Evidence-Based Pharmacotherapy for Mood and Anxiety Disorders with Concurrent Alcoholism

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S6) ◽  
pp. 7-9 ◽  
Author(s):  
Kathleen T. Brady
Keyword(s):  
Substance Use ◽  
Psychiatric Disorder ◽  
American Psychiatric Association ◽  
Alcohol Use Disorders ◽  
Professional Experience ◽  
Evidence Based ◽  
The Face ◽  
A Prospective Study ◽  
Alcohol Dependent

Co-occurring psychiatric and alcohol use disorders can have devastating personal and societal effects, yet little evidence exists to guide clinical treatment. In the face of scant data, individual practitioners must rely instead on professional experience and those limited practice guidelines that currently exist. The American Psychiatric Association (APA) advises that failure to treat a concurrent psychiatric disorder reduces the likelihood that the treatment for a substance use disorder (SUD) will be effective. Indeed, the effects of nontreatment were demonstrated in a prospective study assessing alcohol-dependent patients for 1 year following hospitalization for alcohol dependence, in which untreated depression was directly associated with a shorter time to first drink. The results also showed that among those patients with depression (Slide 1), taking antidepressants at the time of discharge increased the likelihood of an individual remaining abstinent during the follow-up period.

Homeless youth in London: II. Accommodation, employment and health outcomes at 1 year

2000 ◽  
Vol 30 (1) ◽  
pp. 187-194 ◽  
Author(s):  
T. K. J. CRAIG ◽  
S. HODSON
Keyword(s):  
Substance Use ◽  
Young People ◽  
Psychiatric Disorder ◽  
Health Outcomes ◽  
Homeless Youth ◽  
Homeless People ◽  
Antisocial Behaviour ◽  
Medical Needs ◽  
The Impact

Background. While there is considerable evidence of a high prevalence of psychiatric disorder among homeless youth, much less is known about its long-term course or the impact it may have on accommodation outcomes.Method. A random sample of 161 homeless people 16–21 years of age were recruited from consecutive attendees at two of London's largest facilities for homeless young people. These young people were traced and re-interviewed a year later to examine accommodation, occupation and health outcomes.Results. A total of 107 (67%) people were successfully re-interviewed. Psychiatric disorder was identified in 55% at follow up. Two thirds of those with a psychiatric disorder at index interview remained symptomatic at follow-up. Persistence of psychiatric disorder was associated with adverse childhood experiences and rough sleeping. Satisfactory accommodation outcomes were achieved by 45 subjects (42%). Better accommodation outcomes were associated with three variables measured at the index assessment: ethnic minority status; educational achievement; and, the presence of accommodation plans negotiated through a resettlement agency. While psychiatric disorder at index interview was not associated with accommodation outcome, persistent substance use in the follow-up year was associated with poor accommodation outcome. Over half of the young people had been involved in petty crime and just under a third had been convicted for more serious criminal activity. Offending and antisocial behaviour in the follow-up year were related to a history of conduct disorder, persistent substance abuse and poor accommodation outcomes.Conclusions. Young homeless people are characterized by multiple social and medical needs. Successful resettlement of this population may depend upon integrated services that address problems of persisting substance use and mental illness as well as the immediate housing need.

scholarly journals Innovative Virtual Role-Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 (Preprint)

2021 ◽  
Author(s):  
Glenn Albright ◽  
Nikita Khalid ◽  
Kristen Shockley ◽  
Kelsey Robinson ◽  
Kevin Hughes ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Pilot Study ◽  
Problem Solving ◽  
Communication Strategies ◽  
Role Play ◽  
Evidence Based ◽  
Health Initiatives ◽  
Public Health Initiatives

