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Thai H, Audet ÉC, Koestner R, Lepage M, O'Driscoll GA. The role of motivation in clinical presentation, treatment engagement and response in schizophrenia-spectrum disorders: A systematic review. Clin Psychol Rev 2024; 113:102471. [PMID: 39111125 DOI: 10.1016/j.cpr.2024.102471] [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: 03/15/2024] [Revised: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 09/09/2024]
Abstract
Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.
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Affiliation(s)
- Helen Thai
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Élodie C Audet
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Richard Koestner
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Martin Lepage
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Gillian A O'Driscoll
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Herchenroeder L, Kracke-Bock J, Rentia S, Dodge T. Application of Self-Determination Theory to Substance Use and Its Treatment: A Scoping Review of the Literature. Subst Use Misuse 2024; 59:1464-1480. [PMID: 38789403 DOI: 10.1080/10826084.2024.2352622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background: Self-determination theory (SDT) may provide important insights for understanding substance misuse and treatment outcomes. However, to date, the literature applying SDT to substance use and its treatment is varied and difficult to integrate. Methods: The authors searched psycINFO and PubMed on October 26th, 2021 to identify articles applying SDT to substance use and its treatment. Eligible studies were published in peer-reviewed articles in English, on adult populations (18+), and explicitly applied SDT to the context of substance use or its treatment. Results were categorized as studies applying SDT in non-treatment or treatment settings and were synthesized within these categories by substance(s) of focus, primary outcome(s), component(s) of SDT utilized, and relevant findings. Results: The search revealed 38 articles applying SDT in non-treatment (k = 16) and treatment (k = 22) settings. Causality orientations and the basic psychological needs were the most frequently studied components of SDT. Studies that applied SDT in non-treatment settings placed a greater emphasis on causality orientations, whereas treatment studies more frequently targeted or measured basic psychological needs. Conclusions: SDT constructs consistently predicted both substance misuse and treatment outcomes in a theoretically consistent manner, however, several important gaps remain and opportunities for future research are discussed.
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Affiliation(s)
- Luke Herchenroeder
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Jonah Kracke-Bock
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Saba Rentia
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
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Ayaz L, Nazari F. Enhancing Relapse Prevention: Examining the Impact of Experiential Avoidance, Integrative Self-Knowledge, and Basic Psychological Needs in Substance Use Treatment. ADDICTION & HEALTH 2024; 16:69-75. [PMID: 39051040 PMCID: PMC11264483 DOI: 10.34172/ahj.2024.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/15/2024] [Indexed: 07/27/2024]
Abstract
Background The harmful effects of drug relapse have always been one of the major challenges in addiction treatment. The present study aimed to predict drug relapse in addicted men under treatment based on experiential avoidance, integrative self-knowledge, and basic psychological needs. Methods The present study was a correlational one. The statistical population included all addicted men in Choubindar prison in Qazvin in 2021, among whom 200 individuals were selected randomly. Then, the participants filled out the Relapse Prediction Scale (RPS), Multidimensional Experiential Avoidance Questionnaire (MEAQ), Integrative Self-Knowledge Scale (ISK), and Basic Psychological Needs Scale (BPNS). Data were analyzed using stepwise regression via SPSS software (version 25). Findings The results of the study demonstrated that some of the components of experiential avoidance including distraction, distress endurance, behavioral avoidance, and distress aversion could account for 14.0% of the variance of the relapse in the addicts (P<0.05). Moreover, the obtained results considering the reflective self-knowledge component and the overall score of integrative self-knowledge could explain 15.0% of the variance in relapse in the addicts. Among the basic psychological needs, communication could predict 3.8% of the variance in relapse. Conclusion Based on the results of the present study, it is suggested that through addiction treatment and prevention of relapse programs, psychologists reduce drug relapse in addicts by decreasing distractions and behavioral avoidance, increasing distress endurance, enhancing self-knowledge, and improving efficient relationships.
