Psychiatric Diagnoses in a Sample of HIV-infected People of Color in Methadone Treatment

Little diagnostic information is available for those who represent a significant part of the HIV epidemic: substance-using members of racial and ethnic minority communities. Our paper describes the rates of psychiatric diagnoses in a convenience sample of HIV-positive, African American and Hispanic clients in methadone treatment in the Bronx, NY. Out of 139 HIV-positive volunteers, 99 subjects had diagnoses in addition to opioid dependence on agonist therapy. The mean number of diagnoses was 3.84 (SD = 1.41). These findings confirm the need to target mental health as part of the national response to the HIV/AIDS epidemic in inner cities.This study was funded by grant 6 UDI SM52393. This single site study of triply diagnosed methadone patients is currently being employed in a multi-site research study, HIV/AIDS Treatment Adherence Health Outcomes and Cost Study (HIV/AIDS Cost Study) to investigate integrated interventions for HIV primary care, mental health and substance abuse. The HIV/AIDS Cost Study is a collaboration of six federal entities: The Center for Mental Health Services (CMHS), which has lead administrative responsibility and the Center for Substance Abuse Treatment (CSAT), both of which are components of the Substance Abuse and Mental Health Services Administration (SAMHSA); the HIV/AIDS Bureau within the Health Resources and Services Administration (HRSA); the National Institute of Mental Health (NIMH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), all of which are part of the National Institutes of Health (NIH).     

News on psychiatric research. Two recent advisory reports.

Two recent reports have rendered psychiatric research a great service in acknowledging the serious problem under which this research has been laboring and by making recommendations for improved functioning. The President's Biomedical Research Panel is the first high-level government body to take note of what it has felicitously called the "precipitous decline" in research support of the National Institute of Mental Health. Its recommendations of a greatly strengthened research advisory capability of the Alcohol, Drug Abuse, and Mental Health Administration Institutes effectively complements its recommendations for increased funding of these institutes. The Committee on Biomedical Research in the Veterans Administration, noting the "severely limited" support of research on the VA's massive problem of mental illness, proposed a series of specific recommendations for an improved and expanded research effort.     

A study of paraprofessionals in mental health

This article summarizes data gathered on 15 paraprofessional training programs sponsored by the National Institute of Mental Health (NIMH). Data on the backgrounds of trainees working as paraprofessionals are presented along with a breakdown of the kinds of tasks in which they are employed, as well as characteristics linked with ratings of success and retention in the programs. Trainees tended to be employed in a wide variety of tasks, often at rather sophisticated levels. Analysis of the tasks indicates that projects are fulfilling the NIMH New Careers goal of contributing to greater community impact in mental health. Results corroborate earlier findings that paraprofessionals have been accepted both by professionals and clients.The work upon which this publication is based was performed pursuant to Contract No. HSM-42-72-143 with the National Institute of Mental Health; Alcohol, Drug Abuse, and Mental Health Administration.     

Integrated substance use and mental health treatment for adolescents: aligning organizational and financial incentives

The high prevalence of the dual diagnosis of mental and substance use disorders (SUD) has been increasingly documented for both adolescents and adults (Crowley and Riggs 1995; Kandel et al. 1999; Whitmore et al. 1997). For more than a decade, the National Institute of Drug Abuse (NIDA) has included integrated treatment of comorbid psychiatric disorders as one of nine core treatment principles (National Institute on Drug Abuse 1999). Despite empirically supported practice guidelines, implementation of integrated treatment has been slow (New Freedom Commission on Mental Health 2003; U.S. Department of Health and Human Services 1999). In response to the growing call for integrated treatments and systems of care, this paper: (1) identifies systemic and economic barriers that have impeded widespread implementation of integrated care for adolescents with co-occurring SUD, specifically the supply of treatment providers, shifting priorities of gatekeepers to specialty care, and financing streams; and (2) describes possibilities for aligning economic incentives in order to facilitate the dissemination and implementation of integrated care for adolescents with co-occurring SUD.     

The federal mental health program: past, present, and future.

Dr. Brown traces the history of America's federal mental health program from its beginning in the early 1900s. NIMH, the institute he currently directs, was established in 1946 for the treatment and prevention of mental and emotional illnesses through research,training, and services. It is now one of the institutes of the Alcohol, Drug Abuse, and Mental Health Administration of the Department of Health, Education, and Welfare. Dr. Brown describes its continuous progress toward providing high-quality mental health care to the entire population, and discusses priorities for the future that include continuation of research on schizophrenia and depression and research that will benefit children and the elderly.     

