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Rocelli M, Aquili L, Palmieri A, Romaioli D, Ferrari L, Faccio E. 'But … Would I Be Able to Toast With Friends?' When Service Users Ask for New Care Pathways. Health Expect 2024; 27:e14148. [PMID: 39238199 PMCID: PMC11377498 DOI: 10.1111/hex.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION The WHO European Mental Health Action Plan (2013-2030) emphasises the need to generate services that are more inclusive and attentive to the co-construction of care practices. This exploratory research investigates the needs of young substance abusers shown during their stay in residential communities; in particular, it explores the idea that treatment may include a new phase focused on how to manage moderate or controlled alcohol intake during residential care. Interviews with young ex-users open up critical reflections on complete abstinence programmes from all substances, including alcohol, as a prerequisite for discharge and also provide examples of how to co-design a plan for mindful drinking. METHODS Fourteen young adults, aged 19-32 years, non-alcoholists, treated at rehab in Fermo, in central Italy, were interviewed during a programme between 6 and 18 months of period. They were asked about exploring needs in preparation for the conclusion of the rehabilitation pathway. From this exploration emerged the need to introduce controlled alcohol intake during the rehabilitation stay. This request became the focus of the semi-structured interviews. RESULTS Three main themes emerged, which are as follows: (1) difficulties in integrating the new identity with the past of consumption, (2) resistance to the idea of total abstinence in social relations and (3) uncertainties about post-community behaviour regarding alcohol intake. At the same time, three unexpected needs were expressed: (1) test the personal knowledge and skills on how to manage the alcohol intake, (2) receive support during the residential path to build up self-control competence given the post-discharge period and (3) build a personalised therapeutic path together with the supervisor and the operators while still at the rehab, according to the realistic lifestyle and routine outside the rehab. CONCLUSIONS This research highlights the importance of personalising treatment based on each user's needs, going far beyond the standardised treatments for users previously considered unable of self-control and self-determination. For that purpose, the relationship between the users and the operators might be privileged, as it is able to cover the specific needs aimed for the new identity. INVOLVING THE PARTICIPANTS The research sparked a discussion within the community, involving and initiating an open dialogue between the operators and the users, allowing them to focus on certain innovative strategies offered by the service, putting the users' needs at the very centre of the attention. The results were compared and discussed actively with the participants involved.
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Affiliation(s)
- Michele Rocelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Ludovica Aquili
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Arianna Palmieri
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Diego Romaioli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Lea Ferrari
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Elena Faccio
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
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Foley J, Batchelder AW, Bernier L, Glynn T, Moskowitz J, Carrico A. Facets of mindfulness are associated with inflammation biomarkers in a sample of sexual minority men with HIV. PSYCHOL HEALTH MED 2024:1-16. [PMID: 39315986 DOI: 10.1080/13548506.2024.2407445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/15/2024] [Indexed: 09/25/2024]
Abstract
Sexual minority men (SMM) are disproportionately impacted by HIV and thus, HIV related-health complications. HIV has been linked to earlier onset of multi-morbid chronic diseases and declines in physical and cognitive functioning attributable to chronic HIV immune activation and resulting inflammation. Inflammation has been targeted with mindfulness-based interventions (MBIs); however, hypothesized negative associations between mindfulness and inflammation need to be confirmed in SMM with HIV. This is a secondary data analysis of baseline data from a randomized clinical trial (RCT) of SMM living with HIV with biologically confirmed recent methamphetamine use (ARTEMIS). Mindfulness was assessed with the Five Factor Mindfulness Questionnaire (FFMQ). Inflammation was assessed via cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Separate adjusted (for age, viral load, CD4 count, and methamphetamine use) regression models evaluated associations between four facets of mindfulness (description, awareness, non-judgement, and non-reactivity) with IL-6 and TNF-α. The average age of the participants was 43.86 (SD = 8.95). Both description (b = .54, se = .24) and awareness (b = .50, se=.23) were positively associated with IL-6. All other associations between mindfulness and inflammation were non-significant in adjusted models. There was also some evidence to suggest that engagement in care moderated associations between description and non-reactivity with IL-6 (ΔR2 = .03, F = 3.64), such that description and non-reactivity were each positively associated with inflammation among those who attended <100% of primary care appointments (b = 1.04, se=.34 and b = 1.23, se=.39, respectively), but was not associated with inflammation among those who attended 100% of appointments (b =.16, se=.32 and b=-.17, se=.40, respectively). There was also a significant interaction between 12-step program attendance and awareness with IL-6 (ΔR2= .03, F = 4.26), such that awareness was positively associated with inflammation among those who attended 12-step programming (b = 1.25, se = .41), but not associated with inflammation among those who did not (b = .22, se = .28). Further research is needed to understand how and under what circumstances mindfulness is associated with pro- versus anti-inflammatory processes.Trial Registration: NCT01926184.
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Affiliation(s)
- Jacklyn Foley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Bernier
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, Boston University, Boston, MA, USA
| | - Tiffany Glynn
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith Moskowitz
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Adam Carrico
- Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
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Wang T, Ma Y, Du X, Li C, Peng Z, Wang Y, Zhou H. Digital interventions for autism spectrum disorders: A systematic review and meta-analysis. Pediatr Investig 2024; 8:224-236. [PMID: 39347529 PMCID: PMC11427904 DOI: 10.1002/ped4.12417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 10/01/2024] Open
Abstract
Importance Digital technology is now widely available for the interventions of autism, but its validity and feasibility remain to be proved. Objective This study aimed to investigate the effectiveness of digital health interventions (DHIs) in improving core symptoms or intelligence quotient in patients with autism spectrum disorder (ASD). Methods Three databases including PubMed, Cochrane, and Scopus, were searched on November 15, 2022. Randomized clinical trials that enrolled patients with ASD who received DHIs and a control group without DHI treatment were included. Cochrane risk of bias tool (RoB 2) was applied to assess the risk of bias. Results A total of 33 studies, involving 1285 participants (658 [51.2%] in DHI groups and 627 [48.8%] in control groups), were analyzed to investigate the differences between DHI groups and control groups. Significantly greater improvements in the overall performance of ASD were observed in the DHI groups compared to the control groups (including active, waitlist, treatment-as-usual, and no treatment) with an effect size of 1.89 (Cohen's d 95% confidence interval [CI]: 1.26-2.52). Studies with treatment-as-usual, waitlist, and no treatment control demonstrated large effect sizes of Cohen's d 3.41 (95% CI: 0.84-5.97), Cohen's d 4.27 (95% CI: 1.95-6.59), and Cohen's d 4.52 (95% CI: 2.98-6.06) respectively. In contrast, studies with active control revealed insignificant effect sizes (Cohen's d 0.73, 95% CI: 0.12-1.33). Interpretation This meta-analysis found significantly greater improvements in core symptoms or intelligence quotient in ASD patients receiving DHIs compared to those in control conditions. ASD patients may benefit from the DHIs and reduce the economic burden.
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Affiliation(s)
- Tianqi Wang
- Department of Neurology National Children's Medical Center, Children's Hospital of Fudan University Shanghai China
| | - Yu Ma
- Department of Neurology National Children's Medical Center, Children's Hospital of Fudan University Shanghai China
| | - Xiaonan Du
- Department of Neurology National Children's Medical Center, Children's Hospital of Fudan University Shanghai China
| | - Chunpei Li
- Department of Neurology National Children's Medical Center, Children's Hospital of Fudan University Shanghai China
| | - Zhongbi Peng
- Department of Neurological Rehabilitation Guizhou Branch of Shanghai Children's Medical Center Shanghai Jiao Tong University School of Medicine Guizhou China
| | - Yi Wang
- Department of Neurology National Children's Medical Center, Children's Hospital of Fudan University Shanghai China
| | - Hao Zhou
- Department of Neurological Rehabilitation Guizhou Branch of Shanghai Children's Medical Center Shanghai Jiao Tong University School of Medicine Guizhou China
- Department of Pediatrics Guizhou Provincial People's Hospital, Medical College of Guizhou University Guizhou China
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Lannoy S, Svikis DS, Stephenson M, Polak K, Kendler KS, Edwards AC. Personality correlates of past-year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1168-1175. [PMID: 38627204 PMCID: PMC11178444 DOI: 10.1111/acer.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a highly impairing condition with important public health impacts. Despite the availability of treatment options for AUD, research shows that few people receive treatment, and even fewer can maintain abstinence/low-drinking levels. This study investigated the role of personality traits in past-year alcohol use among individuals with severe AUD who ever attended Alcoholics Anonymous (AA), a widespread and easily accessible self-help group for alcohol problems. METHODS Univariable and multivariable regressions were performed separately in females and males with alcohol consumption as an outcome. Socioeconomic factors, genetic liability, and psychopathology were included as covariates in the analyses. RESULTS Results from the multivariable model indicated that in females who attended AA, greater alcohol use was related to both positive and negative urgency and low sensation seeking, while in males, greater alcohol use was related to positive urgency. Results also showed that, in both sexes, younger age and lower educational levels were associated with greater alcohol use. Moreover, single males and individuals with lower AUD severity were at higher risk of using alcohol in the past year. CONCLUSIONS These findings highlight sex-specific correlates of drinking in individuals with AUD who engaged in self-help groups. These findings may help to improve treatment options, as personality encompasses modifiable traits that can be targeted in psychological interventions.
