October PD Blog

Professional development

You can add to the professional development post by commenting below or emailing the library.

Online resources

Webpage

The Healing Foundation has a website linking to resources about intergenerational trauma in Aboriginal and Torres Strait Islanders.

Read – professional reading

Available from the library database

Armstrong, G., Spittal, M. J., & Jorm, A. F. (2018). Are we underestimating the suicide rate of middle and older‐aged Indigenous Australians? An interaction between ‘unknown’Indigenous status and age. Australian and New Zealand Journal of Public Health.

Barnett, A. I., Hall, W., Fry, C. L., Dilkes‐Frayne, E., & Carter, A. (2017). Drug and alcohol treatment providers’ views about the disease model of addiction and its impact on clinical practice: A systematic review. Drug and Alcohol Review.

Hunt, G., Antin, T., Sanders, E., & Sisneros, M. (2018). Queer youth, intoxication and queer drinking spaces. Journal of Youth Studies, 1-21.

Kristjansson, A. L., Kogan, S. M., Mann, M. J., Smith, M. L., Juliano, L. M., Lilly, C. L., & James, J. E. (2018). Does early exposure to caffeine promote smoking and alcohol use behavior? A prospective analysis of middle school students. Addiction.

McCann, T. V., & Lubman, D. I. (2018). Help-seeking barriers and facilitators for affected family members of a relative with alcohol and other drug misuse: A qualitative study. Journal of Substance Abuse Treatment, 93, 7-14.

Wakeford, G., Kannis‐Dymand, L., & Statham, D. (2018). Anger rumination, binge eating, and at‐risk alcohol use in a university sample. Australian Journal of Psychology, 70(3), 269-276.

Open Access Articles

Bryant, L., Garnham, B., Tedmanson, D., & Diamandi, S. (2018). Tele-social work and mental health in rural and remote communities in Australia. International Social Work, 61(1), 143-155.

Lamont-Mills, A., Christensen, S., & Moses, L. (2018). Confidentiality and informed consent in counselling and psychotherapy: a systematic review. Melbourne: PACFA.

Petrakis, M., Robinson, R., Myers, K., Kroes, S., & O’Connor, S. (2018). Dual diagnosis competencies: A systematic review of staff training literature. Addictive Behaviors Reports, 7, 53-57.

Roberts, R. M., Ong, N. W. Y., & Raftery, J. (2018). Factors That Inhibit and Facilitate Wellbeing and Effectiveness in Counsellors Working With Refugees and Asylum Seekers in Australia. Journal of Pacific Rim Psychology, 12.

Tsou, C., Green, C., Gray, G., & Thompson, S. C. (2018). Using the Healthy Community Assessment Tool: Applicability and Adaptation in the Midwest of Western Australia. International Journal of Environmental Research and Public Health, 15(6).

Useful resources

Insight have produced several toolkits of resources for use by workers including:

AOD Literacy Toolkit  

First Nations AOD Toolkit

The 2018 Global Drug Survey has just been released

e-Book of the month

Bukowski, W. M., Laursen, B. P., & Rubin, K. H. (2018). Handbook of Peer Interactions, Relationships, and Groups, Second Edition. New York: The Guilford Press.

The definitive handbook on peer relations has now been significantly revised with 55% new material. Bringing together leading authorities, this volume presents cutting-edge research on the dynamics of peer interactions, their impact on multiple aspects of social development, and the causes and consequences of peer difficulties. From friendships and romance to social withdrawal, aggression, and victimization, all aspects of children’s and adolescents’  relationships are explored. The book examines how individual characteristics interact with family, group, and contextual factors across development to shape social behavior. The importance of peer relationships to emotional competence, psychological well-being, and achievement is analyzed, and peer-based interventions for those who are struggling are reviewed. Each chapter includes an introductory overview and addresses theoretical considerations, measures and methods, research findings and their implications, and future directions (from publisher).