BACKGROUND Substance use places a significant burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of interventions can supplement the work being done by existing public health initiatives. OBJECTIVE This pilot study examines the impact of the One Degree: Shift the Influence role-play simulation, designed to teach family, friends and coworkers to effectively manage problem-solving conversations with individuals that they are concerned about regarding substance use. METHODS Participants recruited for this mixed methods study completed a pre-survey, the simulation, a post survey, and were sent a six-week follow-up survey. The simulation involves practicing a role-play conversation with a virtual human coded with emotions, memory and personality. A virtual coach provides feedback in using evidence-based communication strategies such as motivational interviewing. RESULTS Matched sample ANOVA revealed significant increases at follow-up in composite attitudinal constructs of preparedness (P<.001) and self-efficacy (P=.012), including: 1) starting a conversation with someone regarding substance use, 2) avoiding upsetting someone while bringing up concerns, 3) focusing on observable facts, and 4) problem-solving. Qualitative data provided further evidence of the simulation’s positive impact on ability to have meaningful conversations about substance use. CONCLUSIONS This study provides preliminary evidence that conversation-based simulations like One Degree: Shift the Influence, that utilize role-play practice, can teach individuals to use evidence-based communication strategies and can cost-effectively reach geographically dispersed populations to support public health initiatives for primary prevention.

Initial assessment and management

2019 ◽  
pp. 55-65
Author(s):  
Navneet Kapur ◽  
Robert Goldney
Keyword(s):  
Mental Health ◽  
Psychiatric Disorder ◽  
Mental State ◽  
Psychological Treatment ◽  
Initial Assessment ◽  
Psychological Interventions ◽  
Evidence Based ◽  
Clinical Perspective ◽  
Suicidal Intent

This chapter takes a clinical perspective on the initial assessment and management of a person who presents with suicidal thoughts or behaviour. Establishing rapport is vitally important. Asking about suicidal intent, an enquiry about access to means of suicide, and an assessment of mental state are all required components of an assessment. A good assessment may itself be therapeutic. If there is evidence of a psychiatric disorder then appropriate evidence-based treatment should be initiated. Even when there is no evidence of a mental health problem, psychological interventions, follow-up, and other forms of support may be helpful. Research evidence suggests that we should consider offering formal psychological treatment to all those who present having harmed themselves.

scholarly journals Is dual use of nicotine products and cigarettes associated with smoking reduction and cessation behaviours? A prospective study in England

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e036055 ◽  
Author(s):  
Sarah E Jackson ◽  
Emma Farrow ◽  
Jamie Brown ◽  
Lion Shahab
Keyword(s):  
Cigarette Consumption ◽  
Evidence Based ◽  
Smoking Reduction ◽  
Dual Use ◽  
Over The Counter ◽  
Factors Associated ◽  
Quit Attempt ◽  
Quit Attempts ◽  
A Prospective Study

ObjectivesTo investigate associations of dual use of e-cigarettes and cigarettes with subsequent quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids). To overcome potential confounding by factors associated with use of pharmacological support, we selected dual use of over-the-counter nicotine replacement therapy (OTC NRT) and cigarettes as a behavioural control.DesignProspective cohort study with 6-month follow-up.SettingEngland, 2014–2016.Participants413 current smokers participating in the Smoking Toolkit Study, a representative survey of adults in England, who reported current use of e-cigarettes or OTC NRT and provided data at 6-month follow-up.Main outcome measuresThe exposure was dual use of e-cigarettes or OTC NRT at baseline. Outcomes were change in cigarette consumption, quit attempts and use of evidence-based cessation aids during quit attempts over 6-month follow-up. Relevant sociodemographic and smoking characteristics were included as covariates.ResultsAfter adjustment for covariates, dual e-cigarette users smoked two fewer cigarettes per day at follow-up than at baseline compared with dual OTC NRT users (B=2.01, 95% CI −3.62; −0.39, p=0.015). While dual e-cigarette users had 18% lower odds than dual OTC NRT users to make a quit attempt at follow-up (risk ratio (RR) 0.82, 95% CI 0.67 to 1.00, p=0.049), the groups did not differ in use of cessation aids (RR 1.06, 95% CI 0.93 to 1.21, p=0.388).ConclusionsDual use of e-cigarettes is associated with a greater reduction in cigarette consumption than dual use of OTC NRT. It may discourage a small proportion of users from making a quit attempt compared with dual OTC NRT use but it does not appear to undermine use of evidence-based cessation aids.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Increasing Adoption and Use of Evidence- Based Substance Use Screenings in Schools

2014 ◽  
Author(s):  
S. W. Evans ◽  
J. R. Koch ◽  
C. Brady ◽  
P. Meszaros ◽  
J. Sadler
Keyword(s):  
Substance Use ◽  
Evidence Based
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