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Journal article

Seeing double

Authors:
GORRY Ann, DODD Tom
Journal article citation:
Mental Health Today, September 2009, pp.24-25.
Publisher:
Pavilion
Place of publication:
Hove

The Dual Diagnosis Programme was set up  in 2005 to improve and develop services for people with a mental illness and a drug or alcohol addiction problem. This article presents key points from policy guidance, reports on the Programme plan for 2009/10 and highlights good practice in the field.

Journal article

Overview of the NIMHE/CSIP national dual diagnosis programme in England

Authors:
GORRY Ann, DODD Tom
Journal article citation:
Advances in Dual Diagnosis, 1(1), August 2008, pp.9-13.
Publisher:
Emerald

This article reviews the work of the national dual diagnosis programme established in England in response to recommendations for improvements in the way that services treat people with mental health problems and substance misuse issues. National policy drivers are explained, as well as the aims and achievements of the programme to date.

Journal article Full text available online for free

Supported employment: assessing the evidence

Authors:
MARSHALL Tina, et al
Journal article citation:
Psychiatric Services, 65(1), 2014, pp.16-23.
Publisher:
American Psychiatric Association

Objective: Supported employment is a direct service with multiple components designed to help adults with mental disorders or co-occurring mental and substance use disorders choose, acquire, and maintain competitive employment. This article describes supported employment and assesses the evidence base for this service. Methods: Authors reviewed meta-analyses, research reviews, and individual studies from 1995 through 2012. Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. Authors chose from three levels of evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence for service effectiveness. Results: The level of research evidence for supported employment was graded as high, based on 12 systematic reviews and 17 randomized controlled trials of the individual placement and support model. Supported employment consistently demonstrated positive outcomes for individuals with mental disorders, including higher rates of competitive employment, fewer days to the first competitive job, more hours and weeks worked, and higher wages. There was also strong evidence supporting the effectiveness of individual elements of the model. Conclusions: Substantial evidence demonstrates the effectiveness of supported employment. Policy makers should consider including it as a covered service. Future research is needed for subgroups such as young adults, older adults, people with primary substance use disorders, and those from various cultural, racial, and ethnic backgrounds. (Publisher abstract)

Journal article

Facilitators and barriers in dual recovery: a literature review of first-person perspectives

Authors:
NESS Ottar, BORG Marit, DAVIDSON Larry
Journal article citation:
Advances in Dual Diagnosis, 7(3), 2014, pp.107-117.
Publisher:
Emerald

Purpose: The co-occurrence of mental health and substance use problems is prevalent, and has been problematic both in terms of its complexity for the person and of the challenges it poses to health care practitioners. Recovery in co-occurring mental health and substance use problems is viewed as with multiple challenges embedded in it. As most of the existing literature on recovery tends to treat recovery in mental health and substance use problems separately, it is critical to assess the nature of our current understanding of what has been described as “complex” or “dual” recovery. The purpose of this paper is to identify and discuss what persons with co-occurring mental health and substance use problems describe as facilitators and barriers in their recovery process as revealed in the literature. Design/methodology/approach: The method used for this study was a small-scale review of the literature gleaned from a wider general view. Searches were conducted in CINAHL, Psych info, Medline, Embase, SweMed+, and NORART. Findings: Three overarching themes were identified as facilitators of dual recovery: first, meaningful everyday life; second, focus on strengths and future orientation; and third, re-establishing a social life and supportive relationships. Two overarching themes were identified as barriers to dual recovery: first, lack of tailored help and second, complex systems and uncoordinated services. Originality/value: The recovery literature mostly focuses on recovery in mental health and substance use problems separately, with less attention being paid in the first-person literature to what helps and what hinders dual recovery. (Publisher abstract)

Journal article

Studying implementation of dual diagnosis services: a review

Authors:
SYLVAIN Chantal, LAMOTHE Lise
Journal article citation:
Journal of Dual Diagnosis, 9(2), 2013, pp.195-207.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Over the past 15 years, considerable time and energy has been devoted to implementing integrated services for individuals with dual disorders. While the key factors in the successful implementation of such services have been documented, applying them remains a challenge. In this article the authors attempt to answer question of 'what is missing?' by examining how implementation studies of integrated services have been carried out. The aim is to identify possible avenues for future implementation research. Methods: Update of a recent literature review of published studies on service implementation. Articles written in English and organisation-level factors were included. The reviewed articles were categorised based on two aspects of their methodology: their approach to the implementation process (content- or process-centered) and their objective (descriptive or explanatory). Results: In the 15 studies reviewed, a tendency toward a content-centered approach (n = 9) with a majority having an explanatory objective was observed. Studies that reflected this trend identified the most common determining factors in order to explain the level of implementation achieved within a given period of time. These studies did not examine the sequencing and transformation of the implementation process over time. Such a process-centered approach was used in only six studies. Conclusions: Research exploring the evolutive dynamics of implementation projects should be prioritised to counter the lack of knowledge on the subject. Such studies have the potential to greatly enhance our understanding as well as our capacity to master the implementation of integrated services. (Publisher abstract)

Journal article

Substance use and mental health disorders: why do some people suffer from both?

