, NH 03766, USA
| | - MARY F BRUNETTE
- Psychiatric Research Center, Dartmouth Medical
School, 2 Whipple Place, Suite 202, Lebanon, NH 03766, USA
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23
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Modeling the Ecological Validity of Neurocognitive Assessment in Adults with Acquired Brain Injury. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9075-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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