Dissertation (Ph.D.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p.145-155).

Background: Compared to the general population, individuals with intellectual disabilities have a higher prevalence of health problems, including psychiatric and/or behavioural conditions (dual diagnosis). Research suggests that the proportion of persons with intellectual disabilities who have a dual diagnosis ranges from 14% to 64% depending on the population studied and the diagnostic criteria used. However, there is little population-based information in Canada about people with such a dual diagnosis. Objectives: The aims of this study were to estimate the prevalence of psychiatric or behavioural conditions among adults with an intellectual disability in Canada, and to estimate the use of mental health services among these individuals. Methods: This study was a secondary analysis of two cross-sectional, population-based surveys (2005 Canadian Community Health Survey: CCHS and 2006 Participation and Activity Limitation Survey: PALS), and the 2008/09 Survey of Adults with Intellectual Disabilities in South Eastern Ontario: SAID-SEO. Relevant variables were identified in the surveys to answer the study objectives. Confidence intervals were provided for all estimates and the results were compared within subgroups for each survey, as well as between surveys. Results: The proportion of Canadian adults with an intellectual disability is 0.2% according to the CCHS and 0.5% according to the PALS. The proportion of individuals with a dual diagnosis was found to be 31% in the CCHS, 44% in the PALS, and 33% in the SAID-SEO. These prevalence estimates fall within the ranges reported in the literature. Lastly, the majority of adults with a dual diagnosis reported using health services in the past year. Conclusion: According to the three surveys examined (CCHS, PALS, SAID-SEO), psychiatric and behavioural conditions are present in about a third of the individuals with intellectual disabilities, which is in accordance with published literature. However, the estimates of the prevalence of intellectual disabilities in the CCHS and PALS were considerably lower when compared to the literature. Among the surveys, the PALS presented the highest quality of data regarding the population with a dual diagnosis. The surveys found that a majority of individuals with a dual diagnosis access some form of health services at least once a year. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-10-28 00:15:54.488

Recent publicity has focused on the problems created by the usage of illicit drugs in the community. The growing use of illicit drugs throughout the Grampians region and the lack of resources and professional services available to regional and rural areas raise many questions as to treatment options and the accessibility and appropriateness of drug and alcohol and mental health services. Despite the fact that mental health professionals in rural/regional areas are expected to deliver the most appropriate care to individuals with a comorbid drug and alcohol and psychiatric disorder, a number of these rural/regional mental health professionals have limited preparation and experience in dealing with dual diagnosis issues. This phenomenological study focuses on the area of dual diagnosis, specifically the experiences of health professionals who care for clients diagnosed with a serious mental illness and a coexisting drug and alcohol disorder. Results are described in the form of four themes, which emerged from data collected during in-depth interviews with 13 mental health professionals who care for clients with a dual diagnosis. The themes captured in this research will be described using metaphors as headings. The first theme Sink or swim represents mental health professionals’ initial preparation to care for this group of complex clientele. Treading water symbolises mental health professionals’ endeavours to keep their head above water and reflects on their feelings while endeavouring to do so. Rowing against the tide describes mental health professionals’ understanding of clients’ drug misuse, which impacts greatly on the level of care. / Master of Nursing

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1994. / Vita. Abstract. Includes bibliographical references (leaves 101-113). Also available via the Internet.

