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Nyashanu T, Scheibe A, Visser M. 'I went for rehab many times and it never worked, but the harm reduction process has given me renewed hope'. Perceptions on the effectiveness of harm reduction and community-based opioid substitution therapy. Health Promot J Austr 2024; 35:653-661. [PMID: 37605794 DOI: 10.1002/hpja.789] [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: 03/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
ISSUE ADDRESSED The accessibility of opioid substitution therapy (OST), one of the recommended treatments for opioid dependence, remains low. This study sought to explore the perceived effectiveness of OST from the perspectives of peer outreach workers and OST clients in a community-based harm reduction programme. METHODS The research was done within the Community-Oriented Substance Use Programme (COSUP) in Tshwane, South Africa. Fifteen peer educators (13 males and 2 females) took part in two focus group discussions. Thereafter, there were semi-structured interviews in which 15 OST clients (11 males and 4 females) participated. A convenience cross-sectional study was used. Interviews were audio-recorded. Using thematic analysis, themes were examined to evaluate how OST and the harm reduction approach were perceived to contribute to the improved health status of people with opioid dependence. RESULTS Peer outreach workers and COSUP clients significantly endorsed OST as an effective treatment for opioid dependence. Participants perceived greater effectiveness of OST compared to abstinence-centred inpatient rehabilitation programmes. However, there were sentiments that more community education on OST was needed to motivate people with opioid dependence to access services and to address misconceptions about OST. CONCLUSIONS There is a lack of multi-level and multi-sectoral engagement of various stakeholders in opioid dependence services, needed to accelerate utilisation of OST services. SO WHAT?: The research unpacks the need for an integrated approach to service use optimisation, and the need to evaluate the role that increased awareness and community education on harm reduction strategies can play in enhancing the utilisation of OST services.
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Affiliation(s)
- Tichaenzana Nyashanu
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Andrew Scheibe
- Community Oriented Primary Care Research Unit, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maretha Visser
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Parsons A, Hoadley B, Hitzeman C, Parkin S, Kasinathan J. A six-session group-based pilot intervention for alcohol and other drug use in hospitalised mentally ill young offenders. Australas Psychiatry 2022; 30:509-512. [PMID: 35073775 DOI: 10.1177/10398562211065289] [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: 11/15/2022]
Abstract
OBJECTIVE This study aims to evaluate a group-based intervention for alcohol and other drug (AOD) use offered to incarcerated youth hospitalised with mental illness. METHODS A six-session group-based intervention for AOD use was offered to young offenders with mental illness, hospitalised in the Adolescent Unit of the Forensic Hospital, Sydney, between June 2015 and May 2017. Pre- and post-intervention measures were collected using the Brief Psychiatric Rating Scale (BPRS), Treatment Entry Questionnaire, Drug-Related Locus of Control (DRLOC) and Drug-Taking Confidence Questionnaire, short version. RESULTS Pre- and post-intervention measures were compared utilising paired t-tests. Following the intervention, there was a significant reduction in the severity of psychiatric symptoms rated using the BPRS and a significant difference in DRLOC measures, reflecting increased internal locus of control. CONCLUSIONS Improved internal drivers for reducing AOD use and improvement in symptoms of mental illness suggest similar interventions may be beneficial and may not impact recovery even during episodes of acute illness.
