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Narratives of recovery in people with coexisting mental health and alcohol misuse difficulties
- Authors:
- Stott Andrew, PRIEST Helena
- Journal article citation:
- Advances in Dual Diagnosis, 11(1), 2018, pp.16-29.
- Publisher:
- Emerald
Purpose: Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this paper is to use a narrative approach to explore the process of recovery as an individual journey in a social context. It focuses on people who use alcohol in order to explore the impact of alcohol’s specific cultural meanings on the recovery journey. Design/methodology/approach: Ten interviews with people with coexisting mental health and alcohol misuse difficulties were conducted, audio-recorded, and transcribed. The transcriptions were analysed using narrative analysis. Findings: Most participants’ narratives shared a three-part structure, from a traumatic past, through an episode of change, to an ongoing recovery phase. Change and recovery were attributed to several factors including flexible and practical support from services, therapeutic relationships with key professionals, and peer support. Some participants redefined themselves and their alcohol use in relation to ideas of what it is to be “normal”. Research limitations/implications: The research excluded people who recover outside of services, replicating a shortcoming of much research in this area. Practical implications: The value placed on professionals having specialised therapeutic skills in working with trauma highlights the need for training in this area. The role for practical and material support underlines the importance of multi-agency working. Originality/value: The narrative methodology enables the study to draw links between personal stories of recovery and wider social influences, allowing comment on the implications for services. Further, the experiences of people with coexisting mental health and alcohol misuse difficulties have rarely been studied apart from the dual diagnosis population in general, so this paper is able to investigate the specific challenges for this population. (Publisher abstract)
A novel treatment resource for co-occurring symptoms
- Authors:
- McCALLUM Stacey L., et al
- Journal article citation:
- Advances in Dual Diagnosis, 6(4), 2013, pp.155-167.
- Publisher:
- Emerald
This paper describes the development of a self-directed treatment tool which uses cognitive behavioural therapy techniques to reduce anxiety symptoms in patients seeking treatment for alcohol-related problems. The booklet was formatted for the patients to completed over four weeks, with each week targeting a different CBT technique. Semi-structured interviews were conducted with 15 patients presenting to hospital for alcohol related problems and 10 practitioners working at inpatient, outpatient and residential treatment facilities in Adelaide, South Australia. The majority of patients (80 percent) and practitioners (90 percent) felt the booklet was a practical, usable educational resource for patients sufferening from co-occuring anxiety symptoms in substance abuse facilities. Participants also outlined the limitations of the resource. It was suggested that the booklet would be most suitable for patients with moderate to high cognitive ability, who also exhibit a motivation to change alcohol consumption and have access to additional support. Findings suggest suggest that the booklet may be most useful for improving treatment accessibility and treatment seeking behaviours, rather than reducing practitioner-patient contact. (Edited publisher abstract)
Dual diagnosis and drinking behaviors in an outpatient treatment seeking sample of adolescents with alcohol use disorders
- Authors:
- DEAS Deborah, et al
- Journal article citation:
- Journal of Dual Diagnosis, 2(1), 2005, pp.47-57.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Co-occurring psychiatric disorders are common in adolescents with substance abuse. This American study examined this relationship to investigate whether certain psychiatric disorders impact severity of drinking behaviours in adolescents with alcohol use disorders. Thirty four outpatient adolescents with alcohol use disorders for comorbid psychiatric disorders using the K-SADS were examined. Their drinking behaviour patterns were examined using the Time-Line Follow-Back. The alcohol drinking parameters were (1) drinks per drinking day (DDD), (2) percent heavy drinking days (PHD), (3) percent heavy drinking days when drinking (PHDD), and (4) percent days abstinent (PDA). Results revealed no significant effect of either ODD or any mood/anxiety disorder on drinking indices; MANOVA revealed a significant effect of ADHD diagnosis. Univariate analysis showed that for all four drinking indices, the group with ADHD had more severe alcohol use. The results suggest that adolescents with ADHD who meet diagnostic criteria for alcohol use disorders have greater drinking severity than those without ADHD. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Locked down and drinking? Are more people self-identifying as having mental health difficulties alongside their drinking via an online platform?
