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Zhang B, Deng H, Ren J, Legrand FD, Ahmad Yusof H, Zhang R, Leong Bin Abdullah MFI. Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial. BMJ Open 2024; 14:e080315. [PMID: 38926142 PMCID: PMC11216053 DOI: 10.1136/bmjopen-2023-080315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The prevalence of major depressive disorder (MDD) is on the rise globally, and the use of antidepressant medications for its treatment does not usually result in full remission. However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients. This three-armed, parallel-group, double-blinded randomised controlled trial (RCT) aims to assess and compare the effects between the combination of exergame and acceptance and commitment therapy (e-ACT) programme, ACT only and treatment-as-usual (TAU) control groups on the severity of depression and anxiety symptoms, the degree of experiential avoidance and quality of life (QoL) and the serum levels of depression biomarkers (such as brain-derived neurotrophic factor, C-reactive protein and vascular endothelial growth factor) among patients with MDD across three time points. METHODS AND ANALYSIS This RCT will recruit 126 patients with MDD who will be randomised using stratified permuted block randomisation into three groups, which are the combined e-ACT programme, ACT-only and TAU control groups in a 1:1:1 allocation ratio. The participants in the e-ACT and ACT-only intervention groups will undergo once a week intervention sessions for 8 weeks. Assessments will be carried out through three time points, such as the pre-intervention assessment (t0), assessment immediately after completion of the intervention at 8 weeks (t1) and assessment at 24 weeks after completion of the intervention (t2). During each assessment, the primary outcome to be assessed includes the severity of depression symptoms, while the secondary outcomes to be assessed are the severity of anxiety symptoms, experiential avoidance, QoL and depression biomarkers. ETHICS AND DISSEMINATION Approval of this study was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/PP/23050420). The findings of the study will be published in academic peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05812001 (ClinicalTrials.gov). Registered on 12 April 2023.
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Affiliation(s)
- Bingyu Zhang
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Hongdu Deng
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Jinli Ren
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | | | - Hazwani Ahmad Yusof
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Ruiling Zhang
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
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Yadav AS, Kumar A, Singh S, Singh T. Navigating Adherence: Unraveling Factors Shaping Opioid Substitution Therapy Compliance. Cureus 2024; 16:e51577. [PMID: 38313900 PMCID: PMC10836039 DOI: 10.7759/cureus.51577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Background and objective In drug-deaddiction programs, dropout is a major problem in any drug de-addiction program, as dependence is a chronic illness known to relapse frequently. Understanding factors that predict dropout can help design targeted interventions to promote follow-up. This study aimed to assess the various sociodemographic characteristics of opioid-dependent subjects on buprenorphine maintenance treatment and dropping out at or before the three-month follow-up period. Method In this study, the sociodemographic characteristics and quality of life (QOL) of 34 opioid-dependent subjects (males, 32, 94%; females, 2, 6%) on the day of their enrolment in an opioid substitution therapy (OST) center were assessed, and a comparison of sociodemographic and drug use pattern was made between those who followed up and those who dropped out by the end of three months. Results Statistical analysis of the various sociodemographic characteristics using appropriate tests yielded that predictors of good follow-up are younger age (F = 4.57907, P = 0.04008), better education (F = 5.07221, P = 0.031305), and being part of a nuclear family. Longer follow-up was associated with shorter opioid intake duration (F = 8.58908, P = 0.006195). Better social relationships, as evidenced by the social relationship domain score of QOL, predicted longer follow-up (F = 8.58908, P = 0.006195). Other characteristics analyzed did not yield significant associations. Conclusions The study unveils the complexity of opioid addiction recovery, revealing the interplay of age, education, family, addiction duration, and support, shaping one's resilience in recovery.
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Affiliation(s)
- Anupam S Yadav
- Department of Psychiatry, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Ashutosh Kumar
- Department of Psychiatry, Sarojini Naidu Medical College, Agra, IND
| | - Sonali Singh
- Department of Pediatrics, King George's Medical University, Lucknow, IND
| | - Tejpal Singh
- Department of Medicine, Sarojini Naidu Medical College, Agra, IND
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Schell C, Godinho A, Cunningham JA. Examining Changes in Quality of Life as an Outcome Measure in Three Randomized Controlled Trials of Online Interventions That Included an Intervention for Hazardous Alcohol Use. Subst Use Misuse 2023; 59:50-57. [PMID: 37735801 DOI: 10.1080/10826084.2023.2259453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Quality of life (QOL) summarizes an individual's perceived satisfaction across multiple life domains. Many factors can impact this measure, but research has demonstrated that individuals with addictions, physical, and mental health concerns tend to score lower than general population samples. While QOL is often important to individuals, it is rarely used by researchers as an outcome measure when evaluating treatment efficacy. METHODS This secondary analysis used data collected during three separate randomized controlled trials testing the efficacy of different online interventions to explore change in QOL over time between treatment conditions. The first project was concerned with only alcohol interventions. The other two combined either a gambling or mental health intervention with a brief alcohol intervention. Males and females were analyzed separately. RESULTS This analysis found treatment effects among female participants in two projects. In the project only concerning alcohol, female quality of life improved more among those who received an extensive intervention for hazardous alcohol use compared to a brief intervention (p = .029). QOL among females who received only the mental health intervention improved more than those who also received a brief alcohol intervention (p = .049). CONCLUSION Poor QOL is often cited as a reason individuals decide to make behavior changes, yet treatment evaluations do not typically consider this patient-important outcome. This analysis found some support for different treatment effects on QOL scores in studies involving at least one intervention for hazardous alcohol use.
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Affiliation(s)
- Christina Schell
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
| | - Alexandra Godinho
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
- Research Office, Humber River Hospital, Toronto, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Cheng Q, Bajis S, Cunningham E, Shih STF, Schulz M, Marshall AD, Martin NK, Miners A, Hajarizadeh B, Wiseman V, Dore GJ, Grebely J. Health-related quality of life among people who inject drugs in Australia. Qual Life Res 2023; 32:3195-3207. [PMID: 37351701 PMCID: PMC10522523 DOI: 10.1007/s11136-023-03465-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We aimed to evaluate factors associated with HRQoL among a cohort of PWID in Australia. METHODS Participants were enrolled in an observational cohort study (the LiveRLife Study) between 2014 and 2018 at 15 sites in Australia. They provided fingerstick whole-blood samples for point-of-care HCV RNA testing and underwent transient elastography to assess liver disease. Participants completed the EQ-5D-3L survey at enrolment. Regression models were used to assess the impact of clinical and socioeconomic characteristics on the EQ-5D-3L scores. RESULTS Among 751 participants (median age, 43 years; 67% male), 63% reported injection drug use in the past month, 43% had current HCV infection, and 68% had no/mild liver fibrosis (F0/F1). The mean EQ-5D-3L and EQ-VAS scores were 0.67 and 62, respectively, for the overall study population. There was no significant difference in the EQ-5D-3L scores among people with and without recent injecting drug use (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.78, P = 0.405), and among people receiving and not receiving opioid agonist therapy (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.76, P = 0.215). Participants who were employed were found to have the highest mean EQ-5D-3L (0.83) and EQ-VAS scores (77). The presence of current HCV infection, liver fibrosis stage, and high-risk alcohol consumption had little impact on HRQoL. CONCLUSIONS The study findings provide important HRQoL data for economic evaluations, useful for guiding the allocation of resources for HCV elimination strategies and interventions among PWID.
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Affiliation(s)
- Qinglu Cheng
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Evan Cunningham
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Sophy T F Shih
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Marcel Schulz
- St Vincent's Clinical School, UNSW Medicine, Sydney, NSW, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Virginia Wiseman
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
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Woodhead EL, Ilgen M, Timko C. Telephone monitoring and 15-month outcomes for patients with co-occurring substance use and mental health disorders: Moderating effects of high-risk patient characteristics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209094. [PMID: 37285924 DOI: 10.1016/j.josat.2023.209094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/27/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Telephone monitoring interventions for substance use disorders are an important component of continuing care to reduce relapse and connect patients to services. However, a knowledge gap still exists as to which patient groups benefit most from them. This secondary analysis of a randomized controlled trial examined moderators of associations between telephone monitoring and 15-month substance use outcomes among patients with co-occurring substance use and mental health disorders. High-risk patient characteristics at baseline were examined as potential moderators of the effectivness of telephone monitoring, including history of incarceration, severity of depression symptoms, and suicide risk. METHODS Participants were 406 psychiatry inpatients with documented substance use and mental health disorders who were randomized to treatment as usual (TAU; n = 199) or TAU plus telephone monitoring (TM; n = 207). Outcomes included abstinence self-efficacy (Brief Situational Confidence Questionnaire) and alcohol and drug use severity (Addiction Severity Index composites) at 15-month follow-up. Analyses examined main effects of treatment condition and moderators, and interactions between treatment condition and moderators. RESULTS The study found five significant main effects, three of which were qualified by significant interactions. Incarceration history was associated with higher drug use severity; higher suicide risk was associated with higher abstinence self-efficacy. Regarding interaction effects, among participants with an incarceration history, TM compared to TAU was associated with significantly lower alcohol use severity at 15-month follow-up; this finding did not hold for never-incarcerated participants. For participants with less severe depression symptoms, TM compared to TAU was associated with significantly lower alcohol use severity and higher abstinence self-efficacy at follow-up; this did not hold for participants with more severe depression symptoms. Suicide risk was not a significant moderator of any outcome. CONCLUSIONS Results indicate that TM is effective in improving alcohol use severity and abstinence self-efficacy for some subgroups of patients, including patients with an incarceration history or less severe depression. Results inform the clinical provision of substance use disorder care by means of telehealth, which increased due to the COVID-19 pandemic.
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Affiliation(s)
- Erin L Woodhead
- Department of Psychology, San José State University, 1 Washington Square, San José, CA, 95192-0120, USA.
| | - Mark Ilgen
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI 48109, USA; University of Michigan Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI 48109, USA.
