Sex differences in comorbidity between substance use and mental health in adolescents two sides of the same coin / Diferencias de Sexo en Comorbilidad entre Consumo de Sustancias y Salud Mental en Adolescentes: Dos Caras de la Misma Moneda

BACKGROUND: This study aims to evaluate sex differences in alcohol and cannabis use and mental health disorders (MHD) in adolescents, and to evaluate the predictive role of mental health disorders for alcohol and cannabis use disorders (AUD and CUD respectively). METHOD: A sample of 863 adolescents from the general population (53.7% girls, Mage = 16.62, SD = 0.85) completed a computerized battery including questions on substance use frequency, the Brief Symptom Inventory, the Cannabis Problems Questionnaire for Adolescents - Short version, the Rutgers Alcohol Problem Index and the DSM-IV-TR criteria for AUD and CUD. Bivariate analyses and binary logistic regressions were performed. RESULTS: Girls presented significantly more mental health problems and a higher prevalence of comorbidity between SUD and MHD. Obsessive-compulsive symptoms and phobic anxiety indicated a higher risk of AUD, whereas depression and interaction between hostility and obsessive-compulsive disorder indicated a higher risk of CUD. CONCLUSIONS: Comorbidity between SUD and MHD is high among adolescents, and significantly higher among girls

ANTECEDENTES: el objetivo de esta investigación es evaluar las diferencias de sexo en el uso de cannabis y alcohol y en trastornos de salud mental TSM en adolescentes, y el rol predictivo de los TSM sobre los trastornos por uso de alcohol y cannabis (TUA y TUC, respectivamente). MÉTODO: una muestra de 863 adolescentes de la población general (53,7% chicas, edad media = 16.62, DT = 0,85) completaron una batería informatizada sobre la frecuencia de uso de sustancias, el Inventario Breve de Síntomas, el Cuestionario de Problemas por Consumo de Cannabis - versión breve, el Índice de Rutgers de Problemas con el Alcohol y los criterios DSM-IV-TR para el TUA y TUC. Se realizaron análisis bivariados y de regresión logística binaria. RESULTADOS: las chicas presentaron significativamente más problemas de salud mental y mayor prevalencia de comorbilidad entre TUS y TSM. El trastorno obsesivo-compulsivo (TOC) y la ansiedad fóbica indicaron un mayor riesgo de TUA, mientras que la depresión y la interacción entre hostilidad y TOC indicaron mayor riesgo de TUC. CONCLUSIONES: la comorbilidad entre TUS y TSM es alta entre los adolescentes, y significativamente mayor entre las chicas

Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders.

Importance: Cannabis use and cannabis use disorder (CUD) are common among youths and young adults with mood disorders, but the association of CUD with self-harm, suicide, and overall mortality risk is poorly understood in this already vulnerable population. Objective: To examine associations of CUD with self-harm, suicide, and overall mortality risk in youths with mood disorders. Design, Setting, and Participants: A population-based retrospective cohort study was performed using Ohio Medicaid claims data linked with death certificate data. The analysis included 204 780 youths (aged 10-24 years) with a diagnosis of mood disorders between July 1, 2010, and December 31, 2017, who were followed up to 365 days from the index diagnostic claim until the end of enrollment, the self-harm event, or death. Statistical analysis was performed from April 4 to July 17, 2020. Exposure: Physician-diagnosed CUD defined using outpatient and inpatient claims from 180 days prior to the index mood disorder diagnostic claim through the 365-day follow-up period. Main Outcomes and Measures: Nonfatal self-harm, all-cause mortality, and deaths by suicide, unintentional overdose, motor vehicle crashes, and homicide. Marginal structural models using inverse probability weights examined associations between CUD and outcomes. Results: This study included 204 780 youths (133 081 female participants [65.0%]; mean [SD] age at the time of mood disorder diagnosis, 17.2 [4.10] years). Cannabis use disorder was documented for 10.3% of youths with mood disorders (n = 21 040) and was significantly associated with older age (14-18 years vs 10-13 years: adjusted risk ratio [ARR], 9.35; 95% CI, 8.57-10.19; and 19-24 years vs 10-13 years: ARR, 11.22; 95% CI, 10.27-12.26), male sex (ARR, 1.79; 95% CI, 1.74-1.84), Black race (ARR, 1.39; 95% CI, 1.35-1.44), bipolar or other mood disorders (bipolar disorders: ARR, 1.24; 95% CI, 1.21-1.29; other mood disorders: ARR, 1.20; 95% CI, 1.15-1.25), prior history of self-harm (ARR, 1.66; 95% CI, 1.52-1.82), previous mental health outpatient visits (ARR, 1.26; 95% CI, 1.22-1.30), psychiatric hospitalizations (ARR, 1.66; 95% CI, 1.57-1.76), and mental health emergency department visits (ARR, 1.54; 95% CI, 1.47-1.61). Cannabis use disorder was significantly associated with nonfatal self-harm (adjusted hazard ratio [AHR], 3.28; 95% CI, 2.55-4.22) and all-cause mortality (AHR, 1.59; 95% CI, 1.13-2.24), including death by unintentional overdose (AHR, 2.40; 95% CI, 1.39-4.16) and homicide (AHR, 3.23; 95% CI, 1.22-8.59). Although CUD was associated with suicide in the unadjusted model, it was not significantly associated in adjusted models. Conclusions and Relevance: Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.

