Pub Date : 2022-10-01Epub Date: 2022-09-30DOI: 10.1080/15504263.2022.2126058
Laura Whiteley, Elizabeth M Olsen, Kayla K Haubrick, Chaerim Kang, Ian Vaughan, Larry K Brown
Objective: Cannabis use disorder (CUD) is associated with an elevated risk for psychiatric disorders and symptoms, contributing to poor health outcomes and increased medical costs. Unfortunately, interventions that simultaneously address cannabis use and co-occurring psychiatric disorders are limited in availability. Targeted digital interventions to reduce cannabis use could be beneficial for patients with psychiatric disorders. Digital interventions could be easily disseminated and used in numerous clinical locations, including outpatient, inpatient, residential, and community psychiatric treatment settings.
Methods: Literature on digital cannabis reduction interventions for persons with psychiatric disorders was examined between April 2021 and June 2021. Articles were obtained from PubMed and PsycINFO databases. English language randomized controlled trials (RCT), feasibility and acceptability studies, pilot studies, and published protocols were included.
Results: There is significant evidence that digital interventions can effectively reduce cannabis use in general, non-clinical populations. However, there is less literature examining interventions for persons living with co-occurring psychiatric illness-most of which is tailored to patients living with chronic psychosis.
Conclusions: There is great need for accessible and tailored digital interventions for co-occurring CUD and psychiatric disorders.
{"title":"A Review of Digital Interventions to Decrease Cannabis Use Among Patients With Comorbid Psychiatric Disorders.","authors":"Laura Whiteley, Elizabeth M Olsen, Kayla K Haubrick, Chaerim Kang, Ian Vaughan, Larry K Brown","doi":"10.1080/15504263.2022.2126058","DOIUrl":"10.1080/15504263.2022.2126058","url":null,"abstract":"<p><strong>Objective: </strong>Cannabis use disorder (CUD) is associated with an elevated risk for psychiatric disorders and symptoms, contributing to poor health outcomes and increased medical costs. Unfortunately, interventions that simultaneously address cannabis use and co-occurring psychiatric disorders are limited in availability. Targeted digital interventions to reduce cannabis use could be beneficial for patients with psychiatric disorders. Digital interventions could be easily disseminated and used in numerous clinical locations, including outpatient, inpatient, residential, and community psychiatric treatment settings.</p><p><strong>Methods: </strong>Literature on digital cannabis reduction interventions for persons with psychiatric disorders was examined between April 2021 and June 2021. Articles were obtained from PubMed and PsycINFO databases. English language randomized controlled trials (RCT), feasibility and acceptability studies, pilot studies, and published protocols were included.</p><p><strong>Results: </strong>There is significant evidence that digital interventions can effectively reduce cannabis use in general, non-clinical populations. However, there is less literature examining interventions for persons living with co-occurring psychiatric illness-most of which is tailored to patients living with chronic psychosis.</p><p><strong>Conclusions: </strong>There is great need for accessible and tailored digital interventions for co-occurring CUD and psychiatric disorders.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10311985/pdf/nihms-1891697.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10117608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-09-23DOI: 10.1080/15504263.2022.2123119
Jessica E Hoyt, Nikhil Teja, Tammy Jiang, Luke Rozema, Jiang Gui, Bradley V Watts, Brian Shiner, Jaimie L Gradus
Objective: To investigate whether direct-acting antivirals (DAA) for hepatitis C viral infection (HCV): glecaprevir/pibrentasvir (GLE/PIB), ledipasvir/sofosbuvir (LDV/SOF), and sofosbuvir/velpatasvir (SOF/VEL) are associated with reduced alcohol consumption among veterans with alcohol use disorder (AUD) and co-occurring post-traumatic stress disorder (PTSD).
Methods: We measured change in Alcohol Use Disorder Identification Test-Consumption Module (AUDIT-C) scores in a retrospective cohort of veterans with PTSD and AUD receiving DAAs for HCV.
Results: One thousand two hundred and eleven patients were included (GLE/PIB n = 174, LDV/SOF n = 808, SOF/VEL n = 229). Adjusted frequencies of clinically meaningful improvement were 30.5% for GLE/PIB, 45.5% for LDV/SOF, and 40.5% for SOF/VEL. The frequency was lower for GLE/PIB than for LDV/SOF (OR = 0.59; 95% CI [0.40, 0.87]) or SOF/VEL (OR = 0.66; 95% CI [0.42, 1.04]).
Conclusions: DAA treatment for HCV was associated with a substantial reduction in alcohol use in patients with AUD and co-occurring PTSD. Further exploration of the role of DAAs in AUD treatment is warranted.
