Text in English / Against the background of high prevalence of substance abuse in the globe generally and South Africa in particular, research has shown an association between substance abuse and other mental disorders or vice-versa. With most rehabilitation centres offering separate diagnosis and treatment for the two disorders, the problem of relapse has been significant. The purpose of this study is to explore the perceived effectiveness of CBT as a treatment model for substance use disorders with co-occurring disorders. Subsequently, the research will add to the already existing research evidence. The study was conducted in five rehabilitation centres in Gauteng Province. The qualitative descriptive research approach was used to conduct the study. Both purposive and snowball sampling were used to recruit participants in this study. The sample consisted of CBT specialist participants from diverse race, gender, ethnicity, and age ranging from 30 to 65 years, with at least a minimum of five years’ experience. A pilot study with two specialist participants was conducted, and this enhanced trustworthiness and authenticity of the study. The primary method of qualitative data collection employed in this study was semi-structured individual interviews for specialist participants. Grounded theory analysis was employed to analyse data. The findings of the study emphasised a need to not separate treatment of substance use disorders and psychiatric pathologies. More importantly, the effectiveness of CBT in treating both disorders was established by the study. The study further encourages more time in therapy as the way to increase effective results accompanied by less relapse rate. Accordingly, the findings of this study encourage more research and use of CBT treatment for substance use disorders with co-occurring disorders in South Africa. This study found that the most used substances are both legal and illegal, and they are further classified as depressants, stimulants, opioids, and new psychoactive substances. A vulnerable population to abuse substances includes adolescent and young adults, individuals with co-occurring disorders, and low socio-economic status. The disorders that normally co-exist with substance use disorder ranges from depression, bipolar disorder, schizophrenia, sleeping disorder, impulsivity, antisocial behaviour, borderline disorder, paranoia, panic disorder, and suicide behaviour. The study found that genetic predisposition, depression, parental neglect and financial problems, experimentation with substances for relaxation, peer group pressure, and co-occurring disorders are high risk causes for substance abuse. The experience of participants in treating substance use disorder with co-occurring disorders involves which disorders get treated first, and the mental state of patients for effective treatment. The various substance abuse treatment models includes person centred approach, bio-psychosocial approach, holistic approach, eclectic therapy, integrated approach, resilient approach, rational emotive behavioural therapy, family therapy, motivational interviewing, 12-step programme, and cognitive behavioural therapy. The participants’ experience with CBT entails its usability in both individual and group therapy, the use of CBT skills after therapy, and CBT effectiveness in relapse prevention. Accessibility and affordability of CBT treatment is influenced by access to rehabilitation centres and cost of rehabilitation centres. Lastly, individual factors, family factors, and environmental factors are part of the contributing factors towards high relapse rates. / Psychology / M.A. (Psychology)

OBJECTIF : Un fréquent recours aux services de l'urgence hospitalière (SU) pour des troubles mentaux (TM) est coûteux pour les finances publiques, il contribue à l'engorgement des urgences, et n’améliore pas toujours l’état de santé de l’usager de ces services. Ce mémoire porte sur les raisons évoquées pour le recours fréquent aux SU par les patients qualifiés de grands utilisateurs (≥3 visites/an) et ayant des TM courants (TMC) (par ex. troubles dépressifs, troubles anxieux, troubles de comportement), des troubles liés aux substances psychoactives (TLS) (par ex. intoxication, troubles induits par une substance, dépendance) ou des TMC-TLS concomitants. Leurs perspectives sont comparées et les aspects identifiés par les patients comme aidant à réduire leur recours aux SU sont examinés. MÉTHODOLOGIE : S’inscrivant dans un projet de recherche d’envergure financé par les Instituts de recherche en santé du Canada (IRSC), les données de 42 grands utilisateurs des SU avec TMC, TLS ou TMC-TLS concomitants ont été collectées, en 2021-2022, basées sur des entrevues semi-dirigées et un examen des dossiers médicaux des patients. Le recrutement des patients s’est effectué dans deux SU du Québec (Canada). Cette étude qualitative s’est fondée sur l’analyse de contenu. RÉSULTATS : Globalement, les