- Authors:
- CALCAN Angela, HOLMES Mark
- Journal article citation:
- Advances in Dual Diagnosis, 14(3), 2021, pp.159-166.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to offer a viewpoint on the impact that the COVID-19 pandemic has had on people’s engagement with an online alcohol service in the UK. This paper examines whether self-reported mental health concerns increased during the pandemic compared to pre-pandemic times. Design/methodology/approach: A comparison was made between service data captured in one contract area – West Sussex, England – pre-pandemic (April 2019 to March 2020) and during pandemic (April 2020 to March 2021). Findings: Self-reported mental health treatment needs increased during the pandemic period (71.2% of presentations compared to 50% pre-pandemic) via the online coaching service. Male referrals increased by 74% during the pandemic period compared to the previous year. Female referrals decreased by 4% in the same time period. Feelings of shame and guilt as well as loss of a confidential space to engage in online interventions were common concerns reported by service users. Research limitations/implications: Research limitations include the relatively small sample size, the sample comprised of self-referred treatment seeking clients, and there was no control group. All data collected is self-report therefore subjective and not necessarily meeting diagnostic criteria. Practical implications: Of note was the impact of the pandemic on women and their reduced access to the online service during the pandemic. Commissioners and services must adapt their service design and delivery alongside the new “normal” way of living and working. Routine screening of mental health and alcohol use are recommended. Originality/value: This paper offers insight from an established online/digital service and the impact of the pandemic on people’s engagement with the service. (Edited publisher abstract)
Service provider response to mental health and alcohol in the North West Region of England: a scoping exercise
- Author:
- HUGHES Elizabeth
- Journal article citation:
- Advances in Dual Diagnosis, 4(3), 2011, pp.141-151.
- Publisher:
- Emerald
The purpose of this paper was to obtain an insight into how mental health and alcohol services are responding to people presenting with both alcohol and mental health problems. It forms part of a wider North West Alcohol and Mental Health Project commissioned by Drink Wise North West and Alcohol Improvement Programme (Department of Health). An electronic survey was sent to managers and clinical leads in mental health and alcohol services across the North West region of England. Twelve responses were received from across a range of services (60% response rate). The findings reveal variation in definitions of dual diagnosis and that not all areas had a strategy in place. NHS mental health and alcohol services seemed to offer a wider range of treatment options; reflecting the more complex nature of the service users. Workforce issues were highlighted. Barriers to accessing effective care included lack of agreements between local agencies, and solutions included greater partnership working. The authors conclude that, while limited in scope, their survey reveals that even after ten years of service development around alcohol and mental health, there are still significant barriers to effective care, and better workforce development and multi-agency collaboration are required.
How can older people's mental health services in the UK respond to the escalating prevalence of alcohol misuse among older adults?
- Authors:
- RAKSHI Maureen, et al
- Journal article citation:
- Advances in Dual Diagnosis, 4(1), 2011, pp.17-27.
- Publisher:
- Emerald
Alcohol use among older adults (aged 65 and over) in the UK is an increasing cause of concern for health and social care services. Statistical and research evidence suggests that the prevalence of alcohol misuse is increasing among older adults. Alcohol misuse among older people can be difficult to detect and may often go unidentified and untreated. Older adults with mental health problems have increased vulnerability to problematic alcohol use, and this is likely to have a significant impact on older people's mental health services (OPMHS). This paper discusses some of the problems facing OPMHS in relation to increasing alcohol misuse among services users, particularly considering the use of alcohol-screening tools (ASTs) as part of a health care assessment to improve detection. This paper reviews the use of different ASTs in the detection of alcohol related illness among older adults with mental health problems, and proposes a care pathway for the management of alcohol misuse in OPMHS.
Addressing the needs of older people with co-morbid alcohol and mental health disorders: a case series from a London Community Mental Health Team (CMHT)
- Authors:
- ANDREWS Tresa, REDDY Lenna, WHELAN Paul
- Journal article citation:
- Advances in Dual Diagnosis, 4(1), 2011, pp.8-16.
