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Lau P, Amestoy ME, Roth M, Monson C. Patient-related factors associated with patient retention and non-completion in psychosocial treatment of borderline personality disorder: A systematic review. Personal Ment Health 2024. [PMID: 38807472 DOI: 10.1002/pmh.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/22/2024] [Accepted: 05/12/2024] [Indexed: 05/30/2024]
Abstract
The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non-completion (TNC), with meta-analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high-powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC.
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Affiliation(s)
- Parky Lau
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
| | - Maya E Amestoy
- University of Toronto Scarborough, Scarborough, ON, Canada
| | - Maya Roth
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
- St Joseph's Healthcare London, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Candice Monson
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
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Franco Corso SJ, O'Malley K, Subaiya S, Mayall D, Dakwar E. The role of non-ordinary states of consciousness occasioned by mind-body practices in mental health illness. J Affect Disord 2023; 335:166-176. [PMID: 37150220 DOI: 10.1016/j.jad.2023.04.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Research with hallucinogens suggests that non-ordinary states of consciousness (NOSCs), particularly mystical-type experiences, predict improvements in various affective disorders and substance use disorders (SUDs). Little is known, however, about the therapeutic potential of NOSCs induced by mind-body practices such as meditation, yoga and breathwork. METHODS We conducted a literature review in online databases (PubMed, Scopus, Google Scholar) and preprint databases (SSRN, bioRxiv) to identify studies of NOSCs induced by mind-body practices and their effects in affective disorders and SUDs. RESULTS A wide variety of mind-body practices involving physical movement (i.e., shamanic drumming, yoga) and hyper-focused immersive mental experiences (i.e., meditation, breathwork) have been reported in the literature. Preliminary evidence, mostly from qualitative studies and open label studies, suggest that mind-body practices produce NOSCs. Such experiences have been associated with short-term reduced levels of anxiety and depression, increased motivation to quit addictive behaviors, and enhanced self-awareness and spiritual well-being. LIMITATIONS Findings are limited by the scarcity of literature in this field. Further rigorous and methodologically sound empirical research is needed, including comparative studies of NOSCs occasioned by different methods. CONCLUSIONS Mind-body practices may represent a promising approach for treating mental health disorders. The NOSCs induced by such practices may lead to beneficial shifts in perceptions, values, beliefs, and behaviors. Given the challenges with hallucinogen-based therapies, mind-body practices may represent a more accessible and acceptable way of eliciting potentially helpful NOSCs in clinical practice.
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Affiliation(s)
- Silvia J Franco Corso
- Department of Psychiatry, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, United States of America; Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America.
| | - Kate O'Malley
- Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
| | - Saleena Subaiya
- Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
| | - Danielle Mayall
- Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
| | - Elias Dakwar
- Department of Psychiatry, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, United States of America; Division on Substance Use, New York State Psychiatric Institute and Department of Psychiatry, New York, NY, United States of America
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Individual factors predict substance use treatment course patterns among patients in community-based substance use disorder treatment. PLoS One 2023; 18:e0280407. [PMID: 36634070 PMCID: PMC9836276 DOI: 10.1371/journal.pone.0280407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders (SUDs) usually involve a complex natural trajectory of recovery alternating with symptom reoccurrence. This study examined treatment course patterns over time in a community SUD clinic. We examined depressive symptoms level, primary SUD assigned at each admission, and lifetime misuse of multiple substances as potential risk factors for premature treatment termination and subsequent treatment readmission. METHODS De-identified longitudinal data were extracted from charts of 542 patients from an SUD treatment center. Survival analysis methods were applied to predict two time-to-event outcomes: premature treatment termination and treatment readmission. RESULTS Primary opioid (vs alcohol) use disorder diagnosis at admission was associated with higher hazard of premature termination (HR = 1.91, p<0.001). The interaction between depressive symptoms level and substance use status (multiple vs single use) on treatment readmission was significant (p = 0.024), such that higher depressive symptoms level was predictive of readmission only among those with a history of single substance use (marginally significant effect). Lifetime use of multiple (vs single) substances (HR = 1.55, p = 0.002) and age (HR = 1.01, p = 0.019) predicted increased hazard of readmission. CONCLUSIONS Findings did not support a universal role for depressive symptoms level in treatment course patterns. Primary SUD diagnosis, age, and history of substance misuse can be easily assessed and incorporated into treatment planning to support SUD patients and families. This study is the first to our knowledge that afforded a stringent test of these relationships and their interactions in a time-dependent, recurrent event, competing risks survival analysis examining both termination and readmission patterns utilizing a real-world clinic-based sample.