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Affiliation(s)
- Séverine Lannoy
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Dace S. Svikis
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women’s Health, Virginia Commonwealth University, Richmond,VA, USA
| | - Mallory Stephenson
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Kathryn Polak
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Alexis C. Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
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Minozzi S, Saulle R, Amato L, Traccis F, Agabio R. Psychosocial interventions for stimulant use disorder. Cochrane Database Syst Rev 2024; 2:CD011866. [PMID: 38357958 PMCID: PMC10867898 DOI: 10.1002/14651858.cd011866.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Simillis C, Charalambides M, Mavrou A, Afxentiou T, Powar MP, Wheeler J, Davies RJ, Fearnhead NS. Operative blood loss adversely affects short and long-term outcomes after colorectal cancer surgery: results of a systematic review and meta-analysis. Tech Coloproctol 2023; 27:189-208. [PMID: 36138307 DOI: 10.1007/s10151-022-02701-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this meta-analysis was to assess the impact of operative blood loss on short and long-term outcomes following colorectal cancer surgery. METHODS A systematic literature review and meta-analysis were performed, from inception to the 10th of August 2020. A comprehensive literature search was performed on the 10th of August 2020 of PubMed MEDLINE, Embase, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials. Only studies reporting on operative blood loss and postoperative short term or long-term outcomes in colorectal cancer surgery were considered for inclusion. RESULTS Forty-three studies were included, reporting on 59,813 patients. Increased operative blood loss was associated with higher morbidity, for blood loss greater than 150-350 ml (odds ratio [OR] 2.09, p < 0.001) and > 500 ml (OR 2.29, p = 0.007). Anastomotic leak occurred more frequently for blood loss above a range of 50-100 ml (OR 1.14, p = 0.007), 250-300 ml (OR 2.06, p < 0.001), and 400-500 ml (OR 3.15, p < 0.001). Postoperative ileus rate was higher for blood loss > 100-200 ml (OR 1.90, p = 0.02). Surgical site infections were more frequent above 200-500 ml (OR 1.96, p = 0.04). Hospital stay was increased for blood loss > 150-200 ml (OR 1.63, p = 0.04). Operative blood loss was significantly higher in patients that suffered morbidity (mean difference [MD] 133.16 ml, p < 0.001) or anastomotic leak (MD 69.56 ml, p = 0.02). In the long term, increased operative blood loss was associated with worse overall survival above a range of 200-500 ml (hazard ratio [HR] 1.15, p < 0.001), and worse recurrence-free survival above 200-400 ml (HR 1.33, p = 0.01). Increased blood loss was associated with small bowel obstruction caused by colorectal cancer recurrence for blood loss higher than 400 ml (HR 1.97, p = 0.03) and 800 ml (HR 3.78, p = 0.02). CONCLUSIONS Increased operative blood loss may adversely impact short term and long-term postoperative outcomes. Measures should be taken to minimize operative blood loss during colorectal cancer surgery. Due to the uncertainty of evidence identified, further research, with standardised methodology, is required on this important subject.
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Affiliation(s)
- C Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - M Charalambides
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - A Mavrou
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - T Afxentiou
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - M P Powar
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N S Fearnhead
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Di Carlo F, Alessi MC, Picutti E, Pettorruso M, Martinotti G, di Giannantonio M. Online 12-step groups during the Covid-19 pandemic: A patient's perspective. EMERGING TRENDS IN DRUGS, ADDICTIONS, AND HEALTH 2022; 2:100047. [PMID: 36119451 PMCID: PMC9464309 DOI: 10.1016/j.etdah.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/28/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Following the Covid-19 pandemic, lockdown strategies have been adopted by many Governments worldwide to stop the spread of the virus. Twelve-step programs for people with substance use disorders (SUDs) as Narcotics Anonymous (NA) experienced forced interruption as well, in some cases organizing online meetings to continue their activities. The purpose of this article is to reflect on concerns and advantages of online setting for 12-step groups. METHODS We report the experience of an Italian NA participant attending for the first time an online NA group during the Covid-19 pandemic. RESULTS The strengths and limitations of the online setting, showing up from the living voice of this participant, are expressed in the light of the present pandemic situation. Together with the general advantages derived from telehealth technologies, specific benefits of the virtual setting for 12-step programs are shown. Concerns are also discussed, as those related to privacy and social presence. CONCLUSIONS The case highlights many possibilities of the online setting for 12-step programs. On the other hand, it suggests the critical importance of in-person groups to accompany the recovery process. Future outcome research is needed about the combination of these approaches.
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Affiliation(s)
- Francesco Di Carlo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Maria Chiara Alessi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Elena Picutti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
- Department of Pharmacy, Pharmacology, Clinical Sciences, University of Hertfordshire, Herts, UK
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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Kovács I, Gál BI, Horváth Z, Demeter I, Rózsa S, Janka Z, Urbán R, Demetrovics Z, Andó B. Externalizing personality characteristics define clinically relevant subgroups of alcohol use disorder. PLoS One 2022; 17:e0265577. [PMID: 35303035 PMCID: PMC8932598 DOI: 10.1371/journal.pone.0265577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
AIMS Higher levels of externalizing characteristics, i.e. impulsivity, novelty seeking and aggression, could contribute to the development, progression and severity of alcohol use disorder (AUD). The present study aims to explore whether these externalizing characteristics together have a potential group-forming role in AUD using latent profile analysis (LPA). METHODS Externalizing characteristics of 102 AUD patients were analyzed using LPA to explore the group-forming role of externalizing symptoms; groups were compared in terms of demographic and alcohol-related variables, indices of psychopathological, depressive and anxiety symptom severity. RESULTS LPA revealed and supported a two-group model based on externalizing symptoms. The group with higher levels of externalizing symptoms showed significantly elevated levels of alcohol-related and anxio-depressive symptoms. CONCLUSIONS Externalizing characteristics converge and have a group-forming role in chronic AUD, and are associated with a more severe form of AUD. By making the diagnostic category less heterogeneous, these different subtypes within AUD may provide aid in tailoring treatments to patients' specific needs.
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Affiliation(s)
- Ildikó Kovács
- Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- * E-mail: (IK); (BA)
| | - Bernadett I. Gál
- Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zsolt Horváth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ildikó Demeter
- Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Sándor Rózsa
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary
| | - Zoltán Janka
- Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Róbert Urbán
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Bálint Andó
- Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- * E-mail: (IK); (BA)
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Deehan GA. The enduring behavioral and neurobiological effects of a flavor cue paired with alcohol drinking during adolescence on the incentive properties of the flavor cue in adulthood in female alcohol-preferring (P) rats. Drug Alcohol Depend 2022; 232:109289. [PMID: 35051698 DOI: 10.1016/j.drugalcdep.2022.109289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) affect 15 million people nationwide, 4% of which are adolescents (ages 12-17) and adolescents who binge drink significantly increase their likelihood of suffering from an AUD in adulthood. Research shows that cues (i.e. flavors) paired with alcohol (EtOH) produce significant cue-induced alcohol craving and contribute to relapse in adolescent and adult populations. However, there is a lack of research focused on how cues that accompany EtOH drinking during adolescence, affect EtOH craving later in life. The current study sought to examine the sex- and developmental-dependent effects of adolescent exposure to flavor cues associated with EtOH on operant-lick behavior and cue-induced dopamine (DA) levels within the nucleus accumbens shell (AcbSh; reward structure) in adulthood. METHODS Adolescent alcohol-preferring (P) rats were randomly assigned to one of 4 groups and received 24 hr. access to three bottles on their home cage: Paired: 0.1% blueberry flavor extract (BB) + 15% v/v EtOH and 2 water bottles; Unpaired: 0.1% BB, 15% v/v EtOH, and water; 15% EtOH alone, and 2 water bottles; BB alone and 2 water bottles. Home cage fluid consumption was measured for 2-weeks. On the third week bottles were removed and all animals underwent 9 days of operant training using an operant sipper paradigm. This consisted of two sipper spouts connected to the computer by a lickometer, which registered tongue contacts with the sipper tube (Paired: BB+EtOH or water; Unpaired BB or EtOH; EtOH alone: EtOH or water; BB alone: BB or water). When the fixed ratio (FR) requirement for number of licks/tongue contacts was met, a liquid delivery solenoid dispensed 0.05 ml of fluid into the sipper tube. Following the final operant session all rats remained in their home-cage for approximately 40 days until adulthood at which point they were returned to the operant chambers and tested for appetitive and consummatory behavior in response to the flavor cue (all rats: BB or water; NO EtOH). Two weeks after the final operant session all rats underwent microdialysis testing to examine cue-induced DA levels in the AcbSh. RESULTS Data indicated that animals in the paired group exhibited a significantly greater level of licking at the BB sipper and a significantly greater level of DA release in response to the flavor cue compared to the other groups. CONCLUSIONS Overall, the data suggest that cues paired with EtOH during adolescence may produce persistent changes to the behavioral and neurobiological mechanisms that contribute to an increased risk of developing an AUD later in life.