目的:探讨治疗丙型肝炎病毒感染(HCV)的直接作用抗病毒药物(DAA):格列卡韦/皮布伦他韦(GLE/PIB)、莱迪帕韦/索非司布韦(LDV/SOF)、,和索非布韦/韦帕他韦(SOF/VEL)与患有酒精使用障碍(AUD)和合并创伤后应激障碍(PTSD)的退伍军人的饮酒量减少有关包括211名患者(GLE/PIB n = 174,LDV/SOF n = 808,SOF/VEL n = 229)。GLE/PIB、LDV/SOF和SOF/VEL的临床意义改善调整频率分别为30.5%、45.5%和40.5%。GLE/PIB的频率低于LDV/SOF(OR = 0.59;95%置信区间[0.40、0.87])或SOF/VEL(or = 0.66;95%可信区间[0.42,1.04])。结论:DAA治疗HCV与AUD和合并PTSD患者的酒精使用显著减少有关。有必要进一步探索DAAs在AUD治疗中的作用。
{"title":"Changes in Alcohol Consumption following Direct-Acting Antiviral Treatment for Hepatitis C in VA Patients with Comorbid Alcohol Use Disorder and PTSD.","authors":"Jessica E Hoyt, Nikhil Teja, Tammy Jiang, Luke Rozema, Jiang Gui, Bradley V Watts, Brian Shiner, Jaimie L Gradus","doi":"10.1080/15504263.2022.2123119","DOIUrl":"10.1080/15504263.2022.2123119","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether direct-acting antivirals (DAA) for hepatitis C viral infection (HCV): glecaprevir/pibrentasvir (GLE/PIB), ledipasvir/sofosbuvir (LDV/SOF), and sofosbuvir/velpatasvir (SOF/VEL) are associated with reduced alcohol consumption among veterans with alcohol use disorder (AUD) and co-occurring post-traumatic stress disorder (PTSD).</p><p><strong>Methods: </strong>We measured change in Alcohol Use Disorder Identification Test-Consumption Module (AUDIT-C) scores in a retrospective cohort of veterans with PTSD and AUD receiving DAAs for HCV.</p><p><strong>Results: </strong>One thousand two hundred and eleven patients were included (GLE/PIB <i>n</i> = 174, LDV/SOF <i>n</i> = 808, SOF/VEL <i>n</i> = 229). Adjusted frequencies of clinically meaningful improvement were 30.5% for GLE/PIB, 45.5% for LDV/SOF, and 40.5% for SOF/VEL. The frequency was lower for GLE/PIB than for LDV/SOF (<i>OR</i> = 0.59; 95% CI [0.40, 0.87]) or SOF/VEL (<i>OR</i> = 0.66; 95% CI [0.42, 1.04]).</p><p><strong>Conclusions: </strong>DAA treatment for HCV was associated with a substantial reduction in alcohol use in patients with AUD and co-occurring PTSD. Further exploration of the role of DAAs in AUD treatment is warranted.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719291/pdf/nihms-1848219.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10411118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2018-09-05DOI: 10.1080/15504263.2018.1473906
Ryan J Martin, Beth H Chaney
Objective: In clinical and athlete populations, research has found that experiencing a concussion (or traumatic brain injury) is correlated with experiencing other psychiatric conditions, including depression and alcohol problems. However, less is known about concussion comorbidity in other population segments. The purpose of this study is to examine the relationships between concussions and depression symptoms, anxiety symptoms, and hazardous drinking among a large sample of college students (N = 1776) enrolled in a mandatory health course. Methods: This study used an online health survey to examine concussion frequency (informal and formal diagnoses), sports-related concussions, depression symptoms, anxiety symptoms, and hazardous drinking in the sample. Bivariate and multivariate analyses were conducted to examine comorbid relationships between concussion frequency and the dependent variables of interest (anxiety symptoms, depression symptoms, and hazardous drinking). Results: We found that 691 (39.1%) participants indicated having at least one concussion. Analyses indicated that concussion frequency scores of both formal or informal diagnoses were significantly associated with scores of depression symptoms, anxiety symptoms, and hazardous drinking. When examining concussion frequency scores of only formal diagnoses, only hazardous drinking evidenced a statistically significant relationship. In addition, participants who had a sports concussion had significantly higher concussion frequency scores and hazardous drinking scores than those who have had a concussion that was not sport-related. Conclusions: The comorbid concussion relationships found in this study are consistent with those observed in clinical and athlete populations. It is important for college health professionals to be aware that concussion comorbidity is not limited to the athlete population and can impact the entire student body.
