Treatment Of Co-occurring Disorders Research Articles

Transformation of Children's Mental Health Services: The Role of School Mental Health

The New Freedom Commission has called for a transformation in the delivery of mental health services in this country. The commission's report and recommendations have highlighted the role of school mental health services in transforming mental health care for children and adolescents. This article examines the intersection of school mental health programs and the commission's recommendations in order to highlight the role of school mental health in the transformation of the child and adolescent mental health system. Schools are uniquely positioned to play a central role in improving access to child mental health services and in supporting mental health and wellness as well as academic functioning of youths. The New Freedom Commission report articulated several goals related to school mental health: reducing stigma, preventing suicide, improving screening and treating co-occurring disorders, and expanding school mental health programs. The authors suggest strategies for change, including demonstrating relevance to schools, developing consensus among stakeholders, enhancing community mental health-school connections, building quality assessment and improvement, and considering the organizational context of schools.

Feasibility and outcomes of an innovative cognitive‐behavioural skill training programme for co‐occurring disorders in the youth alcohol and other drug (AOD) sector

There are limited treatment options available for young drug users with comorbid mental health problems who present to alcohol and other drug (AOD) services within Australia. While there is some evidence for the use of cognitive-behaviour therapy (CBT) in the treatment of co-occurring disorders, CBT is rarely used to address comorbidity in the AOD sector. This paper describes the development, implementation and evaluation of a brief cognitive-behavioural skills (BCBS) training programme for addressing comorbidity within two youth AOD services in Australia. Ten youth AOD workers completed a 2-day training programme in the BCBS. Training was evaluated using measures of trainees' cognitive-behavioural knowledge, attitudes towards mental health interventions and level of skills and confidence in each of the BCBS pre- and 6 months post-training. The BCBS training had a positive impact on the knowledge, skills and confidence of trainees and was perceived to be highly relevant and appropriate. These findings provide preliminary support for the feasibility and effectiveness of the BCBS training programme for workers within the youth AOD sector.

Treatment for Co-occurring Mental and Substance Use Disorders in Five State Medicaid Programs

Objectives: This study described the locations and patterns of psychiatric and substance abuse treatment for Medicaid beneficiaries with cooccurring mental and substance use disorders in five states. Methods: Medicaid beneficiaries aged 21 to 65 with psychiatric or substance use disorders were identified with claims and encounter records. Groups were further divided into those with and those without a diagnosed substance use disorder. Adjusted odds of treatment in community-based settings, inpatient facilities, emergency departments, and hospital outpatient departments were calculated. Results: A total of 92,355 persons had a psychiatric disorder, 34,158 had a substance use disorder, and 14,256 had co-occurring psychiatric and substance use disorders. In all five states, beneficiaries with severe mental illness (schizophrenia, bipolar disorder, or major depression) and a substance use disorder had higher odds of inpatient, emergency department, and hospital-based outpatient psychiatric treatment, compared with those with severe mental illness alone. In four of five states, both severe and less severe mental illness and a co-occurring substance use disorder were associated with lower odds of community-based treatment compared with those with the respective mental illness alone. Compared with those with less severe mental illness alone, individuals with less severe psychiatric disorders and a co-occurring substance use disorder had higher odds of inpatient treatment in all states and of emergency department use in three of five states. Odds of inpatient and outpatient hospital use and emergency department use for substance abuse treatment were higher for persons with severe mental illness and a co-occurring substance use disorder in most states, compared with odds for those with a substance use disorder alone. Conclusions: Heavy inpatient and emergency department use by Medicaid beneficiaries with co-occurring substance use disorders is a consistent cross-state problem. Co-occurring disorders may decrease the likelihood of community-based treatment for those with less severe mental disorders and for those with severe mental illness, suggesting that policies focusing only on these settings may miss a significant proportion of people with these co-occurring disorders. (Psychiatric Services 58:942–948, 2007)

