New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from an Unemployment Office Differ from Detoxification Treatment Inpatients?

Background: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). Results: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.

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Help-seeking behavior for problematic substance uses in Bahir Dar town, North-West Ethiopia

10.1101/363705 ◽

2018 ◽

Author(s):

Habte Belete ◽

Tesfa Mekonen ◽

Wubalem Fekadu ◽

Getasew Legas ◽

Asmamaw Getnet

Keyword(s):

Substance Use ◽

Mental Disorders ◽

Help Seeking ◽

Common Mental Disorders ◽

Bahir Dar ◽

Help Seeking Behavior ◽

Substance Users ◽

Seeking Behavior ◽

Problematic Substance ◽

History Of

AbstractBackgroundMental, neurological and substance use disorders are common, but 76% to 85% of people with those disorders in low and middle-income countries did not receive treatment.ObjectiveOur objective was to assess the level of help seeking behavior and associated factors among residents with problematic substance uses (alcohol, khat, tobacco and hashish).MethodsCommunity based cross sectional study was conducted in Bahir Dar town among total of 548 participants with problematic substance users. We had interviewed for help seeking behavior by pre-tested modified General Help Seeking Questionnaire. Logistic regression was done and p-value < 0.05 was used for declaration of significant level. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) have been used.ResultsAmong five hundred and forty-eight participants with problematic substance users, only one hundred and sixty-eight (30.7%) sought help for their substance related problems. Participants’ age above 35 years [AOR = .47 95% CI (.25, .90)], positively screened for common mental disorders [AOR = 4.12, 95% CI (2.7, 6.3)], comorbid medical [AOR = 3.0, 95% CI (1.7, 5.3)], and grand-families’ history of substance user [AOR = 2.18, 95% CI (1.4, 3.4)] found significantly associated with help seeking.ConclusionThere was low proportion of help seeking behavior among participants with problematic substance users. Advanced age was a barrier to seek help while medical illnesses, common mental disorders and history of substance use in grand families were found to enforce to seek help.

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M120. IMPAIRED CLINICAL INSIGHT AS A PREDICTOR OF RELAPSE IN SCHIZOPHRENIA

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.432 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S180-S181

Author(s):

Jean-Pierre Lindenmayer ◽

Anzalee Khan ◽

Philip Harvey ◽

Richard Keefe ◽

Lora Liharska ◽

...

Keyword(s):

Substance Use ◽

Age At Onset ◽

Treatment Compliance ◽

Chronic Schizophrenia ◽

Negative Consequences ◽

Care Providers ◽

Psychiatric Facility ◽

Inpatient Hospitalization ◽

Clinical Prognosis

Abstract Background Many individuals with chronic or treatment resistant schizophrenia experience multiple relapses or treatment failures during the course of the illness. Some of these relapses are due to poor treatment compliance that is inherent to schizophrenia. Poor insight may be a leading cause for partial- or non-adherence to treatment as a high proportion of individuals with schizophrenia are partially or completely unaware of their mental disorder. The first two years after stabilization are thought to be key for long-term functional and clinical prognosis. In the present study, we first estimated the rate of treatment failure or relapse following clinical stability at one and two years, investigate the time to occurrence of relapse among individuals with chronic schizophrenia and the association between baseline clinical features recorded during the inpatient hospitalization and relapse at one- and two-year time points. We hypothesized that lack of insight, as measured by the PANSS item G12, would be a greater predictor of relapse than other characteristics previously suggested as possible predictors, including other symptoms from the PANSS, age, duration of illness, age at onset of illness, substance use, number of prior hospitalizations, and length of stay of the pre-discharge hospitalization. Methods A total of 138 participants diagnosed with schizophrenia or schizo-affective disorder were assessed with a comprehensive assessment at one year and two-year following discharge from a long-term psychiatric facility. Regression models were used to determine factors predicting time to relapse and other elements of functioning. Baseline factors examined included PANSS, MCCB, PSP, demographics and treatment variables. Results Relapse rates were 56.52% (n=78 of 138) by Year 1, and 69.56% (n=96 of 138) by end of Year 2. The estimated relapse-free period for all individuals at the end of the study was 8.78 months. The backward elimination (–2 log likelihood=189.59, χ2=9.01, df=2, p=.021) showed that the best predictive variables for relapse were lack of insight/judgment as assessed by PANSS item G12 at baseline (B=.20, SE=.09, df=1, p=.011, Exp[B]=1.36), lifetime years of substance use (B=.16, SE=.11, df=1, p=.029, Exp[B]=1.33), PANSS Factor baseline score on Disorganization (B=.15, SE=.12, df=1, p=.031, Exp[B]=1.56), and number of previous hospitalizations (B=.13, SE=.11, df=1, p=.048, Exp[B]=1.23). No other baseline variables were found to be significant. Discussion Poor insight is a fundamental symptom of schizophrenia that, while not entirely and uniformly expressed in all individuals, is among the most common symptoms across subjects. Our study shows that the numerous negative consequences of lack of insight should lead clinicians and researchers to make insight a high priority for allocation of clinical resources. Effective approaches to managing these predictive characteristics will allow affected individuals and their families and care providers to take part in collaborative treatment and relapse risk-management paradigms.

