People with a dual diagnosis of both mental health and substance misuse problems are currently considered to be one of greatest challenges to services. The DVD features people with a dual diagnosis and a range of experts who describe the difficulties faced both by services and service users. The film shows that many service users are self-medicating with street drugs because they find such substances more helpful and less damaging than prescribed psychiatric medication. The film argues that the problem is not necessarily due to service users with multiple needs but with services whose approach can be the cause of many more problems for service users.
People with a dual diagnosis of both mental health and substance misuse problems are currently considered to be one of greatest challenges to services. The DVD features people with a dual diagnosis and a range of experts who describe the difficulties faced both by services and service users. The film shows that many service users are self-medicating with street drugs because they find such substances more helpful and less damaging than prescribed psychiatric medication. The film argues that the problem is not necessarily due to service users with multiple needs but with services whose approach can be the cause of many more problems for service users.
Subject terms:
medication, mental health problems, service users, substance misuse, access to services, dual diagnosis;
Journal of Dual Diagnosis, 8(1), January 2012, pp.74-84.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Substance misuse is predicted to become an increasing problem in the older adult population in the United States. This article uses a brief clinical case study to illustrate the issues and to introduce a review of the literature related to substance use and psychiatric illness in older adults. The review looks at prevalence of substance use disorders, psychiatric illness and co-occurrence in older adults, drug interactions and sensitivity and tolerance to alcohol and drugs, neurobiological consequences and cognitive impairment, including alcoholism, depression and brain changes, identification and assessment, and treatment of co-occurring disorders in older people. The article notes the unique challenges relating to treatment of older adults with co-occurring disorders. The authors suggest that further research into the older adult population with substance use disorders and co-occurring illness is required.
Substance misuse is predicted to become an increasing problem in the older adult population in the United States. This article uses a brief clinical case study to illustrate the issues and to introduce a review of the literature related to substance use and psychiatric illness in older adults. The review looks at prevalence of substance use disorders, psychiatric illness and co-occurrence in older adults, drug interactions and sensitivity and tolerance to alcohol and drugs, neurobiological consequences and cognitive impairment, including alcoholism, depression and brain changes, identification and assessment, and treatment of co-occurring disorders in older people. The article notes the unique challenges relating to treatment of older adults with co-occurring disorders. The authors suggest that further research into the older adult population with substance use disorders and co-occurring illness is required.
Subject terms:
medication, mental health problems, older people, substance misuse, treatment, therapy and treatment, assessment, dual diagnosis;
Journal of Mental Health, 19(5), October 2010, pp.470-474.
Publisher:
Taylor and Francis
Place of publication:
London
The proportion of referrals who self-reported sub-optimal adherence among 172 referrals to a crisis resolution home treatment (CHRT) service in the North East of England were examined. The study also investigated whether non-adherence was associated with greater likelihood of admission rather than community treatment. The Tablet Routines Questionnaire was used to quantify medication adherence patterns for the month prior to presentation to the CHRT service. Thirty percent of subjects reported suboptimal adherence to prescribed psychotropic medications (less than 70% adherence) in the month prior to the CHRT assessment. These individuals were significantly more likely to have a dual diagnosis and assessment was significantly more likely to be followed by admission. Non-adherence remained a significant predictor of admission when the odds were adjusted for confounders. The authors conclude that clinicians need to proactively identify and manage non-adherence as it is a potentially preventable trigger of relapse often present for months prior to the index crisis referral. Non-adherence is a meaningful target for improving clinical and cost-effectiveness of general adult mental health services.
The proportion of referrals who self-reported sub-optimal adherence among 172 referrals to a crisis resolution home treatment (CHRT) service in the North East of England were examined. The study also investigated whether non-adherence was associated with greater likelihood of admission rather than community treatment. The Tablet Routines Questionnaire was used to quantify medication adherence patterns for the month prior to presentation to the CHRT service. Thirty percent of subjects reported suboptimal adherence to prescribed psychotropic medications (less than 70% adherence) in the month prior to the CHRT assessment. These individuals were significantly more likely to have a dual diagnosis and assessment was significantly more likely to be followed by admission. Non-adherence remained a significant predictor of admission when the odds were adjusted for confounders. The authors conclude that clinicians need to proactively identify and manage non-adherence as it is a potentially preventable trigger of relapse often present for months prior to the index crisis referral. Non-adherence is a meaningful target for improving clinical and cost-effectiveness of general adult mental health services.
