Quality of life, alcohol detoxification and relapse: is quality of life a predictor of relapse or only a secondary outcome measure?

[The psychosocial rehabilitation in addiction medicine]

OBJECTIVES

Addictive behaviors constitute complex behaviors that are usually related to social habits, such as substance use, gambling or gaming activities, or sexual or physical activity. They progressively overrun and stifle the routine habits of the concerned individuals, for example within their occupational or family spheres of life, as well as in their hobbies or in their main physiological functions, such as sleep or eating cycles. The rehabilitation approach of care integrates the objective of restoring the altered habits and functional rhythms, to optimize the clinical outcomes and improve quality of life of the concerned persons.

METHODS

Using a focused and narrative literature review, we aimed to explain what psychosocial rehabilitation consists in, and why this approach is particularly relevant for the addiction care, although to date it has remained insufficiently developed in the routine practice of many facilities.

RESULTS

The "rehab" approach, is first based on a structured and comprehensive assessment of the clinical and functional aspects of the patient, which secondarily allows to frame an individualized project of care that is closely built together with the patient. This project of care can integrate classical pharmacotherapeutic and psychotherapeutic tools, but it also emphasizes wider approaches for restoring some basic social and physiological functions of the concerned person, such as sleep, eating, social functioning, physical activity, or spiritual needs. Priorities among these different dimensions have to be defined by the concerned person.

CONCLUSIONS

The "rehab" approach is particularly relevant in addiction medicine. It represents a more global conception of care that conceives the recovery of social and physiological functioning as a core treatment objective for the concerned persons. The consequences for care organization are that many additional professionals should be integrated into the treatment schemes for addiction, including peer counselors, occupational therapists, physical activity coaches, or dieticians.

A Study of the association of neurocognition with relapse and quality of life in patients of alcohol dependence

Background

Alcohol is a widely consumed substance associated with around 5.6% of all causes of death. Alcohol use disorder (AUD) is a chronic relapsing and remitting illness and has been known to be associated with impaired executive functions, processing speed, memory, attention, and fluency. It is also associated with impaired quality of life (QoL), which in turn can affect overall prognosis.

Aim

To assess neurocognition in patients with alcohol dependence and correlate it with QoL and relapse.

Materials and Methods

This study was a prospective, longitudinal study of sixty alcohol dependence patients from January 2020 to June 2021 after appropriate ethical approval. Participants were assessed for baseline alcohol dependence, neurocognition (focused, sustained and divided attention; processing speed; verbal and category fluency; working memory; response inhibition; verbal comprehension; verbal learning and memory; visuospatial construction; visual learning and memory) and QoL using Alcohol Use Disorders Identification Test (AUDIT), National Institute of Mental Health and Neurosciences (NIMHANS) battery for neurocognition and WHO-BREF (WHO-Quality of Life-short-form scale) World Health Organization-scale, respectively. A follow-up was conducted in three months to assess relapse in the patients. Statistical analysis was conducted by International Business Machines Statistical Package for the Social Sciences (IBM SPSS) v16.

Results

Mean age of the study participants was 41.3 ± 5.03 years, mean age of onset of alcohol use was 20.88 ± 4.27 years, mean duration of alcohol use of 16.6 ± 7.92 years, and average 14.55 ± 4.86 drinks per day. The mean AUDIT score of the study population was 25.21 ± 7.18. There was significant positive correlation between duration of use and CTT-2; 37 out of 57 participants relapsed to alcohol (three participants had died in follow-up) with mean 37.48 ± 23.27 days of relapse, mean 3.32 ± 1.2 drinking days per week, and mean 6 ± 1.2 drinks per drinking day. There was negative and positive correlation between neurocognition and relapse and between neurocognition and QoL.

Conclusion

Alcohol use also resulted in impaired cognitive function of the study participants. There was also significant difference in score for neurocognition test between relapse and abstinent group. The significant correlation between neurocognition and QoL as well as neurocognition and relapse proves the deleterious effect of alcohol in every aspect of life.

Improvement in quality of life among women and men aged 60 years and older following treatment for alcohol use disorder

BACKGROUND

Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults.

AIMS

In a clinical sample of older adults with DSM-5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow-ups. We also examined the effect of gender and explored interaction effects with gender on QoL.

