Treatment Outcomes of People Living with Mental Illnesses due to Substance Abuse - Research Proposal Example

Research Proposal Student’s Name Institutional Affiliation Research Proposal: Treatment Outcomes of People living with Mental Illnesses due to Substance Abuse Aims and objectives The aim of this cluster-randomized controlled trial attributes to the evaluation of the effectiveness of concomitant administration of cognitive behavioural therapy (CBT), multidimensional family therapy (MDFT) and pharmacotherapy intervention (PI) for improving the mental health outcomes of the patients affected with the psychosocial manifestations of substance abuse. This research study will analyze the potential of multidisciplinary psychosocial as well as behavioural interventions in bringing health advantages to the addicted individuals. The pattern of substance abuse considerably influences the psychosocial, mental and physical health of the affected patients as well as their family members (CSAT, 2004). Therefore, the advantages of familial, cognitive and behavioural approaches require exploration in the context of determining the scope of mental health benefits obtained after integrating these multidisciplinary interventions with the conservative treatment methodology. Research Questions 1. What are the potential mental health advantages of the simultaneous administration of CBT, MDFT and pharmacotherapy to the mentally ill patients affected with the pattern of substance abuse? 2. How the integrated behavioural and family interventions add value to the treatment of the mental manifestations of the addicted patients? 3. What particular modifications or improvements require incorporation in the medical management of the addicted patients in the context of improving their mental health outcomes? 4. What are the potential knowledge gaps among nurse professionals regarding the implementation of behavioural strategies for enhancing the health and quality of life of patients affected with substance addiction? 5. To what extent the combination of behavioural interventions with pharmacotherapy approaches is advantageous as compared to the administration of conservative pharmacotherapy approaches for elevating the mental outcomes of the addicted patients? Background and Rationale Evidence-based research literature indicates the highly co-morbid status of substance abuse disorders and associated mental manifestations (Kelly & Daley, 2013). These disorders arise from the repeated utilization of psychoactive drugs leading to the establishment of disability and distress among the affected individuals (McHugh, Hearon, & Otto, 2010). The combination treatment proves advantages for treating multiple conditions with the utilization of pharmacotherapy and psychotherapy interventions by nurses, counselors, physicians and psychotherapists. The research findings by (Marcus & Zgierska, 2009) indicate the effectiveness of mindfulness based behavioural interventions for reducing the tendency of drugs addicts in terms of acquiring mental comfort with the utilization of maladaptive behaviours like drugs addiction. These behavioural approaches assist the enhancement of the degree of mindfulness of individuals that inversely affect their level of distress and negative thoughts emanating from the pattern of substance abuse (Marcus & Zgierska, 2009). The findings by (Friedman & Williams, 2015) indicate the positive implications of therapies like motivational interviewing, CBT, medication interventions, detoxification techniques, community-based approaches and self-help programs on the mental health status of the older and younger subjects of substance abuse. Treatment of mental health problems of addicted patients requires careful dose adjustment particularly for the elderly patients. Contrarily, treatment of marijuana addicts requires the administration of anti-depressants while reducing the scope of their over-prescription in real time scenarios (Friedman & Williams, 2015). However, the true potential of medication interventions for treating the mental problems of addicted patients in the absence of behavioural approaches is still unknown. Similarly, the sole administration of behavioural approaches in treating the mental manifestations of addicted patients fails to generate 100% cure in every patient scenario. Therefore, the combination approaches provide prospective opportunities to the healthcare professionals in terms of effectively reducing the mental health issues of the patients affected with the pattern of drugs addiction across the community environment. The administration of these integrative approaches requires close collaboration between the multidisciplinary health experts including physicians, nurses, physiotherapists and paramedics for brining the desirable health outcomes among the mentally ill patients. Indeed, the increase in the level of public awareness, enhancement in the identification of the mental health problems among patients and elevated accessibility of drugs addicts to the healthcare services highly warranted for enhancing their wellness pattern and responses to the combinatorial healthcare interventions (Friedman & Williams, 2015). Contingency management approaches assist addicted patients in acquiring abstinence from drugs addiction behaviour in lieu of receiving monetary benefits from the treatment facilitators (McHugh, Hearon, & Otto, 2010). The findings by (Watkins, et