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BackgroundKeeping substance use disorder patients actively engaged in treatment is a challenge. Horse-assisted therapy (HAT) is increasingly used as a complementary therapy, with claimed motivational and other benefits to physical and psychological health. This naturalistic study aimed to assess HAT’s impact on the duration and completion of treatment for young substance users at Oslo University Hospital.MethodsDischarge and other data were derived from the Youth Addiction Treatment Evaluation Project (YATEP) database for patients (n = 108) admitted during an 18-month period. An intention-to-treat design, and univariate and multivariate analyses were used to compare those receiving treatment as usual (n = 43) with those who received treatment as usual plus HAT (n = 65).ResultsDespite a lack of randomization, the baseline characteristics of the two groups were similar. However, more HAT participants completed treatment (56.9 vs 14 %, p < 0.001), remained in treatment for longer (mean 141 vs 70 days, p < 0.001) and had a significantly higher chance of completing their treatment than those not given the HAT program. Excluding time in treatment, and after controlling for the potentially confounding influence of age, sex, education, number and severity of substances used, psychological distress and number of temporary exits, the adjusted odds ratio for treatment completion was 8.4 in the HAT group compared with those not participating in HAT (95 % CI 2.7–26.4, p < 0.001).ConclusionThe study found a statistically significant association between HAT participation and time in treatment, and between HAT participation and completion of treatment. This association does not infer causality. However, it adds supporting evidence for the development of an innovative therapy, and warrants investment in further research in relation to its inclusion in substance use disorder treatment.

OBJECTIVEPatients with co-occurring autism spectrum disorders (ASD) and substance use disorder (SUD) require special attention from clinical services. Screening for this co-occurrence is not generally an integral part of routine clinical assessments, and failure to identify and understand this group of patients may contribute to a worsening of their symptoms and/or an increase in drug abuse. Thus, there is a need to review the evidence base on patients with co-occurring ASD and SUD in order to enhance clinical practice and future research.METHODSWe reviewed all identified papers on patients with co-occurring ASD and SUD. The focus of the review was on epidemiology, patient characteristics, function of drug use, and the effect of current interventions.RESULTSA total of 18 papers were included in the analysis. Eleven papers were based on epidemiological studies, although only one study reported the prevalence of ASD in an SUD population. Two papers explored the role of personality, three papers studied subgroups of individuals serving prison for violent or sexual crimes, and one paper explored the function of drugs in the ASD patient group. There were no studies testing specific treatment interventions.CONCLUSIONSIn most of the treatment settings studied, there were relatively few patients with co-occurring ASD and SUD, but due to differences in study samples it was difficult to establish a general prevalence rate. The one consistent finding was the lack of focused treatment studies. There is clearly a need for research on interventions that take account of the special needs of this patient group.

This article describes the results of an eight-month follow-up investigation from a randomized controlled trial of day hospital psychotherapy (DHP) compared with outpatient individual psychotherapy (OIP) for patients with personality disorders (N=114). The patients were randomly assigned to either 18 weeks of day hospital treatment followed by long-term conjoint group and individual therapy (DHP), or outpatient individual psychotherapy (OIP). The main outcome measures were attrition rate, suicide attempts, suicidal thoughts, self-injury, psychosocial functioning, symptom distress, and interpersonal and personality problems. The study showed a low dropout rate and a moderate improvement on a broad range of clinical measures for both treatments. However, there was no indication of the superiority of one treatment over the other. Neither was there any indication that day hospital treatment was better for the most poorly functioning patients. Further studies will follow this group of patients for the next few years, the results of which may have implications for resource allocation and the organization of mental health services for patients with personality disorders.

