301
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Popescu G, Negrei C, Bălălău D, Ciobanu AM, Baconi D. The relevance of the psychological evaluation in drug dependence. J Med Life 2014; 7 Spec No. 3:120-2. [PMID: 25870708 PMCID: PMC4391414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Psychological interventions are considered a central part of the individual psychotherapy in the rehabilitation counseling of psychiatrically symptomatic drug-dependent patients during methadone maintenance treatment in community programs. The need for psychological counseling should be evaluated for each individual patient. Medication is an important part of the treatment and individual psychotherapy focuses on the reduction or total cessation of drug use. The Recipient is G.M. 31, sentenced to a seven-year term of imprisonment for trafficking and use of and high-risk drugs, diagnosed on admission with opioid and methadone dependence, withdrawal syndrome. Following the observation and psychological evaluation, psychiatric and clinical examination, initiation of methadone substitution treatment was recommended, according to the following regimen: twelve 2.5 mg tablets for the first 2 days, followed by increase with about 5 mg per week until the complete remission of withdrawal symptoms, stabilization of the dose but not exceeding 200 mg methadone hydrochloride per day. Specialist monitoring, specialized counseling and individual and group psychotherapy were provided.
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Affiliation(s)
- G Popescu
- Department of Toxicology, “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania
| | - C Negrei
- Department of Toxicology, “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania
| | - D Bălălău
- Department of Toxicology, “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania
| | - AM Ciobanu
- Department of Drug Control, “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania
| | - D Baconi
- Department of Toxicology, “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania
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302
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Sorsdahl K, Stein DJ, Carrara H, Myers B. Problem solving styles among people who use alcohol and other drugs in South Africa. Addict Behav 2014; 39:122-6. [PMID: 24090621 DOI: 10.1016/j.addbeh.2013.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/15/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
The present study examines the relationship between problem-solving styles, socio-demographic variables and risk of alcohol and other drug (AOD)-related problems among a South African population. The Social Problem-Solving Inventory-Revised, Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were administered to a convenience sample of 1000 respondents. According to the ASSIST, 32% and 49% of respondents met criteria for moderate to high risk of alcohol use and illicit drug use respectively. After adjusting for the effects of other variables in the model, respondents who were of "Coloured" ancestry (PR=1.20, 95% CI 1.0-1.4), male (PR=1.19, 95% CI 1.04-1.37), older (PR=1.01, 95% CI 1.00-1.02), who adopted an avoidance style of coping with problems (PR=1.03, 95% CI 1.01-1.05) and who met criteria for depression (PR=1.42, 95% CI 1.12-1.79) were more likely to be classified as having risky AOD use. This suggests that interventions to improve problem solving and provide people with cognitive strategies to cope better with their problems may hold promise for reducing risky AOD use.
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303
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Shrier LA, Rhoads AM, Fredette ME, Burke PJ. "Counselor in Your Pocket": Youth and Provider Perspectives on a Mobile Motivational Intervention for Marijuana Use. Subst Use Misuse 2014; 49:134-144. [PMID: 24000892 DOI: 10.3109/10826084.2013.824470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Previous interventions for marijuana use have been administered out of the real-life contexts in which use occurs. In 2010, we interviewed youth aged 15-24 years who use marijuana frequently (n = 8) and providers who treat them (n = 6) on the acceptability and utility of a mobile intervention involving momentary self-monitoring of use-related contexts and responsive motivational messaging following clinic-based brief motivational enhancement therapy. Thematic analysis was used to examine youth and provider perspectives on the mobile intervention. Results suggest that mobile technology is a promising tool for brief interventions to reduce youth marijuana use and warrants further development.
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Affiliation(s)
- Lydia A Shrier
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
| | - Amanda M Rhoads
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
| | - Meghan E Fredette
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
| | - Pamela J Burke
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
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304
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Kim H. Exercise rehabilitation for smartphone addiction. J Exerc Rehabil 2013; 9:500-5. [PMID: 24409425 PMCID: PMC3884868 DOI: 10.12965/jer.130080] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 12/19/2013] [Accepted: 12/23/2013] [Indexed: 12/22/2022] Open
Abstract
Internet addiction after launching smartphone is becoming serious. Therefore this paper has attempted to sketch out the diverse addiction treatment and then check the feasibility of exercise rehabilitation. The reason to addict the internet or smartphone is personalized individual characters related personal psychological and emotional factors and social environmental factors around them. We have shown that 2 discernible approaches due to 2 different addiction causes: that is behavioral treatment and complementary treatment. In the behavioral treatment, cognitive behavioral approach (CBT) is representative methods for changing additive thoughts and behaviors. Motivational interviewing (MI) is also the brief approach for persons not ready to change their behavior. Mindfulness behavioral cognitive treatment (MBCT) also the adapted treatment based on CBT. There are different types following the emphatic point, mindfulness-based relapse prevention (MBRP) or mindfulness oriented recovery enhancement (MORE). It is apparent that therapeutic recreation, music therapy using drumming activity, and art therapy are useful complementary treatment. Exercise rehabilitation contained the systematic procedures and comprehensive activities compared to previous addiction treatments by contents and techniques. Exercise rehabilitation can treat both physical symptoms at first and mental problems in the next step. So more evidence-based exercise rehabilitation researches need to do, but it is highly probable that exercise rehab can apply for smartphone addiction.
