Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs

BACKGROUND

People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder.

METHODS

Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder (n = 175).

RESULTS

Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month.

FOLLOW-UP

CONCLUSIONS

Brief psychoeducation for antisocial personality disorder increased patients' self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.

Assessment of personality-related levels of functioning: a pilot study of clinical assessment of the DSM-5 level of personality functioning based on a semi-structured interview

BACKGROUND

The personality disorder categories in the Diagnostic and Statistical Manual of Mental Disorders IV have been extensively criticized, and there is a growing consensus that personality pathology should be represented dimensionally rather than categorically. The aim of this pilot study was to test the Clinical Assessment of the Level of Personality Functioning Scale, a semi-structured clinical interview, designed to assess the Level of Personality Functioning Scale of the DSM-5 (Section III) by applying strategies similar to what characterizes assessments in clinical practice.

METHODS

The inter-rater reliability of the assessment of the four domains and the total impairment in the Level of Personality Functioning Scale were measured in a patient sample that varied in terms of severity and type of pathology. Ratings were done independently by the interviewer and two experts who watched a videotaped Clinical Assessment of the Level of Personality Functioning Scale interview.

RESULTS

Inter-rater reliability coefficients varied between domains and were not sufficient for clinical practice, but may support the use of the interview to assess the dimensions of personality functioning for research purposes.

CONCLUSIONS

While designed to measure the Level of Personality Functioning Scale with a high degree of similarity to clinical practice, the Clinical Assessment of the Level of Personality Functioning Scale had weak reliabilities and a rating based on a single interview should not be considered a stand-alone assessment of areas of functioning for a given patient.

[The regional network ADAPTHERA : Rheumatology care through coordinated cooperation: comprehensive, trans-sectoral, covering all health insurance. Initial results]

The aim of the rheumatology network ADAPTHERA ("risk-adapted rheumatology therapy") is to achieve a comprehensive improvement in rheumatology care by coordinating treatment in a regional, trans-sectoral network. Accompanying biomedical research projects, training concepts, and the construction of a rheumatology register (gathering data and biomaterials) should furthermore ensure the stable and sustainable optimisation of care. In the pilot phase (2012-2015) the focus of the ADAPTHERA network, required as a "regional key project" within the framework of the Initiative on Health Economy of Rheinland-Palatinate (RL-P), Germany, was placed on the optimisation of the early diagnosis of rheumatoid arthritis, where it is well-known that there is a significant care deficit.Through the intensive, stable, and coordinated cooperation of all health care partners in the field of rheumatology (registered general practitioners and orthopaedic specialists, registered core rheumatologists as well as the Association of Rheumatology of RL-P) a unique regional, comprehensive offer with verifiable care optimisation has been established in RL-P. The network is supported by outstanding collaboration with the Association of Statutory Health Insurance Physicians and the self-help organisation Rheumatology League.The aims that were established at the start of the project will be achieved by the end of the pilot phase:- significant improvement in the early diagnosis of rheumatoid arthritis (an average of 23.7 days until diagnosis by rheumatologists)- access covering all health insurance (regardless of the particular scheme the patients belong to)- comprehensive (verifiable participation of general practitioners from all over RL-P)- data and biomaterials collection, established as a basis for biomarker research, and a rheumatology register for RL-P.

Magnetospheric Multiscale Observations of the Electron Diffusion Region of Large Guide Field Magnetic Reconnection

We report observations from the Magnetospheric Multiscale (MMS) satellites of a large guide field magnetic reconnection event. The observations suggest that two of the four MMS spacecraft sampled the electron diffusion region, whereas the other two spacecraft detected the exhaust jet from the event. The guide magnetic field amplitude is approximately 4 times that of the reconnecting field. The event is accompanied by a significant parallel electric field (E_{∥}) that is larger than predicted by simulations. The high-speed (∼300  km/s) crossing of the electron diffusion region limited the data set to one complete electron distribution inside of the electron diffusion region, which shows significant parallel heating. The data suggest that E_{∥} is balanced by a combination of electron inertia and a parallel gradient of the gyrotropic electron pressure.

