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Tsutsumi S, Takano A, Usami T, Kumakura Y, Kanazawa Y, Takebayashi T, Sugiyama D, Matsumoto T. Risk and protective factors for early dropout from telephone monitoring for individuals with drug convictions in community mental health centers in Japan. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209347. [PMID: 38494050 DOI: 10.1016/j.josat.2024.209347] [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: 10/17/2023] [Revised: 01/27/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Individuals involved with the criminal justice system face challenges in receiving and maintaining substance use disorder (SUD) treatment and support. Although telephone monitoring (TM) could reduce these barriers, data on TM for community-dwelling individuals involved with the criminal justice system and research on individuals who drop out of TM are scarce. We examined the factors associated with dropping out early from the Voice Bridges Project, which provides TM for individuals on probation for drug-related convictions through community mental health centers in Japan. METHODS Participants (n = 546) were individuals aged ≥20 years with methamphetamine-related convictions who were on probation. Univariate analyses examine the associations between one-year follow-up status and baseline variables, and multivariate Cox proportional hazards regression analyses identify the risk and protective factors associated with dropping out. Stratified analyses report results based on sex and halfway-house residency. RESULTS The one-year dropout rate was 43.6 % (n = 238). Multivariate analysis identified two risk factors for dropping out-halfway-house residency and suicide attempts in the past year, and two protective factors-higher education and the current use of SUD services. Sex-stratified analyses showed that halfway-house residency was a risk factor for both men and women. Attempted suicide was a risk factor for women. Conversely, higher education and current use of SUD services were protective factors for men. CONCLUSIONS Our results identify unique risk factors for women, such as a recent history of suicide attempts, and distinctive protective factors for men, including higher education and current use of SUD services, emphasizing the importance of sex-specific approaches. Furthermore, the study reveals that irrespective of sex, vulnerable individuals, such as halfway-house residents, are at a higher risk of dropping out from TM.
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Affiliation(s)
- Shiori Tsutsumi
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan; Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan.
| | - Ayumi Takano
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan.
| | - Takashi Usami
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan; Kitakyushu Municipal Mental Health and Welfare Center, 1-7-1 Bashaku, Kokurakita Ward, Kitakyushu, Fukuoka, Japan
| | - Yousuke Kumakura
- Department of Neuropsychiatry, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuka Kanazawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan
| | - Toru Takebayashi
- Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan; Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan.
| | - Daisuke Sugiyama
- Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan; Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan; Faculty of Nursing and Medical Care, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan.
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan.
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Timko C, Lewis M, Lor MC, Aldaco-Revilla L, Blonigen D, Ilgen M. Hazardous Drinking Interventions Delivered During Medical-Surgical Care: Patient and Provider Views. J Clin Psychol Med Settings 2024; 31:224-235. [PMID: 36959430 PMCID: PMC10035972 DOI: 10.1007/s10880-023-09954-4] [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] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
Addressing hazardous drinking during medical-surgical care improves patients' health. This formative evaluation examined patients' consideration of options to change drinking and engage in treatment. It explored whether interventions such as "DO-MoST" overcome treatment barriers. We interviewed 20 medical-surgical patients with hazardous drinking in a trial of DO-MoST, and 16 providers. Analyses used a directed content approach. Patients were receptive to and comfortable discussing drinking during medical-surgical care. Interventions like DO-MoST (patient-centered, motivational approach to shared decision making) addressed some treatment barriers. Patients and providers viewed such interventions as helpful by building a relationship with a psychologist who facilitated self-awareness of drinking behaviors, and discussing connections between alcohol- and physical health-related problems and potential strategies to address drinking. However, both groups expressed concerns about individual and system-level barriers to long-term change. Interventions like DO-MoST bridge the gap between the patient's medical treatment episode and transition to other health care settings. TRIAL REGISTRATION: The study is registered on ClinicalTrials.gov (ID: NCT03258632).
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Affiliation(s)
- Christine Timko
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd. (152-MPD), Menlo Park, CA, 94025, USA.
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA.