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Affiliation(s)
- Annie Parsons
- 161777Justice Health and Forensic Mental Health Network, Matraville, Australia
| | - Benjamin Hoadley
- The University of Sydney and 7800The University of New South Wales, Sydney, Australia
| | - Cortney Hitzeman
- Justice Health and Forensic Mental Health Network, Matraville, Australia
| | - Sarah Parkin
- Justice Health and Forensic Mental Health Network, Matraville, Australia
| | - John Kasinathan
- 161777Justice Health and Forensic Mental Health Network, Matraville, Australia
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Walji A, Romano I, Levitt E, Sousa S, Rush B, MacKillop J, Urbanoski K, Costello MJ. Psychometric evaluation of the treatment entry questionnaire to assess extrinsic motivation for inpatient addiction treatment. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100014. [PMID: 36845886 PMCID: PMC9949302 DOI: 10.1016/j.dadr.2021.100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Valid multi-faceted measurement of motivation for substance use disorder (SUD) treatment is needed to help inform treatment approaches and predict outcomes. This study examined evidence of validity for the Treatment Entry Questionnaire (TEQ-9). METHODS Data represented individuals entering inpatient SUD treatment (n = 1455). We used confirmatory factor analysis (CFA) to assess the three-factor structure of the TEQ-9 [identified (i.e., values/personally chooses treatment), introjected (i.e., internally controlled by guilt/shame) and external motivations (i.e., external pressure/demands)], and examined measurement invariance across gender, age, and ethno-racial identity. Correlation with readiness and confidence assessed convergent validity, while correlations with substance use problem severity and previous substance use treatment assessed meaningful group differences. RESULTS A three-factor structure was confirmed with all items loading significantly onto their respective factors (ps < 0.001). Each subscale demonstrated high internal consistency (Identified α = 0.90; Introjected α = 0.79; External α = 0.85). Each subscale demonstrated measurement invariance up to the scalar level across all sub-groups. Readiness, confidence, and substance use problem severity correlated as expected across various substances with the identified (rs = 0.098 - 0.262, ps < 0.05), and external (rs = -0.096 - -0.178, ps < 0.05) subscales. Additionally, the mean Identified subscale score was significantly higher among those who previously engaged in SUD treatment (p < 0.001). Findings for the Introjected subscale were more ambiguous. CONCLUSIONS Findings provide evidence for factorial validity, measurement invariance, convergent validity and group differences of the TEQ-9 in a large clinically mixed inpatient SUD treatment population, providing further support of its clinical and research utility.
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Affiliation(s)
- Alyna Walji
- Homewood Research Institute, Guelph, ON, Canada
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Isabella Romano
- Homewood Research Institute, Guelph, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Emily Levitt
- Homewood Research Institute, Guelph, ON, Canada
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen Urbanoski
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Canadian Institute for Substance Use Research, University of Victoria, BC, Canada
- School of Public Health and Social Policy, University of Victoria, BC, Canada
| | - Mary Jean Costello
- Homewood Research Institute, Guelph, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Saur S, Weisel KK, Lang C, Fuhrmann LM, Steins-Loeber S, Enewoldsen N, Reichl D, Zink M, Jakobi F, Rudolph M, Ahnert A, Braunwarth WD, Falkai P, Koller G, Behle N, Hager L, Hillemacher T, Heepe P, Müller FN, Kraus T, Kiderman Y, Horn N, Kornhuber J, Lins S, Spitzer P, Bönsch D, Counot C, Stemmler M, Hildebrand A, Amelung V, Kerkemeyer L, Berking M. App-based maintenance treatment for alcohol use disorder after acute inpatient treatment: Study protocol for a multicentre randomized controlled trial. Internet Interv 2022; 28:100517. [PMID: 35251940 PMCID: PMC8888955 DOI: 10.1016/j.invent.2022.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alcohol use disorder, a prevalent and disabling mental health problem, is often characterized by a chronic disease course. While effective inpatient and aftercare treatment options exist, the transferal of treatment success into everyday life is challenging and many patients remain without further assistance. App-based interventions with human guidance have great potential to support individuals after inpatient treatment, yet evidence on their efficacy remains scarce. OBJECTIVES To develop an app-based intervention with human guidance and evaluate its usability, efficacy, and cost-effectiveness. METHODS Individuals with alcohol use disorder (DSM-5), aged 18 or higher, without history of schizophrenia, undergoing inpatient alcohol use disorder treatment (N = 356) were recruited in eight medical centres in Bavaria, Germany, between December 2019 and August 2021. Participants were randomized in a 1:1 ratio to either receive access to treatment as usual plus an app-based intervention with human guidance (intervention group) or access to treatment as usual plus app-based intervention after the active study phase (waitlist control/TAU group). Telephone-based assessments are conducted by diagnostic interviewers three and six weeks as well as three and six months after randomization. The primary outcome is the relapse risk during the six months after randomization assessed via the Timeline Follow-Back Interview. Secondary outcomes include intervention usage, uptake of aftercare treatments, AUD-related psychopathology, general psychopathology, and quality of life. DISCUSSION This study will provide further insights into the use of app-based interventions with human guidance as maintenance treatment in individuals with AUD. If shown to be efficacious, the intervention may improve AUD treatment by assisting individuals in maintaining inpatient treatment success after returning into their home setting. Due to the ubiquitous use of smartphones, the intervention has the potential to become part of routine AUD care in Germany and countries with similar healthcare systems.
