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Roos CR, Kiluk B, Carroll KM, Bricker JB, Mun CJ, Sala M, Kirouac M, Stein E, John M, Palmer R, DeBenedictis A, Frisbie J, Haeny AM, Barry D, Fucito LM, Bowen S, Witkiewitz K, Kober H. Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder. Ann Med 2024; 56:2315228. [PMID: 38382111 PMCID: PMC10883107 DOI: 10.1080/07853890.2024.2315228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND/OBJECTIVES There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD. PATIENTS/MATERIALS Ten adults receiving outpatient treatment for SUD. METHODS Phase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support. RESULTS Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently. CONCLUSIONS Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.
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Affiliation(s)
- Corey R. Roos
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Chung Jung Mun
- Edson College of Nursing and Health Innovation, AZ State University, Tempe, AZ, USA
| | - Margarita Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Megan Kirouac
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Elena Stein
- Medical Center, VA Puget Sound Health Care System, Seattle, VA, USA
| | - Maya John
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Palmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Andrew DeBenedictis
- Department of Mental Health Counseling, Boston College, Chestnut Hill, MA, USA
| | | | - Angela M. Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Declan Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Bowen
- Department of Psychology, Pacific University
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Roos CR, Bricker J, Kiluk B, Trull TJ, Bowen S, Witkiewitz K, Kober H. A smartphone app-based mindfulness intervention to enhance recovery from substance use disorders: Protocol for a pilot feasibility randomized controlled trial. Contemp Clin Trials Commun 2024; 41:101338. [PMID: 39233850 PMCID: PMC11372603 DOI: 10.1016/j.conctc.2024.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/21/2024] [Accepted: 07/23/2024] [Indexed: 09/06/2024] Open
Abstract
Background Poor long-term recovery outcomes after treatment (e.g., readmission to inpatient treatment) are common among individuals with substance use disorders (SUDs). In-person mindfulness-based treatments (MBTs) are efficacious for SUDs and may improve recovery outcomes. However, existing MBTs for SUD have limited public health reach, and thus scalable delivery methods are needed. A digitally-delivered MBT for SUDs may hold promise. Methods We recently developed Mindful Journey, a smartphone app-based adjunctive MBT for improving long-term recovery outcomes. In this paper, we present details on the app and describe the protocol for a single-site pilot feasibility randomized controlled trial of Mindful Journey. In this trial, individuals (n = 34) in an early phase of outpatient treatment for SUDs will be randomized to either treatment-as-usual (TAU) plus Mindful Journey, or TAU only. The trial will focus on testing the feasibility (e.g., engagement) and acceptability of the app (e.g., perceived usability and helpfulness for recovery), as well as feasibility of study procedures (e.g., assessment completion). The trial will incorporate ecological momentary assessment before and after treatment to assess mechanisms in real-time, including mindfulness, craving, difficulties with negative emotion regulation, and savoring. To examine the sensitivity to change of outcomes (substance use, substance-related problems, and psychological distress) and mechanism variables (noted above), we will test within-treatment-condition changes over time. Discussion The proposed pilot trial will provide important preliminary data on whether Mindful Journey is feasible and acceptable among individuals with SUDs. Trial registration ClinicalTrials.gov NCT05109507.
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Affiliation(s)
- Corey R Roos
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Brian Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, USA
| | - Sarah Bowen
- Department of Psychology, Pacific University, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
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Newberger NG, Ho D, Thomas ED, Goldstein SC, Coutu SM, Avila AL, Stein LAR, Weiss NH. Observations of substance use treatment engagement during the period of community re-entry following residential treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209430. [PMID: 38852820 DOI: 10.1016/j.josat.2024.209430] [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: 02/16/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND The period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period. METHOD This observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment. RESULTS Most participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025). CONCLUSION Findings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.
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Affiliation(s)
- Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Diana Ho
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Emmanuel D Thomas
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Stephen M Coutu
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Alyssa L Avila
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Lynda A R Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America; Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, Cranston, RI, United States of America
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America.
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MacLean SJ, Caluzzi G, Ferry M, Bruun A, Sundbery J, Skattebol J, Neale J, Bryant J. Young people returning to alcohol and other drug services as incremental treatment. Soc Sci Med 2024; 357:117181. [PMID: 39121568 DOI: 10.1016/j.socscimed.2024.117181] [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: 05/02/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Young people who attend intensive alcohol and other drug (AoD) treatment commonly do so more than once. This paper aims to understand precipitators, enablers and barriers to young people's re-engagement in programs. Data come from a longitudinal qualitative study involving three waves of interviews with Australian young people recruited while attending intensive AoD programs (n = 38 at wave 1). We found that young people's ambitions for what they might achieve with a new stay and capacity to benefit from programs, evolved. Skills learnt in earlier stays or changed life circumstances often helped them achieve better outcomes subsequently. Ongoing contact with an AoD worker was the most important enabler to service re-engagement. Across the span of a year, we saw most young people in our study sample develop a stronger sense of wellbeing and control over substance use. While researchers tend to focus on evaluating outcomes associated with single stays at specific programs, young people think about their trajectories towards managing substance use and their lives as occurring more holistically, supported by engagements with a range of services. We argue that the notion of incremental treatment is useful in depicting the synergistic effects of service engagement over time.
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Affiliation(s)
- Sarah J MacLean
- Social Work and Social Policy & Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia.
| | - Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia; School of Social Sciences, University of New South Wales, Sydney, Australia.
| | - Mark Ferry
- Ted Noffs Foundation, Randwick, NSW, Australia.
| | - Andrew Bruun
- Youth Support and Advocacy Service, Fitzroy, Australia.
| | - Jacqui Sundbery
- Indigenous Health Equity Unit, Onemda Aboriginal and Torres Strait Islander Health and Wellbeing, University of Melbourne, 3010, Australia.
| | | | - Joanne Neale
- Addictions Qualitative Research, Addictions Department, King's College London, London, UK.
| | - Joanne Bryant
- School of Social Sciences, University of New South Wales, Sydney, Australia.
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Belay GM, Mak YW, Wong FKY, Lam KKW, Liu Q, Yang F, Mao T, Wu CST, Ho KY. Psychosocial treatment options for adolescents and young adults with alcohol use disorder: systematic review and meta-analysis. Front Public Health 2024; 12:1371497. [PMID: 39114525 PMCID: PMC11303970 DOI: 10.3389/fpubh.2024.1371497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/22/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Psychosocial intervention is imperative for treating alcohol use disorder (AUD), but there is no comprehensive evidence regarding its effectiveness. Therefore, this study aimed to determine the effectiveness of psychosocial interventions in treating AUD amongadolescents and young adults. Methods In this systematic review and meta-analysis, articles were searched from EMBASE, PubMed, Medline, CINAHL, Web of Science, PsycINFO, and Scopus. Also, articles were retrieved from gray literature. The quality of articles has been assessed using the Cochrane risk of bias assessment. Results A total of 12 randomized controlled trials were included. Integrated family and CBT, CBT, guided self-change, and ecologically based family therapy had a mild effect in reducing alcohol use frequency. On the other hand, integrated motivational enhancement therapy and CBT (-0.71 [95% CI: -0.97, -0.45]) and common elements treatment approaches (4.5 [95% CI: 6.9, 2.2]) had the highest effect size for reducing alcohol use frequency and amount, respectively. In conclusion, most of the interventions had no significant effect on different drinking outcomes. Nonetheless, the effectiveness of combined interventions surpassed that of the single interventions. The effect of psychosocial interventions on abstinence was inconclusive. Therefore, future studies will explore alternative, newly emerged third-wave therapeutic approaches. Systematic review registration PROSPERO, CRD42023435011, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=435011.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ka Yan Ho
- School of Nursing, Hong Kong Polytechnic University, HKSAR, Kowloon, Hong Kong SAR, China
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Klingemann JI, Wieczorek Ł. A crisis of exhaustion in the game of escalation: a qualitative exploration of the consequences of occupational burnout among addiction therapists. POSTEPY PSYCHIATRII NEUROLOGII 2024; 33:18-25. [PMID: 38948685 PMCID: PMC11211912 DOI: 10.5114/ppn.2023.135054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/23/2023] [Indexed: 07/02/2024]
Abstract
Purpose Research shows that occupational burnout can affect health, the quality of personal relationships, and levels of job satisfaction and engagement. At the same time, the impact of individual burnout at the group and organisational levels has tended to be neglected. We aim to provide theoretical insights into the multidimensionality of burnout consequences at the individual, interpersonal and societal levels. Methods A theory-driven, computer-assisted qualitative data analysis was conducted, comprising a thematic analysis of 40 semi- structured telephone interviews with therapists working in alcohol treatment facilities in Poland. Maximum variation sampling was used to ensure the representation of participants with different characteristics. Results To theorise the implications of the collected data, the different viewpoints of addiction therapists on burnout and its consequences were interpreted through the lens of Rosa's resonance theory. Four interrelated sets of consequences were identified in the data: they related to (a) the therapists themselves, (b) their patients and the therapeutic process, and - in a broader sense - (c) the therapeutic team and (d) the treatment facility. Conclusions Occupational burnout in individual therapists has serious implications for their patients and colleagues. It can also lead to a reduction in the quality and ultimately the effectiveness of the treatment of alcohol use disorders leading to a negative social image of the treatment facility and thus creating a further barrier to treatment for people with alcohol-related problems. Furthermore, the complexity of the individual experience of occupational burnout and a cause-and-effect chain forms a loop, deepening the severity of its consequences.