BOOKS

Book reviewed in this article: Wilkinson. J. C. M., & K. Latif: Common neuroses in general practice. National Institute of Mental Health; Alcohol, Drug Abuse, and Mental Health Administration: Lithium in the treatment of mood disorders. Routh, D. K. (ed.): The experimental psychology of mental retardation.     

Mental Health and Substance Abuse Services Preferences among American Indian People of the Northern Midwest

This study examines factors that influence preferences between traditional cultural and western mental health and substance use associated care among American Indians from the northern Midwest. Personal interviews were conducted with 865 parents/caretakers of tribally enrolled youth concerning their preferences for traditional/cultural and formal healthcare for mental health or substance abuse problems. Adults strongly preferred traditional informal services to formal medical services. In addition, formal services on reservation were preferred to off reservation services. To better serve the mental health and substance abuse treatment needs of American Indians, traditional informal services should be incorporated into the current medical model.Melissa L. Walls, Kurt D. Johnson, Les B. Whitbeck, Dan R. Hoyt are affiliated with the Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE 68588-0324, USA; e-mail: mwalls@unlserve.unl.edu.This research was funded by the National Institute on Drug Abuse (DA13580) and the National Institute of Mental Health (MH67281), Les B. Whitbeck, Principal Investigator.     

Mental disorders among parents/caretakers of American Indian early adolescents in the Northern Midwest*

Background This study reports prevalence and comorbidty of five DSM-III-R diagnoses (alcohol abuse, alcohol dependence, drug abuse, major depressive episode, and generalized anxiety disorder) among American Indian and Canadian First Nations parents/caretakers of children aged 10–12 years from the Northern Midwest United States and Canada. Lifetime prevalence rates were compared to adults in the National Comorbidity Survey (NCS) and Southwest and Northern Plains cultures from the AI-SUPERPFP study. Method Native interviewers used computer-assisted personal interviews to administer the University of Michigan Composite International Diagnostic Interview (UM-CIDI) to 861 tribally enrolled parents and caretakers (625 females; 236 males) of 741 tribally enrolled children aged 10–12 years. Fathers/male caretakers ranged in age from 21 years to 68 years with an average age of 41 years; mothers/female caretakers ranged in age from 17 years to 77 years with an average of 39 years. Results About three-fourths (74.6%) of the adults met lifetime criteria for one of the five disorders; approximately one-third (31.6%) met lifetime criteria for two or more of the five disorders. Prevalence of the substance use disorders was higher than those in the general population (NCS); prevalence of internalizing disorders (major depressive disorder and generalized anxiety disorder) was very similar to those in the general population. Prevalence rates for alcohol abuse among the Northern Midwest adults were higher than those reported for Southwest and Northern Plains Tribes, but rates of alcohol dependency were very similar across cultures. Conclusions The higher prevalence rates for some mental disorders found for the Northern Midwest are discussed in terms of potential method variance. The Northern Midwest results reflect unique patterns of psychiatric disorders in the ubiquity of substance abuse disorders and the co-occurrence of substance abuse disorders with internalizing disorders. Reducing lifetime occurrences of substance abuse disorders would have an enormous positive impact on the mental health of this population. *This research was funded by the National Institute on Drug Abuse (DA13580) and the National Institute of Mental Health (MH67281), Les B. Whitbeck, Principal Investigator. The authors acknowledge the helpful comments of two anonymous reviewers.     

Community mental health centers and the elderly: A time for expansion of planning,research, and demonstration projects

The purpose of this paper is to acquaint persons working in Community Mental Health Centers with federal funding resources which support planning, research, and demonstration projects related to mental health and aging. The significance of exploration by CMHCs into the aging area is suggested by the legislative histories of CMHCs and aging programs, our expanding aging population which requires increasing health and mental health services, and the growing number of resources available for the development of services related to aging. Principal funding sources related to mental health and aging are: Alcohol, Drug Abuse and Mental Health Administration; National Institutes of Health; Administration on Aging; and Health Care Financing Administration. Each funding source is presented through a review of five key items: 1) name of program; 2) objectives; 3) funds awarded; 4) legislative mandate; and 5) contact person and address. Program areas for each funding source are discussed. Knowledge of these funding resources should enable CMHCs to plan services and to expand capabilities to serve the growing over-60 population.Research was sponsored in part by an Administration on Aging IV-B Grant, 90 A-1658.     

