101
|
Helplessness and the Need to Withdraw From Drugs: The Beginning of the Path to Recovery. ADDICTIVE DISORDERS & THEIR TREATMENT 2018. [DOI: 10.1097/adt.0000000000000122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
102
|
Orum MH, Kara MZ, Egilmez OB, Kalenderoglu A. Complete blood count alterations due to the opioid use: what about the lymphocyte-related ratios, especially in monocyte to lymphocyte ratio and platelet to lymphocyte ratio? J Immunoassay Immunochem 2018; 39:365-376. [PMID: 29757708 DOI: 10.1080/15321819.2018.1460272] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study was designed to compare the complete blood count values of opioid users (N = 61) and healthy subjects (N = 61), particularly monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR). PLR, MLR, and percentage of monocyte (MONO%) were significantly lower in opioid use disorder (OUD) group (P = 0.012, P = 0.005, P = 0.000). The area under the ROC curve of MLR and PLR levels for OUD was 0.349 and 0.368. MONO% correlated with substance use duration. Measurements like lymphocyte-related ratios and MONO% in opioid use can be important in substance monitoring, detection, and differentiation of acute and chronic conditions.
Collapse
Affiliation(s)
- Mehmet Hamdi Orum
- a Faculty of Medicine, Department of Psychiatry , Adiyaman University , Adiyaman , Turkey
| | - Mahmut Zabit Kara
- b Child and Adolescent Psychiatry , Adiyaman University Training and Research Hospital , Adiyaman , Turkey
| | - Oguzhan Bekir Egilmez
- a Faculty of Medicine, Department of Psychiatry , Adiyaman University , Adiyaman , Turkey
| | - Aysun Kalenderoglu
- a Faculty of Medicine, Department of Psychiatry , Adiyaman University , Adiyaman , Turkey
| |
Collapse
|
103
|
Scott CK, Grella CE, Dennis ML, Nicholson L. Linking Individuals with Substance Use Disorders (SUDs) in Primary Care to SUD Treatment: the Recovery Management Checkups-Primary Care (RMC-PC) Pilot Study. J Behav Health Serv Res 2018; 45:160-173. [PMID: 29181779 PMCID: PMC5871558 DOI: 10.1007/s11414-017-9576-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Linking individuals in primary care settings with substance use disorders (SUDs) to SUD treatment has proven to be challenging, despite the widespread use of Screening, Brief Intervention, and Referral to Treatment (SBIRT). This paper reports findings from a pilot study that examined the efficacy of the Recovery Management Checkups intervention adapted for primary care settings (RMC-PC), for assertively linking and engaging patients from Federally Qualified Health Centers into SUD treatment. Findings showed that patients in the RMC-PC (n=92) had significantly higher rates of SUD treatment entry and received more days of SUD treatment compared with those who receive the usual SBIRT referral (n=50). Receipt of RMC-PC had both direct and indirect effects, partially mediated through days of SUD treatment, on reducing days of drug use at 6 months post intake. RMC-PC is a promising intervention to address the need for more assertive methods for linking patients in primary care to SUD treatment.
Collapse
Affiliation(s)
- Christy K Scott
- Lighthouse Institute, Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610; Phone: (312) 664-4321; Fax: (312)664-4324;
| | - Christine E. Grella
- Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610; Phone: (310) 267-5451; Fax: (310) 473-7885;
| | - Michael L. Dennis
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761; Phone: (309)451-7801; Fax: (309)451-7765;
| | - Lisa Nicholson
- Chestnut Health Systems, Chicago, IL 221 W. Walton, Chicago, IL 60610; Phone: (312) 664-4321; Fax: (312)664-4324;
| |
Collapse
|
104
|
Hämäläinen MD, Zetterström A, Winkvist M, Söderquist M, Karlberg E, Öhagen P, Andersson K, Nyberg F. Real-time Monitoring using a breathalyzer-based eHealth system can identify lapse/relapse patterns in alcohol use disorder Patients. Alcohol Alcohol 2018; 53:368-375. [DOI: 10.1093/alcalc/agy011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Elin Karlberg
- Innovation Akademiska, Akademiska Sjukhuset, Uppsala, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjöldsväg 14 B, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Skillsta 4, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, Uppsala, Sweden
| |
Collapse
|
105
|
De Boni RB, Peratikos MB, Shepherd BE, Grinsztejn B, Cortés C, Padgett D, Gotuzzo E, Belaunzarán-Zamudio PF, Rebeiro PF, Duda SN, McGowan CC. Is substance use associated with HIV cascade outcomes in Latin America? PLoS One 2018; 13:e0194228. [PMID: 29543857 PMCID: PMC5854364 DOI: 10.1371/journal.pone.0194228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The HIV care cascade has improved in Latin America over the last decade. However, the influence of alcohol and noninjected drug use (NIDU) on cascade outcomes is mostly unknown. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF). METHODS Individuals ≥18 years attending routine HIV clinic visits and completing the Rapid Screening Tool (RST; evaluating NIDU and ART adherence in 7-day recall period) during 2012-13 were followed up to 2015 in the Caribbean, Central and South America network for HIV epidemiology. Adjusted odds ratios (aOR) were calculated for the association of alcohol consumption and NIDU with retention in care by logistic regression; adjusted hazard ratios (aHR) were estimated for the associations with LTFU and VF by Cox regression. RESULTS Among 3604 individuals, the proportions retained in care for one year were 84%, 79%, 72%, and 69% for patients reporting non-use, alcohol use, NIDU, and both alcohol and NIDU, respectively. For the same patient groups, the proportions LTFU over 18 months were 6%, 8%, 12%, and 13%, respectively. There were 1901 patients (53%) with HIV RNA results; VF proportions were similar between users and nonusers (ranging from 14-16%). After controlling for age, sex, study site, HIV transmission mode, time on ART, AIDS status, and CD4 count, neither alcohol use (aOR = 1.1, CI = 0.9-1.4; aHR = 1.0, CI = 0.8-1.3) nor NIDU (aOR = 1.3, CI = 0.9-1.8; aHR = 1.4, CI = 0.9-2.1) were significantly associated with retention or VF, respectively. However, both alcohol use (aHR = 1.2, CI = 1.02-1.4) and NIDU (aHR = 1.3, CI = 1.00-1.8) were associated with increased LTFU. CONCLUSION Alcohol use and NIDU in a 7-day recall period increased the risk of being LTFU during the next 18 months, highlighting the need for routine screening and targeted interventions to keep these individuals in care and on ART.
Collapse
Affiliation(s)
- Raquel B. De Boni
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Bryan E. Shepherd
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | - Claudia Cortés
- Fundación Arriaran–Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Denis Padgett
- Instituto Hondureno de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras
| | | | - Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Peter F. Rebeiro
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Stephany N. Duda
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | | |
Collapse
|
106
|
Quanbeck A, Gustafson DH, Marsch LA, Chih MY, Kornfield R, McTavish F, Johnson R, Brown RT, Mares ML, Shah DV. Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study. J Med Internet Res 2018; 20:e37. [PMID: 29382624 PMCID: PMC5811649 DOI: 10.2196/jmir.8928] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. OBJECTIVE The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. METHODS In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS The outcomes according to the RE-AIM framework are as follows: Reach-Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness-Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption-Patients sustained high levels of Seva use-between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation-At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance-Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. CONCLUSIONS Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge.
