Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-14T09:30:42.117Z Has data issue: false hasContentIssue false
  • English
  • Français

Temporal trends in rates of dual diagnoses at a Canadian addictions hospital over a five-year period

Published online by Cambridge University Press:  13 June 2014

Nathan J Kolla ,
David C Marsh  and
Patricia G Erickson
Nathan J Kolla
Affiliation:
Department of Psychiatry, University of Toronto CAMH, 250 College St, Room 814, Toronto, Ontario, Canada M5T 1R8
David C Marsh
Affiliation:
Addiction Medicine, Vancouver Coastal Health and Providence Health Care, Vancouver, British Columbia, Canada
Patricia G Erickson
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Dual diagnosis refers to co-occurring substance use and psychiatric disorders. The principal aims of this investigation were two-fold: 1) to identify aspects of patients' drug use and prior treatment histories associated with their receiving a dual diagnosis upon admission to the Donwood Institute, a residential drug treatment facility located in Toronto, Canada; 2) to track temporal trends in the rates of diagnosed comorbidities over a five-year period at this same institution.

Methods: We conducted an analysis of the intake assessment forms and hospital records of 159 patients who had been admitted to a drug treatment facility during the month of September for each of the years between 1998 and 2002 inclusive. Comparisons were made between patients who had received a psychiatric diagnosis on admission and patients who had received no such diagnosis. We then employed logistic regression analyses to explore the relationship of the variable psychiatric diagnosis on admission to other patient variables.

Results: Among the patients studied in our sample, those receiving psychotherapy or taking prescription psychotropic medication at the time of their admission as well as patients whose primary problem substance was cannabis or who had been previously admitted to the treatment facility were significantly more likely to have received a psychiatric diagnosis on admission, in spite of our finding that several patients receiving psychotherapy or taking at least one psychotropic medication did not receive a psychiatric diagnosis on admission.

Conclusions: Whilst our data indicate that psychiatric comorbidity is common among individuals in treatment for substance use disorders at the Donwood Institute, it is possible that some individuals with psychiatric illness in our sample were not diagnosed as such when presenting for treatment of their substance use difficulties. Moreover, temporal tracking of rates of dual diagnoses did not reveal a consistent increase during the period studied.

