Journal of Dual Diagnosis最新文献

{"title":"Differential Predictors of Suicidal Ideation and Suicide Attempts: Internalizing Disorders and Substance Use in a Clinical Sample of Adolescents.","authors":"Lauren M Berny,&nbsp;Emily E Tanner-Smith","doi":"10.1080/15504263.2021.2016343","DOIUrl":"https://doi.org/10.1080/15504263.2021.2016343","url":null,"abstract":"<p><p><b>Objective:</b> Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. <b>Methods:</b> Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. <b>Results:</b> Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. <b>Conclusions:</b> Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":"18 1","pages":"59-69"},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960344/pdf/nihms-1770857.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10484159","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}

{"title":"Catatonic Episodes Related to Substance Use: A Cross-Sectional Study Using Electronic Healthcare Records.","authors":"Su Ying Yeoh,&nbsp;Emmert Roberts,&nbsp;Fraser Scott,&nbsp;Timothy R Nicholson,&nbsp;Anthony S David,&nbsp;Jonathan P Rogers","doi":"10.1080/15504263.2021.2016342","DOIUrl":"https://doi.org/10.1080/15504263.2021.2016342","url":null,"abstract":"<p><p><b>Objective:</b> Substance use has increasingly been linked to the onset of catatonic episodes; however, no large observational studies have examined this association. This study aimed to identify catatonic episodes temporally associated with acute intoxication, withdrawal or chronic substance use, investigate which substances were involved, and compare clinical characteristics of substance-related and non-substance-related catatonic episodes. <b>Methods:</b> This study retrospectively identified all catatonic episodes recorded in an electronic case register hosted at a large secondary mental health trust in London, UK. Episodes were categorized as substance-related if the clinical record reported either a positive urine drug screen, an ICD-10 diagnosis of a mental or behavioral disorder due to substance use, or documented substance use between two weeks prior to the catatonic episode and the date of the catatonic episode. <b>Results:</b> 108 of 2130 catatonic episodes (5.1%) were deemed substance-related. The number of contemporaneously reported substance-related episodes increased between 2007 and 2016 [<i>r</i> = 0.72, <i>p</i> = 0.02]. Episodes in the context of acute intoxication (<i>n</i> = 54) were most frequently related to cannabis (<i>n</i> = 31) or cocaine (<i>n</i> = 5) use, whilst those in the context of drug withdrawal (<i>n</i> = 8) were most commonly related to alcohol, opioids and benzodiazepines. There were 50 episodes of catatonia associated with chronic substance use without intoxication or withdrawal, of which the majority were related to cannabis use (<i>n</i> = 37). 21 episodes had overlapping intoxication, withdrawal and chronic use of different substances within an episode. Compared to catatonic episodes not related to substance use, episodes of substance-related catatonia occurred in individuals who were younger (mean age 31.3 years [SD 12.2] vs 35.7 years [SD 16.3], <i>p</i> = 0.01) and more likely to be men (74.0% vs 54.3%, <i>p</i> < 0.001). The clinical features of catatonia were similar between the two groups. <b>Conclusions:</b> A relatively small proportion of catatonic episodes were temporally associated with reported substance use within their electronic records. Substance-related catatonic episodes were mostly related to cannabis use, but other substances including cocaine, alcohol, opioids and benzodiazepines were sometimes implicated. This is likely an underestimate of substance-related catatonia use due to issues with documentation and appropriate investigation.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":"18 1","pages":"52-58"},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9106613","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}