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Affiliation(s)
- Justyna I. Klingemann
- Department of Health Sociology and Addiction Research, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Wieczorek
- Department of Health Sociology and Addiction Research, Institute of Psychiatry and Neurology, Warsaw, Poland
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7
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Gao T, Luo JL, Guo P, Hu XW, Wei XY, Hu Y. Impact of continuous care on cardiac function in patients with lung cancer complicated by coronary heart disease. World J Clin Cases 2024; 12:314-321. [PMID: 38313633 PMCID: PMC10835687 DOI: 10.12998/wjcc.v12.i2.314] [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: 11/03/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Despite sharing similar pathogenic factors, cancer and coronary heart disease (CHD) occur in comparable populations at similar ages and possess similar susceptibility factors. Consequently, it is increasingly commonplace for patients to experience the simultaneous occurrence of cancer and CHD, a trend that is steadily rising. AIM To determine the impacts of continuing care on lung cancer patients with CHD following percutaneous coronary intervention (PCI). METHODS There were 94 lung cancer patients with CHD following PCI who were randomly assigned to the intervention group (n = 38) and the control group (n = 41). In the intervention group, continuing care was provided, while in the control group, routine care was provided. An evaluation of cardiac and pulmonary function, medication compliance, a 6-min walk test, and patient quality of life was performed. RESULTS Differences between the two groups were significant in left ventricular ejection fraction, 6-min walk test, oxygen uptake, quality of life and medication compliance (P < 0.05). In comparison with the control group, the enhancement in the intervention group was more significant. The intervention group had more patients with high medication compliance than the control group, with a statistically significant difference (P < 0.05). CONCLUSION After undergoing PCI, lung patients with CHD could benefit from continued care in terms of cardiac and pulmonary function, medications compliance, and quality of life.
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Affiliation(s)
- Ting Gao
- Division of Cardiovascular First Ward, Department of Internal Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Jin-Lan Luo
- Department of Cardiovascular Medicine, Wuhan Wuchang Hospital, Wuhan 430063, Hubei Province, China
| | - Pan Guo
- Cardiovascular Clinical Medical Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Xi-Wen Hu
- Cardiovascular Clinical Medical Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Xiao-Yan Wei
- Cardiovascular Clinical Medical Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Yan Hu
- Department of Second Thoracic Surgery, Hubei Cancer Hospital, Wuhan 430079, Hubei Province, China
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Kelly PJ, Ingram I, Deane FP, Baker AL, Byrne G, Degan T, Osborne B, Meyer JM, Townsend C, Nunes J, McKay JR, Robinson L, Nolan E, Palazzi K, Lunn J. Feasibility and preliminary results of a call centre delivered continuing care intervention following residential alcohol and other drug treatment. Drug Alcohol Rev 2023; 42:1395-1405. [PMID: 37248675 DOI: 10.1111/dar.13693] [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: 05/01/2022] [Revised: 03/31/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION To help reduce relapse rates following alcohol and other drug (AOD) treatment, continuing care interventions have been recommended. Previous continuing care interventions have incorporated telephone and face-to-face sessions to help promote participant engagement. The study was conducted as a randomised controlled feasibility study and examined a call centre delivered continuing care intervention for people leaving residential rehabilitation services. METHODS Participants were attending AOD residential treatment services in NSW, Australia (N = 154). Participants were randomised to either 12- or 4-sessions of continuing care. Follow up assessments were completed at 6-months. The primary outcomes were demand and implementation. Secondary outcomes were AOD use, mental health and physical health at 6-months. RESULTS Interest in continuing care was high, with 93% of participants approached reporting an interest in being involved. Of the participants who completed the consent and baseline procedures, 29% of people were contacted post residential treatment and randomised. For those people randomised, the average number of sessions completed was 2.78 (SD = 1.65) for the 4-session arm and 4.81 (SD = 4.46) for the 12-session arm. Fidelity to the treatment manual was high. Both treatment arms showed higher complete abstinence at 6-months compared to baseline (12-session OR 28.57 [2.3, 353.8]; 4-session OR 28.11 [3.6, 221.2]). DISCUSSION AND CONCLUSIONS A major challenge associated with the call centre approach was re-engaging participants once they left the residential facility and delivering the planned dose of treatment. Further work is required to promote greater uptake of these protocols once people leave residential treatment.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Isabella Ingram
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | | | - Tayla Degan
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Johanna M Meyer
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Jason Nunes
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Erin Nolan
- Hunter Medical Research Institute, Newcastle, Australia
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Hazama K, Katsuta S. Factors to Reduce Drug-Related Recidivism Among Paroled Methamphetamine Users in Japan: 10-Year Data Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231172651. [PMID: 37178158 DOI: 10.1177/0306624x231172651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study explored factors to reduce drug-related recidivism among paroled methamphetamine users in Japan, especially the significance of continuing care and motivation, internationally shown as positively related to better treatment outcomes. Cox proportional hazards regression analysis was performed on 10-year drug-related recidivism data from 4,084 methamphetamine users paroled in 2007 who received a mandatory educational program conducted by professional and volunteer probation officers. Independent variables included participant characteristics, an index of motivation, and the length of parole as a substitute for the duration of continuing care with consideration of the Japanese legal system structures and socio-cultural context. Older age, lower number of previous prison sentences, shorter imprisonment, longer parole, and index of higher motivation were significantly and negatively associated with drug-related recidivism. The results indicate the benefit of continuing care and motivation on treatment outcomes, regardless of the differences in socio-cultural context and criminal justice system.
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Affiliation(s)
| | - Satoshi Katsuta
- Yokohama Probation Office, Ministry of Justice in Japan, Kanagawa, Japan
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Ramadas E, de Lima MP, Caetano T, Lopes J, Dixe MDACR. Effectiveness of smartphone interventions as continuing care for substance use disorders: A systematic review. Acta Psychol (Amst) 2023; 235:103898. [PMID: 37001396 DOI: 10.1016/j.actpsy.2023.103898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
As a chronic disease with consistent relapse rates, substance use disorders (SUD) require a continuity-of-care approach. Unfortunately, many patients do not have access to continuing care. This systematic review analysed the current scientific knowledge to better understand if app-based smartphone interventions can be an effective alternative. The databases Cochrane Library, PubMed, Web of Science, and PsycINFO were used to find experimental and quasi-experimental studies investigating the effectiveness of a smartphone intervention in individuals who had completed treatment for SUD. After removing duplicates, a total of 1488 studies were screened, with 48 being selected for a full-text review. Four studies met all the criteria, with one other being added by identification through other resources, making a total of 5 studies included in the present review. Out of the four studies using a control group, only one found no significant differences in favour of the experimental group. That study used an active control group and compared the smartphone intervention to its therapeutic group equivalent. There were no significant differences between the two experimental groups. Overall, the results indicate that app-based smartphone interventions can be an effective alternative to traditional forms of continuing care. However, literature is still scarce, and more research needs to be made on this subject. This systematic review is registered at PROSPERO with the identifier [CRD42021272070].
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Kelly LM, Correia N, Kearns MD, Lang SG, Yermash J, Guigayoma J, Helseth SA, Becker SJ. From parenting skills to adolescent treatment needs: Questions elicited by parents of adolescents discharged from residential treatment. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100110. [PMID: 36844169 PMCID: PMC9949345 DOI: 10.1016/j.dadr.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
Background Despite the utility of parent involvement in continuing care following adolescent residential treatment, parent engagement in traditional office-based treatment is low. In our prior work, we found that parents who had access to a continuing care forum directed questions to a clinical expert and to other parents around five topics: parenting skills; parent support; managing the post-discharge transition; adolescent substance use; family functioning. The current qualitative study elicited questions from parents without access to a continuing care support forum to explore overlapping and new themes. Methods This study was embedded within the pilot trial of a technology-assisted intervention for parents of adolescents in residential treatment for substance use. Thirty-one parents randomized to residential treatment as usual were asked two prompts at follow-up assessments: what questions they would like to ask a clinical expert and what questions they would like to ask other parents of adolescents discharged from residential care. Thematic analysis identified major themes and subthemes. Results Twenty-nine parents generated 208 questions. Analyses revealed three themes identified in prior work: parenting skills; parent support; adolescent substance use. Three new themes emerged: adolescent mental health; treatment needs; socialization. Conclusions The current study identified several distinct needs among parents who did not receive access to a continuing care support forum. Needs identified in this study can inform resources to support parents of adolescents during the post-discharge period. Parents may benefit from convenient access to an experienced clinician for advice on skills and adolescent symptoms, paired with access to parental peer support.
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Influence of Information-Based Continuous Care on Disease Control and Treatment Compliance of Elderly Diabetic Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4023123. [PMID: 36285157 PMCID: PMC9588350 DOI: 10.1155/2022/4023123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Background The incidence of diabetes is increasing year by year. For elderly diabetic patients, poor blood glucose control and worsening immune function greatly increase the risk of complications, which will seriously affect their quality of life. Purpose This paper primarily clarifies the influence of information-based continuous care on disease control and treatment compliance of elderly diabetic patients. Methods From December 2018 to December 2021, 106 elderly diabetic patients were selected, and their clinical data were retrospectively studied. Patients were grouped according to the type of care they received: an observation group (OG) comprising 56 cases receiving information-based continuous care and a control group (CG) including 50 cases treated with routine nursing. The two cohorts of patients were compared regarding disease control, treatment compliance, glucose and lipid metabolism (GLM), and self-management. Results After analysis, it was found that the disease control and treatment compliance were statistically higher in OG compared with CG. OG also showed significantly reduced fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), total cholesterol (TC), and triglyceride (TG) after nursing that were all lower compared with CG. In terms of self-management, OG outperformed CG in diet, exercise, blood glucose monitoring, and adherence to medical regimens. Conclusions Information-based continuous care has beneficial effects on disease control and treatment compliance of elderly diabetic patients and can help control blood sugar and optimize patients' self-management level, with high clinical promotion value.
