Concurrent disorder refers to a diverse set of combinations of substance use disorders and mental disorders simultaneously in need of treatment. Concurrent disorders are underdiagnosed, undertreated, and more complex to manage, practicing the best recommendations can support better outcomes. The purpose of this work is to systematically assess the quality of the current concurrent disorders’ clinical recommendation management guidelines. Literature searches were performed by two independent authors in electronic databases, web, and gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2000 and 2020. The initial search resulted in 8841 hits. A total of 24 guidelines were identified and assessed with the standardized guidelines assessment tool: AGREE II (Appraisal of Guidelines for Research and Evaluation). Most guidelines had acceptable standards, however, only the NICE guidelines had all detailed information on all AGREE II Domains. Guidelines generally supported combinations of treatments for individual disorders with a very small evidence base for concurrent disorders, and they provided little recommendation for further structuring of the field, such as level of complexity or staging, or evaluating different models of treatment integration.

Objectives: A little more than a decade ago British Columbia (BC) decided to improve the treatment of individuals suffering from severe concurrent disorders. They provided funding for the development of a novel evidence-based, recovery oriented, provincial tertiary inpatient treatment centre laid out for 100 beds. Integrated multidisciplinary treatment teams involving professionals from more than a dozen disciplines covering the full range of supports are now providing integrated services in one institution. We have seen changes in the population we treat and have adapted our approach. The basic concept was published in a paper 8 years ago. The current paper summarises changes in the population served, conceptual modifications, and continued issues. Methods: Reported changes in the population are based on a comparison of cross-sectional client interviews conducted 10 years ago (2009/10) and again from 2018 until 2020, mainly 2018/19. Results: Overall, we saw limited changes in the characteristics of the population such as age, gender, ethnic background, level of childhood trauma etc., but substantial changes in diagnoses, including changes in primary substances use disorders. We further present and discuss conceptual changes, such as changes in the model of care, and changes in daily practice, such as contact to, and interaction with community services. Conclusions: We feel that severe concurrent disorders continue to present a major challenge for any health care system. There continue to be substantial gaps both in research on this population and in availability of adequate health services. Services such as the one described in this paper for BC need to continue to evolve and be optimized, as they utilize innovations based on evidence that still requires further proof of practicability and efficacy. Objectifs: Il y a un peu plus d’une décennie, la Colombie-Britannique (CB) a décidé d’améliorer le traitement des personnes souffrant de troubles concomitants graves. Ils ont financé le développement d’un nouveau centre de soins tertiaires provincial de traitements éprouvés pour patients hospitalisés axé sur le rétablissement et doté de 100 lits. Des équipes de traitement multidisciplinaires intégrées regroupant des professionnels de plus d’une douzaine de disciplines couvrant toute la gamme des soutiens offrent maintenant des services intégrés dans un seul établissement. Nous avons vu des changements dans la population que nous traitons et avons adapté notre approche. Le concept de base a été publié dans un journal il y a 8 ans. Le présent document résume les changements dans la population desservie, les modifications conceptuelles et les problèmes persistants. Méthodes: Les changements signalés dans la population sont basés sur une comparaison d’entretiens transversaux avec des clients menés il y a 10 ans (2009/10) et à nouveau de 2018 à 2020, principalement 2018/19. Résultats: Dans l’ensemble, nous avons constaté des changements limités dans les caractéristiques de la population telles que l’âge, le sexe, l’origine ethnique, le niveau de traumatisme de l’enfance, etc., mais des changements substantiels dans les diagnostics, y compris des changements dans les troubles primaires liés à l’utilisation de substances. Nous présentons et discutons en outre des changements conceptuels, tels que les changements dans le modèle de soins et les changements dans la pratique quotidienne, tels que le contact et l’interaction avec les services communautaires. Conclusions: Nous pensons que les troubles concomitants graves continuent de représenter un défi majeur pour tout système de soins de santé. Il subsiste des lacunes substantielles tant dans la recherche sur cette population que dans la disponibilité de services de santé adéquats. Les services tels que celui décrit dans ce document pour la Colombie-Britannique doivent continuer d’évoluer et d’être optimisés, car ils utilisent des innovations basées sur des preuves qui nécessitent encore des preuves supplémentaires de faisabilité et d’efficacité.