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A 12-year follow-up of a sample of patients dependent upon heroin

International Psychiatry ◽

10.1192/s1749367600005282 ◽

2007 ◽

Vol 4 (4) ◽

pp. 94-95 ◽

Cited By ~ 1

Author(s):

Saima Niaz ◽

Nadia Arshad ◽

Mariam Haroon ◽

Fahd A. Cheema ◽

Khalid A. Mufti ◽

...

Keyword(s):

Opioid Dependence ◽

Age At Onset ◽

Heroin Addiction ◽

Long Term Follow Up ◽

History Of ◽

Employment Rates ◽

Opium Use ◽

Significant Mortality

Heroin addiction is a chronic, relapsing and remitting condition. Each year 2–5% of addicts discontinue drug use permanently and 1–2% die, mostly of overdose (Robins, 1993). A study of 129 opiate-addicted patients on a monthly maintenance regimen found that those with a family history of opium use had an earlier age at onset (Chaudhry et al, 1991). Long-term follow-up studies of people who misuse opiates have revealed that opioid dependence appears to run a chronic, relapsing and remitting course with a significant mortality (10–15%) over 10 years (Robson, 1992). Metrebian et al (1998) reported that long-term heroin abstinence was associated with less criminality, psychological distress and morbidity; Hser et al (2001) reported it was associated with higher employment rates.

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Mental disorders as a worldwide public health issue

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780199696758.003.0003 ◽

2012 ◽

pp. 10-13

Author(s):

Benedetto Saraceno

Keyword(s):

Public Health ◽

Mental Health ◽

Health Care ◽

Substance Use ◽

Mental Disorders ◽

Communicable Diseases ◽

Health Priorities ◽

Public Health Issue ◽

Treatment Gap ◽

Brain Disorder

The twentieth century has witnessed significant improvements in somatic health in most countries. A number of key public health threats have been eradicated or brought under control under the leadership of WHO. Priority was given to communicable diseases in view of their inherent potential to spreading. At the present time, a focus on non-communicable diseases and mental health would now appear as the next natural step in public health priorities. In the case of mental health, this is due to the capacity of mental disorders to proliferate not only as a result of complex and multiple biological, psychological but also social determinants. WHO estimates that at any given time 450 million people suffer from some form of mental or brain disorder, including alcohol and substance use disorders. In other words, one in four of the world’s population suffer from different forms of mental, behavioural, and neurological disorders. This chapter looks at the economic and social costs of mental disorders, global resources for mental health, the treatment gap for mental disorders, and improving mental health care.

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Substance Use Disorders

Management of Sleep Disorders in Psychiatry ◽

10.1093/med/9780190929671.003.0022 ◽

2020 ◽

pp. 372-386

Author(s):

Shirshendu Sinha ◽

Bhanu Prakash Kolla ◽

Meghna P. Mansukhani

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Sleep Disturbances ◽

Time Course ◽

Drugs Of Abuse ◽

Treatment Options ◽

Treatment Strategies ◽

Specific Treatment ◽

Early Recovery ◽

Individual Substance

Sleep disturbances although highly prevalent conditions in patients with substance use disorders, they are underreported, underrecognized, underdiagnosed, and often untreated. Alcohol and various drugs of abuse interfere with the initiation and maintenance of sleep. The sleep disturbances can be experienced during active substance use including intoxication as well as during early recovery. Literature also indicates insomnia is a risk factor for substance abuse. Thus sleep disturbances can play a major role in initiating and maintaining substance use and increase the risk of relapse. This review describes the existing literature on the bidirectional relationships between sleep disturbances and substance use disorders in the context of alcohol, cannabis, opioid, and cocaine use disorders. Evidence with regards the type and severity of the sleep disruption, its time course, relationship to relapse, and treatment options when available are discussed. Specific treatment strategies focused on individual substance-related sleep disturbances will improve global outcome in substance use disorders and sleep and enhance the quality of life of the patients.

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Levels of mental distress over 18 years after entering treatment for substance use disorders: A longitudinal cohort study

Nordic Studies on Alcohol and Drugs ◽

10.1177/1455072520947249 ◽

2020 ◽

Vol 37 (4) ◽

pp. 352-364

Author(s):

Arne Jan Hjemsæter ◽

Jørgen G Bramness ◽

Robert Drake ◽

Ivar Skeie ◽

Bent Monsbakken ◽

...