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Affiliation(s)
- Gerald A Deehan
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA.
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10
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Muncie HL, Anderson II G, Oge L. Care of the Alcoholic Patient. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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[G-CSF for prophylaxis of neutropenia and febrile neutropenia, anemia in cancer : Guidelines on supportive treatment part 1]. Urologe A 2022; 61:537-551. [PMID: 35476110 PMCID: PMC9044390 DOI: 10.1007/s00120-022-01831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
Infections in patients with neutropenia following chemotherapy are mostly manifested as fever (febrile neutropenia, FN). Some of the most important determinants of the risk of FN are the type of chemotherapy, the dose intensity and patient-specific factors. When the risk of FN is 20% or more granulopoiesis is prophylactically stimulated with granulocyte colony stimulating factor (G-CSF) after the treatment. Anemia should always be clarified and if necessary be treated according to the cause when symptomatic. If an absolute or functional iron deficiency is present, intravenous iron substitution is mostly necessary. Erythropoiesis-stimulating agents can be used after chemotherapy with hemoglobin (Hb) levels less than 10 g/dl (6.2 mmol/l). In cases of chronic anemia and Hb levels less than 7-8 g/dl (<4.3-5.0 mmol/l) the indications for transfusion of erythrocyte concentrates should be assessed primarily based on the individual clinical symptoms.
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12
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Al Khaldi M, Gryspeerdt F, Carrier FM, Bouchard C, Simoneau È, Rong Z, Plasse M, Létourneau R, Dagenais M, Roy A, Lapointe R, Massicotte L, Vandenbroucke-Menu F, Rioux-Massé B, Turcotte S. Effect of intraoperative hypovolemic phlebotomy on transfusion and clinical outcomes in patients undergoing hepatectomy: a retrospective cohort study. Can J Anaesth 2021; 68:980-990. [PMID: 33945107 PMCID: PMC8175312 DOI: 10.1007/s12630-021-01958-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/03/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is no consensus on how to best achieve a low central venous pressure during hepatectomy for the purpose of reducing blood loss and red blood cell (RBC) transfusions. We analyzed the associations between intraoperative hypovolemic phlebotomy (IOHP), transfusions, and postoperative outcomes in cancer patients undergoing hepatectomy. METHODS Using surgical and transfusion databases of patients who underwent hepatectomy for cancer at one institution (11 January 2011 to 22 June 2017), we retrospectively analyzed associations between IOHP and RBC transfusion on the day of surgery (primary outcome), and with total perioperative transfusions, intraoperative blood loss, and postoperative complications (secondary outcomes). We fitted logistic regression models by inverse probability of treatment weighting to adjust for confounders and reported adjusted odds ratio (aOR). RESULTS There were 522 instances of IOHP performed during 683 hepatectomies, with a mean (standard deviation) volume of 396 (119) mL. The IOHP patients had a 6.9% transfusion risk on the day of surgery compared with 12.4% in non-IOHP patients (aOR, 0.53; 95% confidence interval [CI], 0.29 to 0.98; P = 0.04). Total perioperative RBC transfusion tended to be lower in IOHP patients compared with non-IOHP patients (14.9% vs 22.4%, respectively; aOR, 0.72; 95% CI, 0.44 to 1.16; P = 0.18). In patients with a predicted risk of ≥ 47.5% perioperative RBC transfusion, 24.6% were transfused when IOHP was used compared with 56.5% without IOHP. The incidence of severe postoperative complications (Clavien-Dindo scores ≥ 3) was similar in patients whether or not IOHP was performed (15% vs 16% respectively; aOR, 0.97; 95% CI, 0.53 to 1.54; P = 0.71). CONCLUSIONS The use of IOHP during hepatectomy was associated with less RBCs transfused on the same day of surgery. Trials comparing IOHP with other techniques to reduce blood loss and transfusion are needed in liver surgery.
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Affiliation(s)
- Maher Al Khaldi
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Filip Gryspeerdt
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - François Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
- Critical Care Service, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Claudia Bouchard
- Department of Hematology-Transfusion Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Ève Simoneau
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Zhixia Rong
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Marylène Plasse
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Richard Létourneau
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Michel Dagenais
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - André Roy
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Réal Lapointe
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Luc Massicotte
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Franck Vandenbroucke-Menu
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada
| | - Benjamin Rioux-Massé
- Department of Hematology-Transfusion Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Simon Turcotte
- Hepatopancreatobiliary Surgery and Liver Transplantation Service, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Pavillon R. 900, rue St-Denis, porte R10.430, Montreal, QC, H2X 0A9, Canada.
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Heather N. Let's not turn back the clock: Comments on Kelly et al., "Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers". Alcohol Alcohol 2021; 56:377-379. [PMID: 33316028 DOI: 10.1093/alcalc/agaa137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
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Kelly JF, Abry AW. Leave the Past Behind by Recognizing the Effectiveness and Cost-Effectiveness of 12-Step Facilitation and Alcoholics Anonymous. Alcohol Alcohol 2021; 56:380-382. [PMID: 33616171 PMCID: PMC8243271 DOI: 10.1093/alcalc/agab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John F Kelly
- Department of Psychiatry, Massachusetts General Hospital Recovery Research Institute. 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA
| | - Alexandra W Abry
- Department of Psychiatry, Massachusetts General Hospital Recovery Research Institute. 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA
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Beck AK, Kelly PJ, Deane FP, Baker AL, Hides L, Manning V, Shakeshaft A, Neale J, Kelly JF, Gray RM, Argent A, McGlaughlin R, Chao R, Martini M. Developing a mHealth Routine Outcome Monitoring and Feedback App ("SMART Track") to Support Self-Management of Addictive Behaviours. Front Psychiatry 2021; 12:677637. [PMID: 34220583 PMCID: PMC8249767 DOI: 10.3389/fpsyt.2021.677637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Routine outcome monitoring (ROM) has been implemented across a range of addiction treatment services, settings and organisations. Mutual support groups are a notable exception. Innovative solutions are needed. SMART Track is a purpose built smartphone app designed to capture ROM data and provide tailored feedback to adults attending Australian SMART Recovery groups for addictive behaviour(s). Objective: Details regarding the formative stage of app development is essential, but often neglected. Improved consideration of the end-user is vital for curtailing app attrition and enhancing engagement. This paper provides a pragmatic example of how principles embedded in published frameworks can be operationalised to address these priorities during the design and development of the SMART Track app. Methods: Three published frameworks for creating digital health technologies ("Person-Based Approach," "BIT" Model and IDEAS framework) were integrated and applied across two stages of research to inform the development, design and content of SMART Track. These frameworks were chosen to ensure that SMART Track was informed by the needs and preferences of the end-user ("Person-Based"); best practise recommendations for mHealth development ("BIT" Model) and a collaborative, iterative development process between the multi-disciplinary research team, app developers and end-users (IDEAS framework). Results: Stage one of the research process generated in-depth knowledge to inform app development, including a comprehensive set of aims (clinical, research/organisation, and usage); clear articulation of the target behaviour (self-monitoring of recovery related behaviours and experiences); relevant theory (self-determination and social control); appropriate behavioural strategies (e.g., behaviour change taxonomy and process motivators) and key factors that may influence engagement (e.g., transparency, relevance and trust). These findings were synthesised into guiding principles that were applied during stage two in an iterative approach to app design, content and development. Conclusions: This paper contributes new knowledge on important person-centred and theoretical considerations that underpin a novel ROM and feedback app for people with addictive behaviour(s). Although person-centred design and best-practise recommendations were employed, further research is needed to determine whether this leads to improved usage outcomes. Clinical Trial Registration: Pilot Trial: http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336.
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Affiliation(s)
- Alison K. Beck
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Peter J. Kelly
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Frank P. Deane
- Faculty of the Arts, Social Sciences and Humanities, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Joanne Neale
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - John F. Kelly
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Rebecca M. Gray
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Ryan Chao
- GHO, Customer Experience Agency, Sydney, NSW, Australia
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Roberts C. The implications of noncompliance for randomized trials with partial nesting due to group treatment. Stat Med 2021; 40:349-368. [PMID: 33118193 PMCID: PMC7821326 DOI: 10.1002/sim.8778] [Citation(s) in RCA: 4] [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: 01/23/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 01/09/2023]
Abstract
Analyses of trials of group administered treatments require an identifier for therapy group to account for clustering by group. All patients randomized to receive the group administered treatment could be assigned an intended group identifier following randomization. Alternatively, an actual group could be based on those patients that comply with group therapy. We investigate the implications for intention-to-treat (ITT) analyses of using either the intended or actual group to adjust for the clustering effect. We also consider causal models using the actual group. A simulation study showed that ITT estimates based on random effects models or GEE with an exchangeable correlation matrix performed much better when using the intended group than the actual group. OLS with robust standard errors performed well with both. Most compliance average causal effect (CACE) models performed well. While practical constraints of the clinical setting may determine the choice between an intended or actual group analyses, it is desirable to record both. An ITT analysis using mixed models can then be fitted using the intended group with data generation assumptions checked by a causal model using the actual group. Where an ITT analysis is based on the actual group, worse outcome for never-takers than compliers may allow one to infer that some estimators are biased toward no treatment effect. The work here is motivated and illustrated by a trial of a group therapy, but also has relevance to trials with treatment related clustering due to therapist examples of which include physical and talking therapies or surgery.