Adictividad: una dimensión independiente en el síndrome psicótico. Presentación de la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP) / Addictiveness: an independent dimension in the psychotic syndrome. Presentation of the Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS)

Los modelos de patología dual suelen considerar a los trastornos por uso de sustancias (TUS) y al resto de trastornos mentales como dos entidades nosológicas que coinciden en una misma persona. Este estudio adopta un punto de partida diferente y estima que la adictividad sería una novena dimensión clínica independiente en los trastornos psicóticos, que se añadiría a las de alucinaciones, delirio, habla desorganizada, conducta psicomotriz anormal, síntomas negativos, déficit cognitivo, depresión y manía. Todas ellas derivarían, en último término, de una disfunción fronto-subcortical común con implicación dopaminérgica, glutamatérgica y gabaérgica. Se presenta la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP), que busca ser un instrumento integrado y sencillo para la evaluación de la adictividad en los trastornos psicóticos. Se basa en la recogida de datos sobre el primer uso, el tiempo de consumo, el último consumo, la frecuencia de consumo y la intensidad de la adicción de doce tipos de sustancias o conductas adictivas. Los resultados de la aplicación de la EASP a una muestra de 105 sujetos psicóticos sugieren unas buenas características psicométricas, así como la independencia de la adictividad respecto a otras dimensiones clínicas. (AU)

Models of dual pathology habitually consider substance-use disorders (SUD) and the rest of mental disorders as two pathological conditions coincident in a same person. This study adopts a different point of view and accept adictivity as the nineth clinical dimension in the psychotic disorders to be added to hallucinations, delusion, disorganised speech, abnormal psychomotor behaviour, negative symptoms, cognitive deficit, depression, and mania. In the last term, all of them seems to derive from a common fronto-subcortical disfunction with dopaminergic, glutamatergic and gabaergic implication. The Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS) is presented. It wants to be an integrated and easy to use tool for evaluating adictivity in the psychotic disorders. It is based in data collected with respect of first use, length of use, last use, frequency of use and addiction intensity regarding twelve types of substances or addictive behaviours. Results of the application of APSAS on a sample of 105 psychotic subjects suggest good psychometric characteristics as well as the independency of adictivity respect with other clinical dimensions. (AU)

Addictiveness: an independent dimension in the psychotic syndrome. Presentation of the Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS) / Adictividad: una dimensión independiente en el síndrome psicótico. Presentación de la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP)

Models of dual pathology habitually consider substance-use disorders (SUD) and the rest of mental disorders as two pathological conditions coincident in a same person. This study adopts a different point of view and accept adictivity as the nineth clinical dimension in the psychotic disorders to be added to hallucinations, delusion, disorganised speech, abnormal psychomotor behaviour, negative symptoms, cognitive deficit, depression, and mania. In the last term, all of them seems to derive from a common fronto-subcortical disfunction with dopaminergic, glutamatergic and gabaergic implication. The Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS) is presented. It wants to be an integrated and easy to use tool for evaluating adictivity in the psychotic disorders. It is based in data collected with respect of first use, length of use, last use, frequency of use and addiction intensity regarding twelve types of substances or addictive behaviours. Results of the application of APSAS on a sample of 105 psychotic subjects suggest good psychometric characteristics as well as the independency of adictivity respect with other clinical dimensions. (AU)

