This article describes the experience of transforming a residential substance dependence treatment program from an extended non-structured program to a structured, differentiated short-term residential treatment which allows for treatment personalization. Carried at the National Rehabilitation Centre, Abu Dhabi, United Arab Emirates, and commissioned by its management, the transformation aimed to address extended length of stay, long waiting lists, service expansion requirement, and diversity in demand for treatment. Transforming the residential program would optimize efficiency as it is the most common and resourceful phase of substance dependence treatment regionally, hence the significance of this effort. The transformation process extended from April 2009 to April 20l3 over two phases: (a) program development and (b) implementation. Gaps in human resource capacity, and the absence of monitoring and evaluation systems were identified as major challenges in transformation. Six recommendations were generated including further differentiation of the residential program, one of the components of the continuum of care, to phases with measurable outcomes. Adoption of evidence-based interventions should ensure not only selection but extend to cover quality of delivery and integration of interventions. Engagement of staff delivering these programs through adequate capacity building and regular program assessments becomes indispensable. In order to achieve proper program transformation, efficient leadership dedicated to the process is imperative.
Addiction and human immunodeficiency virus (HIV) patients suffer from many medical problems. Family can be a source of stress or relief for the patients. Therefore, we explored and compared the perception of family members of HIV patients with and without a history of injecting drug use (IDU) in Indonesia in the context of: (i) care provided for HIV patients, (ii) harmful impact of the disease for their relatives, and (iii) the hopes of family members concerning the future of their sick relatives. An exploratory case study was conducted with 79 family members: 36 family members of HIV patients with a history of IDU and 43 family members of HIV patients without a history of IDU. They were recruited through consecutive sampling in a HIV clinic in an urban setting in West Java. The Family Contact Information Support scale, the Family Member Impact scale, and the Hopefulness-hopelessness questionnaire were used to interview the family members. Most family members were spouses/partners (30%) or parents (28%). Families of HIV patients showed good satisfaction about the care given by health care providers. Families of HIV patients with a history of IDU perceived more worrying behaviour of their sick relatives compared to the families of HIV patients without a history of IDU. Hope for the future of their sick relatives was high and comparable in these two groups. This study shows that family members of HIV patients with a history of IDU perceived the disease as more harmful, which should be addressed by the healthcare providers to support the family and heighten their involvement in the treatment.Keywords: co-existing problemsdrug useassessmentserviceopiate dependence AcknowledgmentThe authors thank the interviewers, staffs from non-government organizations, Department of Clinical Psychology, Padjadjaran University, and staffs in Hasan Sadikin Hospital. S.I. received a fellowship from Radboud University, The Netherlands. All the authors have no conflict of interest.FundingFinancial support was provided by "IMPACT" (Integrated Management of Prevention And Care and Treatment of HIV), a collaborative research funded by the European Commission (SANTE/2005/105–033) and contracted by CORDAID.
Protective factors are aspects that enhance resiliency and decrease the probability of drug abuse. The aim of this study was to identify the opinion of family members or people significant to illegal drug users about protective factors that help to prevent involvement with these drugs. The study used a convergent parallel mixed methods design that combines quantitative and qualitative methods. In the quantitative component, 100 subjects participated in the study. Participants were recruited at a primary health-care service located in the Northern district of an inner city in Brazil. They defined themselves as being personally affected by having a family member or significant other who was a former or current illegal drugs user. The subjects were asked about protective factors in general and linked to the specific case of their relative or significant other who is or was a drug user. Data were statistically analyzed using the Statistical Package for the Social Sciences. The qualitative data were collected through semistructured interviews with 10 subjects who were selected among the participants and declared themselves as highly involved with the illegal drug user. Qualitative data were analyzed through thematic analysis. Among the protective factors mentioned, the participants highlighted the community circumstances with a higher percentage than the other domains, suggesting a notion of institutionalization of the problem of illegal drug use. The results brought key information for the implementation of protective factors at the individual, family, and community levels by different private and public actors.Keywords: illegal drug usersprotective factors to drug usefamily and significant others perceptionsindividual protective factorsfamily protective factorscommunity protective factors
As a trauma-informed clinician working with substance use disorder (SUD) patients I find it highly interesting that the trauma-informed care curriculum says virtually nothing about discontinuation of drug use qualifying as a potentially traumatizing event. The idea that patients who have been emotionally attached to their drug of choice might generate feelings leading to symptoms of post-traumatic stress disorder (PTSD) after “giving up” their drug of choice is a phenomenon that the clinical literature has paid little attention to. For SUD patients to understand that that is the potential source and cause of their emotional, psychological, physiological, and behavioral symptoms, can in turn help them make sense of why they feel the way they do. Such an approach to trauma-informed care in the venue of SUD treatment can help clients see the relevance of that approach in the absence of their experiencing a classically recognized trauma event. This letter attempts to provoke dialog among trauma-informed clinicians that spurs consideration for the comparison of DSM-5 criteria for PTSD and drug-loss-induced PTSD-like symptoms among patients in SUD treatment.
