Co-occurring Mental Health Disorders Research Articles

Protocol of a randomized controlled trial examining psychosocial enhancement and standard medication treatment for co-occurring opioid use and mental health disorders: A half fractional factorial randomized controlled trial

BackgroundThe opioid epidemic disproportionately affects individuals with co-occurring opioid use and mental health disorders (COD), who often have poor treatment engagement. Multicomponent treatment models are popular solutions to increase treatment access and engagement for those with COD. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is a hybrid multicomponent linkage and treatment approach that provides assertive community outreach combined with psychosocial treatment. This protocol paper describes a randomized controlled trial comparing MISSION and medication for opioid use disorder (MOUD), its multicomponent parts along with MOUD, and MOUD treatment as usual (TAU) to assess improvements in health and social outcomes. MethodsThis study will use a half fractional factorial design and randomize 1000 patients with COD to one of five treatment conditions: (1) the full MISSION intervention plus MOUD; (2–4) a combination of two out of three MISSION components plus MOUD; or (5) TAU. Secondary aims include examination of mechanisms of action, economic evaluation of the implementation of MISSION and/or its components plus MOUD versus TAU, and exploratory predictive modeling to match optimal MISSION parts with patient needs. DiscussionThis randomized controlled trial will help determine the effectiveness of MISSION (or its parts) and MOUD compared to TAU to improve engagement in treatment, substance use, and mental health symptoms. This trial is the first to compare MISSION and its parts with MOUD versus TAU in a real-world treatment scenario to determine which components are necessary and sufficient to drive treatment outcomes according to patient needs.

Detection of Psychological Dysfunction and Suicide Risk Among Postpartum Women.

Prevalence rates of perinatal mood disorders range from 5 to 25%. Furthermore, suicide is a leading cause of death in postpartum women. Various factors have been associated with an increased risk of suicide in postpartum women, including co-occurring mental health disorders, lack of mental health care, and substance use. It is important for mental health screening and psychological assessment used within OB-GYN clinics to be current with regard to postpartum mood dysfunction and suicide risk assessment. We collected data from a sample of 78 postpartum women (0-6-month post-delivery), focusing specifically on patterns of emotional/internalizing dysfunction, using three different screening measures as predictors. Contrary to hypotheses, our sample did not produce significant elevations on target criterion scales of the Minnesota multiphasic personality inventory-3 (MMPI-3). Although the multidimensional behavioral health screen (MBHS) was better at differentially capturing MMPI-3 elevations when compared to the Edinburgh postnatal depression scale (EDPS) and patient health questionnaire-9 (PHQ-9), two of the three comparisons were not statistically significant. Statistical analyses were challenged by our extremely low base rate for elevated suicide risk. Despite this, the MBHS performed better than the EPDS and PHQ-9 at accurately capturing elevated suicide risk.

What do we know about autism and policing globally? Preliminary findings from an international effort to examine autism and the criminal justice system.

Research has demonstrated that autistic individuals have higher rates of police contact, however, research has seldom explored the fundamental reasons for these interactions and how this might vary across international contexts. To remedy this, the Global Autism and Criminal Justice Consortium created and disseminated the Global Criminal Justice Survey. Descriptive statistics of survey respondents with and without police contact were compared to glean differential characteristics. Frequency and type of recent police interactions (within the last 5 years) among autistic individuals were also examined to better contextualize the reasons that autistic individuals encounter police. Study findings indicated that across a global sample (i.e., North America, Scandinavia, Europe, and Oceania) nearly half of all autistic individuals had an interaction with police and that those with a history of police contact were usually older, had higher educational qualifications, and were more likely to have a co-occurring mental health or developmental disorder. Among types of interactions, noncriminal encounters, such as welfare checks, traffic incidents, wandering, and behaviors associated with autism, were most common, followed by autistic individuals alleging a crime was committed against them. These findings offer important directions for future research and for targeted policy responses that can address the unique needs of autistic individuals within the justice system.