METHODS

We utilized data from the "Elderly Study," a multi-national, single-blind, randomized, controlled trial of 693 adults aged 60+ with DSM-5 AUD. Alcohol use was assessed with the Form-90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4-, 12-, 26-, and 52-week follow-ups. Multilevel mixed-effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL.

RESULTS

Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1-year follow-up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4-3.9), psychological health (β: 3.5, 95% CI: 3.3-3.8), social relationships (β: 4.0, 95% CI: 2.5-5.6), and environmental health (β: 1.4, 95% CI: 0.4-2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05).

CONCLUSIONS

Among 60+ year-old adults receiving treatment for DSM-5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender.

A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research

ISSUES

Assessing drug and alcohol inpatient withdrawal treatment programs is important, as these represent a first step of treatment among people with alcohol and drug problems. However, there are many ways of measuring outcomes making it difficult for service providers to decide which domains and methods to use. This narrative review aims to clarify frequencies of the domains and methods used to assess withdrawal treatment outcomes.

APPROACH

We reviewed published studies that examined outcomes of inpatient drug and alcohol withdrawal treatment. The types of outcome measures used and the frequency of use were summarised.

KEY FINDINGS

The review showed that assessment of withdrawal treatment outcomes goes beyond traditional abstinence measures. Outcomes mainly focus on biological and psychological outcomes, with social outcomes rarely measured. Even within outcome domains (e.g., cravings), there were many assessment methods.

IMPLICATIONS

The review provides service providers with an outline of common outcome domains and measures. Given the importance of social functioning to recovery from alcohol and drug problems, greater emphasis on such measures is desirable. Future research could develop greater consensus on outcome measures for use in withdrawal management services to facilitate clarity around factors associated with treatment success.

CONCLUSION

Outcome assessment in withdrawal treatment goes beyond abstinence to include holistic measurement of biological, psychological and some social outcomes; but more work needs to be done to cohere the different assessment methods and broaden the scope to include social functioning.

Multidimensional Quality of Life Across the Spectrum of Alcohol Use Behavior

Objective

Quality of life (QoL) is inversely associated with alcohol misuse and is a key measure by which recovery from alcohol use disorder (AUD) might be assessed. Yet, the determinants of QoL are scarcely known. The authors examined three ways through which demographic characteristics, familial and early life factors, and psychopathology conferred risks for QoL, including unique direct effects, developmental pathways, and clinical risk Profiles.

Methods

Cross-sectional data from 1095 adults (50.4% without AUD; 49.6% with AUD) who participated in the NIAAA Natural History Protocol from January 2015 to March 2022 were analyzed. Multivariable regressions, path analysis, and latent Profile analysis were conducted.

Results

AUD was uniquely associated with lower QoL, and adverse effects of child maltreatment history and psychopathology symptoms on QoL were of similar or larger magnitudes. Mediation analysis indicated family history of AUD and child maltreatment history were indirectly associated with lower QoL through higher attention-deficit/hyperactivity disorder symptoms, higher depressive symptoms, and positive AUD diagnosis. Latent Profile analysis of an enriched set of clinical characteristics identified four latent Profiles capturing the full range of alcohol use behavior. Latent Profiles with greater severity of familial and early life factors, psychopathology, and problematic drinking showed dose-response associations with lower levels of physical, psychological, social, and environment QoL.

Conclusions

A constellation of developmental and clinical characteristics disproportionately affects individuals with AUD and is negatively associated with QoL domains. To improve QoL, prevention and intervention need to target multiple factors, including history of child maltreatment, comorbid psychopathology, and problematic drinking itself.

Health-related quality of life in outpatients with substance use disorder: evolution over time and associated factors

Background

Health-related quality of life (HRQoL) is an important element of patient care and clinical research. The aim of this study was to describe HRQoL changes and identify associated factors during a 6-month follow-up of outpatients starting care for alcohol or opioid dependence.

Methods

HRQoL was measured at baseline and 3 and 6 months later using the SF-12. Data on the patients’ sociodemographics, clinical characteristics and levels of anxiety and depression were collected using the Hospital Anxiety and Depression Scale (HADS). Repeated-measures analyses were performed to assess factors associated with global HRQoL differences and the evolution of HRQoL indicated by both physical and mental scores (PCS and MCS, respectively).

