Does an Adapted Dialectical Behaviour Therapy Skills Training Programme Result in Positive Outcomes for Participants with a Dual Diagnosis? A Mixed Methods Study



Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation.


A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data.


Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants’ experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors.


This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.

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webinar United Kingdom

The Link between Childhood Trauma and Dissociation in Frequent Users of Psychedelics and Dissociatives

Research suggests clear associations between the severity of childhood trauma, levels of substance use and dissociation - the detachment or disruption to normal consciousness. Despite the apparent link, it remains unclear whether the level of substance use can, in some part, explain the relationship between trauma severity and the extent of dissociation.

A recent study, published in the Journal of Substance Use, has investigated whether substance use significantly influences the link between childhood trauma and the severity of depersonalization - a common symptom of dissociation involving changes in perception and emotion processing.

Participants completed online questionnaires that collected information about childhood abuse, depersonalization severity and substance use.

Results found that

  • Dissociation severity, in the form of depersonalization, is predicted by both the severity of childhood trauma and the use of illicit substances.
  • The link between traumatic childhood experiences and dissociation was not, however, moderated by the quantity of classic psychedelics or dissociatives used by participants.
  • Differences in dissociation severity were explained more by childhood trauma than substance use.

Overall the study adds further evidence to support the link between childhood trauma and dissociation. The researchers suggest that it may be the context of substance use rather than the quantity of substance use that influence severity dissociation.

Implementing Effective Systems of Care for Children, Youth, and Transition-Aged Youth with or At-Risk of SED in Rural Communities

Event Date
United States

Tuesday, August 6, 2019 3:00:00 PM EDT - 4:30:00 PM EDT (Washington DC time)


To register, please visit:

In 2017, 4.5% (11.2 million) of Americans 18 years or older had a serious mental illness (SMI), and it is estimated that 6.8 to 11.5 percent of children and youth have a serious emotional disturbance (SED). To address this challenge, SAMHSA has included in the FY2019 – FY2023 Strategic Plan a goal to “Reduce the impact of SMI and SED and improve treatment and recovery support services through the implementation of the comprehensive set of recommendations put forward by the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).”

On Tuesday, August 6, 2019, from 3:00 pm to 4:30 pm Eastern Time, a SAMHSA-sponsored webinar developed under a contract by the National Association of State Mental Health Program Directors (NAMHPD) and National Federation of Families for Children’s Mental Health, will take place. During the webinar, the panelists will discuss the challenges, successes, and lessons learned from their experiences in the implementation of effective rural Systems of Care. The discussion will include research findings related to engaging students and families in rural educational settings, cultural considerations, and strategies for engaging youth in remote communities. Presenters will offer insights and recommendations of interest to those who are currently involved in this work and for those who are contemplating the implementation of a rural System of Care. This webinar will be of interest to all audiences.

SAMHSA has a rich history of funding Systems of Care across the country. Implementation of these systems in rural communities is often challenging, in part due to factors such as culture and geography. These challenges require that implementers be well-grounded in community dynamics and demographics and that creative solutions be brought to the design of the framework for successful, rural systems.


  • Kurt Michaels, Ph.D., Professor of Psychology, Appalachian State University
  • Hannah Soundrarajan, B.S., Youth Engagement Coordinator, Minnesota System of Care
  • Brenda Donaldson, M.S., Family and Youth Engagement Program Manager, Tennessee System of Care, TN Department of Mental Health and Substance Abuse Services
  • Julie Smith, M.S., Child and Youth Care Coordinator, System of Care Across Tennessee (SOCAT)


  • Lynda Gargan, Ph.D., Executive Director, National Federation of Families for Children’s Mental Health

To register, please CLICK HERE

When in the seminar room, the Adobe Connect Log-in screen appears:

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  2. Enter your name and state in the “Name” field (Ex. Jane Doe-AK)
  3. Click on "Enter Room"

For attendees, this is a “listen only” webinar. Should you need to dial in, the instructions are on the note pad in the seminar room.