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Affiliation(s)
- Chris Roberts
- Centre for Biostatistics, Division of Population Health, School of Health SciencesUniversity of ManchesterManchesterUK
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White S, Foster R, Marks J, Morshead R, Goldsmith L, Barlow S, Sin J, Gillard S. The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis. BMC Psychiatry 2020; 20:534. [PMID: 33176729 PMCID: PMC7657356 DOI: 10.1186/s12888-020-02923-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. METHOD We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. RESULTS Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. CONCLUSIONS One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. TRIAL REGISTRATION Prospero identifier: CRD42015025621 .
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Affiliation(s)
- Sarah White
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Rhiannon Foster
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Jacqueline Marks
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Rosaleen Morshead
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Sally Barlow
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Jacqueline Sin
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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Kelly JF, Abry A, Ferri M, Humphreys K. Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers. Alcohol Alcohol 2020; 55:641-651. [PMID: 32628263 PMCID: PMC8060988 DOI: 10.1093/alcalc/agaa050] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. METHODS Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. RESULTS A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. CONCLUSIONS AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra Abry
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marica Ferri
- Best Practices, Knowledge Exchange and Economic Issues, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Stanford University Stanford School of Medicine, Stanford, CA, USA
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Acin MT, Rueda JR, Saiz LC, Parent Mathias V, Alzueta N, Solà I, Garjón J, Erviti J. Alcohol intake reduction for controlling hypertension. Cochrane Database Syst Rev 2020; 9:CD010022. [PMID: 32960976 PMCID: PMC8094445 DOI: 10.1002/14651858.cd010022.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND High blood pressure constitutes one of the leading causes of mortality and morbidity all over the world. At the same time, heavy drinking increases the risk for developing cardiovascular diseases, including cardiomyopathy, hypertension, atrial arrhythmias, or stroke. Several studies have already assessed specifically the relationship between alcohol intake and hypertension. However, the potential effect on blood pressure of alcohol intake reduction interventions is largely unknown. OBJECTIVES To assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. To determine additional effects related to mortality, major cardiovascular events, serious adverse events, or quality of life. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to June 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2020), MEDLINE Ovid (from 1946), MEDLINE Ovid Epub Ahead of Print, and MEDLINE Ovid In-Process, Embase Ovid (from 1974), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. Trial authors were contacted when needed and no language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials with minimum 12 weeks duration and including 50 or more subjects per group with quantitative measurement of alcohol consumption and/or biological measurement of the outcomes of interest. Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. We included any intervention implemented to reduce their alcohol intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed search results and extracted data using standard methodological procedures adopted by Cochrane. MAIN RESULTS A total of 1210 studies were screened. We included one randomised controlled trial involving a total of 269 participants with a two-year follow-up. Individual patient data for all participants were provided and used in this review. No differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95% CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92 mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98 mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive-behavioural intervention group and the control group. We also did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95% CI 0.88 to 1.65; very low-certainty evidence). Concerning secondary outcomes, the alcohol intake was significantly reduced in the cognitive-behavioural intervention compared with the control group (MD 191.33 g, 95% CI 85.36 to 297.30 g). We found no differences between the active and control intervention in the proportion of subjects with lower-risk alcohol intake versus higher-risk and extreme drinkers at the end of the study (RR 1.04, 95% CI 0.68 to 1.60). There were no estimable results for the quality of life outcome. AUTHORS' CONCLUSIONS An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question.
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Affiliation(s)
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | - Natalia Alzueta
- Drug Prescribing Service, Navarre Health Service, Pamplona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Javier Garjón
- Medicines Advice and Information Service, Navarre Health Service, Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
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Kelly PJ, Beck AK, Baker AL, Deane FP, Hides L, Manning V, Shakeshaft A, Larance B, Neale J, Kelly J, Oldmeadow C, Searles A, Treloar C, Gray RM, Argent A, McGlaughlin R. Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in Mutual Support Groups Coordinated by SMART Recovery Australia: Protocol for a Pilot Study. JMIR Res Protoc 2020; 9:e15113. [PMID: 32673272 PMCID: PMC7380906 DOI: 10.2196/15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the importance and popularity of mutual support groups, there have been no systematic attempts to implement and evaluate routine outcome monitoring (ROM) in these settings. Unlike other mutual support groups for addiction, trained facilitators lead all Self-Management and Recovery Training (SMART Recovery) groups, thereby providing an opportunity to implement ROM as a routine component of SMART Recovery groups. OBJECTIVE This study protocol aims to describe a stage 1 pilot study designed to explore the feasibility and acceptability of a novel, purpose-built mobile health (mHealth) ROM and feedback app (Smart Track) in SMART Recovery groups coordinated by SMART Recovery Australia (SRAU) The secondary objectives are to describe Smart Track usage patterns, explore psychometric properties of the ROM items (ie, internal reliability and convergent and divergent validity), and provide preliminary evidence for participant reported outcomes (such as alcohol and other drug use, self-reported recovery, and mental health). METHODS Participants (n=100) from the SMART Recovery groups across New South Wales, Australia, will be recruited to a nonrandomized, prospective, single-arm trial of the Smart Track app. There are 4 modes of data collection: (1) ROM data collected from group participants via the Smart Track app, (2) data analytics summarizing user interactions with Smart Track, (3) quantitative interview and survey data of group participants (baseline, 2-week follow-up, and 2-month follow-up), and (4) qualitative interviews with group participants (n=20) and facilitators (n=10). Feasibility and acceptability (primary objectives) will be analyzed using descriptive statistics, a cost analysis, and a qualitative evaluation. RESULTS At the time of submission, 13 sites (25 groups per week) had agreed to be involved. Funding was awarded on August 14, 2017, and ethics approval was granted on April 26, 2018 (HREC/18/WGONG/34; 2018/099). Enrollment is due to commence in July 2019. Data collection is due to be finalized in October 2019. CONCLUSIONS To the best of our knowledge, this study is the first to use ROM and tailored feedback within a mutual support group setting for addictive behaviors. Our study design will provide an opportunity to identify the acceptability of a novel mHealth ROM and feedback app within this setting and provide detailed information on what factors promote or hinder ROM usage within this context. This project aims to offer a new tool, should Smart Track prove feasible and acceptable, that service providers, policy makers, and researchers could use in the future to understand the impact of SMART Recovery groups. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/15113.
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Affiliation(s)
- Peter J Kelly
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Alison K Beck
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Frank P Deane
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane St Lucia, Australia
| | - Victoria Manning
- Faculty of Medicine, Nursing and Health Sciences, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Anthony Shakeshaft
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Briony Larance
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Joanne Neale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - John Kelly
- Centre for Addiction Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Andrew Searles
- Health Research Economics Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Carla Treloar
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Rebecca M Gray
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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Abstract
AbstractThis research project aimed at obtaining an in-depth analysis of the experiences of self-identified co-dependents, who chose twelve-steps groups as a way for dealing with difficulties identified as co-dependency. Interpretative phenomenological analysis (IPA) was used as the methodology for the research. Eight participants volunteered from local support groups for co-dependency in the UK. Data were collected through 3 in-depth interviews with each participant over a period of 3–6 months. A visual method was used to gain a more in-depth phenomenological perspective. It included photographs, drawings and images chosen by the participants to describe their experiences. The analysis revealed 2 contradicting and complementary themes: (1) representations of the twelve-step group as a helpful tool and (2) representations of the twelve-step group as no longer meaningful. It demonstrated that the participants found their groups useful as an initial pathway for recovery; however, it did not feature as a central aspect in their recovery, as different levels of engagement were described. The results of this study provide a base for developing a more empathic and contextualised understanding of the experience of individuals who attend twelve-step groups for co-dependency, which in turn will enable health professionals to offer support which is relevant to these individuals’ experiences.
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Hayat A, Piper BJ. Characteristics of Dispensary Patients that Limit Alcohol after Initiating Cannabis. J Psychoactive Drugs 2020; 52:145-152. [PMID: 31813342 PMCID: PMC7275884 DOI: 10.1080/02791072.2019.1694199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/31/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
Many patients have reported that they decrease their use of opioids after starting medical cannabis (MC) but less is known for alcohol. The objective of this exploratory study was to identify any factors which differentiate alcohol abaters from those that do not modify their alcohol use after starting MC (non-abaters). Comparisons were made to identify any demographic, dosing, or health history characteristics which differentiated alcohol abaters (N = 47) from non-abaters (N = 65). Respondents selected from among a list of 37 diseases/health conditions (e.g. diabetes, sleep disorders). Abaters and non-abaters were indistinguishable in terms of sex, age, or prior drug history. A greater percentage of abaters (59.6%) than non-abaters (40.6%, p < .05) reported using MC two or more times per day. Abaters were more likely to be employed (68.1%) than non-abaters (51.1%, p < .05). Abaters also reported having significantly more health conditions and diseases (3.3 ± 2.0) than non-abaters (2.4 ± 1.4, p < .05). This small study offers some insights into the profile of patients whose self-reported alcohol intake decreased following initiation of MC. Additional prospective or controlled research into the alcohol abatement phenomenon following MC may be warranted.