Attend – informal learning sessions, journal club, seminar series

Insight Queensland

Free training sessions at Biala Community Health Centre in Brisbane, unless otherwise specified including:

Online induction modules are a prerequisite to some of the courses. To access and download them visit www.insightqld.org

5 October, 08:30-16:00: Introduction to Motivational Interviewing – Townsville. Prerequisite Module 5

9 October, 09:00-16:30: “AOD Crash Course” – Introduction to Working with People who use Substances – Logan

9 October, 09:00-16:30: “AOD Crash Course” – Introduction to Working with People who use Substances – Brisbane

11 October, 09:00-16:30: Introduction to AOD Clinical Supervision – Brisbane

12 October, 09:00-16:30: Introduction to Motivational Interviewing – Gold Coast. Prerequisite Module 5

16 October, 09:00-16:30: Advanced Harm Reduction – Brisbane. NB: Participants must have completed Insight’s “Understanding Psychoactive Drugs” workshop or be an existing employee of an AOD or Mental Health service to be eligible for this workshop.

18 October, 09:00-16:30: Introduction to Motivational Interviewing – Sunshine Coast. Prerequisite Module 5

18 October, 09:00-16:30: Family Inclusive Practice in AOD Treatment – Brisbane

23 October, 09:00-16:30: Introduction to Withdrawal Management – Logan

23 October, 09:00-16:30: Case Formulation – Brisbane

25 October, 09:00-16:30: Introduction to Motivational Interviewing – Logan. Prerequisite Module 5

25 October, 09:00-16:30: Advanced Harm Reduction – Ipswich. NB: Participants must have completed Insight’s “Understanding Psychoactive Drugs” workshop or be an existing employee of an AOD or Mental Health service to be eligible for this workshop.

25 October, 09:00-16:30: AOD Relapse Prevention and Management – Brisbane. Prerequisite Module 6

30 October, 09:00-16:30: “AOD Crash Course” – Introduction to Working with People who use Substances –  Toowoomba

30 October, 09:00-16:30: Advanced Harm Reduction – Logan. NB: Participants must have completed Insight’s “Understanding Psychoactive Drugs” workshop or be an existing employee of an AOD or Mental Health service to be eligible for this workshop.

Listen – podcasts, webinars

Cracks in the Ice

Supporting frontline workers with information and resources about crystal methamphetamine. 17 October, 11:00-12:00 AEST

Presented by Allan Trifonoff and Roger Nicholas, National Centre for Education and Training on Addiction (NCETA), Flinders University

This webinar will provide attendees with information about
– How ice affects people and communities
– Worker safety and preventing, managing and recovering from ice-related critical incidents
– The impacts of using ice with alcohol and other drugs

Register here

Past Cracks in the Ice webinars are available here

Insight

Free webinars at 10:00-11:00 AEST:

10 October: The Great Vape Debate

17 October: FASD as an Indigenous Rights Issue

24 October: HIV Prevention and U=U

31 October: Becoming a Trauma Informed Clinician- Taming the Inner Chimp by Talking to the Elephant in the Room

Past Insight webinar recordings available now on YouTube

 

Annotated bibilography: Cognitive Behavioural Therapy

Annotated bibliography

Curran, G. M., Woo, S. M., Hepner, K. A., Lai, W. P., Kramer, T. L., Drummond, K. L., & Weingardt, K. (2015). Training Substance Use Disorder Counselors in Cognitive Behavioral Therapy for Depression: Development and Initial Exploration of an Online Training Program. Journal of Substance Abuse Treatment, 58(1), 33-42.
The authors of this paper state that evidence-based psychotherapies (EBP) are underutilised and that to combat this models for training in EBP are necessary. These need to be cost-effective, minimally disruptive and flexible, which led them to consider internet technology as a potential platform for delivery. They developed an online training package for the Building Recovery by Improving Goals, Habits and Thoughts (BRIGHT) program, which is based on cognitive behaviour therapy (CBT). This was a sixteen session group depression treatment for people with substance use disorders (SUD). They explored the possibility of delivering the BRIGHT training to counsellors online rather than in a face-to-face program. Eight volunteer counsellors across seven Veterans’ Affairs SUD programs completed the training. A lack of protected time for the counsellors to do the training was the largest barrier. Many had to do it in their own time or in breaks between clients and found it frustrating and fragmented. Those who completed the training found it a positive and useful experience. A limitation in this study is the small and specific sample size.

