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      Treatment outcome in substance use disorder patients with and without comorbid posttraumatic stress disorder: A systematic review

      Author(s): , ,
      Publication date Created:
      Publication date (Electronic):
      Journal: Psychotherapy Research
      Publisher: Informa UK Limited

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          Abstract

          We investigated the role of comorbid posttraumatic stress disorder (CO-PTSD) in substance use disorder (DSM-IV/ICD-10 substance abuse or dependence, SUD) treatment. We conducted a systematic review of treatment outcome studies in SUD patients with and without CO-PTSD from 2000 to 2011. The N = 22 studies found differed clearly with regard to methodology and the sufficiency of provided study information, limiting their comparability. Remarkably, no consistent indication of a negative effect of CO-PTSD on the reported SUD treatment outcome was found. In addition to CO-PTSD, we point out possible further effect modifiers which need to be better understood. Finally, we emphasize the requirements for future research such as methodological standardization and a focus on long-term studies.

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          Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature.

          Ilana Nossel, Groves Dixon, Julie Kreyenbuhl (2009)
          Disengagement from mental health services can lead to devastating consequences for individuals with schizophrenia and other serious mental illnesses who require ongoing treatment. We review the extent and correlates of dropping out of mental health treatment for individuals with schizophrenia and suggest strategies for facilitating treatment engagement. Although rates vary across studies, reviews of the literature suggest that up to one-third of individuals with serious mental illnesses who have had some contact with the mental health service system disengage from care. Younger age, male gender, ethnic minority background, and low social functioning have been consistently associated with disengagement from mental health treatment. Individuals with co-occurring psychiatric and substance use disorders, as well as those with early-onset psychosis, are at particularly high risk of treatment dropout. Engagement strategies should specifically target these high-risk groups, as well as high-risk periods, including following an emergency room or hospital admission and the initial period of treatment. Interventions to enhance engagement in mental health treatment range from low-intensity interventions, such as appointment reminders, to high-intensity interventions, such as assertive community treatment. Disengagement from treatment may reflect the consumer's perspective that treatment is not necessary, is not meeting their needs, or is not being provided in a collaborative manner. An emerging literature on patient-centered care and shared decision making in psychiatry provides suggestive evidence that efforts to enhance client-centered communication and promote individuals' active involvement in mental health treatment decisions can also improve engagement in treatment.
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            Treatment of substance abusing patients with comorbid psychiatric disorders.

            Thomas M Kelly, Dennis C Daley, Antoine Douaihy (2012)
            To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients. Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity. Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions. Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders.

              M A Wallach, Joshua L O’Neal, Lauren E. Drake (2007)
              This report reviews studies of psychosocial interventions for people with co-occurring substance use disorder and severe mental illness. We identified 45 controlled studies (22 experimental and 23 quasi-experimental) of psychosocial dual diagnosis interventions through several search strategies. Three types of interventions (group counseling, contingency management, and residential dual diagnosis treatment) show consistent positive effects on substance use disorder, whereas other interventions have significant impacts on other areas of adjustment (e.g., case management enhances community tenure and legal interventions increase treatment participation). Current studies are limited by heterogeneity of interventions, participants, methods, outcomes, and measures. Treatment of co-occurring severe mental illness and substance use disorder now has a large but heterogeneous evidence base that nevertheless supports several types of interventions. Future research will need to address methodological standardization, longitudinal perspectives, interventions for subgroups and stages, sequenced interventions, and the changing realities of treatment systems.
              Article 0 comments Cited 61 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Psychotherapy Research
                Abbreviated Title: Psychotherapy Research
                Publisher: Informa UK Limited
                ISSN (Print): 1050-3307
                ISSN (Electronic): 1468-4381
                Publication date Created: December 17 2014
                Publication date Created: September 03 2015
                Publication date (Electronic): June 26 2014
                Publication date (Print): September 03 2015
                Volume: 25
                Issue: 5
                Pages: 565-582
                Article
                DOI: 10.1080/10503307.2014.923125
                PubMed ID: 24967646
                SO-VID: d7c1ce9e-9726-4a54-99ba-24d80710d385
                Copyright © © 2015
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