Showing papers in "Advances in Dual Diagnosis in 2016"

Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings.

Abstract: These Guidelines aim to provide alcohol and other drug (AOD) workers with evidence-based information to assist with the management of co-occurring, or comorbid, AOD and mental health conditions. They represent an update and revision of the first edition of these Guidelines published in 2009. Population estimates indicate that more than one-third of individuals with an AOD use disorder have at least one comorbid mental health disorder; however, the rate is even higher among those in AOD treatment programs. Additionally, there are a large number of people who present to AOD treatment who display symptoms of disorders while not meeting criteria for a diagnosis of a disorder. The high prevalence of comorbidity means that AOD workers are frequently faced with the need to manage complex psychiatric symptoms that may interfere with their ability to treat clients’ AOD use. Furthermore, clients with comorbid mental health conditions often have a variety of other medical, family, and social problems (e.g., housing, employment, welfare, legal problems). As such, it is important that AOD workers adopt a holistic approach to the management and treatment of comorbidity that is based on treating the person, not the illness (see Chapter B1). The first step in responding to comorbidity is being able to identify the person’s needs (see Chapters B2 and B3). Despite high rates of comorbidity among clients of AOD services, it is not unusual for comorbid mental health conditions to go unnoticed. This is mostly because AOD workers are not routinely looking for them. It is a recommendation of these Guidelines that all clients of AOD treatment services should be screened and assessed for comorbidity as part of routine clinical care. Once identified, symptoms of mental health conditions may be effectively managed while the person is undergoing AOD treatment (see Chapters B5 and B6). The goal of management is to allow AOD treatment to continue without mental health symptoms disrupting the treatment process, and to retain clients in treatment who might otherwise discontinue such treatment. Comorbidity is not an insurmountable barrier to treating people with AOD use disorders. Indeed, research has shown that clients with comorbid mental health conditions can benefit just as much as those without comorbid conditions from usual AOD treatment. Some clients with comorbidity may require additional treatment for their mental health problems (see Chapter B6). Some interventions have been designed for the treatment of specific comorbidities; however, these interventions generally have not been well researched. Where there is an absence of specific research on comorbid disorders, it is recommended that best practice is to use the most effective treatments for each disorder. Both psychosocial and pharmacological interventions have been found to have some benefit in the treatment of many comorbidities. Consideration should also be given to the use of e-health interventions, physical activity, and complementary and alternative therapies, as an adjunct to traditional treatments. In addition to mental health services, AOD workers may need to engage with a range of other services to meet clients’ needs, including housing, employment, education, training, community, justice, and other support services. A broad, multifaceted, and co-ordinated approach is needed in order to address all of these issues effectively, and it is important that AOD services and workers develop links with a range of local services (see Chapter B4).

LETS ACT: a behavioral activation treatment for substance use and depression

Abstract: Purpose – Substance use disorders (SUDs) often co-occur with major depressive disorder (MDD), yet treatments targeting this comorbidity are limited, especially in resource-limited settings where individuals with SUDs often receive treatment. The paper aims to discuss this issue. Design/methodology/approach – Based upon principles of reinforcement and behavioral economic models of substance use, as well as the Brief Behavioral Activation Treatment for Depression (Lejuez et al., 2011), the Life Enhancement Treatment for Substance Use (LETS ACT) (Daughters et al., 2008) was developed to meet the unique needs of patients with MDD-SUD comorbidity. Findings – This paper presents a summary of the theoretical foundations and key components of LETS ACT. Originality/value – A specific focus on increasing dissemination via the flexible delivery dependent on patient and treatment setting characteristics is provided throughout.