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13
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Vest N, Hennessy E, Castedo de Martell S, Smith R. A Socio-Ecological Model for Collegiate Recovery Programs. ADDICTION RESEARCH & THEORY 2022; 31:92-99. [PMID: 37283915 PMCID: PMC10241438 DOI: 10.1080/16066359.2022.2123471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 06/08/2023]
Abstract
Given the major public health issue of substance use in the college environment and among college students, we must improve our understanding of students attempting to resolve substance related issues. Though much of research and policy attention has focused on individual progress according to personal characteristics and experiences, a much broader, theoretically informed understanding based on interpersonal relationships and contextual conditions of the school and society is warranted. Collegiate recovery programs (CRPs) are a system-level intervention that acknowledges the individual in context and seeks to support them and capitalize on their own skills within a safe environment to practice recovery. To ground CRPs as an environmental support targeting emerging adults that can improve student health and well-being, we developed a social-ecological framework that conceptualizes the multifaceted factors that influence them. Specifically, we aimed to understand factors influencing individuals in CRPs through direct and indirect effects. This conceptualization will better inform the development, implementation, and evaluation of these programs. Our theory-driven framework elucidates the multi-level complexity of CRPs and the importance of individual interventions as well as intervention from multiple stakeholder groups.
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Affiliation(s)
- Noel Vest
- Boston University School of Public Health, Boston, MA, USA
| | - Emily Hennessy
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA USA
| | - Sierra Castedo de Martell
- School of Public Health - Austin Regional Campus, University of Texas Health Science Center at Houston, Austin, TX USA
| | - Rebecca Smith
- Department of Psychology, Virginia Commonwealth University, Richmond, VA USA
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14
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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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15
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Clinical Efficacy and Psychological Impact of Omaha-Based Continuing Care for Prostate Cancer Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8735363. [PMID: 35836919 PMCID: PMC9276497 DOI: 10.1155/2022/8735363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
Prostate cancer is a common malignancy elderly male urogenital system, because of the special disease position, and postoperative complications such as urinary retention, urinary incontinence, and sexual dysfunction, if not treated, can increase the patients' physical pain, anxiety, and other psychological burden; endocrine therapy after surgery can affect self-image and quality of life of patients. Omaha system was originally used for community health nurses, which contains three main contents: problem classification, nursing intervention, and outcome evaluation. The problem classification dimension includes four dimensions: environment, physiology, social psychology, and health-related behavior. The nursing intervention dimension is composed of 75 intervention objectives and four behavior types. Omaha system is a nursing intervention model based on individual psychological, physiological, educational level, and family and social background. The model has good clinical application effect. This study aimed to explore the continuous nursing intervention effect in the nursing of patients with prostate cancer and its psychological impact. A total of 96 prostate patients with cancer who were admitted to Taizhou First People's Hospital from November 2019 to May 2021 were divided into Omaha system care group and routine care group with 48 cases each by random number table method. The routine care group received routine care and discharge guidance, and the Omaha system care group on the basis of the routine care group; continuation care based on the Omaha system was implemented. The differences in mental state, life quality score, serum prostate specific antigen (PSA) level, average urine flow rate, and self-care ability score were compared between the routine care and Omaha system care group. The results showed that Omaha-based continuation care for prostate cancer is beneficial to reduce bad mood, improve patients' life quality score and self-care ability, and provide certain reference for clinical care of prostate cancer patients.
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16
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Digital approaches to continuing care. Curr Opin Psychiatry 2022; 35:259-264. [PMID: 35781465 PMCID: PMC9260953 DOI: 10.1097/yco.0000000000000801] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an update of studies on the effectiveness of digital and telephonic approaches to providing remote continuing care for substance use disorders. RECENT FINDINGS Effective continuing care can be provided via smartphone apps, text messaging, interactive voice response, and structured telephone counseling. The remote continuing care interventions with the strongest evidence of efficacy are the Addiction Comprehensive Health Enhancement Support System app and Telephone Monitoring and Counseling. Positive effects for these intervention on drinking outcomes in patients with alcohol use disorders were replicated in a recent randomized controlled study. SUMMARY Continuing care is widely believed to be an important component of treatment for substance use disorders, especially for sustaining positive outcomes. However, many individuals do not attend clinic-based continuing care, due to a variety of reasons, including competing work and family responsibilities, disabilities, transportation challenges, and recently the COVID-19 pandemic. Remote continuing care, provided via smartphone apps, text messaging, and various telephonic approaches, has been shown to be effective, and could be used to provide continuing care to patients who would otherwise not receive it. Further work is needed to determine how to effectively combine more traditional continuing care with newer digitized and telephonic approaches.
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17
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Stahler GJ, Mennis J, Stein LAR, Belenko S, Rohsenow DJ, Grunwald HE, Brinkley-Rubinstein L, Martin RA. Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015-2018. Drug Alcohol Depend 2022; 236:109498. [PMID: 35605535 DOI: 10.1016/j.drugalcdep.2022.109498] [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: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine the use and association of medications for opioid use disorder (MOUD) with treatment completion and retention for criminal justice referred (CJR) admissions to residential treatment. METHODS A retrospective analysis of the Treatment Episode Dataset-Discharge (TEDS-D; 2015-2018) for adults (N = 205,348) admitted to short-term (ST) (< 30 days) or long-term (LT) (>30 days) residential treatment for OUD. Outcomes were MOUD in treatment plans, and treatment completion and retention (ST >10 days; LT > 90 days). Logistic regression analyses were conducted separately for ST and LT settings. RESULTS CJR admissions were less likely to have MOUD than non-CJR admissions (ST, 11% vs. 21%; LT, 10% vs. 24%, respectively) and were more likely to complete and be retained in treatment. In ST settings, MOUD was associated with higher likelihood of treatment completion and retention. In LT settings, MOUD was associated with higher likelihood of treatment retention and lower likelihood of treatment completion. These associations tended to be slightly weaker for CJR admissions, with the exception of treatment completion in LT settings, but the moderating effect size of CJR status in all models was very small. Small differences in the moderating effect of CJR status by race and ethnicity were observed in LT settings. CONCLUSIONS MOUD is greatly under-utilized for CJR patients, and given that MOUD was associated with positive outcomes, there is a critical need to find ways to increase access to MOUD for CJR patients in residential treatment. Race and ethnicity appear to have relatively little impact on outcomes.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, United States
| | - L A R Stein
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States; Department of Psychology, The University of Rhode Island, United States
| | - Steven Belenko
- Department of Criminal Justice, Temple University, United States
| | - Damaris J Rohsenow
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
| | | | | | - Rosemarie A Martin
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
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18
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Høyland SA, Schuchert A, Mamen A. A holistic perspective on continuing care for substance use and dependence: Results and implications from an in-depth study of a Norwegian continuing care establishment. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:503-520. [PMID: 36284745 PMCID: PMC9549220 DOI: 10.1177/14550725221099702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
This article explores, systematically and in depth, users’ perceptions of participating
in a Norwegian non-profit establishment that provides a continuing care programme for
substance use and dependence. Identified results are linked to a holistic system
perspective, where human, technology, and organisation (HTO), as well as external
environment, are viewed as intertwined. At the establishment level, i.e., where the
continuing care programme is delivered, we find that a clear holistic and user-oriented
profile – comprising combined interventions including physical and social activities – can
create a safe and stable environment that exerts a positive mental and physical influence
on the user and thereby promotes abstinence from substances. However, our results suggest
that the internal environment needs to connect more strongly with the external
environment, such as a substance-free network, close family, and working life. At the
establishment level, we conclude that there is a need to develop an explicit strategy and
practice for collaborating with the external environment, built on systemisation and
application of individual users’ insights into the design of the current interventions.
Further research should explore the presence and absence of interplays between elements of
human, technology, and organisation and the external environment, and the associated
consequences for intervention processes and users’ health outcomes. Our holistic system
model, empirically informed by data from a Norwegian context, can represent a starting
point for such endeavours. The holistic system model also constitutes an original and
novel contribution to research on continuing care interventions.
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19
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Curry JF, Kaminer Y, Goldston DB, Chan G, Wells KC, Burke RH, Inscoe AB, Meyer AE, Cheek SM. Adaptive Treatment for Youth With Substance Use and Depression: Early Depression Response and Short-term Outcomes. J Am Acad Child Adolesc Psychiatry 2022; 61:508-519. [PMID: 34371102 PMCID: PMC8818057 DOI: 10.1016/j.jaac.2021.07.807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/22/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach. METHOD At 2 sites, 95 youths (ages 14-21, mean [SD] = 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children's Depression Rating Scale-Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU). RESULTS Thirty-five adolescents (37%; 95% CI, 27%-47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961-0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031-0.716) predicted EDR. Frequency of drinking (F1,82 = 11.09, η2 = 0.119, p = .001), heavy drinking (F1,82 = 19.91, η2 = 0.195, p < .0001), and cannabis use (F1,220 = 35.01, η2 = 0.137, p < .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F2,220 = 4.16, η2 = 0.036, p = .0169). Negative (clean) urine screens increased over time (F1,219 = 5.10, η2 = 0.023, p = .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F1,48 = 64.20, η2 = 0.572, p < .001), with no advantage for CBT-D. CONCLUSION Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.
