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Nord-Baade S, Ness O, Jensen CB, Rowe M, Opheim E, Landheim A. Barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems. A qualitative scoping review. PLoS One 2024; 19:e0315758. [PMID: 39680564 PMCID: PMC11649107 DOI: 10.1371/journal.pone.0315758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 11/30/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND People with concurrent mental health and substance use problems are among the most socially excluded groups in our society, yet little attention has been paid to what socially excluded people see as central to promoting their social inclusion. The aim of this qualitative scoping review is to provide an overview of barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems, based on first-person perspectives, to help guide future research, policies, and practice. METHODS We explored first-person perspectives on social inclusion among people with concurrent mental health and substance use problems, employing Arksey and O'Malleys framework. We searched Medline, PsycINFO, Embase, Scopus, Cinahl, and other sources for studies published between January 2000 and September 2023. We employed content analysis and followed the PRISMA checklist. RESULTS We included 55 articles included in our review and identified sub themes of: Intrapersonal baseline (identity, belonging), Components of social inclusion (relationships, meaningful activities, employment, economy), and Systemic failure or success (housing, public health and welfare services, the criminal justice system). CONCLUSION Social inclusion is rarely studied outside the context of direct services. Our results point to knowledge gaps in addressing social inclusion in a broad, societal context; implementing gaps in services; and developing policies to assure the fundamental needs and human rights of socially excluded persons.
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Affiliation(s)
- Silje Nord-Baade
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Ottar Ness
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Camilla Bergsve Jensen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
| | - Michael Rowe
- Inland Norway University of Applied Sciences, Elverum, Norway
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Elin Opheim
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
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Hetland J, Lundervold AJ, Erga AH. Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study. BMC Psychiatry 2024; 24:143. [PMID: 38378466 PMCID: PMC10880353 DOI: 10.1186/s12888-024-05600-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation. METHODS N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates. RESULTS The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five. CONCLUSIONS Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.
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Affiliation(s)
- Jens Hetland
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Aleksander H Erga
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Institute of Social Sciences, University of Stavanger, Stavanger, Norway
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Puértolas-Gracia B, Barbaglia MG, Gotsens M, Parés-Badell O, Brugal MT, Torrens M, Treviño L, Rodríguez-Díaz C, Vázquez-Vázquez JM, Pascual A, Coromina-Gimferrer M, Jiménez-Dueñas M, Oliva I, González E, Mestre N, Bartroli M. Lifetime Dual Disorder Screening and Treatment Retention: A Pilot Cohort Study. J Clin Med 2022; 11:jcm11133760. [PMID: 35807045 PMCID: PMC9267195 DOI: 10.3390/jcm11133760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
The coexistence of a substance use disorder and another mental disorder in the same individual has been called dual disorder or dual diagnosis. This study aimed to examine the prevalence of lifetime dual disorder in individuals with alcohol or cocaine use disorder and their retention in treatment. We conducted a pilot cohort study of individuals (n = 1356) with alcohol or cocaine use disorder admitted to treatment in the public outpatient services of Barcelona (Spain) from January 2015 to August 2017 (followed-up until February 2018). Descriptive statistics, Kaplan−Meier survival curves and a multivariable Cox regression model were estimated. The lifetime prevalence of screening positive for dual disorder was 74%. At 1 year of follow-up, >75% of the cohort remained in treatment. On multivariable analysis, the factors associated with treatment dropout were a positive screening for lifetime dual disorder (HR = 1.26; 95% CI = 1.00−1.60), alcohol use (HR = 1.35; 95% CI = 1.04−1.77), polysubstance use (alcohol or cocaine and cannabis use) (HR = 1.60; 95% CI = 1.03−2.49) and living alone (HR = 1.34; 95% CI = 1.04−1.72). Lifetime dual disorder is a prevalent issue among individuals with alcohol or cocaine use disorders and could influence their dropout from treatment in public outpatient drug dependence care centres, along with alcohol use, polysubstance use and social conditions, such as living alone. We need a large-scale study with prolonged follow-up to confirm these preliminary results.