Intimate partner violence, fatherhood, and co-parenting of men in residential substance misuse treatment

Abstract: Purpose The purpose of this paper is to examine the role of co-parenting, childhood experiences, and satisfaction with fathering in a sample of men in a long-term residential drug rehabilitation program. Design/methodology/approach A paper and pencil survey was completed by 128 men between the ages of 18 and 68 (M age=30.42 years) in a court ordered residential rehabilitation center for drug misuse. Of the 128 respondents, 40.625 percent (n=52) were fathers and completed a longer survey to assess their co-parenting relationships. Findings The percentage of men with positive role models did not differ between the fathers and non-fathers, with 40.4 percent of fathers having had a positive role model growing up, χ2(1, n=127)=0.54, p=0.816. Fathers were more likely to report witnessing IPV between their parents during childhood than non-fathers, χ2(1, n=125)=4.7888, p=0.029. Linear regression models examining factors associated with co-parenting agreement and exposure to conflict were significant, but witnessing IPV as a child was the only significant individual predictor. Practical implications Exposure to IPV in childhood was a common experience for fathers in residential treatment for substance misuse. Fathers reported significant problems in their co-parenting relationships indicating a need for fatherhood and co-parenting focused services available within residential treatment programs. Originality/value There is little research about fathers with co-occurring histories of substance misuse and IPV in residential treatment. This paper is the first to examine co-parenting in this specific population.

Cognitive impairment in older people with alcohol use disorders in a UK community mental health service

Abstract: Purpose The assessment of cognitive impairment in community services for older people remains under-explored. The paper aims to discuss this issue. Design/methodology/approach Cognitive impairment was examined in 25 people aged 65 and over with alcohol use disorders, on the caseload of community mental health services over a six-month period. All subjects assessed using Addenbrooke’s Cognitive Assessment (ACE-III). Findings In total, 76 per cent of the group scored below the cut-off point for likely dementia but only 45 per cent of people scored below the cut-off point for tests of language, compared with 68-84 per cent people in other domains. Research limitations/implications This finding has implications for the detection of alcohol-related brain cognitive impairment in clinical settings. Practical implications Standardised cognitive testing is common within mental health services for older people, but may also have utility within addiction services. Social implications The early detection of alcohol-related cognitive impairment can improve social outcomes in both drinking behaviour and the social consequences of alcohol-related dementia. Originality/value This may be the first published study of cognitive impairment in patients under a mental team for older people with alcohol use disorders and offers some unique findings within this sampling frame.

Behavioral activation treatment for smoking (BATS) in smokers with depressive symptomatology

Abstract: Purpose – Cigarette smoking remains the primary preventable cause of mortality and morbidity globally. The purpose of this paper is to disseminate the behavioral activation treatment for smoking (BATS), which integrates behavioral activation principles with standard treatment guidelines to assist individuals in achieving short- and long-term smoking cessation. Through a series of sequential steps, BATS guides individuals who wish to quit smoking to increase their engagement in healthy, pleasurable, and value-consistent activities. Design/methodology/approach – The document provides the BATS rationale and contains an abridged manual for use by clinicians and/or researchers in the context of clinical trials. Findings – BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms. Practical implications – A description of key components, forms, and strategies to address common treatment barriers are included...

What can be done to improve outcomes for prisoners with a dual diagnosis

Abstract: Purpose – The purpose of this paper is to review the literature on offenders with a dual diagnosis and discuss how prison-based services can improve to better meet the needs of prisoners with co-occurring substance misuse and mental health disorders. Design/methodology/approach – A comprehensive literature search of PsycINFO, JSTOR, PubMed and Google Scholar, reviewing international studies on dual diagnosis amongst offender and community samples spanning the last three decades, supplemented by international policy, guidance papers and reports was conducted to explore how services can be improved. Findings – It was found that research into dual diagnosis amongst prisoners internationally was scarce. However, from the evidence available, several consistent factors emerged that led to the following recommendations: integrated treatment needs to be coordinated and holistic, staged and gender-responsive; increased availability of “low level”, flexible interventions; transitional support and continuity of care...

