Decisional Balance Regarding Substance Use Among Persons with Schizophrenia

State-of-the-science treatment of substanceabuse relies on decisional balance activities (weighingpros and cons of continued substance use) to enhancemotivation for change. Few data are available regarding the feasibility of these activities amongpersons dually diagnosed with schizophrenia andsubstance use disorder. To address this lacuna in theliterature, we completed focus groups with 21participants, all of whom had a schizophrenia-spectrumdiagnosis and lifetime substance abuse or dependence.These key informants discussed the pros and cons ofsubstance use as well as the pros and cons of quitting in response to a structured group interview.Our qualitative data indicate that persons living withschizophrenia can generate rich and diverse decisionalbalance information. We describe salient themes, contrast complementary perspectives (i.e., thepros of using and cons of quitting), and suggesttreatment implications based on thesefindings.     

Using Discrete-Time Survival Analysis to Examine Patterns of Remission from Substance Use Disorder Among Persons with Severe Mental Illness

Mental Health Services Research - Investigators in mental health research are often interested in examining critical events such as onset, relapse, and recovery from illness, including substance...     

Emotional Processing in Individuals with Substance Use Disorder and Posttraumatic Stress Disorder

Previous research has shown that individuals with substance use disorder (SUD) and posttraumatic stress disorder (PTSD) have emotional processing difficulties. However, no studies have specifically investigated the role of emotional processing in those with co-morbid SUD-PTSD. This study investigated whether there are more emotional processing abnormalities among patients with SUD-PTSD, than those with either a single diagnosis of PTSD or SUD. Emotional processing was assessed in three groups [1) SUD (without PTSD); 2) PTSD (without SUD); and 3) co-morbid SUD-PTSD] using the Emotional Processing Scale (EPS-25) and the International Affective Picture System (IAPS). Each of the three groups reported evidence of emotional processing dysfunction relative to the normal population. Within the SUD-PTSD group there was significant evidence that the additional impact of trauma increased emotional processing dysfunction but less evidence to suggest that substance use increased emotional processing dysfunction further. These findings call into question current United Kingdom guidelines for the treatment of co-morbid SUD-PTSD, which recommend that the drug or alcohol problem should be treated first.     

The Risk of Sleep Disorder Among Persons with Mild Traumatic Brain Injury

Sleep disorders and mild traumatic brain injury (mTBI) are among the most commonly occurring neurological problems clinicians encounter simultaneously. Each can cause the other, and both share common predisposing factors. An important question that remains to be addressed is whether high-risk groups can be defined. We observed an accumulation of considerable knowledge on sleep dysfunction in mTBI in recently published works. The results highlight sleep disturbances in mTBI as the product of diverse internal and external influences, acting on a genetically determined substrate. This may partially explain the clinical heterogeneity of mTBI, pointing to the importance of establishing an accurate history on the onset and course of a specific sleep disorder in the early stages post-mTBI in the individual patient. Such an approach will aid not only diagnosis and treatment but may also lead to identification of disorders whose symptoms mimic those of TBI and thereby direct the most suitable treatment and management.     

Stress Among a Sample of Returning Citizens Living with HIV and Substance Use Disorder: A Mixed Methods Analysis

This mixed-methods study asks: among a sample of returning citizens living with HIV and substance use disorder, how is stress experienced; and what are the leading stressors and stress-coping strategies? Data is from a parent study that randomized 36 people to a yoga intervention and 36 people to treatment as usual. Qualitative analysis found that securing basic life needs was more acute in early reentry, and challenges with HIV acceptance were greater among those with a more recent HIV diagnosis. Social support was the most widely employed coping strategy but many lacked social networks. Post-program, multiple regression found older age(β?=?? 0.38, p?<?.05), greater income(β?=?? 0.002, p?<?.01), shorter incarceration(β?=?.03, p?<?.01) and randomization to yoga(β?=?6.92, p?<?.01) predicted lower levels of stress. Results indicate that reentry needs for people living with HIV and substance use disorder include basic life needs, social supports, and stress-coping interventions that address physical and mental stress symptoms (such as yoga).

     

Service Use Among Transition-Age Youth with Autism Spectrum Disorder

Journal of Autism and Developmental Disorders - This study explored predictors of service use among 174 transition-age youth (age 16–30) with an Autism Spectrum Disorder using...     

Association of Substance Use Patterns with Psychiatric Disorders in Homeless Persons with Psychiatric Disorders in Vancouver

International Journal of Mental Health and Addiction - Substance use and psychiatric disorders are highly prevalent in persons experiencing homelessness. We aimed to investigate the associations...     

