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Schijven EP, Hulsmans DHG, VanDerNagel JEL, Lammers J, Otten R, Poelen EAP. The effectiveness of an indicated prevention programme for substance use in individuals with mild intellectual disabilities and borderline intellectual functioning: results of a quasi-experimental study. Addiction 2021; 116:373-381. [PMID: 32678489 PMCID: PMC7891383 DOI: 10.1111/add.15156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/20/2019] [Accepted: 06/05/2020] [Indexed: 01/30/2023]
Abstract
AIMS To assess the effectiveness of Take it personal!, a prevention programme for individuals with mild intellectual disabilities and borderline intellectual functioning (MID-BIF) and substance use (SU). The prevention programme aims to reduce SU (alcohol, cannabis and illicit drugs) among experimental to problematic substance users. DESIGN A quasi-experimental design with two arms and a 3-month follow-up. SETTING Adolescents were recruited from 14 treatment centres in the Netherlands specialized in offering intra- and extramural care for people with MID-BIF and behavioural problems. PARTICIPANTS Data were collected from 66 individuals with MID-BIF assigned either to the intervention condition (n = 34) or to the control condition (n = 32). INTERVENTIONS Take it personal! was designed to target four personality traits: sensation-seeking, impulsive behaviour, anxiety sensitivity and negative thinking. For each of these profiles, interventions were developed that were structurally the same but contained different personality-specific materials, games and exercises. The control group received care as usual. MEASUREMENTS Primary outcomes at 3-month follow-up were frequency of SU, severity of SU and binge drinking. RESULTS Results showed intervention effects for SU frequency (F(1, 50.43) = 9.27, P = 0.004) and binge drinking (F(1, 48.02) = 8.63, P = 0.005), but not for severity of SU (F(1, 42.09) = 2.20, P = 0.145). CONCLUSIONS A prevention programme to reduce substance use among experimental to problematic users with mild intellectual disabilities and borderline intellectual functioning helped participants to decrease substance use frequency and binge drinking.
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Affiliation(s)
- Esmée P. Schijven
- Research and DevelopmentPlurynNijmegenthe Netherlands
- Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
| | - Daan H. G. Hulsmans
- Research and DevelopmentPlurynNijmegenthe Netherlands
- Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
| | - Joanneke E. L. VanDerNagel
- TactusCentre for Addiction and Intellectual Disability (CAID)Deventerthe Netherlands
- Radboud University, Nijmegen Institute for Scientist‐Practitioners in AddictionNijmegenthe Netherlands
- AveleijnBornethe Netherlands
- Faculty of Electrical Engineering, Mathematics, and Computer Science, Human Media InteractionUniversity of TwenteEnschedethe Netherlands
| | - Jeroen Lammers
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtthe Netherlands
| | - Roy Otten
- Research and DevelopmentPlurynNijmegenthe Netherlands
- Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
- REACH Institute, Department of PsychologyArizona State UniversityTempeAZUSA
| | - Evelien A. P. Poelen
- Research and DevelopmentPlurynNijmegenthe Netherlands
- Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
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102
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Buttazzoni A, Tariq U, Thompson-Haile A, Burkhalter R, Cooke M, Minaker L. Adolescent Gender Identity, Sexual Orientation, and Cannabis Use: Potential Mediations by Internalizing Disorder Risk. HEALTH EDUCATION & BEHAVIOR 2021; 48:82-92. [PMID: 33103513 PMCID: PMC7791274 DOI: 10.1177/1090198120965509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Adolescents who identify as nonbinary gender or as not heterosexual report higher levels of mental illness than their counterparts. Cannabis use is a commonly employed strategy to cope with mental illness symptoms among adolescents; however, cannabis use can have many deleterious health consequences for youth. Within the frame of minority stress theory, this study investigates the relationships between gender identity and sexual orientation, internalizing disorder symptoms, and cannabis use among adolescents. METHOD A national cross-sectional survey of a generalizable sample of high school students in Canada from the 2017 wave (N = 15,191) of the Cancer Risk Assessment in Youth Survey was analyzed in spring 2019. Mediation analyses were completed to examine risk of internalizing disorder symptoms as a potential mediator of the association between (1) gender identity and (2) sexual orientation, and cannabis use. RESULTS Indirect effects in all models show significantly higher levels of reported internalizing disorder symptoms for female (OR = 3.44, 95% CI [2.84, 4.18]) and nonbinary gender (OR = 3.75, 95% CI [2.16, 6.51]) compared with male students. Sexual minority adolescents had higher odds of internalizing disorder risk relative to non-sexual minority adolescents (OR = 3.13, 95% CI [2.63, 3.74]). Students who reported higher rates of internalizing disorder symptoms were more likely to have ever used cannabis. Patterns of partial mediation are also present among all groups. DISCUSSION/CONCLUSIONS Findings can be used to better inform mental health interventions for adolescents. Future study should explore specific mental health stressors of vulnerable adolescent groups with respect to cannabis use as a coping mechanism.
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Affiliation(s)
| | - Ulaina Tariq
- University of Waterloo, Waterloo,
Ontario, Canada
| | | | | | - Martin Cooke
- University of Waterloo, Waterloo,
Ontario, Canada
| | - Leia Minaker
- University of Waterloo, Waterloo,
Ontario, Canada
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103
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Ford JA, McCabe SE, Schepis TS. Sources of prescription opioids and tranquilizers for misuse among U.S. young adults: differences between high school dropouts and graduates and associations with adverse outcomes. J Addict Dis 2021; 39:54-65. [PMID: 32921294 PMCID: PMC7927204 DOI: 10.1080/10550887.2020.1814122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background and Objectives: Prior research has identified that sources of prescription drugs for misuse vary based on educational attainment, which is important as certain sources are associated with adverse outcomes. The current research addressed limitations of the extant literature by creating distinct categories of push factors for high school dropout (e.g., negative school performance/experiences), pull factors for high school dropout (e.g., starting a family or getting a job), and high school graduates who did not attend college.Methods: Using data from the 2009-2014 National Survey on Drug Use and Health, prevalence of sources were estimated and design-based multivariable logistic regression investigated the association between sources and educational attainment. Additionally, multivariable logistic regression assessed the associations between sources and adverse outcomes (i.e., substance use, substance use disorders, and mental health) separately for each educational category.Results: College respondents were more likely to report "physician" and free from "friend/relative" and less likely to report "purchased" as sources. For most educational categories, "purchasing" prescription drugs was associated with adverse outcomes. Additionally, "theft/fake" prescription emerged as a source associated with adverse outcomes for college respondents, while "friend/relative" was associated with adverse outcomes for high school graduates that did not go on to college.Conclusions: This research has important clinical implications as it identified young adults with a college education as being less likely to obtain prescription drugs from sources known to be associated with adverse outcomes. It also highlighted how associations between sources and adverse outcomes vary based on educational attainment.
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Affiliation(s)
- Jason A. Ford
- Department of Sociology, University of Central Florida
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of Michigan
- Institute for Social Research, University of Michigan
- Center for Human Growth and Development, University of Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan
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104
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Green KE, Blue JR, Natal SN. An Integrated Model of Nature and Nurture Factors that Contribute to Addiction and Recovery. Subst Use Misuse 2021; 56:1095-1107. [PMID: 33870829 DOI: 10.1080/10826084.2021.1901929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the context of the opioid epidemic and growing awareness of addiction as a public health concern, there are efforts to inform the public, patients, families, and policy makers about the factors that contribute to addiction and facilitate recovery. Several theoretical models provide useful frameworks for this discussion, but each of them has limitations. OBJECTIVES This paper presents an accessible yet comprehensive theoretical model that integrates empirical evidence about addiction etiology and recovery using the nature-nurture paradigm. RESULTS The model presents substance use along a continuum, and identifies risk and protective factors in multiple domains that have been identified by research. The domains on the nature side of the model include genetic and biological factors, comorbid psychiatric and medical disorders, physiological reinforcement of substance use, and changes to neural mechanisms. The domains on the nurture side of the model include sociocultural factors, environmental factors, personality, emotions, cognitions, psychological reinforcement of substance use, and cognitive and behavioral changes. The progression from increased or decreased substance use to addiction or recovery is mediated by changes in neural mechanisms and cognitive and behavioral changes, which have feedback loops with the physiological and psychological reinforcement.Conclusions/Importance: This model is a useful heuristic, consistent with a public health framework, for discussing addiction and recovery with patients, their families, and the public. This integrated model of nature and nurture factors has the potential to inform clinical practice, consultation, research, prevention programs, educational programs, and public policy.