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Affiliation(s)
- Beatriz Puértolas-Gracia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - María Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93202-7702
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Oleguer Parés-Badell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - María Teresa Brugal
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marta Torrens
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Faculty of Medicine, Universitat de Vic i Catalunya Central, Vic, 08500 Barcelona, Spain
| | - Lara Treviño
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Concepción Rodríguez-Díaz
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - José María Vázquez-Vázquez
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Alicia Pascual
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marcela Coromina-Gimferrer
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Míriam Jiménez-Dueñas
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Israel Oliva
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Erick González
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Nicanor Mestre
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
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Ghosh A, Bn S, Sharma K, Roub FE, Mahintamani T, Basu D, Mattoo SK. How did the COVID-19 lockdown impact patients with dual diagnoses? ADVANCES IN DUAL DIAGNOSIS 2022. [DOI: 10.1108/add-03-2022-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose
Individuals with dual diagnoses might experience significant clinical and social vulnerabilities during the pandemic and lockdown. This study aims to compare medication adherence, substance use, clinical stability and overall functioning before and during lockdown periods.
Design/methodology/approach
This was a cross-sectional survey among patients registered in dual diagnosis clinic of an addiction psychiatry center in Northern India between March 2019 and February 2020. This study approached 250 patients for telephonic interviews. This study assessed adherence to medications with the brief adherence rating scale (BARS). Global functioning was measured by global assessment of functioning. Clinical interviews assessed substance use and the clinical status of psychiatric disorders.
Findings
One hundred fifty patients were recruited. The mean age of the sample was 35.8 years. The sample had a slight preponderance of alcohol dependence. Depressive disorder was the largest category of psychiatric diagnosis. Compared to prelockdown period, during the lockdown, there were an increased number of days of nonadherence (X2 17.61, p < 0.05), proportion of patients underdosing (X2 8.96, p = 0.003) and lower BARS scores (t = 10.52, df = 144, p < 0.0001). More patients were abstinent from substances during the lockdown (X2 49.02, p < 0.0001). Clinical stability of psychiatric disorders did not differ during the two-time points, but overall functioning decreased during the lockdown (t = 2.118, p = 0.036). This study observed a small positive correlation (r = 0.2, p = 0.02) between functioning and adherence levels.
Originality/value
Lockdown was associated with poor medication adherence, change in substance use patterns and functional impairment. In the future, treatment programs and policies must take preemptive steps to minimize the effects of restrictions.
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Köck P, Meyer M, Elsner J, Dürsteler KM, Vogel M, Walter M. Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders - A Narrative Review. Front Psychiatry 2022; 13:827658. [PMID: 35280170 PMCID: PMC8907594 DOI: 10.3389/fpsyt.2022.827658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Adolescence and emerging adulthood are often referred to as youth. Transitional psychiatry addresses this target group, which considers patients between 15 and 25 years of age. Substance use usually begins and peaks at this stage of life. Psychiatric disorders, foremost attention-deficit/hyperactivity disorder, and affective disorders, conduct disorders, and first-episodes psychosis frequently appear in early life stages. This review aims to provide a broad overview of transitional-aged youth's most common psychiatric comorbidities with substance use disorders. A literature search was conducted in Embase and Pubmed, and the main findings are described narratively. We present main findings for the following comorbidities: attention-deficit/hyperactivity disorder, conduct disorder, personality disorders, affective disorders, psychotic disorders, and the phenomena of overdose and suicidality. In conclusion, co-occurring mental health disorders are common and appear to facilitate the development of substance use disorders and exacerbate their overall course. Substance use also affects the severity and course of comorbid psychiatric disorders. Overall, data on transition-age youth with substance use disorders are highly inconsistent. Universal screening and treatment guidelines do not yet exist but should be aimed for in the future.
