Journal of Dual Diagnosis最新文献

Objective: Abstinence has been the primary treatment goal for alcohol and other drug (AOD) users attending withdrawal treatment. However, other outcomes including harm reduction have also been identified. This observational study aimed to describe participants' goals and reasons for seeking inpatient withdrawal treatment and compare the needs of clients with comorbid mental health problems and those without.

Methods: Participants completed questionnaires at intake and discharge. Questionnaires assessed reasons for entering withdrawal treatment, goals, comorbidity, and perceived help received.

Results: The sample comprised 1746 participants (69.4% male). Participants endorsed diverse reasons for entering withdrawal treatment. The most and least endorsed reasons were "stop using" (97.9%) and "legal reasons" (43.1%). Comorbidity groups varied significantly in their endorsement of reasons for mental health, physical health, harm reduction, financial, and legal.

Conclusion: AOD users enter withdrawal treatment with a variety of reasons and goals including harm reduction. Variations in rates of endorsement highlight the importance of identifying individual needs dependent on mental health comorbidity.

Objective: The associations between posttraumatic stress disorder (PTSD) symptom severity, alcohol use, and alcohol use motives are well-established. Emotion regulation difficulties have been implicated in the association between PTSD symptoms and alcohol use. A dearth of empirical work, however, has examined these associations among Black/African American college students, a population with high prevalence of exposure to potentially traumatic events, PTSD symptomatology, and alcohol-related consequences.

Methods: This study examined PTSD symptoms, emotion regulation difficulties, and alcohol use severity and motives among a sample of Black/African American trauma-exposed college students (N = 282; 77.4% identified as female; M age = 22.36, SD = 4.71).

Results: PTSD symptom severity was related to alcohol use and coping and conformity motives for alcohol use through heightened emotion regulation difficulties. Findings were significant above and beyond the effects of trauma load (i.e., number of potentially traumatic event types experienced).

Conclusions: This study extends past work to an understudied population and contributes to groundwork for culturally informed interventions.

Objective: Client centered care (CCC) is strongly advocated for improving the quality of health care. The aim of the current study was to explore client and staff perspectives of a new model of CCC implemented in a residential alcohol and other drug (AOD) treatment service. Specifically, the study aimed to (i) describe the defining features of CCC, and (ii) describe the benefits and challenges of implementing CCC at the service. Methods: Participants were 18 clients and eight staff who took part in focus groups and interviews. Thematic analysis of four client focus groups and eight staff individual interviews was conducted. Results: Staff identified the defining features of CCC as flexible, comprehensive, open-minded, and inclusive. Clients and staff shared predominantly positive views on the CCC model. Shared themes included the challenge of balancing flexibility and structure, and delivering comprehensive and individualized care within the limits of staff knowledge, skills, and resources. Conclusions: Results suggest that implementing CCC across an AOD treatment setting has clear benefits to staff and clients, along with challenges that require careful consideration and planning. Future research should evaluate the effectiveness of providing guidelines that address many of the challenges associated with implementing CCC.

Objective: Emerging adulthood is a vulnerable period for problematic alcohol use, defined by a pattern of use associated with physical and functional impairment. Obsessive-compulsive psychopathology, which demonstrates high rates of onset in emerging adults, seems to be related to problematic alcohol use in this age group, consistent with research among the general population suggesting an association between emotional disorders and alcohol use in the context of coping drinking motives. Pain intensity, another risk factor of problematic alcohol use, may link obsessive-compulsive symptoms to problematic alcohol use among emerging adults. Therefore, the current study examined the moderating role of pain intensity on the association between obsessive-compulsive symptoms and problematic alcohol use among emerging adults. Methods: Participants were 198 college students (81.30% female, M_age = 22.33, SD = 4.38) who reported problematic alcohol use. Results: Results from the current study supported a significant moderation role of pain intensity for the association between obsessive-compulsive symptoms and problematic alcohol use, whereby the association between obsessive-compulsive symptoms and problematic alcohol use was stronger for emerging adults with high compared to low pain intensity. Conclusions: These results highlighted a clinically-relevant interaction between obsessive-compulsive symptoms and pain intensity concerning the risk of problematic alcohol use among emerging adults as a vulnerable population.