A demonstration program for homeless male alcohol and other drug abusers

The National Institute on Alcohol Abuse and Alcoholism, in consultation with the National Institute on Drug Abuse, awarded nine demonstration grants in 1988 for community-based programs addressing issues of the homeless alcohol and other drug (AOD) abusers. Project Connect in Louisville, Kentucky, was one of the nine demonstration grants. The three-year project was designed to address a multitude of needs of the homeless male AOD abuser, including housing, medical, employment/economic, and social support, in addition to treatment for AOD abuse. The present article details the evolution and implementation of Project Connect and describes characteristics of the target population. In addition, the article presents issues and problems that surfaced during program implementation in order to assist other communities that are considering similar programs for their homeless populations.     

Control and service implementation in drug abuse treatment programs

The major purpose of this paper is to examine the relationship between control and implementation of drug treatment services while controlling for the structure of the organization. It is based on a study of 19 drug abuse programs in eight counties of North Carolina. The analysis of the data indicates that greater control will not necessarily increase the effectiveness of organization performance; rather, for change to occur, control by professional personnel will have to decrease. This would allow the organization to be more responsive to environmental concerns, and therefore more effective.This research was supported by Grant #1 R01 DA00602-01 from the United States Public Health Service Alcohol, Drug Abuse, and Mental Health Administration, Division of Research, National Institute on Drug Abuse.     

Substance abuse treatment management information systems: balancing federal, state, and service provider needs

There is increased interest in documenting the characteristics and treatment outcomes of clients served with Alcohol, Drug Abuse, and Mental Health Block Grant funds. The evolution of federal client-based management systems for substance abuse treatment services demonstrates that data collection systems are important but require continued support. A review of the Massachusetts substance abuse management information system illustrates the utility of a client-based data set. The development and implementation of a comprehensive information system require overcoming organizational barriers and project delays, fostering collaborative efforts among staff from diverse agencies, and employing considerable resources. In addition, the need to develop mechanisms for increasing the reliability of the data and ongoing training for the users is presented. Finally, three applications of the management information system's role in shaping policy are reviewed: developing services for special populations (communities of color, women, and pregnant substance abusers, and injection drug users), utilizing MIS data for evaluation purposes, and determining funding allocations.     

Expenditures of time and money by families of people with severe mental illness and substance use disorders

Families are typically a major source of support for people with mental illness, but substance abuse places an additional burden on family relations and could reduce the amount of direct support they give. Data from families of 169 people with cooccurring mental illnes and substance abuse indicate that they give a substantial amount of time and money to their relatives with dual disorders. More severe current substances abuse appeared to reduce family spending but not direct caregiving. Clients with more severe alcohol problems were more likely to live with parents than with other family members.Research for this article was supported by grant numbers R01-MH47567 and K02-MH00839 from the national Institute of Mental Helth. The authors gratefully acknowledge Marian Wheeler's assistance with data collection.     

The use of shelters as substance abuse stabilization sites

The feasibility of providing postdetoxification residential substance abuse programming (stabilization) in large emergency shelters was examined as part of a demonstration project funded by the National Institute on Alcohol Abuse and Alcoholism under Section 613 of the Stewart B. McKinney Act (Public Law 100-71). The program completion rates of 773 homeless/near-homeless substance-abusing individuals assigned to two large shelters (71% and 62%) and two traditional substance abuse treatment agencies (68% and 54%) were comparable. These data support the expansion of shelter services to include substance abuse programming and intervention. Shelters represent windows of opportunity into the lives of homeless substance-abusing men and women, and full advantage of this opportunity should be taken to impact this subgroup of the homeless.     

A SAMHSA research initiative assessing the effectiveness of jail diversion programs for mentally ill persons

For nearly 30 years jail diversion programs have had wide support as a way to prevent people with mental illnesses and substance use disorders from unnecessarily entering the criminal justice system by providing more appropriate community-based treatment. Although these programs have had wide support, very few systematic outcomes studies have examined their effectiveness. This paper discusses findings on rates of incarceration of persons with serious mental illness and co-occurring substance use disorders in U.S. jails, summarizes recently completed research on jail diversion programs, and describes a three-year research initiative begun in 1997 by the Substance Abuse and Mental Health Services Administration that uses a standardized protocol to examine the characteristics and outcomes of various types of jail diversion programs in nine sites throughout the U.S.     

