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Brown JM, Sofis M, Zimmer S, Kaplan BA. Delay discounting is associated with addiction and mental health measures while controlling for health behaviors and health barriers in a large US sample. Addict Behav Rep 2024; 19:100545. [PMID: 38680208 PMCID: PMC11046061 DOI: 10.1016/j.abrep.2024.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background Excessive discounting of future rewards [delay discounting (DD)] may be a transdiagnostic process and treatment target underlying behavioral health outcomes, including trauma, depression, anxiety, and problematic substance use. However, multiple health behaviors and barriers are also related to these outcomes, including social media usage, adverse childhood experiences (ACEs), sleep quality, healthcare access, housing status, and exercise. To extend research examining DD as transdiagnostic process, we recruited a large, heterogenous sample to examine the association between DD, problematic substance use, and mental health outcomes while controlling for certain health behaviors and health barriers. Method In a cross-sectional online survey of 3992 US residents, we administered validated measures of PTSD, depression, anxiety, and problematic alcohol, stimulant, and opioid use. Using linear or ordinal logistic models, scores for each outcome were regressed onto DD while controlling for demographics, health behaviors, and health barriers. Results Including only DD and demographics, DD was associated with each outcome at low effect sizes (ƒ2 = .013, OR range = 1.08-1.16). Except for opioid ASSIST scores, these relationships held when controlling for social media usage, sleep, housing status, healthcare access, ACEs, physical exercise, and demographic variables (ƒ2 = .002, OR range = 1.03-1.12), increasing confidence that DD concurrently and directly relates to four of these five clinical outcomes. Discussion These findings support the conceptualization of DD as a transdiagnostic process underlying certain psychopathologies and suggest targeting DD in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.
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Affiliation(s)
- Jeremiah M. Brown
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Michael Sofis
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Sara Zimmer
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Brent A. Kaplan
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
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Andreu M, Balcells-Olivero M, Alcaraz N, Marco O, Bueno L, Gual A, Barrio P. Destination Matters More: Relapse following Hospital-Based Treatment of Substance Use Disorders With and Without Co-Occurring Disorders. J Dual Diagn 2024; 20:111-121. [PMID: 38367999 DOI: 10.1080/15504263.2024.2311634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
OBJECTIVES Addressing substance use in psychiatric care encounters significant barriers, but the emergence of specialized services offers an opportunity to advance and scale up the integration of addiction services within psychiatric settings. However, research gaps still exist in this field, particularly in understanding the substance relapse rates of people with co-occurring disorders after a psychiatric hospitalization. This study aimed to investigate and compare the relapse rates of patients under inpatient care with exclusively addiction-related issues and those with co-occurring disorders after a hospitalization in a psychiatric ward and gain insights into differences in outcomes for these two patient groups. METHODS This retrospective analysis examined electronic medical records of patients admitted to the Acute Psychiatry Ward of the Hospital Clinic of Barcelona with a substance use disorder diagnosis between January 2019 and February 2021. Cox regression was used to identify variables independently associated with the first relapse episode. RESULTS From a total of 318 admissions (79.2% with psychiatric comorbidity), 76.1% relapsed during the study follow-up, with a median survival time of 54 days. Younger age, female gender, voluntary admission, and outpatient follow-up were independently associated with relapse. The presence of a co-occurring disorder was not associated with relapse. CONCLUSION This study highlights the need for interventions aimed at improving post-discharge abstinence rates for addiction-related hospitalizations. It also challenges the notion that co-occurring disorders automatically imply a worsened prognosis and emphasizes the importance of addressing addiction and psychiatric comorbidity in a comprehensive, integrated, and specialized manner.
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Affiliation(s)
- Magalí Andreu
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Doctoral Program of Medicine and Translational Research, University of Barcelona, Barcelona, Spain
| | - Mercè Balcells-Olivero
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Noelia Alcaraz
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Oriol Marco
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Bueno
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antoni Gual
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Barrio
- Research Group of Clinical Addictions (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Psychiatry and Psychology Service, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Evans SK, Dopp A, Meredith LS, Ober AJ, Osilla KC, Komaromy M, Watkins KE. Findings from an Organizational Context Survey to Inform the Implementation of a Collaborative Care Study for Co-occurring Disorders. J Behav Health Serv Res 2024; 51:4-21. [PMID: 37537428 PMCID: PMC10733218 DOI: 10.1007/s11414-023-09851-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
Primary care is an opportune setting to deliver treatments for co-occurring substance use and mental health disorders; however, treatment delivery can be challenging due multi-level implementation barriers. Documenting organizational context can provide insight into implementation barriers and the adaptation of new processes into usual care workflows. This study surveyed primary care and behavioral health staff from 13 clinics implementing a collaborative care intervention for opioid use disorders co-occurring with PTSD and/or depression as part of a multisite randomized controlled trial. A total of 323 completed an online survey for a 60% response rate. The Consolidated Framework for Implementation Research guided this assessment of multi-level factors that influence implementation. Most areas for improvement focused on inner setting (organizational level) constructs whereas individual-level constructs tended to be strengths. This work addresses a research gap regarding how organizational analyses can be used prior to implementation and provides practical implications for researchers and clinic leaders.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Karen C Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Miriam Komaromy
- Boston Medical Center, Grayken Center for Addiction, One Boston Medical Center Place, Boston, MA, 02118, USA
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Xu KY, Huang V, Williams AR, Martin CE, Bazazi AR, Grucza RA. Co-occurring psychiatric disorders and disparities in buprenorphine utilization in opioid use disorder: An analysis of insurance claims. Drug Alcohol Depend Rep 2023; 9:100195. [PMID: 38023343 PMCID: PMC10630609 DOI: 10.1016/j.dadr.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Background As the overdose crisis continues in the U.S. and Canada, opioid use disorder (OUD) treatment outcomes for people with co-occurring psychiatric disorders are not well characterized. Our objective was to examine the influence of co-occurring psychiatric disorders on buprenorphine initiation and discontinuation. Methods This retrospective cohort study used multi-state administrative claims data in the U.S. to evaluate rates of buprenorphine initiation (relative to psychosocial treatment without medication) in a cohort of 236,198 people with OUD entering treatment, both with and without co-occurring psychiatric disorders, grouping by psychiatric disorder subtype (mood, psychotic, and anxiety-and-related disorders). Among people initiating buprenorphine, we assessed the influence of co-occurring psychiatric disorders on buprenorphine retention. We used multivariable Poisson regression to estimate buprenorphine initiation and Cox regression to estimate time to discontinuation, adjusting for all 3 classes of co-occurring disorders simultaneously and adjusting for baseline demographic and clinical characteristics. Results Buprenorphine initiation occurred in 29.3 % of those with co-occurring anxiety-and-related disorders, compared to 25.9 % and 17.5 % in people with mood and psychotic disorders. Mood (adjusted-risk-ratio[aRR] = 0.82[95 % CI = 0.82-0.83]) and psychotic disorders (aRR = 0.95[0.94-0.96]) were associated with decreased initiation (versus psychosocial treatment), in contrast to greater initiation in the anxiety disorders cohort (aRR = 1.06[1.05-1.06]). We observed an increase in buprenorphine discontinuation associated with mood (adjusted-hazard-ratio[aHR] = 1.20[1.17-1.24]) and anxiety disorders (aHR = 1.12[1.09-1.14]), in contrast to no association between psychotic disorders and buprenorphine discontinuation. Conclusions We observed underutilization of buprenorphine among people with co-occurring mood and psychotic disorders, as well as high buprenorphine discontinuation across anxiety, mood, and psychotic disorders.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Vivien Huang
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Arthur Robin Williams
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, USA
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and the VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alexander R. Bazazi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Richard A. Grucza
- Department of Family and Community Medicine, St. Louis University, St. Louis, Missouri, USA
- Department of Health and Clinical Outcomes Research, St. Louis University, St Louis, Missouri, USA
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Green J, Lindqvist Bagge AS, Laporte N, Andiné P, Wallinius M, Hildebrand Karlén M. A latent class analysis of mental disorders, substance use, and aggressive antisocial behavior among Swedish forensic psychiatric patients. Compr Psychiatry 2023; 127:152428. [PMID: 37778180 DOI: 10.1016/j.comppsych.2023.152428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Patients in the forensic mental health services (FMHS) with a mental disorder, a co-occurring substance use disorder (SUD), and high risk of aggressive antisocial behavior (AAB) are sometimes referred to as the 'triply troubled'. They suffer poor treatment outcomes, high rates of criminal recidivism, and increased risk of drug related mortality. To improve treatment for this heterogeneous patient group, more insight is needed concerning their co-occurring mental disorders, types of substances used, and the consequent risk of AAB. METHODS A three-step latent class analysis (LCA) was used to identify clinically relevant subgroups in a sample of patients (n = 98) from a high-security FMHS clinic in Sweden based on patterns in their history of mental disorders, SUD, types of substances used, and AAB. RESULTS A four-class model best fit our data: class 1 (42%) had a high probability of SUD, psychosis, and having used all substances; class 2 (26%) had a high probability of psychosis and cannabis use; class 3 (22%) had a high probability of autism and no substance use; and class 4 (10%) had a high probability of personality disorders and having used all substances. Both polysubstance classes (1 and 4) had a significantly more extensive history of AAB compared to classes 2 and 3. Class 3 and class 4 had extensive histories of self-directed aggression. CONCLUSIONS The present study helps disentangle the heterogeneity of the 'triply troubled' patient group in FMHS. The results provide an illustration of a more person-oriented perspective on patient comorbidity and types of substances used which could benefit clinical assessment, treatment planning, and risk-management among patients in forensic psychiatric care.