Magnetospheric Multiscale Satellites Observations of Parallel Electric Fields Associated with Magnetic Reconnection

We report observations from the Magnetospheric Multiscale satellites of parallel electric fields (E_{∥}) associated with magnetic reconnection in the subsolar region of the Earth's magnetopause. E_{∥} events near the electron diffusion region have amplitudes on the order of 100  mV/m, which are significantly larger than those predicted for an antiparallel reconnection electric field. This Letter addresses specific types of E_{∥} events, which appear as large-amplitude, near unipolar spikes that are associated with tangled, reconnected magnetic fields. These E_{∥} events are primarily in or near a current layer near the separatrix and are interpreted to be double layers that may be responsible for secondary reconnection in tangled magnetic fields or flux ropes. These results are telling of the three-dimensional nature of magnetopause reconnection and indicate that magnetopause reconnection may be often patchy and/or drive turbulence along the separatrix that results in flux ropes and/or tangled magnetic fields.

The Impulsive Lifestyle Counseling Program for Antisocial Behavior in Outpatient Substance Abuse Treatment

Antisocial behavior is associated with low quality of life for the patient and with adverse effects on society and those close to the antisocial patient. However, most patients with antisocial behavior are not seen in treatment settings that focus on their personality but rather in criminal justice settings, substance-abuse treatment, and social welfare settings. This article describes the adaptation and implementation of a highly structured manualized treatment, Impulsive Lifestyle Counseling (ILC), based on the Lifestyle Issues program, a 10-week psychoeducation program studied in prison settings. ILC consists of four sessions over 4 weeks and a booster session 8 weeks later. The goal of treatment is described to patients as "to help people identify their impulsive thoughts and lifestyle leading to problems with drug use, other people, and the police." Two clinical examples and reflections on our experiences with the training and implementation of the ILC program are presented.

Electron-scale measurements of magnetic reconnection in space

Magnetic reconnection is a fundamental physical process in plasmas whereby stored magnetic energy is converted into heat and kinetic energy of charged particles. Reconnection occurs in many astrophysical plasma environments and in laboratory plasmas. Using measurements with very high time resolution, NASA's Magnetospheric Multiscale (MMS) mission has found direct evidence for electron demagnetization and acceleration at sites along the sunward boundary of Earth's magnetosphere where the interplanetary magnetic field reconnects with the terrestrial magnetic field. We have (i) observed the conversion of magnetic energy to particle energy; (ii) measured the electric field and current, which together cause the dissipation of magnetic energy; and (iii) identified the electron population that carries the current as a result of demagnetization and acceleration within the reconnection diffusion/dissipation region.

Floral diversity and pollination strategies of three rheophytic Schismatoglottideae (Araceae)

Homoplastic evolution of 'unique' morphological characteristics in the Schismatoglottideae - many previously used to define genera - prompted this study to compare morphology and function in connection with pollination biology for Aridarum nicolsonii, Phymatarum borneense and Schottarum sarikeense. Aridarum nicolsonii and P. borneense extrude pollen through a pair of horned thecae while S. sarikeense sheds pollen through a pair of pores on the thecae. Floral traits of spathe constriction, presence and movement of sterile structures on the spadix, the comparable role of horned thecae and thecae pores, the presence of stamen-associated calcium oxalate packages, and the timing of odour emission are discussed in the context of their roles in pollinator management. Pollinators for all investigated species were determined to be species of Colocasiomyia (Diptera: Drosophilidae).

'Make it another for me and my mates': Does social capital encourage risky drinking among the Danish general population?

AIMS

The aim of this study was to examine the relationship between several indicators of social capital and risky single occasion drinking (RSOD) in a representative survey sample of the Danish general population.

METHODS

Data from the 2011 Danish national survey (n=2569) with respondents aged 15-79 years were used. Ordered logit modelling was applied to investigate the influence of social networks, social support, social participation and trust on RSOD.

RESULTS

A strong positive relationship was found between frequency of contact with male friends and RSOD between both sexes. Furthermore, social trust among men and membership in voluntary organisations among women was significantly associated with RSOD. Additionally, contact with male family members for women and active participation in religious services for both sexes were strongly and negatively correlated with RSOD.

CONCLUSIONS

Some aspects of social capital can be positively related to at-risk health behaviours, as was found for RSOD in the Danish general population.

Psycho-education for substance use and antisocial personality disorder: a randomized trial

BACKGROUND

Antisocial personality disorder often co-exists with drug and alcohol use disorders.