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Affiliation(s)
- Leila Ayaz
- Faculty of Humanities and Arts, Islamic Azad University, Zanjan Branch, Zanjan, Iran
| | - Fatemeh Nazari
- Department of Psychology, Faculty of Humanities and Arts, Islamic Azad University, Zanjan Branch, Zanjan, Iran
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Chigangaidze RK, Noel Garikai M, Samuel Lisenga S. How deep is the cancerous cut of substance use disorders on human rights? The effects of substance use disorders from a human rights perspective: The thinking of Developmental Clinical Social Work. SOCIAL WORK IN HEALTH CARE 2023:1-15. [PMID: 37276187 DOI: 10.1080/00981389.2023.2221706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
Developmental Clinical Social Work (DCSW) involves the integration of social development approaches to the prevention, assessment, diagnosis, and treatment of psychological, behavioral, emotional, and medical disorders through social work methods. In doing so, it also covers the predispositions that occur over time in one's life course. Utilising the thinking of Developmental Clinical Social Work, the paper explores the effects of substance use disorders from a human rights perspective. The human rights to health, adequate housing, food and nutrition, development, clean and healthy environment, occupational health and safety, education, parental and children rights have been discussed considering the effects of substance use disorders. The article stimulates the realization that investment in the prevention of substance use disorders advances for the attainment and enjoyment of the above-mentioned human rights. To its end, the paper contradicts with the notion that the use of drugs is a "human right". It justifies the need for court sanctioned substance use disorder treatment facilities that are evidence-based and adhere to human rights. It should be noted that this is a conceptual reflection of three academics, two of whom have taught on the advanced substance use and treatment course and one has taught on developmental social work courses.
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Affiliation(s)
- Robert K Chigangaidze
- School of Health, Science and Wellbeing (Staffordshire University), Stoke-on-Trent, UK
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De Salis HF, Martin R, Mansoor Z, Newton-Howes G, Bell E. A realist review of residential treatment for adults with substance use disorder. Drug Alcohol Rev 2023; 42:827-842. [PMID: 36747370 DOI: 10.1111/dar.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023]
Abstract
ISSUES Completion of residential treatment for substance use disorder (SUD) relates to improvements in substance use and mental health. Findings from systematic reviews have been equivocal about which interventions work best for clients. There has been limited attention to the theories that explain the effectiveness of residential treatment. APPROACH We conducted a realist review of the literature to identify program theories that would explain successful and unsuccessful outcomes from residential treatment for SUD. The unit of analysis was context-mechanism-outcome (CMO). Inclusion criteria were studies of residential treatment of more than 30 days for adults with SUD. Pharmacological studies were excluded. KEY FINDINGS We identified 24 studies from 5748 screened. The studies were from settings comprising Indigenous programs, faith-based programs, psycho-social interventions and therapeutic communities and were conducted in North America, Scandinavia, Continental Europe and Australasia. We chose six CMO configurations as the best explanations for outcomes from residential treatment. Theories that best explained the mechanisms of change were the need to belong, meaning in life, and self-determination theory. IMPLICATIONS Previous research has noted similar outcomes from different residential treatment interventions, but has not been able to explain these similarities. In contrast, our findings suggest that the outcomes can be explained by causal mechanisms that apply across all programs, regardless of the philosophy of treatment. CONCLUSION We identified six CMO configurations whose mechanisms of change could be explained by three overarching theories-the need to belong, meaning in life and self-determination theory. The findings apply across ethnicities and genders.