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Affiliation(s)
- Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Corresponding author at: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Nägelsbachstraße 25a, Erlangen, Germany.
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lukas M. Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Erlangen, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Mathias Zink
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Ansbach, Germany
| | - Fabian Jakobi
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Ansbach, Germany
| | - Melanie Rudolph
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Ansbach, Germany
| | - Andreas Ahnert
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Erlangen, Germany
| | - Wolf-Dietrich Braunwarth
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Erlangen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Nina Behle
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Laura Hager
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Peter Heepe
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Felix-Nicolai Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Thomas Kraus
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Engelthal, Germany
| | - Yaroslav Kiderman
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Engelthal, Germany
| | - Nicola Horn
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Engelthal, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Lins
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Spitzer
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominikus Bönsch
- Department for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Lohr, Lohr am Main, Germany
| | - Cyril Counot
- Department for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Lohr, Lohr am Main, Germany
| | - Mark Stemmler
- Department of Psychological Assessment, Quantitative Methods and Forensic Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Hildebrand
- Department of Psychological Assessment, Quantitative Methods and Forensic Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Volker Amelung
- inav — Institute for Applied Health Services Research, Berlin, Germany
| | - Linda Kerkemeyer
- inav — Institute for Applied Health Services Research, Berlin, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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A Substance Use Treatment Programme for Mentally Ill Forensic Patients in an Australian Setting: A Pilot Study of Feasibility, Acceptability and Preliminary Efficacy. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Glass JE, Matson TE, Lim C, Hartzler AL, Kimbel K, Lee AK, Beatty T, Parrish R, Caldeiro RM, Garza McWethy A, Curran GM, Bradley KA. Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives. J Med Internet Res 2021; 23:e25866. [PMID: 34255666 PMCID: PMC8293157 DOI: 10.2196/25866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Catherine Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rebecca Parrish
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Angela Garza McWethy
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Geoffrey M Curran
- University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Rush B, Marcus O, García S, Loizaga-Velder A, Loewinger G, Spitalier A, Mendive F. Protocol for Outcome Evaluation of Ayahuasca-Assisted Addiction Treatment: The Case of Takiwasi Center. Front Pharmacol 2021; 12:659644. [PMID: 34093190 PMCID: PMC8170098 DOI: 10.3389/fphar.2021.659644] [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: 01/28/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023] Open
Abstract
The present study describes the protocol for the Ayahuasca Treatment Outcome Project (ATOP) with a special focus on the evaluation of addiction treatment services provided through Takiwasi Center, the first ATOP study site. The goal of the project is to assess treatment outcomes and understand the therapeutic mechanisms of an Ayahuasca-assisted, integrative treatment model for addiction rehabilitation in the Peruvian Amazon. The proposed intervention protocol highlights the significance of treatment setting in the design, delivery, and efficacy of an addiction rehabilitation program that involves the potent psychedelic tea known as Ayahuasca. After describing the context of the study, we put forth details about our mixed-methods approach to data collection and analysis, with which we seek to gain an understanding of why, how, and for whom this specific ayahuasca-assisted treatment program is effective across a range of outcomes. The ATOP protocol employs qualitative research methods as a means to determine which aspects of the setting are meaningful to clients and practitioners, and how this may correlate with outcome measures. This paper delineates the core principles, methods, and measures of the overall ATOP umbrella, then discusses the role of ATOP in the context of the literature on long-term residential programs. To conclude, we discuss the strengths and limitations of the protocol and the intended future of the project.