If you dial in, please ensure that your computer speakers are turned off so that there is no audio feedback. Note: If you are only able to join the audio portion, then you will not be able to see the webinar presentation. We highly recommend that you test your connection to Adobe Connect in advance of the webinar to ensure access. You may need to work with your state’s IT Department to resolve any firewall issues. To test your connection, please go to: You may be prompted to install ActiveX control, Adobe Flash Player, and Adobe Connect add-ins. If you encounter any difficulty testing your connection or logging into the webinar, please contact Technical Support by calling 1-800-459-5680.

If you have any questions please contact Kelle Masten via email at kelle [dot] masten [at] nasmhpd [dot] org or at 703-682-5187.

Please note that c losed-captioning is available for this webinar.

CEU credits will not be offered. However, letters of attendance are offered upon request.

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Youth Substance Abuse and Co-Occurring Disorders

70%–80% of adolescents with a substance use disorder also manifest comorbid psychopathology, known also as co-occurring disorders or dual diagnosis. Co-occurring disorders are the presence of one or more comorbid psychiatric disorders in addition to a substance use disorder.

These comorbidities can greatly complicate assessment and treatment, and this book provides clinicians with not only the theory behind the various approaches to substance use disorder but also the practical knowledge that is essential to understand and treat psychiatric comorbidity in these adolescents.

Some of the most prominent investigators in the field have contributed scholarly chapters to the volume, which offers a multitude of useful features:

  • An extensive examination of the cause of a substance use disorder, focusing on whether psychopathology may precede a substance use disorder, as in the majority of cases, develop as a consequence of preexisting a substance use disorder, or originate from a common vulnerability;
  • Consistent emphasis on future directions in clinical research and treatment advancement, which helps the reader identify critical gaps in understanding the relationship between a substance use disorder and psychiatric comorbidity among youth
  • Thorough, state-of-the-art chapters on the developmental pathways and relationships between substance use and co-occurring psychiatric disorders, screening tools and interventions, and the full range of co-occurring disorders make the book ideal for instructional use
  • Information on risk factors for the development of a substance use disorder in adolescence, including psychiatric disorders in childhood such as disruptive behaviour disorders, mood, anxiety disorders, etc.

Clinically useful and scientifically rigorous, Youth Substance Abuse and Co-occurring Disorders should stimulate further discussion and advancement of the field, ultimately resulting in improved and more effective services and intervention modalities for these youth.

Implementation of the Mental Health Gap Action Programme (mhGAP) within the Fijian Healthcare System: A Mixed-Methods Evaluation



To facilitate decentralisation and scale-up of mental health services, Fiji’s Ministry of Health and Medical Services committed to implementing the World Health Organization’s mental health Gap Action Programme (mhGAP). mhGAP training has been prolific; however, it remains unclear, beyond this, how successfully Fiji’s national mental health program has been implemented. We aim to evaluate Fiji’s mental health program to inform Fiji’s national mental health program and to develop an evidence-base for best practice.


The study design was guided by the National Implementation Research Network and adhered to the Consolidated Framework for Implementation Research. CFIR constructs were selected to reflect the objectives of this study and were adapted where contextually necessary. A mixed-methods design utilised a series of instruments designed to collect data from healthworkers who had undertaken mhGAP training, senior management staff, health facilities and administrative data.


A total of 66 participants were included in this study. Positive findings include that mhGAP was considered valuable and easy to use, and that health workers who deliver mental health services had a reasonable level of knowledge and willingness to change. Identified weaknesses and opportunities for implementation and system strengthening included the need for improved planning and leadership.


This evaluation has unpacked the various implementation processes associated with mhGAP and has simultaneously identified targets for change within the broader mental health system. Notably, the creation of an enabling context is crucial. If Fiji acts upon the findings of this evaluation, it has the opportunity to not only develop effective mental health services in Fiji but to be a role model for other countries in how to successfully implement mhGAP.