Los modelos de patología dual suelen considerar a los trastornos por uso de sustancias (TUS) y al resto de trastornos mentales como dos entidades nosológicas que coinciden en una misma persona. Este estudio adopta un punto de partida diferente y estima que la adictividad sería una novena dimensión clínica independiente en los trastornos psicóticos, que se añadiría a las de alucinaciones, delirio, habla desorganizada, conducta psicomotriz anormal, síntomas negativos, déficit cognitivo, depresión y manía. Todas ellas derivarían, en último término, de una disfunción fronto-subcortical común con implicación dopaminérgica, glutamatérgica y gabaérgica. Se presenta la Escala de Evaluación de la Adictividad en el Síndrome Psicótico (EASP), que busca ser un instrumento integrado y sencillo para la evaluación de la adictividad en los trastornos psicóticos. Se basa en la recogida de datos sobre el primer uso, el tiempo de consumo, el último consumo, la frecuencia de consumo y la intensidad de la adicción de doce tipos de sustancias o conductas adictivas. Los resultados de la aplicación de la EASP a una muestra de 105 sujetos psicóticos sugieren unas buenas características psicométricas, así como la independencia de la adictividad respecto a otras dimensiones clínicas. (AU)

Patología dual en personas sin hogar en el Área de Salud de Avilés / Dual pathology in homeless people in the Avilés Health Area

El objetivo principal del presente estudio es estimar la prevalencia de trastornos mentales graves y de uso de sustancias en personas en la situación de estar sin hogar. El trabajo se realizó a partir de los datos obtenidos de una muestra representativa de personas sin hogar en Avilés (Asturias) (n=100) utilizando la Entrevista Neuropsiquiátrica Internacional (M.I.N.I.). Los resultados de nuestro estudio ponen de manifiesto una estrecha relación entre el uso de sustancias y el sinhogarismo. Más de la mitad de las personas sin hogar tiene trastornos relacionados con el uso de sustancias en comparación con el uso problemático de sustancias en la población general. Se discute la atención psicosocial y la organización de una red de apoyo a las personas sin hogar. (AU)

The main objective of the present study is to estimate the prevalence of severe mental disorders and substance use in the homeless situation. The work was carried out from the data obtained from a representative sample of homeless people in Avilés (Asturias) (n = 100) using the International Neuropsychiatric Interview (M.I.N.I.). The results of our study reveal a close relationship between substance use and homelessness. More than half of the homeless have substance use disorders compared to problem substance use in the general population. Psychosocial care and the organization of a support network for the homeless are discussed. (AU)

Dual pathology in homeless people in the Avilés Health Area / Patología dual en personas sin hogar en el Área de Salud de Avilés

The main objective of the present study is to estimate the prevalence of severe mental disorders and substance use in the homeless situation. The work was carried out from the data obtained from a representative sample of homeless people in Avilés (Asturias) (n = 100) using the International Neuropsychiatric Interview (M.I.N.I.). The results of our study reveal a close relationship between substance use and homelessness. More than half of the homeless have substance use disorders compared to problem substance use in the general population. Psychosocial care and the organization of a support network for the homeless are discussed. (AU)

El objetivo principal del presente estudio es estimar la prevalencia de trastornos mentales graves y de uso de sustancias en personas en la situación de estar sin hogar. El trabajo se realizó a partir de los datos obtenidos de una muestra representativa de personas sin hogar en Avilés (Asturias) (n=100) utilizando la Entrevista Neuropsiquiátrica Internacional (M.I.N.I.). Los resultados de nuestro estudio ponen de manifiesto una estrecha relación entre el uso de sustancias y el sinhogarismo. Más de la mitad de las personas sin hogar tiene trastornos relacionados con el uso de sustancias en comparación con el uso problemático de sustancias en la población general. Se discute la atención psicosocial y la organización de una red de apoyo a las personas sin hogar. (AU)

Risk-taking and fairness among cocaine-dependent patients in dual diagnoses: Schizophrenia and Anti-Social Personality Disorder.