Subject terms:
medication, mental health care, mental health problems, hospital admission, risk, treatment compliance, crisis resolution, dual diagnosis;
The prevalence of dual diagnosis is high among those who access mental health and addiction services. Definitions of dual diagnosis, the prevalence of the condition and the reasons why people with mental illness use substances are briefly examined. Methods of assessment, the importance of integrated treatment and issues that need to be considered in management plans for this group, such as drug interactions and treatment approaches are also discussed.
The prevalence of dual diagnosis is high among those who access mental health and addiction services. Definitions of dual diagnosis, the prevalence of the condition and the reasons why people with mental illness use substances are briefly examined. Methods of assessment, the importance of integrated treatment and issues that need to be considered in management plans for this group, such as drug interactions and treatment approaches are also discussed.
Subject terms:
integrated services, medication, mental health problems, substance misuse, treatment, therapies, therapy and treatment, assessment, dual diagnosis;
Providing adequate treatment and supervision for drug offenders with co-occurring disorders in the United States has been a challenge because they are usually not eligible for drug court and often fail to comply with the conditions of probation in other drug diversion programs. The authors report the results of a process evaluation of the Co-Occurring Disorders Court (CODC) implemented by the Superior Court of the County of Orange, California. Drug offenders who are chronically, persistently mentally ill and diagnosed with bipolar disorder, schizophrenia, or a major depressive disorder participated in an 18-month program that provides integrated treatment. Following evaluation by a psychiatrist and the drug court team (judge, public defender, probation officer, and mental health caseworker), they are placed on medication and referred to residential and/or outpatient drug treatment. During the program they are randomly drug tested and their progress is monitored by the drug court team; they receive sanctions for program non-compliance or rewards for program compliance. In the first two years of operation the CODC admitted 72 offenders. The study findings indicate the majority of participants are being stabilized on their medications, which increases their treatment stay and improves their quality of life. At 6 months the participants show advances in social functioning, decreasing problems due to substance use, and productivity in the achievement of life goals. The results of the process evaluation indicate the program is achieving the stated objectives. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Providing adequate treatment and supervision for drug offenders with co-occurring disorders in the United States has been a challenge because they are usually not eligible for drug court and often fail to comply with the conditions of probation in other drug diversion programs. The authors report the results of a process evaluation of the Co-Occurring Disorders Court (CODC) implemented by the Superior Court of the County of Orange, California. Drug offenders who are chronically, persistently mentally ill and diagnosed with bipolar disorder, schizophrenia, or a major depressive disorder participated in an 18-month program that provides integrated treatment. Following evaluation by a psychiatrist and the drug court team (judge, public defender, probation officer, and mental health caseworker), they are placed on medication and referred to residential and/or outpatient drug treatment. During the program they are randomly drug tested and their progress is monitored by the drug court team; they receive sanctions for program non-compliance or rewards for program compliance. In the first two years of operation the CODC admitted 72 offenders. The study findings indicate the majority of participants are being stabilized on their medications, which increases their treatment stay and improves their quality of life. At 6 months the participants show advances in social functioning, decreasing problems due to substance use, and productivity in the achievement of life goals. The results of the process evaluation indicate the program is achieving the stated objectives. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
law courts, medication, mental health problems, offenders, treatment, treatment compliance, therapy and treatment, drug misuse, dual diagnosis, evaluation;
This book is for practitioners who work in drug and alcohol services or other settings such as health, social care and criminal justice. It gives an overview of the link between drug misuse and mental health. The booklet covers the following topics: mental health problems; commonly prescribed medication for mental health; mental health services - what do they do?; drug use and mental health - dual diagnosis; roles of the drug worker - responding to drugs and mental health issues; and summaries of mental health law, standards and guidance.
