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Walsh BE, Manzler CA, Noyes ET, Schlauch RC. Examining the daily reciprocal relations between alcohol abstinence self-efficacy and drinking among non-treatment seeking individuals with alcohol use disorder (AUD). Addict Behav 2024; 156:108068. [PMID: 38772225 DOI: 10.1016/j.addbeh.2024.108068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 05/23/2024]
Abstract
Theoretical and empirical models of alcohol use and misuse indicate that abstinence self-efficacy (ASE) predicts improvements in treatment outcomes among individuals with alcohol use disorder (AUD). More recently, studies have begun examining daily fluctuations in ASE to better understand in-the-moment determinants of drinking behaviors. With the goal of assessing how ASE is implicated in maintenance (rather than changing) of hazardous drinking patterns, the current study examined daily reciprocal relations between ASE and drinking among individuals with AUD. Non-treatment seeking adults (n = 63) with AUD were recruited and completed daily surveys assessing ASE and drinking behaviors for 14 days. Data were analyzed using time-lagged multilevel modeling. Results indicated that both within- and between-person elevations in ASE predicted decreased likelihood of drinking, but only within-person ASE predicted fewer drinks consumed on drinking days. Previous-day drinking behavior was unrelated to next-day ASE; however, higher percentage of drinking days during the monitoring period (between-person) was associated with lower daily ASE. These results demonstrate that confidence in one's ability to abstain from drinking varies considerably across days, and that fluctuations may be implicated in daily drinking decisions. The lack of effect of previous-day drinking on ASE (combined with the significant effect of average drinking frequency) may suggest that sustained periods of reduced drinking or abstinence are necessary to impact ASE. This study points to ASE's role in the maintenance of daily drinking behavior among non-treatment-seeking individuals with AUD and reiterates the importance of self-efficacy in behavioral control and decision-making at the daily level.
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Affiliation(s)
- Brendan E Walsh
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Charles A Manzler
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Emily T Noyes
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
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2
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Wang H, Tse N, Kwan Mary Ip T, Mo PKH, Yu Y, Lau JTF. Validation of the psychoactive substance refusal Self-Efficacy Questionnaire (PSRSEQ) in adolescent case-clients of social workers in Hong Kong. Addict Behav 2024; 157:108093. [PMID: 38908049 DOI: 10.1016/j.addbeh.2024.108093] [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: 03/14/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Self-efficacy is a key concept in various behavioral theories. Refusal self-efficacy is important in understanding issues related to psychoactive substance use. To facilitate related research, this study translated and validated the Chinese version of the 14-item Psychoactive Substance Refusal Self-efficacy Questionnaire (PSRSEQ) among adolescents. There is a debate about whether such a refusal self-efficacy scale should be unidimensional or multidimensional. METHODS A survey was conducted among 601 adolescent case-clients of social workers in Hong Kong from July 2021 to June 2022. Various psychometric properties were examined. RESULTS The confirmatory factor analysis (CFA) supported the original 3-factor structure of the PSRSEQ (emotional relief, opportunistic, and social facilitation refusal self-efficacy), which showed satisfactory psychometric properties (internal consistency, convergent validity in terms of significant negative correlations with the intention of psychoactive substance use in the next year and psychoactive substance use behavior in the past six months, and the absence of floor effect) but ceiling effect was obvious. Notably, unacceptable discriminant validity of one subscale and strong correlations among the three subscales were observed. In another set of analyses using two split-half subsamples, the exploratory factor analysis identified a 1-factor 14-item structure, which was confirmed by CFA and showed satisfactory psychometric properties. CONCLUSIONS The 1-factor PSRSEQ, instead of the one having a 3-factor structure, was preferred and recommended to assess psychoactive substance refusal self-efficacy among Chinese adolescents. It is warranted to validate the scale in other adolescent and age groups in future studies.
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Affiliation(s)
- He Wang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain health), Wenzhou Medical University, Wenzhou, China.
| | - Nick Tse
- Department of Applied Social Sciences, HKCT Institute of Higher Education, Hong Kong Special Administrative Region.
| | - Tsun Kwan Mary Ip
- Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Phoenix K H Mo
- Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Yanqiu Yu
- School of Public Health, Fudan University, Shanghai, China.
| | - Joseph T F Lau
- Public Mental Health Center, School of Mental Health, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
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3
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Black N, Chung S, Tisdale C, Fialho LS, Aramrattana A, Assanangkornchai S, Blaszczynski A, Bowden-Jones H, van den Brink W, Brown A, Brown QL, Cottler LB, Elsasser M, Ferri M, Florence M, Gueorguieva R, Hampton R, Hudson S, Kelly PJ, Lintzeris N, Murphy L, Nadkarni A, Neale J, Rosen D, Rumpf HJ, Rush B, Segal G, Shorter GW, Torrens M, Wait C, Young K, Farrell M. An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders. J Clin Med 2024; 13:2154. [PMID: 38610919 PMCID: PMC11012938 DOI: 10.3390/jcm13072154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.
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Affiliation(s)
- Nicola Black
- National Drug and Alcohol Research Centre, UNSW, Sydney 2052, Australia
| | - Sophie Chung
- International Consortium for Health Outcomes Measurement, London W12 8EU, UK
| | - Calvert Tisdale
- National Drug and Alcohol Research Centre, UNSW, Sydney 2052, Australia
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London W12 8EU, UK
| | - Apinun Aramrattana
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Alex Blaszczynski
- School of Psychology, Brain and Mind Centre, Faculty of Science, University of Sydney, Sydney 2006, Australia;
| | - Henrietta Bowden-Jones
- Department of Psychiatry, University College London, London NW1 2AE, UK
- Department of Psychiatry, Cambridge University, Cambridge CB2 1QW, UK
| | - Wim van den Brink
- Amsterdam University Medical Centers, Department of Psychiatry, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Adrian Brown
- Northwick Park Hospital, Central and North West London Trust, London HA1 3UJ, UK
| | - Qiana L. Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Medicine & Public Health and Health Professions, University of Florida, Homestead, FL 33031, USA
| | | | - Marica Ferri
- Department of Psychology, Faculty of Community and Health, European Monitoring Centre for Drugs and Drug Addiction, 1249-289 Lisbon, Portugal;
| | - Maria Florence
- Department of Biostatistics, School of Public Health, University of the Western Cape, Cape Town 7535, South Africa;
| | - Ralitza Gueorguieva
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06511, USA
| | | | - Suzie Hudson
- Network of Alcohol and Other Drugs Agencies, Sydney 2751, Australia;
| | - Peter J. Kelly
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong 2522, Australia;
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
| | | | - Abhijit Nadkarni
- Addictions and Related Research Group, Sangath, Bardez 403501, Goa, India
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Joanne Neale
- Addictions Department, King’s College London, London SE1 9NH, UK
| | - Daniel Rosen
- School of Social Work, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Hans-Jürgen Rumpf
- Translational Psychiatry Unit, Universität zu Lübeck, 23562 Lübeck, Germany
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Gabriel Segal
- Department of Philosophy, King’s College London, London SE1 9NH, UK;
| | - Gillian W. Shorter
- Drug and Alcohol Research Network, School of Psychology, Queen’s University Belfast, Belfast BT9 5AJ, UK
- Institute of Mental Health Sciences, Ulster University, Coleraine BT52 1SA, UK
| | - Marta Torrens
- Addiction Service, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Katherine Young
- International Consortium for Health Outcomes Measurement, London W12 8EU, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney 2052, Australia
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Brobbin E, Deluca P, Coulton S, Parkin S, Drummond C. Comparison of transdermal alcohol concentration and self-reported alcohol consumption in people with alcohol dependence attending community alcohol treatment services. Drug Alcohol Depend 2024; 256:111122. [PMID: 38367536 DOI: 10.1016/j.drugalcdep.2024.111122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
AIM We aimed to assess the accuracy and wearability of a transdermal alcohol sensor (TAS) (BACtrack Skyn) with people currently receiving treatment at alcohol services. METHOD A mixed methods observational study involving three NHS alcohol services in south London was conducted. All participants (7=male, 9=female) wore a TAS for 1 week and met with the researcher every other weekday to complete the TAS data download and a TimeLine Follow Back (TLFB). At the end of the week, a post-wear survey was completed. Transdermal Alcohol Concentration (TAC) from the TAS was compared to the TLFB. Post-wear survey responses, attendance voucher incentives and descriptive TAS data (removals, missing and skin temperature data) were analysed. We investigated different drinking event thresholds changing the criteria of TAC level and length of time TAC was increased and analysed each drinking threshold sensitivity, specificity, positive and negative predicative values, and percentage accuracy classification. RESULTS The TAS recorded the number of alcohol-drinking days with a high degree of accuracy compared to the TLFB as gold-standard. However, of the participation time of the 16 participants, 14.5% of the TAS data was missing in output and 16.4% of the recorded data suggests the TAS was not currently being worn. Of the data recorded, in line with the drinking event threshold of >15 ug/l TAC, >15minutes, we found that sensitivity = 93%, specificity = 84% and a Pearson correlation of r(16) =.926, p = <.001, BCa 95% CI [.855 -.981]. The threshold with the highest accuracy was TAC>15 ug/l, >60minutes which classified alcohol events with 90% accuracy, AUC =.910, sensitivity = 90%, specificity = 96%. The post-wear survey reported that most participants found it comfortable and that wearing it did not interfere with daily activities. Six participants reported side effects, including itching and a rash, but these would not deter them from wearing it again with all six reporting they would wear the TAS again and for longer than one week. CONCLUSIONS The TAS did not capture every drinking event that was self-reported but maintained a high correlation. There were instances of missing TAS data and TAS removals. Overall, our findings would support the acceptability and feasibility of TAS as a tool that could be used in clinical settings for objective alcohol monitoring with patients being responsible for the TAS.