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Affiliation(s)
- John F Curry
- Duke University School of Medicine, Durham, North Carolina.
| | - Yifrah Kaminer
- Alcohol Research Center, University of Connecticut, Farmington
| | | | - Grace Chan
- Alcohol Research Center, University of Connecticut, Farmington
| | - Karen C Wells
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Allison E Meyer
- At the time of the study, Duke University, Durham, North Carolina; University of Michigan, Ann Arbor, Michigan
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20
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Wilson H, Schulz M, Rodgers C, Lintzeris N, Hall JJ, Harris-Roxas B. What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners. Drug Alcohol Rev 2022; 41:1152-1160. [PMID: 35353935 DOI: 10.1111/dar.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/10/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Alcohol and other drug (AOD) use is common in Australia with significant health and community impacts. General practitioners (GP) often see people with AOD use; however, there is little research to understand how specialist AOD services could assist GPs in the management of patients with AOD issues. METHODS Thirty-five GPs working in general practice in a metropolitan area in Sydney in New South Wales, Australia, participated in one of three focus groups. The groups were recorded, transcribed and thematically analysed. RESULTS The five themes raised by participants were: GP personal agency and interest in AOD issues; GP education and training gaps; improving pathways between GP and specialist AOD services; easier access to AOD specialist advice; and improving access to collaborative care for patients with complex AOD presentations. Participants requested education on screening, assessing, managing AOD issues, focused on alcohol, stimulants and high-risk prescription medicines. They suggested better referral processes, discharge summaries and care planning for complex presentations. Participants wanted easy access to specialist advice and suggested collaborative care assisted by experienced AOD liaison nurses. DISCUSSION AND CONCLUSIONS Australia has several existing programs; online referral pathways and specialist phone advice, that address some of the issues raised. Unfortunately, many participants were not aware of these. GP education must be supported by multiple processes, including durable referral pathways, ready access to local specialist advice, clear communication (including patient attendance and a treatment plan), care planning and written summaries.
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Affiliation(s)
- Hester Wilson
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia.,School of Population Health, UNSW Sydney, Sydney, Australia.,Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, Australia
| | - Michelle Schulz
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Services, St Vincent's Hospital, Sydney, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia.,School of Population Health, UNSW Sydney, Sydney, Australia.,Department of Addiction Medicine, University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Health, Sydney, Australia
| | - John J Hall
- School of Population Health, UNSW Sydney, Sydney, Australia.,Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, Australia
| | - Ben Harris-Roxas
- School of Population Health, UNSW Sydney, Sydney, Australia.,Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Health, Sydney, Australia.,Population and Community Health, South Eastern Sydney Local Health District, Sydney, Australia
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21
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Day E, Daly C. Clinical management of the alcohol withdrawal syndrome. Addiction 2022; 117:804-814. [PMID: 34288186 DOI: 10.1111/add.15647] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
Up to half of individuals with a history of long-term, heavy alcohol consumption will experience the alcohol withdrawal syndrome (AWS) when consumption is significantly decreased or stopped. In its most severe form, AWS can be life-threatening. Medically assisted withdrawal (MAW) often forms the first part of a treatment pathway. This clinical review discusses key elements of the clinical management of MAW, necessary adjustments for pregnancy and older adults, likely outcome of an episode of MAW, factors that might prevent completion of the MAW process and ways of overcoming barriers to ongoing treatment of alcohol use disorder. The review also discusses the use of benzodiazepines in MAW. Although there is clear evidence for their use, benzodiazepines have been associated with abuse liability, blunting of cognition, interactions with depressant drugs, craving, delirium, dementia and disrupted sleep patterns. Because glutamatergic activation and glutamate receptor upregulation contribute to alcohol withdrawal, anti-glutamatergic strategies for MAW and other potential treatment innovations are also considered.
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Affiliation(s)
- Ed Day
- Addiction Psychiatry, Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Chris Daly
- Addiction Psychiatry, Greater Manchester Mental Health FT, Chapman Barker Unit, Prestwich Hospital, Manchester, UK
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22
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Carswell SB, Gordon MS, Gryczynski J, Taxman FS, Schadegg M, Ferguson KN, Maher K. Continuing Care App for Probationers and Parolees with Substance use Disorders. JOURNAL OF DRUG EDUCATION 2022; 51:32-48. [PMID: 35832032 DOI: 10.1177/00472379221111541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This pilot proof-of-concept study examined the feasibility and acceptability of a Continuing Care mobile application (app) designed to meet the recovery and personal support needs of individuals under justice supervision who were receiving outpatient substance use disorder (SUD) treatment. The study included adults on probation or parole who were enrolled in an outpatient SUD treatment program (N = 15; 86.7% males). Participants were instructed to utilize the Continuing Care app daily for 4 weeks. At the end of the study, they completed a satisfaction questionnaire. Of the 15 participants enrolled in the study, 12 (80%) completed the Continuing Care app modules and the satisfaction questionnaire, and all of these participants indicated high levels of satisfaction with the app (on a scale of 1-10, Mean = 1.8, SD = 1.2). The Continuing Care app was well-utilized and perceived as valuable by this group of low-income, underserved, and hard-to-reach individuals. Further research is needed to refine app content and evaluate its ability to meaningfully enhance and extend the benefits of SUD treatment.
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Affiliation(s)
| | | | | | | | - Mary Schadegg
- 8083The University of Mississippi, University, MS, USA
| | | | - Kelly Maher
- 215392Friends Research Institute, Baltimore, MD, USA
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23
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Artman WJ, Johnson BA, Lynch KG, McKay JR, Ertefaie A. Bayesian set of best dynamic treatment regimes: Construction and sample size calculation for SMARTs with binary outcomes. Stat Med 2022; 41:1688-1708. [DOI: 10.1002/sim.9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/06/2021] [Accepted: 01/02/2022] [Indexed: 11/08/2022]
Affiliation(s)
- William J. Artman
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester New York USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester New York USA
| | - Kevin G. Lynch
- Center for Clinical Epidemiology and Biostatistics (CCEB) and Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - James R. McKay
- Department of Psychiatry, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester New York USA
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24
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Godley MD, Passetti LL, Hunter BD, Griffin BA. Volunteer Recovery Support for Adolescents: Using propensity score based methods to understand dosage effects within a randomized controlled trial. J Subst Abuse Treat 2022; 132:108637. [PMID: 34654584 PMCID: PMC8671322 DOI: 10.1016/j.jsat.2021.108637] [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: 02/11/2021] [Revised: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND In a recently published randomized controlled trial (RCT) of Volunteer Recovery Support for Adolescents (VRSA), a secondary finding indicated that better adherence to planned VRSA telephone session frequency resulted in significantly higher remission rates relative to lower session adherence. However, interpretation of this dose-response relationship may have been confounded by participant characteristics such as baseline levels of substance use and mental health problems. METHODS The present study used statistical methods designed to approximate RCTs when comparing more than two nonequivalent groups that include an assessment of the potential impact of omitted variables. Classification and Regression Tree (CRT) analysis was used to establish the cut-point between high (H) and low (L) VRSA dosage groups. Because we were interested in generalizing to youth with poor attendance, the L-VRSA group served as the reference group. Balancing weights for H-VRSA and a services as usual (SAU) control group were calculated to ensure similarity of baseline pretreatment characteristics to the reference group, and sensitivity of findings to unobserved confounding variables was assessed. RESULTS Findings suggested that superior remission rates at the end of the intervention phase were the result of high adherence to planned VRSA session frequency. Recommendations to achieve high VRSA participation among a larger segment of youth and to test whether longer VRSA duration improves the stability of recovery outcomes are provided. CONCLUSION Few published dose-response studies have adequately controlled for selection confounds from both observed and unobserved confounding. As such, the present study aims to both assess the impact of different dosage levels of VRSA and provide a template for how to apply state-of-the-art statistical methods designed to approximate randomized controlled trials to such studies.
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Affiliation(s)
- Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
| | - Brooke D Hunter
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
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25
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Ingram I, Kelly PJ, Carradus LJ, Deane FP, Baker AL, Byrne G, McKay JR, Osborne B, Meyer JM, Nunes JL, Robinson LD, Lunn J. Continuing care following residential alcohol and other drug treatment: Continuing care worker perceptions. Drug Alcohol Rev 2022; 41:88-95. [PMID: 34134173 DOI: 10.1111/dar.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Little is known about the experiences of continuing care workers (CCW) in the implementation of continuing care programs. The current study sought to understand CCWs and supervisor perceptions of the successes and challenges of implementing a telephone-based continuing care intervention following residential alcohol and other drug treatment services. It also aimed to provide recommendations for treatment providers wishing to integrate continuing care into their treatment model, including the resources, training and supervision needs of CCWs. METHODS The participants were eight CCWs and two independent supervisors who completed semi-structured interviews. Interview coding and analysis was guided by Iterative Categorisation procedures and an implementation framework. The Consolidated Framework for Implementation Research was used. RESULTS Telephone delivery was advantageous, but even more enhanced, when there was a face-to-face session first to build rapport. Other key successes included CCWs who were confident and competent, as well as a match between the organisation's values and the philosophy of the continuing care program. Key challenges faced by CCWs related to a perceived lack of support from managers, difficulties accessing quiet office spaces and participant disengagement. DISCUSSION AND CONCLUSIONS Interviews revealed several factors that may influence successful delivery of continuing care as part of alcohol and other drug treatment. These included features of the intervention (e.g. telephone delivery, evidence-based content), characteristics of the individual CCWs (e.g. flexibility in delivery of the intervention while maintaining fidelity), organisational culture (e.g. alignment of organisational values with continuing care) and resources (e.g. office space, flexible work schedules).