Treatment for Co-occurring Mental and Substance Use Disorders in Five State Medicaid Programs

This study described the locations and patterns of psychiatric and substance abuse treatment for Medicaid beneficiaries with co-occurring mental and substance use disorders in five states. Medicaid beneficiaries aged 21 to 65 with psychiatric or substance use disorders were identified with claims and encounter records. Groups were further divided into those with and those without a diagnosed substance use disorder. Adjusted odds of treatment in community-based settings, inpatient facilities, emergency departments, and hospital outpatient departments were calculated. A total of 92,355 persons had a psychiatric disorder, 34,158 had a substance use disorder, and 14,256 had co-occurring psychiatric and substance use disorders. In all five states, beneficiaries with severe mental illness (schizophrenia, bipolar disorder, or major depression) and a substance use disorder had higher odds of inpatient, emergency department, and hospital-based outpatient psychiatric treatment, compared with those with severe mental illness alone. In four of five states, both severe and less severe mental illness and a co-occurring substance use disorder were associated with lower odds of community-based treatment compared with those with the respective mental illness alone. Compared with those with less severe mental illness alone, individuals with less severe psychiatric disorders and a co-occurring substance use disorder had higher odds of inpatient treatment in all states and of emergency department use in three of five states. Odds of inpatient and outpatient hospital use and emergency department use for substance abuse treatment were higher for persons with severe mental illness and a co-occurring substance use disorder in most states, compared with odds for those with a substance use disorder alone. Heavy inpatient and emergency department use by Medicaid beneficiaries with co-occurring substance use disorders is a consistent cross-state problem. Co-occurring disorders may decrease the likelihood of community-based treatment for those with less severe mental disorders and for those with severe mental illness, suggesting that policies focusing only on these settings may miss a significant proportion of people with these co-occurring disorders.

Enhanced outpatient treatment for co-occurring disorders: Main outcomes

This study, which was conducted in an outpatient substance abuse treatment program, randomly assigned clients with mental health symptoms to either a control group, which received basic program services, or an experimental group, which was configured as a modified therapeutic community (TC) track, with the addition of modified TC features and three specific elements—psychoeducational seminar, trauma-informed addictions treatment, and case management. The experimental group had significantly better outcomes as compared with the control group on measures of psychiatric severity and on the key measure of housing stability; no difference was observed for substance use, crime, and employment. The findings must be qualified because (a) only 3 of 34 representative measures (<10%) showed significant differential treatment effects and (b) analysis revealed partial implementation of the enhancements. The study provides modest support for the effectiveness, on specific outcomes, of outpatient substance abuse treatment programs that add modified TC features and targeted interventions to strengthen their capacity to treat co-occurring disorders.

Consumer Perspectives on Co-Occurring Disorders Treatment

A series of four focus groups were conducted with 35 clients with a co-occurring diagnosis of mental illness and substance abuse to obtain their perspectives on treatment. Four content areas emerged. System barriers, such as poor therapeutic environment, difficulties navigating complex systems, and poor integration of services were most frequently mentioned. Factors facilitating recovery included consumer strengths, a positive therapeutic environment, and helpful recovery tools. Consumer challenges refer to obstacles in the client's life including the long-term chronic nature of their illness, self-medication of psychiatric symptoms, and limited personal resources and options. Specific treatment needs, such as treatment from “similar others,” one-on-one counseling, and time management were identified. The results demonstrate that a client-centered approach is preferred. Limited system resources continue to be a barrier. Improved coordination of services and cross-training on co-occurring diagnosis are needed. Consumers recognize the long-term nature of their problems and have strengths for dealing with them.

Creating an Agency Integrated Treatment Program for Co-occurring Disorders

This article concerns the creation of a community agency's integrated mental illness and substance abuse co-occurring disorders assessment and treatment program, with a focus on the barriers and strategies encountered as its development progressed. The discussion of barriers was framed according to the factors (attitude, mastery, leadership, staffing, policies, workflow, and program monitoring) identified by Moser and colleagues (Moser, DeLuca, Bond, & Rollins, 2004) in their comparison of the implementation of Assertive Community Treatment and Integrated Dual Disorders Treatment. It was found that resolution of these barriers was important to the implementation of this program.