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Affiliation(s)
- Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Olivia Marcus
- Department of Anthropology, University of Connecticut, Storrs, CT, United States
| | - Sara García
- Takiwasi Center for Rehabilitation of Drug Addicts and Research on Traditional Medicine, Tarapoto, Peru
| | - Anja Loizaga-Velder
- Nierika Institute, National Autonomous University of Mexico, Mexico City, Mexico
| | - Gabriel Loewinger
- School of Public Health, Harvard University, Boston, MA, United States
| | | | - Fernando Mendive
- Takiwasi Center for Rehabilitation of Drug Addicts and Research on Traditional Medicine, Tarapoto, Peru
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8
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Hosseini F, Alavi NM, Mohammadi E, Sadat Z. Scoping Review on the Concept of Patient Motivation and Practical Tools to Assess it. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:1-10. [PMID: 33954092 PMCID: PMC8074736 DOI: 10.4103/ijnmr.ijnmr_15_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 01/20/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022]
Abstract
Background: In this scoping review, the concept of patients' motivation and the tools that have been designed to measure this concept in clinical settings are presented. Materials and Methods: Arksey and O'Malley's framework was used in conducting the current scoping review. Google Scholar, PubMed, Scopus, and Web of Science databases were searched for relevant English articles published between January 1995 and January 2020 using the keywords motivation and tool, and their synonyms. Out of 2820 articles, 34 articles were chosen and were entered into the final analysis. Definitions of patients' motivation were determined using Kyngäs et al., content analysis method. Results: The findings showed that new tools had been developed in 38% of the studies and other studies had revised or translated existing questionnaires. Moreover, 62% of the tools were used to measure patient motivation in mental disorders. Most of the studies did not clearly define the concept of patient motivation in the clinical environment. The findings of content analysis outlined the 3 categories of motivation determinant factors, decisions, and behaviors that determine overall levels of motivations and its consequences. Conclusions: Motivation is a dynamic concept and is a result of internal and external motives that lead to decisions and behaviors. There are limited tools for measuring motivation in clinical settings. This addresses the need to design specific tools in various diseases, especially chronic diseases. By the concept defined in this study, it is possible to design a short tool with general application that can be used in all diseases.
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Affiliation(s)
- Fatemeh Hosseini
- PhD Candidate of Nursing, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Negin Masoud Alavi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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9
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Tran D, Bhar S. Predictors for treatment expectancies among young people who attend drug and alcohol services: A pilot study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Diem Tran
- Drug Health Services, Western Health, Footscray, Victoria, Australia,
| | - Sunil Bhar
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia,
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10
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Giovannetti C, Garcia Arce S, Rush B, Mendive F. Pilot Evaluation of a Residential Drug Addiction Treatment Combining Traditional Amazonian Medicine, Ayahuasca and Psychotherapy on Depression and Anxiety. J Psychoactive Drugs 2020; 52:472-481. [DOI: 10.1080/02791072.2020.1789247] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Cecile Giovannetti
- Institute for Tropical Medicine and International Health, Charité Universitätmedizin Berlin, Berlin, Germany
| | - Sara Garcia Arce
- Takiwasi Center for Rehabilitation of Drug Addicts and Research on Traditional Medicine, Tarapoto, Peru
| | - Brian Rush
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
- Departments of Psychiatry and Public Health Sciences, University of Toronto, Toronto, Canada
| | - Fernando Mendive
- Takiwasi Center for Rehabilitation of Drug Addicts and Research on Traditional Medicine, Tarapoto, Peru
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11
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Turpin A, Shier ML. Supporting Intrapersonal Development in Substance Use Disorder Programs: A Conceptual Framework for Client Assessment. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2017; 14:131-146. [PMID: 28388336 DOI: 10.1080/23761407.2017.1302860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Improvements to intrapersonal development of clients involved with substance use disorder treatment programs has widely been recognized as contributing to the intended goal of reducing substance misuse behaviors. This study sought to identify a broad framework of primary outcomes related to the intrapersonal development of clients in treatment for substance misuse. METHOD Using qualitative research methods, individual interviews were conducted with program participants (n = 41) at three treatment programs to identify the ways in which respondents experienced intrapersonal development through participation in treatment. RESULTS The findings support the development of a conceptual model that captures the importance and manifestation of achieving improvements in the following outcomes: self-awareness, coping ability, self-worth, outlook, and self-determination. DISCUSSION The findings provide a conceptual framework for client assessment that captures a broad range of the important intrapersonal development factors utilized as indicators for client development and recovery that should be measured in tandem during assessment.