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Affiliation(s)
- J Green
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
| | - A S Lindqvist Bagge
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - N Laporte
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - P Andiné
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden; Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Wallinius
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - M Hildebrand Karlén
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
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6
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Gaba A, Helm A, Shaffer PM, Pridgen B, Drawbridge D, Smelson D. Community reentry: Racial/ethnic differences in unmet needs among adults with co-occurring opioid use and mental health disorder. Int J Law Psychiatry 2023; 91:101924. [PMID: 37690361 DOI: 10.1016/j.ijlp.2023.101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/30/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Adults with co-occurring opioid use and mental health disorder (COD) recently released from incarceration have many social and health needs that place them at the most significant risk for overdose and poor reentry outcomes. Little is known about racial/ethnic differences in this population. METHODS To examine racial/ethnic differences in social and health needs, data were analyzed for 293 adults with COD within two weeks of release, a high-risk period for overdose, from six Massachusetts jails. RESULTS Overall, participants (62.6% non-Hispanic White, 23.1% Hispanic, 14.3% non-Hispanic Black, and 73.5% male) reported multiple health and social needs across groups. Chi-square tests and Kruskal-Wallis one-way ANOVAs were used to compare social and health needs among racial/ethnic groups. Non-Hispanic Black participants reported more problems with crack/cocaine, whereas Non-Hispanic White and Hispanic participants reported more problems with opioids (p < .001). Despite similar lifetime rates of illicit substance use, non-Hispanic Black and Hispanic participants received less treatment (p < .001). Non-Hispanic White participants reported more opioid and alcohol use (p < .006), trauma symptoms (p = .020), utilization of behavioral health treatment (p = .008), and more medical needs than Hispanic and/or non-Hispanic Black participants (p = .001). Non-Hispanic Black and Hispanic participants reported more needs related to social determinants of health (p = .008). CONCLUSIONS While re-entry is a vulnerable period for all adults with COD, this paper identifies specific needs by race/ethnicity and proposes strategies to advance equity and improve care for all formerly incarcerated adults with a COD.
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Affiliation(s)
- Ayorkor Gaba
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Abigail Helm
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Paige M Shaffer
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Bailey Pridgen
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Dara Drawbridge
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
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Chung H, Joseph Parks, Minkoff K, Raney L. A New, Comprehensive Approach to Integration Using Measurement to Demonstrate Value. Psychiatr Serv 2023; 74:1088-1091. [PMID: 37042108 DOI: 10.1176/appi.ps.20220542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The comprehensive health care integration (CHI) framework promotes the delivery of integrated physical and behavioral health care to adults and children in community settings by providing a flexible integration approach for both physical and behavioral health settings, including ongoing measurement of outcomes linked to payment methodologies. The CHI framework demonstrates value, strengthening alignment between provider organizations and payers to support service integration at implementation and on an ongoing basis.
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Affiliation(s)
- Henry Chung
- Montefiore Care Management Organization and Department of Psychiatry, Albert Einstein College of Medicine, New York City (Chung); National Council for Mental Wellbeing, Washington, D.C. (Parks); Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts (Minkoff); Zia Partners, Catalina, Arizona (Minkoff); Collaborative Care Consulting, Denver (Raney)
| | - Joseph Parks
- Montefiore Care Management Organization and Department of Psychiatry, Albert Einstein College of Medicine, New York City (Chung); National Council for Mental Wellbeing, Washington, D.C. (Parks); Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts (Minkoff); Zia Partners, Catalina, Arizona (Minkoff); Collaborative Care Consulting, Denver (Raney)
| | - Ken Minkoff
- Montefiore Care Management Organization and Department of Psychiatry, Albert Einstein College of Medicine, New York City (Chung); National Council for Mental Wellbeing, Washington, D.C. (Parks); Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts (Minkoff); Zia Partners, Catalina, Arizona (Minkoff); Collaborative Care Consulting, Denver (Raney)
| | - Lori Raney
- Montefiore Care Management Organization and Department of Psychiatry, Albert Einstein College of Medicine, New York City (Chung); National Council for Mental Wellbeing, Washington, D.C. (Parks); Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts (Minkoff); Zia Partners, Catalina, Arizona (Minkoff); Collaborative Care Consulting, Denver (Raney)
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8
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Zisman-Ilani Y, Smith WR, Morris NP. Addressing Substance Use in Psychiatric Care: An Old Problem With Renewed Urgency. Psychiatr Serv 2023; 74:201-203. [PMID: 35833255 DOI: 10.1176/appi.ps.202100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patients, clinicians, researchers, and policy makers have long called for greater integration of services for people with co-occurring mental and substance use disorders. Decades later, these services remain fragmented in psychiatry across much of the United States. Mounting deaths from drug-related overdoses call for renewed focus on bringing substance use into the center of psychiatric services. This Open Forum explores factors within the field of psychiatry, including insufficient training related to substance use, prevalent stigma surrounding substance use, and limited availability of co-occurring disorder specialists, that reinforce this divide and offers solutions for better addressing substance use disorders in psychiatric care.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani); Department of Psychiatry, University of Pennsylvania, Philadelphia (Smith); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Morris)
| | - William R Smith
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani); Department of Psychiatry, University of Pennsylvania, Philadelphia (Smith); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Morris)
| | - Nathaniel P Morris
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani); Department of Psychiatry, University of Pennsylvania, Philadelphia (Smith); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Morris)
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Claudat K, Reilly EE, Convertino AD, Trim J, Cusack A, Kaye WH. Integrating evidence-based PTSD treatment into intensive eating disorders treatment: a preliminary investigation. Eat Weight Disord 2022; 27:3599-3607. [PMID: 36401788 PMCID: PMC9803734 DOI: 10.1007/s40519-022-01500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Given data suggesting common co-occurrence and worse outcomes for individuals with eating disorders (EDs) and post-traumatic stress disorder (PTSD), it is critical to identify integrated treatment approaches for this group of patients. Past work has explored the feasibility and initial efficacy of intervention approaches that draw on evidence-based treatments for both EDs and PTSD; however, this work remains limited in scope. In the current study, we explored the feasibility and naturalistic outcomes of PTSD treatment delivered within the context of intensive ED treatment. METHOD Participants were 57 adult men and women with DSM-5 EDs and comorbid PTSD who completed a course of either Prolonged Exposure (PE; n = 22) or Cognitive Processing Therapy (CPT; n = 35) (Msessions = 10.40; SD = 5.13) and weekly validated measurements of clinical symptoms while enrolled in ED programming. RESULTS Multi-level models for PTSD symptoms indicated a significant linear effect of time, such that participants demonstrated significant decreases over time in PTSD symptoms, regardless of treatment modality. CONCLUSION Our preliminary investigation provides support for the feasibility and efficacy of an integrated approach to treating EDs and PTSD. It is critical for future work to undertake randomized tests of this integrated approach using large, heterogeneous samples. LEVEL OF EVIDENCE Level IV, multiple time series with intervention.
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Affiliation(s)
- Kimberly Claudat
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA.
| | - Erin E Reilly
- Department of Psychiatry, University of California, San Francisco, USA
| | - Alexandra D Convertino
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Julie Trim
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
| | - Anne Cusack
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
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Brown C, Cook JA, Jonikas JA, Steigman PJ, Burke-Miller J, Hamilton MM, Rosen C, Tessman DC, Santos A. Nutrition and Exercise for Wellness and Recovery: A Randomized Controlled Trial of a Community-Based Health Intervention. Psychiatr Serv 2022; 74:463-471. [PMID: 36377367 DOI: 10.1176/appi.ps.202200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. METHODS Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. RESULTS Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. CONCLUSIONS NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.
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Affiliation(s)
- Catana Brown
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Judith A Cook
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jessica A Jonikas
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Pamela J Steigman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jane Burke-Miller
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Marie M Hamilton
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Cherise Rosen
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Dorothy Clare Tessman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Alberto Santos
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
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Sabbatini AK, Hoeft TJ, Duber HC, Kern E, Sylling PW, Desrosiers A, McKee MB, Hernandez SE. Behavioral Health Integration in Community Health Centers and Emergency Department Use. Psychiatr Serv 2022; 73:1298-1301. [PMID: 35578806 DOI: 10.1176/appi.ps.202100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medicaid enrollees with behavioral health disorders often experience fragmented care, leading to high rates of preventable use of emergency departments (EDs). As part of its Medicaid Transformation Program, the Washington Health Care Authority partnered with regional accountable communities of health to collect data on behavioral health integration in community health centers. Clinics who participated in the integrated care demonstration received technical and financial support to increase capacity for integration. This column describes results from an analysis that linked clinic surveys to Medicaid claims to explore characteristics of highly integrated clinics and assess whether clinic capacity for behavioral health integration is associated with ED visit frequency.
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Affiliation(s)
- Amber K Sabbatini
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Theresa J Hoeft
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Herbert C Duber
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Eli Kern
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Philip W Sylling
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Alexis Desrosiers
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Michael B McKee
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
| | - Susan E Hernandez
- Department of Emergency Medicine (Sabbatini, Duber) and Department of Psychiatry and Behavioral Sciences (Hoeft), University of Washington, Seattle;Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle (Sabbatini, Hoeft, Kern, Hernandez); Assessment, Policy Development and Evaluation Unit, Public Health-Seattle & King County (Kern, Hernandez); King County Department of Community and Human Services, Seattle (Sylling); HealthierHere, Seattle (Desrosiers, McKee)
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Berdine DE, Thomas MC, Kahn LS, Vest BM. Challenges and Lessons Learned in the Regional Implementation of MISSION-CJ in Drug Treatment Courts. Psychiatr Serv 2022; 73:950-953. [PMID: 35193374 DOI: 10.1176/appi.ps.202000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column discusses lessons learned during a regional implementation of the evidence-based MISSION-CJ (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice) case management program across multiple drug treatment courts, including discussion of key components, implementation challenges encountered, and strategies that helped address these challenges. The authors' experiences may assist other programs in planning for similar implementations and suggest that programs can enhance success among drug court participants with the MISSION-CJ model but that the programs may need to be flexible with regard to implementation fidelity and to establishing and communicating their specific role within the court.