Collapse
Affiliation(s)
- Andrew Quanbeck
- Department of Family Medicine and Community Health, University of Wisconsin - Madison, Madison, WI, United States
- Center for Health Enhancement Systems Studies, University of Wisconsin - Madison, Madison, WI, United States
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin - Madison, Madison, WI, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Ming-Yuan Chih
- College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Rachel Kornfield
- School of Journalism and Mass Communications, University of Wisconsin - Madison, Madison, WI, United States
| | - Fiona McTavish
- Center for Health Enhancement Systems Studies, University of Wisconsin - Madison, Madison, WI, United States
| | - Roberta Johnson
- Department of Family Medicine and Community Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Randall T Brown
- Department of Family Medicine and Community Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Marie-Louise Mares
- College of Letters and Science, University of Wisconsin - Madison, Madison, WI, United States
| | - Dhavan V Shah
- School of Journalism and Mass Communications, University of Wisconsin - Madison, Madison, WI, United States
| |
Collapse
|
107
|
McKay JR, Gustafson DH, Ivey M, McTavish F, Pe-Romashko K, Curtis B, Oslin DA, Polsky D, Quanbeck A, Lynch KG. Effects of automated smartphone mobile recovery support and telephone continuing care in the treatment of alcohol use disorder: study protocol for a randomized controlled trial. Trials 2018; 19:82. [PMID: 29382367 PMCID: PMC5791199 DOI: 10.1186/s13063-018-2466-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background New smartphone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. One such system is the Addiction version of the Comprehensive Health Enhancement Support System (A-CHESS), which provides a range of automated functions that support patients. A-CHESS improved drinking outcomes over standard continuing care when provided to patients leaving inpatient treatment. Effective continuing care can also be delivered via telephone calls with a counselor. Telephone Monitoring and Counseling (TMC) has demonstrated efficacy in two randomized trials with alcohol-dependent patients. A-CHESS and TMC have complementary strengths. A-CHESS provides automated 24/7 recovery support services and frequent assessment of symptoms and status, but does not involve regular contact with a counselor. TMC provides regular and sustained contact with the same counselor, but no ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve automated mobile technology and counselor contact, but little is known about how best to integrate these services. Methods/Design To address this question, the study will feature a 2 × 2 design (A-CHESS for 12 months [yes/no] × TMC for 12 months [yes/no]), in which 280 alcohol-dependent patients in intensive outpatient programs (IOPs) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to A-CHESS produces fewer heavy drinking days than TMC or A-CHESS alone and test for TMC and A-CHESS main effects. We will determine the costs of each of the four conditions and the incremental cost-effectiveness of the three active conditions. Analyses will also examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects. Discussion The results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact. Trial registration ClinicalTrials.gov, NCT02681406. Registered on 2 September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2466-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- James R McKay
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia VAMC, Philadelphia, PA, 19104, USA.
| | - David H Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Megan Ivey
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Fiona McTavish
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Klaren Pe-Romashko
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Brenda Curtis
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David A Oslin
- Center for the Study of Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia VAMC, Philadelphia, PA, 19104, USA
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew Quanbeck
- Department of Family Medicine & Community Health, and Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Kevin G Lynch
- Center on Continuum of Care in Addictions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
108
|
Cousijn J, Luijten M, Feldstein Ewing SW. Adolescent resilience to addiction: a social plasticity hypothesis. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:69-78. [PMID: 30169197 PMCID: PMC6373770 DOI: 10.1016/s2352-4642(17)30148-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/20/2017] [Accepted: 09/28/2017] [Indexed: 12/12/2022]
Abstract
The prevalence of substance use disorders is highest during adolescence; however, many adolescents experience a natural resolution of their substance use by early adulthood, without any formal intervention. Something appears to be unique and adaptive about the adolescent brain. In this Review, we examine the roles of the social environment and neurocognitive development in adolescents' natural resilience to substance use disorders. At present, little is known about the neurocognitive mechanisms that underlie this adaptive phenomenon, since neurodevelopmental studies have mainly focused on the risk side of the substance use equation: escalation of substance use. To provide a framework for future studies, we put forth a social plasticity model that includes developmentally limited enhanced social attunement (ie, the need to harmonise with the social environment), affective processing, and brain plasticity, which underlie adolescents' capacity to learn from and adapt to their constantly evolving social environments.
Collapse
Affiliation(s)
- Janna Cousijn
- ADAPT Laboratory, Department of Psyc hology, and Amsterdam Brain and Cognition (ABC), University of Amsterdam, Netherlands.
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Sarah W Feldstein Ewing
- Division of Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
109
|
Mericle AA, Kaskutas LA, Polcin DL, Karriker-Jaffe KJ. Independent and Interactive Effects of Neighborhood Disadvantage and Social Network Characteristics on Problem Drinking after Treatment. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018; 37:1-21. [PMID: 29657357 DOI: 10.1521/jscp.2018.37.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Socioecological approaches to public health problems like addiction emphasize the importance of person-environment interactions. Neighborhood and social network characteristics may influence the likelihood of relapse among individuals in recovery, but these factors have been understudied, particularly with respect to conceptualizing social network characteristics as moderators of neighborhood disadvantage. Drawing from a larger prospective study of individuals recruited from outpatient treatment (N=451) and interviewed 1, 3, 5, and 7 years later, the aim of this study was to examine the independent and interactive effects of neighborhood and social network characteristics on continued problem drinking after treatment. Models using generalized estimating equations controlling for demographic and other risk factors found the number of heavy drinkers in one's network increases risk of relapse, with the effects being significantly stronger among those living in disadvantaged neighborhoods than among those in non-disadvantaged neighborhoods. No independent effects were found for neighborhood disadvantage or for the number of network members supporting reduced drinking. Future research is needed to examine potential protective factors in neighborhoods which may offset socioeconomic disadvantage as well as to investigate the functions that network members serve in helping to improve long-term treatment outcomes.
