Co-occurring Addiction Research Articles

Cross-sectional study of co-occurring addiction problems among high school students in Tunisia.

Addictive behaviours are a major public health problem, especially among adolescents, who are susceptible to experiencing multiple co-occurring addictions. To assess the prevalence of addiction problems and co-occurrences of addictive behaviours (substance abuse, problematic video gaming and social media addiction) and disorders among high school students in Sousse, Tunisia. A cross-sectional study was conducted in 2018 in public high schools, in the urban area of Sousse, Tunisia. A structured self-administered questionnaire was used to obtain relevant information from the students. Statistical analysis was performed using SPSS version 10 and confidence intervals of 95% were calculated. Chi-square test was used to compare qualitative variables and multinomial regression was conducted to determine independent factors related to the number of addictive behaviour co-occurrences. Of the 1399 high school students, 60.5% were girls and mean age was 17 ± 2.28 years. Analysis of single addiction problems revealed 20.9% prevalence for all tobacco products, 10.1% for alcohol, 7.0% for all drugs, 36.1% for Facebook, and 35.3% for video games. Analysis of co-occurring addiction problems showed that 46.0% of the study population had 1 addiction problem, 12.2% had 2 addiction problems, 4.5% had 3, and 2.7% had the maximum number of 4 addiction problems. Multinomial regression showed an increase in co-occurrence of addiction problems among boys (aOR = 217.004; P < 0.001), participants who had repeated a school grade (aOR = 0.232; P < 0.001), those who had moderate or severe depression (aOR = 0.232; P < 0.001), and those who were anxious (aOR = 0.335; P = 0.003) and had alexithymia (aOR = 0.361; P = 0.005). The rate of co-occurrent addictions among adolescents in Sousse, Tunisia, is alarming. Problematic use of Facebook, gaming and tobacco use were the most frequent addictive behaviours. There is an urgent need for effective and multisectoral programmes to prevent addictions among children in Tunisia and other countries in the Middle East and North Africa Region.

Compulsive Study Behaviors Are Associated with Eating Disorders and Have Independent Negative Effects on Well-Being: A Structural Equation Model Study among Young Musicians

Compulsive overworking and eating disorders (EDs) show considerable similarities in terms of risk factors (e.g., rigid perfectionism), clinical manifestation (e.g., excessive controlling behaviors), and consequences (e.g., physical exhaustion and depression). This study aimed to examine the hypotheses that compulsive study behaviors (conceptualized as study addiction) are related to EDs and that they have independent negative effects on well-being among young musicians, who constitute a highly vulnerable population for these types of problematic behaviors. The relatively high prevalence of study addiction and its pronounced negative relationship with psychosocial functioning make it a pending challenge for sustainable education. A total of 255 students from various music academies in Poland took part in the study. The Bergen Study Addiction Scale, assessing compulsive studying (conceptualized as addictive behavior), the Eating Attitude Test-26 (EAT-26), the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and the quality-of-life measure were used. A structural equation model was investigated. Study addiction was positively related to the general factor of EDs and the social pressure component. Both problematic behaviors showed negative and independent effects on the well-being of young musicians. EDs may be 8 to 16 times more prevalent among the students of music academies who are addicted to studying than among the general population. About 80% of those students showing all seven symptoms of study addiction exhibited at least mild depression, while more than half had clinically significant levels of depression. Almost 90% had clinically significant levels of anxiety. Without addressing co-occurring study addiction and eating disorders, including their commonalities and idiosyncrasies, their prevention and treatment cannot be effective and it will substantially affect the sustainability of education and work.