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Killeen TK, Wen CC, Neelon B, Baker N. Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders. Subst Use Misuse 2023; 58:500-511. [PMID: 36705433 DOI: 10.1080/10826084.2023.2170183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model. Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD.ClinicalTrials.gov # NCT02755103.
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Affiliation(s)
- Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathanial Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Psychiatric Comorbidities of Substance Use Disorders: Does Dual Diagnosis Predict Inpatient Detoxification Treatment Outcomes? Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractComorbidity of substance use and psychiatric disorders, particularly depressive disorders, are well established. The impact of comorbidity on treatment outcomes, particularly following short-term inpatient detoxification and medical management units, has yet to be fully explored. This study reviewed 456 records of patients voluntarily presenting for medical management of substance misuse in Sydney, Australia. Documented psychiatric comorbidities and primary substance of misuse were extracted and used to predict length of stay, discharge against medical advice and number of readmissions. Our results showed that psychiatric comorbidity did not significantly predict treatment outcomes, although depression was reported in more than half our cohort, along with elevated rates of Post-traumatic Stress Disorder, anxiety disorders and bipolar affective disorders. Medication non-compliance and primary substance of misuse significantly predicted length of stay and discharge against medical advice. Further research into how specific substances interact and affect specific psychiatric disorders is needed to guide optimal treatment options.
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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
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Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, Baldacchino A, Ekhtiari H. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat 2021; 131:108558. [PMID: 34366202 DOI: 10.1016/j.jsat.2021.108558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD). METHOD The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors. RESULTS Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up. CONCLUSION Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Daneshmand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alex Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioral Sciences, St Andrews, Scotland, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA.
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Stanojlović M, Davidson L. Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:1178221820976988. [PMID: 34211275 PMCID: PMC8216338 DOI: 10.1177/1178221820976988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/31/2020] [Indexed: 11/15/2022]
Abstract
Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client’s disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes.
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Affiliation(s)
- Milena Stanojlović
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
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Grundmann J, Lotzin A, Sehner S, Verthein U, Hiller P, Hiersemann R, Lincoln TM, Hillemacher T, Schneider B, Driessen M, Scherbaum N, Dotten AC, Schäfer I. Predictors of attendance in outpatient group treatment for women with posttraumatic stress disorder and substance use disorder. Psychother Res 2020; 31:632-643. [DOI: 10.1080/10503307.2020.1817604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Johanna Grundmann
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rena Hiersemann
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Hamburg, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Barbara Schneider
- Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Cologne, Cologne, Germany
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, Ev. Klinikum Bielefeld, Bielefeld, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - André C. Dotten
- Department of Psychiatry, Psychotherapy, Psychosomatic and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Traits associated with treatment retention in a therapeutic community for substance dependence. THERAPEUTIC COMMUNITIES 2018. [DOI: 10.1108/tc-10-2016-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose
The treatment of severe and chronic substance dependence is challenged by high rates of treatment attrition, highlighting the need to identify factors that hinder treatment retention. The paper aims to discuss this issue.
Design/methodology/approach
The present study examined certain neurocognitive and personality traits in relation to treatment retention in a sample of 46 residents of an Australian therapeutic community (TC). The traits examined were previously found to be associated with problematic substance use in non-clinical samples and were also previously shown to differentiate TC clients from social drinkers. The hypothesis was thus that traits that appear to be risk factors for addictions are also likely to impact on TC treatment retention.
Findings
Group comparisons of those retained for more than the recommended 90 days vs those who left treatment prematurely showed that after controlling for the influence of depression, those who left treatment prematurely reported significantly higher levels of trait impulsivity, punishment sensitivity and executive cognitive dysfunction. There was a very high rate of alexithymia in the sample (52 per cent), but alexithymia was unrelated to retention.
Research limitations/implications
The final sample size was less than planned but reflected the strict participation criteria and temporal limitations of this study. No statistical assumptions were violated and the reliability indices of the scales completed by clients ranged from acceptable to excellent. Another limitation was that dropout cannot be assumed to mean relapse, as the reasons for client dropout were not available.