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
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Kim JJ, Nikoo M, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Gholami A, Lafooraki NY, Vogel M, Rezazadeh-Azar P, Meyer M, Cabanis M, Jang K, Aknondzadeh S, Krausz M. Quality of life of patients treated with opium tincture or methadone: A randomized controlled trial. Drug Alcohol Depend 2023; 249:110874. [PMID: 37402335 DOI: 10.1016/j.drugalcdep.2023.110874] [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: 04/25/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Quality of life (QoL) is an increasingly recognized patient-centered treatment outcome in individuals with opioid use disorder. There is a gap in literature on the impact of opium tincture (OT) on patients' QoL compared to standard treatment options such as methadone. This study aimed to compare the QoL of participants with opioid use disorder receiving OAT using OT or methadone and identify the factors associated with their QoL during treatment. METHODS The opium trial was a multicenter non-inferiority randomized clinical trial in four private OAT outpatient clinics in Iran. The study assigned patients to either OT (10 mg/ml) or methadone sirup (5 mg/ml) for a follow-up of 85 days. QoL was assessed using the brief version of the World Health Organization Quality of Life instrument (WHOQOL- BREF). RESULTS A total of 83 participants, 35 (42.2%) in the OT arm and 48 (57.8%) in the methadone arm, completed the WHOQOL-BREF in full and were included in the primary analysis. The mean score of patients' QoL showed improvement compared to baseline, but differences were not statistically significant between OT and methadone arms (p = 0.786). Improvements were mainly observed within the first 30 days of receiving treatment. Being married and lower psychological distress were associated with an improved QoL. Within the social relationships domain, male gender showed significantly higher QoL compared to females. CONCLUSION OT shows promise as an OAT medication, comparable to methadone in improving patients' QoL. There is a need to incorporate psychosocial interventions to further sustain and improve the QoL in this population. Identifying other social determinants of health which affect QoL and the cultural adaptation of assessments for individuals from various ethnocultural backgrounds are critical areas of inquiry.
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Affiliation(s)
- Jane J Kim
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada.
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Nooshin Nikoo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Alireza Kazemi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Sari, Mazandaran, Iran
| | - Neda Y Lafooraki
- Islamic Azad University, Science and Research Branch, Mazandaran, Iran
| | - Marc Vogel
- Division of Substance Use Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Pouya Rezazadeh-Azar
- Complex Pain and Addiction Services, Vancouver General Hospital & Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Maximilian Meyer
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Maurice Cabanis
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, Stuttgart, 70374, Germany
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Shahin Aknondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Iran
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
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Dehghan M, Malakoutikhah A, Kazemy H, Fattahi Toqroljerdi MH, Mokhtarabadi S, Zakeri MA. The relationship between beliefs in substance craving and quality of life among narcotics anonymous: a cross-sectional study in southeastern Iran. BMC Psychol 2023; 11:126. [PMID: 37081556 PMCID: PMC10116790 DOI: 10.1186/s40359-023-01164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/09/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Addiction is a chronic and relapsing disorder characterized by compulsive drug seeking and lasting changes in the brain. Low quality of life may influence the substance craving, which leads to relapsing. Therefore, the present study aimed to investigate the relationship between beliefs in substance craving and quality of life among narcotics anonymous. METHODS This cross-sectional study was performed on 202 narcotics anonymous in Kerman, southeastern Iran. Convenience sampling was used to select anonymous patients in the Narcotics Anonymous (NA) association in Kerman city. Narcotics anonymous completed the demographic questionnaire, the Craving Beliefs Questionnaire (CBQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression model was used to determine the predictors of craving beliefs. The data were then analyzed using SPSS 22. RESULTS The mean age of the participants was 38.48 ± 11.32 years. The majority of the samples were male (86.1%), married (65.4%), educated (93.6%) and urban (86.1%). The mean scores of craving beliefs and overall Quality of Life (QOL) were 77.58 ± 20.70 and 64.42 ± 23.13, respectively. Forty-two-point 1% had high level of craving beliefs. We found a significant negative and weak correlation between beliefs in substance craving, physical health domain (r = -0.16, p = 0.02), and overall quality of life (r = -0.15, p = 0.03). History of crack use, job, and physical health domain of QOL were predictors of beliefs in substance craving among the NAs. CONCLUSION Based on the study results, the participants had a high level of substance craving, and some aspects of the quality of life had an impact on the beliefs of addiction. However, it is necessary to conduct more studies in this field; psychological interventions and programs to increase the quality of life may reduce the substance craving.
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Affiliation(s)
- Mahlagha Dehghan
- Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
- M.Sc. in psychiatric nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Malakoutikhah
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Homayoon Kazemy
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Sima Mokhtarabadi
- M.Sc. in Medical Surgical Nursing, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Ali Zakeri
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Della Rocca F, Maremmani AGI, Bacciardi S, Pacini M, Lamanna F, Tripodi B, Miccoli M, Maremmani I. Characteristics of Stress Sensitivity in Heroin Use Disorder Patients during Their Opioid Agonist Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4566. [PMID: 36901575 PMCID: PMC10002439 DOI: 10.3390/ijerph20054566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
In the present study, performed on a sample of Heroin Use Disorder (HUD) patients undergoing Opioid Agonist Treatment (OAT), we attempted to explore the relationships between stress sensitivity and heroin addiction-related clinical aspects. HUD patients' stress sensitivity was evaluated with the Heroin/PTSD-Spectrum questionnaire (H/PSTD-S). The Drug Addiction History Questionnaire (DAH-Q), the Symptomatological Check List-90 (SCL-90), and The Behavioural Covariate of Heroin Craving inventory (CRAV-HERO) were all used, as were the Deltito Subjective Wellness Scale (D-SWS), a self-report scale evaluating subjective well-being; the Cocaine Problem Severity Index (CPSI), a questionnaire determining the extent of a cocaine problem; and the Marijuana Craving Questionnaire (MC-Q), an instrument assessing craving for cannabinoids. We checked correlations between stress sensitivity and the extent of HUD clinical features and compared patients with and without problematic stress sensitivity. H/PTSD-S was positively correlated with patients' income, altered mental status, legal problems, the lifetime different treatments index, the current treatment load index, and all SCL-90 indexes and factors. Regarding subjective well-being, stress sensitivity negatively correlated with the contrast best week (last five years) index. Patients with high-stress sensitivity were females with a low income. They exhibited a more severe mental status at treatment entry, greater difficulty in working adaptation, and legal problems during treatment. Additionally, these patients showed a higher level of psychopathology, more impairment in well-being, and more risky behaviours during treatment. Stress sensitivity, as H/PTSD-S, must be considered an outcome of HUD. HUD's addiction history and clinical features are significant risk factors for H/PTSD-S. Therefore, social and behavioural impairment in HUD patients could be considered the clinical expression of the H/PTSD spectrum. In summary, the long-term outcome of HUD is not represented by drug-taking behaviours. Rather, the inability to cope with the contingent environmental conditions is the key feature of such a disorder. H/PTSD-S, therefore, should be seen as a syndrome caused by an acquired inability (increased salience) concerning regular (daily) life events.
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Affiliation(s)
- Filippo Della Rocca
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
| | - Angelo G. I. Maremmani
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- Department of Psychiatry and Addictions, Section of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Viareggio, Italy
| | - Silvia Bacciardi
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- Department of Psychiatry and Addictions, Section of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Viareggio, Italy
| | - Matteo Pacini
- V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy
| | - Francesco Lamanna
- Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Pisa Zone, Via delle Torri 160, 56124 Pisa, Italy
| | - Beniamino Tripodi
- Department of Mental Health and Addictions, Division of Psychiatry, ASST Crema, Via Largo Dossena 2, 26013 Crema, Italy
| | - Mario Miccoli
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Icro Maremmani
- Addiction Research Methods Institute, World Federation for the Treatment of Opioid Dependence, 225 Varick Street, Suite 402, New York, NY 10014, USA
- V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy
- Saint Camillus International University of Health Sciences (UniCamillus), Via di Sant’Alessandro 8, 00131 Rome, Italy
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Sun C, Wang X, Huang X, Shao Y, Ling A, Qi H, Zhang Z. Sleep disorders as a prospective intervention target to prevent drug relapse. Front Public Health 2023; 10:1102115. [PMID: 36684873 PMCID: PMC9846318 DOI: 10.3389/fpubh.2022.1102115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Objective The high rate of relapse has become the primary obstacle of drug rehabilitation. In this study, we explored the relationship between sleep disorders and relapse inclination in substance users, as well as the potential mediating mechanisms and corresponding interventions. Methods A total of 392 male substance users were recruited to complete the questionnaires on sleep disorders, quality of life and relapse inclination. On account of this, 60 participants with sleep disorders were randomly screened and allocated to the intervention and control groups. The former received 12 weeks of Health Qigong aimed at treating sleep disorders, whereas the latter performed their regular production work. Results Sleep disorders had a positive effect on relapse inclination, quality of life was a potential mediator of this relationship, and 12-week Health Qigong designed to treat sleep disorders improved not only their sleep quality but also their overall quality of life, which in turn reduce the tendency to relapse. Conclusion Current research not only explores the high-risk factors influencing relapse, but also develops customized intervention strategies, which have theoretical and practical implications for decreasing relapse and increasing abstinence.
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Affiliation(s)
- Chao Sun
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xiaojun Wang
- China Wushu School, Beijing Sport University, Beijing, China,*Correspondence: Xiaojun Wang ✉
| | - Xuetong Huang
- China Wushu School, Beijing Sport University, Beijing, China
| | - Yongcong Shao
- School of Psychology, Beijing Sport University, Beijing, China
| | - Anna Ling
- Beihu Road Primary School, Liuzhou, Guangxi, China
| | - Huanhuan Qi
- China Wushu School, Beijing Sport University, Beijing, China
| | - Zhuolin Zhang
- China Wushu School, Beijing Sport University, Beijing, China
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10
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Domingo AK, Pasche S, Jarvis L, Weich L. Perceptions and experiences of patients attending an opioid substitution clinic in South Africa. S Afr J Psychiatr 2022; 28:1936. [PMID: 36569808 PMCID: PMC9773002 DOI: 10.4102/sajpsychiatry.v28i0.1936] [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: 05/12/2022] [Accepted: 08/03/2022] [Indexed: 12/23/2022] Open
Abstract
Background Opioid substitution therapy (OST) is endorsed as the recommended treatment for opioid use disorders. Opioid substitution therapy is not widely used in South Africa, so little is known about its perceived clinical utility in this setting. There is also a paucity of qualitative research that explores the subjective experiences of patients using OST. Aim To explore patients' perceptions and experiences attending a South African OST outpatient clinic (OST-OC). Setting The OST-OC at Stikland Psychiatric Hospital, Cape Town, South Africa. Methods We conducted a qualitative study using semi-structured interviews with eight participants who had been attending the OST-OC for at least 6 months. Transcripts were analysed using Atlas.ti software and thematic content analysis was used to identify themes. Results Patients stated that OST helped them to regain and maintain a stable lifestyle. Autonomy and agency, the therapeutic relationship and family support were perceived as contributing to successful patient outcomes. The preference for methadone and buprenorphine treatment depended on individual experiences. Patients valued kindness from staff members but reported that improved interactions with some nonclinical staff could better facilitate treatment. Challenges experienced included stigma and cost. Conclusions This study offers insights about OST that are pertinent to low- and middle-income countries. Reducing the cost of OST, collaborative decision-making between staff and patients, and a non-judgemental attitude by clinical staff were recognised as important factors for optimised service delivery. Contribution Understanding patients' experiences of OST in a South African setting will allow for future policy development for the treatment of opioid use disorders in similar settings locally and abroad.
