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Álvaro-Alonso EA, Gómez-Álvarez MDC, Segovia-Tapiador B, Del-Pino-Illaconza MI, Valencia J, Ryan P, Aguilar-Ros A, Escobar-Rodríguez I. Persistence in the Methadone Maintenance Program and Its Relationship with the Medication Regimen Complexity Index in Opioid-Dependent Patients. Pharmaceuticals (Basel) 2024; 17:567. [PMID: 38794137 PMCID: PMC11123973 DOI: 10.3390/ph17050567] [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: 04/15/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
It has been shown that the Medication Regimen Complexity Index (MRCI) is a useful and reliable tool for calculating the complexity of the pharmacotherapeutic regimen (CPR). Furthermore, a high MRCI is associated with lower adherence. However, the MRCI of opioid-dependent patients (ODP) has not been studied. The aim of this study is to calculate the Methadone Maintenance Program (MMP) persistence and the MRCI score in a ODP cohort. Second, to analyze its relationship and association with other variables. To accomplish this research, an observational study including adults with a confirmed diagnosis of opiate-dependency according to the DSM-5 in a MMP center was carried out. To define MMP-persistence, a group was created by the researchers who defined five weighted items according to their agreed importance. Our first contribution was to create a new definition of MMP-persistence. This study also identified age, comorbidities, and received methadone maintenance doses as successful predictors for MMP-persistence. We have also shown that the MRCI does not seem to be a useful tool to determine MMP-persistence, probably because there are multiple factors that influence it in addition to the CPR. It is necessary to continue searching for more precise selection and stratification tools for ODP to improve their persistence.
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Affiliation(s)
- Elena Alba Álvaro-Alonso
- Pharmacy Department, Infanta Leonor University Hospital, Av. Gran Vía del Este, 80, 28031 Madrid, Spain;
| | - María del Carmen Gómez-Álvarez
- General Subdirectorate of Pharmaceutical Inspection and Management, Authorization Area for Pharmaceutical Centers, Services and Establishments, Ministry of Health, C/Aduana, 29, 28013 Madrid, Spain;
| | - Beatriz Segovia-Tapiador
- Vallecas Comprehensive Care Center for Drug Addicts, Calle de las Cinco Villas, 5, 28051 Madrid, Spain; (B.S.-T.); (M.I.D.-P.-I.)
| | - María Isabel Del-Pino-Illaconza
- Vallecas Comprehensive Care Center for Drug Addicts, Calle de las Cinco Villas, 5, 28051 Madrid, Spain; (B.S.-T.); (M.I.D.-P.-I.)
| | - Jorge Valencia
- Internal Medicine Department, Infanta Leonor University Hospital, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.V.); (P.R.)
| | - Pablo Ryan
- Internal Medicine Department, Infanta Leonor University Hospital, Av. Gran Vía del Este, 80, 28031 Madrid, Spain; (J.V.); (P.R.)
| | - Antonio Aguilar-Ros
- Instituto Universitario de Estudios de las Adicciones IEA-CEU, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain;
| | - Ismael Escobar-Rodríguez
- Pharmacy Department, Infanta Leonor University Hospital, Av. Gran Vía del Este, 80, 28031 Madrid, Spain;
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Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial. J Addict Med 2022:01271255-990000000-00109. [PMID: 36300816 DOI: 10.1097/adm.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In this study, we aimed to examine the prevalence of alcohol consumption among methadone maintenance treatment (MMT) clients in Shanghai and to determine whether a brief intervention (BI) affects drinking among them. METHODS A total of 837 clients from 14 local MMT clinics were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). One hundred one were included in the study and randomly assigned to the BI group or the control group. Clients in the BI group received a BI and general health education, whereas clients in the control group received the general health education only. Baseline and postintervention assessments were conducted by using the AUDIT, the Drinking Attitude Questionnaire, the Depression Module of the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the General Well-Being Schedule. RESULTS Two hundred fifty-nine (30.9%) reported drinking during the last year, and 103 (12.3%) met the criteria for harmful use. At the 3-month follow-up, the AUDIT scores of the 2 groups were significantly decreased, and the time effect was statistically significant ( F = 6.224, P = 0.018), but there was no group difference in AUDIT scores ( F = 1.953, P = 0.172). Both groups had a main time effect of time on the improvement of depression ( F = 8.044, P = 0.008), anxiety ( F = 9.650, P = 0.004), and general well-being ( F = 5.056, P = 0.033). However, there was no statistical difference between the 2 groups ( P > 0.05), and no statistical difference in the time ( F = 1.738, P = 0.198) and group ( F = 0.658, P = 0.424) effect of drinking attitude. CONCLUSIONS Alcohol consumption is common among MMT clients in China. Brief intervention, in its current form, could not effectively help them reduce their alcohol consumption.
