Dual diagnosis clients' treatment satisfaction - a systematic review

Validation of the client satisfaction questionnaire: a pilot psychometric analysis in Portuguese routine practice

Treatment satisfaction has been found to have good therapeu- tic results in psychotherapy, and the 18-item version of the client satisfaction questionnaire (CSQ-18) is one of the most widely used measures to evaluate it. This study sought to carry out a pilot analysis of the psychometric's properties and factorial structure, as well as validate the CSQ-18's applicability to the Portuguese population within the context of routine clinical practice. It also sought to explore the association that treatment satisfaction has with general symptoms, therapeutic alliance, and expectations at an early stage of psychotherapy. The sample comprised 98 clients who were undergoing psychotherapy in a routine practice context. All these clients completed self-reported measures for symptom assessment and therapeutic relationship, namely the clinical out- come routine evaluation-outcome measure, working alliance in- ventory, and credibility/expectancy questionnaire, in addition to the CSQ-18. The semi-confirmatory factorial analysis demon- strated that the CSQ-18 has good psychometric properties and re- vealed an association between treatment satisfaction and therapeutic alliance. The results corroborate the findings of other versions of the measure and present a good adjustment model for the semi-confirmatory factorial analysis.

Adapting Chinese Qigong Mind-Body Exercise for Healthy Aging in Older Community-Dwelling Low-income Latino Adults: Pilot Feasibility Study

BACKGROUND

Research translating the evidence for the benefit of mind-body exercise in older Latinos with limited access to community-based healthy aging programs is sparse.

OBJECTIVE

This study aimed to evaluate the feasibility of Function Improvement Exercises for Older Sedentary Community-Dwelling Latino Residents (FITxOlder), a Community Health Worker (CHW)-led, mobile technology-facilitated Chinese Qigong mind-body exercise program for healthy aging and to explore its impact on physical and cognitive function and quality of life (QoL) in older community-dwelling low-income Latino adults.

METHODS

This study was designed as a Stage 1 feasibility study to develop and pilot-test FITxOlder. In Phase 1 (Stage 1A), a working group of seniors, CHWs, and senior center staff guided the adaptation of Chinese Qigong into a healthy aging program. In Phase 2 (Stage 1B), 49 older Latino adults participated in a 3-arm controlled study to test the feasibility and preliminary effect of CHW-led FITxOlder on physical and cognitive function and QoL measures over 16 weeks.

RESULTS

Although the COVID-19 pandemic disrupted the implementation of the study protocol, we found favorable results regarding participant recruitment, retention, and fidelity of implementation. Notable findings included an 89.3% participant retention, 79.4% of the participants completed at least 70% of the weekly exercise goal, and no report of adverse events. The effects on intervention outcome measures were modest.

CONCLUSIONS

FITxOlder is feasible for promoting healthy aging in older Latino adults; future research needs to compare its feasibility with other low-impact exercise programs for healthy aging using a randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04284137; https://clinicaltrials.gov/ct2/show/NCT04284137.

"Take Care of You" - Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial

BACKGROUND

Depression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care.

METHODS

A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016-March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment.

RESULTS

All interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions.

CONCLUSIONS

This study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.

Impact of Cluster B Personality Disorders in Drugs Therapeutic Community Treatment Outcomes: A Study Based on Real World Data

BACKGROUND

The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities.

METHOD

The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88.

RESULTS

Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009).

CONCLUSIONS

Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.

Prevalence and clinical correlates of substance use amongst acute psychiatric inpatients in Gauteng, South Africa

Background

Mental disorders and substance use disorders (SUD) commonly occur together, impacting healthcare outcomes. The diagnosis of substance use is often inadequate when comorbidity is present. It is vital to understand the prevalence of substance use amongst psychiatric patients to inform both clinical practice and service development in South Africa.

Aim

To ascertain the prevalence and clinical correlates of SUD amongst acute psychiatric inpatients.