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Affiliation(s)
- Abdul K. Domingo
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sonja Pasche
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lucy Jarvis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lize Weich
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Ferguson E, Lewis B, Teitelbaum S, Reisfield G, Robinson M, Boissoneault J. Longitudinal associations between pain and substance use disorder treatment outcomes. J Subst Abuse Treat 2022; 143:108892. [PMID: 36228338 PMCID: PMC11025107 DOI: 10.1016/j.jsat.2022.108892] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Pain is commonly reported among those in treatment for substance use disorders (SUD) and is associated with poorer SUD treatment outcomes. The current study examined the trajectory of pain over the course of SUD treatment and associations with substance use outcomes. METHODS This observational study included adults seeking treatment for alcohol, cannabis, or opioid use disorders (N = 811). Participants completed a battery of assessments at treatment admission, 30 days post admission, and at discharge, including measures of demographics, pain, quality of life, abstinence self-efficacy, and craving. RESULTS Analyses indicated linear reductions in pain intensity and interference over time. Significant interactive effects were observed for opioid use disorder (OUD) and time, such that participants with OUD had greater reductions in pain intensity and interference over time compared to those without OUD. Elevated pain intensity was associated with negative treatment outcomes, including reduced quality of life and abstinence self-efficacy, and greater craving and negative affect. CONCLUSIONS Reductions in pain occur over the course of SUD treatment, particularly for those with OUD. Greater pain was also associated with adverse SUD treatment outcomes. Results suggest that treatment and associated abstinence may be beneficial for those with co-occurring pain and SUD, highlighting an additional benefit of improving access to SUD treatment for patients and health care systems. Future research should replicate these findings among diverse samples and further characterize the trajectory of pain during and after SUD treatment.
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Affiliation(s)
- Erin Ferguson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Scott Teitelbaum
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Gary Reisfield
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.
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12
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Earnest JD, Hatch MR, Hurlocker MC. Quality of Life and Opioid Use Motives: Direct and Indirect Associations with Risky Opioid Use in a Community Sample of Adults. Subst Use Misuse 2022; 57:2117-2125. [PMID: 36308739 PMCID: PMC10238058 DOI: 10.1080/10826084.2022.2136497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Purpose: The opioid epidemic in the United States has resulted in mass mortality and economic costs exceeding $1 trillion. Poor health-related quality of life is evident among individuals entering treatment for opioid use disorder (OUD). Yet, little research has examined the influence of quality of life on risky opioid use among non-treatment-seeking adults. To help inform OUD prevention efforts, this study examined the association among quality of life domains, opioid use motives, and risky opioid behaviors in a community sample of opioid users. Methods: Participants (N = 278) were adults who endorsed past month opioid use and were not currently in treatment for OUD. Participants responded to questions regarding their opioid use and misuse, opioid use motives, opioid use consequences, and quality of life. Results: The physical health domain of quality of life was associated with risky opioid use. Specifically, poorer physical health predicted risky opioid use and this relationship was partially explained by more social and pain motives to use opioids. Surprisingly, no other quality of life domains predicted risky opioid use. Conclusion: This study represents a meaningful first step in identifying optimal targets for OUD prevention efforts with community samples. Our findings suggest that physical health is an important quality of life indicator to prevent opioid-related harm and development of OUD.
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Affiliation(s)
| | - Melissa R. Hatch
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Margo C. Hurlocker
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
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13
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Therapeutic Value of Traditional Chinese Massage plus Moxibustion for Degenerative Knee Osteoarthritis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8305561. [PMID: 35815286 PMCID: PMC9262557 DOI: 10.1155/2022/8305561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022]
Abstract
Objective To evaluate the therapeutic value of traditional Chinese massage plus moxibustion for degenerative knee osteoarthritis (DKOA). Methods From January 2019 to October 2021, 152 patients with DKOA were enrolled. All patients were randomly divided into the treatment group and the control group. The control group was treated with oral glucosamine hydrochloride capsules. The treatment group was treated with traditional Chinese massage and moxibustion on the basis of the control group. The duration of treatment in the two groups was 8 weeks. The effectiveness, visual analog scale (VAS) score, the hospital for special surgery (HSS) score, World Health Organization Quality of Life Scale (WHOQOL-BREF) score, serum high-sensitivity C-reactive protein (CRP), and interleukin-6 (IL-6) levels were compared between the two groups before and after treatment. Results There were no significant differences in age, sex, and the duration of disease between the two groups (P > 0.05). The overall response rate in the treatment group was significantly higher than that of the control group after treatment (92.1% vs 78.9%; P=0.038); the VAS score of both two groups were significantly decreased, and the VAS score in the treatment group was significantly lower than that of the control group (3.5 ± 1.4 vs 4.8 ± 1.1; P < 0.001); the HSS score and WHOQOL-BREF score significantly improved in both groups, and the HSS score and WHOQOL-BREF score improved more in the treatment group than those of the control group (P < 0.05). The high-sensitivity CRP level significantly decreased in both groups, and the high-sensitivity CRP level in treatment group is lower than that of the control group (2.79 ± 1.65 vs 4.37 ± 1.54; P < 0.001); the IL-6 level was significantly decreased in the treatment group than in the control group (7.22 ± 3.41 vs 4.59 ± 2.98; P < 0.001). Conclusion Traditional Chinese massage plus moxibustion is worthy of clinical application, which has a significant clinical effect on DKOA, reducing pain and improving knee joint function and quality of life.
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14
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Golan OK, Totaram R, Perry E, Fortson K, Rivera-Atilano R, Entress R, Golan M, Andraka-Christou B, Whitaker D, Pigott T. Systematic review and meta-analysis of changes in quality of life following initiation of buprenorphine for opioid use disorder. Drug Alcohol Depend 2022; 235:109445. [PMID: 35430522 DOI: 10.1016/j.drugalcdep.2022.109445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND People with opioid use disorder (OUD) experience lower quality of life (QoL) than the general population, but buprenorphine treatment for OUD could help improve QoL of individuals with OUD. Thus, we conducted a systematic review and meta-analysis of the impact of buprenorphine on QoL among people with OUD. METHODS Seven databases were searched through August 2020. We included English-language studies with pre- and post- QoL assessments internationally. Standardized mean differences were calculated for five domains of QoL measures using a random effects model for correlated effect sizes with robust variance estimation. Meta-regression was used to assess variation in effect sizes based on QoL domain, treatment, and patient factors. RESULTS Twenty-one peer-reviewed studies from twelve countries were included. Only three studies included a no-treatment control group and five studies assigned groups using randomization. Improvements between baseline and follow-up were observed across all five domains of QoL measures (overall, physical, psychological, social, and environmental). The certainty of evidence was low for all domains of QoL, and very low for environmental QoL. We did not observe differences in the effect of buprenorphine on QoL by QoL domain, duration, dose, participant characteristics, or adjunctive counseling services. CONCLUSIONS Buprenorphine treatment likely improves overall, physical, psychological, and social QoL, and may improve environmental QoL, for individuals with OUD. Findings are limited by study quality, including lack of control groups and incomplete reporting. Future studies with more rigorous methods and comprehensive reporting are needed.
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Affiliation(s)
- Olivia K Golan
- School of Public Health, Georgia State University, Atlanta, GA, United States.
| | - Rachel Totaram
- School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States
| | - Elizabeth Perry
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Kennicia Fortson
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | | | - Rebecca Entress
- School of Public Administration, University of Central Florida, Orlando, FL, United States
| | - Matthew Golan
- School of Law, Emory University, Atlanta, GA, United States
| | - Barbara Andraka-Christou
- School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States; Department of Internal Medicine, University of Central Florida, Orlando, FL, United States
| | - Daniel Whitaker
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Therese Pigott
- School of Public Health, Georgia State University, Atlanta, GA, United States; College of Education & Human Development, Georgia State University, Atlanta, GA, United States
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15
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Alawa J, Muhammad M, Kazemitabar M, Bromberg DJ, Garcia D, Khoshnood K, Ghandour L. Medication for opioid use disorder in the Arab World: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103617. [PMID: 35182841 PMCID: PMC9851143 DOI: 10.1016/j.drugpo.2022.103617] [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: 11/09/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) is a global public health concern. The standard of care for OUD involves treatment using medications such as buprenorphine, methadone, or naltrexone. No known review exists to assess the contextual factors associated with medication for opioid use disorder (MOUD) in the Arab World. This systematic review serves as an implementation science study to address this research gap and improve the uptake of MOUD in the Arab World. METHODS Systematic searches of Medline, PsycINFO, and EMBASE, and a citation analysis, were used to identify peer-reviewed articles with original data on MOUD in the Arab World. Quality assessment was conducted using the CASP appraisal tools, and main findings were extracted and coded according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS 652 research articles were identified, and 10 met inclusion criteria for final review. Four studies considered health-systems aspects of MOUD administration, such as cost-effectiveness, the motivations for and impact of national MOUD policies, the types of social, political, and scientific advocacy that led to the adoption of MOUD in Arab countries, and the challenges limiting its wide-scale adoption in the Arab World. Six papers considered MOUD at individual and group patient levels by evaluating patient quality of life, addiction severity, patient satisfaction, and patient perspectives on opioid agonist therapy. CONCLUSION Despite financial and geographic barriers that limit access to MOUD in the Arab World, this review found MOUD to be cost-effective and associated with positive health outcomes for OUD patients in the Arab World. MOUD can be successfully established and scaled to the national level in the Arab context, and strong coalitions of health practitioners can lobby to establish MOUD programs in Arab countries. Still, the relative novelty of MOUD in this context precludes an abundance of research to address its long-term delivery in the Arab World.
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Affiliation(s)
- Jude Alawa
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Muzzammil Muhammad
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Maryam Kazemitabar
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Daniel J Bromberg
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danilo Garcia
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Box 100, 405 30 Gothenburg, Gothenburg, Sweden; Department of Behavioral Sciences and Learning, Linköping University, SE 581 83, Linköping, Sweden
| | - Kaveh Khoshnood
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Van Dyck Building, PO Box 11-0236, Riad El-Solh Beirut, 1107 2020, Lebanon.
