Journal of Dual Diagnosis最新文献

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: 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: 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.

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: Substance-induced psychosis (SIP) is a prevalent psychotic disorder among patients with substance use disorders. SIP implies clinical severity, including suicidal behaviors. To date, few studies have focused on suicidal behaviors among patients with SIP. This study aimed to perform a scoping review to summarize the current findings on suicidal behaviors in patients with SIP and outline the implications for clinical practice.

Methods: A scoping review was conducted using the most relevant published information on suicidal behaviors among SIP, sourced from two databases.

Results: The 19 reviewed articles reported a high prevalence of suicidal behaviors among SIP. Specifically, the prevalence of suicidal ideation ranges from 14.5% to 68%, while suicide attempts vary between 10.5% and 48% depending on the timeframe, setting, and assessment methods used. Several clinical factors such as levels of depression, lifetime trauma, comorbidities, and the substance responsible for inducing psychosis are associated with suicidal behaviors in this population. However, significant knowledge gaps persist, warranting further investigation.

Conclusions: Suicidal behaviors are common among patients with SIP and are associated with several clinical factors. However, further investigation is needed to better understand and address suicidal behaviors in patients with SIP.

Objective: The primary objective of this study was to assess the association between psychiatric comorbidity and current substance use in a sample of patients with opioid use disorder (OUD) receiving opioid agonist treatment (OAT) with methadone in outpatient drug treatment centers. Secondary objectives were: (a) to examine the associations between socio-demographic and clinical characteristics and specific substance use (opioids, cocaine, alcohol, cannabis), and (b) to identify the socio-demographic and clinical factors associated with substance use based on lifetime psychiatric comorbidity status.

Methods: A convenience sample of 588 patients (20% women; M_age 48.4) was recruited from eight outpatient drug treatment centers in Catalonia (Spain), which offer a comprehensive treatment approach. Dual diagnosis was assessed using the Dual Disorder Screening Interview (DDSI), and self-reported substance use (opioids, cocaine, cannabis, and alcohol) was evaluated through a specific questionnaire. Poisson regression with a log link was used to test five models adjusted for sociodemographic, clinical, and treatment variables.

Results: A total of 63.5% of the patients tested positive for a lifetime dual diagnosis, and 83.5% reported substance use in the past month. No increased likelihood of opioid, cocaine, or alcohol use was observed among those with a lifetime dual diagnosis, except for cannabis use (PR = 1.29).

Conclusions: Psychiatric comorbidity was not associated with current substance use in methadone-treated patients, except cannabis use. The observed patterns may be influenced by the pharmacological effects of methadone and the comprehensive treatment approach provided to patients.

Objective: Motivational interviewing (MI) is a client centered counseling approach which aims to promote behavior change by enhancing patient motivation through the exploration and resolution of ambivalence. This type of psychotherapy, initially designed for the treatment of substance use disorders (SUD), is now seen as an effective way to manage chronic physical and psychiatric diseases. Patients with Dual Diagnosis (DD), people who simultaneously have a SUD diagnosis and a mental illness, are a complex group of psychiatric patients who have a particularly low treatment engagement. It was hypothesized that MI could be a valuable add-on therapy for DD patients. This review summarizes the main findings of randomized controlled trials applying MI to patients' psychiatric diagnoses and substance use. We aim to clarify previous inconsistent results regarding MI effectivity in this complex and challenging disorder.

Method: The systematic literature search of PubMed/MEDLINE, Web Of Science and Scopus followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The final selection for this systematic review comprised exclusively of randomized controlled trials (RCTs) comparing MI alone or integrated into routine care. All patients included in the selected studies were over 16 years old. The studies' quality assessment was conducted with the Jadad Scale.

Results: 8 RCTs were included in this review. The patients who underwent MI interventions showed an improvement in functioning, psychiatric symptoms, medication compliance and substance use, although without statistical significance. The number of relapses, total days in relapse and alcohol binge days showed a significant improvement in favor of the intervention group (p = .002, Bellack et al., 2006; p = .006, Haddock et al., 2003; and p = .02).

Conclusions: Although there was a clear improvement in most of these outcomes, most studies failed to detect significant results. A significant clinical outcome of MI application was found in lower relapse occurrence and alcohol abuse. The disparity of findings may be due to the disorder's heterogeneity, and/or to methodological limitations. Our results emphasize the need for more methodically sound RCTs with adaptable characteristics specific to the pairing of psychiatric disease and substance abuse.

Objective: Individuals who use opioids are at elevated risk of posttraumatic stress disorder (PTSD). The objective of this study was to examine the influence of PTSD diagnosis on opioid use outcomes over a 60-day period. Methods: Participants were individuals with a history of trauma and recent opioid use who were recruited from the community (M_age = 43.45 years; 54.8% white). Participants were administered a structured diagnostic assessment for PTSD during a baseline session, and reported 30-day opioid use, opioid treatment engagement, impaired control around using opioids, and opioid overdose using a Timeline Follow-back during baseline (N = 84) and follow-up (N = 56) sessions. Multilevel models were used to examine the influence of PTSD on change in opioid use, treatment, and impaired control over the course of the 60-day observation period among the 56 individuals that completed follow-up interviews. Results: Two-thirds of the sample had a diagnosis of PTSD (66.7%). Compared to those without PTSD, individuals with PTSD were less likely to decrease opioid use (OR = 1.04, 95% CI [1.02, 1.06], p < .001), but were not more likely to report episode of impaired control (OR = 1.02, 95% CI [0.98, 1.06], p = .268), over the 60-day period. Although individuals with PTSD were less likely to increase their engagement with opioid treatment (OR = 0.96, 95% CI [0.95, 0.97], p < .001), these individuals engaged in treatment at much higher levels compared to individuals without PTSD. Conclusions: Findings underscore the high prevalence and impact of PTSD on opioid use outcomes among trauma-exposed community individuals who use opioids.

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.