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Affiliation(s)
- Henry F De Salis
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Rachelle Martin
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.,Burwood Academy Trust, Burwood Hospital, Christchurch, New Zealand
| | - Zara Mansoor
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.,Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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Nelson LA, Collins SE, Birch J, Burns R, McPhail G, Onih J, Cupp C, Ubay T, King V, Taylor E, Masciel K, Slaney T, Bunch J, King R, Mahinalani-Garza C, Piper BKS, Squetimkin-Anquoe A. Content Analysis of Preferred Recovery Pathways Among Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorders. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2022. [DOI: 10.1177/00220221221132778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately three fourths of the American Indian and Alaska Native (AI/AN) population lives in urban areas, and urban AI/ANs are disproportionately affected by alcohol-related morbidity and mortality. Although no studies have documented alcohol use disorder (AUD) treatment outcomes specific to urban AI/ANs, studies in other Native communities highlight concerns about the cultural acceptability of directive, abstinence-based approaches, such as cognitive behavioral therapy and 12-step programs. Understanding this population’s desired recovery pathways in their own words may help providers create more culturally appropriate, patient-centered, and effective approaches. Participants ( N = 31) were urban AI/ANs who screened positive for AUD using the AUDIT-C. They participated in semi-structured interviews eliciting their experiences in AUD treatment to date and suggestions for redesigning AUD treatment in their own vision. Conventional content analysis was used to create a thematic description. Findings indicated that intrinsic motivation and not extrinsic pressure (e.g., mandated treatment) was associated with positive treatment engagement and outcomes. Participants appreciated feeling safe and supported in AUD treatment, but also felt AUD treatment could be institutional and oppressive. Participants preferred compassionate counselors with lived experience who could provide insights into recovery; they largely did not appreciate a “tough love” approach or power struggles with counselors. Native-led treatment centers providing access to cultural practices were preferred. Moving forward, participants suggested AUD treatment providers should help patients meet basic needs, prioritize patient-driven versus provider-driven goal-setting, support patients’ reconnection with meaningful activities, facilitate access to a supportive community network, and recognize cultural activities as important recovery pathways.
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Affiliation(s)
| | - Susan E. Collins
- Washington State University, Spokane, USA
- University of Washington School of Medicine, Seattle, USA
| | | | | | | | | | | | | | | | - Emily Taylor
- University of Washington School of Medicine, Seattle, USA
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Epperson MW, Sarantakos SP, Suslovic BJ, Thompson JG, Self JJ. "You feed and water a rose bush and eventually it blossoms": Constructions of self-transformation among mental health court defendants. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 85:101839. [PMID: 36209667 DOI: 10.1016/j.ijlp.2022.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
This study qualitatively examined adaptive responses to mental health court mandates through individual interviews with defendants in a mental health court (n = 31). Thematic analysis of interview data revealed that defendants engaged in meaning-making to comprehend and adapt to the perceived programmatic demands of mental health court. Programmatic burdens, court-enforced accountability, and intrinsic rewards were themes that converged to form a distinct adaptive response: construction of self-transformation narratives. Defendants in this study tended to interpret the intense burdens of participation as intrinsically rewarding and meaningful, leading them to see the expectations of mental health court as an opportunity to better themselves. The findings help to differentiate between compliance versus full treatment engagement among defendants with serious mental illness (SMI). This study's findings have important implications for how individuals with serious mental illness engage with court diversion programs and mandated treatment, and how these defendants may be best served in specialized mental health court programs.
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Affiliation(s)
- Matthew W Epperson
- University of Chicago, Crown Family School of Social Work, Policy, & Practice, 969 E. 60(th) Street, Chicago, IL 60637, United States of America.
| | - Sophia P Sarantakos
- University of Chicago, Crown Family School of Social Work, Policy, & Practice, 969 E. 60(th) Street, Chicago, IL 60637, United States of America.
| | - Brianna J Suslovic
- University of Chicago, Crown Family School of Social Work, Policy, & Practice, 969 E. 60(th) Street, Chicago, IL 60637, United States of America.
| | - Julian G Thompson
- University of Chicago, Crown Family School of Social Work, Policy, & Practice, 969 E. 60(th) Street, Chicago, IL 60637, United States of America.
| | - Jesse J Self
- University of Chicago, Crown Family School of Social Work, Policy, & Practice, 969 E. 60(th) Street, Chicago, IL 60637, United States of America.