Co-occurring addiction problems among high school students in Sousse (Tunisia)

Abstract Background Adolescence is a transitory period characterized by psychological, physical and emotional changes. Teenagers seek new experiences and engage in a range of risky behaviors, including the consumption of psychoactive substances that lead to addiction problems. Adolescent addiction represents a major public health and safety issue. Addictions co-occur in the same individual, increasing the risk of negative outcomes and health problems. We aimed to determine the prevalence of occurring and co-occurring addiction behaviors among high school students in the region of Sousse and to specify the risk factors. Methods A cross-sectional study was conducted from February 5 to March 14, 2018 in public high schools in the governorate of Sousse. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 10. Results A total of 1399 high school students were included in our study. An average age of 17±2.28 years and a female predominance (60.5%) were noted. The prevalence of tobacco product use and alcohol consumption was 20.9% and 10.1% respectively. The prevalence of illicit substance use was 7%. Facebook and video game addiction were reported among 36.1% and 35.3% high school students respectively. The analysis of co-occurring addiction problems showed that 12.2% and 4.5% had two and three addiction problems, respectively. Almost 3% of included adolescents had the maximum number of four addiction problems. Multivariate analysis showed that co-occurring addiction increases among boys, participants that repeated the grade and among those with moderate or severe depression, anxiety and alexithymia. Conclusions The findings have implications for identifying the risk factors of co-occurring addictive behaviors, and the development of primary prevention strategies resulting from such factors Key messages The prevalence of addictive behavior is very high in middle school students. Understanding the risk factors of co-occurrence addictive problems is important for prevention program planning.

Reexamining opioid addiction as a co-occurring disorder: A clinical perspective on the “Chronic Pain Paradox”

The use of opioids as an anodyne for chronic pain was not prevalent before the 1980s1. Students in medical schools had learnt to avoid prescribing opioids, considered highly addictive for treatment of non-malignant chronic pain1. Yet, from the early 1990s, prescription opioids emerged as a widely accepted method of treating chronic pain and palliative care2. Previously, chronic pain was treated in multidisciplinary clinics with coordinated care which included physical exams, medication management, biopsychosocial evaluation, cognitive behavioral treatment, physical therapy, and occupational therapy2. Starting in the early 1990’s, under dubious antecedence, opioid analgesics were promoted as the proprietary remedy for chronic pain and received endorsement and support from care providers across the United States3. Non-cancerous chronic pain, as a phenomenon, was thus elevated to an ailment or a medical condition by its own right from its erstwhile status as a corollary to another medical condition. This led to an increase in opioid analgesic prescriptions, followed by a wide-ranging abuse by patients, converting opioid use disorder (OUD) to a problem of epidemic proportions4. Apart from the legal course of action initiated against Perdue Pharma, in 2020, the maker and distributor of Oxycontin that resulted in a $3.8 billion lawsuit settlement, in which Perdue Pharma pleaded guilty; since the recognition of this problem, new measures have been adopted to counter the opioid epidemic by clinicians. There has been a significant shift towards circumvention by physicians prescribing opioids for non-cancerous chronic pain. In a few instances, providers have resorted to putting a temporary moratorium on prescribing opioids to all non-cancerous chronic pain cases5. The Center for Disease Control (CDC) and various state agencies have passed protocols, installed prescription monitoring programs (PMPs), and created taskforces to rein in flagrant prescription practices by medical providers. Mental health counseling and alternative, non-prescriptive pain management procedures have been reintroduced in treatment as a new way of approaching the problem6,7. The Substance Abuse and Mental Health Administration (SAMHSA) have suggested hybrid programs such as medically assisted treatment (MAT) which utilizes the medical approach of prescribing slow releasing drugs with concomitant counseling for patients, as one of the best practices to intervene with opioid use disorders8. An integrated healthcare approach brought primary care physicians, nurses, and physician’s assistants together with addiction counselors and social workers to coordinate and implement treatment for opioid misuse9,10. These new approaches are laudable and effective, yet we argue, in this paper, for ascertaining the treatment of chronic pain as a co-occurring disorder to addiction. While acknowledging the two original transgressions of the opioid epidemic: a) the delineation and decontextualization of chronic pain as an independent medical phenomenon, and b) the over-prescription of opioid analgesics to treat chronic pain; we argue that recognizing chronic pain as a co-occurring disorder with addiction and psychological trauma could help providers contextualize it better, leading to an improved treatment protocol. Over last two decades, persistent over-prescribing has set forth a culture of righteous demand among patients to obtain opioids and receive instant pharmacological sedation as an antidote to chronic pain. This culture, which may have taken roots, could cause resistance among chronic pain patients towards any change to alternative treatment plans. This could frustrate medical providers and reformers as they usher in the new treatment procedures promulgated by SAMHSA and the CDC. Thus, a co-occurring diagnostic framework could provide a pathway to better understand this treatment dilemma. The co-occurring disorder lens of diagnosis could provide a pathway to understand this treatment dilemma. In this paper, we do a critical, non-systematic review of existing literature that explores the intersection of chronic pain and OUD to make a case that these issues should be treated as co-occurring disorders and not as disconnected, independent phenomenon. We review the scope of the problem and provide an analysis of the complex relationship between chronic pain and usage of opioids from both pharmacological and psychological viewpoints and explore the challenges to treatment. We take an ecological and exchange theory perspective to understand the co-occurrence of pain and opioids addiction from a trauma-informed lens to unpack the complexity that OUD poses in juxtaposition to chronic pain. Furthermore, we explore the strategies to develop an integrated healthcare workforce from a co-occurring disorder perspective. Furthermore, we explain the context of co-occurring pain, addiction, and psychological trauma and identify the pertinent questions that such co-occurrences pose for treatment protocols. We draw our argument from a critical review of the literature as well as the incidence and prevalence of OUD.