The goal of the study was to explore how adults living with stimulant abuse and bipolar disorder experience treatment at treatment centres in the Gauteng Province. As the study was aimed at gaining an in-depth understanding of the lived experiences of service users in terms of treatment, a qualitative research approach was implemented. The research findings were aimed at adding knowledge to the field of social work, which could contribute to the development of treatment programmes and possible policy changes that could positively impact the recovery of individuals living with a dual-diagnosis, specifically the dual-diagnosis of bipolar disorder and stimulant abuse. A phenomenological research design was used as it allowed the researcher to discover and report on the details pertaining to the participants' experiences in terms of the treatment they received. The phenomenological research design also enabled the researcher to describe the commonalities and discords expressed by participants in relation to the phenomenon. The sampling process for the research study took place in three phases. In the first phase, purposive sampling was implemented to select three substance abuse treatment centres in the Gauteng Province, and more specifically the Tshwane Metropolitan Municipality. The second phase of sampling was also purposive sampling, where inclusion criteria were supplied to a social worker at each treatment centre who identified possible participants. During the third phase of sampling, possible participants were approached and informed of the study and ultimately four (N=4) individuals volunteered to participate in the study. Data was collected through the use of semi-structured one-on-one interviews which were guided by an interview schedule. Data gathered during the literature review and interviews were analysed through the process of thematic analysis and aimed at answering the research question "How do adults living with stimulant abuse and bipolar disorder experience services at treatment centres in the Gauteng Province?" The key findings indicate that admission to in-patient treatment programmes, for both stimulant abuse and psychiatric care, was prevalent among all participants, but re-occurring admissions to substance abuse treatment was more evident. Stimulants were primarily used as a means of coping with moods and emotions, as unstable mood patterns and emotions persisted regardless of the pharmacological treatment for bipolar disorder. The most helpful component of treatment which aided participants in managing their mood was counselling. When stimulants were not available and counselling was insufficient, other means of achieving psychological relieve were employed by participants, such as exercise, nicotine use, sweets and caffeine. The role of religion and spirituality in treatment is not clear, but all participants believe that religion and spirituality should be included in treatment. The need for education in terms of bipolar disorder, addictive behaviours, lifestyle changes and coping mechanisms were mentioned by most participants. In addition to education provided by professionals, participants expressed a need for sharing experiences with individuals that have managed to recover from bipolar disorder and/or stimulant abuse. When treatment plans and goals are set participants believe that they and their family should be included, a factor relevant to in-patient and reintegration services. With regards to in-patient treatment programmes, the psychosocial-cultural environment created within the physical environment was also mentioned as a component that needs to be considered. In order to deliver services that allow for the effective treatment and reintegration of individuals that abuse stimulants and are diagnosed with bipolar disorder the following recommendations are made: 1) Interventions, including prevention and early interventions, should be developed based on research findings focused on dual-diagnosis, to ensure that concurrent treatment and reintegration is achieved and sustained, thus promoting recovery, or the management, of both disorders. 2) Education in terms of stimulant addiction, cross-addiction, bipolar disorder, lifestyle changes, coping skills, as well as the interplay between these factors should be included in treatment programmes, however, education should be expanded to service providers and extended to family members too. 3) The role of religion and spirituality as part of dual-diagnosis treatment should be considered. 4) Treatment and support groups that focus on the specific dual-diagnosis of stimulant use and bipolar disorder, should be developed as part of in-patient treatment programmes, as well as supporting out-patient programmes, which could improve long-term recovery. 5) The physical and the psychosocial environments which are conducive to the recovery of dual-diagnosis patients should be established, as these environments could possibly be replicated, for example at home, and could ensure long-term recovery. 6) Service users and their families should be included in decisions regarding treatment planning and reintegration, as inclusion in this area of treatment could promote compliance to treatment. However, it should be stated that many of these recommendations are dependent on governing bodies, such as the Department of Social Development and the Department of Health, who are responsible for changing, developing and monitoring policies guiding treatment, which has a direct impact on the long-term recovery of individuals living with this dual-diagnosis. Future research studies that can contribute to understanding this phenomenon can focus on 1) Repeating the study within other private and government based treatment centres across South Africa in order to determine whether treatment needs differ or whether it presents the same results. 2) Comparing studies from different centres and areas of South Africa in order to establish treatment needs of individuals diagnosed with a dual-diagnosis. 3) Research should be done to determine the actual prevalence of the dual-diagnosis of stimulant abuse and bipolar disorder in South Africa, focused on admissions in both substance abuse treatment centres and psychiatric treatment facilities. 4) Treatment programmes developed from research findings should be implemented, and research should be conducted on the effectiveness of treatment. 5) Research on different combinations of dual-diagnosis is necessary to determine how treatment needs differ, as this will ensure the development of appropriate treatment. Individuals working at treatment centres (for both substance abuse and psychiatric disorders) should be aware of the needs of dual-diagnosis patients, and be educated on this phenomenon. 6) It is recommended that research should be done with the staff of psychiatric treatment centres, as well as staff at substance abuse treatment centres, to determine their views and knowledge in terms of dual-diagnosis. 7) Research focussed on the costs of not treating dual-diagnosis should be conducted. When the actual costs of non-treatment are established, government agencies and the private sector might be more prone to support treatment strategies. 8) Intervention strategies focused on families of dual-diagnosis patients should be implemented and the impact of these interventions on both patients and families should be researched. 9) More research in terms of this dual-diagnosis is necessary as this could allow for the development of effective treatment strategies that could lower relapse and readmission rates. / Mini Dissertation (MSW)--University of Pretoria, 2017. / Social Work and Criminology / MSW / Unrestricted

