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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Elison-Davies S, Newsome J, Jones A, Davies G, Ward J. Associations between psychosocial risk factors, and changes in substance dependence and psychosocial functioning, during engagement with digital cognitive behavioral therapy for methamphetamine use: use of 'Breaking Free from Substance Abuse' by incarcerated people during the COVID-19 pandemic. HEALTH & JUSTICE 2022; 10:28. [PMID: 36070026 PMCID: PMC9449936 DOI: 10.1186/s40352-022-00190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/30/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND Methamphetamine use can be associated with involvement with correctional services and incarceration. Traditionally, treatments for methamphetamine use have been delivered in-person - however, lockdowns initiated during the COVID-19 pandemic significantly reduced access to such in-person support in prisons. Therefore, in May 2020 a digital cognitive-behavioral therapy (CBT) program for substance use disorders - 'Breaking Free from Substance Abuse' - was made available across prisons in Ohio in order to meet this treatment gap. This represents the first time this digital CBT intervention has been made widely available to incarcerated people residing in prisons or jails in the United States (US). This was a within-subjects study using data from 2187 Ohio prison residents who engaged with this digital CBT program to address their methamphetamine use. RESULTS Participants reported multiple psychosocial risk factors, including moderate to severe substance dependence, depression and anxiety; interpersonal conflict; aggressive behavior; paranoia; and difficulties with work, education and accommodation. Significant reductions in substance dependence, depression/anxiety and biopsychosocial impairment, and improvements in quality of life, were identified in the sample. Risk factors were associated with less positive outcomes, specifically interpersonal conflict and poor mental health. Completion of specific components of the program were associated with more positive outcomes - a dose response was also identified. CONCLUSIONS Digital CBT can be delivered in secure US correctional settings and may help to fill unmet needs for in-person treatment. Specifically, this digital CBT program may support incarcerated individuals to address methamphetamine use, with outcomes being associated with psychosocial risk factors and program engagement.
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Affiliation(s)
| | | | - Andrew Jones
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Glyn Davies
- LifeWorks, Manchester Science Park, Manchester, UK
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Puértolas-Gracia B, Barbaglia MG, Gotsens M, Parés-Badell O, Brugal MT, Torrens M, Treviño L, Rodríguez-Díaz C, Vázquez-Vázquez JM, Pascual A, Coromina-Gimferrer M, Jiménez-Dueñas M, Oliva I, González E, Mestre N, Bartroli M. Lifetime Dual Disorder Screening and Treatment Retention: A Pilot Cohort Study. J Clin Med 2022; 11:jcm11133760. [PMID: 35807045 PMCID: PMC9267195 DOI: 10.3390/jcm11133760] [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: 04/25/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
The coexistence of a substance use disorder and another mental disorder in the same individual has been called dual disorder or dual diagnosis. This study aimed to examine the prevalence of lifetime dual disorder in individuals with alcohol or cocaine use disorder and their retention in treatment. We conducted a pilot cohort study of individuals (n = 1356) with alcohol or cocaine use disorder admitted to treatment in the public outpatient services of Barcelona (Spain) from January 2015 to August 2017 (followed-up until February 2018). Descriptive statistics, Kaplan−Meier survival curves and a multivariable Cox regression model were estimated. The lifetime prevalence of screening positive for dual disorder was 74%. At 1 year of follow-up, >75% of the cohort remained in treatment. On multivariable analysis, the factors associated with treatment dropout were a positive screening for lifetime dual disorder (HR = 1.26; 95% CI = 1.00−1.60), alcohol use (HR = 1.35; 95% CI = 1.04−1.77), polysubstance use (alcohol or cocaine and cannabis use) (HR = 1.60; 95% CI = 1.03−2.49) and living alone (HR = 1.34; 95% CI = 1.04−1.72). Lifetime dual disorder is a prevalent issue among individuals with alcohol or cocaine use disorders and could influence their dropout from treatment in public outpatient drug dependence care centres, along with alcohol use, polysubstance use and social conditions, such as living alone. We need a large-scale study with prolonged follow-up to confirm these preliminary results.
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Affiliation(s)
- Beatriz Puértolas-Gracia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - María Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93202-7702
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Oleguer Parés-Badell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - María Teresa Brugal
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marta Torrens
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Faculty of Medicine, Universitat de Vic i Catalunya Central, Vic, 08500 Barcelona, Spain
| | - Lara Treviño
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Concepción Rodríguez-Díaz
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - José María Vázquez-Vázquez
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Alicia Pascual
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marcela Coromina-Gimferrer
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Míriam Jiménez-Dueñas
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Israel Oliva
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Erick González
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Nicanor Mestre
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
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Gueta K, Tam S. Intensive-invisible mothering: The experiences of mothers of adult children with dual diagnosis. Int J Ment Health Nurs 2019; 28:997-1007. [PMID: 31120591 DOI: 10.1111/inm.12605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 12/30/2022]
Abstract
The experiences of mothers of adult offspring with a dual diagnosis have rarely been discussed in the literature, despite growing involvement and responsibility of mothers for daily care of their children. Interpretive phenomenological analysis of in-depth interviews was used to examine the mothering experience of 12 mothers of adult offspring with dual diagnosis. The analysis revealed that the mothers' experiences were intensive, abusive, and isolating, and simultaneously rendered them invisible, undervalued, or ignored by professionals, community, and family. Furthermore, the analysis indicated that this experience of 'intensive-invisible' mothering was promoted or prevented by three intersecting mechanisms, identified here as discursive, institutional, and spatial. The research contributes to the fields of knowledge regarding family members of people with mental health problems, by adding a theoretical layer that takes into account how public discourses of motherhood mould women's accounts of their mothering experience. Practical implications of these findings for professionals working with these mothers are discussed. Specifically, therapeutic intervention that focuses on identifying and modifying the underlying psychological and social processes associated with the 'intensive-invisible' mothering experience could be useful.
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Affiliation(s)
- Keren Gueta
- Criminology Department, Bar-Ilan University, Ramat-Gan, Israel
| | - Shosh Tam
- Criminology Department, Bar-Ilan University, Ramat-Gan, Israel
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Elison S, Weston S, Dugdale S, Ward J, Davies G. A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616630013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.
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