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Affiliation(s)
- Diane E Berdine
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo (Berdine, Thomas, Kahn, Vest), and HOPE of Erie County (Berdine), Buffalo, New York. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Matthew C Thomas
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo (Berdine, Thomas, Kahn, Vest), and HOPE of Erie County (Berdine), Buffalo, New York. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Linda S Kahn
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo (Berdine, Thomas, Kahn, Vest), and HOPE of Erie County (Berdine), Buffalo, New York. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo (Berdine, Thomas, Kahn, Vest), and HOPE of Erie County (Berdine), Buffalo, New York. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
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Chicoine G, Côté J, Pepin J, Boyer L, Rouleau G, Jutras-Aswad D. Experiences and perceptions of nurses participating in an interprofessional, videoconference-based educational programme on concurrent mental health and substance use disorders: a qualitative study. BMC Nurs 2022; 21:177. [PMID: 35787275 DOI: 10.1186/s12912-022-00943-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Individuals with co-occurring mental health and substance use disorders (i.e., concurrent disorders) have complex healthcare needs, which can be challenging for nurses to manage. Providing optimal care for this subpopulation requires nurses to develop high-level competencies despite limited resources at their disposal and the isolated settings in which many of them work. The Extension for Healthcare Community Outcomes (ECHO®) is a promising collaborative learning and capacity building model that uses videoconference technology to support and train healthcare professionals in the management of complex and chronic health conditions. The aim of this study was to explore the experiences and perceptions of nurses participating in a Canadian ECHO programme on concurrent disorders about the competencies they developed and used in their clinical practice, and which factors have influenced this process. Methods The study was qualitative, guided by an interpretive description approach. Individual semi-structured interviews were held with ten nurses who had participated in the programme between 2018 and 2020. A thematic analysis was conducted iteratively using an inductive approach to progressive data coding and organization. Results Four themes and eighteen sub-themes were identified. During their participation in ECHO, the nurses perceived as having further developed eight clinical nursing competencies. Nurses viewed ECHO as a unique opportunity to open themselves to their peers’ experiences and reflect on their own knowledge. Learning from experts in the field of concurrent disorders helped them to build their confidence in managing complex clinical situations. The nurses’ sense of belonging to a community further enhanced their engagement in the programme, and learning was facilitated through the programme’s interprofessional environment. Nevertheless, the lack of contextualized educative content linked to local realities, the limited resources in concurrent disorders, and time constraints were experienced as factors limiting competency development. Conclusions ECHO is a promising alternative to conventional, in-person continuing education programmes to improve the development of advanced competencies among nurses providing care to individuals with chronic and complex health conditions. These findings can inform clinicians, educators, researchers, and decision makers who are developing, implementing, evaluating, and escalating future educational interventions in the field of CDs. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00943-w.
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Marcovitz DE, Pettapiece-Phillips M, Kast KA, White K, Himelhoch H, Audet C. Implementation of a Hub-and-Spoke Partnership for Opioid Use Disorder Treatment in a Medicaid Nonexpansion State. Psychiatr Serv 2022; 73:819-822. [PMID: 34875847 DOI: 10.1176/appi.ps.202100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hub-and-spoke (H&S) partnerships for managing opioid use disorder vary by U.S. state. This column provides the first description of the development of an H&S partnership in Tennessee, a Medicaid nonexpansion state. Medicaid expansion allows states to fund evidence-based substance use disorder treatment and community-based psychosocial interventions. In an H&S model in a Medicaid nonexpansion context, federal grant support must fund not only treatment itself but also the creation and maintenance of parallel billing and documentation processes for various partners, reducing the funds available for patient care.
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Affiliation(s)
- David E Marcovitz
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Mariah Pettapiece-Phillips
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Kristopher A Kast
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Katie White
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Heather Himelhoch
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Carolyn Audet
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
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Butler A, Nicholls T, Samji H, Fabian S, Lavergne MR. Prevalence of Mental Health Needs, Substance Use, and Co-occurring Disorders Among People Admitted to Prison. Psychiatr Serv 2022; 73:737-744. [PMID: 34809437 DOI: 10.1176/appi.ps.202000927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People who are incarcerated experience social exclusion and have higher rates of mental and substance use disorders than the general population. Prisons are not suitable for treating mental illness, and understanding how the profile of prison populations changes provides essential information for correctional service planning. This study examined changes in the prevalence of mental and substance use disorders among people admitted to provincial prisons in British Columbia (BC), Canada. METHODS The study included all people admitted to any of the 10 provincial prisons in BC from 2009 through 2017 (N=47,117). Using the Jail Screening Assessment Tool, a validated intake screening tool designed for rapid identification of mental health needs, the authors calculated the period prevalence (by calendar year) of mental health needs, substance use disorders, and drug use. RESULTS The proportion of people with co-occurring mental health needs and substance use disorders increased markedly per year, from 15% in 2009 to 32% in 2017. Prevalence of methamphetamine use disorder increased nearly fivefold, from 6% to 29%, and heroin use disorder increased from 11% to 26%. The proportion of people with any mental health need and/or substance use disorder increased from 61% to 75%. CONCLUSION The clinical profile of people admitted to BC prisons has changed, with dramatic increases in the proportion of people with co-occurring disorders and reported methamphetamine use. More treatment and efforts to address social and structural inequities for people with complex clinical profiles are required in the community to reduce incarceration among people with multifaceted and complex mental health care needs.
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Affiliation(s)
- Amanda Butler
- Faculty of Health Sciences (Butler, Samji, Lavergne) and School of Criminology (Fabian), Simon Fraser University, Burnaby, British Columbia, Canada; Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, Canada (Nicholls); British Columbia Mental Health and Substance Use Services, Vancouver, Canada (Nicholls); British Columbia Centre for Disease Control, Vancouver, Canada (Samji)
| | - Tonia Nicholls
- Faculty of Health Sciences (Butler, Samji, Lavergne) and School of Criminology (Fabian), Simon Fraser University, Burnaby, British Columbia, Canada; Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, Canada (Nicholls); British Columbia Mental Health and Substance Use Services, Vancouver, Canada (Nicholls); British Columbia Centre for Disease Control, Vancouver, Canada (Samji)
| | - Hasina Samji
- Faculty of Health Sciences (Butler, Samji, Lavergne) and School of Criminology (Fabian), Simon Fraser University, Burnaby, British Columbia, Canada; Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, Canada (Nicholls); British Columbia Mental Health and Substance Use Services, Vancouver, Canada (Nicholls); British Columbia Centre for Disease Control, Vancouver, Canada (Samji)
| | - Sheri Fabian
- Faculty of Health Sciences (Butler, Samji, Lavergne) and School of Criminology (Fabian), Simon Fraser University, Burnaby, British Columbia, Canada; Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, Canada (Nicholls); British Columbia Mental Health and Substance Use Services, Vancouver, Canada (Nicholls); British Columbia Centre for Disease Control, Vancouver, Canada (Samji)
| | - M Ruth Lavergne
- Faculty of Health Sciences (Butler, Samji, Lavergne) and School of Criminology (Fabian), Simon Fraser University, Burnaby, British Columbia, Canada; Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, Canada (Nicholls); British Columbia Mental Health and Substance Use Services, Vancouver, Canada (Nicholls); British Columbia Centre for Disease Control, Vancouver, Canada (Samji)
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Abstract
People with co-occurring mental and substance use disorders experience poor outcomes and incur high costs in multiple domains. Efforts to develop and disseminate evidence-based integrated programs for people with such co-occurring disorders began to wane in the past decade as efforts shifted toward integrating primary health care. Several recent trends underscore the need to refocus efforts on providing integrated care for people with both mental and substance use disorders. The authors summarize what is known about integrated care for people with these co-occurring disorders and recommend advancing implementation and research on integration and improving outcomes with existing resources.
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Affiliation(s)
- Kenneth Minkoff
- ZiaPartners, Tucson, Arizona (Minkoff); Department of Psychiatry, Harvard Medical School, Boston (Minkoff); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York City (Covell)
| | - Nancy H Covell
- ZiaPartners, Tucson, Arizona (Minkoff); Department of Psychiatry, Harvard Medical School, Boston (Minkoff); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York City (Covell)
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Padwa H, Huang D, Mooney L, Grella CE, Urada D, Bell DS, Bass B, Boustead AE. Medical conditions of primary care patients with documented cannabis use and cannabis use disorder in electronic health records: a case control study from an academic health system in a medical marijuana state. Subst Abuse Treat Prev Policy 2022; 17:36. [PMID: 35527269 PMCID: PMC9080201 DOI: 10.1186/s13011-022-00467-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America. METHODS The study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression. RESULTS Of 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43-48.73), any mental health disorder (OR = 6.99; 95% CI 5.03-9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18-77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58-24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66-22.51); depression (OR = 7.01: 95% CI 4,79-10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90-14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53-5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53-5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10-21.39), other substance use disorder (OR = 5.88; 95% CI 2.42-14.22), depression (OR = 2.85; 95% CI 1.90-4.26), and anxiety (OR = 2.19: 95% CI 1.57-3.05) diagnoses. CONCLUSION The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.
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Affiliation(s)
- Howard Padwa
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA.
| | - David Huang
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Larissa Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Christine E Grella
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Darren Urada
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Douglas S Bell
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, USA
- Clinical and Translational Science Institute, University of California, Los Angeles, USA
| | - Brittany Bass
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, Tucson, USA
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Ober AJ, Hunter SB, McCullough CM, Leamon I, McCreary M, Beas I, Montero A, Tarn DM, Bromley E, Hurley B, Sheehe J, Martinez J, Watkins KE. Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness. Psychiatr Serv 2022; 73:271-279. [PMID: 34281359 PMCID: PMC8770719 DOI: 10.1176/appi.ps.202000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics. METHODS Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed. RESULTS In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001). CONCLUSIONS These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.
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Affiliation(s)
| | | | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Ivan Beas
- David Geffen School of Medicine at UCLA
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Kruse-Diehr AJ, Shamblen SR, Courser MW. Longitudinal Assessment of a Manualized Group Treatment Program for Gambling Disorder: The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders. J Gambl Stud 2022. [PMID: 34973141 DOI: 10.1007/s10899-021-10089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Individuals with gambling disorder (GD) experience a host of negative psychosocial and physical health outcomes, yet few seek treatment. Of particular concern are individuals with co-occurring mental and behavioral health disorders, a group at higher risk for GD in the state of Ohio. To better serve this population, the Ohio Department of Mental Health and Addiction Services developed a group-based GD treatment manual for adults with co-occurring disorders. Over the course of 5 years, 353 individuals engaged in at least some of the manual's 12 weekly modules, and more than one-third (n = 122) completed the entire curriculum. Participants who completed all 12 modules completed pre-and post-tests, and after controlling for covariates, participants significantly decreased their GD symptom severity, though changes in self-esteem and gambling urges were non-significant. These findings suggest the treatment manual holds promise at reducing gambling behaviors for individuals with co-occurring disorders, but further research is warranted to explore best practices on how to intervene on the psychological antecedents to gambling in this population.
