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Ray LA, Bujarski S, Grodin E, Hartwell E, Green R, Venegas A, Lim AC, Gillis A, Miotto K. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:124-140. [PMID: 30373394 DOI: 10.1080/00952990.2018.1528265] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. OBJECTIVE This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. METHOD This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. SCIENTIFIC SIGNIFICANCE One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.
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Affiliation(s)
- Lara A Ray
- a Department of Psychology , University of California , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Spencer Bujarski
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Erica Grodin
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Emily Hartwell
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - ReJoyce Green
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Alexandra Venegas
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Aaron C Lim
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Artha Gillis
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Karen Miotto
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
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152
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Schluter RS, Daams JG, van Holst RJ, Goudriaan AE. Effects of Non-invasive Neuromodulation on Executive and Other Cognitive Functions in Addictive Disorders: A Systematic Review. Front Neurosci 2018; 12:642. [PMID: 30283294 PMCID: PMC6156514 DOI: 10.3389/fnins.2018.00642] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/28/2018] [Indexed: 01/29/2023] Open
Abstract
Background: In order to improve the current treatment of addictive disorders non-invasive neuromodulation over the dorsolateral prefrontal cortex (DLPFC) has gained attention. The DLPFC is crucially involved in executive functioning, functions which are related to the course of addictive disorders. Non-invasive stimulation of the DLPFC may lead to changes in executive functioning. Currently an overview of effects of neuromodulation on these functions is lacking. Therefore, this systematic review addresses the effects of non-invasive neuromodulation on executive functioning in addictive disorders. Methods: The current review is conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015) guidelines and has been registered in PROSPERO International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/prospero/, registration number: CRD42018084157). Original articles were searched using the Ovid MEDLINE, Embase and PsycINFO database. Results: The systematic search resulted in 1,228 unique studies, of which sixteen were included in the current review. Some of these studies do not address the classic definition of executive functions, but another cognitive function. However, they were included in this review since the field is small and still under development and we aim to give an inclusive overview in its broadest sense. The following executive and other cognitive functioning domains were assessed: attention, cognitive flexibility, response inhibition, memory and learning, problem solving, social cognition, risk taking, cognitive bias modification and overall executive functioning. The executive function domain most positively affected was social cognition followed by memory & learning, response inhibition, cognitive flexibility and attention. Conclusions: The studies addressed in the current review used a large variability of stimulation protocols and study designs which complicates comparability of the results. Nevertheless, the results of these studies are promising in light of improvement of current treatment. Therefore, we recommend future studies that compare the effect of different types of stimulation, stimulation sides and number of stimulation sessions in larger clinical trials. This will significantly increase the comparability of the studies and thereby accelerate and clarify the conclusion on whether non-invasive neuromodulation is an effective add-on treatment for substance dependence.
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Affiliation(s)
- Renée S Schluter
- Department of Psychiatry and Amsterdam Institute for Addiction Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ruth J van Holst
- Department of Psychiatry and Amsterdam Institute for Addiction Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Donders Institute for Cognition, Brain and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry and Amsterdam Institute for Addiction Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Arkin, Department of Care, Research and Quality of Care, Amsterdam, Netherlands
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153
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Relapse prevention: Using sound to reduce the probability of recidivism and suffering following detoxification. Med Hypotheses 2018; 118:84-91. [DOI: 10.1016/j.mehy.2018.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 01/23/2023]
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154
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Kim HS, Hodgins DC. Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions. Front Psychiatry 2018; 9:406. [PMID: 30233427 PMCID: PMC6127248 DOI: 10.3389/fpsyt.2018.00406] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/10/2018] [Indexed: 11/16/2022] Open
Abstract
Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated. However, we argue that a more effective and efficient treatment approach is to conceptualize behavioral and substance use addictions as different expressions of a common underlying disorder and, in treatment, to address the underlying mechanisms common to both. To this end, the article presents a developing transdiagnostic treatment model of addictions that targets underlying similarities between behavioral and substance use addictions, called the component model of addiction treatment (CMAT). The CMAT is transdiagnostic in that it can be used in the treatment of both behavioral and substance use addictions. It is pragmatic in that it targets component vulnerabilities, which are enduring, yet malleable, individual psychological, cognitive, and neurobiological characteristics that are common to all addictive disorders and have been demonstrated to be modifiable. A working model of CMAT is presented, including proposed component vulnerabilities: lack of motivation, urgency, maladaptive expectancies, deficits in self-control, deficits in social support, and compulsivity, as well as their potential intervention possibilities. Future directions and potential implications of the CMAT are discussed.
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Affiliation(s)
- Hyoun S. Kim
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
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155
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Nurturing Our Better Nature: A Proposal for Cognitive Integrity as a Foundation for Autonomous Living. Behav Genet 2018; 49:154-167. [PMID: 30101395 DOI: 10.1007/s10519-018-9919-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
As we account for the genetic and environmental influences on morally-relevant character traits like intellectual honesty, industriousness, and self-control, do we risk becoming ever less accountable to ourselves? Behavioral genetic research suggests that about half the variance in such character traits is likely attributable to heredity, and a small fraction to the shared family environment. The remaining 40-60% is explained by neither genes nor family upbringing. This raises the question: how active a role can individuals play in shaping their own character? What, if anything, can and should one do to take responsibility for the kind of person one becomes? This paper sketches a novel theoretical proposal for addressing these questions, by drawing on several previously disparate lines of research within behavior genetics, philosophy, and experimental psychology. Our core proposal concerns the metacognitive capacity to engage in active, reality-based cognition, as opposed to passive, stimulus-driven processing or an active pretense at cognition (i.e., self-deception). We review arguments and evidence indicating that human beings both can and should exercise this capacity, which we have termed "cognitive integrity." We argue that doing so can in a certain sense "set us free" of our genetic and environmental influences-not by rendering them irrelevant, but by giving us the awareness and motivation to manage them more responsibly. This perspective has important implications for guiding the development of psychosocial interventions, and for informing how we direct ourselves more generally, both as individuals and as a society.
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156
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Wolitzky-Taylor K, Drazdowski TK, Niles A, Roy-Byrne P, Ries R, Rawson R, Craske MG. Change in anxiety sensitivity and substance use coping motives as putative mediators of treatment efficacy among substance users. Behav Res Ther 2018; 107:34-41. [PMID: 29852309 PMCID: PMC10980288 DOI: 10.1016/j.brat.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Anxiety sensitivity and coping motives for substance use are processes implicated in anxiety and substance use disorder (SUD) comorbidity, and are malleable treatment targets. Little is known about whether changes in anxiety sensitivity or coping motives during cognitive behavioral therapy (CBT) for anxiety disorders (with or without CBT for SUD) mediate substance use outcomes among patients with comorbid anxiety disorders and SUD. We examined whether changes in anxiety sensitivity and coping motives during treatment for comorbid SUD and anxiety disorders (either CBT for SUD only or CBT for SUD and anxiety disorders) were associated with substance use outcomes. METHODS Repeated measurements of anxiety sensitivity and coping motives throughout treatment were examined from a randomized clinical trial comparing usual, CBT-based treatment at a substance use disorder specialty clinic (UC) to that usual care plus a brief CBT for anxiety program for patients with comorbid anxiety and substance use disorders (CALM ARC). RESULTS Anxiety sensitivity decline during treatment was significantly steeper among those who received CALM ARC than those in UC. Decreases in anxiety sensitivity mediated the effect of treatment group on alcohol use following treatment such that the greater reduction in anxiety sensitivity in CALM ARC explained the superior outcomes for alcohol use in CALM ARC compared to UC. Declines in substance use coping motives were not observed in either condition, and did not differ between CALM ARC and UC. Thus, declines in coping motives did not mediate substance use after treatment. CONCLUSIONS These findings provide preliminary evidence suggesting alcohol use outcomes were related to decreasing anxiety sensitivity rather than decreasing coping motives. Implications and future directions are discussed.