Atención de las Urgencias en Salud Mental

Esta publicación forma parte de la serie “Recomendaciones para la Red Integrada de Salud Mental con base en la Comunidad”, y tiene como objetivo acercar sugerencias y recomendaciones como herramientas de trabajo que orienten a la asistencia de las personas que refieran o presenten un padecimiento mental (incluyendo consumo problemático de sustancias y/o adicciones), sin ningún tipo de menoscabo o discriminación en toda institución de salud y en la zona o ámbito comunitario de atención de dicha institución. Se halla enmarcado en la Convención de los Derechos de las Personas con Discapacidad y la Ley Nacional de Salud Mental N°26.657, su decreto reglamentario N°603/2013, entendiendo que la atención de la Salud Mental no debe llevarse a cabo en instituciones monovalentes, sino en el ámbito más cercano a la comunidad de la persona que la requiere. Estas Recomendaciones incluyen sugerencias para la práctica clínica, como también herramientas básicas a los equipos de salud para atender y dar respuesta a las urgencias en salud mental.

Applications open: 2019 Neuroscience, Mental Health and Addiction Collaborative Research Seed Funding

Applications are now open for the 2019 round of UNSW Medicine Neuroscience, Mental Health and Addiction Theme and SPHERE Clinical Academic Group (CAG) Collaborative Research Seed Funding.

The UNSW Medicine Neuroscience, Mental Health and Addiction Theme and SPHERE CAG aims to address the burdens imposed by neurological, mental health, and drug and alcohol disorders. It constitutes a network of internationally recognised researchers and clinicians leading in the understanding and treatment of complex clinical conditions with physical, behavioural, mental and social dimensions across the lifespan.

In the 2019 funding round, Neuroscience, Mental Health and Addiction will seek to award eight research proposals, two from each sub-theme:

  • Children and Adolescent Wellbeing
  • Complex and Difficult to Treat Diseases
  • Healthy Ageing
  • Brain Sciences and Translational Neuroscience
Jose Luis Vazquez Martinez

Participación de la Dra. Nayeli Páez Martínez en el Seminario: “La epidemia de Enfermedades Crónicas no Transmisibles en México

Alcohol and NCDs – Harm and Solutions: Factsheet

IOGT International has released a new factsheet to illustrate how alcohol fuels the global NCDs tsunami – based on the latest scientific evidence – and to outline cost-effective solutions for change.

The factsheet includes information about the links between alcohol and cancer, cardiovascular disease, digestive problems, diabetes and mental health. The resource also highlights measures that can be implemented to reduce the harm caused by alcohol. 

Jose Luis Vazquez Martinez Fantástica explicación de la Dra Nora Volkow, Investigadora y Neurocientífica, en la actualidad Directora del National Institute on Drug Abuse de los Estados Unidos (NIDA).

Leadership in Mental Health

Event Date

9th-20th December 2019

This course is an excellent opportunity to enhance your understanding and skills in the field of global mental health. The course takes place annually at Sangath, Goa, India, and it welcomes participants from across the world to share their experiences and learn collaboratively. SANGATH is now welcoming applications for this year's course.


Course content:

Meet the tutors:

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Alcohol Misuse in the Armed Forces

Alcohol misuse in the UK armed forces is more than double than that of the general population, yet many of those who drink at harmful levels do not seek help. Preliminary research has shown how effective digital technologies can be used as a health intervention.

In a research project titled ‘Information about Drinking in Ex-serving personnel’ (InDEx), researchers and professionals from the University of Liverpool, King’s College London, Alcohol Research UK and Royal British Legion joined together to developed an app, to help people monitor and manage their alcohol consumption.

Involving Service Users in Mental Health Policy Making

There has been increasing support for the engagement of people who use mental services in the process of policy improvement. It would seem to make sense that those most directly affected by policy responses should have their views represented. This brings in to question the alternate forms of ‘evidence’ that can be used as part of evidence-based practice.

A recent study, conducted in Australia, has analysed interviews with individuals involved in drug policy discussions.

The aim of the study was to see how the idea of “consumer” is considered in relation to the discussion around the development of ‘evidence-based policy’, as well as question how power may be seen as centred through evidence-based practice, which may be considered conservative in the way it values forms of knowledge.