METHODS

This trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n = 96) delivered by site clinicians (n = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure.

RESULTS

Overall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score (p = .018) and in PDA (p = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up.

CONCLUSIONS

Moderate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN67266318 , 17/7/2012.

WITHDRAWN: Case management for persons with substance use disorders

The review has been withdrawn from publication because it is out of date and the authors are currently not available for updating it

The editorial group responsible for this previously published document have withdrawn it from publication.

Drunken environments: a survey of bartenders working in pubs, bars and nightclubs

There is evidence that bartenders play a key role in respect of the health and safety of patrons in nightlife environments. However, little is known of how bartenders themselves are affected by the environments in which they work, especially with regard to their exposure to violence, pressure to drink and stress. We used a cross-sectional survey to assess the experiences of bartenders (n = 424) working in pubs, bars and nightclubs in Denmark. 71% of the respondents reported drinking while working, 6% reported using other drugs than alcohol at work, and 33% reported drinking even when they did not feel like it because of pressure to drink at work. Verbal assaults and threats were common and associated with higher levels of perceived stress. Bartenders’ work environment poses a risk for the development of alcohol use disorders. The fact that many bartenders consume significant quantities of alcohol during their working hours may pose a risk not only to their own safety, but also to that of their colleagues and patrons.

Childhood socio-economic status, school failure and drug abuse: a Swedish national cohort study

AIM

To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood.

DESIGN, SETTING AND PARTICIPANTS

Register study in a Swedish national cohort born 1973-88 (n = 1,405,763), followed from age 16 to 20-35 years. Cox regression analyses were used to calculate hazard ratios (HR) for any indication of drug abuse.

MEASUREMENTS

Our outcomes were hospital admissions, death and criminality associated with illicit drug abuse. Data on socio-demographics, school grades and parental psychosocial problems were collected from censuses (1985 and 1990) and national registers. School failure was defined as having mean school grades from the final year in primary school lower than -1 standard deviation and/or no grades in core subjects.

FINDINGS

School failure was a strong predictor of illicit drug abuse with an HR of 5.87 (95% CI: 5.76-5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. The lowest stratum had a HR of 2.28 (95% CI: 2.20-2.37) compared with the highest stratum as the reference, when adjusted for other socio-demographic variables. In the fully adjusted model, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19-1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13-4.31).

CONCLUSIONS

School failure and childhood socio-economic status predict illicit drug abuse independently in youth and young adults in Sweden.

The influence of guides on alcohol consumption among young tourists at a nightlife resort

OBJECTIVE

The aim of this study was to assess how participation in party activities with guides affects alcohol consumption among young tourists at an international nightlife resort.

METHODS

Prospective survey of 112 Danish tourists in Sunny Beach, Bulgaria, who were asked about their drinking and activities with guides on three separate nights out.

RESULTS

Participation in party activities with guides, such as drinking games and Pub Crawls, were associated with heavily increased drinking compared with nights out without guides, but not in a dose-response type relationship.

CONCLUSION

Participating in party activities with guides increases drinking among young tourists who are already drinking large amounts of alcohol during their vacation. Further studies are needed to measure, describe, and change the role played by guides at nightlife resorts.

The ASRS-6 has two latent factors: attention deficit and hyperactivity

OBJECTIVE

To test whether the adult self-report scale for ADHD, six-items version (ASRS-6), measures inattentiveness and hyperactivity independently.

METHOD

The ASRS-6 was completed by 234 university students and 157 outpatients treated for drug dependence. In both samples, the ASRS-6 was subjected to two confirmatory factor analyses, one testing a one-factor model and the other testing a model with two correlated factors indicating inattentiveness and hyperactivity, respectively. Test-retest reliability of the subscales was tested on a subset of the student sample (n = 25).

RESULTS

In both samples, the one-factor solution did not fit the data, but the two-factor solution fit the data better. Subscales differed in their correlates in ways that mirror the correlates of inattentiveness and hyperactivity in the published literature on ADHD. In the student sample, the test-retest reliability was adequate for hyperactivity (r = .70) and inattentiveness (r = .77).

CONCLUSION

The ASRS-6 measures two correlated constructs, rather than one unitary construct.