Association Between Cardiometabolic Index and Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus.

Mental health conditions show high co-occurrence rates with alcohol or other drug use disorders (AOD), often leading to more complex clinical presentations than observed with AOD alone. Among adults in the United States aged 18 or older, 33% percent (or 84.5 million people) had either a mental health disorder, alcohol use disorder, or a substance use disorder in the past year (National Household Survey on Drug Use and Health [NHSDUH], 2023). Adults with AOD report roughly 40% co-occurrence rates with any mental health condition, and among those with any mental health condition, roughly 30% report AOD (NHSDUH, 2023). The COVID-19 pandemic has also exacerbated the prevalence of co-occurring disorders, underscoring the continued need for effective mental health and substance use treatments (). Overtime, treatment for AOD with one or more co-occurring mental health disorders (AOD/MHD) has evolved from targeting either condition in isolation or in a pre-determined sequence (e.g., identifying one condition as primary and targeting remission prior to addressing the secondary condition) to considering integrated care as best practice. Integrated treatment models, that combine mental health and substance use services, have been shown to improve outcomes by addressing both disorders concurrently (). These methods range from integrated care programs (e.g., Assertive Community Treatment; ) to specific treatment models. Regarding the latter, cognitive-behavioral therapy (CBT) may be particularly promising because it is highly flexible and has demonstrated support for many relevant conditions such as alcohol use disorder, substance use disorders, mood disorders, and post-traumatic stress disorder (PTSD; ; ; ). The efficacy of cognitive-behavioral therapy has led to increased utilization, evolution, and integration with other modalities suggesting a larger umbrella term such as cognitive-behaviorally-based intervention (CBI) may be a useful way to frame the growing applications of CBT (). In prior meta-analyses, CBIs targeting co-occurring disorders have demonstrated efficacy for substance use and mental health symptom outcomes when compared to interventions targeting a substance use disorder or mental health condition only, but not when added to existing services and compared to those services alone (; ; = 15 studies with = 12 included in the current review). Effect sizes were small in magnitude and varied by the specific conditions targeted with the most promising effects observed in studies targeting alcohol use disorder and PTSD (; ). However, other studies do not unanimously support these conclusions. For example, examined 12 studies of co-occurring substance use and PTSD treatment ( = 2 included in the current review) and did not find differential benefit of dual compared to single disorder modalities. A review examining integrated CBT for substance use and depression suggested efficacy over no treatment controls, but not other therapies (; = 12 studies with = 3 included in the current review). Therefore, the above literature on best treatment methods for AOD/MHD is mixed with potentially important differences in treatment effect when considering experimental comparator and the specific AOD or mental health condition targeted.