Participants included policymakers, advocates, non-governmental organisation representatives, consumer representatives, researchers and clinicians.

The authors present their findings in relation to two overarching ideas: Enacting difference, constituting “consumers”, and Difference and resistance.

Enacting difference, constituting “consumers”:

  • The drug policy ‘sector’ is viewed as a disjointed collection of different people with different perspectives and distinct interests in the policy process.
  • It was almost universally assumed that ‘consumers’ would be less powerful than others engaged in the policy process
  • It was clear the development of evidence-based policy privileges the ‘objective’ and ‘rational’ knowledge of clinicians and researchers

Difference and resistance:

  • Considered, rational argument and objectivity instead of subjectivity  fit more easily  with  evidence-based policy
  • Lived experience is devalued
  • There was a lack of alignment between understanding through lived experience and knowledge through scientific or ‘evidence-based’ definition.

Overall, although there is a move towards service user participation in developing policy, there is clear tension between the concept of ‘evidence base’ and how the process can be made to be inclusive.

Mental Health in the Americas: An Overview of the Treatment Gap

[ABSTRACT]. Objective. To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Methods. Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Results. Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% – 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. Conclusion. The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease.

[RESUMEN]. Objetivo. Comprender la brecha en el tratamiento de la salud mental en la Región de las Américas mediante la revisión de la prevalencia de los trastornos de salud mental, el uso de los servicios de salud mental y la carga mundial de enfermedad. Métodos. Se utilizaron datos de encuestas comunitarias de trastornos mentales de Argentina, Brasil, Canadá, Chile, Colombia, Estados Unidos, Guatemala, México y Perú. Se emplearon los datos publicados de la Encuesta Mundial de Salud Mental para estimar la brecha de tratamiento. Para Canadá, Chile y Guatemala, la brecha de tratamiento se calculó a partir de los archivos de datos. Se estimaron la brecha de tratamiento media, media ponderada, y mediana, y la prevalencia de 12 meses por gravedad y categoría de trastorno mental para las poblaciones generales de adultos, niños y adolescentes, e indígenas. Se calcularon los años de vida ajustados por discapacidad y los años vividos con discapacidad a partir del estudio Carga Global de Enfermedad. Resultados. Los trastornos mentales y por consumo de sustancias representaron el 10,5% de la carga mundial de enfermedad en las Américas. La tasa de prevalencia de 12 meses de los trastornos mentales severos varió del 2% al 10% en los estudios. La brecha de tratamiento media ponderada en las Américas para los trastornos moderados a graves fue del 65,7%; en América del Norte de 53,2%; en América Latina de 74,7%; en Mesoamérica de 78,7%; y en América del Sur de 73,1%. La brecha de tratamiento para los trastornos mentales graves en niños y adolescentes fue superior al 50%. Un tercio de la población indígena en los Estados Unidos y el 80% en América Latina no recibieron tratamiento. Conclusión. La brecha de tratamiento para la salud mental sigue siendo un problema de salud pública. Una gran proporción de adultos, niños y personas indígenas con enfermedades mentales graves continúan sin tratamiento. El resultado implica una prevalencia elevada de trastornos mentales y de la carga mundial de enfermedad.