Keywords

Dual diagnosisTreatment facilitiesDrug dependency.
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 23 , Issue 1 , March 2006 , pp. 10 - 16
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ziedonis, DM, Rayford, BS, Bryant, KJ, Rounsaville, BJ. Psychiatric comorbidity in white and African-American cocaine addicts seeking substance abuse treatment. Hosp Community Psychiatry 1994; 45:43–9.Google ScholarPubMed
2.Timko, C, Lesar, M, Calvi, NJ, Moos, RH. Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs. J Behav Health Serv Res 2003; 30:145–60.CrossRefGoogle ScholarPubMed
3.Penick, EC, Powell, BJ, Nickel, EJet al.Co-morbidity of lifetime psychiatric disorder among male alcoholic patients. Alcohol Clin Exp Res 1994; 18:1289–93.CrossRefGoogle ScholarPubMed
4.Ross, HE, Glaser, FB, Germanson, T. The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry 1988; 45:1023–1031.CrossRefGoogle ScholarPubMed
5.Weiss, RD, Mirin, SM, Michael, JL, Sollogub, AC. Psychopathology in chronic cocaine abusers. Am J Drug Alcohol Abuse 1986; 12:17–29.CrossRefGoogle ScholarPubMed
6.Kosten, TR, Rounsaville, BJ. Psychopathology in opioid addicts. Psychiatr Clin North Am 1986;9:515–32.CrossRefGoogle ScholarPubMed
7.Rounsaville, BJ, Anton, SF, Carroll, K, Budde, D, Prusoff, BA, Gawin, F. Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch Gen Psychiatry 1991; 48:43–51.CrossRefGoogle ScholarPubMed
8.Brooner, RK, King, VL, Kidorf, M, Schmidt, C W Jr, Bigelow, GE. Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 1997;54:71–80.CrossRefGoogle ScholarPubMed
9.Regier, DA, Farmer, ME, Rae, DSet al.Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264:2511–8.CrossRefGoogle ScholarPubMed
10.Drake, RE, Essock, SM, Shaner, Aet al.Implementing dual diagnosis services for clients with several mental illness. Psychiatr Serv 2001; 52:469–76.CrossRefGoogle Scholar
11.Sheehan, MFDual diagnosis. Psychiatr Q 1993; 64:107–34.CrossRefGoogle ScholarPubMed
12.Hien, D, Zimberg, S, Weisman, S, First, M, Ackerman, S. Dual diagnosis subtypes in urban substance abuse and mental health clinics. Psychiatr Serv 1997; 48:1058–63.Google ScholarPubMed
13.Grella, CE, Hser, Yl. A county survey of mental health services in drug treatment programs. Psychiatr Serv 1997; 48:950–52.Google ScholarPubMed
14.Young, NK, Grella, CE. Mental health and substance abuse treatment services for dually diagnosed clients: results of a statewide survey of county administrators. J Behav Health Serv Res 1998; 25:83–92.Google ScholarPubMed
15.Drake, RE, Mercer-McFadden, C, Mueser, KT, McHugo, GJ, Bond, GR. Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophr Bull 1998; 24:589–608.CrossRefGoogle ScholarPubMed
16.Room, R. Farewell to a unique institution. Addiction 1999; 94:1781–3.Google ScholarPubMed
17.Garfinkel, PE, Simpson, J, Baumann, A. An amalgamation of four specialty hospitals: Lessons learned. Hosp O. 1999; 2:14–23.Google ScholarPubMed
18.McCarty, D, Caspi, Y, Panas, L, Krakow, M, Mulligan, DH. Detoxification centers: who's in the revolving door? J Behav Health Serv Res 2000; 27:245–56.CrossRefGoogle ScholarPubMed
19.Stein, B, Orlando, M, Sturm, R. The effect of copayments on drug and alcohol treatment following inpatient detoxification under managed care. Psychiatr Serv 2000; 51:195–8.CrossRefGoogle ScholarPubMed
20.Primm, AB, Gomez, MB, Tzolova-lontchev, I, Perry, W, Vu, HT, Crum, RM. Mental health versus substance abuse treatment programs for dually diagnosed patients. J Subst Abuse Treat 2000; 19:285–90.CrossRefGoogle ScholarPubMed
21.Havassy, BE, Alvidrez, J, Owen, KK. Comparisons of patients with comorbid psychiatric and substance use disorders: implications for treatment and service delivery. Am J Psychiatry 2004; 161:139–45.CrossRefGoogle ScholarPubMed
22.Wu, LT, Kouzis, AC, Leaf, PJ. Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the National Comorbidity Survey. Am J Psychiatry 1999; 156:1230–6.CrossRefGoogle ScholarPubMed