{"title":"Exploration of the Relationship Between Concussions and Depression Symptoms, Anxiety Symptoms, and Hazardous Drinking Among a Sample of College Students.","authors":"Ryan J Martin, Beth H Chaney","doi":"10.1080/15504263.2018.1473906","DOIUrl":"https://doi.org/10.1080/15504263.2018.1473906","url":null,"abstract":"<p><p><b>Objective:</b> In clinical and athlete populations, research has found that experiencing a concussion (or traumatic brain injury) is correlated with experiencing other psychiatric conditions, including depression and alcohol problems. However, less is known about concussion comorbidity in other population segments. The purpose of this study is to examine the relationships between concussions and depression symptoms, anxiety symptoms, and hazardous drinking among a large sample of college students (<i>N</i> = 1776) enrolled in a mandatory health course. <b>Methods:</b> This study used an online health survey to examine concussion frequency (informal and formal diagnoses), sports-related concussions, depression symptoms, anxiety symptoms, and hazardous drinking in the sample. Bivariate and multivariate analyses were conducted to examine comorbid relationships between concussion frequency and the dependent variables of interest (anxiety symptoms, depression symptoms, and hazardous drinking). <b>Results:</b> We found that 691 (39.1%) participants indicated having at least one concussion. Analyses indicated that concussion frequency scores of both formal or informal diagnoses were significantly associated with scores of depression symptoms, anxiety symptoms, and hazardous drinking. When examining concussion frequency scores of only formal diagnoses, only hazardous drinking evidenced a statistically significant relationship. In addition, participants who had a sports concussion had significantly higher concussion frequency scores and hazardous drinking scores than those who have had a concussion that was not sport-related. <b>Conclusions:</b> The comorbid concussion relationships found in this study are consistent with those observed in clinical and athlete populations. It is important for college health professionals to be aware that concussion comorbidity is not limited to the athlete population and can impact the entire student body.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15504263.2018.1473906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01Epub Date: 2022-06-29DOI: 10.1080/15504263.2022.2090650
Elina Dirani, Rami Bou Khalil, Georges Raad, Sami Richa
Objective: It is well-established that Bipolar Disorder (BD) has comorbidity with Alcohol Use Disorder (AUD) and could present the same symptoms of an underlying diagnosis of BD, therefore delaying the proper relevant treatment. Recent studies show the occurrence of alterations in the circulating levels of inflammatory mediators in patients dealing with AUD as well as those with BD. The objective of this study is to get an assessment of whether patients with AUD and BD comorbidity [BD(+)] would present different ratios of the Complete Blood Count (CBC) in comparison with patients with AUD but without a BD comorbidity [BD(-)]. Methods: This is a retrospective study, conducted through a selection of patients files who were admitted to the psychiatric department at Hôtel-Dieu de France University Hospital in Beirut, Lebanon, between January of the year 2016 and May of the year 2021. Overall, 83 files of patients dealing with AUD were included in this study. Results: Patients with BD(+) showed a higher Eosinophils to Lymphocytes Ratio (ELR) in comparison to those with BD(-). The Receiver Operation Characteristic (ROC) analysis had an area under the curve at 0.719 with a p = .001. The cutoff value of ELR that best differentiates BD(-) from BD(+) was 0.087 (Sensitivity = 81.3%; Specificity = 63.6%). The logistic regression analysis showed that an ELR superior to 0.087 presented a statistically significant difference, exposing patients belonging to the BD(+) group (OR = 11.66; p < .001). Conclusions: Our data suggest that ELR may be a valuable, reproducible, easily accessible, and cost-effective inflammatory marker, pointing at the presence of a BD comorbidity with AUD.