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8
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Seto MC, Healey LV, Ahmed AG. Legally Mandated, Formally Pressured, or Voluntary Anger Treatment: Associations With Treatment Recommendations, Refusal, and Completion. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20012-NP20039. [PMID: 34715763 DOI: 10.1177/08862605211050100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Legally mandated treatment is common in the criminal justice system, for example, for anger management, substance misuse, and intimate partner violence. Past studies have compared voluntary and legally mandated treatment participants but have not distinguished a third, in-between group that is formally pressured to participate in treatment, but not mandated by the criminal justice system. The current study aimed to assess differences on individual characteristics (e.g., sociodemographic and psychiatric) and baseline measures of psychopathology (e.g., anger, aggression, and depression) across three levels of voluntariness and to determine whether voluntariness was associated with treatment recommendation, refusal, and completion at an outpatient anger treatment clinic. Data were retrospectively gathered from the clinical charts of 405 participants. Referrals were classified as voluntary (e.g., self-referred, 61%), formally pressured (e.g., required by work, 14%), or legally mandated (e.g., court order, 25%). Legally mandated participants were younger, more likely to have substance use disorder, less likely to be women, to have a high school education, or to be on psychiatric medications compared to the other two groups. Voluntary participants scored higher on measures of self-reported anger, depression, and stress than the legally mandated participants. Legally mandated participants in particular presented with non-clinical levels of anger and aggression. Level of voluntariness did not affect the decision to recommend individual or group therapy after an intake assessment, but legally mandated participants were significantly more likely (OR = 2.30) than voluntary participants to refuse recommended treatment. Level of voluntariness did not have a significant association with treatment completion. Findings support our distinction between legally mandated and formally pressured participants, but do not support previous research that suggests legally mandated individuals have lower attrition rates in similar treatment programs. The study has implications for the criminal justice system and for anger treatment programs who admit participants with varying levels of voluntariness.
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Stahler GJ, Mennis J, Stein LAR, Belenko S, Rohsenow DJ, Grunwald HE, Brinkley-Rubinstein L, Martin RA. Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015-2018. Drug Alcohol Depend 2022; 236:109498. [PMID: 35605535 DOI: 10.1016/j.drugalcdep.2022.109498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine the use and association of medications for opioid use disorder (MOUD) with treatment completion and retention for criminal justice referred (CJR) admissions to residential treatment. METHODS A retrospective analysis of the Treatment Episode Dataset-Discharge (TEDS-D; 2015-2018) for adults (N = 205,348) admitted to short-term (ST) (< 30 days) or long-term (LT) (>30 days) residential treatment for OUD. Outcomes were MOUD in treatment plans, and treatment completion and retention (ST >10 days; LT > 90 days). Logistic regression analyses were conducted separately for ST and LT settings. RESULTS CJR admissions were less likely to have MOUD than non-CJR admissions (ST, 11% vs. 21%; LT, 10% vs. 24%, respectively) and were more likely to complete and be retained in treatment. In ST settings, MOUD was associated with higher likelihood of treatment completion and retention. In LT settings, MOUD was associated with higher likelihood of treatment retention and lower likelihood of treatment completion. These associations tended to be slightly weaker for CJR admissions, with the exception of treatment completion in LT settings, but the moderating effect size of CJR status in all models was very small. Small differences in the moderating effect of CJR status by race and ethnicity were observed in LT settings. CONCLUSIONS MOUD is greatly under-utilized for CJR patients, and given that MOUD was associated with positive outcomes, there is a critical need to find ways to increase access to MOUD for CJR patients in residential treatment. Race and ethnicity appear to have relatively little impact on outcomes.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, United States
| | - L A R Stein
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States; Department of Psychology, The University of Rhode Island, United States
| | - Steven Belenko
- Department of Criminal Justice, Temple University, United States
| | - Damaris J Rohsenow
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
| | | | | | - Rosemarie A Martin
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, United States
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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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Urbanoski K, Merrigan S, Milligan K. Gendered harms: The lack of evidence on treatment that is mandated by child protection services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103481. [PMID: 34653767 DOI: 10.1016/j.drugpo.2021.103481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/12/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Karen Urbanoski
- Canadian Institute for Substance Use Research, Public Health and Social Policy, University of Victoria, 2300 McKenzie Ave., Victoria BC V8P 5C2 Canada.
| | - Sydele Merrigan
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria BC V8P 5C2 Canada.
| | - Karen Milligan
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto ON M5B 2K3, Canada.