Results

The mean PCS and MCS scores were initially low at 45.4 (SD = 8.6) and 36.0 (SD = 10.9), respectively. The improvement in HRQoL was rapid in the first 3-month period and then slowed and remained stable over the subsequent 3-month period. Being employed (p = 0.012), having no comorbidities (p = 0.014) and having no depression (p = 0.004) were associated with significant differences in the average PCS scores at the 3 time points. Patients who had lower overall HRQoL MCS scores on average were those for whom a medication was initiated (p = 0.009), as was the case for patients with anxiety (p < 0.001) and depression (p < 0.001). Patients with depression at baseline were also those for whom a significantly greater increase in MCS score during the 6 months of follow-up was observed.

Conclusion

Our findings highlight the importance of screening early psychological distress and considering other factors associated with HRQoL changes in outpatients after the first 3-month period of treatment for substance use disorder.

Sociodemographic and Clinical Characteristics Associated with Improvements in Quality of Life for Participants with Opioid Use Disorder

Background: The Houston Emergency Opioid Engagement System was established to create an access pathway into long-term recovery for individuals with opioid use disorder. The program determines effectiveness across multiple dimensions, one of which is by measuring the participant’s reported quality of life (QoL) at the beginning of the program and at successive intervals. Methods: A visual analog scale was used to measure the change in QoL among participants after joining the program. We then identified sociodemographic and clinical characteristics associated with changes in QoL. Results: 71% of the participants (n = 494) experienced an increase in their QoL scores, with an average improvement of 15.8 ± 29 points out of a hundred. We identified 10 factors associated with a significant change in QoL. Participants who relapsed during treatment experienced minor increases in QoL, and participants who attended professional counseling experienced the largest increases in QoL compared with those who did not. Conclusions: Insight into significant factors associated with increases in QoL may inform programs on areas of focus. The inclusion of counseling and other services that address factors such as psychological distress were found to increase participants’ QoL and success in recovery.

Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital

Background

Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors.

Results

The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X²= 12.525, p=0.014; X²= 12.525, p=0.023; and X²= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse.

Conclusions

Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.

Willingness to pay vs lottery equivalent to value the impact of alcohol misuse on quality of life

OBJECTIVES

To estimate the impact of alcohol disorders using lottery equivalent (LE) and willingness to pay (WTP) methods and compute the WTP for a QALY (WTP-Q) derived from these values.

METHODS

Two samples of 300 people valued nine states of alcohol misuse. LE and WTP were used in sample 1 and 2, respectively. The ability to discriminate between methods was tested. Regression models were performed to estimate the preference weights of dimensions. Several values of WTP-Q were obtained by combining the estimated values from both samples.

RESULTS

LE and WTP produce the same ranking of states but LE is more sensitive. The estimated impact of the nine states ranges between 0.91 and 0.22 QALYs, and the WTP for avoiding them ranges between €10,444 and €4132. WTP-Q varies between €11,473 and €19,092 when the mean values of the states are used. The WTP-Q tends to decrease with the severity.

CONCLUSIONS

Although LE and WTP provide values for cost-utility and cost-benefit analyses, respectively, LE seems to be preferable for measuring the impact of alcohol disorders. As the lower sensitivity of WTP seems to explain a WTP-Q decrease with severity, more research is needed before recommending the use of different WTP-Q values.

Factors associated with quality of life trajectories among inpatients treated for alcohol use disorders: A prospective cohort study

AIMS

The main study purpose was to investigate patient- and treatment-related factors associated with overall quality of life (OQOL) trajectories during and after inpatient alcohol use disorder (AUD) treatment.

DESIGN

A large-scale prospective multicenter cohort study of patients with different substance use disorder (SUD) types who were consecutively admitted for inpatient SUD treatment. Data were obtained at treatment entry (T1), discharge (T2), three months after discharge (T3), and one year after discharge (T4). The inclusion criterion was that the patient be dependent solely on alcohol. OQOL data were collected at all four time points. Independent variables included demographics, mental distress, psychiatric disorders, substance use, treatment history, and patient satisfaction.

RESULTS

Among the 611 patients available, 236 met the AUD inclusion criterion and completed T1 assessments. A linear mixed model showed substantial co-occurrence between higher mental distress and lower OQOL. Higher patient satisfaction with inpatient treatment (T2) was associated with higher trajectories of OQOL, whereas abstinence (T3) was not. There was a substantial increase in OQOL from T1 to T2, which then remained stable during the last two assessment time points.