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Affiliation(s)
- Kelly E Green
- Department of Psychology and Behavioral Neurosciences, St. Edward's University, Austin, Texas, USA
| | - Jasmin R Blue
- Department of Psychology and Behavioral Neurosciences, St. Edward's University, Austin, Texas, USA
| | - Samantha N Natal
- Department of Psychology and Behavioral Neurosciences, St. Edward's University, Austin, Texas, USA
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105
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Kim SY, Park T, Kim K, Oh J, Park Y, Kim DJ. A Deep Learning Algorithm to Predict Hazardous Drinkers and the Severity of Alcohol-Related Problems Using K-NHANES. Front Psychiatry 2021; 12:684406. [PMID: 34305681 PMCID: PMC8299053 DOI: 10.3389/fpsyt.2021.684406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: The number of patients with alcohol-related problems is steadily increasing. A large-scale survey of alcohol-related problems has been conducted. However, studies that predict hazardous drinkers and identify which factors contribute to the prediction are limited. Thus, the purpose of this study was to predict hazardous drinkers and the severity of alcohol-related problems of patients using a deep learning algorithm based on a large-scale survey data. Materials and Methods: Datasets of National Health and Nutrition Examination Survey of South Korea (K-NHANES), a nationally representative survey for the entire South Korean population, were used to train deep learning and conventional machine learning algorithms. Datasets from 69,187 and 45,672 participants were used to predict hazardous drinkers and the severity of alcohol-related problems, respectively. Based on the degree of contribution of each variable to deep learning, it was possible to determine which variable contributed significantly to the prediction of hazardous drinkers. Results: Deep learning showed the higher performance than conventional machine learning algorithms. It predicted hazardous drinkers with an AUC (Area under the receiver operating characteristic curve) of 0.870 (Logistic regression: 0.858, Linear SVM: 0.849, Random forest classifier: 0.810, K-nearest neighbors: 0.740). Among 325 variables for predicting hazardous drinkers, energy intake was a factor showing the greatest contribution to the prediction, followed by carbohydrate intake. Participants were classified into Zone I, Zone II, Zone III, and Zone IV based on the degree of alcohol-related problems, showing AUCs of 0.881, 0.774, 0.853, and 0.879, respectively. Conclusion: Hazardous drinking groups could be effectively predicted and individuals could be classified according to the degree of alcohol-related problems using a deep learning algorithm. This algorithm could be used to screen people who need treatment for alcohol-related problems among the general population or hospital visitors.
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Affiliation(s)
- Suk-Young Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Taesung Park
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, United States
| | - Kwonyoung Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, South Korea
| | - Jihoon Oh
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoonjae Park
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea
| | - Dai-Jin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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106
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Hámor PU, Gobin CM, Schwendt M. The role of glutamate mGlu5 and adenosine A2a receptor interactions in regulating working memory performance and persistent cocaine seeking in rats. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109979. [PMID: 32470496 DOI: 10.1016/j.pnpbp.2020.109979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/17/2023]
Abstract
Cocaine use disorder (CUD) is associated with neurobehavioral deficits that are resistant to current treatments. While craving and high rates of relapse are prominent features of CUD, persistent cognitive impairments are common and linked to poorer treatment outcomes. Here we sought to develop an animal model to study post-cocaine changes in drug seeking and working memory, and to evaluate 'therapeutic' effects of combined glutamate mGlu5 and adenosine A2a receptor blockade. As mGlu5 antagonists reduce drug seeking, and A2a blockade ameliorates working memory impairment, we hypothesized that mGlu5 + A2a antagonist cocktail would reduce both cocaine relapse and post-cocaine working memory deficits. Adult male Sprague-Dawley rats were first trained and tested in an operant delayed match-to-sample (DMS) task to establish the working memory baseline, followed by 6 days of limited and 12 days of extended access cocaine self-administration. Chronic cocaine reduced working memory performance (abstinence day 30-40) and produced robust time-dependent cocaine seeking at 45-, but not 120-days of abstinence. Systemic administration of A2a antagonist KW-6002 (0.125 and 1 mg/kg) failed to rescue post-cocaine working memory deficit. It also failed to reverse working memory impairment produced by mGlu5 NAM MTEP (1 mg/kg). Finally, KW-6002 prevented the ability of MTEP to reduce cocaine seeking and increased locomotor behavior. Thus, despite mGlu5 and A2a being exclusively co-localized in the striatum and showing behavioral synergism towards reducing cocaine effects in some studies, our findings advocate against the use of mGlu5 + A2a antagonist cocktail as it may further compromise cognitive deficits and augment drug craving in CUD.
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Affiliation(s)
- Peter U Hámor
- Department of Psychology, University of Florida, FL, USA; Center for Addiction Education and Research, University of Florida, FL, USA
| | - Christina M Gobin
- Center for Addiction Education and Research, University of Florida, FL, USA; Department of Pharmacodynamics, University of Florida, FL, USA
| | - Marek Schwendt
- Department of Psychology, University of Florida, FL, USA; Center for Addiction Education and Research, University of Florida, FL, USA.
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107
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Li S, Saviano A, Erstad DJ, Hoshida Y, Fuchs BC, Baumert T, Tanabe KK. Risk Factors, Pathogenesis, and Strategies for Hepatocellular Carcinoma Prevention: Emphasis on Secondary Prevention and Its Translational Challenges. J Clin Med 2020; 9:E3817. [PMID: 33255794 PMCID: PMC7760293 DOI: 10.3390/jcm9123817] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated mortality globally. Given the limited therapeutic efficacy in advanced HCC, prevention of HCC carcinogenesis could serve as an effective strategy. Patients with chronic fibrosis due to viral or metabolic etiologies are at a high risk of developing HCC. Primary prevention seeks to eliminate cancer predisposing risk factors while tertiary prevention aims to prevent HCC recurrence. Secondary prevention targets patients with baseline chronic liver disease. Various epidemiological and experimental studies have identified candidates for secondary prevention-both etiology-specific and generic prevention strategies-including statins, aspirin, and anti-diabetic drugs. The introduction of multi-cell based omics analysis along with better characterization of the hepatic microenvironment will further facilitate the identification of targets for prevention. In this review, we will summarize HCC risk factors, pathogenesis, and discuss strategies of HCC prevention. We will focus on secondary prevention and also discuss current challenges in translating experimental work into clinical practice.
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Affiliation(s)
- Shen Li
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
| | - Antonio Saviano
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg, 67000 Strasbourg, France;
| | - Derek J. Erstad
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
| | - Yujin Hoshida
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Department of Internal Medicine, Dallas, TX 75390, USA;
| | - Bryan C. Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
| | - Thomas Baumert
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg, 67000 Strasbourg, France;
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
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108
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Cunningham M, Stapinski L, Griffiths S, Baillie A. Dysmorphic Appearance Concern and Hazardous Alcohol Use in University Students: The Mediating Role of Alcohol Expectancies. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lexine Stapinski
- National Drug and Alcohol Research Centre (NDRAC), The University of New South Wales,
| | | | - Andrew Baillie
- Department of Human Sciences (Psychology), Macquarie University,
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109
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Moreno-Flórez D. The Preponderance of Psychic Elements in Drug Addiction. Psychoanal Rev 2020; 107:473-488. [PMID: 33079635 DOI: 10.1521/prev.2020.107.5.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The clinical perspective used to understand a patient with an addiction affects the course of treatment and the possibilities for recovery. Positivist and pharmacological models have become popular in the treatment of addictions. These models claim that addiction is primarily a pharmacological occurrence and privilege the biochemical effects of specific substances over the intrapsychic conflict of the patient in order to justify the phenomenology of addiction. Although psychoanalytic approaches have been previously used to treat addictive patients, they have frequently been considered unsuitable and inadequate for such cases. The author's purpose is to use the scope that psychoanalytic comprehension provides to examine the subject who is addicted in relation to his or her maturational development; considering the roles played by pleasure, ego defects, and defensive behavior, derived from case vignettes, in order to illustrate the role of intrapsychic life in the maintaining of an addiction.
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110
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Jennings AN, Soder HE, Wardle MC, Schmitz JM, Vujanovic AA. Objective analysis of language use in cognitive-behavioral therapy: associations with symptom change in adults with co-occurring substance use disorders and posttraumatic stress. Cogn Behav Ther 2020; 50:89-103. [PMID: 33021143 DOI: 10.1080/16506073.2020.1819865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Substance use disorders (SUD) commonly co-occur with posttraumatic stress disorder (PTSD) symptoms, and the comorbidity is prevalent and difficult-to-treat. Few studies have objectively analyzed language use in psychotherapy as a predictor of treatment outcomes. We conducted a secondary analysis of patient language use during cognitive-behavioral therapy (CBT) in a randomized clinical trial, comparing a novel, integrated CBT for PTSD/SUD with standard CBT for SUD. Participants included 37 treatment-seeking, predominantly African-American adults with SUD and at least four symptoms of PTSD. We analyzed transcripts of a single, matched session across both treatment conditions, using the Linguistic Inquiry and Word Count (LIWC) program. The program measures language use across multiple categories. Compared to standard CBT for SUD, patients in the novel, integrated CBT for PTSD/SUD used more negative emotion words, partially consistent with our hypothesis, but less positive emotion words. Further, exploratory analyses indicated an association between usage of cognitive processing words and clinician-observed reduction in PTSD symptoms, regardless of treatment condition. Our results suggest that language use during therapy may provide a window into mechanisms active in therapy.