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Affiliation(s)
- Eileen Brobbin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Ingesson-Hammarberg S, Jayaram-Lindström N, Hammarberg A. Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking. Addict Sci Clin Pract 2024; 19:12. [PMID: 38388959 PMCID: PMC10882804 DOI: 10.1186/s13722-024-00443-z] [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: 11/10/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD. METHODS This study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses. RESULTS BSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. CONCLUSIONS BSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking. TRIAL REGISTRATION The original study was registered retrospectively at isrtcn.com (14539251).
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Affiliation(s)
- Stina Ingesson-Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
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Kervadec E, Fauvel B, Strika-Bruneau L, Amirouche A, Verroust V, Piolino P, Romeo B, Benyamina A. Reduction of alcohol use and increase in psychological flexibility after a naturalistic psychedelic experience: a retrospective survey. Alcohol Alcohol 2024; 59:agad078. [PMID: 37981297 DOI: 10.1093/alcalc/agad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Alcohol use can be significantly associated with negative social, professional, and health outcomes. Even more so, alcohol use disorder (AUD) is a critical public health issue and major avoidable risk factor. This study aimed to examine the effect of a naturalistic psychedelic experience on alcohol use and related measures. METHODS A retrospective online survey was conducted on 160 individuals who reported a psychedelic experience and a concomitant drinking habit but did not necessarily have an AUD. Demographic data, characteristics of the psychedelic experience, and changes in alcohol consumption and psychological flexibility were surveyed. Results: The mean number of drinking days per week and AUDIT scores significantly decreased after the psychedelic experience (P < .001). Subjects who quit or reduced drinking had a more severe AUD (P < .01) and lower psychological flexibility (P = .003) before the psychedelic session. Alcohol use reduction was significantly associated with the intensity of the mystical experience (P = .03). Psychological flexibility increased more in participants who reduced their alcohol use (P < .001), and the change in psychological flexibility was one of the predictors of alcohol use improvement (P = .003). Conclusion: Our findings suggest that a naturalistic psychedelic experience could be associated with a reduction in alcohol use and dependency. Such positive health outcomes can be associated with the intensity of the mystical experience as well as an increase in psychological flexibility.
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Affiliation(s)
- Ewen Kervadec
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif F-94800, France
| | - Baptiste Fauvel
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université Paris Cité, Site Boulogne-Centre Henri Pié ron71, avenue Edouard Vaillant 92774 Boulogne-Billancourt, Paris, France
| | - Lana Strika-Bruneau
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif F-94800, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions-PSYCOMADD-Paris Saclay University Île-de-France, Hôpital Paul Brousse AP-HP12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Ammar Amirouche
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif F-94800, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions-PSYCOMADD-Paris Saclay University Île-de-France, Hôpital Paul Brousse AP-HP12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Vincent Verroust
- Unité de Recherche Psychiatrie-Comorbidités-Addictions-PSYCOMADD-Paris Saclay University Île-de-France, Hôpital Paul Brousse AP-HP12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
- Université Picardie-Jules Vernes, Chemin du Thil, 80000 Amiens, France
| | - Pascale Piolino
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université Paris Cité, Site Boulogne-Centre Henri Pié ron71, avenue Edouard Vaillant 92774 Boulogne-Billancourt, Paris, France
| | - Bruno Romeo
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif F-94800, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions-PSYCOMADD-Paris Saclay University Île-de-France, Hôpital Paul Brousse AP-HP12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Amine Benyamina
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif F-94800, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions-PSYCOMADD-Paris Saclay University Île-de-France, Hôpital Paul Brousse AP-HP12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
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Hammarberg SI, Wallhed Finn S, Rosendahl I, Andréasson S, Jayaram-Lindström N, Hammarberg A. Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction 2024; 119:86-101. [PMID: 37658776 DOI: 10.1111/add.16325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/21/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIMS Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. DESIGN Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion. SETTING Three specialized dependency care clinics in Stockholm, Sweden. PARTICIPANTS Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD. INTERVENTION AND COMPARATOR BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. MEASUREMENTS Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption. CONCLUSIONS A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.
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Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sara Wallhed Finn
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Andréasson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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St Quinton T, Morris B, Lithopoulos A, Norman P, Conner M, Rhodes RE. Self-efficacy and alcohol consumption: Are efficacy measures confounded with motivation? COGENT PSYCHOLOGY 2023. [DOI: 10.1080/23311908.2023.2180872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Tom St Quinton
- School of Psychology & Therapeutic Studies, Leeds Trinity University, Leeds, UK
| | - Ben Morris
- School of Psychology & Therapeutic Studies, Leeds Trinity University, Leeds, UK
| | - Alexander Lithopoulos
- School of Exercise Science, Physical & Health Education, University of Victoria, BC, Canada
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Ryan E. Rhodes
- School of Exercise Science, Physical & Health Education, University of Victoria, BC, Canada
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Morris J, Boness CL, Burton R. (Mis)understanding alcohol use disorder: Making the case for a public health first approach. Drug Alcohol Depend 2023; 253:111019. [PMID: 37952353 PMCID: PMC11061885 DOI: 10.1016/j.drugalcdep.2023.111019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
'Alcohol use disorder' (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an 'alcoholism' master narrative in which disease model stereotypes come with multiple costs for prevention and 'recovery'. The persistence of a problematic 'alcoholism' paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and 'other', and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual's essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.
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Affiliation(s)
- James Morris
- London South Bank University, Centre for Addictive Behaviours Research, UK.
| | - Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, USA
| | - Robyn Burton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Diaz LA, Winder GS, Leggio L, Bajaj JS, Bataller R, Arab JP. New insights into the molecular basis of alcohol abstinence and relapse in alcohol-associated liver disease. Hepatology 2023:01515467-990000000-00605. [PMID: 37862466 DOI: 10.1097/hep.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
Alcohol use disorder remains a significant public health concern, affecting around 5% of adults worldwide. Novel pathways of damage have been described during the last years, providing insight into the mechanism of injury due to alcohol misuse beyond the direct effect of ethanol byproducts on the liver parenchyma and neurobehavioral mechanisms. Thus, the gut-liver-brain axis and immune system involvement could be therapeutic targets for alcohol use disorder. In particular, changes in gut microbiota composition and function, and bile acid homeostasis, have been shown with alcohol consumption and cessation. Alcohol can also directly disrupt intestinal and blood-brain barriers. Activation of the immune system can be triggered by intestinal barrier dysfunction and translocation of bacteria, pathogen-associated molecular patterns (such as lipopolysaccharide), cytokines, and damage-associated molecular patterns. These factors, in turn, promote liver and brain inflammation and the progression of liver fibrosis. Other involved mechanisms include oxidative stress, apoptosis, autophagy, and the release of extracellular vesicles and miRNA from hepatocytes. Potential therapeutic targets include gut microbiota (probiotics and fecal microbiota transplantation), neuroinflammatory pathways, as well as neuroendocrine pathways, for example, the ghrelin system (ghrelin receptor blockade), incretin mimetics (glucagon-like peptide-1 analogs), and the mineralocorticoid receptor system (spironolactone). In addition, support with psychological and behavioral treatments is essential to address the multiple dimensions of alcohol use disorder. In the future, a personalized approach considering these novel targets can contribute to significantly decreasing the alcohol-associated burden of disease.
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Affiliation(s)
- Luis Antonio Diaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institutes of Health, NIDA and NIAAA, Baltimore, Maryland, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia, USA
| | - Ramon Bataller
- Liver Unit, Hospital Clinic, Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University, London, Ontario, Canada
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Tryggedsson JSJ, Andersen K, Behrendt S, Bilberg R, Bogenschutz MP, Buehringer G, Søgaard Nielsen A. Improvement in quality of life among women and men aged 60 years and older following treatment for alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1952-1963. [PMID: 37864528 DOI: 10.1111/acer.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/14/2023] [Accepted: 08/07/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults. AIMS In a clinical sample of older adults with DSM-5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow-ups. We also examined the effect of gender and explored interaction effects with gender on QoL. METHODS We utilized data from the "Elderly Study," a multi-national, single-blind, randomized, controlled trial of 693 adults aged 60+ with DSM-5 AUD. Alcohol use was assessed with the Form-90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4-, 12-, 26-, and 52-week follow-ups. Multilevel mixed-effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL. RESULTS Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1-year follow-up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4-3.9), psychological health (β: 3.5, 95% CI: 3.3-3.8), social relationships (β: 4.0, 95% CI: 2.5-5.6), and environmental health (β: 1.4, 95% CI: 0.4-2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05). CONCLUSIONS Among 60+ year-old adults receiving treatment for DSM-5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender.