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Affiliation(s)
- Patrick Köck
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Maximilian Meyer
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Julie Elsner
- University Psychiatric Clinics Basel, Clinic for Children and Adolescents, University of Basel, Basel, Switzerland
| | - Kenneth M Dürsteler
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Vogel
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Division of Substance Use Disorders, Psychiatric Clinic, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland
| | - Marc Walter
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
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Degan TJ, Kelly PJ, Robinson LD, Deane FP, Smith AM. Health literacy of people living with mental illness or substance use disorders: A systematic review. Early Interv Psychiatry 2021; 15:1454-1469. [PMID: 33254279 DOI: 10.1111/eip.13090] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/22/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023]
Abstract
AIM Health literacy is one's ability to use cognitive and social skills to access, understand and appraise health information. Despite poor health outcomes of people living with mental illness there is limited research assessing their health literacy. This systematic review aims to synthesise research on health literacy rates, conceptualizations, and outcomes of people living with mental illness, including substance use disorders. This will provide insights into how health literacy might be targeted to reduce these health inequities. METHODS A search of published literature in multiple databases up until February 2019 was conducted. One reviewer screened the titles, abstracts and keywords of identified publications and the eligibility of all full-text publications were assessed for inclusion along with a second reviewer. Both reviewers independently rated the quality of the included studies. RESULTS Fourteen studies were included in the review. Rates and measures of health literacy varied. Low health literacy and health literacy weaknesses were identified. There is a lack of research on the relationship between health literacy and other outcomes, particularly health service engagement. CONCLUSION The review highlights the high rates of low health literacy within this population compared with general populations. Most studies used a functional health literacy measure, despite its limitations, with only a few using multidimensional measures. Overall, there is limited research examining the impact that this populations health literacy has on their recovery and how it affects them over time. The review emphasizes the importance of practitioners assessing and targeting health literacy needs when working with this population.
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Affiliation(s)
- Tayla J Degan
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Anna M Smith
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
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Kruckow L, Tjagvad C, Clausen T, Banner J. Psychiatric disorders in a population of deceased drug users. Nord J Psychiatry 2021; 75:472-478. [PMID: 33650457 DOI: 10.1080/08039488.2021.1887350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To estimate the prevalence of psychiatric morbidity and dual diagnosis in a population of decedents with positive drug toxicology and evaluate changes over time between 2001-2002 and 2011-2012. MATERIALS AND METHODS A total of 520 autopsied drug users with positive toxicology were included in the study from 2001 to 2002 and from 2011 to 2012. Materials included autopsy reports, toxicological screening during autopsy and data from the Danish national health registers, including psychiatric diagnoses from psychiatric hospitals and ambulatory functions, dispensed prescription use from pharmacies and registered treatment for drug use disorders. RESULTS In 2001-2002, 63.3% of the decedents had only positive toxicology, 22.5% also had psychiatric morbidity, and 14.2% had a dual diagnosis. In 2011-2012, 56.4% had only positive toxicology, 26.1% also had psychiatric morbidity, and 17.5% had a dual diagnosis. None of the changes were significant. Decedents with only positive toxicology became older at time of death over time; decedents with psychiatric morbidity and a dual diagnosis did not. The prevalence of nonprescribed psychotropic medication, methadone and benzodiazepines increased. CONCLUSION Decedents with psychiatric morbidity and dual diagnosis did not increase their lifespan over a 10-year period. Decedents with only positive toxicology increasingly consumed nonprescribed psychotropic medication and may have suffered from undiagnosed psychiatric disorders. The prevalence of prescribed and nonprescribed benzodiazepines and methadone increased and may have contributed to premature mortality.
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Affiliation(s)
- Line Kruckow
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Tjagvad
- Norwegian Centre for Addiction Research [SERAF], University of Oslo, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research [SERAF], University of Oslo, Oslo, Norway
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Ünübol H, Sayar GH. Substance use and its risk factors in Turkey: a nationally representative sample study. J Ethn Subst Abuse 2020; 21:476-498. [DOI: 10.1080/15332640.2020.1781731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Icick R, Melle I, Etain B, Ringen PA, Aminoff SR, Leboyer M, Aas M, Henry C, Bjella TD, Andreassen OA, Bellivier F, Lagerberg TV. Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. J Affect Disord 2019; 256:348-357. [PMID: 31202989 DOI: 10.1016/j.jad.2019.05.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. METHODS 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. RESULTS 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. LIMITATIONS Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. CONCLUSION Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
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Affiliation(s)
- R Icick
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France.
