Relapse to alcohol and drug use among individuals diagnosed with co-occurring mental health and substance use disorders: A review

Research Institute on Addictions, University at Buffalo, United States.
Clinical Psychology Review (Impact Factor: 7.18). 04/2006; 26(2):162-78. DOI: 10.1016/j.cpr.2005.11.005
Source: PubMed


This paper reviews the literature investigating relapse to alcohol and drug use among individuals dually diagnosed with a substance use and a co-occurring mood, anxiety, schizophrenia-spectrum, or personality disorder. Prevalence rates for each co-occurring set of disorders are discussed, followed by research studies that examine predictors of relapse to substance use within these groups. Relevant conceptual models well-suited to incorporating relapse as an outcome variable, and psychiatric factors both as predictor and outcome variables, are presented. Suggestions for future studies are provided. A priority area is developing and using consistent and well-articulated definitions of relapse across studies. Several diagnostic issues surfaced such as using structured clinical interviews to determine diagnosis (preferably following detoxification from alcohol and/or drugs), separating individuals with only alcohol use disorders from those with alcohol and drug use disorders in analyses, reporting the rates and types of overlap in mental health diagnoses, and conducting analyses that include and exclude multiply disordered individuals. Finally, future studies that focus on isolating predictors of relapse and abstinence could make substantive contributions to improving treatment for individuals with co-occurring substance use and mental health disorders.

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Available from: Clara M Bradizza, Aug 27, 2014
    • "Approximately one-third of alcohol-dependent individuals exhibit depressive symptoms (Bradizza et al., 2006). Although selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for the treatment of depression, clinical trials examining the efficacy of SSRIs in treating comorbid alcohol dependence and depression have shown few promising results, and there are few pharmacogenetic studies of these drugs. "
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    ABSTRACT: Alcohol use disorders (AUDs) represent a significant health burden worldwide. Currently, there are three medications approved by the U.S. Food and Drug Administration for the treatment of AUDs, and other drugs are being prescribed off-label for this purpose. However, response rates for pharmacologic treatment are low, and extant research suggests that treatment effects may partially depend on genetic factors. Personalized medicine, or using a patient's genetics and/or personal history to determine efficacy of treatment prior to prescription, is an emerging tool that will help clinicians treat their patients more effectively and safely. This review systematically discusses current findings from AUD pharmacotherapy trials examining disulfiram, acamprosate, naltrexone, the injectable naltrexone, and topiramate. Furthermore, it presents pharmacogenetics findings associated with these medications in an attempt to further the field of personalized medicine. Research from trials examining AUDs and comorbid major depressive disorder and anxiety disorders is also presented, and pharmacogenetic findings for these treatments are discussed. Lastly, the authors comment on the present and future states of the field of personalized medicine for AUD.
    No preview · Article · Oct 2015
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    • "To further enhance long-term remission after AUD treatment, subsequent interventions should focus on PTSD treatment. Since PTSD symptoms were found to trigger AUD, they might likewise play an important role in the remission of AUD (Bradizza et al., 2006). Unfortunately, the majority of dually diagnosed patients were never previously referred to any trauma-focused treatment (Brown et al., 1998). "
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    ABSTRACT: There is much evidence that alcohol use disorders (AUD) often co-occur with posttraumatic stress disorders (PTSD), and that the comorbid condition is associated with a more severe clinical profile than that of PTSD without AUD. However, little is known about the role of childhood adversities as specific risk factors for the development of AUD in individuals presenting with PTSD. The aim of the study was to explore whether specific stressors from the spectrum of trauma and childhood adversities contribute to the development of AUD among subjects with PTSD. From a large community sample, of N=140 individuals with PTSD, N=24 (17.14%) received an additional diagnosis of AUD with an onset after the onset of PTSD. Those with comorbid PTSD/AUD and those with PTSD only were compared regarding type and features of their trauma, childhood adversities and psychiatric comorbidity. Compared to PTSD alone, PTSD/AUD was associated with higher levels of stress in terms of childhood adversities; in particular, sexual abuse below the age of 16, but also with having been brought up in a foster home. PTSD/AUD was also associated with an earlier age of adverse events. Treatment of AUD should include standardized assessments of trauma, especially of trauma experienced during childhood. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Psychiatry Research
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    • "Further data are needed to better understand how patient characteristics predict addictions treatment performance in adults with co-occurring disorders. Understanding predictors of treatment outcomes will help better tailor interventions to match patient needs, by allowing us to target patients with the highest likelihood of success , and by helping us identify patients who may be at risk of treatment failure and adapting interventions to meet their needs (Bradizza et al., 2006). Toward that end, the current study identified independent demographic, substance use, psychiatric, and service use predictors of in-treatment abstinence during a 12-week contingency management (CM) intervention targeting psycho-stimulants and other drugs in a sample of adults with co-occurring disorders. "
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    ABSTRACT: Background: Severe mental illness is often exclusionary criteria for studies examining factors that influence addiction treatment outcome. Therefore, little is known about predictors of treatment response of individuals receiving psychosocial treatments for addictions who suffer from co-occurring severe mental illness. Methods: The impact of demographic, substance abuse severity, psychiatric severity, and service utilization variables on in-treatment performance (i.e., longest duration of abstinence) in a 12-week contingency management (CM) intervention for stimulant abuse in 96 severely mentally ill adults was investigated. A 4-step linear regression was used to identify independent predictors of in-treatment abstinence. Results: This model accounted for 37.4% of variance in the longest duration of abstinence outcome. Lower levels of stimulant use (i.e., stimulant-negative urine test) and psychiatric severity (i.e., lower levels of psychiatric distress), as well as higher rates of outpatient treatment utilization at study entry were independently associated with longer duration of drug abstinence. Conclusion: These data suggest that individuals with low levels of stimulant use and psychiatric severity, as well as those actively engaged in services are most likely to succeed in a typical CM intervention. For others, modifications to CM interventions, such as increasing the value of reinforcement or adding CM to evidence based psychiatric interventions may improve treatment outcomes.
    Full-text · Article · Dec 2012 · Drug and alcohol dependence
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