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Volume 15
Issue 1
Online publication date 2014-03-12
Title Evaluation of the qualitative and quantitative characteristics of dual diagnosis (Pilot Study)
Author Maria Prodromou, Savoula Ghobrial, Koukia Eumorfia
Abstract
Dual diagnosis can be defined as a combination of a substance use disorder and a coexistent psychiatric disorder in one patient. It constitutes a challenge for Therapeutic Rehabilitation Programme, because of its multifaceted nature. This pilot study was conducted using a naturalistic approach to study for eighteen months, Clients were admitted as inpatients in Residential Therapeutic Rehabilitation Program offered by the Mental Health Services in Cyprus. 

Methods: Forty-five consecutive patients admitted to the Residential Therapeutic Rehabilitation Program (RTRP) under the Mental Health Services in Cyprus during the period of January 2009 to June 2010. Primary outcomes were the coexistence of psychiatric disorder and substance use disorder, the client profile with dual diagnosis and treatment retention. The EuropASI questionnaire and examination of personal records were used, which included the psychiatric diagnosis of the patients according to the DSM-IV.

Results: A total of forty five patients were used, 30 were males (80%) with mean age 27.5 ± 6.7, and 15 were females, (20%) with mean age 26.4 ± 4.1. The study revealed that 33.3% of patients suffered with psychiatric disorder with coexistence of drug dependency, thus, showing that only a minority of patients admitted to the (RTRP) in Mental Health Services have double diagnosis. Additionally the most commonly appeared psychiatric disorder is mood disorder. The psychiatric disorder is often associated with the main drug use (heroin, cocaine, THC e.t.c), further more patients diagnosed with double diagnosis often abandoned the Residential Rehabilitation Program early. Results support that the group of dually diagnosed and the group with drug-dependence are showing differences in relation to their treatment retention. In conclusion, the results have shown the individual characteristics of the clients with dual diagnosis in comparison with clients with substance use disorder. The characteristics included e.g. the educational background, their occupation, their police record, their family and interpersonal relationships.

Conclusion: Despite the fact that the minority of the patients admitted in (RTRP) have double diagnosis, this study reports that patients with dual diagnosis live treatment earlier than patients with drug addiction only. Dual diagnosis negatively affect prognosis in patients with drug dependence. Concluding this pilot study is supporting those clients that are diagnosed with co morbid disorder should be assessed and evaluated at the beginning of their treatment in order to offer them care that is meeting their needs and encourage them to adhere with their treatment.
Citation
References
Alexandrakou, P., Velentza, Κ., Aivalioti, C., Kiovreki, Α., Manousis, Ν., 2004. “Comorbidity study of substance users in a population of 1963 patients nursed during the last three years in the clinic,” Galini. Psychiatry, Vol.15(1), pp.144

Baker, A., Lewin, T., Reichler, H. Clancy, R., Carr, V., Garrett, R. et al., 2002. "Evaluation of a motivational interview for substance use within psychiatric in-patient services," Addiction, Vol.97(10), pp.1329-37, http://dx.doi.org/10.1046/j.1360-0443.2002.00178.x
 
Brewer, D.D., Catalano, R.F., Haggerty, K., Gainey, R.R., Fleming, C.B, 1998. "Research report. A meta-analysis of predictors of continued drug use during and after treatment for opiate addiction," Addiction, Vol.93(1), pp.73-92, http://dx.doi.org/10.1046/j.1360-0443.1998.931738.x
 
Bunt, G. C. Muehlbach, B. Moed, C. O. (2008). "The therapeutic community: an international perspective," Substance Abuse, Vol.29(3), pp.81-7, http://dx.doi.org/10.1080/08897070802218844
 
Cacciola, J.S., Alterman, A.I., McLellan, A.T.,Lin, Y.T., & Lynch, K.G, 2007. "Initial evidence for the reliability and validity of a lite version of the addiction severity index," Drug and Alcohol Dependence, Vol.87(2-3), pp.297-302, http://dx.doi.org/10.1016/j.drugalcdep.2006.09.002
 
Cheryl, D., Swofford, J., Kasckow, W., Geri Scheller-Gilkey, Lawrence, B.I., 1995. "Substance use: A powerful predictor of relapse in schizophrenia," Schizophrenia Research, Vol.20, pp.145-151
 
Chouljian, T.L., Shumway, M., Balancio, E., Dwyer, E.V., Surber, R., Jacobs, M., 1995. "Substance use among schizophrenic outpatients: Prevalence, course, and relation to functional status," Ann Clin Psychiatry, Vol.7(1), pp.19-24, http://dx.doi.org/10.3109/10401239509149020
 
De Leon, G., Ziegenfuss, Jr., 1986. "Therapeutic communities for addictions: Perspective and approach," In: De Leon, G. & Zeigenfuss (Eds.), The therapeutic community treatment for addictions theory research and practice, Springfield Illinois Charlew C Thomas
 
