Barriers to comorbidity service delivery: the complexities of dual diagnosis and the need to agree on terminology and conceptual frameworks

2010 ◽  
Vol 34 (3) ◽  
pp. 262 ◽  
Author(s):  
Rachel Canaway ◽  
Monika Merkes
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Service Delivery ◽  
Substance Use Disorders ◽  
Service Provision ◽  
Service Providers ◽  
Complex Problem ◽  
Conceptual Frameworks ◽  
Treatment Service ◽  
Variable Nature

This paper draws from a literature review commissioned as part of a larger project evaluating comorbidity treatment service models, which was funded by the Australian Government Department of Health and Ageing as part of the National Comorbidity Initiative. The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. This paper outlines conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, particularly around the variable nature of comorbidity, and the impacts of the separation of the mental health (MH) and alcohol and other drug (AOD) sectors with their differing institutional cultures, aetiological concepts, philosophical underpinnings, educational requirements, administrative arrangements, and screening and treatment approaches. Issues pertaining to the lack of consistent definitions and conceptual frameworks for comorbidity are discussed, particularly in relation to the reported lack of communication, collaboration, and linkages between the sectors. It is suggested that the adoption of consistent terminology and conceptual frameworks may provide a valuable step towards consistency in service provision and research and could lead to improved capacity to address the many issues relating to comorbidity service provision and treatment efficacy. What is known about the topic?The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. However, the service system is not sufficiently developed and coordinated to serve clients with comorbid problems well. What does this paper add?This paper summarises the issues pertaining to conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, including the different aetiologies of comorbidity and types and settings of service providers. What are the implications for practitioners?There is a need for practitioners and other stakeholders to agree on consistent terminology and framework(s) relevant to comorbidity to overcome the barriers and complexities that currently limit service delivery and access to treatment.

scholarly journals Perspectives of Service Providers on Aftercare Service Provision for Persons with Substance Use Disorders at a Rural District in South Africa.

2021 ◽  
Author(s):  
December Mandlenkosi Mpanza ◽  
Pragashnie Govender ◽  
Anna Voce
Keyword(s):  
South Africa ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Service Provision ◽  
Service Providers ◽  
Rural District ◽  
Aftercare Services ◽  
Policy Level ◽  
Rural Context ◽  
Aftercare Service

Abstract Background: Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should achieve successful reintegration of persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores the perspectives of service providers in aftercare service provision for PWSUD in a rural district.Methods: A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data.Results: Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations. Conclusions: The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.

scholarly journals Prevalence of Mental Disorders and Suicidality in Canadian Provinces

2019 ◽  
Vol 64 (11) ◽  
pp. 761-769
Author(s):  
Joshua Palay ◽  
Tamara L. Taillieu ◽  
Tracie O. Afifi ◽  
Sarah Turner ◽  
James M. Bolton ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
Service Providers ◽  
The Past ◽  
Canadian Provinces

Objective: There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality. Method: Data were extracted from the 2012 Canadian Community Health Survey—Mental Health ( n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed. Results: The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%). Conclusions: Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.

Screening for Mental Health and Substance Use Disorders

2006 ◽  
Author(s):  
Richard R. Owen ◽  
Kathryn M. Magruder ◽  
Ralph H. Johnson ◽  
Daniel R. Kivlahan
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders

scholarly journals Reducing Substance Use and Improving Mental Health Among Construction Workers: An Interview With Chris Trahan Cain

2021 ◽  
pp. 104829112110301
Author(s):  
Alando Hall
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Occupational Safety ◽  
Task Force ◽  
Construction Workers ◽  
Building Trades ◽  
The North ◽  
Safety And Health ◽  
Prevention Methods

Construction workers, their unions, and the construction industry face important challenges in addressing substance use disorders and mental health issues. To examine these issues further, we spoke with Chris Trahan Cain, Executive Director of CPWR—The Center for Construction Research and Training, a nonprofit organization that is affiliated with North America’s Building Trades Unions and the National Institute for Occupational Safety and Health. As the chair of the North America’s Building Trades Unions opioid task force, she has been working with construction unions and employers to develop primary, secondary, and tertiary prevention methods to help combat the opioid epidemic, other substance use disorders and to improve worker mental health.

scholarly journals Perceived family cohesion, social support, and quality of life in patients undergoing treatment for substance use disorders compared with patients with mental and physical disorders

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bente Birkeland ◽  
Bente Weimand ◽  
Torleif Ruud ◽  
Darryl Maybery ◽  
John-Kåre Vederhus
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Family Cohesion ◽  
Service Providers ◽  
Cancer Data ◽  
Physical Disorders ◽  
Patient Groups

Abstract Purpose Support from family and other social network elements can be important in helping patients to cope with practical and emotional consequences of diseases. The aim of the study was to examine perception of family and social support and quality of life (QoL) in patients undergoing treatment for substance use disorders (SUDs). We compared them with patients in treatment for mental disorders (MDs) and physical disorders (PDs). Methods We used data from a national multicenter study that recruited patients (N  =  518) from three treatment domains; SUD treatment units, MD treatment units, and PD treatment units (severe neurological conditions or cancer). Data on family cohesion, social support, and QoL were compared across patient groups. In addition, data on health variables was collected. We used a multiple linear regression procedure to examine how health and support variables were associated with QoL. Results Family cohesion and social support in the SUD and MD groups were rated at similarly low levels, substantially lower than in the PD group. The SUD group exhibited a somewhat lower QoL than did the PD group, but their QoL was still in the near-to-normal range. In contrast, the MD group had markedly low QoL. When examining factors associated with QoL, we found that greater family cohesion and social support were positively associated with QoL. Mental distress was the strongest factor, and was negatively associated with QoL (beta − 0.15, 95% CI  =  − 0.17/− 0.14, p  <  0.001). Conclusion Service providers need to be aware of the weaker networks and less regulatory family and/or social support available to patients with SUDs. Providers should focus consistently on the social networks of patients and include patients’ families in treatment processes.

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