Reconsidering the associations between self-reported alcohol use disorder and mental health problems in the light of co-occurring addictions in young Swiss men.

BackgroundAlcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems.MethodParticipants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction.ResultsOverall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR’s ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder.ConclusionsAUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders.

An Examination of the Relationship between Religious Beliefs, Behaviors, Commitment, and Connection and Addiction among African American Women

This study examines the religious/spiritual practices of 106 African American women when addiction is present. Stratified sampling was based on addiction status: no addiction (n=58); addiction to one of either alcohol, marijuana, or cocaine (n=22); and addiction to two or more of the substances (n=26). Using items from the Religiosity Scale to assess belief in God, religious behaviors, commitment and connection, analyses revealed that the majority of the women (84%) believe God exists and is active in their lives. However not all demonstrated formal religious behaviors or have a commitment or connection to religious activities. Women addicted to two or more substances were more likely to report religious behaviors, commitment, and connection such as regular personal religious-based reading/studying and having a feeling of religious commitment compared to women with no or only one addiction. Women with co-occurring addictions may utilize religious-based practices in an attempt to alleviate their emotional pain. Further exploration of religious/spiritual practices and co-morbid substance addiction is needed, as this research may be vital to implementing effective interventions with this population.

Prevalence of HIV risk behavior among male substance abusing offenders of intimate partner violence

PurposeThe purpose of this paper is to assess the rates of HIV risk-taking behavior and sexual violence among clients with co-occurring addiction and intimate partner violence (IPV). The current study also aims to determine whether HIV risk-taking behaviors (e.g. trading sex for money or drugs, having unprotected sex with multiple partners) differ among substance using IPV offenders with and without a history of sexual aggression.Design/methodology/approachSecondary analyses were conducted from Easton et al.’s (2017) randomized controlled trial of substance use domestic violence treatment among substance using IPV offenders. Correlational analyses were conducted to assess the relationship between pre-treatment sexual aggression, HIV risk-taking behaviors, substance use and aggression. Analyses of covariance were conducted in order to determine differences in participants’ HIV risk-taking behaviors based on their history of sexual aggression while controlling for hours of contact with the female partners.FindingsIn a sample of 63 participants, males with higher rates of sexual aggression were more likely to engage in sexual risk-taking behaviors. This study encountered a correlation between pre-treatment risk-taking behavior and verbal and physical aggression, as well as a correlation between pre-treatment risk-taking behaviors and cocaine use. Results neither suggest a relationship between sexual aggression and alcohol use nor HIV risk-taking behaviors and alcohol use at pre-treatment.Research limitations/implicationsThe present study is limited by sample size and power.Originality/valueThis study is among the first of its kind to investigate HIV risk-taking behaviors among substance using offenders of IPV. This study provides support for the inclusion of treatment targeting HIV risk-taking behaviors among IPV offenders.

Building trust and recovery capital: the professionals’ helpful practice

PurposeThe possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement.Design/methodology/approachIn all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.FindingsRecovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).Practical implicationsRecovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.Originality/valueImprovement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

Collaborating with Families: Exploring Family Member and Health Care Provider Perspectives on Engaging Families Within Medical Education.

