Journal of Dual Diagnosis最新文献

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 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: 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.

Objectives: This rapid review and meta-analysis explores two hypotheses. First, people with a concurrent mental health and substance use disorder (SUD) respond less favorably to currently utilized treatment interventions, than do those with a single disorder. Second, the potential for certain already vulnerable groups including women, members of racialized minority groups and those who live in or near poverty may be even further disadvantaged.

Methods: A multimethod sampling frame of 35 previous systematic reviews and or meta-analyses (2000-2024) augmented with peer-reviewed and grey research literature databases (2020-2024), resulted in the selection of 13 primary studies.

Results: The pooled, sample-weighted risk ratio of 1.71 (95% confidence interval 1.38, 2.13) seemed to strongly suggest that those with concurrent disorders are largely disadvantaged in treatment compared to those with a single disorder.

Conclusions: The results of this review confirmed people with a concurrent disorder are twice as likely to experience such undesirable outcomes as relapse and related poor outcomes including emergency department visits, rehospitalization and death. However, no evidence was found enabling exploration of potential moderations of overall treatment effects by gender, race or income.

Objective: Bipolar Disorder (BD) is often complicated by co-occurring substance use disorders (SUD). We assessed the prevalence of SUD among BD hospitalization episodes and analyzed its association with hospitalization outcomes.

Methods: We performed a retrospective observational study using a database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. Hospitalizations with a primary or secondary diagnosis of BD were selected. To compare episodes with and without a diagnosis of SUD, an independent sample t-test was used for age, whereas the non-parametric Mann-Whitney U test was used for LoS, CCI, and charges. Sex, in-hospital mortality, re-hospitalizations, and psychiatric comorbidities were analyzed using the Pearson's chi-squared test.

Results: SUD was registered in 11.3% of episodes, with alcohol use disorder being the most prevalent (5.8%). A non-linear increase in the number of hospitalizations throughout the study period was found. Episodes with a concomitant register of SUD were associated with younger (44.1 ± 12.5 years old) and male hospitalizations (56.6%), shorter length of stay (LoS) (15.0 (8.0;24.0) days), higher Charlson Comorbidity Index (CCI) (0.24 ± 0.76), and with higher rates of attention-deficit, conduct, and disruptive behavior disorders, personality disorders, and suicide and intentional self-inflicted injury, compared to those without this comorbidity.

Conclusions: Comorbid SUD increased and had a measurable impact on BD hospitalization outcomes. Timely detection and management of SUD among BD patients may likely prevent the high burden.

Objective: People with a psychotic disorder are more likely to experience pain and interference from pain in their daily lives. There is also a high prevalence of cannabis use among people with psychotic disorders, which is known to be effective in pain management. This study investigates whether pain is a predictor of cannabis use in people with psychosis. Since sedating antipsychotics may also suppress pain, this is included as a covariate. Methods: This sample included 108 Dutch people with a psychotic disorder, participating in the VAT observational cohort study. Cross-sectional regression analyses were performed with cannabis use (yes/no and units per week) as outcomes, and pain and the degree of interference from pain (RAND-36-SF items 7 and 8) as predictors. Covariates included were age, sex, severity of psychosis, and use of sedating antipsychotics. Results: In this sample, 59% experienced some degree of pain and 18.5% used cannabis. Pain and interference from pain were not significant predictors of cannabis use, nor of the amount of cannabis use. However, the use of antipsychotics with low sedating effects was associated with a greater amount of cannabis use in our participants (p = .028). Conclusions: We found no direct link between pain experience and cannabis use in people with psychotic disorders. It is possible that cannabis effectively suppresses the pain, and participants using cannabis therefore did not report experiencing pain. Furthermore, our finding that participants who were prescribed antipsychotic drugs with low sedating effects use more cannabis warrants further investigation. It is possible that people with psychotic disorders who experience numbness and sedation from their antipsychotics, may be less inclined to attempt to reach these effects using cannabis, which could potentially influence the choice of prescribed antipsychotics in the treatment of psychotic disorders in the future.

Objectives: Alcohol Use Disorder (AUD) is comorbid with major mental illnesses, but prescribing rates for medications for AUD (mAUD) are low. Methods: We surveyed 71 mental health and 42 substance use disorder (SUD) treatment providers in an academic medical center about AUD treatment practices. Results: Fifty-three mental health and 14 SUD providers responded. Among the n = 22 mental health prescribers, a minority (29%) prescribed mAUD often. Sixty percent of mental health providers viewed mAUD as effective. Barriers to mAUD prescribing in mental health included believing SUD providers were better equipped to prescribe mAUD, whereas SUD providers assumed that patients were not interested in mAUD. All providers were willing to participate in mAUD education initiatives, but few were willing to engage in more time-intensive implementation activities. Conclusions: Improving knowledge and attitudes may improve mental health provider delivery of mAUD, but evidence-based strategies for improving prescribing may be less acceptable and feasible for providers.

Objective: Cannabis use contributes to negative psychosocial outcomes among youth in Early Psychosis Intervention (EPI) programs and families are crucial to recovery. This study sought to understand how youth in EPI programs perceive their families to influence their cannabis use and how cannabis affects family relationships.

Methods: A qualitative approach and thematic analysis were used to investigate the perspectives of youth ages 20-30 in EPI programs (n = 15).

Results: Participants described parental disapproval toward cannabis use, intra-family consumption, family influence, changing parental attitudes, and increased closeness.

Conclusions: Most participants reported cannabis contributed to tension and conflicts with parents due to risk for exacerbating psychosis, though some family members enabled use through role modeling, approval, and intra-family consumption. Some noted positive effects of consumption on bonding and closeness. Research is needed to understand how parents can support their child's recovery after cannabis-related psychosis, and prevalence and contributing factors behind intra-family consumption.