{"title":"Eosinophils to Lymphocytes Ratio (ELR) as a Potential Inflammatory Biomarker in Patients with Dual Diagnosis of Bipolar and Alcohol Use Disorders: A Retrospective Cohort Study.","authors":"Elina Dirani, Rami Bou Khalil, Georges Raad, Sami Richa","doi":"10.1080/15504263.2022.2090650","DOIUrl":"https://doi.org/10.1080/15504263.2022.2090650","url":null,"abstract":"<p><p><b>Objective:</b> It is well-established that Bipolar Disorder (BD) has comorbidity with Alcohol Use Disorder (AUD) and could present the same symptoms of an underlying diagnosis of BD, therefore delaying the proper relevant treatment. Recent studies show the occurrence of alterations in the circulating levels of inflammatory mediators in patients dealing with AUD as well as those with BD. The objective of this study is to get an assessment of whether patients with AUD and BD comorbidity [BD(+)] would present different ratios of the Complete Blood Count (CBC) in comparison with patients with AUD but without a BD comorbidity [BD(-)]. <b>Methods:</b> This is a retrospective study, conducted through a selection of patients files who were admitted to the psychiatric department at Hôtel-Dieu de France University Hospital in Beirut, Lebanon, between January of the year 2016 and May of the year 2021. Overall, 83 files of patients dealing with AUD were included in this study. <b>Results:</b> Patients with BD(+) showed a higher Eosinophils to Lymphocytes Ratio (ELR) in comparison to those with BD(-). The Receiver Operation Characteristic (ROC) analysis had an area under the curve at 0.719 with a <i>p</i> = .001. The cutoff value of ELR that best differentiates BD(-) from BD(+) was 0.087 (Sensitivity = 81.3%; Specificity = 63.6%). The logistic regression analysis showed that an ELR superior to 0.087 presented a statistically significant difference, exposing patients belonging to the BD(+) group (<i>OR</i> = 11.66; <i>p</i> < .001). <b>Conclusions:</b> Our data suggest that ELR may be a valuable, reproducible, easily accessible, and cost-effective inflammatory marker, pointing at the presence of a BD comorbidity with AUD.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40409193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01Epub Date: 2022-06-27DOI: 10.1080/15504263.2022.2089799
Aidan J Flynn, Gabriella Y Navarro, Heather K Basehore
Objective: Posttraumatic stress disorder (PTSD) is one of the most frequently treated behavioral health conditions within the Department of Veterans Affairs and often co-occurs with alcohol or substance use. Past research suggests that alcohol and/or substance use may be used to cope with PTSD symptoms but there are inconsistent findings in how specific PTSD symptom clusters are associated with alcohol use disorder (AUD) or substance use disorder (SUD). Evaluating the relationship between PTSD symptom clusters and craving for individual drug of dependence may help explain these ambiguous results. Methods: Veterans (N = 167) recently engaged in mental health residential treatment were recruited to participate in a semi-structured diagnostic interview (Structured Clinical Interview for the DSM-5, Research Version [SCID-5-RV]) to assess for past 12-month history of AUD/SUD. Participants also completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) to assess PTSD symptoms. Results: Covarying for severity of alcohol use, avoidance symptoms were significantly associated with alcohol craving for veterans with alcohol as their drug of dependence. Covarying for severity of stimulant use, no PTSD symptom clusters were associated with stimulant craving for veterans with stimulants as their drug of dependence. Conclusions: Veterans with high levels of PTSD avoidance symptoms may experience alcohol craving symptoms because they believe that alcohol use will eliminate or alleviate thoughts, feelings, or external reminders of the trauma. These results have important clinical implications in the treatment of co-occurring PTSD and AUD.
{"title":"PTSD Avoidance Symptoms Associated With Alcohol Craving in Treatment-Seeking Veteran Population.","authors":"Aidan J Flynn, Gabriella Y Navarro, Heather K Basehore","doi":"10.1080/15504263.2022.2089799","DOIUrl":"https://doi.org/10.1080/15504263.2022.2089799","url":null,"abstract":"<p><p><b>Objective:</b> Posttraumatic stress disorder (PTSD) is one of the most frequently treated behavioral health conditions within the Department of Veterans Affairs and often co-occurs with alcohol or substance use. Past research suggests that alcohol and/or substance use may be used to cope with PTSD symptoms but there are inconsistent findings in how specific PTSD symptom clusters are associated with alcohol use disorder (AUD) or substance use disorder (SUD). Evaluating the relationship between PTSD symptom clusters and craving for individual drug of dependence may help explain these ambiguous results. <b>Methods:</b> Veterans (<i>N</i> = 167) recently engaged in mental health residential treatment were recruited to participate in a semi-structured diagnostic interview (Structured Clinical Interview for the <i>DSM-5</i>, Research Version [SCID-5-RV]) to assess for past 12-month history of AUD/SUD. Participants also completed the Posttraumatic Stress Disorder Checklist for <i>DSM-5</i> (PCL-5) to assess PTSD symptoms. <b>Results:</b> Covarying for severity of alcohol use, avoidance symptoms were significantly associated with alcohol craving for veterans with alcohol as their drug of dependence. Covarying for severity of stimulant use, no PTSD symptom clusters were associated with stimulant craving for veterans with stimulants as their drug of dependence. <b>Conclusions:</b> Veterans with high levels of PTSD avoidance symptoms may experience alcohol craving symptoms because they believe that alcohol use will eliminate or alleviate thoughts, feelings, or external reminders of the trauma. These results have important clinical implications in the treatment of co-occurring PTSD and AUD.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01Epub Date: 2022-07-05DOI: 10.1080/15504263.2022.2090648
Laura D Robinson, Frank P Deane
Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.