Delgadillo, J., Gore, S., Ali, S., Ekers, D., Gilbody, S., Gilchrist, G., & … Hughes, E. (2015). Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment. Journal of Substance Abuse Treatment, 55(1), 6-14.

Depression and frequent alcohol and drug use often co-exist prompting this study, which conducted a trial to examine the practicality of screening, recruitment, randomisation and engagement of drug and alcohol users for psychological interventions to treat depressive symptoms The participants (n=50) were all involved in community drugs and alcohol treatment (CDAT). They were then randomly assigned to behavioural intervention delivered by psychologists (n=23) or CBT based self-help introduced by CDAT workers (n=27). Recruitment and retention rates, along with changes in depressive symptoms and changes in days abstinent were measured at the 24 week follow up. The fifty participants were recruited from a pool of approximately 200 individuals and the randomisation produced comparable groups. Seventy-eight percent of the participants were present at the 24 week follow up point. The engagement rate for the participants who received psychological interventions was low with only 42% attending at least one session and there was no significant difference in engagement between the two groups. However, those from both groups who engaged with treatment did have moderate improvements in depressive symptoms. Co-existence of alcohol and drug services and mental health services does appear to improve engagement with treatment. A limitation was the high attrition rate, which was more likely in those with polysubstance use.

Epstein, E. E., McCrady, B. S., Hallgren, K. A., Gaba, A., Cook, S., Jensen, N., & … Litt, M. D. (2018). Individual versus group female-specific cognitive behavior therapy for alcohol use disorder. Journal of Substance Abuse Treatment, 88(1), 27-43.

This study aimed to test group-based female-specific CBT (G-FS-CBT) for women with alcohol use disorder (AUD) against an individual female-specific CBT (I-FS-CBT). The authors wanted to describe the development of G-FS-CBT. They also aimed to examine its content, feasibility, acceptability, group process, participant engagement and treatment outcomes. The study was a randomised controlled trial in which 155 women with AUD were randomly assigned to twelve manual guided sessions of G-FS-CBT or I-FS-CBT. Of the participants, 138 women attended at least one session. Women who were assigned into the G-FS-CBT group attended less sessions than those assigned the I-FS-CBT group. Engagement rate was rated as high in both groups by independent assessors and women in both groups reported high satisfaction with their treatment. During the first six weeks of treatment, participants in both groups significantly reduced their percent drinking days and percent heavy drinking days by equivalent amounts, which they maintained during treatment and at the twelve month follow up. They all also reported significant improvement in treatment outcomes including depression, self-efficacy, anxiety and abstinence. They concluded that the study offered support for G-FS-CBT as a treatment for women with AUD, offering single gender community support, programmed specifically for women. A limitation in the study was the limited demographics in the group being studied, although it was felt that as the program was a tailored one, it could be adapted for different age groups and different socio-economic groups.

Haller, M., Norman, S. B., Cummins, K., Trim, R. S., Xu, X., Cui, R., & … Tate, S. R. (2016). Integrated Cognitive Behavioral Therapy Versus Cognitive Processing Therapy for Adults With Depression, Substance Use Disorder, and Trauma. Journal of Substance Abuse Treatment, 62(1), 38-48.