Collapse
|
110
|
Labots M, Cousijn J, Jolink LA, Kenemans JL, Vanderschuren LJMJ, Lesscher HMB. Age-Related Differences in Alcohol Intake and Control Over Alcohol Seeking in Rats. Front Psychiatry 2018; 9:419. [PMID: 30233434 PMCID: PMC6129585 DOI: 10.3389/fpsyt.2018.00419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/15/2018] [Indexed: 11/22/2022] Open
Abstract
Alcohol use disorder (AUD) is characterized by excessive and persistent alcohol use, despite adverse consequences. AUD often originates during adolescence, as do other substance use disorders. However, despite periods of excessive alcohol intake, many adolescents reduce their alcohol use by early adulthood. Brain development, social context, personality traits, and genetic makeup are thought to play an important role in these age-dependent fluctuations in alcohol use. However, studies that directly investigate age-related differences in the effects of alcohol exposure on brain and behavior are sparse. Therefore, to better understand the relationship between adolescent alcohol consumption and AUD-like behavior, this study compared the degree of control over alcohol seeking in rats that differed in terms of age of onset of alcohol drinking and in their level of alcohol consumption. We hypothesized that control over alcohol seeking is more prominent in adolescent-onset rats than in adult-onset rats, and that control over alcohol seeking is related to the consumed amount of alcohol. To test this hypothesis, alcohol seeking in the presence of a conditioned aversive stimulus was assessed after 2 months of intermittent alcohol access (IAA) in rats that consumed alcohol from postnatal day 42 (adolescence) or day 77 (adulthood). The rats were subdivided into low (LD), medium (MD), or high (HD) alcohol drinking rats, in order to assess the impact of the extent of alcohol intake on control over alcohol seeking. The adolescent-onset animals consumed slightly, but significantly less alcohol compared to the adult-onset rats. In adult-onset rats, we found that conditioned suppression of alcohol seeking, i.e., reduction of alcohol seeking by presentation of a conditioned aversive stimulus, was most pronounced in LD. By contrast, in the adolescent-onset rats, MD and HD showed increased alcohol seeking compared to LD, which was suppressed by conditioned aversive stimuli. Taken together, these findings reveal a complex relationship between the age of onset and level of alcohol intake with control over alcohol seeking, whereby adolescent rats consume less alcohol than adults. In adult rats, control over alcohol seeking is negatively related to preceding levels of alcohol intake. By contrast, adolescent rats appear to retain control over alcohol seeking, even after a history of high levels of alcohol intake.
Collapse
Affiliation(s)
- Maaike Labots
- Department of Animals in Science and Society, Division of Behavioural Neuroscience, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Janna Cousijn
- ADAPT-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, Netherlands
| | - Linda A Jolink
- Department of Animals in Science and Society, Division of Behavioural Neuroscience, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - J Leon Kenemans
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, Utrecht, Netherlands
| | - Louk J M J Vanderschuren
- Department of Animals in Science and Society, Division of Behavioural Neuroscience, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Heidi M B Lesscher
- Department of Animals in Science and Society, Division of Behavioural Neuroscience, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
111
|
Munro A, Allan J, Shakeshaft A, Breen C. "I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service. Subst Abuse Treat Prev Policy 2017; 12:49. [PMID: 29208008 PMCID: PMC5718008 DOI: 10.1186/s13011-017-0135-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff. METHODS This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program. RESULTS A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process. CONCLUSION This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.
Collapse
Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| |
Collapse
|
112
|
O’Sullivan D, Xiao Y, Watts JR. Recovery Capital and Quality of Life in Stable Recovery From Addiction. REHABILITATION COUNSELING BULLETIN 2017. [DOI: 10.1177/0034355217730395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality of life is becoming an increasingly important outcome measure in both relapse prevention research and rehabilitation counseling research. Recovery capital is a collection of the people and resources believed to contribute to long-term recovery from addiction. Recovery capital indicators were assessed along with quality of life in a national sample of peer support participants in stable recovery ( n = 76) to determine which recovery capital indicators relate to quality of life at this stage. Results reveal that relapse history, refusal self-efficacy, and self-stigma significantly explained about 23% of quality of life in our sample. A discussion of recovery stages and recovery capital is included, as well as implications for rehabilitation counseling practice and research.
Collapse
Affiliation(s)
| | - Yi Xiao
- The Pennsylvania State University, University Park, USA
| | | |
Collapse
|
113
|
A police-led addiction treatment referral program in Gloucester, MA: Implementation and participants' experiences. J Subst Abuse Treat 2017; 82:41-47. [PMID: 29021114 DOI: 10.1016/j.jsat.2017.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The increasing rates of opioid use disorder and resulting overdose deaths are a public health emergency, yet only a fraction of individuals in need receive treatment. OBJECTIVE To describe the implementation of and participants' experiences with a novel police-led addiction treatment referral program. METHODS Follow-up telephone calls to participants in the Gloucester Police Department's Angel Program from June 2015-May 2016. Open-ended survey questionnaires assessed experiences of program participants and their close contacts, confirmed police-reported placement, and queried self-reported substance use and treatment outcomes. RESULTS Surveys were completed by 198 of 367 individuals (54% response rate) who participated 214 times. Reasons for participation included: the program was a highly-visible entry point to the treatment system, belief that placement would be obtained, poor prior treatment system experiences, and external pressure to seek treatment. Most participants reported positive experiences citing the welcoming, non-judgmental services. In 75% (160/214) of the encounters, entry into referral placement was confirmed. Participants expressed frustration when they did not meet program entry requirements and had difficulty finding sustained treatment following initial program placement. At a mean follow-up time of 6.7months, 37% of participants reported abstinence since participation, with no differences between participants who entered referral placement versus those who did not. CONCLUSIONS A police-led referral program was feasible to implement and acceptable to participants. The program was effective in finding initial access to treatment, primarily through short-term detoxification services. However, the program was not able to overcome a fragmented treatment system focused on acute episodic care which remains a barrier to long-term recovery.
Collapse
|
114
|
A Unique Model for Adolescent Addiction Treatment: A Description of the Alberta Adolescent Recovery Centre. ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
115
|
Finch AJ, Tanner-Smith E, Hennessy E, Moberg DP. Recovery high schools: Effect of schools supporting recovery from substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:175-184. [PMID: 28767275 DOI: 10.1080/00952990.2017.1354378] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recovery high schools (RHSs) provide post-treatment education and recovery support for young people with substance use disorders (SUDs). This is the first quasi-experimental outcome study to determine RHS effectiveness relative to students in non-RHSs. OBJECTIVES To examine effects of RHS attendance on academic and substance use outcomes among adolescents treated for SUDs 6 months after recruitment to the study. METHODS A quasi-experimental design comparing outcomes for adolescents with treated SUDs who attended RHSs for at least 28 days versus a propensity-score balanced sample of students with treated SUDs who did not attend RHSs. The sample included 194 adolescents (134 in RHSs, 60 in non-RHSs) enrolled in Minnesota, Wisconsin, or Texas schools (M age = 16; 86% White; 49% female). Multilevel linear regression models were used to examine the effect of RHS attendance on students' outcomes, after adjusting for a range of potential confounders. RESULTS Adolescents attending RHSs were significantly more likely than non-RHS students to report complete abstinence from alcohol, marijuana, and other drugs at the 6-month follow-up (OR = 4.36, p = .026), significantly lower levels of marijuana use (d = -0.51, p = .034) and less absenteeism from school (d = -0.56, p = .028). CONCLUSION These results indicate that RHSs have significantly beneficial effects on substance use and school absenteeism after 6 months for adolescents treated for SUDs.