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Hood C, Patton R. Exploring the role of psychological need fulfilment on stress, job satisfaction and turnover intention in support staff working in inpatient mental health hospitals in the NHS: a self-determination theory perspective. J Ment Health 2021; 31:692-698. [PMID: 34565267 DOI: 10.1080/09638237.2021.1979487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Meeting psychological needs for autonomy, competence and relatedness as described by Self-Determination Theory (SDT) has been associated with increased well-being and job satisfaction in mental health staff and improved care outcomes for patients. AIMS The study investigated whether psychological need satisfaction predicted stress, turnover intention and job satisfaction in health care assistants (HCA) working in inpatient mental health hospitals in the United Kingdom including full time (FT) and temporary agency worker (TAW) staff. METHODS A cross-sectional survey explored need satisfaction between FT (n = 63) and TAW (n = 39) staff using the Work-Related Basic Need Satisfaction Scale. Multiple regression was used to explore whether satisfaction of the needs for autonomy, competence and relatedness predicted scores on measures of stress, job satisfaction and turnover intention. RESULTS Results were comparable between FT and TAW staff. Autonomy was the need least satisfied, a need which predicted self-reported job satisfaction, stress and turnover intention. Relatedness also predicted job satisfaction and turnover intention. CONCLUSIONS Recommendations are made to explore experiences of (and barriers to) autonomy and relatedness in inpatient HCA staff to target and improve autonomy and relatedness in this workforce. Implications of doing so are considered at a staffing, organisational and patient level.
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Affiliation(s)
- Charlotte Hood
- Faculty of Health and Medical Sciences (School of Psychology), University of Surrey, Guildford, Surrey, UK
| | - Robert Patton
- Faculty of Health and Medical Sciences (School of Psychology), University of Surrey, Guildford, Surrey, UK
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13
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Lucabeche VX, Quinn PV. Court-Mandated Treatment Outcomes for Prescribed Opioid Use Disorder: A Gender Based Study. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211044410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study provides empirical information suggesting court-mandated treatment may be a more effective treatment pathway for opioid use disorder (OUD). To examine the effects of mandated treatment for prescription opioid users, we consider the differences in discharge completion rates for court-mandated and non-mandated treatment for both males and females. We use the Treatment Episode Data Set-Discharges (TEDS-D) from 2015 to 2017 with 13,239, 14,765, and 15,433 cases, respectively, to study successful completion rates for males and females with OUD. Logistic regression analysis confirms a greater completion rate for mandated treatment episodes. Of all mandated females, 59% completed treatment in each of the 3 years as compared to the 59%, 65%, and 64% of successful completion for mandated males, respectively, from 2015 to 2017. Our results suggest court-mandated treatment pathways are more effective on treatment completion for individuals with OUD, yet treatment completion disparity between sexes increases even when females are mandated.