al., 2012) indicate the effectiveness of group CBT interventions in controlling the pattern of major depression experienced by the patients receiving residential substance abuse treatment by the healthcare professionals. Group CBT interventions require the systematic administration of counseling sessions for relieving the addictive symptoms of the addicted patients. The research analysis by reveals the effectiveness of CBT in controlling the manifestations of somatoform and anxiety disorders, general stress and anger management complications (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). The preliminary goal of CBT management approaches attributes to the reduction in mental symptoms, remission of substance abuse disorder and enhancement of the psychosocial functioning of the treated patients. CBT strategies also assist the addicted patients in terms of elevating their problem-solving skills for cognitive enhancement and reciprocal reduction in the patterns of maladaptive behaviour (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). The clinical findings also reveal the greater effectiveness of combinatorial therapy (including CBT and pharmacotherapy, as compared to CBT alone) in treating the mental manifestations of the addicted patients (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). The findings of the randomized controlled study by (Yonkers, et al., 2009) reveal the effectiveness of systematized CBT sessions in enhancing the mental health outcomes of substance abusing pregnant women across the primary care setting. The evaluation of substance use triggers and their utilization pattern highly warranted in the context of configuring appropriate CBT interventions for enhancing the wellness outcomes of the affected patients. The research findings by (Rowe, 2010) indicate the effectiveness of MDFT in treating the mental complications experienced by the substance abusing adolescent individuals. The multidimensional family therapy takes into account the significant factors like family conflicts, parental rejection, compromised parental discipline approaches and ineffective parental monitoring while configuring treatment approaches for the mentally ill substance-abusing adolescents (Rowe, 2010). The growth mixture modeling approach utilized by (Henderson, Greenbaum, Gayle, Dakof, & Howard, 2010) confirms superior treatment outcomes of MDFT among the mentally ill substance-abusing youths. MDFT approaches focus on the effective mitigation of the empirical risk factors like parental interaction and abrupt behaviour of the addicted individuals while treating their co-morbid psychiatric conditions (Henderson, Greenbaum, Gayle, Dakof, & Howard, 2010). Multidimensional family therapy exhibits greater efficacy in treating the psychosocial complications of the patients affected with Cannabis addiction. Indeed, MDFT offers greater health advantage as compared to CBT and home-based interventions to the mentally ill marijuana-abusing youngsters. MDFT strategies evaluate the emotional expressions of the addicted individuals as well as their extra-familial context for the enactment of appropriate therapeutic and behavioural strategies with the objective of enhancing the mental health outcomes of the affected patients (Bonnaire, Bastard, Couteron, Har, & Phan, 2014). Research findings by (Liddle, Rowe, Dakof, Henderson, & Greenbaum, 2009) indicate the effectiveness of MDFT in reducing the frequency of substance use, internalized distress level and psychosocial risks of the underprivileged ethnic minority youngsters. The evidence-based findings by (Goldstein, et al., 2014) reveal the significance of the concomitant administration of adjunctive family focused treatment with pharmacotherapy intervention in treating the mental manifestations of the substance-abusing children and adults. This integrative intervention assists the addicted individuals in falsification of the belief that advocates the benefit of self-medication in treating the adverse symptoms related to mood and thinking. Evidence-based literature reveals the significant barriers that hinder the administration of pharmacotherapy interventions utilized in treating the mental health issues of substance-abusing individuals (Oliva, Maisel, Gordon, & Harris, 2011). These barriers attribute to the knowledge deficits of physicians, nurses as well as patients in the appropriate utilization of prescription drugs for the treatment of substance abuse disorders. Furthermore, lack of trust of underprivileged patients on the pharmacotherapy approaches as well as their incapacity to comply with the recommended treatment regimen leads to the ineffectiveness of these strategies in improving psychosocial outcomes of the substance – abusing individuals. Therefore, the research community needs to explore the scope of multidisciplinary combinatorial and integrative interventions in effectively treating the mental symptoms of the patients affected with the pattern of substance abuse. Evidence-based research literature reveals the limited success rate of pharmacotherapy intervention in treating the mental manifestations of the patients affected with chronic cocaine abuse (Kreek, Borg, Ducat, & Ray, 2010). Indeed, the administration of long-term maintenance pharmacotherapy warranted in the context of reducing the adverse psychosocial manifestations of drugs addiction among the affected patients. These evidence-based