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157
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Wolitzky-Taylor K, Niles AN, Ries R, Krull JL, Rawson R, Roy-Byrne P, Craske M. Who needs more than standard care? Treatment moderators in a randomized clinical trial comparing addiction treatment alone to addiction treatment plus anxiety disorder treatment for comorbid anxiety and substance use disorders. Behav Res Ther 2018; 107:1-9. [DOI: 10.1016/j.brat.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
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158
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Garza CM, Nigg CR, Konishi M, An JY, Wagner AF, Goya DK. Risk and Protective Factors of Alcohol Use Identified by Community Providers and Stakeholders in Hawai'i: Qualitative Data Analysis. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2018; 77:183-187. [PMID: 30083430 PMCID: PMC6077954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to identify community providers' perspectives on risk and protective factors for youth alcohol use in Hawai'i to inform future trainings of providers. A total of 104 providers within communities and prevention organizations in Hawai'i were asked to list risk and protective factors for underage drinking in each of the socioecological levels (individual, family, community, and society). The majority of participants were female (66.3%). Overall, 507 risk and protective factors were listed. There were significantly more risk factors identified (54.8%) than protective factors (45.2%). Participants identified significantly fewer society level risk and protective factors than all other levels. The top three overall themes identified by participants were resources (8.3%), peer influence (7.7%), and family function (6.9%). These results not only provide information about how providers conceptualize substance abuse, but may also indicate that it is necessary to continue training providers in how to identify society level factors influencing individuals' substance use. It is recommended that more research should be conducted with community providers in Hawai'i to understand the attitudes about prevention in the community. Such research may allow for improvements in prevention strategies by providing a larger picture of substance use in the community.
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Affiliation(s)
- Codie M Garza
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (CMG, CRN, MK, AFW, DKG)
- School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ (JA)
| | - Claudio R Nigg
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (CMG, CRN, MK, AFW, DKG)
- School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ (JA)
| | - Minami Konishi
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (CMG, CRN, MK, AFW, DKG)
- School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ (JA)
| | - Ji-Young An
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (CMG, CRN, MK, AFW, DKG)
- School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ (JA)
| | - Allison F Wagner
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (CMG, CRN, MK, AFW, DKG)
- School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ (JA)
| | - Danilyn K Goya
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (CMG, CRN, MK, AFW, DKG)
- School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ (JA)
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159
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Årstad J, Nesvåg SM, Njå ALM, Biong SN. How enough becomes enough: Processes of change prior to treatment for substance use disorder. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1436608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Janne Årstad
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Sverre Martin Nesvåg
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Anne-Lill Mjølhus Njå
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Stian Nissen Biong
- Centre for Mental Health and Substance Abuse, University College of South-East Norway, Faculty of Health Sciences, Drammen, Norway
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160
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Derefinko KJ, Salgado García FI, Sumrok DD. Smoking Cessation for Those Pursuing Recovery from Substance Use Disorders. Med Clin North Am 2018; 102:781-796. [PMID: 29933829 DOI: 10.1016/j.mcna.2018.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This article summarizes the literature regarding the similar biopsychosocial mechanisms of tobacco use and alcohol and substance use disorders, and the evidence for and against the provision of tobacco cessation for those in treatment for alcohol and substance use disorders. The practicality of treatment, focusing on methods, timing, and breadth of intervention strategies, are also presented. Common methodologies that may be used across tobacco use and alcohol and substance use disorder to prevent lapse and relapse are discussed. Physicians can and should adhere to the policy that tobacco use is a common and dangerous comorbid condition that demands concomitant treatment.
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Affiliation(s)
- Karen J Derefinko
- University of Tennessee Health Science Center, 66 North Pauline Street, Suite 305, Memphis, TN 38163-2181, USA.
| | - Francisco I Salgado García
- University of Tennessee Health Science Center, 66 North Pauline Street, Suite 305, Memphis, TN 38163-2181, USA
| | - Daniel D Sumrok
- University of Tennessee Health Science Center, Department of Addiction Medicine, 6401 Popular Avenue, Suite 500, Memphis, TN 38119, USA
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161
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Zhang M, Ying J, Wing T, Song G, Fung DSS, Smith H. A Systematic Review of Attention Biases in Opioid, Cannabis, Stimulant Use Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061138. [PMID: 29857586 PMCID: PMC6025086 DOI: 10.3390/ijerph15061138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/19/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. Advances in experimental psychology have suggested that automatic attention biases might be responsible for relapse. Prior reviews have provided evidence for the presence of these biases in addictive disorders and the effectiveness of bias modification. However, the prior studies are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have failed to adopt a systematic approach in evidence synthesis. Objectives: The primary aim of this current systematic review is to synthesise the current evidence for attention biases amongst opioid use, cannabis use, and stimulant use disorders. The secondary aim is to determine the efficacy of attention bias modification interventions and other addictions related outcomes. Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Six randomised trials were identified. The evidence synthesized from these trials have provided strong evidence that attentional biases are present in opioid and stimulant use disorders. Evidence synthesis for other secondary outcome measures could not be performed given the heterogeneity in the measures reported and the limited number of trials. The risk of bias assessment for the included trials revealed a high risk of selection and attrition bias. Conclusions: This review demonstrates the potential need for interventions targeting attention biases in opiate and cocaine use disorders.
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Affiliation(s)
- Melvyn Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore 539747, Singapore;
- Family Medicine & Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore;
- Correspondence: melvynzhangweibin@gmail; Tel.: +65-3892504
| | - Jiangbo Ying
- National Psychiatry Residency Program, National Healthcare Group, Singapore 539747, Singapore; (J.Y.); (T.W.)
| | - Tracey Wing
- National Psychiatry Residency Program, National Healthcare Group, Singapore 539747, Singapore; (J.Y.); (T.W.)
| | - Guo Song
- National Addiction Management Service, Institute of Mental Health, Singapore 539747, Singapore;
| | | | - Helen Smith
- Family Medicine & Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore;
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162
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A Novel, Integrated Cognitive-Behavioral Therapy for Co-Occurring Posttraumatic Stress and Substance Use Disorders: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2018; 26:307-322. [PMID: 31631955 DOI: 10.1016/j.cbpra.2018.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No preferred, evidence-based treatments for PTSD/SUD comorbidity are presently available. Promising integrated treatments have combined prolonged exposure therapy with cognitive-behavioral relapse prevention therapy for SUD. We describe a case study that showcases a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS). The TIPSS program integrates cognitive processing therapy with cognitive-behavioral therapy for SUD for the treatment of co-occurring PTSD/SUD. The present case report, based upon a woman with PTSD comorbid with both cocaine and alcohol dependence, demonstrates that TIPSS has the potential to effectively reduce PTSD symptoms as well as substance use.
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163
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Gold AK, Otto MW, Deckersbach T, Sylvia LG, Nierenberg AA, Kinrys G. Substance use comorbidity in bipolar disorder: A qualitative review of treatment strategies and outcomes. Am J Addict 2018; 27:188-201. [PMID: 29596721 DOI: 10.1111/ajad.12713] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 02/18/2018] [Accepted: 03/03/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders (SUDs) are present in up to 70% of patients with bipolar disorder (BD) and contribute to high rates of disability, morbidity, and treatment non-adherence. Despite this prevalence, few trials have investigated targeted psychosocial interventions for comorbid BD and SUDs. METHODS Using PubMed and PsycINFO, we conducted a search of the literature up to January 2018 for psychosocial interventions targeted to patients with comorbid BD and SUDs. We identified eight total trials. Of these studies, four randomized and two open trials targeted the types of substance use (alcohol and illicit drugs) of primary concern to mood stability; the remaining two studies, both open trials, targeted smoking cessation. RESULTS None of the randomized trials provided consistent evidence for management of both mood symptoms and substance use though integrated group therapy (IGT) demonstrated consistent beneficial effects on substance use outcomes. Other treatments showed benefit for mood symptoms without benefits for alcohol or illicit substance use. Small pilot studies of combined treatments for smoking cessation provided some initial promise. CONCLUSIONS At present, IGT is the most-well validated and efficacious approach if substance use is targeted in an initial treatment phase. For a subsequent phase, additional psychosocial BD treatments may be needed for mood and functioning benefits. SCIENTIFIC SIGNIFICANCE This review synthesizes the psychosocial interventions that have been conducted in comorbid BD and SUDs while also providing a perspective on which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. (Am J Addict 2018;27:188-201).