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McHugh RK, Hilton BT, Chase AM, Griffin ML, Weiss RD. Do people with opioid use disorder and posttraumatic stress disorder benefit from dding Individual opioid Drug Counseling to buprenorphine? Drug Alcohol Depend 2021; 228:109084. [PMID: 34607194 PMCID: PMC8595708 DOI: 10.1016/j.drugalcdep.2021.109084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Large randomized trials have found that behavioral therapy for opioid use disorder (e.g., Individual Drug Counseling, Cognitive Behavioral Therapy for Opioid Use Disorder) does not improve buprenorphine maintenance outcomes, on average, for individuals with opioid use disorder. However, recent studies indicate that certain subgroups of patients may benefit from the addition of behavioral therapy to buprenorphine. In particular, people with more complex and severe psychosocial needs may benefit from the addition of behavioral therapy for opioid use disorder. METHODS In this study, we conducted a secondary analysis of a large, multi-site randomized trial (N = 357) of buprenorphine maintenance with and without individual Opioid Drug Counseling (ODC) for the treatment of opioid use disorder. We hypothesized that participants with posttraumatic stress disorder (PTSD) would benefit from the addition of ODC. RESULTS Logistic regression models indicated a significant PTSD by treatment condition interaction. Specifically, 67% of those with PTSD had a successful opioid use disorder treatment outcome when they were assigned to receive both ODC and buprenorphine, compared to a 36% response rate among those who received buprenorphine alone. CONCLUSIONS Although these results require replication, our findings provide initial indication that ODC is an important complement to buprenorphine maintenance treatment for people with co-occurring PTSD and opioid use disorder.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, USA; Department of Psychiatry, Harvard Medical School, USA.
| | - Blake T Hilton
- Division of Alcohol, Drugs and Addiction, McLean Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
| | | | - Margaret L Griffin
- Division of Alcohol, Drugs and Addiction, McLean Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs and Addiction, McLean Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
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Zullig KJ, Lander LR, Tuscano M, Garland M, Hobbs GR, Faulkenberry L. Testing Mindfulness-Based Relapse Prevention with Medications for Opioid Use Disorder Among Adults in Outpatient Therapy: a Quasi-experimental Study. Mindfulness (N Y) 2021;:1-11. [PMID: 34659584 DOI: 10.1007/s12671-021-01763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
Objectives This study aimed to explore the effectiveness of mindfulness-based relapse prevention (MBRP) with individuals receiving medication for opioid use disorder (MOUD) in a naturalistic, open-ended outpatient group treatment setting. Methods Eighty participants (mean age 36.3) who had at least 90 consecutive days substance free self-selected into treatment (MBRP, n = 35) or comparison groups (treatment as usual, TAU, n = 45). Outcomes tracked included treatment retention and relapse, and self-reported craving, anxiety, depression, and mindfulness at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. MBRP group participants attended biweekly 60-min sessions for 24 weeks. A linear mixed model analysis of variance determined the significance of the MBRP intervention on changes in craving, anxiety, depression, and mindfulness. Results No significant differences in sex, education level, insurance status, relationship status, or employment status were detected at baseline between groups. The 36-week retention (74%, MBRP/MOUD; 71%, TAU/MOUD) and relapse rates (43%, MBRP/MOUD; 47%, TAU/MOUD) were similar for the groups. There were only four relapses on opioids. Significant reductions (p < .05) were observed in the MBRP/MOUD group for craving, anxiety, and depression in addition to significant increases in mindfulness compared to those in TAU/MOUD. Conclusions Although state and federal resources are available to expand MOUD, no standard of behavioral therapy has been established as most complimentary to MOUD. The current study results suggest MBRP can be implemented as an outpatient therapy for individuals in MOUD.
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Baumgartner C, Schaub MP, Wenger A, Malischnig D, Augsburger M, Lehr D, Blankers M, Ebert DD, Haug S. "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. Drug Alcohol Depend 2021; 225:108806. [PMID: 34171823 DOI: 10.1016/j.drugalcdep.2021.108806] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Addiction and Drug Coordination Vienna, Vienna, Austria
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Dirk Lehr
- Division of Online Health Training, Leuphana University Lueneburg, Germany
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Watkins KE, Hunter SB, Cohen CC, Leamon I, Hurley B, McCreary M, Ober AJ. Organizational Capacity and Readiness to Provide Medication for Individuals with Co-Occurring Alcohol Use Disorders in Public Mental Health Settings. Adm Policy Ment Health 2021; 48:707-717. [PMID: 33387128 PMCID: PMC8628547 DOI: 10.1007/s10488-020-01103-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Alcohol use disorders (AUD) in individuals with mental illness are largely untreated. The purpose of this study was to identify gaps in organizational capacity and readiness to provide medications for AUD in outpatient public mental health clinics. We selected a purposive sample of eight publicly funded outpatient mental health clinics operated by the Los Angeles County Department of Mental Health; clinics were chosen to maximize heterogeneity. Guided by theories of organizational capacity and readiness and research on the adoption of pharmacotherapy for AUD in primary and specialty care treatment settings, we conducted semi-structured interviews and focus groups with administrators, providers and staff, and a qualitative analysis of the results. Respondents described significant organizational capacity and behavioral readiness constraints to providing medication treatment for AUD. Both groups articulated a perception that mental health clinics were not designed to provide co-occurring AUD treatment because of large caseloads, staffing configurations, and time constraints that did not support the delivery of appropriate treatment, and a lack of protocols and workflow procedures. We documented organizational capacity and readiness constraints which impede the delivery of medication treatment for AUD in a large mental helth system. While some constraints have straightforward solutions, others require structural changes to the way care is delivered, and state-level funding and policy changes.
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Affiliation(s)
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Michael McCreary
- Health Services and Society, UCLA Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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Kelly E, Pasquarella FJ, Davis L, Hunt A, Lee S, Fairhurst S, Giambone L, Murch L, Thorning H, Brekke JS. Managing substance use for clients with serious mental illnesses: Knowledge, attitude, and training challenges among outpatient behavioral health providers in California, Ohio, and New York. J Subst Abuse Treat 2021; 131:108547. [PMID: 34244012 DOI: 10.1016/j.jsat.2021.108547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/16/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Individuals with serious mental illness have high rates of substance use. The most commonly used substances among this population are alcohol and cannabis, and whether clinical providers delivering mental health services feel adequately prepared to address substance use is unclear. While information about the effects of alcohol are well established, the effects of cannabis are less well known and staff may feel less confident in their abilities to assess its use and may rely on more informal sources to learn about it. METHODS Mental health agencies in three states (California, Ohio, and New York) surveyed their staff (n =717) to explore their knowledge, training, and expertise in assessment of substance use generally as well as cannabis and alcohol specifically. RESULTS Overall, providers felt more prepared to address their clients' alcohol use than cannabis use. In between-state comparisons, California providers felt significantly less well prepared to assess, discuss, and refer their clients to treatment compared to Ohio and New York providers. Using a series of multi-categorical mediation models, we confirmed that deficits in training for these specific substances largely accounted for between-state differences in assessment, capacity, and treatment. CONCLUSIONS Substance use training to address the service needs of individuals with co-occurring disorders is insufficient and a significant need exists for systemic changes to workforce training of community mental health providers.
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Affiliation(s)
- Erin Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, United States of America.
| | - Fred J Pasquarella
- Culver City Mental Health Services, Sepulveda Blvd, Los Angeles, CA, United States of America.
| | - Lisa Davis
- Center for Health Services and Society, University of California, Los Angeles, 10920 Wilshire Blvd # 300, Los Angeles, CA 90024, United States of America.
| | - Andrew Hunt
- Department of Psychiatry, Case Western University Hospitals, 10524 Euclid Ave, Cleveland, OH 44106, United States of America.
| | - Sae Lee
- Culver City Mental Health Services, Sepulveda Blvd, Los Angeles, CA, United States of America.
| | - Scott Fairhurst
- Pacific Clinics, 800 South Santa Anita Blvd, Arcadia, CA, United States of America.
| | - Leslie Giambone
- Mental Health America Los Angeles, East 7th Street, Long Beach, CA 90804, United States of America.
| | - Lezlie Murch
- Exodus Recovery, Incorporated, 9808 Venice Boulevard, Los Angeles 90232, United States of America.
| | - Helle Thorning
- Columbia University, Department of Psychiatry, New York, NY, United States of America.
| | - John S Brekke
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Los Angeles, CA 90089, United States of America.
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Felner JK, Haley SJ, Jun HJ, Wisdom JP, Katuska L, Corliss HL. Sexual orientation and gender identity disparities in co-occurring depressive symptoms and probable substance use disorders in a national cohort of young adults. Addict Behav 2021; 117:106817. [PMID: 33626483 DOI: 10.1016/j.addbeh.2021.106817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/21/2022]
Abstract
This study examined sexual orientation and gender identity differences in co-occurring depressive symptoms and substance use disorders (SUDs) among young adults in the Growing Up Today Study national cohort (n = 12,347; ages 20-35; 93% non-Hispanic white). Self-administered questionnaires assessed recent co-occurring depressive symptoms and probable nicotine dependence, alcohol use disorder, and drug use disorder. Multinomial logistic regressions with generalized estimating equations quantified differences in prevalences of depressive symptoms only, SUDs only, and co-occurrence, among sexual minorities (mostly heterosexual; lesbian, gay, and bisexual [LGB]) compared to completely heterosexual participants, and gender minorities compared to cisgender participants. Analyses stratified by sex assigned at birth revealed sexual minorities evidenced greater odds of co-occurrence than their completely heterosexual counterparts (assigned female AORs: 3.11-9.80, ps < 0.0001; assigned male AORs: 2.90-4.87, ps < 0.001). Sexual orientation differences in co-occurrence were pronounced among LGB participants assigned female at birth who evidenced nearly 10 times the odds of co-occurring depressive symptoms with nicotine dependence and drug use disorders than did heterosexual participants assigned female at birth. Relationships between gender identity and co-occurrence were generally weaker, possibly due to low power. Gender minorities assigned male at birth, however, evidenced greater odds of co-occurring depressive symptoms and alcohol use disorders (AOR 2.75, p = 0.013) than their cisgender counterparts. This study adds to the limited research quantifying sexual orientation or gender identity differences in recent co-occurring depressive symptoms and SUDs among young adults and suggests sexual and gender minority young adults should be prioritized in prevention and treatment of co-occurring depression and SUDs.
