Concurrent disorder refers to a diverse set of combinations of substance use disorders and mental disorders simultaneously in need of treatment. Concurrent disorders are underdiagnosed, undertreated, and more complex to manage, practicing the best recommendations can support better outcomes. The purpose of this work is to systematically assess the quality of the current concurrent disorders’ clinical recommendation management guidelines. Literature searches were performed by two independent authors in electronic databases, web, and gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2000 and 2020. The initial search resulted in 8841 hits. A total of 24 guidelines were identified and assessed with the standardized guidelines assessment tool: AGREE II (Appraisal of Guidelines for Research and Evaluation). Most guidelines had acceptable standards, however, only the NICE guidelines had all detailed information on all AGREE II Domains. Guidelines generally supported combinations of treatments for individual disorders with a very small evidence base for concurrent disorders, and they provided little recommendation for further structuring of the field, such as level of complexity or staging, or evaluating different models of treatment integration.

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Objectives: A little more than a decade ago British Columbia (BC) decided to improve the treatment of individuals suffering from severe concurrent disorders. They provided funding for the development of a novel evidence-based, recovery oriented, provincial tertiary inpatient treatment centre laid out for 100 beds. Integrated multidisciplinary treatment teams involving professionals from more than a dozen disciplines covering the full range of supports are now providing integrated services in one institution. We have seen changes in the population we treat and have adapted our approach. The basic concept was published in a paper 8 years ago. The current paper summarises changes in the population served, conceptual modifications, and continued issues. Methods: Reported changes in the population are based on a comparison of cross-sectional client interviews conducted 10 years ago (2009/10) and again from 2018 until 2020, mainly 2018/19. Results: Overall, we saw limited changes in the characteristics of the population such as age, gender, ethnic background, level of childhood trauma etc., but substantial changes in diagnoses, including changes in primary substances use disorders. We further present and discuss conceptual changes, such as changes in the model of care, and changes in daily practice, such as contact to, and interaction with community services. Conclusions: We feel that severe concurrent disorders continue to present a major challenge for any health care system. There continue to be substantial gaps both in research on this population and in availability of adequate health services. Services such as the one described in this paper for BC need to continue to evolve and be optimized, as they utilize innovations based on evidence that still requires further proof of practicability and efficacy. Objectifs: Il y a un peu plus d’une décennie, la Colombie-Britannique (CB) a décidé d’améliorer le traitement des personnes souffrant de troubles concomitants graves. Ils ont financé le développement d’un nouveau centre de soins tertiaires provincial de traitements éprouvés pour patients hospitalisés axé sur le rétablissement et doté de 100 lits. Des équipes de traitement multidisciplinaires intégrées regroupant des professionnels de plus d’une douzaine de disciplines couvrant toute la gamme des soutiens offrent maintenant des services intégrés dans un seul établissement. Nous avons vu des changements dans la population que nous traitons et avons adapté notre approche. Le concept de base a été publié dans un journal il y a 8 ans. Le présent document résume les changements dans la population desservie, les modifications conceptuelles et les problèmes persistants. Méthodes: Les changements signalés dans la population sont basés sur une comparaison d’entretiens transversaux avec des clients menés il y a 10 ans (2009/10) et à nouveau de 2018 à 2020, principalement 2018/19. Résultats: Dans l’ensemble, nous avons constaté des changements limités dans les caractéristiques de la population telles que l’âge, le sexe, l’origine ethnique, le niveau de traumatisme de l’enfance, etc., mais des changements substantiels dans les diagnostics, y compris des changements dans les troubles primaires liés à l’utilisation de substances. Nous présentons et discutons en outre des changements conceptuels, tels que les changements dans le modèle de soins et les changements dans la pratique quotidienne, tels que le contact et l’interaction avec les services communautaires. Conclusions: Nous pensons que les troubles concomitants graves continuent de représenter un défi majeur pour tout système de soins de santé. Il subsiste des lacunes substantielles tant dans la recherche sur cette population que dans la disponibilité de services de santé adéquats. Les services tels que celui décrit dans ce document pour la Colombie-Britannique doivent continuer d’évoluer et d’être optimisés, car ils utilisent des innovations basées sur des preuves qui nécessitent encore des preuves supplémentaires de faisabilité et d’efficacité.

Objectives The purpose of this review is to examine human study evidence on the effectiveness of oxytocin in this patient population. Despite stimulant use disorder being a major public health concern, there are no validated pharmacological treatments. Psychosocial interventions show limited effectiveness especially in the more severe cases of stimulant use disorder, whereas animal models suggest that oxytocin may be a useful treatment. Methods A literature search using Medline, Embase, and PsychInfo was undertaken. Search results were subsequently imported into Covidence to identify relevant studies. Results Six studies were included in this review, two of which were pilot studies. Although oxytocin was well tolerated across studies, no study showed a statistically significant reduction in reported cocaine use or cravings. One study suggested oxytocin increased the desire to use cocaine, although the population of participants should be taken into consideration. In contrast, one study showed a trend towards reduced self-reported cocaine use. Conclusion Available research does not support the use of oxytocin in the management of stimulant use disorder; however, included studies are small in sample size and limited in number. There were several noteworthy findings unrelated to this review’s primary and secondary outcomes, which are of interest and warrant further research. We provide suggestions for future studies in this area of research. Considering the limited data available at this time, further studies are required before any definitive conclusions can be made regarding the use of oxytocin in stimulant use disorder management.