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Affiliation(s)
- Assad Hayat
- Geisinger Commonwealth School of Medicine, Scranton, PA 18509 USA
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA 18509 USA
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, PA 18704 USA
- Neuroscience Program, Bowdoin College, Brunswick, ME 04011 USA
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23
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Iacobucci G. Sixty seconds on . . . AA. BMJ 2020; 368:m1056. [PMID: 32169952 DOI: 10.1136/bmj.m1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Alcohol use disorder (AUD) confers a prodigious burden of disease, disability, premature mortality, and high economic costs from lost productivity, accidents, violence, incarceration, and increased healthcare utilization. For over 80 years, Alcoholics Anonymous (AA) has been a widespread AUD recovery organization, with millions of members and treatment free at the point of access, but it is only recently that rigorous research on its effectiveness has been conducted. OBJECTIVES To evaluate whether peer-led AA and professionally-delivered treatments that facilitate AA involvement (Twelve-Step Facilitation (TSF) interventions) achieve important outcomes, specifically: abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, CINAHL and PsycINFO from inception to 2 August 2019. We searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 15 November 2018. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and bibliographies of included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs and non-randomized studies that compared AA or TSF (AA/TSF) with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants, or no treatment. We also included healthcare cost offset studies. Participants were non-coerced adults with AUD. DATA COLLECTION AND ANALYSIS We categorized studies by: study design (RCT/quasi-RCT; non-randomized; economic); degree of standardized manualization (all interventions manualized versus some/none); and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). For analyses, we followed Cochrane methodology calculating the standard mean difference (SMD) for continuous variables (e.g. percent days abstinent (PDA)) or the relative risk (risk ratios (RRs)) for dichotomous variables. We conducted random-effects meta-analyses to pool effects wherever possible. MAIN RESULTS We included 27 studies containing 10,565 participants (21 RCTs/quasi-RCTs, 5 non-randomized, and 1 purely economic study). The average age of participants within studies ranged from 34.2 to 51.0 years. AA/TSF was compared with psychological clinical interventions, such as MET and CBT, and other 12-step program variants. We rated selection bias as being at high risk in 11 of the 27 included studies, unclear in three, and as low risk in 13. We rated risk of attrition bias as high risk in nine studies, unclear in 14, and low in four, due to moderate (> 20%) attrition rates in the study overall (8 studies), or in study treatment group (1 study). Risk of bias due to inadequate researcher blinding was high in one study, unclear in 22, and low in four. Risks of bias arising from the remaining domains were predominantly low or unclear. AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi-randomized evidence) RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high-certainty evidence). This effect remained consistent at both 24 and 36 months. For percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI -4.36 to 10.43; 4 studies, 1999 participants; very low-certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; low-certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; low-certainty evidence). For longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI -0.30 to 1.50; 2 studies, 136 participants; low-certainty evidence). For drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD -0.17, 95% CI -1.11 to 0.77; 1 study, 1516 participants; moderate-certainty evidence) and percentage days heavy drinking (PDHD) (MD -5.51, 95% CI -14.15 to 3.13; 1 study, 91 participants; low-certainty evidence). For alcohol-related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD -2.88, 95% CI -6.81 to 1.04; 3 studies, 1762 participants; moderate-certainty evidence). For alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low-certainty evidence). AA/TSF (non-manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi-randomized evidence) For the proportion of participants completely abstinent, non-manualized AA/TSF may perform as well as other clinical interventions at three to nine months follow-up (RR 1.71, 95% CI 0.70 to 4.18; 1 study, 93 participants; low-certainty evidence). Non-manualized AA/TSF may also perform slightly better than other clinical interventions for PDA (MD 3.00, 95% CI 0.31 to 5.69; 1 study, 93 participants; low-certainty evidence). For drinking intensity, AA/TSF may perform as well as other clinical interventions at nine months, as measured by DDD (MD -1.76, 95% CI -2.23 to -1.29; 1 study, 93 participants; very low-certainty evidence) and PDHD (MD 2.09, 95% CI -1.24 to 5.42; 1 study, 286 participants; low-certainty evidence). None of the RCTs comparing non-manualized AA/TSF to other clinical interventions assessed LPA, alcohol-related consequences, or alcohol addiction severity. Cost-effectiveness studies In three studies, AA/TSF had higher healthcare cost savings than outpatient treatment, CBT, and no AA/TSF treatment. The fourth study found that total medical care costs decreased for participants attending CBT, MET, and AA/TSF treatment, but that among participants with worse prognostic characteristics AA/TSF had higher potential cost savings than MET (moderate-certainty evidence). AUTHORS' CONCLUSIONS There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non-manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non-manualized, may be at least as effective as other treatments for other alcohol-related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder.
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Affiliation(s)
- John F Kelly
- Massachusetts General Hospital and Harvard Medical School, Recovery Research Institute, Center for Addiction Medicine, 151 Merrimac Street, 6th Floor, Boston, Massachusetts, USA, 02114
| | - Keith Humphreys
- Stanford University Stanford School of Medicine, Veterans Affairs and Stanford University Medical Centers, 401 North Quarry Road, Stanford, CA, USA
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Best practices, knowledge exchange and economic issues, Cais do Sodre' 1249-289 Lisbon, Lisbon, Portugal
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25
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May T, Pratt TC. Treating Offenders with Substance Abuse Problems: Implicit Beliefs about Addiction and Failed Drug Tests. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23774657.2020.1728203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Teresa May
- Harris County Community Supervision and Corrections Department, Houston, USA
| | - Travis C. Pratt
- Harris County Community Supervision and Corrections Department, University of Cincinnati Corrections Institute, Cincinnati, USA
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26
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Care of the Alcoholic Patient. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_66-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Glassman HS, Rhodes P, Buus N. A Critical Review of Qualitative Interview Studies with Alcoholics Anonymous Members. Subst Use Misuse 2020; 55:387-398. [PMID: 31686562 DOI: 10.1080/10826084.2019.1681450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Alcoholics Anonymous (AA) is a community-based NGO that supports people with alcohol misuse concerns to achieve and maintain abstinence. Qualitative methods are best suited to investigate individual experiences of recovery in AA, since this typically involves not only abstinence from alcohol but also the global psychological growth of the whole person. Despite this, the growing body of qualitative research exploring individual experiences in AA has yet to be collated. Objectives: The aims of this paper were to systematically search for and critically review qualitative interview studies with AA members. Methods: A systematic database and citation search identified 21 articles published between 1977 and 2014. Two independent reviewers assessed each research report and extracted data pertaining to the findings and the methodological quality of the studies. Results: Major themes across the reviewed articles included 'rock-bottom' experiences and powerlessness, and identity and change processes in AA. Findings related to the methodological quality of the papers were both general to qualitative research and more specific to AA. Conclusions/Importance: Research in this field has been characterized by a relatively uncritical discovery of AA narratives among AA members and by a lack of methodological rigor, which is likely to perpetuate its negative standing in the context of academia, and therefore in public and political discourse. Overall, findings demonstrated a pressing need for high quality qualitative research on AA.
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Affiliation(s)
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Niels Buus
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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28
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Ross CA, Jakubec SL, Berry NS, Smye V. The business of managing nurses’ substance‐use problems. Nurs Inq 2019; 27:e12324. [DOI: 10.1111/nin.12324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Charlotte A. Ross
- Douglas College Coquitlam BC Canada
- Simon Fraser University Burnaby BC Canada
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29
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Grim BJ, Grim ME. Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse. JOURNAL OF RELIGION AND HEALTH 2019; 58:1713-1750. [PMID: 31359242 PMCID: PMC6759672 DOI: 10.1007/s10943-019-00876-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study reviews the voluminous empirical evidence on faith's contribution to preventing people from falling victim to substance abuse and helping them recover from it. We find that 73% of addiction treatment programs in the USA include a spirituality-based element, as embodied in the 12-step programs and fellowships initially popularized by Alcoholics Anonymous, the vast majority of which emphasize reliance on God or a Higher Power to stay sober. We introduce and flesh out a typology of faith-based substance abuse treatment facilities, recovery programs, and support groups. This typology provides important background as we then move on to make an economic valuation of nearly 130,000 congregation-based substance abuse recovery support programs in the USA. We find that these faith-based volunteer support groups contribute up to $316.6 billion in savings to the US economy every year at no cost to tax payers. While negative experiences with religion (e.g., clergy sex abuse and other horrendous examples) have been a contributory factor to substance abuse among some victims, given that more than 84% of scientific studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed, we conclude that the value of faith-oriented approaches to substance abuse prevention and recovery is indisputable. And, by extension, we also conclude that the decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern.