{"title":"Substance Use Disorder and Anxiety, Depression, Eating Disorder, PTSD, and Phobia Comorbidities Among Individuals Attending Residential Substance Use Treatment Settings.","authors":"Laura D Robinson, Frank P Deane","doi":"10.1080/15504263.2022.2090648","DOIUrl":"https://doi.org/10.1080/15504263.2022.2090648","url":null,"abstract":"<p><p><b>Objective:</b> Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. <b>Methods:</b> Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. <b>Results:</b> Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. <b>Conclusions:</b> Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40473246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1080/15504263.2022.2090649
Nada M Goodrum, Donte L Bernard, Angela D Moreland
Objective: Many women receiving substance use treatment report histories of interpersonal violence (IV) victimization, including physical and sexual assault. IV is a risk factor for mental and behavioral health difficulties such as posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Consistent with the self-medication hypothesis, PTSD may explain elevated SUD among IV survivors. Yet, few studies have investigated whether PTSD may have differential mediating effects for different substances, which has significant treatment implications. Methods: In 124 women (M age = 35.37, SD = 11.90) in substance use treatment, we examined PTSD symptoms as a mediator between IV and severity of different types of substance use, including alcohol, cannabis, cocaine, and opioid use. Participants completed self-report measures including the ASSIST, PCL-5, and LEC-5. Data were analyzed using path analysis in Mplus 8.3. Both dichotomous and continuous outcomes of problematic substance use outcomes were examined. Results: Most women (53.3%) reported problematic substance use with at least one substance, including opioids (39.7%), cocaine (13.0%), alcohol (9.6%), and cannabis (5.6%). Most (83.2%) of the sample reported at least one IV incident. On average, women reported clinically significant PTSD symptom severity. When problematic substance use was examined dichotomously, findings revealed significant indirect effects from IV exposure to opioid (β = 0.10, p = .010) and cocaine use (β = 0.07, p = .039) via elevated PTSD symptoms. There were no significant indirect effects for problematic alcohol (β = 0.03, p = .260) or cannabis use (β = 0.02, p = .562). When substance use was examined continuously, results revealed significant indirect effects from IV exposure to opioid (β = 0.09, p = .017), cocaine use (β = 0.09, p = .015), and alcohol use (β = 0.08, p = .020) via elevated PTSD symptoms. Indirect effects for cannabis use remained nonsignificant (β = 0.05, p = .100). Conclusions: IV survivors may be particularly at risk for opioid and cocaine misuse because of elevated PTSD symptoms. Treatments that integrate PTSD and SUD are needed to simultaneously target traumatic stress and substance use. Women with opioid and cocaine misuse may particularly benefit from trauma-focused exposure-based psychotherapy to reduce symptoms of PTSD, and thus, decrease opioid and cocaine misuse.
目的:许多接受药物使用治疗的妇女报告了人际暴力(IV)受害史,包括身体和性侵犯。静脉注射是精神和行为健康困难的危险因素,如创伤后应激障碍(PTSD)和物质使用障碍(SUD)。与自我用药假说一致,PTSD可以解释静脉注射幸存者中SUD升高的原因。然而,很少有研究调查PTSD是否对不同物质有不同的介导作用,这对治疗有重要意义。方法:在124名接受药物使用治疗的女性(M年龄= 35.37,SD = 11.90)中,我们检查了PTSD症状作为不同类型药物使用(包括酒精、大麻、可卡因和阿片类药物使用)的IV和严重程度之间的中介。参与者完成了自我报告测量,包括ASSIST、PCL-5和LEC-5。数据分析采用Mplus 8.3的通径分析。对问题物质使用结果的二分类和连续结果进行了检查。结果:大多数女性(53.3%)报告至少使用一种物质,包括阿片类药物(39.7%)、可卡因(13.0%)、酒精(9.6%)和大麻(5.6%)。大多数(83.2%)的样本报告了至少一次静脉注射事件。平均而言,女性报告临床显著的PTSD症状严重程度。当对问题物质使用进行二分类检查时,结果显示静脉暴露于阿片类药物(β = 0.10, p = 0.010)和可卡因使用(β = 0.07, p = 0.039)通过增加PTSD症状产生显著的间接影响。问题酒精(β = 0.03, p = .260)或大麻使用(β = 0.02, p = .562)没有显著的间接影响。当持续检查药物使用情况时,结果显示静脉暴露于阿片类药物(β = 0.09, p = 0.017)、可卡因使用(β = 0.09, p = 0.015)和酒精使用(β = 0.08, p = 0.020)通过增加PTSD症状产生显著的间接影响。大麻使用的间接影响仍然不显著(β = 0.05, p = .100)。结论:由于PTSD症状升高,静脉注射幸存者滥用阿片类药物和可卡因的风险可能特别高。创伤后应激障碍和SUD的综合治疗需要同时针对创伤应激和物质使用。滥用阿片类药物和可卡因的妇女可能特别受益于以创伤为重点的基于暴露的心理治疗,以减轻创伤后应激障碍的症状,从而减少阿片类药物和可卡因的滥用。
{"title":"Interpersonal Violence, PTSD, and Substance Use Types among Women Receiving Substance Use Treatment.","authors":"Nada M Goodrum, Donte L Bernard, Angela D Moreland","doi":"10.1080/15504263.2022.2090649","DOIUrl":"https://doi.org/10.1080/15504263.2022.2090649","url":null,"abstract":"<p><p><b>Objective:</b> Many women receiving substance use treatment report histories of interpersonal violence (IV) victimization, including physical and sexual assault. IV is a risk factor for mental and behavioral health difficulties such as posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Consistent with the self-medication hypothesis, PTSD may explain elevated SUD among IV survivors. Yet, few studies have investigated whether PTSD may have differential mediating effects for different substances, which has significant treatment