{"title":"Sex Differences across Retrospective Transitions in Posttraumatic Stress and Substance Use Disorders.","authors":"MacKenzie R Peltier,&nbsp;Walter Roberts,&nbsp;Terril L Verplaetse,&nbsp;Yasmin Zakiniaeiz,&nbsp;Catherine Burke,&nbsp;Kelly E Moore,&nbsp;Sherry A McKee","doi":"10.1080/15504263.2021.2016027","DOIUrl":"https://doi.org/10.1080/15504263.2021.2016027","url":null,"abstract":"<p><p><b>Objectives:</b> Concurrent substance use disorder (SUD) and posttraumatic stress disorder (PTSD) occur at high rates and are typically associated with poor treatment outcomes in both sexes. However, women have a propensity to cope with increased negative affect via substance use in comparison to men; thus, it is important to elucidate the sex-specific bidirectional relationships between SUD and PTSD to improve our understanding of concurrent SUD/PTSD in men and women. <b>Methods:</b> Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-Wave 3; <i>n</i> = 36,309), the present study evaluated the impact of sex on the relationship between past-year SUDs (new, remitted, ongoing), including alcohol and drug use, and retrospective transitions in new <i>vs.</i> absent and ongoing <i>vs.</i> remitted diagnoses of PTSD. Additionally, the impact of sex was explored in models examining past year PTSD (new, remitted, ongoing) and retrospective transitions in new <i>vs.</i> absent and ongoing <i>vs.</i> remitted diagnosis of SUDs. Diagnostic transitions were based on retrospective reporting. <b>Results:</b> Results indicated that new, remitted, and ongoing SUDs increase the likelihood of new PTSD diagnoses (<i>OR</i> range = 2.53-8.11; <i>p</i> < 0.05). Among individuals with ongoing drug use disorders (DUD), there were greater odds of ongoing PTSD (<i>OR</i> = 2.10, <i>p</i> < 0.01). When examining the relationship reciprocally, new, remitted, and ongoing PTSD increased the likelihood of new SUDs (<i>OR</i> range = 2.50-8.22; <i>p</i> < 0.05), and ongoing PTSD increased the likelihood of ongoing SUD and DUD (<i>OR</i> = 1.40, 1.70, respectively; <i>p</i> < 0.05). Sex-specific analyses revealed that the relationship between PTSD and SUDs varies between sexes, particularly among women. For instance, women with new PTSD had higher odds of SUDs, and women with ongoing PTSD were almost 2.5 times more likely to have an ongoing DUD. Women with a new PTSD diagnosis were more likely to be diagnosed with a new SUD (<i>OR</i> = 3.27) and an ongoing DUD (<i>OR</i> = 3.08). <b>Conclusions:</b> Results indicate a bidirectional relationship between PTSD and SUD that is in many instances larger in women. Thus, illustrating potential sex-specific differences in underlying mechanisms implicated in SUD/PTSD, warranting additional research.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":"18 1","pages":"11-20"},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086923/pdf/nihms-1798509.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10457320","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}

{"title":"Moderators for the Relationship between Post-Traumatic Stress Disorder and Opioid Use Disorder.","authors":"Samia Tasmim,&nbsp;Bernard Le Foll,&nbsp;Ahmed N Hassan","doi":"10.1080/15504263.2021.2016341","DOIUrl":"https://doi.org/10.1080/15504263.2021.2016341","url":null,"abstract":"<p><p><b>Objective:</b> Post-traumatic stress disorder (PTSD) is a common risk factor for opioid use disorder (OUD). However, not all individuals with PTSD develop OUD when exposed to opioids. As the underlying moderators remain unexplored, this analysis aimed to determine if non-traumatic adverse experiences and stressors prior to the age of 18 moderate the relationship between PTSD and OUD. <b>Methods:</b> In a matched dataset (<i>n</i> = 830) of individuals with or without PTSD who reported lifetime use of opioids, the following non-traumatic adverse experiences and stressors were assessed: emotional abuse, emotional neglect and physical neglect, parents' adverse experiences, and number of days jailed before the age of 18. Using the PROCESS macro in SAS for each factor, the conditional effects were estimated through simple slopes. Moderation was inferred through significant interaction effects. <b>Results:</b> The matched data were similar on age, gender, ethnicity, education, being born in the US, living with, or losing biological parents before age 18, and family history of depression, anxiety, and substance use disorder. Significantly more individuals in the preexisting PTSD group had preexisting psychiatric disorders, and preexisting substance use and schizotypal personality disorder. Childhood emotional abuse and neglect and physical neglect (effect: 0.03; 95%CI: 0.001-0.056; <i>p</i> = .039), and more than one event of adversity experienced by parents (effect: 0.34; 95%CI: 0.07-0.61; <i>p</i> = .013) significantly interacted with PTSD to lead to OUD. <b>Conclusion:</b> The conditional effect of PTSD on the development of OUD after exposure to opioids was dependent on the frequency and severity of childhood non-traumatic adverse experiences. To identify individuals with PTSD who are at a high risk of developing OUD, programs may focus on non-traumatic adverse childhood experiences that are not commonly explored. Future steps may include focusing on educational schemes to mitigate this higher risk of developing OUD in at-risk individuals, for example, by discussing the risks when prescribing opioids.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":" ","pages":"3-10"},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39660849","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}

