Issues in the treatment of dual diagnosis clients who have chronic mental illness.

Polcin, Douglas L.

doi:10.1037/0735-7028.23.1.30

Cited by 31 publications

(18 citation statements)

References 50 publications

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“…This has often resulted in sequential or parallel treatment approaches, which tend to result in poor treatment outcomes, [12,16-18]. To overcome these difficulties, the Integrated Treatment (IT) approach was developed in the United States at the end of the 1980’s [18,19] and clinical guidelines to this treatment were later described by Minkoff [20].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

2014

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BackgroundIntegrated Treatment (IT) has proved effective in treating patients with Substance Use Disorders (SUD) co-occurring with severe Mental Disorders (MD), less is known about the effectiveness of IT for patients with SUD co-occurring with less severe MD.The aim of this study was to investigate the effectiveness of IT for patients with SUD co-occurring with anxiety and/or depression on the following parameters:1. The use of substances, as measured by the Alcohol Use Identification Test (AUDIT), the Drug Use Identification Test (DUDIT), and the Addiction Severity Index (EuropASI).2. The severity of psychiatric symptoms, as measured by the Symptom Check List 90 r (SCL 90R).3. The client’s motivation for changing his/her substance use behaviour, as measured by the Substance Abuse Treatment Scale (SATSr).MethodsThis is a group randomized clinical trial comparing the effectiveness of IT to treatment as usual in Community Mental Health Centres (CMHCs). Five CMHCs were drawn to the Intervention Group (IG) and four CMHCs to the Control Group (CG). The allocation to treatment conditions was not blinded. New referrals were screened with the AUDIT and the DUDIT. Those who scored above the cut-off level of these instruments were assessed with the Structured Clinical Interview for DSM-IV 1 and 2. We included patients with anxiety and/or depression together with one or more SUDs.ResultsWe included 55 patients in the IG and 21 in the CG. A linear multilevel model was used. Both groups reduced their alcohol and substance use during the trial, while there was no change in psychiatric symptoms in either group. However, the IG had a greater increase in motivation for substance use treatment after 12 months than had the CG with an estimate of 1.76, p = 0.043, CI95% (0.08; 3.44) (adjusted analyses). There were no adverse events.ConclusionsIntegrated treatment is effective in increasing the motivation for treatment amongst patients with anxiety and/or depression together with SUD in outpatient clinics.Trial registrationClinicalTrials.gov: NCT00447733.

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Section: Introductionmentioning

confidence: 99%

The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

2014

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“…Implementation of evidence-based recommendations, however, has lagged behind. This gap can have serious implications, such as increased probability of rehospitalization, depression, suicide, incarceration, relapse, inability to manage finances, unstable housing, medication noncompliance, compromised physical health, poor family relationships, and higher service use and cost (Dickey & Azeni, 1996; Drake, Mueser, Clark, & Wallach, 1996; Drake et al, 1998; Mueser et al, 2003; Polcin, 1992; Rosenberg et al, 2001; Wallen & Weiner, 1989). Because of the gap between evidence and practice, consumers often “bounce” from addiction treatment to psychiatric care and back again, benefitting little from either (Center for Substance Abuse Treatment, 2005).…”

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confidence: 99%

Implementing Residential Integrated Treatment for Co-occurring Disorders

McKee

Harris

Cormier

2013

Journal of Dual Diagnosis

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Objective: Much is now known about effective treatment for co-occurring substance abuse and psychiatric difficulties and many evidence-based practice recommendations have been disseminated. Implementation of these recommended interventions in daily clinical practice has been more of a struggle. This article describes successful implementation of integrated treatment for co-occurring disorders in a small residential program. Methods: A traditional 28-day addiction service was transformed into a 3-month integrated treatment program and 155 individuals with co-occurring disorders agreed to participate in its evaluation. The transformation entailed a completely new manualized service, training in a number of clinical interventions for all program clinicians, ongoing clinical supervision, and formal measurement of clients’ backgrounds, substance abuse, quality of life, mental health symptoms, self-esteem, and satisfaction with the program. We also obtained collateral informants’ reports on participants’ symptoms, substance use, and quality of life. Fidelity to the treatment model was continuously assessed, as were participants’ knowledge and skill acquisition. In addition, impact of the implementation on the program clinicians’ morale and attitudes toward evidence-based practices was assessed, as was staff turnover and per diem costs. Results: Despite very problematic clinical and sociodemographic histories, the 86 participants who completed the program showed clinically significant mental health symptom improvement, acquisition of knowledge and skill, and high self-esteem and satisfaction with the program. Program fidelity, clinician morale, commitment to the program, and attitudes toward evidence-based practice were uniformly high. These successes were achieved while maintaining the lowest per–inpatient day cost of all hospital inpatient units. Conclusions: The findings support the contention that evidence-based integrated treatment can be implemented with fidelity in regular clinical practice to the benefit of participants, staff, and the hospital. Our experience was that having a scientist-practitioner working as a staff member on the program to lead the implementation was a key element. Future reports will focus on longer-term follow-up of substance use and quality of life outcomes.

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“…Cummings and Follette (1968;Follette & Cummings, 1967) noted three decades ago that psychiatric patients with physical illnesses may experience an exacerbation of both their physical and their mental problems. This still holds true today (Cummings, 1995;Fulop, Strain, Hammer, & Lyons, 1989;Polcin, 1992;Walen, 1985). When such individuals present to physicians not trained in psychiatry, the likelihood of misdiagnosis of the medical problem is heightened, as is the likelihood of nondiagnosis of the psychiatric disorder (Cummings, 1993;Fifer, 1994;Kelleher, 1995;Wells et al, 1989).…”

Section: How To Find a Nichementioning

confidence: 98%

New areas for psychological assessment in general health care settings: What to do today to prepare for tomorrow

Stout¹,

Cook²

1999

J. Clin. Psychol.

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Unique roles of the professional psychologist are outlined with respect to increasingly restrictive utilization practices of managed care. Suggestions of how to develop less traditional venues of practice, the types of instruments to use, and report formats, along with ways to persuade primary care physicians (PCPs), managed care organizations, and facilities to utilize psychological assessment services are provided. Medical cost offsets, cost-efficient quality of care, and models of practice are also discussed.

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Issues in the treatment of dual diagnosis clients who have chronic mental illness.

Cited by 31 publications

References 50 publications

The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

Implementing Residential Integrated Treatment for Co-occurring Disorders

New areas for psychological assessment in general health care settings: What to do today to prepare for tomorrow

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