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Affiliation(s)
- Aaron Turpin
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Micheal L Shier
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
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12
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Vian T, Bachman DeSilva M, Cabral HJ, Williams GC, Gifford AL, Zhong L, Xie W, Gill CJ, Sabin LL. The role of motivation in predicting antiretroviral therapy adherence in China. J Health Psychol 2016; 23:1895-1904. [PMID: 28810359 DOI: 10.1177/1359105316672922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on improving adherence; however, we did not find evidence that self-determination theory predicts adherence in this population of HIV-positive patients. Autonomous motivation was strongly associated with perceived competence; among low adherers, external regulation was negatively correlated with adherence.
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Affiliation(s)
- Taryn Vian
- 1 Boston University School of Public Health, USA
| | | | | | | | - Allen L Gifford
- 1 Boston University School of Public Health, USA.,3 Edith Nourse Rogers Memorial Veterans Hospital, USA
| | | | - Wubin Xie
- 4 FHI 360, China.,5 The George Washington University, USA
| | | | - Lora L Sabin
- 1 Boston University School of Public Health, USA
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Wild TC, Yuan Y, Rush BR, Urbanoski KA. Client Engagement in Legally-Mandated Addiction Treatment: A Prospective Study Using Self-Determination Theory. J Subst Abuse Treat 2016; 69:35-43. [DOI: 10.1016/j.jsat.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
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Jochems EC, van Dam A, Duivenvoorden HJ, Scheffer SCM, van der Feltz-Cornelis CM, Mulder NL. Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment. Clin Psychol Psychother 2015. [PMID: 26202731 DOI: 10.1002/cpp.1971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self-determination theory, the transtheoretical model and the integral model of treatment motivation. It was investigated to which extent clinicians of patients with SMI were able to estimate their patient's perspective on motivation for engaging in treatment, to which extent they agreed on the patient's motivation and which factors were associated with estimation and agreement on treatment motivation. It was found that clinicians were poorly to moderately capable of estimating their patient's type of motivation and readiness for change. Further, agreement on the level of motivation between patients and clinicians was moderate. These findings were consistent across diagnostic groups (psychotic and personality disorders). A higher quality therapeutic relationship was generally associated with higher clinician-rated motivation. The patient's ethnicity and socially desirable responding were factors that differentiated between scales of different motivation theories. It is concluded that patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment, regardless of the theoretical framework that is used to measure motivation. The findings imply that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Clinicians show poor to moderate capability in estimating how patients perceive their motivation for engaging in treatment, especially so when the patient's motives revolve around feelings of shame and guilt. Clinicians generally give higher motivation ratings for patients where they experience a higher quality therapeutic relationships with, whereas-depending on the scale that is used to measure motivation-they give lower ratings to patients who respond in socially desirable ways and to ethnic minority patients. As patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment (regardless of the theoretical framework that is used to assess motivation), this implies that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions.