QuikFix: enhanced motivational interviewing interventions for youth substance use

Abstract: Purpose – The purpose of this paper is to explore the background principles, theories and components of the QuikFix intervention for primary and comorbid substance use in young people. Design/methodology/approach – QuikFix is a brief motivational interviewing (MI) intervention utilising cognitive-behavioural coping skills training to reduce vulnerability to substance use and comorbid mental health problems in young people. It is delivered in two to three brief sessions including an assessment. A new version, QuikFix personality intervention (PI) which incorporates coping skills training targeting sensation seeking, impulsive, depressive and anxious personality styles that may underlie primary and comorbid substance use problems is presented. Findings – The original QuikFix intervention has demonstrated efficacy in young alcohol and cannabis users with comorbid depression and anxiety symptoms. The efficacy of the new personality targeted version of QuikFix is currently being tested in a large randomized controlled trial among young people with alcohol related injuries/illnesses. Future research is required to determine the efficacy of QuikFix PI in comorbid populations including those with behavioural disorders. Practical implications – QuikFix interventions can be delivered via telephone or face-to-face in clinical settings for clients with primary substance use and comorbid depression and anxiety symptoms. Originality/value – This paper describes a novel two to three session manualised personality targeted substance use intervention. The full original QuikFix treatment manual is available online (Hides and Carroll, 2010).

Positive psychology in dual diagnosis: a preliminary investigation

Abstract: Purpose Positive psychology is an area of rapid development in mainstream psychology, yet it has had little impact thus far in the field of dual diagnosis (DD). Effective treatment for clients with DD is limited, due to the lack of all-encompassing interventions that treat the two conditions simultaneously. The purpose of this paper is threefold: first, to discover the prevalence of DD among users of selected drug services in Manchester; second, to explore differences between DD clients and those with substance use in hope, resilience, and well-being; and third, to identify predictors of hope, resilience, and well-being in this population. Design/methodology/approach The Snyder Hope Scale, the Connor-Davidson Resilience Scale, and the Short Warwick-Edinburgh Mental Well-being Scale were administered to 113 users of drug services through a convenience sampling method. Findings Findings from this preliminary investigation indicated that the DD group were more vulnerable as they were less hopeful, less resilient, and had poorer well-being than their counterparts. Practical implications This population of clients might benefit from specialized integrated treatment facilitating hope and resilience, which in turn would improve their well-being. Originality/value The present study addresses a gap in the literature. Although the above positive psychological aspects have been looked at in relation to mental health, and in relation to addiction, the current research explores these positive dimensions with regard to the co-occurrence of substance abuse and mental illness.

Comparative Analysis of Treatment Conditions upon Psychiatric Severity Levels at Two Years Among Justice Involved Persons.

Abstract: Purpose – The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. Design/methodology/approach – A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. Findings – Participants randomly assigned to residential conditions reported significant reductions...

“Negotiating partnerships:” parents’ experiences of collaboration in community mental health and substance use services

Abstract: Purpose - The importance of collaboration in the mental health field is a well established theoretical principle, but there has so far been less attention to its practical implications from a paren ...

Dual diagnoses among detained female systematic offenders

Abstract: Purpose – The purpose of this paper is to examine the prevalence of psychopathology including substance use disorders in a sample of detained female systematic offenders.Design/methodology/approach – All case files of female systematic offenders who had been subjected to a special court order for systematic offenders in the period 2004-2014 were studied. A total of 81 fairly complete case files were selected for the study. These were all systematic offenders as they had been sentenced for at least 25 offences with an average of 102 offences over a period of 17.5 years. Findings – All except one woman were addicted to substances in the past year, with an average duration of addiction of 21 years. In addition, 53 per cent were diagnosed with another DSM Axis I disorder and 73 per cent were diagnosed with a personality disorder. Furthermore, 32-59 per cent were found to have intellectual dysfunctions. In total, 12 per cent had one type of the above disorders, 43 per cent two types, 31 per cent three types and 14 per cent all four types. The prevalence rates of these disorders were higher than those reported in other prison studies. Research limitations/implications – It is concluded that female systematic offenders can be characterised as problematic in many respects. Even in such a problematic group treatment can be provided. Originality/value – The present study is the only study that provides prevalence data of mental disorders among female systematic offenders.