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16
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Interim opioid agonist treatment for opioid addiction: a systematic review. Harm Reduct J 2022; 19:7. [PMID: 35090475 PMCID: PMC8800211 DOI: 10.1186/s12954-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Opioid use disorder is a public health problem and treatment variability, coverage and accessibility poses some challenges. The study’s objective is to review the impact of interim opioid agonist treatment (OAT), a short-term approach for patients awaiting standard OAT, in terms of treatment retention, access to standard OAT, quality of life and satisfaction with treatment. Method We conducted a systematic review searching MEDLINE, EMBASE, PsycINFO, and CENTRAL up to May 2020. Due to variability between studies and outcome measurements, we did not pool effect estimates and reported a narrative synthesis of findings rating their certainty according to GRADE. Results We identified 266 unique records and included five randomized trials with some limitations in risk of bias and one observational study limited by selection bias. The studies assessed similar approaches to interim OAT but were compared to three different control conditions. Four studies reported on treatment retention at 4 months or less with no significant differences between interim OAT and waiting list or standard OAT. Two studies reported treatment retention at 12 months with no differences between interim OAT and standard OAT. Two trials assessed access to standard OAT and showed significant differences between interim OAT and waiting list for standard OAT. We rated the quality of evidence for these outcomes as moderate due to the impact of risk of bias. Data on quality of life or satisfaction with treatment was suboptimal. Conclusions Interim OAT is likely more effective than a waiting list for standard OAT in access to treatment, and it is probably as effective as standard OAT regarding treatment retention. PROSPERO registration CRD42018116269. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00592-x.
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Detecting change in psychiatric functioning in clinical trials for cocaine use disorder: sensitivity of the Addiction Severity Index and Brief Symptom Inventory. Drug Alcohol Depend 2021; 228:109070. [PMID: 34600247 PMCID: PMC8595796 DOI: 10.1016/j.drugalcdep.2021.109070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Assessment instruments commonly used in clinical trials to measure functional outcomes in substance users may lack sensitivity to detect change during treatment, potentially limiting findings regarding benefits of reduced drug use. This study evaluated the sensitivity of the Addiction Severity Index (ASI) to detect change in psychiatric functioning among cocaine users. METHODS Data were pooled across five clinical trials for cocaine use disorder (N = 492) that included a 12-week treatment period and 6-month follow-up. Within-person cohen's d' was used to evaluate effect size of change on the Psychiatric Composite Score of the ASI (ASI-Psych) and Global Severity Index (GSI) of the Brief Symptom Inventory, as well as cocaine use. RESULTS Effect sizes were larger for GSI than ASI-Psych from baseline to week 12 (GSI d' = 0.59; ASI-Psych d' = 0.16), and 6-month follow-up (GSI d' = 0.48; ASI-Psych d' = 0.10). For those with non-zero ASI-Psych at baseline (n = 252), medium effect sizes were found over the 12-week period (d' = 0.53) and 6-month follow-up (d' = 0.47). Effect sizes for change in days of cocaine use were most similar to GSI in either sample. CONCLUSIONS The ASI Psychiatric Composite Score may have limited sensitivity to detect change in psychiatric functioning among clinical trial participants who reduce cocaine use. It may be useful for detecting change amongst those reporting some psychiatric problems at the start of treatment. Future research should consider an instrument's sensitivity to change when assessing the potential functional benefits of reducing cocaine use.
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18
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Tun S, Vicknasingam B, Singh D. Factors affecting addiction severity index (ASI) among clients enrolled in methadone maintenance treatment (MMT) program in Myanmar. Harm Reduct J 2021; 18:84. [PMID: 34353331 PMCID: PMC8340446 DOI: 10.1186/s12954-021-00523-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid substitution with methadone maintenance treatment (MMT) is shown to reduce illicit opioid use and renew social functioning. Understanding factors that undermine clients' social functioning during MMT treatment is vital for improving treatment compliance and quality of life. METHOD A total of 210 respondents who were already enrolled in a formal MMT program in Myanmar were recruited from five cities through stratified random sampling for this cross-sectional study. The addiction severity index (ASI) was used to objectively assess respondents social functioning in the last 30 days. Higher ASI scores denote poorer social functioning. RESULT Respondents total ASI scores in the respective domains were: employment (47.4%), alcohol (44.4%), drug use (7.2%), legal (49.2%) and social-family relationship (10.7%). Those reported to have never injected drugs in the last 30 days had lower ASI total scores than those who reported injection drug use (p = 0.01). After identifying the differences in ASI total scores, we found there were significant associations in the clients' hepatitis C status, age category, frequency of heroin injection, quality of life score, marital status, current leisure status with family/friend, current history of injection in the last 30 days, income status, satisfaction with current marital status, as well as reported drug and alcohol use (p < 0.05). Stepwise binary logistic regression showed that alcohol and higher frequency of heroin injection were associated with higher ASI scores. Meanwhile, older age, respondents those who had leisure time with family, and satisfied with current marital status had lower ASI scores (p < 0.05). CONCLUSION Our results indicate that those enrolled in the MMT program in Myanmar faced many challenges in their daily social functioning. Treatment providers must take heed of these apparent impediment to ensure clients chequered social functioning does not undermine their treatment compliance. TRIAL REGISTRATION NA.
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Affiliation(s)
- Sun Tun
- Myanmar Medical Association, Yangon, Myanmar.
- Centre for Drug Research, Universiti Sains Malaysia, George Town, Penang, Malaysia.
| | - B Vicknasingam
- Centre for Drug Research, Universiti Sains Malaysia, George Town, Penang, Malaysia
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, George Town, Penang, Malaysia
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Shouan A, Ghosh A, Singh SM, Basu D, Mattoo SK. Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India. Indian J Psychiatry 2021; 63:355-365. [PMID: 34456348 PMCID: PMC8363890 DOI: 10.4103/psychiatry.indianjpsychiatry_448_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 04/14/2021] [Accepted: 06/17/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. AIM To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. MATERIALS AND METHODS A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention - 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital - baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. RESULTS AND CONCLUSIONS Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.
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Affiliation(s)
- Anish Shouan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surendra Kumar Mattoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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20
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Oberoi DV, Longo CJ, Reed EN, Landmann J, Piedalue KAL, Carlson LE. Cost-Utility of Group Versus Individual Acupuncture for Cancer-Related Pain Using Quality-Adjusted Life Years in a Noninferiority Trial. J Altern Complement Med 2021; 27:390-397. [PMID: 33904784 DOI: 10.1089/acm.2020.0386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: Individual acupuncture (AP) is the gold standard method of AP delivery for cancer-related pain; however, costs can be prohibitive. Group AP allows four to six patients to be treated in a single session. This study sought to examine the cost-utility of group AP compared with individual AP from a patient perspective. Materials and Methods: Effectiveness and cost data from a noninferiority randomized trial of group versus individual AP for cancer-related pain were used. In the trial, 74 patients were randomly assigned to individual or group AP treatments twice per week for 6 weeks. The EuroQol five-dimension five level questionnaire (EQ-5D-5L) was used to assess health-related quality of life, and the EQ-5D Utility Index was used as a composite measure constituted of five domains (mobility, self-care, usual activities, anxiety-depression, and pain-discomfort). Linear mixed models were used to compare the change in EQ-5D-5L states pre-post intervention between the two arms. A cost-utility analysis was performed in terms of the incremental costs per additional quality-adjusted life year (QALY) gained. Results: Group AP participants experienced more significant relief in the pain-discomfort subscale of the EQ-5D-5L measure compared with individual AP participants (group × time, F = 6.18; p = 0.02). The effect size on pain-discomfort for group AP (d = 0.80) was higher than that of individual AP (d = 0.34). There were no significant differences between the two study arms for other subscales of the EQ-5D-5L over time. QALYs at 6 weeks were slightly higher for group AP (0.020) compared with individual AP (0.007) leading to an incremental QALY gained by the group arm of 0.013, but this difference was not statistically significant (p = 0.07). The cost of delivering AP treatment for the group arm over 6 weeks ($201.25) was nearly half of the individual arm ($400). Conclusions: Group AP was superior to individual AP in cancer patients. These findings have implications for the use of group AP in low-resource settings and in health care systems where AP for cancer patients is not covered by public health insurance. ClinicalTrials.gov (NCT03641222). Registered July 10, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03641222.
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Affiliation(s)
- Devesh V Oberoi
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychosocial Oncology, Cancer Control Alberta, Holy Cross Centre Phase I, Calgary, Canada
| | | | - Erica Nicole Reed
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Katherine-Ann Laura Piedalue
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychosocial Oncology, Cancer Control Alberta, Holy Cross Centre Phase I, Calgary, Canada
| | - Linda E Carlson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychosocial Oncology, Cancer Control Alberta, Holy Cross Centre Phase I, Calgary, Canada
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21
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Ruíz Ruíz JJ, Martinez Delgado JM, García-Marchena N. Evaluation of functional status among patients undergoing maintenance treatments for opioid use disorders. Harm Reduct J 2021; 18:41. [PMID: 33849574 PMCID: PMC8042937 DOI: 10.1186/s12954-021-00488-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/24/2021] [Indexed: 12/23/2022] Open
Abstract
Background Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients with pharmacological opioid maintenance treatments according to different socio-demographic characteristic, health and disabilities domains and sexual difficulties. Methods A total of 593 patients from the Andalusia community, 329 were undergoing methadone treatment and 264 were undergoing buprenorphine treatment. The patients were interviewed by socio-demographic and opioid-related variables, assessed by functioning,
disability and health domains (WHODAS 2.0.) and for sexual problems (PRSexDQ-SALSEX). Results We found significant differences in the socio-demographic and the opioid-related variables as the onset of opioid use, being on previous maintenance programs, opioid intravenous use, the length of previous maintenance programs, polydrug use and elevated seroprevalence rates (HCV and HIV) between the methadone group and the buprenorphine group. Regarding health and disability domains there were differences in the Understanding and communication domain, Getting around domain, Participation in society domain and in the WHODAS 2.0. simple and complex score, favoring buprenorphine-treated patients. The methadone group referred elevated sexual impairments compared with the buprenorphine group. Opioid-related variables as seroprevalence rates, other previous lifetime maintenance program, the daily opioid dosage and the daily alcohol use are the most discriminative variables between both groups. Participation in society variables and sexual problems were the most important clinical variables in distinguishing the methadone group from the buprenorphine group regarding their functional status. Conclusions The methadone group showed higher prevalence in opioid dependence-related variables, elevated disabilities in participation in society activities and sexual problems compared with the buprenorphine group. This study shows the importance of carry out a functional evaluation in the healthcare follow-up, especially in those areas related with social activity and with sexual problems.
