Treatment of substance abuse in dual diagnosis

Interventions for substance use–related problems are limited for individuals with intellectual disability (ID). This is problematic, as the lack of interventions can lead to substance use initiation, progression of substance use into substance use disorder, poorer outcomes of treatment, and stigmatization of individuals with dual diagnosis. Additionally, staff who work with individuals with ID and addiction treatment lack resources to effectively help substance use in individuals with ID. Nevertheless, there has been an increase in studies assessing the feasibility and outcomes of interventions for substance use and abuse in individuals with ID. This chapter reviews psychological and pharmacological interventions for individuals with dual diagnosis of substance abuse and ID

The generalizability of the structure of substance abuse and antisocial behavioral syndromes:A systematic review

Background: Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies. Purpose: The objective was to establish the generalizability of transdiagnostic models of externalizing disorders across different types of disorders and populations, in regard to the strength of the evidence. Method: We conducted a systematic literature review using combinations of two sets of keywords: 1) "antisocial", "externalizing", "conduct disorder", "disruptive behavior disorder", "substance abuse", "substance-related disorder", "cannabis", "cocaine", "hallucinogen", "alcoholism", "opioid"; 2) "latent structure", "factor analysis", "multivariate analysis". Results: Models supporting a superordinate factor appeared dominant in a limited set of different populations, on which the majority of the research sample was focused. Conclusions: Although the externalizing spectrum model is a promising angle for future research and treatment, extending research on this model in a higher diversity of populations is recommended to enhance the understanding and applicability of the externalizing spectrum model

“Disruptive Behavior” or “Expected Benefit” Are Rationales of Seclusion Without Prior Aggression

Objective: In the Netherlands, seclusion of patients with a psychiatric disorder is a last-resort measure to be used only in the event of (imminent) severe danger or harm. Although aggressive behavior is often involved, seclusions not preceded by aggression also seem to occur. We sought insight into the non-aggressive reasons underlying seclusion and investigated the factors associated with it. Method: We included all patients admitted to a Dutch psychiatric hospital in 2008 and 2009. Seclusions had been registered on Argus-forms, and aggression incidents had been registered on the Staff Observation Aggression Scale-Revised (SOAS-R), inspectorate forms and/or patient files. Determinants of seclusion with vs. without prior aggression were analyzed using logistic regression. Reasons for seclusion without prior aggression were evaluated qualitatively and grouped into main themes. Results: Of 1,106 admitted patients, 184 (17%) were secluded at some time during admission. Twenty-one (11.4%) were excluded because information on their seclusion was lacking. In 23 cases (14%), neither SOAS-R, inspectorate forms nor individual patient files indicated any aggression. Univariable and multivariable regression both showed seclusion without preceding aggression to be negatively associated with daytime and the first day of hospitalization. In other words, seclusion related to aggression occurred more on the first day, and during daytime, while seclusion for non-aggressive reasons occurred relatively more after the first day, and during nighttime. Our qualitative findings showed two main themes of non-aggressive reasons for seclusion: “disruptive behavior” and “beneficial to patient.” Conclusion: Awareness of the different reasons for seclusion may improve interventions on reducing its use. Thorough examination of different sources showed that few seclusions had not been preceded by aggression. The use of seclusion would be considerably reduced through interventions that prevent aggression or handle aggression incidents in other ways than seclusion. However, attention should also be paid to the remaining reasons for seclusion, such as handling disruptive behavior and focusing on the beneficial effects of reduced stimuli. Future research on interventions to reduce the use of seclusion should not only aim to reduce seclusion but should also establish whether seclusions preceded by aggression decrease different from seclusions that are not preceded by aggression

Multidisciplinaire richtlijn ‘Probleemgedrag bij volwassenen met een verstandelijke beperking’

Recent is de nieuwe multidisciplinaire richtlijn ‘Probleemgedrag bij volwassenen met een verstandelijke beperking’ verschenen. Doel van de richtlijn is om de kwaliteit van leven bij volwassenen met een verstandelijke beperking (VB) en probleemgedrag te verbeteren en last en lijden bij deze groep én naastbetrokkenen te verminderen. Belangrijke bijkomende doelen zijn het beter signaleren, vaststellen en behandelen van psychiatrische stoornissen, het verbeteren van de inzet van niet-medicamenteuze behandelingen en de effectieve inzet van psychofarmaca. The new multidisciplinary guideline ‘Challenging behaviour in adults with intellectual disabilities’ has recently been published. The aim of the guideline is to improve the quality of life of people with ID and challenging behaviour, and to reduce the suffering for this group and their relatives. Important additional aims include improvement of the recognition, diagnosis and assessment and treatment of psychiatric conditions, improvement of the use of non-pharmaceutical treatments and the effective use of psychotropic medication

Multidisciplinaire richtlijn ‘Probleemgedrag bij volwassenen met een verstandelijke beperking’

Recent is de nieuwe multidisciplinaire richtlijn ‘Probleemgedrag bij volwassenen met een verstandelijke beperking’ verschenen. Doel van de richtlijn is om de kwaliteit van leven bij volwassenen met een verstandelijke beperking (VB) en probleemgedrag te verbeteren en last en lijden bij deze groep én naastbetrokkenen te verminderen. Belangrijke bijkomende doelen zijn het beter signaleren, vaststellen en behandelen van psychiatrische stoornissen, het verbeteren van de inzet van niet-medicamenteuze behandelingen en de effectieve inzet van psychofarmaca. The new multidisciplinary guideline ‘Challenging behaviour in adults with intellectual disabilities’ has recently been published. The aim of the guideline is to improve the quality of life of people with ID and challenging behaviour, and to reduce the suffering for this group and their relatives. Important additional aims include improvement of the recognition, diagnosis and assessment and treatment of psychiatric conditions, improvement of the use of non-pharmaceutical treatments and the effective use of psychotropic medication