Lifetime Dual Disorder Screening and Treatment Retention: A Pilot Cohort Study

Abstract

The coexistence of a substance use disorder and another mental disorder in the same individual has been called dual disorder or dual diagnosis. This study aimed to examine the prevalence of lifetime dual disorder in individuals with alcohol or cocaine use disorder and their retention in treatment. We conducted a pilot cohort study of individuals (n = 1356) with alcohol or cocaine use disorder admitted to treatment in the public outpatient services of Barcelona (Spain) from January 2015 to August 2017 (followed-up until February 2018). Descriptive statistics, Kaplan–Meier survival curves and a multivariable Cox regression model were estimated. The lifetime prevalence of screening positive for dual disorder was 74%. At 1 year of follow-up, >75% of the cohort remained in treatment. On multivariable analysis, the factors associated with treatment dropout were a positive screening for lifetime dual disorder (HR = 1.26; 95% CI = 1.00–1.60), alcohol use (HR = 1.35; 95% CI = 1.04–1.77), polysubstance use (alcohol or cocaine and cannabis use) (HR = 1.60; 95% CI = 1.03–2.49) and living alone (HR = 1.34; 95% CI = 1.04–1.72). Lifetime dual disorder is a prevalent issue among individuals with alcohol or cocaine use disorders and could influence their dropout from treatment in public outpatient drug dependence care centres, along with alcohol use, polysubstance use and social conditions, such as living alone. We need a large-scale study with prolonged follow-up to confirm these preliminary results.

Examining Lurasidone Efficacy in Patients with Schizophrenia Spectrum Illness and Concurrent Alcohol and Substance Use Disorder: A Prospective, Multicentric, Real-World Investigation

“…However, the dropout rate was substantial, with 39.13% of participants not completing the study, including those who were lost to follow-up, those who discontinued due to lack of efficacy, those who relapsed into substance use, or those who withdrew due to treatment-emergent adverse events (TEAE). This observation aligns with previous research, encompassing reviews and clinical trials [16,[65][66][67]. In this context, it is crucial to recognize the poor treatment adherence of dual-diagnosis patients as an inherent characteristic of this intriguing, yet complex, population.…”

Investigating the Effectiveness of Brexpiprazole in Subjects with Schizophrenia Spectrum Illness and Co-Occurring Substance Use Disorder: A Prospective, Multicentric, Real-World Study

“…However, we observed a high treatment dropout rate (29.2%), with 7 in 24 subjects discontinuing brexpiprazole treatment prior to one month, likely due to the inherent nature of the study. Indeed, these data can be elucidated by the intrinsic characteristics of the sample and the peculiar features of SUD, which may have influenced adherence to drug therapy (5 out of 7 patients discontinued treatment due to non-adherence to drug therapy), as evidenced by various studies on SUD [ 44 , 45 , 46 ]. On one hand, most patients were managed in an outpatient setting, which presented challenges for continuous monitoring and tracking in cases of missed appointments.…”

Recent Advances in Dual Disorders (Addiction and Other Mental Disorders)

“…In a novel way, they use the Concise Health Risk Tracking Self-Report, a measure that assesses associated symptoms related to suicide as ideation, intent, pessimism, lack of social support, helplessness, and despair. Both studies [4,5] strongly support that entry into treatment for SUD as an invaluable opportunity to assess the presence of other mental disorders or DDs, evaluate suicide risk, and apply adequate treatment and early prevention plans.…”

“…Puértolas-Gracia et al [4] showed in a cohort study of 1356 patients with alcohol or cocaine use disorder, which were admitted to treatment in the public addiction outpatient services in Barcelona, that the lifetime prevalence of screening positive for DDs was 74%, with depression being the most frequent (76.4%). These patients were more frequently women, younger, unemployed, reported higher polysubstance use, poorer self-perceived health, and other medical conditions.…”