Journal of Dual Diagnosis最新文献

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: 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: 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: We aimed to evaluate the diagnostic accuracy a rapid 9-item peer-administered questionnaire, the Quick Screening Tool (QST), to detect urgent mental health symptoms in an urban community setting in France of People who use drugs (PWUD). Methods: Participants were recruited through Respondant-Driven Sampling. We used modules from the Mini International Neuropsychiatric Interview as the reference standard (current major depressive episode, suicidal risk, or current psychotic disorder). We calculated the area under the curve as well as sensitivity and specificity. Results: Thirty-four percent of the 175 participants were assessed as in need of urgent mental care. The prevalence for depressive episode, suicidal risk and current psychotic syndrome was 11%, 19%, and 8%, respectively. The QST had an area under the curve for the detection of urgent psychiatric symptoms of 0.82. With a cutoff of 3, it had a sensitivity of 83.3% and a specificity of 64.4%. Conclusions: The performance of the QST in screening for urgent mental health symptoms was satisfactory. This questionnaire could be more broadly used in hard-to-reach PWUD populations in community-based interventions.

Objective: Early leaving in substance use disorder treatment may be the single largest variable undermining treatment success. Existing work on early leaving tends to explore either client factors, which include age, race, gender, and diagnoses, or treatment factors, which include the type of treatment activities offered, treatment experiences of clients and staff, treatment amenities, and environmental factors in the residential treatment program. However, existing work on both client factors and treatment factors provides mixed results on what contributes to early leaving. Further, there has been very little research in the private residential treatment setting. This study aims to explore the factors influencing early leaving in a private residential treatment setting. Methods: The study analyzed admission and treatment records from 247 consecutive clients at a private treatment facility in Southern California to identify factors related to shorter retention. The program employs a biopsychosocial approach and evidence-based practices to assist clients in recovery from substance use disorders and mental health conditions. We utilize a battery of client measures, including the Outcome Questionnaire 45.2, Trauma History Questionnaire, as well as demographic and psychiatric variables in our analyses. Results: Findings challenge previous research by showing that age and gender do not predict shorter retention, contrary to findings in the extant literature on public treatment centers. Instead, clients with higher symptoms of distress stay longer, as indicated by scores on the Outcome Questionnaire 45.2. Additionally, we find the majority of the cohort stayed in residential treatment for more than 30 days, with the average length of stay being 47.92 days, indicating that treatment completion of clients with severe symptomatology for an extended time in treatment (30 days or more) is achievable. Conclusions: The study underscores the importance of considering client symptomologies and severities in understanding and improving retention in substance use disorder treatment programs. This study highlights the potential impact of treatment services offered in private settings on client retention.

Objective: This study examined feasibility, acceptability, and preliminary clinical impact of Veterans Affairs Coordinated Anxiety Learning and Management- Substance (VA CALM-S), a computer-assisted, transdiagnostic cognitive behavioral intervention for co-occurring anxiety and substance use disorders (SUDs) among veterans.

Methods: Veterans with co-occurring anxiety and SUDs were randomized to receive VA CALM-S (n = 14) or usual care (n = 12). Acceptability and feasibility were assessed via treatment completion rates and qualitative feedback. Changes in self-reported anxiety symptoms, substance use, and substance-related consequences were assessed at posttreatment.

Results: Eighty-five percent of participants completed all VA CALM-S modules. Qualitative feedback indicated the intervention was well-received and helpful. Moderate-to-large effect sizes were observed for VA CALM-S in reducing anxiety symptoms (d = 0.64), substance use (d = 0.69), and substance-related consequences (d = 0.34). Relatively smaller effect sizes were observed for the usual care condition in anxiety symptoms (d = 0.24), substance use (d = 0.12), and substance-related consequences (d = -0.46).

Conclusions: Findings support the feasibility and acceptability of VA CALM-S for veterans with co-occurring anxiety and SUDs.

Objective: Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) represents a prevalent and problematic comorbidity. Functional health literacy (FHL) may play a role in this comorbidity based on its previously documented role in hazardous drinking. The current study examined functional health literacy (FHL) regarding hazardous drinking among a sample with probable posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Methods: The current study is a secondary analysis of data from a project studying the transdiagnostic risk and maintenance factors of PTSD and hazardous alcohol use among people with probable PTSD and AUD. Participants were 565 nationally recruited adults with probable PTSD and hazardous alcohol use (52.2% female, 68.8% non-Hispanic White, average age = 39.2 years ± 10.9 years). Linear regression models were conducted regressing hazardous alcohol use onto PTSD symptoms and FHL scores. An interaction term between FHL and PTSD symptoms was included in the regression models with age, biological sex, race, and income included as covariates. Results: Low FHL maintained a statistically significant role in predicting greater hazardous drinking (p < .001) even in the context of posttraumatic stress. High posttraumatic stress also emerged as a statistically significant predictor of hazardous alcohol use (p < .001). The interaction term between FHL and PTSD was not found to be a significant predictor of hazardous alcohol use (p = .222). Conclusion: FHL may be a relevant variable for better understand hazardous drinking among persons with comorbid PTSD and AUD.

Objective: Depressed youth exhibit higher rates of suicidal behavior compared to healthy controls, with problematic substance use potentially intensifying this risk. Accordingly, this study aimed to examine the impact of comorbid depression and problematic substance use and its association with suicidality in youth populations. Methods: We examined differences in clinical features and demographic characteristics between 797 depressed youth ages 8-20 years with and without problematic substance use from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Additionally, to assess whether the effect of depression severity on suicidal ideation and suicide attempt history were influenced by problematic substance use, multivariable linear and logistic regression analyses were conducted. Results: Depressed youth with problematic substance use (versus those without) were significantly older, more likely to exhibit suicidal ideation and a history of suicide attempts and had significantly worse school functioning after controlling for age, sex, race, and ethnicity. Problematic substance use did not moderate the effect of depression severity on suicidal ideation or suicide attempt history. Conclusions: Findings shed light on the impact of problematic substance use in depressed youth which may allow for earlier and more specified intervention efforts aimed at identifying and targeting youth suicidality.