CONCLUSIONS

Routine OQOL screening at treatment entry, and targeting mental distress both during and after inpatient treatment, may be associated with improved OQOL among individuals with AUD. Further research should investigate inpatient treatment factors that contribute to OQOL improvement and those that moderate the relationship between patient satisfaction and OQOL.

Physical activity participation is associated with higher quality of life scores in men with alcohol use disorders: a study from Uganda

Background

There is a growing recognition of the importance of encouraging people with alcohol use disorders (AUD) to become more active as an achievable strategy to reduce the disability-associated burden.

Objective

We investigated whether physical activity and sedentary behaviour in men with AUD contribute to their quality of life (QoL).

Methods

Fifty male Ugandan inpatients with AUD (33.0±10.7 years) completed the World Health Organization Quality of Life Assessment brief version, Simple Physical Activity Questionnaire and the Alcohol Use Disorders Identification Test while waist circumference, body mass index and blood pressure were assessed. Linear multiple regression analysis explored the total variance in QoL explained by all predictor variables.

Results

SIMPAQ walking and SIMPAQ exercise explained 46% of the variability in physical QoL, 45% of the variability in psychological QoL, and 40% of the variability in environmental QoL. The SIMPAQ walking score predicted 37% of the variability in social QoL.

Conclusion

The current findings suggest that higher levels of walking and exercising are associated with a better QoL. Our study therefore provides a platform for future research to investigate the role of physical activity on QoL levels in people with AUD, also in low resourced settings in low-income countries such as Uganda.

Predictors of premature treatment termination in a large residential addiction medicine program

BACKGROUND

While inpatient programs are a common setting for addiction treatment, patients' premature termination is a major concern. Predicting premature treatment termination has the potential to substantially improve patient outcomes by identifying high-risk profiles and suggesting care paths that might reduce dropout. The current study examined the predictors of premature termination from an inpatient addiction medicine service.

METHODS

In 1082 patients admitted to a large inpatient addiction medicine service, we used intake assessments of severity of alcohol use disorder, illicit drug use disorder, post-traumatic stress disorder (PTSD), anxiety disorders, and major depressive disorder to predict planned termination (n = 922) or premature termination (n = 160). We used two complementary analytic approaches-traditional binary logistic regression and a data-driven latent profile analysis (LPA).

RESULTS

Binary logistic regression revealed that alcohol use severity, illicit drug use severity, and PTSD severity significantly predicted termination status, although alcohol use severity notably exhibited an inverse relationship. The LPA revealed four distinct profiles, with one profile exhibiting a significantly higher rate of premature termination and another exhibiting a significantly lower rate of premature termination. The high-risk profile was characterized by high drug severity, high comorbid psychopathology (PTSD, depression, and anxiety symptoms), but low alcohol severity. The low-risk profile was characterized by high alcohol severity, but low drug use and low comorbid psychopathology.

CONCLUSIONS

These results provide converging evidence that illicit drug severity and psychiatric severity, and particularly PTSD, were associated with premature termination. Moreover, the LPA revealed distinct latent subgroups of patients with meaningfully higher and lower risk of premature termination, suggesting that addiction services should develop strategies for identifying high-risk individuals or develop care paths for high-risk symptom clusters. Approaches that are trauma-informed or otherwise focus on the management of comorbid psychiatric conditions may be particularly appropriate for reducing premature termination.

Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence

Background

Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients’ HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence.

Methods

HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients’ levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively).

Results

Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (β = 5.5; p = 0.001) and a lower baseline PCS score (β = − 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (β = − 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (β = 0.1; p = 0.02) and a lower baseline MCS score (β = − 0.7; p < 0.0001) were associated with significant MCS improvement.

Conclusion

The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients’ early satisfaction to identify areas of improvement and thus improve HRQoL.

The Auckland alcohol detoxification outcome study: Measuring changes in quality of life in individuals completing a medicated withdrawal from alcohol in a detoxification unit

AIM

To measure outcomes in Quality of Life in alcohol dependent patients' following a medicated withdrawal from alcohol.

