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Research on the effectiveness of the modified therapeutic community for persons with co-occurring substance use and mental disorders
- Authors:
- SACKS Stanley, SACKS JoAnn Y.
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 31(2), Summer 2010, pp.176-211.
- Publisher:
- Emerald
This article highlights the development of the modified therapeutic community (MTC) as an approach to the treatment of co-occurring disorders. Four research studies are presented, each of which investigated the effectiveness of the MTC. Nine hundred and two subjects had mental disorders co-occurring with substance use disorders, and all four studies were undertaken by the same investigative team. Better outcomes were observed for the MTC group in every study, but the measures and domains in which differences were detected varied from study to study. Analysis showed significant improvements in outcomes for the MTC group in five of six outcome domains – substance use, mental health, crime, employment and housing. However, no significant differences were detected in HIV-risk. The paper concludes with brief summaries of preliminary findings from two current studies. In ending, the paper presents a discussion of staff training, aftercare services, and future directions for research related to the MTC.
The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials
- Authors:
- SYDOW Kirsten Von, et al
- Journal article citation:
- Family Process, 49(4), December 2010, pp.457-485.
- Publisher:
- Wiley
There are many reviews on the effectiveness of CBT and psychodynamic therapy. However, there is a lack of research on systemic therapy, although it is one of the most widespread therapy options. This review analysed the efficacy of systemic therapy for the treatment of mental disorders in adults. All randomised controlled trials (RCT) evaluating systemic and systems therapy in various settings with adult patients suffering from mental disorders were identified by database searches and cross-references in other reviews. The RCTs were content analysed according to their research methodology, interventions applied, and results. The study identified 38 trials, 34 of which showed systemic therapy to be effective for the treatment of mood disorders, eating disorders, substance use disorders, mental and social factors related to medical conditions and physical disorders, and schizophrenia. Findings were stable across follow-up periods of up to 5 years. The authors concluded that there is a firm evidence-base for the efficacy of systemic therapy for adult patients in at least five diagnostic settings.
Harm reduction in community mental health settings
- Authors:
- MANCINI Michael A., LINHORST Donald M.
- Journal article citation:
- Journal of Social Work in Disability and Rehabilitation, 9(2-3), April 2010, pp.130-147.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Fifty percent of people with psychiatric disabilities have a co-occurring substance misuse disorder, and are more likely to have a range of chronic disease conditions such as heart disease, diabetes, hypertension and chronic pulmonary disease. Harm reduction is a conceptual framework and set of practices that focus on the minimisation of the physical, social, and legal harms substance users do to themselves and to society as a whole. Its application to community mental health settings is relatively new, and can create controversies and ethical dilemmas if not properly designed, implemented, and evaluated. Building on the harm reduction literature, the community mental health literature, and the authors' experiences with a community mental health programme that uses a harm reduction approach, the authors offer five guidelines for its successful implementation. The authors conclude that when properly integrated with other recovery-based services, and when appropriately applied to the individual client's stage of change, harm reduction can effectively be used, and should be used, in community mental health settings with clients with co-occurring substance use and psychiatric disorders.
Mind your language – complexities in defining “dual diagnosis”
- Author:
- SMITH Martin
- Journal article citation:
- Addiction Today, 21(126), September 2010, pp.34-35.
- Publisher:
- Addiction Recovery Foundation
Professionals often feel isolated when dealing with patients with dual diagnosis, or complex needs. This can be made worse by different interpretations, leading to varying policies across agencies. The author assesses clinical and social issues to develop recommendations. The author suggests there are differences between evidence-based practice, law and social policies, leading to social exclusion of this population. Comprehensive education on the issues should facilitate change. This should be aimed at hospitals, GPs, mental health services, social services, employment services and other relevant services. A service would address substance misuse, risk, housing, social and economic issues, and must have the flexibility to adapt services to client needs. It is this inherent complexity that leaves professionals feeling isolated –adding clear lines of responsibility mitigating the problem.
A common sense approach to working with defendants and offenders with mental health problems
- Author:
- BRYANT Linda
- Publisher:
- Together: Working for Wellbeing
- Publication year:
- 2010
- Pagination:
- 27p.
- Place of publication:
- London
It is widely acknowledged that people with mental health issues are overrepresented in all parts of the criminal justice system. This guide is targeted at frontline criminal justice agency staff to support them when dealing with people with mental health problems. It aims to provide professionals such as police officers, probation officers, security and court staff with practical advice on what to do and which agencies to go to for help. The guide describes a 4-step approach: spot the potential issue; understand the impact of the surroundings; ask questions to find out more; and respond. The final step of the approach advises how to signpost to, and work in a joined-up manner, with other health and social care agencies and includes information on helping the person to register with a GP. Quick reference guides are also included covering the issues of: mental health, alcohol and substance misuse; learning disabilities and learning difficulties; and self-harm and suicide.
Mental health, substance use, and adaptive coping among social work students in the aftermath of hurricanes Katrina and Rita
- Authors:
- LEMIEUX Catherine M., et al
- Journal article citation:
- Journal of Social Work Education, 46(3), 2010, pp.391-410.