This book is for practitioners who work in drug and alcohol services or other settings such as health, social care and criminal justice. It gives an overview of the link between drug misuse and mental health. The booklet covers the following topics: mental health problems; commonly prescribed medication for mental health; mental health services - what do they do?; drug use and mental health - dual diagnosis; roles of the drug worker - responding to drugs and mental health issues; and summaries of mental health law, standards and guidance.
Extended abstract:
Author
VOSE Colin
Title
Mental health and drugs: a drug workers' guide to working with service users who have a mental illness
Publisher
HIT, 2005
Summary
This booklet is for practitioners who work in drug and alcohol services or other settings such as health, social care and criminal justice. It gives an overview of the link between drug misuse and mental health.
Context
There is increasing concern about the link between drug use and mental health problems. People with drug problems are more likely than the rest of the population to have mental health problems, and people with mental health problems are more likely to have drug problems. Mental health and drug services have gaps in service provision and knowledge with the result that many individuals with both problems find themselves being passed between services, each service claiming it is ill-equipped to respond to the combination of drug dependence and mental illness.
Contents
The booklet seeks to provide drug workers with a sufficient knowledge base about mental health problems to ensure they can recognise and assess mental health problems in the client group and liaise with and work alongside mental health services to deliver effective care. The introduction outlines the extent and nature of illicit drug use in the UK ; use by young people and the general population; effects, risks and harms; and the pattern of drug use. Section 1 explains mental health problems, with sections on neurosis, depression, anxiety states, insomnia, eating disorders, post-traumatic stress disorder, personality disorder, psychosis, organic psychosis, functional psychosis, hallucinations, delusions, schizophrenia, psychosis and mania, schizoid-affective disorder, bipolar disorders, suicide, diagnosing mental health problems, early diagnosis of psychosis, and the cost of mental illness. Section 2 describes commonly-prescribed medication for mental illness: anti-psychotics, anti-depressants, and minor tranquillisers and sleeping tablets, and interactions between prescribed and abused medication. It also states there is more to treating mental illness than medication, and discusses the drug worker's paradox: his or her aim is to reduce harmful drug use; the mental health worker's role is often to encourage them to take their prescribed drugs. Section 3 explains what mental health services do, outlining primary and secondary care, the community mental health team, assertive outreach, crisis resolution and the home treatment team, the early intervention team, the acute psychiatric hospital ward, the psychiatric intensive care unit, and the way in and out of mental health services. Section 4 discusses the dual diagnosis of drug use and mental health (co-morbidity), with sub-sections on the prevalence of substance misuse among those with severe and enduring mental health problems and of mental health problems among substance-misuse populations, and the relationship between drug misuse and mental health. It summarises the links between certain drugs and mental health problems, discussing cannabis, dopamine, other psychedelic drugs, stimulants, and alcohol. Section 5 is about the role of the drug worker in responding to drugs and mental health issues: assessment, treatment and care at three levels (screening and referral, drug use triage assessment, and comprehensive drug use assessment); key indicators of mental health and/or substance misuse problems; risk assessment; care planning and the care programme approach; and discharge planning. Section 6 summarises mental health law. Section 7 describes standards and guidance: the National Service Framework for Mental Health, the Department of Health Dual Diagnosis Good Practice Guide, the UK drugs strategy, and the National Treatment Agency and Models of Care. It ends with a “Must do!” list and three case studies, giving for each the required action and a summary. Sources of further information are listed.
13 references
Subject terms:
medication, mental health care, mental health law, mental health problems, mental health services, standards, drug misuse, dual diagnosis;
AIDS Care, 16(Supplement 1), January 2004, pp.S137-S153.