METHODS

79 patients that were admitted to a detoxification unit in Auckland, New Zealand between March 2016 and September 2016 were assessed for severity of alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependency Questionnaire (SADQ) and Quality of Life (QOL) using the World Health Organisation Quality of Life-abbreviated version of the WHOQOL 100 New Zealand version (WHOQOL-BREF NZ). Patients were followed up at three months and 12 months and an estimate of drinking behavior and the WHO-QOL BREF NZ were completed via telephone interview. QOL domain scores were assessed from baseline to three months and baseline to 12 months in both relapse and abstinent groups. At three months, a single question was asked in order to collect qualitative data.

RESULTS

At baseline, the study population had statistically significantly lower mean QOL domain scores than scores reported from the general population. QOL improved in patients following detoxification at three months and 12 months in both the relapse and abstinent groups; however, the change in scores from baseline was greater in the abstinent group compared to the relapse group. The majority of patients reported that the admission had been a positive experience.

CONCLUSION

QOL improves in individuals following a medicated withdrawal from alcohol regardless of whether individual's relapse; however, those that remain abstinent have greater improvements in quality of life.

Quality of life in substance use disorder patients with and without attention deficit hyperactivity disorder 12 months after treatment: a naturalistic follow-up study

There is sparse research on quality of life (QoL) as an outcome measure in patients with substance use disorders (SUD), with or without attention deficit hyperactivity disorder (ADHD). We aimed to investigate whether SUD patients with and without ADHD (SUD + ADHD vs. SUD - ADHD) differed in QoL at baseline and at a 12-month follow-up after SUD treatment. The groups were additionally compared with data from a national population sample (NPS). From a sample of 16 SUD + ADHD and 87 SUD - ADHD patients originally recruited between 2010 and 2012, eight SUD + ADHD (50.0%) and 28 SUD - ADHD (32.2%) patients were reached at follow-up. QoL was measured with the short version of the World Health Organization QoL instrument (WHOQOL-BREF). Cross-sectional data on QoL from NPS was utilized. Compared to NPS, SUD patients reported significantly lower QoL at baseline and follow-up. Furthermore, QoL was similar at baseline in SUD + ADHD and SUD - ADHD patients. At a 12-month follow-up after SUD treatment, SUD + ADHD patients 'QoL had improved, however, not significantly differing from SUD - ADHD patients or the NPS. SUD - ADHD patients' QoL remained significantly lower. At follow-up, SUD + ADHD patients' QoL improved nominally compared to SUD - ADHD patients, but not the NPS. The clinical and functional relevance of these findings should be investigated further.

Outpatient Addiction Treatment for Problematic Alcohol Use: What Makes Patients Who Dropped Out Different from Those Who Did Not?

BACKGROUND

A minority of individuals with problematic alcohol use effectively seek help. Moreover, dropouts from care are not uncommon. It remains a major concern for health professionals, as adherence to treatment is significantly associated with better physical and psychological outcomes.

OBJECTIVES

The main aim of this research was to assess what factors could distinguish patients with problematic alcohol use who dropped out from those who did not.

METHODS

The sample included 150 patients followed-up in an outpatient treatment center in France for a problematic alcohol use. Two measurement times were planned: at the first appointment and after six month of treatment. A large set of individual, environmental and institutional variables were considered to compare both subgroups.

RESULTS

Patients who dropped out mostly differ from patients who did not with a higher level of alcohol-related problems, ambivalence, inclinations to use the substance, number of missed appointments. Significant results were also observed regarding a lower time gap between the first contact with the center and the first appointment, as well as the season of the last appointment.

CONCLUSIONS

Tailored motivational interventions could be offered to ambivalent patients, especially during the beginning of the treatment and some significant periods of the year. A particular focus should be brought on patients presenting such profiles in terms of level of alcohol problems, inclinations to drink and motivation to change. Overall, the study provides elements to better understand what may bring one patient to drop out of the treatment, and to improve the continuity of care.

The role of spirituality in alcohol abstinence self-efficacy amongst alcoholics anonymous members

Purpose

Previous research indicates that Alcoholics Anonymous (AA) can play an effective role in alcohol use disorder recovery (Kelly, Stout, Magill, Tonigan and Pagano, 2011). Acceptance of a “Higher Power” and experiencing a “spiritual awakening” are essential components of AA recovery programme (Alcoholics Anonymous World Service, 2014). The purpose of this paper is to identify if there are high associations in levels of spirituality and alcohol abstinence self-efficacy (AASE) measures amongst AA members.

Design/methodology/approach

Self-reported measures were collected from members of AA of their spiritual and religious beliefs and their everyday experiences of alcohol abstinence. Demographic information of participant’s ethnical background, age and length of AA membership was also obtained.

