Journal of Dual Diagnosis最新文献

Objective: This study evaluates the feasibility and acceptability of delivering Mindful Self-Compassion (MSC) to veterans with moral injury and co-occurring PTSD and substance use disorder (PTSD-SUD). Methods: Veterans (N = 26; M age = 50.92; 100% male) were recruited for an 8-week MSC group. Participants completed measures of self-compassion, guilt, shame, PTSD, and substance use outcomes at baseline, post-treatment, and one-month post-treatment. Results: The recruitment target was easily met, and dropout rates were low (30.8%) for a comorbid veteran sample. Participants reported satisfaction with the intervention. Clinically meaningful change was examined for self-compassion, trauma-related symptoms, and substance use. A clinically meaningful increase for self-compassion and clinically meaningful decreases in PTSD symptoms, guilt, shame, and number of drinking days were observed. Conclusions: The open-label design and small sample size preclude conclusions regarding efficacy. However, these preliminary findings are encouraging and suggest further investigation of MSC as a compliment to existing trauma-related therapies (NCT03681288).

Objective: The relationship between concurrent depression and Opioid Use Disorder (OUD) treatment outcomes remains incompletely understood. Prior studies found mixed results regarding the impact of psychiatric comorbidities on retention to medications for OUD. This study aims to evaluate how the receipt of pharmacotherapy for depression impacts retention to buprenorphine therapy among patients with OUD and concurrent depression. Methods: We conducted a retrospective cohort study using the Humana Healthcare Research claims database (2014-2020) on a sample of adult patients who initiated buprenorphine for OUD between January 2015, and September 2019. Patients were required to have a 180-day buprenorphine-free period pre-index. Patients with concurrent depression were identified via diagnosis in a medical claim within the baseline period. Antidepressant use was defined as cumulative exposure from the start of the baseline through the end of the 180-day follow-up period. The primary outcome was time to buprenorphine discontinuation, defined as a gap of more than 30 days from the day of last supply. Cox Proportional Hazards regression was used to estimate the association between antidepressant receipt and buprenorphine discontinuation. Sensitivity analyses on specific classes of antidepressants were also conducted. Results: The final analytical cohort included 1,973 patients with OUD and concurrent depression. Of these, 235 (11.91%) discontinued buprenorphine during the follow-up period, with a mean time to discontinuation of 97.92 (±68.64) days. Survival analysis revealed that patients who received antidepressants had a significantly lower hazard of discontinuation [aHR (95% CI): 0.995 (0.994, 0.996); p < .0001]. Initiated dose of buprenorphine also had a significant effect on the hazard of discontinuation [0.976 (0.956, 0.997); p = .0270]. Conclusions: Our findings support the notion that continuation of antidepressants when initiating buprenorphine therapy for OUD positively influences buprenorphine retention among patients with OUD and concurrent depression.

Objective: This study examined behavioral health clinician perceptions at the beginning stages of the COVID-19 pandemic regarding their preparedness, training, and effectiveness in delivering telehealth to adults and adolescents in substance use and mental health settings. Methods: Data were collected through an anonymous online survey of 241 behavioral health practitioners in Pennsylvania from November 17, 2020, to January 3, 2021. Quantitative descriptive and qualitative analyses on survey results are presented. Results: Clinicians believed they were effective in their delivery of therapeutic services through telehealth modalities. However, they noted key training needs for delivering telehealth. Results indicate greater difficulty in delivering telehealth to adolescent clients and those with substance use. Practitioners indicate that telehealth allows greater access to treatment. Conclusions: Researchers recommend increasing training for practitioners and conducting training for patients. Policies should be reconsidered and address the changing landscape of behavioral health service provision.

Objective: Explore local leaders' perceptions of substance use and psychosis treatment to inform the implementation of an assertive community treatment model for historically marginalized youth. Methods: Interviews were conducted with local leaders in a Northeast city with relevant expertise. Interviews were recorded, transcribed, and analyzed using the Consolidated Framework of Implementation Research domains. Results: Fifteen leaders completed interviews and four key themes emerged: (1) A patchwork of systems attempts to catch youth early on, but often fails; (2) The inability to simultaneously address mental health and substance use concerns complicates care; (3) An ideal program would be flexible in the ways the current system is inflexible; (4) factors important in tailoring a program to serve historically marginalized youth. Conclusion: When designing a program to support the engagement of youth with symptoms of psychosis and SUD, it is important to take a patient-centered and flexible approach that accounts for the community-based setting.

Objective: To examine how non-pharmacological integrated treatment components are presented in the literature, to facilitate high-quality dual diagnosis treatment and support informed decision-making in the development of integrated treatment facilities. Methods: A literature search was conducted in databases Ovid/Embase, PubMed, CINAHL focusing on intervention studies published between 2013 and 2023, describing integrated treatment for patients with dual diagnosis. A six-stage methodological framework for scoping reviews was used for selection and analysis of the papers included. Results: Twenty-six studies were included. Most integrated interventions were group therapy sessions guided by CBT or MI, however there was a large heterogeneity in the remaining core components and outcome measurements. Staff competence was often vaguely defined and described. Conclusions: The heterogeneity of the studies included influences reproductivity and comparability which makes it challenging to condense firm recommendations and point directions for design of treatment and scientific practice.