{"title":"Posttraumatic Stress Disorder and Substance Misuse Among Black Emerging Adults: The Influence of Social Support.","authors":"Miranda E Reyes, Joseph S Rossi, Emmanuel D Thomas, Silvi C Goldstein, Nicole H Weiss","doi":"10.1080/15504263.2021.2017221","DOIUrl":"10.1080/15504263.2021.2017221","url":null,"abstract":"<p><p><b>Objective:</b> Black emerging adults are significantly impacted by substance misuse. Posttraumatic stress disorder (PTSD) is associated with heightened substance misuse among Black emerging adults. However, limited research has identified protective factors that may influence the strength of the relation between PTSD and substance misuse in this population. Addressing this important limitation, the present study examined the potential moderating role of perceived social support in the association between PTSD symptoms and substance (i.e., alcohol and drug) misuse. <b>Methods:</b> Participants were 182 trauma-exposed Black emerging adults (<i>M</i> age = 20.50; 71.3% women) who completed self-report measures assessing PTSD symptoms, alcohol and drug misuse, and perceived social support. <b>Results:</b> PTSD symptoms were significantly and positively correlated with both alcohol and drug misuse. Moderation analyses indicated that positive relations between PTSD symptoms and both alcohol and drug misuse were only significant among Black emerging adults with lower (but not higher) levels of perceived social support. <b>Conclusions:</b> These findings suggest the potential utility of addressing social support in the assessment and treatment of substance misuse in trauma-exposed Black emerging adults.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":"18 1","pages":"42-51"},"PeriodicalIF":1.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128832/pdf/nihms-1804490.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10806605","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}

{"title":"Journal of Dual Diagnosis: Highlights from 2021.","authors":"E Sherwood Brown","doi":"10.1080/15504263.2022.2022298","DOIUrl":"https://doi.org/10.1080/15504263.2022.2022298","url":null,"abstract":"The year 2021 will be remembered for, among other events, the prolonged coronavirus outbreak due to the emergence of the Delta and Omicron variants. The pandemic has brought death and isolation, as well as unemployment and other economic consequences. It has also had a negative effect on research. This difficult year has, however, seen growth in the Journal of Dual Diagnosis. The journal’s 2020 impact factor increased to 1.613. The 5-year impact factor continues to increase and once again reached a new high, as did the article influence score, immediacy index, Eigenfactor score and total citations. The journal is also international in reach with papers from 24 countries published in the journal over the past three years. Dr. Alan Green, the Journal of Dual Diagnosis’ editor for many years, passed away in late 2019 after a long illness. His extraordinary contributions both to the Journal of Dual Diagnosis and to the dual diagnosis field were remembered in several editorials in Issue 2 (Brown, 2021; Brunette, 2021; Buckley, 2021; Henricks et al., 2021). Several papers during 2021 focused on trauma and substance use. Lebeaut et al. examined a group of firefighters with post-traumatic stress disorder (PTSD) and alcohol use disorder, PTSD only, alcohol use disorder only and only trauma exposure. They observed that firefighters with PTSD only or PTSD with alcohol use disorder demonstrated elevated anxiety sensitivity and emotional regulation tolerance, and reduced distress tolerance and mindfulness compared to other groups (Lebeaut et al., 2021). Blakey et al. examined drinking to cope in a large sample of men with and without military experience. They observed that drinking to cope was more common in those with military experience even after controlling for PTSD diagnosis (Blakey et al., 2021). McGee-Vincent et al. discuss the development of mobile mental health apps from the National Center for PTSD (McGee-Vincent et al., 2021). The paper discussed above highlights the potential for technology to change dual diagnosis treatment. Another paper on this topic from the past year was by Sugarman et al. The authors observed that few patients were currently using apps and other web-based technology. However, they determined that patients expressed interest in this technology and identified areas in which this technology might be useful for young women (Sugarman et al., 2021). Systematic reviews summarize findings from a variety of studies allowing the readers to better evaluate available evidence (Gopalakrishnan & Ganeshkumar, 2013). The Journal of Dual Diagnosis published three such papers in 2021. Hawes et al. reviewed the literature on psychosocial interventions for smoking cessation on people with major psychiatric illnesses and found that most studies suggest these types of interventions increase abstinence (Hawes et al., 2021). Moraleda-Barreno et al. reviewed the literature on executive functioning in people with substance use and personality disorde","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39746465","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}