| | - Mandy Lewis
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, North Campus Research Complex, University of Michigan, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
| | - Mai Chee Lor
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd. (152-MPD), Menlo Park, CA, 94025, USA
| | - Laura Aldaco-Revilla
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, North Campus Research Complex, University of Michigan, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
| | - Daniel Blonigen
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd. (152-MPD), Menlo Park, CA, 94025, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Mark Ilgen
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, North Campus Research Complex, University of Michigan, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
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Woodhead EL, Ilgen M, Timko C. Telephone monitoring and 15-month outcomes for patients with co-occurring substance use and mental health disorders: Moderating effects of high-risk patient characteristics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209094. [PMID: 37285924 DOI: 10.1016/j.josat.2023.209094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/27/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Telephone monitoring interventions for substance use disorders are an important component of continuing care to reduce relapse and connect patients to services. However, a knowledge gap still exists as to which patient groups benefit most from them. This secondary analysis of a randomized controlled trial examined moderators of associations between telephone monitoring and 15-month substance use outcomes among patients with co-occurring substance use and mental health disorders. High-risk patient characteristics at baseline were examined as potential moderators of the effectivness of telephone monitoring, including history of incarceration, severity of depression symptoms, and suicide risk. METHODS Participants were 406 psychiatry inpatients with documented substance use and mental health disorders who were randomized to treatment as usual (TAU; n = 199) or TAU plus telephone monitoring (TM; n = 207). Outcomes included abstinence self-efficacy (Brief Situational Confidence Questionnaire) and alcohol and drug use severity (Addiction Severity Index composites) at 15-month follow-up. Analyses examined main effects of treatment condition and moderators, and interactions between treatment condition and moderators. RESULTS The study found five significant main effects, three of which were qualified by significant interactions. Incarceration history was associated with higher drug use severity; higher suicide risk was associated with higher abstinence self-efficacy. Regarding interaction effects, among participants with an incarceration history, TM compared to TAU was associated with significantly lower alcohol use severity at 15-month follow-up; this finding did not hold for never-incarcerated participants. For participants with less severe depression symptoms, TM compared to TAU was associated with significantly lower alcohol use severity and higher abstinence self-efficacy at follow-up; this did not hold for participants with more severe depression symptoms. Suicide risk was not a significant moderator of any outcome. CONCLUSIONS Results indicate that TM is effective in improving alcohol use severity and abstinence self-efficacy for some subgroups of patients, including patients with an incarceration history or less severe depression. Results inform the clinical provision of substance use disorder care by means of telehealth, which increased due to the COVID-19 pandemic.
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Affiliation(s)
- Erin L Woodhead
- Department of Psychology, San José State University, 1 Washington Square, San José, CA, 95192-0120, USA.
| | - Mark Ilgen
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI 48109, USA; University of Michigan Department of Psychiatry, North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI 48109, USA.
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
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Suzuki J, Loguidice F, Prostko S, Szpak V, Sharma S, Vercollone L, Garner C, Ahern D. Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study. JMIR Form Res 2023; 7:e43304. [PMID: 37405844 DOI: 10.2196/43304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches-individuals with the lived experience of recovery who obtain training to be coaches-are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. OBJECTIVE We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. METHODS This study was conducted on an American Society of Addiction Medicine-Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. RESULTS All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01). CONCLUSIONS The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Frank Loguidice
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Sara Prostko
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Veronica Szpak
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Samata Sharma
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Lisa Vercollone
- Harvard Medical School, Boston, MA, United States
- Department of Internal Medicine, Brigham and Women's Faulkner Hospital, Boston, MA, United States
| | - Carol Garner
- Harvard Medical School, Boston, MA, United States
- Department of Internal Medicine, Brigham and Women's Faulkner Hospital, Boston, MA, United States
| | - David Ahern
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Wang J, Deane FP, Kelly PJ, Robinson L. A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research. Drug Alcohol Rev 2023; 42:415-426. [PMID: 36633552 PMCID: PMC10108086 DOI: 10.1111/dar.13591] [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: 08/24/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
ISSUES Assessing drug and alcohol inpatient withdrawal treatment programs is important, as these represent a first step of treatment among people with alcohol and drug problems. However, there are many ways of measuring outcomes making it difficult for service providers to decide which domains and methods to use. This narrative review aims to clarify frequencies of the domains and methods used to assess withdrawal treatment outcomes. APPROACH We reviewed published studies that examined outcomes of inpatient drug and alcohol withdrawal treatment. The types of outcome measures used and the frequency of use were summarised. KEY FINDINGS The review showed that assessment of withdrawal treatment outcomes goes beyond traditional abstinence measures. Outcomes mainly focus on biological and psychological outcomes, with social outcomes rarely measured. Even within outcome domains (e.g., cravings), there were many assessment methods. IMPLICATIONS The review provides service providers with an outline of common outcome domains and measures. Given the importance of social functioning to recovery from alcohol and drug problems, greater emphasis on such measures is desirable. Future research could develop greater consensus on outcome measures for use in withdrawal management services to facilitate clarity around factors associated with treatment success. CONCLUSION Outcome assessment in withdrawal treatment goes beyond abstinence to include holistic measurement of biological, psychological and some social outcomes; but more work needs to be done to cohere the different assessment methods and broaden the scope to include social functioning.
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Affiliation(s)
- Jing Wang
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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Kiburi SK, Ngarachu E, Tomita A, Paruk S, Chiliza B. Digital interventions for opioid use disorder treatment: A systematic review of randomized controlled trials. J Subst Abuse Treat 2023; 144:108926. [PMID: 36356329 DOI: 10.1016/j.jsat.2022.108926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 09/05/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Opioid use disorders are associated with a high burden of disease and treatment gap. Digital interventions can be used to provide psycho-social treatment for opioid use disorders, as an alternative to or together with face-to-face interventions. This review aimed to assess the application and effectiveness of digital interventions to treat opioid use disorder globally. METHODS The study team searched four electronic databases (PubMed, Psych INFO, Web of Science and Cochrane Central register of controlled trials). The inclusion criteria were: randomized controlled trials, assessment for opioid use before and at least once following intervention, and use of digital interventions. The primary outcomes were opioid use and/or retention in treatment, with data being summarized in tables and a narrative review presented. RESULTS The initial database search yielded 3542 articles, of which this review includes 20. Nineteen were conducted among adults in the United States. The digital interventions used included web-based, computer-based, telephone calls, video conferencing, automated self-management system, mobile applications and text messaging. They were based on therapeutic education systems, community reinforcement approaches, cognitive behavior therapy, relapse prevention, brief interventions, supportive counselling and motivational interviewing. The studies had mixed findings; of the 20 studies, 10 had statistically significant differences between the treatment groups for opioid abstinence, and four had significant differences for treatment retention. Comparisons were difficult due to varying methodologies. Participants rated the interventions as acceptable and reported high rates of satisfaction. CONCLUSION The use of digital interventions for opioid use disorder treatment was acceptable, with varying levels of effectiveness for improving outcomes, which is influenced by participant and intervention delivery factors. Further studies in different parts of the world should compare these findings, specifically in low- and middle-income countries.
