Impact of physical activity and social support on mental health, quality of life and substance use in adults with dual diagnosis: a systematic review

Substance use disorders (SUDs) are prevalent in the United States and costly to society. SUDs contribute significantly to decreased quality of life and overdose deaths. Physical activity (PA) interventions may be one efficacious method to improve recovery and long-term abstinence from substance use; although PA interventions have resulted in positive physical and psychological outcomes, their adherence and attrition rates have been problematic. To address lack of adherence and high attrition rates, it is important to understand the preferences and attitudes for PA among patients in SUD treatment. We, therefore, conducted a literature review to examine preferences and attitudes for PA among adults with SUDs. Five articles met inclusion and exclusion criteria. The findings from this small sample of studies suggest that adults with SUDs are interested in PA. Walking, strength training, and cycling were the activities preferred most frequently. Participants said that they would like to engage in these activities either alone or with small groups and would prefer their exercise options to be located at facilities they already frequented, such as treatment clinics. Nurses are well positioned to assess patient preferences and attitudes and to enhance recovery efforts in this population. Further exploration of this population's unique preferences and attitudes regarding PA may lay the groundwork for efficacious PA interventions with improved adherence and attrition rates, which may lead to improved recovery outcomes.

Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity.

Patients with both mental illness and substance abuse pose a major clinical challenge to mental health and substance abuse clinicians. The literature seems to support the hypothesis that mental illness and substance abuse occur together more frequently than chance would predict. Assessment and classification of these patients should be guided by clinicians' needs to make meaningful therapeutic judgments and to communicate effectively with each other in coordinating treatment. Different phases of treatment require different approaches to assessment and classification. In initial classification, the clinician should recognize the problem of dual diagnosis and resist premature assumptions about which diagnosis is primary. Long-term treatment and rehabilitation may require systematic evaluation of alternative clinical by potbeses about why a patient exhibits both disorders. This approach eventually may lead to better ways to assess, classify, and treat these difficult patients.

Schizophrenia and Co-Occurring Substance Use Disorder

The Evidence for SBIRT in Adolescents

Findings from a small body of evidence suggest that physical activity comprising of yoga, treadmill exercise or support to increase physical activity may improve symptoms but not quality of life or abdominal pain in people diagnosed with IBS but we have little confidence in these conclusions due to the very low certainty of evidence. The numbers of reported adverse events were low and the certainty of these findings was very low for all comparisons, so no conclusions can be drawn. Discussions with patients considering physical activity as part of symptom management should address the uncertainty in the evidence to ensure fully informed decisions. If deemed sufficiently important to patients and healthcare providers, higher quality research is needed to enable more certain conclusions.

Fostering physical activity motivation at substance use disorder treatment facilities: A qualitative study grounded in self-determination theory

Although the review included nine trials, the evidence for how to increase children's physical activity in outside-school hours care settings remains limited, both in terms of certainty of evidence and magnitude of the effect. Of the types of interventions identified, when assessed using GRADE there was low-certainty evidence that multi-component interventions, with a specific physical activity goal may have a small increase in daily moderate-to-vigorous physical activity and a slight reduction in BMI. There was very low-certainty evidence that interventions increase cardiovascular fitness. By contrast there was moderate-certainty evidence that interventions were effective for increasing proportion of time spent in moderate-to-vigorous physical activity, and online training is cost-effective.

BackgroundChronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis (MS) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles. However, no studies to date have systematically evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS. This study involves a randomized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels.Methods/DesignA randomly-allocated, three-parallel group, time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study. Our goal is to recruit 189 ambulatory individuals with MS who will be randomized into one of three telehealth interventions: (1) a contact-control social support intervention, (2) a physical activity-only intervention, and (3) a physical activity plus fatigue management intervention. All interventions will last 12 weeks and will be delivered entirely over the phone. Our hypothesis is that, in comparison to the contact-control condition, both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function, with the physical activity plus fatigue management intervention yielding significantly larger improvements. To test this hypothesis, outcome measures will be administered at Weeks 1, 12, and 24. Primary outcomes will be the Fatigue Impact Scale, the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and Actigraph accelerometers. Secondary outcomes will include the SF-12 Survey, Mental Health Inventory, Multiple Sclerosis Impact Scale, the Community Participation Indicator, and psychosocial constructs (e.g., self-efficacy).DiscussionThe proposed study is novel, in that it represents a multi-disciplinary effort to merge two promising lines of research on MS: fatigue management and physical activity promotion. Collectively, the proposed study will be the largest randomized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registrationNCT01572714

The link between bipolarity and substance use: A controlled clinic based study.

ObjectiveThis systematic review investigates physical activity (PA) interventions for (1) reducing substance use and associated outcomes, (2) increasing physical activity, and (3) improving mental health in young people aged 12–25 years at increased risk for problematic substance use. MethodFour databases (PsycINFO, CINAHL, SPORTDiscus, and Medline) and grey literature, including hand searches, were searched (2021–2022). Non-randomized controlled or randomized controlled trials of a) multimodal or unimodal, short or long-term physical activity interventions in young people at increased risk of problematic substance use that b) investigated substance use outcomes were included. PA and mental health outcomes were explored where possible. ResultsSixty-one percent of the studies (k = 17/28) reported a significant improvement in outcomes related to tobacco (e.g., abstinence, cravings, withdrawal symptoms, smoking pattern), alcohol (e.g., quantity, frequency), or other substance use (e.g., frequency, quantity, recent use). Eight studies reported an increase in PA participation; two reported a beneficial effect on depression symptoms. The certainty of the evidence, i.e., the confidence in the reported effect estimates, was downgraded based on the risk of bias assessment. Findings should therefore be interpreted cautiously. ConclusionsA range of physical activity intervention formats and modalities may decrease substance use and associated outcomes and increase physical activity participation among people at risk for problematic substance use. Future research is warranted to better establish efficacy and investigate the effectiveness of implementing physical activity as part of treatment for substance use in young people.

