Emerald | Advances in Dual Diagnosis | Table of Contents

A study of the psychotropic prescriptions of people attending an addiction service in England

Fri, 17 May 2013 00:00:00 +0100

Abstract

Purpose - This study aims to examine the prescribed psychotropic medications taken by newly referred people with a range of substance use disorders (SUD) who attend a specialist community addiction service.Design/methodology/approach - Anonymised data on newly referred people (n = 1537) with SUD attending a specialist community addiction service for their first episode of treatment between August 2007 and July 2010 were obtained from the database of the service. Data were cleaned and the percentage of people taking prescribed psychotropic medications at their first episode of treatment was calculated.Findings - More than half (56.1%) of people attending the service were on prescriptions of antidepressants and anxiolytics at their first episode of treatment whilst 15.2% of people were on antipsychotics. Alcohol and opioids were the primary referral substances for 77% and 15% of people respectively. People referred for ‘other’ substances (cannabis, stimulants, sedatives, hallucinogens, solvents and polydrug use) made up the remaining 8% and had the highest percentage of prescribed psychotropics (antipsychotics = 47%, antidepressants and anxiolytics = 64.3%) compared to those referred for alcohol and opioids (p < 0.0005). Originality/value - To our knowledge, this is the first study of psychotropic prescribing among people with a range of SUD in the UK. The high prevalence of psychotropic prescribing raises questions about the appropriateness of these prescriptions and calls for scrutiny of prescribing practice in this group.

Findings from the Making Every Adult Matter (MEAM) service pilots: a summary paper

Fri, 17 May 2013 00:00:00 +0100

Abstract

Purpose - During 2011 the Making Every Adult Matter (MEAM) coalition supported three pilots to better coordinate existing local services for people facing multiple needs and exclusions. These individuals experience a combination of problems such as homelessness, substance misuse, mental health problems and offending. Many face difficulties consistent with dual diagnosis in its broadest sense. This article summarises the evaluation of the pilots, undertaken by FTI Consulting/Compass Lexecon in partnership with Pro Bono Economics. The full report of the evaluation is available at www.meam.org.uk/service-pilots Design/methodology/approach - The evaluation examined the three pilots, which took place in Cambridgeshire, Derby and Somerset in England. The study looked at two main effects as individuals engaged with better coordinated services: changes in wellbeing and changes in the use and cost of wider local services. Primary wellbeing data were collected from clients and primary service use data were collected directly from relevant local agencies (police, health, housing etc). The study followed 39 individuals across the pilot sites.Findings - The findings show significant improvements in wellbeing for nearly all clients across three quantitative measures. The evaluation also recorded changes in the use and cost of local services. Some costs decreased in the first year of the pilot, for example, criminal justice costs in the Cambridgeshire and Somerset pilot areas. Other costs increased in the first year as people accessed the help they needed. In Cambridgeshire, the reduction in crime costs (£100,000 or 31%) was large enough to lead to an overall cost reduction. The total cost of service use in the first year increased in the other two areas.Originality/value - Collecting primary data on clients’ actual service use directly from local agencies provides a strong methodological base. The evaluation will continue for a further year to examine the longitudinal impact of the pilots. The evaluation findings are of relevance to service providers, commissioners and policy makers interested in improving services for people facing multiple needs and exclusions.

Recovery in mental health and substance misuse services

literatinetwork@emeraldinsight.com (Andy Bell, Marcus Roberts) — Fri, 17 May 2013 00:00:00 +0100

Abstract

Purpose - To promote debate about applying Recovery principles to services for people with a 'dual diagnosis'.Design/methodology/approach - Discussion based on expert roundtableFindings - The ideas behind Recovery in mental health and substance misuse services have some differences but significant common ground in focusing on improving quality of life.Research limitations/implications - This paper points to the need to understand Recovery in both services from the perspectives of those who have a dual diagnosis and need support from each service.Practical implications - It could be used to develop new approaches to supporting people with a dual diagnosis with a consistent Recovery focus.Originality/value - We are not aware of any previous work of this kind and we hope it will prompt more exploration in this area.

Family of Origin Influences on the Parenting of Men with Co-Occurring Substance Abuse and Intimate Partner Violence

literatinetwork@emeraldinsight.com (carla smith stover, Marissa Kahn) — Fri, 17 May 2013 00:00:00 +0100

Abstract

Purpose - Purpose: Research indicates significant associations between intimate partner violence (IPV), substance abuse (SA) and childhood experiences of abuse. Yet few studies have interviewed fathers with co-occurring IPV and SA about their experiences in their own families and how that impacts their parenting. This study was designed to fill that gap and explore the ways in which fathers with co-occurring IPV and SA describe the parenting of their own parents and how it is related to the ways they parent. Design/methodology/approach - Methodology: Forty fathers with co-occurring IPV and SA were interviewed about their experiences of childhood abuse and the ways they are like and unlike their parents for this qualitative study using thematic analysis. Findings - Findings: A large percentage of the fathers experienced childhood abuse and reported negative images of their fathers and mothers most commonly due to: father absence and abusive/harsh parenting by both parents. Most fathers indicated a wish to be more present, available and warm with their children. Fathers did not draw associations between their childhood histories and their own behaviors. Originality/value - Implications: Focus on multigenerational transmission of IPV, SA and child maltreatment may be important areas to focus in intervention with father with co-occurring IPV and SA issues.