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Affiliation(s)
- Sarah Kanana Kiburi
- Discipline of Psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Psychiatry, Mbagathi Hospital, Nairobi, Postal address P.O. Box 20725-00202, Nairobi, Kenya.
| | - Elizabeth Ngarachu
- Department of Psychiatry, Mathari Teaching and Referral Hospital, Nairobi, Kenya
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Saeeda Paruk
- Discipline of Psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Timko C, Vest N, Cucciare MA, Smelson D, Blonigen D. Substance use and criminogenic thinking: Longitudinal latent class analysis of veterans with criminal histories. J Subst Abuse Treat 2022; 143:108893. [PMID: 36215912 PMCID: PMC9940453 DOI: 10.1016/j.jsat.2022.108893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/02/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective of this study was to inform clinical practice by identifying distinct subgroups of US veterans with criminal histories in residential mental health treatment. The study characterized veteran patients on their alcohol and drug use and criminogenic thinking. We also examined predictors and outcomes of subgroup membership. METHODS Participants were 341 veterans with a criminal history in residential mental health care. A parallel latent growth trajectory model characterized participants' alcohol and drug use and criminogenic thinking at treatment entry and at 6- and 12-month follow-ups. RESULTS The study identified four distinct classes: 53 % Normative Improvement, 27 % High Criminogenic Thinking, 11 % High Recurrence (of substance use), and 9 % High Drug Use. Compared to the Normative Improvement class, prior to treatment entry, patients in the High Recurrence class were less likely to be on parole or probation, and patients in the High Criminogenic Thinking class were more likely to be chronically homeless. Compared to the Normative Improvement class, at follow-ups, patients in the High Drug Use and High Criminogenic Thinking classes were more likely to recidivate, and patients in the High Drug Use class were more likely to report unstable housing. Depression scores were higher (nearly double) in the High Drug Use, High Recurrence, and High Criminogenic Thinking classes at follow-ups compared to the Normative Improvement class. CONCLUSIONS That the Normative Improvement class entered mental health residential treatment with relatively low alcohol and drug use and criminogenic thinking, and sustained these low levels, suggests that treatment does not need to be broadened or intensified to improve these domains for these patients with criminal histories. In contrast, findings for the High Drug Use, High Recurrence, and High Criminogenic Thinking classes, which composed 47 % of the sample, suggest that more integrated and sustained treatment may be needed to reduce recidivism, depression, and homelessness among these patients.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Noel Vest
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA
| | - David Smelson
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA 01730, USA; University of Massachusetts Chan Medical School, Worcester, MA 01655,. USA
| | - Daniel Blonigen
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Chen F, Xu Y, Shi K, Zhang Z, Xie Z, Wu H, Ma Y, Zhou Y, Chen C, Yang J, Wang Y, Robbins TW, Wang K, Yu J. Multi-omics study reveals associations among neurotransmitter, extracellular vesicle-derived microRNA and psychiatric comorbidities during heroin and methamphetamine withdrawal. Biomed Pharmacother 2022; 155:113685. [PMID: 36137407 DOI: 10.1016/j.biopha.2022.113685] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022] Open
Abstract
Despite decades of research in the field of substance withdrawal, molecular biomarkers and related mechanistic study have generally been lacking. In addition to known neurotransmitters, circulating miRNAs are found in small vesicles known as exosomes within blood that have diagnostic potential and are known to contribute to psychiatric disorders. The aim of this work was to characterize the changes in neurotransmitter and exosomal miRNA profiles during heroin and methamphetamine withdrawal using a cross-sectional study design, and to determine their associations to psychiatric comorbidities in a large group of patients with substance use disorders (SUDs). Using weighted gene co-expression network analysis, a series of known, conserved, and novel exosomal miRNAs were identified as being associated with the severity of anxiety and depression, as well as the concentrations of neurotransmitters GABA, choline, and serotonin. Bioinformatics analyses established that the differences in the miRNA profile target signaling pathways are significantly associated with developmental and intellectual abnormalities. Notably, a set of dysregulated miRNA signatures including hsa-mia-451a and hsa-mir-21a resulted in an AUC of 0.966 and 0.861, respectively, for predicting the patients with SUDs. Furthermore, hsa-miR-744a-5p was positively correlated with serotonin, and its important role in maintaining neuronal development and function was revealed using an in vitro human induced pluripotent stem cells derived neuronal model. Our results suggest that the miRNA content of circulating exosomes represent a biomolecular "fingerprint" of the progression of substance withdrawal and may uncover the putative mechanism of how these exosomal miRNAs contribute to psychiatric symptoms.