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Affiliation(s)
- Jeppe Sig Juelsgaard Tryggedsson
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Silke Behrendt
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael P Bogenschutz
- NYU Langone Medical Center, New York, New York, USA
- Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Gerhard Buehringer
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- IFT Institut für Therapieforschung, Munich, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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12
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Liu SW, You CW, Fang SC, Chang HM, Huang MC. A smartphone-based support system coupled with a bluetooth breathalyzer in the treatment of alcohol dependence: A 12-week randomized controlled trial. Internet Interv 2023; 33:100639. [PMID: 37435041 PMCID: PMC10331416 DOI: 10.1016/j.invent.2023.100639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023] Open
Abstract
Background Our prior open trial showed the feasibility of a smartphone-based support system coupled with a Bluetooth breathalyzer (SoberDiary) in assisting recovery for patients with alcohol dependence (AD). In this 24-week follow-up study, we further explored the efficacy of supplementing SoberDiary to treatment as usual (TAU) over 12 weeks of intervention and whether the efficacy persisted in the post-intervention 12 weeks. Methods 51 patients who met the DSM-IV criteria of AD were randomly assigned to the technological intervention group (TI group, receiving technology intervention of SoberDiary plus TAU, n = 25) or those receiving only TAU (TAU group, n = 26). After 12 weeks of intervention (Phase I), all participants were followed for another post-intervention 12 weeks (Phase II). We collected the drinking variables and psychological assessment data every 4 weeks (i.e., weeks 4, 8, 12, 16, 20, and 24). In addition, the cumulative abstinence days and retention rates were recorded. We used mixed-model analysis to compare the difference in outcomes between groups. Results In Phase I or Phase II, we did not find differences in drinking variables, alcohol craving, depression, or anxiety severity between the two groups. However, the TI group showed greater self-efficacy for drinking refusal in Phase II than the TAU group. Conclusions Although our system (SoberDiary) did not demonstrate benefits in drinking or emotional outcomes, we found the system holds promise to enhance self-efficacy on drinking refusal. Whether the benefit in promoting self-efficacy persists longer than 24 weeks requires further investigation.
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Affiliation(s)
- Shu-Wei Liu
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chuang-Wen You
- Graduate Institute of Art and Technology, National Tsing Hua University, Hsinchu City, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Hu-Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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13
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Hobden B, Freund M, Lawson S, Bryant J, Walsh J, Leigh L, Sanson‐Fisher R. The impact of organisational factors on treatment outcomes for those seeking alcohol or other drug treatment: A systematic review. Drug Alcohol Rev 2023; 42:1220-1234. [PMID: 37005012 PMCID: PMC10947488 DOI: 10.1111/dar.13653] [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: 07/05/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Organisational factors have been found to be associated with health outcomes in a number of health-care settings. Despite likely being an important influence on the quality of care provided within alcohol and other drug (AOD) treatment centres, the impact of organisational factors on AOD treatment outcomes have not been extensively explored. This systematic literature review examines the characteristics, methodological quality and findings of published studies exploring the association between organisational factors and client AOD treatment outcomes. METHODS Medline, Embase, PsycINFO and the Cochrane database were searched from 2010 to March 2022 for relevant papers. Studies meeting the inclusion criteria underwent quality assessment using the Joanna Brigg's Institute critical appraisal tool for cross-sectional studies, followed by data extraction of key variables pertaining to the aims. A narrative summary was used to synthesise the data. RESULTS Nine studies met the inclusion criteria. Organisational factors examined included cultural competency, organisational readiness for change, directorial leadership, continuity of care practices, service access, service to needs ratios, dual diagnosis training, therapeutic optimism and the funding model/health-care system that treatment was delivered in. Outcome measures included duration, completion or continuation of treatment; AOD use; and patient perceptions of treatment outcomes. Seven out of nine papers found a significant interaction between at least one organisational variable and AOD treatment outcomes. DISCUSSION AND CONCLUSIONS Organisational factors are likely to impact treatment outcomes for patients seeking treatment for AOD. Further examination of the organisational factors that influence AOD outcomes is needed to inform systemic improvements to AOD treatment.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Megan Freund
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Samuel Lawson
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Jamie Bryant
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Justin Walsh
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Lucy Leigh
- Clinical Research Design and StatisticsHunter Medical Research InstituteNewcastleAustralia
| | - Rob Sanson‐Fisher
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
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14
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Avery M, LaVoice J. The effect of "failed" community mental health centers on non-white mortality. HEALTH ECONOMICS 2023; 32:1362-1393. [PMID: 36864606 DOI: 10.1002/hec.4671] [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: 07/26/2021] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/04/2023]
Abstract
The Community Mental Health Act of 1963 established Community Mental Health Centers (CMHCs) across the country with the goal of providing continuous, comprehensive, community-oriented care to people suffering from mental illness. Despite this program being considered a failure by most contemporary accounts, the World Health Organization advocates for a transition from the institutionalization of the mentally ill to a system of community-centered care. In this paper, we construct a novel dataset documenting the rollout of CMHCs from 1971 to 1981 to identify the effect of establishing a CMHC on county level mortality rates, focusing on causes of death related to mental illness. Though we find little evidence that access to a CMHC impacted mortality rates in the white population, we find large and robust effects for the non-white population, with CMHCs reducing suicide and homicide rates by 8% and 14%, respectively. CMHCs also reduced deaths from alcohol in the female non-white population by 18%. These results suggest the historical narrative surrounding the failure of this program does not represent the non-white experience and that community care can be effective at reducing mental health related mortality in populations with the least access to alternative treatment options.
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Affiliation(s)
- Mallory Avery
- Department of Economics, Monash University, Clayton, Australia
| | - Jessica LaVoice
- Department of Economics, Bowdoin College, University of Pittsburgh, Brunswick, Maine, USA
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15
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Seddon J, Wadd S. The characteristics and treatment outcomes of people with very late onset of problem drinking. Alcohol Clin Exp Res 2023; 47:756-762. [PMID: 37093459 DOI: 10.1111/acer.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/17/2022] [Accepted: 01/25/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The characteristics and outcomes of people who begin to experience problems with alcohol later in life are not well understood. This study examines whether people with a very late-onset of problem drinking, defined as occurring after the age of 60, differ in their use of alcohol, mental health functioning, and alcohol treatment outcomes from people with an earlier onset of problem drinking. METHOD Seven hundred eighty participants aged 50+ were categorized as either early onset (<25 years, n = 119, 15%), mid-onset (25-39 years, n = 200, 26%), late-onset (40-59 years, n = 376, 48%) or very late-onset problem drinkers (≥60 years, n = 85, 11%). Participants completed measures on alcohol use, mental health, and cognitive functioning. RESULTS Eleven percent of participants had very late onset of problem drinking. After controlling for age as a covariate, age of onset of problem drinking was not associated with level of alcohol intake or cognitive functioning, but individuals with very late onset of problem drinking had significantly lower levels of depression and significantly better mental health well-being. Age of onset was not associated with treatment outcomes (i.e., change in alcohol use following treatment or treatment completion). CONCLUSION People who first experience problems with alcohol after the age of 60 may have better mental health functioning than people with an earlier age of problem drinking. The results suggest that the age of onset of problem drinking may be a poor predictor of alcohol use severity and treatment outcomes and older adults can benefit from alcohol treatment irrespective of the age problem drinking began.
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Affiliation(s)
- Jennifer Seddon
- Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Sarah Wadd
- Substance Misuse and Ageing Research Team, University of Bedfordshire, Luton, UK
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16
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Nolte-Troha C, Roser P, Henkel D, Scherbaum N, Koller G, Franke AG. Unemployment and Substance Use: An Updated Review of Studies from North America and Europe. Healthcare (Basel) 2023; 11:healthcare11081182. [PMID: 37108016 PMCID: PMC10137824 DOI: 10.3390/healthcare11081182] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Since the industrial revolution, the relationship between unemployment and psychiatric disorders has been a subject of high interest. Currently, regarding the correlation between unemployment and substance-use disorders (SUDs), only older, often isolated and fragmented research results are available in the literature. This review was based on an extensive literature search of the European and North American literature in most relevant databases for "unemployment" and "substance use" related to "drugs", "alcohol", "nicotine", and "tobacco" between November 2022 and January 2023, according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) guidelines. A total of 59,117 papers were identified, of which only 33 articles were identified as relevant to the research objective. The literature showed significantly higher prevalence rates of SUDs involving divergent psychotropic substances among unemployed people. Unemployment was found to be a risk factor for SUD, and vice versa. However, the correlation between unemployment and relapses or smoking cessation was inconsistent. In addition, there appeared to be a mild effect of business cycles on SUD. The results showed significant multifaceted correlations between unemployment and SUD, indicating that prevention and early intervention are required to prevent harmful psychosocial consequences, such as social disintegration and severe psychiatric disorders.