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Affiliation(s)
- Isabella Ingram
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Lenna J Carradus
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Gerard Byrne
- The Salvation Army, Sydney, Australia
- We Help Ourselves, Sydney, Australia
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Briony Osborne
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Johanna M Meyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Jason L Nunes
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Laura D Robinson
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
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Paquette CE, Rubalcava DT, Chen Y, Anand D, Daughters SB. A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial. JMIR Form Res 2021; 5:e25749. [PMID: 34730535 PMCID: PMC8600431 DOI: 10.2196/25749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/14/2021] [Accepted: 08/01/2021] [Indexed: 01/22/2023] Open
Abstract
Background Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887
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Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dillon T Rubalcava
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yun Chen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deepika Anand
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,CBT Center of Chicago, Chicago, IL, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Vest N, Reinstra M, Timko C, Kelly J, Humphreys K. College programming for students in addiction recovery: A PRISMA-guided scoping review. Addict Behav 2021; 121:106992. [PMID: 34087765 PMCID: PMC8259809 DOI: 10.1016/j.addbeh.2021.106992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The health and well-being of students in recovery from substance use disorder are increasingly being recognized as a priority on college campuses. This scoping review maps the state of the existing literature evaluating collegiate recovery programming to highlight research gaps and inform policy. METHOD We conducted a systematic search of articles related to collegiate recovery programming published before August 2020. The 15 extracted study characteristics included publication type, study design, primary outcomes, reporting of behavioral addictions, mutual-help group attendance, sample demographic information, school size, ownership, and funding source. RESULTS The PRISMA-guided search strategy identified 357 articles for abstract review; of 113 articles retained for full-text review, 54 studies met criteria for inclusion. Primary outcomes were coded into four domains: clinical, recovery experience, program characterization, and stigma. Most (57%) used quantitative observational designs and 41% employed qualitative research designs. Government or foundation grants funded 11% of the studies. CONCLUSION The domains identified offer a framework for healthcare providers, college administrators, and researchers to understand and improve programs, thereby better serving this vulnerable student group.
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Affiliation(s)
- Noel Vest
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States.
| | - Meg Reinstra
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States
| | - Christine Timko
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States
| | - John Kelly
- Harvard Medical School, Boston, MA 02114, United States
| | - Keith Humphreys
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, United States; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States
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Costello MJ, Li Y, Zhu Y, Walji A, Sousa S, Remers S, Chorny Y, Rush B, MacKillop J. Using conventional and machine learning propensity score methods to examine the effectiveness of 12-step group involvement following inpatient addiction treatment. Drug Alcohol Depend 2021; 227:108943. [PMID: 34390964 DOI: 10.1016/j.drugalcdep.2021.108943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Continuing care following inpatient addiction treatment is an important component in the continuum of clinical services. Mutual help, including 12-step groups like Alcoholics Anonymous, is often recommended as a form of continuing care. However, the effectiveness of 12-step groups is difficult to establish using observational studies due to the risks of selection bias (or confounding). OBJECTIVE To address this limitation, we used both conventional and machine learning-based propensity score (PS) methods to examine the effectiveness of 12-step group involvement following inpatient treatment on substance use over a 12-month period. METHODS Using data from the Recovery Journey Project - a longitudinal, observational study - we followed an inpatient sample over 12-months post-treatment to assess the effect of 12-step involvement on substance use at 12-months (n = 254). Specifically, PS models were constructed based on 34 unbalanced confounders and four PS-based methods were applied: matching, inverse probability weighting (IPW), doubly robust (DR) with matching, and DR with IPW. RESULTS Each PS-based method minimized the potential of confounding from unbalanced variables and demonstrated a significant effect (p < 0.001) between high 12-step involvement (i.e., defined as having a home group; having a sponsor; attending at least one meeting per week; and, being involved in service work) and a reduced likelihood of using substances over the 12-month period (odds ratios 0.11 to 0.32). CONCLUSIONS PS-based methods effectively reduced potential confounding influences and provided robust evidence of a significant effect. Nonetheless, results should be considered in light of the relatively high attrition rate, potentially limiting their generalizability.
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Affiliation(s)
| | - Yao Li
- Homewood Research Institute, Guelph, ON, Canada
| | - Yeying Zhu
- Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Alyna Walji
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, ON, Canada
| | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
| | | | | | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, ON, Canada
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Racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) and their effects on residential drug treatment outcomes in the US. Drug Alcohol Depend 2021; 226:108849. [PMID: 34198132 DOI: 10.1016/j.drugalcdep.2021.108849] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study examines racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) in residential treatment and the influence of race/ethnicity on the association between MOUD use and treatment retention and completion. METHODS Data were extracted from SAMHSA's 2015-2017 Treatment Episode Dataset-Discharge (TEDS-D) datasets for adult opioid admissions/discharges to short-term (ST) (30 days or less) (N = 83,032) or long-term (LT) (> 30 days) residential treatment settings (N=61,626). Logistic regression estimated the likelihood of MOUD use among racial/ethnic groups and the moderation of race/ethnicity on the probability of treatment completion and retention, controlling for background factors. RESULTS After adjusting for covariates, compared to Whites, MOUD use was less likely for Blacks in ST (OR = 0.728) and LT settings (OR = 0.725) and slightly less likely for Hispanics in ST settings (OR = 0.859) but slightly more likely for Hispanics in LT settings (OR = 1.107). In ST settings, compared to Whites, the positive effect of MOUD on retention was enhanced for Blacks (OR = 1.191) and Hispanics (OR = 1.234), and the positive effect on treatment completion was enhanced for Hispanics (OR = 1.144). In LT settings, the negative association between MOUD and treatment completion was enhanced for Hispanics (OR = 0.776). CONCLUSIONS Access to medications for opioid use disorder in short term residential treatment is particularly beneficial for Blacks and Hispanics, though adjusted models indicate they are less likely to receive it compared to Whites. Results are mixed for long-term residential treatment. Residential addiction treatment may represent an important setting for mitigating low rates of medication initiation and early discontinuation for minority patients.
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Bonar EE, Kidwell KM, Bohnert ASB, Bourque CA, Carter PM, Clark SJ, Glantz MD, King CA, Losman ED, McCabe SE, Philyaw-Kotov ML, Prosser LA, Voepel-Lewis T, Zheng K, Walton MA. Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol. Contemp Clin Trials 2021; 108:106523. [PMID: 34352386 PMCID: PMC8453131 DOI: 10.1016/j.cct.2021.106523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy S B Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA; Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie A Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Sarah J Clark
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Meyer D Glantz
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 3WFN BG 11601 RM 08C79 MSC 6020, 301 North Stonestreet Ave., Bethesda, MD 20892, USA
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Eve D Losman
- Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Meredith L Philyaw-Kotov
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lisa A Prosser
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Terri Voepel-Lewis
- Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Kai Zheng
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA; Department of Emergency Medicine, School of Medicine, University of California, Irvine, CA 92697, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Grahn R. The association between history of civil commitment for severe substance use and future imprisonment: A Swedish registry study. J Subst Abuse Treat 2021; 134:108613. [PMID: 34481690 DOI: 10.1016/j.jsat.2021.108613] [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: 05/04/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Civil commitment for individuals with severe substance use is fairly common and a part of many treatment systems worldwide. In Sweden, individuals with severe substance use and experience with civil commitment are more likely to use higher levels of alcohol and drugs, to be younger, and be more socially marginalized compared to their counterparts. The study examined whether civil commitments for severe substance use increased the likelihood of imprisonment following the civil commitment. METHOD Baseline ASI-data merged with national registry data on prison sentences (2007 through 2016). Cox regression was used to estimate, for a Swedish sample of 12,044 adults assessed for risky substance use, the importance of having a history of civil commitment for severe substance use, controlling for age, gender and baseline assessment of ASI composite scores in seven areas (alcohol, drugs other than alcohol, legal, mental- and physical health, family & social relationships and employment) on the likelihood of future imprisonment. RESULTS The regression showed that being a male, those with experience of civil commitment and elevated ASI composite scores for both legal and employment were significantly associated with imprisonment post-civil commitment. Civil commitment for severe substance use showed 1.29 (HR = 1.29, 95% CI: 1.03-1.49, p < 0.001) increased likelihood of imprisonment post-civil commitment. CONCLUSION Having been in treatment through civil commitment due to severe substance use was strongly associated with imprisonment post-civil commitment episode. This is concerning since civil commitment is supposed to mediate against the consequences of severe substance use and promote voluntary treatment participation. Those with severe substance use and a history of civil commitment are in need of a well-coordinated and integrated system of extensive aftercare services to reduce the likelihood of imprisonment.
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Affiliation(s)
- Robert Grahn
- Department of Social Work, Umeå University, SE-901 87 Umeå University, Sweden.
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Beaulieu M, Tremblay J, Baudry C, Pearson J, Bertrand K. A systematic review and meta-analysis of the efficacy of the long-term treatment and support of substance use disorders. Soc Sci Med 2021; 285:114289. [PMID: 34365074 DOI: 10.1016/j.socscimed.2021.114289] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE The reconceptualization of substance use disorders (SUD) as a chronic phenomenon calls for a paradigm shift in service provision, particularly by way of long-term treatment and support. Studies that have evaluated the efficacy of long-term treatment models seem to indicate that they are an improvement on more standard short-term treatments, even though these studies do not take the durations into consideration. OBJECTIVE Measure the efficacy of SUD treatments and support lasting 18 months or more regarding their ability to decrease substance use as compared to shorter treatments. METHODS A meta-analysis based on a systematic literature review was conducted. Eight databases were consulted for peer-reviewed studies. Certain variables were coded as moderators: intervention length, participant characteristics, and treatment characteristics. RESULTS The main results suggest that the people who received a planned long-term treatment or support had a 23.9 % greater chance of abstaining or consuming moderately than did people who received a shorter standard treatment (OR = 1.347 [CI 95 % = 1.087-1.668], p < .006, adjusted OR = 1.460 [CI 95 % = 1.145-1.861]). None of the moderation analyses revealed any variation in the efficacy of the long-term treatments and support. CONCLUSIONS The reconceptualization of the SUD as a chronic disorder among people with this problem leads us to reconsider both the length of the services provided and the paradigms underlying their organization.