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Shaffer PM, Rodriguez CP, Gaba A, Byrne T, Casey SC, Harter J, Smelson D. Engaging vulnerable populations in drug treatment court: Six month outcomes from a co-occurring disorder wraparound intervention. Int J Law Psychiatry 2021; 76:101700. [PMID: 33864989 DOI: 10.1016/j.ijlp.2021.101700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Although drug treatment courts (DTCs) have demonstrated positive outcomes, participants with co-occurring mental health and substance use disorders (CODs) are a high-risk group that often struggle with treatment engagement not previously examined. This pilot study fills this gap by looking at six-month behavioral health and criminal justice outcomes among a hard to engage DTC COD participant sample in two Massachusetts DTCs receiving a wraparound-treatment (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice - MISSION-CJ). METHODS Participants were evaluated at baseline and at six-month follow-up. Bivariate analyses examined baseline differences between clients with higher versus low engagement were examined. A mixed analysis of variance (ANOVA) for repeated measures with time as the within subject factor, and level of engagement as the between subject factor was performed for criminal justice (CJ) and behavioral health outcomes. RESULTS Participants were primarily male (86.6%), White (90.6%), living in unstable housing (86.2%), had an average of 18.94 years of criminal justice involvement, had an average of 15.49 years of regular illicit substance use, and mild mental health symptoms as measured by the BASIS-32 average total score (0.51), with no statistically significant differences at baseline from bivariate analyses. Mixed ANOVA results demonstrated significant effect time of time in MISSION-CJ on reducing nights in jail (p = 0.0266), opioid use (p = 0.0013), and mental health symptom (p = 0.0349). Additional improvements in nights in jail p = 0.0139), illicit substance use (p = 0.0358), and opioid use (p = 0.0013), were observed for clients that had high engagement in MISSION-CJ. CONCLUSIONS Wraparound services, such as MISSION-CJ, alongside DTC programming for a chronic relapsing DTC population can improve engagement in treatment and CJ and behavioral health outcomes. Future research is needed with MISSION-CJ that includes a randomized trial and a larger sample.
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Affiliation(s)
- Paige M Shaffer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | | | - Ayorkor Gaba
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Thomas Byrne
- School of Social Work, Boston University, Boston, MA, USA
| | | | - Jennifer Harter
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Kour P, Lien L, Kumar B, Biong S, Pettersen H. Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders. Subst Abuse 2020; 14:1178221820970929. [PMID: 33281448 PMCID: PMC7691914 DOI: 10.1177/1178221820970929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
Immigrants are considered at risk of psychological distress and therefore
involvement in substance abuse, due to a variety of pre- and post-migration
factors. Further, there is lower treatment engagement, a higher dropout rate,
and less frequent hospitalizations among this group compared to the general
population. There are few studies on the subjective understanding of
co-occurring substance use disorder (SUD) and mental health disorder (MHD) among
immigrants in Norway. This qualitative study aims to explore the treatment
experiences of immigrant men living with co-occurring SUD and MHD. Within a
collaborative approach, individual interviews were conducted with 10 men of
immigrant background, living with co-occurring SUD and MHD, who had treatment
experiences from the Norwegian mental health and addiction services. Data were
analyzed using a systematic text condensation. The analysis yielded 6 categories
where participants described their treatment experiences in mental health and
addiction services in Norway as: lack of connection, lack of individually
tailored treatment, stigma and discrimination preventing access to treatment,
health professionals with multi-cultural competence, care during and after
treatment, and raising awareness and reducing stigma. A significant finding was
the mention by participants of the value of being seen and treated as a “person”
rather than their diagnosis, which may increase treatment engagement. They
further mentioned aftercare as an important factor to prevent relapse. This
study provides an enhanced understanding of how immigrant men living with
co-occurring SUD and MHD experienced being treated in Norwegian healthcare
settings. These experiences may add to the knowledge required to improve
treatment engagement.
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Affiliation(s)
- Prabhjot Kour
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NK-ROP), Innlandet Hospital Trust and University of South-Eastern Norway, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NK-ROP) Innlandet Hospital Trust; and Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
| | | | - Stian Biong
- University of South-Eastern Norway, Kongsberg, Norway
| | - Henning Pettersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NK-ROP) Innlandet Hospital Trust; and Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
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Cook JA, Jonikas JA, Burke-Miller JK, Hamilton M, Powell IG, Tucker SJ, Wolfgang JB, Fricks L, Weidenaar J, Morris E, Powers DL. Whole Health Action Management: A Randomized Controlled Trial of a Peer-Led Health Promotion Intervention. Psychiatr Serv 2020; 71:1039-1046. [PMID: 32838676 DOI: 10.1176/appi.ps.202000012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Adults with serious mental illness have high rates of general medical comorbidity and encounter challenges in dealing with multiple health conditions. Chronic illness self-management programs may help them more effectively cope with comorbid illnesses, especially when instructors are certified peer specialists. This study assessed the longitudinal effectiveness of a peer-delivered health promotion program. METHODS Community mental health program clients in Georgia and Illinois with serious mental illness and health impairments were randomly assigned to receive either Whole Health Action Management (WHAM), a medical illness self-management program led by peer specialists, or care as usual, resulting in a sample of N=139 (WHAM N=68, control N=71). Assessments were conducted at study baseline and at 3 and 6 months. Generalized estimating equations were used to examine change over time in the primary outcome of patient activation and secondary outcomes of general health, hope, and employment. RESULTS Longitudinal analysis indicated that compared with control participants, WHAM participants demonstrated significantly greater improvement over time in patient activation for health care. Intervention participants also demonstrated greater improvement in their self-assessed general health, overall hopefulness, and paid employment. Reactions to the WHAM program were positive, with 97% reporting being very or somewhat satisfied, and almost two-thirds (63%) reporting that their health was better than before they joined the program. CONCLUSIONS The WHAM program improved patient activation, perceived general medical health, hopefulness, and likelihood of paid employment among people with serious mental illness and co-occurring medical conditions. Results suggest that peer-delivered health self-management education is effective and well received by participants.
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Affiliation(s)
- Judith A Cook
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Jessica A Jonikas
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Jane K Burke-Miller
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Marie Hamilton
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Ike G Powell
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Sherry Jenkins Tucker
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Jacqueline B Wolfgang
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Larry Fricks
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Joni Weidenaar
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Elliott Morris
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Destiny L Powers
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
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Balboni G, Rebecchini G, Elisei S, Tassé MJ. Factors affecting the relationship between adaptive behavior and challenging behaviors in individuals with intellectual disability and co-occurring disorders. Res Dev Disabil 2020; 104:103718. [PMID: 32585440 DOI: 10.1016/j.ridd.2020.103718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Previous studies have reported an inverse relationship between adaptive behavior and challenging behaviors in individuals with ID. However, it is unclear which characteristics might influence this relationship in individuals with ID and co-occurring conditions. We found a positive correlation between adaptive behavior (Vineland-II) and challenging behaviors (Nisonger Child Behavior Rating Form) in a study of 105 individuals who presented with mostly severe to profound ID and comorbid physical and mental health conditions. These results might be the consequence of the individual participant characteristics. Therefore, participants were separated out into two groups representing the top (n = 24) and bottom quartiles (n = 28) for presence of challenging behaviors. The participants with the highest levels of challenging behaviors had higher levels of adaptive behavior, higher frequency of intermittent explosive/conduct disorder, but lower frequency of epilepsy and cerebral palsy. All participants with the highest levels of challenging behaviors lived in an institutional setting; whereas, those with the lowest level of challenging behaviors lived in either an institutional setting or with their family. In participants with severe/profound ID and multiple co-occurring disorders, a minimum level of adaptive behavior seems to be necessary for the expression of challenging behaviors.
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Affiliation(s)
| | | | - Sandro Elisei
- Serafico Institute of Assisi, Research Centre "InVita", Assisi, PG, Italy
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Florentin S, Neumark Y, Raskin S, Bdolah-Abram T, Rosca P. Differential Effect of Community Rehabilitation Reform on Hospitalizations of Patients with Chronic Psychotic Disorders With and Without Substance Use Disorder, Israel, 1991-2016. Adm Policy Ment Health 2020; 48:354-362. [PMID: 32780219 DOI: 10.1007/s10488-020-01077-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The co-occurrence of schizophrenia and substance use disorder (SUD) is clinically challenging and increasingly prevalent. This study compares trends in hospitalization characteristics of chronic psychotic patients with and without SUD in Israel, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000. The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorders, hospitalized in 1991-2016 (at least once in 2010-2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of group (patients with and without co-occurring disorders (COD)), time-period (Period1: 1991-2000, Period2: 2001-2009, Period3: 2010-2016) and age, on hospitalization measures-average length of stay (LOS), annual number of hospitalizations and hospitalization days. Among non-COD patients hospitalized in all three periods, LOS declined by half from 133.3 days in Period1 to 63.2 in Period3, and the annual number of hospitalizations increased slightly from 0.45 to 0.56. Among COD patients, LOS declined moderately from 82.7 days to 58.3 days, while annual hospitalizations increased dramatically from 0.56 to 0.82. The annual average number of hospitalization days/capita declined from 49.7 in Period1 to 26.3 in Period3 among non-COD patients, yet remained virtually unchanged among COD patients-39.6 and 37.4 in the two periods, respectively. Since introduction of the law, a significant improvement in hospitalization characteristics of chronic psychotic non-COD patients has been noted, whereas the situation worsened somewhat for COD patients. Community rehabilitation services for COD patients in Israel have yet to develop as a suitable alternative to hospitalization, and additional rehabilitation services are urgently needed.
