Showing papers in "Advances in Dual Diagnosis in 2018"

Building trust and recovery capital: the professionals’ helpful practice

Abstract: Purpose The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement. Design/methodology/approach In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis. Findings Recovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital). Practical implications Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery. Originality/value Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

How meaningful activities influence the recovery process

Abstract: The purpose of this paper is to explore two research questions: how do people with concurrent substance abuse and mental health disorders (concurrent conditions) experience and describe meaningful activities? And how do meaningful activities influence the recovery process?,This qualitative study uses an explorative and interpretive design in a phenomenological-hermeneutic approach. Transcribed interviews are analysed using a phenomenological-hermeneutic method for researching lived experience. The study was submitted to the Norwegian Center for Research Data where it was approved (Case No. 54661).,Structural analysis resulted in three overarching themes: achieving a positive identity through actions and feeling worthwhile; physically outside but inside the norms of society, and idleness, isolation, and obstacles on the road to recovery. Meaningful activities, considered a cornerstone in the recovery process, vary widely and are primarily described in social contexts, thereby confirming the significance of social aspects of recovery in addition to recovery as an individual journey. The findings also show that experiencing meaningful activities contributes to recovery capital and the development of recovery-promotive identities.,The study consisted of a small sample size, recruited at one location which served as a primary research limitation.,This paper provides insights for health care practitioners and health care decision makers regarding the importance of meaningful activities viewed through a recovery perspective.,Few studies to date have used a comprehensive approach to describe the influence of experiencing meaningful activities on the recovery process.

Initiating and maintaining a recovery process – experiences of persons with dual diagnosis

Abstract: Purpose - The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have rece ...

Challenges in working with patients with dual diagnosis

Abstract: Studies have shown that mental health professionals find working with patients with dual diagnosis challenging, and the purpose of this paper is to examine some of these challenges.,In total, 85 mental health professionals from 8 different mental health centres in Denmark were interviewed. The data analysis was inspired by a grounded theory approach.,Different challenges in the dual diagnosis treatment were identified and they suggested that the focus of treatment was mainly on the mental illness rather than the substance use disorder. The single focus of the treatment made it challenging to treat patients with dual diagnosis sufficiently. While several studies explain the single focus by inadequate competencies among professionals, the present study suggests that the single focus is also explained by the way that the treatment is organised. For instance, standardized treatment packages and insufficient guidelines on substance abuse treatment make it challenging to treat patients with dual diagnosis.,This paper suggests that a more flexible, and a longer period of, treatment, together with more sufficient guidelines on dual diagnosis treatment and a more formalized collaboration with the substance abuse treatment centres, will make it a less challenging issue to treat patients with dual diagnosis.

Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities

Abstract: Purpose Mothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis. Design/methodology/approach This is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps. Findings Engagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed. Originality/value Engagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.

Avatar and technology assisted platforms in the treatment of co-occurring addiction and IPV among male offenders

Abstract: Purpose The purpose of this paper is to review the research on the use of technology in mental health and addiction treatment, focusing on the use of technology-assisted treatment. Although initial research investigating technology-assisted treatment for substance use has demonstrated promising results, this paper highlights the need for treatment to address co-occurring substance use and intimate partner violence (IPV). This paper defines the benefits associated with the use of behavioral health avatar coaches in mental health treatment targeting substance use and IPV as well as providing preliminary research results regarding the use of avatar coaches in clinical settings. Design/methodology/approach A literature review of the research relating to the use of technology in mental health and addiction treatment is provided. Additionally, a preliminary study aimed to develop an interactive therapy platform that utilizes virtual avatars as therapy coaches to help clients with substance abuse and IPV is presented. In this preliminary study, male participants were shown videos of various technology-based coaches matched on length, gestures and content. Researchers investigated whether patients preferred a virtual reality health coach, a cartoon health coach or a human health coach; as well as patient satisfaction and preference between two versions of the avatar. Findings A review of the relevant literature suggests that a majority of research has focused on using technology to replace face-to-face therapy with little research focusing on technology-assisted or augmented mental health and addiction treatment. Although initial research investigating avatar-assisted treatment for substance use has demonstrated promising results, research suggests a high prevalence of co-occurring substance use and IPV, suggesting the need for treatment to address co-occurring substance use and IPV. A preliminary research study was conducted to obtain patient feedback for personalizing avatar development into behavioral health interventions that target addiction and IPV. Research limitations/implications Although results of the preliminary study combined with previous research on avatar-assisted treatment for substance use has demonstrated promising results, theory-based research needs to be expanded to focus on randomized controlled trials of avatar-assisted treatment for co-occurring substance use and IPV. Practical implications This paper provides an overview of the use of technology-assisted treatment for co-occurring substance use and IPV. The preliminary results regarding patient satisfaction led to the development of additional avatars for use in interactive therapy. Originality/value This paper is one of the first to explore the use of avatar-assisted treatment for male offenders with co-morbid substance use and IPV.