Expenditures on mental health and addictions for Canadian provinces in 2003 and 2004

OBJECTIVE: To measure total public and private expenditures on mental health in each province. METHOD: Data for expenditures on mental health services were collected in the following categories: physician expenditures (general and psychiatrist fees for service and alternative funding), inpatient hospital (psychiatric and general), outpatient hospital, community mental health, pharmaceuticals, and substance abuse. Data for 2 years, 2003 and 2004, were collected from the Canadian Institute for Health Information (hospital inpatient and fees for service physicians), the individual provinces (pharmaceuticals, alternative physician payments, hospital outpatient, and community), and the Canadian Centre on Substance Abuse. Totals were expressed in terms of per capita and as a percentage of total provincial health spending. RESULTS: Total spending on mental health was $6.6 billion, of which $5.5 billion was from public sources. Nationally, the largest portion of expenditures was for hospitals, followed by community mental health expenses and pharmaceuticals. This varied by province. Public mental health spending was 6% of total public spending on health, while total mental health spending was 5% of total health spending. CONCLUSIONS: Canadian public mental health spending is lower than most developed countries, and a little below the minimum acceptable amount (5%) stated by the European Mental Health Economics Network.     

New trends in cannabis potency in USA and Europe during the last decade (2008–2017)

European Archives of Psychiatry and Clinical Neuroscience - Through the potency monitoring program at the University of Mississippi supported by National Institute on Drug Abuse (NIDA), a total of...     

Detection of substance use disorders in severely mentally ill patients

Severe mental illness is frequently complicated by substance use disorder. Approximately half of the severely mentally ill patients treated in acute care psychiatric settings have abused one or more of these substances. Despite the high rate of comorbidity, substance use disorders are generally not detected in acute care psychiatric settings, leading to incorrect diagnoses and ineffective treatments. The reasons for nondetection are complex, and research is needed to refine instruments and procedures for the detection of substance abuse in the severely mentally ill population. Nevertheless, clinicians can make better use of existing techniques of multimodal assessment to increase significantly the rate of accurate detection.Presented at the annual convention of the American Psychiatric Association in New Orleans, LA, May, 1991.This work was supported in part by a National Institute of Mental Health Level II Research Scientist Development Award, K02-MH-00839.     

Use of mental health care and substance abuse treatment among adults with co-occurring disorders

OBJECTIVES: This study investigated patterns of use of mental health care and substance abuse treatment for a nationally representative sample of adults with co-occurring mental health problems and a substance use disorder and compared these patterns with those of persons with either a mental health problem or a substance use disorder. METHODS: Data were from the 2001 and 2002 National Surveys on Drug Use and Health. The study examined rates of substance use disorders and mental health problems among adults aged 18 years and older, rates of substance use disorders among adults with mental health problems, and rates of mental health problems among adults with substance use disorders. Next, rates of substance abuse treatment and mental health care use were calculated among five groups that were formed on the basis of the presence of a substance use disorder, mental health problems, or both in the past year. RESULTS: A total of 2,851 respondents had a substance use disorder only, 1,633 had a substance use disorder with one or more mental health symptoms and without serious mental illness, 1,872 had a substance use disorder with serious mental illness, 13,759 had one or more mental health symptoms only, and 7,530 had a serious mental illness only. A substantial proportion of adults with comorbid mental health problems and a substance use disorder did not receive any treatment (46 percent of those with serious mental illness and 65 percent of those with one or more mental health symptoms). Co-occurring substance use disorder was not associated with increased use of mental health care. The likelihood of receiving any substance abuse treatment increased with the presence and severity of mental health problems. Across all five groups, use of mental health care was more common than use of substance abuse treatment. Less than one-third of patients with comorbid mental health problems and a substance use disorder who used mental health care also received substance abuse treatment. CONCLUSIONS: The large proportion of untreated individuals with mental and substance use disorders reinforces existing concerns about barriers to beneficial treatment. Low rates of use of substance abuse treatment among patients who have comorbid mental health problems and a substance use disorder and use mental health care suggest that recommendations that substance use disorders be treated before, or concurrently with, mental disorders have not been widely adopted.