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Affiliation(s)
| | | | - Nuria García-Marchena
- Unidad de Adicciones- Servicio de Medicina Interna, Institut D'Investigació en Ciènces de La Salut Germans Trias I Pujol (IGTP), Campus Can Ruti, Carrer del Canyet s/n, 08916, Badalona, Barcelona, Spain. .,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
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Moazen-Zadeh E, Ziafat K, Yazdani K, Kamel MM, Wong JSH, Modabbernia A, Blanken P, Verthein U, Schütz CG, Jang K, Akhondzadeh S, Krausz RM. Impact of opioid agonist treatment on mental health in patients with opioid use disorder: a systematic review and network meta-analysis of randomized clinical trials. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:280-304. [PMID: 33780647 DOI: 10.1080/00952990.2021.1887202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: There is a knowledge gap in systematic reviews on the impact of opioid agonist treatments on mental health.Objectives: We compared mental health outcomes between different opioid agonist treatments and placebo/waitlist, and between the different opioids themselves.Methods: This meta-analysis of randomized clinical trials (RCTs) was pre-registered at PROSPERO (CRD42018109375). Embase, MEDLINE, PsychInfo, CINAHL Complete, and Web of Science Core Collection were searched from inception to May 2020. RCTs were included if they compared opioid agonists with each other or with placebo/waitlist in the treatment of patients with opioid use disorder and reported at least one mental health outcome after 1-month post-baseline. Studies with psychiatric care, adjunct psychotropic medications, or unbalanced psychosocial services were excluded. The primary outcome was overall mental health symptomatology, e.g. Symptom Checklist 90 total score, between opioids and placebo/waitlist. Random effects models were used for all the meta-analyses.Results: Nineteen studies were included in the narrative synthesis and 15 in the quantitative synthesis. Hydromorphone, diacetylmorphine (DAM), methadone, slow-release oral morphine, buprenorphine, and placebo/waitlist were among the included interventions. Based on the network meta-analysis for primary outcomes, buprenorphine (SMD (CI95%) = -0.61 (-1.20, -0.11)), DAM (-1.40 (-2.70, -0.23)), and methadone (-1.20 (-2.30, -0.11)) were superior to waitlist/placebo on overall mental health. Further direct pairwise meta-analysis indicated that overall mental health improved more in DAM compared to methadone (-0.23 (-0.34, -0.13)).Conclusions: Opioid agonist treatments used for the treatment of opioid use disorder improve mental health independent of psychosocial services.
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Affiliation(s)
- Ehsan Moazen-Zadeh
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimia Ziafat
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kiana Yazdani
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Mostafa M Kamel
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Tanta University, Tanta, Egypt
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amirhossein Modabbernia
- Department of Psychiatry and Seaver Autism Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Blanken
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Groep, Hague, Netherlands
| | - Uwe Verthein
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian G Schütz
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry Jang
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - R Michael Krausz
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Quality of life among people who use drugs living in poor urban communities in the Philippines. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103160. [PMID: 33721576 DOI: 10.1016/j.drugpo.2021.103160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD. METHODS A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate. RESULTS In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group. CONCLUSION A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.
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Weimand B, Solli K, Reichelt W, Tanum L. Enablers and hindrances for longer-term abstinence in opioid dependent individuals receiving treatment with extended-release naltrexone: A Norwegian longitudinal recovery trial (NaltRec study). Contemp Clin Trials Commun 2021; 21:100728. [PMID: 33665469 PMCID: PMC7900681 DOI: 10.1016/j.conctc.2021.100728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/05/2020] [Accepted: 01/11/2021] [Indexed: 01/03/2023] Open
Abstract
Opioid-dependence is a comprehensive, relapsing disorder with negative individual, - family, - and societal consequences. Recovery is difficult to achieve. Research has shown reduced substance use and improved health- and psychosocial factors with extended-release naltrexone (XR-NTX) treatment. Pharmacological treatment should include psychosocial interventions to improve longer-term recovery. This study explores how voluntary monthly treatment with extended-release naltrexone hydrochloride (Vivitrol®) will influence longer-term recovery, health and psychosocial relationships in opioid-dependent patients. Close relatives' experiences and societal costs will be assessed. This Norwegian naturalistic, multicenter, open-label study includes 150 opioiddependent patients. Patients are assessed every four weeks for 24 weeks, with 28 weeks optional follow-up treatment-period, and at three, six and 12 months posttreatment. Controls are opioid-dependent patients enrolled in Opioid Maintenance Treatment programs (n = 150). Data on recovery will be collected from participants, close relatives, and community health service providers. Genetic analyses of major signaling pathways and national registries on prescriptions and health care use will be analyzed. Recruitment period is September 2018 to September 2020. The assessment of medical, psychological, relational and societal factors may provide novel in-depth knowledge on the complexity of personal recovery-processes. The results are expected to have impact on priorities in treatment and follow-up for opioid dependent patients.
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Affiliation(s)
- B.M. Weimand
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, University of South-Eastern Norway, Drammen, Norway
| | - K.K. Solli
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Toensberg, Norway
| | - W.H. Reichelt
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - L. Tanum
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, Oslo, Norway
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Leong Bin Abdullah MFI, Yuvashnee N, Singh D. Effect of regular kratom ( Mitragyna speciosa Korth.) use on quality of life of people who use kratom. Subst Abus 2021; 42:444-449. [PMID: 33617750 DOI: 10.1080/08897077.2021.1876809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Kratom (Mitragyna speciosa Korth.) is a traditional folk remedy used in Southeast Asia and is known to have a significant opioid-like effect. However, it is unknown whether kratom consumption can impair quality of life (QoL). This study aimed to examine the QoL of people who use kratom by comparing it with that of healthy non-kratom using controls and to determine the association between patterns of kratom use and QoL among people who use kratom. Methods: 200 respondents (100 subjects who use kratom and 100 healthy controls) were recruited for this cross-sectional study. The World Health Organization Quality of Life-BREF was administered to all the respondents to assess QoL, while the Kratom Dependence Scale (KDS) was used to assess the severity of kratom dependence among the subjects who use kratom. Results: The physical health, psychological, and environment QoL scores of the subjects who use kratom were significantly lower than those of the healthy controls. Multiple linear regression analysis revealed greater KDS score and longer duration of kratom use were significant predictors of physical health QoL, while only greater KDS score significantly predicted psychological and environment QoL scores. Conclusion: Prolonged kratom use and kratom dependence may negatively impact the QoL of people who use kratom, hence kratom addiction has to be treated adequately.
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Affiliation(s)
| | - Novline Yuvashnee
- Centre for Drug Research, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Lake S, St Pierre M. The relationship between cannabis use and patient outcomes in medication-based treatment of opioid use disorder: A systematic review. Clin Psychol Rev 2020; 82:101939. [PMID: 33130527 DOI: 10.1016/j.cpr.2020.101939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Despite high rates of cannabis use during medication-based treatment of opioid use disorder (MOUD), uncertainty remains around how cannabis influences treatment outcomes. We sought to investigate the relationship between cannabis use during MOUD and a number of patient outcomes. We searched seven databases for original peer-reviewed studies documenting the relationship between cannabis use and at least one primary outcome (opioid use, treatment adherence, or treatment retention) among patients enrolled in methadone-, buprenorphine-, or naltrexone-based therapy for OUD. In total, 41 articles (including 23 methadone, 7 buprenorphine, 6 naltrexone, and 5 mixed modalities) were included in this review. For each primary outcome area, there was a small number of studies that produced findings suggestive of a supportive or detrimental role of concurrent cannabis use, but the majority of studies reported that cannabis use was not statistically significantly associated with the outcome. No studies of naltrexone treatment demonstrated significantly worse outcomes for cannabis users. We identified methodological shortcomings and future research priorities, including exploring the potential role of adjunct cannabis use for improving opioid craving and withdrawal during MOUD. While monitoring for cannabis use may help guide clinicians towards an improved treatment plan, cannabis use is unlikely to independently threaten treatment outcomes.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Michelle St Pierre
- Department of Psychology, University of British Columbia, 3187 University Way, Kelowna, BC V1V 1V7, Canada
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Marks M, Scheibe A, Shelly S. High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion. Harm Reduct J 2020; 17:25. [PMID: 32295595 PMCID: PMC7161298 DOI: 10.1186/s12954-020-00368-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in South Africa. In April 2017, South Africa's first low-threshold opioid agonist therapy demonstration project was launched in Durban. The project provided 54 low-income people with heroin use disorders methadone and voluntary access to psychosocial services for 18 months. At 12 months, retention was 74%, notably higher than the global average. In this paper, we aim to make sense of this outcome. METHODS Thirty semi-structured interviews, two focus groups, ten oral histories and ethnographic observations were done at various project time points. These activities explored participants' pathways into drug use and the project, their meaning attributed to methadone, the factors contributing to project success and changes they experienced. Recordings, transcripts, notes and feedback were reviewed and triangulated. Key factors contributing to retention were identified and analysed in light of the existing literature. RESULTS The philosophy and architecture of the project, and social cohesion were identified as the main factors contributing to retention. The use of a harm reduction approach enabled participants to set and be supported to achieve their treatment goals, and was shown to be important for the development of trusting therapeutic relationships. The employment of a restorative justice paradigm provided a sense of acceptance of humanity and flaws as well as an imperative to act responsibly towards others, fostering a culture of respect. Social cohesion was fostered through the facilitation of group sessions, a peace committee and group sport (soccer). In concert, these activities provided opportunities for participants to demonstrate care and interest in one another's life, leading to interdependence and care, contributing to them remaining in the project. CONCLUSIONS We believe that the high retention was achieved through attraction. We argue that opioid agonist therapy programmes should take the principles of harm reduction and restorative justice into consideration when designing low-threshold opioid agonist therapy services. Additionally, ways to support cohesion amongst people receiving agonist therapy should be explored to support their effective scale-up, both in low-middle income countries and in high-income countries.