Originality/value
Findings highlight the important roles of trait factors in TC treatment retention in addition to the motivational and interpersonal factors identified in previous work.
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Cui R, Haller M, Skidmore JR, Goldsteinholm K, Norman S, Tate SR. Treatment Attendance Among Veterans With Depression, Substance Use Disorder, and Trauma. J Dual Diagn 2016; 12:15-26. [PMID: 26828770 PMCID: PMC4837955 DOI: 10.1080/15504263.2016.1146384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Low attendance in psychotherapy, particularly among individuals with comorbid disorders, is a pervasive challenge. The present study examined predictors of treatment attendance in a sample of veterans with depression, substance use disorder, and trauma. METHODS This is an analysis of data collected as part of a larger clinical trial involving outpatients at a Veterans Administration dual diagnosis clinic. Individuals were excluded if they had significant memory deficits, schizophrenia, bipolar disorder, or substantial travel constraints. Participants (N = 146) received 12 weeks of group-delivered integrated cognitive behavioral therapy for depression and substance use, followed by randomization to 12 additional weeks of individually delivered cognitive behavioral therapy (n = 62) or cognitive processing therapy (n = 61) modified to address substance use and trauma. Participants, therapists, and researchers were not blinded to group assignment. For this study, we included only the 123 participants who were randomized into the second phase, analyzing predictors of treatment attendance categorized into predisposing factors, enabling factors, and need factors. RESULTS Participants were primarily male (89%) and Caucasian (76%) and averaged 47 years old (SD = 12). Forty-four percent had alcohol use disorder, 16% had drug use disorder, and 40% had polysubstance use disorder. Most met criteria for PTSD (82%), with 44% having combat-related trauma, 33% sexual trauma, and 28% other trauma. Treatment attendance did not differ between groups. More education was associated with increased group (r = .19, p = .04) and individual session attendance (r = .28, p = .002). Individuals with chronic housing problems attended fewer group sessions (r = -.19, p = .04), while individuals with sexual trauma, compared to those with other traumas, attended more individual sessions (r = .23, p = .01). Number of group sessions attended was positively associated with individual session attendance. CONCLUSIONS Few variables were significantly predictive of treatment attendance, possibly due to the complex nature of comorbid disorders. Including a focus on trauma was not associated with lower attendance. Special consideration may need to be given to education level, homelessness, and trauma when trying to engage and retain patients with comorbid disorders in treatment. This clinical trial is registered at www.clinicaltrials.gov as NCT00958217.
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Affiliation(s)
- Ruifeng Cui
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Moira Haller
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | | | | | - Sonya Norman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
- National Center for PTSD, White River Junction, Vermont, USA
| | - Susan R. Tate
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Fradgley EA, Paul CL, Bryant J. A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries? Int J Equity Health 2015; 14:52. [PMID: 26051244 PMCID: PMC4464126 DOI: 10.1186/s12939-015-0179-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 04/29/2015] [Indexed: 02/21/2023] Open
Abstract
Health utilization and need assessment data suggest there is considerable variation in access to outpatient specialist care. However, it is unclear if the types of barriers experienced are specific to chronic disease groups or experienced universally. This systematic review provides a detailed summary of common and unique barriers experienced by chronic disease groups when accessing and receiving care, and a synthesized list of possible health service initiatives to improve equitable delivery of optimal care in high-income countries. Quantitative articles describing barriers to specialist outpatient services were retrieved from CINAHL, MEDLINE, Embase, and PyscINFO. To be eligible for review, studies: were published from 2002 to May 2014; included samples with cancer, diabetes mellitus, osteoporosis, arthritis, ischaemic heart disease, stroke, asthma, chronic pulmonary disorder (COPD) or depression; and, were conducted in high-income countries. Using a previously validated model of access (Penchansky and Thomas' model of fit), barriers were grouped according to five overarching domains and defined in more detail using 33 medical subject headings. Results from reviewed articles, including the scope and frequency of reported barriers, are conceptualized using thematic analysis and framed as possible health service initiatives. A total of 3181 unique records were screened for eligibility, of which 74 studies were included in final analysis. The largest proportion of studies reported acceptability barriers (75.7 %), of which demographic disparities (44.6 %) were reported across all diseases. Other frequently reported barriers included inadequate need assessment (25.7 %), information provision (32.4 %), or health communication (20 %). Unique barriers were identified for oncology, mental health, and COPD samples. Based on the scope, frequency and measurement of reported barriers, eight key themes with associated implications for health services are presented. Examples include: common accommodation and accessibility barriers caused on service organization or physical structure, such as parking and appointment scheduling; common barriers created by poor coordination of care within the healthcare team; and unique barriers resulting from inadequate need assessment and referral practices. Consideration of barriers, across and within chronic diseases, suggests a number of specific initiatives are likely to improve the delivery of patient-centered care and increase equity in access to high-quality health services.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2305, Australia.