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Affiliation(s)
- Fengrong Chen
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; School of Medicine, Kunming University of Science and Technology
| | - Yu Xu
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Kai Shi
- College of Science, Guilin University of Technology, Guilin 541004, China
| | - Zunyue Zhang
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; School of Medicine, Yunnan University, Yunnan, China
| | - Zhenrong Xie
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Hongjin Wu
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yuru Ma
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yong Zhou
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Cheng Chen
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jiqing Yang
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yuan Wang
- Department of R&D, Echo Biotech Co., Ltd, Beijing, China
| | - Trevor W Robbins
- Department of Psychology and the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Kunhua Wang
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; School of Medicine, Yunnan University, Yunnan, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Juehua Yu
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
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Cucciare MA, Han X, Timko C. Predictors of alcohol use disorder treatment outcomes over 12 months: Role of concerned others' functioning and Al-Anon participation. Drug Alcohol Depend 2022; 238:109546. [PMID: 35780624 DOI: 10.1016/j.drugalcdep.2022.109546] [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: 05/05/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study included dyads comprised of adults entering treatment for alcohol use disorder and their Concerned Others (COs) to examine indicators of COs functioning (Al-Anon attendance and involvement, relationship stressors, use of approach coping and stigma) as predictors of patient outcomes (Alcoholics Anonymous (AA) attendance and involvement, abstinence and risk of substance use) over 12 months following adults' entry into AUD treatment. METHODS Dyads (n = 279) were assessed when patients entered treatment and at 3-, 6- and 12-month follow-ups. Data were collected through participants' self-report. Lagged generalized linear mixed models were used to examine associations between indicators of COs' functioning at baseline, 3- and 6-month follow-ups and patients' outcomes at 3-, 6- and 12-month follow-ups. RESULTS Patients reported less AA attendance and involvement and likelihood of maintaining abstinence from alcohol use over time. Findings from our multivariate analysis showed that any CO involvement in Al-Anon, relative to none, was associated with more patient AA attendance. In contrast, more stigma (e.g., need to hide patient's drinking) reported by COs was associated with lower patient AA participation and involvement, while more CO use of approach coping was associated with less patient risk for alcohol and drug use. CONCLUSIONS Findings suggest that COs' functioning can affect longer-term outcomes of adults entering AUD treatment. Treatment programs should increase the availability of help to COs to improve their functioning and patient outcomes.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA.
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA.
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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10
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Digital approaches to continuing care. Curr Opin Psychiatry 2022; 35:259-264. [PMID: 35781465 PMCID: PMC9260953 DOI: 10.1097/yco.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an update of studies on the effectiveness of digital and telephonic approaches to providing remote continuing care for substance use disorders. RECENT FINDINGS Effective continuing care can be provided via smartphone apps, text messaging, interactive voice response, and structured telephone counseling. The remote continuing care interventions with the strongest evidence of efficacy are the Addiction Comprehensive Health Enhancement Support System app and Telephone Monitoring and Counseling. Positive effects for these intervention on drinking outcomes in patients with alcohol use disorders were replicated in a recent randomized controlled study. SUMMARY Continuing care is widely believed to be an important component of treatment for substance use disorders, especially for sustaining positive outcomes. However, many individuals do not attend clinic-based continuing care, due to a variety of reasons, including competing work and family responsibilities, disabilities, transportation challenges, and recently the COVID-19 pandemic. Remote continuing care, provided via smartphone apps, text messaging, and various telephonic approaches, has been shown to be effective, and could be used to provide continuing care to patients who would otherwise not receive it. Further work is needed to determine how to effectively combine more traditional continuing care with newer digitized and telephonic approaches.
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11
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Goldman-Mellor S, Olfson M, Schoenbaum M. Acute injury mortality and all-cause mortality following emergency department presentation for alcohol use disorder. Drug Alcohol Depend 2022; 236:109472. [PMID: 35490593 PMCID: PMC10492647 DOI: 10.1016/j.drugalcdep.2022.109472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alcohol-related morbidity and mortality have increased substantially in the U.S. Understanding the population health implications of these concerning trends, including by identifying clinical subgroups of alcohol users at increased risk for potentially preventable acute causes of mortality, is of critical importance. METHODS This retrospective cohort study used statewide, all-payer, longitudinally-linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED at least once in 2009-2011 with a diagnosis of alcohol use disorder (AUD). Participants were followed for one year after index ED visit to assess acute injury (unintentional poisoning, suicide, homicide, motor vehicle crash, and fall- or fire-related injury) and all-cause mortality rates per 100,000 person-years. Age-, sex-, race/ethnicity-adjusted standardized mortality rates (SMRs) for acute injury causes of death were determined using statewide mortality data. RESULTS Among 437,855 patients with index non-fatal ED visits for AUD, the 12-month acute injury mortality rate was 608.6 per 100,000 (SMR=8.0; 95% CI=7.7, 8.3), and all-cause mortality was 5700.7 per 100,000 (SMR=6.5; 95% CI=6.4, 6.6). Unintentional poisoning accounted for 46.5%, and suicide for 19.7%, of acute-injury deaths. Acute injury deaths comprised 71.7% of all-cause mortality among patients aged 10-24 years, but much lower proportions among older patients. Female AUD patients had lower rates for all mortality outcomes. CONCLUSIONS Emergency department patients with a recognized AUD comprise a population at persistently elevated risk for mortality. Age-related AUD patient differences in common causes of death, including drug overdose and suicide, can inform the structure of future clinical interventions.