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Hypotheses for the Reasons behind Beer Consumer's Willingness to Purchase Beer: An Expanded Theory from a Planned Behavior Perspective. Foods 2020; 9:foods9121842. [PMID: 33322076 PMCID: PMC7764129 DOI: 10.3390/foods9121842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022] Open
Abstract
Because beer is one of the most common alcoholic beverages consumed in the world, this research adopted an expanded theory of planned behavior (TPB) perspective to understand why beer consumers purchase beer. This study investigated the effects of injunctive norms, descriptive norms, attitude, and perceived behavioral control on alcohol identity and purchase intention. The possible mediating role of alcohol identity was also investigated. This study was conducted in Taiwan, and a total of 452 beer consumers participated in the survey. Structural equation modeling was used to examine the relationship among the study variables. The results revealed that alcohol identity positively influences purchase intention, and attitude positively affects alcohol identity and purchase intention. In addition, injunctive norms have a positive influence on alcohol identity, and descriptive norms positively affect purchase intention. In particular, perceived behavioral control has a negative influence on alcohol identity but has a positive influence on purchase intention. This study also found that alcohol identity mediates the attitude–purchase intention relationship. By examining the consumption behavior of beer consumers from the TPB perspective, this study contributed to an understanding of beer consumption behavior.
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Abstract
Objectives: Unhealthy alcohol use is associated with negative health outcomes in clients attending methadone maintenance therapy (MMT) programs. However, debates exist regarding the methadone dose of drinkers, and little is known about the health outcomes of drinkers with other types of alcohol use. This study examined the drinking pattern and its association with methadone dose, and depressive and anxiety symptoms in Chinese clients undergoing MMT. Methods: A secondary data analysis was conducted with data from a large-scale cross-sectional survey of 549 clients of 3 MMT clinics in Wuhan, China. Depression, anxiety, and alcohol dependence were measured with Zung Self-rating Depression Scale, Zung Self-rating Anxiety Scale, and Alcohol Dependence Scale, respectively. Drinking pattern was assessed using 3 indicators: weekly amount of alcohol consumed, weekly frequency of alcohol consumed, and severity of alcohol dependence. Results: The prevalence of current drinking, hazardous drinking, regular drinking, and alcohol abuse/dependence was 29.0%, 10.4%, 14.2%, and 8.7%, respectively. In adjustment analyses, relative to nondrinkers, drinkers had significantly lower weight-based methadone dose (β = −0.136, P = 0.008); hazardous drinkers, irregular drinkers, and drinkers without alcohol abuse/dependence had less severe depression (β = −3.67, P = 0.004; β = −2.37, P = 0.034; β = −3.20, P = 0.001) and anxiety (β = −4.90, P < 0.001; β = −3.24, P = 0.006; β = −4.52, P < 0.001), but drinkers with alcohol abuse/dependence had more severe depression (β = 5.55, P < 0.001) and anxiety (β = 4.31, P = 0.005). Conclusion: In Chinese MMT clinics, drinkers may use alcohol to compensate for inadequate MMT and self-medicate negative emotions. Compared with nondrinkers, the severities of depression and anxiety were lower among drinkers without alcohol abuse/dependence, but higher among those with alcohol abuse/dependence.