With 40 to 65% of mental health patients being cared for by family members, nearly 500,000 Canadians are serving as caregivers. Yet family members are often excluded from daily clinical interactions and the development of mental health continuing medical education (CME). This qualitative study aimed to understand how best to involve families in mental health CME and how to advance their meaningful and equitable engagement in such initiatives. Semi-structured interviews were conducted with two samples: mental health care providers (n = 8) and family members of individuals diagnosed with a co-occurring addiction and mental health problems (n = 12) to explore barriers, facilitators, and strategies for family engagement. Several themes related to the perception of expertise emerged from the interviews, including the tension between the validity of knowledge based on education/credentials and knowledge based on lived experience, as well as expressions of "voice." Participants also identified barriers to, and ethical considerations related to, family engagement, including stigma and confidentiality, and recommended strategies and supports to meaningfully include the family perspective within mental health CME. Aligning with the movement to improve collaboration between mental health professionals and service users requires developing relationships with family members. Identifying strategies to involve families in the development of CME is crucial to initiating and maintaining family engagement.

Sensitivity of the ASAM Criteria to Psychiatric Need

The ASAM Criteria (ASAM) is one of the most widely used placement tools in the addiction field. Its use, however, has focused on placement of individuals into addiction-only or co-occurring addiction and mental health services, not individuals who need primary mental health treatment. This study examined whether the ASAM, particularly dimension 3 (D3), was sensitive to mental health needs of a group of individuals placed into addiction services using the ASAM then followed for 1 year to determine whether they received mental health services. Individuals who received mental health services had D3 scores that were twice as high as those who did not, and individuals with a “Psychotic Disorder” had higher scores than all other diagnostic clusters. At a cutoff of 1, D3 had a sensitivity of .89 and specificity of .44 (C = .73). These results argue for an expanded application of the ASAM across the behavioral health continuum.

Daddy’s Gone A Hunting

Back to table of contents Previous article Next article Book ReviewsFull AccessDaddy’s Gone A HuntingJeffrey L. Geller, M.D., M.P.H., Ann L. Hackman, M.D.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., Editor, Ann L. HackmanSearch for more papers by this author, M.D.Published Online:1 Dec 2014https://doi.org/10.1176/appi.ps.651212AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Mary Higgins Clark; New York, Simon & Schuster, 2013, 352 pagesWhen a summer novel I have agreed to review appears in my mailbox secured in a brown envelope, I always feel excitement tinged with a bit of trepidation. What will it be?This year, I received Daddy’s Gone A Hunting, a suspense novel by Mary Higgins Clark. I felt as if my brown envelope had contained a large bag of M&Ms, for me a reliable, satisfying treat. Mary Higgins Clark is the grande dame of suspense novels; hers often include a bit of mystery, a little romance, a plucky heroine, and a title borrowed from an old song. Since her first novel, Where Are the Children? in 1974, Mary Higgins Clark has written over 30 novels, with more than 100 million copies sold in the United States alone. I have read a few of her books over the years, and I can always count on her to tell a good story and hold her reader’s attention.Daddy’s Gone A Hunting is no exception. The story begins at a family-owned furniture company, where an explosion leaves one young woman in a coma and her sister searching for answers. The novel is appropriate for review in Psychiatric Services because a key character is a Viet Nam veteran whose life has been largely destroyed by untreated posttraumatic stress disorder. The character is skillfully drawn; Clark and her staff did the appropriate homework. This disorder is portrayed accurately, and there is a reasonable description of services available and barriers to care for individuals who are homeless and dealing with psychiatric illness and co-occurring addiction and somatic illness.I will refrain from giving away the plot, but fans of this author will find that the story does not disappoint. Daddy’s Gone A Hunting is perfect summer reading, great for an afternoon at the beach or a long flight. Grab a bag of M&Ms and sit back and enjoy.Dr. Hackman is associate professor at the Department of Psychiatry, University of Maryland, College Park.The reviewer reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 65Issue 12 December 01, 2014Pages e5-e5 Metrics The reviewer reports no financial relationships with commercial interests.PDF download History Published online 1 December 2014 Published in print 1 December 2014

The Addiction Psychiatrist as Dual Diagnosis Physician: A Profession in Great Need and Greatly Needed

Addiction is the number one cause of premature illness and death in the U.S., especially among people with mental illness. Yet American medicine lacks sufficient workforce capacity, expertise, training, infrastructure, and research to support treatment for people with co-occurring addictions and mental illness. This essay argues that the addiction psychiatrist is essential in dual diagnosis care.