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Affiliation(s)
- Sidra Goldman-Mellor
- University of California, Merced, Merced, CA 95343, USA; School of Social Sciences, Humanities, and Arts, Merced, CA 95343, USA; Department of Public Health, Merced, Merced, CA 95343, USA.
| | - Mark Olfson
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA.
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12
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Froelich J, Timko C, Woodhead EL. Motives for substance use and 6-month substance use outcomes among detoxification patients with a history of physical or sexual abuse or posttraumatic stress disorder. J Trauma Stress 2022; 35:976-987. [PMID: 35255172 DOI: 10.1002/jts.22806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
Trauma-exposed individuals with a history of physical or sexual abuse or documented posttraumatic stress disorder (PTSD) diagnosis may use substances to address trauma-related symptoms. However, the motives for using substances among adults with a trauma history or PTSD are unclear despite their informative role in treatment planning. Additionally, trauma is associated with poorer substance use outcomes, although this has not been examined among detoxification patients. The current study examined motives for substance use at baseline and substance use outcomes during 6 months postbaseline among 298 veteran detoxification patients (i.e., alcohol, opioids, or both) with and without (a) a history of physical or sexual abuse and (b) a PTSD diagnosis. At baseline, participants with a physical or sexual abuse history were more likely to report the use of substances to temporarily lower stress, forget problems, and avoid uncomfortable feelings than those without this history, ds = 0.25-0.40. Compared with participants without a PTSD diagnosis, participants with diagnosed PTSD were more likely to report using substances to temporarily lower stress, d = 0.25. Longitudinal analyses demonstrated that the baseline characteristics of physical abuse history, sexual abuse history, and diagnosed PTSD were all associated with higher scores on a measure of risk factors for relapse (e.g., cravings, family/social problems) as assessed during the postdetoxification period, φ = .13, .10, and .09, respectively. Detoxification patients with physical and/or sexual abuse histories or PTSD diagnoses may need treatments that better address trauma symptoms to help them sustain abstinence.
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Affiliation(s)
- Jessilyn Froelich
- National Center for PTSD, Veterans Affairs (VA) Health Care System, Menlo Park, California, USA.,Department of Psychology, San José State University, San José, California, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Erin L Woodhead
- Department of Psychology, San José State University, San José, California, USA
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13
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Uhl S, Bloschichak A, Moran A, McShea K, Nunemaker MS, McKay JR, D'Anci KE. Telehealth for Substance Use Disorders: A Rapid Review for the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Substance Use Disorders. Ann Intern Med 2022; 175:691-700. [PMID: 35313116 DOI: 10.7326/m21-3931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 20.4 million Americans met criteria for a substance use disorder (SUD) in 2019; however, only about 12.2% of persons with an SUD receive specialty care. Telehealth offers alternatives to traditional forms of substance use treatment. PURPOSE To synthesize recent findings on the efficacy of telehealth for SUDs. DATA SOURCES MEDLINE, Embase, PubMed, and the Cochrane Library from January 2015 through August 2021 (English language only). STUDY SELECTION Randomized controlled trials (RCTs) of adults with a diagnosis of SUD based on the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases. DATA EXTRACTION One investigator abstracted data and assessed study quality, and a second checked for accuracy. DATA SYNTHESIS This rapid review synthesized evidence from 17 RCTs. Evidence is very uncertain that telehealth provided as videoconference therapy (1 RCT) or web-based cognitive behavioral therapy (CBT) (3 RCTs) has similar effects to in-person therapy for improving abstinence from alcohol or cannabis. Low-strength evidence suggests that web-based CBT has similar effects for improving abstinence in multiple SUDs (2 RCTs). Low-strength evidence suggests that adding supportive text messaging to follow-up care improves abstinence and amount of alcohol per day (2 RCTs) but does not improve emergency department visits or frequency of consumption (2 RCTs). Enhanced telephone monitoring likely reduces readmissions for SUD detoxification compared with usual follow-up alone (1 RCT) but does not reduce days of substance use (low-strength evidence). LIMITATION Narrative synthesis, heterogeneity of telehealth interventions, no assessment of publication bias, and study methodology. CONCLUSION Evidence is very uncertain that telehealth is similar to in-person care for SUD outcomes. Limited evidence suggests some benefit of adding telehealth to usual SUD care. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs Veterans Health Administration.
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Affiliation(s)
- Stacey Uhl
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Aaron Bloschichak
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Amber Moran
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Kristina McShea
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Megan S Nunemaker
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - James R McKay
- University of Pennsylvania, Philadelphia, Pennsylvania (J.R.M.)
| | - Kristen E D'Anci
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
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Perry C, Liberto J, Milliken C, Burden J, Hagedorn H, Atkinson T, McKay JR, Mooney L, Sall J, Sasson C, Saxon A, Spevak C, Gordon AJ. The Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2022; 175:720-731. [PMID: 35313113 DOI: 10.7326/m21-4011] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION In August 2021, leadership within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the management of substance use disorders (SUDs). This synopsis summarizes key recommendations. METHODS In March 2020, the VA/DoD Evidence-Based Practice Work Group assembled a team to update the 2015 VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The guideline panel developed key questions, systematically searched and evaluated the literature, created two 1-page algorithms, and distilled 35 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis presents the recommendations that were believed to be the most clinically impactful. RECOMMENDATIONS The scope of the CPG is broad; however, this synopsis focuses on key recommendations for the management of alcohol use disorder, use of buprenorphine in opioid use disorder, contingency management, and use of technology and telehealth to manage patients remotely.