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Affiliation(s)
- Anthony N Jennings
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center , Houston, TX, USA
| | - Heather E Soder
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center , Houston, TX, USA
| | - Margaret C Wardle
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center , Houston, TX, USA.,Department of Psychology, University of Illinois at Chicago , Chicago, IL, USA
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center , Houston, TX, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston , Houston, TX, USA
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111
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Stevenson BL, Blevins CE, Marsh E, Feltus S, Stein M, Abrantes AM. An ecological momentary assessment of mood, coping and alcohol use among emerging adults in psychiatric treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:651-658. [PMID: 32851900 DOI: 10.1080/00952990.2020.1783672] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Emerging adulthood is a critical period for the onset of both mental health disorders and problematic alcohol use. Coping strategies can play an important role in mitigating the onset and progression of these conditions in emerging adulthood. The current study examined daily mood, coping strategy use, and alcohol use during an individualized, ecological momentary intervention (EMI).Objectives: To examine the within-person relationship between mood, coping strategy use, and alcohol use.Methods: Emerging adults (N = 20, 55% female) in a partial hospital program for anxiety or mood disorders who endorsed drinking to cope completed a 6-week EMI to increase non-substance coping skills. The study also measured mood, coping strategy use, and alcohol use over the course of the intervention.Results: Mood and coping variables did not predict the likelihood of drinking on a given day. On drinking days, the number of pre-consumption coping strategies were related to reduced alcohol use (p =.02) and there was a significant interaction between negative mood and coping in predicting alcohol use (p <.01). When pre-consumption negative mood was high, coping strategies predicted decreased alcohol use (p =.02), but when negative mood was low, this relationship was nonsignificant.Conclusions: Using coping skills was associated with reduced alcohol use on days when negative mood was high. Increasing non-substance coping skills may help emerging adults reduce their alcohol use in response to negative mood.
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Affiliation(s)
- Brittany L Stevenson
- Department of Psychiatry and Human Behavior, Brown University , Providence, RI, USA
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Brown University , Providence, RI, USA.,Butler Hospital , Providence, RI, USA
| | | | | | - Michael Stein
- Health Law, Policy, and Management, School of Public Health, Boston University , Boston, MA, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Brown University , Providence, RI, USA.,Butler Hospital , Providence, RI, USA
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112
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Dellazizzo L, Potvin S, Luigi M, Dumais A. Evidence on Virtual Reality-Based Therapies for Psychiatric Disorders: Meta-Review of Meta-Analyses. J Med Internet Res 2020; 22:e20889. [PMID: 32812889 PMCID: PMC7468638 DOI: 10.2196/20889] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)–based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders. Objective This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies. Methods A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence. Results The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia. Conclusions VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Stéphane Potvin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Mimosa Luigi
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada.,Institut national de psychiatrie légale Philippe-Pinel, Montreal, QC, Canada
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113
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Emad OJ, Osman IM, Aljeesh YI. Effectiveness of cognitive behavioural therapy in reinforcing positive adaption among patients with substance use disorders in the Gaza Strip. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1800843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Osama Jabr Emad
- Clinical Psychology, General Mental Health Directorate, MOH, Palestine, Gaza
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114
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Roos CR, Kober H, Trull TJ, MacLean RR, Mun CJ. Intensive longitudinal methods for studying the role of self-regulation strategies in substance use behavior change. CURRENT ADDICTION REPORTS 2020; 7:301-316. [PMID: 33510995 DOI: 10.1007/s40429-020-00329-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose of review Many psychosocial interventions for substance use disorders (SUDs) focus on teaching self-regulation strategies. Research using intensive longitudinal methods (ILM), such as ecological momentary assessment and daily diaries, is critical for elucidating if and how these strategies function as mechanisms of change among individuals with SUDs. We review this emerging area of research. Recent findings We found a small number of studies using ILM to study self-regulation strategies in SUD (n=18 studies), with most conducted among college student drinkers (n=9) and cigarette smokers (n=7), and few among treatment-engaged individuals, and those with other drug use disorders. There is preliminary evidence that the use of specific self-regulation strategies commonly taught in psychosocial interventions for SUDs (i.e., cognitive reappraisal, problem solving, stimulus control, harm reduction) is associated with decreased momentary or daily substance use, at the within-person level. Summary There is a need for further ILM research on self-regulation strategies as mechanisms of substance use behavior change. Such research can inform the development, refinement, and personalization of interventions that teach self-regulation strategies, including mobile interventions that facilitate strategy use in the moment. One key next step is developing psychometrically validated ILM assessments of self-regulation strategy use.
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Affiliation(s)
- Corey R Roos
- Yale University School of Medicine, New Haven CT 06510
| | - Hedy Kober
- Yale University School of Medicine, New Haven CT 06510
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, 65211
| | - R Ross MacLean
- Yale University School of Medicine, New Haven CT 06510.,VA Connecticut Healthcare System, West Haven, CT 06515
| | - Chung Jung Mun
- Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Bahji A, Carlone D, Altomare J. Acceptability and efficacy of naltrexone for criminal justice-involved individuals with opioid use disorder: a systematic review and meta-analysis. Addiction 2020; 115:1413-1425. [PMID: 31863669 DOI: 10.1111/add.14946] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Criminal justice-involved individuals carry a disproportionately higher burden of opioid use disorder (OUD) than those not involved with the criminal justice system, and are often unable to access opioid agonist therapies such as methadone and buprenorphine. The opioid receptor antagonist naltrexone (NTX) is effective for the prevention of relapse to OUD and may be more acceptable in criminal justice settings. The objectives of this review were to: (1) provide an overall summary effect across studies for the efficacy and acceptability of oral and injectable NTX for the treatment of OUD among criminal justice-involved individuals and (2) examine systematic variations in study results to explain heterogeneity among study-specific effects. METHODS Systematic review and meta-analysis of 1045 patients across 11 studies (10 randomized controlled trials, one quasi-experimental study). All available outcomes were pooled using random-effects meta-analysis. Subgroup analyses were conducted for oral and injectable naltrexone; meta-regression analyses were conducted for socio-demographic and study-level characteristics. RESULTS NTX improved retention in treatment [risk ratio (RR) = 1.31; 95% confidence interval (CI) = 1.05, 1.63], reduced rates of re-incarceration (RR = 0.70, 95% CI = 0.54-0.92), reduced opioid relapse (RR = 0.63, 95% CI = 0.53-0.76) and improved opioid abstinence (RR = 1.38, 95% CI = 1.16-1.65). While NTX was associated with a greater burden of adverse events overall (RR = 1.49, 95% CI = 1.13-1.95), the findings were inconclusive as to whether or not a difference was present for the number of serious adverse events or overdoses. CONCLUSIONS Naltrexone appears to be efficacious and acceptable for the treatment of opioid use disorder among criminal justice-involved individuals; however, the risk for adverse events must be weighed against the potential benefits.
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Affiliation(s)
- Anees Bahji
- Department of Public Health Sciences, Queen's University, Kingston, Canada.,Department of Psychiatry, Queen's University, Kingston, Canada
| | - David Carlone
- Department of Psychiatry, Queen's University, Kingston, Canada
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Vogel EA, Ly K, Ramo DE, Satterfield J. Strategies to improve treatment utilization for substance use disorders: A systematic review of intervention studies. Drug Alcohol Depend 2020; 212:108065. [PMID: 32442754 DOI: 10.1016/j.drugalcdep.2020.108065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many people who need specialty treatment for substance use disorders (SUDs) do not receive it. Clinical interventions could increase treatment utilization but are not routinely used. This systematic review aimed to describe clinical interventions that may increase SUD specialty treatment utilization (i.e., treatment initiation, attendance, meaningful engagement) and to determine which intervention(s) most consistently increase treatment utilization. METHODS We conducted a systematic review of clinical intervention studies (published in English between 2000 and 2017) reporting outcomes relevant to specialty SUD treatment utilization. Outcomes were treatment initiation, attendance, and meaningful engagement. Risk of bias was assessed using Cochrane guidelines and randomized controlled trials (RCTs) with bias scores < 3 were included in a synthesis of results. Proportions of positive to negative utilization outcomes were calculated for each low-bias RCT; studies with 50% positive outcomes or more were considered "majority-positive". Studies were categorized by theory-based approach. RESULTS Twenty-three RCTs had low risk of bias and were synthesized. Among intervention types with two or more studies, cognitive-behavioral (100% majority-positive) and coordinated care (67% majority-positive) interventions were most likely to increase treatment initiation, while 12-step promotion interventions were most likely to increase treatment attendance (50% majority-positive). One study (12-step promotion) measured meaningful engagement, with majority-positive outcomes. CONCLUSIONS A systematic review and narrative synthesis of clinical interventions promoting specialty SUD treatment utilization provided preliminary evidence that cognitive-behavioral and coordinated care interventions may increase treatment initiation, while 12-step promotion interventions may promote treatment attendance. More quality studies and greater consistency in treatment utilization measurement are needed.
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Affiliation(s)
- Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, X3C16, Stanford, CA 94305, United States.
| | - Khanh Ly
- Department of Medicine, University of California, San Francisco, 1701 Divisadero, Suite 500, San Francisco, CA 94115, United States
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, 350 Parnassus Avenue, Suite 810, San Francisco, CA 94143, United States; Hopelab, 100 California Street, Suite 1150, San Francisco, CA 94111, United States
| | - Jason Satterfield
- Department of Medicine, University of California, San Francisco, 1701 Divisadero, Suite 500, San Francisco, CA 94115, United States
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Abstract
Opioid use disorder (OUD) is a chronic, relapsing disease. Genetic variability, dysregulated stress system response, and history of opioid experimentation or escalating exposure all contribute to the likelihood of developing OUD, which produces complex brain changes that make it difficult to stop opioid use. Understanding the neurobiology of OUD helps nurses anticipate the behaviors of patients with OUD and approach them with empathy. Here, the authors discuss the pathophysiology of OUD, available screening tools, medical treatments, and behavioral interventions that have demonstrated efficacy in reducing substance use.