Collapse
Affiliation(s)
- Andrew J Finch
- a Department of Human & Organizational Development , Vanderbilt University , Nashville , TN , USA
| | - Emily Tanner-Smith
- a Department of Human & Organizational Development , Vanderbilt University , Nashville , TN , USA
| | - Emily Hennessy
- a Department of Human & Organizational Development , Vanderbilt University , Nashville , TN , USA
| | - D Paul Moberg
- b School of Medicine and Public Health, Department of Population Health Sciences , University of Wisconsin-Madison , Madison , WI , USA
| |
Collapse
|
116
|
Day E, Mitcheson L. Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism? Addiction 2017; 112:1329-1336. [PMID: 28044376 DOI: 10.1111/add.13644] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based treatments beyond 'routine counselling'. ANALYSIS We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice. CONCLUSION The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions.
Collapse
Affiliation(s)
- Ed Day
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Solihull Integrated Addiction Service, Solihull, UK
| | - Luke Mitcheson
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
117
|
Perlman DC, Jordan AE. Considerations for the Development of a Substance-Related Care and Prevention Continuum Model. Front Public Health 2017; 5:180. [PMID: 28770195 PMCID: PMC5513894 DOI: 10.3389/fpubh.2017.00180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/04/2017] [Indexed: 12/19/2022] Open
Abstract
There are significant gaps in the identification and engagement in care and prevention services of people who use illicit substances. Care continuum models have proven to be useful tools in the evaluation of care for HIV and other conditions; numerous issues in substance-related care and prevention resemble those identified in other continua models. Systems of care for substance misuse and substance use disorders (SUDs) can be viewed as consisting of a prevention and care continuum, reflecting incidence and prevalence of substance misuse and SUDs, screening and identification, medical and psychosocial evaluation for treatment, engagement in evidence-based treatment, treatment retention, relapse prevention, timeliness of step completion, and measures of overall and substance use-related specific morbidity and mortality. Care and prevention continuum models could potentially be applied at program, local, regional, state, and national levels. We discuss important lessons that can be drawn from applications of continuum models in other fields. The development and use of a substance-related care and prevention continuum may yield significant patient care, program evaluation and improvement, and population-level benefits.
Collapse
Affiliation(s)
- David C. Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
- Center for Drug Use and HIV Research, New York, NY, United States
| | - Ashly E. Jordan
- Center for Drug Use and HIV Research, New York, NY, United States
- Department of Epidemiology, School of Public Health, City University of New York, New York, NY, United States
| |
Collapse
|
118
|
Mericle AA, Polcin DL, Hemberg J, Miles J. Recovery Housing: Evolving Models to Address Resident Needs. J Psychoactive Drugs 2017; 49:352-361. [PMID: 28657823 DOI: 10.1080/02791072.2017.1342154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment-a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford HouseTM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.
Collapse
Affiliation(s)
- Amy A Mericle
- a Research Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Douglas L Polcin
- b Senior Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jordana Hemberg
- c Research Associate , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jennifer Miles
- d Doctoral Candidate , The Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA
| |
Collapse
|
119
|
Resting state brain connectivity patterns before eventual relapse into cocaine abuse. Behav Brain Res 2017; 327:121-132. [DOI: 10.1016/j.bbr.2017.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 12/27/2016] [Accepted: 01/01/2017] [Indexed: 11/20/2022]
|
120
|
Best D, de Alwis S. Community Recovery as a Public Health Intervention: The Contagion of Hope. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1318647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David Best
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, England
| | - Stephanie de Alwis
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, England
| |
Collapse
|
121
|
McKay JR. Making the hard work of recovery more attractive for those with substance use disorders. Addiction 2017; 112:751-757. [PMID: 27535787 PMCID: PMC5315690 DOI: 10.1111/add.13502] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/12/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research has led to improvements in the effectiveness of interventions for substance use disorders (SUD), but for the most part progress has been modest, particularly with regard to longer-term outcomes. Moreover, most individuals with SUD do not seek out treatment. ARGUMENT/ANALYSIS This paper presents two recommendations on how to improve treatment engagement and long-term outcomes for those with SUD. First, treatments should go beyond a focus on reducing or eliminating substance use to target greater access to and more time spent in experiences that will be enjoyable or otherwise rewarding to clients. Secondly, there must be sufficient incentives in the environment to justify the effort needed to sustain long-term abstinence for individuals who often have limited access to such incentives. CONCLUSIONS To increase rates of long-term recovery from substance misuse, treatments should link clients to reinforcers that will make continued abstinence more appealing. This work needs to extend beyond interventions focused on the individual or family to include the local community and national policy in an effort to incentivize longer-term recoveries more strongly.
Collapse
Affiliation(s)
- James R. McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; and Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| |
Collapse
|
122
|
Garrido-Fernández M, Marcos-Sierra JA, López-Jiménez A, Ochoa de Alda I. Multi-Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment. JOURNAL OF MARITAL AND FAMILY THERAPY 2017; 43:338-351. [PMID: 27747887 DOI: 10.1111/jmft.12195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this study, we evaluate the efficacy of multi-family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi-family therapy with a reflecting team (MFT-RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi-family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic-constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.
Collapse
|
123
|
Best D, De Alwis SJ, Burdett D. The recovery movement and its implications for policy, commissioning and practice. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:107-111. [PMID: 32934473 PMCID: PMC7450866 DOI: 10.1177/1455072517691058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/08/2016] [Indexed: 11/15/2022] Open
|
124
|
Manning V, Garfield JB, Best D, Berends L, Room R, Mugavin J, Larner A, Lam T, Buykx P, Allsop S, Lubman DI. Substance use outcomes following treatment: Findings from the Australian Patient Pathways Study. Aust N Z J Psychiatry 2017; 51:177-189. [PMID: 26769978 DOI: 10.1177/0004867415625815] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Our understanding of patient pathways through specialist Alcohol and Other Drug treatment and broader health/welfare systems in Australia remains limited. This study examines how treatment outcomes are influenced by continuity in specialist Alcohol and Other Drug treatment, engagement with community services and mutual aid, and explores differences between clients who present with a primary alcohol problem relative to those presenting with a primary drug issue. METHOD In a prospective, multi-site treatment outcome study, 796 clients from 21 Alcohol and Other Drug services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. A total of 555 (70%) completed a follow-up assessment of subsequent service use and Alcohol and Other Drug use outcomes 12-months later. RESULTS Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/amphetamine (66%) as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (odds ratio = 2.5) and community service engagement (odds ratio = 2.0) for clients with alcohol as the primary drug of concern, and completion of the index treatment (odds ratio = 2.8) and continuity in Alcohol and Other Drug care (odds ratio = 1.8) when drugs were the primary drugs of concern. CONCLUSION This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug services. Results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to maximise outcomes.