| | - I Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Etain
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - P A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - S R Aminoff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Leboyer
- FondaMental Foundation, Créteil F-94000, France; Inserm U955, Psychiatric Genetics Team, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Henri Mondor, DHU PePsy, Psychiatry Center, Créteil F-94000, France
| | - M Aas
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France
| | - T D Bjella
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - T V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Risk Factors Associated With Psychiatric Comorbidity in a Sample of Male Egyptian Patients With Substance Use Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2019. [DOI: 10.1097/adt.0000000000000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Co-Occurrence of Substance use Disorders with other Psychiatric Disorders: Implications for Treatment Services. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/nsad-2014-0002] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction This paper critically evaluates the literature on the co-occurrence of substance-use disorders (SUDs) with other psychiatric conditions. Our review considers the variety of different associations between the two, and suggests the implications of the literature for the design of treatment services that address both types of disorders. Methods: A narrative review of research and theory was conducted, covering epidemiology of co-occurring psychiatric disorders worldwide, mechanisms underlying co-occurrence, and treatment models. Results: Epidemiological research has documented a high prevalence of co-occurring disorders in both clinical samples and the general population, although the literature is based primarily on studies in high-income countries and some of the overlap might be due to the co-occurrence of milder forms of both types of disorders. Consistent with what has been reported in other reviews, we conclude that clients with co-occurring disorders tend to have a more severe course of illness, more severe health and social consequences, more difficulties in treatment, and worse treatment outcomes than clients with a single disorder; we address the implications of these findings for the design of treatment services. Conclusions: Much of the evidence shows that separately, treatments for both SUD and other psychiatric disorders are effective in reducing substance use and in improving behavioral, familial, and psychosocial outcomes. The evidence further suggests that these outcomes might be improved when treatment modalities are offered in combination within an integrated treatment plan that simultaneously addresses substance abuse and psychiatric problems. It is concluded that there is potentially more to be gained from taking a public health perspective and working on efforts to implement existing evidence-based practices at the systems level, than from the current tendency to look for ever more powerful individual-level interventions at the clinical level.
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Milosevic I, Chudzik SM, Boyd S, McCabe RE. Evaluation of an integrated group cognitive-behavioral treatment for comorbid mood, anxiety, and substance use disorders: A pilot study. J Anxiety Disord 2017; 46:85-100. [PMID: 27568875 DOI: 10.1016/j.janxdis.2016.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/29/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
This paper presents the development and preliminary evaluation of an integrated group cognitive-behavioral treatment (CBT) for comorbid mood, anxiety, and substance use disorders. The 12-session, manualized treatment was developed collaboratively by a mental health program in a teaching hospital and a community-based addictions service and administered in both settings. Results from an uncontrolled effectiveness trial of 29 treatment completers suggest that integrated group CBT may reduce stress and alcohol use symptoms and improve substance refusal self-efficacy. Changes in symptoms of anxiety, depression, and drug use were not significant, although the effect size for anxiety reduction was in the medium range. Nonetheless, the clinical significance of treatment effects on mood, anxiety, and substance use symptoms was modest. Changes in coping skills and quality of life were not significant, although medium-to-large effects were observed for changes in several coping skills. Participants reported being highly satisfied with treatment, found the treatment strategies to be useful, and noted an improvement in their functioning, particularly socially. Methodological and sample size limitations warrant more rigorous follow-up investigations of this treatment. Results are considered in the context of the current literature on integrated psychological treatments for these common comorbidities.
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Affiliation(s)
- Irena Milosevic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Susan M Chudzik
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Susan Boyd
- Alcohol, Drug and Gambling Services, 21 Hunter St. E, 3rd Floor, Hamilton, Ontario, L8N 1M2, Canada.
