Enhancing Validity in Co-occurring Disorders Treatment Research

G J Mchugo,R E Drake,A I Green,H Xie,S M Essock,M F Brunette

doi:10.1093/schbul/sbl009

G J Mchugo, R E Drake + Show 4 more

Open Access

https://doi.org/10.1093/schbul/sbl009

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Abstract

Despite the high prevalence of co-occurring mental health and substance-use disorders, there has been a relative lack of treatment research with this population, and the existing research often has limited validity. This article explores some of the barriers to the conduct of research on promising interventions for substance-abuse treatment for people with co-occurring disorders, using the concepts of external and ecological validity to make recommendations for future investigation. The central recommendation is to move rapidly from efficacy studies to more credible and valid effectiveness studies, in order to facilitate the adoption of evidence-based interventions in routine practice settings.

Highlights

Co-occurring severe mental illness and substance abuse, often called dual diagnosis or dual disorders, is a major public health problem.[1]
There are fundamental differences between efficacy and effectiveness research, and we have reviewed a number of ways to enhance the validity of the latter, with special emphasis on external and ecological validity
Efficacy studies are necessary in identifying promising interventions that yield a discernible treatment effect under ideal conditions, but their success does not guarantee adoption of the tested interventions

Summary

Introduction

Co-occurring severe mental illness and substance abuse, often called dual diagnosis or dual disorders, is a major public health problem.[1]. They have been used to study the validity of measures, patient attitudes and motivations, reasons for noncompliance, and system barriers to dissemination and implementation.[21] For the study of co-occurring disorders, qualitative methods have been used to understand recovery from substance abuse from the patients’ perspective, to assess natural social support networks, and to explain treatment refusal or dropout.[22,23] This discussion highlights the value of the RCT for determining intervention efficacy, but it reveals the shortcomings of efficacy research for developing the evidence base in support of a given intervention. The primary advantage is that the dissemination and implementation of effective interventions will be facilitated due to the credibility and clinical meaningfulness of the research rather than assumed due to the statistical significance of the findings

Design

Summary