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Gustavo Kinrys
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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164
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Dalle Grave R, Calugi S, El Ghoch M. Are Personality Characteristics as Measured by the Temperament and Character Inventory (TCI) Associated with Obesity Treatment Outcomes? A Systematic Review. Curr Obes Rep 2018; 7:27-36. [PMID: 29427047 DOI: 10.1007/s13679-018-0294-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Some personality traits seem to be associated with obesity, but there is little information available regarding their association with obesity treatment outcomes. The aim of this systematic review was therefore to assess the associations between personality traits-evaluated by means of the Temperament and Character Inventory (TCI)-and outcomes of obesity treatment, including attrition, weight loss, and weight loss maintenance. The PubMed database was searched, and studies were screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and data were collated using a narrative approach. RECENT FINDINGS Of the 886 articles retrieved, 9 studies assessing personality traits by means of the TCI in participants with obesity met the inclusion criteria and were reviewed. This approach revealed three main findings: (i) only one study found that attrition rate-during a 6-month behavioral weight loss program-is predicted by low reward dependence scores at baseline; (ii) two studies found that lower novelty-seeking and higher self-directedness scores at baseline positively predict short-term weight-loss magnitude; and (iii) four studies found that higher persistence and lower novelty-seeking scores at baseline predicted weight maintenance at 12 and 24 months. Novelty-seeking and self-directedness traits appear to be predictors of short-term weight loss (≤ 6 months), and persistence and novelty-seeking traits may be related to long-term weight loss maintenance (≥ 12 months), although great uncertainty still exists regarding predictors of attrition.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
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165
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Pietrzak T, Lohr C, Jahn B, Hauke G. Embodied Cognition and the Direct Induction of Affect as a Compliment to Cognitive Behavioural Therapy. Behav Sci (Basel) 2018; 8:E29. [PMID: 29495377 PMCID: PMC5867482 DOI: 10.3390/bs8030029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 12/15/2022] Open
Abstract
We make the case for the possible integration of affect experience induced via embodiment techniques with CBT for the treatment of emotional disorders in clinical settings. Theoretically we propose a possible integration of cognitive behavioural theory, neuroscience, embodied cognition and important processes of client change outcomes such as the therapeutic alliance to enhance client outcomes. We draw from evidence of bidirectional effects between embodiment modes of bottom-up (sensory-motor simulations giving rise to important basis of knowledge) and top-down (abstract mental representations of knowledge) processes such as CBT in psychotherapy. The paper first describes the dominance and success of CBT for the treatment of a wide range of clinical disorders. Some limitations of CBT, particularly for depression are also outlined. There is a growing body of evidence for the added value of experiential affect-focused interventions combined with CBT. Evidence for the embodied model of cognition and emotion is reviewed. Advantages of embodiment is highlighted as a complimentary process model to deepen the intensity and valence of affective experience. It is suggested that an integrated embodiment approach with CBT enhances outcomes across a wide range of emotional disorders. A description of our embodiment method integrated with CBT for inducing affective experience, emotional regulation, acceptance of unwanted emotions and emotional mastery is given. Finally, the paper highlights the importance of the therapeutic alliance as a critical component of the change process. The paper ends with a case study highlighting some clinical strategies that may aid the therapist to integrate embodiment techniques in CBT that can further explore in future research on affective experience in CBT for a wider range of clinical disorders.
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Affiliation(s)
- Tania Pietrzak
- School Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
| | - Christina Lohr
- Embodiment Resource Academy Europa (Munich), 80634 Munich, Germany.
| | - Beverly Jahn
- Embodiment Resources Academy Europa (Leipzig), 04105 Leipzig, Germany.
| | - Gernot Hauke
- Embodiment Resource Academy Europa (Munich), 80634 Munich, Germany.
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166
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Salas-Wright CP, Amodeo M, Fuller K, Mogro-Wilson C, Pugh D, Rinfrette E, Furlong J, Lundgren L. Teaching Social Work Students about Alcohol and Other Drug Use Disorders: From Faculty Learning to Pedagogical Innovation. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2018; 18:71-83. [PMID: 30766451 PMCID: PMC6370321 DOI: 10.1080/1533256x.2017.1413983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
| | - Maryann Amodeo
- School of Social Work, Boston University, Boston, MA, United States
| | - Kimberley Fuller
- School of Social Work, University of Connecticut, Hartford, CT, United States
| | - Cristina Mogro-Wilson
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - David Pugh
- Department of Social Work, Edinboro University, Edinboro, PA, United States
| | - Elaine Rinfrette
- Department of Social Work, Edinboro University, Edinboro, PA, United States
| | - Janice Furlong
- School of Social Work, Boston University, Boston, MA, United States
| | - Lena Lundgren
- Graduate School of Social Work, University of Denver, Denver, CO, United States
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167
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Abstract
Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders. CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories. The focus of CBT is manifold and the focus is on targeting maintaining factors of addictive behaviours and preventing relapse. Relapse prevention programmes are based on social cognitive and cognitive behavioural principles. Interventions for preventing relapse include, behavioural strategies to decrease the valence of addictive behaviours, coping skills to deal with craving, arousal, negative mood states, assertiveness skills to manage social pressures, family psychoeducation and environmental manipulation and cognitive strategies to enhance self-efficacy beliefs and modification of outcome expectancies related to addictive behaviours. More recent developments in the area of managing addictions include third wave behaviour therapies. Third wave behaviour therapies are focused on improving building awareness, and distress tolerance skills using mindfulness practices. These approaches have shown promise, and more recently the neurobiological underpinnings of mindfulness strategies have been studied. The article provides an overview of cognitive behavioural approaches to managing addictions.
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Affiliation(s)
- Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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168
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Vujanovic AA, Smith LJ, Green CE, Lane SD, Schmitz JM. Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial. Contemp Clin Trials 2018; 65:123-129. [PMID: 29287668 PMCID: PMC5803416 DOI: 10.1016/j.cct.2017.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/23/2017] [Accepted: 12/24/2017] [Indexed: 01/11/2023]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, 'gold standard' treatments for PTSD/SUD comorbidity are currently available. The present pilot randomized clinical trial was designed to evaluate the feasibility and preliminary efficacy of a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS), as compared to standard cognitive-behavioral treatment (CBT) for SUD. The TIPSS program integrates cognitive processing therapy with CBT for SUD for the treatment of co-occurring PTSD/SUD. Both treatment conditions are comprised of 12, 60-minute individual psychotherapy sessions, delivered twice-weekly over six weeks. Primary aims examine whether TIPSS, compared to standard CBT for SUD, reduces: (1) PTSD symptoms and (2) substance use outcomes (i.e., self-report, objective). Secondary aims examine whether (a) trauma- and substance cue reactivity and (b) distress tolerance (i.e., actual or perceived ability to withstand uncomfortable emotional or physical states) are significant mechanisms of change. The study was recently closed to new enrollment. Participants included adults with substance dependence and at least four symptoms of PTSD.
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Affiliation(s)
| | - Lia J Smith
- Department of Psychology, University of Houston, United States
| | - Charles E Green
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, United States
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, United States
| | - Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, United States
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169
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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.
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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
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170
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Zhang MWB, Ying J, Wing T, Song G, Fung DSS, Smith HE. Cognitive Biases in Cannabis, Opioid, and Stimulant Disorders: A Systematic Review. Front Psychiatry 2018; 9:376. [PMID: 30158880 PMCID: PMC6104190 DOI: 10.3389/fpsyt.2018.00376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Opiates, cannabis, and stimulants are highly abused and are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. The dual-process theory has posited that while the repeated use of a substance leads to increased automatic processing and increased automatic tendencies to approach substance-specific cues, in addition to the inhibition of other normal cognitive processes. Prior reviews are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have not reviewed the published literature extensively. Objectives: The primary aim of this review is to synthesize the evidence for cognitive biases in opioid use, cannabis use, and stimulant use disorders. The secondary aim of the review is to determine if cognitive bias could be consistently detected using the different methods. Lastly, this review will narratively synthesize the evidence of possible associations between cognitive biases and other addiction-related outcomes. Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. Articles were included if participants had a primary diagnosis of opioid use, cannabis use, or stimulant use disorder. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Results: A total of 38 studies were identified. The main finding is the evidence that cognitive biases are present in the 38 studies identified, except for a single study on opioid use and stimulant use disorders. Cognitive biases were reported despite a variety of different methods being utilized. Synthesis of secondary outcome was not feasible, due to the varied outcomes reported. Conclusions: Cognitive biases have been consistently observed in opioid use, cannabis use, and stimulant use disorders, despite a range of assessment tools being utilized in the assessment for these biases.
