Journal of Dual Diagnosis最新文献

Objective: Cognitive impairment is common among patients with alcohol use disorder of which relapse is a common feature. This study investigates the prevalence of cognitive impairment in patients with alcohol use disorder and also explores the relationship between cognitive impairment and craving.

Methods: In this cross-sectional study, we assessed 30 male patients with alcohol use disorder in an inpatient deaddiction unit between June to August 2023. The patients were between 29 and 60 years of age. The patients included for the study did not have any active alcohol withdrawal symptoms, medical or other psychiatric disorders affecting cognition or intellectual disability. Their cognitive functions were tested using Montreal Cognitive Assessment (MoCA) and Frontal Assessment Battery (FAB). Craving for alcohol was assessed by Visual Analogue Scale. We used Independent T test and ANOVA to compare means. Pearson correlation test was used to compare quantitative variables.

Results: Global cognitive impairment (MoCA < 26) was seen in 86.7% of participants while 30% had frontal executive dysfunction (FAB < 12). Craving was found to be positively correlated with the amount of alcohol consumed and negatively correlated with the Montreal Cognitive Assessment (MoCA) score.

Conclusions: Our findings support the relationship between cognitive impairment and craving in alcohol use disorder. Majority of the patients in the study (86.7%) exhibited global cognitive dysfunction as measured by MoCA test. Furthermore, patients with global cognitive impairment had significantly higher subjective craving scores as measured by VAS.

Objective: Psychiatric and substance use disorders commonly co-occur, yet treatment is often siloed. To improve treatment utilization for individuals with co-occurring disorders in the psychiatric setting it important to understand current practices. This study analyzed adults seen by community-based psychiatric emergency services with co-occurring disorders to identify: (1) reason for visit; (2) prevalence of suicidality and past attempts; (3) whether suicidality predicted future psychiatric emergency department (ED) presentation.

Methods: Retrospective chart review of patients seen by the Boston Emergency Services Team with first encounters between 2017-2021 (N = 352).

Results: The sample had an average age of 38 years old, 66% male, 57% White. Thirty-eight percent of patients reported suicidal ideation (SI), of whom 25% described SI involving overdose. Sixty patients had attempted suicide, 35 by overdose. In a Cox Regression model, suicidality in the first visit did not predict future psychiatric ED use.

Conclusions: The high co-occurrence of SUDs with suicidality indicates the importance of screening and intervention in specialty mental health and addiction treatment settings.

Objective: To examine the association of comorbid mood and/or anxiety disorders (M/AD) and psychological distress (PD) with treatment retention in substance use disorder (SUD) trials. Methods: Data are from 21 NIDA-sponsored randomized controlled trials (RCTs) for SUDs (n = 5,404). M/AD was assessed using the DSM-IV criteria and PD was assessed using the Addiction Severity Index. Treatment retention was defined as trial completion based on last visit attendance. Analyses used doubly-robust multivariable logistic regression with propensity score weighting. Results: Average treatment retention was 71.8%. Comorbid M/AD was associated with higher odds of treatment retention in pharmacological trials of cocaine and methamphetamine use disorder. However, comorbid PD was associated with lower treatment retention in behavioral trials of any stimulant use disorders and higher retention in pharmacological trials of methamphetamine use disorder. Conclusion: M/AD is associated with better treatment retention in SUD trials, while PD's effects depend on treatment type and trial target substance.

Objective: The current study aimed to systematically review the prevalence of comorbid Cannabis Use Disorder (CUD) in individuals with Anxiety and Related Disorders (ARDs).

Method: PubMed, PsycInfo, and Web of Science were searched electronically to identify studies comprised of participants 18+ years, diagnosed with a current ARD via clinician interview and experiencing comorbid CUD (interview or validated screener). Of the 1646 articles identified, 11 were included.

Results: Across general population samples (n = 7), approximately 1 in 30 to 1 in 5 individuals with an ARD had comorbid CUD (lifetime prevalence: 3.3%-21.6%; current prevalence: 4.3%-20.0%). Among veteran samples with PTSD (n = 4), comorbid CUD was reported in approximately 1 in 25 to 1 in 3 individuals for current prevalence (4.1%-34.0%), and about 1 in 9 for lifetime prevalence (11.3%-12.5%).

Conclusion: Preliminary evidence suggests that individuals with ARDs may be susceptible to developing comorbid CUD. Current comorbidity rates may be higher among veterans with PTSD compared to adults in general population samples; however, due to the limited number of eligible studies and methodological heterogeneity, further research is needed to confirm this difference. Given the recent global increase in cannabis legalization, understanding ARD-CUD comorbidity in high-risk populations is essential to inform treatment and improve outcomes.

Objective: Given important links between cannabis use and psychosis, we explored communications around about cannabis use with young people receiving Coordinated Specialty Care (CSC) for first episodes of psychosis and parents of such clients. Methods: In individual semi-structured interviews, clients (n = 15) and parents (n = 16) discussed experiences, concerns, and preferences talking about cannabis use, and how such conversations could be more beneficial. Analysis followed Braun and Clark's six-phase thematic analysis. Results: We discerned four themes toward optimizing communication: (1) Respect for Developing Client Autonomy, (2) "Good Information" about Cannabis and Its Effects, (3) Good Communication Process, and (4) Conversations Complicated by Changing Norms. Conclusions: Analysis revealed agreement between clients and parents about what makes conversations positive, but difficulties understanding each other's perspectives, and both feeling misunderstood. Interventions that build communication skills, support these difficult conversations, and provide high quality information in non-judgmental ways could support better cannabis discourse.