Objective: Drug use and related harm among women of color who experience intimate partner violence (IPV) is a serious clinical concern. Depression symptoms have been identified as an important risk factor for the development of drug use and related harm among women of color with a history of IPV. The current study advances this research by examining the roles of distinct domains of racial microaggressions in the relation between depression symptoms and drug use and related harm in this population. Method: Participants were 103 women of color experiencing IPV (M_age = 40.39, 51% Black/African American). Results: Results indicated an indirect effect of depression symptoms on drug use and related harm via racial microaggression domains of Assumptions of Inferiority, Second-Class Citizen and Assumptions of Criminality, Microinvalidations, Exoticization and Assumptions of Similarity, and Environmental Microaggressions. Conclusions: Findings provide preliminary support for the role of racial microaggressions in the association between depression and drug use and related harm among women of color experiencing IPV.

Objective: Co-occurrence of schizophrenia/schizoaffective disorder (SSD) and stimulant use disorder (StUD) is an ongoing clinical problem and can lead to poor outcomes. Although emerging evidence has suggested psychostimulant substitution therapy may result in improved outcomes in those with StUD, the efficacy and safety of psychostimulant substitution therapy for StUD in those with concurrent SSD is uncertain. This review aims to systematically find and assess all available efficacy and safety evidence on the use of prescription psychostimulants in those with co-occurring SSD and StUD. Methods: Electronic searches of MEDLINE, PsycINFO, Embase, Scopus, ClinicalTrials, EU Clinical Trials, and CADTH were conducted from inception to February 27, 2024. Any study design was accepted if they involved the following concepts 1) SSD and StUD and 2) prescription psychostimulants. Given the paucity of trials meeting criteria, outcomes of interest were described qualitatively. Risk of bias was assessed using Q-Coh and ROB2. Results: Only seven articles met criteria, and most of these were case reports and series. The single RCT included was at high risk of bias. Outcomes included abstinence, reductions in non-prescribed stimulant use, psychiatric hospitalizations, levels of craving, improvements in mental health, improvements in psychosocial functioning, adherence to antipsychotic medications, and retention in treatment. Most of the results indicated that psychostimulant substitution therapy in individuals with SSD-StUD was not associated with improved outcomes. Conclusion: Available evidence for treatment of StUD via psychostimulant substitution therapy in individuals with SSD is lacking. More exploration is required for this clinical question to allow for current practice to be backed by evidence.

Objective: Adverse Childhood Events (ACEs) are associated with increased vulnerability for posttraumatic stress disorder (PTSD), but not everyone who experiences ACEs develops PTSD. Impulsivity has gained interest as a potential mediator between ACEs and PTSD, given that both PTSD and ACEs have been closely related to impulsivity. However, less is known about the relationship within the context of substance use disorder (SUD), a population highly vulnerable to co-occurring PTSD. This study examined whether impulsivity mediates the relationship between ACEs and PTSD symptoms in adults seeking residential treatment for substance use disorder (SUD). Methods: N = 134 consenting adults in residential treatment for SUD completed questionnaires measuring impulsivity (UPPS-P), ACEs (ACEs Scale), and PTSD symptoms (PCL-5). Regression models tested our hypotheses that ACEs would predict PTSD symptoms and that impulsivity would mediate this relationship. Results: Two-thirds of participants met the PCL-5 score threshold for a provisional diagnosis of PTSD. ACEs score and impulsivity were significant direct predictors of PTSD symptoms (coeff = 2.23, p < .001; coeff = 1.03, p < .001). Among UPPS-P subconstructs, only lack of premeditation emerged as a partial mediator (z = 2.14, p = 0.032). Conclusions: Individuals with SUD experience adverse and traumatic events at alarming rates and are at increased risk for PTSD. Our mediation finding suggests that impulsivity and especially lack of premeditation may be clinically relevant in the development or maintenance of PTSD symptoms among individuals with SUD.

Objective: Substance use is common among people with primary mental illness especially schizophrenia and bipolar disorder compared to the general population and complicates treatment outcomes. Methods: We enrolled 385 patients with primary mental illnesses in southwestern Uganda between June and August 2022. We collected information on alcohol and cannabis use, social support, religiosity, adherence to treatment and sociodemographic characteristics. We run a logistic regression model to determine the factors associated with substance use disorder. Results: At multivariable analysis, being male (AOR = 13.61, 95% CI [3.66-50.63]: p <.001) and prior history of cannabis/alcohol use (AOR = 34.95, 95% CI [8.80-138.72]: p < .001) were significantly associated with substance use disorder while adherence to treatment was against substance use disorder (AOR = 0.27, 95% CI [0.09-0.83]: p = .03). Conclusions: Adherence to treatment is protective against substance use disorder among people with mental illness. Interventions aiming at preventing substance use disorder among people with mental illness should aim at promoting adherence to treatment.