Background/Objectives: There is a significant gap in accessibility to mental healthcare in Canada. This study aims to examine the population of Canadian crisis hotline responders and investigate the variables that contributed to burnout and professional quality of life during COVID-19. Crisis hotline responders are hypothesized to be affected by burnout and poor professional quality of life, due to the inherent nature of the job and the widespread negative mental health effects of COVID-19, which are expected to continue even after the pandemic. Methods: An online, cross-sectional, mixed-methods survey assessed sociodemographic information, shift-related variables, burnout and related factors, and current support methods utilized by crisis hotline responders across Canada. The open-ended questions helped to more personally reflect participants’ experiences. Data were analyzed using chi-square tests, an analysis of variance, and a regression analysis. Results: The survey was completed by 136 participants (78.7% female) with an average age of 39.68. Participants reported relatively high levels of burnout/stress on both the Copenhagen Burnout Inventory and professional quality of life survey. Younger age, less work experience, and working overnight shifts emerged as possible predictors of worse mental wellbeing. Conclusions: Findings suggest that Canadian crisis hotline responders require greater support to manage workplace burnout/stress. Nevertheless, conducting comprehensive studies during times when there are no public health emergencies are warranted to understand the full scope of burnout in this population. We offer five recommendations to support the mental wellbeing of responders and improve access to this important public health resource.

Background/Objectives: The initial systematic review of “Concurrent Disorder Management Guidelines. Systematic Review” assessed the quality of the concurrent disorders’ clinical management guidelines in 2020, including the guidelines in the field from 2000 to 2020. Twenty-four guidelines were identified and assessed with AGREE II (Appraisal of Guidelines for Research and Evaluation). As dual disorder needs increased specifically among the younger population, requiring significant healthcare resources, more efficient approaches targeting complex concurrent disorders are essential. Since 2020, multiple new guidelines have been developed in response to new developments in the field of substance use disorder management. This systematic review update aimed to identify and appraise all new available concurrent disorder management guidelines to strategize the management of concurrent disorders, support better outcomes and further research directions. Methods: The review was registered, and protocol is available in the international register—PROSPERO. Literature searches were performed by two independent authors in electronic databases and the gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2020 and 2025. Sources that were not formal clinical guidelines, not addressed to physicians for adult age group, addressed to intellectual/developmental disability, or written in languages other than English were excluded. Results: The initial search resulted in 5003 records. A total of eight new guidelines were identified and assessed with AGREE II, highlighting the consistent gap in the evidence-based management recommendations. Conclusions: The appraised guidelines had similar quality to the 2020 findings, supporting dual or combined treatment; however, all guidelines had multiple domains not developed rigorously and with methodological limitations. Levels of complexity and staging of treatment were not considered in recommendations. Average domain scores were very low, with the lowest being applicability and editorial independence. Development of high-quality, rigorously developed, evidence-based guidelines, addressing staging, resource implications, and patient involvement is recommended as the evidence base remains underdeveloped.

Introduction: There is a significant gap in accessibility to mental health care in Canada, worsened by various factors including rurality. Therefore, an important resource is crisis hotlines. Responders are hypothesized to be affected by the occupational phenomenon of burnout, partly due to the inherent nature of the job and partly due to the widespread negative mental health effects of the COVID-19 pandemic. Difficulties for crisis hotlines is expected to continue due to the ongoing fallout from the pandemic and from increased awareness of the Canada Suicide Prevention Line after introduction of a new 3-digit (9-8-8) number. This manuscript aims to characterize the population of Canadian crisis hotline responders and investigate the variables that contributed to burnout during COVID-19.; Methods: An online questionnaire assessed sociodemographic information, shift related variables, burnout, and current support methods utilized by crisis hotline responders across Canada. A qualitative component was also included to reflect participants’ experiences; Results: The cross-sectional assessment was completed by 136 participants. During COVID-19 Canadian crisis hotline responders reported relatively high levels of burnout/stress on both the Copenhagen Burnout Inventory and Professional Quality of Life Survey. Younger age emerged as the sole predictor of greater burnout amongst the variables we studied. The normal limitations of a cross-sectional survey apply. The COVID-19 pandemic may have affected the generalizability through several factors.; Conclusions: Findings suggest that Canadian crisis hotline responders, especially younger ones, require greater support to manage workplace burnout. Nevertheless, conducting comprehensive studies during times when there are no public health emergencies are warranted to understand the full scope of burnout in this population.; Recommendations: Based on our data, we offer 5 recommendations to mitigate the risk of burnout for responders and improve access to this important public health resource.