- Publisher:
- Emerald
Community mental health teams (CMHTs) for older adults inevitably encounter service users with alcohol use disorders (AUDs). However, little attention has been given to the needs of older adults with a dual diagnosis. This paper argues against a wholesale transfer of knowledge and practices from working age adults with dual diagnosis to the older age group. Drawing on the experience of care professionals in a central London’s CMHT between 2008 and 2010, the paper illustrates the challenges encountered when working with older adults with co-morbid mental health problems and AUDs. The management and progress of 4 older adult service users are described. This case study series illuminates some of the clinical and professional dilemmas and challenges encountered when working with this group. Suggestions of how to respond to some of these challenges are provided by focussing on aspects of identification, assessment and treatment.
Double trouble
- Author:
- EATON Lynn
- Journal article citation:
- Health Service Journal, 4.01.06, 2006, pp.22-24.
- Publisher:
- Emap Healthcare
Patients who are both mentally ill and addicted to drugs or alcohol are very difficult to treat. This article looks at the slow progress in the NHS in providing care and services for this group. The article also briefly highlights two good practice examples from Turning Point and The Priory Group.
Cheers?: understanding the relationship between alcohol and mental health
- Author:
- MENTAL HEALTH FOUNDATION
- Publisher:
- Mental Health Foundation
- Publication year:
- 2006
- Pagination:
- 40p.
- Place of publication:
- London
While much debate has taken place recently about alcohol, researchers have failed to draw out the reasons why so many people have troubled relationships with it. The reasons we drink and the consequences of excessive drinking are intimately linked with our mental health, and this holds the key to dealing with growing worries about alcohol misuse. Evidence outlined in this report shows that: there are significant connections between reported alcohol use and depressive symptoms; people report using alcohol to help them sleep people drink more when experiencing moderate to high levels of shyness or fear; anxious people use drinking ‘to cope’ and are more likely to avoid social situations where alcohol is not available; as many as 65% of suicides have been linked to excessive drinking 70% of men who kill themselves have drunk alcohol before doing so almost a third of suicides amongst young people are committed while the person is intoxicated; anxiety and depressive symptoms are more common in heavy drinkers; heavy drinking is more common in those with anxiety and depression; there is a significant relationship between job stress and alcohol consumption. Many GPs believe that alcohol is a cause of mental health problems.
Comparison of the internal state scale to clinician-administered assessments in patients with bipolar disorder and alcohol abuse or dependence
- Authors:
- SRISINROONGRUANG Rattapol, et al
- Journal article citation:
- Journal of Dual Diagnosis, 1(3), 2005, pp.61-69.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Self-report measures require less clinician time to administer than clinician-rated assessments. The Internal State Scale (ISS) is a well-validated self-report measure that assesses symptoms of mania and depression in patients with bipolar disorder (BPD). However, the ISS has never been specifically evaluated in patients with BPD and comorbid substance misuse. Substances can induce mood symptoms complicating diagnosis and mood state assessment. The ISS was compared with the Hamilton Rating Scale for Depression (HRSD), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS) in 21 patients with BPD and alcohol abuse/dependence at baseline and for up to 16 weeks postbaseline. In addition, ISS-determined mood state was compared to mood state from a structured diagnostic interview. Significant baseline correlations were observed between the ISS depression subscale and HRSD, ISS activation subscale and YMRS, and ISS perceived conflict subscale and BPRS. Significant correlations of baseline to exit change scores were found between the ISS activation and YMRS, but not ISS depression and HRSD, or ISS perceived conflict and BPRS. All participants had a mixed mood state by structured diagnostic interview. The ISS diagnosed the manic/hypomanic portion of this mood state in 76% of participants but found depression in only 38%. As in BPD patients without substance abuse, the ISS generally showed correlations with clinician-rated scales at baseline, with less strong correlations observed on change scores. The ISS diagnosis of mania or hypomania appeared to correspond more highly than depression with the findings from a structured diagnostic interview.(Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)