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Affiliation(s)
- Monique Marks
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
| | - Andrew Scheibe
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Shaun Shelly
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
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Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
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Müller O, Baumann C, Di Patrizio P, Viennet S, Vlamynck G, Collet L, Clerc-Urmès I, Schwan R, Bourion-Bédès S. Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence. Health Qual Life Outcomes 2020; 18:6. [PMID: 31910879 PMCID: PMC6947996 DOI: 10.1186/s12955-019-1267-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/23/2019] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Ophélie Müller
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Cédric Baumann
- Unit of Methodology, Data Management and Statistics, University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France.,EA4360 APEMAC (Health adjustment, measurement and assessment, interdisciplinary approaches) MICS team, University of Lorraine, 54500, Vandoeuvre-lès-Nancy, France
| | - Paolo Di Patrizio
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Sarah Viennet
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Guillaume Vlamynck
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Laura Collet
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Isabelle Clerc-Urmès
- Unit of Methodology, Data Management and Statistics, University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
| | - Raymund Schwan
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Stéphanie Bourion-Bédès
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France. .,EA4360 APEMAC (Health adjustment, measurement and assessment, interdisciplinary approaches) MICS team, University of Lorraine, 54500, Vandoeuvre-lès-Nancy, France. .,Service médico-psychologique régional, 1, Rue Seulhotte B.P, 15082 57073, Metz, France.
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Wang Y, Zuo J, Hao W, Shen H, Zhang X, Deng Q, Liu M, Zhao Z, Zhang L, Zhou Y, Li M, Liu T, Zhang X. Quality of Life in Patients With Methamphetamine Use Disorder: Relationship to Impulsivity and Drug Use Characteristics. Front Psychiatry 2020; 11:579302. [PMID: 33192720 PMCID: PMC7555609 DOI: 10.3389/fpsyt.2020.579302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The quality of life (QOL) of patients with methamphetamine use disorder (MAUD) is increasingly recognized as an important outcome. Previous studies have found that impulsivity is negatively associated with QOL in mental disorders, but this relationship is rarely confirmed in patients with MAUD. We hypothesized that impulsivity is negatively correlated with QOL in patients with MAUD based on previous findings. In addition, a variety of drug use characteristics of patients that may potentially affect their QOL need to be further explored. Therefore, the purpose of this study was to explore the relationship between impulsivity, multiple drug use characteristics, and QOL in patients with MAUD. METHODS A total of 379 patients with MAUD were recruited, and the majority of them were male (85.5%), with an average age of 33.93 ± 7.08 years. Two psychiatrists conducted semi-structured interviews with methamphetamine (MA) users in two compulsory drug rehabilitation centers to obtain their demographics and drug use characteristics. The Barratt Impulsiveness Scale-11 (BIS-11) and Brief WHO Quality of Life Assessment (WHOQOL-BREF) were used to assess patients' impulsivity and QOL, respectively. Correlation and univariate regression analysis were used to explore the relationships between impulsivity, a series of drug use characteristics and patients' QOL in different domains. Further multiple linear regression analysis was used to identify what extent the above clinical variables explained the variations in patients' QOL. RESULTS Age, marital status, employment, and various drug use characteristics were significantly associated with at least one QOL domain. Among them, married and full-time job were positively correlated with QOL, while others were negatively correlated with QOL. The total score of BIS-11 was significantly negatively correlated with all four domains of QOL. Impulsivity, a range of drug use characteristics and certain demographic characteristics collectively explained varying degrees of variation in different domains of QOL. CONCLUSIONS Impulsivity and various drug use characteristics can significantly predict QOL in all fields of MAUD patients. In addition, we have also found differences in the predictors of QOL in different domains. Overall, this study provides clinical guidance for the treatment of MAUD patients, that is, management of impulsivity in patients with MAUD may help improve their QOL and even sustain their drug rehabilitation.
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Affiliation(s)
- Yingying Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinsong Zuo
- College of Life Sciences and Chemistry, Hunan University of Technology, Zhuzhou, China
| | - Wei Hao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hongxian Shen
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaojie Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qijian Deng
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mengqi Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhiqiang Zhao
- Department of Medicine Addiction, Xinjiang Mental Health Center and Urumqi Fourth People's Hospital, Urumqi, China
| | - Lina Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Zhou
- Department of Psychiatry, Brains Hospital of Hunan Province, Changsha, China
| | - Manyun Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tieqiao Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Institute of Mental Health and Hunan Medical Center for Mental Health, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Yaghubi M, Abdekhoda M, Khani S. Effectiveness of Religious-Spiritual Group Therapy on Spiritual Health and Quality of Life in Methadone-treated Patients: A Randomized Clinical Trial. ADDICTION & HEALTH 2019; 11:156-164. [PMID: 31839913 PMCID: PMC6904977 DOI: 10.22122/ahj.v11i3.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Spirituality is one of the most important factors that can contribute to the recovery of substance use disorder (SUD). The objective of this study is to evaluate the efficacy of the religious-spiritual group therapy on the spiritual health and the quality of life in methadone-treated patients. Methods This study was carried out in Qom City, Iran, in 2018. 72 methadone-treated patients were randomly selected and assigned in two groups: the experimental group (which received religious-spiritual therapy) and control group (which received no treatment). At the beginning of the study (pre-test), eight weeks after the start of the study (post-test), and three months after the start of the study (follow-up test), all participants completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Spiritual Well-Being Scale (SWBS). Participants in the experimental group received 8 sessions (90 minutes for each session) of spiritual and religious training, while the control group received no religious-spiritual intervention; it just was trained with general information on addiction. Data were analyzed using SPSS software and descriptive and inferential statistics methods. Findings The results of repeated measures analysis of variance (ANOVA) showed that there was no significant difference between the intervention and control groups in the pretest, but religious-spiritual training significantly increased spiritual health and the patients' quality of life (P < 0.001). Conclusion Religious-spiritual education can improve the quality of life and spiritual well-being in methadone-treated patients. The findings suggest that religious -spiritual education can be considered as an inexpensive, accessible, useful, and effective treatment for SUD treatment.
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Affiliation(s)
- Mehdi Yaghubi
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Samira Khani
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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Mokhtari MR, Alavi M, Pahlavanzadeh S, Weimand BM, Visentin D, Cleary M. Comparison of the effectiveness of a 12 step substance use recovery program on quality of life. Nurs Health Sci 2019; 22:390-397. [PMID: 31828941 DOI: 10.1111/nhs.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
Substance-related disorders can adversely impact quality of life. This study assessed a 12 step program on health-related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi-experimental, two group, three stage, pre- and post-test design and collected data at baseline, and at 1 and 3 months' post-intervention. The treatment group comprised 35 participants in a 12 step program with a non-equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality-of-life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health-related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions - physical functioning and role limitations due to emotional problems - at 1 month post-intervention. There were additional improvements at 3 months' follow up in six of eight quality-of-life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life.
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Affiliation(s)
- Mohammad Reza Mokhtari
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Pahlavanzadeh
- Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bente M Weimand
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Evidence and Social Innovation, School of Nursing and Midwifery, Queens University, Belfast, Ireland.,Department of Research and Development Mental Health, Akershus University Hospital, Lørenskog, Norway
| | - Denis Visentin
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, Bruneau J, Altice FL, Henderson G, Rahimi-Movaghar A, Larney S. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet 2019; 394:1560-1579. [PMID: 31657732 PMCID: PMC7068135 DOI: 10.1016/s0140-6736(19)32229-9] [Citation(s) in RCA: 411] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022]
Abstract
We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville, Montreal, QC, Canada
| | | | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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Fischer JA, Roche AM, Kostadinov V. Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review. Drug Alcohol Rev 2019; 38:674-689. [PMID: 31577056 DOI: 10.1111/dar.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Quality of life (QOL) is increasingly recognised as an important treatment indicator in the alcohol and other drug (AOD) sector, particularly in treatment modalities providing 'whole of life programmes', such as residential rehabilitation. However, it is currently unclear how studies conducted in AOD residential rehabilitation settings have operationally defined and measured QOL. This study therefore aimed to determine current practices in defining and measuring the QOL of residential rehabilitation clients. DESIGN AND METHODS A systematic review of studies examining the QOL of AOD residential rehabilitation clients was conducted. Potential studies published in English between 1990 and 2018 were identified through a search of electronic databases (e.g. PsycINFO and PubMed), search engines (Google Scholar) and article reference lists. RESULTS The search identified a total of 1267 records, of which 16 met the inclusion criteria. Less than half of the included studies provided an operational definition of QOL. QOL was generally understood to be a subjective, multidimensional, client assessment construct. Twelve different instruments were used to assess QOL, of which two enabled clients to identify QOL dimensions important to themselves. DISCUSSION AND CONCLUSIONS QOL has been inconsistently measured in studies of AOD residential rehabilitation clients. As a result, the comparability and validity of research in this field may be weakened. There is a need to develop a consensual operational definition of QOL, including a core set of domains relevant to and endorsed by residential rehabilitation clients. Appropriate tools to measure client QOL need to be identified and disseminated.
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Affiliation(s)
- Jane A Fischer
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Ann M Roche
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Victoria Kostadinov
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
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Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use. J Clin Med 2019; 8:jcm8091407. [PMID: 31500211 PMCID: PMC6780566 DOI: 10.3390/jcm8091407] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 01/18/2023] Open
Abstract
People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (‘Patient Pathways’), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of “SUD treatment success” (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p < 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL; however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use.
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Confirming the factor structure of a generic quality of life instrument among pre-treatment substance use disorder patients. Health Qual Life Outcomes 2019; 17:84. [PMID: 31101049 PMCID: PMC6525421 DOI: 10.1186/s12955-019-1152-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/01/2019] [Indexed: 11/27/2022] Open
Abstract
Background Quality of life (QoL) is a patient-reported outcome of increasing importance in the substance use disorder (SUD) treatment field, and impaired QoL may be an important impetus for treatment uptake. Instruments and methodologies abound, precluding comparison, as does a dearth of population norms. The QOL10 is a generic, overall QoL tool containing ten items and with simple scoring procedures. It is therefore a potential alternative to the gold standard WHOQOL-BREF. This study aimed to assess the two-factor structure of the QOL10 that has been suggested by a previous exploratory factor analysis. Methods Adults entering 21 participating inpatient or outpatient SUD treatment were recruited to join a national longitudinal cohort study. 531 completed the QOL10 at treatment entry and were included in the analysis. Structural equation modelling (SEM) was used to confirm the model fit of a two-factor structure, and the scaling qualities of the QOL10 were reported. Results According to the SEM analysis, the QOL10 was comprised of one latent variable measuring social QoL, and one measuring global QoL, and all ten items were retained. Goodness of fit tests included: root mean square of approximation = 0.063, 90% CI 0.050–0.076; normed-fit index = 0.919; and comparative fit index = 0.943. Conclusions The QOL10 should be considered when clinicians in the SUD treatment field need a short, valid instrument that measures both global QoL and social QoL, with minimum respondent and administrator burden. The social domain is of particular utility and may be used as a stand-alone instrument. Test-retest reliability should be established in future studies. Electronic supplementary material The online version of this article (10.1186/s12955-019-1152-7) contains supplementary material, which is available to authorized users.