Posttraumatic stress disorder (PTSD), depression and SUD are often comorbid conditions suffered by veterans. Research has previously indicated that veterans who had comorbidity of these three conditions did not maintain treatment gains from CBT as well as those with depression and SUD but not PTSD. The aim of this study was to investigate if adding trauma-focused treatment after an initial group-based integrated CBT for SUD and depression resulted in improved treatment outcomes. They recruited 123 veterans (89% male) from a single healthcare system to participate in the study. They all received integrated CBT sessions twice a week for 12 weeks (Phase 1). They were then randomly allocated to receive 12 individual follow-up sessions (Phase 2) using either integrated CBT or cognitive processing therapy modified to include SUD treatment (CPT-M). PTSD and depressive symptoms improved slightly at the end of Phase 1 and improved further during Phase 2, except for those without PTSD who received CPT-M. These improvements were maintained one year later. Substance use significantly improved by the end of Phase 1 and was maintained throughout Phase 2 and at one year follow-up. Similar levels of symptom improvement were seen in participants in the trauma-focused Phase 2 treatment (CPT-M) as those in the non-trauma focused treatment (integrated CBT), but there was a slight advantage of CPT-M over integrated CBT in heavy drinking outcomes for participants with PTSD. They concluded that generally group integrated CBT followed by either individual integrated CBT or CPT-M seemed to be effective for veterans with depression, SUD and PTSD. An important limitation of the study was that the participants were mainly male and that the results may not apply to female veterans.

Kiluk, B. D., DeVito, E. E., Buck, M. B., Hunkele, K., Nich, C., & Carroll, K. M. (2017). Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance. Journal of Substance Abuse Treatment, 82(1), 87-92.

The development of coping skills has generally been considered to be a result of CBT for SUD but there is little statistical evidence to support this. The aim of this study was to reproduce and expand previous research on the quality of coping skills as a predictor of abstinence in substance users who had participated in a computerised CBT program. The participants were cocaine-dependent individuals enrolled in a methadone maintenance program. They were randomly assigned to treatment as usual (TAU) (n=54) or computerised CBT and TAU (n=47), which consisted of seven modules accessed on a special computer in a private room. They were interviewed by a research assistant at the beginning and end of treatment, twice weekly during treatments and 1, 3 and 6 months after treatment. Coping skills were measured using the Drug Risk Response Test (DRRT). At the 6 month post treatment point, 89 participants remained. They were unable to replicate the results of the previous studies, which may have been due to differences in the study participants. Their analysis did not support the acquisition of coping skills as a predictor of treatment outcome. However those assigned to computerised CBT and TAU, showed greater improvement in coping skills than those assigned to TAU only. A limitation in the study was the small sample size.

Morris, L., Stander, J., Ebrahim, W., Eksteen, S., Meaden, O., Ras, A., & Wessels, A. (2018). Effect of exercise versus cognitive behavioural therapy or no intervention on anxiety, depression, fitness and quality of life in adults with previous methamphetamine dependency: a systematic review. Addiction Science & Clinical Practice, 13(1), 1-12.

Methamphetamine is a psychostimulant used by approximately 52 million people globally and is extremely addictive. When used chronically it can cause adverse psychological, physical and neurological changes, including increases in depression and anxiety and decreases in fitness and quality of life. It has been suggested that exercise has the possibility of reversing these changes. This systematic review aimed to examine the available evidence on the effectiveness of exercise as opposed to CBT, standard care or no intervention on reducing anxiety and depression and improving fitness and quality of life in previous users of methamphetamine. The initial search identified 251 articles, which was first reduced to 14 potentially relevant studies, whose abstracts were reviewed. The final selection was three articles comprising two randomised control trials and one quasi-experimental pilot. The review concluded that depression and anxiety scores were significantly reduced with exercise as opposed to CBT. There were also significant improvements in quality of life scores in those exercising. It recommended that exercise be included in therapy for methamphetamine use. A limitation in this study was the small number of studies reviewed.

Zhang Z, Zhang L, Zhang G, Jin J, Zheng Z. The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry [serial online]. December 1, 2018; 18(1):1-14. Available from: E-Journals, Ipswich, MA. Accessed March 25, 2018

CBT and its variations could be effective in preventing relapse in individuals with major depressive disorder (MDD). This review therefore aimed to evaluate the efficacy of CBT in preventing relapse in MDD. The researchers searched several databases to find relevant studies. They found sixteen studies investigating a total of 1945 participants, which met the criteria of the review. CBT was found to be more efficacious than control in reducing relapse in MDD individuals who were in remission. In those with three or more previous depressive episodes, mindfulness-based cognitive (MBCT) was more effective than control in reducing relapse. They concluded that using CBT in individuals with MDD may decrease the risk of relapse and that MBCT may only work for those MDD individuals with three or more previous episodes. The limitations in the study include the trial sizes in some of the studies evaluated and that the research was limited to MDD, rather than all depressive disorders.