principales raisons évoquées expliquant le grand recours aux SU étaient rattachées à des facteurs liés au système de santé mentale (par ex. l’adéquation, l’accessibilité et la continuité des soins), aux profils des patients (par ex. les problèmes biopsychosociaux urgents et récurrents, les systèmes de soutien et les capacités individuelles) et aux pratiques professionnelles des cliniciens (par ex. leur connaissance et leur aisance avec les TM, la qualité des échanges avec les patients et la collaboration entre les cliniciens). Des interactions complexes entre ces différents facteurs sont rapportées et celles-ci semblent entraver le processus de III rétablissement des patients et perpétuent des cycles menant à une fréquente utilisation des SU. Quelques différences significatives ont aussi émergé entre les trois groupes de patients. Les patients souffrant de TMC se sont distingués par d'importantes barrières d’accès aux soins ambulatoires et des besoins non satisfaits, alors que les patients souffrant de TLS se sont démarqués principalement par leur manque de confiance dans les services ambulatoires, ainsi qu’en eux-mêmes, tandis que ceux souffrant de TMC-TLS par des problèmes de coordination des soins. CONCLUSION : Les résultats mettent en relief la nécessité d’investir davantage dans le système de santé mentale du Québec afin d’améliorer l’accès aux services ambulatoires, la collaboration entre les prestataires de soins et la continuité de soins diversifiés auprès des patients après l’utilisation des SU, ainsi que plus de traitements intégrés pour les TM-TLS. Les pratiques en santé mentale, fondées sur les données probantes, ont besoin d’être encore plus consolidées dans les soins primaires et conformément au modèle de soins chroniques. Ce qui inclus de meilleurs outils de détection précoce des TM et TLS, des modèles de soins par étapes, ainsi que des formations orientées vers le patient, pour la gestion des symptômes. Les grands utilisateurs des SU bénéficieraient ainsi d’une surveillance accrue, de l’élargissement des plans individualisés de soins et des gestionnaires de cas, ainsi que des formations continues en santé mentale offertes aux cliniciens des soins primaires. / AIMS: High emergency department (ED) use for mental disorders is costly for public finances, contributes to ED overcrowding and does not always improve the health status of the ED user. This dissertation investigates the reasons given for the frequent use of ED by patients qualified as high users (≥3 visits/year) and having common mental disorders (CMD) (e.g., depressive disorders, anxiety disorders, behavioral disorders), substance-related disorders (SRD) (e.g., intoxication, substance-induced disorders, dependance) or co-occurring CMD-SRD. Their perspectives are compared, and aspects identified by patients as helpful to reduce their ED use are examined. METHODOLOGY: As part of a large research project funded by the Canadian Institutes of Health Research (CIHR), data from 42 high ED users with CMD, SRD or co-occurring CMD-SRD were collected, between 2021-2022, based on semi-structured interviews and examination of patients’ medical records. Patients were recruited from two large ED in Quebec (Canada). This qualitative study was based on content analysis. RESULTS: Overall, the main reasons reported for high ED use were linked to factors related to the mental healthcare system (e.g., adequacy, accessibility and continuity of care), patient profiles (e.g., urgent and recurrent biopsychosocial problems, support systems and individual disabilities) and clinicians’ professional practices (e.g., knowledge and comfort with mental disorders, quality of exchanges with patients and collaboration between clinicians). Complex interplay between these different factors is reported, hindering patient recovery process and perpetuating cycles leading to high ED use. Few notable differences also emerged between the three groups of patients. Patients with CMD were faced with important barriers to outpatient care and unmet needs, while patients with SRD mostly distinguished by their lower trust in outpatient services, as well as in their self-efficacy, and those V with MD-SRD struggled with care coordination issues. CONCLUSION: Findings highlight the need for greater investment in Quebec’s mental healthcare system to improve access to outpatient care, collaboration between care providers and continuity of diversified care after ED use, with more integrated MD-SRD treatment. Evidence-based mental health practices need to be further consolidated in primary care and according to the chronic care model. This includes better MD and SRD early detection, stepped-care model along with patient symptoms management training could help prevent ED use. High ED users would also benefit more extensive monitoring, the deployment of individual care plan and case management, as well as more continuous mental health training for primary care clinicians.