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Rivera D, Dueker D, Sanchez M, Amaro H. Examination of referral source and discharge outcomes among women in residential substance use disorder treatment. J Subst Abuse Treat 2021; 125:108319. [PMID: 34016303 DOI: 10.1016/j.jsat.2021.108319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/06/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Court-mandated substance use disorder (SUD) treatment, compared to nonmandated treatment, has been associated with increased retention and completion. However, due to limitations of previous studies, whether child protective services (CPS) and criminal justice (CJ) mandated treatment improve treatment completion and retention among women in residential treatment remains unclear. PURPOSE This study investigated differences in treatment completion and progress based on three clinical discharge outcomes (i.e., completer, noncompleter with significant progress, and noncompleter without significant progress). We hypothesized that women mandated by (1) CJ will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to women who are CPS mandated; (2) CPS will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to nonmandated women. METHODS Study staff conducted multinomial logistic regression analyses on data for a diverse sample of 161 women mandated or nonmandated (CJ: N = 71, CPS: N = 66, nonmandated: N = 24) into residential SUD treatment to determine each group's clinically defined treatment discharge outcomes while controlling for covariates. RESULTS Multinomial logistic regression analyses revealed that being mandated by the CJ system predicted being a treatment completer compared to those who were CPS mandated (RR = 9.88, p = .009). The study found no differences in discharge status of completer without satisfactory progress between those who were CPS mandated and those who were CJ mandated or nonmandated. For women mandated by the CPS system compared to nonmandated women, the risk of being a treatment completer relative to noncompleters with satisfactory progress was not significant (RR = 1.08, p = .897). Analyses showed that being mandated by the CJ system predicted an improved clinically defined discharge outcome of treatment completer compared to women who were nonmandated to treatment (RR = 10.74, p = .016). In several of the models, drug and alcohol craving was associated with increased odds of being a noncompleter of treatment without satisfactory progress. CONCLUSIONS This study demonstrates that improved treatment completion and discharge status cannot be assumed based solely on being mandated by the CJ or CPS systems. As evidenced by variability in treatment discharge outcomes within and among referral groups, the paper suggests directions for future research.
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Affiliation(s)
- Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MRF 214, Los Angeles, CA 90089, United States of America.
| | - Donna Dueker
- Department of Health Sciences, California State University, Dominguez Hills, 1000 East Victoria Street, Carson, CA 90747, United States of America.
| | - Mariana Sanchez
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, United States of America.
| | - Hortensia Amaro
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, United States of America; Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, United States of America.
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15
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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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16
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Rivera D, Dueker D, Amaro H. Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:21. [PMID: 33653374 PMCID: PMC7927366 DOI: 10.1186/s13011-021-00357-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
Background Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. Trial registration ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648.
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Affiliation(s)
- Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MRF 214, Los Angeles, CA, 90089, USA.
| | - Donna Dueker
- Department of Health Sciences, California State University, Dominguez Hills, 1000 East Victoria Street, Carson, CA, 90747, USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC 5, Miami, FL, 33199, USA
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Sharp A, Armstrong A, Moore K, Carlson M, Braughton D. Patient Perspectives on Detox: Practical and Personal Considerations through a Lens of Patient-Centered Care. Subst Use Misuse 2021; 56:1593-1606. [PMID: 34228598 DOI: 10.1080/10826084.2021.1936050] [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: 10/20/2022]
Abstract
Inpatient detoxification is often required before a client can move on to additional substance abuse treatment services. Although often short-term, time spent in inpatient detoxification tends to have long-lasting effects on the recovery process. This qualitative study focuses on one treatment facility in Tampa, Florida that offers a range of recovery services, including inpatient detox and outpatient treatment. Focus groups (N = 70 participants) captured client perceptions of direct clinical care operations, access to resources, and relationships with direct care staff within the inpatient detox program. Perceptions were then assessed using a thematic analysis approach with attention to the literature on person-centered care best practices, behavior change, and patient engagement theories to better understand how facility practices affect treatment engagement and retention. Findings elucidated several practical facilitators and barriers to recovery such as facility resources, services offered, transition to aftercare, and sustainability of treatment. Findings also illuminated several personal facilitators and barriers including patient-staff interactions, personal motivation, and family and community support. The resulting recommendations for practice and research are discussed.