Introducing the recovery inspiration group: promoting hope for recovery with inspirational recovery stories

Abstract: The purpose of this paper is to undertake a preliminary evaluation of a novel intervention – Recovery Inspiration Group, which uses recovery stories to promote hope and inspiration for recovery among people with complex mental health difficulties.,The Recovery Inspiration Group was delivered to women on a specialist personality disorder inpatient unit, who were concurrently participating in a dialectical behaviour therapy (DBT) Programme. In total, 12 service users participated in the RIG and as part of the intervention, wrote down key reflections after hearing each recovery story. A thematic analysis of these reflections formed the primary basis of the evaluation. Descriptive statistics derived from a service user feedback survey (n=6) supplemented the qualitative findings.,Three themes were identified in the qualitative data, suggesting that participants had engaged with recovery-oriented reflections and experiences: recovery stories as validating and inspiring; Generalisation of DBT skills; shifting perspectives of recovery: doing better rather than being better. The survey results unanimously endorsed the RIG as a worthwhile and validating experience, which participants would recommend to other service users.,Recovery Inspiration Group appears to be a low-cost and easily replicable intervention with the potential to promote hope and inspiration for recovery among people with complex mental health difficulties.,Recovery Inspiration Group is a novel approach to harnessing the wisdom of people with lived experience of mental health difficulties, to foster hope among users of mental health inpatient services.

Typology of substance using offenders of IPV: violence and substance use outcomes

Abstract: Purpose The purpose of this paper is to investigate whether aggression and substance use assessed during treatment differ based on risk level for substance-using male offenders of intimate partner violence (IPV). Design/methodology/approach Secondary analyses were conducted using data from Easton et al.’s (2017) study on substance-dependent IPV offenders. A cluster analysis was utilized in order to classify participants into typology groups. Analyses of covariance were conducted in order to determine group differences in aggression and substance use during treatment. Findings The paper provides results-related response to treatment based on offender typology. Results appear to reflect two typology groups with significant differences in psychopathy among groups. High-risk offenders demonstrated higher rates of violence throughout treatment compared to moderate- and low-risk offenders; however, no differences in substance use outcomes were found. Research limitations/implications A limitation of the study is the extent to which the results can be generalized beyond substance using IPV offenders. Further investigation of treatment outcomes including alternate measures is needed in order to better translate theoretical typologies to clinical settings. Practical implications Results provide support for differentiating treatment for substance-using male offenders of IPV based on typology as those with low/moderate risk level appear to be distinctly different and have different treatment outcomes compared to high risk level offenders. Originality/value Although the relationship between risk level and treatment outcomes has been researched with Drug Court Offenders, treatment outcomes based on typology has not been evaluated among substance using male offenders of IPV.