BACKGROUND:This prospective analysis evaluated the efficacy of a contingency management (CM) intervention to improve the psychological health of non-treatment seeking, homeless, substance-dependent, men who have sex with men in Los Angeles. It was hypothesized that administration of CM would be associated with reductions in participants' symptoms of psychological and emotional distress.METHODS:One hundred and thirty-one participants were randomized into either a voucher-based contingency management (CM; n = 64) condition reinforcing substance abstinence and prosocial/health-promoting behaviors, or to a control condition (n = 67). Participants' symptoms of psychological and emotional distress were assessed at intake and at 12-months post-randomization.RESULTS:Participants randomized into the CM intervention exhibited significantly lower levels of psychological distress in all measured symptom domains up to one year post randomization, reductions not evidenced in the control arm. Omnibus tests resultant from seemingly unrelated regression analysis confirmed that CM was significantly associated with reductions in symptoms of psychological and emotional distress, even when controlling for biomarker-confirmed substance use outcomes (χ2(9) = 17.26; p < 0.05).CONCLUSIONS:Findings demonstrate that a CM intervention reduced symptoms of psychological and emotional distress among a sample of non-treatment seeking, homeless, substance-dependent men who have sex with men.
The Equality Act 2010 in mental health is a deceivingly comprehensive resource text effectively divided into four parts, the chapters of which may be read independently as standalone discussion pie...
OBJECTIVE:Aggressive behavior is strongly associated with both posttraumatic stress disorder (PTSD) and substance use disorders (SUD) among civilians. However, little research has examined correlates of aggression among Veterans with co-occurring PTSD and SUD.METHODS:This exploratory study examined the prevalence and correlates of recent (i.e., past 30 days) and lifetime aggressive behavior among a sample of U.S. Veterans (N=97) enrolled in a study examining integrated psychosocial treatment of co-occurring PTSD/SUD.RESULTS:The findings revealed high rates of recent and lifetime aggressive behaviors (39.2% and 57.7%, respectively). Participants who endorsed recent aggressive behaviors were younger, had less education, more severe PTSD numbing and hyperarousal symptoms, were more likely to report recent suicidal ideation, more frequent alcohol and marijuana use, had higher rates of physical and sexual abuse, greater combat exposure, and more severe aftermath of battle experiences. Participants who endorsed lifetime aggression were younger, reported more total PTSD symptom severity, PTSD re-experiencing severity, depression severity, and fewer post-deployment stressors compared to those who did not. Logistic regression analyses indicated that education and number of drinking days were correlated with recent aggression while depression and post-deployment stressors were correlated with lifetime aggression.CONCLUSIONS:The findings demonstrate high rates of aggressive behaviors among Veterans with PTSD/SUD, as well as clinically relevant correlates of aggressive behaviors. Although preliminary, the findings suggest potential targets for improving assessment and treatment of Veterans with PTSD/SUD.