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Affiliation(s)
| | - Joseph Liberto
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC (J.L.)
| | - Charles Milliken
- Office of the Surgeon General, U.S. Army, Bethesda, Maryland (C.M.)
| | - Jennifer Burden
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Salem, Virginia (J.B.)
| | - Hildi Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota (H.H.)
| | - Timothy Atkinson
- VA Tennessee Valley Healthcare System, Murfreesboro, Tennessee (T.A.)
| | - James R McKay
- Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania (J.R.M.)
| | - Larissa Mooney
- VA Greater Los Angeles Healthcare System, Los Angeles, California (L.M.)
| | - James Sall
- Quality and Patient Safety, Veterans Administration Central Office, Washington, DC (J.S.)
| | - Comilla Sasson
- Medical Advisory Panel, VA Medical Center and Pharmacy Benefits Management, Denver, Colorado (C.S.)
| | - Andrew Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington (A.S.)
| | | | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Healthcare System, and Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah, Salt Lake City, Utah (A.J.G.)
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15
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Ameral V, Hocking E, Leviyah X, Newberger NG, Timko C, Livingston N. Innovating for real-world care: A systematic review of interventions to improve post-detoxification outcomes for opioid use disorder. Drug Alcohol Depend 2022; 233:109379. [PMID: 35255353 DOI: 10.1016/j.drugalcdep.2022.109379] [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: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inpatient detoxification is a common health care entry point for people with Opioid Use Disorder (OUD). However, many patients return to opioid use after discharge and also do not access OUD treatment. This systematic review reports on the features and findings of research on interventions developed specifically to improve substance use outcomes and treatment linkage after inpatient detoxification for OUD. METHODS Of 6419 articles, 64 met inclusion criteria for the current review. Articles were coded on key domains including sample characteristics, study methods and outcome measures, bias indicators, intervention type, and findings. RESULTS Many studies did not report sample characteristics, including demographics and co-occurring psychiatric and substance use disorders, which may impact postdetoxification OUD treatment outcomes and the generalizability of interventions. Slightly more than half of studies examined interventions that were primarily medical in nature, though only a third focused on initiating medication treatment beyond detoxification. Medical and combination interventions that focused on initiating medications for OUD generally performed well, as did psychological interventions with one or more reinforcement-based components. CONCLUSIONS Research efforts to improve post-detoxification outcomes would benefit from clearer reporting of sample characteristics that are associated with treatment and recovery outcomes, including diagnostic comorbidities. Findings also support the need to identify ways to introduce medication for opioid use disorder (MOUD) and other effective treatments including reinforcement-based interventions during detoxification or soon after.
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Affiliation(s)
- Victoria Ameral
- VISN 1 Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | | | - Xenia Leviyah
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Noam G Newberger
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Christine Timko
- VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Nicholas Livingston
- VA Boston Healthcare System, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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16
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Day E, Daly C. Clinical management of the alcohol withdrawal syndrome. Addiction 2022; 117:804-814. [PMID: 34288186 DOI: 10.1111/add.15647] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
Up to half of individuals with a history of long-term, heavy alcohol consumption will experience the alcohol withdrawal syndrome (AWS) when consumption is significantly decreased or stopped. In its most severe form, AWS can be life-threatening. Medically assisted withdrawal (MAW) often forms the first part of a treatment pathway. This clinical review discusses key elements of the clinical management of MAW, necessary adjustments for pregnancy and older adults, likely outcome of an episode of MAW, factors that might prevent completion of the MAW process and ways of overcoming barriers to ongoing treatment of alcohol use disorder. The review also discusses the use of benzodiazepines in MAW. Although there is clear evidence for their use, benzodiazepines have been associated with abuse liability, blunting of cognition, interactions with depressant drugs, craving, delirium, dementia and disrupted sleep patterns. Because glutamatergic activation and glutamate receptor upregulation contribute to alcohol withdrawal, anti-glutamatergic strategies for MAW and other potential treatment innovations are also considered.