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Affiliation(s)
- S Florentin
- Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12272, 9112102, Jerusalem, Israel.
| | - Y Neumark
- Hebrew University-Hadassah Braun School of Public Health & Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Raskin
- Jerusalem Mental Health Center Affiliated with The Hebrew University of Jerusalem, Jerusalem, Israel
| | - T Bdolah-Abram
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - P Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel.,The Hebrew University of Jerusalem, Jerusalem, Israel
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Bromley E, Tarn DM, McCreary M, Hurley B, Ober AJ, Watkins KE. Attitudes about medications for alcohol use disorder among individuals with serious mental illness: A health belief model analysis. J Subst Abuse Treat 2020; 114:108007. [PMID: 32527506 DOI: 10.1016/j.jsat.2020.108007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medications for alcohol use disorder (MAUD) are underutilized in mental health settings. Increasing use of MAUD requires increasing both the availability of these medications and the demand by individuals who could benefit. Few studies have explored the views of individuals with severe mental illness and alcohol use disorder about MAUD. We sought to examine, among individuals treated in publicly funded community mental health clinics, perceived need for and attitudes toward MAUD. METHODS We conducted 8 focus groups with 87 participants treated in public mental health clinics in Los Angeles County. We aimed to include individuals with a current or past AUD diagnosis and individuals helping others (e.g., a family member) who drink. We examined responses using domains associated with the Health Belief Model to identify factors that shape acceptance of MAUD. RESULTS Participants were 53% female; most were minorities. Average age was 47 years (SD = 11). Twenty-four reported never drinking, 13 of whom had a current or past diagnosis of AUD. Twenty-two reported drinking 4 or more times per week. Three-quarters had not heard of naltrexone. Participants understood that alcohol use has severe adverse consequences and perceived themselves to be highly susceptible to these consequences. Regarding attitudes toward MAUD, participants described an internal locus of control (e.g., their own desires, actions, and effort) as central to addressing problem drinking; this shaped their views that MAUD would have only modest benefits and potentially high burden. Those individuals who had tried MAUD expressed the most optimism about its effectiveness. CONCLUSIONS Participants worried MAUD would impede the development of self-control over drinking by fostering dependence on medication and undermining self-discipline. Client education and counseling that emphasizes MAUD as a tool to build clients' self-control may increase demand for these medications in mental health settings.
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Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, United States of America; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
| | - Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, United States of America
| | - Michael McCreary
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, United States of America
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, United States of America; Los Angeles County Department of Health Services, 313 N Figueroa Street, Los Angeles, CA 90012, United States of America
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America
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Robertson AG, Easter MM, Lin HJ, Khoury D, Pierce J, Swanson J, Swartz M. Gender-specific participation and outcomes among jail diversion clients with co-occurring substance use and mental health disorders. J Subst Abuse Treat 2020; 115:108035. [PMID: 32600621 DOI: 10.1016/j.jsat.2020.108035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/16/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
Men and women with co-occurring substance use disorders and mental illness are at relatively high risk for becoming involved in the criminal justice system. Programs, such as post-booking jail diversion, aim to connect these individuals to community-based treatment services in lieu of pursuing criminal prosecution. Gender appears to have an important influence on risk factors and pathways through the criminal justice system, which in turn may influence how interventions like jail diversion work to engage men and women in treatment services and reduce recidivism. Different circumstances, levels of engagement, and outcomes by gender may be related to both person-level characteristics and external factors such as availability of gender-specific services and resources. This mixed-methods study identified specific ways in which men and women use services and reoffend after being diverted, and complemented those findings with in-depth insights from program clinicians about how program experiences and resources differ in important ways by gender. We matched and merged administrative records from 2007 to 2009 for 16,233 adults from several state agencies in Connecticut, and included data on demographic characteristics, clinical diagnoses, outpatient and inpatient behavioral health treatment utilization, arrest, and incarceration. Using propensity analysis, the 1693 men and women who participated in the statewide jail diversion program were matched to respective comparison groups of nondiverted men and women. We used longitudinal multivariable regression analyses to estimate the effects of jail diversion participation on treatment utilization, arrest, and incarceration, separately for men and women. We conducted three focus groups with jail diversion clinicians from around the state (n = 21) to gain in-depth insight from them about how circumstances, program experiences, and resources differ by gender in important ways; these subjective clinician insights complement the quantitative analyses of diversion outcomes for men and women. For both men and women, diversion was associated with reductions in risk for incarceration and increases in utilization of outpatient treatment services. For men only, diversion was associated with higher utilization of inpatient mental health care. No differences in treatment or criminal justice outcomes were observed in models that compared men and women directly. Major themes from the focus groups included: the existence of too few inpatient and residential resources for women with co-occurring disorders; different challenges to treatment engagement that men and women face; and a need for more effective, gender-specific services for all program participants. Results from this mixed-methods study offer information on gender-specific program outcomes and surrounding circumstances that can help programs to better understand and address unique risks and needs for men and women with co-occurring substance use and mental health disorders who are involved in the criminal justice system.
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Perreault M, Milton D, Alunni-Menichini K, Archambault L, Perreault N, Bertrand K. Montreal Cross-Training Program: The contribution of positional clarification activities to help bridge fragmented prevention and treatment services for co-occurring disorders. Health Soc Care Community 2020; 28:1090-1098. [PMID: 31885130 DOI: 10.1111/hsc.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/28/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
Co-occurring disorders in mental health and addiction present a high prevalence, but services available to prevent and treat them are often fragmented. Cross-training activities have been used to help minimise breaks in service continuity. This study assesses to what extent positional clarification (a specific type of cross-training activity) can help bridge fragmented services for co-occurring disorders by providing information and promoting interactions to help professionals better orient and treat their clientele. A total of 2,107 participations were recorded for 11 positional clarification events taking place within the Montreal Cross-Training Program for mental health and substance use disorders between 2010 and 2016. The Kirkpatrick four-level training evaluation model was used to evaluate these activities. Evaluation questionnaires (n = 1,650) and interviews with a convenience sample of 32 participants were analysed using descriptive statistics and thematic analysis. More than three-quarters of participants reported that the activity met their expectations and was relevant to their practice. Respondents also reported receiving useful information to better orient their clientele, discovering new resources, learning about the functioning of other resources, identifying members of other networks who could orient them when needed, and learning more about the theme of the activity and the different mechanisms for collaboration among the related services. Among those who participated in more than one positional clarification event, roughly three-quarters reported that they were able to call upon new resources at least once as a result of their participation, and were able to establish referrals towards resources that were unknown or less familiar to them prior to their participation. Results suggest that the programme meets its service integration objectives and that positional clarification events can lead to changes that can help facilitate the integration of fragmented services by improving participants' knowledge of specific themes and available resources to better orient and treat their clientele.
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Affiliation(s)
- Michel Perreault
- Department of Psychiatry, McGill University and Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Diana Milton
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | | | | | - Nicole Perreault
- Direction régionale de santé publique de Montréal, Montreal, Canada
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Cunningham JA, Hodgins DC, Keough M, Hendershot CS, Schell C, Godinho A. Online interventions for problem gamblers with and without co-occurring unhealthy alcohol use: Randomized controlled trial. Internet Interv 2020; 19:100307. [PMID: 32042600 PMCID: PMC7000801 DOI: 10.1016/j.invent.2020.100307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Problem gambling and unhealthy alcohol use often co-occur. The current trial sought to establish whether adding a brief online intervention for unhealthy alcohol use to an online problem gambling intervention would lead to improvements in gambling and drinking among those with both of these concerns. METHODS Participants were recruited from across Canada using an advertisement targeting those concerned about their gambling who were interested in online help. No mention of unhealthy alcohol use was made in the advertisement. Participants meeting criteria for problem gambling were randomized to either receive just an online intervention for gambling (G-only) or to receive an online gambling intervention plus a brief personalized feedback intervention for unhealthy alcohol use (G + A). Participants were followed up at 3 and 6 months. RESULTS A total of 282 participants were recruited for the trial. Follow-up rates were good (80% and 84% at 3 and 6 months). There were significant reductions in gambling (p < .001) across time but no significant differences (p > .05) between those who received either the G-only or G + A interventions. Further, for those with unhealthy alcohol use (41% of the sample), there were no significant reductions in alcohol consumption (p > .05) across time or differences between condition. DISCUSSION AND CONCLUSION The addition of a brief intervention for unhealthy alcohol use to an online intervention for gambling did not appear to improve either gambling or drinking outcomes among people concerned about their gambling. Further research is merited to examine whether a combined intervention (with gambling and drinking components integrated) might result in improved outcomes and whether such an intervention might benefit the subgroup of participants who would specifically seek help for both gambling and alcohol concerns.Trial registration:ClinicalTrials.govNCT03323606; Registration date: October 24, 2017.
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Affiliation(s)
- John A. Cunningham
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
- Australian National University, Canberra, Australia
| | | | | | - Christian S. Hendershot
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
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Jessell L, Stanhope V, Manuel JI, Mateu-Gelabert P. Factors associated with benzodiazepine prescribing in community mental health settings. J Subst Abuse Treat 2020; 109:56-60. [PMID: 31856952 PMCID: PMC6989035 DOI: 10.1016/j.jsat.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/27/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE One class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription. METHODS Retrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine. RESULTS Of the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50-1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01-4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55-7.22). DISCUSSION Our findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.
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Affiliation(s)
- Lauren Jessell
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003, USA.
| | - Victoria Stanhope
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003, USA
| | - Jennifer I Manuel
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003, USA
| | - Pedro Mateu-Gelabert
- City University of New York, Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY 10027, USA
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Agterberg S, Schubert N, Overington L, Corace K. Treatment barriers among individuals with co-occurring substance use and mental health problems: Examining gender differences. J Subst Abuse Treat 2020; 112:29-35. [PMID: 32199543 DOI: 10.1016/j.jsat.2020.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the narrowing gender gap in the prevalence of substance use disorders, women continue to be vastly underrepresented in substance use services. Relational factors, family responsibilities, mental health, and stigma may present unique barriers encountered by women. AIMS The aims of this study were to examine: (1) gender differences in substance use treatment barriers, (2) gender differences in perceptions of stigmatization for seeking substance use treatment, and symptoms of depression, anxiety, and trauma-related stress, and (3) whether perceived stigmatization and mental health symptoms are associated with greater barriers among women. METHODS One hundred adults (50% self-identified women) from a substance use and concurrent disorders program in Ontario, Canada, completed a questionnaire package containing measures of sociodemographic information, substance use, mental health, perceived stigma, and substance use treatment barriers. RESULTS Women reported more barriers related to family responsibilities, relational factors, and mental health (p < .01), and higher levels of perceived stigma (p < .01) compared to men. CONCLUSIONS Findings from this study contribute to our understanding of treatment barriers and perceived stigmatization among women. This knowledge may be used to aid in the development and delivery of accessible, gender-responsive services that address these barriers and challenge the stigma attached to substance use among women.