{"title":"Associations Between Lifetime Panic Attacks, Posttraumatic Stress Disorder, and Substance Use Disorders in a Nationally Representative Sample.","authors":"Shannon M Blakey,&nbsp;Sarah B Campbell,&nbsp;Tracy L Simpson","doi":"10.1080/15504263.2021.2013096","DOIUrl":"https://doi.org/10.1080/15504263.2021.2013096","url":null,"abstract":"<p><p><b>Objective:</b> Rates of lifetime substance use disorder (SUD) are high among people with lifetime posttraumatic stress disorder (PTSD). Panic attacks are also prevalent among trauma survivors and people with SUD, yet studies on PTSD/SUD have rarely examined comorbid panic. This potentially creates additional barriers to effective treatment for people with PTSD/SUD, in that panic may be under-diagnosed among people with PTSD/SUD and consequently attenuate treatment outcome. Additionally, research on PTSD/SUD often combines people with alcohol use disorder (AUD) and people with drug use disorders (DUDs) into a single group despite evidence that these two PTSD/SUD subgroups differ along important sociodemographic and clinical variables. This study tested the hypothesis that among adults with lifetime PTSD, panic attacks would be associated with greater lifetime risk for both AUD and DUD. We also explored whether panic attacks were associated with specific DUDs that frequently co-occur with PTSD (cannabis, sedatives/tranquilizers, heroin/opioids, and cocaine). <b>Methods:</b> Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a cross-sectional national study. Adults with lifetime PTSD (<i>N</i> = 2,230) were classified into one of three groups based on diagnostic interview data: adults with PTSD/AUD (i.e., met criteria for PTSD and AUD but not DUD; <i>n</i> = 656), adults with PTSD/DUD (i.e., met criteria for PTSD and DUD, regardless of AUD diagnostic status; <i>n</i> = 643), or adults with PTSD-only (i.e., met criteria for PTSD but not AUD or DUD; <i>n</i> = 1,031). <b>Results:</b> Weighted logistic regression analyses showed that lifetime risk of PTSD/AUD and PTSD/DUD, each relative to PTSD-only, was greater for adults who were younger at the time of data collection, were male, and had a history of panic attacks. Panic attacks did not predict <i>specific</i> DUD diagnoses comorbid with PTSD in exploratory analyses adjusting for sociodemographic and clinical covariates. <b>Conclusions:</b> Findings highlight the importance of assessing and targeting panic in PTSD/SUD clinics, but suggest panic may not discriminate between specific DUDs that commonly co-occur with PTSD. Study limitations and future directions are discussed.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":" ","pages":"21-32"},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39883617","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}

{"title":"Comparison of Perceptions and Smoking Cessation Experiences Between Smokers With and Without Serious Mental Illness in a Large Health Maintenance Organization.","authors":"Jennifer Kertes,&nbsp;Yehuda Neumark,&nbsp;Leon Grunhaus,&nbsp;Orit Stein-Reisner","doi":"10.1080/15504263.2021.1979348","DOIUrl":"https://doi.org/10.1080/15504263.2021.1979348","url":null,"abstract":"<p><strong>Objective: </strong>Smoking prevalence is threefold higher among people with serious mental illness (PWSMI) than in the general population, yet smoking cessation rates for PWSMI are lower. Numerous reasons have been posited as to why tobacco use is higher and abstinence rates are lower among PWSMI. This study explores smoking cessation perceptions and experiences among PWSMI and people without serious mental illness (SMI).</p><p><strong>Methods: </strong>Participants in this cross-sectional study were recruited from among members of a large health maintenance organization (HMO) in Israel who had registered for or commenced a smoking cessation program in 2015 through 2017. The sample comprised 208 PWSMI and a matched sample of people without SMI (<i>N</i> = 428). Telephone surveys were used to collect information about smoking status and smoking/cessation history, use of smoking cessation programs and aids (prescription medications, nicotine replacement therapy, electronic cigarettes), motivation and intention to quit, self-efficacy (to quit), smoking cessation outcome expectancies, physician support to quit, barriers and facilitators for those who had not quit, and reinforcements/challenges for those who had quit.</p><p><strong>Results: </strong>Of those without SMI, 27% quit smoking compared to 20% of PWSMI (<i>p</i> = .051). Irrespective of mental health status, the most significant predictor of abstinence was the use of smoking cessation prescription medications. Family physicians were significantly less likely to inquire about motivation to quit, refer to smoking cessation programs, or prescribe smoking cessation medications for PWSMI than for people without SMI. Beyond these factors, no differences were noted between respondents with and without SMI regarding motivation to quit, intention to quit, and abstinence self-efficacy. PWSMI who had not quit were more likely to be concerned about how quitting might affect their functioning and how they would pass the time without cigarettes.</p><p><strong>Conclusions: </strong>PWSMI have similar levels of motivation and intention to quit smoking as those without SMI. However, they are disadvantaged by the reduced support received from their family physicians and lower cessation medication usage. Efforts to promote the implementation of smoking cessation treatment guidelines will help promote smoking abstinence among PWSMI.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":" ","pages":"284-295"},"PeriodicalIF":2.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39519746","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}