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Affiliation(s)
- Myriam Beaulieu
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Joël Tremblay
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Claire Baudry
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Jessica Pearson
- Université Du Québec à Trois-Rivières, Centre Universitaire de Québec, 850 Av. de Vimy Entrée #8, CP. 32, Québec, QC, G1S 0B7, Canada.
| | - Karine Bertrand
- Université de Sherbrooke, Campus de Longueuil, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, Québec, J4K 0A8, Canada.
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Park SJ, Lee SJ, Kim H, Kim JK, Chun JW, Lee SJ, Lee HK, Kim DJ, Choi IY. Machine learning prediction of dropping out of outpatients with alcohol use disorders. PLoS One 2021; 16:e0255626. [PMID: 34339461 PMCID: PMC8328309 DOI: 10.1371/journal.pone.0255626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is a chronic disease with a higher recurrence rate than that of other mental illnesses. Moreover, it requires continuous outpatient treatment for the patient to maintain abstinence. However, with a low probability of these patients to continue outpatient treatment, predicting and managing patients who might discontinue treatment becomes necessary. Accordingly, we developed a machine learning (ML) algorithm to predict which the risk of patients dropping out of outpatient treatment schemes. METHODS A total of 839 patients were selected out of 2,206 patients admitted for AUD in three hospitals under the Catholic Central Medical Center in Korea. We implemented six ML models-logistic regression, support vector machine, k-nearest neighbor, random forest, neural network, and AdaBoost-and compared the prediction performances thereof. RESULTS Among the six models, AdaBoost was selected as the final model for recommended use owing to its area under the receiver operating characteristic curve (AUROC) of 0.72. The four variables affecting the prediction based on feature importance were the length of hospitalization, age, residential area, and diabetes. CONCLUSION An ML algorithm was developed herein to predict the risk of patients with AUD in Korea discontinuing outpatient treatment. By testing and validating various machine learning models, we determined the best performing model, AdaBoost, as the final model for recommended use. Using this model, clinicians can manage patients with high risks of discontinuing treatment and establish patient-specific treatment strategies. Therefore, our model can potentially enable patients with AUD to successfully complete their treatments by identifying them before they can drop out.
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Affiliation(s)
- So Jin Park
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Biomedicine & Health Sciences, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sun Jung Lee
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Biomedicine & Health Sciences, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - HyungMin Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Biomedicine & Health Sciences, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Kwon Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Biomedicine & Health Sciences, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Won Chun
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Biomedicine & Health Sciences, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo-Jung Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Kook Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dai Jin Kim
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Biomedicine & Health Sciences, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Stanojlović M, Davidson L. Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:1178221820976988. [PMID: 34211275 PMCID: PMC8216338 DOI: 10.1177/1178221820976988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/31/2020] [Indexed: 11/15/2022]
Abstract
Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client’s disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes.
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Affiliation(s)
- Milena Stanojlović
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
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Predictors of consent and engagement to participate in telephone delivered continuing care following specialist residential alcohol and other drug treatment. Addict Behav 2021; 117:106840. [PMID: 33556669 DOI: 10.1016/j.addbeh.2021.106840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND AIMS Although continuing care programs have been shown to improve alcohol and other drug (AOD) treatment outcomes, uptake of continuing care has been low. The current study aimed to determine predictors of participants' who both re-confirmed consent to engage in telephone-based continuing care and commenced continuing care once they left residential AOD treatment. These participants had initially consented to partake in continuing care during the course of their residential stay. METHODS Participants were 391 individuals (232 males, 59% and 158 females, 40%) accessing therapeutic communities for AOD treatment provided by The Australian Salvation Army and We Help Ourselves (WHOS). Measures at baseline, collected during residential treatment, included demographics, primary substance of concern, abstinence goal, refusal self-efficacy, cravings for substances, mental health diagnoses, psychological distress, quality of life and feelings of loneliness. All measures were used as predictor variables to determine characteristics of participants who re-confirmed consent to engage in continuing care and commenced continuing care following residential AOD treatment. RESULTS Completing residential treatment, being unmarried, and higher levels of loneliness predicted re-confirmation of consent to participate in continuing care following discharge from residential treatment. Participants who were Aboriginal and/or Torres Strait Islander were less likely to provide re-confirmation of consent. Participants were more likely to commence continuing care if they completed residential treatment, were older, and had longer years of substance use. CONCLUSIONS Tailoring continuing care programs to reach a broader array of individuals such as Indigenous populations and persons who exit treatment services early is needed to ensure these programs can reach all individuals who might need them.
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MacLean SJ, Caluzzi G, Ferry M, Bruun A, Skattebol J, Neale J, Bryant J. Why we stopped using the term 'aftercare'. Drug Alcohol Rev 2021; 41:3-6. [PMID: 34046957 DOI: 10.1111/dar.13332] [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: 12/22/2020] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
The words we choose to describe alcohol and other drug (AOD) treatments and interventions reveal assumptions about how we understand AOD use. Moreover, they have important implications for how the treatment is imagined, implemented and funded. Service provision which follows engagement in an intensive (usually residential) program is often called 'aftercare' in the international AOD field. In this commentary, we argue that the term 'aftercare' fails to articulate the nature of ongoing care required by people who are managing AOD use. We maintain that 'aftercare' positions post-residential care as being less important than other treatment modalities, rather than as integral to a continuum of care. It is a term that implies that care should be acute, like much treatment delivered through a medical model, and assumes that people follow linear pathways in managing their AOD use. Assumptions embedded in the term 'aftercare' such as these may disincline governments from funding ongoing services for people exiting intensive programs. Alternative terms including 'continuing coordinated care' more aptly signal the integrated and ongoing service provision that should be available to support people in sustaining changes initiated through other AOD interventions.
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Affiliation(s)
- Sarah J MacLean
- Social Work and Social Policy and Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | | | - Andrew Bruun
- Youth Support and Advocacy Service, Melbourne, Australia
| | | | - Joanne Neale
- Addictions Department, King's College London, London, UK
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Becker SJ, Helseth SA, Janssen T, Kelly LM, Escobar KI, Souza T, Wright T, Spirito A. Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Pilot randomized trial of a technology-assisted parenting intervention. J Subst Abuse Treat 2021; 127:108457. [PMID: 34134877 DOI: 10.1016/j.jsat.2021.108457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Adolescents in residential level of care for substance-related problems have high risk of relapse following discharge. Parent engagement lowers relapse risk, but there are myriad barriers to engaging parents in residential treatment and continuing care. Parent SMART (Substance Misuse in Adolescents in Residential Treatment) is a technology-assisted parenting intervention that was designed to circumvent barriers associated with traditional, office-based continuing care interventions to better engage parents. This pilot randomized trial assessed the acceptability, feasibility, and preliminary effectiveness of Parent SMART as an adjunctive intervention to adolescent residential treatment-as-usual (TAU). Sixty-one parent-adolescent dyads were randomized to Parent SMART+TAU or TAU-only. Thirty-seven dyads were recruited from a short-term facility and 24 dyads were recruited from a long-term facility. Those randomized to Parent SMART received a multi-component technology-assisted intervention combining an off-the-shelf online parenting program, coaching sessions, and a parent networking forum. Parent and adolescent assessments were conducted at baseline, 6, 12, and 24-weeks post-discharge. Feasibility (e.g., parental effectiveness) and acceptability (e.g., parental satisfaction, willingness to recommend the intervention) benchmarks were specified a priori as the primary hypotheses. Secondary effectiveness indicators were the proportion of days adolescent used alcohol, cannabis, and any substance. All acceptability and feasibility benchmarks were met or exceeded among dyads in both short- and long-term residential. Generalized linear mixed models showed no significant effects pooled across sites. Analyses by facility revealed two significant time by condition interactions. Adolescents in short-term residential whose parents received Parent SMART showed fewer drinking days and fewer school problems over time, relative to adolescents whose parents received TAU. Results indicate that Parent SMART was both acceptable and feasible, with preliminary indication of effectiveness among those in short-term residential. A fully-powered trial is warranted to reliably test the effectiveness of Parent SMART and understand possible mechanisms of improvement.
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Affiliation(s)
- Sara J Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America..
| | - Sarah A Helseth
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Lourah M Kelly
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Katherine I Escobar
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Timothy Souza
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Thomas Wright
- Rosecrance Health Network, University of Illinois College of Medicine, United States of America
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
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Cheng WJ, Chen LY, Fang SC, Chang HM, Yang TW, Chang RC, Hsing TC, Huang MC. Examining factors associated with postintervention recidivism in DUI repeat offenders after alcohol treatment: One-year follow-up study. J Subst Abuse Treat 2021; 130:108426. [PMID: 34118707 DOI: 10.1016/j.jsat.2021.108426] [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: 09/09/2020] [Revised: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Taiwan has deemed driving under the influence of alcohol (DUI) to be criminal, and offenders are subjected to fines and jail penalties without being offered alcohol-related treatment, although alcohol use problems are prevalent in this population. We followed the recidivism records of DUI repeat offenders for one year after they had received a newly established legal-medical joint intervention program for alcohol treatment and examined factors related to postintervention recidivism. In this study, 231 DUI repeat offenders with alcohol use problems screened out by the Alcohol Use Disorder Identification Test were referred from the prosecutors' office to one psychiatric hospital for SBIRT-based alcohol treatment. We divided the participants into two groups based on the official recidivism records within the year following the end of treatment. The study used a Cox proportional hazards model to examine the hazard ratio of the baseline clinical characteristics and intervention duration for post-treatment recidivism. The study used generalized estimation equation models to examine changes in psychological symptoms and drinking behaviors over time. We found that participants who recidivated in the next year after intervention did not differ from those without recidivism records in all measurements except for the length of duration they stayed in treatment. Survival analysis determined that participants who had received the intervention for >4 months showed significantly lower rates of one-year postintervention recidivism rates The study participants showed improved psychological symptoms and drinking behaviors during the follow-up period. In conclusion, adequate duration of alcohol treatment is a significant factor associated with a lower risk of postintervention recidivism. The results provide some insight into the design of a collaborative program between legal and medical systems to reduce DUI recidivism and improve mental health of DUI repeat offenders.