[RESUMO]. Objetivo. Compreender a lacuna de tratamento em saúde mental na Região das Américas examinando a prevalência de transtornos mentais, o uso de serviços de saúde mental e a carga global de doença. Métodos. Foram utilizados dados de inquéritos comunitários de transtornos mentais na Argentina, Brasil, Canadá, Chile, Colômbia, Guatemala, México, Peru e Estados Unidos. Os dados publicados na Pesquisa Mundial de Saúde Mental foram utilizados para estimar a lacuna de tratamento. Para o Canadá, Chile e Guatemala, a lacuna de tratamento foi calculada a partir de arquivos de dados. A lacuna de tratamento média, média ponderada e mediana, e a prevalência de 12 meses por gravidade e categoria de transtorno mental foram estimadas para as populações adulta, infantil-adolescente e indígena em geral. Os anos de vida ajustados por incapacidade e os anos de vida com incapacidade foram calculados a partir do estudo Carga Global de Doença. Resultados. Os transtornos mentais e de uso de substâncias foram responsáveis por 10,5% da carga global de doença nas Américas. A taxa de prevalência de 12 meses de transtornos mentais graves variou de 2% a 10% entre os estudos. A lacuna de tratamento média ponderada nas Américas para transtornos moderados a graves foi de 65,7%; em América do Norte de 53,2%; em América Latina de 74,7%; em Mesoamérica de 78,7%; e na América do Sul de 73,1%. A lacuna de tratamento para transtornos mentais graves em crianças e adolescentes foi superior a 50%. Um terço da população indígena nos Estados Unidos e 80% na América Latina não recebeu tratamento. Conclusão. A lacuna de tratamento para a saúde mental continua sendo uma preocupação de saúde pública. Uma alta proporção de adultos, crianças e indígenas com doença mental grave permanece sem tratamento. O resultado é uma elevada prevalencia de transtornos mentais e de carga global de doença.

2nd International Conference on Addiction Research & Behavioral Health

Event Date

The 2nd International Conference on Addiction Research and Behavioural Health will take place on October 16-17th October in Vancouver, Canada.

The theme of the event is “Exploring Innovation in Addiction Research present Era" and topics that will be addressed will include:

  • Addiction treatment and therapy
  • Drug Addiction
  • Neurotoxicology
  • Current research aspects on addiction
  • Addiction rehabilitation therapies

The event is designed for stakeholders, researchers, product developers, solution providers, sales and marketing professionals, management bodies and Experts Looking for Collaborative Work.

The conference will allow participants to meet experts in the field and network on a global level. The latest research will be presented and there will be an opportunity to build a new customer base.

The event organisers are currently accepting abstracts.

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Webinar: How Do Co-occurring Mental Health and Substance Use Disorders Affect Young People?

This webinar will present an update on research into co-occurring mental and substance use disorders among young people in Australia.

It will ask:

  • how many young people experience co-occurring mental and substance use disorders?
  • What is the impact?
  • And what are the implications for research, prevention and treatment?

It will include a discussion of some recent trends in drug and alcohol use among young Australians, changing gender patterns across the world, and will raise some questions for future directions in research and prevention of mental and substance use disorders.

This webinar will draw on the latest research to provide a big picture view of the changing landscape of mental and substance use disorders in Australia and what it means for young people. 

Key Learning Objectives:

  1. Learn about patterns of co-occurring mental and substance use disorders among young people in Australia
  2. Explore how these patterns are changing
  3. Discuss the implications for research, prevention and treatment

Perceptions about Mental Illness among General Practitioners



General practitioners (GPs) play an important role in the physical care of patients with severe mental illness, so our aim was to analyse the relationships between GPs’ sociodemographic status and worked-related variables and their perceptions about mental illness.


A descriptive, cross-sectional study was conducted in the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population comprised all GPs working in the 13 primary care centres (PCCs) in the hospital’s catchment area during the study period. GPs were interviewed to collect data on their attitudes to and knowledge of mental illness, psychiatry and the local mental health team, as well as their sociodemographic status, professional qualifications and experience. Bivariate analysis was carried out.


145 GPs answered the questionnaire (77%). ANOVA revealed that most of the PCCs with the best relationship with their mental health team and best attitude to mental illness were in the Central Community Mental Health Unit, which operated a collaborative model of care.


These results indicated that GPs who worked more closely with their specialist mental health team had a better perception of their relationship with the mental health centre and less stigmatisation in regard to mental illness.

Recovery Connects 2019

Event Date
United Kingdom

The Recovery Collective are pleased to announce Scotland's first ever alcohol and drug-free festival Recovery Connects at Queen's Park Arena on Sunday 12th May!

Alongside an amazing line up of acts, the festival will also provide addiction, mental health and homelessness services, recovery communities and local social enterprises an opportunity to set up stalls to promote the work they do whilst also entertaining the crowd with a range of family-based activities. 

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