Journal of Dual Diagnosis最新文献

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: 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: The authors aimed to conduct a systematic review and meta-analysis of the proportion of dual diagnosis patients in the clinical setting. Methods: Researchers searched MEDLINE and Google Scholar from inception until July 2024. Observational, retrospective, and cohort studies that reported the proportion of patients with dual diagnosis in a clinical setting were included. Random-effects meta-analysis and risk of bias assessment were conducted, along with subgroup and sensitivity analysis. Results: The sample included 32 studies (cumulative N = 2,805,009) and found high heterogeneity among the studies, which persisted in the subgroup analysis. The median proportion was 47.90% (ranging from 5.9% to 91.55%), with a pooled proportion of 44.70% (95% confidence interval, 0.28 to 0.63). Conclusions: Dual diagnosis is highly prevalent in clinical settings with variability in prevalence based on different settings, assessment methods, and country of origin. Further research on dual diagnosis and due recognition for integrated management are required.

Objective: Nearly half of people with early psychosis report lifetime problematic substance use. Current treatments have limited impact on substance use and supporting the client's family could improve recovery. The current study explored: (1) the impact of substance use and early psychosis on the family, and (2) experiences with their client relative's treatment. Methods: Participants were family members (n = 19) of clients with early psychosis and substance use. We used quantitative and qualitative data from the Community Reinforcement and Family Training for Early Psychosis and substance use (CRAFT-EP) pilot study to assess family members' views. Results: Many participants reported concern about the client's cannabis use and its negative impact on family wellbeing and communication, with most participants wanting more guidance on how to support the client's treatment. Conclusions: Implementing family interventions are needed to improve family relationship quality and communication to promote recovery among people with early psychosis who use substances.

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: People may consume alcohol as a self-medicating strategy to cope with the stressors of the COVID-19 pandemic. The study evaluated COVID-19 stresses in distinguishing nondrinkers, moderate drinkers, and binge drinkers as guided by the self-medication hypothesis. Methods: Adults (N = 484) answered a question assessing drinker type (nondrinkers vs. moderate drinkers vs. binge drinkers) and completed the COVID-19 Stress Scales embodied by the subscales of danger and contamination stress, socioeconomic stress, xenophobia stress, traumatic stress, and compulsive checking stress. Results: Discriminant function analysis using the set of five COVID-19 stress subscales as predictors statistically classified participants into nondrinkers, moderate drinkers, and binge drinkers for the male and female samples. Afterward, 2 (gender: males vs. females) × 3 (drinker status: nondrinkers vs. moderate drinkers vs. binge drinkers) factorial multivariate analysis of variance (MANOVA) and analyses of variance (ANOVAs) scrutinized mean differences. Specifically, males compared to females experienced significantly higher socioeconomic stress, xenophobia stress, traumatic stress, and compulsive checking stress, but no gender difference was exhibited for danger and contamination stress. Furthermore, binge drinkers compared to nondrinkers reported significantly higher scores on all the COVID-19 stress subscales. Binge drinkers compared to moderate drinkers endorsed significantly higher scores on all the COVID-19 stress subscales. Moderate drinkers compared to nondrinkers exhibited significantly higher scores on all COVID-19 subscales except for danger and contamination stress. Conclusions: The findings are consistent with the self-medication, such that people experiencing more COVID-19 pandemic stresses are more likely to consume alcohol in heavier quantities.

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.

Objective: Homelessness is a significant social issue in developed countries, linked to high rates of substance use, psychiatric disorders, and chronic somatic health conditions, which contribute to premature mortality. Despite Denmark's comprehensive welfare system, marginalized groups, including people in homelessness, face barriers to accessing healthcare, resulting in increased use of acute care services and poorer health outcomes compared to the general population. This study examines the health burden and mortality of some of Denmark's most marginalized individuals by analyzing registry data from users of a low-threshold healthcare service placed at the open drug scene in Copenhagen, Denmark. Methods: This retrospective cohort study spans seven years (2009-2015). The study includes 1,242 individual health service users identified through patient records from the low threshold service linked with demographic, educational, and healthcare utilization data from Danish registries. No approval from the Danish Research Ethics Committees for the Capital Region was needed since only national registers were used. Results: The population was predominantly male with a median age of 42 years. Most participants were of ethnic Danish origin and had low educational attainment. This study revealed high morbidity, with significant proportions of the population affected by somatic diseases, psychiatric disorders, and substance use disorders, including 56% with Dual Diagnosis and 53% with Dual Diagnosis and somatic disease (Triple Diagnosis). Analysis of mortality showed 158 deaths, predominantly among males, with substance use-related causes and cardiovascular diseases being the leading causes of death. The mean age at death was 47.3 years, with a notable proportion occurring at a relatively young age. Conclusion: Our study reveals a high prevalence of both somatic and psychiatric disorders among the shelter health clinic users. Findings indicate that they are in a similar or often poorer health state than Danish shelter users overall, with a high prevalence of dual diagnoses alongside chronic somatic diseases (Triple Diagnosis) and early disease onset. This highlights the need for targeted support and the implementation of primary prevention measures to slow disease progression and improve healthcare access.

Objective: This systematic review describes studies focussed on co-occurring mental health and substance use (MH/SU) conditions among Aboriginal and Torres Strait Islander people, including the: characteristics; co-occurring conditions examined; cultural methodological quality; traditional scientific methodological quality of studies; and study outcomes. Methods: A systematic review examined the literature on co-occurring MH/SU conditions among Aboriginal and Torres Strait Islander people. Four databases were searched, with data from relevant studies extracted for narrative synthesis. Results: Twelve articles (11 studies) were included. Nine studies used cross-sectional designs; one was a qualitative study and one a mixed methods study with a nested randomized controlled trial. Cultural methodological quality was low across the studies, with a maximum of 7 out of 14 criteria met. Thirty-three combinations of co-occurring conditions were examined. Conclusion: Most research to date has been cross-sectional with limited research exploring the effectiveness of treatments for co-occurring MH/SU conditions. Further Indigenous-led research is needed to find culturally safe, responsive and effective solutions in reducing the burden associated with MH/SU conditions and improving wellbeing.