findings rationally indicate that no single therapy offers considerable health advantage to the substance-abusing individuals and therefore combinatorial approaches require utilization in the context of potentially improving the mental health outcomes of the addicted patients. The inclusion of patient’s family members, peers and friends in the process of medical decision-making is highly warranted for improving his/her compliance to the proposed therapeutic and behavioural regimen. Person-centered, multidisciplinary, combinatorial and multidimensional therapeutic and mental management strategies require utilization by the healthcare professionals for effectively mitigating the mental health issues of the drugs addicts. However, the organization of prospective research studies highly warranted in the context of exploring systematic combinatorial strategies for treating the psychosocial and mental health problems faced by the substance abusing individuals. Study Design The cluster randomized controlled trial will be conducted for evaluating the potential of combinatorial approaches (including CBT, MDFT and PI) in reducing the mental health issues of the patients affected with the pattern of substance abuse. The process of randomization will be carried out in psychotherapy wards across various hospitals and associated healthcare units. The intervention as well as the control groups will be randomly assigned in the absence of biasing and predefined treatment strategies will be administered accordingly in multiple stages to both groups in the treatment centers. The study will require the enrolment of 15, 000 subjects affected with the pattern of substance abuse and associated mental manifestations. Patients affected with Cannabis and alcohol addiction will be the preferred candidates for the research study. The proposed study intervention will include the candidates of various age groups (including children, adolescents, youngsters, middle-aged people and elders). However, patients affected with serious co-morbidities like HIV, cancer, end stage renal disease, hepatic failure and autoimmune disorders will be summarily excluded in the research study. The candidates require enrolment irrespective of their gender and the facilitators will prefer to engage both female and male subjects in equal proportion in the research study. The intervention group will receive the combinatorial treatment approaches; however, the study group will be treated merely with pharmacotherapeutic interventions across the healthcare settings. Indeed, 78 healthcare settings will require selection across the region for executing the research intervention in the context of acquiring the desirable outcomes. The drop-out rate of 12% expected following the enrollment of subjects in the research study. Hypothesis Primary Hypothesis: The intervention group will exhibit considerable mental health advantage following the administration of combinatorial intervention as compared to the control group. Indeed, 85% decrease in the mental health problems will be observed in the intervention group as compared to the control group that will exhibit a 15% reduction in mental complications of the substance-abusing individuals. This rationally indicates the great potential of combinatorial interventions in normalizing the lives of addicted individuals and reducing the pattern of their maladaptive drugs addiction behaviour. Secondary Hypothesis: 1. The mean life expectancy of the mentally ill substance-abusing people will increase in the intervention group as compared to the patients in the control group. 2. The patients in the intervention group will develop the pattern of self-sufficiency and exhibit better immunity in comparison to the subjects enrolled in the control group. Sampling Methods The sampling will be done across health centers in South, West and North regions while including the patients from the ethnic minorities and underprivileged sections of the society. During the initial stage, 25 clusters (i.e. healthcare centers) from South region will require the selection in accordance with the proportion of substance-abusing individuals studied through the centralized hospitals databases. Similarly, 25 clusters (each from the West and North regions) will require configuration in the subsequent stage of the intervention. From each cluster, 5, 000 mentally ill and substance-abusing patients will require equitable selection for their random assignment to intervention and control groups. Resultantly, 7500 subjects (including male and female candidates) will be randomly included in the intervention group and an equal amount of individuals will comprise of the control group accordingly. Intervention The intervention group will receive the blend of "cognitive behavioural therapy", "multidimensional family therapy" and "pharmacotherapy treatment" for improving the state of mental health and psychosocial outcomes of the substance-abusing individuals of various age groups. Control The control group will receive the conventional pharmacotherapy with the utilization of standard drugs with known potential for treating the mental health issues of the substance abusing individuals. Inclusion and Exclusion Criteria for Patients The individuals within the age range of 5 – 100 years considered for their selection in the research intervention. However, selected individuals must be affected with substance abuse and experiencing