Open Access articles can be accessed by clicking on the titles, others are available from our library datatbase for Healthy Options Australia staff and volunteers.

February PD

Professional development

You can add to the professional development post by commenting below or emailing the library.

Online resources

Read – professional reading

Available from the library database

  • Chen, J. A., Owens, M. D., Browne, K. C., & Williams, E. C. (2018). Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort. Journal of Substance Abuse Treatment, 85, 1-9.
  • Cunningham, M., Stapinski, L., Griffiths, S., & Baillie, A. (2017). Dysmorphic Appearance Concern and Hazardous Alcohol Use in University Students: The Mediating Role of Alcohol Expectancies. Australian Psychologist, 52 (6), 424-432.
  • Gair, S., & Baglow, L. (2017). Australian Social Work Students Balancing Study, Work, and Field Placement: Seeing it Like it Is. Australian Social Work, 1-12.
  • Powers, J. R., Loxton, D., Anderson, A. E., Dobson, A. J., Mishra, G. D., Hockey, R., & Brown, W. J. (2018). Changes in smoking, drinking, overweight and physical inactivity in young Australian women 1996–2013. Health Promotion Journal of Australia, 28(3), 255-259.
  • Thompson, K., & van Vliet, P. (2018). Critical Reflection on the Ethics of Mindfulness. Australian Social Work, 71(1), 120-128.
Open Access Articles

 

Open access online journal

Addictive behaviours

Open access textbook

Lester, D. (2014). The” I” of the Storm: Understanding the Suicidal Mind. Walter de Gruyter GmbH & Co KG.

Useful resources

Harm Reduction Australia, Opioid Treatment Programs 2017 Forum Reports: Queensland; NSW; Victoria

Hepatitis SA Library for resources and information on hepatitis

Open access resources for health sciences from Curtin University

e-Book of the month

Bhatia, S. C., Petty, F., & Gabel, T. (2017). Substance and Nonsubstance Related Addiction Disorder: Diagnosis and Treatment. [S.l.]: Bentham Science Publishers Ltd.

An accessible handbook about the two main types of addiction disorders. It is divided into three sections which cover 1) the scientific underpinnings of addiction disorders (neurobiology, addiction neural reward pathways, genetic and psychosocial basis of addiction, screening and treatment), 2) information about substances commonly used by addicts (pharmacology, diagnostics and treatment considerations) and 3) current understandings of the diagnosis and treatment of behavioral problems (such as gambling), respectively. Key features: covers both substance abuse and behavioral problems uses a reader friendly format with a patient education handout style includes key learning points listed in each chapter -includes clinical vignettes which outline brief history, evaluation, diagnostic considerations with successful pharmacological, psychological and social interventions -includes references in each chapter disorders. (copied from the EBSCO database)

Free to download for all HOA staff from the library catalogue on work computers

National comorbidity guidelines free online training and website

The training program consists of 10 training modules that can be completed in any order. Registrants can choose which modules to engage in based on interest and experience. Those wishing to receive a certificate of completion must complete all modules (in any order) and successfully complete all quizzes.

At the end of each module, registrants will be presented with a quiz. All questions must be answered correctly before the module is completed, but there is no limit to how many times the quiz can be taken. Incorrect answers will refer participants to relevant sections of the Guidelines website.

At the completion of all modules, training participants will receive a certificate of completion.

Journal club TBA

Attend – conferences 

Australia and New Zealand Addiction Conference, 28-30 May 2018 at QT Gold Coast

This conference will cover a range of topics including  prevention, treatment, systematic responses, behaviours, mental health and harm reduction in relation to all types of addiction.  The program will include emerging trends and the various addictive habits of alcohol and other drugs, gambling, internet, sex, gaming,  food, shopping, pyromania, kleptomania.