| | - Christine L Paul
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2305, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2305, Australia.
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Cui R, Tate SR, Cummins K, Skidmore JR, Brown SA. Chronic physical health problems moderate changes in depression and substance use among dual diagnosed individuals during and after treatment. Subst Use Misuse 2015; 50:174-83. [PMID: 25290658 PMCID: PMC4374892 DOI: 10.3109/10826084.2014.962052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Physical illnesses frequently co-occur with depression and substance use disorders and may impact their improvement. Physical illness symptoms may overlap with or exacerbate somatic symptoms of depression. Individuals may use substances to cope with symptoms of physical illness. OBJECTIVES We examined whether chronic physical health problems moderated changes in depression and substance use among dual diagnosed individuals during and in the year following treatment. METHODS Participants were recruited from a Veterans Affairs dual diagnosis outpatient program between March 2000 and November 2007 and were randomized to either Integrated Cognitive-Behavioral Therapy or Twelve-Step Facilitation Therapy. A total of 214 veterans with assessment data for the variables of interest were included in analyses. Participants completed quarterly depression, substance use, and health assessments over an 18 month period. We used linear-mixed effects models to analyze patterns of change for depression and substance use. RESULTS Individuals with severe chronic health problems and higher intake depression showed slower improvements in both nonsomatic and somatic depression symptoms. Individuals with severe chronic health problems and higher midtreatment substance use showed less improvement in substance use. CONCLUSIONS Assessing and addressing physical health issues during depression and substance use disorder treatment may improve outcomes.
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Affiliation(s)
- Ruifeng Cui
- 1Veterans Affairs San Diego Healthcare System, Research Service , San Diego, California , USA
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Mills KL, Ewer P, Dore G, Teesson M, Baker A, Kay-Lambkin F, Sannibale C. The feasibility and acceptability of a brief intervention for clients of substance use services experiencing symptoms of post traumatic stress disorder. Addict Behav 2014; 39:1094-9. [PMID: 24657001 DOI: 10.1016/j.addbeh.2014.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/18/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trauma exposure and post traumatic stress disorder (PTSD) are common among clients of substance use services. Existing treatments for these co-occurring conditions tend to be lengthy, treatment retention is relatively poor, and they require extensive training and clinical supervision. The aim of the present study was to conduct a preliminary examination of the feasibility and acceptability of a brief intervention for PTSD symptoms among individuals seeking substance use treatment. METHODS An uncontrolled open-label pilot study was conducted among 29 inpatients of a medicated detoxification unit in Sydney, Australia. All participants completed a baseline interview followed by the brief intervention. The intervention consists of a single, one-hour manualised session providing psychoeducation pertaining to common trauma reactions and symptom management. PTSD and substance use outcomes were assessed at 1-week, 1-month and 3-month post-intervention. RESULTS PTSD symptom severity (assessed using the Clinicians Administered PTSD Scale) decreased significantly from baseline to 1-week follow up (β -10.87, 95%CI: -19.75 to -1.99) and again between the 1-week and 3-month follow-ups (β -15.38, 95%CI: -23.20 to -7.57). Despite these reductions, the majority of participants continued to meet criteria for a diagnosis of PTSD and there was no change in participants' negative post-traumatic cognitions. Participants expressed high levels of satisfaction with the intervention. CONCLUSIONS Brief psychoeducation for traumatised clients attending substance use services appears to be feasible, acceptable, and may be of some benefit in reducing PTSD symptoms. However, participants continued to experience symptoms at severe levels; thus, brief intervention may best be conceptualised as a "stepping stone" to further trauma treatment.