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Affiliation(s)
- Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, United States of America.
| | - Nicholas Schubert
- The Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada.
| | - Louise Overington
- The Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada; The Royal's Institute of Mental Health Research, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada.
| | - Kimberly Corace
- The Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada; The Royal's Institute of Mental Health Research, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada; Faculty of Medicine, Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada.
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Desrosiers JJ, Tchiloemba B, Boyadjieva R, Jutras-Aswad D. Implementation of a contingency approach for people with co-occurring substance use and psychiatric disorders: Acceptability and feasibility pilot study. Addict Behav Rep 2019; 10:100223. [PMID: 31828202 PMCID: PMC6889619 DOI: 10.1016/j.abrep.2019.100223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The prevalence of co-occurrent substance use and psychiatric disorders is high. Contingency-based interventions have been shown to be effective in promoting adherence to treatment for people with substance use disorders but are among the least used evidence-based interventions for clients with comorbid psychiatric disorders, related to acceptability issues. Objective The present implementation study aims to evaluate the acceptability and feasibility of a contingency approach in co-occurring disorders specialized treatment services. Methodology Focus groups were conducted with health professionals and service users recruited from a specialized co-occurring disorder program (COD). Pre-intervention focus groups were conducted to select preferred modalities to implement the program. Post-intervention focus groups were conducted to document the satisfaction and benefits of the intervention. Throughout the study, program monitoring was conducted systematically to determine the gaps between planned and actual interventions. Results Both health professionals consulted and service users agreed that the contingency approach could be integrated within usual co-occurring disorders treatment. In general, patients more readily accepted the contingency approach than health professionals. The higher functioning level group reported several benefits from the approach and implementation in its group sessions went as planned. Contingency approach was described by all participants as consistent with general treatment goals and led to patient's awareness about their group attendance. Conclusion This study highlights several challenges related to the implementation of a contingency approach. It also suggests that implementation of this approach could benefit from taking into account the needs and perspectives of service users.
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Affiliation(s)
| | - Bianief Tchiloemba
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Quebec, Canada
| | - Rositsa Boyadjieva
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Quebec, Canada
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Affiliation(s)
- Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA. .,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
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Assefa MT, Ford JH, Osborne E, McIlvaine A, King A, Campbell K, Jo B, McGovern MP. Implementing integrated services in routine behavioral health care: primary outcomes from a cluster randomized controlled trial. BMC Health Serv Res 2019; 19:749. [PMID: 31651302 PMCID: PMC6814122 DOI: 10.1186/s12913-019-4624-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
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
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Affiliation(s)
- Mehret T Assefa
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - James H Ford
- School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Eric Osborne
- Office of Behavioral Health and Managed Care, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA, 98504, USA
| | - Amy McIlvaine
- School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Ahney King
- Office of Behavioral Health and Managed Care, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA, 98504, USA
| | - Kevin Campbell
- Washington State Health Care Authority, Olympia, WA, 98501, USA
| | - Booil Jo
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Mark P McGovern
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, 94304, USA.
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Abstract
Substance use disorders (SUDs) are commonly co-occurring among adolescents with depression. Integrated treatment is important given treatment implications and increased rates of suicidality. All adolescents should be screened for SUD using Screening, Brief Intervention, and Referral to Treatment. Review of randomized controlled trials in adolescents reveals motivational enhancement therapy/cognitive behavioral therapy is an evidence-based intervention and should be considered first-line treatment. If depression does not improve, fluoxetine should be considered, as it is well-tolerated in substance-involved adolescents with depression. Adolescents who do not show improvement in SUD or who have severe SUD should be referred to evidence-based SUD treatment.
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Affiliation(s)
- Jesse D Hinckley
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS F570, Aurora, CO 80045, USA.
| | - Paula Riggs
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS F570, Aurora, CO 80045, USA
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Haverfield MC, Ilgen M, Schmidt E, Shelley A, Timko C. Social Support Networks and Symptom Severity Among Patients with Co-occurring Mental Health and Substance Use Disorders. Community Ment Health J 2019; 55:768-76. [PMID: 30863904 DOI: 10.1007/s10597-019-00396-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
Patients entering an inpatient psychiatry program (N = 406) with co-occurring mental health and substance use disorders reported on their social support networks (source, type) at treatment intake, and completed symptom measures at baseline and 3-, 9-, and 15-month follow-ups (77%). Longitudinal growth models found aspects of participants' support networks were associated with specific symptoms over time. Less family support (i.e., more conflict) was the most consistent predictor of mental health and substance use outcomes and was associated with greater psychiatric, depression, Post Traumatic Stress Disorder (PTSD), and drug use severity. More peer support (via mutual-help involvement) was associated with greater initial improvement in alcohol use severity. Findings suggest that to facilitate the benefits of social support for patients with a dual diagnosis returning to the community, specific components of support should be assessed and considered in the treatment plan, rather than viewing support as a general and undifferentiated factor affecting recovery.
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Hanna J, Kubiak S, Pasman E, Gaba A, Andre M, Smelson D, Pinals DA. Evaluating the implementation of a prisoner re-entry initiative for individuals with opioid use and mental health disorders: Application of the consolidated framework for implementation research in a cross-system initiative. J Subst Abuse Treat 2019; 108:104-114. [PMID: 31285078 DOI: 10.1016/j.jsat.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/15/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Abstract
Given the interrelated nature of opioid use, criminal justice interaction, and mental health issues, the current opioid crisis has created an urgent need for treatment, including medication assisted treatment, among justice-involved populations. Implementation research plays an important role in improving systems of care and integration of evidence-based practices within and outside of criminal justice institutions. The current study is a formative qualitative evaluation of the implementation of a cross-system (corrections and community-based) opioid use treatment initiative supported by Opioid State Targeted Response (STR) funding. The purpose of the study is to assess the fit of the Consolidated Framework for Implementation Research (CFIR) to a cross-system initiative, and to identify key barriers and facilitators to implementation. The process evaluation showed that adaptability of the clinical model and staff flexibility were critical to implementation. Cultural and procedural differences across correctional facilities and community-based treatment programs required frequent and structured forums for cross-system communication. Challenges related to recruitment and enrollment, staffing, MAT, and data collection were addressed through the collaborative development and continuous review of policies and procedures. This study found CFIR to be a useful framework for understanding implementation uptake and barriers. The framework was particularly valuable in reinforcing the use of implementation research as a means for continuous process improvement. CFIR is a comprehensive and flexible framework that may be adopted in future cross-system evaluations.
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Affiliation(s)
- Julie Hanna
- Center for Behavioral Health and Justice, Wayne State University, 5201 Cass Avenue, Detroit, MI 48202, USA.
| | - Sheryl Kubiak
- School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA.
| | - Emily Pasman
- Center for Behavioral Health and Justice, Wayne State University, 5201 Cass Avenue, Detroit, MI 48202, USA.
| | - Ayorkor Gaba
- Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, USA.
| | - Michael Andre
- Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, USA.
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, USA.
| | - Debra A Pinals
- University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA; Michigan Department of Health and Human Services, USA.
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Tormohlen KN, Tobin KE, Latkin C. Sources of Stress among Adults with Co-occurring Drug Use and Depressive Symptoms. J Urban Health 2019; 96:379-389. [PMID: 30120726 PMCID: PMC6565771 DOI: 10.1007/s11524-018-0304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Stress, drug use, and depression are interconnected, but less is understood about sources of stress among adults with co-occurring drug use and depressive symptoms. The current study aimed to identify sources of stress and correlates among these adults. Data come from a cross-sectional baseline survey, including participants (n = 336) 18 to 55 years old, who reported past 6-month heroin or cocaine use and depressive symptoms. Exploratory factor analysis was conducted to identify sources of stress. Chi-square and multivariable Poisson regression with robust error variance were used to explore correlates of each factor. Three sources of stress were identified: financial stress related to drugs, stress due to community features, and stress involving a person's network. Past 6-month injection drug use (aPR = 1.34, 95% CI 1.07-1.67), perceived lack of control over drug use (aPR = 1.80, 95% CI 1.41-2.30), and difficulty abstaining from drug use (aPR = 1.55, 95% CI 1.22-1.97) were associated with an increased risk of high drug-related financial stress. Neighborhood disorder (aPR = 2.42, 95% CI 1.80-3.24) and sleeping on the street (aPR = 1.37, 95% CI 1.04-1.80) were associated with an increased risk of high community-level stress. Past 6-month injection drug use (aPR = 1.28, 95% CI 1.04-1.58), perceived lack of control over drug use (aPR = 1.37, 95% CI 1.10-1.70), and drug use stigma was associated with an increased prevalence of high drug network stress (aPR = 1.32, 95% CI 1.05-1.65). Stress is a complex construct, including distinct sources and correlates. Further understanding of sources of stress is beneficial in recognizing potentially modifiable challenges faced by individuals who use drugs and experience depressive symptoms.