W116 - Emotion Dysregulation Fully Mediates the Relationship between Stress and Impulsivity in Inpatients With Co-Occurring Substance Use and Mental Health Disorders

W116 - Emotion Dysregulation Fully Mediates the Relationship between Stress and Impulsivity in Inpatients With Co-Occurring Substance Use and Mental Health Disorders

The receipt of medications for opioid use disorder among pregnant individuals in the USA: a multilevel analysis

PurposeThis study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and substance use policies in all 50 states in the USA.Design/methodology/approachThis study describes MOUD receipt among pregnant people with an opioid use disorder (OUD) in 2018. The authors explored sociodemographic differences in MOUD receipt, referrals and co-occurring mental health disorders. The authors included a comparison of MOUD receipt among states that have varying substance use policies and examined the impact of these policies and the political affiliation on MOUD. The authors used multilevel binary logistic regression to examine effects of individual and state-level characteristics on MOUD.FindingsAmong 8,790 pregnant admissions with OUD, the majority who received MOUD occurred in the Northeast region (71.52%), and 14.99% were referred by the criminal justice system (n = 1,318). Of those who were self-referred, 66.39% received MOUD, while only 30.8% of referrals from the criminal justice system received MOUD. Those referred from the criminal justice system or who had a co-occurring mental health disorder were least likely to receive MOUD. The multilevel model showed that while policies were not a significant predictor, a state’s political affiliation was a significant predictor of MOUD.Research limitations/implicationsThe study has some methodological limitations; a state-level analysis, even when considering the individual factors, may not provide sufficient description of community-level or other social factors that may influence MOUD receipt. This study adds to the growing literature on the ineffectiveness of prenatal substance use policies designed specifically to increase the use of MOUD. If such policies are consistently assessed as not contributing to substantial increase in MOUD among pregnant women over time, it is imperative to investigate potential mechanisms in these policies that may not facilitate MOUD access the way they are intended to.Practical implicationsFindings from this study aid in understanding the impact that a political affiliation may have on treatment access; states that leaned more Democratic were more likely to have higher rates of MOUD, and this finding can lead to research that focuses on how and why this contributes to greater treatment utilization. This study provides estimates of underutilization at a state level and the mechanisms that act as barriers, which is a stronger assessment of how state-specific policies and practices are performing in addressing prenatal substance use and a necessary step in implementing changes that can improve the links between pregnant women and MOUD.Originality/valueTo the best of the authors’ knowledge, this is the first study to explore individual-level factors that include mental health and referral sources to treatment that lead to MOUD use in the context of state-level policy and political environments. Most studies estimate national-level rates of treatment use only, which can be useful, but what is necessary is to understand what mechanisms are at work that vary by state. This study also found that while substance use policies were designed to increase MOUD for pregnant women, this was not as prominent a predictor as other factors, like mental health, being referred from the criminal justice system, and living in a state with more Democratic-leaning affiliations.

Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness.

Individuals experiencing chronic homelessness have high rates of persistent co-occurring mental health and substance use disorders (COD), and they often have difficulty with service engagement and retention, resulting in symptom exacerbation and housing loss. This study pilot tested Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking (MISSION), a multicomponent wraparound treatment approach to improve COD symptoms and housing stability among individuals experiencing chronic homelessness and persistent COD. This open pilot study enrolled and assessed 109 individuals with a COD experiencing chronic homelessness and offered one year of MISSION. Statistically significant improvements were observed in behavioral health symptoms and functioning, days of illicit drug use, and housing stability. By treatment completion, 85% of participants were referred to social and behavioral supports. This pilot study demonstrates that MISSION helped to successfully engage participants in treatment, reduce substance use and mental health symptoms, and improve housing outcomes.

Examining patterns of patient adherence to Cognitive Behavioural Therapy in chronic physical illnesses and comorbid mental health disorders: a scoping review protocol

Objective To examine the patient adherence patterns to Cognitive Behaviour Therapy (CBT) intervention in persons living with long term physical illness and co-occurring mental health conditions. Introduction Current literature on patient treatment adherence is mostly focused on the medical/pharmacological treatment or is disorder/ therapy specific and does not address co-occurring or comorbid mental health disorders with physical health disorders in general. The objective of this scoping review is to provide insights into adherence behaviours and patterns outside of pharmacological intervention focusing on psychotherapeutic intervention specifically Cognitive Behaviour Therapy (CBT) in persons living with long-term medical conditions with co-existing mental health disorders/ conditions. The results of the review will highlight different aspects of adherence to CBT including facilitating and impeding factors influencing adherence, and variations across comorbid mental and physical health conditions. These results will aid in developing targeted CBT interventions and strategies to improve adherence rates. Furthermore, identifying gaps in the existing literature will guide future research to optimise health outcomes in this population. Inclusion Criteria Using the Population, Concept, and Context (PCC) criteria, studies will be included if they reported on patient adherence patterns of CBT in persons living with chronic medical conditions and co-occurring mental health conditions. Methods The scoping review will follow the Joanna Briggs Institute (JBI) guidelines for scoping review and reported according to the PRISMA-ScR checklist. A systematic search of PubMed, CINAHL Plus (including full academic search, APA PsychInfo, and Medline), Scopus, Cochrane library, EMBASE, Google Scholar, and University College Cork (UCC) library’s one search platform will be conducted. The JBI standard data extraction tool will be tailored to the review objectives. The findings will be presented using a descriptive and narrative approach.