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Affiliation(s)
- Amanda Sharp
- University of South Florida, Tampa, Florida, USA
| | | | | | | | - David Braughton
- Agency for Community Treatment Services, Tampa, Florida, USA
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18
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Smith WT. Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. J Subst Abuse Treat 2020; 116:108045. [DOI: 10.1016/j.jsat.2020.108045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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19
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Amini-Rarani M, Khedmati Morasae E, Pashaei T, Moeeni M. Redemption from plight: a qualitative study on reasons behind treatment decisions among Iranian male opioid users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:57. [PMID: 32771025 PMCID: PMC7414986 DOI: 10.1186/s13011-020-00299-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Opioid use remains a significant cause of harm to individual health. Perceived motives are of the main factors that help lead a patient into seeking treatment voluntarily to obviate that harm. The current study expands on the literature by exploring when and how male users of opioids become motivated to voluntarily seek treatment services. METHODS In a qualitative study in Isfahan city from January 2018 to March 2019, 55 male participants who had already started a variety of treatment services to withdraw their dependence on opioids were recruited. Selection of participants was based on a maximum variation purposive sampling strategy. Each participant took part in a unstructured interview to identify his motives for seeking opioid use treatment. Interviews were undertaken in eight different treatment centers. An inductive thematic analysis method was used to analyze the interviews. RESULTS The findings highlight that Iranian male opioid users have different motivations to seek treatment. To be precise, the findings illuminate three global themes and six themes as treatment-seeking motives among the participants including; motives related to family (reason for family and reason of family), quality of life (adverse effects on personal lifestyle and health) and economic motives (financial failure and job failure). CONCLUSIONS The findings can improve our understanding of the motives for seeking treatment from the perspective of opioid patients who entered themselves into treatment. Particularly, these findings could help policymakers and treatment providers to better understand opioid-use patient's perceived concerns and fears as motives for treatment-seeking.
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Affiliation(s)
- Mostafa Amini-Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Tahereh Pashaei
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maryam Moeeni
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Hezar-Jerib Ave, Isfahan, 81746 73461, Iran.
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20
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Pickard JG, Sacco P, van den Berk-Clark C, Cabrera-Nguyen EP. The effect of legal mandates on substance use disorder treatment completion among older adults. Aging Ment Health 2020; 24:497-503. [PMID: 30588828 DOI: 10.1080/13607863.2018.1544209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: This study seeks to determine the relationship between referral type (legally mandated versus non-mandated) and substance use disorder (SUD) treatment completion among older adults and by primary substance used.Method: We used data from the Treatment Episode Data Set - Discharges (TEDS-D) from 2011. Using data for persons age 55 and over (n = 104,747), we used propensity score matching (PSM) to address selection bias and attenuate the likelihood of a type I error. Logistic regression models estimated the effect of referral type on treatment completion based on treatment for a primary substance for five categories of substances.Results: In the matched sample, those who faced treatment mandates had 71% greater odds of completing treatment compared with those who entered treatment voluntarily (OR =1.71, 95% CI [1.64, 1.79]). Based on the primary drug used, odds of treatment completion were highest for alcohol, with 86% greater treatment completion for the mandated individuals compared with those entering treatment without a legal mandate (OR =1.86, 95% CI [1.75, 1.97]).Conclusion: These findings suggest that the motivating influence of treatment mandates may encourage completion of SUD treatment among older adults. Although the legal mandates for treatment are punitive, they may act to keep older adults with SUD engaged in treatment, an important factor as treatment completion is inversely related to relapse of a SUD.
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Affiliation(s)
- Joseph G Pickard
- University of Missouri-St. Louis, School of Social Work, St. Louis, MO, USA
| | - Paul Sacco
- University of Maryland-Baltimore, School of Social Work, Baltimore, MD, USA
| | - Carissa van den Berk-Clark
- Saint Louis University School of Medicine, Department of Family and Community Medicine, St. Louis, MO, USA
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21
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Urbanoski KA. Commentary on Pilarinos et al. (2020): Scientific realism and the study of coerced substance use treatment. Addiction 2020; 115:107-108. [PMID: 31709654 DOI: 10.1111/add.14832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Karen A Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, BC, Canada.,School of Public Health and Social Policy, University of Victoria, BC, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
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