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Abstract
Taking opioids is often accompanied by the development of dependence. Unfortunately, treatment of opioid dependence is difficult, particularly because of codependence - for example, on alcohol or other drugs of abuse. In the presented study, we analyzed the potential influence of disulfiram, a drug used to aid the management of alcoholism, on opioid abstinence syndrome, which occurs as a result of opioid withdrawal. Opioid dependence in mice was induced by subcutaneous administration of either morphine or methadone at a dose of 48 mg/kg for 10 consecutive days. To trigger a withdrawal syndrome, the opioid receptor antagonist, naloxone, was administered at a dose of 1 mg/kg (subcutaneous), and the severity of withdrawal signs was assessed individually. Interruption of chronic treatment with morphine or methadone by naloxone has led to the occurrence of opioid abstinence signs such as jumping, paw tremor, wet-dog shakes, diarrhea, teeth chattering, ptosis, and piloerection. Importantly, pretreatment with disulfiram (25, 50, and 100 mg/kg) reduced the intensity of withdrawal signs induced by naloxone in morphine or methadone-treated mice. These findings show the effectiveness of disulfiram in reducing opioid abstinence signs.
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Grall-Bronnec M, Laforgue EJ, Challet-Bouju G, Cholet J, Hardouin JB, Leboucher J, Guillou-Landréat M, Victorri-Vigneau C. Prevalence of Coaddictions and Rate of Successful Treatment Among a French Sample of Opioid-Dependent Patients With Long-Term Opioid Substitution Therapy: The OPAL Study. Front Psychiatry 2019; 10:726. [PMID: 31681038 PMCID: PMC6812413 DOI: 10.3389/fpsyt.2019.00726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Opioid use disorder (OUD) is a worldwide major health concern due to increased early mortality and morbidity. Opioid substitution therapy (OST) is approved in the context of a global OUD treatment (OUDT), in conjunction with psychosocial interventions. Many factors can explain why unsuccessful treatment rates remain high. While the phenomenon of addiction switching is often proposed, it is not known whether this also includes gambling addiction. The primary objective of the OPAL study was to determine the prevalence of coaddictions, including problem gambling, among patients with OUDT. Secondary objectives were to assess the rate of unsuccessful OUDT and to characterize the associated factors. Methods: For this observational transversal multicenter study, patients with OUDT including OST for at least 6 months were recruited. Clinical assessment was based on a clinically structured interview and a set of self-reported questionnaires. Coaddictions were screened using the Fagerström, the CRAFFT, and the Lie/Bet questionnaires. Unsuccessful OUDT was defined as the persistence of opioid use and/or the worsening of another substance use or gambling practice. After a descriptive analysis, a multivariate analysis was performed to identify the factors associated with unsuccessful OUDT. Results: The sample consisted of 263 patients. Prevalence of coaddictions reached 97% of the sample. Problem gambling was associated with 10% of the patients. OUDT was considered as "unsuccessful" for 60% of the patients. Associated factors included having drug-using friends, psychiatric and professional negative consequences related to opioid use, more than one OST-prescribing physician, and impulsivity, especially high scores for lack of premeditation and sensation seeking. Conclusions: This study provides further evidence of the need to consider coaddictions and the usefulness of global addictive evaluations. Poor prognostic factors must alert the clinician to initiate more sustained care. Further implications are discussed.
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Affiliation(s)
- Marie Grall-Bronnec
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,HUGOPSY Network, Nantes, France
| | - Edouard-Jules Laforgue
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
| | - Gaëlle Challet-Bouju
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France
| | - Jennyfer Cholet
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Methodology and Biostatistic Department, DRCI, CHU Nantes, Nantes, France
| | - Juliette Leboucher
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Morgane Guillou-Landréat
- HUGOPSY Network, Nantes, France.,Addictive Medicine Department, CHU Brest, Brest, France.,Université de Bretagne Occidentale, ERCR SPURBO, Brest, France
| | - Caroline Victorri-Vigneau
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