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Affiliation(s)
- Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, 2 Yude Road, 40447 Taichung, Taiwan; Department of Public Health, China Medical University, 91 Hsueh-Shih Road, 40402 Taichung, Taiwan; Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, 2 Yude Road, 40447, Taichung, Taiwan
| | - Lian-Yu Chen
- Kunming Prevention and Control Center, Taipei City Hospital, 100 Kunming Street, 10844 Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, 17 Xu-Zhou Road, 100 Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, 46 Sec. 3 Zhongzheng Rd., 252 New Taipei City, Taiwan
| | - Hu-Ming Chang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan
| | - Tien-Wei Yang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan
| | - Ru-Chi Chang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan
| | - Tai-Chao Hsing
- Taiwan Supreme Prosecutors' Office, 131, BoAi Road, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 110 Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, 250 Wu-Hsing Street, 110 Taipei, Taiwan.
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Abstract
Continuing care is widely believed to be an important component of effective treatment for substance use disorder, particularly for those individuals with greater problem severity. The purpose of this review was to examine the research literature on continuing care for alcohol and drug use disorders, including studies that addressed efficacy, moderators, mechanisms of action, and economic impact. This narrative review first considered findings from prior reviews (published through 2014), followed by a more detailed examination of studies published more recently. The review found that research has generally supported the efficacy of continuing care for both adolescents and adults, but the picture is complex. Reviews find relatively small effects when results from individual studies are combined. However, continuing care of longer duration that includes more active efforts to keep patients engaged may produce more consistently positive results. Moreover, patients at higher risk for relapse may benefit to a greater degree from continuing care. Several newer approaches for the provision of continuing care show promise. These include incentives for abstinence and automated mobile health interventions to augment more conventional counselor-delivered interventions. Primary care can be used to provide medications for opioid and alcohol use disorders over extended periods, although more research is needed to determine the optimal mix of behavioral treatments and other psychosocial services in this setting. Regardless of the intervention selected for use, the status of most patients will change and evolve over time, and interventions need to include provisions to assess patients on a regular basis and to change or adapt treatment when warranted.
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Affiliation(s)
- James R McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania. Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Dong H, Hayashi K, Fairbairn N, Milloy MJ, DeBeck K, Wood E, Kerr T. Long term pre-treatment opioid use trajectories in relation to opioid agonist therapy outcomes among people who use drugs in a Canadian setting. Addict Behav 2021; 112:106655. [PMID: 32977270 DOI: 10.1016/j.addbeh.2020.106655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Opioid agonist therapy (OAT) models are generally provided without consideration of how pre-treatment characteristics may be associated with outcome. Therefore, we aimed to first characterize longitudinal trajectories of opioid use before initiating OAT. Then we explored the impact of OAT on opioid use across these pre-treatment trajectories. METHODS Data were derived from three prospective cohort studies involving people who use drugs in Vancouver, Canada. Latent class growth analysis was applied to identify opioid use trajectories based on individual-level observations three years before starting OAT. Multivariable generalized linear mixed model was used to examine whether engaging in OAT was associated with lower risk of illicit opioid use among participants with different pre-treatment opioid use trajectories. RESULTS 464 participants were included in the study between September 2005 and November 2018. Two pre-treatment opioid use trajectories were identified: high frequency users (246, 53.0%) and gradually increasing frequency users (218, 47.0%). We observed different strengths of association between OAT engagement and illicit opioid use among high frequency users (adjusted odds ratio [AOR] = 0.36, 95% Confidence Interval [CI]: 0.20 - 0.63) and gradually increasing frequency users (AOR = 0.91, 95% CI: 0.53 - 1.56). Unstable housing, any stimulant use, experiencing violence, drug dealing, sex work involvement, and incarceration were independently and positively associated with ongoing illicit opioid use. CONCLUSIONS Distinct pre-treatment opioid use trajectories are likely to influence treatment outcomes. Research is required to determine if tailored strategies specific to people with different pre-treatment opioid use patterns have potential to improve outcomes of OAT.
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Affiliation(s)
- Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6 Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6 Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada.
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Graser Y, Stutz S, Rösner S, Moggi F, Soravia LM. Telephone- and Text Message-Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study. Alcohol Clin Exp Res 2020; 45:224-233. [PMID: 33245589 DOI: 10.1111/acer.14499] [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: 02/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is characterized by extremely high rates of postresidential treatment relapse, and as such, continuing care to prevent relapse has become an important element in AUD treatment. In this regard, research has yielded heterogeneous evidence on telephone-based (TEL) and text message-based (TEX) continuing care. We aimed to compare the effectiveness of TEL and TEX continuing care provided in different frequencies by psychotherapists for patients from residential treatments in mitigating the occurrence of posttreatment relapse in patients who completed a 12-week abstinence-oriented residential treatment program for AUD. METHODS A total of 240 patients from 2 residential treatment programs for AUD were included in the study. Patients were randomly assigned to high- (10 contacts) or low-frequency (3 contacts) TEL, TEX (10 contacts) continuing care, or control group (1 contact) from discharge to 6-month follow-up. The TEL was intended to be supportive and consisted of several cognitive behavioral therapy components, whereas the TEX was based on behavioral self-monitoring techniques and additional calls in case of relapse or as needed. Sociodemographic, clinical, and alcohol-specific variables at residential treatment discharge and at 5-month follow-up were assessed through interviews and questionnaires. RESULTS Compared with the control group, patients in the high-frequency TEL were significantly more likely to be abstinent at 6-month follow-up and, in case of relapse, showed a tendency toward a longer time to first drink. Moreover, the high-frequency TEL and TEX groups had significantly higher alcohol-related self-efficacy 6 months after residential treatment. CONCLUSION High-frequency proactive telephone contact by psychotherapists known to the patient may help patients to surmount the vulnerable phase after residential treatment and, in case of relapse, might help patients stay connected to health services, which in turn prevents chronification and facilitates recovery from AUD.
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Affiliation(s)
- Yolanda Graser
- From the, Research, (YG, LMS), Suedhang Clinic, Kirchlindach, Switzerland
| | - Sonja Stutz
- Research and Development, (SS, SR), Forel Clinic, Ellikon, Switzerland
| | - Susanne Rösner
- Research and Development, (SS, SR), Forel Clinic, Ellikon, Switzerland
| | - Franz Moggi
- Translational Research Center, (FM, LMS), University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Leila M Soravia
- From the, Research, (YG, LMS), Suedhang Clinic, Kirchlindach, Switzerland.,Translational Research Center, (FM, LMS), University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Palzes VA, Kline-Simon AH, Satre DD, Sterling S, Weisner C, Chi FW. Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data. J Stud Alcohol Drugs 2020. [PMID: 32800079 DOI: 10.15288/jsad.2020.81.436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder (AUD). METHOD We conducted a longitudinal study of 4,078 adults with AUD who screened positive for unhealthy drinking between October 1, 2015, and September 30, 2016. We extracted EHR data up to 3 years after screening until October 1, 2018. We used survival analysis to examine associations between remission (i.e., reporting abstinence or low-risk drinking at a subsequent screening) and patient characteristics, comorbidities, and treatment utilization. RESULTS The median time to remission from unhealthy drinking was 1.7 years. Factors significantly associated with greater odds of remitting from unhealthy drinking during follow-up were female gender; older age (50-64 years); Black or Latino/Hispanic race/ethnicity; having more medical comorbidities; not having a comorbid drug use disorder; lower alcohol consumption levels; and receiving addiction medicine treatment before the index screening. In the first follow-up year, individuals with mental health comorbidities were more likely to remit, but those in psychiatric treatment were less likely. Receiving addiction treatment during follow-up was not associated with remission. CONCLUSIONS Ethnic minorities and individuals with mental illness were more likely to remit, which is encouraging given the health disparities observed among these clinically important subgroups and warrants further research. Our findings may inform research on AUD recovery and clinical practice, as remission from unhealthy drinking is a crucial component of the early stages of recovery.
