Enhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project: Améliorer les programmes de traitement intégré pour les troubles mentaux et les troubles liés à l'usage de substances psychoactives graves et concomitants : aperçu de la problématique des surdoses dans le cadre du projet ROAR CANADA

Abstract

ObjectiveThis paper summarizes methods and initial overdose-related results from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal observational study of individuals with severe concurrent substance use and mental disorders (also called dual disorders or dual diagnosis). The study sampled patients treated at two tertiary treatment centres in British Columbia, Red Fish Healing Centre and Heartwood Centre, along with a concurrent treatment unit at St. Joseph's in Ontario. These facilities have implemented evidence-based integrated treatment programs. Our first analysis explores selected baseline characteristics as potential risk factors for drug overdose in this population.MethodSociodemographic factors, trauma history, and impulsivity were part of a more comprehensive longitudinal assessment. In this first investigation, we use bivariate analysis and logistic and linear regression modelling to examine these variables in relation to overdose history.ResultsOverall, 291 of 450 participants (64.7%) reported a history of ≥1 overdose. Across the three centres, patients had a lifetime average of 7.6 (SD = 12.9) overdoses. The prevalence and mean number of overdoses were somewhat higher among Red Fish patients (74.5% and 8.5, respectively). Adverse childhood events, lifetime trauma history, and impulsivity were all high, but only lifetime trauma history emerged as significantly associated with overdose across all treatment centres. Impulsivity indicators were selectively associated with overdose by site, but not consistently within the overall sample.ConclusionsThese results highlight the importance of prioritizing trauma-informed care in the treatment of individuals with severe concurrent substance use and mental disorders, who are at high risk of overdose. The integration of trauma treatment into existing programs may enhance patient outcomes and contribute to the ongoing evolution of effective care strategies for this complex population. These findings are particularly relevant in light of the overdose crisis.Plain Language Summary TitleEnhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project.

Keywords: dual diagnosis; evidence-based medicine; health disparities; inpatient psychiatry; integrated treatment; mental health services; overdose; risk factor.

Figure 1.

Heatmap of bivariate associations. Note. Heatmap of bivariate associations between age, number of lifetime overdoses (log-transformed OD), trauma and adversity measures (BTQ, ACE), impulsivity personality traits (S-UPPS-P Pos. Urg, Sen. Seek, Lack Prem, Lack Pers, and Neg. Urg), and delay discounting (DD100, DD1,000). BTQ = Brief Trauma Questionnaire; ACE = Adverse Childhood Experience Questionnaire; S-UPPS-P = Shortened Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency Impulsive Behavior Scale; Pos. Urg = positive urgency; Sen. Seek = sensation seeking; Lack Prem = lack of premeditation; Lack Pers = lack of perseverance; Neg. Urg = negative urgency; DD = delay discounting.