Authors:
REEDY Amanda R., KOBAYASHI Rie
Journal article citation:
Social Work in Mental Health, 10(6), 2012, pp.496-517.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Co-occurring substance use disorders (SUD) and mental health disorders (MHD) are prevalent in the United States, affecting between 7 and 10 million adults. Social workers frequently practice in mental health and substance use disorder treatment settings where they are likely to encounter clients who have co-occurring disorders. Therefore, social workers should be familiar with the various etiological models of co-occurring disorders and the strengths and weaknesses of these models, in order to effectively assess and assist clients with co-occurring disorders. The purpose of this article is to describe and critique 4 different models of the etiology of co-occurring disorders: MHD leads to SUD - the self-medication model; SUD leads to MHD model; common factor model; and the combination model. The theory that social workers are most familiar with is the self-medication model, but this may not best explain the client's experience. While there is not definitive support for any of the models, each one seems to have its place in helping researchers and practitioners better understand co-occurring disorders. Implications for practice, policy, and research are discussed.

Journal article

Patterns and predictors of changes in substance use in individuals with schizophrenia and affective disorders

Authors:
BENNETT Melanie E., et al
Journal article citation:
Journal of Dual Diagnosis, 8(1), January 2012, pp.2-12.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Involving 240 participants recruited from outpatient mental health treatment centres who were assessed 5 times over 12 months, this US study looked at cocaine use in individuals with schizophrenia and affective disorders. It examined patterns of cocaine use over time, baseline predictors of continued cocaine use over one year, and predictors of transitions into and out of drug use and treatment. The article describes the participants, the measures used, data analysis and study results. Overall, the researchers found that rates and intensity of cocaine use did not change over the year, but a number of baseline variables were found to predict a decreased likelihood of cocaine use and transitions into and out of outpatient substance abuse treatment. They discuss the study results and report that the findings illustrate how drug use may show a cyclical pattern for those with serious mental illness, in which more severe use is followed by decreased use over time.

Journal article

A randomized controlled trial comparing integrated cognitive behavioral therapy versus individual addiction counseling for co-occurring substance use and posttraumatic stress disorders

Authors:
MCGOVERN Mark P., et al
Journal article citation:
Journal of Dual Diagnosis, 7(4), October 2011, pp.207-227.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

A cognitive behavioural therapy approach was adapted for use with people with co-occurring post traumatic stress disorder (PTSD) and substance use. Its 3 primary components were: anxiety reduction technique, patient education, and cognitive and behavioural coping skill development. This article reports on a randomised pilot trial undertaken as part of the therapy development process. It used 53 participants from community addiction treatment programmes in New England, receiving either integrated cognitive behavioural therapy or individual addiction counselling, with assessments at baseline and at 3 and 6 months follow-up. The article describes the study methodology and analysis, and discusses the results. Integrated cognitive behavioural therapy was found to be more effective than individual addiction counselling in reducing PTSD re-experiencing symptoms and PTSD diagnosis, and generally participants with severe PTSD were more likely to benefit from integrated cognitive behavioural therapy. The authors conclude that the findings support the potential efficacy of integrated cognitive behavioural therapy in improving outcomes for people in addiction treatment with PTSD.

Journal article

Co-existing mental health and substance use and alcohol difficulties – why do we persist with the term “dual diagnosis” within mental health services?

Authors:
GUEST Christian, HOLLAND Mark
Journal article citation:
Advances in Dual Diagnosis, 4(4), 2011, pp.162-172.
Publisher:
Emerald

This paper offers a critique of dual diagnosis and the potential impact on service access and treatment, and makes practical suggestions for alternative ways of conceptualising co-existing mental health and substance difficulties. The term “dual diagnosis” has been widely accepted as referring to co-existing mental illness and substance misuse. However, it is clear from the literature that individuals with these co-existing difficulties continue to be excluded from mainstream mental health services. This paper argues that the association between mental illness and substance misuse is an intricate and often a complex relationship involving a multitude of psychosocial factors that cannot be simply explained by an individual having two co-existing disorders. From this perspective, this paper seeks to argue that the term dual diagnosis should be de-emphasised. The paper identifies five principles which support individuals with a wide spectrum of co-existing difficulties and to counteract the stigma often associated with the term dual diagnosis. These collective principles allow the practitioner to consider the needs of the service user from the service user's perspective and therefore not be distracted by the perceived set of expected behaviours that are implied by dual diagnosis.

Journal article

Adolescent co-occurring disorders treatment: clinicians' attitudes, values, and knowledge

Authors:
DENBY Ramona W., BRINSON Jesse A., AYALA Jessica
Journal article citation:
Child and Youth Services, 32(1), January 2011, pp.56-74.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

In the United States, over 1 million young people are in contact with the youth justice system. Eighty per cent of these are estimated to have some form of mental health disorder. To effectively intervene, youth justice workers must be able to detect such disorders, along with substance misuse. This study investigated 294 community-based clinicians’ attitudes, experiences, values, and knowledge relating to issues of co-occurring disorders, within the youth justice system. Findings indicated that clinicians self-rate their clinical values and attitudes at or above the expected level of competency, but they acknowledged that their skill and knowledge levels were not adequate. Comparison measures reveal that employment setting conditions, geographic region, hours worked per week, and strongly held convictions about the importance of integrated mental health and substance use disorders service delivery distinguish clinicians’ co-occurring disorders knowledge levels. Implications for practice are discussed.

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