Objective: To assess the test-retest and inter-rater reliability of the Scale for the Assessment of Positive Symptoms of Cocaine Induced Psychosis (SAPS-CIP) in a sample of cocaine users treated at a therapeutic community.

Methods: Cross-sectional study of a consecutive systematic sample of patients treated for cocaine-use disorder (n = 60) at a therapeutic community in Spain. Participants completed the SAPS-CIP and the Lifetime Severity for Cocaine Use Disorder scale (LSI-C).

Results: Inter-rater reliability was strong, with 15 of the 17 SAPS-CIP items presenting weighted kappa values considered "excellent" and the remaining two items were "good." Test-retest reliability was good, with 12 of the 17 items presenting weighted kappa values considered "good," 3 "excellent," and two "fair."

Conclusions: These findings support the validity and reliability of the SAPS-CIP-R as a tool to measure and assess cocaine-induced psychotic symptoms. Further research is needed to determine the reliability and validity of instruments that assess CIP.

Objective: To compare the effectiveness of long-acting injectable (LAI) versus oral naltrexone in improving post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) outcomes in United States Department of Veterans Affairs (VA) patients with co-occurring PTSD and AUD.

Methods: We reviewed medical records of patients with PTSD and AUD receiving VA care from 10/1/1999 and 9/30/2019. Participants met eligibility criteria for an emulated clinical trial comparing LAI and oral naltrexone (n = 3739). We used inverse probability weights to adjust for possible confounding. PTSD symptom change was assessed using the PTSD Checklist for DSM-V (PCL-5). Alcohol consumption and adverse psychiatric outcomes were also assessed in a 2-year continuity phase.

Results: Under the assumption of no residual confounding, we estimated that continuous use of LAI was associated with a 11.9% decrease 95% CI [-22.3, 0.8] in the probability of having clinically meaningful improvement in PTSD symptoms compared to continuous oral naltrexone use over 12-weeks. However, we found no difference in improvement comparing initiation of LAI versus oral naltrexone (-1.8% [95% CI: -11.4, 7.4]). No differences were observed in the probability of PTSD remission, probability of AUD remission, or rates of adverse psychiatric outcomes.

Conclusion: Our analyses suggest that LAI naltrexone provides no benefits in improving PTSD or AUD outcomes compared to its oral counterpart among patients with comorbid PTSD and AUD. In fact, our results suggest that oral naltrexone may provide an increased probability of clinically meaning PTSD improvements if a high level of medication adherence is maintained.

Objective: To examine associations between employment-based self-regulatory processes and meaningful employment attainment among veterans with co-occurring conditions. Methods: A survey was administered to a national Qualtrics panel of 534 employed veterans self-reporting mental health and substance use conditions. We tested whether career exploration, goal clarity, job-searching skills, and self-regulation skills explained unique variance in meaningful employment beyond other relevant predictors: mental health symptoms, alcohol and drug use severity, economic constraints, marginalization, job prestige, and employment status. Results: Hierarchical regression analysis revealed career exploration, goal clarity, job-searching skills, and self-regulation skills were significantly associated with meaningful employment beyond other predictors. Job prestige, employment status, and mental health symptoms also had significant associations with meaningful employment, while economic constraints and alcohol use lost significance in the final model. Conclusions: Interventions promoting exploration, goal clarity, job-searching, and self-regulation may improve meaningful employment attainment while buffering the effects of alcohol use and economic constraints.

Objective: U.S. Food and Drug Administration (FDA)-approved medications for Opioid Use Disorder (MOUD) effectively reduce opioid cravings, use, relapse, and overdose. However, adherence to MOUD is a significant challenge. Depression relates to poorer adherence across several medical conditions and may be a prime factor relating to poor MOUD adherence. The goal of this meta-analysis is to quantify the relationship between depression and MOUD adherence and to identify moderators of this association. Methods: A systematic literature search was conducted using PsycINFO, PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature [CINAHL] databases. Pearson's r was used for the effect size statistic. A random effects model was utilized for all effect size analyses. Results: Nine studies met eligibility criteria, with a total of 3493 participants. Higher baseline depressive symptoms were found to predict greater prospective adherence to MOUD (r = 0.130, 95% CI: 0.060-0.199, p < .001). This effect was not moderated by the MOUD type or depression measurement type. Conclusions: In contrast to prior medical adherence research, depression predicted better, not poorer, adherence to MOUD. The literature was limited by few studies examining naltrexone, limited diversity of samples, and a lack of clear consensus on adherence measurement. Future research should test whether this relationship extends to naltrexone; use samples with more racial minorities, women and gender minorities, and inpatient samples; clearly define and measure adherence, and identify mechanisms and moderators of this relationship, to best inform future clinical applications and improve outcomes for those with OUD.