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Affiliation(s)
- Hyunna Kim
- Department of Social Welfare, Cheongam College, Suncheon, Korea
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305
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Abstract
After decades of defining which behavioral treatments are effective for treating addictions, the focus has shifted to exploring how these treatments work, how best to disseminate and implement them in the community, and what underlying factors can be manipulated in order to increase the rates of treatment success. These pursuits have led to advances in our understanding of the mechanisms of treatment effects, the incorporation of technology into the delivery of current treatments and development of novel applications to support relapse prevention, as well as the inclusion of neurocognitive approaches to target the automatic and higher-order processes underlying addictive behaviors. Although such advances have the promise of leading to better treatments for more individuals, there is still much work required for these promises to be realized. The following review will highlight some of these recent developments and provide a glimpse into the future of behavioral treatments.
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Affiliation(s)
- Brian D. Kiluk
- Corresponding Author Phone: (203) 974-5736 Fax: (203) 974-5790
| | - Kathleen M. Carroll
- Yale School of Medicine, Department of Psychiatry 950 Campbell Ave (151D) West Haven, CT 06516 Phone: (203) 932-5711x7403 Fax: (203) 937-3486
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306
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Konova AB, Moeller SJ, Goldstein RZ. Common and distinct neural targets of treatment: changing brain function in substance addiction. Neurosci Biobehav Rev 2013; 37:2806-17. [PMID: 24140399 PMCID: PMC3859814 DOI: 10.1016/j.neubiorev.2013.10.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/17/2013] [Accepted: 10/08/2013] [Indexed: 01/28/2023]
Abstract
Neuroimaging offers an opportunity to examine the neurobiological effects of therapeutic interventions for human drug addiction. Using activation likelihood estimation, the aim of the current meta-analysis was to quantitatively summarize functional neuroimaging studies of pharmacological and cognitive-based interventions for drug addiction, with an emphasis on their common and distinct neural targets. More exploratory analyses also contrasted subgroups of studies based on specific study and sample characteristics. The ventral striatum, a region implicated in reward, motivation, and craving, and the inferior frontal gyrus and orbitofrontal cortex, regions involved in inhibitory control and goal-directed behavior, were identified as common targets of pharmacological and cognitive-based interventions; these regions were observed when the analysis was limited to only studies that used established or efficacious interventions, and across imaging paradigms and types of addictions. Consistent with theoretical models, cognitive-based interventions were additionally more likely to activate the anterior cingulate cortex, middle frontal gyrus, and precuneus, implicated in self-referential processing, cognitive control, and attention. These results suggest that therapeutic interventions for addiction may target the brain structures that are altered across addictions and identify potential neurobiological mechanisms by which the tandem use of pharmacological and cognitive-based interventions may yield synergistic or complementary effects. These findings could inform the selection of novel functional targets in future treatment development for this difficult-to-treat disorder.
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Affiliation(s)
- Anna B. Konova
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794
| | - Scott J. Moeller
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029
| | - Rita Z. Goldstein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029
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307
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Blodgett JC, Maisel NC, Fuh IL, Wilbourne PL, Finney JW. How effective is continuing care for substance use disorders? A meta-analytic review. J Subst Abuse Treat 2013; 46:87-97. [PMID: 24075796 DOI: 10.1016/j.jsat.2013.08.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 01/20/2023]
Abstract
Given the often chronic nature of substance use disorders, patients sometimes receive less intensive continuing care following an initial period of more intensive treatment. This meta-analysis estimated the effect of continuing care and formally tested several proposed moderators (intervention duration, intensity, modality, and setting) of that effect. A systematic search identified 33 controlled trials of continuing care; 19 included a no/minimal treatment condition and were analyzed to assess the overall effect of continuing care versus control. Continuing care had a small, but significant, positive effect size, both at the end of the continuing care interventions (g=0.187, p<0.001) and at follow-up (g=0.271, p<0.01). Limited by a small number of studies, analyses did not identify any significant moderators of overall effects. These results show that continuing care can provide at least modest benefit after initial treatment. We discuss study characteristics that may have reduced the magnitude of the overall continuing care effect estimate.
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Affiliation(s)
- Janet C Blodgett
- Center for Health Care Evaluation, VA Palo Alto Health Care System (152MPD), 795 Willow Rd., Menlo Park, CA 94025, USA.
