Comorbidity in detoxification
Co-occurring substance use and mental health disorders (CODs) are common. However, very little is known about individuals' recognition of, and perception of the relationship between these disorders. The current study aimed to examine problem recognition, perceived disorder relationships, treatment intentions, and treatment preferences of individuals attending Australian detoxification facilities. Questionnaires were completed by 225 participants, including the Mental Health Screening Form III and the Treatment Preferences Questionnaire.
Comorbid (co-occurring) mental health disorders are common; results indicated that 56.4% of participants screened positive for CODs over the preceding 30 days, with only 4.2% failing to recognise their mental health problems. 85% had experienced a mental health disorder in their lifetime. Participants perceived a functional relationship between disorders, where improvement/deterioration of one disorder leads to the improvement/deterioration of the other. Most (75%) describe the relationship between the two such that, as the symptoms of substance abuse disorders worsen, mental health symptoms become more pronounced. A smaller but important group of (15%) perceive an opposite effect, where reduced alcohol and drug use leads to an increase in mental health symptoms. Identification of clients who have this pattern of interaction between their substance use and mental health symptoms is likely to be important in helping them manage their comorbid disorders. It is also important to identify and educate clients who are unaware of or deny comorbid mental health disorders, as this can adversely affect their treatment intentions and outcomes. Recognition of mental health problems and perception of a functional relationship between disorders, predict high mental health treatment intentions. These findings have important clinical implications when planning treatment programs and counselling individuals with CODs.
The study also investigated the treatment preferences of comorbid disorder clients. Half (50%) of clients with both substance abuse and mental health disorders prefer treatment that addresses both disorders concurrently. Approximately a quarter prefer substance abuse treatment as a priority. Few (14%) prefer treatment for substance abuse only. Another finding from this study was that a single screening item was highly accurate at identifying those with comorbid mental health conditions, and could be effectively be used for this purpose with minimal demands on both clients and treatment staff.
Vella, V., Deane, F. P., & Kelly, P. J. (2015). Comorbidity in detoxification: Symptom interaction and treatment intentions. Journal of Substance Abuse and Treatment, 49, 35-42.
Definitive version: www.sciencedirect.com/science/article/pii/S0740547214001664
Screening for mental disorder comorbidity in residential treatment
There has been much international impetus to address the importance of identifying and treating clients experiencing both a substance use disorder and a mental disorder in treatment settings. Gaps in the literature still exist after a decade of research into this area. There is little research on the prevalence of co-occurring mental disorders (CODs) in the residential alcohol and other drug (AOD) treatment modality. In this study, the mental disorder status of 278 participants resident in AOD treatment settings across Australia was estimated using the Addiction Severity Index—Self Report (J.S. Cacciola, A. Pecoraro, & A.I. Alterman, 2008) and the Mental Health Screening Form III (J.F.X. Carroll & J.J. McGinley, 2001). The estimated rate of diagnosable Axis I mental disorder comorbidity varied from 64% to 71% depending upon which cutoff score was used with the MHSF-III. Missing data emerged as a major limitation of the self-report version of the Addiction Severity Index psychiatric composite score in this population.
Mortlock, K. S., Deane, F. P., & Crowe, T. P. (2011). Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings. Journal of substance abuse treatment, 40(4), 397-404.
Submitted version: works.bepress.com/fdeane/45/
Definitive version: www.sciencedirect.com/science/article/pii/S0740547211000092
Comparing outcomes of substance use disorder only and dual diagnosis clients
In a separate study of clients in Residential Treatment Service Centres, the 3 month telephone interview follow-up data was used to identify those who were likely to have a comorbid substance abuse and mental health disorder. Approximately two-thirds of clients were classified as likely to have comorbid disorders, with the remaining third classified as substance abuse only. Although those with comorbid disorders and those with only substance abuse disorder reported similar decreases in substance use problems, those with comorbid disorders perceived less improvement.