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
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13
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Abstract
OBJECTIVES Episodes of psychotic agitation are frequent in patients with dual diagnosis, that is, in patients with concomitant psychiatric and substance use disorders. Rapid intervention is needed to treat the agitation at a mild stage to prevent the escalation to aggressive behavior. Inhaled loxapine has been demonstrated to rapidly improve symptoms of mild-to-moderate agitation in adults with psychiatric disorders (schizophrenia and bipolar disorder), but data on patients with dual diagnosis are scarce. METHODS This study is a retrospective review of data from a case series of patients with dual diagnosis, which were attended for symptoms of agitation while at the emergency room (n = 9), in the outpatient clinic (n = 4), or during hospitalization (n = 1) at 1 center in Spain. All patients received inhaled loxapine for treating the agitation episodes. RESULTS Data from 14 patients with dual diagnosis were reviewed. All patients had 1 or more psychiatric disorders (schizophrenia, bipolar I disorder, drug-induced psychotic disorder, posttraumatic stress, borderline or antisocial personality disorder, depression, or anxiety) along with a variety of substance use disorders (alcohol, cocaine, cannabis, amphetamines, hypnotics and antianxiety drugs, caffeine, or street drugs). Overall, only 1 dose of inhaled loxapine (9.1 mg) was needed to calm each patient during an acute episode of agitation. CONCLUSIONS Inhaled loxapine was rapid, effective, and well accepted in all dual-pathology patients presenting with acute agitation in the emergency setting. Inhaled loxapine facilitated both patient cooperation and an adequate management of his or her disease.
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14
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Gidhagen Y, Philips B, Holmqvist R. Outcome of psychological treatment of patients with substance use disorders in routine care. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1200149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Payer DE, Park MTM, Kish SJ, Kolla NJ, Lerch JP, Boileau I, Chakravarty MM. Personality disorder symptomatology is associated with anomalies in striatal and prefrontal morphology. Front Hum Neurosci 2015; 9:472. [PMID: 26379535 PMCID: PMC4553386 DOI: 10.3389/fnhum.2015.00472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/12/2015] [Indexed: 01/18/2023] Open
Abstract
Personality disorder symptomatology (PD-Sx) can result in personal distress and impaired interpersonal functioning, even in the absence of a clinical diagnosis, and is frequently comorbid with psychiatric disorders such as substance use, mood, and anxiety disorders; however, they often remain untreated, and are not taken into account in clinical studies. To investigate brain morphological correlates of PD-Sx, we measured subcortical volume and shape, and cortical thickness/surface area, based on structural magnetic resonance images. We investigated 37 subjects who reported PD-Sx exceeding DSM-IV Axis-II screening thresholds, and 35 age, sex, and smoking status-matched control subjects. Subjects reporting PD-Sx were then grouped into symptom-based clusters: N = 20 into Cluster B (reporting Antisocial, Borderline, Histrionic, or Narcissistic PD-Sx) and N = 28 into Cluster C (reporting Obsessive–Compulsive, Avoidant, or Dependent PD-Sx); N = 11 subjects reported PD-Sx from both clusters, and none reported Cluster A (Paranoid, Schizoid, or Schizotypal) PD-Sx. Compared to control, Cluster C PD-Sx was associated with greater striatal surface area localized to the caudate tail, smaller ventral striatum volumes, and greater cortical thickness in right prefrontal cortex. Both Cluster B and C PD-Sx groups also showed trends toward greater posterior caudate volumes and orbitofrontal surface area anomalies, but these findings did not survive correction for multiple comparisons. The results point to morphological abnormalities that could contribute to Cluster C PD-Sx. In addition, the observations parallel those in substance use disorders, pointing to the importance of considering PD-Sx when interpreting findings in often-comorbid psychiatric disorders.