implications. <b>Methods:</b> In 124 women (<i>M</i> age = 35.37, <i>SD =</i> 11.90) in substance use treatment, we examined PTSD symptoms as a mediator between IV and severity of different types of substance use, including alcohol, cannabis, cocaine, and opioid use. Participants completed self-report measures including the ASSIST, PCL-5, and LEC-5. Data were analyzed using path analysis in Mplus 8.3. Both dichotomous and continuous outcomes of problematic substance use outcomes were examined. <b>Results:</b> Most women (53.3%) reported problematic substance use with at least one substance, including opioids (39.7%), cocaine (13.0%), alcohol (9.6%), and cannabis (5.6%). Most (83.2%) of the sample reported at least one IV incident. On average, women reported clinically significant PTSD symptom severity. When problematic substance use was examined dichotomously, findings revealed significant indirect effects from IV exposure to opioid (<i>β</i> = 0.10, <i>p =</i> .010) and cocaine use (<i>β</i> = 0.07, <i>p =</i> .039) via elevated PTSD symptoms. There were no significant indirect effects for problematic alcohol (<i>β</i> = 0.03, <i>p =</i> .260) or cannabis use (<i>β</i> = 0.02, <i>p</i> = .562). When substance use was examined continuously, results revealed significant indirect effects from IV exposure to opioid (<i>β</i> = 0.09, <i>p =</i> .017), cocaine use (<i>β</i> = 0.09, <i>p =</i> .015), and alcohol use (<i>β</i> = 0.08, <i>p =</i> .020) via elevated PTSD symptoms. Indirect effects for cannabis use remained nonsignificant (<i>β</i> = 0.05, <i>p = .</i>100). <b>Conclusions:</b> IV survivors may be particularly at risk for opioid and cocaine misuse because of elevated PTSD symptoms. Treatments that integrate PTSD and SUD are needed to simultaneously target traumatic stress and substance use. Women with opioid and cocaine misuse may particularly benefit from trauma-focused exposure-based psychotherapy to reduce symptoms of PTSD, and thus, decrease opioid and cocaine misuse.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9721397/pdf/nihms-1848217.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9817514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01Epub Date: 2022-06-28DOI: 10.1080/15504263.2022.2090647
Sandra J Japuntich, Melissa Adkins-Hempel, Carina Lundtvedt, Sara J Becker, Sarah A Helseth, Steven S Fu, Jennifer Tidey, A Eden Evins, Rebekah Pratt
Objective: Tobacco use is rarely addressed in community mental healthcare settings, despite its high prevalence among people with serious mental illness. The aim of the current study was to gather stakeholder feedback regarding the feasibility of chronic care management strategies for tobacco dependence in community mental health centers (CMHCs). Chronic care strategies evaluated included the 5 As (Ask about tobacco use, Advise users of tobacco to quit, Assess interest in cessation, Assist with cessation, and Arrange for follow-up) and proactive telephone outreach (reaching out to all users of tobacco to offer connection to tobacco cessation treatment). Methods: Using a semi-structured interview guide informed by the Practical Robust Implementation and Sustainability Model, we conducted individual semi-structured interviews with providers, leaders, and clients across two CMHCs. Our objectives were to capture their attitudes toward smoking cessation treatment, two chronic care model interventions (i.e., proactive outreach, the 5 As), and to determine the infrastructure needed to implement such interventions in their CMHCs. Thematic analysis was conducted by two independent coders to uncover pertinent themes. Results: Participants (n = 20) included nine providers, six leaders, and five clients. Thematic analysis revealed three major themes: (1) characteristics of recipients, (2) characteristics of the intervention, and (3) infrastructure needed for implementation and sustainability. Providers, leaders, and clients all reported that tobacco cessation treatment was rarely provided in CMHCs and expressed an interest in such treatments becoming more available. The 5 As and proactive outreach were viewed as feasible and acceptable to deliver and receive. Providers, leaders, and clients wanted support to connect clients with smoking cessation treatment. Providers and leaders requested a range of implementation supports, including didactic trainings, decision aids, performance feedback, and coaching on evidence-based tobacco cessation treatments for people with serious mental illness. Clients requested tobacco cessation resources, such as a cessation counseling provided at the CMHC and prescriptions for cessation medication. Conclusions: CMHC providers, leaders, and clients are interested in making tobacco cessation services more widely accessible and available. The feedback gathered in this study can be used to inform the delivery and implementation of guideline-adherent tobacco dependence care in CMHCs.
