Cognitive and Mindfulness‐Based Therapy for Adolescents with Co‐Occurring Post‐Traumatic Stress and Substance Use Disorder

Early life experiences of trauma are known to significantly increase the risk of substance use in adolescence and adulthood. It has been suggested that individuals may use alcohol or drugs as a means of temporarily relieving themselves from psychological distress, however this can lead to increased emotional dysregulation in the long term.

Mindfulness-Based Cognitive Therapy (MBCT) for adolescent suffering from PTSD and SUDs focuses on developing awareness of unhelpful thought patterns and cognitive restructuring. 

Results suggest feasibility, safety, and effectiveness of Mindfulness-Based Cognitive Therapy for adolescents with PTSD, depression, and substance use.
Results suggest feasibility, safety, and effectiveness of Mindfulness-Based Cognitive Therapy for adolescents with PTSD, depression, and substance use. 

A recent study, published in the Journal of Psychology and Psychotherapy, has examined the impact of 12-week MBCT sessions involving 37 young people experiencing symptoms of PTSD and SUD. The researchers used standardised measures and urine drug screens to analyse changes in PTSD symptoms, depression, and substance use frequency.

Highlights from the results:

  • Cannabis was the most commonly used substance.
  • Throughout the 12 weeks, there was a significant improvement in PTSD symptoms, trauma‐related cognitions and depression symptoms.
  • Alcohol use remained consistent from baseline to end of treatment; however, cannabis use dropped from 16% to 9% following the course of therapy.

The preliminary results of the study highlight the feasibility, safety, and potential clinical effectiveness of MBCT for young people suffering from PTSD and SUD.

Jose Luis Vazquez Martinez

La Dra. Marta Torrens, del Institut de Neuropsiquiatria i Addiccions-IMIM, del Hospital del Mar, en Barcelona, habla sobre el modelo y funcionamiento de las unidades de atención para personas con trastornos psiquíatricos y al mismo tiempo, trastornos por consumo de drogas.

Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents with Physical or Mental Illness and/or Substance Abuse

Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.

Jose Luis Vazquez Martinez

Poznyak V. World Health Organization guidelines for the treatment of substance use disorders and comorbid conditions. RIIAD [Internet]. 1Jan.2018 [cited 7Jan.2019];4(1):1-.

Jose Luis Vazquez Martinez
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Comorbidity of substance use and men

Guidelines on the Management of Co-Occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and Other Drug Treatment Settings

First published in 2009 and updated in 2014 the  Guidelines on the Management of Co-Occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and Other Drug Treatment Settings are offered in tandem with an online training programme. 

Created by the National Centre of Research Excellence in Mental Health and Substance Use (NARDC) and funded by the Australian Government Department of Health, the resource is free to access through the NHMRC. It was developed in consultation and collaboration with clinicians, researchers, consumers, and carers from across Australia.

The guidelines are designed to improve knowledge and awareness of the comorbidity of mental illness and substance use problems and make it easier for practitioners and clinical staff to implement evidence-based care approaches. 

Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (second edition)

Mental Health Atlas 2017

6 June 2018 – WHO's Mental Health Atlas 2017 reveals that although some countries have made progress in mental health policy-making and planning, there is a global shortage of health workers trained in mental health and a lack of investment in community-based mental health facilities.

“This latest edition of the Mental Health Atlas provides us with yet more evidence that scale-up of resources for mental health is not happening quickly enough. We know what works. Failure to invest in mental health as a matter of urgency will have health, social and economic costs on a scale that we have rarely seen before,” said Dr Shekhar Saxena, Director of WHO’s Department of Mental Health and Substance Abuse.

The Atlas provides information on the existence of policies, plans and laws for mental health, and their alignment with established human rights instruments; the human and financial resources available; the type of facilities providing care; and mental health programmes for prevention and promotion.

It is based on data provided by 177 WHO Member States, representing 97% of the world’s population, and measures the extent to which countries are strengthening leadership and governance for mental health; providing comprehensive mental health and social care; implementing strategies to promote mental health and prevent problems, and strengthen evidence and research – as outlined in WHO’s Comprehensive Mental Health Action Plan 2013-2020.

In low-income countries, the rate of mental health workers can be as low as 2 per 100 000 population, compared with more than 70 in high-income countries. This is in stark contrast with needs, given that 1 in every 10 person is estimated to need mental health care at any one time.

Less than half of the 139 countries that have instituted mental health policies and plans, have these aligned with human rights conventions which stress the importance of transition from psychiatric institution to community-based services and the participation of people with mental disorders in decisions concerning them. And all too often, when mental health plans are made, they are not supported by adequate human and financial resources.

Brian Morales

UNODC Scientific Consultation – December 2015

 

SUBSTANCE USE DISORDERS AND CO-OCCURRING ATTENTION DEFICIT DISORDER

 

Brian Morales

UNODC Scientific Consultation – December 2015

 

CO-OCCURRING MENTAL HEALTH AND DRUG USE DISORDERS