The relationship between alcoholism and generalized anxiety disorder (GAD) has been discussed in two research areas: research on the prevalence of GAD in alcoholics, and the prevalence of alcoholism in individuals diagnosed with GAD. Studies indicate that between 6 to 26% of alcoholics have a current diagnosis of GAD, with a lifetime prevalence rate of up 51%. In the general population, 4% would currently receive a diagnosis of GAD, with a lifetime prevalence of 8%. This meta-analytic review of the empirical literature examines the relationship between GAD and alcoholism. The author used percentages to compare the results of various studies. The averaged results of these various studies suggested there is a 25% comorbidity rate of GAD and alcoholism. critical review of the studies examined in this review revealed substantial methodological errors. Based on a critical review of the research methodology in the studies cited, the author proposed further research.

Mental health and substance abuse treatment systems have a history of incompatible philosophies and conflicts that have been associated with poor treatment outcomes for persons dually diagnosed. The purpose of this study was to determine whether or not there are differences in attitudes between mental health and substance abuse professionals toward the dually diagnosed client and whether or not academic discipline, levels of training and experience, occupation, and amount of contact affect the attitudes of these professional groups. A non-experimental survey research design was used for this study, and data were collected by means of a revised Opinions About Mental Illness (OMI) survey instrument and supplemental demographic questionnaire. The modified OMI instrument was piloted by a panel of subject matter experts experienced in the treatment of persons who are dually diagnosed in which they rated each item for favorableness to concepts of dual diagnosis. The modified OMI survey and a demographic questionnaire were administered to a sample consisting of mental health and substance abuse professionals employed at a local community mental health center. A total of 86 respondents representing 95% of the sample population completed the modified OMI survey and demographic questionnaire. Data were analyzed using descriptive, independent sample t-test, and multiple analysis of variance (MANOVA) statistics. Results revealed no statistically significant differences in attitude between mental health and substance abuse professionals toward dually diagnosed clients. Analysis of the independent variables academic discipline, level of training and experience, occupation, and amount of contact demonstrated no significant interaction effects between mental health and substance abuse professionals. Despite the absence of statistically significant differences in attitude between the mental health and substance abuse professionals, the similarities may be significant in terms of the psychological value for building positive relationships. The atmosphere of agency culture and the significance of co-location of mental health and substance abuse professionals were also potentially important factors in the outcome of the present study. / Ed. D.