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Affiliation(s)
- Brian J. Grim
- Institute for Studies of Religion, Baylor University, One Bear Place #97236, Waco, TX 76798 USA
| | - Melissa E. Grim
- Religious Freedom & Business Foundation, 1A Perry Circle, Annapolis, MD 21402 USA
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30
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Raftery D, Kelly PJ, Deane FP, Baker AL, Dingle G, Hunt D. With a little help from my friends: cognitive-behavioral skill utilization, social networks, and psychological distress in SMART Recovery group attendees. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Dayle Raftery
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J. Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank P. Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Genevieve Dingle
- School of Psychology, University of Queensland, Brisbane, Australia
| | - David Hunt
- Smart Recovery, Australia, Sydney, Australia
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31
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Hauser SR, Deehan GA, Knight CP, Waeiss RA, Truitt WA, Johnson PL, Bell RL, McBride WJ, Rodd ZA. Conditioned stimuli affect ethanol-seeking by female alcohol-preferring (P) rats: the role of repeated-deprivations, cue-pretreatment, and cue-temporal intervals. Psychopharmacology (Berl) 2019; 236:2835-2846. [PMID: 31093721 PMCID: PMC6697605 DOI: 10.1007/s00213-019-05264-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE Evidence indicates that drug-paired stimuli can evoke drug-craving leading to drug-seeking and repeated relapse periods can influence drug-seeking behaviors. OBJECTIVES The present study examined (1) the effect of an interaction between repeated deprivation cycles and excitatory conditioning stimuli (CS+) on ethanol (EtOH)-seeking; (2) the effects of EtOH-paired cue-exposure in a non-drug-paired environment on subsequent conditioning in a drug-paired environment; and (3) the temporal effects of conditioned cues on subsequent EtOH-seeking. METHODS Adult female alcohol-preferring (P) rats were exposed to three conditioned odor cues; CS+ associated with EtOH self-administration, CS- associated with the absence of EtOH (extinction training), and a neutral stimulus (CS0) presented in a neutral non-drug-paired environment. The rats underwent four deprivation cycles or were non-deprived, following extinction they were maintained in a home cage for an EtOH-free period, and then exposed to no cue, CS+, CS-, or CS0 to assess the effect of the conditioned cues on EtOH-seeking behavior. RESULTS Repeated deprivations enhanced and prolonged the duration of CS+ effects on EtOH-seeking. Presentation of the CS- in a non-drug-paired environment blocked the ability of a CS+ to enhance EtOH-seeking in a drug-paired environment. Presentation of the CS+ or CS- in a non-drug-paired environment 2 or 4 h earlier significantly altered EtOH-seeking. CONCLUSION Results indicated an interaction between repeated deprivation cycles and CS+ resulted in a potentiation of CS+ evoked EtOH-seeking. In addition, a CS- may have therapeutic potential by providing prophylactic protection against relapse behavior in the presence of cues in the drug-using environment.
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Affiliation(s)
- Sheketha R Hauser
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Gerald A Deehan
- Department of Psychology, East Tennessee State University, Johnson City, TN, 37614, USA
| | - Christopher P Knight
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Robert A Waeiss
- Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indianapolis, 46202, IN, USA
| | - William A Truitt
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Philip L Johnson
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Richard L Bell
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - William J McBride
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Zachary A Rodd
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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32
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Pettersen H, Landheim A, Skeie I, Biong S, Brodahl M, Benson V, Davidson L. Helpful Ingredients in the Treatment of Long-Term Substance Use Disorders: A Collaborative Narrative Study. Subst Abuse 2019; 13:1178221819844996. [PMID: 31065215 PMCID: PMC6487766 DOI: 10.1177/1178221819844996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/28/2019] [Indexed: 12/20/2022]
Abstract
Relatively few individuals with a substance use disorder (SUD) seek or receive treatment, and knowledge about the effective ingredients in SUD treatment, from the perspective of those who receive it, is scarce. Our study purpose was to explore the experiences of those with long-term SUDs and the aspects they found helpful during treatment and long-term recovery. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a long-term SUD, and who had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to study planning, preparation, and initial analyses. Participants preferred individualized, long-term treatment, and support from both therapists and other clients. They further acknowledged the importance of their own sense of responsibility for their treatment and recovery success. Greater focus should be placed on viewing long-term SUD as a long-term condition, similar to somatic diseases, and SUD treatment services should place greater emphasis on developing partnership care models, long-term monitoring and support, and actively engaging recovered clients in the care of others in SUD treatment.
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Affiliation(s)
- Henning Pettersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
- SERAF – Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Ivar Skeie
- SERAF – Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- District Psychiatric Centre Gjøvik, Innlandet Hospital Trust, Brumunddal, Norway
| | - Stian Biong
- Faculty for Health Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
| | - Victoria Benson
- Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, CT, USA
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33
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Gilbert PA, Pro G, Zemore SE, Mulia N, Brown G. Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample. Alcohol Clin Exp Res 2019; 43:722-731. [PMID: 30807660 PMCID: PMC6443428 DOI: 10.1111/acer.13965] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of adults with alcohol use disorders do not obtain help, and women are less likely to utilize alcohol services than men. We sought to quantify gender differences in alcohol services utilization, overall and by type, using national longitudinal data and to explore potential gender differences in perceived need for help and reasons for not seeking help. METHODS We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions from White, African American, and Hispanic adults (n = 2,592) who met DSM-IV criteria for alcohol abuse or dependence at Wave 1 (2000 to 2001). We tested gender differences in Wave 2 (2004 to 2005) services utilization, perceived need for help, and treatment barriers using Rao-Scott chi-square tests and assessed predictors of outcomes in multivariable logistic regression, adjusting for problem severity, co-occurring disorders, and demographics. RESULTS Women had much lower odds than men of utilizing any alcohol service (adjusted odds ratio [aOR] 0.53; 95% confidence interval [95% CI]: 0.33, 0.86), specialty services (aOR 0.41; 95% CI 0.19, 0.87), and 12-step groups (aOR 0.39; 95% CI 0.21, 0.71). Perceived need for help among those who had not used any services was very low (5%), with no gender difference. Further, men and women reported equivalent numbers of treatment barriers and the same rank order for the most frequently endorsed barriers. However, women were twice as likely as men to think a problem would get better by itself-the most frequent reason for not seeking help (47% vs. 24%, p < 0.001), and men were more likely than women to report unsuccessful past help-seeking and not thinking anyone could help (19% vs. 3%, p < 0.001 and 17% vs. 5%, p = 0.001, respectively). CONCLUSIONS Consistent with previous studies, women were less likely to utilize alcohol services than men. Future interventions should address low problem recognition, and tailoring to gender-specific barriers may help close the disparity in services utilization.
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Affiliation(s)
- Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - George Pro
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Sarah E Zemore
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Grant Brown
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
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Pettersen H, Landheim A, Skeie I, Biong S, Brodahl M, Oute J, Davidson L. How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819833379. [PMID: 30886519 PMCID: PMC6410387 DOI: 10.1177/1178221819833379] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/18/2019] [Indexed: 12/31/2022]
Abstract
Individuals with a substance use disorder (SUD) often have fewer social support network resources than those without SUDs. This qualitative study examined the role of social relationships in achieving and maintaining stable recovery after many years of SUD. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and each of whom had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses. The relationship that most participants described as helpful for initiating abstinence was recognition by a peer or a caring relationship with a service provider or sibling. These findings suggest that, to reach and maintain abstinence, it is important to maintain positive relationships and to engage self-agency to protect oneself from the influences of negative relationships. Substance use disorder service providers should increase the extent to which they involve the social networks of clients when designing new treatment approaches. Service providers should also focus more on individualizing services to meet their clients on a personal level, without neglecting professionalism or treatment strategies.
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Affiliation(s)
- Henning Pettersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway.,Inland Norway University of Applied Sciences, Faculty of Social and Health Sciences, Elverum, Norway.,Yale Program for Recovery and Community Health, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway.,Inland Norway University of Applied Sciences, Faculty of Social and Health Sciences, Elverum, Norway.,SERAF -Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Ivar Skeie
- SERAF -Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.,District Psychiatric Centre Gjøvik, Innlandet Hospital Trust, Brumunddal, Norway
| | - Stian Biong
- Faculty for Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jeppe Oute
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Larry Davidson
- Yale Program for Recovery and Community Health, Yale School of Medicine, Yale University, New Haven, CT, USA
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Tsai J, Gu X. Utilization of addiction treatment among U.S. adults with history of incarceration and substance use disorders. Addict Sci Clin Pract 2019; 14:9. [PMID: 30836991 PMCID: PMC6402155 DOI: 10.1186/s13722-019-0138-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background The high prevalence of substance use disorders (SUDs) among incarcerated adults in the U.S. is well-known, but there has been less examination of SUD treatment and rates of incarceration among the population of adults with SUDs as the denominator. The current study uses a population-based sample to address three questions: (1) What is the rate of lifetime incarceration among the population of U.S. adults with SUDs?; (2) Among adults with SUDs, what proportion of those with incarceration histories use SUD treatment compared to those without incarceration histories?; and (3) What individual characteristics are associated with utilization of SUD treatment among adults with incarceration histories? Methods Data were based on the National Epidemiologic Survey on Alcohol and Related Conditions-III which surveyed a nationally representative sample of U.S. adults through structured interviews. This study focused on the 10,853 respondents who had any lifetime SUD, including 2670 (weighted 22.4%) who reported a lifetime history of incarceration. Results In the total weighted sample of respondents with SUDs, 22% had been incarcerated before but only 37% had used any alcohol use disorder treatment and 18% had used drug use disorder treatment. Controlling for confounding variables, respondents with SUDs and incarceration histories had 3.1 times the odds of using alcohol use disorder treatment and 1.6 times the odds of using drug use disorder treatment compared to their counterparts with SUDs and no incarceration histories. Having an opioid use disorder, especially heroin use disorder, and a stimulant use disorder, such as cocaine use disorder, had strong associations with any SUD treatment use. Conclusions Many U.S. adults with SUDs have histories of incarceration but only a minority use any SUD treatment. Public health approaches that increase access and incentives to engage in and complete SUD treatment may help resolve problems of both incarceration and SUDs in the population.