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Affiliation(s)
- Carina Nolte-Troha
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Patrik Roser
- Department of Psychiatry and Psychotherapy, LVR University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Dieter Henkel
- Main Institute of Addiction Research (ISFF), University of Applied Sciences Frankfurt, Nibelungenplatz 1, 60318 Frankfurt am Main, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Andreas G Franke
- University of Applied Labour Studies, Seckenheimer Landstr. 16, 68163 Mannheim, Germany
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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18
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Andersson HW, Mosti MP, Nordfjaern T. Inpatients in substance use treatment with co-occurring psychiatric disorders: a prospective cohort study of characteristics and relapse predictors. BMC Psychiatry 2023; 23:152. [PMID: 36894934 PMCID: PMC9999667 DOI: 10.1186/s12888-023-04632-z] [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: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The characteristics of substance use disorder (SUD) inpatients with co-occurring psychiatric disorders (COD) have been scantly described in the extant literature. This study investigated psychological, demographic and substance use characteristics in these patients, along with predictors of relapse 3 months post-treatment. METHODS Prospective data from a cohort of 611 inpatients were analyzed for demographics, motivation, mental distress, SUD diagnosis, psychiatric diagnoses (ICD-10) and relapse rate at 3 months post-treatment (retention rate = 70%). RESULTS Compared to patients without COD (n = 322), those with COD (n = 289) were younger, had higher mental distress, lower education and higher likelihood of no permanent residence. The relapse rate was also higher in patients with COD (39.8%) relative to patients without COD (26.4%) (OR = 1.85, 95% CI: 1.23-2.78). The relapse rate was particularly high for patients with COD who were diagnosed with cannabis use disorder (53.3%). Multivariate analysis revealed that among patients with COD, relapse was more likely for individuals with a cannabis use disorder (OR = 2.31, 95% CI: 1.34-4.00), and less likely for older ages (OR = 0.97, 95% CI: 0.94-1.00), females (OR = 0.56, 95% CI: 0.33-0.98) and for those with higher intrinsic motivation (OR = 0.58, 95% CI: 0.42-0.81). CONCLUSION This study showed that among SUD inpatients, those with COD had relatively persistent high levels of mental distress and an increased risk of relapse. Enhanced measures aimed at COD patients' mental health problems during the inpatient stay, along with close and personalized follow-up after discharge from residential SUD treatment may reduce the probability of relapse in this group.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Pb 3250 Sluppen, Trondheim, 7006, Norway.
| | - Mats P Mosti
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Pb 3250 Sluppen, Trondheim, 7006, Norway
| | - Trond Nordfjaern
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Pb 3250 Sluppen, Trondheim, 7006, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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19
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Lillie KM, Shane A, Jansen KJ, Trinidad SB, Shaw JL. Recovery from alcohol among urban Alaska Native and American Indian people. J Ethn Subst Abuse 2023; 22:154-170. [PMID: 34033515 PMCID: PMC8613305 DOI: 10.1080/15332640.2021.1918599] [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] [Indexed: 10/21/2022]
Abstract
Alaska Native and American Indian (ANAI) people experience dramatic alcohol-related health disparities compared to the general US population. Although the majority of ANAI people reside in urban settings (>70%), data are sparse on alcohol abstinence among urban ANAI people with alcohol use disorder (AUD). We conducted a qualitative study using a phenomenological approach to examine the experiences of 20 urban ANAI adults recovering from AUD. Participants' narratives had their own unique dimensions but shared a clear, interrelated trajectory of pre-alcohol recovery, a turning point, and ongoing alcohol recovery. All participants reported a combination of external and internal motivation to stop using alcohol.
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20
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Nabunya P, Byansi W, Damulira C, Ssewamala FM. Self-efficacy, academic performance and school transition among orphaned adolescents in southern Uganda. CHILDREN AND YOUTH SERVICES REVIEW 2022; 143:106707. [PMID: 36483662 PMCID: PMC9728805 DOI: 10.1016/j.childyouth.2022.106707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Self-efficacy is critical to adolescents' development. This study examined the relationship between self-efficacy, academic performance and transition to post primary education among orphaned adolescents in southern Uganda. METHODS Longitudinal data from a cluster randomized clinical trial for orphaned adolescents was analyzed. Adolescents (N = 1410) between 10 and 16 years at study initiation, in their last three years of primary schooling were eligible to participate in the study. Data collected at baseline, 12, 24, 36 and 48-months follow-up were analyzed. Ordinary least square and logistic regression analyses were conducted to assess the relationship between adolescents' self-efficacy, academic performance -as measured by Primary Leaving Examinations (PLE) scores, and transition to post primary education. RESULTS Results indicate that adolescents' self-efficacy was associated with better PLE grades (lower scores indicate better performance [b = -0.05, 95 % CI = -0.09, -0.01, p≤0.01]) and a higher likelihood of transition to post primary education (OR = 1.02, 95 % CI = -0.09, 1.00, 1.03, p≤0.01). CONCLUSION Findings point to the importance of integrating components focused on promoting self-efficacy among adolescents -especially those made vulnerable by poverty and HIV/AIDS in low resource settings.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, United States
| | - William Byansi
- Boston College School of Social Work, United States of America
| | | | - Fred M. Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, United States
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21
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Graser Y, Stutz S, Rösner S, Wopfner A, Moggi F, Soravia LM. Different Goals, Different Needs: The Effects of Telephone- and Text Message-Based Continuing Care for Patients with Different Drinking Goals After Residential Treatment for Alcohol Use Disorder. Alcohol Alcohol 2022; 57:734-741. [PMID: 35909224 DOI: 10.1093/alcalc/agac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS Drinking goal has emerged as a promising predictor variable for alcohol-related outcomes. Many patients with alcohol use disorder (AUD) choose another drinking goal than abstinence after residential AUD treatment program. We aimed to examine the effects of an abstinent drinking goal (ADG) and conditional abstinence drinking goal (CADG) 6 months after residential treatment on drinking outcomes in patients with severe AUD and investigate the effectiveness of telephone-based (TEL) or text message-based (TEX) continuing care according to the individual drinking goal. METHODS A total of 240 patients from two specialized residential treatment programs for AUD were included in the study. Patients were randomly assigned to high-frequency (nine contacts) or low-frequency (two contacts) TEL, TEX (nine contacts), or control group (no contact) from treatment discharge to the 6-month follow-up. RESULTS Patients with an ADG were significantly more often abstinent (58%) at the 6-month follow-up compared to patients with a CADG (32.1%), and in the case of relapse, showed a significantly longer time to the first drink. Patients with a CADG of the high-frequency TEL showed a tendency to be more abstinent at the 6-month follow-up and reported significantly higher alcohol-related self-efficacy compared to the CADG patients of the control group. CONCLUSIONS Patients with CADG are more vulnerable to relapse, and therefore may benefit more from high-frequency telephone contacts to deal with alcohol-related problems and reach their goal. In the case of relapse, the high-frequent contacts may help patients stay connected to health services, preventing chronification and facilitating recovery from AUD.
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Affiliation(s)
- Yolanda Graser
- Research, Suedhang Clinic, Südhang 1, 3038 Kirchlindach, Switzerland
| | - Sonja Stutz
- Research and Developement, Forel Clinic, Islikonerstrasse 5, 8548 Ellikon, Switzerland
| | - Susanne Rösner
- Research and Developement, Forel Clinic, Islikonerstrasse 5, 8548 Ellikon, Switzerland
| | - Alexander Wopfner
- Research, Suedhang Clinic, Südhang 1, 3038 Kirchlindach, Switzerland
| | - Franz Moggi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Departement of Psychology, Bolligenstrasse 111, 3072 Bern, Switzerland
| | - Leila M Soravia
- Research, Suedhang Clinic, Südhang 1, 3038 Kirchlindach, Switzerland.,Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Departement of Psychology, Bolligenstrasse 111, 3072 Bern, Switzerland
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22
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Psychometric evaluation of a Swedish version of the Impaired Control Scale for individuals with alcohol use disorder. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:553-567. [DOI: 10.1177/14550725221110195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Aim: The aim of this study was to evaluate the psychometric properties of a Swedish version of the Impaired Control Scale. Impaired control (IC) over alcohol consumption is a core symptom of alcohol use disorder and a predictor of treatment outcome, but measures of IC are not well utilised in clinical practice. Methods: The study comprised 250 individuals from a randomised controlled trial conducted at an adult outpatient addiction clinic in Sweden. The statistical analyses concern dimensionality, convergent and divergent validity, reliability, measurement invariance and sensitivity to change. Results: Regarding dimensionality, a principal component analysis of the standardised residuals from a Rasch model indicated some evidence of further dimensions underlying the responses in the Failed Control (FC) and Perceived Control (PC) parts. Two parallel items (12 and 22 respectively) seemed to drive potential multidimensionality. When these items were excluded, goodness of fit to one-dimensional models was improved. Tests of convergent and divergent validity showed that failed control had the strongest associations to impaired control and alcohol use disorder while the attempted control part was not associated with the construct of impaired control or alcohol use disorder. Conclusion: The present results show that the FC part is the most valid measure of the underlying construct of IC. In addition, FC had close to a large effect in regard to sensitivity to change. This suggests that the FC part has potential utility for use as an assessment and evaluation tool of treatment effect on impaired control of drinking.