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Affiliation(s)
- Kate Garland Brown
- Kate Garland Brown is a clinical research NP at Rockefeller University in New York City, where Bernadette Capili is director of the Heilbrunn Family Center for Research Nursing. The authors acknowledge Mary Jeanne Kreek, MD, Eduardo Butelman, PhD, and Brian Reed, PhD, for their assistance in providing scientific information during manuscript preparation. Contact author: Kate Brown, . This article incorporates research supported in part by grant no. UL1TR001866 from the National Center for Advancing Translational Sciences' Clinical and Translational Science Awards Program. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Reynolds L, Rogers O, Benford A, Ingwaldson A, Vu B, Holstege T, Alvarado K. Virtual Nature as an Intervention for Reducing Stress and Improving Mood in People with Substance Use Disorder. JOURNAL OF ADDICTION 2020; 2020:1892390. [PMID: 32518704 PMCID: PMC7256771 DOI: 10.1155/2020/1892390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/17/2022]
Abstract
Substance use disorder (SUD) afflicts a large percentage of the United States population, with negative implications that cost more than $420 billion annually. This population often experiences negative emotions throughout the recovery process, including anxiety, depression, stress, and negative affect. Currently, evidence-based treatment strategies for SUD include cognitive behavioral therapy, motivational interviewing, 12-step programs, and mindfulness-based treatment. One intervention that has not been studied at length among individuals with SUD is use of the natural environment as treatment. Among other patient populations, nature has been shown to reduce stress and anxiety by regulating autonomic nervous system function, reducing symptoms of depression, and improving mood. The purpose of this study was to investigate whether viewing nature videos could similarly reduce stress and improve mood in individuals with SUD. A crossover design was used to compare viewing a nature scene and practicing mindfulness-based activities for women with SUD at a residential treatment facility. Over four weeks, participants engaged in the two activities for the first 10 minutes of their daily program. Immediately before and after each 10 minute session, measures were taken for heart rate, in beats per minute (BPM); affect, using the Positive and Negative Affect Scale (PANAS); and overall mood, using a 10-point rating scale from "very unpleasant" to "pleasant." Thirty-six women completed the study. For viewing a nature scene and practicing the mindfulness-based activities, there were statistically significant reductions in mean negative affect scores (p=0.001) and heart rate (p ≤ 0.001). In addition, for participants in both conditions, overall mood improved significantly (p=0.030). The results from this study provide initial evidence that viewing nature has similar benefits to MBT in the treatment of stress and negative mood associated with the SUD recovery process and may be an additional, cost-effective treatment strategy for individuals with SUD.
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Affiliation(s)
- Lori Reynolds
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th Street, Phoenix, AZ 85004, USA
| | - Oaklee Rogers
- Faculty Lead for the Community Health Mentor Program (CHMP), 435 N 5th Street, Phoenix, AZ 85004, USA
| | - Andrew Benford
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th Street, Phoenix, AZ 85004, USA
| | - Ammie Ingwaldson
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th Street, Phoenix, AZ 85004, USA
| | - Bethany Vu
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th Street, Phoenix, AZ 85004, USA
| | - Tiffany Holstege
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th Street, Phoenix, AZ 85004, USA
| | - Korinna Alvarado
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th Street, Phoenix, AZ 85004, USA
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Kooteh BR, Dolatshahi B, Nosratabadi M, Bakhshani NM, Mahdavi A, Hakami MC. Combination Therapy and Opioids: Effectiveness of Transcranial Direct-Current Stimulation (tDCS) and Emotion Regulation Training in Reducing Current Drug Craving. MAEDICA 2020; 15:53-60. [PMID: 32419861 PMCID: PMC7221269 DOI: 10.26574/maedica.2020.15.1.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background and objectives: Craving is the main symptom of addiction that is accompanied by dependence and relapse. The present study was aimed to compare the effectiveness of combined Transcranial Direct-Current Stimulation (tDCS) and emotion regulation training with that of separate tDCS and emotion regulation training in reducing current drug craving and thoughts and fantasies about drug use. Materials and methodology: This was a quasi-experimental study with a pretest-posttest design and three intervention groups. The statistical population included all patients dependent on opioids in medium-term residential drug rehabilitation centers in Zahedan, Iran, in 2018-2019. From eight randomly selected centers, a total of 54 patients were selected based on inclusion and exclusion criteria, and randomly divided into three intervention groups. Data were gathered using the Personal Drug Use Questionnaire, Desires for Drug Questionnaire (DDQ), and Drug Use Thoughts, Fantasies, and Temptations Questionnaire. All analyses were performed using SPSS-16. Results: The Kruskal-Wallis test indicated significant differences between the three intervention groups in current drug craving and thoughts and fantasies about drug use (P ..001). In addition, examination of the mean rank showed that t significant decrease was higher for the combined tDCS and emotion regulation training group. Conclusion: Addiction is very similar to other chronic disorders. Therefore, combined (integrated) therapies can have a very important role in treating addiction, especially in relapse prevention.
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Affiliation(s)
- Behzad Rigi Kooteh
- Department of Clinical Psychology, Faculty of Behavioral Science, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Behrooz Dolatshahi
- Substance Abuse and Dependence Research Center, Department of Clinical Psychology, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Masoud Nosratabadi
- University of Social Welfare and Rehabilitation Science, Paarand Specialized Center for Human Enhancement, Tehran, Iran
| | - Nour Mohammad Bakhshani
- Children and Adolescents' Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Abed Mahdavi
- Department of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Mousa Chakeri Hakami
- Department of Clinical Psychology, Faculty of Behavioral Science, University of Social Welfare and Rehabilitation Science, Tehran, Iran
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Ward HB, Mosquera MJ, Suzuki J, Mariano TY. A Systematic Review of Noninvasive Brain Stimulation for Opioid Use Disorder. Neuromodulation 2020; 23:301-311. [DOI: 10.1111/ner.13108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Heather B. Ward
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Matthew J. Mosquera
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Joji Suzuki
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Timothy Y. Mariano
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
- Butler Hospital Providence RI USA
- Center for Neurorestoration and Neurotechnology Providence Veterans Affairs Medical Center Providence RI USA
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121
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Tiu MMH, Fung CKM, Fung WY, Lai YY, Tse CM, Wong TH, Wong TK, Wong WY, Wu MS, Yeung KM, Yeung LT, Yu YY. Experience of Drug Abusers Participating in Community-Based Drug Rehabilitation Services Provided by the Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in Hong Kong. Health (London) 2020. [DOI: 10.4236/health.2020.128075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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LeCocq MR, Randall PA, Besheer J, Chaudhri N. Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development. Neurotherapeutics 2020; 17:43-54. [PMID: 31898285 PMCID: PMC7007469 DOI: 10.1007/s13311-019-00824-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Environmental contexts that are reliably associated with the use of pharmacologically active substances are hypothesized to contribute to substance use disorders. In this review, we provide an updated summary of parallel preclinical and human studies that support this hypothesis. Research conducted in rats shows that environmental contexts that are reliably paired with drug use can renew extinguished drug-seeking behavior and amplify responding elicited by discrete, drug-predictive cues. Akin to drug-associated contexts, interoceptive drug stimuli produced by the psychopharmacological effects of drugs can also influence learning and memory processes that play a role in substance use disorders. Findings from human laboratory studies show that drug-associated contexts, including social stimuli, can have profound effects on cue reactivity, drug use, and drug-related cognitive expectancies. This translationally relevant research supports the idea that treatments for substance use disorders could be improved by considering drug-associated contexts as a factor in treatment interventions. We conclude this review with ideas for how to integrate drug-associated contexts into treatment-oriented research based on 4 approaches: pharmacology, brain stimulation, mindfulness-based relapse prevention, and cognitive behavioral group therapy. Throughout, we focus on alcohol- and tobacco-related research, which are two of the most prevalent and commonly misused drugs worldwide for which there are known treatments.
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Affiliation(s)
- Mandy Rita LeCocq
- Department of Psychology, Center for Studies in Behavioural Neurobiology, Concordia University, 7141 Sherbrooke Street West, Room SP 244, Montreal, Quebec, H4B-1R6, Canada
| | - Patrick A Randall
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Joyce Besheer
- Department of Psychiatry, Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nadia Chaudhri
- Department of Psychology, Center for Studies in Behavioural Neurobiology, Concordia University, 7141 Sherbrooke Street West, Room SP 244, Montreal, Quebec, H4B-1R6, Canada.
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123
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Kowalchuk A, Gonzalez SJ, Mejia MC, Zoorob RJ. Substance Use Disorders. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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124
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Lespasio M, Mont M, Guarino A. Identifying Risk Factors Associated With Postoperative Infection Following Elective Lower-Extremity Total Joint Arthroplasty. Perm J 2020; 24:1-3. [PMID: 33482967 DOI: 10.7812/tpp/20.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article addresses the importance of identifying risk factors associated with postoperative infection following elective lower-extremity total joint arthroplasty. Specifically, this review discusses risk factors recognized by the American Academy of Orthopaedic Surgeons that should be carefully considered and assessed by the orthopaedic team in collaboration with the primary care provider before proceeding with surgery.