Cost from $500-1000. Register here

Write – presentations and papers

Are you thinking of getting your work published in an academic journal? Read these tips of what not to do from a large publisher.

Call for abstract submissions for the Australia and New Zealand Addiction Conference. It can be in the form of a 3o minute presentation, a poster presentation or a panel presentation on one of the conference topics. Closing date 05/02/2018. More details are available here.

Listen – podcasts, webinars

NueRA talks:  a series of free online seminars which bring information on neuroscience research. Examples include:

  • Living loving schizophrenia
  • The neuroscience of resilience to stress

Insight presentation recordings available now on YouTube

Assessed learning – short courses, certificates, diplomas, bachelors, post-grad

Strengths based practice: This workshop will provide participants with the chance to practice strength based skills:

Date: 22/02/2018, 09:00-16:30

Location:      Lighthouse Resources Upstairs Training Room Kyabra Street RUNCORN, QLD. 4113

Cost: $240. Register here

Lighthouse Resources run a number of other workshops

 

Annotated bibliography: Comorbidity

Annotated bibliography

Bonevski, B., Regan, T., Paul, C., Baker, A. L., & Bisquera, A. (2014). Associations between alcohol, smoking, socioeconomic status and comorbidities: evidence from the 45 and Up Study. Drug and Alcohol Review, 33(2), 169-176.

This study aimed to examine if there were any links between mental illness and low socioeconomic status (SES) and concurrent tobacco and alcohol consumption. Data was obtained from the 45 and Up Study of 267153 adults aged over 45 in New South Wales, who completed a survey assessing alcohol, smoking, psychological distress, treatment for anxiety or depression and a range of SES factors. The research found strong links between low SES, treatment for anxiety or depression, psychological distress and concurrent tobacco smoking and alcohol misuse. It recommended a move away from the silo approach of addressing tobacco, alcohol and mental health, as it has proved ineffective in reducing the high smoking rates among people experiencing mental illness or seeking help for alcohol and other drug problems. It suggested a comprehensive and holistic approach was needed in treating these people. It also recommended more research to explore the potential for the community service sectors to provide treatment for people with multiple health and social concerns.

Brière, F. N., Rohde, P., Seeley, J. R., Klein, D., & Lewinsohn, P. M. (2014). Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Comprehensive Psychiatry, 55(3), 526-533.

The aim of this study was to examine the development of comorbidity between alcohol use disorder (AUD) and major depressive disorder (MDD). It focussed on the relationship between the disorders at different time periods in adolescence and young adulthood. Participants were interviewed at ages 16, 17, 24 and 30. There were 861 participants who were predominantly white and equally split between male and female. Comorbidity was found to be low in adolescence but increased in adulthood, with most individuals with one disorder having the other. The exception was women with MDD. Adolescents with AUD were at increased risk of developing MDD and young adults with MDD were more likely to develop AUD. People diagnosed with comorbidity of MDD and AUD had an increased risk of alcohol dependence, suicide attempts and life dissatisfaction than those diagnosed with either MDD or AUD. Lifetime rates of comorbid MDD and AUD were higher than in previous studies and the report recommended screening for the other disorder at regular intervals when an individual presented with either MDD or AUD.

Carter, M., Fisher, C., & Isaac, M. (2013). Recovery from comorbidity: depression or anxiety with alcohol misuse—a systematic and integrative supradisciplinary review and critical appraisal. SAGE Open, 3(4), 2158244013512133.

Comorbidity of mood and anxiety disorders with alcohol misuse is not unusual. The study conducted a systematic literature review across different disciplines and research methodologies. Inconsistencies were found in definitions and measurements in the literature reviewed. Little evidence was found to support treatment plans. Competing paradigms in mental illness and addiction pose a barrier to progress and consumers frequently fall between the gaps. Clinicians feel undertrained and may be judgmental or unrecognise comorbidity, particularly in high risk populations. It suggested a consideration of different combinations of comorbidity and other factors such as social support, housing and employment which are crucial to recovery. It also recommended a need to build on the limited evidence and generalisation that was available.