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Affiliation(s)
- Melvyn W B Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Jiangbo Ying
- National Psychiatry Residency Program, National Healthcare Group, Singapore, Singapore
| | - Tracey Wing
- National Psychiatry Residency Program, National Healthcare Group, Singapore, Singapore
| | - Guo Song
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel S S Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen E Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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171
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Abstract
BACKGROUND Addictions are highly stigmatized and increasingly construed as biomedical diseases caused by genes, partly to reduce stigma by deflecting blame. However, genetic explanations may have negative effects, which have been understudied in the context of addiction. How the effects of genetic explanations might differ for substance addictions versus behavioral addictions is also unknown. AIMS This study examined the impact of genetic explanations for addiction on measures of treatment expectancies, blame, and perceived agency and self-control, as well as whether these varied depending on whether the addiction was to a substance or a behavior. METHODS Participants read about a person ('Charlie') with either alcohol use disorder or gambling disorder, receiving either a genetic or nongenetic explanation of Charlie's problem. They rated how much they blamed Charlie for his disorder, his likelihood of benefitting from medication or psychotherapy, and how much agency and self-control they ascribed to him. RESULTS Compared to the nongenetic explanation, the genetic explanation reduced blame and increased confidence in the effectiveness of pharmacotherapy. However, it also decreased the expected effectiveness of psychotherapy and reduced ascriptions of agency and self-control. CONCLUSION Genetic explanations for addiction appear to be a 'double-edged sword', with beneficial effects that come at a cost.
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Affiliation(s)
- Matthew S Lebowitz
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, New York, NY, USA Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Paul S Appelbaum
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, New York, NY, USA Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
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172
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Paltun SC, Altunsoy N, Özdemir SD, Okay IT. Does trait mindfulness level affect quitting cannabis use? A six week follow-up study. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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173
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Elison S, Jones A, Ward J, Davies G, Dugdale S. Examining effectiveness of tailorable computer-assisted therapy programmes for substance misuse: Programme usage and clinical outcomes data from Breaking Free Online. Addict Behav 2017. [PMID: 28645092 DOI: 10.1016/j.addbeh.2017.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
RATIONALE When evaluating complex, tailorable digital behavioural interventions, additional approaches may be required alongside established methodologies such as randomised controlled trials (RCTs). Research evaluating a computer-assisted therapy (CAT) programme for substance misuse, Breaking Free Online (BFO), is informed by Medical Research Council (MRC) guidance recommending examination of 'mechanisms of action' of individual intervention strategies, which is relevant when evaluating digital interventions with content that may evolve over time. AIMS To report findings from examination of mechanisms of action of tailoring advice within the BFO programme and outcomes from specific intervention strategies. METHODOLOGY Analysis of covariance and linear regressions were used to assess intervention completion data, and psychometric and clinical outcomes, for 2311 service users accessing drug and alcohol treatment services across the UK. RESULTS Tailoring advice provided to users appeared to prompt them to prioritise completion of intervention strategies associated with their areas of highest biopsychosocial impairment. Completion of specific intervention strategies within BFO were associated with specific clinical outcomes, with a dose response also being found. Mechanisms of action analyses revealed the primacy of cognitions, with cognitive restructuring strategies being associated with improvements in mental health, severity of substance dependence, quality of life and global biopsychosocial functioning. CONCLUSIONS The MRC framework provides an evolved research paradigm within the field of digital behavioural change. By assessing baseline profiles of need, BFO can target the most appropriate clinical content for individual users. Mechanisms of action research can be used to inform modifications to BFO to continually update clinical content and the technology platform.
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174
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175
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Rehm J, Barbosa C. The cost-effectiveness of therapies to treat alcohol use disorders. Expert Rev Pharmacoecon Outcomes Res 2017; 18:43-49. [DOI: 10.1080/14737167.2018.1392241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C. Barbosa
- Behavioral Health and Criminal Justice Division, RTI International, Chicago, IL, USA
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176
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Hershberger AR, Um M, Cyders MA. The relationship between the UPPS-P impulsive personality traits and substance use psychotherapy outcomes: A meta-analysis. Drug Alcohol Depend 2017; 178:408-416. [PMID: 28709080 PMCID: PMC5561735 DOI: 10.1016/j.drugalcdep.2017.05.032] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although impulsive personality traits have been well implicated in substance use disorder (SUD) risk, little work has established how specific impulsive personality traits influence and are influenced by SUD psychotherapy outcomes. The purpose of this meta-analysis was to quantitatively review existing work to examine 1) how impulsive personality traits affect SUD psychotherapy outcomes and 2) reductions in impulsive personality traits during SUD psychotherapy. METHODS Studies were identified by conducting a comprehensive review of the literature. RESULTS For aim one (k=6), significant effects were found for lack of premeditation (g=0.60, SE=0.30, 95% CI 0.01-1.20; z=1.99, p=0.05) and negative urgency (g=0.55, SE=0.17, 95% CI 0.22-0.88, z=3.30, p=0.001), with trait scores related to poorer SUD psychotherapy outcomes. For aim two (k=10), decreases in sensation seeking (g=-0.10, SE=0.05, 95% CI -0.20 to 0.004; z=-1.88, p=0.02) and negative urgency (g=-0.25, SE=0.14, 95% CI -0.53 to 0.03; z=-1.75, p=0.03) during SUD psychotherapy were significant. CONCLUSIONS Overall, our quantitative synthesis suggests that lack of premeditation and negative urgency are related to poorer SUD psychotherapy outcomes. Although negative urgency and sensation seeking are decreasing during SUD psychotherapy, the magnitude of the change is quite small. Overall, we suggest that the measurement and targeting of impulsive personality traits in psychotherapy has strong potential to improve clinical outcomes across SUDs and a wide range of clinical problems and disorders.
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Affiliation(s)
- Alexandra R Hershberger
- Department of Psychology, Indiana University - Purdue University, Indianapolis, 402 North Blackford Street, Indianapolis, Indiana, 46202, United States.
| | - Miji Um
- Department of Psychology, Indiana University - Purdue University, Indianapolis, 402 North Blackford Street, Indianapolis, Indiana, 46202, United States
| | - Melissa A Cyders
- Department of Psychology, Indiana University - Purdue University, Indianapolis, 402 North Blackford Street, Indianapolis, Indiana, 46202, United States
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177
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Ajonijebu DC, Abboussi O, Russell VA, Mabandla MV, Daniels WMU. Epigenetics: a link between addiction and social environment. Cell Mol Life Sci 2017; 74:2735-2747. [PMID: 28255755 PMCID: PMC11107568 DOI: 10.1007/s00018-017-2493-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 01/14/2023]
Abstract
The detrimental effects of drug abuse are apparently not limited to individuals but may also impact the vulnerability of their progenies to develop addictive behaviours. Epigenetic signatures, early life experience and environmental factors, converge to influence gene expression patterns in addiction phenotypes and consequently may serve as mediators of behavioural trait transmission between generations. The majority of studies investigating the role of epigenetics in addiction do not consider the influence of social interactions. This shortcoming in current experimental approaches necessitates developing social models that reflect the addictive behaviour in a free-living social environment. Furthermore, this review also reports on the advancement of interventions for drug addiction and takes into account the emerging roles of histone deacetylase (HDAC) inhibitors in the etiology of drug addiction and that HDAC may be a potential therapeutic target at nucleosomal level to improve treatment outcomes.