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Affiliation(s)
- Michelle Lespasio
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA
| | - Michael Mont
- Northwell Health Physician Partners Orthopaedic Institute at Lenox Hill, Lenox Hill Hospital, New York, NY
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125
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Perales JC, King DL, Navas JF, Schimmenti A, Sescousse G, Starcevic V, van Holst RJ, Billieux J. Learning to lose control: A process-based account of behavioral addiction. Neurosci Biobehav Rev 2019; 108:771-780. [PMID: 31846653 DOI: 10.1016/j.neubiorev.2019.12.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/24/2022]
Abstract
Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.
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Affiliation(s)
- José C Perales
- Department of Experimental Psychology, Mind Brain and Behavior Research Center (CIMCYC), University of Granada, Spain
| | - Daniel L King
- College of Education, Psychology, & Social Work, Flinders University, Australia
| | - Juan F Navas
- Department of Basic Psychology, Autonomous University of Madrid, Spain; Universitat Oberta de Catalunya, Spain.
| | | | - Guillaume Sescousse
- Lyon Neuroscience Research Center - INSERM U1028 - CNRS UMR5292, PSYR2 Team, University of Lyon, France
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia
| | - Ruth J van Holst
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Netherlands
| | - Joël Billieux
- Addictive and Compulsive Behaviours Lab. Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Centre for Excessive Gambling, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
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Parnarouskis L, Schulte EM, Lumeng JC, Gearhardt AN. Development of the Highly Processed Food Withdrawal Scale for Children. Appetite 2019; 147:104553. [PMID: 31836494 DOI: 10.1016/j.appet.2019.104553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Highly processed foods (with added fats and/or refined carbohydrates) may trigger an addictive-like process, including withdrawal when these foods are reduced. Withdrawal is marked by affective, cognitive, and physical symptoms that may hinder dietary change. A recently developed scale of highly processed food withdrawal in adults (ProWS) provides evidence for this construct. Children commonly consume highly processed foods, but no measures currently exist to examine highly processed food withdrawal in children. The purpose of this study was to develop a measure (ProWS-C) to assess for signs of highly processed food withdrawal in children. METHODS Parents who had recently attempted to reduce their child's highly processed food consumption were recruited through an online crowdsourcing platform. 304 parents (56.9% mothers) reported on their 3-11-year-old children (63.8% male). The ProWS-C was designed to reflect parents' observations of child behavior. Internal consistency and validity were evaluated using the Dimensional Yale Food Addiction Scale Version 2.0 for Children (dYFAS-C 2.0.), Children's Food Neophobia Scale-Modified (CFNS), and body mass index (BMI) silhouettes. RESULTS Exploratory factor analysis revealed a one-factor structure with 21 items (α = 0.94). The ProWS-C demonstrated convergent validity with more child food addiction symptoms (r = 0.55, p < 0.001) and higher child BMI (r = 0.24, p < 0.001) and discriminant validity with child food neophobia (r = -0.10, p = 0.08). The ProWS-C was associated with less success in reducing child highly processed food intake independent of child addictive-like eating and BMI (p = 0.001). DISCUSSION The ProWS-C provides preliminary evidence for highly processed food withdrawal in children and appears to be a psychometrically sound tool for assessing parent-reported withdrawal symptoms in children. Illuminating specific challenges families face when reducing highly processed foods may improve parents' ability to help their children make sustainable dietary changes.
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Affiliation(s)
| | - Erica M Schulte
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Martín-Pérez C, Navas JF, Perales JC, López-Martín Á, Cordovilla-Guardia S, Portillo M, Maldonado A, Vilar-López R. Brief group-delivered motivational interviewing is equally effective as brief group-delivered cognitive-behavioral therapy at reducing alcohol use in risky college drinkers. PLoS One 2019; 14:e0226271. [PMID: 31821350 PMCID: PMC6903743 DOI: 10.1371/journal.pone.0226271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022] Open
Abstract
College students are particularly vulnerable to risky alcohol use, which increases their likelihood of developing an alcohol use disorder in the future. As such, preventing and reducing alcohol use among college students should be a priority for health and social policies. This work was aimed to show that brief group-delivered MI is as effective as brief-group CBT at reducing alcohol use in college students. Eighty-nine college students (69 females; mean age = 21.01, SD = 2.85) with risky alcohol use, as measured by the AUDIT-C, were assigned to two groups, receiving three sessions of either brief group-delivered MI or CBT (bMI/bCBT). Alcohol use was assessed 3 and 6 months after the interventions, and analyzed according to an Intention-to-treat design. Changes in alcohol use at both points (relative to baseline) as well as post-intervention scores of intention to continue treatment and satisfaction with the psychologist were compared across groups, using one-sided Bayesian t-tests. Alcohol use decreased in both groups at the 3- and 6-months measurement points (relative to baseline). However, using bCBT superiority as an alternative hypothesis and the absence of such superiority as a point-null hypothesis, the Bayes factors supported the null at both the 3- and the 6-months follow-up (BF01 = 7.13, and BF01 = 5.22 respectively). Furthermore, the intention to continue treatment was substantially higher in the bMI group (BF10 = 9.77). These results are considerably robust to changes in analyses’ priors. This study suggests that bCBT is not more effective than bMI at reducing alcohol use in our college student group (in which females are overrepresented). Additionally, bMI showed higher intention to continue treatment scores. The comparable results of brief and group-delivered CBT and MI interventions in alcohol use reduction allows clinicians to select treatments based on their own skills or preferences without any detriment to efficacy.
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Affiliation(s)
| | - Juan F. Navas
- Department of Experimental Psychology, Autonomous University of Madrid, Madrid, Spain
| | - José C. Perales
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | | | - Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | | | - Antonio Maldonado
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Raquel Vilar-López
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
- * E-mail:
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Change & Grow ® Therapeutic Model for Addiction: Preliminary Results of an Interventional Study. Behav Sci (Basel) 2019; 9:bs9120137. [PMID: 31817105 PMCID: PMC6960925 DOI: 10.3390/bs9120137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
The last years have seen a paradigm shift concerning addictive disorders, indicating the necessity to study alternative therapeutic models. In this longitudinal study, the objective was to explore the impact of the Change & Grow® therapeutic model developed and used by VillaRamadas on certain psychological variables that frequently appear associated with addiction. A repeated measures (first and last weeks of treatment) design was used, and the psychological measurements were Beck’s Depression Inventory II (BDI-II), Suicide Ideation Questionnaire (SIQ), State-Trait Anxiety Inventory (STAI), and Montreal Cognitive Assessment (MoCA). Results include 26 (16 male and 10 female) patients. Age varied between 17 and 64 years (M = 35.62, SD = 12.60) and duration of treatment between 91 and 193 days (M = 147.35, SD = 27.05). The MoCA total result was significantly higher in the last week of treatment. The results of BDI-II, SIQ, and STAI (both state and trait) were all significantly lower. Neither duration of treatment nor self-reported motivation presented significant correlation values with the difference between measures for any of the variables. The Change & Grow® therapeutic model appears to have an impact on relevant psychological variables in patients admitted into treatment for addictive disorders.
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129
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Kane JC, Murray SM, Vinikoor MJ, Greene MC, Fine SL, Paul R, Murray LK. Concordance of Self- and Partner-Reported Alcohol Consumption Among Couples Experiencing Intimate Partner Violence in Zambia. Alcohol Clin Exp Res 2019; 43:2568-2577. [PMID: 31557344 PMCID: PMC6904506 DOI: 10.1111/acer.14205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hazardous alcohol use is a predictor of intimate partner violence (IPV), and both are increasingly prevalent in sub-Saharan Africa. The accurate measurement of alcohol consumption is therefore critical in IPV intervention studies that target hazardous drinking. Collecting a collateral report in addition to self-report is one convergent validity approach to improve alcohol measurement. We investigated concordance between self- and partner-reported alcohol use among women who reported recent IPV and their male partners in Zambia. METHODS Data were from the baseline of a randomized IPV intervention trial of 247 heterosexual couples in which a woman has reported recent IPV and her male partner has recent hazardous alcohol use. Both partners completed the Alcohol Use Disorders Identification Test (AUDIT) in reference to their own drinking and in reference to their partner's drinking. We calculated percent agreement across a range of outcomes: any use, quantity, frequency, and hazardous use. We also compared self- and partner-reported AUDIT scores using t-tests. RESULTS Concordance was poor across most outcomes. Percent agreement with respect to the women's drinking ranged from 60% to 65% across outcomes and with respect to the men's drinking from 51% to 89%. Women's average partner-reported AUDIT score (20.7) was statistically significantly (p < 0.0001) higher than men's average self-reported score (15.8). CONCLUSIONS In contrast to collateral report studies conducted in the United States, concordance between self- and partner-reported alcohol consumption was poor among families experiencing IPV in Zambia. Given the possible biases associated with self-reported alcohol use, findings suggest that a convergent validity approach is useful in this research context.