Findings

The analysis revealed high levels of spirituality amongst participants with a mean of 70.14 (2dp). There was no difference in participant high or low spiritual beliefs and their attitude towards alcohol abstinence. The frequency measures of spiritual activities showed that 73.7 per cent of participants engage in private spiritual or religious activities more than once a week.

Originality/value

Overall the study supports previously conduced researches in the field of spirituality and AASE amongst AA members when considering other variables associated with sustained sobriety. The implications of the results of this study are discussed and suggestions have been made for further investigation.

"I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service

BACKGROUND

The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff.

METHODS

This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program.

RESULTS

A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process.

CONCLUSION

This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.

Predicting drinking outcomes: Evidence from the United Kingdom Alcohol Treatment Trial (UKATT)

AIMS

To explore client characteristics that predict drinking outcomes using data from the UK Alcohol Treatment Trial (UKATT).

METHODS

Multiple linear regression was used to determine if there were any characteristics, measured before the start of treatment, that could predict drinking outcomes at three and 12months, as measured by percent day abstinent (PDA) and drinks per drinking day (DDD) over the preceding 90days.

RESULTS

Lower baseline DDD score and greater confidence to resist drinking predicted lower DDD at both three and twelve months following entry to treatment. In addition to baseline PDA and having greater confidence to resist heavy drinking, female gender, aiming for abstinence, more satisfaction with family life and a social network that included less support for drinking were predictors of percent days abstinent.

CONCLUSIONS

Overall the strongest and most consistent predictors of outcome were confidence to avoid heavy drinking and social support for drinking. More predictors were identified for percent of days abstinent than for drinks per drinking day. For percent of days abstinent, a number of client characteristics at baseline consistently predicted outcome at both month three and month twelve.

Barking up the Wrong Tree: Why and How We May Need to Revise Alcohol Addiction Therapy

One of the main characteristics of alcohol abuse and addiction is the loss of control over alcohol intake and the continuation of drinking in the face of negative consequences. Mounting evidence strongly suggests that an alcohol-induced imbalance between goal-directed and habitual behavior may be one of the main driving factors of this key feature of addiction and furthermore play a key role in staying abstinent. Current therapies often focus only on deficient inhibitory control (i.e., goal-directed behavior), but largely neglect the potential of the well-functioning habit formation found in patients. Yet, focusing on intact habitual/automatic mechanisms in addition to or maybe even instead of deficient cognitive control might equip us with a more effective tool to battle the current alcohol abuse and addiction epidemic, especially with respect to more severely impacted patients who likely suffer from permanent alcohol-induced brain damage. Against this background, I would like to advocate the application and scientific evaluation of habit reversal therapy (HRT) for alcohol abuse and addiction.

Motivation to change and posttreatment temptation to drink: a multicenter study among alcohol-dependent patients

BACKGROUND

An inpatient 28-day rehabilitation program for alcohol dependence is focused on detoxification, enhancing motivation to change, and coping strategies for the management of emotional distress and temptation to drink. The aims of the present study were to investigate 1) changes over time in motivation to change, anxiety, and depression in individuals undergoing residential rehabilitation treatment for alcohol addiction, and 2) which pretreatment factors are associated with posttreatment temptation to drink.

METHODS

We assessed 432 patients diagnosed with alcohol dependence based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) consecutively recruited from seven residential rehabilitation centers in Northern Italy. Patients were assessed by means of self-report questionnaires at the beginning of rehabilitation (pretreatment) and before their hospital discharge (posttreatment) regarding motivation to change and self-efficacy (motivation assessment of change - alcoholism version), readiness to change and temptation to drink (visual analog scales), and depression and anxiety (cognitive behavioral assessment - outcome evaluation).

RESULTS

Results showed an overall improvement in motivation to change and a significant reduction over time in depression and anxiety levels for the total sample, particularly patients with low baseline level of temptation to drink. Multivariate linear regression analysis revealed that significant predictors of posttreatment temptation to drink were polysubstance dependence (p<0.001), readiness to change (p=0.01), and self-efficacy (p=0.05).

CONCLUSION

Inpatients' rehabilitation for alcohol dependence is associated with an overall improvement in motivation to change and a significant reduction of psychological distress. Treatments for alcohol-dependent patients should focus on motivation to change, negative moods, and relapse prevention strategies for the management of craving.