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Affiliation(s)
- Duyilemi C Ajonijebu
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Oualid Abboussi
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa.
| | - Vivienne A Russell
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Musa V Mabandla
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - William M U Daniels
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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178
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Schoenthaler SJ, Blum K, Fried L, Oscar-Berman M, Giordano J, Modestino EJ, Badgaiyan R. The effects of residential dual diagnosis treatment on alcohol abuse. ACTA ACUST UNITED AC 2017; 3. [PMID: 28868159 PMCID: PMC5576155 DOI: 10.15761/jsin.1000169] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This multi-center study of dual diagnosis (DD) programs involved 804 residential patients with co-occurring alcohol and mental health disorders. The Addiction Severity Index was administered at admission and at one, six, and 12 months after discharge. Repeated measures analysis showed the intoxication rate per month stabilized between months six and 12 with 68% still in remission and an 88% mean reduction from baseline (F = 519, p < .005). A comparison between patients with and without weekly relapse produced significant differences in hospitalization (odds ratio 11.3:1; 95% C.I., 5.5 to 23.2). Eight ANCOVAs used mean intoxication days per month after discharge as the outcome variable, pre-admission intoxication days per month as a covariate, and eight variables associated with relapse (e.g. depression) as factors. Patients with these factors at admission did not have significantly higher intoxication rates after discharge than patients without them. This suggests that these DD programs successfully integrated treatment of both disorders and explained their effectiveness. Co-occurring DSM IV mood disorders such as anxiety and depression as well as drug abuse involving opioids or cocaine fell between 66 and 95% at months one, six, and twelve.
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Affiliation(s)
| | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.,Dominion Diagnostics, LLC North Kingstown, RI, USA.,National Institute of Holistic Studies, North Miami Beach, FL, USA.,Department of Psychiatry, Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, College of Medicine Burlington, VT, USA.,Department of Addiction Research & Therapy, Nupathways, Innsbrook, MO, USA.,Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton OH, USA.,Department of Psychiatry, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.,Division of Addition Research & Therapy, The Shores Treatment & Recovery Center, Port St. Lucie, FL, USA.,Division of Precision Medicine, Geneus Health, LLC, San Antonio, TX, USA
| | - Lyle Fried
- Division of Addition Research & Therapy, The Shores Treatment & Recovery Center, Port St. Lucie, FL, USA
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, 02118, USA
| | - John Giordano
- National Institute of Holistic Studies, North Miami Beach, FL, USA
| | | | - Rajendra Badgaiyan
- Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton OH, USA
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179
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Säfsten E, Forsell Y, Ramstedt M, Galanti MR. Comparing counselling models for the hazardous use of alcohol at the Swedish National Alcohol Helpline: study protocol for a randomised controlled trial. Trials 2017; 18:257. [PMID: 28587621 PMCID: PMC5461736 DOI: 10.1186/s13063-017-2005-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hazardous and harmful consumption of alcohol is a leading cause of preventable disease and premature deaths. Modifying the amount and pattern of risky alcohol consumption conveys substantial benefits to individuals and to society at large. Telephone helplines provide a feasible alternative to face-to-face counselling in order to increase the reach of brief interventions aiming at modifying the hazardous and harmful use of alcohol. However, there is a lack of studies on the implementation and evaluation of population-based telephone services for the prevention and treatment of alcohol misuse. METHODS/DESIGN A randomised controlled trial was designed to compare a brief, structured intervention to usual care within the Swedish National Alcohol Helpline (SAH), concerning their effectiveness on decreasing the hazardous use of alcohol. Between May 2015 and December 2017, about 300 callers are to be individually randomised with a 1:1 ratio to a brief, structured intervention (n = 150) or to usual care (n = 150). The brief, structured intervention consists of the delivery of a self-help booklet followed by one proactive call from SAH counsellors to monitor and give feedback about the client's progression. Callers assigned to usual care receive telephone counselling according to existing practice, i.e., motivational interviewing in a tailored and client-driven combination of proactive and reactive calls. The primary outcome is defined as a change from a higher to a lower AUDIT risk-level category between baseline and follow-up. General linear modeling will be used to calculate risk ratios of the outcome events. The primary analysis will follow an intention-to-treat (ITT) approach. DISCUSSION The trial is designed to evaluate the effectiveness in decreasing the hazardous and harmful consumption of alcohol of a brief, structured intervention compared to usual care when delivered at the SAH. The results of the study will be used locally to improve the effectiveness of the service provided at the SAH. Additionally, they will expand the evidence base about optimal counselling models in population-based telephone services for alcohol misuse prevention and treatment. TRIAL REGISTRATION ISRCNT.com, ID: ISRCTN13160878 . Retrospectively registered on 18 January 2016.
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Affiliation(s)
- Eleonor Säfsten
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care District, 113 65 Stockholm, Sweden
| | - Mats Ramstedt
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), 107 25 Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care District, 113 65 Stockholm, Sweden
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180
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Ward J, Davies G, Dugdale S, Elison S, Bijral P. Achieving digital health sustainability: Breaking Free and CGL. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-07-2016-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Multiple challenges remain in achieving sustainability of digital health innovations, with many failing to realise their potential due to barriers to research, development and implementation. Finding an approach that overcomes these challenges is important if society is to derive benefit from these new approaches to healthcare. Having been commissioned by local authorities, NHS Trusts, prisons, charities, and third sector providers across the UK, Breaking Free Group, who in 2010 launched Breaking Free Online (BFO), a computer-assisted therapy programme for substance misuse, have overcome many of these challenges. This has been possible through close collaborative working with partner organisations, to overcome barriers to implementation and sustainability. The paper aims to discuss these issues.
Design/methodology/approach
This paper synthesises findings from a series of qualitative studies conducted by Breaking Free Group in collaboration with health and social care charity, Change, Grow, Live (CGL), which explore barriers and facilitators of implementation and sustainability of BFO at CGL. Data are analysed using thematic analyses with findings conceptualised using behavioural science theory.
Findings
This partnership has resulted in UK wide implementation of BFO at CGL, enhanced focus on digital technologies in substance misuse recovery, and a growing body of published collaborative research.
Originality/value
Valuable lessons have been learnt through the partnership between Breaking Free Group and CGL, which will be of interest to the wider digital health community. This paper outlines those lessons, in the hope that they will provide guidance to other digital health developers and their partners, to contribute to the continued evolution of a sustainable digital health sector.
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Dugdale S, Elison S, Davies G, Ward J. Applying Behavior Change Theories and Qualitative Methods in Substance Misuse Implementation Research: Conceptualizing the Adoption of Breaking Free Online in Real-World Clinical Practice. QUALITATIVE HEALTH RESEARCH 2017; 27:1049-1059. [PMID: 28818021 DOI: 10.1177/1049732316683379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is insufficient research examining the implementation of complex novel interventions within health care. This may be due to a lack of qualitative research providing subjective insights into these implementation processes. The authors investigate the advantages of applying behavior change theories to conceptualize qualitative data describing the processes of implementation of complex interventions. Breaking Free Online (BFO), a digital treatment intervention for substance misuse, is described as an example of a complex intervention. The authors review previous qualitative research which explored initial diffusion, or spread, of the BFO program, and its subsequent normalization as part of standard treatment for substance misuse within the health and social care charity, "Change, Grow, Live" (CGL). The use of behavior change models to structure qualitative interview findings enabled identification of facilitators and barriers to the use of BFO within CGL. These findings have implications for the development of implementation research in novel health care interventions.
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182
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Gisquet-Verrier P, Tolédano D, Le Dorze C. Bases physiologiques communes pour les troubles de stress post-traumatique et la dépendance aux drogues d’abus : conséquences pour de nouvelles approches thérapeutiques. Therapie 2017; 72:357-366. [DOI: 10.1016/j.therap.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 11/16/2022]
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183
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Marandure BN, Graham HL. Self-reported reasons for voluntary abstinences by adolescent cannabis users. DRUGS AND ALCOHOL TODAY 2017. [DOI: 10.1108/dat-01-2016-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Factors influencing cannabis use have been previously identified mainly using multivariate approaches. However, there is a dearth of information collected from the perspective of the adolescent cannabis user, in particular for voluntary abstinences. The paper aims to discuss these issues.