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Affiliation(s)
- Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Abstract
The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Research and Education, VA Central Western Massachusetts, Leeds, Massachusetts
| | - Michael Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education, and Clinical Center and Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
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Bergman BG, Kelly JF. Online digital recovery support services: An overview of the science and their potential to help individuals with substance use disorder during COVID-19 and beyond. J Subst Abuse Treat 2020; 120:108152. [PMID: 33129636 PMCID: PMC7532989 DOI: 10.1016/j.jsat.2020.108152] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/22/2020] [Accepted: 09/24/2020] [Indexed: 02/09/2023]
Abstract
Background The COVID-19 pandemic and related social distancing public health recommendations will have indirect consequences for individuals with current and remitted substance use disorder (SUD). Not only will stressors increase risk for symptom exacerbation and/or relapse, but individuals will also have limited service access during this critical time. Individuals with SUD are using free, online digital recovery support services (D-RSS) that leverage peer-to-peer connection (i.e., social-online D-RSS) which simultaneously help these individuals to access support and adhere to public health guidelines. Barriers to SUD treatment and recovery support service access, however, are not unique to the COVID-19 epoch. The pandemic creates an opportunity to highlight problems that will persist beyond its immediate effects, and to offer potential solutions that might help address these long-standing, systemic issues. To help providers and other key stakeholders effectively support those interested in, or who might benefit from, participation in free, social-online D-RSS, this review outlines the following: 1) theories of expected therapeutic benefits from, and potential drawbacks of social-online D-RSS participation; 2) a typology that can be used to describe and classify D-RSS; 3) a D-RSS “case study” to illustrate how to apply the theory and typology; 4) what is known empirically about social-online D-RSS; and 5) whether and how to engage individuals with these online resources. Method Narrative review combining research and theory on both in-person recovery supports and social-online D-RSS. Results Studies examining in-person recovery support services, such as AA and other mutual-help organizations, combined with theory about how social-online D-RSS might confer benefit, suggest these digital supports may engage individuals with SUD and mobilize salutary change in similar ways. While people may use in-person and digital supports simultaneously, when comparing the two modalities, communication science and telemedicine group therapy data suggest that D-RSS may not provide the same magnitude of benefit as in-person services. D-RSS can be classified based on the a) type of service, b) type of platform, c) points of access, and d) organizations responsible for their delivery. Research has not yet rigorously tested the effectiveness of social-online D-RSS specifically, though existing data suggest that those who use these services generally find their participation to be helpful. Content analyses suggest that these services are likely to facilitate social support and unlikely to expose individuals to harmful situations. Conclusions When in-person treatment and recovery support services are limited, as is the case during the COVID-19 pandemic, expected therapeutic benefits and emerging data, taken together, suggest providers, mentors, and other community leaders may wish to refer individuals with current and remitted SUD to free, social-online D-RSS. Given the array of available services in the absence of best practice guidelines, we recommend that when making D-RSS referrals, stakeholders familiarize themselves with theorized benefits and drawbacks of participation, use a typology to describe and classify services, and integrate current empirical knowledge, while relying on trusted federal, academic, and national practice organization resource lists. Social-online, digital recovery support services (D-RSS) may address systemic service access barriers highlighted by COVID-19 To aid provider and other stakeholder practices, we review relevant D-RSS theory and research Theory suggests D-RSS may mobilize salutary mechanisms of behavior change, though data also point to potential challenges Emerging D-RSS research is promising, though rigorous studies of their effectiveness have not yet been conducted The typology and resource lists from organizations provided here may be used for those who wish to make D-RSS referrals
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Affiliation(s)
- Brandon G Bergman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Van Horn DHA, Goodman J, Lynch KG, Bonn-Miller MO, Thomas T, Del Re AC, Babson K, McKay JR. The predictive validity of the progress assessment, a clinician administered instrument for use in measurement-based care for substance use disorders. Psychiatry Res 2020; 292:113282. [PMID: 32711168 PMCID: PMC9434595 DOI: 10.1016/j.psychres.2020.113282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/01/2022]
Abstract
We tested the predictive validity of the Progress Assessment (PA), a brief counselor administered tool for use in measurement-based care for substance use disorders. The PA includes 5 items assessing relapse risk and 5 items assessing factors protective against relapse. Data were drawn from a completed study of continuing care for cocaine dependence (McKay et al., 2013) and includes 12 months of follow-up on158 participants (76% male) who received brief telephone or face-to-face sessions. Each session began with the administration of the PA, followed by cognitive-behavioral counseling tied to the results of the PA and anticipated risky situations. Outcome was assessed via urine toxicology every 3 months. As administered in an effectiveness trial, average PA risk and protective scales within each 3-month segment of the study predicted urine toxicology results at the end of that period, with higher risk scores and lower protective scores predicting greater rates of cocaine positive urine drug screens. PA scores did not predict dropout from continuing care participation. The 10-item PA shows promise as a pragmatic clinical tool for ongoing monitoring during continuing care for substance dependence.
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Affiliation(s)
- Deborah H. A. Van Horn
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA,Corresponding author: Deborah H. A. Van Horn; voice: 856-905-5261; fax: 856-845-9081;
| | - Jessica Goodman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA,Center of Excellence in Substance Abuse Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104 USA
| | - Kevin G. Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA
| | - Marcel O. Bonn-Miller
- Center of Excellence in Substance Abuse Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104 USA,National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA,Center for Innovation to Implementation, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA
| | - Tyrone Thomas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA
| | - AC Del Re
- Center for Innovation to Implementation, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA
| | - Kimberly Babson
- National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System; 795 Willow Rd., Menlo Park, CA 94025 USA
| | - James R. McKay
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine; 3535 Market St, Philadelphia, PA 19104 USA,Center of Excellence in Substance Abuse Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104 USA
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Azulai A, Hall BL. Barriers to the Recognition of Geriatric Depression in Residential Care Facilities in Alberta. Issues Ment Health Nurs 2020; 41:887-898. [PMID: 32497452 DOI: 10.1080/01612840.2020.1742258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study explored the barriers that regulated nurse professionals encountered in recognizing and assessing geriatric depression in residential care facilities in the Canadian province of Alberta. The study used a convergent parallel mixed methods design, including a cross-sectional survey (N = 635) and qualitative interviews (N = 14) with regulated nurse professionals. Findings revealed six major barriers to the recognition of geriatric depression in Alberta, including 1) insufficient clinical knowledge and training in geriatric depression; 2) misconceived beliefs about geriatric depression; 3) limited access to resources; 4) unclear depression assessment protocol and procedures in facilities; 5) characteristics of models of care and organizational culture in facilities; and 6) communication difficulties among all stakeholders in the process. Socio-cultural values and beliefs about geriatric depression played a key role in the complex interaction of the various structural and agential barriers to the effective recognition and assessment of depression in residential care facilities in Alberta.
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Affiliation(s)
- Anna Azulai
- School of Social Work, Faculty of Health and Community Studies, MacEwan University, Edmonton, Alberta, Canada
| | - Barry L Hall
- Faculty of Social Work, University of Calgary, Calgary, Canada
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How Do Regulated Nurse Professionals in Alberta Assess Geriatric Depression in Residential Care Facilities? Can J Aging 2020; 39:468-484. [PMID: 32723411 DOI: 10.1017/s0714980819000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Although geriatric depression is a prevalent, serious, and under-recognized mental health condition in residential care facilities, there is a dearth of related research in Canada. This exploratory mixed methods study examines the perspectives and practices of regulated nurse professionals on assessment of geriatric depression in residential care facilities in Alberta. Findings from the quantitative surveys (n = 635) and qualitative interviews (n = 14) suggest that geriatric depression is not systematically assessed in these care settings due to multiple challenges, including confusing assessment protocol, inconsistent use and contested clinical utility of current assessment methods in facilities, limited availability of mental health professionals in facilities, and the varied views of regulated nurse professionals on who is responsible for depression assessment in facilities. Implications and future research directions are discussed.
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Palzes VA, Kline-Simon AH, Satre DD, Sterling S, Weisner C, Chi FW. Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data. J Stud Alcohol Drugs 2020; 81:436-445. [PMID: 32800079 PMCID: PMC7437559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/07/2020] [Indexed: 03/30/2024] Open
Abstract
OBJECTIVE Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder (AUD). METHOD We conducted a longitudinal study of 4,078 adults with AUD who screened positive for unhealthy drinking between October 1, 2015, and September 30, 2016. We extracted EHR data up to 3 years after screening until October 1, 2018. We used survival analysis to examine associations between remission (i.e., reporting abstinence or low-risk drinking at a subsequent screening) and patient characteristics, comorbidities, and treatment utilization. RESULTS The median time to remission from unhealthy drinking was 1.7 years. Factors significantly associated with greater odds of remitting from unhealthy drinking during follow-up were female gender; older age (50-64 years); Black or Latino/Hispanic race/ethnicity; having more medical comorbidities; not having a comorbid drug use disorder; lower alcohol consumption levels; and receiving addiction medicine treatment before the index screening. In the first follow-up year, individuals with mental health comorbidities were more likely to remit, but those in psychiatric treatment were less likely. Receiving addiction treatment during follow-up was not associated with remission. CONCLUSIONS Ethnic minorities and individuals with mental illness were more likely to remit, which is encouraging given the health disparities observed among these clinically important subgroups and warrants further research. Our findings may inform research on AUD recovery and clinical practice, as remission from unhealthy drinking is a crucial component of the early stages of recovery.
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Affiliation(s)
- Vanessa A. Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Stahler GJ, Mennis J. The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US. Drug Alcohol Depend 2020; 212:108067. [PMID: 32445926 DOI: 10.1016/j.drugalcdep.2020.108067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. METHODS Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. RESULTS Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. CONCLUSIONS Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
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Molfenter T, Kim JS, Zehner M. Increasing Engagement in Post-Withdrawal Management Services Through a Practice Bundle and Checklist. J Behav Health Serv Res 2020; 48:400-409. [PMID: 32347425 DOI: 10.1007/s11414-020-09700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Individuals with substance use disorders (SUDs) who engage in post-withdrawal management (or detoxification) continuing care are more likely to remain drug free or sober and less likely to be incarcerated or die of overdose. Yet, just 21-35% of individuals receiving emergency withdrawal management services receive continuing care. This deficiency is occurring, while overdose rates are high, and limited evidence exists on how to improve this vital transition. To address this gap, withdrawal management service providers employed the LINK Care Transition Implementation System to improve withdrawal management to continuing care transition rates. This system integrates three evidence-based implementation science approaches: (a) practice bundle, (b) process checklist, and (c) standardized organizational change model. This integrated implementation approach improved withdrawal management to continuing care transition rates from 20 (baseline average) to 43% (post-intervention) in (n = 6) Wisconsin withdrawal management centers. This study provides insights into how to improve transitions to enhance SUD care and outcomes.
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Affiliation(s)
- Todd Molfenter
- University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, USA.
| | - Jee-Seon Kim
- University of Wisconsin-Madison, 1067 Educational Sciences, Madison, WI, 53706-1706, USA
| | - Mark Zehner
- UW Center for Tobacco-Research and Intervention (CTRI), 1930 Monroe Street, Ste. 200, Madison, WI, 53711, USA
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