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23
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Wallach JD, Gueorguieva R, Phan H, Witkiewitz K, Wu R, O’Malley SS. Predictors of abstinence, no heavy drinking days, and a 2-level reduction in World Health Organization drinking levels during treatment for alcohol use disorder in the COMBINE study. Alcohol Clin Exp Res 2022; 46:1331-1339. [PMID: 35616436 PMCID: PMC9887652 DOI: 10.1111/acer.14877] [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: 02/27/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Data from trials of medications for alcohol use disorder (AUD) can be used to identify predictors of drinking outcomes regardless of treatment, which can inform the design of future trials with heterogeneous populations. Here, we identified predictors of abstinence, no heavy drinking days, and a 2-level reduction in World Health Organization (WHO) drinking levels during treatment for AUD in the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study. METHODS We utilized data from the COMBINE Study, a randomized placebo-controlled trial evaluating the efficacy of naltrexone and acamprosate, both alone and in combination, for AUD (n = 1168). A tree-based machine learning algorithm was used to construct classification trees predicting abstinence, no heavy drinking days, and a 2-level reduction in WHO drinking levels in the last 4 weeks of treatment, based on 89 baseline variables. RESULTS The final tree for predicting abstinence had one split based on consecutive days abstinent prior to randomization, with a higher proportion of subjects achieving abstinence among those classified as abstinent for >2 versus ≤2 consecutive weeks prior to randomization (66% vs. 29%). The final tree for predicting no heavy drinking days in the last 4 weeks of treatment had three splits based on consecutive days abstinent, age, and total Alcohol Dependence Scale score at baseline. Seventy-three percent of the subjects classified as abstinent for >2 consecutive weeks prior to randomization had no heavy drinking days in the last 4 weeks of treatment. Among those classified as abstinent ≤2 consecutive weeks prior, three additional splits showed that younger subjects (age ≤44 years; 37%), and older subjects (age >44) with a total Alcohol Dependence Scale score >13 and complete abstinence (56%) or other drinking goals (35%), were less likely to have no heavy drinking days than older subjects with a total Alcohol Dependence Scale score ≤13 (67%). The final tree for predicting a 2-level reduction in WHO levels had no splits. CONCLUSIONS Consecutive days abstinent prior to randomization may predict abstinence and no heavy drinking days and total Alcohol Dependence Scale score and age may predict no heavy drinking days. The 2-level reduction in WHO levels outcome may be less likely to discriminate based on multiple patient characteristics.
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Affiliation(s)
- Joshua D. Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Psychiatry, Yale Medical School, New Haven, Connecticut, USA
| | - Huong Phan
- Department of Statistics, University of Washington, Washington, USA
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions, Albuquerque New Mexico, USA
| | - Ran Wu
- Department of Psychiatry, Yale Medical School, New Haven, Connecticut, USA
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24
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Santos-de-Pascual A, López-Cano LM, Alcántara-López M, Martínez-Pérez A, Castro-Sáez M, Fernández-Fernández V, López-Soler C. Effects of a Residential Multimodal Psychological Treatment in an Addicted Population, at 6 and 12 Months: Differences Between Men and Women. Front Psychiatry 2022; 13:862858. [PMID: 35782433 PMCID: PMC9243417 DOI: 10.3389/fpsyt.2022.862858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to explore the effects of a residential multimodal treatment intervention for an addict population. We gathered participants from the "Programa Base" (n = 166) of the Solidarity and Reinsertion Foundation of Murcia, and assessed the various problematic areas with the EuropASI at baseline level, 6 months and 12 months of treatment. We found improved outcomes in every area except for Legal Status. In addition, we found differences between male and female participants in their baseline evaluation, as well as between completers and non-completers. In conclusion, this data shows us some changes which occurred in individuals with problematic drug use during treatment, going further into the complex social reality which causes great suffering and damage to people and their families.
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25
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Kim M, Byrne AM, Jeon J. The Effect of Vocational Counseling Interventions for Adults with Substance Use Disorders: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4674. [PMID: 35457542 PMCID: PMC9027488 DOI: 10.3390/ijerph19084674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
The authors reviewed the research literature evaluating the effectiveness of vocational counseling interventions focused on employment for consumers with substance use disorders. This review included 11 articles related to vocational counseling interventions, which are either incorporated with substance use treatment or not. The results of this review revealed that vocational counseling services have been highly efficacious in resulting in part-time and full-time jobs. The study designs had some limitations, and few studies employed randomized control trials (RCT).
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Affiliation(s)
- Min Kim
- Department of Social Welfare, Incheon National University, Incheon 22012, Korea;
| | - Andrew M. Byrne
- School of Education, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
| | - Jihye Jeon
- Department of Social Welfare, Incheon National University, Incheon 22012, Korea;
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26
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Ritter A, van de Ven K, Vuong T, Chalmers J, Dobbins T, Livingston M, Berends L. Are market mechanisms associated with alcohol and other drug treatment outcomes? Addiction 2022; 117:1105-1116. [PMID: 34472670 DOI: 10.1111/add.15681] [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: 04/13/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The configuration of alcohol and other drug treatment service systems has been influenced by the uptake of market mechanisms for treatment funding and purchasing. This study measured the impact of market mechanisms for funding and purchasing alcohol and drug treatment services on client outcomes. DESIGN An observational cross-sectional study, employing multi-level analysis: episodes of care data, nested within person-level data, nested within treatment site and nested within organization. SETTING AND PARTICIPANTS One hundred and seventy-eight alcohol and other drug treatment service sites in Australia. MEASUREMENTS Client outcome variables were length of stay and successful treatment completion. Predictor variables were competitive tendering, number of funding contracts, recurrent funding, the ratio of episodes to staff, type of professions, years of clinical experience, staff turnover and type of provider (government; non-government). Analyses controlled for drug type, type of treatment received and client characteristics. FINDINGS There were no significant associations between the procurement and contracting variables and length of stay [incidence rate ratios (IRRs) ranged between 1.01 and 1.07, all P > 0.05; Bayes factors (BF) < 0.03], and inconclusive results for treatment completion [odds ratios (ORs) ranged between 1.04 and 1.15, all P > 0.05, BF = 0.51-0.63]. Having an alcohol and other drug (AOD) work-force relative to an 'other' work-force (IRR = 0.79, P = 0.021) and lower case-loads (IRR = 0.99, P = 0.047) may be associated with longer stay in treatment. Receiving services from a government compared to non-government provider may also be associated with less treatment completion (OR = 0.34, P = 0.023, BF = 2.14). CONCLUSIONS There appears to be no association between client outcomes and procurement and funding contract arrangements for alcohol and drug treatment services.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, University of NSW, Sydney, NSW, Australia
| | - Katinka van de Ven
- Drug Policy Modelling Program, Social Policy Research Centre, University of NSW, Sydney, NSW, Australia.,Centre for Rural Criminology, University of New England, Armidale, NSW, Australia
| | - Thu Vuong
- Drug Policy Modelling Program, Social Policy Research Centre, University of NSW, Sydney, NSW, Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, Social Policy Research Centre, University of NSW, Sydney, NSW, Australia
| | - Timothy Dobbins
- School of Population Health, University of NSW, Sydney, NSW, Australia
| | - Michael Livingston
- National Drug Research Institute, Health Sciences, Curtin University, Bentley, WA, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Lynda Berends
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, Australia
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27
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Roberts W, Zhao Y, Verplaetse T, Moore KE, Peltier MR, Burke C, Zakiniaeiz Y, McKee S. Using machine learning to predict heavy drinking during outpatient alcohol treatment. Alcohol Clin Exp Res 2022; 46:657-666. [PMID: 35420710 PMCID: PMC9180421 DOI: 10.1111/acer.14802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accurate clinical prediction supports the effective treatment of alcohol use disorder (AUD) and other psychiatric disorders. Traditional statistical techniques have identified patient characteristics associated with treatment outcomes. However, less work has focused on systematically leveraging these associations to create optimal predictive models. The current study demonstrates how machine learning can be used to predict clinical outcomes in people completing outpatient AUD treatment. METHOD We used data from the COMBINE multisite clinical trial (n = 1383) to develop and test predictive models. We identified three priority prediction targets, including (1) heavy drinking during the first month of treatment, (2) heavy drinking during the last month of treatment, and (3) heavy drinking between weekly/bi-weekly sessions. Models were generated using the random forest algorithm. We used "leave sites out" partitioning to externally validate the models in trial sites that were not included in the model training. Stratified model development was used to test for sex differences in the relative importance of predictive features. RESULTS Models predicting heavy alcohol use during the first and last months of treatment showed internal cross-validation area under the curve (AUC) scores ranging from 0.67 to 0.74. AUC was comparable in the external validation using data from held-out sites (AUC range = 0.69 to 0.72). The model predicting between-session heavy drinking showed strong classification accuracy in internal cross-validation (AUC = 0.89) and external test samples (AUC range = 0.80 to 0.87). Stratified analyses showed substantial sex differences in optimal feature sets. CONCLUSION Machine learning techniques can predict alcohol treatment outcomes using routinely collected clinical data. This technique has the potential to greatly improve clinical prediction accuracy without requiring expensive or invasive assessment methods. More research is needed to understand how best to deploy these models.