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Affiliation(s)
- Kayla N Tormohlen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 888, Baltimore, MD, 21205, USA.
| | - Karin E Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21205, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 737, Baltimore, MD, 21205, USA
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Stallvik M, Flemmen G, Salthammer JA, Nordfjærn T. Assessing health service satisfaction among users with substance use disorders within the municipalities in Norway. Subst Abuse Treat Prev Policy 2019; 14:18. [PMID: 31060571 PMCID: PMC6501295 DOI: 10.1186/s13011-019-0207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Marianne Stallvik
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Grete Flemmen
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Jo Arild Salthammer
- Center of Drug and Alcohol expertise, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Nordfjærn
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Jones CM, McCance-Katz EF. Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug Alcohol Depend 2019; 197:78-82. [PMID: 30784952 DOI: 10.1016/j.drugalcdep.2018.12.030] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/27/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Co-occurring substance use and mental disorders among people with opioid use disorder (OUD) increase risk for morbidity and mortality. Addressing these co-occurring conditions is critical for improving treatment and health outcomes. There is limited recent research on the prevalence of co-occurring disorders, demographic characteristics associated with co-occurring disorders, and receipt of mental health and substance use treatment services among those with OUD. This limits the development of targeted and resourced policies and clinical interventions. METHODS Using 2015-2017 National Survey on Drug Use and Health data, prevalence of co-occurring substance use and mental disorders and receipt of mental health and substance use treatment services was estimated for adults aged 18-64 with OUD. Multivariable logistic regression assessed demographic and substance use characteristics associated with past-year mental illness (AMI) and serious mental illness (SMI) among adults with OUD as well as treatment receipt. RESULTS Among adults with OUD, prevalence of specific co-occurring substance use disorders ranged from 26.4% (95% CI:23.6%-29.4%) for alcohol to 10.6% (95% CI:8.6%-13.0%) for methamphetamine. Prevalence of AMI was 64.3% (95% CI:60.4%-67.9%) and SMI was 26.9% (95% CI:24.2%-29.8%). Receiving both mental health and substance use treatment services in the past year was reported by 24.5% (95% CI:21.5%-29.9%) of adults with OUD and AMI and 29.6% (95% CI:23.3%-36.7%) of adults with OUD and SMI. CONCLUSIONS Co-occurring substance use and mental disorders are common among adults with OUD. Expanding access to comprehensive service delivery models that address the substance use and mental health co-morbidities of this population is urgently needed.
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Affiliation(s)
- Christopher M Jones
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
| | - Elinore F McCance-Katz
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
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Cunningham JA, Hodgins DC, Mackenzie CS, Godinho A, Schell C, Kushnir V, Hendershot CS. Randomized controlled trial of an Internet intervention for problem gambling provided with or without access to an Internet intervention for co-occurring mental health distress. Internet Interv 2019; 17:100239. [PMID: 30906694 PMCID: PMC6411631 DOI: 10.1016/j.invent.2019.100239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND AIMS The current randomized controlled trial tested whether there was benefit to providing an online gambling intervention and a separate self-help mental health intervention for anxiety and depression (i.e. MoodGYM) (G + MH), compared to only a gambling intervention (G only) among people with co-occurring gambling problems and mental health distress. The primary outcome of interest was improvement in gambling outcomes. Secondary analyses also tested for the impact of the combined intervention on depression and anxiety outcomes. METHODS Participants who were concerned about their gambling were recruited to help evaluate an online intervention for gamblers. Those who met criteria for problem gambling were randomized to receive either the G only or the G + MH intervention. Participants were also assessed for current mental health distress at baseline, with three quarters (n = 214) reporting significant current distress and form the sample for this study. Participants were followed-up at 3- and 6-months to assess changes in gambling status, and improvements in depression and anxiety. RESULTS Follow-up rates were poor (47% completed at least one follow-up). While there were significant reductions in gambling outcomes, as well as on measures of current depression and anxiety, there was no significant difference in outcomes between participants receiving the G only versus the G + MH intervention. DISCUSSION AND CONCLUSION There does not appear to be a benefit to providing access to an additional online mental health intervention to our online gambling intervention, at least among participants who are concerned about their gambling.Trial registration: ClinicalTrials.govNCT02800096; Registration date: June 14, 2016.
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Affiliation(s)
- John A. Cunningham
- Centre for Addiction and Mental Health, Toronto, Canada,Australian National University, Canberra, Australia,University of Toronto, Toronto, Canada,Corresponding author at: Centre for Addiction and Mental Health, 33 Russell St., Toronto, Ontario M5S 2S1, Canada.
| | | | | | | | | | | | - Christian S. Hendershot
- Centre for Addiction and Mental Health, Toronto, Canada,University of Toronto, Toronto, Canada
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Eggink E, de Waal MM, Goudriaan AE. Criminal offending and associated factors in dual diagnosis patients. Psychiatry Res 2019; 273:355-362. [PMID: 30682557 DOI: 10.1016/j.psychres.2019.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/10/2018] [Accepted: 01/13/2019] [Indexed: 12/24/2022]
Abstract
Dual diagnosis patients perpetrate crime more often than healthy individuals. Crime perpetration has major mental health consequences for the victim. Knowledge of factors related to perpetration is needed for the development of prevention programs. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. The current study investigated cross-sectional associations between demographic and clinical factors and perpetration of three crime types (violence, threat, and property crime) in 243 treatment-seeking dual diagnosis patients. In our sample, perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. Expression of threat was independently associated with severity of alcohol use problems and higher manic symptom scores. Perpetration of property crime was independently associated with severity of alcohol and drug use problems. Remarkably, gender was not associated with any type of perpetration. These findings indicate that criminal offending is a significant problem among dual diagnosis patients and are a first step towards understanding the complex causal networks that lead to criminal perpetration. Future longitudinal research should investigate additional risk factors and establish causality to support the development of treatment programs to prevent criminal offending by dual diagnosis patients.
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Affiliation(s)
- Esmé Eggink
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam, the Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Marleen M de Waal
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.
| | - Anna E Goudriaan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
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48
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Snyder SM, Morse SA, Bride BE. A comparison of 2013 and 2017 baseline characteristics among treatment-seeking patients who used opioids with co-occurring disorders. J Subst Abuse Treat 2019; 99:134-138. [PMID: 30797385 DOI: 10.1016/j.jsat.2019.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/29/2022]
Abstract
The opioid epidemic is a public health crisis that has captured the attention of the media and political leaders, but how much do we know about its implications for substance use disorder treatment providers? This study is the first to investigate the differing baseline characteristics among patients with co-occurring disorders who used opioids and entered residential treatment in 2013 and 2017. Our sample consisted of 1413 unique adults who reported using opioids upon admission to integrated residential treatment for co-occurring substance use and mental health disorders during 2013 (n = 718) and 2017 (n = 695). Opioid use was defined as self-reported use of heroin or illicit use of prescription opioids, including methadone, during the month prior to admission into the treatment program. All study participants completed an admission interview that included the Addiction Severity Index (ASI). The 2017 cohort demonstrated higher severity than the 2013 cohort on the employment, psychiatric, and alcohol and drug ASI composite scores. A comparison of days per month that the cohorts used various substances also reveals this trend, with the following comparisons listing the 2017 cohort data first, and the 2013 cohort data second: (1) alcohol (8.6 days vs. 7.0 days); (2) cocaine (4.1 days vs. 2.2 days); (3) amphetamines (6.2 days vs. 3.6 days); and (4) polysubstance use in one day (16.6 days vs. 11.6 days). The 2017 cohort was also intoxicated from alcohol more days per month (7.2 days vs. 5.1 days). However, the 2017 cohort reported fewer days using prescription opioids (9.9 days vs. 12.4 days). A higher proportion of the 2017 cohort reported (1) depression (74% vs. 68%); (2) anxiety (88% vs. 84%); (3) hallucinations (14% vs 8%); and (4) and suicidal ideation (22% vs. 17%).
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Affiliation(s)
- Susan M Snyder
- School of Social Work, Georgia State University, 55 Park Place, Rm. 575, Atlanta, GA 30303, United States of America.
| | - Siobhan A Morse
- Universal Health Services, Inc., 1000 Health Park Drive, Building 3, Suite 400, Brentwood, TN 37027, United States of America.
| | - Brian E Bride
- School of Social Work, Georgia State University, 55 Park Place, Rm. 552, Atlanta, GA 30303, United States of America.
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Semenza DC, Grosholz JM. Mental and physical health in prison: how co-occurring conditions influence inmate misconduct. Health Justice 2019; 7:1. [PMID: 30612284 PMCID: PMC6717981 DOI: 10.1186/s40352-018-0082-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/02/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND Research has shown that inmate misconduct is related to a range of demographic factors and experiences with the criminal justice system. Poor mental and physical health has also been associated with inmate misconduct, although no research has examined the relationship between co-occurring conditions and misconduct in prison populations. METHODS We rely on data from the 2004 Survey of Inmates in State Correctional Facilities (N = 14,499) and use negative binomial regression models to examine the relationship between types of co-occurring mental and physical conditions and misconduct. RESULTS The results demonstrate that people in prison dealing with concurrent mental and physical health problems are significantly more likely to engage in prison misconduct than healthy incarcerated individuals. After accounting for physical and co-occurring health conditions, mental conditions are not associated with serious misconduct. CONCLUSIONS Enhancements in prison healthcare may not only improve the general health of those in prison, but also contribute to a decrease in misconduct. Research that examines the relationship between mental health and deviant behavior in and out of prison should consider the multifaceted elements of a person's health, including acute and chronic physical ailments.
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Affiliation(s)
- Daniel C. Semenza
- Department of Sociology, Anthropology, & Criminal Justice, Rutgers University, 405-7 Cooper Street, Camden, NJ 08102-1521 USA
| | - Jessica M. Grosholz
- College of Liberal Arts and Social Sciences, University of South Florida Sarasota-Manatee, Sarasota, FL USA
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Abstract
Mental health and substance use disorders co-occur frequently, and are associated with poorer outcomes in life domains including housing, employment, health, and recovery. Finding evidence-based interventions for engagement and recovery can be a challenge for practitioners and organizations, as it involves accepting new interventions, and then implementing and measuring the results. However, practitioners frequently use their opinions or non-generalizable experiences rather than evidence-based findings to guide their practice. Medication-assisted therapy programs, especially for individuals with co-occurring mental health and substance use disorders, is an area of treatment where there are solid evidence-based outcome findings and where, nonetheless, many practitioners continue to use less-, or non-effective treatment approaches. Conflict between groups of staff using two different approaches can have serious negative impact on treatment outcome. These can be effectively addressed through a combination of education and interventions aimed at resolving intra-staff conflict.
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Affiliation(s)
- Mark M Lowis
- Michigan Department of Health and Human Services, Lansing, MI, USA
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