Design/methodology/approach
In total, 38 cannabis users were identified from a sample of 261 adolescents recruited from schools. They completed open-ended questions identifying reasons for voluntary abstinences. Thematic analysis was used to assess their responses.
Findings
Voluntary abstinences by cannabis users were influenced by both internal and external factors. These were the user’s state of mind, an attempt to quit, negative effects of cannabis, prior to important events, prior to family interactions and peers.
Research limitations/implications
The results show that adolescent cannabis users are flexible in their approach to using cannabis, being able to briefly stop when the situation warrants it. However, the study is limited by a lack of in depth and rich data, limiting the scope of the analysis.
Originality/value
This is the first study to identify reasons for voluntary abstinences from the user’s perspective in adolescent cannabis users.
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184
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Milosevic I, Chudzik SM, Boyd S, McCabe RE. Evaluation of an integrated group cognitive-behavioral treatment for comorbid mood, anxiety, and substance use disorders: A pilot study. J Anxiety Disord 2017; 46:85-100. [PMID: 27568875 DOI: 10.1016/j.janxdis.2016.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/29/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
This paper presents the development and preliminary evaluation of an integrated group cognitive-behavioral treatment (CBT) for comorbid mood, anxiety, and substance use disorders. The 12-session, manualized treatment was developed collaboratively by a mental health program in a teaching hospital and a community-based addictions service and administered in both settings. Results from an uncontrolled effectiveness trial of 29 treatment completers suggest that integrated group CBT may reduce stress and alcohol use symptoms and improve substance refusal self-efficacy. Changes in symptoms of anxiety, depression, and drug use were not significant, although the effect size for anxiety reduction was in the medium range. Nonetheless, the clinical significance of treatment effects on mood, anxiety, and substance use symptoms was modest. Changes in coping skills and quality of life were not significant, although medium-to-large effects were observed for changes in several coping skills. Participants reported being highly satisfied with treatment, found the treatment strategies to be useful, and noted an improvement in their functioning, particularly socially. Methodological and sample size limitations warrant more rigorous follow-up investigations of this treatment. Results are considered in the context of the current literature on integrated psychological treatments for these common comorbidities.
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Affiliation(s)
- Irena Milosevic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Susan M Chudzik
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Susan Boyd
- Alcohol, Drug and Gambling Services, 21 Hunter St. E, 3rd Floor, Hamilton, Ontario, L8N 1M2, Canada.
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
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185
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Thurn D, Kuntsche E, Weber JA, Wolstein J. Development and Validation of the Amphetamine-Type Stimulants Motive Questionnaire in a Clinical Population. Front Psychiatry 2017; 8:183. [PMID: 28993742 PMCID: PMC5622292 DOI: 10.3389/fpsyt.2017.00183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/11/2017] [Indexed: 01/12/2023] Open
Abstract
Approximately 35.7 million people world-wide use amphetamine-type stimulants (ATS) leading to a high demand for effective treatment. Understanding the motives behind ATS use is a necessary basis for preventive and therapeutic treatment. The objective of this study is to develop the Amphetamine-Type stimulants Motive Questionnaire (AMQ) and to confirm its construct and concurrent validity in respect to the first and the latest month of ATS use based on answers of 233 patients with ATS disorders (74.2% male; mean age: 31.1 years). Confirmatory factor analyses were employed to test for the construct validity of the AMQ. Nested models of confirmatory factor analyses with increasing constraints for gender and age were estimated to test the equivalence of the factor structure in different subgroups. Independent sample t-tests were conducted to test for mean differences in the motive dimensions. A structural equation model was estimated to confirm the concurrent validity using the latent four motive factors (i.e., enhancement, coping, social, and conformity motives) as independent variables and frequency of ATS use in the first and the latest month of use as a dependent variable. The results confirmed the AMQ's four-dimensional factor structure in general, and across gender and age groups for both periods of time. Men (first month: M = 4.21, SD = 0.75; latest month: M = 3.86, SD = 0.93) use ATS more frequently due to enhancement motives than women (first month: M = 3.85, SD = 1.12; latest month: M = 3.46, SD = 1.29) at both periods of time [first month: t(77) = -2.33, p = 0.022; latest month: t(80) = -2.19, p = 0.031]. Structural equation modeling confirmed an association between coping motives and use frequency, for both periods of time (first and latest month: β = 0.32, p < 0.001), as well as between social motives and frequency of use for the latest month of use (β = 0.30, p < 0.01). To conclude, the AMQ is a valid and reliable instrument for assessing motives of ATS use in a clinical population. It can provide important insights into the motivational structure of the first and latest months of ATS use which are useful for preventive and therapeutic treatments as well as the development of abstinence skills.
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Affiliation(s)
- Daniela Thurn
- Clinical Addiction Medicine, Bezirkskrankenhaus Bayreuth, Bayreuth, Germany.,Department of Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Jennifer Anna Weber
- Department of Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany
| | - Jörg Wolstein
- Department of Psychology, Otto-Friedrich-University Bamberg, Bamberg, Germany
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186
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The eCHECKUP TO GO for High School: Impact on risk factors and protective behavioral strategies for alcohol use. Addict Behav 2017; 64:93-100. [PMID: 27597129 DOI: 10.1016/j.addbeh.2016.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 12/28/2022]
Abstract
The eCHECKUP TO GO is identified as a highly effective, low-cost individually-focused alcohol intervention by the NIAAA CollegeAIM guide. The research on the eCHECKUP TO GO for High School is less consistent, suggesting that the program content, originally designed for college students, may need modification for this age group. This randomized controlled study examined the effectiveness of the eCHECKUP TO GO for High School on shifting risk and protective factors for alcohol use targeted by the program at a 4-6week follow-up. Female high school students in the intervention group reported a reduction in perceptions of peer drinking, beliefs about alcohol, and positive alcohol expectancies, compared to students in the control group. There were no group differences in risk factors for males or in protective behavioral strategies for either males or females. Results indicate the eCHECKUP TO GO for High School may be more effective for females and that program content targeting protective behavioral strategies may need modification for this age group.
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187
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Testing the effectiveness of a transdiagnostic treatment approach in reducing violence and alcohol abuse among families in Zambia: study protocol of the Violence and Alcohol Treatment (VATU) trial. Glob Ment Health (Camb) 2017; 4:e18. [PMID: 29230314 PMCID: PMC5719477 DOI: 10.1017/gmh.2017.10] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Violence against women and girls (VAWG) is an urgent global health problem. Root causes for VAWG include the individual- and family-level factors of alcohol abuse, mental health problems, violence exposure, and related adverse experiences. Few studies in low- and middle-income countries (LMIC) have assessed the effectiveness of psychological interventions for reducing VAWG. This randomized controlled trial, part of the What Works to Prevent Violence Against Women and Girls consortium, examines the effectiveness of a common elements treatment approach (CETA) for reducing VAWG and comorbid alcohol abuse among families in Zambia. METHODS/DESIGN Study participants are families consisting of three persons: an adult woman, her male husband or partner, and one of her children aged 8-17 (if available). Eligibility criteria include experience of moderate-to-severe intimate partner violence by the woman and hazardous alcohol use by her male partner. Family units are randomized to receive CETA or treatment as usual. The primary outcome is VAWG as measured by the Severity of Violence Against Women Scale, assessed along with secondary outcomes at 24 months post-baseline. Interim assessments are also conducted at 4-5 months (following CETA completion) and 12 months post-baseline. CONCLUSIONS This ongoing trial is one of the first in sub-Saharan Africa to evaluate the use of an evidence-based common elements approach for reducing VAWG by targeting a range of individual- and family-level factors, including alcohol abuse. Results of this trial will inform policy on what interventions work to prevent VAWG in LMIC with local perspectives on scale up and wider implementation.
