Objective: Medications for opioid use disorder (MOUD) have shown promise in facilitating positive treatment outcomes for those with comorbid mental disorders. However, whether MOUD receipt differs by specific mental disorder comorbidities has not been thoroughly investigated. To address this gap, the present study examined associations of specific mental disorder comorbidities with MOUD among discharges from outpatient substance use treatment. Methods: Data came from the 2016-2022 Treatment Episode Dataset-Discharges (TEDS-D). The analytic sample included 12,219 adult outpatient treatment discharges with comorbid OUD and mental disorders (mood disorder, anxiety disorder, or psychotic disorder comorbidity). Multilevel logistic regression models with random intercepts for state were used to examine associations between type of mental disorder and planned MOUD, adjusting for opioid-related, treatment-related, sociodemographic and state-level MOUD availability covariates. Results: When adjusting for covariates, discharges with depressive disorders (AOR = 1.48, 95% CI = 1.19-1.85) and anxiety disorders (AOR = 1.43, 95% CI = 1.14-1.80) had higher odds of MOUD than discharges with psychotic disorders. Conclusions: These findings signify the influence of specific mental disorder diagnoses with MOUD access. Disparities in access for those with comorbid psychotic disorders warrant further investigation.
Background: Clinical guidance exists on the provision of care for co-occurring mental health and substance use conditions in the UK. This systematic review aimed to identify the extent to which the guidance has been applied, including barriers and facilitators to delivery, and to examine use of strategies to support implementation of the guidance. Methods: We searched PsychINFO, MEDLINE, CINAHL, Embase, and Web of Science for articles published between 1st January 2017 (when the guidance was published) to 28th January 2025. Studies were eligible if they focused on service use and/or treatment provision for adults in the UK with co-occurring substance use and mental health conditions. The findings were analyzed using a thematic synthesis, through line-by-line coding of study findings to develop analytical themes. Results: Three themes were identified from 17 eligible studies. Theme one reflects "challenges to care for co-occurring conditions", which describes how service users face 'wrong doors'; issues surrounding the recognition of co-occurring conditions; and access to care when and where it is needed, despite guidance recommending the 'no wrong doors' approach. Theme two reflects approaches for the "integration of care" as recommended in the guidance, such as communication across services and ensuring that support for people with co-occurring conditions is 'everyone's job'. The third theme highlights barriers (e.g., stigma) and facilitators (e.g., therapeutic optimism) to applying the guidance. Conclusion: This review identified an implementation gap between best practice guidance and the provision of care for co-occurring conditions in the UK setting, which needs to be explored across a global context. There were positive examples of strategies to implement the guidance, particularly from small-scale intervention evaluations, yet studies of larger scale real-world intervention implementation are needed.
Objective: Nicotine addiction remains one of the most prevalent substance use disorders worldwide, particularly within psychiatric inpatient populations. The inability of many psychiatric patients to leave the ward has caused patients to experience acute nicotine withdrawal that can exacerbate underlying mental health conditions. The aim of this project was to reduce the time to nicotine replacement therapy (NRT) initiation and ensure adequate dosing to decrease nicotine withdrawal-related agitation and aggression. Methods: The project was implemented in three stages: a baseline data collection period of three months; on-the-job NRT education for all staff; and a post-education data collection period of three months. Results: Between the pre- and post-education groups, there was: an increase (63.6% pre-, 86.7% post-) in patients prescribed NRT within 24 hours (p = .024) and; an increase (14.6% pre-, 70% post-) in the supply of adequate NRT for nicotine dependence (p < .001). For post-education patients, there was a trend toward decreased surrogate markers of agitation and arousal. Conclusion: NRT education for staff was successful in reducing time to prescription and increasing number of patients receiving adequate NRT. Patients that received adequate NRT in a timely manner were less likely to demonstrate severe agitation.
Objective: Nicotine use in schizophrenia remains markedly higher than in the general population, contributing to increased morbidity, relapse, and functional impairment. While biological factors have been widely studied, limited attention has been given to the psychosocial factors that sustain nicotine use in this group. This review synthesizes available evidence on these psychosocial influences to inform intervention planning and policy development. Methods: A narrative review was conducted using PubMed, Scopus, ProQuest, and Google Scholar to identify studies from 2000 to 2025 that examined psychosocial, socio-cultural, or systemic factors associated with nicotine use in schizophrenia. Thirty articles meeting the inclusion criteria were analyzed thematically across three domains: psychological, socio-cultural, and systemic influences. Results: Psychological factors such as stress regulation, cognitive enhancement, loneliness, maladaptive coping, and low self-efficacy reinforced nicotine use. Socio-cultural determinants included male gender, unmarried status, peer influence, social exclusion, stigma, and familial smoking patterns, while systemic enablers encompassed institutional permissiveness, limited cessation support, and pro-tobacco policies. Collectively, these dimensions interact to maintain nicotine dependence and impede recovery and contribute to an increased risk of relapse in schizophrenia, poorer prognosis, higher Disability- Adjusted Life Years, impaired functional recovery, and disability. Conclusions: Nicotine use in schizophrenia is reinforced by interconnected psychosocial and structural forces extending beyond biological vulnerability. A biopsychosocial approach-combining psychoeducation, family support, social rehabilitation, and institutional policy reform-offers a pathway to sustainable cessation and functional recovery in this population.