{"title":"Implementation of a Multi-Modal Training Program for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings: Pathways to Comorbidity Care (PCC).","authors":"Eva Louie,&nbsp;Kirsten C Morley,&nbsp;Vicki Giannopoulos,&nbsp;Gabriela Uribe,&nbsp;Katie Wood,&nbsp;Christina Marel,&nbsp;Katherine L Mills,&nbsp;Maree Teesson,&nbsp;Michael Edwards,&nbsp;Steven Childs,&nbsp;David Rogers,&nbsp;Adrian Dunlop,&nbsp;Andrew Baillie,&nbsp;Paul S Haber","doi":"10.1080/15504263.2021.1984152","DOIUrl":"https://doi.org/10.1080/15504263.2021.1984152","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the impact of the Pathways to Comorbidity Care (PCC) training program for alcohol and other drugs (AOD) clinicians to improve the management of comorbidity.</p><p><strong>Methods: </strong>A controlled before-and-after study using PCC training was conducted across 6 matched sites in Australia including 35 clinicians. Controls received standard workplace training. PCC training included seminar presentations, workshops conducted by local \"clinical champions,\" individual clinical supervision, and access to an online information portal. We examined (a) identification (screening, assessment) and treatment (treatment, referral) of comorbidity in practice (<i>N</i> = 10 clinical files per clinician), (b) self-efficacy, knowledge, and attitudes of clinicians.</p><p><strong>Results: </strong>Significant improvements were observed in the PCC group but not the control sites with regards to the rate of clinical files showing identification of comorbidity (+50% v -12% change from baseline, respectively; [<i>X²</i> (1, <i>N</i> = 340) = 35.29, <i>p</i> = .01] with only a trend for improvements in the rate of files demonstrating treatment of comorbidity [<i>X²</i> (1, <i>N</i> = 340) = 10.45, <i>p</i> = .06]. There were significant improvements in the PCC relative to the control group for clinician self-efficacy, <i>F</i>(1,33) = 6.40, <i>p</i> = .02 and knowledge and attitudes of comorbidity monitoring, <i>F</i>(1,33) = 8.745, <i>p</i> = .01.</p><p><strong>Conclusions: </strong>The PCC training package may help improve identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity in drug and alcohol settings.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":" ","pages":"304-312"},"PeriodicalIF":2.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39558543","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}

{"title":"Economic Evaluation of the SOS Training to Reduce Victimization in Dual Diagnosis Patients.","authors":"Marleen M de Waal,&nbsp;Matthijs Blankers,&nbsp;Nick M Lommerse,&nbsp;Martijn J Kikkert,&nbsp;Jack J M Dekker,&nbsp;Anna E Goudriaan","doi":"10.1080/15504263.2021.1965409","DOIUrl":"https://doi.org/10.1080/15504263.2021.1965409","url":null,"abstract":"<p><strong>Objective: </strong>Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyze the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU).</p><p><strong>Methods: </strong>We performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up.</p><p><strong>Results: </strong>There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [-€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [-0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs.</p><p><strong>Conclusions: </strong>At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.</p>","PeriodicalId":46571,"journal":{"name":"Journal of Dual Diagnosis","volume":" ","pages":"333-343"},"PeriodicalIF":2.2,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39454113","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}