This study reports experimental results from a clinical sample of patients with a cocaine-related disorder and dual diagnosis: Schizophrenia and Anti-Social Personality Disorder. Both types of patients as well as a non-clinical group of students performed two incentivized decision-making tasks. In the first part of the experiment, they performed a lottery-choice task in order to elicit their degree of risk aversion. In the second part, they decided in two modified dictator games aimed at eliciting their aversion to advantageous and disadvantageous inequality. It is found that the Anti-Social Personality Disorder group exhibits no significant differences from the non-clinical sample in either task. However, compared with the students' sample, subjects from the group with schizophrenia show more risk aversion and exhibit more aversion towards disadvantageous inequality.

Prevalence, predictors, and patterns of mechanical restraint use for inpatients with dual diagnosis.

PURPOSE: This study examined the prevalence, predictors, and patterns of mechanical restraint in an inpatient dual diagnosis population. DESIGN AND METHODS: Data were longitudinally collected from patients affected by severe mental illness and comorbid substance abuse that were hospitalized in three large wards from 2006 to 2012. FINDINGS: In a sample of 1698 hospitalizations, the use of mechanical restraint ranged between 1% and 4% per year. The diagnosis of schizophrenia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.29-5.40), the use of stimulant substances (OR, 5.68; 95% CI, 2.78-11.59) and male sex (OR, 3.22; 95% CI, 1.12-9.27) were associated with an increased risk of being exposed to mechanical restraint. PRACTICE IMPLICATIONS: Specialized interventions targeting people at risk of mechanical restraint may further reduce the incidence of restraint and improve treatment outcomes.

Substance use disorders in people with intellectual disability.

PURPOSE OF REVIEW: To provide an overview of studies on substance use and substance use disorder (SUD) in individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF). RECENT FINDINGS: Many individuals with MID-BIF use tobacco, alcohol, and drugs. On average, rates of substance use and SUD are similar to or even higher than those in peers with average intelligence. Individuals with MID-BIF are overrepresented in (forensic) addiction care. Several instruments are now available for the assessment of SUD and its risk factors in this target group. Prevention and intervention programs have been shown feasible and with promising outcomes, although the evidence base is still small. Professionals in addiction care and intellectual disability care facilities show deficiencies in skills in addressing SUD in clients with MID-BIF. SUMMARY: Research in this area is still in its infancy, though an increasing number of studies show promising outcomes regarding case identification, assessment, and treatment of SUD in intellectual disability. Policy and practice should be adapted to the characteristics of individuals with MID-BIF.

Frequent Attendance to the Emergency Department after Release from Prison: a Prospective Data Linkage Study.

The aim of this paper was to identify characteristics and predictors of frequent emergency department (ED) use among people released from prisons in Queensland, Australia. Baseline interview data from a sample of sentenced adults were linked to ED and hospital records. The association between baseline characteristics and frequent ED attendance was modelled by fitting multivariate logistic regression models. Participants who had ≥ 4 visits to the ED in any 365-day period of community follow-up were defined as frequent attenders (FA). The analyses included 1307 people and mean follow-up time in the community was 1063 days. After adjusting for covariates, those with a dual diagnoses of mental illness and substance use (RR = 2.42, 95% CI 1.47-3.99) and those with mental illness alone (RR = 2.47, 95% CI 1.29-4.73) were at higher risk of frequent ED attendance, compared with those with no disorder. Future research should assess whether individually tailored transition supports from prison to community reduce the frequency of ED use among this population.

'The group was the only therapy which supported my needs, because it helped me feel normal and I was able to speak out with a voice': A qualitative study of an integrated group treatment for dual diagnosis service users within a community mental health setting.

Whilst the evidence for the efficacy of treatment interventions for individuals with dual diagnosis has been developing in recent decades, little is known about individual perceptions and the personal benefits of attending integrated treatment programmes within this population group. A qualitative methodology, Interpretive phenomenological analysis, was used to investigate the experiences of individuals with a range of complex mental health and coexisting substance misuse problems who took part in a psychoeducational group (PEG) programme. This comprised of social support and therapeutic peer group relationship facilitation. Semi-structured interviews were undertaken with 15 service users who successfully participated in this treatment programme. Findings identify the complexity of the therapeutic process and understanding of the treatment from the service users perspective. This included the importance of forming meaningful therapeutic relationships as an influential factor in countering a range of distressing and incompatible environmental and situational stressors, such as self-regulatory control, self-awareness of a need for change and the importance of integrated treatment in reducing the sense of stigma and exclusion linked with using mental health services. The study findings support the use of integrated treatment programmes in mental health services with a dual diagnosis population group.

