A Comparison of Treatment Outcomes for Individuals with Substance Use Disorder Alone and Individuals with Probable Dual Diagnosis

Delivery Outcomes Among Pregnant Women With Comorbid Psychiatric and Substance Use Disorders Receiving Comprehensive Treatment

BACKGROUND: Pregnant women with substance use disorders (SUDs) are at risk for adverse delivery outcomes, and some of these women have psychiatric comorbidities that increase this risk. AIMS: Although comprehensive care models offering prenatal care services and substance abuse treatment have been found to positively affect delivery outcomes for pregnant women with SUDs, there is a dearth of research to support such models for women who have psychiatric comorbidities. METHODS: A secondary data analysis was conducted to understand the relationship between pretreatment psychiatric comorbidity and delivery outcomes for pregnant clients with SUDs receiving comprehensive treatment. We analyzed two groups of pregnant women with SUDs and hypothesized that women with psychiatric comorbidities would have worse neonatal and maternal outcomes compared with those who did not have any pretreatment psychiatric comorbidity. Regression models were used to examine changes in delivery outcome criteria (birthweight, neonatal abstinence syndrome, maternal urine toxicology screens at delivery, and hospital length of stay) in relation to psychiatric comorbidity among a sample of 74 mother-baby dyads receiving comprehensive care treatment. RESULTS: Results did not support our hypothesis as delivery outcomes were statistically similar for both groups. CONCLUSION: Findings suggest comprehensive care can reduce the risk of negative delivery outcomes among women with SUDs who have psychiatric comorbidities. Treatment and research implications are provided.

An examination of abstinence social support among recovery home residents with psychiatric comorbidity

BACKGROUND

Although social support is a resource that helps persons in their recovery from substance use disorders, it is not clear whether specific types buffer the effects of stress and optimize outcomes for those with psychiatric comorbidity. This investigation examined two types of social support in relation to lengths of stay to identify mechanisms related to retention among individuals with psychiatric comorbidity living in community-based settings.

METHODS

Baseline rates of social support (abstinence specific and general types) and stress were examined in relation to follow-up lengths of stay (at four-months and beyond) among individuals (N = 368) with psychiatric comorbidity (n = 90) and no psychiatric comorbidity (n = 278) living in community-based settings (Oxford Houses) in the U.S. The psychiatric severity index of the Addiction Severity Index was used as a proxy measure of psychiatric comorbidity. Moderated mediation analyses were conducted to test the potential mediating effects of abstinence social support and general social support on the relationship between stress and lengths of stay, and whether these were influenced by psychiatric comorbidity.

RESULTS

A full mediating effect was observed for abstinence social support for residents with psychiatric comorbidity, whereas a partial mediating effect for general social support was observed for all residents.

CONCLUSIONS

Findings demonstrate qualities of social support have differential effects, substantiating the notion that specific components of social support optimize outcomes for those with psychiatric comorbidity living in recovery homes.

Psychological Symptoms and Outcomes in Adults Receiving Community-based Treatment for Substance Use Disorders

BACKGROUND

Mental health issues in individuals with substance use disorders are common and can affect treatment outcomes.

OBJECTIVES

Secondary analysis of a multi-center trial of an internet-delivered psychosocial SUD treatment intervention (Therapeutic Education System; TES) to: 1) describe psychological symptoms over time, 2) explore whether treatment assignment was associated with psychological symptoms 3) explore whether psychological symptoms at baseline moderated the effect of TES on abstinence or retention at the end of treatment.

METHODS

Psychological symptoms were measured using the Global Severity Index (GSI) from the Brief Symptom Inventory (BSI-18), PHQ-9, and MINI SPIN (social anxiety). Zero-inflated-negative-binomial models given high numbers of "0" GSI scores and multivariate logistic regression models were run to estimate the effect of the interaction between treatment and baseline psychological symptoms.

RESULTS

The mean age was 35, 37.9% were female, 56.0% were white. Fifty-four percent had a negative urine drug or breath alcohol screen at baseline. Mean GSI score at baseline was 13.5 (SD = 12.6). GSI scores significantly improved (p<.0001) over time. Treatment was not significantly associated with GSI scores (aIRR = 0.97, 95%CI = 0.85-1.11). Those with social anxiety at baseline had a higher likelihood of achieving abstinence when receiving TES compared to TAU (b = 1.2071, SE = 0.6109, p = 0.0482).

CONCLUSIONS

Psychological symptoms may improve over time in individuals seeking treatment for SUD, and for those with social anxiety, technology-based treatments may result in a better response. Examining the effect of SUD treatment on broader psychological outcomes in addition to abstinence may help clinicians provide more individualized care for those with co-occurring conditions.

The relationship between substance misuse and complicated grief: A systematic review

Complicated grief is a prolonged, bereavement-specific disorder with significant psychological and physical consequences. Although complicated grief represents a risk to individuals with substance misuse, this relationship is poorly understood. Consequently, this systematic literature review examined empirical findings regarding the relationship between substance misuse and complicated grief. We searched 11 databases to identify pertinent quantitative studies published in English. Our search yielded 12 peer-reviewed journal articles (N = 1749) published between 1997 and 2017. Included studies evaluated the prevalence, assessment, etiology, correlates, risk factors, and treatment of complicated grief and substance misuse among individuals with one or both conditions. Our review found evidence of a positive relationship between complicated grief and substance misuse. Individuals with substance misuse were at increased risk for subsequent development of complicated grief, particularly when increases in substance consumption preceded bereavement. Conversely, complicated grief predicted increases in smoking and alcohol dependence. Multiple risk factors for individuals with complicated grief and substance misuse were identified and discussed. An existing complicated grief assessment performed well among individuals with substance misuse, and grief interventions were effective in reducing symptoms of complicated grief and substance misuse simultaneously. Given the severity of consequences associated with both conditions, more research is needed to understand this relationship, identify effective assessment tools, and evaluate intervention strategies to improve outcomes.

Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community

BACKGROUND

Program attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures.

METHODS

Retrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8).

RESULTS

Completion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems.

CONCLUSION

The findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.

Comparative Analysis of Treatment Conditions upon Psychiatric Severity Levels at Two Years Among Justice Involved Persons

PURPOSE

The aim of this investigation was to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses.

DESIGN/METHODOLOGY

A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n = 39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome.

FINDINGS

Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions.

RESEARCH LIMITATIONS/IMPLICATIONS

Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally-run residential integrated treatments for justice involved persons who have dual diagnoses.

SOCIAL IMPLICATIONS

Results support the utilization of low-cost, community-based treatments for a highly marginalized population.

ORIGINALITY/VALUE

Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.