Clients with comorbid disorders entered treatment with higher symptom distress compared to those with substance abuse only. Although both groups improved at a similar rate, because those with comorbid disorders started treatment with greater symptom severity, they remained significantly more symptomatic at follow-up. This suggests that those with comorbid disorders may benefit from a different treatment approach (e.g., longer, more intense and/or different content) in order to achieve equivalent outcomes to those who have only a substance abuse disorder.
Cridland, E. K., Deane, F. P., Hsu, C.-l., & Kelly, P. J. (2012). A comparison of treatment outcomes for individuals with substance use disorder alone and individuals with probable dual diagnosis. International Journal of Mental Health and Addiction, 10(5), 670-683.
Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=4147&context=hbspapers
Definitive version: link.springer.com/article/10.1007/s11469-011-9364-z
Depression and substance abuse computer-based intervention
A large proportion of people attending residential alcohol and other substance abuse treatment have a co-occurring mental illness. Empirical evidence suggests that it is important to treat both the substance abuse problem and co-occurring mental illness concurrently and in an integrated fashion. However, the majority of residential alcohol and other substance abuse services do not address mental illness in a systematic way. It is likely that computer delivered interventions could improve the ability of substance abuse services to address co-occurring mental illness. This protocol describes a study in which we will assess the effectiveness of adding a computer delivered depression and substance abuse intervention for people who are attending residential alcohol and other substance abuse treatment.
Participants will be recruited from residential rehabilitation programs operated by the Australian Salvation Army. All participants who satisfy the diagnostic criteria for an alcohol or other substance dependence disorder will be asked to participate in the study. After completion of a baseline assessment, participants will be randomly assigned to either a computer delivered substance abuse and depression intervention (treatment condition) or to a computer-delivered typing tutorial (active control condition). All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based treatment facility. Randomisation will be stratified by gender (Male, Female), length of time the participant has been in the program at the commencement of the study (4 weeks or less, 4 weeks or more), and use of anti-depressant medication (currently prescribed medication, not prescribed medication). Participants in both conditions will complete computer sessions twice per week, over a five-week period. Research staff blind to treatment allocation will complete the assessments at baseline, and then 3, 6, 9, and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period.
This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioural therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs.
Kelly, P. J., Kay-Lambkin, F. J., Baker, A. L., Deane, F. P., Brooks, A. C., Mitchell, A., . . . Dingle, G. A. (2012). Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment. BMC public health, 12(1), 113-121.
Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=4032&context=hbspapers
Definitive version: www.biomedcentral.com/1471-2458/12/113
Dual diagnosis capability of residential addiction treatment centres
The Dual Diagnosis Capability of Addiction Treatment (DDCAT) index is used to assess the capacity of substance abuse services to work with individuals with co-occurring mental health problems. The current study aimed to: (i) examine the dual diagnosis capability of residential substance abuse programs in Australia; (ii) identify managers' perceptions regarding both priorities and confidence for change following the completion of the DDCAT; and (iii) to examine the usefulness of the DDCAT to residential substance abuse programs. The DDCAT was completed across 16 residential substance abuse units. An external researcher administered and scored the DDCAT. A Unit Manager from each site completed the Comorbidity Priorities and Confidence Survey following the completion of the DDCAT review. This survey examined the usefulness of the DDCAT, and the unit's priorities to improve its capability, and confidence to improve its DDCAT score. Across the services, program structure and staff training were the DDCAT domains that required the most improvement. While training was the highest endorsed priority area for improvement, program structure was the lowest priority. Overall the Unit Managers reported positive attitudes towards use of the DDCAT and were confident that their unit could improve their DDCAT scores. DDCAT scores of Australian residential substance abuse programs are comparable with previous published results. However, there is still substantial work required to improve the capability of these programs. Future research should examine strategies to promote sustained improvements in the capability of residential substance abuse programs.
Matthews, H., Kelly, P. J., & Deane, F. P. (2011). The dual diagnosis capability of residential addiction treatment centres: priorities and confidence to improve capability following a review process. Drug and Alcohol Review, 30(2), 195-199.
Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=1999&context=hbspapers
Definitive version: onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2010.00215.x/full