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Affiliation(s)
- Ed Day
- Addiction Psychiatry, Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Chris Daly
- Addiction Psychiatry, Greater Manchester Mental Health FT, Chapman Barker Unit, Prestwich Hospital, Manchester, UK
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17
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Timko C, Grant KM, Han X, Young LB, Cucciare MA. Al-Anon Intensive Referral to facilitate concerned others' participation in Al-Anon Family Groups: a randomized controlled trial. Addiction 2022; 117:590-599. [PMID: 34427006 PMCID: PMC8844037 DOI: 10.1111/add.15670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/11/2021] [Indexed: 11/27/2022]
Abstract
AIMS To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon). DESIGN, SETTING AND PARTICIPANTS Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%). INTERVENTION AND COMPARATOR AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs. MEASUREMENTS Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months. SECONDARY OUTCOMES number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition. FINDINGS There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [β = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (β = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition. CONCLUSIONS Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Kathleen M Grant
- Mental Health and Behavioral Science Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE, 68105, USA,Pulmonary Section, Department of Internal Medicine, University of Nebraska Medical Center, 42 and Emile Streets, Omaha, NE, 68198, USA
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA
| | - Lance Brendan Young
- Department of Communication, Western Illinois University-Quad Cities, 3300 River Drive, Moline, IL, 61265, USA
| | - Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA
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18
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Woodhead EL, Brief D, Below M, Timko C. Health outcomes among detoxification patients: The role of chronic pain. Appl Psychol Health Well Being 2021; 13:922-934. [PMID: 33945212 DOI: 10.1111/aphw.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
Understanding associations between chronic pain and health outcomes among detoxification patients may help improve treatment outcomes and abstinence rates. Exercise is a modifiable lifestyle factor that may reduce the effect of pain on outcomes in this population. The current study examined whether baseline pain, exercise, and their interaction were associated with psychiatric and medical severity, and abstinence self-efficacy, over six months following detoxification. Participants were veteran patients in alcohol or opioid detoxification treatment (N = 298) who were followed for six months (91.1%). Psychiatric severity and abstinence self-efficacy improved over the six months after detoxification; medical severity was stable. More intense pain at baseline was associated with poorer psychiatric and medical outcomes during the post-detoxification period. Regular exercise at baseline was associated with less psychiatric severity and more abstinence self-efficacy during the post-detoxification period. A significant pain by exercise interaction at baseline indicated that regular exercise was associated with more abstinence self-efficacy during the post-detoxification period only among participants with less intense pain. Pain by exercise interactions was not significant for the outcomes of psychiatric and medical severity. Among detoxification patients, exercise may be beneficial in improving outcomes among those with less intense pain.
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Affiliation(s)
- Erin L Woodhead
- Department of Psychology, San José State University, San José, CA, USA
| | - Deborah Brief
- VA Boston Health Care System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Maureen Below
- VA Boston Health Care System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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19
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Timko C, Cucciare MA, Grant KM, Young LB, Rossi FS, Lor MC, Woodhead E. Patients With Alcohol Use Disorders and Their Concerned Others: Concordance of Lived Experience as a Moderator of Treatment Outcomes. J Stud Alcohol Drugs 2021; 82:395-400. [PMID: 34100708 PMCID: PMC8328236 DOI: 10.15288/jsad.2021.82.395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/31/2020] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Growing up with an adult with an alcohol use disorder (AUD) is common and negatively affects adult functioning. This study examined two questions concerning the lived experience of growing up in a home with AUD. METHOD AND RESULTS The first question asked how adults entering AUD treatment (n = 402) who had this lived experience (58%) compared to those who did not (42%) on indicators of alcohol use severity. Patients with lived experience reported alcohol use at a younger age, more times having been arrested and charged, and greater risk for future substance use. The second question examined concordance between patients and their concerned others on this lived experience (n = 277 dyads) and patients' treatment outcomes 3 months later. The associations between patients' lived experience and better treatment outcomes were stronger when patients' concerned others had a concordant lived experience. When patient-concerned other dyads reported concordant lived experiences at baseline, patients had lower substance use and risk scores at the 3-month follow-up than when the dyads reported discordant lived experiences with regard to growing up in a home with AUD; effect sizes were small. CONCLUSIONS Concordance and discordance on this lived experience could be considered in treatment planning for patients with AUD and their concerned others. Providers could ask about each member's childhood and aim interventions at helping dyads discuss their childhoods in ways that validate each other's needs and provide emotional support, without stigmatization. Delivery may consider relationship type (spousal or other) and be in educational or treatment sessions that include the dyad or one member.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kathleen M. Grant
- Mental Health and Behavioral Science Department, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Pulmonary Section, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lance Brendan Young
- Department of Communication, Western Illinois University-Quad Cities, Moline, Illinois
| | - Fernanda S. Rossi
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, California
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Mai Chee Lor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, California
| | - Erin Woodhead
- San José State University Department of Psychology, San Jose, California
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Livingston N, Ameral V, Hocking E, Leviyah X, Timko C. Interventions to Improve Post-Detoxification Treatment Engagement and Alcohol Recovery: Systematic Review of Intervention Types and Effectiveness. Alcohol Alcohol 2021; 57:136-150. [PMID: 33791782 DOI: 10.1093/alcalc/agab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Most inpatient alcohol detoxification patients do not seek treatment post-discharge, which increases the risk of relapse and re-hospitalization. To date, there have been no efforts to synthesize the evidence supporting the broad range of available interventions for this critical transition. The current study is a systematic review and evaluation of interventions designed to promote treatment engagement and recovery following alcohol detoxification. METHODS The initial literature search yielded 6419 articles, published since 1999, from PubMed, CINAHL, PsycINFO, Psychology & Behavioral Sciences Collection and PsycARTICLES databases, 49 of which were eligible for full review. Data extraction included in-depth evaluation of intervention types, study and research design features, reported outcomes and study quality/bias indicators. All articles were coded by independent raters and final results were obtained through consensus. RESULTS Interventions included medical/medication, psychological/psychosocial, technological, mutual-help and combined approaches. On average, medical/medication interventions were less, and psychological/psychosocial and technological interventions were more likely to demonstrate efficacy with respect to treatment engagement and recovery. There was significant variability in study quality/bias but no significant differences across intervention types. Studies differed considerably across measured outcomes, internal and external validity, in/exclusion criteria and documentation of co-occurring psychiatric disorders. CONCLUSION Over half of studies reviewed reported empirical support for the intervention(s) evaluated. Although findings slightly favor non-medical interventions, the variability in study design and quality/bias requires more rigorous follow-up research. Recommendations from this review may guide future implementation and intervention development, which are critically needed to improve post-detoxification care and outcomes for patients with alcohol use disorder.
