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New advancements in the study of co-occurring substance use and psychiatric disorders

Taylor & Francis
Journal of Mental Health
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... Moreover, trauma-focused interventions have rarely been evaluated for the impact on adolescent substance use outcomes. Such interventions must integrate treatment for both trauma and SUDs using a developmental approach in order to equally impact on substance use and mental health outcomes [215,227]. ...
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Exposure to childhood maltreatment and trauma has a strong relationship with onset and development of substance use disorders. The purpose of this chapter is to review important models and mechanisms that explain pathways from childhood trauma to substance misuse and dependence. This chapter integrates findings from several cross-sectional and longitudinal studies conducted in this area with a focus on three main categories of explanatory mechanisms and models: (1) neurocognitive mechanisms; (2) negative reinforcement and self-medication mechanisms; and (3) psychosocial development mechanisms. Each section describes the dominant models and explanatory mediators that link childhood trauma to substance use disorders. In the final section, the clinical implications and directions for future studies are presented.
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Several large-scale studies examining outcome predictors across various substance use treatments indicate a need to focus on psychiatric comorbidity as a very important predictor of poorer SUD treatment involvement and outcome. We have previously argued that current cognitive-behavioral treatments (CBT) approaches to SUD treatment do not focus on the necessary content in treatment in order to effectively address specific forms of psychiatric comorbidity, and thus only provide clients with generic coping strategies for managing psychiatric illness (as would be achieved in other SUD treatment approaches; Conrod et al., 2000). Furthermore, following our review of the literature on dual-focused CBT treatment programs for concurrent disorders in this article, we argue that combining CBT-oriented SUD treatments with specific CBT treatments for psychiatric disorders is not as straightforward as one would think. Rather, it requires very careful consideration of the functional relationship between specific disorders, patient reactions to specific treatment components, and certain barriers to treatment in order to achieve an integrated dual-diagnosis focus in treatment that is meaningful and to which clients can adhere.
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This study examined the patient and treatment factors associated with 6-month outcome in 649 opiate-, alcohol-, and cocaine-dependent (male and female) adults, treated in inpatient and outpatient settings, in 22 publicly and privately funded programs. Outcomes were predicted by similar factors, regardless of the drug problem of the patient or the type of treatment setting or funding. Greater substance use at follow-up was predicted only by greater severity of alcohol and drug use at treatment admission, not by the number of services received during treatment. Better social adjustment at follow-up was negatively predicted by more severe psychiatric, employment, and family problems at admission and positively predicted by more psychiatric, family, employment, and medical services provided during treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Background: High anxiety sensitivity (AS; fear of anxiety sensations) is associated with frequent and problem drinking (Stewart, Samoluk, & MacDonald, 1999). Aims: It was hypothesized that a program designed to reduce AS levels in young adult women would also result in a decrease in their dysfunctional drinking behavior. Method: The brief cognitive behavioral therapy (CBT) intervention was conducted in small group format. Participants were selected to form high and low AS groups, according to their scores on the Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992), and randomly assigned to participate in 3 one-hour sessions of either brief CBT (i.e., psycho-education, cognitive restructuring, and physical exercise interoceptive exposure) or a control group seminar (discussion about psychology ethics). Drinking measures were assessed at pre-treatment and 10 weeks post-intervention. Results: Following the intervention, high AS participants in the CBT condition revealed significant reduction in conformity motivated drinking and emotional relief expectancies, as well as a 50% reduction in proportion meeting criteria for hazardous alcohol use as compared to other three groups. Conclusion: Findings suggest that alcohol abuse might be effectively prevented among high risk individuals with a brief CBT approach targeting high AS, and that AS may operate as one underlying determinant of dysfunctional drinking behavior. Declaration of interests: None.
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Background: Personality-targeted cognitive-behavioural interventions have been proven to be effective in reducing alcohol-related behaviours in adolescents. Aims: As these interventions target personality traits linked to risk for non-addictive psychopathology, the aim of this study is to examine the extent to which this approach can also prevent the onset or reduce relevant psychological problems in youth. Method: Participants aged 13 – 16 years (n = 423) were randomly assigned to either a personality matched cognitive-behavioural intervention or a no-intervention control. The personality matched interventions targeted four personality risk factors: negative thinking (NT), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS). Results: Baseline and follow-up data were obtained on depression scores, panic attacks, and reckless behaviour. Results showed a moderate effect of the NT intervention on depression scores, and a similar effect of the AS intervention on panic attack and truancy (i.e., school avoidance). A small but significant intervention effect was found for shoplifting for the entire sample, as well as a moderate intervention effect on this outcome for the IMP intervention group. Conclusions: These intervention effects indicate that personality-targeted interventions designed to prevent alcohol misuse, can concurrently reduce other relevant psychological problems in youth.