Collapse
Affiliation(s)
- Victoria Manning
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
- 2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joshua Bb Garfield
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
- 2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - David Best
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
- 3 Sheffield Hallam University, Sheffield, UK
| | - Lynda Berends
- 4 Centre for Health and Social Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Robin Room
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
- 5 Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- 6 Stockholm University, Stockholm, Sweden
| | - Janette Mugavin
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
- 5 Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Larner
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | - Tina Lam
- 7 Curtin University, Perth, WA, Australia
| | - Penny Buykx
- 8 University of Sheffield, Sheffield, UK
- 9 School of Rural Health, Monash University, Melbourne, VIC, Australia
| | | | - Dan I Lubman
- 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia
- 2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
125
|
Boffin N, Antoine J, Moreels S, Wanyama S, De Ridder K, Peremans L, Vanmeerbeek M, Van Casteren V. General practice patients treated for substance use problems: a cross-national observational study in Belgium. BMC Public Health 2016; 16:1235. [PMID: 27927240 PMCID: PMC5143443 DOI: 10.1186/s12889-016-3885-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/26/2016] [Indexed: 12/01/2022] Open
Abstract
Background General Practitioners (GPs) are well placed to care for patients with (chronic) substance use problems. This pilot was carried out to study the feasibility and usefulness of a continuous surveillance of substance use problems among general practice patients. The objectives were (i) to describe variables with missing values exceeding 1% and whether patients were reported without substance-related problems; (ii) the profile and the magnitude of the patient population that is treated for substance use problems. Methods Observational study by the Belgian Network of Sentinel General Practices (SGP) in 2013. Baseline (at the first encounter) and 7-month follow-up data were reported of all patients treated for substance use problems. Two main measurements were type of substance use and patient status at follow-up. Multiple logistic regression analysis was used to examine patient status at follow-up. Results Of 479 patients, 47.2% had problems with alcohol alone, 20.3% with prescription drugs, 16.7% with illicit drugs other than heroin or methadone and 15.9% with heroin or methadone. Problems with alcohol alone were more prevalent in Flanders (53.0%; 95% confidence interval (CI) 46.8–59.1%) than in Wallonia-Brussels (39.8%; 95% CI 33.1–46.8%), while problems with heroin or methadone were more prevalent in Wallonia-Brussels (27.0%; 95% CI 21.1–33.5%) than in Flanders (7.1%; 95% CI 4.3–10.9%). At follow-up, 32.8% of the patients had dropped out, 29.0% had discontinued GP treatment and 38.2% had continued GP treatment. Overall, 32.4% of 479 patients had continued GP treatment for substance use problems during the study period. In Wallonia-Brussels, this proportion was higher (42.7%; 95% CI 35.9–49.6%) than in Flanders (24.3%; 95% CI 19.2–29.8%). Conclusions A continuous surveillance of the general practice population treated for substance use problems seems to be feasible and useful. The latter is suggested by the specific profile and the relative magnitude of the population. Inter-regional health system differences should be taken into account to estimate the epidemiology of substance use problems among general practice patients. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3885-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicole Boffin
- OD Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.
| | - Jerome Antoine
- OD Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Sarah Moreels
- OD Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Simeon Wanyama
- OD Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Karin De Ridder
- OD Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Lieve Peremans
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Marc Vanmeerbeek
- Département de Médecine Générale, Université de Liège, Liège, Belgium
| | - Viviane Van Casteren
- OD Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| |
Collapse
|
126
|
Manuel JI, Yuan Y, Herman DB, Svikis DS, Nichols O, Palmer E, Deren S. Barriers and facilitators to successful transition from long-term residential substance abuse treatment. J Subst Abuse Treat 2016; 74:16-22. [PMID: 28132695 DOI: 10.1016/j.jsat.2016.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 11/17/2022]
Abstract
Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals' basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment.
Collapse
Affiliation(s)
- Jennifer I Manuel
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003, United States.
| | - Yeqing Yuan
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003, United States.
| | - Daniel B Herman
- Silberman School of Social Work at Hunter College, 2180 Third Avenue @ 119th St., New York, NY 10035, United States.
| | - Dace S Svikis
- Virginal Commonwealth University Department of Psychology, 806 West Franklin Street, Richmond, Virginia 23284-2018, United States.
| | - Obie Nichols
- Services for the UnderServed, Inc., 305 Seventh Avenue, 10th Floor, New York, NY 10001, United States.
| | - Erin Palmer
- Services for the UnderServed, Inc., 305 Seventh Avenue, 10th Floor, New York, NY 10001, United States.
| | - Sherry Deren
- New York University Rory Meyers College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, United States.
| |
Collapse
|
127
|
Timko C, Flatley B, Tjemsland A, McGuire J, Clark S, Blue-Howells J, Blonigen D, Rosenthal J, Finlay A. A Longitudinal Examination of Veterans Treatment Courts' Characteristics and Eligibility Criteria. JUSTICE RESEARCH AND POLICY : JOURNAL OF THE JUSTICE RESEARCH AND STATISTICS ASSOCIATION : JRP 2016; 17:123-136. [PMID: 30034296 PMCID: PMC6051754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although the number of Veterans Treatment Courts (VTCs) has been growing at a rapid rate, thus far, VTC components have not been standardized, due in part to a lack of empirical evidence on the extent to which components vary across VTCs nationwide and change over time. This study analyzed data collected by the Department of Veterans Affairs' Veterans Justice Program, on VTCs in 2012 (n = 173 Courts), 2013 (n = 266), and 2014 (n = 351), to describe Court characteristics, participant eligibility criteria, and Courts' mentoring component. Despite growth in VTC numbers, the survey found consistency over time in these aspects of VTCs. Regarding characteristics, the majority of Courts had jurisdiction at the county level. Across survey years, the range of means was 22-24 for veteran participant census, 10-14 for number of months spent in the Court for misdemeanors, and 18-19 for number of months spent in the Court for felonies. Eligibility requirements suggested openness to veterans of different backgrounds and status. Less than two thirds of Courts had the mentoring component; Courts with the mentoring component had a higher participant census and a longer duration of participants' time under Court supervision than Courts without this component. Existing mentoring programs were organized mainly by volunteers. VTCs' adherence to policies supportive of veterans may benefit from having paid mentor coordinators in order to further ensure this hallmark of VTCs.
Collapse
Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Bessie Flatley
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA, USA
- Department of Veterans Affairs, Veterans Justice Programs, Lexington, KY, USA
| | - Amanda Tjemsland
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Jim McGuire
- Department of Veterans Affairs, Veterans Justice Programs, Greater Los Angeles Health Care System–West LA Campus, Los Angeles, CA, USA
| | - Sean Clark
- Department of Veterans Affairs, Veterans Justice Programs, Lexington, KY, USA
| | | | - Daniel Blonigen
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Palo Alto University, Clinical Psychology Program, Palo Alto, CA, USA
| | - Joel Rosenthal
- Department of Veterans Affairs, Veterans Justice Programs, Menlo Park, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA, USA
- Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
128
|
Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
|
129
|
Passetti LL, Godley MD, Kaminer Y. Continuing care for adolescents in treatment for substance use
disorders. Child Adolesc Psychiatr Clin N Am 2016; 25:669-84. [PMID: 27613345 PMCID: PMC5018300 DOI: 10.1016/j.chc.2016.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents who enter treatment for substance use often do not complete the program and do not connect with continuing care services. Most return to some level of substance use. Our review found 10 outcome studies of continuing care treatment. More assertive approaches can increase continuing care initiation rates and rapid initiation of continuing care makes a difference in reducing substance use. Continuing care is appropriate for those who complete treatment and for those who do not. Adaptive treatment designs hold promise for establishing decision rules as to which adolescents need low-intensity continuing care services and which need more intensive care.