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Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Yize Zhao
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Terril Verplaetse
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - MacKenzie R Peltier
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Catherine Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sherry McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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28
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Vidrine JI, Shih YCT, Businelle MS, Sutton SK, Hoover DS, Cottrell-Daniels C, Fennell BS, Bowles KE, Vidrine DJ. Comparison of an automated smartphone-based smoking cessation intervention versus standard quitline-delivered treatment among underserved smokers: protocol for a randomized controlled trial. BMC Public Health 2022; 22:563. [PMID: 35317789 PMCID: PMC8939152 DOI: 10.1186/s12889-022-12840-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is the leading cause of preventable morbidity and mortality in the United States. Individuals with low socioeconomic status have disproportionately high smoking rates and greater difficulty quitting smoking. Efficiently connecting underserved smokers to effective tobacco cessation programs is crucial for disease prevention and the elimination of health disparities. Smartphone-based interventions have the potential to enhance the reach and efficacy of smoking cessation treatments targeting underserved smokers, but there is little efficacy data for these interventions. In this study, we will partner with a large, local hunger-relief organization to evaluate the efficacy and economic impact of a theoretically-based, fully-automated, and interactive smartphone-based smoking cessation intervention. METHODS This study will consist of a 2-group randomized controlled trial. Participants (N = 500) will be recruited from a network of food distribution centers in West Central Florida and randomized to receive either Standard Treatment (ST, n = 250) or Automated Treatment (AT, n = 250). ST participants will be connected to the Florida Quitline for telephone-based treatment and will receive a 10-week supply of nicotine replacement therapy (NRT; transdermal patches and lozenges). AT participants will receive 10 weeks of NRT and a fully-automated smartphone-based intervention consisting of interactive messaging, images, and audiovisual clips. The AT intervention period will span 26 weeks, with 12 weeks of proactive content and 26 weeks of on-demand access. ST and AT participants will complete weekly 4-item assessments for 26 weeks and 3-, 6-, and 12-month follow-up assessments. Our primary aim is to evaluate the efficacy of AT in facilitating smoking abstinence. As secondary aims, we will explore potential mediators and conduct economic evaluations to assess the cost and/or cost-effectiveness of ST vs. AT. DISCUSSION The overall goal of this project is to determine if AT is better at facilitating long-term smoking abstinence than ST, the more resource-intensive approach. If efficacy is established, the AT approach will be relatively easy to disseminate and for community-based organizations to scale and implement, thus helping to reduce tobacco-related health disparities. TRIAL REGISTRATION Clinical Trials Registry NCT05004662 . Registered August 13, 2021.
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Affiliation(s)
- Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA. .,Department of Oncologic Sciences, University of South Florida, Morsani College of Medicine, Tampa, FL, USA. .,Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael S Businelle
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Cherell Cottrell-Daniels
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA
| | - Bethany Shorey Fennell
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA
| | - Kristina E Bowles
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA.,Department of Oncologic Sciences, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
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29
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Filiz N, Polat S. The correlation between the addiction profile and general self-efficacy of patients receiving treatment for substance use disorder. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2047808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nupel Filiz
- Generel Intensıve Care Department, Izmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Sibel Polat
- Faculty of Health Sciences, Department of Psychiatric Nursing, SANKO University, Gaziantep, Turkey
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30
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Fleury MJ, Grenier G, Cao Z, Huỳnh C. Profiles of individuals with cannabis-related disorders. Subst Abus 2022; 43:855-864. [PMID: 35179451 DOI: 10.1080/08897077.2021.2007515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996-1997 to 2014-2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015-2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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31
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Myers B, Koch JR, Johnson K, Harker N. Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. Addict Sci Clin Pract 2022; 17:8. [PMID: 35109915 PMCID: PMC8812030 DOI: 10.1186/s13722-022-00289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nadine Harker
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
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Senn S, Volken T, Rösner S, Wieber F. What is the relapse risk during treatment? Survivor analysis of single and multiple relapse events in inpatients with alcohol use disorder as part of an observational study. J Subst Abuse Treat 2022; 138:108754. [DOI: 10.1016/j.jsat.2022.108754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/21/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
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Micalizzi L, Sokolovsky AW, Delaney DJ, Gunn RL, Hernandez L, Kemp K, Spirito A, Stein LAR. A psychometric assessment of the Brief Situational Confidence Questionnaire for Marijuana (BSCQ-M) in juvenile justice-involved youth. Addict Behav 2022; 125:107154. [PMID: 34735980 PMCID: PMC8662708 DOI: 10.1016/j.addbeh.2021.107154] [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: 06/24/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Cannabis refusal self-efficacy, defined as confidence in the ability to refuse cannabis or to avoid cannabis use, is associated with decreased cannabis use. Juvenile justice-involved youth are at high risk for cannabis use and may have lower refusal self-efficacy. While court-involved, non-incarcerated (CINI) and incarcerated youth are groups that are both at high-risk for cannabis use, the experience of incarceration may impact the measurement of refusal self-efficacy for cannabis. The factor structure, measurement invariance, and concurrent validity of the Brief Situational Confidence Questionnaire for Cannabis (BSCQ-M) was assessed among CINI (n = 148) and incarcerated (n = 199) youth (80.7% male, Mage = 16.3). Confirmatory factor analyses indicated that a correlated 3-factor model including positive/good times, negative internal, and negative external situational factors best fit the data. Multigroup measurement invariance testing revealed that the BSCQ-M demonstrated configural, metric, scalar, and residual invariance across CINI and incarcerated samples, indicating measurement invariance across the two groups. Negative binomial regressions revealed that BSCQ-M scores were significantly negatively associated with concurrent cannabis use. Results suggest that the BSCQ-M is a brief, psychometrically sound measure of refusal self-efficacy for cannabis among juvenile justice-involved youth that can be utilized with both CINI and incarcerated youth.
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Affiliation(s)
- Lauren Micalizzi
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States
| | - Alexander W. Sokolovsky
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States
| | - Daniel J. Delaney
- Department of Psychology, Chafee Social Science Center, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, United States
| | - Rachel L. Gunn
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States
| | - Lynn Hernandez
- CUNY School of Medicine, The City College of New York, 160 Convent Avenue, New York, NY 10031
| | - Kathleen Kemp
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States,Rhode Island Family Court Mental Health Clinic, 1 Dorrance Street, Providence, RI 02903 United States
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States
| | - L. A. R. Stein
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States,Department of Psychology, Chafee Social Science Center, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, United States,Rhode Island Training School, Department of Children, Youth & Families, 57 Power Road, Cranston, RI 02920, United States
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Schückher F, Berglund K, Engström I, Sellin T. Predictors for Abstinence in Socially Stable Women Receiving Treatment for Alcohol Use Disorder. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2021.2018957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fides Schückher
- Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | | | - Ingemar Engström
- Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Healthcare Research Center, Örebro University, Sweden
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Patel N, Sharma H, Mahida A, Mistry H. Relationship of alcohol use pattern with locus of control and impulsivity: A cross-sectional study in hospitalized alcohol use disorder patients in Western India. J Family Med Prim Care 2022; 11:987-993. [PMID: 35495781 PMCID: PMC9051702 DOI: 10.4103/jfmpc.jfmpc_1181_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Alcohol use disorders (AUDs) are increasing in developing countries like India and it has high relapse rates. Locus of control (LOC) and impulsivity can be important predictors of relapse and knowledge about them can help in management of AUD. Method: Cross-sectional analytical study of 116 indoor patients in tertiary care hospital, between ages 18 and 65 years diagnosed as AUD according to DSM-5, after acute detoxification was done. For interview, a sociodemographic sheet, Alcohol Use Disorder Identification Test, Drinking-Related Locus of Control Scale, and Barrett’s Impulsiveness Scale 11 scale (Gujarati versions) were used. Patients with complicated withdrawal and any other comorbid organic brain conditions were excluded. The data were analyzed using SPSS version 25. Result: Total participants consisted of 65% middle-aged (35–50 years) rural inhabitants. Eighty-six-percent of patients were employed and around 80% were educated >5th standard. No association was found between sociodemographic variables and severity of alcohol use. Severity of alcohol use increased with more duration of alcohol consumption (P = 0.001). Patients being earlier aged for first intake of alcohol had a high external LOC (r = 0.209, P = 0.050). Patients with high external LOC (P = 0.003) and more impulsivity (P = 0.001) had more relapses (more numbers of attempts to quit alcohol). With increased external LOC (r = 0.315) and increased impulsivity (r = 0.716), severity of alcohol use also increased. As impulsivity increased, patients’ LOC was found more toward external side (P = 0.007) (r = 0.345). Conclusion: External LOC and impulsivity have a strong association with alcohol use. Patients with high external LOC and more impulsivity had early age of first intake, severe alcohol use, and more duration of alcohol consumption.
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Nagy NES, Ella EIA, Shorab EM, Moneam MHEDA, Tohamy AA. Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital. MIDDLE EAST CURRENT PSYCHIATRY, AIN SHAMS UNIVERSITY 2022; 29:80. [PMCID: PMC9579533 DOI: 10.1186/s43045-022-00246-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors. Results The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X2= 12.525, p=0.014; X2= 12.525, p=0.023; and X2= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse. Conclusions Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.