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188
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Abstract
The use of tobacco, alcohol, and illicit drugs is widespread and has significant negative consequences for the individual, their families, and the communities to which they belong. A substantial number of users develop an addiction disorder. Cure-oriented addiction treatment is challenging regarding treatment retention and relapse rates. Here, we discuss the potential of eye movement desensitization and reprocessing (EMDR) therapy to aid addiction treatment. Two approaches are distinguished: trauma-focused and addiction-focused EMDR therapy. Existing adapted EMDR protocols and research on both approaches is critically reviewed. Despite 20 years of development and research, the feasibility and efficacy of addiction-focused EMDR therapy is still largely uninvestigated. Exciting new possibilities, offered by research on working memory theory, are discussed. An overview of all resourcing and EMDR therapy interventions in addiction is presented: the palette of EMDR interventions in addiction (PEIA). The article finishes with recommendations for further research in this field.
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189
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Wu SS, Schoenfelder E, Hsiao RCJ. Cognitive Behavioral Therapy and Motivational Enhancement Therapy. Child Adolesc Psychiatr Clin N Am 2016; 25:629-43. [PMID: 27613342 DOI: 10.1016/j.chc.2016.06.002] [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: 11/27/2022]
Abstract
Although cognitive behavioral therapy (CBT) is widely recognized as the preferred treatment of psychiatric disorders, less is known about the application of CBT to substance use disorders, particularly in adolescence. This article discusses how CBT conceptualizes substance use and how it is implemented as a treatment of adolescent substance abuse. The article draws on several manuals for CBT that implement it as a standalone treatment or in combination with motivational enhancement therapies. Also reviewed are several studies that examined the efficacy of CBT. Finally, the implications are discussed. Numerous starting resources are provided to help a clinician implement CBT.
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Affiliation(s)
- Sarah S Wu
- Psychiatry and Behavioral Health, Seattle Children's Hospital, 4800 Sand Point Way, OA.5.154, PO Box 5371, Seattle, Washington 98145-5005, USA
| | - Erin Schoenfelder
- Psychiatry and Behavioral Health, Seattle Children's Hospital, 4800 Sand Point Way, OA.5.154, PO Box 5371, Seattle, Washington 98145-5005, USA
| | - Ray Chih-Jui Hsiao
- Child and Adolescent Psychiatry Residency Training Program, Washington State Medical Association, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Mailstop OA.5.154, PO Box 5371, Seattle, WA 98105-0371, USA; Adolescent Substance Abuse Program, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Mailstop OA.5.154, PO Box 5371, Seattle, WA 98105-0371, USA.
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190
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Moore BA, Fiellin DA, Cutter CJ, Buono FD, Barry DT, Fiellin LE, O'Connor PG, Schottenfeld RS. Cognitive Behavioral Therapy Improves Treatment Outcomes for Prescription Opioid Users in Primary Care Buprenorphine Treatment. J Subst Abuse Treat 2016; 71:54-57. [PMID: 27776678 DOI: 10.1016/j.jsat.2016.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/10/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
To determine whether treatment outcomes differed for prescription opioid and heroin use disorder patients, we conducted a secondary analysis of a 24-week (N=140) randomized trial of physician management (PM) or PM plus cognitive behavioral therapy (CBT) in primary care buprenorphine/naloxone treatment. Self-reported opioid use and urine toxicology analyses were obtained weekly. We examined baseline demographic differences between primary prescription opioid use patients (n=49) and primary heroin use patients (n=91) and evaluated whether treatment response differed by assigned condition. Compared to primary heroin use patients, primary prescription opioid use patients had marginally fewer years of opioid use, were less likely to have had a previous drug treatment or detoxification, and were less likely to report injection drug use. Although opioid abstinence only, and treatment retention did not differ by opioid use group, opioid category moderated the effect of CBT on urine samples negative for all drugs. Primary prescription opioid use patients assigned to PM-CBT had more than twice the mean number of weeks of abstinence for all drugs (7.6) than those assigned to PM only (3.6; p=.02), while primary heroin use patients did not differ by treatment. Findings suggest that examination of other factors that may predict response to behavioral interventions is warranted.
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Affiliation(s)
- Brent A Moore
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher J Cutter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Frank D Buono
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn E Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick G O'Connor
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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191
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Schulte M, Liang D, Wu F, Lan YC, Tsay W, Du J, Zhao M, Li X, Hser YI. A Smartphone Application Supporting Recovery from Heroin Addiction: Perspectives of Patients and Providers in China, Taiwan, and the USA. J Neuroimmune Pharmacol 2016; 11:511-22. [PMID: 26846506 PMCID: PMC4974153 DOI: 10.1007/s11481-016-9653-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/25/2016] [Indexed: 12/17/2022]
Abstract
Smartphone-based interventions are increasingly used to support self-monitoring, self-management, and treatment and medication compliance in order to improve overall functioning and well-being. In attempting to develop a smartphone application (S-Health) that assists heroin-dependent patients in recovery, a series of focus groups (72 patients, 22 providers) were conducted in China, Taiwan, and the USA to obtain their perspectives on its acceptance and potential adoption. Data were analyzed according to the Diffusion of Innovation (DOI) theory of characteristics important to the adoption of innovation. Important to Relative Advantage, USA participants cited S-Health's potential ability to overcome logistical barriers, while those in China and Taiwan valued its potential to supplement currently limited services. In terms of Compatibility, participants across sites reported recovery needs and goals that such an application could be helpful in supporting; however, its utility during strong craving was questioned in China and Taiwan. Important factors relevant to Complexity included concerns about smartphone access and familiarity, individualization of content, and particularly in China and Taiwan, participants wanted assurance of privacy and security. The study results suggest a general acceptance, but also indicate cultural variations in access to therapeutic and other social support systems, legal repercussions of substance use, societal perceptions of addiction, and the role of family and other social support in recovery. Taking these factors into consideration is likely to increase diffusion as well as effectiveness of these smartphone-based interventions.
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Affiliation(s)
| | - Di Liang
- University of California, Los Angeles, CA, USA
| | - Fei Wu
- , Los Angeles County, CA, USA
| | | | - Wening Tsay
- Food and Drug Administration, Taipei, Taiwan
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yih-Ing Hser
- University of California, Los Angeles, CA, USA.
- China Medical University, Taichung, Taiwan.
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192
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Jain R, Stark JG. Safety and efficacy considerations due to misuse of extended-release formulations of stimulant medications. Postgrad Med 2016; 128:672-81. [DOI: 10.1080/00325481.2016.1218259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Rakesh Jain
- Department of Psychiatry, Texas Tech Health Sciences Center Medical School at Permian Basin, Midland, TX, USA
| | - Jeffrey G. Stark
- Division of Early Phase Services, Worldwide Clinical Trials, Austin, TX, USA
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193
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Vujanovic AA, Meyer TD, Heads AM, Stotts AL, Villarreal YR, Schmitz JM. Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:402-415. [PMID: 27494547 DOI: 10.1080/00952990.2016.1199697] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously. OBJECTIVES The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity. RESULTS Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression. CONCLUSION Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.
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Affiliation(s)
- Anka A Vujanovic
- a Department of Psychology, University of Houston , Houston , TX , USA.,b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Thomas D Meyer
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Angela M Heads
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Angela L Stotts
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Yolanda R Villarreal
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Joy M Schmitz
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
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194
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Bergman BG, Kelly JF, Nargiso JE, McKowen JW. "The Age of Feeling in-Between": Addressing Challenges in the Treatment of Emerging Adults With Substance Use Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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195
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Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy 2016; 11:24. [PMID: 27451854 PMCID: PMC4959048 DOI: 10.1186/s13011-016-0068-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 06/28/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A common alternative treatment for substance abuse is auricular acupuncture. The aim of the study was to evaluate the short and long-term effect of auricular acupuncture on anxiety, sleep, drug use and addiction treatment utilization in adults with substance abuse. METHOD Of the patients included, 280 adults with substance abuse and psychiatric comorbidity, 80 were randomly assigned to auricular acupuncture according to the NADA protocol, 80 to auricular acupuncture according to a local protocol (LP), and 120 to relaxation (controls). The primary outcomes anxiety (Beck Anxiety Inventory; BAI) and insomnia (Insomnia Severity Index; ISI) were measured at baseline and at follow-ups 5 weeks and 3 months after the baseline assessment. Secondary outcomes were drug use and addiction service utilization. Complete datasets regarding BAI/ISI were obtained from 37/34 subjects in the NADA group, 28/28 in the LP group and 36/35 controls. Data were analyzed using Chi-square, Analysis of Variance, Kruskal Wallis, Repeated Measures Analysis of Variance, Eta square (η(2)), and Wilcoxon Signed Ranks tests. RESULTS Participants in NADA, LP and control group improved significantly on the ISI and BAI. There was no significant difference in change over time between the three groups in any of the primary (effect size: BAI, η(2) = 0.03, ISI, η(2) = 0.05) or secondary outcomes. Neither of the two acupuncture treatments resulted in differences in sleep, anxiety or drug use from the control group at 5 weeks or 3 months. CONCLUSION No evidence was found that acupuncture as delivered in this study is more effective than relaxation for problems with anxiety, sleep or substance use or in reducing the need for further addiction treatment in patients with substance use problems and comorbid psychiatric disorders. The substantial attrition at follow-up is a main limitation of the study. TRIAL REGISTRATION Clinical Trials NCT02604706 (retrospectively registered).