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Affiliation(s)
- Eline C Jochems
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Topclinical Center for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands.
| | - Arno van Dam
- Western North Brabant Mental Health Center (GGZ Westelijk Noord Brabant), Bergen op Zoom, The Netherlands.,Department of Tranzo, Faculty of Social Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - Sylvia C M Scheffer
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Christina M van der Feltz-Cornelis
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Topclinical Center for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands.,Department of Tranzo, Faculty of Social Sciences, Tilburg University, Tilburg, The Netherlands
| | - Niels L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Parnassia Bavo Groep, Rotterdam, The Netherlands
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Okon S, Webb D. Self-Determination: A Curriculum of Empowerment for Health and Wellness in a Psychosocial Rehabilitation Clubhouse. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/0164212x.2014.911672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dugosh KL, Festinger DS, Lynch KG, Marlowe DB. The Survey of Treatment Entry Pressures (STEP): identifying client's reasons for entering substance abuse treatment. J Clin Psychol 2014; 70:956-66. [PMID: 24719233 DOI: 10.1002/jclp.22093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Systematically identifying reasons that clients enter substance abuse treatment may allow clinicians to immediately focus on issues of greatest relevance to the individual and enhance treatment engagement. We developed the Survey of Treatment Entry Pressures (STEP) to identify the specific factors that precipitated an individual's treatment entry. The instrument contains 121 items from 6 psychosocial domains (i.e., family, financial, social, medical, psychiatric, legal). The current study examined the STEP's psychometric properties. METHOD A total of 761 participants from various treatment settings and modalities completed the STEP prior to treatment admission and 4-7 days later. Analyses were performed to examine the instrument's psychometric properties including item response rates, test-retest reliability, internal consistency, and factor structure. RESULTS The items displayed adequate test-retest reliability and internal consistency within each psychosocial domain. Generally, results from exploratory and confirmatory factor analyses support a 2-factor structure reflecting type of reinforcement schedule. CONCLUSION The study provides preliminary support for the psychometric properties of the STEP. The STEP may provide a reliable way for clinicians to characterize and capitalize on a client's treatment motivation early on which may serve to improve treatment retention and therapeutic outcomes.
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Jochems EC, Mulder CL, Duivenvoorden HJ, van der Feltz-Cornelis CM, van Dam A. Measures of motivation for psychiatric treatment based on self-determination theory: psychometric properties in Dutch psychiatric outpatients. Assessment 2014; 21:494-510. [PMID: 24391079 DOI: 10.1177/1073191113517928] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory-The Treatment Entry Questionnaire (TEQ), Health Care Climate Questionnaire (HCCQ), and the Short Motivation Feedback List (SMFL)-in a sample of 348 Dutch adult outpatients with primary diagnoses of mood, anxiety, psychotic, and personality disorders. Structural equation modeling showed that the empirical factor structures of the TEQ and SMFL were adequately represented by a model with three intercorrelated factors. These were interpreted as identified, introjected, and external motivation. The reliabilities of the Dutch TEQ, HCCQ, and SMFL were found to be acceptable but can be improved on; congeneric estimates ranged from 0.66 to 0.94 depending on the measure and patient subsample. Preliminary support for the construct validities of the questionnaires was found in the form of theoretically expected associations with other scales, including therapist-rated motivation and treatment engagement and with legally mandated treatment. Additionally, the study provides insights into the relations between measures of motivation based on self-determination theory, the transtheoretical model and the integral model of treatment motivation in psychiatric outpatients with severe mental illness.