Setting

The setting for this study was Helen Joseph Hospital acute psychiatric ward.

Methods

A cross-sectional study was conducted whereby consecutively admitted patients were invited to participate in a structured clinical interview utilising the alcohol use disorders identification test (AUDIT) and drug use disorders identification test (DUDIT) questionnaires. Statistical comparisons were made between those with and without SUD.

Results

Of 150 participants, 100 (67%) were identified with a SUD. Those with SUD were younger (p = 0.0010), more often male (p = 0.012), less likely to have a disability grant (p = 0.015) and more likely to be brought to hospital by police, ambulance or self than by a family member (p = 0.025). Almost half of people with bipolar disorder (47.3%) and schizophrenia (41.4%) had comorbid SUD. Twenty-three (15%) participants identified with SUD on questionnaire had been missed clinically. Only two participants were referred for inpatient substance rehabilitation on discharge.

Conclusion

Substance use disorders are highly prevalent amongst psychiatric inpatients. The AUDIT and DUDIT are potentially useful screening tools in routine clinical practice. Greater collaboration between psychiatric and substance rehabilitation services is recommended.

Dual diagnosis: A systematic review of the organization of community health services

BACKGROUND

Dual diagnosis (DD), as the co-occurrence of a substance use disorder and a psychiatric disorder, is underestimated, under-diagnosed and often poorly treated throughout the world, although it is highly prevalent in people suffering from a mental disorder.

AIMS AND METHODS

This review analyzed 48 studies from a PubMed and PsycINFO databases search, in order to verify the state of the art regarding the organization of community health services for DD treatment.

RESULTS

Four macro-themes have been identified: service organization, critical issues, assessment tools and evidence-based interventions. An effective service recognizes the complexity of DD, promotes a common staff culture, and tailors the organization to local needs. The main critical issues in its implementation include the lack of specific staff training, the poor management of resources and the need for greater personalization of care plans, with attention to psychosocial interventions. Integrated service assessment tools can be used as a benchmark measure at the program level for implementation planning and at the national level to affect policy change. The integrated treatment model for DD should also aim to improve access to care and offer treatments based on scientific evidence. It is also evident that the integration of services can improve outcomes but it is not a guarantee for it.

CONCLUSION

There is an urgent need to improve networking between mental health and addiction services in order to deal with DD and create new integrated intervention models, paying attention to an approach to the whole person, seen in his/her absolute uniqueness.

Implementing integrated services in routine behavioral health care: primary outcomes from a cluster randomized controlled trial

BACKGROUND

An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders.

METHODS

This study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not?

RESULTS

From baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen's d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen's d = 0.91) and Continuity of Care (p = 0.026, Cohen's d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen's d = 0.51) were found.

CONCLUSIONS

Overall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders.

TRAIL REGISTRATION

ClinicalTrials.gov, NCT03007940 . Retrospectively registered January 2017.

Assessing health service satisfaction among users with substance use disorders within the municipalities in Norway

BACKGROUND

The purpose of this study was to assess what is associated with health service satisfaction among adults with a substance use disorder receiving services provided within different municipalities in Norway. An additional aim was to examine demographic and municipality characteristics, mental health, and types of substance use associated with health service satisfaction.

METHOD

A cross-sectional partial explorative study was executed in 2017 among 491 service users with substance use disorders from 20 randomly selected municipalities. The sample consisted of 70% males. The sample majority were single and unemployed, and their main sources of healthcare were the general practitioner (78%), The Norwegian Labor and Welfare Administration (72%), and addiction counsellors (62%).

RESULTS

Overall satisfaction was negatively associated with age, size of municipality, Global Severity Index (GSI) and illicit substance use during the last 12 months. Satisfaction with practical help, such as housing, economy, work and education, was negatively associated with GSI and positively associated with onset of first alcohol intoxication. Satisfaction with personnel was positively associated with onset of first alcohol intoxication and negatively associated with municipality size, GSI and illicit use the last 12 months. The results showed that more than half of the respondents (54%) to a large or great extent were satisfied with the overall services provided. The services they were less satisfied with were related to housing, economy, getting started with exercise and establishing a social network.

