Journal of Dual Diagnosis最新文献

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.

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: 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: 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: 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.