Behavioral responses in people affected by alcohol use disorder and psychiatric comorbidity: correlations with addiction severity.

AIM: In this study, we investigated in people suffering from alcohol use disorder (AUD) with or without dual diagnosis (concomitant psychiatric disability) how they feel their dependence condition. We predicted that AUD people with a dual diagnosis could feel potentiated their addiction. METHODS: Alcohol habits and psychiatric conditions of 183 AUD men and 62 AUD women were measured by using the DSM-5, the severity of alcohol dependence questionnaire (SADQ), the alcohol anamnesis and psychiatric examination by the symptom check list 90-R (SCL-90-R). RESULTS: We have shown that alcohol drinking does not correlate with both psychiatric examination and self-reported psychopathology. SADQ shows that severe alcohol dependence correlates with highest psychiatric symptoms and with the levels of alcohol consumption. CONCLUSIONS: This finding suggests that high SADQ scores may represent a tool to early disclose only patients with dual diagnosis. SADQ may provide information to address pharmacological interventions because revealing aspects of the dark side of addiction potentiated by AUD associated psychopathology.

Profiles of Clinical Need Among Homeless Individuals with Dual Diagnoses.

This study explored patterns of clinical need among homeless individuals with dual diagnoses, and explored whether certain profiles are characteristic of different demographic groups. Data were drawn from two larger studies conducted with dually diagnosed, homeless individuals (n = 373). Hierarchical cluster analysis identified four subgroups: (1) Clinically least severe, characterized by less frequent psychological symptoms and no history of physical or sexual abuse; (2) Moderate clinical needs, including shorter history of substance use and less frequent psychological symptoms, but symptoms consistent with severe mental illness; (3) Clinically severe, with frequent anxiety, depression, past and recent physical or sexual abuse, and long history of substance use; (4) Least frequent psychological symptoms, but frequent history of physical or sexual abuse and long history of drug use. Women veterans were mostly likely to be classified in cluster 3, and male civilians in cluster 2. Subgroups of homeless individuals with dual diagnoses demonstrated different clusters of clinical needs, having implications for service delivery to the population.

Intensive-invisible mothering: The experiences of mothers of adult children with dual diagnosis.

The experiences of mothers of adult offspring with a dual diagnosis have rarely been discussed in the literature, despite growing involvement and responsibility of mothers for daily care of their children. Interpretive phenomenological analysis of in-depth interviews was used to examine the mothering experience of 12 mothers of adult offspring with dual diagnosis. The analysis revealed that the mothers' experiences were intensive, abusive, and isolating, and simultaneously rendered them invisible, undervalued, or ignored by professionals, community, and family. Furthermore, the analysis indicated that this experience of 'intensive-invisible' mothering was promoted or prevented by three intersecting mechanisms, identified here as discursive, institutional, and spatial. The research contributes to the fields of knowledge regarding family members of people with mental health problems, by adding a theoretical layer that takes into account how public discourses of motherhood mould women's accounts of their mothering experience. Practical implications of these findings for professionals working with these mothers are discussed. Specifically, therapeutic intervention that focuses on identifying and modifying the underlying psychological and social processes associated with the 'intensive-invisible' mothering experience could be useful.

Error-related brain activity in relation to psychopathic traits in multi-problem young adults: An ERP study.

One of the most prominent issues in psychopathy is the inability to adequately monitor one's performance and learn from one's mistakes. We investigated the relationship between psychopathic traits, as measured with the Youth Psychopathy Inventory - Short Version, and both early and late error-related brain activity in an at-risk sample of male young adults. These multi-problem young adults (age 18-27) are severely dysfunctional in society and suffer from multiple problems including financial problems, delinquency, psychological problems, and drug use. Our final sample consisted of 115 multi-problem young adults and 26 controls. Participants performed an Eriksen-Flanker task during EEG measurements. We used the difference wave of the error-related negativity (ΔERN) as a measure of early error processing and the error positivity (Pe) as a measure of late error processing. Multi-problem young adults showed reduced ERN amplitudes compared to controls, but did not differ in Pe amplitude. We found no statistically significant relation between psychopathic traits and ERN and Pe amplitudes within the multi-problem group. Thus, we found evidence for dysfunctional error-processing in multi-problem young adults compared to controls. However, within the multi-problem sample we did not find evidence for a relationship between psychopathic traits and dysfunctional error-processing. One explanation may be that this is due to the specific developmental stage of our young adult participants in which a transition between error-processing deficits, as present in adolescents high in psychopathic traits, and error-processing overcompensation, as present in adults high in psychopathic traits, may occur.