BackgroundA good therapeutic relationship is a strong predictor of successful treatment in addiction and other psychological illness. Recent studies of horse-assisted therapy (HAT) have drawn attention to the importance of the client's relationship to the horse in psychotherapy. Few have reported on the patient's own perspective and none have reported specifically on the human–horse relationship in substance use disorder (SUD) treatment and its implications for health and well-being.AimThis article explores SUD patients’ own experience of their relationship with the horse and their perceptions of its contribution to their therapy.MethodsAs part of a large mixed-method study of HAT in SUD treatment, we used semi-structured interviews of eight patients to gather information about their experiences of HAT. From the data obtained, the relationship with the horse was found to be a significant part of participants’ HAT experience. It is therefore the subject of the current phenomenological study, in which thematic analysis was used to investigate how the participants constructed the reality of their relationship with the horse(s) and their perceptions of the consequences of that reality in SUD treatment.ResultsParticipants’ own descriptions suggest that the horses were facilitators of a positive self-construct and provided important emotional support during treatment. Analysis found relationship with the horse, emotional effect, and mastery to be important and interrelated themes. The findings were interpreted within an attachment theory context.ConclusionThe results appear to be consistent with key addiction treatment theories and with findings in HAT theoretical and empirical studies. They add to our understanding of the impact of HAT on SUD treatment. However, further research is needed into both the construct validity of the patient–horse therapeutic relationship and the possible variance within and between different populations.

Objective The objective in this study was to test the validity of a new dimensional measure of maladaptive core pathology for personality disorders (PDs), the Severity Indices of Personality Problems (SIPP‐118), by comparing a Norwegian sample of 114 patients with PDs with two Dutch samples. In addition, Avoidant PD and Borderline PD were compared, and the relationship between scores on the SIPP‐118 and commonly used clinical measures were investigated. Results The results showed good psychometric properties of the SIPP‐118 at the facet level. The Norwegian PD sample had scores equal to the Dutch PD sample and significantly below the general population sample. Correlation with other clinical measures was in the low to moderate range. Conclusion The cross‐national validity of the SIPP‐118 was good, and the instrument seems promising as a dimensional instrument for measuring personality pathology. Further research should be undertaken to establish the structure of higher‐order domains, its use as a measure of therapeutic change, and its capacity to distinguish Axis II from Axis I pathology. Copyright © 2009 John Wiley & Sons, Ltd.

Objective: To evaluate the feasibility and effectiveness of the CORDIAL program, a psychosocial intervention consisting of cognitive behavioral therapy (CBT), cognitive rehabilitation, and reminiscence to manage depressive symptoms for people with mild cognitive impairment (MCI) or dementia. Design: We conducted a randomized controlled trial, based on a two-group (intervention and control), pre-/post-intervention design. Setting: Participants were recruited from five different old age psychiatry and memory clinics at outpatients’ hospitals. Participants: Hundred and ninety-eight people with MCI or early-stage dementia were included. Intervention: The intervention group (n = 100) received 11 individual weekly sessions of the CORDIAL program. This intervention includes elements from CBT, cognitive rehabilitation, and reminiscence therapy. The control group (n = 98) received treatment-as-usual. Measurements: We assessed Montgomery–Åsberg Depression Rating Scale (MADRS) (main outcome), Neuropsychiatric Inventory Questionnaire, and Quality of Life in Alzheimer’s disease (secondary outcomes) over the course of 4 months and at a 10-month follow-up visit. Results: A linear mixed model demonstrated that the depressive symptoms assessed by MADRS were significantly more reduced in the intervention groups as compared to the control group (p < 0.001). The effect persisted for 6 months after the intervention. No significant differences between groups were found in neuropsychiatric symptoms or quality of life. Conclusion: Our multicomponent intervention, which comprised 11 individual sessions of CBT, cognitive rehabilitation, and reminiscence therapy, reduced depressive symptoms in people with MCI and dementia.

Inclusion of horse-assisted therapy (HAT) in substance use disorder (SUD) treatment is rarely reported. Our previous studies show improved treatment retention and the importance of the patient–horse relationship. This qualitative study used thematic analysis, within a social constructionist framework, to explore how eight patients experienced contextual aspects of HAT’s contribution to their SUD treatment. Participants described HAT as a “break from usual treatment”. However, four interrelated aspects of this experience, namely “change of focus”, “activity”, “identity”, and “motivation,” suggest HAT is more than just a break from usual SUD treatment. The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the “patient/self” receiving treatment for a problem. The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader SUD policy and treatment practices warrants further study.