Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: A call to action

Boston University, Boston, Massachusetts, United States
Biological Psychiatry (Impact Factor: 10.26). 12/2004; 56(10):703-13. DOI: 10.1016/j.biopsych.2004.10.002
Source: PubMed


The Depression and Bipolar Support Alliance (DBSA) is the nation's largest, illness-specific organization run by and for people living with depression or bipolar disorder. In November 2003, the DBSA convened a conference to address the unmet needs of substance use disorders in persons with depression or bipolar disorder. The prevalence and severity of substance use disorders that are comorbid with other mental illnesses was acknowledged; however, the DBSA conference focused on comorbid mood and substance use disorders. Unless otherwise specified, the term "substance use disorders" is used in this statement to include the full spectrum of abuse and dependence on alcohol, nicotine, and illegal and prescription drugs. Participants included 43 experts in psychiatry, psychology, addiction treatment, health care policy, primary care, adolescent health, epidemiology, and advocacy. Presentations and deliberations from the conference and articles published in this special issue of Biological Psychiatry (Vol 56) are reflected herein. Participants listened to presentations, debated workgroup reports, and provided input to interim versions of this statement. All authors approved the final version. The objectives of this statement are to assess available data, describe unmet needs, and outline priority clinical actions and research directions that are needed to improve treatment, access to care, and professional training. Recommendations for priority actions are evidence-based, when possible; however, there is a remarkable lack of empirical data in this area. When data are available, they are often gleaned from heterogeneous populations that include patients with psychiatric diagnoses other than mood disorders. Thus, by necessity, the remaining priority action recommendations are based on the opinions and clinical experiences of the experts who participated in this conference. This statement reflects input from all participants. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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    • "College students also report that they believe men drink more heavily, are more likely to drink and drive, are less concerned with campus alcohol use, and use fewer protective behavioral strategies than their female counterparts (Lewis and Neighbors, 2004; Lewis et al., 2009). In order to inform more effective interventions for targeted harm reduction, researchers have recognized the need for both increased concentration on college populations and more indepth investigation of subgroup differences (e.g., gender; Cranford et al., 2009; O'Brien et al., 2004). As such, research examining gender differences with respect to known antecedents to drinking (drinking identity) and buffers against drinking (decisional balance) may have both practical utility and clinical significance in terms of informing drink-reduction programs. "
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    ABSTRACT: Background: The aim of the present study was to test promising constructs (decisional balance and drinking identity) and their interaction with gender as predictors of risky college drinking. We expected that, consistent with previous work, drinking identity would be positively associated with alcohol consumption and problems. We further expected that drinking identity would be more strongly related to outcomes among individuals scoring low in decisional balance. Additionally, we expect the relationship between drinking identity and alcohol behavior to vary as a function of decisional balance. Methods: Participants included 329 undergraduates (M=23.11; SD=5.63; 74.47% female) who met heavy drinking criteria (defined as women who consumed 4 or more drinks per occasion and men who consumed 5 or more drinks per occasion) and completed an online survey comprised of self-report measures. Results: Decisional balance was negatively correlated with both drinking and problems, which partially supported expectations. As expected, drinking identity was positively correlated with drinking and problems. A two-way interaction emerged between drinking identity and decisional balance regarding problems, indicating that drinking identity was associated with more problems, especially among those lower in decisional balance. A three-way interaction between drinking identity, decisional balance, and gender emerged regarding problems such that drinking identity was associated with more problems for those lower in decisional balance and this effect was stronger among men. Discussion: Findings lend support to the perspective that decisional balance, drinking identity, and gender are all influential factors that are associated with the experience of alcohol problems.
    Full-text · Article · Oct 2014 · Drug and Alcohol Dependence
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    • "Given the complicated nature of co-occurring disorders, the provision of integrated mental health and substance use treatment services is critical. Yet, funding for both mental health and substance abuse treatment is limited and continues to decline (O'Brien et al. 2004). The shift in emphasis to community-based care as a result of deinstitutionalization has broadened the forms and locations of treatments offered. "
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    ABSTRACT: This study examined trends in general hospital discharges and dispositions involving episodes of severe mental illness (SMI) with and without co-occurring substance use disorders. We analyzed data from the National Hospital Discharge Survey from 1979 through 2008. Discharges involving SMI and co-occurring substance use disorders (COD) were associated with shorter lengths of stay and had a greater likelihood of being discharged routinely or home and reduced likelihood of being transferred to a short- or long-term facility. Although COD discharges had a greater odds of leaving against medical advice than SMI discharges, this effect was not significant over time. A greater understanding of hospital discharge planning practices is needed to ensure that patients are linked to appropriate aftercare services.
    Full-text · Article · Feb 2014 · Administration and Policy in Mental Health and Mental Health Services Research
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    • "Similar trends are affecting social workers, psychologists, and nurses, endangering the entire behavioral health field (Lewis, Sheff, Richard, Brandt, & Zollinger, 2012). Second, the behavioral health system of the U.S., including research, professional training, and clinical care, remains firmly entrenched in a segregated view of addictions and mental illnesses as unrelated entities (Gonzales & Insel, 2004; O'Brien et al., 2004). Even as most behavioral health patients live with dual diagnosis (Grant, 1996; Grant et al., 2004; Kessler, 2004; Kessler et al., 1994; Lasser et al., 2000), and despite mounting evidence suggesting the biological interrelatedness of these diseases (Chambers, 2013; Chambers et al., 2001; D'Souza et al., 2005; Lappalainen et al., 1998; Zhang, Stein, & Hong, 2010), NIDA, the National Institute of Mental Health, and the National Institute on Alcohol Abuse and Alcoholism still primarily fund research that focuses on drug abuse or alcohol abuse or mental illness as separate disorders. "
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    ABSTRACT: Addiction is the number one cause of premature illness and death in the U.S., especially among people with mental illness. Yet American medicine lacks sufficient workforce capacity, expertise, training, infrastructure, and research to support treatment for people with co-occurring addictions and mental illness. This essay argues that the addiction psychiatrist is essential in dual diagnosis care.
    Full-text · Article · Aug 2013 · Journal of Dual Diagnosis
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