Objective: Mental health and substance use disorders are commonly associated with disrupted sleep and circadian rest-activity rhythms. How these disorders in combination relate to sleep and circadian organization is not well studied. We provide here the first quantitative assessment of sleep and rest-activity rhythms in inpatients with complex concurrent disorders, taking into account categories of substance use (stimulant vs. stimulant and opioid use) and psychiatric diagnosis (psychotic disorder and mood disorder). We also explore how sleep and rest-activity rhythms relate to psychiatric functioning. Methods: A total of 44 participants (10 female) between the age of 20-60 years (median = 29 years) wore wrist accelerometers over 5-70 days and completed standardized questionnaires assessing chronotype and psychiatric functioning (fatigue, psychiatric symptom severity, and impulsiveness). To examine potential influences from treatment, we computed (1) length of stay; (2) days of abstinence from stimulants and opioids as a measure of withdrawal; and (3) a sedative load based on prescribed medications. Results: Participants exhibited a sustained excessive sleep duration, frequent nighttime awakenings, and advanced rest-activity phase related to sedative load. Sleep disruptions were elevated in participants with a history of opioid use. Patients with a psychotic disorder showed the longest sleep and most fragmented and irregular rest-activity patterns. Non-parametric circadian rhythm analysis revealed a high rhythm amplitude by comparison with population norms, and this was associated with greater psychiatric symptom severity. Psychiatric symptom severity was also associated with greater fatigue and later MCTQ chronotype. Conclusions: This pilot study provides initial information on the prevalence and severity of sleep and circadian rhythm disturbances in individuals with severe concurrent disorders. The results underline the need for further studies to start to understand the role of sleep in the disease and recovery process in this understudied population.

Background: The current study aimed to understand how people with mental health conditions who currently smoke or recently quit engaged with family members or peers when quitting and assessed interest in involving family or peers in cessation interventions. Methods: Adults with mental health conditions who smoke or had quit within the past 5 years were recruited from publicly funded mental health programs (N = 24). We conducted virtual qualitative interviews between November 2020 and August 2021 and analyzed the data using the rapid thematic analytic approach. Results: Most participants were men (62%), and 71% were current smokers. We found that: having family/peers who were interested in quitting presented communal quitting opportunities, communication that facilitated quitting tended to be encouraging, and strong relationships with family members increased willingness to involve them in cessation interventions. But family or peer support was less helpful for individuals who were not ready to quit. Conclusion: Training family and peers to engage in supportive behaviors may promote cessation in this population. Cessation interventions may benefit from recruiting support partners who share a strong relationship with the smoker.

Objective: This study evaluated the presence of drug-free family and friends in the social networks of patients treated in an inpatient setting for co-occurring psychiatric disorders and substance use problems. Methods: Social network interviews were conducted with inpatients at the Johns Hopkins Bayview Acute Psychiatric Unit with co-occurring psychiatric disorders and substance use problems (N = 90). Results: Participants reported about five social network members, of which four were drug-free. Most participants (> 70%) were willing to include a drug-free person in the current inpatient treatment plan to support recovery efforts (M = 1.8 network members) and identified several areas of recovery support. Conclusions: These results demonstrate that people treated in an inpatient psychiatric setting have local drug-free family or friends that they are willing to include in the treatment process. These findings support further study of methods to mobilize network members to enhance social support during and following hospitalization.

Objective: This research was undertaken to evaluate factors related to program retention among participants in a community-based peer recovery program for women of childbearing age with a history of substance use disorder. Methods: In all, 184 women of childbearing age with a history of substance use disorder were enrolled in a community-based peer recovery program. Half of the participants were pregnant or postpartum. The outcome of interest was retention in the program as measured at 2 and 6 months. Participants were paired with a peer recovery coach (PRC). PRCs were women with a personal history of substance use disorder who assisted with healthcare system navigation, facilitated access to local resources, and provided advice and emotional support. All PRCs were also licensed perinatal community health workers. Independent variables included gestational status, depression, anxiety, type and frequency of substance use, childhood trauma, abuse, readiness for treatment, and attachment patterns. Results: Anxiety was found to be a key factor associated with retention. Moderate anxiety was associated with higher rates of retention compared to normal to mild anxiety. Severe anxiety was associated with lower rates of retention compared to normal to mild anxiety. Attrition was highest in the first 2 months. Conclusions: Early integration with mental health services to address severe anxiety symptoms could potentially improve retention in substance use disorder recovery programs, thereby improving outcomes. More research is needed regarding severe anxiety and care-avoidant behaviors, particularly among women of childbearing age.