De Leon, G., Wexler, H.K., and Jainchill, N., 1982. "The therapeutic community: Success and improvement rates 5 years after treatment," The international Journal of the Addictions, Vol.17(4), pp.703-747
 
Ding, K., Yank, J., Cheng, G., Schiltz, T., Summers, M.K., Skinstad, A.H., 2011. "Hospitalizations and hospital charges for co-occuring substance use and mental disorders," Journal of Substance Abuse Treatment, Vol.40, pp.366-375, http://dx.doi.org/10.1016/j.jsat.2010.12.005
 
Drake, R.E., Osher, F.C., Wallach, M.A., 1989. "Alcohol use and abuse in schizophrenia: A prospective community study", J Nerv Ment Dis., Vol.177(7), pp.408-14, http://dx.doi.org/10.1097/00005053-198907000-00004
 
Drake, R.E., Mercer-McFadden, C., Mueser, K.T., McHugo, G.J., Bond, G.R., 1998. "Review of integrated mental health and substance abuse treatment for patients with dual disorders," Schizophr Bull., Vol.24(4), pp.589-608, http://dx.doi.org/10.1093/oxfordjournals.schbul.a033351
 
European Monitoring Center for Drugs and Drug Addiction - Annual Report 2007
 
Havassy, B., Allvidrez, J., Owen, K., 2004. "Comparisons of patients with comorbid psychiatric and substance use disorders: Implications for treatment and service delivery," Am J Psychiatry, January, Vol.161, pp.139-145
 
Kessler, R., 2004. "The epidemiology of dual diagnosis," Biol Psychiatry, Vol.56, pp.730-737, http://dx.doi.org/10.1016/j.biopsych.2004.06.034
 
Kokkevi, A., Stefanis, C.N., 1995. Psychiatric co morbidity in substance abuse department of psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece
 
Kokkevi, A., Stefanis, N., Anastasopoulou, E., Kostogianni, C., 1998. "Personality disorders in drug abusers: Prevalence and their association with AXIS I disorders as predictors of treatment retention," Addiction Behaviour, Vol.23(6), pp.841-53,
http://dx.doi.org/10.1016/S0306-4603(98)00071-9
 
Liang, W., Chikritzhs, T., 2011. "Affective disorders, anxiety disorders and the risk of alcohol dependence and misuse," The British Journal of Psychiatry, Vol.199, pp.219-224, http://dx.doi.org/10.1192/bjp.bp.110.086116
 
Moore, T. H. M. Zammit, S. Lingford- Hughes, A. Barnes, T. R.E. Jones, B. P Burke, M. Lewis, G., 2010. "Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review," Lancet, Vol.370, pp.319-28, http://dx.doi.org/10.1016/S0140-6736(07)61162-3
 
Moragues, E.V., Gonzalez-Saiz, F., Lozano, M.O., Espinosa, P.B., Calderon, F.F. Acebos, I.B., Garcia, M.P., Garcia, A.V., 2012. "Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders," Elsevier Psychiatry Research, Vol.200, pp.734-741,
http://dx.doi.org/10.1016/j.psychres.2012.07.043
 
Mastrigt, V.S. Addington, D. Addington, J., 2004. Substance misuse at presentation to an early psychosis program, Vol.39, pp.69-72
 
Maser, J. D. & Patterson, T., 2002. "Spectrum and nosology: Implications for DSM-5," Psychiatric clinics of North America, December, Vol.4, pp.855-885
 
McLellan, A.T, Cacciola, J.S., Alterman, A.I., Rikoon, S.H. & Carise, D., 2006. "The addiction severity index at 25: Origins, contributions and transitions," American Journal of Addiction, Vol.15(Issue2), pp.113-124, http://dx.doi.org/10.1080/10550490500528316
 
McKeown, O., 2010. "Definition, recognition and assesment of dual diagnosis," In: Philips, P., McKeown, O. and Sandford, T. (Eds.), Dual diagnosis practice in context, pp.1-13
 
Menezes, P.R., Johnson, S. Thornicroft, G., 1996. "Drug and alcohol problems among individuals with severe mental illness in south London," Br j Psychiatry, Vol.168, pp.612-19, http://dx.doi.org/10.1192/bjp.168.5.612
 
Moline, R.A., 1977. "The therapeutic community and milieu therapy: A review and current assessment," Community Ment Health Rev., Vol.2(5)1, pp. 3-13
 
Mueser, K.T, Bennett, M, and Kushner, M.G., 1995. "Epidemiology of substance use disorders among persons with chronic mental illnesses," In: Lehman, A.F. and Dixon, L. (Eds.), Double jeopardy: Chronic mentall illness and substance abuse, New York, NY: Harwood Academic Publishers, pp.9-25
 
Najt, P. Fusar-Poli, P. Brambilla, P., 2011. "Co-occuring mental and substance abuse disorders: A review on the potential predictors and clinical outcomes," Psychiatry Res, Vol.186, pp.159-164, http://dx.doi.org/10.1016/j.psychres.2010.07.042
 