This study examined the underlying structure of DSM-IV schizotypal personality disorder (SPD) among individuals with and without a substance use disorder. Using a nationally representative sample of U.S. adults, taxometric analyses were conducted on SPD in the total sample and among individuals with and without a substance use disorder. The structure of SPD in the total sample and among individuals without substance use disorders was dimensional (comparison curve fit indices (CCFI): 0.440, 0.365) whereas a taxonic structure was demonstrated among individuals with a substance use disorder (CCFI: 0.679). Taxonicity underlying schizotypy and SPD in prior taxometric research may have been the result of sampling high risk subsamples of the population. Taxometric research on SPD and other personality psychopathology among high risk subgroups of the population can help elucidate the complex etiology of SPD and the role played by comorbid substance use disorders in the expressivity of these disorders.
BACKGROUND:Recent research has begun to examine the early maladaptive schemas of substance abusers, as it is believed that targeting these core beliefs in treatment may result in improved substance use outcomes. One special population that has received scant attention in the research literature, despite high levels of substance use, is airline pilots.AIMS:The current study examined the early maladaptive schemas of a sample of airline pilots (n = 64) who were seeking residential treatment for alcohol dependence and whether they differed in early maladaptive schemas from non-pilot substance abusers who were also seeking residential treatment for alcohol dependence (n = 45).METHOD:Pre-existing medical records from patients of a residential substance abuse treatment facility were reviewed for the current study.RESULTS:Of the 18 early maladaptive schemas, results demonstrated that pilots scored higher than non-pilots on the early maladaptive schema of unrelenting standards (high internalized standards of behavior), whereas non-pilots scored higher on insufficient self-control (low frustration tolerance and self-control).CONCLUSIONS:Early maladaptive schemas may be a relevant treatment target for substance abuse treatment seeking pilots and non-pilots.
With increasing recognition of the importance of mental and substance use disorders for population health and health systems and the potential value of systems-based performance indicators in addressing this issue, we aimed to describe the development and content of key performance indicators for mental and substance use disorders. Publications were identified through official websites, Google searches and PubMed. Following ‘PRISMA’ guidelines, twenty-five studies were kept for qualitative synthesis and six for quantitative analysis. We describe their use in practice by comparing their application across a range of public and mixed healthcare systems. Currently, key performance indicator development for mental and substance use disorders adopts several methodologies, including expert opinion, literature review, stakeholder consultation and the structured consensus method. The rationales provided for selection of particular key performance indicators vary greatly between systems. Systems exhibit different levels of key performance indicator adaptability, which is reflective of dynamic changes in evidence-based practices. We noted bias in the level of key performance indicator assessment towards system/health plan evaluation followed by programme/service evaluation. Similarly, there is a large skew towards key performance indicators that reflect evaluation of processes. Collection of data in all systems is nearly exclusively reliant on electronic administrative/medical data. Experiences from these systems are synthesized into methodological recommendations, and considerations for further research and clinical practice are provided.
In 2001, Portugal enacted what, for some, was a radical shift in its national drug policy, decriminalized drugs, and implemented a treatment-driven response to drug use. Empirical evaluation of the impacts of this policy “U-turn” continues and the evidence produced so far is both consistent and convincing. It seems by almost any measurement, the Portuguese experiment of drug decriminalization/treatment-driven responses, has been a resounding success. However, these empirical findings do not yet appear to have influenced national drug policy in the USA, which continue to regard decriminalization as “radical” and “extreme”. Similarly disturbing is the lack of substantive contributions to this debate from nurses, especially Psychiatric/Mental Health (P/MH) nurses, which is troubling in a number of ways. Therefore what the authors do in this paper is: first, highlight Portugal's drug decriminalization policy and the evidence forthcoming from evaluations. Second, illuminate the disconcerting lack of substantive contributions to this debate that have been made by P/MH nurses. Third, examine the congruence between Humanistic approaches to P/MH nursing and many of the tenets of Libertarian thinking and policies. And then in drawing these three elements together, the authors exhort P/MH nurses to fulfill their rhetorical, macro-care role and contribute to this much-needed debate.