Problematic Internet Use and Associated High-Risk Behavior in an Adolescent Clinical Sample: Results from a Survey of Psychiatrically Hospitalized Youth.

Problematic Internet use (PIU) is a growing clinical concern to clinicians working in adolescent mental health, with significant potential comorbidities like depression and substance use. No prior study has examined associations between PIU, high-risk behavior, and psychiatric diagnoses specifically in psychiatrically hospitalized adolescents. Here, we analyzed how PIU severity correlated with preadmission Internet habits, psychiatric symptoms, and high-risk behavior in this unique population. We hypothesized that as the severity of PIU increased, so would endorsement of mood symptoms, engagement in risky behaviors, and chances of having comorbid mood and aggression-related diagnoses. We performed a cross-sectional survey on an adolescent psychiatric inpatient unit in an urban community hospital in Massachusetts. Participants were 12-20 years old (n = 205), 62.0 percent female, and of diverse racial/ethnic backgrounds. Relationships between PIU, high-risk symptoms, diagnoses, and behaviors were performed both using chi-square tests and determining Pearson correlation coefficients. Two hundred five adolescents participated in the study. PIU severity was associated with being female (p < 0.005), sexting (p < 0.05), cyberbullying (p < 0.005), and increased suicidality within the last year (p < 0.05). Adolescents with aggressive and developmental disorders, but not depressive disorders, also had significantly higher PIU scores (p ≤ 0.05). In our sample of psychiatrically hospitalized adolescents, PIU severity was significantly associated with both serious psychiatric symptoms and high-risk behaviors, including those related to suicide. Our findings may improve safety assessments in this vulnerable adolescent population by identifying comorbid risks associated with problematic digital media use.

Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial.

Importance: Immigrants are at an increased risk for co-occurring mental health and substance misuse symptoms; however, effective treatments are lacking. Objective: To evaluate the effectiveness of the Integrated Intervention for Dual Problems and Early Action (IIDEA) program compared with enhanced usual care. Design, Setting, and Participants: This effectiveness randomized clinical trial was conducted from September 2, 2014, to February 2, 2017, in 17 clinics or emergency departments and 24 community sites in Boston, Massachusetts, as well as in Madrid and Barcelona, Spain. Equal randomization (1:1) in 2-person blocks was used, assigning participants to either the IIDEA treatment group (n = 172) or the enhanced usual care control group (n = 169). Intent-to-treat analyses assessed effectiveness, and post hoc analyses examined whether results varied by symptom severity or treatment dose. Eligible participants were between 18 and 70 years of age, self-identified as Latino, screened positive for co-occurring symptoms, and were not receiving specialty behavioral health services. Interventions: Participants were randomized to a 10-session IIDEA treatment or to enhanced usual care. Main Outcomes and Measures: Primary outcomes were changes in alcohol and drug misuse and results of a urine test for drug metabolites but not for alcohol misuse. Secondary outcomes were symptoms of depression, generalized anxiety, posttraumatic stress disorder, and overall mental health. Results: In total, 341 participants were randomized to either the IIDEA treatment group (n = 172; 94 [54.7%] female, mean [SD] age, 33.5 [11.6] years) or the enhanced usual care control group (n = 169; 80 [47.3%] female, mean [SD] age, 34.3 [11.8] years). No statistically significant effects of IIDEA were found for primary drug and alcohol outcomes (ASI Lite-drug score: ß = -0.02 [SE, 0.69; P = .88; Cohen d, 0.00; 95% CI, -0.17 to 0.17]; ASI Lite-alcohol score: ß = -0.01 [SE, 1.19; P = .66; Cohen d, 0.00; 95% CI, -0.12 to 0.12]; urine drug test result: ß = -0.36 [SE, 0.43; P = .50; OR, 0.70; 95% CI, 0.30-1.61]), but statistically significant effects were observed for secondary mental health outcomes. The IIDEA treatment was effective in reducing depressive symptoms per the Public Health Questionnaire-9 score (ß = -1.14; SE, 0.47; P = .02; Cohen d, 0.20 [95% CI, 0.04-0.36]), posttraumatic stress disorder symptoms per the Posttraumatic Stress Disorder Checklist-5 score (ß = -3.23; SE, 1.59; P = .04; Cohen d, 0.25 [95% CI, 0.01-0.37]), and overall mental health symptoms per the Hopkins Symptom Checklist-20 (ß = -0.20; SE, 0.07; P = .01; Cohen d, 0.25 [95% CI, 0.08-0.42]) and composite mental health (ß = -3.70; SE, 1.75; P = .04; Cohen d, 0.19 [95% CI, 0.01-0.36]) scores at the 6-month follow-up. Exploratory analyses suggested that 6-month treatment effects occurred for patients whose drug misuse was moderate to severe at the baseline assessment. Among patients with moderate to severe substance misuse, IIDEA substantially reduced substance use per the urine test results (odds ratio, 0.25 [95% CI, 0.09-0.67]; P = .01). Treatment dose showed small to large effect sizes by outcome. Conclusions and Relevance: The IIDEA treatment did not change drug misuse but did improve secondary mental health and substance misuse outcomes for a heterogeneous population with moderate to severe symptoms; this finding provides a path for treating Latino immigrants with co-occurring mental health and substance misuse symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02038855.