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15
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Valencia JG, Méndez Villanueva MP. [Factors Associated With the Temporary Abandonment of Treatment for Disorders Due to Substance Abuse in an Institution in Medellin, Colombia]. REVISTA COLOMBIANA DE PSIQUIATRIA 2014; 43:7-17. [PMID: 26573251 DOI: 10.1016/s0034-7450(14)70037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/21/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the frequency and factors associated withtreatment drop-out in patients from a Substance User Treatment Center in Medellín, Colombia. METHODS A case-control study was conducted, with patients with an early treatment dropout as cases, and patients who completed the treatment as controls. Demographic data, substance use pattern, concomitant diseases, and the decision to initiate treatment were compared between cases and controls. RESULTS The frequency of early drop-out was 59%, but a high proportion of this drop-out (47.5%) occurred in the transition period between the program stages. The variables associated with drop-out were: psychotic disorder (OR=0.32; 95% CI, 0.11-0.91), bipolar disorder (OR=0.31; 95% CI, 0.12-0.77), heroin as the principal substance compared to alcohol (OR=6.68; 95% CI, 1.52-29.4), decision to initiate the treatment by the family compared to personal decision (OR=3.02; 95% CI, 1.28-7.17), and previous treatments (OR=1.87; 95% CI, 1.02-3.44). CONCLUSIONS The drop-out frequency is similar to those reported in other studies. Associated factors were found, which could be considered in order to plan strategies to improve the program results.
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Affiliation(s)
- Jenny García Valencia
- Médica, Especialista en Psiquiatría, Magíster en Epidemiología, Doctora en Epidemiología; Coordinadora de Investigación, Samein S.A.S; Profesora asociada, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia.
| | - María Paulina Méndez Villanueva
- Médica, Especialista en Psiquiatría; Coordinadora, Centro de Atención de Drogodependencias de Samein S.A.S., Medellín, Antioquia, Colombia
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16
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Tripp JC, Skidmore JR, Cui R, Tate SR. Impact of Physical Health on Treatment for Co-occurring Depression and Substance Dependence. J Dual Diagn 2013; 9:10.1080/15504263.2013.806111. [PMID: 24223036 PMCID: PMC3821391 DOI: 10.1080/15504263.2013.806111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE There is a high rate of comorbidity among substance dependence, depression, and physical health problems. This study aimed to examine the impact of pre-treatment physical health stressors (acute and chronic conditions) on outcomes of treatment in a sample of veterans with dual disorders (depression and substance dependence) who were randomized to integrated cognitive behavioral therapy versus 12-Step interventions. METHODS This study included 205 veterans (89.8% male, mean age = 49.5 years) enrolled in a clinical treatment outcomes trial. Chronic health problems (persistent, ongoing conditions lasting 2 weeks or more; e.g., arthritis, diabetes) and acute health events (occurring on a discrete date; e.g., injury, surgery, myocardial infarction) were coded dichotomously (presence versus absence) and evaluated separately. The impact of physical health stressors on abstinence (defined dichotomously), percentage of days abstinent, and depression symptoms were analyzed at the end of 12 and 24 weeks of treatment. Additionally, associations between intake motivation to change, health stressors, and substance use were examined. RESULTS Analyses revealed that participants who had experienced a pretreatment acute health event had higher rates of abstinence at 12-weeks, higher percentage of days abstinent at 24-weeks, and higher depression symptoms at intake. Participants with chronic health difficulties had more severe depression at intake and those participants with severe chronic difficulties had greater depression symptoms across all time points. Chronic health difficulties were related to the Taking Steps factor of motivation to change substance use, but acute health events were not related to motivation to change. Motivation to change was also not related to substance outcomes in our sample. CONCLUSIONS Physical health appears to have a complex relationship with co-occurring depression and substance dependence. Acute health problems predicted lower substance use, whereas chronic health problems were associated with higher depression levels. Explicitly addressing the connection between substance use and health events during treatment may improve addiction treatment outcomes. However, individuals with chronic health problems may benefit from extending treatment or adjunct strategies focused on addressing chronic health concerns. This is an analysis of data collected as part of a clinical trial registered at www.ClinicalTrials.gov as NCT00108407.
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Affiliation(s)
- Jessica C Tripp
- VA San Diego Healthcare System, San Diego, California, USA ; The University of Memphis, Memphis, Tennessee, USA
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