CONCLUSION

The results show areas associated with satisfaction and domains where the municipalities can improve their services to meet the users' needs and increase service satisfaction.

Acceptability of a lifelogging wearable camera in older adults with mild cognitive impairment: a mixed-method study

BACKGROUND

The main objective of this research was to evaluate the acceptance of technology based on a wearable lifelogging camera in a sample of older adults diagnosed with mild cognitive impairment (MCI).

METHODS

A mixed-method design was used, consisting of a self-report questionnaire, numerous images taken by users, and a series of focus group discussions. The patients were involved in an individualized training programme.

RESULTS

Nine MCI patients and their caregiver relatives were included. They showed good acceptance of the camera and downloaded an appropriate number of images on a daily basis. Perceived severity and ease of use were the main factors associated with the intention to use the device.

CONCLUSIONS

Older adults with MCI can become competent users of lifelogging wearable cameras with a good level of acceptance. Privacy concerns are outweighed by the potential benefits for memory. Limitations, strengths and implications for future research are discussed.

The contribution of participant, treatment, and outcome factors to treatment satisfaction

Treatment satisfaction, which refers to the positive appraisal of process and outcome attributes of a treatment, is a prominent indicator of quality care. Although it is known that participant, treatment, and outcome factors influence treatment satisfaction, it remains unclear which factors contribute to satisfaction with each process and outcome attribute. In this study, we examined the extent to which participant (age, gender, education, race, employment), treatment (type of therapy, method of assignment to therapy), and outcome (self-reported improvement in outcome) factors contribute to satisfaction with the process and outcome attributes of therapies for insomnia. This study consists of a secondary analysis of data obtained from a partially randomized preference trial in which persons with chronic insomnia (N = 517) were assigned to treatment randomly or by preference. Four types of behavioral therapies were included: sleep hygiene, stimulus control therapy, sleep restriction therapy, and multi-component therapy. Self-reported improvement in insomnia and satisfaction were assessed with validated measures at post-test. Multiple regression analysis was used to examine which factors influenced satisfaction with each treatment attribute. The findings showed that treatment and outcome, more so than participant, factors influenced satisfaction with the process and outcome attributes of the behavioral therapies for insomnia. Future research on satisfaction should explore the contribution of treatment (type and preference-matching) and outcome factors on satisfaction to build a better understanding of treatment attributes viewed favorably. Such understanding has the potential to inform modifying or tailoring treatments to improve their acceptance to participants and optimize their effectiveness.

Using NIATx strategies to implement integrated services in routine care: a study protocol

Background

Access to integrated services for individuals with co-occurring substance use and mental health disorders is a long-standing public health issue. Receiving integrated treatment services are both more effective and preferred by patients and families versus parallel or fragmented care. National policy statements and expert consensus guidelines underscore the benefits of integrated treatment. Despite decades of awareness, adequate treatment for individuals with co-occurring substance use and mental health disorders occurs infrequently. The underlying disease burden associated with alcohol, illicit and prescription drug problems, as well as mental health disorders, such as depression, posttraumatic stress disorder and schizophrenia, is substantial.

Methods

This cluster randomized controlled trial (RCT) is designed to determine if the multi-component Network for the Improvement of Addiction Treatment (NIATx) strategies are effective in implementing integrated services for persons with co-occurring substance use and mental health disorders. In this study, 50 behavioral health programs in Washington State will be recruited and then randomized into one of two intervention arms: 1) NIATx implementation strategies, including coaching and learning sessions over a 12-month intervention period to implement changes targeting integrated treatment services; or 2) wait-list control. Primary outcome measures include: 1) fidelity - a standardized organizational assessment of integrated services (Dual Diagnosis in Addiction Treatment [DDCAT] Index); and 2) penetration - proportion of patients screened and diagnosed with co-occurring disorders, proportion of eligible patients receiving substance use and mental health services, and psychotropic or substance use disorder medications. Barriers and facilitators, as determinants of implementation outcomes, will be assessed using the Consolidated Framework for Implementation Research (CFIR) Index. Fidelity to and participation in NIATx strategies will be assessed utilizing the NIATx Fidelity Scale and Stages of Implementation Completion (SIC).

