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Validity of self-reported drug use among people with co-occurring mental health and substance use disorders
- Authors:
- JACKSON Carlos T., et al
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.49-63.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The validity of self-reports of drug use from individuals who abuse substances has been questioned. Results from studies examining the accuracy of such self-reports have been mixed, indicating the need for closer examinations of the factors associated with concordance between self-reported drug use and results of urine screens. Methods: As part of a larger study examining the effectiveness of interventions for people with co-occurring mental health and substance use disorders, we examined the agreement between self-report and urine screens for recent drug use. Overall, the concordance between self-report and results from urine screens was high (80-84% agreement overall and 75-79% for the subset where the urine screen indicated recent drug use). Estimates for the likelihood of use of marijuana and cocaine within the past 30 days were 15% and 32%, respectively, based on urine screens, 25% and 35% based on self-report, and 28% and 43% based on information from both sources combined. About 1/3 of individuals who had at least one positive urine screen misrepresented their drug use at least once. Such misrepresentation tended to increase with time in the study. The relatively high concordance rates between selfreport and urine screens indicate that situations can be structured so that individuals with co-occurring mental health and substance use disorders report instances of substance use accurately most of the time. Given the observed increase in failure to report use through time, the utility of biologicalmarkers may be more valuable as clients develop relationships with clinicians. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Substance abuse and psychiatric dual disorders: focus on tobacco
- Authors:
- GOLD Mark S., FROST-PINEDA Kimberley
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.15-35.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Smoking is a leading cause of morbidity and is the single most important preventable cause of mortality in the United States. The link between tobacco smoking and lung cancer, heart disease, stroke, chronic lung disease, other cancers, and other medical diseases is now generally accepted. The link between tobacco and psychiatric diseases has become a focus for recent epidemiological studies, which have even led to the suggestion that in the differential diagnosis of "smoker" highest on the list are depression, alcohol dependence, and schizophrenia. Less is known about the role of second hand tobacco exposure, either in utero or during childhood, in the risk of dual disorders. Here the authors explore the issue of substance abuse and psychiatric dual disorders, prenatal and early childhood Second Hand Smoke (SHS) exposure and the relationship to the genesis of these dual disorders. They describe a novel method of detecting SHS exposure and the public health implications of this development. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Dual diagnosis: discovery of a critical role for environmental exposure
- Author:
- GOLD Mark S.
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.5-13.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
It is estimated that 10 million persons in the United States have at least one mental disorder and at least one substance-related disorder in any given year. Dual disorders are common in psychiatry, but misdiagnosis may be even more common. Drug and alcohol testing should be expanded from routine use in the Olympics and intercollegiate athletics to psychiatric diagnosis of drug intoxication, dependence, and withdrawal states. Major Depression is co-morbid with opiate addiction, alcohol dependency, tobacco smoking, and many other substance abuse disorders. Drug use induces adaptations in brain systems associated with mood and motivation. The acute rewarding effects of drugs change the mesolimbic dopaminergic system. Cessation of drug self-administration induces dysphoria and anhedonia as a result of changes in monoamine levels in brain reward circuits; opposite to the effects that occur after the administration of drugs of abuse. While most models for dual disorders assume compulsive or volitional use or self administration, we have been interested in second-hand exposure which was common in the past among flight attendants and occurs today between smoking parent and child. We expand the concept from parent-to-child environmental tobacco toxicity to a workplace toxicity hypothesis for anesthesiologists. Such a hypothesis can explain the high rates of depression, workplace and social distress, drug abuse, and drug addiction among anesthesiologists. While co-occurring disorders have been the focus of epidemiological studies and twin and genetic studies, the role of exposure to potent drugs of abuse in the intra-uterine, home, and workplace environment has been neglected. We have demonstrated the unequivocal presence of fentanyl and other potent drugs of abuse in the air that anesthesiologists breathe in the operating room. Drug exposure sensitizes the brain. When sensitization is coupled with the stress of operating room, employment may produce the pattern of co-occurring disorders seen in anesthesiologists but not psychiatrists. Prevention is the goal in environmental or toxicity-related illness. After diagnosis, treatment for dual disorders should be vigorous with remission of all disorders in mind. For anesthesiologists, limiting toxic environmental exposure may prevent both drug and affective disorders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Co-morbidity of substance misuse and mental illness collaborative study (COSMIC): research summary
- Editors:
- ADBULRAHIM Dima, (ed.)