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Klimas J, Fairgrieve C, Tobin H, Field C, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018; 12:CD009269. [PMID: 30521696 PMCID: PMC6517179 DOI: 10.1002/14651858.cd009269.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. OBJECTIVES To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included seven trials (825 participants). We judged the majority of the trials to have a high or unclear risk of bias.The psychosocial interventions considered in the studies were: cognitive-behavioural coping skills training (one study), twelve-step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol-related harm. The results were as follows.Comparison 1: cognitive-behavioural coping skills training versus twelve-step programme (one study, 41 participants)There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low.Comparison 2: brief intervention versus treatment as usual (three studies, 197 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI -0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI -0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants)More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate.Comparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. AUTHORS' CONCLUSIONS We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
- School of Medicine, University College DublinHealth Science Centre, Belfield, UCDDublinIrelandD4
| | - Christopher Fairgrieve
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
| | - Helen Tobin
- University College DublinSchool of MedicineDublinIreland
| | - Catherine‐Anne Field
- National University of Ireland GalwayCollege of Medicine, Nursing, & Health Sciences, School of Health SciencesGalwayIreland
| | - Clodagh SM O'Gorman
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Graduate Entry Medical School, University of LimerickDepartment of PaediatricsLimerickIreland
| | - Liam G Glynn
- Graduate Entry Medical School, University of LimerickGeneral PracticeLimerickIreland
| | - Eamon Keenan
- Health Service ExecutiveAddiction ServicesBridge House, Cherry Orchard HospitalBallyfermotDublinIreland10
| | - Jean Saunders
- Graduate Entry Medical School, University of LimerickStatistical Consulting Unit/ Applied Biostatistics Consulting Centre /CSTARLimerickIreland
| | - Gerard Bury
- University College DublinSchool of MedicineDublinIreland
| | - Colum Dunne
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Faculty of Education and Health Sciences, University of LimerickCentre for Interventions in Infection, Inflammation & Immunity (4i)LimerickIreland
| | - Walter Cullen
- University College DublinSchool of MedicineDublinIreland
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Alcohol and tobacco use among methadone maintenance patients in Vietnamese rural mountainside areas. Addict Behav Rep 2017; 7:19-25. [PMID: 29450252 PMCID: PMC5805500 DOI: 10.1016/j.abrep.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction The expansion of methadone maintenance treatment (MMT) program requires more data about the factors affecting the effectiveness of treatment, especially behavioral data such as smoking and alcohol use among patients. This study aimed to examine the prevalence of tobacco and alcohol consumption and identify related factors among MMT patients in the Vietnamese rural mountainside. Methods We interviewed 241 MMT patients in two clinics in Tuyen Quang, a mountainous province in Vietnam. Patients were asked to report the smoking status (current smoker or not), nicotine dependence (by Fagerström test for nicotine dependence - FTND) and alcohol use (by using the Alcohol Use Disorders Identification Test – AUDIT-C). EuroQol-5 dimensions-5 levels (EQ-5D-5L) and EQ-Visual analogue scale (EQ-VAS) were employed to measure health-related quality of life. Multivariate logistic and Tobit regressions were used to identify the associated factors. Results The majority of respondents were current smokers (75.7%) and a low proportion were hazardous drinkers (18.3%). People receiving treatment in a rural clinic (OR = 0.45; 95%CI = 0.22–0.92) and had problems in usual activities (OR = 0.20; 95%CI = 0.06–0.70) were less likely to be smokers. Q-VAS score (Coef. = 0.03; 95%CI = 0.02–0.05) and having problems in mobility (Coef. = 0.72; 95%CI = 0.03–1.42) was found to be associated with the increase of nicotine dependence. In terms of alcohol drinking, people with other jobs were more likely to drink hazardously compared to unemployed patients (OR = 2.86; 95%CI = 1.20–6.82). Similarly, patients having higher duration of MMT had higher likelihood of being hazardous drinkers (OR = 1.07; 95%CI = 1.01–1.13). Conclusions This study highlights the low rate of alcohol abusers but a considerably high proportion of current smokers among MMT patients in the rural mountainside area. Alcohol and tobacco counseling programs combined with social and family support also play an essential role in alcohol and tobacco control. In addition, implementing mass community-based behavioral change campaigns to reduce drug addiction-related stigmatization should also be prioritized. Rates of tobacco and alcohol use were high among MMT patients in the rural mountainside area. The bi-directional association existed between being at risk of hazardous drinking and MMT duration. A comprehensive MMT approach is needed to improve both physical and mental health outcome, which facilitates MMT patients to quit smoking and alcohol use. Alcohol and tobacco counseling programs combined with social and family support are necessary.