Collapse
Affiliation(s)
| | - Mark D. Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761
| | - Yifrah Kaminer
- Alcohol Research Center, University of Connecticut School of
Medicine, 263 Farmington Avenue, Farmington, CT 06030
| |
Collapse
|
130
|
Abstract
BACKGROUND Having a stable and safe place to live is integral to recovery from addiction. Recovery residences represent an important component in the substance use continuum of care, but research on them has been limited to certain types of recovery residences and has yet to examine quality of life among those who live in them. METHODS This study presents data on the characteristics of residents (N = 104) living in a stratified random sample of recovery homes in Philadelphia (N = 13) as well as data from a random subsample of residents (N = 27) who participated in 3-month follow-up interviews. RESULTS Residents in these homes reported deficits in a variety of aspects of their lives critical to helping them initiate and sustain their recovery; many (20%) reported living in a shelter or on the streets prior to moving in, 37% had less than a high school education, and only 26% reported currently working for pay. Although the majority of residents rated their quality of life as good or very good (74%), average physical health, social relationship, and environment domain scores measured by the World Health Organization Quality of Life (WHOQOL)-Bref were generally lower than scores found among community samples. At follow-up, all residents were housed and rates of substance use (7%), criminal justice involvement (0%), and employment (44%) in the past 30 days were encouraging. Quality of life domain scores were unchanged, with the exception of psychological health, which decreased. CONCLUSIONS These findings highlight the complex needs of residents living in Philadelphia recovery homes and the role that these homes play in maintaining residents in their early recovery. Studies with larger samples of residents followed up over longer periods of time are needed to assess the role that these homes may play in promoting long-term recovery and improving the well-being of the vulnerable population of individuals who live in them.
Collapse
Affiliation(s)
- Amy A Mericle
- a Alcohol Research Group , Public Health Institute , Emeryville , California , USA
| | | |
Collapse
|
131
|
Pasareanu AR, Vederhus JK, Opsal A, Kristensen Ø, Clausen T. Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: results from compulsorily and voluntarily admitted patients. BMC Health Serv Res 2016; 16:291. [PMID: 27439499 PMCID: PMC4955204 DOI: 10.1186/s12913-016-1548-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 07/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act calls for mandated treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. This study aims to examine substance use–related outcomes at 6 months following inpatient treatment and to analyse factors associated with improved outcomes and abstinence. Method This prospective study followed 202 hospitalized patients with SUD who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographic and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at 6 months of follow-up. Results The frequency of use of a preferred substance showed marked improvement for both VA and CA patients (61 and 37 %, respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53 % of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose in the past 6 months and lower abstinence rates (24 % versus 50 %) at follow-up. A lower severity of drug use at intake (non–injection drug use), voluntary treatment modality, and higher treatment involvement during follow-up all were significant factors associated with abstinence at 6 months after treatment. Conclusion Voluntary treatment for SUD generally yielded better outcomes; nevertheless, we also found improved outcomes for CA patients. It is important to keep in mind that in reality, the alternative to CA treatment is no treatment at all and instead a continuation of life-threatening drug use behaviours. Our observed outcomes for CA patients support the continuation of CA treatment.
Collapse
Affiliation(s)
- Adrian R Pasareanu
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, 4604, Kristiansand, Norway. .,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway.
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, 4604, Kristiansand, Norway
| | - Anne Opsal
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, 4604, Kristiansand, Norway.,University of Agder, Kristiansand, Norway
| | - Øistein Kristensen
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, 4604, Kristiansand, Norway
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, 4604, Kristiansand, Norway.,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| |
Collapse
|
132
|
Shepherd RM, Vacaru M. What is the Future Path of Recovery for Excessive Psychic Hotline Callers? Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
133
|
Dalton M, Crowley KF, Crouch JWJ, Kelly SE. “Check in, check up”: an evaluation of the impact of post-treatment follow-ups on substance users’ recovery. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1182593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
134
|
Atroszko PA, Andreassen CS, Griffiths MD, Pallesen S. Study Addiction: A Cross-Cultural Longitudinal Study Examining Temporal Stability and Predictors of Its Changes. J Behav Addict 2016; 5:357-62. [PMID: 27156381 PMCID: PMC5387788 DOI: 10.1556/2006.5.2016.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background and aims "Study addiction" has recently been conceptualized as a behavioral addiction and defined within the framework of work addiction. Using a newly developed measure to assess this construct, the Bergen Study Addiction Scale (BStAS), the present study examined the 1-year stability of study addiction and factors related to changes in this construct over time, and is the first longitudinal investigation of study addiction thus far. Methods The BStAS and the Ten Item Personality Inventory were administered online together with questions concerning demographics and study-related variables in two waves. In Wave 1, a total of 2,559 students in Norway and 2,177 students in Poland participated. A year later, in Wave 2, 1,133 Norwegians and 794 Polish, who were still students completed the survey. Results The test-retest reliability coefficients for the BStAS revealed that the scores were relatively stable over time. In Norway, scores on the BStAS were higher in Wave 2 than in Wave 1, whereas in Poland, the reverse pattern was observed. Learning time outside classes at Wave 1 was positively related to escalation of study addiction symptoms over time in both samples. Being female and scoring higher on neuroticism was related to an increase in study addiction in the Norwegian sample only. Conclusions Study addiction appears to be temporally stable, and the amount of learning time spent outside classes predicts changes in study addiction 1 year later.
Collapse
Affiliation(s)
- Paweł Andrzej Atroszko
- University of Gdansk, Gdansk, Poland,Corresponding author: Paweł Andrzej Atroszko; Institute of Psychology, University of Gdansk, Bazynskiego 4, 80-952 Gdansk, Poland; Phone: +48 58 523 43 22; E-mail:
| | - Cecilie Schou Andreassen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway,The Bergen Clinics Foundation, Bergen, Norway
| | | | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| |
Collapse
|
135
|
McKay JR, Knepper C, Deneke E, O'Reilly C, DuPont RL. An Initial Evaluation of a Comprehensive Continuing Care Intervention for Clients with Substance Use Disorders: My First Year of Recovery (MyFYR). J Subst Abuse Treat 2016; 67:50-4. [PMID: 27296662 DOI: 10.1016/j.jsat.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/15/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Physician health programs (PHPs) generate high rates of sustained abstinence in addicted physicians, through a combination of formal treatment, self-help involvement, regular monitoring via random urine toxicology tests, and powerful incentives generated by the threat of losing one's medical license. Recently, Caron Treatment Centers developed a new continuing care intervention, "My First Year of Recovery" (MyFYR), which is modeled after PHPs but provides extended recovery support to a broader segment of those with substance use disorders. This paper presents initial outcome data from MyFYR. METHODS MyFYR features frequent outcomes monitoring via urine toxicology tests, and also includes a web-based social platform to coordinate efforts of recovery coaches, family members, and others (e.g., employers, probation officers). Participants were the first 198 clients who enrolled in MyFYR after participating in residential treatment at Caron. Substance use outcomes were determined by a combination of urine toxicology tests, client self-report, and information from family members obtained during a 12-month period following entry into MyFYR. RESULTS Clients in MyFYR provided 70% of scheduled urine samples, for an average of 16.4 urine samples per client. Only 4.1% of the samples tested positive for alcohol or any drug. As determined by urine toxicology and client and family reports, 54% of the participants had some use of alcohol or drugs during the follow-up. Of these relapsed clients, 70.1% were retained or re-engaged in MyFYR, and of these, half were able to re-establish abstinence of two months duration or more, as documented by urine toxicology. DISCUSSION These initial results are extremely promising, as they document high rates of sustained participation in urine drug test monitoring and positive outcome in clients not under the threat of losing a professional license or incarceration.