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308
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Finnell DS, Nowzari S. Providing information about the neurobiology of alcohol use disorders to close the 'referral to treatment gap'. Nurs Clin North Am 2013; 48:373-83, v. [PMID: 23998764 DOI: 10.1016/j.cnur.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Only a small proportion of the 18 million Americans who could benefit from alcohol treatment actually receive it. Disseminating information on the neurobiological base of alcohol disorders may be useful in removing the prevailing barriers to accepting a referral to alcohol treatment. Nurses, guided by a set of clinical strategies known as screening, brief intervention, and referral to treatment, can be instrumental in closing this treatment gap.
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Affiliation(s)
- Deborah S Finnell
- School of Nursing, Johns Hopkins University, 525 N Wolfe street, Baltimore, MD 21205, USA.
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309
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Garland EL, Froeliger B, Zeidan F, Partin K, Howard MO. The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways. Neurosci Biobehav Rev 2013; 37:2597-607. [PMID: 23988582 DOI: 10.1016/j.neubiorev.2013.08.006] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/15/2013] [Indexed: 12/19/2022]
Abstract
Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.
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Affiliation(s)
- Eric L Garland
- Supportive Oncology & Survivorship Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States; College of Social Work, University of Utah, Salt Lake City, UT, United States.
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310
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Alcohol consumption, alcohol dependence, and related mortality in Italy in 2004: effects of treatment-based interventions on alcohol dependence. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:21. [PMID: 23758914 PMCID: PMC3686709 DOI: 10.1186/1747-597x-8-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/18/2013] [Indexed: 11/10/2022]
Abstract
Background The tradition of consuming alcohol has long been a part of Italian culture and is responsible for a large health burden. This burden may be reduced with effective interventions, one of the more important of which is treatment for Alcohol Dependence (AD). The aim of this article is to estimate the burden of disease in Italy attributable to alcohol consumption, heavy alcohol consumption, and AD. An additional aim of this paper is to examine the effects of increasing the coverage of treatment for AD on the alcohol-attributable burden of disease. Methods Alcohol-attributable deaths and the effects of treatments for AD were estimated using alcohol-attributable fractions and simulations. Deaths, potential years of life lost, years lived with disability, and disability adjusted life years lost were obtained for 2004 for Italy and for the European Union from the Global Burden of Disease study. Alcohol consumption data were obtained from the Global Information System on Alcohol and Health. The prevalences of current drinkers, former drinkers, and lifetime abstainers were obtained from the GENder Alcohol and Culture International Study. The prevalence of AD was obtained from the World Mental Health Survey. Alcohol relative risks were obtained from various meta-analyses. Results 5,320 deaths (1,530 female deaths; 3,790 male deaths) or 5.9% of all deaths (4.9% of all female deaths; 6.3% of all male deaths) of people 15 to 64 years of age were estimated to be alcohol-attributable. Of these deaths, 74.5% (61.3% for females; 79.8% for males) were attributable to heavy drinking, and 26.9% (25.6% for females; 27.5% for males) were attributable to AD. Increasing pharmacological AD treatment coverage to 40% would result in an estimated reduction of 3.3% (50 deaths/year) of all female and 7.6% (287 deaths/year) of all male alcohol-attributable deaths. Conclusions Alcohol was responsible for a large proportion of the burden of disease in Italy in 2004. Increasing treatment coverage for AD in Italy could reduce that country’s alcohol-attributable burden of disease.
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311
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Feldstein Ewing SW, Chung T. Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: emerging translational approaches that bridge biology and behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:329-35. [PMID: 23815447 PMCID: PMC3864922 DOI: 10.1037/a0031491] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real-time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examine brain-based mechanisms of change, whereas others examine brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors.
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Affiliation(s)
- Sarah W Feldstein Ewing
- University Honors College/University of New Mexico Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, NM 87131, USA.
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312
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Abstract
Objective: Review the literature to evaluate the evidence for effective treatment to mitigate substance misuse and substance use disorders (SUD) following traumatic brain injury (TBI).Design: Systematic review.Data source: Scopus.Study eligibility criteria: A study was considered eligible for review if (a) the intended population specifically included persons with TBI; (b) the experimental intervention targeted misuse of alcohol, illegal drugs or prescription drugs; (c) the intervention was compared to the standard of care, control or another intervention; (d) the outcomes under study included substance use or misuse; and (e) the study design was a controlled trial.Results: Six studies were identified that met the inclusion criteria. Three studies were conducted during the acute phase of recovery using brief interventions, while the remaining three were conducted with individuals in the post-acute phase (usually several years post-injury) using more intensive treatment. All studies were found to be vulnerable to bias due to methodological weaknesses.Conclusions: While firm conclusions could not be drawn from the results of the studies, each study provided important information about the challenges to conducting SUD intervention trials with persons with TBI. The choices researchers will have to make to address these challenges are delineated.