Debell, F., Fear, N. T., Head, M., Batt-Rawden, S., Greenberg, N., Wessely, S., & Goodwin, L. (2014). A systematic review of the comorbidity between PTSD and alcohol misuse. Social Psychiatry and Psychiatric Epidemiology, 49(9), 1401-1425.

This systematic review was performed to ascertain the prevalence of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse and any associations between the conditions. The literature reviewed was limited to that published between 2007 and July 2012.   A total of 42 papers were included in the review, after reviewing 620 abstracts. The incidence of PTSD comorbid to alcohol misuse ranged from 2 to 63% and alcohol abuse comorbid to PTSD 9.8 to 61.3%, with most of the prevalence rates being greater than 10%. These results indicated a strong association between the disorders. Significant evidence was found for association between alcohol misuse and numbing symptoms and hyperarousal. The evidence from the review supports the need for screening comorbidity in individuals who are known to have PTSD or alcohol misuse.

Gorka, S. M., MacNamara, A., Aase, D. M., Proescher, E., Greenstein, J. E., Walters, R., … & Digangi, J. A. (2016). Impact of alcohol use disorder comorbidity on defensive reactivity to errors in veterans with posttraumatic stress disorder. Psychology of Addictive Behaviors, 30(7), 733.

Evidence suggests that people who suffer from both PTSD and alcohol use disorder (AUD) have a heightened defence reactivity. This then maintains both their drinking behaviours and their anxiety or hyperarousal symptoms. Few studies however, have established whether people with PTSD and AUD have greater defence reactivity than those with PTSD without AUD. The aim of this study was to test this hypothesis. Error–related negativity (ERN) was measured, which is increased in anxious individuals and is thought to reflect defence reactivity to errors. Participants consisted of 66 male military veterans who were split into three groups:

  1. Controls with no PTSD or AUD
  2. Those with PTSD and no AUD
  3. Those with both PTSD and AUD

Those from the third group exhibited heightened ERN, whereas those in the first and second groups did not. This suggests that PTSD with AUD is a unique subtype of PTSD, with the comorbidity of AUD enhancing the defence reactivity in people with PTSD. The limitations in the study include the group size and demographics.

Leventhal, A. M., & Zvolensky, M. J. (2015). Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion–smoking comorbidity. Psychological Bulletin, 141(1), 176.

The research on comorbidity between emotional disorders and cigarette smoking has centred on the symptoms of anxiety and depression rather than clinical and theoretical advancement. The researchers who performed this study hypothesized that emotional vulnerabilities or behavioural traits, which reflect maladaptive emotional responses link various depressive and anxiety disorders to smoking. They did a literature review on three emotional vulnerabilities implicated in smoking:

  1. Anhedonia (Anh.)
  2. Anxiety sensitivity (AS): fear of anxiety related sensations
  3. Distress tolerance (DT): ability to withstand distressing situations

They concluded that the three collectively form a foundation for multiple emotional disorders; amplify the anticipated and actual affect enhancing properties of smoking; promote progression towards the smoking pathway and therefore are promising targets for smoking intervention. They used the information collected to propose a model linking emotional psychopathology to smoking:

  • Anh. amplifies smoking’s actual and expected pleasurable effects
  • AS increases smoking’s anxiety reducing effects
  • Low DT increases smoking’s distress reducing effects.

Together these factors reinforce smoking for individuals suffering from emotional disorders, which increases their risk of smoking initiation, progression, maintenance, not stopping, avoidance and relapse. They conclude that the results can be used for clinical and scientific implications that can be expanded to other comorbidities.

Riga, D., Schmitz, L. J., Van Der Harst, J. E., Van Mourik, Y., Hoogendijk, W. J., Smit, A. B., … & Spijker, S. (2014). A sustained depressive state promotes a guanfacine reversible susceptibility to alcohol seeking in rats. Neuropsychopharmacology, 39(5), 1115-1124.

