Outpatient mental health and the dual-diagnosis patient: Utilization of services and community adjustment

Ford, Lucy K.; Snowden, Lonnie R.; Walser, Elizabeth J.

doi:10.1016/0149-7189(91)90011-5

Cited by 27 publications

(17 citation statements)

References 26 publications

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“…People who frequently use substances are 2 times at greater risk of having a comorbid depression or anxiety disorder, and this increases to 5 times greater risk for dependent substance users (Merikangas et al, 1998). This combination of problems often complicates treatment and can result in greater functional impairment (Johnson et al, 1995), reduced treatment adherence (Carroll, Power, Bryant, & Rounsaville, 1993;Ford, Snowden, & Walser, 1991), poor health outcomes (Hasin et al, 2002;McKay et al, 2002) and increased risk of suicide (Harris & Barraclough, 1997).…”

Section: Introductionmentioning

confidence: 98%

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Delgadillo

Gore²,

Ali

et al. 2015

Journal of Substance Abuse Treatment

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Depressed mood often co-exists with frequent drug and alcohol use. This trial examined the feasibility of screening, recruitment, randomization and engagement of drug and alcohol users in psychological interventions for depression symptoms. A total of 50 patients involved in community drugs and alcohol treatment (CDAT) were randomly allocated to behavioral activation delivered by psychological therapists (n = 23) or to cognitive behavioral therapy based self-help introduced by CDAT workers (n = 27). We examined recruitment and engagement rates, as well as changes in depression (PHQ-9) symptoms and changes in percent days abstinent (PDA within last month) at 24 weeks follow-up. The ratio of screened to recruited participants was 4 to 1, and the randomization schedule successfully generated 2 groups with comparable characteristics. Follow-up was possible with 78% of participants post-treatment. Overall engagement in psychological interventions was low; only 42% of randomized participants attended at least 1 therapy session. Patients offered therapy appointments co-located in CDAT clinics were more likely to engage with treatment (odds ratio = 7.14, p = .04) compared to those offered appointments in community psychological care clinics. Intention-to-treat analyses indicated no significant between-group differences at follow-up in mean PHQ-9 change scores (p = .59) or in PDA (p = .08). Overall, it was feasible to conduct a pragmatic trial within busy CDAT services, maximizing external validity of study results. Moderate and comparable improvements in depression symptoms over time were observed for participants in both treatment groups.

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Section: Introductionmentioning

confidence: 98%

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Delgadillo

Gore²,

Ali

et al. 2015

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

show abstract

“…In fact, a diagnosis of a co-occurring disorder has been found to be the greatest predictor of subsequent hospitalizations and the best indicator of missed-appointment rates (Ford, Snowden, & Walser, 1991), reinforcing the view of treatment of the dually diagnosed as "mission impossible" (Roberts, Shaner, Eckman, Tucker, & Vaccaro, 1992, p. 55).…”

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confidence: 94%

Meta-analysis of Interventions With Co-occurring Disorders of Severe Mental Illness and Substance Abuse: Implications for Social Work Practice

Dumaine

2003

Research on Social Work Practice

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Objective: A quantitative analysis of 15 empirical studies is conducted to determine effective interventions with the dually diagnosed. Method: Client and practitioner characteristics, types of interventions, and treatment effectiveness are examined through meta-analytic techniques. Results: (a) Age of client was positively correlated with effect size, (b) there were no statistically significant correlations between practitioner training or practitioner-to-client ratio and effect size, (c) intensive case management was associated with the greatest effect size, and (d) a small positive effect size was found for standard aftercare with outpatient psychoeducational treatment groups. Conclusions: Social work practice implications, based on the results of the quantitative analysis and trends identified in the studies, are that there is a unique role for practitioners in advocating for linkage of resources, additional supports for clients, and the dismantling of barriers that impede resource access.

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“…These problems are often closely related to patients' alcohol or drug use behaviors and have been shown repeatedly to have significant negative impacts on treatment retention and subsequent outcomes (McLellan et al, 1994;Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999). Drug use and alcohol use combined with psychiatric illness have been associated with higher health care costs (Westermeyer, Eames, & Nugent, 1998) and with violent behaviors leading to involvement with courts and jails (Ford, Snowden, & Walser, 1991). Analyses from the Drug Abuse Treatment Outcome Study (DATOS) found that, among cocaine-using patients across three modalities of treatment, those with the most severe problems (i.e., substance dependence or polysubstance use, psychiatric illness and social difficulties, criminal justice involvement, income and employment problems, and low social support) had the highest rates of relapse in the year after treatment (Simpson et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Unmet needs for comprehensive services in outpatient addiction treatment

Pringle

Emptage

Hubbard

2006

Journal of Substance Abuse Treatment

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Outpatient mental health and the dual-diagnosis patient: Utilization of services and community adjustment

Cited by 27 publications

References 26 publications

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Meta-analysis of Interventions With Co-occurring Disorders of Severe Mental Illness and Substance Abuse: Implications for Social Work Practice

Unmet needs for comprehensive services in outpatient addiction treatment

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