Recovery: A common vision for the fields of mental health and addictions.

The vision of recovery is reshaping the fields of mental health and addiction services. This paper reviews how this broad vision is shaping common goals, principles, values and strategies across the two fields. We further examine how a common vision of recovery can positively impact the treatment of co-occurring disorders and speculate on how this vision can bridge the seeming differences between these two fields and reshape a mutual understanding of the essentials of recovery from severe mental illness and addiction.

Evidenced-Based Time-Limited Treatment of Co-occurring Substance-Use Disorders and Civilian-Related Posttraumatic Stress Disorder

Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) frequently co-occur, and this comorbidity results in a more severe clinical presentation and treatment outcome. Consensus is lacking regarding best practices; however, a number of integrated psychosocial treatments (e.g., Seeking Safety, Substance-Dependence PTSD Therapy, Concurrent Treatment of PTSD and Cocaine Dependence) have shown empirically supported promise in reducing symptoms of both disorders. Very little research has been conducted to date on pharmacological treatments for this dual diagnosis or on assessments. This article reviews the developing literature in this area and discusses future directions for research.

Treating Co‐Occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals

The American Journal on AddictionsVolume 15, Issue 5 p. 407-408 Treating Co-Occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals First published: 18 February 2010 https://doi.org/10.1080/10550490600860700Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume15, Issue5September‐October 2006Pages 407-408 RelatedInformation

Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers

As the model for treating co-occurring disorders in addiction treatment settings becomes articulated, service systems need data on prevalence, current practice, and barriers to the implementation of evidence-based practices. A self-report survey was administered to 453 addiction treatment providers (43 agency directors, 110 clinical supervisors, and 300 clinicians) from a single state system of care. Data on prevalence estimates, treatment practices, and barriers to implementing services for co-occurring disorders were obtained. The three groups estimated that several co-occurring disorders were extremely common: mood disorders (40%–42%), anxiety disorders (24%–27%), posttraumatic stress disorder (24%–27%), severe mental illnesses (16%–21%), antisocial personality disorder (18%–20%), and borderline personality disorder (17%–18%). Practice patterns for patients with these co-occurring disorders differed widely, from referral to mental health programs to provision of integrated treatment. Common barriers to providing services to persons with co-occurring disorders were lack of psychiatric personnel and resources. Comprehensive surveys of an addiction treatment service system can rapidly and economically produce estimates of prevalence, current practices, and barriers to evidence-based practices. This objective information is critical for systems intending to enhance services to persons with co-occurring disorders.

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Clinical Case Management, Case Management, and ACT

Back to table of contents Previous article Next article LettersFull AccessLettersJoel Kanter M.S.W., L.C.S.W.-CJoel Kanter M.S.W., L.C.S.W.-CSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.2006.57.4.578aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Clinical Case Management, Case Management, and ACTTo the Editor: The authors of the article "Comparison of ACT and Standard Case Management for Delivering Integrated Treatment for Co-occurring Disorders" ( 1 ) in the February issue use the misleading adjective "standard" to describe the comparison intervention. As described in the article, the "standard case management" used was actually a sophisticated "clinical case management team" ( 2 , 3 , 4 ) that provided multidisciplinary, integrated treatment with ongoing expert consultation. The clinical case managers had a larger caseload than the assertive community treatment team, and cases were assigned to individual case managers rather than to a team. However, even with these differences, the clinical case management approach used in the study has much in common with the assertive community treatment model. Although one wishes that this type of treatment were "standard," case management today too often involves a poorly trained, paraprofessional staff operating apart from other treatment interventions ( 5 ). "Comparison of ACT and Clinical Case Management …" would have been a more apt title for this informative article. Mr. Kanter is in private practice in Silver Spring, Maryland.