Predictors of Community Functioning in Schizophrenia and Substance Use Disorder Patients

Community functioning is a broad term that encompasses various ‘real world’ measures of disability among schizophrenia patients. It includes outcomes such as independent living, social competence and behavioural problems—all of which are priorities for treatment among schizophrenia patients, mental health care providers, and family members. An important goal for rehabilitation programs is to identify predictors of community functioning which, in turn, could be used as targets for intervention. The present case–control study examined socio-demographic and substance use disorder (SUD) variables as well as psychiatric, extrapyramidal, and cognitive symptoms as predictors of community functioning in schizophrenia patients with (DD patients; n = 31) and without comorbid SUDs (SCZ patients; n = 31), and non-psychosis substance abusers (SUD patients; n = 39). Psychiatric and extrapyramidal symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia and the Extrapyramidal Symptoms Rating Scale. Cognition was evaluated using the Cambridge Neuropsychological Test Automated Battery (speed of processing, explicit and working memory). In SCZ patients, community functioning was predicted by explicit memory performance. In DD patients, community functioning was predicted by substance abuse, depression and speed of processing. In SUD patients, community functioning was predicted by substance abuse, positive symptoms and education. Our results suggest that cognition should be among the top treatment priorities in SCZ patients, whereas the key treatment targets in DD patients should be substance abuse and depression. Future studies will need to replicate the current findings, using prospective research designs.     

Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders

There is a significant need for advanced understanding of treatment of co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Approximately half of individuals seeking SUD treatment meet criteria for current PTSD, and individuals with co-occurring PTSD-SUD tend to have poorer treatment outcomes compared with those without such comorbidity. However, there is not sufficient empirical evidence to determine a best course of treatment for these individuals. This paper provides a review of the literature relevant to the treatment of co-occurring PTSD-SUD. To date, treatment studies have focused primarily on non-exposure-based psychosocial treatments, exposure-based psychosocial treatments, and medication trials. The most promising outcome data thus far are for psychosocial treatments that incorporate an exposure therapy component; however, further research is needed, particularly as related to how best to implement these approaches in real-world treatment settings.     

Psychoactive Substance Use Among Methadone Maintenance Therapy Clients in China

A proportion of methadone maintenance therapy (MMT) clients in China shifted their substance use habit from opiate to psychoactive substances. The objective of this study was to examine the pattern and associated factors of psychoactive substance use among MMT clients. The study was conducted among 2448 clients from 68 MMT clinics of China. The type and frequency of psychoactive substance use were self-reported. About 38.1% (N = 933) of the participants reported psychoactive substance use in their lifetime, and 6.5% (N = 158) in the previous 30 days. The most commonly used psychoactive substances were sedative/hypnotic/antidiarrheal agent and amphetamine. Psychoactive substance use in the past 30 days was correlated with younger age, recent heroin use, having psychoactive substance-using friend(s), and depressive symptoms. The finding suggested that urinalysis of psychoactive substances should be routinely administered in the MMT clinics. Young clients, concurrent heroin users, and clients with depressive symptoms deserve more screening and intervention efforts.     

Eating Disorder Behaviours and Substance Use in Women Attending Treatment for Substance Use Disorders: a Latent Class Analysis

International Journal of Mental Health and Addiction - Women with substance use disorders have a greater prevalence of eating disorders which can interfere with long-term recovery. In a sample of...     

Bulimia Nervosa and Substance Use Disorder: Similarities and Differences

The purpose of this study was to compare bulimia nervosa (BN) and substance use disorders (SUD) in cognitive-motivational terms. The cognitive orientation theory was used as a framework for testing the hypothesis that the commonality between BN and SUD consists of a similar motivational disposition for eating disorders, rather than for addiction, as was previously claimed. It was expected that BN and SUD patients would differ from controls but not from each other. The participants were 31 BN, 20 SUD, and 20 healthy controls. They were administered questionnaires for assessing anxiety, depression, addiction and the cognitive orientation for eating disorders. On most parameters BN and SUD scored higher than controls but did not differ from each other except in norm beliefs. Treatment of BN should consider the similarity of BN to SUD in the pathological tendency for eating disorders.     

Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders

Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.     

Substance Use Trends and Treatment Among Israeli School Dropouts

Widespread international concern exists about school dropout and substance use among high risk youth. This article examines the issue in Israel and the impact of a 90 day treatment program on a prospective sample of youth. A cohort of 77 youths completed a self-report questionnaire prior to receiving substance abuse treatment. These youth were compared to those attending and disengaged from school. With the exception of inhalants that tend to be a substance more commonly used by youth in school, dropouts report much higher rates of substance use especially those referred to treatment. For this population, the impact of a 90 day residential treatment program was evaluated. Results show the potential such treatment has on reducing substance use. Given the paucity of literature on this topic, this paper makes an initial contribution to understanding a growing problem of youth who have dropped out of school and who are substance users.