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SCIE research briefing 30: the relationship between dual diagnosis: substance misuse and dealing with health issues
- Authors:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE, CROME Ilana, et al
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2009
- Pagination:
- 23p.
- Place of publication:
- London
This briefing examines the issues presented by service users with dual diagnosis for UK practitioners in health and social care. Confusingly, the term ‘dual diagnosis’ is used to describe several combinations of physical, psychological or developmental conditions; but for the purpose of this briefing, it refers to the co-existence of substance misuse and mental health problems. This briefing considers all age groups and uses the term ‘substance’ to refer to illegal or illicit drugs; alcohol; nicotine and prescription drugs. The terms ‘substance’ and ‘drug’ are used interchangeably. ‘Mental health problems’ refers to severe or enduring conditions, while ‘substance misuse’ refers to chronic or complex substance use problems. The briefing does not consider specific pharmacological or other treatment interventions in detail, but focuses on issues arising at the health and social care interface. It draws on research and literature from other countries, including the US where the majority of research on dual diagnosis has been conducted; to provide an overview for health and social care practitioners in the UK. Where there are gaps in the research, for example, in regard to service user involvement, recovery approaches and personalisation of services, the briefing draws upon evidence from relevant fields such as mental health and substance misuse. Throughout this briefing the terms, patient, client, and service user are used interchangeably to reflect the different usages prevalent within different sectors of health and social care.
Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study
- Authors:
- ZAMMIT Stanley, et al
- Journal article citation:
- British Medical Journal, 23.11.02, 2002, pp.1199-1201.
- Publisher:
- British Medical Association
An association between use of cannabis in adolescence and subsequent risk of schizophrenia was previously reported in a follow up of Swedish conscripts. Arguments were raised that this association may be due to use of drugs other than cannabis and that personality traits may have confounded results. Cannabis use is associated with an increased risk of developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration.
Depression and anxiety symptoms: measuring reliable change in alcohol and drug users
- Author:
- DELGADILLO Jaime
- Journal article citation:
- Advances in Dual Diagnosis, 5(3), 2012, pp.102-114.
- Publisher:
- Emerald
The aim of this study, based on a sample drawn from a project investigating the prevalence and assessment of depression and anxiety in alcohol and drug users, was to describe and compare the reliability and accuracy of different methods of measuring psychiatric symptom changes in the context of substance use. The participants were 60 patients in routine methadone treatment at an inner city addictions treatment clinic in Leeds. Information was gathered through screening questionnaires for depression and anxiety and structured diagnostic interviews, with a follow-up retest after a "watchful wait" period of 4 to 6 weeks. The article describes the study methodology and data analysis, and presents and discusses the results. It reports that measuring change using conventional cut-offs in brief symptom questionnaires tends to overestimate the prevalence of common mental disorders and the rate of improvement, and discusses the relative merits and limitations of alternative psychiatric symptom measurement methods which may improve accuracy and enhance reliability.
Psychosocial intervention research on co-occurring disorders
- Author:
- DRAKE Robert E.
- Journal article citation:
- Journal of Dual Diagnosis, 3(2), 2007, pp.85-93.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This update on the literature of psychosocial interventions for co-occurring disorders shows significant progress since the late 1980s when there were very few relevant intervention studies. By 2006 more than 40 controlled trials of psychosocial interventions had been reported, and there has been a rapid increase in the number of pharmacological trials. A brief summary is presented of evidence on integrated mental health/addiction treatment approaches, and specific psychosocial interventions. The evidence base is currently limited by a lack of methodological standardisation and rigour, and lack of replication. Future research and practice needs, some of which are already being addressed, include the development of methodological standards; longitudinal studies; effectiveness studies of interventions for different stages of recovery, subgroups and treatment settings; the development of practice guidelines; and the development of electronic decision support systems. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Causal association between cannabis and psychosis: examination of the evidence
- Authors:
- ARSENEAULT Louise, et al
- Journal article citation:
- British Journal of Psychiatry, 184(2), February 2004, pp.110-117.
- Publisher:
- Cambridge University Press
Controversy remains as to whether cannabis acts as a causal risk factor for schizophrenia or other functional psychotic illnesses. The aim was to examine critically the evidence that cannabis causes psychosis using established criteria of causality. The authors identified five studies that included a well-defined sample drawn from population-based registers or cohorts and used prospective measures of cannabis use and adult psychosis. On an individual level, cannabis use confers an overall twofold increase in the relative risk for later schizophrenia. At the population level, elimination of cannabis use would reduce the incidence of schizophrenia by approximately 8%, assuming a causal relationship. Cannabis use appears to be neither a sufficient nor a necessary cause for psychosis. It is a component cause, part of a complex constellation of factors leading to psychosis. Cases of psychotic disorder could be prevented by discouraging cannabis use among vulnerable youths. Research is needed to understand the mechanisms by which cannabis causes psychosis.