Collapse
Affiliation(s)
- James R McKay
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, 3440 Market St., Suite 370, Philadelphia, PA, 19104.
| | - Cheryl Knepper
- Caron Treatment Centers, 243 N. Galen Hall Rd., Wernersville, PA, 19565
| | - Erin Deneke
- Caron Treatment Centers, 243 N. Galen Hall Rd., Wernersville, PA, 19565
| | | | - Robert L DuPont
- Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD, 20852
| |
Collapse
|
136
|
Mennis J, Stahler GJ. Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances. J Subst Abuse Treat 2016; 63:25-33. [DOI: 10.1016/j.jsat.2015.12.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
|
137
|
Validation of the alcohol use item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS). Drug Alcohol Depend 2016; 161:316-22. [PMID: 26936412 PMCID: PMC6032515 DOI: 10.1016/j.drugalcdep.2016.02.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) includes five item banks for alcohol use. There are limited data, however, regarding their validity (e.g., convergent validity, responsiveness to change). To provide such data, we conducted a prospective study with 225 outpatients being treated for substance abuse. METHODS Assessments were completed shortly after intake and at 1-month and 3-month follow-ups. The alcohol item banks were administered as computerized adaptive tests (CATs). Fourteen CATs and one six-item short form were also administered from eight other PROMIS domains to generate a comprehensive health status profile. After modeling treatment outcome for the sample as a whole, correlates of outcome from the PROMIS health status profile were examined. RESULTS For convergent validity, the largest correlation emerged between the PROMIS alcohol use score and the Alcohol Use Disorders Identification Test (r=.79 at intake). Regarding treatment outcome, there were modest changes across the target problem of alcohol use and other domains of the PROMIS health status profile. However, significant heterogeneity was found in initial severity of drinking and in rates of change for both abstinence and severity of drinking during follow-up. This heterogeneity was associated with demographic (e.g., gender) and health-profile (e.g., emotional support, social participation) variables. CONCLUSIONS The results demonstrated the validity of PROMIS CATs, which require only 4-6 items in each domain. This efficiency makes it feasible to use a comprehensive health status profile within the substance use treatment setting, providing important prognostic information regarding abstinence and severity of drinking.
Collapse
|
138
|
Polcin D, Korcha R, Gupta S, Subbaraman MS, Mericle AA. Prevalence and Trajectories of Psychiatric Symptoms Among Sober Living House Residents. J Dual Diagn 2016; 12:175-84. [PMID: 27082699 PMCID: PMC4914417 DOI: 10.1080/15504263.2016.1172910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many such residents are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes. METHODS Data for this study were collected as part of a larger study on outcomes among sober living house residents in Northern California. The current study examined data from 300 residents in two housing groups; residents were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations tested changes in BSI global psychological distress and clinical symptom scales over time and examined the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization. RESULTS The average age of residents was 38.5 years (SD = 10.1) and they were mostly male (80%) and Caucasian (65%). Retention rates were high, with 90% (n = 269) participating in at least one follow-up interview. Overall psychological distress (Wald χ(2) = 7.99, df = 3, p = .046), symptoms of depression (Wald χ(2) = 13.57, df = 3, p = .004), and phobic anxiety (Wald χ(2) = 7.89, df = 3, p = .048) significantly improved over time. In all models examining the relationship between BSI scale scores and substance use, rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress (OR = 0.48, p < .001) as well as higher scores on the somatization (OR = 0.56, p < .001), depression (OR = 0.53, p < .001), hostility (OR = 0.71, p = .006), and phobic anxiety (OR = 0.74, p = .012) subscales were significantly associated with a decreased likelihood of abstinence. Symptoms of somatization (B = 0.092, SE = 0.029, p = .002) were associated with an increase in the number of days substances were used among those who reported use. CONCLUSIONS Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.
Collapse
Affiliation(s)
- Doug Polcin
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | - Rachael Korcha
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | - Shalika Gupta
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | | | - Amy A Mericle
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| |
Collapse
|
139
|
Fernández-Montalvo J, López-Goñi JJ, Azanza P, Arteaga A, Cacho R. Gender differences in treatment progress of drug-addicted patients. Women Health 2016; 57:358-376. [DOI: 10.1080/03630242.2016.1160967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - José J. López-Goñi
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain
| | - Paula Azanza
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain
| | - Alfonso Arteaga
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain
| | - Raúl Cacho
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain
| |
Collapse
|
140
|
RACK1 promotes maintenance of morphine-associated memory via activation of an ERK-CREB dependent pathway in hippocampus. Sci Rep 2016; 6:20183. [PMID: 26830449 PMCID: PMC4735742 DOI: 10.1038/srep20183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/23/2015] [Indexed: 12/28/2022] Open
Abstract
Existence of long-term drug-associated memories may be a crucial factor in drug cravings and relapse. RACK1 plays a critical role in morphine-induced reward. In the present study, we used conditioned place preference (CPP) to assess the acquisition and maintenance of morphine conditioned place preference memory. The hippocampal protein level of RACK1 and synaptic quantitation were evaluated by Western blotting, immunohistochemistry and electron microscopy, respectively. Additionally, shRACK1 (shGnb2l1) was used to silence RACK1 in vivo to evaluate the role and the underlying mechanism of RACK1 in maintenance of morphine CPP memory. We found that morphine induced CPP was maintained for at least 7 days after the last morphine treatment, which indicated a positive correlation with hippocampal RACK1 level, and was accompanied simultaneously by increases in the synapse density and hippocampal expression of synaptophysin (SYP), phosphorylation of extracellular signal-regulated kinase1/2 (pERK1/2) and the phosphorylation of cyclic adenosine monophosphate response element-binding (pCREB). ShGnb2l1 icv injection significantly suppressed the expression of all above proteins, decreased the synapse density in the hippocampus and attenuated the acquisition and maintenance of morphine CPP. Our present study highlights that RACK1 plays an important role in the maintenance of morphine CPP, likely via activation of ERK-CREB pathway in hippocampus.