Discussion

This study addresses an issue of substantial public health significance: the gap in access to an evidence-based practice for integrated treatment for individuals with co-occurring mental health and substance use disorders. The study utilizes rigorous and reproducible quantitative approaches to measuring implementation determinants and strategies, and may address a longstanding gap in the quality of care for persons with co-occurring disorders.

Trial registration

ClinicalTrials.gov NCT03007940. Registered 02 January 2017 – Retrospectively Registered

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3241-4) contains supplementary material, which is available to authorized users.

Psychometric evaluation of a multi-dimensional measure of satisfaction with behavioral interventions

Treatment satisfaction is recognized as an essential aspect in the evaluation of an intervention's effectiveness, but there is no measure that provides for its comprehensive assessment with regard to behavioral interventions. Informed by a conceptualization generated from a literature review, we developed a measure that covers several domains of satisfaction with behavioral interventions. In this paper, we briefly review its conceptualization and describe the Multi-Dimensional Treatment Satisfaction Measure (MDTSM) subscales. Satisfaction refers to the appraisal of the treatment's process and outcome attributes. The MDTSM has 11 subscales assessing treatment process and outcome attributes: treatment components' suitability and utility, attitude toward treatment, desire for continued treatment use, therapist competence and interpersonal style, format and dose, perceived benefits of the health problem and everyday functioning, discomfort, and attribution of outcomes to treatment. The MDTSM was completed by persons (N = 213) in the intervention group in a large trial of a multi-component behavioral intervention for insomnia within 1 week following treatment completion. The MDTSM's subscales demonstrated internal consistency reliability (α: .65 - .93) and validity (correlated with self-reported adherence and perceived insomnia severity at post-test). The MDTSM subscales can be used to assess satisfaction with behavioral interventions and point to aspects of treatments that are viewed favorably or unfavorably.

Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review

Background

There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care.

Methods

We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised.

Results

We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians’ primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning.

Conclusion

Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable.

Electronic supplementary material

The online version of this article (doi:10.1186/s13011-017-0104-7) contains supplementary material, which is available to authorized users.

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study

BACKGROUND

Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence.

METHODS

Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level.

RESULTS

A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction.

CONCLUSION

The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.

Efficacy of an internet-based self-help intervention to reduce co-occurring alcohol misuse and depression symptoms in adults: study protocol of a three-arm randomised controlled trial

INTRODUCTION

In the general population, alcohol use disorder and depression more often occur together than any other combination of a mental illness with a substance use disorder. It is important to have a cost-effective intervention that is able to reach at-risk individuals in the early stages of developing alcohol use disorders and depression disorders.

METHODS AND ANALYSIS

This paper presents the protocol for a 3-arm multicentre randomised controlled trial (RCT) to test the efficacy and cost-effectiveness of the combined internet-based self-help intervention Take Care of You (TCOY) to reduce alcohol misuse and depression symptoms in comparison with a waiting list control group and a comparable intervention focusing on problematic alcohol use only. The active interventions consist of modules designed to reduce alcohol use, based on the principles of motivational interviewing and methods of cognitive behavioural therapy, together with additional modules in the combined study arm to reduce symptoms of depression. Data will be collected at baseline, as well as at 3 and 6 months postrandomisation. The primary outcome is the quantity of alcohol used in the past 7 days. A number of secondary outcome measures will be studied. These include the Centre of Epidemiologic Studies of Depression Scale (CES-D) and a combined measure with the criteria of values below the cut-off for severe alcohol use disorder and for CES-D. Data analysis will follow the intention-to-treat principle using (generalised) linear mixed models. In order to investigate the interventions' cost-utility and cost-effectiveness, a full economic evaluation will be performed.