{"title":"Implementing Chronic Care Model Treatments for Cigarette Dependence in Community Mental Health Clinics.","authors":"Sandra J Japuntich, Melissa Adkins-Hempel, Carina Lundtvedt, Sara J Becker, Sarah A Helseth, Steven S Fu, Jennifer Tidey, A Eden Evins, Rebekah Pratt","doi":"10.1080/15504263.2022.2090647","DOIUrl":"10.1080/15504263.2022.2090647","url":null,"abstract":"<p><p><b>Objective:</b> Tobacco use is rarely addressed in community mental healthcare settings, despite its high prevalence among people with serious mental illness. The aim of the current study was to gather stakeholder feedback regarding the feasibility of chronic care management strategies for tobacco dependence in community mental health centers (CMHCs). Chronic care strategies evaluated included the 5 As (Ask about tobacco use, Advise users of tobacco to quit, Assess interest in cessation, Assist with cessation, and Arrange for follow-up) and proactive telephone outreach (reaching out to all users of tobacco to offer connection to tobacco cessation treatment). <b>Methods:</b> Using a semi-structured interview guide informed by the Practical Robust Implementation and Sustainability Model, we conducted individual semi-structured interviews with providers, leaders, and clients across two CMHCs. Our objectives were to capture their attitudes toward smoking cessation treatment, two chronic care model interventions (i.e., proactive outreach, the 5 As), and to determine the infrastructure needed to implement such interventions in their CMHCs. Thematic analysis was conducted by two independent coders to uncover pertinent themes. <b>Results:</b> Participants (<i>n</i> = 20) included nine providers, six leaders, and five clients. Thematic analysis revealed three major themes: (1) characteristics of recipients, (2) characteristics of the intervention, and (3) infrastructure needed for implementation and sustainability. Providers, leaders, and clients all reported that tobacco cessation treatment was rarely provided in CMHCs and expressed an interest in such treatments becoming more available. The 5 As and proactive outreach were viewed as feasible and acceptable to deliver and receive. Providers, leaders, and clients wanted support to connect clients with smoking cessation treatment. Providers and leaders requested a range of implementation supports, including didactic trainings, decision aids, performance feedback, and coaching on evidence-based tobacco cessation treatments for people with serious mental illness. Clients requested tobacco cessation resources, such as a cessation counseling provided at the CMHC and prescriptions for cessation medication. <b>Conclusions:</b> CMHC providers, leaders, and clients are interested in making tobacco cessation services more widely accessible and available. The feedback gathered in this study can be used to inform the delivery and implementation of guideline-adherent tobacco dependence care in CMHCs.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472099/pdf/nihms-1831822.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-03DOI: 10.1080/15504263.2022.2053770
Carlos Gómez-Sánchez-Lafuente, J. Guzmán-Parra, J. Suarez-Perez, A. Bordallo-Aragon, Fernando Rodriguez-de-Fonseca, F. Mayoral-Cleríes
Abstract Objective Substance use disorders are highly prevalent in people living with a mental health disorder. Co-occurring substance use disorders have been associated with a worse prognosis and poorer adherence to treatment. The aim of this study was to analyze the temporal trends in the prevalence of substance use disorders in patients admitted to a psychiatric inpatient unit between 1998 and 2020. Methods This is a retrospective study based on the registry of 18,367 hospitalizations and 7,124 patients with a mental health disorder admitted during the period 1998 to 2020 in Malaga, Spain. Time trend analysis by gender and substance used was calculated using a segmented regression model. The permutation test was used to determine inflection points. A sensitivity analysis was performed based on the assumptions of autocorrelation and homoscedasticity. Results A total of 22.2% of admissions had a diagnosis of mental health disorder and co-occurring substance use disorders. Prevalence was higher among males (30.0%) than females (9.4%; p < .001). Patients with both disorders had a shorter length of stay by 2 days (p < .001) and a younger age at first admission (by 6.5 years; p < .001) compared to patients without substance use disorders. There was no difference in the total number of hospitalizations between the two groups. Psychotic disorders and multiple drug use disorders were the most prevalent diagnoses in men compared to women, whereas personality disorders and alcohol use were the most common diagnoses in women. We observed an increase in the prevalence of dual diagnosis between 2005 and 2020. There was a 3.0% increase in cannabis-related admissions per year during the whole study period (p < .001). Cannabis and cocaine use disorders have become the most prevalent in the last 10 years, while opioid and alcohol use disorders have decreased. Conclusions Co-occurring substance use disorders are highly prevalent among hospitalized patients. In recent years, the pattern of substance use has shifted, with cannabis being the most prevalent, while opiates and alcohol substance use have decreased. We need to devise a specialized approach and integrative treatment for patients with co-occurring disorders.