Cigarette-smoking in schizophrenia and its associations with sexual functioning have been relatively under-examined. The study purpose was to determine the factors associated with sexual dysfunction among schizophrenia men with nicotine dependency and those non-smokers. A retrospective study was conducted in a local hospital in Malaysia over a two-year period from 2011 to 2012. There were 54 schizophrenia men with nicotine dependency and 57 non-smokers. Sexual functioning was assessed using the Malay version of the International Index of Erectile Function-15. Logistic regression analysis was employed. All the 111 schizophrenia men had at least one sexual dysfunction domain. For the group with nicotine dependency, Positive and Negative Syndrome Scale (PANSS)-positive was positively associated with the ability to achieve orgasm and ejaculation. However, age of schizophrenia onset was negatively associated with the confidence to attain and keep an erection. For the non-smoker group, married status and duration of schizophrenia were positively associated with the ability to attain erection and overall sex life satisfaction, respectively, while age of schizophrenia onset was negatively associated with the ability to attain erection and erectile sustainability during intercourse. Among the domains, only orgasmic dysfunction was significantly associated with PANSS-positive, i.e. higher PANSS-positive score was a protective factor for orgasmic dysfunction (odds ratio = 0.37; 95% confidence interval: 0.17, 0.80; p = .012). Schizophrenia men may apparently attempt to treat their orgasmic impairment due to effect from antipsychotics through smoking cigarettes. Sexual impairment among the non-smokers may be attributed mostly to relationship issues with their partner.
The majority of studies exploring the mental health disorders, post-traumatic stress disorder (PTSD) and substance use disorders (substance abuse (SA) and dependence), have shown high co-morbidity rates in adolescents, indicating a well-established relationship. However, only a few studies have attempted to examine the functional mechanisms believed to underlie this common form of co-morbidity, and no studies have been carried out in adolescent samples. Knowledge is thus lacking on how specific PTSD symptom clusters may account for the development of specific types of problematic substance use in adolescents. Therefore, we studied this issue in relation to alcohol abuse (AA) and drug abuse (DA) in a probability sample of Danish 15–18-year-olds (n = 1988) in the form of an online survey using self-report questionnaires following the Diagnostic and statistical manual of mental disorders, fourth edition [DSM-IV; APA. (1994). Washington, DC: Author]. After demographic and substance-related variables were controlled for, hierarchical multiple regression models revealed that a significant proportion of variance in AA severity was explained positively by arousal symptoms and negatively by re-experiencing symptoms, whereas DA severity was significantly increased by avoidance symptoms and decreased by arousal symptoms. Current findings suggest that specific PTSD symptom clusters to some extent are independently related to AA and DA, providing this research field with a better understanding of the interrelationship between these two mental health disorders in adolescents while underpinning the importance of acknowledging the specific functional mechanisms underlying the common co-occurrence of PTSD and SA in adolescence.
The objective of this retrospective study covering a period of 4 years (2001-2004), is to characterize and chart the clinical profiles of acute patients in the psychiatric inpatients ward of Hospital S. Francisco Xavier diagnosed with psychosis and substance abuse. During this period, 422 patients diagnosed with nonaffective psychosis (292, 295, 297 and 298, according to ICD9) were admitted. An analysis of the clinical profiles of these inpatients shows that a high percentage (42%) have psychotic pathologies and an history of substance abuse. These are predominantly young males. Schizophrenic patients with an history of substance abuse reached 40%. A particularly relevant finding in view of the fact that substance abuse leads to worse prognostics. Cannabinoids are by far the most widely abused substance, followed by alcohol. There are also 7.2% psychosis due to drug use in which the drug of choice was cannabis. In the light of current scientific knowledge, this is very relevant fact since the use of cannabinoids appears to be a risk factor for the onset of schizophrenia. It was observed that, often, due importance is not given to this association since few nodrug assays are carried out and when they are, they don't cover all drugs. Therefore, this study should alert medical staff to the high prevalence of substance abuse amongst psychotic patients, and to the necessity for a proactive stance in the detection of substance abuse in order to facilitate the development of better therapeutic projects which take into consideration this comorbidity and seek to promote psychoeducation of patients.
Though remission of substance-use disorders (SUDs) has been correlated with increased odds of smoking cessation, a subgroup of remitters continues to smoke. However, information regarding this population is lacking. Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. The sample included 1417 smokers with SUDs who completed Wave 1 (Baseline) and Wave 2 (Follow-up) assessments. Results indicated that the presence of generalized anxiety disorder, Cluster A personality disorders, major depression/dysthymic disorder, or manic depression/hypomanic disorder since Wave 1 was associated with a reduced likelihood of smoking cessation. These data suggest that healthcare providers who treat smokers in remission from SUDs should carefully assess for the presence of mood disorders and provide appropriate treatment, as well as offering adjunctive evidence-based smoking cessation treatments.