Inside-Out Health: An Integrative Health Education Program for Women in Substance Abuse Treatment

Background: Women in treatment for substance use disorders have been identified as at risk for developing co-occurring addictions (e.g., eating disorders) during and following treatment [1] as well as health-related concerns (e.g., inadequate nutrition, weight gain) [2]. Methods: Two evidence-based programs, Full of Ourselves [3] and Healthy Steps to Freedom [4], inspired the development of an integrative health education program (i.e., Inside-Out Health) designed to promote physical activity, healthy nutrition and positive body image. Forty-nine participants aged 18-59 (M=30.61, SD=6.90) came to the weekly program with 74% of participants attending 4 or more sessions out of 6 and 22% having perfect attendance. Nutrition, physical activity and body image were evaluated at pre- and post- and exploratory questions were included to assess program satisfaction. Results: While statistical analyses did not reveal significant changes in body esteem and physical activity, the Food Choice Questionnaire responses on two subscales (i.e., FCQ-weight control, FCQ-nutrition) approached significance. FCQ-weight control scores increased from pretest (M=.2.24, SD=1.0) to posttest (M=2.55, SD=.74) and FCQ-nutrition scores increased from pretest (M=2.70, SD=.67) to posttest (M=2.82, SD=.68). Discussion: This integrative health education program is an initial attempt to incorporate health education and eating disorder prevention efforts into an existing substance abuse treatment program. This study confirms the feasibility of promoting physical activity, nutrition and positive body image among female substance abuse clients.

Living With Co-occurring Addiction and Mental Health Disorders

Department of Psychiatry and Behavioral Sciences University of Miami Miller School of Medicine Miami, Florida

Medical Illness and Schizophrenia, 2nd edition

Back to table of contents Previous article Next article Book ReviewFull AccessMedical Illness and Schizophrenia, 2nd editionMarie Hobart M.D.Marie Hobart M.D.Search for more papers by this authorPublished Online:1 May 2010https://doi.org/10.1176/ps.2010.61.5.533AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail All of us who work with individuals with severe and persistent mental illness must attend to general medical health risks, especially those that are exacerbated by our psychiatric treatments. The latest edition of Medical Illness and Schizophrenia is a concise and useful guide for this endeavor. It is packed with up-to-date and highly relevant information from an array of international experts covering a broad spectrum of topics. The book is based on the premise that general medical care for this population must be integrated into psychiatric care. The authors look at both historical and contemporary data regarding the high rate of comorbid medical conditions and the early mortality rate for persons with schizophrenia. An entire chapter is devoted to the background and outcomes of the CATIE study (Clinical Antipsychotic Trials of Intervention Effectiveness), which sets the stage for an in-depth look at metabolic syndrome, obesity, glucose intolerance and diabetes, lipid abnormalities, and cardiovascular disease. Alhough these chapters focus on persons with schizophrenia, they are broadly applicable to anyone taking antipsychotic medication. Each chapter presents a comprehensive summary of the clinical and epidemiologic aspects of the medical condition, as well as an excellent review of pertinent basic science. In particular, the chapter on lipid metabolism is one of the most understandable and practical reviews I have read. Useful guidance is provided to help distinguish between direct adverse effects of medication, downstream health consequences of their metabolic side effects, and expected medical sequelae of schizophrenia. The chapter on behavioral treatment for weight management reinforces the need to make this issue a routine component of our clinical work.Almost every individual with schizophrenia will also suffer from a co-occurring addiction and its health consequences. The authors review nicotine dependence, as well as marijuana, alcohol, cocaine, and opiate use. The neurocognitive, affective, and social benefits that attract individuals to these substances are discussed. The subsequent devastating health outcomes are a major factor in early morbidity and mortality. Treatment strategies are briefly addressed, but for more details the reader must look elsewhere.The infectious diseases discussed are HIV and hepatitis C. Transmission, neuropsychiatric consequences, and overall health consequences are reviewed for each of these viral infections, as well as associated prevention and treatment strategies.Sexual dysfunction commands a complete chapter. This area is consistently overlooked by practitioners, yet has huge implications for quality of life and medication adherence. It has major implications for clinical management from both psychosocial and biological perspectives. The authors focus on the sexual side effects of psychiatric medications and how these may interact with underlying health conditions. The book concludes with chapters on special populations, including children and adolescents, the elderly, and women of reproductive age.Thematically consistent content helps to create a sense of continuity throughout the work. Each chapter concludes with bullet points that summarize the essential information, which is especially helpful for the busy clinician. I would highly recommend this book to all physicians, nurses, and trainees who treat patients with schizophrenia, either in the psychiatric or the primary care setting. In addition to its value as a continuing education resource, this volume is a great quick reference when dealing with the myriad medical problems our patients face every day.The reviewer reports no competing interests.Dr. Hobart is chief medical officer of Community Healthlink, Inc., Worcester, Massachusetts. FiguresReferencesCited byDetailsCited ByNone Volume 61Issue 5 May, 2010Pages 533-533PSYCHIATRIC SERVICES May 2010 Volume 61 Number 5 Metrics PDF download History Published online 1 May 2010 Published in print 1 May 2010