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Affiliation(s)
- Jack Tsai
- Department of Veterans Affairs (VA), New England Mental Illness Research, Education, and Clinical Center (MIRECC), 950 Campbell Ave., 151D, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George St., New Haven, CT, 06511, USA.
| | - Xian Gu
- Department of Biostatistics, Yale School of Public Health, 60 College St., New Haven, CT, 06520, USA
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Campbell EJ, Flanagan JPM, Walker LC, Hill MKRI, Marchant NJ, Lawrence AJ. Anterior Insular Cortex is Critical for the Propensity to Relapse Following Punishment-Imposed Abstinence of Alcohol Seeking. J Neurosci 2019; 39:1077-1087. [PMID: 30509960 PMCID: PMC6363928 DOI: 10.1523/jneurosci.1596-18.2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/15/2018] [Accepted: 11/04/2018] [Indexed: 11/21/2022] Open
Abstract
Humans with alcohol use disorder typically abstain because of the negative consequences associated with excessive drinking, and exposure to contexts previously associated with alcohol use can trigger relapse. We used a rat model that captures a characteristic of this human condition: namely voluntary abstinence from alcohol use because of contingent punishment. There is substantial variability in the propensity to relapse following extended periods of abstinence, and this is a critical feature preventing the successful treatment of alcohol use disorder. Here we examined relapse following acute or prolonged abstinence. In male alcohol preferring P rats, we found an increased propensity to relapse in Context B, the punishment context after prolonged abstinence. Next, we found that neither alcohol intake history nor the motivational strength of alcohol predicted the propensity to relapse. We next examined the putative circuitry of context-induced relapse to alcohol seeking following prolonged abstinence using Fos as a marker of neuronal activation. The anterior insular cortex (AI) was the only brain region examined where Fos expression correlated with alcohol seeking behavior in Context B after prolonged abstinence. Finally, we used local infusion of GABAA and GABAB receptor agonists (muscimol + baclofen) to show a causal role of the AI in context-induced relapse in Context B, the punishment context after prolonged abstinence. Our results show that there is substantial individual variability in the propensity to relapse in the punishment-associated context after prolonged abstinence, and this is mediated by activity in the AI.SIGNIFICANCE STATEMENT A key feature of alcohol use disorder is that sufferers show an enduring propensity to relapse throughout their lifetime. Relapse typically occurs despite the knowledge of adverse consequences including health complications or relationship breakdowns. Here we use a recently developed rodent model that recapitulates this behavior. After an extended period of abstinence, relapse propensity is markedly increased in the "adverse consequence" environment, akin to humans with alcohol use disorder relapsing in the face of adversity. From a circuitry perspective, we demonstrate a causal role of the anterior insular cortex in relapse to alcohol seeking after extended abstinence following punishment imposed voluntary cessation of alcohol use.
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Affiliation(s)
- Erin J Campbell
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia,
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia, and
| | - Jeremy P M Flanagan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia, and
| | - Leigh C Walker
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia, and
| | - Mitchell K R I Hill
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia, and
| | - Nathan J Marchant
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia, and
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, 1081 HZ, The Netherlands
| | - Andrew J Lawrence
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia,
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia, and
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Rush B, Urbanoski K. Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements. J Stud Alcohol Drugs Suppl 2019; Sup 18:9-21. [PMID: 30681944 PMCID: PMC6377009 DOI: 10.15288/jsads.2019.s18.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 07/16/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE System planners and funders encounter many challenges in taking action toward evidence-informed enhancement of substance use treatment systems. Researchers are increasingly asked to contribute expertise to these processes through comprehensive system reviews. In this role, all parties can benefit from guiding frameworks to help organize key questions and data collection activities, and thereby set the stage for both high-level and on-the-ground strategic directions and recommendations. This article summarizes seven core principles of substance use treatment system design that are supported by a large international evidence base and that together have proven applicable as a framework for several systems review projects conducted predominantly in Canada. METHOD The methodology was based on a narrative review approach. RESULTS The principles address a wide range of issues. Specifically, a broad systems approach is needed to address the full spectrum of issues; accessibility and effectiveness are improved through collaboration across stakeholders; a range of system supports are needed; need for services should be grounded in self-determination, holistic cultural practices, choice, and partnership; attention to diversity and social-structural disadvantages are crucial to equitable system design; systematic screening and assessment is needed to match people to appropriate treatment services in a stepped service framework; and, last, individualized treatment planning must include the right mix of evidence-informed interventions. CONCLUSIONS By bringing researchers and stakeholders back to the high-level goals of substance use treatment systems, these principles provide a comprehensive, evidence-based, organizing framework that has the potential to improve the quality of system design and review internationally.
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Affiliation(s)
- Brian Rush
- Centre for Addiction and Mental Health,
Toronto, Ontario, Canada
| | - Karen Urbanoski
- Centre for Addictions Research of British
Columbia, and School of Public Health and Social Policy, University of Victoria,
Victoria, British Columbia, Canada
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38
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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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Pornnoppadol C, Ratta-apha W, Chanpen S, Wattananond S, Dumrongrungruang N, Thongchoi K, Panchasilawut S, Wongyuen B, Chotivichit A, Laothavorn J, Vasupanrajit A. A Comparative Study of Psychosocial Interventions for Internet Gaming Disorder Among Adolescents Aged 13–17 Years. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9995-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Elias D, Kleber HD. Minding the brain: the role of pharmacotherapy in substance-use disorder treatment. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29302226 PMCID: PMC5741112 DOI: 10.31887/dcns.2017.19.3/hkleber] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With its medicalization as a brain-based disease, addiction has come to be regarded as amenable to biomedical treatment approaches, most commonly pharmacotherapy. Various vulnerabilities are recognized to contribute to maladaptive substance use, and have been linked to diverse neurobiological alterations that may be targeted with pharmacotherapy: withdrawal, craving and cue reactivity, and aberrant reward processing are the most significant. Here, we summarize current thinking regarding pharmacotherapy for substance-use disorders, grouping medications by the type of vulnerability they propose to address and providing insight into their neurobiological mechanisms. We also examine the limitations of the brain-based disease model in addiction treatment, especially as these shortcomings pertain to the place of pharmacotherapy in recovery. We conclude by sketching a framework whereby medications might be integrated fruitfully with other interventions, such as behavioral, existential, or peer-based treatments, targeting aspects of addiction beyond neurobiological deficits.
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Affiliation(s)
- Dakwar Elias
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Herbert D Kleber
- New York State Psychiatric institute, Columbia University Medical Center, New York, New York, USA
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Le TL, Levitan RD, Mann RE, Maunder RG. Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity. Subst Use Misuse 2018; 53:1387-1398. [PMID: 29333895 DOI: 10.1080/10826084.2017.1409764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions. OBJECTIVES This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship. METHODS Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS. RESULTS Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03-.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031-.179; men: 95% CI:.003.-.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.
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Affiliation(s)
- Thao Lan Le
- a Institute of Medical Science, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada.,b Department of Psychiatry , Mount Sinai Hospital , Toronto , Ontario , Canada
| | - Robert D Levitan
- c Department of Psychiatry and Physiology , Centre for Addiction and Mental Health , Toronto , Ontario , Canada
| | - Robert E Mann
- d Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada.,e Institute for Mental Health Policy Research , Centre for Addiction and Mental Health , Toronto , Ontario , Canada
| | - Robert G Maunder
- b Department of Psychiatry , Mount Sinai Hospital , Toronto , Ontario , Canada
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McKenna RA, Rollo ME, Skinner JA, Burrows TL. Food Addiction Support: Website Content Analysis. JMIR Cardio 2018; 2:e10. [PMID: 31758778 PMCID: PMC6834215 DOI: 10.2196/cardio.8718] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/02/2018] [Accepted: 03/10/2018] [Indexed: 12/01/2022] Open
Abstract
Background Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking. Objective This study aimed to evaluate the availability and content of support options, accessible online, for food addiction. Methods A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation. Results Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support. Conclusions This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction.