{"title":"Trends in Psychiatric Hospitalizations of Patients With Dual Diagnosis in Spain","authors":"Carlos Gómez-Sánchez-Lafuente, J. Guzmán-Parra, J. Suarez-Perez, A. Bordallo-Aragon, Fernando Rodriguez-de-Fonseca, F. Mayoral-Cleríes","doi":"10.1080/15504263.2022.2053770","DOIUrl":"https://doi.org/10.1080/15504263.2022.2053770","url":null,"abstract":"Abstract Objective Substance use disorders are highly prevalent in people living with a mental health disorder. Co-occurring substance use disorders have been associated with a worse prognosis and poorer adherence to treatment. The aim of this study was to analyze the temporal trends in the prevalence of substance use disorders in patients admitted to a psychiatric inpatient unit between 1998 and 2020. Methods This is a retrospective study based on the registry of 18,367 hospitalizations and 7,124 patients with a mental health disorder admitted during the period 1998 to 2020 in Malaga, Spain. Time trend analysis by gender and substance used was calculated using a segmented regression model. The permutation test was used to determine inflection points. A sensitivity analysis was performed based on the assumptions of autocorrelation and homoscedasticity. Results A total of 22.2% of admissions had a diagnosis of mental health disorder and co-occurring substance use disorders. Prevalence was higher among males (30.0%) than females (9.4%; p < .001). Patients with both disorders had a shorter length of stay by 2 days (p < .001) and a younger age at first admission (by 6.5 years; p < .001) compared to patients without substance use disorders. There was no difference in the total number of hospitalizations between the two groups. Psychotic disorders and multiple drug use disorders were the most prevalent diagnoses in men compared to women, whereas personality disorders and alcohol use were the most common diagnoses in women. We observed an increase in the prevalence of dual diagnosis between 2005 and 2020. There was a 3.0% increase in cannabis-related admissions per year during the whole study period (p < .001). Cannabis and cocaine use disorders have become the most prevalent in the last 10 years, while opioid and alcohol use disorders have decreased. Conclusions Co-occurring substance use disorders are highly prevalent among hospitalized patients. In recent years, the pattern of substance use has shifted, with cannabis being the most prevalent, while opiates and alcohol substance use have decreased. We need to devise a specialized approach and integrative treatment for patients with co-occurring disorders.","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76387111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01Epub Date: 2022-04-07DOI: 10.1080/15504263.2022.2052225
James H Ford, Deepika Rao, Aaron Gilson, Arveen Kaur, Helene Chokron Garneau, Lisa Saldana, Mark P McGovern
Objective: Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). Methods: In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort 1, n = 25) or to a Waitlist control (Cohort 2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. Results: The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. Conclusions: NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients "wait no longer" to receive integrated treatment and medications for their COD.
{"title":"Wait No Longer: Reducing Medication Wait-Times for Individuals with Co-Occurring Disorders.","authors":"James H Ford, Deepika Rao, Aaron Gilson, Arveen Kaur, Helene Chokron Garneau, Lisa Saldana, Mark P McGovern","doi":"10.1080/15504263.2022.2052225","DOIUrl":"10.1080/15504263.2022.2052225","url":null,"abstract":"<p><p><b>Objective:</b> Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). <b>Methods:</b> In a cluster-randomized waitlist control group design, community addiction treatment agencies (<i>n</i> = 49) were randomized to receive the NIATx strategy (Cohort 1, <i>n</i> = 25) or to a Waitlist control (Cohort 2, <i>n</i> = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. <b>Results:</b> The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. <b>Conclusions:</b> NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients \"wait no longer\" to receive integrated treatment and medications for their COD.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503325/pdf/nihms-1834974.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9258229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}