Treatment Guidelines for Substance Use Disorders and Serious Mental Illnesses: Do They Address Co-Occurring Disorders?

Abstract

Practice guidelines are important tools for improving the delivery of evidence-based practices and reducing inappropriate variation in current treatment approaches. This study examined the degree to which guidelines targeted to the treatment of substance use disorders or serious mental illness address treatment of co-occurring disorders. Guidelines archived by the National Guideline Clearinghouse (NGC) were retrieved in December 2007 and content analyzed. Nineteen pertinent guidelines were identified, and 11 included recommendations regarding the assessment and/or treatment of co-occurring disorders. None of the guidelines making recommendations for treatment of co-occurring disorders included outcomes that clearly targeted both substance use and mental health disorders. Limitations and implications of this study are noted.

RÉSUMÉ

Les directives de pratique sont des outils importants pour améliorer la réalisation des pratiques à base d’évidence et pour réduire le désaccord inconvenant des approches actuelles de traitement. Cette étude a examiné le degré auquel les directives visées au traitement des assuétudes à la drogue ou aux maladies mentales sérieuses abordent le traitement des problèmes coexistants. Les directives archivées par le Centre d’Information National des Directives ont été répertoriées en décembre 2007 et analysées. Dix-neuf directives pertinentes ont été identifiées, et 11 d’entre elles ont inclus des recommandations concernant l’évaluation et/ou le traitement des problèmes coexistants. Aucune des directives faisant des recommandations pour le traitement des problèmes coexistants n’a inclus de résultats qui ont clairement visé à la fois les assuétudes à la drogue et les troubles mentaux. Les limitations et les implications de cette étude sont notées.

Mots clés : Directives de traitement, diagnostic double, problèmes coexistants

RESUMEN

Las pautas de práctica son herramientas importantes para mejorar la entrega de prácticas fundadas en pruebas y para reducir la variación inapropiada que existe en las métodos actuales. Ésta investigación examinó hasta qué punto las pautas dirigidas al tratamiento de la drogadicción o de la enfermedad mental consideran el tratamiento de trastornos coexistentes. Las pautas archivadas por el Centro de Información Nacional para las Pautas fueron fueron recuperadas en diciembre del 2007 y analizadas. Diecinueve pautas pertinentes fueron identificadas, y once incluyeron recomendaciones sobre la evaluación y/o tratamiento de los trastornos coexistentes. Ninguna de las pautas con recomendaciones para el tratamiento de los trastornos coexistentes incluyó resultados que se dirigieron directamente a tanto la drogadicción como las enfermedades mentales. Las limitaciones e implicaciones de esta investigación son notadas.

Palabras Claves: Pautas de práctica, diagnostico doble, trastornos coexistentes

Keywords :

• treatment guidelines
• dual diagnosis
• co-occurring disorders

THE AUTHORS

Brian E. Perron, PhD, is an Assistant Professor of Social Work at the University of Michigan. He studies services for persons with substance use disorders and psychiatric disorders, with an emphasis on their co-occurrence. The focus of his work involves issues related to treatment process, treatment utilization, and quality of care. Dr. Perron's training was funded by the National Institute of Mental Health and National Institute on Drug Abuse. He currently teaches social work courses on the diagnosis and treatment of substance use and psychiatric disorders. Prior to his doctoral training, Dr. Perron worked as a clinical social worker.

Alicia C. Bunger, MSW, is a doctoral candidate at the Brown School of Social Work at Washington University in St Louis and an NIMH pre-doctoral trainee.  Her research interests include partnership development among mental health organizations, the evolution of inter-organizational networks, and the impact on service delivery. She holds an MSW from Rutgers, The State University of New Jersey and a BA in psychology from Susquehanna University.

Kimberly Bender's recent research includes a study of gender-specific pathways from childhood maltreatment to juvenile delinquency among youth in the child welfare system. Her research aims to improve services and develop empirically-based interventions for adolescents at risk of problem behavior. She recently contributed to an intervention research project on methods for engaging runaway youth in substance use treatment funded by the National Institute for Drug Abuse. Prof. Bender has worked in a variety of clinical settings with youth, including residential treatment, inpatient facilities, and outpatient mental health centers.

Michael Vaughn is currently Assistant Professor in the School of Social Work and Holds appointments in Public Policy and the Department of Community Health, Division of Epidemiology, Saint Louis University School of Public Health. In addition to several projects examining resilience, adolescent health, adolescent substance abuse, self-regulation, and violence, he is developing and testing a general biosocial public health model for research and intervention applications.

Matthew O. Howard, PhD, is currently Frank A. Daniels Distinguished Professor of Human Services at the University of North Carolina at Chapel Hill. Formally, he was Professor of Social Work and Psychiatry at the University of Michigan. Dr. Howard has published 125 articles and serves on the editorial boards of Social Work Research, Research on Social Work Practice, Journal of Social Work and Public Health, American Indian and Alaska Native Mental Health Research, Journal of Evidence-Based Social Work, and Journal of Studies on Alcohol. He was the Editor of the Journal of Social Services Research, and presently is a Consulting Editor for the Journal of Social Work Education and Health and Social Work, and regularly reviews for Psychosomatic Medicine, Drug and Alcohol Dependence, and many other journals. Dr. Howard reviews mental health texts for the Guilford, Allyn and Bacon, Sage, Lyceum, and McGraw-Hill publication houses. He has served on three NIH ad hoc grant review study sections, and has received three grants from the National Institute on Drug Abuse.