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Affiliation(s)
- Nahla El Sayed Nagy
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Eman Ibrahim Abo Ella
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Eman Mohamed Shorab
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Mohamed Hossam El-Din Abdel Moneam
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Arwa Ahmed Tohamy
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
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Polcin D, Witbrodt J, Nayak MB, Korcha R, Pugh S, Salinardi M. Characteristics of women with alcohol use disorders who benefit from intensive motivational interviewing. Subst Abus 2022; 43:23-31. [PMID: 31697218 PMCID: PMC7202950 DOI: 10.1080/08897077.2019.1686724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Women with alcohol disorders have more severe problems related to their drinking than men. They have higher mortality from alcohol-related accidents and enter treatment with more serious medical, psychiatric, and social consequences. Objective: This study assessed the effects of Intensive Motivational Interviewing (IMI), a new, 9-session counseling intervention for women with drinking problems. Methods: A randomized clinical trial was conducted with 215 women. Most were white (83%), college educated (61%), and older (mean age 51). Half received IMI and half a standard single session of MI (SMI) along with an attention control (nutritional education). Results: Generalized estimating equations models showed women who were heavy drinkers at baseline in the IMI condition reduced heavy drinking more than those in the SMI condition at 2-, 6-, and 12-month follow-up. Analyses of disaggregated subgroups showed IMI was most effective for women with low psychiatric severity, more severe physical and impulse control consequences associated with drinking, and higher motivation. However, formal 3-way interaction models (condition by moderator by time) showed significant effects primarily at 2 months. Conclusions: Improvements associated with IMI were limited to heavy drinking and varied among subgroups of women. Studies of women with more diverse characteristics are needed.
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Affiliation(s)
- Douglas Polcin
- Public Health Institute, Behavioral Health and Recovery Studies, Oakland, 94607-4058 United States
| | - Jane Witbrodt
- Alcohol Research Group, Emeryville, 94608-1010 United States
| | | | | | - Sheila Pugh
- Alcohol Research Group, Emeryville, California, USA
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Vidrine DJ, Bui TC, Businelle MS, Shih YCT, Sutton SK, Shahani L, Hoover DS, Bowles K, Vidrine JI. Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e33183. [PMID: 34787590 PMCID: PMC8663670 DOI: 10.2196/33183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID) PRR1-10.2196/33183
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Affiliation(s)
- Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Thanh C Bui
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Lokesh Shahani
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Kristina Bowles
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
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Predictors of Inpatient Care in a 10-Year Retrospective Cohort Registered in an Outpatient Substance Use Disorder Treatment Program. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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de Moura AP, e Sousa HFP, Dinis MAP, Ferros LL, Jongenelen I, Negreiros J. Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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41
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Yoshimura A, Kimura M, Matsushita S, Yoneda JI, Maesato H, Komoto Y, Nakayama H, Sakuma H, Yumoto Y, Takimura T, Tohyama T, Iwahara C, Mizukami T, Yokoyama A, Higuchi S. Alcohol dependence severity determines the course of treatment-seeking patients. Alcohol Clin Exp Res 2021; 45:2335-2346. [PMID: 34585408 DOI: 10.1111/acer.14707] [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] [Received: 01/22/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. METHODS This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. RESULTS Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes. CONCLUSIONS The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol-dependent individuals who need additional support in their recovery.
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Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan.,Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mitsuru Kimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Sachio Matsushita
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Jun-Ichi Yoneda
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Hitoshi Maesato
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | | | - Hideki Nakayama
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan.,Hokujinkai Asahiyama Hospital, Sapporo, Japan
| | - Hiroshi Sakuma
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Yosuke Yumoto
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Tsuyoshi Takimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Tomomi Tohyama
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Chie Iwahara
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Takeshi Mizukami
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Akira Yokoyama
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Susumu Higuchi
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
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Guliyev C, İnce-Guliyev E, Ögel K. Predictors of Relapse to Alcohol and Substance Use: Are There Any Differences between 3 and 12 Months after Inpatient Treatment? J Psychoactive Drugs 2021; 54:358-367. [PMID: 34553671 DOI: 10.1080/02791072.2021.1976887] [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: 10/20/2022]
Abstract
Understanding the factors that lead to relapse is important for developing effective treatment strategies. The aim of this study is to examine sociodemographic and clinical factors that predict relapse 3 and 12 months after inpatient treatment in patients with alcohol and substance use disorders. 247 patients were included in the study. A sociodemographic data form and the Addiction Profile Index-Clinical Form (API-C) were filled out during the first days of hospitalization and relapse information was obtained through outpatient interviews. Logistic regression analysis was used to assess predictive factors. Rates of relapse for the 3rd and 12th months were 40.5% and 74.6%, respectively. Motivation to quit substance use, risk of depression, being on probation, and being employed predicted relapse within the 3-month period. At the 12th month, substance use intensity and motivation to quit were the factors associated with relapse. To conclude, motivation to quit is critical to maintaining both early and sustained remission. Moreover, divergent factors may be relevant at different stages of treatment. Defining relapse predictors early in the process and being vigilant to the change in the needs of patients as the treatment continues may help to develop a more effective and focused treatment plan.
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Affiliation(s)
- Cavid Guliyev
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
| | - Ezgi İnce-Guliyev
- Department of Psychiatry, Van Research and Training Hospital, Van, Turkey
| | - Kültegin Ögel
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
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Kruger ES, Serier KN, Pfund RA, McKay JR, Witkiewitz K. Integrative data analysis of self-efficacy in 4 clinical trials for alcohol use disorder. Alcohol Clin Exp Res 2021; 45:2347-2356. [PMID: 34523721 DOI: 10.1111/acer.14713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Self-efficacy has been proposed as a key predictor of alcohol treatment outcomes and a potential mechanism of success in achieving abstinence or drinking reductions following alcohol treatment. Integrative data analysis, where data from multiple studies are combined for analyses, can be used to synthesize analyses across multiple alcohol treatment trials by creating a commensurate measure and controlling for differential item functioning (DIF) to determine whether alcohol treatments improve self-efficacy. METHOD The current study used moderated nonlinear factor analysis (MNLFA) to examine the effect of treatment on self-efficacy across four different treatment studies (N = 3720; 72.5% male, 68.4% non-Hispanic white). Self-efficacy was measured using the Alcohol Abstinence Self-Efficacy Scale (AASE) in the COMBINE Study (n = 1383) and Project MATCH (n = 1726), and the Drug Taking Confidence Questionnaire (DTCQ) in two studies of Telephone Continuing Care (TEL Study 1: n = 303; TEL Study 2: n = 212). DIF was examined across time, study, treatment condition, marital status, age, and sex. RESULTS We identified 12 items from the AASE and DTCQ to create a commensurate measure of self-efficacy using MNLFA. All active treatments, including cognitive-behavioral treatment, a combined behavioral intervention, medication management, motivation enhancement treatment, telephone continuing care, twelve-step facilitation, and relapse prevention, were associated with significant increases in self-efficacy from baseline to posttreatment that were maintained for up to a year. Importantly, treatment as usual in community settings, which consisted of weekly group therapy that included addiction counseling and twelve-step recovery support, was not associated with significant increases in self-efficacy. CONCLUSIONS Alcohol self-efficacy increases following treatment and numerous evidence-based treatments are associated with significant increases in self-efficacy, which are maintained over time. Community treatment that focuses solely on addiction counseling and twelve-step support may not promote increases in self-efficacy.
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Affiliation(s)
- Eric S Kruger
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Rory A Pfund
- University of New Mexico, Albuquerque, New Mexico, USA
| | - James R McKay
- University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
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Desmirean M, Richlitzki C, Pasca S, Teodorescu P, Petrushev B, Rauch S, Steinheber J, Iluta S, Liu J, Dima D, Grewal R, Ma W, Qian L, Tomuleasa C. Correlation between the prevalence of T-cell lymphomas and alcohol consumption. Med Pharm Rep 2021; 94:298-306. [PMID: 34430851 DOI: 10.15386/mpr-1777] [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: 06/13/2020] [Revised: 11/27/2020] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background and aims Alcohol is a psychoactive substance that causes dependence, with many thousands of years in the history of mankind, being widely used in different cultures. According to the International Agency for Research on Cancer, alcohol is involved in the development of cancer, being directly associated with it. Considering that alcohol is involved in the initiation and dissemination of gastrointestinal malignancies, the objective of the study was to assess its role in the pathogenesis of T-cell lymphomas, as well as its possible correlation with chronic consumption. Methods The patient cohort was compiled from the Sixth Medical Center of the People's Liberation Army Navy General Hospital in Beijing, China. A total of 30 patients matched the criteria and were enrolled in the study. Statistical analysis of the raw data was performed using R Statistics version R 3.5.1. released on the 29.08.2018. Results Our data demonstrate that the most common extranodal involvment of T-cell lymphoma patients is represented in decreasing order by bone marrow, peritoneum, rhino-oropharynx and the liver-biliary system. Nodal involvement is mainly represented in decreasing order by the laterocervical, axillary, mediastinal and inguinal regions. Conclusions These findings may be of value in further research and practical/clinical settings. Fever is the most common clinical feature and was present in most studied patients.