the associated mental health problems. The mentally ill patients affected with life threatening or traumatic conditions excluded from the research study. The study included patients irrespective of their gender, cast, creed, nationality and ethnicity. Inclusion and Exclusion Criteria of Patients’ Families The families of the selected patients must not suffer from the pattern of substance abuse, mental health issues or psychosocial manifestations. The family members within the age group of 25 – 65 years considered for their inclusion in the study for taking their assistance in administering various combinatorial and pharmacotherapy interventions to the selected patients. Analysis Method The facilitators will perform data analysis with the effective utilization of the intention to treat method. The primary outcome of the study intervention attributes to the improvement of the mental health outcomes of the patients in the intervention group as compared to the subjects in the control group. The initial outcomes of the study interventions will be categorized in terms of various levels. Level 1 will indicate the increased understanding of the subjects regarding the potential health benefits of non-utilization of psychoactive drugs. However, level 2 will indicate the reduction in the pattern of depression, panic and anxiety of the enrolled subjects. The primary outcomes variable will require analysis with the effective utilization of PROC GENMOD via Poisson regression model (Hayat & Higgins, 2014). The results will be reported for both sided tests in the context of obtaining the primary outcomes. The secondary investigation will focus on the determination of the duration of the combinatorial as well as pharmacotherapy interventions in bringing the desirable health outcomes for the mentally ill substance-abusing individuals. Separate mixed models will require utilization for undertaking repeated measurements of the mental health outcomes of the addicted individuals within the pre-specified tenure of the study intervention. The measurement of consistent effects of the combinatorial approaches will be undertaken by the implementation of linear mixed models. These approaches will determine the fixed and random effects of the treatment interventions across the intervention as well as the control groups. The effect of the treatment approaches over the course of time will be determined to calculate the actual timeline warranted for acquiring the mental health benefits following the administration of combinatorial and pharmacotherapy interventions. The data analysis as well as comparison will require execution with the application of SPSS version 16.0 (Mhango, Kalimbira, & Mwagomba, 2015). The confounding factor will require calculation in the context of determining the scope of errors in the research findings. Proposed Action Plan and Timeline The research study will execute for tenure of two years in multiple stages and results will be calculated accordingly following the above-mentioned analysis approaches. Ethical approval will be taken from the institutional ethics committee in accordance with the conventions of medical ethics, prior to the execution of the research study (IOM, 1995). The research findings as well as the demographic data of the research subjects will be safeguarded with the stringent implementation of the HIPAA (Health Insurance Portability and Accountability Act of 1996) conventions (IOM, BRIEF HISTORY OF HIPAA AND THE PRIVACY RULE, 2009). The facilitators of the research study will keep into consideration the dignity and rights of the enrolled subjects and allow them to leave the study anytime during the course of intervention irrespective of the cause of their exit. Facilitators will also take informed consent from all participants prior to enrolling them in the research study. Qualified physicians, nurses, psychiatrists and healthcare workers will require deployment in the context of facilitating the research interventions for obtaining the desirable outcomes. A team of 250 healthcare professionals and 15 IT professionals will remain engaged throughout the course of research study as per the stipulated requirement. Strategies to Evaluate Impact The impact of the research intervention will require systematic evaluation by the facilitators while assessing the intensity of the mental manifestations of the enrolled subjects at various points of time during the course of the study. The organization of interview sessions with the patients as well as their caretakers will assist in the evaluation of the extent of the reduction of the mental symptoms of the enrolled subjects following the administration of CBT, MDFT and PI interventions. The mental status examination of the enrolled subjects will also provide an insight to the facilitators regarding the level of improvement in mental health issues of the treated patients after the successful administration of the combinatorial interventions. Proposed Budget The financial requirements of the research study attributes to an expense of $2, 484, 184 in accordance with the following details. Summary Requirement Expense ($) (a) Materials $123, 589 (b) Equipments $155, 614 (c) Salary for the teams $1, 596, 758 (d) Communication and Travel $125, 578 (e) Basic Expenses of Patients $154, 697 (f) Unexpected losses and damages $127, 948 (g) Miscellaneous expenses $200, 000 Grand Total $2, 484, 184 References Read More