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Background: The co-morbidity between social phobia and alcohol disorder is well established. Aims: This study investigated the nature of the relationship between traits associated with these disorders. Method: A total of 157 undergraduate drinkers (112 women; 45 men) completed measures tapping aspects of social phobia (i.e., the Social Avoidance and Distress Scale and the Brief Fear of Negative Evaluation scale) and drinking behavior (i.e., the Drinking Motives Questionnaire – Revised, quantity and frequency of alcohol consumption, and the Rutgers Alcohol Problem Index). Results: Correlational analyses (controlling for gender) revealed that: (i) social avoidance and distress was significantly negatively related to drinking frequency; (ii) fear of negative evaluation and social avoidance and distress were both significantly positively related to drinking to cope with negative emotions and to conform to peer pressure; and (iii) fear of negative evaluation was also significantly positively related to drinking to socialize and to drinking problems. The relationship between fear of negative evaluation and drinking problems was mediated by coping and conformity drinking motives. Conclusions: Implications for developing effective integrated treatments for co-occurring social anxiety and alcohol problems are discussed, as are preventative implications.
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Individuals with co-occurring substance abuse and severe mental illness are particularly vulnerable to negative outcomes. This paper reviews findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance-abuse programs; describes the movement toward programs that integrate both types of treatment at the clinical level; reviews evidence related to outcomes in integrated treatment programs; and discusses health-care policy changes that would encourage effective treatments.
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• The authors report on the similarity of outcome predictors across opiate, cocaine, and alcohol treatments. Patients receiving treatment for these addictive behaviors in a variety of treatment centers were followed for a period of 6 mo. Ss were 649 adults admitted to substance abuse treatment in these programs. All patients except those in methadone maintenance treatment were admitted after completion of detoxification or self-induced sobriety. The authors found that outcomes were predicted by similar factors, regardless of the drug used or the type of treatment setting. Greater relapse rates at follow-up were predicted only by greater severity of alcohol and drug use at treatment admission, not by the number of services received during treatment. Other findings revealed that more severe psychiatric, employment, and family problems at admission predicted poorer social adjustment at follow-up; for patients receiving treatment services for these problems, however, outcome was more positive. These findings indicate that successful treatment approaches need to respond to a wide variety of patient problems and not be restricted solely to a focus on substance abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved) • The authors report on the similarity of outcome predictors across opiate, cocaine, and alcohol treatments. Patients receiving treatment for these addictive behaviors in a variety of treatment centers were followed for a period of 6 mo. Ss were 649 adults admitted to substance abuse treatment in these programs. All patients except those in methadone maintenance treatment were admitted after completion of detoxification or self-induced sobriety. The authors found that outcomes were predicted by similar factors, regardless of the drug used or the type of treatment setting. Greater relapse rates at follow-up were predicted only by greater severity of alcohol and drug use at treatment admission, not by the number of services received during treatment. Other findings revealed that more severe psychiatric, employment, and family problems at admission predicted poorer social adjustment at follow-up; for patients receiving treatment services for these problems, however, outcome was more positive. These findings indicate that successful treatment approaches need to respond to a wide variety of patient problems and not be restricted solely to a focus on substance abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Background: It is common for people with psychosis to have co-occurring drug or alcohol problems. This combination of problems is associated with poor outcomes for clients and presents many challenges for services. Aims: This review aims to discuss contextual issues underlying treatment difficulties, to briefly review the treatment literature to date and to describe a randomized controlled treatment trial (RCT) currently being conducted in the UK. Methods: A descriptive review. Results: Consensus agreement emphasizes the need for integrated treatment strategies that match the client's current level of motivation. There have been encouraging results from recent studies evaluating motivational strategies, either alone or in combination with CBT. Whilst for many clients with established illness and substance using histories, brief therapy does not seem to be adequate, longer term interventions show promise. A current RCT evaluating motivational interviewing with CBT is described. Conclusions: The evidence base for treatment recommendations is still quite small. The MIDAS trial will hopefully make a significant contribution to the literature on treatment options for this high risk group. Declaration of interest: The MIDAS trial is funded by the Medical Research Council and the Department of Health.
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Background: Among adolescents, substance abuse often occurs in conjunction with risk-taking behaviors. Aims: This review explores the nature and etiology of concomitant risk-taking behaviors, addressing behavioral, genetic, temperamental, and family factors that accompany adolescent substance use. Method: A literature review was conducted to determine the breadth of factors that contribute to adolescent substance abuse and correlated risk-taking behaviors, and to identify relevant evidence-based treatments. Results: The literature review revealed that among adolescents, substance abuse occurs as part of a cluster of problems and risk-taking behaviors. Predisposing factors include temperament, genetics, neurobehavioral disinhibition, social competencies, parenting, abuse/neglect, and peer behaviors. Various interventions, including individual therapies, parent training, and family therapies comprise the empirically-supported treatments for these co-occurring behaviors. Conclusions: The literature indicates that adolescents being seen for substance-related problems should be evaluated for engagement in other risk-taking behaviors, and school, peer, and social functioning. In addition, the data support that family, versus individual, interventions should be the norm for substance-abusing adolescents. Declaration of interest: The authors neither received financial support, nor are involved in financial relationships that pose a conflict of interest for this work.