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313
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Computer simulation games as an adjunct for treatment in male veterans with alcohol use disorder. J Subst Abuse Treat 2013; 44:316-22. [DOI: 10.1016/j.jsat.2012.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 07/30/2012] [Accepted: 08/08/2012] [Indexed: 11/16/2022]
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314
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Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union. Eur Neuropsychopharmacol 2013; 23:89-97. [PMID: 22920734 DOI: 10.1016/j.euroneuro.2012.08.001] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/02/2012] [Indexed: 12/23/2022]
Abstract
Alcohol consumption is a major risk factor for the burden of disease, and Alcohol Dependence (AD) is the most important disorder attributable to this behavior. The objective of this study was to quantify mortality associated with AD and the potential impact of treatment. For the EU countries, for the age group 15-64 years, mortality attributable to alcohol consumption in general, to heavy drinking, and to AD were estimated based on the latest data on exposure and mortality. Potential effects of AD treatment were modeled based on Cochrane and other systematic reviews of the effectiveness of the best known and most effective interventions. In the EU 88.9% of men and 82.1% of women aged 15-64 years were current drinkers; and 15.3% of men and 3.4% of women in this age group were heavy drinkers. AD affected 5.4% of men and 1.5% of women. The net burden caused by alcohol consumption was 1 in 7 deaths in men and 1 in 13 deaths in women. The majority of this burden was due to heavy drinking (77%), and 71% of this burden was due to AD. Increasing treatment coverage for the most effective treatments to 40% of all people with AD was estimated to reduce alcohol-attributable mortality by 13% for men and 9% for women (annually 10,000 male and 1700 female deaths avoided). Increasing treatment rates for AD was identified as an important issue for future public health strategies to reduce alcohol-attributable harm and to complement the current focus of alcohol policy.
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315
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Sundell K, Ferrer-Wreder L, Fraser MW. Going Global: A Model for Evaluating Empirically Supported Family-Based Interventions in New Contexts. Eval Health Prof 2013; 37:203-30. [PMID: 23291390 DOI: 10.1177/0163278712469813] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The spread of evidence-based practice throughout the world has resulted in the wide adoption of empirically supported interventions (ESIs) and a growing number of controlled trials of imported and culturally adapted ESIs. This article is informed by outcome research on family-based interventions including programs listed in the American Blueprints Model and Promising Programs. Evidence from these controlled trials is mixed and, because it is comprised of both successful and unsuccessful replications of ESIs, it provides clues for the translation of promising programs in the future. At least four explanations appear plausible for the mixed results in replication trials. One has to do with methodological differences across trials. A second deals with ambiguities in the cultural adaptation process. A third explanation is that ESIs in failed replications have not been adequately implemented. A fourth source of variation derives from unanticipated contextual influences that might affect the effects of ESIs when transported to other cultures and countries. This article describes a model that allows for the differential examination of adaptations of interventions in new cultural contexts.
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Affiliation(s)
- Knut Sundell
- National Board of Health and Welfare, Stockholm, Sweden
| | | | - Mark W Fraser
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
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316
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Wells EA, Kristman-Valente AN, Peavy KM, Jackson TR. Social workers and delivery of evidence-based psychosocial treatments for substance use disorders. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:279-301. [PMID: 23731420 PMCID: PMC3684208 DOI: 10.1080/19371918.2013.759033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Social workers encounter individuals with substance use disorders (SUDs) in a variety of settings. With changes in health care policy and a movement toward integration of health and behavioral health services, social workers will play an increased role vis-á-vis SUD. As direct service providers, administrators, care managers, and policy makers, they will select, deliver, or advocate for delivery of evidence-based SUD treatment practices. This article provides an overview of effective psychosocial SUD treatment approaches. In addition to describing the treatments, the article discusses empirical support, populations for whom the treatments are known to be efficacious, and implementation issues.
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Affiliation(s)
- Elizabeth A Wells
- School of Social Work and Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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317
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Bujarski S, O'Malley SS, Lunny K, Ray LA. The effects of drinking goal on treatment outcome for alcoholism. J Consult Clin Psychol 2012; 81:13-22. [PMID: 23231573 DOI: 10.1037/a0030886] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE It is well known to clinicians and researchers in the field of alcoholism that patients vary with respect to drinking goal. The objective in this study was to elucidate the contribution of drinking goal to treatment outcome in the context of specific behavioral and pharmacological interventions. METHOD Participants were 1,226 alcohol-dependent individuals enrolled in a large, multisite trial of combined behavioral intervention, acamprosate, and naltrexone. Drinking goal was coded as follows: (a) controlled drinking, (b) conditional abstinence, and (c) complete abstinence. RESULTS Analysis revealed a main effect of drinking goal on percent days abstinent (p < .0001), days to relapse to heavy drinking (p < .0001), and global clinical outcome (p < .001). These results were such that a goal of complete abstinence was associated with the best outcomes, followed by conditional abstinence; controlled drinking was associated with the poorest outcomes. Conversely, a main effect of drinking goal was observed on drinks per drinking day (p < .01), such that controlled drinking was associated with fewer drinks per drinking day whereas complete abstinence was associated with the highest number of drinks per drinking day. Combined behavioral intervention performed better than medical management alone for participants whose drinking goal was not complete abstinence. CONCLUSION These results suggest that drinking goal represents a highly predictive clinical variable and should be an integral part of the clinical assessment of patients with alcohol dependence. Assessment of patients' drinking goals may also help match patients to interventions best suited to address their goals and clinical needs.