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Affiliation(s)
- Minodora Desmirean
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pathology, Constantin Papilian Military Hospital, Cluj-Napoca, Romania
| | - Cedric Richlitzki
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Bobe Petrushev
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sebastian Rauch
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jacob Steinheber
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Jiaxin Liu
- Department of Hematology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Ravnit Grewal
- South African Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.,South African Medical Research Council, Cape Town, South Africa.,Department of Hematology and Cell Biology, Faculty of Health Sciences, National Health Laboratory Services, University of the Free State, Bloemfontein, South Africa
| | - Weina Ma
- Department of Pathology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Liren Qian
- Department of Hematology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Carroll KM. The profound heterogeneity of substance use disorders: Implications for treatment development. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021; 30:358-364. [PMID: 34483503 PMCID: PMC8415637 DOI: 10.1177/09637214211026984] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A single treatment approach will never be sufficient to address the diversity of individuals with substance use disorders (SUDs). SUDs have historically defied definition through simple characterizations or models, and no single characterization has led to the development of broadly effective interventions. The range of dimensions of heterogeneity among individuals with SUDs, including severity, type of substance, and issues that frequently co-occur underscore that highly tailored approaches are needed. To approach personalized medicine for individuals with SUDs; two major developments are needed. First, given the diversity of individuals with SUDs, multivariate phenotyping approaches are needed to identify the particular features driving addictive processes in any individual. Second, a wider range of interventions that directly target core mechanisms of addiction and the problems that co-occur with them are needed. As clinicians cannot be expected to master the full range of interventions that may target these core processes, developing these so that they can be delivered easily, flexibly, and systematically via technology will facilitate our ability to truly tailor interventions to this highly complex and challenging population. One such technology-delivered intervention, computer-based training for cognitive behavioral therapy (CBT4CBT), is used as an example to illustrate a vision for the future of highly-tailored interventions for individuals with SUDs.
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The Prognostic Role of DSM-5 Alcohol Use Disorder Severity and Age of Onset in Treatment Outcome Among Adults Aged 60. J Addict Med 2021; 16:303-309. [PMID: 34282079 DOI: 10.1097/adm.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To investigate among older adults with DSM-5 alcohol use disorder (AUD) the relevance of (1) baseline DSM-5 AUD severity, (2) age of DSM-5 AUD onset, and (3) the interactions of DSM-5 AUD severity*treatment condition and age of DSM-5 AUD onset*treatment condition for the prediction of AUD treatment outcomes. METHODS The international multicenter RCT "ELDERLY-Study" compared outpatient motivational enhancement therapy (4 sessions) with outpatient motivational enhancement therapy followed by community reinforcement approach for seniors (8 sessions) in adults aged 60+ with DSM-5 AUD. Baseline and 1-, 3-, and 6-month follow-up data from the German and Danish ELDERLY-sites (n = 544) were used (6-month participation rate: 75.9%). DSM-5 AUD diagnoses were obtained using the Mini International Neuropsychiatric Interview and alcohol use using Form 90. Associations between DSM-5 AUD severity and age of onset and AUD treatment outcomes were investigated using multiple logistic regression and generalized linear models. RESULTS The sample was diverse in AUD severity (severe: 54.9%, moderate: 28.2%, mild: 16.9%) and age of onset (median: 50 years; 12-78 years). Overall, with few exceptions, neither AUD severity, nor age of onset, nor their respective interactions with treatment condition significantly predicted drinking outcomes at the different follow-ups (P ≥ 0.05). CONCLUSIONS No indication was found for the need to tailor treatment content according to DSM-5 AUD severity and earlier onset in older adults.
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Lillie KM, Jansen KJ, Dirks LG, Lyons AJ, Alcover KC, Avey JP, Hirchak K, Herron J, Buchwald D, Donovan DM, McDonell MG, Shaw JL. Assessing the Predictive Validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in Alaska Native and American Indian People. J Addict Med 2021; 14:e241-e246. [PMID: 32371661 PMCID: PMC7541407 DOI: 10.1097/adm.0000000000000661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to examine the predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) among Alaska Native and American Indian (ANAI) people with an alcohol use disorder. METHODS The sample was 170 ANAI adults with an alcohol use disorder living in Anchorage, Alaska who were part of a larger alcohol intervention study. The primary outcome of this study was alcohol use as measured by mean urinary ethyl glucuronide (EtG). EtG urine tests were collected at baseline and then up to twice a week for four weeks. We conducted bivariate linear regression analyses to evaluate associations between mean EtG value and each of the three SOCRATES subscales (Recognition, Ambivalence, and Taking Steps) and other covariates such as demographic characteristics, alcohol use history, and chemical dependency service utilization. We then performed multivariable linear regression modeling to examine these associations after adjusting for covariates. RESULTS After adjusting for covariates, mean EtG values were negatively associated with the Taking Steps (P = 0.017) and Recognition (P = 0.005) subscales of the SOCRATES among ANAI people living in Alaska. We did not find an association between mean EtG values and the Ambivalence subscale (P = 0.129) of the SOCRATES after adjusting for covariates. CONCLUSIONS Higher scores on the Taking Steps and Recognition subscales of the SOCRATES at baseline among ANAI people predicted lower mean EtG values. This study has important implications for communities and clinicians who need tools to assist ANAI clients in initiating behavior changes related to alcohol use.
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Affiliation(s)
- Kate M Lillie
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK (KML, KJJ, JPA, JLS); Information School, University of Washington, Box 352840, Mary Gates Hall, Seattle, WA (LGD); Elson S. Floyd College of Medicine, Washington State University, 412 E. Riverpoint BLVD, Spokane, WA (AJL, KCA, MGMD); Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM (KH); Department of Psychology, University of New Mexico, Albuquerque, NM (JH); Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA (DB); Department of Psychiatry and Behavioral Sciences and Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA (DMD)
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Panlilio LV, Stull SW, Bertz JW, Burgess-Hull AJ, Lanza ST, Curtis BL, Phillips KA, Epstein DH, Preston KL. Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use. Psychopharmacology (Berl) 2021; 238:1513-1529. [PMID: 33558983 PMCID: PMC8141007 DOI: 10.1007/s00213-021-05782-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
RATIONALE Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized. OBJECTIVES AND METHODS We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study. RESULTS Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use. CONCLUSIONS People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.
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Affiliation(s)
- Leigh V Panlilio
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA.
| | - Samuel W Stull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Jeremiah W Bertz
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Albert J Burgess-Hull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Stephanie T Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Brenda L Curtis
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
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Recovery From Opioid Problems in the US Population: Prevalence, Pathways, and Psychological Well-Being. J Addict Med 2021; 14:207-216. [PMID: 31385848 DOI: 10.1097/adm.0000000000000561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Research has enhanced our understanding of opioid misuse prevalence and consequences, but few studies have examined recovery from opioid problems. Estimating national recovery prevalence and characterizing individuals who have resolved opioid problems can inform policy and clinical approaches to address opioid misuse. METHODS We conducted a cross-sectional investigation of a nationally-representative sample of US adults who reported opioid problem resolution (OPI). For reference, OPI was compared with an alcohol problem resolution group (ALC). Analyses estimated OPI/ALC prevalence, differences in treatment/recovery service use, and psychological well-being, within 2 recovery windows: <1 year (early recovery) and 1 to 5 years (mid-recovery) since OPI/ALC problem resolution. RESULTS Of those who reported alcohol or drug use problem resolution, weighted problem resolution prevalence was 5.3% for opioids (early recovery 1.2%, mid-recovery 2.2%) and 51.2% for alcohol (early recovery 7.0%, mid-recovery 11.5%). In mid-recovery, lifetime use of formal treatment, pharmacotherapy, recovery support services, mutual help, and current pharmacotherapy were more prevalent in OPI than ALC. Service utilization did not differ between early-recovery OPI and ALC. Common services used by OPI included inpatient treatment (37.8%) and state/local recovery organizations (24.4%) in mid-recovery; outpatient treatment (25.7%) and recovery community centers (27.2%) in early recovery; Narcotics Anonymous (40.2%-57.8%) and buprenorphine-naloxone (15.3%-26.7%) in both recovery cohorts. Regarding well-being, OPI reported higher self-esteem than ALC in early recovery, and lower self-esteem than ALC in mid-recovery. CONCLUSIONS An estimated 1.2 million American adults report resolving an opioid problem. Given the service use outcomes and longer-term problem resolution of mid-recovery OPI, early-recovery OPI may require encouragement to utilize additional or more intensive services to achieve longer-term recovery. OPI beyond recovery-year 1 may need enhanced support to address deficient self-esteem and promote well-being.
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Ruben JP, Paul V, Nicholas AV, Devarbhavi H, Patil M, Selvam S, Mysore. V A. Nurse-conducted Brief Intervention for Alcohol Use Disorders in a Medical In-patient Setting in India - A Feasibility Study. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1901633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Vanila Paul
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
| | | | - Harshad Devarbhavi
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics & Population Health, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - Ashok Mysore. V
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
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