Negrete, J.C., 2003. "Clinical aspects of substance abuse in persons with schizophrenia," Can J Psychiatry, Vol.48(1), pp.14-21
 
Nestler, E.J., and Carlezon, W.A., 2006. "The mesolimbic dopamine reward circuit in depression," Biol Psychiatry, Vol.59(12), pp.1151-1159
http://dx.doi.org/10.1016/j.biopsych.2005.09.018
 
Osher, F.C., Drake, R.E., Noordsy, D.L., Teague, G.B., Hurlbut, S.C. Biesanz, J.C. et al., 1994. "Correlates and outcomes of alcohol use disorder among rural outpatients with schizophrenia," J Clin Psychiatry, Vol.55(3), pp.109-13
 
Prendergast, M. Podus, D., Finney, J., Greenwell, L., Roll, J., 2006. "Contingency management for treatment of substance use disorders: A meta-analysis. Addiction," Vol.101(11), pp.1546-60, http://dx.doi.org/10.1111/j.1360-0443.2006.01581.x
 
Quello, S.B., Brady, K.T., and Sonne, S.C., 2005. "Mood disorders and substance abuse disorders: A complex comorbidity," Science & Practice Perspectives, Vol.3(1), pp.13-24, http://dx.doi.org/10.1151/spp053113
 
Rady, A., Salama, H., Elkholy, O., & Shawky, A., 2013. "845-Dual diagnosis of anxiety disorders and substance abuse: The need for awareness," European Psychiatry, Vol.28 (Supplement1)
 
Robinson, J. Sareen Brian, J. Cox, J. Bolton, M., 2011. "Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitundinal investigation," Arch Gen Psychiatry, Vol.68(8), pp.800-807,
http://dx.doi.org/10.1001/archgenpsychiatry.2011.75
 
Sacks, S., McKendrick, K., Sacks, J.Y., Cleland, C.M., 2010. "Modified therapeutic community for co-occurring disorders: single investigator meta analysis," Subst Abus, Vol.31(3)pp.146-61, http://dx.doi.org/10.1080/08897077.2010.495662
 
Specka, M., Boning, A., Scherbaum, N., 2011. "Contingency management in opioid substitution treatment," Fortschr Neurol Psychiatr, Vol.79(7), pp.395-403,
http://dx.doi.org/10.1055/s-0029-1245810
 
Sorensen, J.L., Andrews S, Delucchi KL, Greenberg B, Guydish J, Masson CL, et al., 2009. "Methadone patients in the therapeutic community: A test of equivalency," Drug Alcohol Depend, Vol.100(1-2), pp.100-6, http://dx.doi.org/10.1016/j.drugalcdep.2008.09.009
 
Stitzer, M.L., Vandrey, R., 2008. "Contingency management: Utility in the treatment of drug abuse disorders," Clin Pharmacol Ther., Vol.83(4), pp.644-7
http://dx.doi.org/10.1038/sj.clpt.6100508
 
Strang, J. McCambridge, J. Best, D. Beswick, T., Bearn, J., Rees, S. et al., 2003. "Loss of tolerance and overdose mortality after inpatient opiate detoxification: Follow up study," BMJ, Vol.326(7396), pp.959-60, http://dx.doi.org/10.1136/bmj.326.7396.959
 
Swendsen, J., Conway, K.P., Degenhardt, L., Glantz, M., Jin, R., Merikangas, K.R., Sampson, N., Kessler, R., 2010. "Mental disorders as risk factors for substance use, abuse and dependence: Results from the 10-year follow-up of the National Comorbidity Survey," Addiction Journal, Vol.105, pp.1117-1128, http://dx.doi.org/10.1111/j.1360-0443.2010.02902.x
 
Villagonzalo, K. A. Dodd, S. Ng, F. Mihaly, S. Langbein, A. Berk, M., 2011. "The relationship between substance use and posttraumatic stress disorder in a methadone maintenance treatment program," Comprehensive Psychiatry, Vol.52, pp.562-566, http://dx.doi.org/10.1016/j.comppsych.2010.10.001
 
Watkins, E.K., Hunter, S.B., Wenzel, S.L., Tu, W., Paddock, M.S., Griffin, A., Ebener, P., 2004. "Prevalence and characteristics of clients with co-occurring disorders in outpatient substance abuse treatment," American Journal of Drug and Alcohol Abuse, Vol.30, No.4, pp.749-764, http://dx.doi.org/10.1081/ADA-200037538
 
Wise, B.K., Cuffe, S.P., Fischer, T., 2001. "Dual diagnosis and successful participation of adolescents in substance abuse treatment," Journal of Substance Abuse Treatment, Vol21(3), pp.161-5, http://dx.doi.org/10.1016/S0740-5472(01)00193-3
 
Keywords Psychiatric disorder, dual diagnosis, drug addiction, substance use disorder, treatment retention
DOI http://dx.doi.org/10.15208/mhsj.2014.02
Pages 8-19
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