Collapse
|
141
|
Shepard DS, Daley MC, Neuman MJ, Blaakman AP, McKay JR. Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial. Drug Alcohol Depend 2016; 159:109-16. [PMID: 26718395 PMCID: PMC4744476 DOI: 10.1016/j.drugalcdep.2015.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/26/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse. METHODS Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes. RESULTS The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p<0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (-$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective. CONCLUSIONS TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered.
Collapse
Affiliation(s)
- Donald S Shepard
- Schneider Institutes for Health Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02454-9110, United States.
| | - Marilyn C Daley
- Schneider Institutes for Health Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02454-9110, United States
| | - Matthew J Neuman
- U.S. Department of Veterans Affairs, Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA 94025, United States; U.S. Department of Veterans Affairs, Health Care Financing & Economics, VA Boston Health Care System, 150 South Huntington Avenue, Boston, MA 02130, United States
| | | | - James R McKay
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, 3440 Market Street, Suite 370, Philadelphia, PA 19104, United States; U.S. Department of Veterans Affairs, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States
| |
Collapse
|
142
|
Barker SF, Best D, Manning V, Savic M, Lubman DI, Rush B. A tiered model of substance use severity and life complexity: Potential for application to needs-based planning. Subst Abus 2016; 37:526-533. [DOI: 10.1080/08897077.2016.1143907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
143
|
McCollister K, Yang X, McKay JR. Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults. Drug Alcohol Depend 2016; 158:38-44. [PMID: 26621551 PMCID: PMC4698077 DOI: 10.1016/j.drugalcdep.2015.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N=108), or to one of two treatment conditions featuring TMC (N=106) and TMC plus incentives (TMC-plus; N=107). Follow-up assessments were conducted over a 2-year period. METHODS Intervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement. RESULTS From the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake. CONCLUSIONS Telephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness. CLINICAL TRIAL REGISTRATION Clinical Trials.gov Number: NCT00685659.
Collapse
Affiliation(s)
- Kathryn McCollister
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Xuan Yang
- Department Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James R. McKay
- University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
| |
Collapse
|
144
|
Castellano F, Bartoli F, Crocamo C, Gamba G, Tremolada M, Santambrogio J, Clerici M, Carrà G. Facial emotion recognition in alcohol and substance use disorders: A meta-analysis. Neurosci Biobehav Rev 2015; 59:147-54. [DOI: 10.1016/j.neubiorev.2015.11.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/02/2015] [Accepted: 11/02/2015] [Indexed: 12/23/2022]
|
145
|
Hilton TF, Pilkonis PA. The Key to Individualized Addiction Treatment is Comprehensive Assessment and Monitoring of Symptoms and Behavioral Change. Behav Sci (Basel) 2015; 5:477-95. [PMID: 26529025 PMCID: PMC4695774 DOI: 10.3390/bs5040477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022] Open
Abstract
Modern health services now strive for individualized treatment. This approach has been enabled by the increase in knowledge derived from neuroscience and genomics. Substance use disorders are no exception to individualized treatment even though there are no gene-specific medications yet available. What is available is the ability to quickly and precisely assess and monitor biopsychosocial variables known to vary during addiction recovery and which place addicts at increased risk of relapse. Monitoring a broad spectrum of biopsychosocial health enables providers to address diverse genome-specific changes that might trigger withdrawal from treatment or recovery relapse in time to prevent that from occurring. This paper describes modern measurement tools contained in the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) and the NIH Toolbox and suggests how they might be applied to support recovery from alcohol and other substance use disorders in both pharmacological and abstinence-oriented modalities of care.
Collapse
Affiliation(s)
| | - Paul A Pilkonis
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street Pittsburgh, PA 15213, USA.
| |
Collapse
|
146
|
DuPont RL, Seppala MD, White WL. The three missing elements in the treatment of substance use disorders: Lessons from the physician health programs. J Addict Dis 2015; 35:3-7. [DOI: 10.1080/10550887.2015.1102797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
147
|
Saeed AM, Mohammed RM, Aty Ibrahim MEA. Evaluation of cupping therapy as an adjuvant therapy in a smoking cessation program. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.165935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
148
|
Bergman BG, Hoeppner BB, Nelson LM, Slaymaker V, Kelly JF. The effects of continuing care on emerging adult outcomes following residential addiction treatment. Drug Alcohol Depend 2015; 153:207-14. [PMID: 26116368 PMCID: PMC4510025 DOI: 10.1016/j.drugalcdep.2015.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts. METHODS Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates. RESULTS Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups). CONCLUSIONS Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment.
Collapse
Affiliation(s)
- Brandon G. Bergman
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| | - Bettina B. Hoeppner
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| | - Lindsay M. Nelson
- Hazelden Betty Ford Foundation’s Butler Center for Research (Center City, MN)
| | - Valerie Slaymaker
- Hazelden Betty Ford Foundation’s Butler Center for Research (Center City, MN)
| | - John F. Kelly
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| |
Collapse
|
149
|
Laudet AB, Harris K, Kimball T, Winters KC, Moberg DP. Characteristics of students participating in collegiate recovery programs: a national survey. J Subst Abuse Treat 2015; 51:38-46. [PMID: 25481690 PMCID: PMC4346424 DOI: 10.1016/j.jsat.2014.11.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Abstract
Relapse rates are high among individuals with substance use disorders (SUD), and for young people pursuing a college education, the high rates of substance use on campus can jeopardize recovery. Collegiate Recovery Programs (CRPs) are an innovative campus-based model of recovery support that is gaining popularity but remains under-investigated. This study reports on the first nationwide survey of CRP-enrolled students (N = 486 from 29 different CRPs). Using an online survey, we collected information on background, SUD and recovery history, and current functioning. Most students (43% females, mean age =26) had used multiple substances, had high levels of SUD severity, high rates of treatment and 12-step participation. Fully 40% smoke. Many reported criminal justice involvement and periods of homelessness. Notably, many reported being in recovery from, and currently engaging in multiple behavioral addictions-e.g., eating disorders, and sex and love addiction. Findings highlight the high rates of co-occurring addictions in this under-examined population and underline the need for treatment, recovery support programs and college health services to provide integrated support for mental health and behavioral addictions to SUD--affected young people.
Collapse
Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery, National Development and Research Institutes, Inc., New York City, NY 10010, USA.
| | - Kitty Harris
- Center for the Study of Addiction and Recovery, Texas Tech University, Lubbock, TX 79409-1160, USA
| | - Thomas Kimball
- Center for the Study of Addiction and Recovery, Texas Tech University, Lubbock, TX 79409-1160, USA
| | | | | |
Collapse
|
150
|
Brunelle N, Bertrand K, Landry M, Flores-Aranda J, Patenaude C, Brochu S. Recovery from substance use: Drug-dependent people’s experiences with sources that motivate them to change. DRUGS: EDUCATION, PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1021665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|