Enhanced primary care management of common mental and substance use disorders is a key healthcare target. Though primary care may be well placed to achieve this target, a greater understanding of the prevalence and profile of common mental and substance use disorders in primary care settings is needed. We searched the MEDLINE database (2002–2012) to provide an update on biomedical literature describing the prevalence of common mental and substance use disorders in European general practice. Following “PRISMA” guidelines, 17 studies were kept for qualitative synthesis. Prevalence, profile, screening instruments, associated co-morbidities, and gender distribution were tabulated. Depending on the screening method, the prevalence of common mental and substance use disorders ranged from 10.4% (Luxemburg) to 53.6% (Spain). Mood disorders were the most common. High co-morbidity with anxiety and somatisation hindered early identification and management. The continuing burden of common mental and substance use dis...
Alcohol addiction and psychiatric disorders frequently occur together, and individuals affected by both conditions represent a unique patient population in need of specialized treatment. Decades of research have pointed to promising prospective therapeutic options, yet no standardized diagnostic measures or treatment regimens are available for clinicians or their patients. As a result, patients with both alcohol abuse and mental disorders frequently do not receive specialized treatment that addresses both conditions. Moreover, a great deal of research regarding alcohol use disorder treatment has failed to include patients with co-occurring mental illnesses. To address this serious public health concern, a renewed focus on large-scale trials is required to examine the benefits of various therapeutic practices and delivery methods in the mentally ill, alcohol-dependent population. This commentary will provide a brief overview of the diagnostic and therapeutic challenges associated with treating dually diagnosed individuals, the state of current research strategies, and a potential roadmap for improving the future of research in this field.
Previous research is scarce on the problems and needs of the “triply troubled” – among offenders with mental health problems and problematic substance use. Classifying this population into clusters based on problem profiles may provide information about individual needs for treatment. In a previous study, we identified four clusters of triply troubled: less troubled, severely triply troubled, triply troubled with medical problems, and working triply troubled. The present study explored the stability and predictive validity of these clusters in a naturalistic design. In total, 125 triply troubled individuals included in any of the four clusters were followed for approximately three years with regard to their inpatient and outpatient treatment participation. They were also interviewed with the 6th version of the Addiction Severity Index, the Psychopathy Checklist–Revised, and the World Health Organization Quality of Life–Bref. The main finding of the study was that on average the participants of all four cl...
The objective of this research is to develop a clearer understanding as to whether pregabalin is an appropriate and efficacious method to treat individuals presenting with withdrawal symptoms following cessation of opiate drug abuse. The focus of this study is to identify the value of a particular medicine within a particular case, representative of a particular group. The author has identified the participant in advance of the study to meet criteria of opiate dependence and will explore the dynamics of the case in great detail. The sample for this study was a purposive sample of one female lady who has been diagnosed as opiate dependent (DSM-IV criteria). The analysis of data is an inductive cyclical process that involves a process of observing the particular phenomenon from more general to specific observations. Data analysis commenced with interviews with the patient with emphasis on history taking, information gathering, and treatment. Data analysis will include a cross-tabulation of the subjective and objective data and the measurement of change using an evidence-based rating scale. The Clinical Opiate Withdrawal Scale was used to compare the analysis of the presenting symptoms longitudinally. From the objective data, it was a reasonable assumption that the symptoms of withdrawal were controlled better with pregabalin for the subject of this study. The patient acknowledged that this detoxification episode was “a lot easier than previous ones”. It was a positive response in relation to the prescription of pregabalin that she first of all completed the prescribed detoxification regime and second it was acknowledged that the symptoms were alleviated more effectively than previous detoxification episodes.Keywords: opiate dependencesubstance dependenceassessmentscreeningsubstance usedual diagnosis FundingThe study has been produced with no direct or indirect funding from any source. The author have no contractual constraints from any source or organisation