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Duan S, Jin Z, Liu X, Yang Y, Ye R, Tang R, Gao M, Ding Y, He N. Tobacco and alcohol use among drug users receiving methadone maintenance treatment: a cross-sectional study in a rural prefecture of Yunnan Province, Southwest China. BMJ Open 2017; 7:e014643. [PMID: 28363929 PMCID: PMC5387941 DOI: 10.1136/bmjopen-2016-014643] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of ever, current and heavy tobacco and alcohol use and their correlates among patients undergoing methadone maintenance treatment (MMT). DESIGN Cross-sectional study. SETTING The study was conducted in all of the 5 MMT clinics in Dehong Prefecture, China. PARTICIPANTS 2121 (81.6%) eligible MMT participants were included in the study population. ANALYSIS Ordinal logistic regression was used to estimate the ORs and their 95% CIs. RESULTS The overall prevalence of ever, current and heavy smoking was 98.6%, 97.8% and 66.3%, respectively; while that of ever, current and hazardous alcohol drinking was 86.6%, 58.6% and 16.6%, respectively. Among HIV-infected participants, the proportions of those experiencing harmful effects of tobacco and alcohol on AIDS were 53.6% and 72.5%, respectively, and 16.9% and 49.3% had ever tried to quit after diagnosis with HIV. After adjusting for potential confounders, heavier smokers and more hazardous drinkers were more likely to be men, older and less educated. Ethnic minorities were less likely to heavily smoke, but more likely to engage in hazardous drinking. In addition, hazardous drinking was negatively associated with longer years of MMT and HIV infection. Moreover, heavier smoking (OR≥2=2.08, 95% CI 1.16 to 3.73) and more hazardous drinking (OR≥2=2.46, 95% CI 1.53 to 3.97) were positively associated with having multiple sexual partners, and both were positively associated with each other. CONCLUSIONS The prevalence of tobacco and alcohol consumption was extraordinarily high among MMT participants in China, suggesting the urgent need of enhancing MMT patients' awareness of the harmful effects of tobacco and alcohol consumption and implementing comprehensive education and effective intervention programmes.
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Affiliation(s)
- Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Ziyi Jin
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Xing Liu
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Runhua Ye
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Renhai Tang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Meiyang Gao
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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Brief Interventions for Harmful Alcohol Use in Opioid-dependent Patients on Maintenance Treatment With Buprenorphine: A Prospective Study From India. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comorbid Psychopathology and Alcohol Use Patterns among Methadone Maintenance Treatment Patients. JOURNAL OF ADDICTION 2015; 2015:197652. [PMID: 25878919 PMCID: PMC4386644 DOI: 10.1155/2015/197652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 11/23/2022]
Abstract
130 patients from a methadone maintenance treatment program agreed to complete Symptoms Checklist 90-Revised (SCL-90R) and Alcohol Use Disorders Identification Test (AUDIT) self-report scales. Scores higher than the proposed cut-score on SCL-90R scale were observed on depression, obsessions-compulsions, paranoid ideation, anxiety, anger-hostility, somatization, interpersonal sensitivity, and psychoticism subscales. In sum, 42.9% of our sample exhibited depressive symptomatology, 34.9% obsessive-compulsive symptoms, 29.1% somatization, 27.2% anxiety symptoms, 22.2% paranoid ideation, 19% phobic anxiety, 15.1% psychoticism, and 15.1% hostility and 11.9% presented with symptoms of interpersonal sensitivity. Mean score on AUDIT scale was 6.9 ± 7.9. 63.0% of our participants scored below cut-off and were classified as having a low level of alcohol-related problems; 24.4% scored in the range of 8–15 which is an indication of alcohol abuse whereas 12.6% scored 16 and above indicative of serious abuse/addiction. Scores on AUDIT scale were positively correlated with length of time on methadone treatment, but not with length of time on drug use or age of our participants. Positive correlations were observed among AUDIT and SCL-90R scores, namely, with global severity index score, positive symptom distress index, positive symptom total, and all primary symptom dimensions subscales except phobic anxiety.