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Affiliation(s)
- Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA
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318
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Timko C, Valenstein H, Lin PY, Moos RH, Stuart GL, Cronkite RC. Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs. Subst Abuse Treat Prev Policy 2012; 7:37. [PMID: 22958624 PMCID: PMC3489609 DOI: 10.1186/1747-597x-7-37] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems. METHODS We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse. RESULTS Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program's mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs. CONCLUSIONS SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training.
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Affiliation(s)
- Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford, University Medical Center, Palo Alto, CA, USA
- Center for Health Care Evaluation, VA Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Helen Valenstein
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Patricia Y Lin
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford, University Medical Center, Palo Alto, CA, USA
| | - Rudolf H Moos
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford, University Medical Center, Palo Alto, CA, USA
| | - Gregory L Stuart
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Ruth C Cronkite
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford, University Medical Center, Palo Alto, CA, USA
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Yonkers KA, Forray A, Howell HB, Gotman N, Kershaw T, Rounsaville BJ, Carroll KM. Motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice: a randomized trial for treatment of hazardous substance use in pregnancy and after delivery. Gen Hosp Psychiatry 2012; 34:439-49. [PMID: 22795046 PMCID: PMC3428516 DOI: 10.1016/j.genhosppsych.2012.06.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/05/2012] [Accepted: 06/05/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective was to compare the efficacy of motivational enhancement therapy coupled with cognitive behavioral therapy (MET-CBT) to brief advice for treatment of substance use in pregnancy. METHOD This was a randomized, parallel, controlled trial that was yoked to prenatal care and delivered at hospital outpatient clinics. We enrolled 168 substance-using women who had not yet completed an estimated 28 weeks of pregnancy. Obstetrical clinicians provided brief advice, and study nurses administered manualized MET-CBT. The primary outcome was percentage of days in the prior 28 days in which alcohol and/or drugs were used immediately before and 3 months postdelivery. RESULTS There were no significant differences across groups in terms of self-reported percentage of days in which drugs or alcohol were used prior to and 3 months postdelivery. Biological measures showed similar results. There was a trend (P=.08) for lower risk of preterm birth among those who received MET-CBT. CONCLUSIONS The tested interventions had similar therapeutic effects. Hence, both treatments may be suitable for pregnant substance users, depending on the population, setting and provider availability. Interventions that are intensified after delivery may decrease postpartum "rebound" effects in substance misuse.
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Affiliation(s)
- Kimberly A. Yonkers
- Departments of Psychiatry and, Obstetrics, Gynecology and Reproductive Sciences and the School of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA 06510
| | - Ariadna Forray
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA 06510
| | - Heather B. Howell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA 06510
| | - Nathan Gotman
- Department of Psychiatry, Yale University School of Medicine New Haven, CT, USA 06510
| | - Trace Kershaw
- School of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA 06510
| | | | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA 06510
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320
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Ondersma SJ, Winhusen T, Lewis DF. Pre-treatment change in a randomized trial with pregnant substance-abusing women in community-based outpatient treatment. Contemp Clin Trials 2012; 33:1074-9. [PMID: 22710564 PMCID: PMC3415274 DOI: 10.1016/j.cct.2012.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/16/2012] [Accepted: 06/08/2012] [Indexed: 11/19/2022]
Abstract
Participants in clinical trials of interventions for substance use frequently show substantial pre-treatment reductions in use. However, pre-treatment change has not been studied among pregnant women, a group with unique motivational characteristics. It is also not clear whether pre-treatment reduction in substance use can be clearly linked to research activities such as pre-treatment assessment, or if it is the result of more general factors such as the decision to seek treatment. Using an interrupted longitudinal design, we evaluated pre-treatment change among 148 pregnant women, all of whom had completed a clinical trial comparing motivational enhancement therapy to treatment as usual. When baseline period was compared to the period after randomization and before treatment, the change in substance use was substantial (dropping from an average of substance use on 30.5% of days during baseline to 16.7% of days during the pre-treatment phase; p<.001), and was greater in magnitude than change following initiation of study-related treatment. Further, this reduction was significant after controlling for a longitudinal time effect and did not apply to tobacco use. These findings suggest that change following pre-treatment research activities is independent of the decision to seek treatment and is present even among pregnant women, many of whom have already reduced their substance use. These findings also suggest the possible need for re-evaluation of the nature and causes of behavior change, as well as trial design, in clinical trials for substance abuse.