Treatment of mental health problems of addicted patients requires careful dose adjustment particularly for the elderly patients. Contrarily, treatment of marijuana addicts requires the administration of anti-depressants while reducing the scope of their over-prescription in real time scenarios (Friedman & Williams, 2015). However, the true potential of medication interventions for treating the mental problems of addicted patients in the absence of behavioural approaches is still unknown. Similarly, the sole administration of behavioural approaches in treating the mental manifestations of addicted patients fails to generate 100% cure in every patient scenario.

Therefore, the combination approaches provide prospective opportunities to the healthcare professionals in terms of effectively reducing the mental health issues of the patients affected with the pattern of drugs addiction across the community environment. The administration of these integrative approaches requires close collaboration between the multidisciplinary health experts including physicians, nurses, physiotherapists and paramedics for brining the desirable health outcomes among the mentally ill patients.

Indeed, the increase in the level of public awareness, enhancement in the identification of the mental health problems among patients and elevated accessibility of drugs addicts to the healthcare services highly warranted for enhancing their wellness pattern and responses to the combinatorial healthcare interventions (Friedman & Williams, 2015). Contingency management approaches assist addicted patients in acquiring abstinence from drugs addiction behaviour in lieu of receiving monetary benefits from the treatment facilitators (McHugh, Hearon, & Otto, 2010).

The findings by (Watkins, et al., 2012) indicate the effectiveness of group CBT interventions in controlling the pattern of major depression experienced by the patients receiving residential substance abuse treatment by the healthcare professionals. Group CBT interventions require the systematic administration of counseling sessions for relieving the addictive symptoms of the addicted patients. The research analysis by reveals the effectiveness of CBT in controlling the manifestations of somatoform and anxiety disorders, general stress and anger management complications (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).

The preliminary goal of CBT management approaches attributes to the reduction in mental symptoms, remission of substance abuse disorder and enhancement of the psychosocial functioning of the treated patients. CBT strategies also assist the addicted patients in terms of elevating their problem-solving skills for cognitive enhancement and reciprocal reduction in the patterns of maladaptive behaviour (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). The clinical findings also reveal the greater effectiveness of combinatorial therapy (including CBT and pharmacotherapy, as compared to CBT alone) in treating the mental manifestations of the addicted patients (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).

The findings of the randomized controlled study by (Yonkers, et al., 2009) reveal the effectiveness of systematized CBT sessions in enhancing the mental health outcomes of substance abusing pregnant women across the primary care setting. The evaluation of substance use triggers and their utilization pattern highly warranted in the context of configuring appropriate CBT interventions for enhancing the wellness outcomes of the affected patients. The research findings by (Rowe, 2010) indicate the effectiveness of MDFT in treating the mental complications experienced by the substance abusing adolescent individuals.

The multidimensional family therapy takes into account the significant factors like family conflicts, parental rejection, compromised parental discipline approaches and ineffective parental monitoring while configuring treatment approaches for the mentally ill substance-abusing adolescents (Rowe, 2010).

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