Article

Treatment Guidelines for Substance Use Disorders and Serious Mental Illnesses: Do They Address Co-Occurring Disorders?

University of Michigan, School of Social Work, Ann Arbor, MI, USA.
Substance Use & Misuse (Impact Factor: 1.23). 06/2010; 45(7-8):1262-78. DOI: 10.3109/10826080903442836
Source: PubMed

ABSTRACT

Practice guidelines are important tools for improving the delivery of evidence-based practices and reducing inappropriate variation in current treatment approaches. This study examined the degree to which guidelines targeted to the treatment of substance use disorders or serious mental illness address treatment of co-occurring disorders. Guidelines archived by the National Guideline Clearinghouse (NGC) were retrieved in December 2007 and content analyzed. Nineteen pertinent guidelines were identified, and 11 included recommendations regarding the assessment and/or treatment of co-occurring disorders. None of the guidelines making recommendations for treatment of co-occurring disorders included outcomes that clearly targeted both substance use and mental health disorders. Limitations and implications of this study are noted.

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    • "Co-occurring disorders in the form of substance use disorders and serious mental illnesses have been recognized as ongoing and significant health concerns in the United States (Epstein, Barker, Volburger, and Murtha, 2004; National Institute of Mental Health, 2010; Perron, Bunger, Bender, Vaughn, Howard, 2010). In the 1980s, practitioners began to recognize that co-occurring disorders (in the form of substance use disorders and serious mental disorders) complicated adolescents' community adjustment (Drake, Mercer-McFadden, Mueser, McHugo, & Bond, 1998). "
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    ABSTRACT: The Forest for the Trees: Beginning to Clarify the Complexities of Co-Occurring Disorders in Adolescent Drug Users Background and Purpose: Evidence within the growing body of literature concerning co-occurring issues of substance abuse and mental health disorders has established strong correlations between the two, especially within the adolescent population. However, there is little discussion of the variety and types of drugs that are used by this population. Because different drugs’ physical and psychological withdrawal affects impact patients’ abilities in treatment, drug types used have important implications on services and methods of delivery offered to treatment-seeking adolescents as well as aftercare recommendations for this population. Methods: This study examined adolescent responses to the 2012 National Study on Drug Use and Health (NSDUH) to provide further confirmation of the relationship between mental health and substance abuse disorders as well as to investigate relationships between mental health disorders and specific types of drugs abused. The hypothesis guiding the study was: Adolescents who have been diagnosed with anxiety disorder or major depressive disorder within the past year will be more likely to have used or abused alcohol and other types of drugs within the past year. A secondary data analysis was conducted on 2012 NSDUH responses provided by adolescents between the ages of 12 and 17 (n = 17399) regarding whether they had been diagnosed with anxiety disorder or major depressive episode by a medical professional in the past year, if any. A factor analysis examined 111 different drug categories explored by the NSDUH survey. Five categories of interest encompassing the commonly-encountered drugs in substance abuse treatment facilities and agencies (alcohol and marijuana; stimulants; hallucinogens; prescription medications; and heroin, cocaine, and crack) were identified. Separate logistic regression analyses were then conducted using anxiety diagnoses and major depressive episode diagnoses as independent variables predicting the likelihood that respondents had also used drugs in those 5 identified categories while controlling for the effects of age, gender, and race. Findings: Past year anxiety and major depressive disorder diagnoses were found to be statistically significant predictors of past year use of all substance groups identified through the factor analysis. Odds ratios ranged between 1.609 times through 3.503 times more likely for persons diagnosed with anxiety in the past year to have used 1 of the 5 substance groups as compared to persons who were not diagnosed with anxiety. Odds ratios ranged between 2.228 times through 2.831 times more likely for persons diagnosed with major depressive disorder in the past year to have used 1 of the 5 substance groups. Conclusions and Implications: Overall, findings show that anxiety and major depressive disorder diagnoses significantly increase the likelihood of adolescents having used alcohol or other drugs. When considering treatment interventions, practitioners must begin to understand the range of substances used having an impact on the method and types of interventions employed in treatment settings rather than treating substance abuse as one generic condition. Further, this study shows the importance of understanding the prevalence of the co-occurring nature of substance abuse and mental health disorders when considering the treatment interventions used within this population.