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Carlsen SEL, Lunde LH, Torsheim T. Predictors of quality of life of patients in opioid maintenance treatment in the first year in treatment. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1565624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Linn-Heidi Lunde
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Woodhead EL, Timko C, Han X, Cucciare MA. Stigma, Treatment, and Health among Stimulant Users: Life Stage as a Moderator. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2019; 60:96-104. [PMID: 31548756 PMCID: PMC6756791 DOI: 10.1016/j.appdev.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This 3-year study examined associations among drug use stigma, life stage, treatment utilization and health among 710 US adults using stimulants. Consistent with substance use developmental frameworks, life stage was represented by Emerging adulthood (18-25 years old, n=223), Earlymid adulthood (26-44 years old; n=384), and Older adulthood (45-61 years old; n=103). Emerging adults experienced less enacted stigma (i.e., experiences of discrimination) and perceived less public stigma (i.e., unjust treatment) over the course of the study than other life stage groups. More baseline enacted stigma was associated with more mental health and substance use treatment, whereas more baseline self stigma (i.e., negative thoughts about the self) was associated with less treatment utilization. Life stage moderated stigma-outcome associations such that substance use outcomes were worse for Emerging adults reporting more enacted stigma. Although emerging adults experienced less drug use stigma, stigma had a more negative impact on adults in this life stage.
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Affiliation(s)
- Erin L Woodhead
- Department of Psychology, San José State University, 1 Washington Square, San José, CA, 95192-0120, ,
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304 USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205 USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205 USA
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Singh S, Kumar S, Sarkar S, Balhara YPS. Quality of Life and its Relationship with Perceived Stigma among Opioid Use Disorder Patients: An Exploratory Study. Indian J Psychol Med 2018; 40:556-561. [PMID: 30533952 PMCID: PMC6241192 DOI: 10.4103/ijpsym.ijpsym_171_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In view of recent global opioid epidemic and scarcity of literature assessing the quality of life (QoL) and stigma among opioid use disorder (OUD) patients, this study aimed to assess the overall QoL and examine its relationship with perceived stigma among them. MATERIALS AND METHODS This cross-sectional study assessed patients with OUD at a tertiary care centre. QoL was assessed using the World Health Organization Quality of Life-brief version, whereas perceived stigma was measured using the Perceived Stigma of Substance Abuse Scale (PSAS). RESULTS Among 168 patients with OUD, all the four domain-wise scores of physical health (r = 0.79, P < 0.01), psychological health (r = 0.87, P < 0.01), social relationships (r = 0.78, P < 0.01) and environment (r = 0.80, P < 0.01) QoL correlated significantly with average score, with maximum impairment noted in the social domain. The mean PSAS score was 21.19 ± 2.99, with perceived stigma found to be significantly associated with impairments in the physical (β = -0.28, P < 0.01), psychological (β = -0.27, P < 0.01) and environment (β = -0.21, P < 0.01) domains of QoL. Furthermore, being employed was significantly associated with impairment in the social domain of QoL (β = -0.17, P = 0.02). CONCLUSION OUD similarly affects all the four domains of QoL, with a higher level of perceived stigma associated with significantly poorer QoL in the physical, psychological and environment domains. However, future studies assessing different forms of stigma and QoL among patients with OUD are needed to confirm and better characterise the findings of this study.
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Affiliation(s)
- Swarndeep Singh
- Department of Psychiatry and National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar
- Department of Psychiatry and National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry and National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Jarlais DCD, Duong HT. Ending HIV epidemics among people who inject drugs in LMICs. Lancet 2018; 392:714-716. [PMID: 30191815 DOI: 10.1016/s0140-6736(18)31721-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Don C Des Jarlais
- Department of Epidemiology, College of Global Public Health, New York University, New York City, NY 10012, USA.
| | - Huong Thi Duong
- Department of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
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Ghosh A, Basu D, Avasthi A. Buprenorphine-based opioid substitution therapy in India: A few observations, thoughts, and opinions. Indian J Psychiatry 2018; 60:361-366. [PMID: 30405267 PMCID: PMC6201663 DOI: 10.4103/psychiatry.indianjpsychiatry_218_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most evidence-based treatment for opioid dependence is opioid agonist maintenance treatment also known as opioid substitution therapy (OST). However, there are some critical, yet unaddressed issues of buprenorphine-based substitution therapy, especially in the Indian context. These comprise of generalizability of the evidence for OST, especially for natural and pharmaceutical opioids and for all age groups, optimum dose and duration of OST, and mode of treatment delivery including the frequency of dispensing. Notwithstanding the use of buprenorphine-naloxone combination, abuse and diversion are serious but often underreported problems. There is an urgent need for health services research in India on OST, focusing on these aspects. Rather than directly copying from Western models, it is important to try to understand the useful and safe program and policy options likely to be applicable in the Indian setting, with our own assets as well as vulnerabilities.
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Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, PGIMER, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, PGIMER, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
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González-Saiz F, Lozano Rojas O, Trujols J, Alcaraz S, Siñol N, Pérez de Los Cobos J. Evidence of validity and reliability of the Opiate Dosage Adequacy Scale (ODAS) in a sample of heroin addicted patients in buprenorphine/naloxone maintenance treatment. Drug Alcohol Depend 2018; 183:127-133. [PMID: 29247974 DOI: 10.1016/j.drugalcdep.2017.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The Opiate Dosage Adequacy Scale (ODAS) is a clinical tool to individually measure the "adequacy" of opioid doses in patients on maintenance treatment. The aim of this paper is to provide evidence for the validity and reliability of the ODAS in a sample of patients in buprenorphine/naloxone (B/N) maintenance treatment. METHOD Cross-sectional study of a convenience sample of B/N-treated patients (n = 316) from four Autonomous Communities in Spain. Participants completed a battery of instruments to assess the following: buprenorphine dose adequacy; heroin dependence severity; psychological adjustment; and patient-desired adjustment of buprenorphine dose. RESULTS Exploratory Factor Analysis identified four factors from the ODAS that together account for 85.4% of the total variance: "Heroin craving and use"; "Overmedication"; "Objective opiate withdrawal symptoms (OWS)" and 'Subjective OWS'. Compared to patients with an "inadequate" B/N dose (ODAS), patients with "adequate" doses had less heroin use in the last week (0.01 vs. 0.40; t = -2.73; p < 0.01, 95% CI: -0.67, -0.10), less severe heroin dependence (2.20 vs. 5.26, t = -5.14, p < 0.001; 95% CI: -4.23, -1.88), less psychological distress (3.00 vs. 6.31, t = -4.37, p < 0.001; 95% CI: -4.80, -1.81), and greater satisfaction with their doses (42.1% vs. 13.6%, χ2 = 14.44, p < 0.01). Cronbach's alpha coefficient was 0.76 (0.81, 0.92, 0.94, and 0.93, respectively, for the four factor dimensions). CONCLUSION These findings support the validity and reliability of the ODAS as a tool to measure and assess buprenorphine dose adequacy in the context of an opioid dependency treatment program.
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Affiliation(s)
- Francisco González-Saiz
- Unidad de Salud Mental Comunitaria Villamartín, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Spain; Departamento de Neurociencias, Área de Psiquiatría, Universidad de Cádiz, Spain.
| | - Oscar Lozano Rojas
- Departamento de Psicología Clínica, Experimental y Social, Universidad de Huelva, Spain.
| | - Joan Trujols
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Saul Alcaraz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Núria Siñol
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - José Pérez de Los Cobos
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autonoma de Barcelona, Bellaterra, Spain.
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Safety of a Rapidly Dissolving Buprenorphine/Naloxone Sublingual Tablet (BNX-RDT) for Treatment of Opioid Dependence: A Multicenter, Open-label Extension Study. J Addict Med 2018; 11:217-223. [PMID: 28353467 PMCID: PMC5457835 DOI: 10.1097/adm.0000000000000301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To assess the safety of rapidly dissolving buprenorphine/naloxone sublingual tablets (BNX-RDT) in opioid-dependent patients. Methods: This open-label, 24-week extension study enrolled patients who completed primary trials of BNX-RDT. Daily tablet doses ranged from 5.7 to 17.1 mg. The primary endpoint was safety; secondary assessments included opioid cravings, addiction severity, health-related quality of life (QOL), and workplace productivity at screening (final day of the primary trials) through study end, with changes measured from baseline of the primary trials. Results: In all, 665 patients received treatment; 292 (43.9%) completed the study. A total of 258 patients (38.8%) reported 557 treatment-emergent adverse events, most commonly headache (3.2%) and constipation (3.0%). Craving scores showed continued improvement on 100-mm visual analog scale (mean change from primary trial baseline, −52.8 at screening; mean change from extension trial baseline, −60.5 at week 24). Reductions in addiction severity from baseline of both the primary and extension trial were maintained through week 24 on multiple assessments, as were improvements in QOL on Short Form 36. Employment increased by 15% and mean (SD) hours worked per week increased by 4.6 (20.1) from baseline to study end. Mean (SD) scores for impact of opioid dependence on work productivity improved from 4.7 (3.0) at baseline to 0.9 (1.8) at study end (11-point scale). Conclusions: Extended treatment with BNX-RDT demonstrated a safety profile similar to other BNX formulations, reduced opioid cravings, and improved both QOL and work productivity. Continued treatment may enable patients to advance in recovery and return to normal functioning.
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Ghaddar A, Abbas Z, Haddad R. Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon. Harm Reduct J 2017; 14:78. [PMID: 29216892 PMCID: PMC5721516 DOI: 10.1186/s12954-017-0204-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid agonist therapy has been widely used to reduce harms among individuals with opioid use disorder but its effectiveness has not been evaluated in the Middle East North African (MENA) region. This study aims to evaluate the effectiveness of a program using opioid agonist therapy in combination with psychosocial support on improving psychological and social well-being, reducing arrest, and reducing risky behavior in individuals with opioid use disorder in Lebanon. METHODS A one-group pre-test post-test design study was performed at SKOUN Lebanese Addiction Centre between January 2013 and December 2014. Eighty-six out of 181 patients agreed to participate and completed the 3-month assessment and 38 concluded the 12-month assessment. Psychological (depression and anxiety, quality of life), substance dependence/abuse, behavioral (injecting behavior, sharing needles and paraphernalia), and social outcomes were evaluated at baseline, 3, and 12 months post-treatment. RESULTS Remarkable statistical significance improvements were observed 3 months after treatment in most outcome variables including quality of life, anxiety, substance dependence, overdose, employment, and injecting behavior. Improvements were sustained 12 months after treatment. CONCLUSION Results support expanding the access to opioid agonist therapy in other MENA countries to treat substance dependence and reduce harms among individuals with opioid use disorder.