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Klimas J, Tobin H, Field CA, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2014:CD009269. [PMID: 25470303 DOI: 10.1002/14651858.cd009269.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. OBJECTIVES To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, June 2014), MEDLINE (1966 to June 2014); EMBASE (1974 to June 2014); CINAHL (1982 to June 2014); PsycINFO (1872 to June 2014) and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; 2) online registers of clinical trials: Current Controlled Trials, Clinical Trials.org, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies, or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Four studies, involving 594 participants, were included. Half of the trials were rated as having a high or unclear risk of bias. The studies considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (one study; 41 participants), (2) brief intervention versus treatment as usual (one study; 110 participants), (3) group or individual motivational interviewing (MI) versus hepatitis health promotion (one study; 256 participants) and (4) brief motivational intervention (BMI) versus assessment-only (one study; 187 participants). Differences between studies precluded any data pooling. Findings are described for each trial individually.Comparison 1: low-quality evidence; no significant difference for any of the outcomes considered Alcohol abstinence as maximum number of weeks of consecutive alcohol abstinence during treatment: mean difference (MD) 0.40 (95% confidence interval (CI) -1.14 to 1.94); illicit drug abstinence as maximum number of weeks of consecutive abstinence from cocaine during treatment: MD 0.80 (95% CI -0.70 to 2.30); alcohol abstinence as number achieving three or more weeks of consecutive alcohol abstinence during treatment: risk ratio (RR) 1.96 (95% CI 0.43 to 8.94); illicit drug abstinence as number achieving three or more weeks of consecutive abstinence from cocaine during treatment: RR 1.10 (95% CI 0.42 to 2.88); alcohol abstinence during follow-up year: RR 2.38 (95% CI 0.10 to 55.06); illicit drug abstinence as abstinence from cocaine during follow-up year: RR 0.39 (95% CI 0.04 to 3.98), moderate-quality evidence.Comparison 2: low-quality evidence, no significant difference for all the outcomes considered Alcohol use as AUDIT scores at three months: MD 0.80 (95% -1.80 to 3.40); alcohol use as AUDIT scores at nine months: MD 2.30 (95% CI -0.58 to 5.18); alcohol use as number of drinks per week at three months: MD 0.70 (95% CI -3.85 to 5.25); alcohol use as number of drinks per week at nine months: MD -0.30 (95% CI -4.79 to 4.19); alcohol use as decreased alcohol use at three months: RR 1.13 (95% CI 0.67 to 1.93); alcohol use as decreased alcohol use at nine months: RR 1.34 (95% CI 0.69 to 2.58), moderate-quality evidence.Comparison 3 (group and individual MI), low-quality evidence: no significant difference for all outcomes Group MI: number of standard drinks consumed per day over the past month: MD -0.40 (95% CI -2.03 to 1.23); frequency of drug use: MD 0.00 (95% CI -0.03 to 0.03); composite drug score (frequency*severity for all drugs taken): MD 0.00 (95% CI -0.42 to 0.42); greater than 50% reduction in number of standard drinks consumed per day over the last 30 days: RR 1.10 (95% CI 0.82 to 1.48); abstinence from alcohol over the last 30 days: RR 0.88 (95% CI 0.49 to 1.58).Individual MI: number of standard drinks consumed per day over the past month: MD -0.10 (95% CI -1.89 to 1.69); frequency of drug use (as measured using the Addiction Severity Index (ASI drug): MD 0.00 (95% CI -0.03 to 0.03); composite drug score (frequency*severity for all drugs taken): MD -0.10 (95% CI -0.46 to 0.26); greater than 50% reduction in number of standard drinks consumed per day over the last 30 days: RR 0.92 (95% CI 0.68 to 1.26); abstinence from alcohol over the last 30 days: RR 0.97 (95% CI 0.56 to 1.67).Comparison 4: more people reduced alcohol use (by seven or more days in the past month at 6 months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60), moderate-quality evidence. No significant difference was reported for all other outcomes: number of days in the past 30 days with alcohol use at one month: MD -0.30 (95% CI -3.38 to 2.78); number of days in the past month with alcohol use at six months: MD -1.50 (95% CI -4.56 to 1.56); 25% reduction of drinking days in the past month: RR 1.23 (95% CI 0.96 to 1.57); 50% reduction of drinking days in the past month: RR 1.27 (95% CI 0.96 to 1.68); 75% reduction of drinking days in the past month: RR 1.21 (95% CI 0.84 to 1.75); one or more drinking days' reduction in the past month: RR 1.12 (95% CI 0.91 to 1.38). AUTHORS' CONCLUSIONS There is low-quality evidence to suggest that there is no difference in effectiveness between different types of interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- Addiction & Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, 611 Powell Street, Vancouver, BC, V6A 1H2, Canada.