Predicting Co-Occurring Mental Health and Substance Use Disorders in Women: An Automated Machine Learning Approach

Significant clinical overlap exists between mental health and substance use disorders, especially among women. The purpose of this research is to leverage an AutoML (Automated Machine Learning) interface to predict and distinguish co-occurring mental health (MH) and substance use disorders (SUD) among women. By employing various modeling algorithms for binary classification, including Random Forest, Gradient Boosted Trees, XGBoost, Extra Trees, SGD, Deep Neural Network, Single-Layer Perceptron, K Nearest Neighbors (grid), and a super learning model (constructed by combining the predictions of a Random Forest model and an XGBoost model), the research aims to provide healthcare practitioners with a powerful tool for earlier identification, intervention, and personalised support for women at risk. The present research presents a machine learning (ML) methodology for more accurately predicting the co-occurrence of mental health (MH) and substance use disorders (SUD) in women, utilising the Treatment Episode Data Set Admissions (TEDS-A) from the year 2020 (n = 497,175). A super learning model was constructed by combining the predictions of a Random Forest model and an XGBoost model. The model demonstrated promising predictive performance in predicting co-occurring MH and SUD in women with an AUC = 0.817, Accuracy = 0.751, Precision = 0.743, Recall = 0.926 and F1 Score = 0.825. The use of accurate prediction models can substantially facilitate the prompt identification and implementation of intervention strategies.

The Intersections Between Sexual Orientation, Latine Ethnicity, Social Determinants of Health, and Lifetime Suicide Attempts in a Sample Being Assessed for Entry to Co-Occurring Mental Health and Substance Use Disorder Treatment.

Few studies have examined the relationship between the intersections of lesbian, gay, and bisexual (LGB) sexual orientation, Latine ethnicity, and lifetime suicide attempts in Latine individuals with substance use disorder. This study examines this intersection and controls for social determinants of health, mental health disorder symptoms, and substance use disorder symptoms in a sample of Latine adults entering treatment for co-occurring disorders. Bivariate statistics and multivariate logistic regression were used to analyze assessment data (n = 360) from a bilingual/bicultural integrated behavioral health system serving Latine communities in Massachusetts to examine the relationship between sexual orientation, Latine ethnicity, and history of lifetime suicide attempts. We controlled for social determinants of health, mental health disorders, and substance use disorder (SUD) factors significantly associated with lifetime suicide attempts at the bivariate level. Over 27% of the sample and 35% of Puerto Ricans (PR) reported lifetime suicide attempts. The logistic regression identified that PR clients were 78% more likely to have attempted suicide in a lifetime compared to non-PR clients. Clients identifying as LGB were 3.2 times more likely to report having attempted suicide in their lifetime compared to heterosexual clients. Unemployed clients were 2.4 times more likely to report having attempted suicide in their lifetime compared to employed clients. Findings identify high rates of lifetime suicide attempts among LGBs and PRs entering SUD treatment. Targeted outreach and treatment efforts designed to address intersectionality for this underserved population are needed.