Homework compliance among substance using male offenders of IPV

Abstract: Purpose Research suggests that homework compliance within cognitive behavioral therapy is associated with treatment adherence and positive treatment outcomes through generalization of learned skills. The purpose of this paper is to determine whether there were differences in aggression and substance use between participants who did and did not complete therapy homework assignments. Design/methodology/approach Secondary analyses were conducted using data from Easton et al.’s (2017) randomized controlled trial of substance abuse domestic violence (SADV) treatment among substance dependent intimate partner violence (IPV) offenders. Analyses of covariance were conducted in order to determine whether homework completion had a significant effect on aggression and substance use. Correlational analyses were conducted to determine the association between quality of homework and outcomes. Findings Participants (n=63) who completed at least two homework assignments had fewer days of alcohol use during treatment compared to those who did not complete any assignments, p=0.03. There was not a difference in the number of days participants engaged in violence based on homework completion. Analyses indicated that those who displayed aggression proximal to alcohol use during treatment completed significantly fewer homework assignments compared to those who did not display aggression proximal to alcohol use (p=0.04). Research limitations/implications This research was limited to a sample of male substance using offenders of IPV within the US additional research utilizing a larger sample size in order to investigate differences in homework completion across treatment groups is needed. Further analysis of the barriers to and predictors of homework compliance among this population is recommended. Originality/value This research highlights the need for incorporation of homework and further exploration of methods and treatment modalities to ensure homework compliance among substance using male offenders of IPV.

Expanding the use of the ASAM CriteriaTM to make mental health level of care placements

Abstract: Purpose Despite the prevalence of co-occurring mental health and substance use disorders, the assessment and placement processes for each often remain separate. The purpose of this paper is to describe an expanded use of the American Society of Addiction Medicine (ASAM) CriteriaTM to make placements into substance use, co-occurring, and mental health treatment. Design/methodology/approach A rationale for the development of two new domains (Domain 7, substance use and Domain 8, independent living skills) and preliminary data supporting the use of the ASAM CriteriaTM as a placement process for all types of behavioral health issues will be provided. Findings Dimension 3 and Domains 7 and 8 were correlated with selected clinical indices in the expected direction (Dimension 3: depression (F (4, 4650)=202.092, p<0.001), medication usage (F (4, 4,637)=174.254, p<0.001), and psychotic symptoms (F (4, 4,561)=62.954, p<0.001); Domain 7: alcohol use (F (4, 4,458)=213.786, p<0.001) and drug use (F (4, 4,471)=611.491, p<0.001); and Domain 8: functional impairment (F (4, 3,927)=815.646, p<0.001) and number of “high needs” (F (4, 3,927)=737.568, p<0.001). Research limitations/implications The limitations of this research included a lack of inter-rater reliability data and less established intake assessments. Practical implications This single placement approach for clients seeking behavioral health services can create a more efficient, person-centered intake experience. Originality/value This paper suggests that it is possible to deploy a single assessment and placement approach for all types of behavioral health issues.

Prevalence of HIV risk behavior among male substance abusing offenders of intimate partner violence

Abstract: Purpose The purpose of this paper is to assess the rates of HIV risk-taking behavior and sexual violence among clients with co-occurring addiction and intimate partner violence (IPV). The current study also aims to determine whether HIV risk-taking behaviors (e.g. trading sex for money or drugs, having unprotected sex with multiple partners) differ among substance using IPV offenders with and without a history of sexual aggression. Design/methodology/approach Secondary analyses were conducted from Easton et al.’s (2017) randomized controlled trial of substance use domestic violence treatment among substance using IPV offenders. Correlational analyses were conducted to assess the relationship between pre-treatment sexual aggression, HIV risk-taking behaviors, substance use and aggression. Analyses of covariance were conducted in order to determine differences in participants’ HIV risk-taking behaviors based on their history of sexual aggression while controlling for hours of contact with the female partners. Findings In a sample of 63 participants, males with higher rates of sexual aggression were more likely to engage in sexual risk-taking behaviors. This study encountered a correlation between pre-treatment risk-taking behavior and verbal and physical aggression, as well as a correlation between pre-treatment risk-taking behaviors and cocaine use. Results neither suggest a relationship between sexual aggression and alcohol use nor HIV risk-taking behaviors and alcohol use at pre-treatment. Research limitations/implications The present study is limited by sample size and power. Originality/value This study is among the first of its kind to investigate HIV risk-taking behaviors among substance using offenders of IPV. This study provides support for the inclusion of treatment targeting HIV risk-taking behaviors among IPV offenders.