The reported rates of comorbidity between AUD and MDD are high, but preclinical models studying how primary depression affects secondary AUD are lacking. This results in inadequate testing of drug treatment. The authors combined social defeat-induced persistent stress (SDPS) with operant self-administration (SA) concepts to assess causality between the disorders. They used guanfacine, a drug used to reduce cravings in humans against SDPS-induced change of operant alcohol SA. They socially defeated and isolated rats for at least 9 weeks, during which time they assessed depressive symptomology. The rats were then exposed to 5 months of operant SA concept, studying acquisition, motivation, extinction and cue-induced reinstatement of alcohol seek. Then at 6 months they measured the effects of the drug on motivation and relapse. The SDPS rats demonstrated significant changes to social and cognitive behaviour several months after defeat and increased motivation to obtain alcohol. Guanfacine reduced the effects on motivation caused by SDPS. The authors state that their model mimics the symptomology of a sustained depressive state and resultant vulnerability to alcohol abuse and that SDPS is strongly associated with alcohol intake and relapse. They argue that the study indicated that guanfacine has potential as a new treatment for patients with MDD and AUD comorbidity, as it is effective in reducing the sensitivity to alcohol and alcohol-induced stimuli. The limitation to this study is that it was performed on rats so may not translate to humans.

Scott, C. K., Dennis, M. L., & Lurigio, A. J. (2015). Comorbidity among female detainees in drug treatment: an exploration of internalizing and externalizing disorders. Psychiatric Rehabilitation Journal, 38(1), 35.

This study examined the incidence and comorbidity of major psychiatric disorders in female prisoners who were participating in drug treatment programs in a large American prison. The Needs Inventory was used, which includes a large mixture of methods to capture demographics, psychological problems, substance use and drug treatment histories and their criminal thinking tendencies. Two hundred and fifty-three women participated in the study, who were then split into three groups: those with substance use disorders (SUD) but no psychiatric disorders (24%); those with one psychiatric disorder (34%) and those with both internalising and externalising comorbidities (42%). Over 75% of the participants had comorbid psychiatric disorders and SUD, which are linked to lower self-esteem, increased drug use severity and levels of criminal thinking. The authors concluded that female prisoners in drug treatment programs need interventions focussing on both criminal and psychiatric recidivism, both whilst in prison and in the post-release phase. Limitations in the study are that it is a female only study and results may differ in a male population, and it was limited to those in drug treatment.

Emmerik‐van Oortmerssen, K., Glind, G., Koeter, M. W., Allsop, S., Auriacombe, M., Barta, C., … & Casas, M. (2014). Psychiatric comorbidity in treatment‐seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study. Addiction, 109(2), 262-272.

Previous studies have indicated the attention deficit hyperactive disorder (ADHD) is highly comorbid with SUD, and that both ADHD and SUD are associated with other comorbid conditions including mental health disorders. The studies show that the disorders both independently and together increase the risk of comorbidity with psychiatric disorders. The objective of the study was to examine comorbidity patterns in adults seeking treatment for SUD, with or without ADHD. Different subtypes of ADHD and comorbidity patterns were examined, along with differences in gender and primary substance of abuse. They focussed on MDD, current (hypo)manic episode (HME), antisocial personality disorder (ASPD) and borderline personality disorder (BPD). They screened 3558 people from 47 centres in 10 countries, with a final group of 1205 participants. They found that MDD, BPD, ASPD and HME were all more prevalent in participants with ADHD than those without. Both BPD and MDD had increased comorbidity when alcohol was the primary substance of abuse as opposed to drugs. Comorbidity differed between ADHD subtypes with increased MDD in the inattentive and combined subtypes, increased HME and APSD in the hyperactive/impulsive and combined subtypes and increased BPD in all subtypes. The incidence of at least one comorbid disorder was 75% in those with ADHD, compared to 37% in those without. They concluded that treatment-seeking SUD patients with ADHD are at a very high risk of developing psychiatric disorders. The limitations of the study include the data collected was all self-reported and standardised measurement tools were not used between the different centres.

All the articles except the first one are Open Access and can be read by clicking on their titles. The top one is available from our library database to all staff and volunteers at Healthy Options Australia.