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Affiliation(s)
- Jeremy C. Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Michael J. Vinikoor
- University of Alabama at Birmingham School of Medicine, 1720 2nd Ave., S., Birmingham, AL 35294
| | - M. Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Shoshanna L. Fine
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Ravi Paul
- Department of Psychiatry, University of Zambia School of Medicine, Nationalist Road, University Teaching Hospital, PO. Box 50110, Lusaka, Zambia
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
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130
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Knox J, Hasin DS, Larson FRR, Kranzler HR. Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 2019; 6:1054-1067. [PMID: 31630982 PMCID: PMC6883141 DOI: 10.1016/s2215-0366(19)30213-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Abstract
Alcohol use during adolescence is an important and modifiable health risk behavior given the significant acute consequences and long-term impacts on the developing brain. Alcohol is the most common substance used by young adults 12 to 17 years old, with binge drinking, polysubstance use, and co-occurring mental health disorders posing particular concerns in this age group. Physicians can play a crucial role in screening and responding to alcohol use, with targeted brief interventions designed to delay or decrease use.
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Affiliation(s)
- Sarah M Bagley
- Boston Medical Center, 801 Massachusetts Avenue, 2nd floor, Boston, MA 02118, USA.
| | - Sharon Levy
- Division of Developmental Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Langdon KJ, Dove K, Ramsey S. Comorbidity of opioid-related and anxiety-related symptoms and disorders. Curr Opin Psychol 2019; 30:17-23. [PMID: 30711906 PMCID: PMC6609499 DOI: 10.1016/j.copsyc.2018.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 12/28/2022]
Abstract
Opioid use disorder and anxiety disorders co-occur at strikingly high rates, and this comorbidity is marked by a more severe clinical presentation and poorer prognosis for treatment. Given the substantial morbidity and mortality associated with these two disorders, it is imperative to understand factors related to the high rates of co-occurrence in order to inform the development of specialized treatments for this population. Several lines of study suggest that simultaneously addressing opioid-related and anxiety-related symptoms and processes, particularly intolerance of distress and pain-related anxiety, may yield improved outcomes for this high risk, vulnerable population. Future work is needed to identify other novel mechanisms as well as develop specialized treatments to augment standard medication-assisted treatment.
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Affiliation(s)
- Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | | | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States; Division of General Internal Medicine, Rhode Island Hospital, United States; Department of Medicine, Alpert Medical School of Brown University, United States
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Huhn AS, Brooner RK, Sweeney MM, Yip SW, Ayaz H, Dunn KE. Increased neural activity in the right dorsolateral prefrontal cortex during a risky decision-making task is associated with cocaine use in methadone-maintained patients. Drug Alcohol Depend 2019; 205:107650. [PMID: 31669801 PMCID: PMC6905637 DOI: 10.1016/j.drugalcdep.2019.107650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/28/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Methadone maintenance is an effective treatment for opioid use disorder (OUD), yet many methadone-maintained patients (MMPs) struggle with cocaine use during OUD recovery. The current study aimed to identify whether prefrontal cortex (PFC) activity during a risky decision-making task was associated with cocaine use during a 90-day follow-up in MMPs. METHODS MMPs (N = 28) attended a single neuroimaging session wherein PFC activity was measured using functional near-infrared spectroscopy (fNIRS) during the Balloon Analogue Risk Task (BART). Trait impulsivity was assessed via the Barratt Impulsiveness Scale version 11 (BIS-11). Following the neuroimaging session, MMPs were tracked via electronic health records for 90 days to determine treatment outcomes including cocaine use verified by urine drug screens. RESULTS During the BART, MMPs who used cocaine displayed increased neural activity in the right PFC during active decision-making (F1, 22 = 14.75, p = 0.001) and the right dorsolateral PFC during active minus passive decision-making (F1, 22 = 5.56, p = 0.028) compared to participants who did not use cocaine. Receiver operating characteristic curves confirmed that neural activity in the right PFC during active decision-making (AUC = 0.841, 95% CI, 0.697-0.985, p = 002), and in the right dorsolateral PFC during active minus passive decision-making (AUC = 0.805, 95% CI, 0.643-0.968, p = 0.006) was associated with continued cocaine use. MMPs who used cocaine versus those who did not reported increased trait impulsivity on the BIS-11 Total Score (t=-2.28, p = 0.031). CONCLUSIONS The fNIRS device is portable, relatively easy to use, and potentially feasible for use in methadone outpatient programs to assess propensity for negative treatment outcomes such as continued cocaine use.
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Affiliation(s)
- Andrew S Huhn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, 21224, USA.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, 21224, USA
| | - Mary M Sweeney
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, 21224, USA
| | - Sarah W Yip
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, 19104, USA; University of Pennsylvania, Department of Family and Community Health, Philadelphia, PA, 19104, USA; Children's Hospital of Philadelphia, Division of General Pediatrics, Philadelphia, PA, 19104, USA
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, 21224, USA
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DeMarce JM, Gnys M, Raffa SD, Kumpula M, Karlin BE. Dissemination of cognitive behavioral therapy for substance use disorders in the Department of Veterans Affairs Health Care System: Description and evaluation of Veteran outcomes. Subst Abus 2019; 42:168-174. [PMID: 31644386 DOI: 10.1080/08897077.2019.1674238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND As part of the nation's largest dissemination and implementation of evidence-based psychotherapies (EBPs) and the promotion of EBPs for substance use disorders (SUDs), the Veterans Health Administration (VHA) is working to nationally implement Cognitive Behavioral Therapy for SUD (CBT-SUD). The current manuscript describes the approach to system-wide training and reports Veteran outcomes associated with CBT-SUD implementation. Methods: Four-hundred fifty-eight Veterans with a range of treatment goals received treatment through the Department of Veterans Affairs (VA) CBT-SUD Training Program. Veteran outcomes related to substance use, substance use-related problems, and quality of life were assessed with the Brief Addiction Monitor, the Short Inventory of Problems, and the World Health Organization Quality of Life-BREF. Results: Statistically significant reductions in alcohol use, heavy alcohol use, other drug use, and substance use-related problems, as well as significant improvements in quality of life, were observed over the course of treatment. Conclusions: Program evaluation findings suggest that large-scale training in and implementation of EBPs for SUDs is associated with improvements in substance use and other functional outcomes. Limitations from this real-world implementation project, including the lack of a control group and missing post-treatment data, are discussed.
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Affiliation(s)
- Josephine M DeMarce
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA.,VISN 6 Mental Illness Research, Education and Clinical Center, Durham Veterans Affairs Mental Center, Durham, North Carolina, USA
| | - Maryann Gnys
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA.,VISN 6 Mental Illness Research, Education and Clinical Center, Durham Veterans Affairs Mental Center, Durham, North Carolina, USA
| | - Susan D Raffa
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA.,Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mandy Kumpula
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA.,VISN 6 Mental Illness Research, Education and Clinical Center, Durham Veterans Affairs Mental Center, Durham, North Carolina, USA
| | - Bradley E Karlin
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA.,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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135
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Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, Carroll K. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. J Consult Clin Psychol 2019; 87:1093-1105. [PMID: 31599606 DOI: 10.1037/ccp0000447] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. METHOD The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. RESULTS CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. CONCLUSIONS The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Lara Ray
- Department of Psychology, University of California, Los Angeles
| | - Brian Kiluk
- Department of Psychiatry, Yale School of Medicine
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Abstract
OBJECTIVES Transcranial direct current stimulation can be effective in reducing the craving for food, alcohol, and methamphetamine. Because its effects have not been tested on patients with opium use disorder, we investigated its efficacy when it is combined with a standard methadone maintenance therapy protocol. METHODS We carried out a pretest-posttest control group method to evaluate the effect of transcranial direct current stimulation at the dorsolateral prefrontal cortex (right anodal/left cathodal) on opium craving, depression, and anxiety symptoms. We considered opium craving as a primary outcome as well as depression and anxiety symptoms as secondary outcomes. Sixty participants with opium use disorder were randomly assigned into 3 groups (n = 20 for each group): (1) an active transcranial direct current stimulation with methadone maintenance treatment (active tDCS group), (2) sham transcranial direct current stimulation with methadone maintenance treatment (sham tDCS group), and (3) only methadone maintenance treatment (methadone maintenance treatment group). All participants completed the Desire for Drug Questionnaire, Obsessive-Compulsive Drug Use Scale, Beck Depression Inventory II, and Beck Anxiety Inventory a week before and a week after the treatment. The outcomes were assessed by independent assessors who were blind to the treatment conditions. RESULTS The active tDCS group had a significant reduction in opium craving, depression, and anxiety symptoms compared with the other 2 groups. CONCLUSIONS Our results provide a preliminary support for using the transcranial direct current stimulation along with methadone maintenance therapy in the treatment of patients with opium use disorder.
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Mimiaga MJ, Pantalone DW, Biello KB, White Hughto JM, Frank J, O’Cleirigh C, Reisner SL, Restar A, Mayer KH, Safren SA. An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men. AIDS Care 2019; 31:1083-1095. [PMID: 30887824 PMCID: PMC6625920 DOI: 10.1080/09540121.2019.1595518] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jackie M. White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - John Frank
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Behavioral Medicine Service, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Arjee Restar
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Kakko J, Alho H, Baldacchino A, Molina R, Nava FA, Shaya G. Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice. Front Psychiatry 2019; 10:592. [PMID: 31543832 PMCID: PMC6728888 DOI: 10.3389/fpsyt.2019.00592] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders. In this review, we describe the neurobiological and neuroendocrine pathways that underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse and is therefore an important treatment target to reduce the risk of relapse and improve patients' quality of life. Opioid agonist therapies (OAT), such as buprenorphine and methadone, can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches, such as cognitive behavioral therapy and mindfulness-based interventions, as supplementary treatments to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments to improve outcomes for the growing numbers of patients affected by OUD.