Publisher:
Taylor and Francis
Funders of HIV, mental health, and substance abuse research and services are increasingly mandating substantial consumer representation in the programmes they support. A review of the literature reveals that despite considerable challenges, consumer representation in HIV, mental health, and substance abuse research and services can be extremely valuable, both for the consumer representatives and the programmes they serve. The consumer representation model of the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study is described. Consumer representatives and principal investigators are interviewed about their experiences working within the model. Their collective comments form the basis of recommendations for practice when employing consumer representation models
Funders of HIV, mental health, and substance abuse research and services are increasingly mandating substantial consumer representation in the programmes they support. A review of the literature reveals that despite considerable challenges, consumer representation in HIV, mental health, and substance abuse research and services can be extremely valuable, both for the consumer representatives and the programmes they serve. The consumer representation model of the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study is described. Consumer representatives and principal investigators are interviewed about their experiences working within the model. Their collective comments form the basis of recommendations for practice when employing consumer representation models
Subject terms:
HIV AIDS, literature reviews, medication, mental health problems, models, service users, substance misuse, treatment compliance, dual diagnosis;
Teaching pack aimed at all staff working with people with learning difficulties and mental health problems. Contains material on: the aetiology of learning difficulties; individual, family and social adjustment; emotional disorders; the use of behavioural strategies; challenging behaviour; commonly used medication; mental health service factors; epilepsy in people with learning difficulties; stress and burnout; and legal and ethical issues.
Teaching pack aimed at all staff working with people with learning difficulties and mental health problems. Contains material on: the aetiology of learning difficulties; individual, family and social adjustment; emotional disorders; the use of behavioural strategies; challenging behaviour; commonly used medication; mental health service factors; epilepsy in people with learning difficulties; stress and burnout; and legal and ethical issues.
Subject terms:
law, learning disabilities, medication, mental health problems, mental health services, post qualifying education, stress, staff, staff development, behaviour modification, challenging behaviour, conduct disorders, dual diagnosis, epilepsy, ethics;
This book is a practical manual for mental health care for the community health worker, the primary care nurse, the social worker and the primary care doctor, particularly in developing countries. After giving the reader a basic understanding of mental illness, the book goes on to describe more than 30 clinical problems associated with mental illness and uses a problem-solving approach to guide the reader through their assessment and management. Mental health issues as they arise in specific health care contexts are described, for example in a refugee camp, a school health programme or with people suffering from AIDS, as well as in mental health promotion. The final section combines quick reference information for common problems and it also includes chapters for the reader to personalise the manual for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for emotional symptoms. The book includes: a problem-solving approach to diagnosis and management; sections on clinical management of common problems associated with mental illnesses; relevant mental health issues in different contexts of work; case studies;l guide to the use of psychiatric medicines and simple psychological treatments; a glossary of all technical words.
This book is a practical manual for mental health care for the community health worker, the primary care nurse, the social worker and the primary care doctor, particularly in developing countries. After giving the reader a basic understanding of mental illness, the book goes on to describe more than 30 clinical problems associated with mental illness and uses a problem-solving approach to guide the reader through their assessment and management. Mental health issues as they arise in specific health care contexts are described, for example in a refugee camp, a school health programme or with people suffering from AIDS, as well as in mental health promotion. The final section combines quick reference information for common problems and it also includes chapters for the reader to personalise the manual for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for emotional symptoms. The book includes: a problem-solving approach to diagnosis and management; sections on clinical management of common problems associated with mental illnesses; relevant mental health issues in different contexts of work; case studies;l guide to the use of psychiatric medicines and simple psychological treatments; a glossary of all technical words.
Subject terms:
HIV AIDS, medication, mental health problems, mental health services, psychiatry, severe mental health problems, advocacy, assessment, child development, conduct disorders, developing countries, diagnosis, dual diagnosis;
BLOW Frederick C., OSLIN David W., BARRY Kristen L.
Journal article citation:
Generations, 26(1), Spring 2002, pp.50-58.
Publisher:
American Society on Aging
Misuse of illicit drugs and psychoactive medication, as well as alcohol cause problems among older people, but to a lesser extent. These substances have particular effects on older people who are especially vulnerable to them. This article argues that clinicians and researchers must change the way they think about the risks of use of these substances by this segment of the population.
Misuse of illicit drugs and psychoactive medication, as well as alcohol cause problems among older people, but to a lesser extent. These substances have particular effects on older people who are especially vulnerable to them. This article argues that clinicians and researchers must change the way they think about the risks of use of these substances by this segment of the population.
Subject terms:
medication, mental health problems, older people, substance misuse, treatment, therapy and treatment, vulnerable adults, alcohol misuse, diagnosis, drug misuse, dual diagnosis;