OLDER ADULT SUBSTANCE USE DISORDER TREATMENT LANDSCAPE 2020: CLIENT-LEVEL AND FACILITY-LEVEL FACTORS

Abstract Older adult substance use disorders (SUD) care requires specialized clinical practice. This poster reviews two datasets to emphasize client-level and facility-level factors (overall and state-by-state) relevant to older adult treatment programming, co-occurring disorders care, and days waiting for admission to treatment. The 2020 data from the National Survey of Substance Abuse Treatment Services (N-SSATS), administered by The Center for Behavioral Health Statistics and Quality (CBHSQ) of the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, collects data from public/private SUD treatment facilities in the United States. Data from 16,066 facilities demonstrated only 24.7% of all facilities reported programming tailored for older adult care, with state-by-state analysis showing a range of 4.6% to 61.4% of treatment programs reporting older adult tailored care. The deficits of older adult programming availability are explained against the context of the 2020 Treatment Episode Dataset-Admissions (TEDS-A), administered by the CBHSQ, that examines admissions data from all 50 states, as well as the District of Columbia, U.S. territories, and Compact of Free Association (COFA) partners. The TEDS-A data consisted of 1,416,357 admissions, of which 11.8% (n=167,200) were aged 55 years-old or older. Of this older adult sample, 32.8% reported a co-occurring SUD and mental health disorder and 13.9% reported some number of days waiting to enter treatment. These (and other) client-level and facility-level factors (overall and state-by-state) will be used to emphasize specific needs for older adult SUD care.

Borderline personality disorder and the diagnostic co-occurrence of mental health disorders and somatic diseases: A controlled prospective national register-based study.

Information on borderline personality disorder (BPD) and its comorbidities is often limited to concentrate on a few diagnoses. The aim of the study was to use national register data to investigate all diagnostic co-occurring mental health disorders and somatic diseases 3 years before and after initial BPD diagnosis compared with a matched control group. The study was a register-based cohort of 2756 patients with incident BPD (ICD F60.3) and 11,024 matched controls, during 2002-2016. Comorbidity data were classified into main disease groups, in accordance with the World Health Organization ICD-10 criteria. Almost half the patients had been diagnosed with mental and behavioral disorders before the BPD diagnosis as compared to 3% in the control group. Further, the co-occurrence of diseases due to external causes of morbidity, including injury, self-harm, and poisoning were more represented in the BPD group before diagnosis as compared to the control group. In addition, co-occurring morbidity related to diseases in the circulatory, the respiratory, the digestive, the musculoskeletal, and the genitourinary system was more represented in the BPD group. After diagnosis, the proportion of patients with co-occurring morbidity increased further in all main disease groups in the BPD group. As many as 87% of patients had mental and behavioral co-occurring morbidity and 15% nervous diseases as compared with 3% and 4%, respectively, in the control group. Also, comorbidities related to external causes of morbidity, including for example, injury and self-harm were more represented in the BPD group. The BPD group had more somatic co-occurring morbidity, especially digestive, respiratory, circulatory, and endocrine diseases. Finally, the mortality over 12 years was statistically significantly higher in people with BPD than in the control group. Patients with BPD have higher odds for multiple physical health conditions and co-occurrence of mental health disorders.

Reentry Service Engagement Among a Reentry Population with Co-occurring Mental Health and Opioid Use Disorders in Massachusetts Jails

Aim: Co-occurring opioid use and mental health disorders (COD) are common among people with criminal legal involvement. Reentry is a vulnerable period with low treatment engagement, often resulting in relapse, reincarceration, and overdose. While both linkage and multicomponent COD wraparound interventions have supported reentry, little is known about which are most effective for treatment engagement post release.
 Methods: This quasi-experimental study included 293 nonrandomized persons involved in the criminal legal system enrolled in a multicomponent COD intervention (n=173) or a linkage only model (n=120) for treatment. Kaplan Meier Curves and Cox Proportional Hazards were computed to determine differences in engagement.
 Results: Engagement was significantly different between interventions (X2=58.33, P <.0001). We observed a 73.3% reduction in hazard of early discharge for participants receiving the multicomponent COD intervention as compared to the linkage only model (P<.0001) and a higher 12-month engagement rate (51.5%) compared to the linkage only model (20.8%).
 Conclusions: Future research should include a randomized controlled trial to examine factors that influence post-release engagement as well as treatment effects and outcomes. We suggest that programs consider both interventions and assess client reentry needs in advance of release to match to the best suited post-release COD treatment.

Understanding healthcare engagement for people who inject drugs.