- Publisher:
- Council on Social Work Education
In the autumn of 2005, hurricanes Katrina and Rita resulted in catastrophic natural disasters across the US Gulf Coast. This study examined the reactions of 416 social work students from 4 universities in disaster affected areas in the aftermath of the hurricanes. Questionnaires were used to measure demographics, spiritual support, altruism, optimism, peritraumatic emotional responses, volunteer activities, sociopolitical reactions, hurricane-related stressors, previous traumatic experiences, negative reactions, mental health, substance use, and adaptive coping. The researchers found that 93.7% of the students had volunteered during the emergencies, 47% scored at or above the clinical level for depression, there were moderately low levels of post-traumatic stress disorder symptoms, two thirds employed adaptive coping responses, and 16.9% reported substance use. The article discusses the implications for social work education, noting that social work programmes have a critical role in educating students and field instructors about students' potential vulnerability to negative mental health outcomes during times of a natural disaster.
Implementing a gero-infused curriculum in advanced-level MSW courses in health, mental health and substance abuse: an evaluation
- Authors:
- FENSTER Judy, et al
- Journal article citation:
- Journal of Gerontological Social Work, 53(7), October 2010, pp.641-653.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The aim of this project was to increase the capacity of US Master of Social Work (MSW) graduates to serve older adults and their families in health, mental health, and substance abuse settings. The project team undertook a systematic review of each social work faculty syllabus at Adelphi University, in a suburb of New York city, for existing content on gerontology, and developed gerontology-infused model syllabi and teaching modules for each course. They then examined change in students' perception of geriatric self-competency and students' substantive knowledge of the gerontology-infused curriculum subject matter, using a sample of 333 MSW students. The results indicated that students exposed to the new mental health and substance abuse courses reported significantly higher substantive knowledge about working with older adults, and felt more strongly than those in the comparison group that they had learnt about working with older adults in these specific settings.
Psychopathology in a large cohort of sexually abused children followed up to 43 years
- Authors:
- CUTAJAR Margaret C., et al
- Journal article citation:
- Child Abuse and Neglect, 34(11), November 2010, pp.813-822.
- Publisher:
- Elsevier
This long term prospective study examines the rate and risk of clinical and personality disorders in childhood and adulthood in individuals sexually abused as children. The forensic medical records of 2,759 sexually abused children living in Victoria, Australia and assessed between 1964 and 1995 were linked with a public psychiatric database between 12 and 43 years later. Control subjects for comparison, drawn at random from the general population, were matched by gender and age. A lifetime record of contact with public mental health services was found in 23.3% of cases compared to 7.7% of controls. The rate of contact among child sex abuse victims was 3.65 times higher. It was estimated that child sexual abuse accounted for approximately 7.83% of mental health contact. It increased risks for the majority of outcomes including psychosis, affective, anxiety, substance abuse, and personality disorders. Older age at sexual abuse and those exposed to more severe abuse were associated with greater risk for psychopathology. It is concluded that child sexual abuse is a substantial risk factor for a range of mental disorders in both childhood and adulthood.
Models and approaches in family-focused policy and practice
- Author:
- HUGHES Nathan
- Journal article citation:
- Social Policy and Society, 9(4), October 2010, pp.545-555.
- Publisher:
- Cambridge University Press
In 2007, the Social Exclusion Task Force began a cross government review of policies and practices intended to support families at risk – defined as families with multiple and complex problems such as unemployment, poor mental health, or substance misuse. This paper reviews the models and approaches to family-based policy and service provision for those at risk of social exclusion, and suggests three distinct categories for exploration. In the first category, approaches seek to strengthen the ability of family members to offer support to a primary service user within that family. In the second category, family members are recognised as having their own specific and independent needs arising out of their relationship with the primary service user. The third category includes ‘whole family approaches’ focused on shared needs and strengths that could not be dealt with through a focus on family members as individuals. In this article, the third category is considered in detail.
Developing therapeutic communities for the 21st century: bringing traditions together through borrowing and adaptation
- Author:
- YOUNG Michael G.
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 31(1), Spring 2010, pp.48-61.
- Publisher:
- Emerald
A substantial body of research shows that Modified Therapeutic Communities (MTC) can be effective in dealing with addiction. MTCs have evolved to deal with clients who are considered quatra-diagnostic. These individuals suffer from co-occurring disorders including homelessness, substance abuse, mental health problems and criminal behaviour. However, the diverse nature of these problems, and the complex makeup of the populations involved, adds to the challenge of simultaneously dealing with them in one therapeutic context. This paper explores a therapeutic community (TC), Woodwynn Farms in Western Canada, developed with the purpose of serving quatra-diagnosed clients starting with the least challenging of these problems, homelessness, followed with the expansion of services to other clients. Woodwynn Farms utilises a common TC structure, which includes an extended period of attendance in the community of approximately 3 years. Residents participate in regular meetings, educational classes, and therapy groups. This paper identifies the fourth moment of TCs as a new direction in MTC development, which includes an emphasis on combining TC models and evaluation research in the provision of services to growing and diverse populations.