Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs.

Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs.

J Dual Diagn. 2013 4; 9(2): 179-186
Padwa H, Larkins S, Crevecoeur-Macphail DA, Grella CE

Improved understanding of the relative strengths and weaknesses of treatment organizations’ dual diagnosis capability is critical in order to guide efforts to improve services. This study assesses programs’ capacity to meet the needs of clients with dual diagnosis, identifies areas where they are well equipped to serve these clients, and determines where programmatic improvement is needed. The study also undertakes an initial exploration of the potential impact that funding sources have on dual diagnosis capability.We administered Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments at 30 treatment programs in two California counties. Seven of the programs received funding to provide both mental health and substance use disorder services, 13 received funding to provide mental health services, and 10 received funding to provide substance use disorder services.The mean DDCAT/DDCMHT score of programs in the sample was 2.83, and just over 43% of the sample met or exceeded DDCAT/DDCMHT criteria for dual diagnosis capability. Programs scored highest and had the highest rates of dual diagnosis capability in domains related to assessment, training, and staffing, whereas scores were weakest and rates of dual diagnosis capability were lowest in the program structure, treatment, and continuity of care domains. Programs that received funding to provide both mental health and substance use disorder services consistently scored higher than the other programs in the sample, and mental health programs scored higher than substance use disorder treatment programs both on the overall assessments and in most domains.Findings suggest that programs in the sample are functioning at a nearly dual diagnosis capable level. However, structural barriers continue to limit providers’ capacity to serve clients with co-occurring mental health and substance use disorders, and many organizations have not yet translated their potential to deliver dual diagnosis capable services into practice. By enhancing their program structure, treatment services, and continuity of care services, these treatment organizations should be able to deliver fully dual diagnosis capable services. Observed differences in dual diagnosis capability based on funding source indicate a need for further research to better understand the impact that funding streams have on dual diagnosis capability. HubMed – addiction


The Feasibility of a Holistic Wellness Program for HIV/AIDS Patients Residing in a Voluntary Inpatient Treatment Program.

J Holist Nurs. 2013 May 17;
Morgan V

The purpose of this project was to examine the feasibility of an ongoing holistic wellness program in a residential facility treating persons with HIV/AIDS. The goal was to create a voluntary, four week holistic wellness intensive within the established inpatient behavioral health treatment program. Participants were given practicable holistic self care tools to effectively manage HIV related symptoms, general medical issues, addiction, depression, stress and anxiety. The program incorporated evidence-based holistic activities including yoga, therapeutic dance, meditation, Reiki, and reflective journaling. Narrative survey results and post-program evaluation support that an ongoing holistic wellness program within the existing treatment model is feasible and could have numerous potential beneficial effects. This project clearly exemplified the ideal opportunity for holistic nurses to implement innovative holistic interventions within the current healthcare delivery system. It is the author’s observation that future studies with a larger participant group to further examine measurable benefits can lend valuable information and insight into the future development of holistic wellness programs for residential treatment facilities. HubMed – addiction


Response of Neurotensin Basal Ganglia Systems During Extinction of Methamphetamine Self Administration in Rat.

J Pharmacol Exp Ther. 2013 May 17;
Hanson GR, Hoonakker AJ, Robson CM, McFadden LM, Frankel PS, Alburges ME

Due to persistent social problems caused by methamphetamine (METH) new therapeutic strategies need to be developed. Thus, we investigated the response of CNS neurotensin (NT) systems to METH self-administration (SA) and their interaction with basal ganglia dopamine (DA) pathways. Neurotensin is a peptide associated with inhibitory feedback pathways to nigrostriatal DA projections. We observed that NT levels decreased in rats during extinction of METH SA when lever pressing resulted in i.v. infusions of saline rather than METH. Thus, 6 hours after the first session of extinction, NT levels were 53%, 42% and 49% of corresponding controls in the anterior dorsal striatum, posterior dorsal striatum and the globus pallidus, respectively. NT levels were also significantly reduced in corresponding yoked rats in the anterior dorsal striatum (64% of control), but not the other structures examined. The reductions in NT levels in the anterior dorsal striatum particularly correlated with the lever pressing during the first session of extinction (r=0.745). These, and previously reported findings, suggest that the extinction-related reductions in NT levels were mediated by activation of D2 receptors. Finally, administration of the NTR1 agonist (PD149163; 0.25 or 0.5 mg/kg) diminished lever pressing during the first extinction session, while the NTR1 antagonist (SR48692; 0.3 mg/kg/administration) attenuated the reduction of lever pressing during the 2nd-4th days of extinction. In summary, these findings support the hypothesis that endogenous basal ganglia NT systems contribute to the elimination of contingent behavior during the early stages of the METH SA extinction process. HubMed – addiction


Cannabidiol reduces cigarette consumption in tobacco smokers: Preliminary findings.

Addict Behav. 2013 Apr 1; 38(9): 2433-2436
Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK

The role of the endocannabinoid system in nicotine addiction is being increasingly acknowledged. We conducted a pilot, randomised double blind placebo controlled study set out to assess the impact of the ad-hoc use of cannabidiol (CBD) in smokers who wished to stop smoking. 24 smokers were randomised to receive an inhaler of CBD (n=12) or placebo (n=12) for one week, they were instructed to use the inhaler when they felt the urge to smoke. Over the treatment week, placebo treated smokers showed no differences in number of cigarettes smoked. In contrast, those treated with CBD significantly reduced the number of cigarettes smoked by ~40% during treatment. Results also indicated some maintenance of this effect at follow-up. These preliminary data, combined with the strong preclinical rationale for use of this compound, suggest CBD to be a potential treatment for nicotine addiction that warrants further exploration. HubMed – addiction