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321
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Brown C. Can 12 step fellowship and cognitive behaviour therapy work together? A hypothesis on an integrated treatment approach for mild dual diagnosis. ADVANCES IN DUAL DIAGNOSIS 2012. [DOI: 10.1108/17570971211253694] [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
PurposeThe purpose of this paper is to investigate research in the field of addictions utilising CBT and 12 step fellowship methods and to create an evidence base for an integrated treatment method utilising both approaches.Design/methodology/approachResearch on CBT and 12 step fellowships and their current applications in addiction treatment are presented. Models of severe mental illness are referenced and the use of directive and guided referrals are used as a basis to build the paper's hypothesis. A mode of action how the treatments may work together is presented.FindingsFindings indicate that guided treatment approaches for dual diagnosis are more likely to lead to long term therapeutic gains. Discussion involves the practical implications of this treatment and its ability to create a synergistic approach.Practical implicationsImplications include the potential for streamlined treatment approaches which have the potential to increase treatment adherence and outcomes. Implications, such as the joint use of social reinforcement techniques between 12 step fellowship approaches and CBT, are also discussed.Originality/valueThere is no previous research on the application of CBT and 12 step treatment modalities working together in a structured manner. Previous work has focussed primarily on severe mental illness. The current paper aims to provide an approach to treatment which utilises several modes of treatment to create more robust treatments for people suffering from dual diagnoses.
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322
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Baker AL, Thornton LK, Hiles S, Hides L, Lubman DI. Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review. J Affect Disord 2012; 139:217-29. [PMID: 21890213 DOI: 10.1016/j.jad.2011.08.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 08/01/2011] [Accepted: 08/01/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Depression, anxiety and alcohol misuse frequently co-occur. While there is an extensive literature reporting on the efficacy of psychological treatments that target depression, anxiety or alcohol misuse separately, less research has examined treatments that address these disorders when they co-occur. We conducted a systematic review to determine whether psychological interventions that target alcohol misuse among people with co-occurring depressive or anxiety disorders are effective. DATA SOURCES We systematically searched the PubMed and PsychINFO databases from inception to March 2010. Individual searches in alcohol, depression and anxiety were conducted, and were limited to 'human' published 'randomized controlled trials' or 'sequential allocation' articles written in English. STUDY SELECTION We identified randomized controlled trials that compared manual guided psychological interventions for alcohol misuse among individuals with depressive or anxiety disorders. Of 1540 articles identified, eight met inclusion criteria for the review. DATA EXTRACTION From each study, we recorded alcohol and mental health outcomes, and other relevant clinical factors including age, gender ratio, follow-up length and drop-out rates. Quality of studies was also assessed. DATA SYNTHESIS Motivational interviewing and cognitive-behavioral interventions were associated with significant reductions in alcohol consumption and depressive and/or anxiety symptoms. Although brief interventions were associated with significant improvements in both mental health and alcohol use variables, longer interventions produced even better outcomes. CONCLUSIONS There is accumulating evidence for the effectiveness of motivational interviewing and cognitive behavior therapy for people with co-occurring alcohol and depressive or anxiety disorders.
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Affiliation(s)
- Amanda L Baker
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia.
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323
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Martin GW, Rehm J. The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: a review of the evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:350-8. [PMID: 22682572 DOI: 10.1177/070674371205700604] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our objectives were to review the effectiveness of psychosocial modalities in the treatment of alcohol use disorders and problems, and to examine the impact of therapists on treatment outcome, the evidence on best practices for comorbid conditions, and the evidence on treatment matching. We based our review on published systematic reviews of this topic after 2000. There is strong evidence that some, but not all, psychosocial treatments are effective in treating alcohol problems. Those with the strongest empirical support are motivational enhancement therapy, various cognitive-behavioural interventions, and brief interventions. Meta-analyses for several of these modalities suggest typical effect sizes in the low-to-moderate range. When these modalities have been compared with one another in well-designed clinical trials, they have been shown to be of comparable effectiveness. There is little basis on which to recommend one of these modalities over another but good reason to select from among them.
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Affiliation(s)
- Garth W Martin
- Addiction Consultant Services, Clarksburg, Ontario, Canada
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324
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Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B. Cannabinoid Hyperemesis Syndrome: A Case Series and Review of Previous Reports. PSYCHOSOMATICS 2012; 53:212-9. [DOI: 10.1016/j.psym.2012.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 10/28/2022]
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325
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Kelly PJ, Kay-Lambkin FJ, Baker AL, Deane FP, Brooks AC, Mitchell A, Marshall S, Whittington M, Dingle GA. Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment. BMC Public Health 2012; 12:113. [PMID: 22325594 PMCID: PMC3306755 DOI: 10.1186/1471-2458-12-113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A large proportion of people attending residential alcohol and other substance abuse treatment have a co-occurring mental illness. Empirical evidence suggests that it is important to treat both the substance abuse problem and co-occurring mental illness concurrently and in an integrated fashion. However, the majority of residential alcohol and other substance abuse services do not address mental illness in a systematic way. It is likely that computer delivered interventions could improve the ability of substance abuse services to address co-occurring mental illness. This protocol describes a study in which we will assess the effectiveness of adding a computer delivered depression and substance abuse intervention for people who are attending residential alcohol and other substance abuse treatment. METHODS/DESIGN Participants will be recruited from residential rehabilitation programs operated by the Australian Salvation Army. All participants who satisfy the diagnostic criteria for an alcohol or other substance dependence disorder will be asked to participate in the study. After completion of a baseline assessment, participants will be randomly assigned to either a computer delivered substance abuse and depression intervention (treatment condition) or to a computer-delivered typing tutorial (active control condition). All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based treatment facility. Randomisation will be stratified by gender (Male, Female), length of time the participant has been in the program at the commencement of the study (4 weeks or less, 4 weeks or more), and use of anti-depressant medication (currently prescribed medication, not prescribed medication). Participants in both conditions will complete computer sessions twice per week, over a five-week period. Research staff blind to treatment allocation will complete the assessments at baseline, and then 3, 6, 9, and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period. DISCUSSION This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioral therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000618954.