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Affiliation(s)
- Rickard Ahlberg
- />Faculty of Medicine and Health, University Health Care Research Center, Örebro University, P.O. Box 1613, SE-701 16 Örebro, Sweden
| | - Kurt Skårberg
- />Addiction Center, Faculty of Medicine and Health, Örebro University, P.O. Box 1613, SE-701 16 Örebro, Sweden
| | - Ole Brus
- />Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, P.O. Box 1613, SE-701 16 Örebro, Sweden
| | - Lars Kjellin
- />Faculty of Medicine and Health, University Health Care Research Center, Örebro University, P.O. Box 1613, SE-701 16 Örebro, Sweden
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196
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Dugdale S, Ward J, Hernen J, Elison S, Davies G, Donkor D. Using the Behavior Change Technique Taxonomy v1 to conceptualize the clinical content of Breaking Free Online: a computer-assisted therapy program for substance use disorders. Subst Abuse Treat Prev Policy 2016; 11:26. [PMID: 27449786 PMCID: PMC4957914 DOI: 10.1186/s13011-016-0069-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, research within the field of health psychology has made significant progress in terms of advancing and standardizing the science of developing, evaluating and reporting complex behavioral change interventions. A major part of this work has involved the development of an evidence-based Behavior Change Technique Taxonomy v1 (BCTTv1), as a means of describing the active components contained within such complex interventions. To date, however, this standardized approach derived from health psychology research has not been applied to the development of complex interventions for the treatment of substance use disorders (SUD). Therefore, this paper uses Breaking Free Online (BFO), a computer-assisted therapy program for SUD, as an example of how the clinical techniques contained within such an intervention might be mapped onto the BCTTv1. METHOD The developers of BFO were able to produce a full list of the clinical techniques contained within BFO. Exploratory mapping of the BCTTv1 onto the clinical content of the BFO program was conducted separately by the authors of the paper. This included the developers of the BFO program and psychology professionals working within the SUD field. These coded techniques were reviewed by the authors and any discrepancies in the coding were discussed between all authors until an agreement was reached. RESULTS The BCTTv1 was mapped onto the clinical content of the BFO program. At least one behavioral change technique was found in 12 out of 16 grouping categories within the BCTTv1. A total of 26 out of 93 behavior change techniques were identified across the clinical content of the program. CONCLUSION This exploratory mapping exercise has identified the specific behavior change techniques contained within BFO, and has provided a means of describing these techniques in a standardized way using the BCTTv1 terminology. It has also provided an opportunity for the BCTTv1 mapping process to be reported to the wider SUD treatment community, as it may have real utility in the development and evaluation of other psychosocial and behavioral change interventions within this field.
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Sheikh WA, Paul R, Banda H, Agath K, Luty J. Impact of brief relapse prevention intervention in patients with alcohol dependence in Zambia. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1090494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Waqas Ahmed Sheikh
- Department of Psychiatry, School of Medicine, University of Zambia/Chainama Hills Hospital, Lusaka, Zambia
| | - Ravi Paul
- Lecturer &Head Department of Psychiatry, School of Medicine, University of Zambia, Lusaka, Zambia
| | | | - Kostas Agath
- Consultant Psychiatrist & Medical Governor CNWL NHS Foundation Trust, Westminster, UK
| | - Jason Luty
- Consultant in Addictions Psychiatry, Wiselawmill Farmhouse, Lauder, Oxton TD2 6PF, Scotland
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198
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Carlson KM, González-Prendes AA. Cognitive Behavioral Therapy With Religious and Spiritual Clients: A Critical Perspective. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2016. [DOI: 10.1080/19349637.2016.1159940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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199
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Association Splitting: A randomized controlled trial of a new method to reduce craving among inpatients with alcohol dependence. Psychiatry Res 2016; 238:310-317. [PMID: 27086250 DOI: 10.1016/j.psychres.2016.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 11/20/2022]
Abstract
Association Splitting, a novel cognitive intervention, was tested in patients with alcohol dependence as an add-on intervention in an initial randomized controlled trial. Preliminary support for Association Splitting has been found in patients with obsessive-compulsive disorder, as well as in an online pilot study of patients with alcohol use disorders. The present variant sought to reduce craving by strengthening neutral associations with alcohol-related stimuli, thus, altering cognitive networks. Eighty-four inpatients with verified diagnoses of alcohol dependence, who were currently undergoing inpatient treatment, were randomly assigned to Association Splitting or Exercise Therapy. Craving was measured at baseline, 4-week follow-up, and six months later with the Obsessive-Compulsive Drinking Scale (primary outcome) and the Alcohol Craving Questionnaire. There was no advantage for Association Splitting after three treatment sessions relative to Exercise Therapy. Among Association Splitting participants, 51.9% endorsed a subjective decline in craving and 88.9% indicated that they would use Association Splitting in the future. Despite high acceptance, an additional benefit of Association Splitting beyond standard inpatient treatment was not found. Given that participants were concurrently undergoing inpatient treatment and Association Splitting has previously shown moderate effects, modification of the study design may improve the potential to detect significant effects in future trials.
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200
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Penberthy JK, Penberthy JM, Harris MR, Nanda S, Ahn J, Martinez CP, Osika AO, Slepian ZA, Forsyth JC, Starr JA, Farrell JE, Hook JN. Are Smoking Cessation Treatments Associated with Suicidality Risk? An Overview. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:19-30. [PMID: 27081311 PMCID: PMC4830638 DOI: 10.4137/sart.s33389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/29/2022]
Abstract
Risk of suicidality during smoking cessation treatment is an important, but often overlooked, aspect of nicotine addiction research and treatment. We explore the relationship between smoking cessation interventions and suicidality and explore common treatments, their associated risks, and effectiveness in promoting smoking reduction and abstinence. Although active smokers have been reported to have twofold to threefold increased risk of suicidality when compared to nonsmokers,1–4 research regarding the safest way to stop smoking does not always provide clear guidelines for practitioners wishing to advise their patients regarding smoking cessation strategies. In this article, we review pharmacological and cognitive behavioral therapy (CBT) options that are available for people seeking to quit smoking, focusing on the relationship between the ability of these therapies to reduce smoking behavior and promote abstinence and suicidality risks as assessed by reported suicidality on validated measures, reports of suicidal ideation, behaviors, actual attempts, or completed suicides. Pharmacotherapies such as varenicline, bupropion, and nicotine replacement, and CBTs, including contextual CBT interventions, have been found to help reduce smoking rates and promote and maintain abstinence. Suicidality risks, while present when trying to quit smoking, do not appear to demonstrate a consistent or significant rise associated with use of any particular smoking cessation pharmacotherapy or CBT/contextual CBT intervention reviewed.
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Affiliation(s)
- J Kim Penberthy
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - J Morgan Penberthy
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Marcus R Harris
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sonali Nanda
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jennifer Ahn
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Caridad Ponce Martinez
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Apule O Osika
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Zoe A Slepian
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - J Andrew Starr
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Joshua N Hook
- Department of Psychology, University of North Texas, Denton, TX, USA
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