ETHICS AND DISSEMINATION

This RCT will be executed in compliance with the Helsinki Declaration and has been approved by 2 local Ethics Committees. Results will be reported at conferences and in peer-reviewed publications. Participant-friendly summaries of trial findings will be published on the TCOY websites.

TRIAL REGISTRATION NUMBER

ISRCTN10323951.

Patient satisfaction with treatment for alcohol use disorders: comparing patients with and without severe mental health symptoms

BACKGROUND

Previous studies suggest patients with co-occurring alcohol use disorders (AUDs) and severe mental health symptoms (SMHS) are less satisfied with standard AUD treatment when compared to patients with an AUD alone. This study compared patient satisfaction with standard AUD treatment among patients with and without SMHS and explored how standard treatment might be improved to better address the needs of these patients.

METHODS

Eighty-nine patients receiving treatment for an AUD either at an inpatient hospital, outpatient clinic, inpatient detoxification, or residential/therapeutic community services were surveyed. Patient satisfaction with treatment was assessed using the Treatment Perception Questionnaire (range: 0-40). Patients were stratified according to their score on the Depression Anxiety Stress Scale. Forty patients scored in the extremely severe range of depression (score >14) and/or anxiety (score >10) (indicating SMHS) and 49 patients did not. An inductive content analysis was also conducted on qualitative data relating to areas of service improvement.

RESULTS

Patients with SMHS were found to be equally satisfied with treatment (mean =25.10, standard deviation =8.12) as patients with an AUD alone (mean =25.43, standard deviation =6.91). Analysis revealed that being an inpatient in hospital was associated with reduced treatment satisfaction. Patients with SMHS were found to be significantly less satisfied with staffs' understanding of the type of help they wanted in treatment, when compared to patients with AUDs alone. Five areas for service improvement were identified, including staff qualities, informed care, treatment access and continuity, issues relating to inpatient stay, and addressing patients' mental health needs.

CONCLUSION

While findings suggest that AUD treatment services adequately meet the needs of patients with SMHS in treatment, patients with SMHS do feel that staff lack understanding of their treatment needs. Findings have important implications as to how current health care practice might be improved according to the patient's perspective of care.

'I'm a sick person, not a bad person': patient experiences of treatments for alcohol use disorders

Background

Emerging research indicates that standard treatments for alcohol use disorders may not fully meet the needs of patients with co‐occurring severe mental health symptoms. Investigating health quality indicators may provide insight into how current treatment might be improved.

Objective

To better understand the experiences of patients receiving treatment for alcohol use disorders and compare the experiences of patients with and without co‐occurring severe mental health symptoms.

Design

Cross‐sectional qualitative research design using semi‐structured interviews methods and framework analysis approach.

Setting

Inpatient hospital, outpatient service, inpatient detoxification clinic and a residential/ therapeutic community.

Participant's

Thirty‐four patients receiving treatment for an alcohol use disorder.

Main variables studied

Themes relating to patients' experiences of continuity of care, treatment need and satisfaction with treatment were studied. The qualitative data were divided into two groups: patients with (n = 15) and without (n = 19) severe mental health symptoms.

Results

Five themes relating to patient satisfaction with treatment were identified, including: perceived effectiveness of treatment, supportive relationships, specialized but holistic care, patient autonomy and continuity of care. A diverse range of patient treatment needs, staff and service continuity and stigma were also identified as major themes. Five basic themes were identified as more critical to the experiences of patients with severe mental health symptoms.

Discussion and conclusions

Findings suggest that patients look for supportive relationships with others, to be involved in treatment decisions, effective specialized and holistic approaches to care and a non‐judgemental treatment environment.