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Affiliation(s)
- Johan Kakko
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - Hannu Alho
- Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, National Institute of Health and Welfare, Helsinki, Finland
| | - Alexander Baldacchino
- Division of Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Rocío Molina
- Centro de Atencion a las Adicciones de Arganzuela, Madrid Salud, Ayuntamiento de Madrid, Madrid, Spain
| | - Felice Alfonso Nava
- Director Penitentiary Medicine and Drug Abuse Unit, Health Care Unit Padua, Padua, Italy
| | - Gabriel Shaya
- Medical Affairs, Indivior UK Ltd, Slough, United Kingdom
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Calabria B, Shakeshaft AP, Clifford A, Stone C, Clare PJ, Allan J, Bliss D. Reducing drug and alcohol use and improving well‐being for Indigenous and non‐Indigenous Australians using the Community Reinforcement Approach: A feasibility and acceptability study. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2019; 55 Suppl 1:88-95. [DOI: 10.1002/ijop.12603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/13/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Bianca Calabria
- Centre for Mental Health Research, Research School of Population Health Australian National University Acton ACT Australia
- Research School of Psychology Australian National University Acton ACT Australia
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | | | - Anton Clifford
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | - Chiara Stone
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | - Philip J. Clare
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | | | - Donna Bliss
- Yoorana Gunya Family Healing Centre Forbes NSW Australia
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Hosseini N, Shor J, Szabo G. Alcoholic Hepatitis: A Review. Alcohol Alcohol 2019; 54:408-416. [PMID: 31219169 PMCID: PMC6671387 DOI: 10.1093/alcalc/agz036] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 12/16/2022] Open
Abstract
Alcoholic liver disease (ALD) represents a spectrum of injury, ranging from simple steatosis to alcoholic hepatitis to cirrhosis. Regular alcohol use results in fatty changes in the liver which can develop into inflammation, fibrosis and ultimately cirrhosis with continued, excessive drinking. Alcoholic hepatitis (AH) is an acute hepatic inflammation associated with significant morbidity and mortality that can occur in patients with steatosis or underlying cirrhosis. The pathogenesis of ALD is multifactorial and in addition to genetic factors, alcohol-induced hepatocyte damage, reactive oxygen species, gut-derived microbial components result in steatosis and inflammatory cell (macrophage and neutrophil leukocyte) recruitment and activation in the liver. Continued alcohol and pro-inflammatory cytokines induce stellate cell activation and result in progressive fibrosis. Other than cessation of alcohol use, medical therapy of AH is limited to prednisolone in a subset of patients. Given the high mortality of AH and the progressive nature of ALD, there is a major need for new therapeutic intervention for this underserved patient population.
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Affiliation(s)
- Nooshin Hosseini
- University of Massachusetts, Gastroenterology, University of Massachusetts Medical School
| | - Julia Shor
- University of Massachusetts, Gastroenterology, University of Massachusetts Medical School
| | - Gyongyi Szabo
- Professor, Department of Medicine, University of Massachusetts, 364 Plantation Street, LRB-208, Worcester, MA, USA
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McCormick CL, Hervey WM, Monahan C, Gibson CA, Winn JL, Catalano G. Improved Patient Outcomes and Reduced Wait Times: Transforming a VA Outpatient Substance Use Disorder Program. Fed Pract 2019; 36:332-338. [PMID: 31384123 PMCID: PMC6654166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Systematic evaluation and redesign of a substance use disorder treatment program resulted in elimination of wait times, same-day treatment, and increased pharmacotherapy for patients with alcohol and opioid use disorders.
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Affiliation(s)
- Cortney L McCormick
- is Administrative Section Chief; is a Supervisory Psychiatrist; is a Supervisory Psychologist; is a Clinical Psychologist; is Specialty Programs Section Chief; and is Associate Chief of Staff and Chief of the Mental Health and Behavioral Sciences Service; all at James A. Haley Veterans' Hospital in Tampa, Florida. Carri-Ann Gibson is an Assistant Professor; William Hervey is an Associate Professor; and Glenn Catalano is a Professor; all at the University of South Florida College of Medicine in Tampa
| | - William M Hervey
- is Administrative Section Chief; is a Supervisory Psychiatrist; is a Supervisory Psychologist; is a Clinical Psychologist; is Specialty Programs Section Chief; and is Associate Chief of Staff and Chief of the Mental Health and Behavioral Sciences Service; all at James A. Haley Veterans' Hospital in Tampa, Florida. Carri-Ann Gibson is an Assistant Professor; William Hervey is an Associate Professor; and Glenn Catalano is a Professor; all at the University of South Florida College of Medicine in Tampa
| | - Christopher Monahan
- is Administrative Section Chief; is a Supervisory Psychiatrist; is a Supervisory Psychologist; is a Clinical Psychologist; is Specialty Programs Section Chief; and is Associate Chief of Staff and Chief of the Mental Health and Behavioral Sciences Service; all at James A. Haley Veterans' Hospital in Tampa, Florida. Carri-Ann Gibson is an Assistant Professor; William Hervey is an Associate Professor; and Glenn Catalano is a Professor; all at the University of South Florida College of Medicine in Tampa
| | - Carri-Ann Gibson
- is Administrative Section Chief; is a Supervisory Psychiatrist; is a Supervisory Psychologist; is a Clinical Psychologist; is Specialty Programs Section Chief; and is Associate Chief of Staff and Chief of the Mental Health and Behavioral Sciences Service; all at James A. Haley Veterans' Hospital in Tampa, Florida. Carri-Ann Gibson is an Assistant Professor; William Hervey is an Associate Professor; and Glenn Catalano is a Professor; all at the University of South Florida College of Medicine in Tampa
| | - Jaime L Winn
- is Administrative Section Chief; is a Supervisory Psychiatrist; is a Supervisory Psychologist; is a Clinical Psychologist; is Specialty Programs Section Chief; and is Associate Chief of Staff and Chief of the Mental Health and Behavioral Sciences Service; all at James A. Haley Veterans' Hospital in Tampa, Florida. Carri-Ann Gibson is an Assistant Professor; William Hervey is an Associate Professor; and Glenn Catalano is a Professor; all at the University of South Florida College of Medicine in Tampa
| | - Glenn Catalano
- is Administrative Section Chief; is a Supervisory Psychiatrist; is a Supervisory Psychologist; is a Clinical Psychologist; is Specialty Programs Section Chief; and is Associate Chief of Staff and Chief of the Mental Health and Behavioral Sciences Service; all at James A. Haley Veterans' Hospital in Tampa, Florida. Carri-Ann Gibson is an Assistant Professor; William Hervey is an Associate Professor; and Glenn Catalano is a Professor; all at the University of South Florida College of Medicine in Tampa
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142
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Abstract
PURPOSE OF REVIEW Adolescents with HIV include both those infected perinatally and behaviourally. This population is confronted by normative challenges and HIV stressors as they move towards becoming increasingly independent adults. This review focuses on mental health and substance use in adolescents with HIV. These are important issues in their own right as well as having implications for antiretroviral therapy (ART) adherence and HIV management. RECENT FINDINGS Sixteen articles, published from 1 January 2016 to 1 September 2017, were included from 13 distinct studies, mostly from the United States and Africa. Cross-sectional designs predominated. There was only one intervention study. There was evidence of mental health and substance use difficulties, although not at a higher level than comparison groups. Consistent associations were found between ART nonadherence and both mental health difficulties and substance use; environmental stressors and mental health difficulties. SUMMARY Adolescents with HIV display considerable resilience. There is a need, however, for interventions for mental health difficulties and substance use, and for ART adherence interventions to consider these issues. Studies on mental health and substance use should cover a wider range of regions. Mitigating the impact and reducing exposure to environmental stressors is a priority.
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143
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Sutter MB, Watson H, Bauers A, Johnson K, Hatley M, Yonke N, Leeman L. Group Prenatal Care for Women Receiving Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: An Interprofessional Approach. J Midwifery Womens Health 2019; 64:217-224. [PMID: 30864287 DOI: 10.1111/jmwh.12960] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023]
Abstract
Opioid use disorder among pregnant women is common and rapidly increasing nationwide. Group prenatal care is an innovative alternative to individual care for pregnant women and has been shown to improve women's and health care providers' satisfaction and adherence to care. We describe a novel group prenatal care program colocated in an opioid treatment program that integrates prenatal care, substance use disorder counseling, and medication-assisted treatment. Our interprofessional model draws on the unique contributions of physicians, midwives, nurses, and mental health professionals to address the complex needs of pregnant women with opioid use disorder. Participants reported increased trust and engagement with health care providers and peers, improved prenatal care and birth experience, and increased resilience for relapse prevention. Group prenatal care is an accepted and promising model for women with opioid use disorder in pregnancy and has the potential to improve outcomes for women and newborns.