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Affiliation(s)
- Doris E Payer
- Addictions Program, Centre for Addiction and Mental Health, Toronto ON, Canada ; Research Imaging Centre, Centre for Addiction and Mental Health, Toronto ON, Canada ; Department of Psychiatry, University of Toronto, Toronto ON, Canada
| | - Min Tae M Park
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto ON, Canada ; Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun QC, Canada ; Schulich School of Medicine and Dentistry, Western University, London ON, Canada
| | - Stephen J Kish
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto ON, Canada ; Department of Psychiatry, University of Toronto, Toronto ON, Canada
| | - Nathan J Kolla
- Department of Psychiatry, University of Toronto, Toronto ON, Canada ; Complex Mental Illness Program, Forensic Service, Centre for Addiction and Mental Health, Toronto ON, Canada
| | - Jason P Lerch
- Department of Medical Biophysics, University of Toronto, Toronto ON, Canada ; Mouse Imaging Centre, Hospital for Sick Children, Toronto ON, Canada
| | - Isabelle Boileau
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto ON, Canada ; Department of Psychiatry, University of Toronto, Toronto ON, Canada
| | - M M Chakravarty
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto ON, Canada ; Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun QC, Canada ; Department of Psychiatry and Biomedical Engineering, McGill University, Montreal QC, Canada
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16
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Urbanoski K, Kenaszchuk C, Veldhuizen S, Rush B. The Clustering of Psychopathology Among Adults Seeking Treatment for Alcohol and Drug Addiction. J Subst Abuse Treat 2015; 49:21-6. [DOI: 10.1016/j.jsat.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/27/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
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17
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Langås AM. Komorbide lidelser ved rusmiddelavhengighet må behandles. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:918. [DOI: 10.4045/tidsskr.14.0241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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18
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Langås AM, Malt UF, Opjordsmoen S. Independent versus substance-induced major depressive disorders in first-admission patients with substance use disorders: an exploratory study. J Affect Disord 2013; 144:279-83. [PMID: 23158758 DOI: 10.1016/j.jad.2012.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical differences between independent and substance-induced (S-I) major depressive disorders (MDDs) in patients with substance use disorders (SUDs) are insufficiently studied. METHODS The catchment area sample consisted of 42 SUD patients with independent and/or S-I MDD (bipolar disorders excluded), admitted consecutively to addiction clinics or psychiatry departments (inpatient or outpatient) with no previous treatment history from specialized services. Assessments included the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), the Structured Clinical Interview for DSM-IV, Axis II, Personality Disorders (SCID-II), the Inventory of Depressive Symptoms (IDS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Symptom Check List, 90 questions, revised (SCL-90-R). RESULTS Of the 42 SUD patients, 48% had independent MDD episode(s) only, 24% had S-I MDD episode(s) only, and 28% had both independent and S-I MDD episodes. Insomnia, psychomotor agitation, concentration and decision problems, melancholic features, higher total MDD symptom count, longer time being depressed, higher mean score on the Montgomery-Asberg Depression Rating Scale, and shorter duration of SUDs characterized independent MDDs. LIMITATIONS Small sample size with risk of type II error. CONCLUSIONS Independent MDDs were more severe and had different qualities compared with S-I MDDs, suggesting important treatment implications. Longitudinal studies including larger samples and carefully addressing the association between SUD subtypes and MDD subtypes are needed to substantiate our findings.
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Affiliation(s)
- Anne-Marit Langås
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, Lier, Norway.
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Langås AM, Malt UF, Opjordsmoen S. In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry 2012; 12:180. [PMID: 23107025 PMCID: PMC3514215 DOI: 10.1186/1471-244x-12-180] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Assessment of comorbid personality disorders (PDs) in patients with substance use disorders (SUDs) is challenging due to symptom overlap, additional mental and physical disorders, and limitations of the assessment methods. Our in-depth study applied methods to overcome these difficulties. METHOD A complete catchment area sample of 61 consecutively admitted patients with SUDs, with no previous history of specialized treatment (addiction clinics, psychiatry) were studied, addressing PDs and associated clinical and demographic variables. The thorough assessments included the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. RESULTS Forty-six percent of the SUD patients had at least one PD (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively). Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school. CONCLUSION The psychiatric comorbidity and symptom load of SUD patients with PDs differed from those of SUD patients without PDs, suggesting different treatment needs, and stressing the value of the assessment of PDs in SUD patients.
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Affiliation(s)
- Anne-Marit Langås
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, P,O, Box 135, Lier, NO-3401, Norway.
| | - Ulrik Fredrik Malt
- Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway,University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Division of Surgery and Clinical Neuroscience, Dept of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Division of Mental Health and Addiction, Dept of Research and Development, Oslo University Hospital, Oslo, Norway
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