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<b>Background:</b> Individuals with intellectual disabilities (ID) have a higher prevalence of comorbid psychiatric disorders and challenging behaviours compared to the general population. Though less common, one area of concern among those with ID is pica (the ingestion of inedible substances). To date, there is little knowledge of pica, particularly with respect to its risk factors and social consequences. The closure of Ontario's three remaining facilities by 2009 underscores the importance of having knowledge of complex behaviours such as pica for improving supports and services in the community for these individuals. The aim of this study is to better understand the characteristics and support needs of adults with ID and pica. This study is comprised of a quantitative and qualitative component. <b>QUANTITATIVE STUDY</b> <b>Objectives:</b> To investigate the prevalence, risk factors, social and medical characteristics of pica. To determine how pica is managed in terms of hours of supervision, receipt of interventions, and psychotropic medication. <b>Methods:</b> Secondary data analysis was performed on two samples as part of cross-sectional study: 1008 persons with ID from Ontario's facilities and 420 community-dwelling adults with ID from southwestern Ontario. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID)?a comprehensive and standardized instrument that measures a variety of domains for support planning. Bivariate and multivariate analyses were restricted to the facility sample due to the small size of persons with pica in the community. <b>Results:</b>The overall prevalence of pica was 22. 0% and 3. 3% in the facilities and the community, respectively. Logistic regression analysis showed that being male, cognitive functioning, autism, and being non-verbal were associated with a higher odds of having pica, whereas activities of daily living (ADL) was a protective factor. A quadratic relationship was observed between cognitive function and pica: the risk of pica increased with severity of cognitive impairment up to moderate to severe levels of impairment and then diminished among those with very severe cognitive impairment. Behaviour management, self-care skills, and 8 hours or more of one-to-one supervision were more likely to be provided to persons with pica. Compared to persons without pica, persons with pica had higher rates of being prescribed antipsychotic medication. Surprisingly, pica was not associated with higher rates of gastrointestinal health problems, with the exception of acid reflux. The negative social outcomes of pica, however, were many: pica was associated with higher odds of not having a strong and supportive relationship with family, lack of contact with family or other close relations, and absence of participation in social and recreational activities. <b>QUALITATIVE STUDY</b> <b>Objective:</b> To determine the support needs of adults with ID and pica from the perspective of direct-care staff of facility and community settings. <b>Methods</b>: Through two focus groups, the perspectives of four staff from Huronia Regional Centre (HRC), and six staff from community agencies from southwestern Ontario were examined. Transcripts were analyzed thematically for factors that facilitated or hindered the management of pica. <b>Results:</b> Qualitative data revealed three categories that underpinned reduction in pica: preventative measures (environmental controls, close supervision, and the provision of alternative activities), formal supports, and familiarity with the individual. On the other hand, inadequate staff support, lower functioning level of the individual, and lack of knowledge acted as barriers to managing and reducing pica. These barriers were associated with persons participating in fewer recreational activities and community outings, and in some cases the use of mechanical restraints. Barriers specific to each setting in the management of pica were also illuminated. Staff in both settings tended to be self-sufficient and isolated in managing this complex behaviour. <b>Conclusions:</b> Results suggest that attention should be equally paid to the potential social consequences of pica rather than solely to its health risks. Higher staff to client ratios, and training and education for staff to provide more active support to promote individuals' engagement in recreational activity and community integration is needed. Key recommendations also focus on educating and training staff on the risk factors and appropriate management of pica. Improving the collaboration and knowledge exchange among developmental service agencies is also recommended to enhance the management of pica among caregivers. Lastly, the community at large needs education on pica to foster more inclusive community living for those with ID.

This exploratory, quantitative study investigated the prevalence rate of people with cooccurring substance-related and psychiatric disorders (CODs). A treatment-seeking sample from Houghton House Addiction Recovery Centre in Johannesburg, South Africa was used. Details of the case histories of the clients were collected, coded and analysed using Statistical Analysis System (SAS). The results indicated that 57.1% of 419 clients had one or more co-occurring psychiatric disorder, along with a substance-related disorder. Of the 239 with a COD, 155 had a mood disorder, 40 had an anxiety disorder, 39 had ADHD, 35 had an eating disorder, 8 had a conduct disorder and 5 had schizophrenia. Statistically significant relationships were found for ADHD with cannabis-related disorders and polysubstance dependence; anxiety-related disorders with alcohol-related disorders; and mood disorders with cocaine-related disorders, possibly substance-induced disorders and substance-induced disorders. These results showed that there was large group of people who presented for substance abuse treatment who have one or more COD. Having a COD made the nature of their problems particularly complex. There is a need for greater awareness of this vulnerable group. This would serve to improve the treatment that people with CODs receive.