Letter.

Back to table of contents Previous article Next article LetterFull AccessLetterMaggie Jarry M.S.Lindy Fox M.A., L.A.D.C.Carol Coussons de Reyes M.S.Maggie Jarry M.S.Search for more papers by this authorLindy Fox M.A., L.A.D.C.Search for more papers by this authorCarol Coussons de Reyes M.S.Search for more papers by this authorPublished Online:1 May 2010https://doi.org/10.1176/ps.2010.61.5.532AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Lifting the Veil: ReplyIn Reply: More than five million children in the United States have a parent with a serious mental illness, such as schizophrenia, bipolar disorder, and major depression, and some of these parents have co-occurring addictions. It is estimated that 68% of women and 57% of men with a serious mental illness are parents ( 1 ) and that 73% of women and 68% of men with posttraumatic stress disorder are parents ( 2 ). Yet it remains common to find mental health professionals who are unaware of or unwilling to see the relevance of this topic to their work and to the success of the people they serve. With this in mind, we strongly urge readers to consider the concrete recommendations in the letter from Dr. Heru and her colleagues. However, the scope of this dialogue and their recommendations should go further. Our key message is this: Just as we now recognize that employment is a viable option for people with mental illness, we need to recognize that parenting is also a viable life choice for these individuals, including those with illnesses regarded as severe and persistent. Supported parenting should be integrated into all adult mental health systems. Training for mental health professionals should include an understanding of the benefits of working with families. Professionals should be aware of and make available the supportive resources needed to address consumer parents' deepest concerns for their children and thereby contribute to parent and family wellness. Strengthening parenting skills enhances familial attachment and motivates parents toward recovery while also addressing the developmental needs of their children. Data should be collected on the parenting status of people who use adult mental health systems in order to understand where supportive parenting resources can be incorporated. Resources to enhance psychoeducation for young family members exist and are being rapidly developed in the United States and abroad (the fall 2009 special issue of Psychiatric Rehabilitation Journal provides an overview). These resources can be used today while we develop a national infrastructure for supported parenting. The Substance Abuse and Mental Health Services Administration should publish materials for supportive education of children who have a parent with mental illness, as it has for children with addicted parents. Furthermore, parents should not fear losing custody of their children when they disclose their personal health information to any authority, nor should adults who access mental health services be discouraged from having children if that is one of their life goals. For these reasons, mental health systems should partner with child and family services systems to support families.Understanding the unique experiences of daughters and sons who have a parent with mental illness should be a goal of future research. Daughters and sons need access to information that identifies and normalizes their common experiences. Research should go beyond estimating the statistical likelihood of future mental illness among these children to encompass other aspects of this group's experience and demographic characteristics. Daughters and sons often report difficulty with identity formation and preoccupation with the belief that they will experience the same mental illness as their parents. Therefore, we urge that the recommendations in this letter be balanced with an understanding that the need to screen children for illnesses is small compared with the need to unveil fortifying messages of resilience and hope within the family.Ms. Jarry, author of the December Personal Accounts column, is joined in her response by Ms. Fox, who is affiliated with the Dartmouth Psychiatric Research Center, Concord, New Hampshire, and Ms. Coussons de Reyes, a certified peer specialist with the Office of Consumer Affairs, Division of Behavioral Health, Lincoln, Nebraska.