- Publisher:
- National Treatment Agency for Substance Misuse
- Publication year:
- 2004
- Pagination:
- 6p.
- Place of publication:
- London
The study measured the extent of co-morbidity among users of substance misuse services and mental health services. It described the range of co-morbid presentations and treatment needs and looked at differences between London and other areas of the country.
The role of health and social care professionals in promoting social inclusion
- Author:
- GREAT BRITAIN. Office of the Deputy Prime Minister. Social Exclusion Unit
- Publisher:
- Great Britain. Office of the Deputy Prime Minister. Social Exclusion Unit
- Publication year:
- 2004
- Pagination:
- 8p.
- Place of publication:
- London
GPs issue sickness certificates when they assess that a person cannot perform their usual work. Mental health problems are more likely to be listed on sickness certificates in the most deprived areas of the country. What people with mental health problems are told by doctors and other health professionals can have a major impact on their confidence and their aspirations for the future. For many people with mental health problems, the concept of ‘waiting to get well enough’ is not a helpful one, as inactivity is strongly associated with worsening mental health. It is important to ensure appropriate pathways of care between primary and secondary services; up to 28 per cent of referrals from primary care to specialist services are inappropriate. The range of services is more limited in rural areas, with specialist services often absent. Adults with complex needs, such as substance misuse in addition to their mental health problems, often struggle to get their needs met by statutory services.
Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature
- Authors:
- ULDALL K. K., et al
- Journal article citation:
- AIDS Care, 16(Supplement 1), January 2004, pp.S71-S96.
- Publisher:
- Taylor and Francis
Adherence to antiretroviral medications is central to reducing morbidity and mortality among people living with HIV/AIDS. Relatively few studies published to date address HIV adherence among special populations. The purpose of this article is to review the existing literature on HIV antiretroviral adherence, with an emphasis on studies among the triply diagnosed population of people living with HIV/AIDS, mental illness, and chemical dependency. In order to reflect the most current information available, data from conference proceedings, federally funded studies in progress, and the academic literature are presented for consideration.
Literature on integrated HIV care: a review
- Authors:
- SOTO T. A., et al
- Journal article citation:
- AIDS Care, 16(Supplement 1), January 2004, pp.S43-S55.
- Publisher:
- Taylor and Francis
With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.
The use of ‘drug dogs’ in psychiatry
- Authors:
- GORDON Harvey, HAIDER Daniel
- Journal article citation:
- Psychiatric Bulletin, 28(6), June 2004, pp.196-198.
- Publisher:
- Royal College of Psychiatrists
The undertaking of drug dog searches on psychiatric units, being premised on the need to create and maintain a safe therapeutic environment, precludes the obtaining of consent by patients or affording to them any advance warning that such a search is to take place. It would be unreasonable for such a search to be prevented due to refusal of consent by patients with illegal drugs in their possession. Similarly, patients cannot usually be informed in advance as that would defeat the purpose by enabling patients to remove any illegal drugs prior to the search. Patients should, however, be informed generally that drug dogs may be brought in at various times without them knowing specifically exactly when. Staff themselves may have differing views on the use of drug dogs, though no surveys in psychiatric units have been published. Extensive discussion is therefore appropriate on units where such an approach is being introduced.
Double take
- Author:
- GLASSMAN Julie
- Journal article citation:
- Care and Health Magazine, 64, 2004, pp.14-16.
- Publisher:
- Care and Health
Two years from the publication of the Department of Health guidance on treating 'dual diagnosis' patients, asks what services are in place for people needing simultaneous treatment for substance misuse and mental ill health.
Women's experience of co-occurring substancce abuse and mental health conditions
- Authors:
- STROMWALL Layne K., LARSON Nancy C.
- Journal article citation:
- Journal of Social Work Practice in the Addictions, 4(1), 2004, pp.81-96.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study explored the relationship between gender and co-occurring substance abuse and mental health conditions among a sample of 754 consumers of behavioural health services in the southwest U.S. Logistic regression was used to determine factors that would predict women's unique experience of dual diagnosis. Women were almost seven times more likely than men in this sample to have a diagnosis of posttraumatic stress disorder in conjunction with substance abuse. Women were also significantly more likely to experience anxiety and mood disorders and to have been married. Implications of these findings for social work practice are suggested. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)