Psychosis and drug dependence: results from a national survey of prisoners
- Authors:
- FARRELL M., et al
- Journal article citation:
- British Journal of Psychiatry, 181(11), November 2002, pp.393-398.
- Publisher:
- Cambridge University Press
The links between drug use and psychosis are of major aetiological and prognostic significance. Psychosis and drug dependence frequently co-occur within the prison population, providing the opportunity to study this link more closely. Analyses indicated that first use of amphetamines or cocaine before the age of 16 years and severe cannabis or cocaine dependence were related to an increased risk of psychosis. In contrast, severe dependence on heroin was associated with a reduced risk of this classification. Severe dependence on cannabis and psychostimulants is associated with a higher risk of psychosis and is in contrast to severe dependence on heroin, which has a negative relationship with psychosis.
Treatment of drug-dependent individuals with comorbid mental disorders
- Authors:
- ONKEN Lis Simon, et al, (eds.)
- Publisher:
- United States. Department of Health and Human Services. National Institute on Drug Abuse
- Publication year:
- 1997
- Pagination:
- 181p.
- Place of publication:
- Rockville, MD
Promotes effective treatment by reporting state-of-the-art treatment research on individuals with comorbid mental and addictive disorders and research on HIV-related issues among people with comorbid conditions.
Research into homelessness and substance misuse
- Author:
- Deloitte MCS
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2004
- Pagination:
- 212p.
- Place of publication:
- Belfast
The overall aim of the research is to provide a detailed account of substance misuse among homeless people that could be used to inform future prevention and treatment activities. The research leads to the conclusion that substance misuse is a significant issue among homeless people in terms of both prevalence of use and dependency. Risk behaviours were associated with substance use and the incidence of mental illhealth among the population was high. The research also indicates that substance use is a factor in becoming homeless on one or more occasions and remaining homeless. There is a requirement to address the range of services available to homeless people with problem substance use, both in terms of treatment and homelessness provision.
Feasibility and implementation of a Statewide evaluation of substance abuse services
- Authors:
- BORDNICK Patrick S., WALLER Raymond J., KING Michael
- Journal article citation:
- Research on Social Work Practice, 14(6), November 2004, pp.417-423.
- Publisher:
- Sage
US Statewide evaluations of mental health services are colossal undertakings, reports of which are few in the published literature. Social workers are often called on to conduct programme evaluations of both small-and large-scale mental health systems. A statewide evaluation system was implemented in the state of Georgia in 1999 to measure the impact of services on mental health, learning difficulties, and substance abuse programmes. This report delineates the evaluation of substance abuse services for the state of Georgia using the Addiction Severity Index. System-wide outcomes were assessed across 13 mental health regions, and 19 substance abuse programs participated. Consumers admitted to American Society of Addiction Medicine level II services were assessed at intake and 60 days posttreatment. Difficulties with the implementation of the statewide evaluation system, such as attrition, are identified and discussed. Recommendations for improving the evaluation system are also discussed.
The effects of PTSD on treatment adherence, drug relapse, and criminal recidivism in a sample of incarcerated men and women
- Author:
- KUBIAK Sheryl Pimlott
- Journal article citation:
- Research on Social Work Practice, 14(6), November 2004, pp.424-433.
- Publisher:
- Sage
Given the relationship between post-traumatic stress disorder (PTSD) and substance use disorders (SUD), and the prevalence of SUD among offenders, the inattention to trauma before, during, and after incarceration is troubling. This exploratory study compared those with and without co-occurring PTSD among men (n = 139) and women (n = 60) involved in prison-based substance abuse treatment. More than one half the sample met criteria for lifetime PTSD with women experiencing a greater number of events and men experiencing more recent events. Women with PTSD were significantly more likely to relapse than women without. Men with PTSD were more likely to enter community aftercare treatment and recidivate than those without. The findings suggest that trauma-related disorders, among those with SUD, affect postincarceration outcomes. Therefore, from a practice and policy perspective, interventions addressing this co-occurring disorder should be available to men and women within the criminal justice system.