Satisfaction with substance use treatment and 12-step groups predicts outcomes

INTRODUCTION

Satisfaction is a critical component of patient-centered care, yet little is known about the degree to which patient satisfaction is linked to subsequent outcomes, especially in substance use disorder (SUD) treatments and 12-step groups. The current study assessed the degree to which satisfaction with Department of Veterans Affairs (VA) outpatient SUD treatment and with 12-step groups, both measured at 6 months after treatment initiation, was associated with additional treatment utilization and better substance-related outcomes during the next 6 months, that is, up to 1 year after treatment initiation.

METHODS

Participants were 345 patients entering the VA SUD treatment program.

RESULTS

More satisfaction with treatment and with 12-step groups at 6 months was associated with less alcohol use severity and more abstinence at 1 year. More treatment satisfaction was related to less subsequent medical severity, whereas more 12-step group satisfaction was related to less subsequent psychiatric severity. More 12-step group satisfaction was related to subsequent increases in 12-step group attendance and involvement. A single item assessing overall satisfaction appeared best related to subsequent outcomes.

CONCLUSIONS

Satisfied SUD treatment patients and 12-step mutual help members appeared to have better subsequent service utilization patterns and treatment outcomes. SUD treatments can improve outcomes by monitoring and enhancing patient satisfaction.

Problem gambling subtypes based on psychological distress, alcohol abuse and impulsivity

The notion of comorbidities within problem gambling populations has important clinical implications, particularly for appropriate treatment matching. The comorbidities most commonly cited in problem gambling literature include depression, anxiety, alcohol abuse and impulsivity. Previous research shows evidence of patterns in multiple co-occurring comorbidities and that there may be different subtypes of gamblers based on these patterns. To further the current understanding of gambling subtypes, the aim of our study was to identify subtypes of gamblers currently in treatment. Hierarchical Cluster Analysis yielded four mutually exclusive groups of 202 gamblers: (1) gamblers with comorbid psychological problems (35%); (2) 'pure' gamblers without other comorbidities (27%); (3) gamblers with comorbid alcohol abuse (25%); and (4) 'multimorbid' gamblers (13%). The four groups differed on demographic information, drug use and gambling behaviours including gambling activity and problem gambling severity. Gamblers with comorbid psychological problems were more likely to be older women on low income, more likely to report a family history of psychological problems and were more often electronic gaming machine players. As expected, 'pure' gamblers had lower problem gambling severity and were more likely to report current abstinence. Gamblers with comorbid alcohol abuse were more likely to be young men who used stimulant drugs, endorsed a higher quality of life and worked full-time. 'Multimorbid' gamblers were elevated on all comorbidities, had general problems related to their health and wellbeing and reported high rates of hostility and aggression. These groups combine elements of existing conceptual models of gambling subtypes and may require different treatments.

Consumer perceptions of trauma assessment and intervention in substance abuse treatment

Substance abuse treatment programs are increasing their use of integrated interventions for trauma and substance abuse. While positive behavioral outcomes have been associated with this model, the purpose of this study was to determine consumers' satisfaction with it. Participants were 51 men and 102 women who received trauma assessments and interventions through a drug treatment court. Satisfaction with treatment was measured through the Consumer Perception of Care (CPC). Participants were generally satisfied with the trauma assessments and interventions they received. Number of traumatic experiences, measured by the Adverse Childhood Experiences (ACE) scale, and level of distress, as assessed on the Trauma Symptom Inventory (TSI), were significantly associated with assessment and treatment satisfaction. Gender differences were noted, with men reporting fewer traumatic experiences and trauma-symptoms and less satisfaction with trauma assessment. Implications for the integration of trauma and substance abuse interventions in drug treatment courts and other programs are discussed.