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Affiliation(s)
- Rebecca A McKenna
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Megan E Rollo
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Janelle A Skinner
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Hippokratia 2017. [DOI: 10.1002/14651858.cd012880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- John F Kelly
- Massachusetts General Hospital and Harvard Medical School; Center for Addiction Medicine; 151 Merrimac Street 6th Floor Boston Massachusetts USA 02114
| | - Keith Humphreys
- Stanford University Stanford School of Medicine; Veterans Affairs and Stanford University Medical Centers; 401 North Quarry Road Stanford CA USA
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction; Best practices, knowledge exchange and economic issues; Cais do Sodre' 1249-289 Lisbon Lisbon Portugal
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Houston RJ, Schlienz NJ. Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:30-40. [PMID: 29397076 DOI: 10.1016/j.bpsc.2017.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/21/2022]
Abstract
Substance use disorders (SUDs) are one of the most prevalent psychiatric conditions and represent a significant public health concern. Substantial research has identified key processes related to reinforcement and cognition for the development and maintenance of SUDs, and these processes represent viable treatment targets for psychosocial and pharmacological interventions. Research on SUD treatments has suggested that most approaches are comparable in effectiveness. As a result, recent work has focused on delineating the underlying mechanisms of behavior change that drive SUD treatment outcome. Given the rapid fluctuations associated with the key neurocognitive processes associated with SUDs, high-temporal-resolution measures of human brain processing, namely event-related potentials (ERPs), are uniquely suited to expand our understanding of the underlying neural mechanisms of change during and after SUD treatment. The value of ERPs in the context of SUD treatment are discussed along with work demonstrating the predictive validity of ERPs as biomarkers of SUD treatment response. Example associations between multiple ERP components and psychosocial and/or pharmacological treatment outcome include the P3a and P3b (in response to neutral and substance-related cues), the attention-related negativities (e.g., N170, N200), the late positive potential, and the error-related negativity. Also addressed are limitations of the biomarker approach to underscore the need for research programs evaluating mechanisms of change. Finally, we emphasize the advantages of ERPs as indices of behavior change in SUD treatment and outline issues relevant for future directions in this context.
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Affiliation(s)
- Rebecca J Houston
- Health and Addictions Research Center, Department of Psychology, Rochester Institute of Technology, Rochester, New York.
| | - Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Drewes AM, Bouwense SAW, Campbell CM, Ceyhan GO, Delhaye M, Demir IE, Garg PK, van Goor H, Halloran C, Isaji S, Neoptolemos JP, Olesen SS, Palermo T, Pasricha PJ, Sheel A, Shimosegawa T, Szigethy E, Whitcomb DC, Yadav D. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology 2017; 17:720-731. [PMID: 28734722 DOI: 10.1016/j.pan.2017.07.006] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories. For pain relief, current guidelines recommend a simple stepwise escalation of analgesic drugs with increasing potency until pain relief is obtained. Abstinence from alcohol and smoking should be strongly advised. Pancreatic enzyme therapy and antioxidants may be helpful as initial treatment. Endoscopic treatment can be used in patients with evidence of ductal obstruction and may be combined with extracorporeal shock wave lithothripsy. The best candidates are those with distal obstruction of the main pancreatic duct and in early stage of disease. Behavioral interventions should be part of the multidisciplinary approach to chronic pain management particularly when psychological impact is experienced. Surgery should be considered early and after a maximum of five endoscopic interventions. The type of surgery depends on morphological changes of the pancreas. Long-term effects are variable, but high success rates have been reported in open studies and when compared with endoscopic treatment. Finally, neurolytical interventions and neuromodulation can be considered in difficult patients.
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Affiliation(s)
- Asbjørn M Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
| | - Stefan A W Bouwense
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Güralp O Ceyhan
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Myriam Delhaye
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Pramod K Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Shuiji Isaji
- Department of Surgery, Mie University Graduate School of Medicine, Japan
| | - John P Neoptolemos
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Søren S Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Tonya Palermo
- Seattle Children's Hospital Research Institute, Washington School of Medicine, USA
| | - Pankaj Jay Pasricha
- Center for Neurogastroenterology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrea Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Tooru Shimosegawa
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Eva Szigethy
- Visceral Inflammation and Pain Center, Division of Gastroenterology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
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Byrd-Bredbenner C, Wu F, Spaccarotella K, Quick V, Martin-Biggers J, Zhang Y. Systematic review of control groups in nutrition education intervention research. Int J Behav Nutr Phys Act 2017; 14:91. [PMID: 28693581 PMCID: PMC5504837 DOI: 10.1186/s12966-017-0546-3] [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] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 07/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background Well-designed research trials are critical for determining the efficacy and effectiveness of nutrition education interventions. To determine whether behavioral and/or cognition changes can be attributed to an intervention, the experimental design must include a control or comparison condition against which outcomes from the experimental group can be compared. Despite the impact different types of control groups can have on study outcomes, the treatment provided to participants in the control condition has received limited attention in the literature. Methods A systematic review of control groups in nutrition education interventions was conducted to better understand how control conditions are described in peer-reviewed journal articles compared with experimental conditions. To be included in the systematic review, articles had to be indexed in CINAHL, PubMed, PsycINFO, WoS, and/or ERIC and report primary research findings of controlled nutrition education intervention trials conducted in the United States with free-living consumer populations and published in English between January 2005 and December 2015. Key elements extracted during data collection included treatment provided to the experimental and control groups (e.g., overall intervention content, tailoring methods, delivery mode, format, duration, setting, and session descriptions, and procedures for standardizing, fidelity of implementation, and blinding); rationale for control group type selected; sample size and attrition; and theoretical foundation. Results The search yielded 43 publications; about one-third of these had an inactive control condition, which is considered a weak study design. Nearly two-thirds of reviewed studies had an active control condition considered a stronger research design; however, many failed to report one or more key elements of the intervention, especially for the control condition. None of the experimental and control group treatments were sufficiently detailed to permit replication of the nutrition education interventions studied. Conclusions Findings advocate for improved intervention study design and more complete reporting of nutrition education interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0546-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Byrd-Bredbenner
- Rutgers, The State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
| | - FanFan Wu
- Rutgers, The State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
| | | | - Virginia Quick
- Rutgers, The State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA.
| | - Jennifer Martin-Biggers
- Rutgers, The State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
| | - Yingting Zhang
- Rutgers, The State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
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Azbel L, Rozanova J, Michels I, Altice FL, Stöver H. A qualitative assessment of an abstinence-oriented therapeutic community for prisoners with substance use disorders in Kyrgyzstan. Harm Reduct J 2017; 14:43. [PMID: 28693573 PMCID: PMC5504733 DOI: 10.1186/s12954-017-0168-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/20/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Kyrgyzstan, where HIV is concentrated in prisons and driven by injection drug use, provides a prison-based methadone maintenance therapy program as well as abstinence-oriented therapeutic community based on the 12-step model called the "Clean Zone." We aimed to qualitatively assess how prisoners navigate between these treatment options to understand the persistence of the Clean Zone despite a lack of evidence to support its effectiveness in treating opioid use disorders. METHODS We conducted an analysis of policy documents and over 60 h of participant observation in February 2016, which included focus groups with a convenience sample of 20 therapeutic community staff members, 110 prisoners across three male and one female prisons, and qualitative interviews with two former Clean Zone participants. Field notes containing verbatim quotes from participants were analyzed through iterative reading and discussion to understand how participants generally perceive the program, barriers to entry and retention, and implications for future treatment within prisons. RESULTS Our analyses discerned three themes: pride in the mission of the Clean Zone, idealism regarding addiction treatment outcomes against all odds, and the demonization of methadone. CONCLUSION Despite low enrollment and lack of an evidence base, the therapeutic community is buttressed by the strong support of the prison administration and its clients as an "ordered" alternative to what is seen as chaotic life outside of the Clean Zone. The lack of services for Clean Zone patients after release likely contributes to high rates of relapse to drug use. The Clean Zone would benefit from integration of stabilized methadone patients combined with a post-release program.
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Affiliation(s)
- Lyuba Azbel
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Julia Rozanova
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06511 USA
| | - Ingo Michels
- Institute for Addiction Research, Frankfurt University of Applied Sciences, Fachbereich 4: Soziale Arbeit und Gesundheit Nibelungenplatz 1, 60318 Frankfurt, Germany
- Central Asia Drug Action Programme (CADAP), Federal Ministry of Health, Friedrichstr. 108, Berlin, Germany
| | - Frederick L. Altice
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06511 USA
- Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, 135 College Street, Suite 323, New Haven, CT 06511 USA
| | - Heino Stöver
- Institute for Addiction Research, Frankfurt University of Applied Sciences, Fachbereich 4: Soziale Arbeit und Gesundheit Nibelungenplatz 1, 60318 Frankfurt, Germany
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Galanter M. Combining medically assisted treatment and Twelve-Step programming: a perspective and review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:151-159. [PMID: 28387530 DOI: 10.1080/00952990.2017.1306747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. OBJECTIVE To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. METHOD Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. RESULTS The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.
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Affiliation(s)
- Marc Galanter
- a Department of Psychiatry , NYU School of Medicine , New York , NY , USA
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50
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Gee RM, Rushing A, Talley B, Dubert CJ, Hamilton EK, Worrell-Carlisle P. A Journey of Healing from Addiction: One Person’s Story. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1288483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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