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Affiliation(s)
- Eline C Jochems
- Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | | | - Christina M van der Feltz-Cornelis
- Erasmus MC University Medical Center, Rotterdam, Netherlands Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands Breburg Mental Health Center (GGZ Breburg), Tilburg, Netherlands Tilburg University, Tilburg, Netherlands
| | - Arno van Dam
- Western North Brabant Mental Health Center (GGZ Westelijk Noord Brabant), Bergen op Zoom, Netherlands
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Yeterian JD, Greene MC, Bergman BG, Kelly JF. Does Mandated Treatment Benefit Youth? A Prospective Investigation of Adolescent Justice System Involvement, Treatment Motivation, and Substance Use Outcomes. ALCOHOLISM TREATMENT QUARTERLY 2013; 31:431-449. [PMID: 24159252 DOI: 10.1080/07347324.2013.831671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The majority of adolescents treated for substance use disorder (SUD) in the United States are now referred by the criminal justice system. Little is known, however, regarding how justice-system involvement relates to adolescent community treatment outcomes. Controversy exists, also, over the extent to which justice system involvement reflects a lack of intrinsic motivation for treatment. This study examined the relation between justice system referral and reported reason for treatment entry and tested the extent to which each predicted treatment response and outcome. METHOD Adolescent outpatients (N = 127; M age = 16.7, 24% female) with varying levels of justice-system involvement (i.e., no justice system involvement [No-JSI; n = 63], justice-system involved [JSI; n = 40], justice system involved-mandated [JSI-M; n = 24]) and motivation levels (i.e., self-motivated [n = 40], externally-motivated [n = 87]) were compared at treatment intake. Multilevel mixed models tested these groups' effects on percent days abstinent (PDA) and odds of heavy drinking (HD) over 12 months. RESULTS JSI-M were less likely to be self-motivated compared to No-JSI or JSI (p = 0.009). JSI-M had higher PDA overall, but with significant declines over time, relative to no-JSI. Self-motivated patients did not differ from externally-motivated patients on PDA or HD. CONCLUSIONS Mandated adolescent outpatients were substantially less likely to report self-motivated treatment entry. Despite the notion that self-motivated treatment entry would be likely to produce better outcomes, a judicial mandate appears to predict an initially stronger treatment response, although this diminishes over time. Ongoing monitoring and/or treatment may be necessary to help maintain treatment gains for justice system-involved adolescents.
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Affiliation(s)
- Julie D Yeterian
- Massachusetts General Hospital, Center for Addiction Medicine, Department of Psychiatry, and Harvard Medical School, Boston, MA 02114
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Kenaszchuk C, Wild TC, Rush BR, Urbanoski K. Rasch model of the GAIN substance problem scale among Canadian adults seeking residential and outpatient addiction treatment. Addict Behav 2013; 38:2279-87. [PMID: 23583833 DOI: 10.1016/j.addbeh.2013.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 01/29/2013] [Accepted: 02/26/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND The GAIN Substance Problem Scale (SPS) measures alcohol and drug problem severity within a DSM-IV-TR framework. This study builds on prior psychometric evaluation of the SPS by using Rasch analysis to assess scale unidimensionality, item severity, and differential item functioning (DIF). METHODS Participants were attending residential or outpatient treatment in Alberta and Ontario, Canada, respectively (n=372). Rasch analyses modeled a latent problem severity continuum using SPS scores at treatment admission and 6-week follow-up. We examined DIF by gender, treatment modality (outpatient vs. residential), and assessment timing (baseline vs. follow-up). RESULTS Model fit was good overall, supporting unidimensionality and a single underlying continuum of substance problem severity. Relative to person severity, however, the range of item severities was narrow. Items were too severe for many clients to endorse, particularly at follow-up. Overall, the rank order of item severities was stable across gender, treatment modality, and time point. Although traditional Rasch criteria indicated a number of statistically significant and substantive DIF estimates across modality and time points, effect size indices did not suggest a net effect on total scale scores. CONCLUSIONS The analysis broadly supports use of the SPS as an additive measure of global substance severity in men and women and both residential and outpatient settings. Although DIF was not a major concern, there was evidence of item redundancy and suboptimal matching between items and persons. Findings highlight potential opportunities for further improving this scale in future research and clinical applications of the GAIN.
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Affiliation(s)
- Chris Kenaszchuk
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON M5S 2S1, Canada
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