Keyword(s):

Substance Use ◽

Mental Disorders ◽

Substance Use Disorders ◽

Mental Distress ◽

Integrated Treatment ◽

Reciprocal Relationship ◽

Problematic Substance Use ◽

Identification Test ◽

Problematic Substance ◽

Over Time

Aims: The aims were to investigate whether baseline characteristics and problematic substance use were related to change in mental distress over time in patients with substance use disorders during an 18-year period. Method: This was a prospective, longitudinal study of patients followed for 18 years after entering specialised treatment for substance use disorders. A sample of 291 patients was recruited in 1997 and 1998. Mental distress was measured using the Hopkins Symptom Checklist 25 at baseline, and at six and 18 years. Lifetime psychiatric disorders and substance use disorders at baseline were measured using the Composite International Diagnostic Interview, while personality disorders were measured using the Millon Clinical Multiaxial Inventory II. At the six- and 18-year follow-ups, substance use was measured using the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Linear mixed model was estimated to assess the overall level of mental distress over 18 years for participants with complete data at baseline ( n = 232). Results: In an adjusted model, problematic substance use assessed simultaneously with mental distress, having lifetime affective, anxiety and personality disorder at baseline were associated with greater levels of mental distress over the 18-year period. The change in mental distress from baseline to the six-year, but not to the 18-year, follow-up was significantly larger among females than among males. Conclusion: The results suggests a reciprocal relationship over time between substance use and mental health problems. Also, there seems to be an additive effect between ongoing problematic substance use and lifetime mental disorders on greater levels of mental distress. This addresses the importance of integrated treatment for both substance use disorders and mental disorders to improve the long-term course for patients with these comorbid disorders.

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Substance use in pregnancy: The medical challenge

Obstetric Medicine ◽

10.1177/1753495x17750299 ◽

2018 ◽

Vol 11 (2) ◽

pp. 54-66 ◽

Cited By ~ 8

Author(s):

Kerry-Ann Louw

Keyword(s):

Substance Use ◽

Child Outcomes ◽

Critical Window ◽

Child Health Outcomes ◽

Problematic Substance Use ◽

Problematic Substance ◽

Health And Development ◽

The Impact ◽

In Pregnancy

Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.

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Mental disorders, disability and treatment gap in a protracted refugee setting

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.120535 ◽

2014 ◽

Vol 204 (3) ◽

pp. 208-213 ◽

Cited By ~ 19

Author(s):

Augusto E. Llosa ◽

Zeina Ghantous ◽

Renato Souza ◽

Fabio Forgione ◽

Pierre Bastin ◽

...

Keyword(s):

Mental Disorders ◽

Mental Disorder ◽

Mental Health Treatment ◽

Odds Ratio ◽

Refugee Camps ◽

Treatment Gap ◽

Common Diagnosis ◽

Prevalence Estimates ◽

Weighted Prevalence

BackgroundStudies have shown high levels of distress and mental disorder among people living in refugee camps, yet none has confirmed diagnosis through clinical reappraisal.AimsTo estimate the prevalence of mental disorders, related disability and treatment gap in adult refugees living in the Burj el-Barajneh camp.MethodRandomly selected participants were screened by household representative (n = 748) and individual (n = 315) interviews; clinical reappraisal was performed on a subset (n = 194) of 326 selected participants. Weighted prevalence estimates and 95% confidence intervals were calculated.ResultsThe prevalence of current mental disorders was 19.4% (95% CI 12.6–26.2); depression was the most common diagnosis (8.3%, 95% CI 4.4–12.2) and multiple diagnoses were common (42%) among the 88 persons with mental disorder. Lifetime prevalence of psychosis was 3.3% (95% CI 1.0–5.5). Mental disorders were associated with moderate to severe dysfunction (odds ratio = 8.8, 95% CI 4.5–17.4). The treatment gap was 96% (95% CI 92–100).ConclusionsA range of mental disorders and associated disability are common in this long-term refugee setting. Combined with an important treatment gap, findings support the current consensus-based policy to prioritise availability of mental health treatment in refugee camps, especially for the most severe and disabling conditions.

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Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority

BMC Cancer ◽

10.1186/s12885-019-6181-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 26

Author(s):

Claire L. Niedzwiedz ◽

Lee Knifton ◽

Kathryn A. Robb ◽

Srinivasa Vittal Katikireddi ◽

Daniel J. Smith

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Cancer Treatment ◽

Common Mental Disorders ◽

Treatment Options ◽

Future Research ◽

Depression And Anxiety ◽

Substantial Impact ◽

Prevalence Of Depression

Abstract Background A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety. We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high-quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited. Conclusion Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.

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