依存症研究と治療ジャーナル

抽象的な

The Treatment of Complex Dual Disorders: Clinicians' and Service Users' Perspectives

Phillip Therien, Anais S. Lavarenne and Tania Lecomte

Introduction: The present study examined how both clinicians and service users experience existing treatments for Dual Disorders (DDs), namely the co-occurrence of a Severe Mental Illness (SMI) and a Substance Use Disorder (SUD). The literature indicates that many individuals with DDs present with an even more complex clinical portrait, which often includes additional pathologies or stressors, such as cluster B personality disorders, Post-traumatic Stress Disorder (PTSD) or trauma history, and depression. Treatment for these individuals is complicated by these mitigating factors and it is not clear whether extant treatments for DDs are successful with this population, and how they could be improved.

Objective: This study aimed to explore the specific issues, successes and difficulties regarding the treatment of complex DDs, according to both clinicians’ and service users’ perspectives.

Methods: A qualitative design was used in this exploratory study in order to best grasp the complexity of this clinical issue. Thirty clinicians and program directors specialized in the treatment of DDs, and 31 individuals diagnosed with complex DDs participated respectively in three and four focus groups conducted in various settings. Collected data were coded using a mixed open and closed coding procedure.

Results: All participants expressed both positive and negative views on existing treatments. Clinicians and clinical directors expressed various issues, principally: powerlessness, dealing with personality disorders in people with DDs, seeking a common treatment vision, and services issues (notably housing). The main themes emerging in the service users’ interviews pertained to exclusion from services, personalised treatment plans, medication, and therapy.

Conclusion: Although creative, personalised treatments were noted, it is clear to all clinicians, clinical directors and service users that existent services are not efficiently equipped for dealing with complex DDs. More integrated treatments, more comprehensive trainings and better access to adapted services would improve treatment outcomes for individuals diagnosed with complex DDs.