Medical Illness and Schizophrenia, 2nd edition

Back to table of contents Previous article Next article Book ReviewFull AccessMedical Illness and Schizophrenia, 2nd editionMarie Hobart M.D.Marie Hobart M.D.Search for more papers by this authorPublished Online:1 May 2010https://doi.org/10.1176/ps.2010.61.5.533AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail All of us who work with individuals with severe and persistent mental illness must attend to general medical health risks, especially those that are exacerbated by our psychiatric treatments. The latest edition of Medical Illness and Schizophrenia is a concise and useful guide for this endeavor. It is packed with up-to-date and highly relevant information from an array of international experts covering a broad spectrum of topics. The book is based on the premise that general medical care for this population must be integrated into psychiatric care. The authors look at both historical and contemporary data regarding the high rate of comorbid medical conditions and the early mortality rate for persons with schizophrenia. An entire chapter is devoted to the background and outcomes of the CATIE study (Clinical Antipsychotic Trials of Intervention Effectiveness), which sets the stage for an in-depth look at metabolic syndrome, obesity, glucose intolerance and diabetes, lipid abnormalities, and cardiovascular disease. Alhough these chapters focus on persons with schizophrenia, they are broadly applicable to anyone taking antipsychotic medication. Each chapter presents a comprehensive summary of the clinical and epidemiologic aspects of the medical condition, as well as an excellent review of pertinent basic science. In particular, the chapter on lipid metabolism is one of the most understandable and practical reviews I have read. Useful guidance is provided to help distinguish between direct adverse effects of medication, downstream health consequences of their metabolic side effects, and expected medical sequelae of schizophrenia. The chapter on behavioral treatment for weight management reinforces the need to make this issue a routine component of our clinical work.Almost every individual with schizophrenia will also suffer from a co-occurring addiction and its health consequences. The authors review nicotine dependence, as well as marijuana, alcohol, cocaine, and opiate use. The neurocognitive, affective, and social benefits that attract individuals to these substances are discussed. The subsequent devastating health outcomes are a major factor in early morbidity and mortality. Treatment strategies are briefly addressed, but for more details the reader must look elsewhere.The infectious diseases discussed are HIV and hepatitis C. Transmission, neuropsychiatric consequences, and overall health consequences are reviewed for each of these viral infections, as well as associated prevention and treatment strategies.Sexual dysfunction commands a complete chapter. This area is consistently overlooked by practitioners, yet has huge implications for quality of life and medication adherence. It has major implications for clinical management from both psychosocial and biological perspectives. The authors focus on the sexual side effects of psychiatric medications and how these may interact with underlying health conditions. The book concludes with chapters on special populations, including children and adolescents, the elderly, and women of reproductive age.Thematically consistent content helps to create a sense of continuity throughout the work. Each chapter concludes with bullet points that summarize the essential information, which is especially helpful for the busy clinician. I would highly recommend this book to all physicians, nurses, and trainees who treat patients with schizophrenia, either in the psychiatric or the primary care setting. In addition to its value as a continuing education resource, this volume is a great quick reference when dealing with the myriad medical problems our patients face every day.The reviewer reports no competing interests.Dr. Hobart is chief medical officer of Community Healthlink, Inc., Worcester, Massachusetts. FiguresReferencesCited byDetailsCited byNone Volume 61Issue 5 May, 2010Pages 533-533PSYCHIATRIC SERVICES May 2010 Volume 61 Number 5 Metrics PDF download History Published online 1 May 2010 Published in print 1 May 2010