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Fan CY, Tan HKL, Chien IC, Chou SY. Prevalence of psychiatric disorders among heroin users who received methadone maintenance therapy in Taiwan. Am J Addict 2014; 23:249-56. [DOI: 10.1111/j.1521-0391.2014.12090.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/06/2013] [Accepted: 06/01/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Chiung-Yueh Fan
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
| | | | - I-Chia Chien
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
- Department of Public Health and Institute of Public Health; National Yang-Ming University; Taipei Taiwan
| | - Sun-Yuan Chou
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
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Feelemyer J, Jarlais DD, Arasteh K, Abdul-Quader AS, Hagan H. Retention of participants in medication-assisted programs in low- and middle-income countries: an international systematic review. Addiction 2014; 109:20-32. [PMID: 23859638 PMCID: PMC5312702 DOI: 10.1111/add.12303] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/23/2013] [Accepted: 07/11/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. RESULTS There were 58 MAT program studies, with 27 047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI) = 46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI = 22.1, 74.6%) and methadone (56.6%, 95% CI = 45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. CONCLUSION Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.
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Affiliation(s)
- Jonathan Feelemyer
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, USA
| | - Don Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, USA
| | - Kamyar Arasteh
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, USA
| | - Abu S. Abdul-Quader
- Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Holly Hagan
- College of Nursing, New York University, New York, NY, USA
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Moving toward personalized medicine in the methadone maintenance treatment program: a pilot study on the evaluation of treatment responses in Taiwan. BIOMED RESEARCH INTERNATIONAL 2013; 2013:741403. [PMID: 24455721 PMCID: PMC3876825 DOI: 10.1155/2013/741403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/25/2013] [Indexed: 12/26/2022]
Abstract
This pilot study simultaneously evaluated the effects of various factors, including genetic variations of CYP2B6, CYP2C19, and ABCB1, demographic characteristics, disease states, methadone-drug interactions (MDIs), and poly-substance use, on the treatment responses among non-HIV patients in the methadone maintenance treatment program (MMTP) in Taiwan. A total of 178 patients were recruited from two major hospitals that provided MMTP services in southern Taiwan, and information regarding concomitant medications and diseases was acquired from the National Health Insurance (NHI) program. The results demonstrated that the methadone maintenance dose, CYP2B6 785G allele, and ABCB1 2677T allele have positive effects on the methadone plasma concentration. In contrast, patients with HCV coinfection, alcohol problems, and psychiatric diseases may have a negative response to treatment. Thus, a comprehensive evaluation of treatment responses in the MMTP should include not only genetic polymorphisms in methadone metabolism and transporter proteins, but also concomitant diseases, MDIs, and poly-substance use. The results also suggest that personalized medicine may be indispensable for a better outcome of the MMTP.
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Lee KHS, Bowen S, Oei TPS, Yen CF. An expanded self-medication hypothesis based on cognitive-behavioral determinants for heroin abusers in Taiwan: a cross-sectional study. Am J Addict 2013; 21 Suppl 1:S43-8. [PMID: 23786509 DOI: 10.1111/j.1521-0391.2012.00301.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study proposed and examined an expanded self-medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self-efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self-efficacy between negative emotional states and heroin use. METHODS A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self-efficacy. Structural equation modeling was used to examine the eSMH model. RESULTS Results showed that the eSMH model displayed proper goodness-of-fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self-efficacy was not a significant predictor. Additionally, positive self-efficacy was a mediator between negative emotional status and heroin use. CONCLUSION Results support a reduced eSMH model and suggest a significant role of positive self-efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states.
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Affiliation(s)
- Kun-Hua Sam Lee
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.
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[Evolution of patients treated with methadone in general practice]. Presse Med 2013; 42:1660-2. [PMID: 23628444 DOI: 10.1016/j.lpm.2012.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 12/11/2012] [Accepted: 12/18/2012] [Indexed: 11/20/2022] Open
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Huang CLC, Lee CW. Factors associated with mortality among heroin users after seeking treatment with methadone: A population-based cohort study in Taiwan. J Subst Abuse Treat 2013; 44:295-300. [DOI: 10.1016/j.jsat.2012.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/23/2012] [Accepted: 08/03/2012] [Indexed: 01/18/2023]
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