People who inject drugs (PWID) are at an increased risk of multimorbid mental health and chronic diseases, which are frequently underdiagnosed and under-treated due to systemic barriers and ongoing substance use. Healthcare engagement is essential to address these conditions and prevent excess morbidity and mortality. The goal of this study was to understand how PWID engage in care for their chronic health conditions and substance use treatment given the known historic and pervasive barriers. We conducted 24 semistructured qualitative interviews informed by the Behavioral Model for Vulnerable Populations between July-September 2019. Participants were sampled across a range of comorbidities, including co-occurring mental health disorders. Thematic analysis was conducted to explore experiences of healthcare engagement for multimorbid chronic diseases, mental health, and treatment for substance use disorder. Mean age for participants was 58 years; 63% reported male sex and 83% reported Black race. Interviews yielded themes regarding healthcare access and wraparound services, positive patient-provider relationships, service integration for substance use treatment and mental health, healthcare needs alignment,medication of opioid use disorder stigma, and acceptance of healthcare. Taken together, participants described how these themes enabled healthcare engagement. Engagement in care is crucial to support health and recovery. Clinical implications include the importance of strengthening patient-provider relationships, encouraging integration of medical and mental health services, and counseling on substance use treatment options in a non- stigmatizing manner. Additionally, policy to reimburse wrap-around support for substance use recovery can improve care engagement and outcomes related to chronic diseases, mental health, and substance use among PWID. No Patient or Public Contribution: While we acknowledge and thank ALIVE participants for their time for data collection and sharing their perspectives, no ALIVE participants, other people who use drugs, and service users were involved in data collection, analysis or interpretation of data, or in preparation of the manuscript.

Components of Outpatient Child and Youth Concurrent Disorders Programs: A Critical Interpretive Synthesis: Composantes des programmes de troubles concomitants des enfants et des jeunes ambulatoires : une synthèse interprétative critique.

Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs. We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback. Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation. We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities.

The role of co-occurring disorders in criminal recidivism and psychiatric recovery among adults with opioid use disorder and criminal-legal involvement: A statewide retrospective cohort study

IntroductionIndividuals with opioid use disorder (OUD) in the criminal-legal system commonly present co-occurring mental health disorders. However, evidence-based treatment for high-risk populations such as those with co-occurring disorders is often unavailable within jails and prisons. Coordination of timely and affordable access to behavioral health treatment following incarceration is critical to address the multidimensional needs of people with co-occurring needs. However, the role of co-occurring disorders among adults with OUD and criminal-legal involvement who are accessing community-based treatment is understudied. MethodsThis retrospective cohort study investigated community and recovery outcomes among 2039 adults with OUD and criminal-legal involvement enrolled in a statewide forensic treatment initiative between October 2015 to March 2018. Using court records and clinical data, we assessed the impact of co-occurring OUD and mental health disorders on criminal recidivism and psychiatric recovery and the moderating role of co-occurring disorders on the relationship between community-based treatment and these outcomes. ResultsWe found that 47 % of those with OUD also had an underlying mental health disorder. Co-occurring OUD and mental health disorders predicted higher rates of recidivism during the early stages of treatment. Furthermore, group and individual therapy services were associated with lower odds of recidivism. A co-occurring disorder was an important predictor of more severe behavioral health needs when exiting community-based services and did moderate the relationship between service utilization—specifically group therapy and substance use outpatient services—and psychiatric recovery (i.e., behavioral health needs at exit). ConclusionsCo-occurring mental health disorders are highly prevalent among adults with OUD who have criminal-legal involvement, but it appears that they can benefit from social support services in the community. Given the multidimensional needs of this high-risk population, criminal-legal stakeholders and community-based clinicians must work in tandem to develop tailored treatment plans that give individuals with co-occurring OUD and mental health disorders the best chance for success post-incarceration rather than a siloed approach to overlapping disorders.

Characterizing Autism Training Experiences in Clinical Psychology Ph.D. Programs: Recommendations for Improving Training to Enhance Care

ABSTRACT Autistic individuals consistently experience long waitlists to access assessment and intervention. Additionally, they report difficulty obtaining integrated services for their co-occurring medical and mental health disorders. The current study seeks to explore the way that graduate school training may contribute to the specialized and siloed nature of autism spectrum disorder (ASD) assessment and intervention. Multiple sources of data were collected to understand training opportunities related to ASD, child mental health, and the integration of ASD and child mental health in American Psychological Association- (APA) accredited Clinical Psychology Ph.D. programs. Data were collected from information publicly available online, and from clinical psychology doctoral students and graduate program directors (GPD). Results indicate that most programs do not employ a faculty member whose work focuses on ASD. Additionally, ASD experience is encouraged, but not a required element of program curriculum. Therefore, most doctoral students do not obtain training in ASD assessment or intervention during graduate school. Even doctoral students who pursued ASD training experiences reported that they do not feel prepared to meet the mental health needs of autistic individuals. We discuss implications and provide recommendations for how doctoral programs can promote students’ proficiency and comfort diagnosing and supporting autistic individuals.