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Affiliation(s)
- Mary Beth Sutter
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Kate Johnson
- University of New Mexico, Albuquerque, New Mexico
| | - Mandy Hatley
- University of New Mexico, Albuquerque, New Mexico
| | - Nicole Yonke
- Health Sciences Center, University of New Mexico, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Lawrence Leeman
- Health Sciences Center, University of New Mexico, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.,Department of Obstetrics, University of New Mexico, Albuquerque, New Mexico
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144
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Hasanpour-Dehkordi A, Solati K, Tali SS, Dayani MA. Effect of progressive muscle relaxation with analgesic on anxiety status and pain in surgical patients. ACTA ACUST UNITED AC 2019; 28:174-178. [DOI: 10.12968/bjon.2019.28.3.174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ali Hasanpour-Dehkordi
- Associated Professor, Social Determinants of Health Research Center, School of Allied Medical Sciences
| | - Kamal Solati
- Associated Professor, Department of Medical Psychiatry
| | - Shahriar Salehi Tali
- Assistant Professor, Department of Medical-Surgical, Faculty of Nursing and Midwifery
| | - Mohamad Ali Dayani
- Assistant Professor, Department of Radiology All at Shahrekord University of Medical Sciences, Shahrekord, Iran
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145
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Southey MM, Rees T, Rolfe M, Pit S. An evaluation of the maintenance to abstinence (MTA) program in achieving abstinence in opioid users and improving mental health and quality of life. Addict Sci Clin Pract 2019; 14:4. [PMID: 30717808 PMCID: PMC6360677 DOI: 10.1186/s13722-019-0132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residential opioid rehabilitation aims to improve the mental health and quality of life of opioid users through abstinence and residential program participation. This study aimed to determine the depression, anxiety, stress and quality of life amongst maintenance to abstinence (MTA) program residents. Secondary study aims were to assess the personal characteristics of MTA clients, addiction and risk taking behaviours, factors associated with program completion, as well as to assess the reliable change in participants' mental health and quality of life on exit. METHODS Retrospective analysis of routinely collected data (2013-2017) from surveys completed by 100 clients. Outcome measures were: Depression, Anxiety, Stress Score (DASS-42), World Health Organisation Quality of Life 8 questions (WHOQOL-8) and Kessler Psychological Distress Scale (K10). Other variables included demographics, drug use, other addictions, aggression, self-harm, suicidal ideation/attempts, and risk taking behaviours. Statistical methods included Chi-square, Fisher's exact, t-tests, repeated measures analysis of variance and the Reliable Change Index. RESULTS All mean DASS-42, WHOQOL-8 and K10 scores improved significantly in all participants from entry to exit (p < 0.001). The majority of participants demonstrated reliable improvement across all psychometric measures. Completion rates for the MTA program were 51%. Depression (p = 0.023), anxiety (p = 0.010) and stress (p = 0.015) DASS-42 scores decreased significantly more in completers compared to non-completers. The rate of improvement in mean WHOQOL-8 scores and psychological distress scores (K10) was not statistically significantly different between completers and non-completers over time. There was no significant difference between completers and non-completers on socio-demographics, self-reported drug addiction or risk taking behaviour on program entry, except for suicidal thoughts while intoxicated (p = 0.033). Completers were more satisfied with their relationships (p = 0.044) and living place (p = 0.040) on program entry. CONCLUSION Overall, completers and non-completers demonstrated improved mental health and quality of life from entry to exit, regardless of program completion. Depression, anxiety and stress reduced more markedly in program completers. Policy makers and programmers could use these findings to further validate their own programs to improve mental health and quality of life of opioid users.
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Affiliation(s)
| | - Trent Rees
- The Buttery, Binna Burra, QLD, Australia
| | - Margaret Rolfe
- University of Sydney, Sydney, NSW, Australia.,University Centre for Rural Health, 62 Uralba Street, PO Box 3074, Lismore, NSW, 2480, Australia
| | - Sabrina Pit
- Western Sydney University, Sydney, NSW, Australia. .,University of Sydney, Sydney, NSW, Australia. .,University Centre for Rural Health, 62 Uralba Street, PO Box 3074, Lismore, NSW, 2480, Australia. .,Western Sydney University School of Medicine, Campbelltown, NSW, Australia.
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146
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Flanagan JC, Yonce S, Calhoun CD, Back SE, Brady KT, Joseph JE. Preliminary development of a neuroimaging paradigm to examine neural correlates of relationship conflict. Psychiatry Res Neuroimaging 2019; 283:125-134. [PMID: 30581042 PMCID: PMC6379119 DOI: 10.1016/j.pscychresns.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/02/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023]
Abstract
Social stress in the form of conflict between romantic partners is a salient correlate of substance use disorders (SUD), and also plays an integral role in SUD treatment outcomes. Neuroimaging has advanced the study of social stress on SUD etiology, course, and treatment. However, no neuroimaging paradigms have yet been developed to examine neural responses to conflict among romantic couples. In order to fill this gap in the literature, the goal of this exploratory study was to examine the preliminary feasibility of a novel relationship conflict fMRI paradigm. We compared the effects of an auditory relationship conflict versus a neutral cue on functional connectivity in corticolimbic brain regions, and the associations between neural activities and self-report ratings of relationship adjustment, substance use problems, and intimate partner violence. We also explored sex differences in neural correlates of relationship conflict versus neutral cues. Participants demonstrated increased functional connectivity between the amygdala and the prefrontal cortex during the relationship conflict cue compared to the neutral cue. Intimate partner violence was associated with functional connectivity. Sex differences emerged in neural responses to the relationship conflict cue compared to the neutral cue. Collectively, the findings demonstrate preliminary validity of this novel neuroimaging paradigm for couples.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA.
| | - Shayla Yonce
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Casey D Calhoun
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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147
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Lo Coco G, Melchiori F, Oieni V, Infurna MR, Strauss B, Schwartze D, Rosendahl J, Gullo S. Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. J Subst Abuse Treat 2019; 99:104-116. [PMID: 30797382 DOI: 10.1016/j.jsat.2019.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS From residential programs to outpatient services, group therapy permeates the clinical field of substance misuse. While several group interventions for substance use disorders (SUDs) have demonstrated effectiveness, the existing evidence on group therapy has not been systematically reviewed. The current meta-analysis aims to provide estimates of the efficacy of group therapy for SUDs in adults using rigorous methods. METHODS We included studies comparing group psychotherapy to no treatment control groups, individual psychotherapy, medication, self-help groups, and other active treatments applying no specific psychotherapeutic techniques for patients with substance use disorder. The primary outcome was abstinence, and the secondary outcomes were frequency of substance use and symptoms of substance use disorder, anxiety, depression, general psychopathology, and attrition. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, and PsycINFO, complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS Thirty-three studies were included. Significant small effects of group therapy were found on abstinence compared to no treatment, individual therapy, and other treatments. Effects on substance use frequency and SUD symptoms were not significant, but significant moderately sized effects emerged for mental state when group therapy was compared to no treatment. There were no differences in abstinence rates between group therapy and control groups. These results were robust in sensitivity analyses and there was no indication of publication bias. CONCLUSIONS The current findings represent the best available summary analysis of group therapy for SUDs in adults, however cautious interpretation is warranted given the limitations of the available data.
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Affiliation(s)
- Gianluca Lo Coco
- University of Palermo, Department of Psychology, Educational Sciences and Human Movement, Palermo, Italy.
| | | | | | | | - Bernhard Strauss
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Dominique Schwartze
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Jenny Rosendahl
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Salvatore Gullo
- University of Palermo, Department of Psychology, Educational Sciences and Human Movement, Palermo, Italy
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148
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Moore BA, Buono FD, Lloyd DP, Printz DMB, Fiellin DA, Barry DT. A randomized clinical trial of the Recovery Line among methadone treatment patients with ongoing illicit drug use. J Subst Abuse Treat 2018; 97:68-74. [PMID: 30577901 DOI: 10.1016/j.jsat.2018.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/12/2018] [Accepted: 11/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Relapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24 h a day. METHODS The current study was a 12-week randomized clinical efficacy trial of treatment-as-usual (TAU) only or RL + TAU for methadone treatment patients with continued illicit drug use (N = 82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of self-reported illicit drug abstinence and urine screens negative for illicit drugs. RESULTS Days of self-reported illicit drug abstinence improved for patients in RL + TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RL + TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. CONCLUSIONS Although the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.
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Affiliation(s)
- Brent A Moore
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA.
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA
| | - Daniel P Lloyd
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; APT Foundation, New Haven, 06511, CT, USA
| | - Destiny M B Printz
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA
| | - David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, 06510, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; APT Foundation, New Haven, 06511, CT, USA
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149
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Abdoli N, Farnia V, Salemi S, Tatari F, Juibari TA, Alikhani M, Basanj B. Efficacy of the Marlatt cognitive-behavioral model on decreasing relapse and craving in women with methamphetamine dependence: A clinical trial. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1549279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Safora Salemi
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faezeh Tatari
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Touraj Ahmadi Juibari
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrad Basanj
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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150
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Zhang M, Ying J, Amron SB, Mahreen Z, Song G, Fung DS, Smith H. A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study. JMIR Res Protoc 2018; 7:e11822. [PMID: 30455170 PMCID: PMC6277827 DOI: 10.2196/11822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/23/2023] Open
Abstract
Background Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. Objective This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders. Methods This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0. Results This study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study. Conclusions To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use. International Registered Report Identifier (IRRID) PRR1-10.2196/11822
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Syidda B Amron
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Zaakira Mahreen
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel Ss Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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