23.Bartels, SJ, Teague, GB, Drake, RE, Clark, RE, Bush, PW, Noordsy, DL. Substance abuse in schizophrenia: service utilization and costs. J Nerv Ment Dis 1993; 181:227–32.CrossRefGoogle ScholarPubMed
24.Ross, HE, Cutler, M, Sklar, SM. Retention in substance abuse treatment. Role of psychiatric symptom severity. Am J Addict 1997; 6:292–303.Google ScholarPubMed
25.De Leon, G, Skodol, A, Rosenthal, MS. Phoenix House. Changes in psychopathological signs of resident drug addicts. Arch Gen Psychiatry 1973; 28:131–5.CrossRefGoogle ScholarPubMed
26.Ravndal, E, Vaglum, P. Psychopathology and substance abuse as predictors of program completion in a therapeutic community for drug abusers: a prospective study. Acta Psychiatr Scand 1991; 83:217–22.CrossRefGoogle Scholar
27.Agosti, V, Nunes, E, Stewart, JW, Quitkin, FM. Patient factors related to early attrition from an outpatient cocaine research clinic: a preliminary report. Int J Addict 1991; 26:327–34.CrossRefGoogle Scholar
28.Joe, GW, Brown, BS, Simpson, D. Psychological problems and client engagement in methadone treatment. J Nerv Ment Dis 1995; 183:704–10.CrossRefGoogle ScholarPubMed
29.Semple, DM, Mcintosh, AM, Lawrie, SM. Cannabis as a risk factor for psychosis: systematic review. J Psychopharmacol 2005; 19:187–94.CrossRefGoogle ScholarPubMed
30.Arseneault, L, Cannon, M, Witton, J, Murray, RM. Causal association between cannabis and psychosis: examination of the evidence. Br J Psychiatry 2004; 184:110–7.CrossRefGoogle ScholarPubMed
31.Arseneault, L, Cannon, M, Poulton, R, Murray, R, Caspi, A, Moffitt, TE. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. BMJ 2002; 325:1212–3.CrossRefGoogle ScholarPubMed
32.Bovasso, GB. Cannabis abuse as a risk factor for depressive symptoms. Am J Psychiatry 2001; 158:2033–7.CrossRefGoogle ScholarPubMed
33.Degenhardt, L, Hall, W, Lynskey, M. Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction 2001; 96:1603–14.CrossRefGoogle ScholarPubMed
34.Degenhardt, L, Hall, W, Lynskey, M. Exploring the association between cannabis use and depression. Addiction 2003; 98:1493–504.CrossRefGoogle ScholarPubMed
35.Rounsaville, BJ, Kranzler, HR, Ball, S, Tennen, H, Poling, J, Triffleman, E. Personality disorders in substance abusers: relation to substance use. J Nerv Ment Dis 1998; 186:87–95.CrossRefGoogle ScholarPubMed
36.Kranzler, HR, Satel, S, Apter, A. Personality disorders and associated features in cocaine-dependent inpatients. Compr Psychiatry 1994; 35:335–40.CrossRefGoogle ScholarPubMed
37.Weiss, RD, Mirin, SM, Griffin, ML, Gunderson, JG, Hufford, C. Personality disorders in cocaine dependence. Compr Psychiatry 1993; 34:145–9.CrossRefGoogle ScholarPubMed
38.Andersen, SM, Harthorn, BH. The recognition, diagnosis, and treatment of mental disorders by primary care physicians. Med Care 1989; 27:869–86.CrossRefGoogle ScholarPubMed
39.Milby, JB, Sims, MK, Khuder, Set al.Psychiatric comorbidity: prevalence in methadone maintenance treatment. Am J Drug Alcohol Abuse 1996; 22:95–107.CrossRefGoogle ScholarPubMed
40.Marsden, J, Gossop, M, Stewart, D, Rolfe, A, Farrell, M. Psychiatric symptoms among clients seeking treatment for drug dependence. Intake data from the National Treatment Outcome Research Study. Br J Psychiatry 2000; 176:285–9.CrossRefGoogle ScholarPubMed
41.Farrell, M, Boys, A, Bebbington, Pet al.Psychosis and drug dependence: results from a national survey of prisoners. Br J Psychiatry 2002; 181:393–8.CrossRefGoogle ScholarPubMed
42.Swift, W, Williams, G, Neill, O, Grenyer, B. The prevalence of minor psychopathology in opioid users seeking treatment. Br J Addict 1990; 85:629–34.CrossRefGoogle ScholarPubMed
43.Darke, S, Swift, W, Hall, W. Prevalence, severity and correlates of psychological morbidity among methadone maintenance clients. Addiction 1994; 89:211–7.CrossRefGoogle ScholarPubMed
44.De Leon, G. Psychopathology and substance abuse: what is being learned from research in therapeutic communities. J Psychoactive Drugs 1989; 21:177–88.CrossRefGoogle ScholarPubMed