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Affiliation(s)
- Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong 2522, Australia
| | - Frances J Kay-Lambkin
- National Drug and Alcohol Research Centre, University of New South Wales, King Steet, Sydney 2052, Australia
| | - Amanda L Baker
- Centre for Brain and Mental Health Research, University Drive University of Newcastle, Callaghan 2308, Australia
| | - Frank P Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong 2522, Australia
| | - Adam C Brooks
- Treatment Research Institute, Independence Mall West, Philadelphia 19106, USA
| | - Alexandra Mitchell
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong 2522, Australia
| | - Sarah Marshall
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong 2522, Australia
| | - Meredith Whittington
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong 2522, Australia
| | - Genevieve A Dingle
- School of Psychology, University of Queensland, Sir Fred Schonell Drive, Brisbane 4072, Australia
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326
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Burraston BO, Cherrington DJ, Bahr SJ. Reducing juvenile recidivism with cognitive training and a cell phone follow-up: an evaluation of the realvictory program. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2012; 56:61-80. [PMID: 21131310 DOI: 10.1177/0306624x10388635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this research was to evaluate the effects of a cognitive training and cell phone intervention on the recidivism of 70 juvenile offenders. Median days to rearrest were 106 for the control group, 191 for the class-only group, and 278 for the class plus cell phone group. Using rearrest as the survival criterion, the survival ratios of the class-only and class plus cell phone groups were 2.64 and 2.94 times longer than the control group, respectively. After controlling for gender, prior arrests, and risk score, the Poisson regression indicated that the class-only and class plus cell phone groups were 51% lower in total arrests than the control group. These results suggest that cognitive training supplemented with a cell phone coach is an effective and cost-efficient intervention for reducing recidivism.
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Affiliation(s)
- Bert O Burraston
- Department of Sociology, Brigham Young University, Provo, Utah 84602, USA.
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327
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The Role of Physical Activity in Treatment of Substance Use Disorders. ISSUES IN CHILDREN'S AND FAMILIES' LIVES 2012. [DOI: 10.1007/978-1-4614-3606-5_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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328
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Papas RK, Sidle JE, Gakinya BN, Baliddawa JB, Martino S, Mwaniki MM, Songole R, Omolo OE, Kamanda AM, Ayuku DO, Ojwang C, Owino-Ong'or WD, Harrington M, Bryant KJ, Carroll KM, Justice AC, Hogan JW, Maisto SA. Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction 2011; 106:2156-66. [PMID: 21631622 PMCID: PMC3208780 DOI: 10.1111/j.1360-0443.2011.03518.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Dual epidemics of human immunodeficiency virus (HIV) and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted six-session gender-stratified group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV-infected out-patients in Eldoret, Kenya. DESIGN Randomized clinical trial comparing CBT against a usual care assessment-only control. SETTING A large HIV out-patient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration. PARTICIPANTS Seventy-five HIV-infected out-patients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking. MEASUREMENTS Percentage of drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Time line Follow back method. FINDINGS There were 299 ineligible and 102 eligible out-patients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30-day follow-up were large [d=0.95, P=0.0002, mean difference=24.93, 95% confidence interval (CI): 12.43, 37.43 PDD; d=0.76, P=0.002, mean difference=2.88, 95% CI: 1.05, 4.70 DDD]. Randomized participants attended 93% of the six CBT sessions offered. Reported alcohol abstinence at the 90-day follow-up was 69% (CBT) and 38% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college-educated therapists in the United States. Treatment effect sizes were comparable to alcohol intervention studies conducted in the United States. CONCLUSIONS Cognitive-behavioral therapy can be adapted successfully to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV-infected Kenyan out-patients.
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Affiliation(s)
- Rebecca K Papas
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02906,USA.
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329
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Pearson FS, Prendergast ML, Podus D, Vazan P, Greenwell L, Hamilton Z. Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment. J Subst Abuse Treat 2011; 43:1-11. [PMID: 22119178 DOI: 10.1016/j.jsat.2011.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 08/26/2011] [Accepted: 10/11/2011] [Indexed: 12/01/2022]
Abstract
Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders.