Objective-This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nation's largest state prison system. Methods-The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006.An electronic database was used to identify inmates whose parole was revoked within 12 months of their release.The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis.Results-Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7,95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8,95% CI=1.7-4.5) in the 12 months after their release.However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk.Conclusions-These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.Over the past four decades the widespread deinstitutionalization of persons with serious mental illness (1-3), the increase in drug-related arrests (4,5), and the reduction of community-based mental health care (1,2) have resulted in a substantial overrepresentation of persons with serious mental illness in the U.S. correctional system (1,2,6).Approximately 10% to 20% of U.S. prison inmates are estimated to have an axis I major mental disorder of thought or mood, such as major depressive disorder, bipolar disorder, or schizophrenia (7-12).Moreover, a majority of inmates with serious mental illness have a comorbid substance use disorder (7,(12)(13)(14)(15).A number of investigations have examined predictors of recidivism among released inmates (16)(17)(18)(19).Although results of these studies-conducted throughout a variety of criminal justice

Increasing regular physical activity (PA) behavior may be an effective adjunct intervention for substance use disorder (SUD) treatment. This systematic review aims to identify promising behavior change techniques (BCTs), namely, BCTs present in the design of interventions evidencing significant short-term and/or long-term (d ≥ 0.15 for objective measures and d ≥ 0.36 for self-report measures) increase in PA and/or reduction of substance use, secondary psychological measures, and retention in the PA intervention. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the search was performed on March 11, 2021 across databases including MEDLINE, PsycINFO, SPORTDiscus, Cochrane Library, CINAHL, ProQuest, Web of Science Core Collection, Google Scholar, Open Grey, and ProQuest Dissertations & Theses. Studies were included if they measured PA, included participants aged ≥ 18 years, were randomized control trials, and if participants were diagnosed with SUDs. The Cochrane RoB 2.0 Tool was used to assess risk of bias. BCTs from eligible studies were extracted, coded, and ranked according to their proportional presence across studies. The final synthesis included k = 61 studies with N = 12,887 participants. High heterogeneity across outcome measures, interventions, and control conditions was found. In total, 477 applications of BCTs were identified. Instruction on how to perform the behavior, social support (unspecified), behavioral practice/rehearsal, problem-solving, pharmacological support, goal setting (behavior), self-monitoring (behavior), and biofeedback were the eight most frequently used promising BCTs across studies. Incorporating the eight most promising BCTs identified in this review in future PA interventions in SUD populations may improve SUD outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

There has been an international effort to improve the quality of care available to persons living with dementia and their caregivers. As such, community-based interventions designed to help mitigate the health effects associated with caregiving are essential. Physical activity (PA) and social support are two elements with the potential to enhance caregivers' health and may be beneficial to include when designing and implementing interventions. Thus, to inform implementation and future research, this scoping review sought to describe and identify what is already known about PA and/or social support and dementia caregivers' physical, mental and social well-being. Following Arksey and O'Malley's (2005) framework, five databases (i.e., SPORTdiscus, CINAHL, PubMed, MEDLINE, PsychINFO) were searched in October 2022 and February 2024. Studies were selected based on a specific inclusion criterion: (1) dementia caregivers (>18); (2) community-based PA and/or social support interventions; and (3) outcomes of overall health and well-being. Covidence was used to organize all relevant studies, and two researchers independently extracted all data. Knowledge users (i.e., dementia caregivers & community program providers) (n=4) were consulted within a focus group to confirm or refute the results based on their lived experiences. Thirty-one studies met the inclusion criteria. Ten studies examined PA; 12 studies examined social support; and 9 studies examined interventions inclusive of PA and social support. Regardless of the intervention type, the most common finding was participation led to enhanced mental well-being. No difference in health outcomes were found between interventions delivered in-person compared to online. Participation in joint reminiscence therapy was the only intervention to result in a decrease in health. All knowledge users agreed with this finding during the focus group and indicated reminiscence therapy may not be beneficial for all dementia caregivers. This review adds to our understanding of what is known about PA and/or social support and the health of dementia caregivers. It is evident participation in PA and/or social support is beneficial for the physical, mental and social well-being of dementia caregivers. The findings from this review may help to inform the development and improvement of community-based interventions for dementia caregivers.

Illicit substance use overlapping with mental illness has always been a huge clinical concern. The same extends true for ADHD and substance use overlap as both these conditions alone and together can negatively affect the individual’s quality of life. It is important to understand and identify any potential gaps in-regards to the need vs receiving the treatment for these co-occurring disorders. The data was collected from Board certified, USA based adult psychiatrist. No recent data available that studies the prescribing trends among physicians who treat adult ADHD and substance use disorders. It is important to consider risk factors that may lead for ADHD individuals to use more substances. An important clinical concern is ADHD and substance use overlap decreases the life span by increasing mortality. It is crucial to treat both these conditions by using evidence-based practice norms. We highlight the factors that lead to clinical decision making while treating adult ADHD and co-occurring substance use disorders. Treating these individuals is often times challenging; many times, they are facing challenges in several domains of their lives such as homelessness, no medical care, financial constraints, no social support, unplanned pregnancies, and domestic violence/staying in an abusive relationship, to name a few.