Letters

Back to table of contents Previous article Next article LettersFull AccessLettersJoel Kanter M.S.W., L.C.S.W.-CJoel Kanter M.S.W., L.C.S.W.-CSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.2006.57.4.578aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Clinical Case Management, Case Management, and ACTTo the Editor: The authors of the article "Comparison of ACT and Standard Case Management for Delivering Integrated Treatment for Co-occurring Disorders" ( 1 ) in the February issue use the misleading adjective "standard" to describe the comparison intervention. As described in the article, the "standard case management" used was actually a sophisticated "clinical case management team" ( 2 , 3 , 4 ) that provided multidisciplinary, integrated treatment with ongoing expert consultation. The clinical case managers had a larger caseload than the assertive community treatment team, and cases were assigned to individual case managers rather than to a team. However, even with these differences, the clinical case management approach used in the study has much in common with the assertive community treatment model. Although one wishes that this type of treatment were "standard," case management today too often involves a poorly trained, paraprofessional staff operating apart from other treatment interventions ( 5 ). "Comparison of ACT and Clinical Case Management …" would have been a more apt title for this informative article. Mr. Kanter is in private practice in Silver Spring, Maryland.

Letters

Back to table of contents Previous article Next article LettersFull AccessLettersBruce Seitzer M.A.Bruce Seitzer M.A.Search for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.2006.57.4.579AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: I read with interest the article "Comparison of ACT and Standard Case Management for Delivering Integrated Treatment for Co-occurring Disorders" and noted the authors' conclusion that "Integrated treatment can be successfully delivered either by assertive community treatment or by standard clinical case management." With so much interest in evidence-based practice, and with assertive community treatment (ACT) so often touted as the model of choice for treating people with severe and persistent mental illness, this study calls into question the fundamental assumption that what has worked before will work now. One tires of professionals everywhere blindly jumping on the evidence-based-practice bandwagon. The self-congratulatory literature expounding the virtues of this or that evidence-based practice tends to do little more then champion a record of the past, limiting creativity and discouraging attempts to try something new that may in fact be better.ACT was developed more than 20 years ago, and much has changed since then. Perhaps it is finally time to let go of what may be an antiquated and obsolete model and focus on outcomes instead of process.Mr. Seitzer is an associate director of Community Counseling Centers of Chicago. FiguresReferencesCited byDetailsCited byJapanese Journal of Physical Fitness and Sports Medicine, Vol. 61, No. 4 Volume 57Issue 4 April, 2006Pages 579-579PSYCHIATRIC SERVICES April 2006 Volume 57 Number 4 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 2006

