Peer reviewed journal articles on substance abuse disorder and mental health comorbidity

¶ … substance abuse disorder that can mimic a mental health or medical diagnosis. -Addictions or substance abuse counseling

Brooks, AJ & Penn, PE (2003) Comparing Treatments for Dual Diagnosis: Twelve-Step and Self-Management and Recovery Training THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE, 29, 359 -- 383

Brooks and Penn (2003) compared the effectiveness of the 12-step approach with the cognitive-behavioral (Self-Management and Recovery Training [SMART]) approach for people with a dual diagnosis of serious mental illness and substance use disorder. The 112 participants were tested in an intensive outpatient/partial hospitalization setting and were assigned to two treatment conditions. 50 participants completed the 6-month treatment program. The participants were tested during five intermittent periods. Researchers discovered that the 12 Steps program was more efficacious in decreasing alcohol use and increasing social interactions, but that it resulted in a worsening of medical problems, health status, employment status, and psychiatric hospitalization. SMART, on the other hand, showed positive associating with finding employment and improved psychiatric status, but it resulted in increased drug (specifically marijuana) use. Both approaches showed decrease in use of alcohol and increase in life satisfaction. The participants who stayed longer with either program showed greater improvement, whilst completion of the entire program showed positive association with better financial health, less alcohol use, and fewer medical problems.

Although initially a large sample was involved (112 individuals), only 50 completed the program and this may provide too small a sample against which one can draw conclusions for an entire population of people with dual diagnosis. 70 individuals completed a 3-month segment. This shows partial results and is a bit larger. Nonetheless, when one considers the general population of people with dual diagnosis, this, too, may be too small. This is particularly so since so many other variables intervene in influencing factors such as employment, illness, alcohol use, and health status and the demographics of these participants may not have considered every factor, nor may they include factors that individuals outside this sample may experience.

On the other hand, the participants were rigidly tested five times, during different periods of the study, in order to control for distracting factors and in order to follow their progress. Five authoritative and reliable measures were used to test for key constructs and sufficient time (a year) was given following relapse in order to see whether symptoms had disappeared. A significant number of the participants showed similarities in reductions of the same symptoms, and since a pattern appeared and testing was consistent one can say that results were interesting and contributive. However, the disorder does have a cyclical nature and involves far more complex impairments than were taken into consideration in this study.

As regards helpfulness of this study, it is certainly helpful in pointing to practitioners the various benefits of both 12 Steps and the SMART program. Each offers its particular benefits and each contributes different results. The study is immensely helpful in pointing out the results of each. A recommendation would be to integrate both programs for maximum efficacy. Nonetheless, further study, involving multiple measures of substance use and conducted on larger and more diverse populations would be helpful.

2. Timko, C, Dixon, K., & Moos, RH (2005). Treatment for Dual Diagnosis Patients in the Psychiatric and Substance Abuse Systems Mental Health Services Research, 7, 4,

The purpose of this study was to investigate and compare the extent to which psychiatric and substance abuse programs treated dual diagnosis patients in their residential and outpatient Modalities and whether their treatment was affective for this population sample. Managers of 753 programs in the Department of Veterans Affairs that had treatment programs oriented for this population completed surveys .Researchers found that both psychiatric and substance abuse programs contained commonalities. Substance abuse programs, however, seemed to be superior to psychiatric interventions in that they offered helpful supplementary programs such as cognitive behavioral treatment programs as well as assignment of a single case manager to each patient. More so, outpatient psychiatric programs also tested poor on essential management aspects as well as lacking key treatments. Dual-diagnosis is a recurring and recycling situation, and both psychiatric and substance abuse programs lacked long-term interventions that were necessary to deal with the recurrence of the problem. The researchers, therefore, concluded by prescribing that the two modalities learn from one another and improve their systems by incorporating needed technology and programs.

My assessment of this study is that it is a reliable and authoritative study. A significantly large sample of programs was investigated (753) and the people who completed the surveys -- the managers of these departments -- were trustworthy. On the contrary, one may have expected them (due to their subjectivity and personal involvement) to provide more optimistic results. The fact that they did not do so points to the possibility that the situation in these programs may be worse than rated. The institution used - the Department of Veterans Affairs - was also reliable.

The study, consequently, is enormously helpful on several counts. It points out descriptors for improvement in either organization. It also informs potential patients of institutions that would be more helpful for their improvement. Each program has its particular benefits; the study points interested individuals to the merits and demerits of either.

On the other hand, limitations of the study include the fact that the Department of Veterans Affairs is only one of many sectors that offer these services. Other publicly funded systems may offer differing forms of care and investigation needs to be conducted in these to compare. This sector, too, may have poorer funding due to the fact that the Department of Veterans Affairs is a non-profit institution; for-profit and private institutions may show improved conditions.

On the whole, however, findings of this study are helpful in informing program managers about the conditions of their different programs and helping them work towards steps of achieving the ideal integrated system.

3. Ashley, OS, Marsden, MA & Brady, TA (2003) Effectiveness of Substance Abuse Treatment Programming for Women: A Review, THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE, 29, 19-53

Consistent research on substance-abuse and on treatments for substance- abuse show that symptoms of abuse and effects of treatment vary between men and women in substance abuse etiology, disease progression, and access to treatment for substance abuse. The authors, therefore, recommend that substance abuse programs should be stylized differently to suit each gender, with one being particularly for men and another type for women. Few programs, however, have been tailored specifically to suit women. The authors of this study, consequently, review the literature on the extent and effectiveness of substance abuse

Treatment programming for women and provide an overview of recommendations of components of successful treatment programs for women. The authors evaluate and review 38 different programs that were specialized for women. Seven of these studies were randomized, controlled trials, and 31 of the studies were nonrandomized trials. Six components of substance abuse treatment programming for women were examined: child care, prenatal care, women-only programs, supplemental services and workshops that address women-focused topics, mental health programming, and comprehensive programming.