Objective: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.Method: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.Results: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm. Conclusion:The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems. Can J Psychiatry 2008;53(12):810-821Clinical Implications · Clinicians can use sociodemographic characteristics, such as male sex, younger age, and being unemployed, and clinical indicators, such as overall mental health severity and behavioural challenges, to help identify and support people with substance use disorders. · Treatment and support models for co-occurring mental and substance use disorders must include risk management strategies, given the higher prevalence of challenging behaviours within this population. · There is a need for system-wide planning regarding co-occurring mental and substance use disorders. Limitations· Although findings were based on a comprehensive mental health system, the results may not be applicable to every jurisdiction. · Study findings should not necessarily be generalized to acute care, consumer, or peer support programs because they were not included in our study. · Clinical diagnostic interviews were not feasible to validate study criteria for defining co-occurring disorders.

We examined the immediate, short-and long-term effectiveness of the SNAP TM Under 12 Outreach Project (ORP)-a community-based program for children under the age of 12 at risk of having police contact. Sixteen pairs of children were matched on age, sex and severity of delinquency at admission, and randomly assigned to the ORP or to a control group which received less intensive treatment. Level of antisocial behavior was assessed pre and post intervention (immediate effects) and at three follow-up periods (up to 15 months post treatment) to investigate maintenance of possible treatment effects. A search of criminal records was also performed to assess long term effects. Results indicated that ORP children decreased significantly more than controls on the Delinquency and Aggression subscales of the Child Behavior Checklist pre-to post-intervention, and these effects were maintained over time. For statistically significant differences, effect sizes were large (.79 to 1.19). Fewer ORP children (31%) had criminal records at follow-up compared to controls (57%), although this difference was not statistically significant. Overall, the ORP appears to be an effective cognitive-behavioral program for antisocial children in the short term, with possible effects that extend into adolescence and adulthood.Keywords Randomized controlled trial (RCT) . Conduct disorder . Children . Antisocial behavior . Cognitive behavioral therapy There is an abundance of research showing that an early age of onset of conduct disorder is a robust predictor of future criminal involvement and that young children with above average levels of disruptive behavior problems have a two-to three-fold increased risk of

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This study tested the effectiveness of a multifaceted, cognitive-behavioral therapy (CBT) program for antisocial children--the SNAP Under 12 Outreach Project (ORP)--in relation to age, sex and indices of treatment intensity. Study participants were 80 clinic-referred children (59 boys and 21 girls) aged 6-11 years assigned to one of the following groups: control (CG; n = 14) who did not receive the ORP, matched (MG; n = 50) who received the ORP, and experimental (EG; n = 16) who received an enhanced version of the ORP. Results indicated significant pre-post changes for the EG and MG for Child Behavior Checklist (CBCL)-measured delinquency and aggression, but no improvement for the CG. Positive relationships between the number of individual ORP components (e.g. number of children's CBT sessions) received and CBCL change scores were also found. Statistical associations tended to be larger for girls and older children (i.e. 10-11 years old) who may have been more cognitively advanced. Also, the number of children's CBT sessions predicted later convictions, even after controlling for prior CBCL delinquency scores. Findings from this study support the effectiveness of the ORP, but also highlight the need to take into account client characteristics when offering clinical treatment.