Measuring the impact of alcohol-related disorders on quality of life through general population preferences

OBJECTIVE

To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences METHODS: The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated.

RESULTS

Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%).

CONCLUSIONS

Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications.

Perceived quality of life, 6 months after detoxification: Is abstinence a modifying factor?

Purpose

Patients with a substance use disorder (SUD), admitted for detoxification, often suffer from a poor quality of life (QoL). We set out to monitor QoL, together with substance use, in a departure from the usual norm of measuring substance use alone as a treatment outcome. Literature searches revealed scant knowledge of how QoL is influenced. With this in mind, we aimed to investigate whether total abstinence, prior to follow-up, could influence QoL.

Methods

We studied a prospective cohort of 140 patients admitted for inpatient detoxification treatment at Sørlandet Hospital (Norway), from September 2008 to August 2010. QoL was measured by a generic five-item questionnaire, the QoL-5. The extremes of this scale ranged from the worst possible rating of 0.1 to 0.9, as the best. A norm for the general population was benchmarked at 0.69. Change in QoL was calculated by subtracting baseline QoL from that achieved at the 6-month follow-up interview; linear regression modeling was used to study the influence of individual QoL predictors.

Results

The mean QoL at baseline was 0.46, 39 % below that of the general reference population. By applying the clinical interpretation of the scale, we found a modest overall mean improvement in QoL at follow-up (0.11 points); the greatest increases were seen for patients with the lowest baseline QoL scores. Abstinence prior to follow-up correlated with improved QoL, while living alone and psychological distress were negative influences.

Conclusions

For patients with a SUD, clinicians should emphasize that abstinence may help to improve their QoL.

Predictive typology of subjective quality of life among participants with severe mental disorders after a five-year follow-up: a longitudinal two-step cluster analysis

BACKGROUND

This study aims to create a predictive typology of quality of life at five-year follow-up of 204 individuals with severe mental disorders, according to clinical, socio-demographic, and health service use variables.

METHODS

Participant typology was carried out by means of two-step cluster analysis. Independent variables were measured at T0 and subjective quality of life (SQOL) at T2.

RESULTS

Analysis yielded four classes. SQOL at T2 was higher than the mean in Class 4 ("Older, poorly educated single men living in supervised housing, with psychotic disorders but with few serious needs, receiving substantial help from services") and lower than the mean in Class 2 ("Young females with serious needs and co-occurring mental and addiction disorders living in independent apartments").

CONCLUSION

Given that predictive SQOL varies in relation to combinations of associated variables, it would be useful for treatments or service programs to target specific predictors to the different profiles.

Psychological changes in alcohol-dependent patients during a residential rehabilitation program

BACKGROUND

Alcohol-dependent patients usually experience negative affects under the influence of alcohol, and these affective symptoms have been shown to decrease as a result of alcohol-withdrawal treatment. A recent cognitive-affective model suggests an interaction between drug motivation and affective symptoms. The aim of this multicenter study was to evaluate the psychological changes in subjects undergoing a residential rehabilitation program specifically designed for alcohol addiction, and to identify at discharge patients with greater affective symptoms and therefore more at risk of relapse.

MATERIALS AND METHODS

The sample included 560 subjects (mean age 46.91±10.2 years) who completed 28-day rehabilitation programs for alcohol addiction, following a tailored routine characterized by short duration and high intensity of medical and psychotherapeutic treatment. The psychological clinical profiles of anxiety, depression, psychological distress, psychological well-being, and self-perception of a positive change were assessed using the Cognitive Behavioral Assessment - Outcome Evaluation questionnaire at the beginning and at the end of the program. The changes in the psychological variables of the questionnaire were identified and considered as outcome evaluation of the residential intervention. Moreover, differences in the psychological functioning between patients with different characteristics were investigated.

RESULTS

The score measured by the Cognitive Behavioral Assessment - Outcome Evaluation showed significant improvements in all the psychological characteristics assessed, and the profile at discharge was within the normal scores. Some significant differences were found in relation to specific characteristics of the sample, such as age, sex, level of education, type of intervention, and polysubstance use.

CONCLUSION

This study shows the changes in psychological profile in subjects undergoing residential rehabilitation from alcohol and how this profile may permit identification of subjects requiring more psychosocial support after discharge.