Criminal offending and associated factors in dual diagnosis patients.

Dual diagnosis patients perpetrate crime more often than healthy individuals. Crime perpetration has major mental health consequences for the victim. Knowledge of factors related to perpetration is needed for the development of prevention programs. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. The current study investigated cross-sectional associations between demographic and clinical factors and perpetration of three crime types (violence, threat, and property crime) in 243 treatment-seeking dual diagnosis patients. In our sample, perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. Expression of threat was independently associated with severity of alcohol use problems and higher manic symptom scores. Perpetration of property crime was independently associated with severity of alcohol and drug use problems. Remarkably, gender was not associated with any type of perpetration. These findings indicate that criminal offending is a significant problem among dual diagnosis patients and are a first step towards understanding the complex causal networks that lead to criminal perpetration. Future longitudinal research should investigate additional risk factors and establish causality to support the development of treatment programs to prevent criminal offending by dual diagnosis patients.

The relationship between delay discounting and alcohol dependence in individuals with and without comorbid psychopathology.

RATIONALE: Alcohol use disorder (AUD) has been associated with greater discounting of delayed monetary rewards, but it is unclear whether this association is primarily related to alcohol consumption or is secondary to the presence of psychiatric comorbidities. It is also unclear if steeper rates of discounting are associated with greater AUD severity. OBJECTIVE: We sought to determine whether the presence of comorbid psychiatric disorders affected the relationship between AUD and delay discounting. We also examined whether more severe AUD was associated with greater delay discounting. METHODS: In this cross-sectional study, 793 adults completed a delay discounting task. Subjects were divided into four groups based on diagnosis: current AUD with psychiatric comorbidities (N = 226), current AUD without psychiatric comorbidities (N = 203), past AUD (N = 69), and healthy controls (N = 295). In those with AUD, we investigated the relationship between delay discounting and alcohol dependence symptom count and recent drinking history. We also compared individuals seeking treatment to non-treatment seeking individuals. Psychiatric comorbidities examined included mood disorders, anxiety disorders, and substance use disorders. RESULTS: After adjusting for age, sex, income, and education, individuals with current AUD showed significantly higher rates of delay discounting than healthy controls and individuals with a past diagnosis of AUD. The presence of comorbid psychiatric diagnoses was not associated with steeper discounting. Among those with AUD, there was no evidence for a continuous relationship between delay discounting and AUD severity or alcohol consumption. Finally, non-treatment seekers with AUD had steeper delay discounting than treatment seekers. CONCLUSIONS: Individuals with AUD show steeper delay discounting than healthy adults, but the effect is small and there is no added effect from comorbid psychopathology or increased AUD severity. This suggests that steeper delay discounting may have a more limited effect on human alcohol use than previously supposed.