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Affiliation(s)
- Frank S Pearson
- National Development and Research Institutes, Inc., NY 10010-3509, USA.
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330
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Hendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011; 6:17. [PMID: 21771314 PMCID: PMC3163190 DOI: 10.1186/1747-597x-6-17] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/19/2011] [Indexed: 11/10/2022] Open
Abstract
The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.
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Affiliation(s)
- Christian S Hendershot
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5T 1R8, Canada
| | - Katie Witkiewitz
- Department of Psychology, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686, USA
| | - William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
| | - G Alan Marlatt
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
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331
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Potenza MN, Sofuoglu M, Carroll KM, Rounsaville BJ. Neuroscience of behavioral and pharmacological treatments for addictions. Neuron 2011; 69:695-712. [PMID: 21338880 PMCID: PMC3063555 DOI: 10.1016/j.neuron.2011.02.009] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2011] [Indexed: 01/30/2023]
Abstract
Although substantial advances have been made in behavioral and pharmacological treatments for addictions, moving treatment development to the next stage may require novel ways of approaching addictions, particularly ways based on new findings regarding the neurobiological underpinnings of addictions that also assimilate and incorporate relevant information from earlier approaches. In this review, we first briefly review theoretical and biological models of addiction and then describe existing behavioral and pharmacologic therapies for the addictions within this framework. We then propose new directions for treatment development and targets that are informed by recent evidence regarding the heterogeneity of addictions and the neurobiological contributions to these disorders.
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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332
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Witkiewitz K, Marlatt GA. Behavioral therapy across the spectrum. ALCOHOL RESEARCH & HEALTH : THE JOURNAL OF THE NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM 2011; 33:313-9. [PMID: 23580016 PMCID: PMC3860542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Numerous effective behavioral therapies have been developed that can bring the treatment to the patient rather than bringing the patient to treatment. These behavioral therapy techniques, which can provide effective treatment across the spectrum of severity of alcohol abuse disorders, include facilitated self-change, individual therapies, couples and family approaches, and contingency management. New methods of delivery and successful adjuncts to existing behavioral treatments also have been introduced, including computerized cognitive-behavioral treatments, Web-based guided self-change, and mindfulness-based approaches. Although a wide variety of behavioral approaches have been shown to have good efficacy, choosing the treatment most appropriate for a given patient remains a challenge.
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333
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Gunzerath L, Hewitt BG, Li TK, Warren KR. Alcohol research: past, present, and future. Ann N Y Acad Sci 2010; 1216:1-23. [PMID: 21182533 DOI: 10.1111/j.1749-6632.2010.05832.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Created forty years ago, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has played a major role in the great strides made in the understanding, treatment, prevention, and public acceptance of alcohol-use disorders. Throughout most of U.S. history "habitual drunkenness" was viewed as a problem of moral degeneracy or character flaw inherent in the individual. However, the wealth of scientific evidence amassed throughout NIAAA's history has established alcoholism as a medical condition, that is, as a disease for which affected individuals should feel no shame or be treated with disdain. We look at the developments in alcohol epidemiology, typology, etiology, prevention, and treatment research over the past 40 years. We also discuss how NIAAA addresses alcohol disorders from a life-course framework, affecting all stages of the lifespan, from fetus through child, adolescent, and young adult, to midlife/senior adult, with each stage involving different risks, consequences, prevention efforts, and treatment strategies.
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Affiliation(s)
- Lorraine Gunzerath
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland 20892, USA.
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334
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Abstract
Cognitive behavioral therapy (CBT) for substance use disorders has shown efficacy as a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts. Although CBT for substance abuse is characterized by heterogeneous treatment elements such as operant learning strategies, cognitive and motivational elements, and skills-building interventions, across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. These elements, and support for their efficacy, are discussed.
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Affiliation(s)
- R Kathryn McHugh
- Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA.
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335
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Abstract
Obesity and binge eating disorder are detrimental health conditions that are associated with lower qualities of life. Individuals with obesity often face societal discrimination and frequently experience related medical disorders such as diabetes, hypertension, and hyperlipidemia. Current research suggests neurobiological similarities between obesity, binge eating disorder, and substance dependence. In addition, behavioral similarities link the two conditions; obese and substance dependent individuals often report similar features such as loss of control towards food or substances, respectively, and cravings. Treatment options for obesity have begun to use this information to formulate pharmacological and therapeutic interventions that may provide greater results for weight loss and decreased binge frequency. Similarly, treatment approaches to substance addictions should consider aspects of weight management. Findings from research and treatment studies are presented with the aim of reviewing the current literature of obesity within the context of an addiction framework and providing information on empirically supported approaches to the treatment of co-occurring obesity and substance addiction.
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Affiliation(s)
- Katherine A. VanBuskirk
- Department of Psychiatry, Yale University School of Medicine, 2 Church Street South, Suite 215, New Haven, CT, 06519, USA
| | - Marc N. Potenza
- Departments of Psychiatry and Child Study Center, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
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