Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

An improved comorbidity summary score for measuring disease burden and predicting mortality with applications to two national cohorts

Abstract

Research involving administrative healthcare data to study patient outcomes requires the investigator to account for the patient’s disease burden in order to reduce the potential for biased results. Here we develop a comorbidity summary score based on variable importance measures derived from several statistical and machine learning methods and show it has superior predictive performance to the Elixhauser and Charlson indices when used to predict 1-year, 5-year, and 10-year mortality. We used two large Veterans Administration cohorts to develop and validate the summary score and compared predictive performance using the area under ROC curve (AUC) and the Brier score.     

ADHD and its comorbidity: an example of gene–environment interaction and its implications for child and family social work

In many of their cases, child and family social workers, particularly those involved with abuse and neglect, will find themselves also working with children who have been diagnosed with attention deficit hyperactivity disorder (ADHD). The paper reviews current understandings and debates about the nature and causes of ADHD. Although modern evidence suggests the neurobiological basis of the condition and the effectiveness of medication in treating the behaviour, it is also recognized that the quality of the child's caregiving and social environment plays a significant role in the aetiology, maintenance and treatment of ADHD. Recognizing the part that psychosocial elements play in understanding the condition, child and family social workers can be valued members of multidisciplinary teams treating ADHD in which they offer support to parents, helping them to understand and manage their ADHD‐diagnosed child.     

The Relationship Between Divorce and Children with AD/HD of Different Subtypes and Comorbidity: Results from a Clinically Referred Sample

This study investigated the relationship between divorce and the symptom profile of children with attention deficit/hyperactivity disorder (AD/HD). The files of 1,201 children from a pediatric practice in Sydney, Australia were used in this study. Children were aged 6 to 18 years, and were diagnosed with either the inattentive or combined type of AD/HD. Results show that 213 children had parents who were divorced. Children with the combined type, and especially boys with comorbid conduct disorder/oppositional defiant disorder (CD/ODD) were more common in the divorced group, and children of the inattentive type with comorbid learning disabilities were overrepresented in nondivorced families. Results suggest that divorce is associated with disruptive behavior patterns in children with AD/HD. The importance of including marital status as an important correlate in AD/HD treatment outcomes is discussed.     

Comorbid mood and adjustment disorders among pathological gamblers seeking treatment in Hong Kong

Research findings on comorbidity and pathological gambling are non–existent in Chinese communities. The objectives of this study were to: (a) determine the prevalence of comorbid mood and adjustment disorders among pathological gamblers seeking treatment in Hong Kong; (b) compare demographic profiles and clinical features in pathological gamblers with and without comorbid mood and adjustment disorders; and (c) explore the association and temporal relationship between pathological gambling and comorbid mood and adjustment disorders. Assessment instruments included demographic data, BSI, SCID-I, ASI and LIFE-RIFT. Results showed that about two-thirds (63.7%; n = 128) of 201 participants reported lifetime comorbid psychiatric disorders. Most common comorbid disorders were mood disorders (29.4%; n = 59) and adjustment disorders (20.9%; n = 42). Pathological gamblers with comorbid mood or adjustment disorders showed more severe levels of psychopathology, impairment in psychosocial functioning and gambling problems. This study is important because it is the first scientific comorbidity study among pathological gamblers in a Chinese context.     

Problem Gambling and Comorbid Psychiatric and Substance Use Disorders Among Drug Users Recruited from Drug Treatment and Community Settings

Little is known about gambling rates of drug users recruited from drug treatment compared with those recruited from the community. We use the Diagnostic Interview Schedule (DIS) to provide lifetime prevalence estimates of problem gambling (i.e., at least one gambling problem) and DSM-III-R pathological gambling (i.e., at least four gambling problems) and describe the association between gambling and psychiatric disorders for drug users recruited from drug treatment settings (n = 512) and from the community (n = 478). We also report the relative risk of being a recreational and problem gambler in this sample. The sample was first interviewed in 1989–90 as a partof two NIDA-funded St. Louis-based studies. The prevalence of problem gambling in the overall sample was 22% and the prevalence of pathological gambling was 11%. There were no statistically significant differences in problem and pathological gambling rates for subjects recruited from drug treatment and those recruited from the community. The conditional prevalence rates, that is, the rate of problem and pathological gambling only among gamblers were 27% and 13.5%, respectively. Major findings indicate that problem gambling was associated with Antisocial Personality Disorder (ASPD), even after controlling for recruitment source and socio-demographic characteristics. In fact, when examining the temporal order of these disorders, we found that pathological gambling was always secondary to ASPD, occurring on average 11.4 years after the onset of ASPD. Problem gamblers, compared with everyone else, were more likely to be male, African-American, recruited from drug treatment, have ASPD and be dependent on illicit drugs. Multinomial logistic regression analysis predicted the relative risk of being a recreational and problem gambler (compared with a nongambler) in this sample according to socio-demographics, ASPD, and dependence on illicit drugs. Results imply that screening for gambling problems will need to be broad-based among drug users.     

Concurrent binge drinking and current tobacco use and its social and health correlates among adults in Laos

ABSTRACT

The aim of this study was to examine sociodemographic and health correlates of concurrent binge drinking and tobacco use in a national adult population in Laos. A cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2,543 individuals 18–64 years. Questionnaire interview, blood pressure, and anthropometric measurements, and biochemistry tests were conducted. Results indicate that 18.6% (38.3% in men and 5.2% in women) of the participants had engaged in concurrent current tobacco use and past month binge drinking, 15.2% in current tobacco use only and 28.4% in past month binge drinking only. Among current tobacco users, 42.2% engaged in frequent heavy drinking (3 or more times/month), and among past month heavy alcohol users, 55.8% were daily current tobacco users. In adjusted analysis, being 35 to 49 years old, lower education, having normal weight, and moderate or high physical activity were associated with concurrent current tobacco use and past month heavy drinking. Current tobacco use alone increased with age and decreased with education and heavy drinking alone decreased with age and increased with education. Findings suggest sociodemographic and health factors are important for public health interventions in addressing concurrent tobacco and alcohol use.     

Gambling Behaviors Among Oxford House Residents: A Preliminary Investigation

ABSTRACT

The present study investigated the prevalence of gambling behaviors among 71 individuals recovering from substance-dependent disorders and living in self-run recovery homes (Oxford Houses). Residents were given the South Oaks Gambling Screen to assess gambling behaviors and pathological gambling, and 19.7% of the sample was identified as having probable pathological gambling. These residents reported proportionately more involvement in a variety of gambling behaviors than other residents. Engagement in various gambling activities was consistent with previous investigations and suggested that self-run recovery homes such as Oxford Houses might be suitable referral sources for recovering persons who have comorbid gambling problems.     

Health Profiles and Profile-Specific Health Expectancies of Older Women and Men: The Netherlands

SUMMARY

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65–85 years. For both women and men, six profiles were found: I. cancer; II. “other” chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.