EMDR in the Addiction Continuing Care Process Case Study of a Cross-Addicted Female’s Treatment and Recovery

There have been suggestions in the literature since 1994 that eye movement desensitization and reprocessing (EMDR) may serve as an effective adjunct to the addiction treatment process; however, follow-up research in this area has been limited. This case study of a cross-addicted female includes a case review illustrating how EMDR was used in the continuing care process and a semistructured phenomenological interview conducted at 6-month follow-up. Prior to this course of treatment, the participant was treated 12 times with traditional approaches but was unable to achieve more than 4 months of sobriety at any given time. Following EMDR, the participant reported 18 months of sobriety and important changes in functional life domains. The phenomenological interview revealed six critical themes about the addiction and recovery process that can offer insight to clinicians treating co-occurring addiction and trauma.

The views of consumers and frontline workers regarding coordination among addiction and mental health services

Background: Increasing co-ordination among addiction and mental health services is often recommended to improve service delivery for people with co-occurring addiction and mental health disorders. Aims: Regarding their experiences in the addiction and mental health systems, and the development of a model of co-ordination in their community, this study compares the views of 16 consumers and 26 frontline workers to the current literature. Methods: Consumers participated in one of four focus groups and frontline workers participated in a semi-structured individual interview. Results: Consumers and frontline workers placed a higher priority on training workers and providing consumers with a welcoming place to go than on co-ordination. Consumers expressed concern about workers sharing client information. Consumers underscored the importance of peer support groups, and the formal system facilitating the development and maintenance of peer supports. Consumers offered suggestions for how the systems could more ef...

Response: An Insidious Dependence

Jill McGavin: What struck me most in the article (Budney et al., 2007) was the reference to the rise in treatment admissions for primary marijuana dependence in the last 10 years. An increase from 7 to 16 percent of treatment admissions is dramatic. It makes me wonder what the next 10 or 15 years will bring. I’m anxious to go back and review the numbers in our treatment admissions for the past couple of years to see if we’ve already started a shift that has gone undetected. Dana Mackin: I was relieved to see that Dr. Budney and his coauthors addressed the uniqueness of marijuana addiction. When I first started reading their article, I was resistant to the idea that marijuana causes dependence, because when we think of addiction we think of the extreme and striking consequences of methamphetamine or alcohol abuse. On the other hand, we see the occasional person who has no problem dropping alcohol or methamphetamine, but cannot stop smoking pot. McGavin: Marijuana dependence is usually a co-occurring addiction and usually not the more dramatic one. I work primarily with veterans. On average, they are in their 50s. About a third are primarily alcohol-dependent, a third primarily cocaine-dependent, and a third primarily heroin-or opioid-dependent. In only a few cases is marijuana a primary dependency. Christopher Martin: My experience is similar. However, I do see a fair number of patients for whom marijuana abuse is a primary issue. Many of them are young adults who are involved in daily cannabis abuse and are not functioning well. They haven’t moved out of their parents’ homes and are spending a lot of their time alone, playing video games and sitting around the house. Mackin: Marijuana dependence is definitely an issue in our clients’ lives. Someone in recovery who has a heroin or methamphetamine addiction is much more likely to relapse after using pot or taking a drink. A client of mine said, “You don’t relapse on your drug of choice; you relapse with pot. Smoke a joint, and 3 days later, you’ll have a needle in your arm.” In short, once you cut out your executive decision-making ability, relapse is right around the corner. Martin: That’s consistent with studies with animal models, which have shown that drugs have cross-priming properties. Animals addicted to one substance, when exposed to another reinforcing drug, will relapse to use of the original substance. All of these drugs have similar effects on the mesolimbic dopamine system and the reward circuitry, and it’s not surprising that one positively reinforcing substance can make it difficult to stay away from another. McGavin: Also, if you’re hanging on the corner, you’re more likely to be passed something you shouldn’t be using. Mackin: Right. It puts you back into the environment, and you don’t learn to deal with anxiety or craving for your primary drug without the aid of an external substance. You’re repeating the same behavior with a different substance.