A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population--a meta-analysis of 31 studies

BACKGROUND

The aim of the current study was to investigate the association between anxiety and cannabis use/cannabis use disorders in the general population.

METHODS

A total of N = 267 studies were identified from a systematic literature search (any time- March 2013) of Medline and PsycInfo databases, and a hand search. The results of 31 studies (with prospective cohort or cross-sectional designs using non-institutionalised cases) were analysed using a random-effects meta-analysis with the inverse variance weights. Lifetime or past 12-month cannabis use, anxiety symptoms, and cannabis use disorders (CUD; dependence and/or abuse/harmful use) were classified according to DSM/ICD criteria or scores on standardised scales.

RESULTS

There was a small positive association between anxiety and either cannabis use (OR = 1.24, 95% CI: 1.06-1.45, p = .006; N = 15 studies) or CUD (OR = 1.68, 95% CI: 1.23-2.31, p = .001; N = 13 studies), and between comorbid anxiety + depression and cannabis use (OR = 1.68, 95% CI: 1.17-2.40, p = .004; N = 5 studies). The positive associations between anxiety and cannabis use (or CUD) were present in subgroups of studies with ORs adjusted for possible confounders (substance use, psychiatric illness, demographics) and in studies with clinical diagnoses of anxiety. Cannabis use at baseline was significantly associated with anxiety at follow-up in N = 5 studies adjusted for confounders (OR = 1.28, 95% CI: 1.06-1.54, p = .01). The opposite relationship was investigated in only one study. There was little evidence for publication bias.

CONCLUSION

Anxiety is positively associated with cannabis use or CUD in cohorts drawn from some 112,000 non-institutionalised members of the general population of 10 countries.

Pathological gambling, co-occurring disorders, clinical presentation, and treatment outcomes at a university-based counseling clinic

It is the intent of this study to examine the relationship between the number of co-occurring disorders in a sample of pathological gamblers and variables associated with clinical presentation and treatment outcomes. Participants were given screening tools for four common psychological disorders: the hands depression screen, the Mood Disorder Questionnaire, the Carroll-Davidson generalized anxiety disorder screen, and the Sprint-4 PTSD Screen. The number of co-occurring disorders, as indicated by the results of these screening instruments, was compared to severity of gambling problems at outset of treatment, as measured by the NORC diagnostic screen for gambling problems-self administered. The number of co-occurring disorders was also compared to psychosocial functioning at the outset of treatment, as well as level of improvement in psychosocial functioning through treatment. Psychosocial functioning was measured using the Outcome Questionnaire 45 (OQ-45). The number of co-occurring disorders was compared to participant satisfaction with the therapeutic relationship as measured by the working alliance inventory-short form. Results suggest that co-occurring disorders are commonplace among treatment seeking pathological gamblers. Over 86 % of the sample screened positively for at least one of the four targeted psychological disorders. Furthermore, the number of co-occurring disorders was found to be positively related to severity of gambling problems at outset of treatment and negatively related to level of psychosocial functioning at outset of treatment. However, the number of co-occurring disorders was not found to be significantly related to level of improvement in psychosocial functioning through treatment. Overall, those that attended at least six sessions reported significantly improved psychosocial functioning by the end of their sixth session. Finally, the number of co-occurring disorders was not found to be significantly related to participants' reported level of satisfaction with the therapeutic relationship.

Frequent emergency department visits are more prevalent in psychiatric, alcohol abuse, and dual diagnosis conditions than in chronic viral illnesses such as hepatitis and human immunodeficiency virus

BACKGROUND

Repeat users of Emergency Departments (ED), so-called "frequent visitors," place a substantial burden on limited ED resources. The illness features of frequent visitors have not been well defined, though chronic medical and psychiatric illness and substance abuse are implicated.

STUDY OBJECTIVES

This study assessed whether chronic conditions such as hepatitis C (HCV) and human immunodeficiency virus (HIV) are more prevalent in frequent ED users compared to a viral condition with relatively less disability, hepatitis B (HBV). As a comparison, psychiatric complaints and alcohol abuse were also compared in frequent and non-frequent visitors.

