Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence

Meier, Petra; Barrowclough, Christine

doi:10.1080/09687630701741030

Cited by 20 publications

(20 citation statements)

References 79 publications

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“…This is the first study, to our knowledge, to set out to discover whether personality functioning as measured through characteristic adaptations might assist in the identification of potential obstacles to treatment engagement in substance misuse treatment. The evidence provided in this study is broadly consistent with, and extends, previous studies in diverse clinical populations which found that personality functioning was associated with differential responses to treatment [28], with maladaptive levels predicting poorer treatment response [29] and non-engagement [30,31]. High levels of emotional dysregulation had also previously been found to be associated with non-compliance, denial and behavioural disengagement [41].…”

Section: Discussionsupporting

confidence: 89%

The role of personality functioning in drug misuse treatment engagement

et al. 2019

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Background and aim Personality functioning is predictive of drug misuse and relapse, yet little is known about the role of personality in engagement with the treatment process. This study aimed to estimate the extent to which broad‐ and facet‐level characteristic adaptations contribute to or hinder treatment engagement, while controlling for psychosocial indicators. Design Multi‐site cross‐sectional survey. Setting In‐patient treatment units covering 80% of residential treatment entries in Greece. Participants A total of 338 service users, 287 (84.9%) male, 51 (15.1%) female, average age 33.4 years. Measurements Expressions of personality functioning (characteristic adaptations) were assessed using the Severity Indices of Personality Problems (SIPP‐118). Treatment engagement was measured using the Client Evaluation of Self and Treatment, in‐patient version (CEST). Findings Dysfunctional levels of relational capacities predicted counselling rapport [β = 1.50, 95% confidence interval (CI) = 0.326–2.69, P = 0.013], treatment participation (β = 2.09, 95% CI = 1.15–3.11, P < 0.001) and treatment satisfaction (β = 1.65, 95% CI = 0.735–2.57, P < 0.001). Counselling rapport was also predicted by dysfunctional levels in self‐control (β = 1.78, 95% CI = 0.899–2.67, P < 0.001), self‐reflective functioning at the facet‐level (β = 2.24, 95% CI = 1.01–3.46, P < 0.001) and aggression regulation (β = 1.43, 95% CI = 0.438–2.42, P = 0.005). Dysfunctional levels on social concordance (β = −1.90, 95% CI = −2.87 to –0.941, P = 0.001), emotional regulation (β = 1.90, 95% CI = 0.87–2.92, P < 0.001) and intimacy (β = 2.04, 95% CI = 1.31–3.05, P < 0.001) were significant predictors of treatment participation. Treatment readiness and desire for help predicted treatment engagement. Conclusions In people attending substance use treatment services, maladaptive interpersonal patterns and relational intimacy, emotional dysregulation and impulse control may be associated with low levels of counselling rapport and treatment participation. Low frustration tolerance and aggressive impulses also appeared to predict low participation.

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Section: Discussionsupporting

confidence: 89%

The role of personality functioning in drug misuse treatment engagement

et al. 2019

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“…Research into mental health services utilization by patients with COD has yielded mixed findings; however, a major limitation of many studies focused on this subject is the exclusion of patients with acute and severe mental disorders. 31 Furthermore, previous studies analyzing the effect of psychiatric symptom severity on service utilization 32,33 have also found a direct association between these two variables. This may be explained by the increase in interpersonal difficulties at higher levels of disease severity, which may lead to difficulty receiving feedback and instructions from the clinician, 34 or by higher levels of self-stigma and internalized shame, which reduce overall participation in mental health services.…”

Section: Discussionmentioning

confidence: 99%

Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Villalobos-Gallegos

Marín-Navarrete

Roncero

et al. 2017

Rev. Bras. Psiquiatr.

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Objective: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization. Methods: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span. Results:The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p o 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [w Conclusion:The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

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“…Minimum stays of 90 days are now required in the UK as indicators for treatment effectiveness (National Treatment Agency (NTA), 2006a). A recent systematic review by Meier and Barrowclough (2009) included 58 studies published since 1990 that investigated the relationship of co-morbid problems and treatment retention. Except for clients with antisocial personality disorder, the reviewers concluded that, overall, the evidence does not support the common belief that DD clients are at a higher risk of dropout from addiction treatment than other substance misuse clients in general.…”

Section: Introductionmentioning

confidence: 99%

Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment

Schulte

Meier

Stirling

et al. 2010

Mental Health and Substance Use

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Background: While many studies have examined the prevalence of concurrent substance misuse and mental health problems across different treatment populations, we know little as to what extent such co-morbidity is identified in routine clinical practice. However, literature in the field has emphasised the importance of recognising co-morbidity early to avoid adverse treatment outcomes. Aims: To determine: (1) the degree to which co-morbidity is recognised and addressed in outpatient addiction services; and (2) whether unaddressed comorbidity increases the risk of dropout. Method: Clients (n ¼ 176) starting treatment at six UK-based drug and/or alcohol services and their 46 practitioners were followed for 3 months. Multiple assessments were carried out in order to obtain information about clients' mental health, 90-day retention rates, treatment perceptions and practitioners' expertise and training levels in the co-morbidity field. Services' assessment protocols and in-treatment case notes for each client were examined. Results: Of 124 (71%) clients screening positive for mental health problems, services recognised co-morbidity in only 54%, and addressed it in 23%. Clients whose co-morbidity was not addressed were significantly less likely to be retained at 90 days (HR ¼ 0.296, p 5 0.005). Conclusions: Improving assessment and care planning procedures is important because of a link between unaddressed co-morbidity and dropout.

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Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence

Abstract: Background: A sizeable number of recent studies investigating whether clients with substance misuse

Cited by 20 publications

References 79 publications

The role of personality functioning in drug misuse treatment engagement

The role of personality functioning in drug misuse treatment engagement

Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment

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