Community reentry: Racial/ethnic differences in unmet needs among adults with co-occurring opioid use and mental health disorder

BackgroundAdults with co-occurring opioid use and mental health disorder (COD) recently released from incarceration have many social and health needs that place them at the most significant risk for overdose and poor reentry outcomes. Little is known about racial/ethnic differences in this population. MethodsTo examine racial/ethnic differences in social and health needs, data were analyzed for 293 adults with COD within two weeks of release, a high-risk period for overdose, from six Massachusetts jails. ResultsOverall, participants (62.6% non-Hispanic White, 23.1% Hispanic, 14.3% non-Hispanic Black, and 73.5% male) reported multiple health and social needs across groups. Chi-square tests and Kruskal-Wallis one-way ANOVAs were used to compare social and health needs among racial/ethnic groups. Non-Hispanic Black participants reported more problems with crack/cocaine, whereas Non-Hispanic White and Hispanic participants reported more problems with opioids (p < .001). Despite similar lifetime rates of illicit substance use, non-Hispanic Black and Hispanic participants received less treatment (p < .001). Non-Hispanic White participants reported more opioid and alcohol use (p < .006), trauma symptoms (p = .020), utilization of behavioral health treatment (p = .008), and more medical needs than Hispanic and/or non-Hispanic Black participants (p = .001). Non-Hispanic Black and Hispanic participants reported more needs related to social determinants of health (p = .008). ConclusionsWhile re-entry is a vulnerable period for all adults with COD, this paper identifies specific needs by race/ethnicity and proposes strategies to advance equity and improve care for all formerly incarcerated adults with a COD.

Nursing Interventions in the Management of Mental Health and Alcohol Use Disorders: A Comprehensive Review

Co-occurring mental health disorders and alcohol use disorders (AUDs) present a challenge for healthcare professionals. The complexity of these conditions can hinder accurate diagnosis and effective treatment. Therefore, it is crucial for healthcare professionals to be aware of the potential for co-occurring disorders and to provide appropriate care. Evidence-based interventions in nursing are critical in managing these disorders and improving patient outcomes. &#x0D; Nurses must be trained in these interventions to provide optimal care for patients with co-occurring disorders. Patients should be encouraged to disclose any substance use or mental health issues to ensure they receive the best care possible. &#x0D; This review provides a comprehensive overview of nursing interventions for managing mental health and AUDs. It emphasizes the need for further research in this area. Nursing care is pivotal in managing these disorders, and interventions can significantly improve patient outcomes. By unifying the style and using clear, concise, and appropriate language for a scientific audience, this review aims to clarify the importance of nursing interventions in managing co-occurring mental health and AUDs.

“It’s Stable but Not Stable”: A Conceptual Framework of Subjective Housing Stability Definition Among Individuals with Co-occurring Mental Health and Substance Use Disorders

Objective: Despite increasing efforts to improve housing stability, research has largely defined housing stability in a narrow sense and heavily relied on objective measures, such as housing types and housing duration. The present study constructed a conceptual framework for a subjective housing stability definition from the perspectives of individuals with co-occurring mental health and substance use disorders and their behavioral health service providers. Methods: Following the principles of grounded theory, we collected and analyzed qualitative data through semistructured interviews with 24 individuals with serious mental illness and substance use problems and three focus groups with 22 behavioral health service providers. Results: We developed a conceptual framework with two domains of subjective housing stability: functional stability and experiential stability. The functional stability domain includes four theoretical concepts: meeting basic needs, housing quality, housing affordability, and housing permanence. The experiential stability domain includes four theoretical concepts: autonomy and independence, connectedness, safety, and supportiveness. Conclusions: The conceptual framework can inform future research, practices, and policies to move beyond focusing on merely providing housing to consider the diverse and underlying needs in improving housing stability and well-being among those experiencing or at risk of housing instability.

HTA2 The Cost Effectiveness of Telehealth and in-Person Care Versus in-Person Care for Adults with Co-Occurring Mental Health and Substance Use Disorders

Telehealth has proven effective with many disorders, but there is a paucity of data on the cost-effectiveness of telehealth on individuals 18 and over with co-occurring mental health and substance use disorders. This analysis was designed to build a decision analytic model to evaluate medical interventions using telehealth and in-person care or just in-person care to treat adults 18 and over with these conditions.