    Full-text · Conference Paper · Jan 2015
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    • "Commonly, such patients are first referred to and expected to complete substance treatment and achieve a sustained period of abstinence before antidepressant medication is considered; however, successful treatment of SUD is less likely if depression is not treated[12]. Moreover, observational studies tend to suggest that co-occurring depression is associated with worse treatment outcome for SUD[13,14]. Thus, the major controversy is whether to treat pharmacologically these depressed youths with ongoing substance abuse. "
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    ABSTRACT: AimsTo measure the effectiveness of antidepressants for adolescents and young adults with co-occurring depression and substance use disorder.Design, setting, participantsMeta-analysis of randomized controlled clinical trials. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science and PsychINFO was conducted (from 1970 to 2013). Prospective, parallel groups, double-blind, controlled trials with random assignment to an antidepressant or placebo on young patients (age ≤25 years) who met diagnostic criteria of both substance use and unipolar depressive disorder were included. Five trials were selected for this analysis and included 290 patients.MeasurementsOur efficacy outcome measures were depression outcomes (dichotomous and continuous measures) and substance-use outcomes (change of frequency or quantity of substance-use). Secondary analysis was conducted to access the tolerability of antidepressants treatment.FindingsFor dichotomous depression outcome, antidepressants group was significantly more effective than placebo group (RR=1.21; 95% CI 1.01 to 1.45) with low heterogeneity (I2=0%). Although no statistically significant effects for continuous depression outcome (SMD=-0.13; 95% CI, -0.55 to 0.30) were found with moderate heterogeneity (I2=63%), subgroup analysis showed medicine group with sample size of more than 50 showed a statistically significant efficacy compared with the placebo group (SMD -0.53, 95% CI -0.82 to -0.25). Moreover, there was no significant difference for substance-use outcomes and tolerability outcomes between medication group and placebo group.Conclusions Antidepressant medication has a small overall effect in reducing depression in young patients with combined depressive and substance-use disorders but does not appear to improve substance use outcomes.
    Preview · Article · Aug 2014 · Addiction
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    • "The evidence was summarized and categorized to refl ect its susceptibility to bias (Shekelle et al. 1999). In addition, a number of national and international guidelines were reviewed (Lingford- Huhges et al. 2004; van den Brink and Haasen 2006, Connock et al. 2007; Kleber et al. 2007; NHS NICE Clinical Guidelines Nos 51, 52, NICE 2007a,b; Meili et al. 2008; Chou et al. 2009; Fareed et al. 2010; Nicholis et al. 2010; Perron et al. 2010). To achieve uniform and – in the opinion of the Task Force – appropriate ranking of evidence, we adopted the same hierarchy of evidence-based rigor and level of recommendation as was recently "
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    ABSTRACT: To develop evidence-based practice guidelines for the pharmacological treatment of opioid abuse and dependence. An international task force of the World Federation of Societies of Biological Psychiatry (WFSBP) developed these practice guidelines after a systematic review of the available evidence pertaining to the treatment of opioid dependence. On the basis of the evidence, the Task Force reached a consensus on practice recommendations, which are intended to be clinically and scientifically meaningful for physicians who treat adults with opioid dependence. The data used to develop these guidelines were extracted primarily from national treatment guidelines for opioid use disorders, as well as from meta-analyses, reviews, and publications of randomized clinical trials on the efficacy of pharmacological and other biological treatments for these disorders. Publications were identified by searching the MEDLINE database and the Cochrane Library. The literature was evaluated with respect to the strength of evidence for efficacy, which was categorized into one of six levels (A-F). There is an excellent evidence base supporting the efficacy of methadone and buprenorphine or the combination of buprenorphine and naloxone for the treatment of opioid withdrawal, with clonidine and lofexidine as secondary or adjunctive medications. Opioid maintenance with methadone and buprenorphine is the best-studied and most effective treatment for opioid dependence, with heroin and naltrexone as second-line medications. There is enough high quality data to formulate evidence-based guidelines for the treatment of opioid abuse and dependence. This task force report provides evidence for the efficacy of a number of medications to treat opioid abuse and dependence, particularly the opioid agonists methadone or buprenorphine. These medications have great relevance for clinical practice.
    Full-text · Article · Apr 2011 · The World Journal of Biological Psychiatry
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