Behavioral Interventions for Individuals Dually Diagnosed with a Severe Mental Illness and a Substance Use Disorder

Bradizza, Clara M.; Stasiewicz, Paul R.; Dermen, Kurt H.

doi:10.1007/s40429-014-0032-9

Cited by 14 publications

(9 citation statements)

References 40 publications

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“…Among those with serious mental illness, alcohol use negatively impacts psychiatric symptoms and contributes to high rates of homelessness, psychiatric hospitalization, HIV infection, cigarette smoking, and drug abuse (5, 6). Psychosocial treatments demonstrate reductions in alcohol and drug use in adults with serious mental illness (7, 8); however, few are widely available due to their relatively high costs, need for extensive training and fidelity monitoring, and organizational barriers (9, 10). …”

mentioning

confidence: 99%

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness

McDonell

Leickly

McPherson

et al. 2017

AJP

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Objective To determine if a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine if contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior. Method Seventy-nine (37% female, 44% non-white) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomized to 12-weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods. Results Contingency management participants were 3.1 times (95% CI: 2.2, 4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional abstinence relative to controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, relative to controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up. Conclusions This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.

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confidence: 99%

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness

McDonell

Leickly

McPherson

et al. 2017

AJP

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“…Recent systematic reviews and meta-analysis examining the efficacy of behavioral interventions for comorbid serious mentally illness and substance use disorder, including stimulant use disorder, did not find evidence for the efficacy of CBT. One caveat was the small number of studies, all with limited sample sizes (Bradizza, Stasiewicz, & Dermen, 2014). …”

Section: Treatment Approaches Targeting Cognitive Functionsmentioning

confidence: 99%

Cognitive Function as a Transdiagnostic Treatment Target in Stimulant Use Disorders

Sofuoglu

DeVito

Waters

et al. 2016

Journal of Dual Diagnosis

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Stimulant use disorder is an important public health problem, with an estimated 2.1 million current users in the United States alone. No pharmacological treatments are approved by the U.S. Food and Drug Administration (FDA) for stimulant use disorder and behavioral treatments have variable efficacy and limited availability. Most individuals with stimulant use disorder have other comorbidities, most with overlapping symptoms and cognitive impairments. The goal of this article is to present a rationale for cognition as a treatment target in stimulant use disorder, and to outline potential treatment approaches. Rates of lifetime comorbid psychiatric disorders among people with stimulant use disorders are estimated at 65% - 73%, with the most common being mood disorders (13% - 64%) and anxiety disorders (21% - 50%), as well as non-substance induced psychotic disorders (under 10%). There are several models of addictive behavior, but the dual process model particularly highlights the relevance of cognitive impairments and biases to the development and maintenance of addiction. This model explains addictive behavior as a balance between automatic processes and executive control, which in turn are related to individual (genetics, comorbid disorders, psychosocial factors) and other (craving, triggers, drug use) factors. Certain cognitive impairments, such as attentional bias and approach bias, are most relevant to automatic processes, while sustained attention, response inhibition, and working memory are primarily related to executive control. These cognitive impairments and biases are also common in disorders frequently comorbid with stimulant use disorder, and predict poor treatment retention and clinical outcomes. As such, they may serve as feasible trans-diagnostic treatment targets. There are promising pharmacological, cognitive, and behavioral approaches that aim to enhance cognitive function. Pharmacotherapies target cognitive impairments associated with executive control and include cholinesterase inhibitors (e.g., galantamine, rivastigmine) and monoamine transporter inhibitors (e.g., modafinil, methylphenidate). Cognitive behavioral therapy and cognitive rehabilitation also enhance executive control, while cognitive bias modification targets impairments associated with automatic processes. Cognitive enhancements to improve treatment outcomes is a novel and promising strategy, but its clinical value for the treatment of stimulant use disorder, with or without other psychiatric comorbidities, remains to be determined in future studies.

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“…Moreover, absence of AUD was associated with better neurocognitive recovery during the early course of BD (Torres et al, 2014 ). However, few pharmacological and behavioral interventions have effectively addressed the clinical management of dual populations, probably because they may not be well-suited for this cognitively-impaired population (Bradizza et al, 2014 ). Indeed, neurocognitive dysfunction may represent a barrier for dual patients to benefit from psychosocial treatments, and probably also from pharmacological agents through indirect effects on diminished adherence (Martinez-Aran et al, 2009 ; Vieta et al, 2012 ; Jónsdóttir et al, 2013 ; Fagan et al, 2015 ).…”

Section: Implications For Clinical Practice and Researchmentioning

confidence: 99%

Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates

et al. 2015

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Bipolar disorder (BD) and alcohol use disorders (AUDs) are usually comorbid, and both have been associated with significant neurocognitive impairment. Patients with the BD-AUD comorbidity (dual diagnosis) may have more severe neurocognitive deficits than those with a single diagnosis, but there is paucity of research in this area. To explore this hypothesis more thoroughly, we carried out a systematic literature review through January 2015. Eight studies have examined the effect of AUDs on the neurocognitive functioning of BD patients. Most studies found that BD patients with current or past history of comorbid AUDs show more severe impairments, especially in verbal memory and executive cognition, than their non-dual counterparts. Greater neurocognitive dysfunction is another facet of this severe comorbid presentation. Implications for clinical practice and research are discussed. Specifically, the application of holistic approaches, such as clinical staging and systems biology, may open new avenues of discoveries related to the BD-AUD comorbidity.

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Behavioral Interventions for Individuals Dually Diagnosed with a Severe Mental Illness and a Substance Use Disorder

Cited by 14 publications

References 40 publications

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness

Cognitive Function as a Transdiagnostic Treatment Target in Stimulant Use Disorders

Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates

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