Closing the science-practice gap: Introduction to the special issue on psychological interventions for comorbid addictions and mental health problems

Abstract: Guest editorial: Introduction to the special issue on psychological interventions for dual diagnosis.

Reaching out to patients with antisocial personality disorder in substance use disorder treatment: interactions between counsellors and clients in a psycho-educational intervention

Abstract: Purpose – The purpose of this paper is to present the Impulsive Lifestyle Counseling (ILC) program, a time-limited psychoeducational approach to increasing patient awareness of antisocial personality disorder (ASPD) and its consequences. Design/methodology/approach – This paper describes the ILC program, a program developed as an add-on to treatment for substance use disorders (SUDs), gives examples of issues and patient-counselor interactions in the ILC sessions. Findings – During the ILC sessions the patients engaged with the counselors in diverse ways, reflecting the varying levels of psychopathology and overall functioning and barriers and incentive for lifestyle changes. Originality/value – Patients with SUD and comorbid ASPD can receive better care with brief counseling that focusses on antisocial behavior and thinking. More diverse evidence-based treatments are needed for this disorder.

Implementing evidence-based psychological substance misuse interventions in a high secure prison based personality disorder treatment service

Abstract: Purpose – The purpose of this paper is to describe the need for substance misuse treatment with high risk, personality disordered prisoners and the implementation of two evidence-based psychological interventions aimed at addressing substance misuse within a high secure, personality disorder treatment unit and potential future evaluation options. Design/methodology/approach – In addition to the literature base evidencing the need for substance misuse treatment with this population, the Iceberg and “InsideOut” interventions are presented. These interventions adopt a risk reduction and health intervention approach, respectively. This includes explanations of how they came to be implemented within a prison-based personality disorder treatment service and potential ways to evaluate these services. Findings – Evidence-based psychological interventions can be implemented for this population whilst being responsive to changing government priorities for substance misuse treatment. The organisation’s research strategy includes an intention to evaluate these interventions in order to inform future delivery. Practical implications – The high levels of co-morbidity between personality disorder and substance misuse disorders in the high-security prison estate highlights the need for substance-related treatment for this population. Given the responsivity issues relevant to personality disordered offenders, the format of delivery of evidence-based psychological interventions has to be considered. Social implications – The initial development of evidence-based psychological interventions for this service resulted from the dangerous and severe personality disorder pilot and subsequent introduction of the offender personality disorder pathway. Further developments have occurred alongside the revised National Drug Strategy introduced by the UK Government in 2010. This strategy directed a progression within drug and alcohol treatment services promoting that mutual aid be provided alongside the delivery of treatment interventions in order to maximise the probability of service-users maintaining abstinence from substance use. Originality/value – This paper discusses the application of evidence-based psychological interventions for substance use within a high secure, personality disordered population which has developed as a result of ministerial changes within the treatment of both substance misuse and personality disorder.

Substance misuse brief interventions during psychiatric hospital admissions

Abstract: Purpose: To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Design/methodology/approach: The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health. Findings: The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable. Originality/value: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission.

Node-link mapping, an asset?

Abstract: Purpose – The purpose of this paper is to evaluate the use of node-link mapping (NLM) on the effectiveness of a structured treatment for dual diagnosis for men living in a low-secure environment. Design/methodology/approach – In total, 15 participants were recruited and randomly allocated to one of two conditions. The control group, treatment as usual (TAU) or the treatment group, TAU with NLM. Outcome measures used were: a qualitative evaluation form, The Alcohol and Illegal Drugs Decisional Balance Scale and the Brief Situational Confidence Questionnaire. Findings – Results indicate no statistically significant difference for either group on the pre- and post-treatment outcome measures used. Qualitative data indicated that those using NLM reported the intervention as useful and instructive more often. Research limitations/implications – The results gained were only a snapshot of the intervention straight after treatment and did not take into account any long-term benefits of therapy such as substance us...