Treating Co-occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals

Back to table of contents Previous article Next article Book ReviewsFull AccessTreating Co-occurring Disorders: A Handbook for Mental Health and Substance Abuse ProfessionalsJudy Faberman, L.I.C.S.W.Judy FabermanSearch for more papers by this author, L.I.C.S.W.Published Online:1 Feb 2006https://doi.org/10.1176/appi.ps.57.2.279AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Treating patients with co-occurring disorders is incredibly complex and demanding. Daily challenges include decisions about which disorder requires more immediate attention, who is appropriate for programs, how to treat symptoms of co-occurring disorders simultaneously, and how to support clinicians who struggle with their own limitations in training and confidence. To top it all off, most treatment systems and aftercare options are set up to treat one disorder or the other, a reality that leaves a huge proportion of these patients underserved and improperly treated.Treating Co-occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals, by Edward Hendrickson, Marilyn Schmal, and Sharon Eckleberry, addresses many of these concerns. The book begins by identifying the need to treat co-occurring disorders simultaneously in one setting, pointing out that sequential or parallel treatment options are essentially inadequate. The authors use research and their own clinical experience in treatment, supervision, consultation, and training in presenting their positions. Underlying the entire book is the explicit understanding that differential diagnosis, assessment, and treatment are difficult because of the incredible diversity of the population itself and the continuum of possible symptom configurations.The first chapters outline the prevalence of specific co-occurring disorders, providing symptom descriptions directly from DSM-IV and how they interact with substance use. The authors present treatment implications that are direct and helpful for both new and experienced clinicians alike. They next address the complexities of differentiating substance-induced versus true co-occurring disorders by identifying assessment tools and diagnostic questions for clinicians. They discuss the implications of various combinations of severity and duration of substance abuse and mental illness, as well as their relationship to each other, stressing the importance of understanding why clients use substances.The authors devote a major portion of the book to the specific treatments for dual diagnosis in terms of individual case management as well as group and family treatment, providing useful information about treatment tasks, foci, and common traps. They do this comprehensively and use case examples. One of the most helpful assertions the authors make is that decisions about intake and treatment need to be tailored not only to patients' motivation levels but, just as importantly, to their impairment levels.Because it is clear that an appropriate treatment setting for every possible combination of disorders does not exist, the authors of this text address the need for clinicians to expand their skills and frames of reference in order to be effective. They also provide helpful direction for supervisors who are trying to make that possible. The book stresses the importance of understanding and accepting that matching the treatment setting to the patients' needs will not always be optimal and that clinicians need to adhere to a competency-based focus in which small changes are celebrated. Treating Co-occurring Disorders is an extremely valuable resource for professionals in the field. Practical, specific, and easy to read, it has helped immeasurably in my practice.Ms. Faberman is director of the alcohol and drug abuse partial treatment program at McLean Hospital in Belmont, Massachusetts.by Edward Hendrickson, Marilyn Schmal, and Sharon Eckleberry; New York, Haworth Press, 2004, 263 pages, $29.95 softcover FiguresReferencesCited byDetailsCited byNone Volume 57Issue 2 February 2006Pages 279-279 Metrics History Published online 1 February 2006 Published in print 1 February 2006

Comparison of ACT and Standard Case Management for Delivering Integrated Treatment for Co-occurring Disorders

Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes. Although integrated mental health and substance abuse treatment is becoming a standard clinical approach for such clients, the optimal method for delivering integrated treatment remains unclear. This study compared integrated treatment delivered within two different models of community-based case management (assertive community treatment and standard clinical case management). A total of 198 clients in two urban sites who had co-occurring disorders and were homeless or unstably housed were randomly assigned to one of two treatment conditions and were followed for three years. Participants in both treatment conditions improved over time in multiple outcome domains, and few differences were found between the two models. Decreases in substance use were greater than would be expected given time alone. At the site that had higher rates of institutionalization, clients who received standard case management were more likely to be institutionalized. However, in the site that had lower rates of institutionalization, no differences in the rate of institutionalization were found between the two treatment conditions. Integrated treatment can be successfully delivered either by assertive community treatment or by standard clinical case management.

Evaluation of a Cross-Training Curriculum for Mental Health and Addiction Counselors

ABSTRACT Cross-training professionals from mental health and addiction treatment systems can help further the goal of comprehensive treatment for clients with co-occurring mental health and substance use disorders (co-occurring disorders). Two such trainings brought together 122 professionals from mental health and addiction treatment fields. This evaluation study explored changes in treatment staffs' knowledge, beliefs, and cross-disciplinary collaboration over the course of the 22.5 hour training. Results suggest that participants benefited from exposure to content outside their respective discipline, and knowledge of co-occurring disorders and treatment for co-occurring disorders improved. Both groups of professionals endorsed similar beliefs about the nature and etiology of addiction over the course of the training. Differences emerged in participants' views about cross-disciplinary collaboration, with addiction treatment professionals reporting more agency collaboration. Participants favored aspects ...

Enhancing Validity in Co-occurring Disorders Treatment Research

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

News &amp; Notes

News &amp; Notes