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Affiliation(s)
- Ali Ghaddar
- Department of Biomedical Sciences, Lebanese International University, Beirut, Lebanon. .,Observatory of Public Policies and Health, Beirut, Lebanon.
| | - Zeinab Abbas
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.,Department of Narcotics, Ministry of Public Health, Beirut, Lebanon
| | - Ramzi Haddad
- Department of Psychiatry, Lebanese University, Beirut, Lebanon.,Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
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Muller AE, Skurtveit S, Clausen T. Building abstinent networks is an important resource in improving quality of life. Drug Alcohol Depend 2017; 180:431-438. [PMID: 28988006 DOI: 10.1016/j.drugalcdep.2017.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
AIMS To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment. DESIGN Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment. SETTING Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later. METHODS The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI. FINDINGS Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system. CONCLUSIONS Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.
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Affiliation(s)
- Ashley Elizabeth Muller
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Heath, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
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Chen HM, Lu TH, Chang KC, Lee KY, Cheng CM. Opioid users with comorbid hepatitis C spent more time in agonist therapy: A 6-year observational study in Taiwan. Addict Behav 2017; 72:133-137. [PMID: 28395249 DOI: 10.1016/j.addbeh.2017.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/09/2017] [Accepted: 03/29/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is highly prevalent among opioid agonist therapy (OAT) patients, but little is known about long-term OAT use among this population. METHODS Subjects diagnosed as opioid dependence were recruited from Mar. 2006 to Jul. 2008 in a psychiatry center in southern Taiwan with the OAT censored in 2012, and their socio-demographics, drug use characteristics, and markers of blood-borne infection were assessed at entry. Correlates with HCV infection and OAT retention were analyzed by multivariate logistic regression. Retention (OAT utilization) was defined as the in-treatment period of OAT during the 6-year observation period. RESULTS A total of 983 patients (88.3% men) were included. The prevalences of HCV and HIV infection were 91.4% and 17.9%, respectively. The mean duration of OAT during the study period was 2.3±0.8years. Significant correlates with HCV infection were retention of at least three years in OAT (AOR: 4.24, 95%CI: 1.49-12.03), ever sharing injection equipment (AOR: 227.04, 95%CI: 57.22-900.87), not living with family (AOR: 5.54, 95%CI: 1.45-21.16), lower educational attainment (AOR: 2.10, 95%CI: 1.15-3.82) and previous drug offense (AOR: 6.35, 95%CI: 1.69-23.83). Significant correlates with retention were HCV infection (AOR: 2.53, 95%CI: 1.30-4.93) and divorced or separation in marriage (AOR: 0.65, 95%CI: 0.44-0.96). CONCLUSIONS This six-year observational study revealed a better retention in OAT if opioid-dependent individuals had comorbid hepatitis C. This provided opportunities for OAT patients with HCV infection to obtain medical treatment while staying in an OAT program. Further research could explore the possibility of eradicating comorbid HCV infection among these long-term treatment cases.
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Affiliation(s)
- Horng-Maw Chen
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 539, Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan 70101, Taiwan.
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 539, Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan 70101, Taiwan.
| | - Kuan-Ying Lee
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 539, Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan
| | - Ching-Ming Cheng
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 539, Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan
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Marceau EM, Berry J, Lunn J, Kelly PJ, Solowij N. Cognitive remediation improves executive functions, self-regulation and quality of life in residents of a substance use disorder therapeutic community. Drug Alcohol Depend 2017. [PMID: 28651150 DOI: 10.1016/j.drugalcdep.2017.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Executive dysfunction is common in substance use disorder (SUD) populations and hinders treatment. We previously found that 50% of residents in SUD therapeutic communities had been hospitalized for head injuries; this was a significant determinant of cognitive impairment. The current study aimed to establish whether cognitive remediation improves executive functions (EFs) and self-regulation in an ecologically valid sample of female residents attending SUD therapeutic community treatment, including those with past head injuries and psychiatric comorbidities. METHODS Controlled sequential groups design with residents (N=33, all female) receiving treatment as usual (TAU). The intervention group (n=16) completed four weeks of cognitive remediation (CR) and the control, TAU only (n=17). Outcome measures assessed pre- and post-intervention included both performance- and inventory-based measures of EFs, and self-reported self-regulation and quality of life. RESULTS CR relative to TAU significantly improved performance-based assessment of inhibition (Color-Word Interference Test; F=4.29, p=0.047), inventory-based assessment of EFs (Behavior Rating Inventory of Executive Function - Adult Version: Global Executive Composite; F=6.38, p=0.017), impulsivity (Barratt Impulsiveness Scale; F=4.61, p=0.040), self-control (Brief Self-Control Scale; F=5.53, p=0.026), and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form; F=7.68, p=0.010). CONCLUSIONS Findings suggest that CR improves EFs in a heterogeneous sample of female residents in therapeutic community SUD treatment. Future research may explore the possibility of tailoring CR interventions for various SUD subgroups.
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Affiliation(s)
- Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave Wollongong, NSW 2522 Australia
| | - Jamie Berry
- Advanced Neuropsychological Treatment Services, PO Box 4070, Strathfield South, NSW 2136 Australia
| | - Joanne Lunn
- We Help Ourselves (WHOs), Building 128, Church St, Lilyfield, NSW 2040 Australia
| | - Peter J Kelly
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave Wollongong, NSW 2522 Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave Wollongong, NSW 2522 Australia.
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Jones JD, Campbell A, Metz VE, Comer SD. No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone. Addict Behav 2017; 71:104-106. [PMID: 28325710 DOI: 10.1016/j.addbeh.2017.03.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/16/2017] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Some fear that distribution of naloxone to persons at risk of experiencing an opioid overdose may reduce the perceived negative consequences of drug use, leading to riskier patterns of use. This study assessed whether participation in naloxone/overdose training altered drug use frequency, quantity or severity among heroin users in and out of treatment. METHODS Clinical interviews were performed assessing patterns of heroin and other drug use prior to, and at multiple timepoints after overdose education and naloxone training. This study compared baseline drug use to that at 1 and 3months post training. RESULTS Both current heroin users (n=61) and former users in agonist maintenance (n=69) typically showed decreases in heroin and polydrug use at both 1 and 3months after training. The Addiction Severity Index drug composite score also decreased at follow up. CONCLUSIONS This analysis found no evidence of compensatory drug use following naloxone/overdose training among two groups of heroin users. These findings support the acceptance and expansion of naloxone distribution to at-risk populations and may assist in allaying concerns about the potential for unintended negative consequences on drug use.
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Measuring quality of life in opioid-dependent people: a systematic review of assessment instruments. Qual Life Res 2017; 26:3187-3200. [PMID: 28762100 PMCID: PMC5681984 DOI: 10.1007/s11136-017-1674-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/07/2023]
Abstract
Purpose Opioid dependence is a chronic relapsing disorder. Despite increasing research on quality of life (QOL) in people with opioid dependence, little attention has been paid to the instruments used. This systematic review examines the suitability of QOL instruments for use in opioid-dependent populations and the instruments’ quality. Methods A systematic search was performed in the databases Medline, PsycInfo, The Cochrane Library, and CINAHL. Articles were eligible if they assessed QOL of opioid-dependent populations using a validated QOL instrument. Item content relevance to opioid-dependent people was evaluated by means of content analysis, and instrument properties were assessed using minimum standards for patient-reported outcome measures. Results Eighty-nine articles were retrieved, yielding sixteen QOL instruments, of which ten were assessed in this review. Of the ten instruments, six were disease specific, but none for opioid dependence. Two instruments had good item content relevance. The conceptual and measurement model were described in seven instruments. Four instruments were developed with input from the respective target population. Eight instruments had low respondent and administrator burden. Psychometric properties were either not assessed in opioid-dependent populations or were inconclusive or moderate. Conclusions No instrument scored perfectly on both the content and properties. The limited suitability of instruments for opioid-dependent people hinders accurate and sensitive measurement of QOL in this population. Future research is in need of an opioid dependence-specific QOL instrument to measure the true impact of the disease on people’s lives and to evaluate treatment-related services. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1674-6) contains supplementary material, which is available to authorized users.
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Mohammad-Najar N, Khoshnevis E, Banisi P. Effectiveness of Positive Thinking Skills Training on the Hope and Quality of Life of Drug-Dependent People. ADDICTION & HEALTH 2017; 9:120-128. [PMID: 29657692 PMCID: PMC5894791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The increase of hope and quality of life (QOL) can play a significant role in improving the mental health of drug addicts. Accordingly, the present study aimed to determine the effectiveness of positive thinking skills training on hope and QOL of drug-dependent people. METHODS The present study is a quasi-experimental research with pre- and post-test design with the control group. The study population consisted of all men dependent on drugs who visited addiction treatment centers in Tehran, Iran, in 2016. Thirty subjects were selected using cluster sampling and were randomly assigned to control and experimental groups. The results were analyzed using SPSS. FINDINGS The mean scores of pre-test and post-test for hope were 31.67 ± 6.47 and 49.68 ± 10.69, for physical fitness were 17.01 ± 4.21 and 22.84 ± 4.98, for psychological health were 15.36 ± 3.45 and 20.98 ± 3.32, for social relations were 7.80 ± 2.34 and 10.96 ± 2.64, and for environmental health were 20.47 ± 4.36 and 27.50 ± 4.80, respectively, in experimental group (P < 0.050). CONCLUSION It is recommended that addiction treatment centers teach positive thinking skills to drug-dependent people in order to increase their hope and QOL.
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Affiliation(s)
- Narges Mohammad-Najar
- MSc Student, Department of Psychology, School of Humanities, West Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Elaheh Khoshnevis
- Assistant Professor, Department of Psychology, School of Humanities, West Tehran Branch, Islamic Azad University, Tehran, Iran,Correspondence to: Elaheh Khoshnevis PhD,
| | - Parinaz Banisi
- Assistant Professor, Department of Psychology, School of Humanities, West Tehran Branch, Islamic Azad University, Tehran, Iran
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