METHODS

All visits to a university ED in a particular calendar year were retrospectively reviewed. Frequent visitors were defined as those who made four or more visits. Presenting complaints and past medical history were examined for HCV, HIV, HBV, psychiatric complaints, and alcohol abuse.

RESULTS

Frequent visitors accounted for 28% of all ED visits. HCV, HIV, and alcohol abuse were more prevalent in frequent visitors than non-frequent visitors. People with HBV comprised a small proportion of both groups. Frequent visitors with psychiatric complaints were more prevalent than those with HBV or alcohol abuse. Psychiatric history comorbid with alcohol abuse and HCV with alcohol abuse were more prevalent in frequent vs. non-frequent visitors.

CONCLUSION

Although chronic hepatitis and psychiatric complaints are both implicated in frequent ED visits, patients with psychiatric complaints present to the ED more often. Patients with a "dual diagnosis" of psychiatric condition and alcohol abuse are likely to be frequent visitors. This population should be targeted for creative intervention strategies, both within and outside of the emergency system, that comprehensively screen for symptomatology and integrate mental health treatment with substance abuse interventions.

A vacation for the homeless: evaluating a collaborative community respite programme in Canada through clients' perspectives

This study assesses the Urban Breakaway Project, a collaborative project offering a structured vacation in the countryside of the province of Quebec intended for homeless (or street) youths. The objective of this study was to document participants' perspectives regarding this project by examining their satisfaction, intention to change following their stay and perceived improvement with respect to their life situation. Another goal of this research was to investigate the relationship between satisfaction level and perceived improvement of participants. One hundred and seven individuals participated in the study, during Urban Breakaway's first year of operation. Satisfaction with the project, assessed with the global Client Satisfaction Questionnaire-3 score, revealed a positive relationship with global scores of perceived improvement, as measured by the Perceived Improvement Questionnaire [PIQ; r = 0.37 (67), 95% CI (0.15; 0.56)]. Regarding intention to change, the data indicated that 95% of participants had moderate-to-definite intentions to do something to change their lives. Participants reported an improvement for most items covered by the PIQ. They experienced the greatest changes in relation to mood, leisure, appetite, physical condition and self-esteem. Results indicate that the Urban Breakaway Project reaches not only street youths but also an older homeless population. Participants, regardless of their age, were found to be very satisfied with services obtained, and their satisfaction was significantly correlated with the perceived improvement in their situation. Qualitative data indicate that characteristics of the programme, such as the countryside setting, the focus on basic needs, the climate and the opportunity for socialisation, peer support (or belonging) and personal growth were appreciated.

Reflections on capacity‐building initiatives in an Australian state

Purpose

The integration of health or social services is an enduring challenge and especially so in relation to people experiencing “dual diagnosis”, the co‐occurrence of mental health and substance use problems. The emergence of the “dual diagnosis” concept has highlighted the tension between specialist treatment for single problems and complex, individualised care. The purpose of this paper is to examine the evolving nature of dual diagnosis initiatives in an Australian state during recent decades.

Design/methodology/approach

Interpretive, case study analysis of policy documents and key informant interviews (19) illuminates the experience of dual diagnosis initiatives.

Findings

In the case of Victoria, dual diagnosis responsiveness has evolved slowly over the last 20 years, delayed by the inherent difficulty of practice change, a weak perception of need, interprofessional tensions and shortcomings in data collection, coordination and resources. Key enablers have been champions and leaders in policy, management and clinical practice, directive government policy and targeted funding. Achieving a wrap‐around service system entails investment in interpersonal relationship‐building and stigma reduction, as well as technical or structural changes.

Originality/value

The paper presents a unique and independent view of a 20‐year period and indicates progress in attitudinal change that merits wider acknowledgement and application to other settings throughout health and social care.