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Drug and alcohol problems among individuals with severe mental illness in South London
- Authors:
- MENEZES Paulo R., et al
- Journal article citation:
- British Journal of Psychiatry, 168, May 1996, pp.612-619.
- Publisher:
- Cambridge University Press
High rates of comorbid alcohol and drug disorders have previously been found among individuals with severe mental illnesses such a schizophrenia and bipolar affective disorders. Clinical and social outcomes have been reported to be worse in this group and service costs greater than in individuals with severe mental illness only. This article looks at a study of these 'dual diagnosis' patients to study patterns of substance abuse. Concludes that the prevalence of substance problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. Recognises this as a significant clinical problem, with cost implications.
Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs
- Authors:
- TIMKO Christine, et al
- Journal article citation:
- Journal of Mental Health, 15(2), April 2006, pp.163-177.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
This American study evaluated the effectiveness and cost-effectiveness of community- and hospital-based acute residential treatment for dually disordered patients, and whether moderately-ill patients benefited more from community care, and severely-ill patients from hospital care. Two hundred and thirty patients with dual substance use and psychiatric disorders were randomly assigned to community or hospital acute care programs that had the same level of service-intensity. They were followed for 1 year (80%) using the Addiction Severity Index. Patients' health care utilization was assessed from charts, VA databases, and health care diaries; costs were assigned using methods established by the VA Health Economics Resource Center. Patients had better substance use outcomes when they were initially assigned to community rather than to hospital acute care. Patients assigned to hospital care had shorter index stays, but these index stays were more costly than were the longer index stays of patients assigned to community care. Patients assigned to hospital care also had more mental health follow-up outpatient visits, and more costly mental health follow-up stays, over the study year. The authors concluded that cost savings may be achieved without loss of benefit to all but the most decompensated dually disordered patients by shifting the locus of acute treatment from hospital to community care.
Survey of staff perceptions of illicit drug use among patients in a medium secure unit
- Authors:
- DOLAN Mairead, KIRWAN Helen
- Journal article citation:
- Psychiatric Bulletin, 25(1), January 2001, pp.14-17.
- Publisher:
- Royal College of Psychiatrists
This study is a survey of staff perceptions of illicit drug among in-patients in a medium secure unit. Results showed that sixty per cent of staff were aware of drug misuse on the unit. Less than one-third of staff were clear about the unit's policy for dealing with in-patient drug use and few have had adequate training in the management of patients with dual diagnoses. Strategies for dealing with drug misuse appear to focus on security rather than therapeutic issues. Services need to provide adequate training for staff on the management of patients with co-morbid substance misuse, introduce patient education programmes and develop and disseminate clear policies that emphasise both therapy and security.
Substance use and misuse in psychiatric wards: a model task for clinical governance?
- Authors:
- WILLIAMS Richard, COHEN Jeff
- Journal article citation:
- Psychiatric Bulletin, 24(2), February 2000, pp.43-46.
- Publisher:
- Royal College of Psychiatrists
Substance use has reached endemic proportions. Inevitably, the world of psychiatric wards must reflect issues arising in our society. Recognition of its impact on the psychiatric ward is a key issue for staff and patients alike. This paper discusses the problems of substance use in this setting and suggests some procedures and approaches for dealing with its impact.
Assessing dual diagnosis in an acute in-patient psychiatric unit
- Authors:
- KING Linda Partridge, et al
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 2(4), 1999, pp.19-32.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Dual diagnosis has been a label used to describe the multiple and complex problems of a population that is characterised by two distinct diagnostic entities. This research explores the use of established assessment instruments to identify possible depression and alcohol abuse of dependence. The research also investigates whether the results of these assessments are predictive of the working diagnosis of these individuals in an in-patient treatment unit located in a large urban public hospital. Findings suggest that over 44% of the sample are identified as having possible moderate to severe depression and probable alcoholism. Assessing and recognising the existence of comorbidity is central to effective treatment planning process.