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Affiliation(s)
- Nicholas Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Victoria Ameral
- Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road Bedford, MA 01730, USA
| | - Elise Hocking
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Xenia Leviyah
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Christine Timko
- VA Palo Alto Health Care System, 3801 Miranda AvenuePalo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
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21
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Timko C, Grant KM, Mohankumar R, Cucciare MA. Functioning of adults in alcohol use disorder treatment: Role of concerned others. J Subst Abuse Treat 2020; 113:108003. [PMID: 32359669 DOI: 10.1016/j.jsat.2020.108003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined patients in treatment for alcohol use disorders ("Patients") and their "concerned others" (COs-family and friends): (1) Did Patients' functioning differ according to COs' study participation? Among Patients with participating COs, (2) did Patients and COs agree on Patients' functioning, and (3) was Patients' functioning associated with COs' functioning and quality of CO-Patient relationships? METHOD Four-hundred and two Patients (mean age = 44, majority white men) and 277 COs (mean age = 52, majority white women) completed validated assessments. RESULTS (1) Unexpectedly, Patients who did not identify a CO for potential study participation had more protective factors against future substance use and more readiness to participate in Alcoholics Anonymous (AA) than patients who did identify a CO. (2) Patients had higher scores than COs did when rating the Patient's protective factors, viewed the Patient-CO relationship as having more resources and fewer stressors than COs did, and reported fewer incidents of violence toward the CO than the CO did. (3) Patients had higher risk factors scores when their COs binge drank, and the Patient-CO relationship had more stressors and violence. Patients had higher protective factors scores when COs had greater readiness for Al-Anon participation, and Patients had attended more AA meetings, reported more resources in their relationship with their CO, and used more negotiation tactics when in conflict with their CO. CONCLUSIONS Findings suggest that interventions to improve Patients' functioning should be broadened beyond COs who are spouses or partners, decrease COs' binge drinking, facilitate 12-step participation, decrease relationship stressors and conflict, and increase relationship resources.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Kathleen M Grant
- Mental Health and Behavioral Science Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA; Pulmonary Section, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile Streets, Omaha, NE 68198, USA.
| | - Rakshitha Mohankumar
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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22
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Timko C, Nash A, Owens MD, Taylor E, Finlay AK. Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221819901281. [PMID: 32132821 PMCID: PMC7040926 DOI: 10.1177/1178221819901281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 11/15/2022]
Abstract
Evidence indicates that substance use and mental health treatment is often associated with reduced criminal activity. The present systematic review examined this association among military veterans, and aimed to provide a comprehensive summary of needed research to further contribute to reduced criminal activity among veterans. This systematic review was derived from a scoping review that mapped existing research on justice-involved veterans' health. For the current systematic review, a subset of 20 publications was selected that addressed the question of whether criminal activity declines among veterans treated for substance use and mental health disorders. Generally, veterans improved on criminal outcomes from pre- to post-treatment for opioid use, other substance use, or mental health conditions, and more sustained treatment was associated with better outcomes. This occurred despite high rates of criminal involvement among veterans prior to entering treatment. Needed are substance use and mental health treatment studies that include women justice-involved veterans, follow criminally-active veterans for longer periods of time, and use validated and reliable measures of criminal activity with fully transparent statistical procedures. Future randomized trials should evaluate new treatments against evidence-based treatments (versus no-treatment control conditions). Subsequent studies should examine how to link veterans to effective treatments, facilitate sustained treatment engagement, and ensure the availability of effective treatments, and examine mechanisms (mediators and moderators) that explain the association of treatment with reduced criminal activity among veterans. Best practices are needed for reducing criminal activity among the minority of justice-involved veterans who do not have diagnosed substance use and/or mental health disorders.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Amia Nash
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA
| | - Mandy D Owens
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA.,National Center on Homelessness Among Veterans, Department of Veterans Affairs
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23
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Kahler CW, Surace A, Durst A, Pantalone DW, Mastroleo NR, Miguez MJ, Bueno D, Liu T, Monti PM, Mayer KH. Telehealth interventions to reduce alcohol use in men with HIV who have sex with men: Protocol for a factorial randomized controlled trial. Contemp Clin Trials Commun 2019; 16:100475. [PMID: 31701045 PMCID: PMC6831665 DOI: 10.1016/j.conctc.2019.100475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Heavy alcohol use is prevalent among men who have sex with men (MSM) living with HIV and is associated with reduced antiretroviral therapy adherence, reduced HIV viral suppression, and reduced survival. We recently found that compared to HIV treatment as usual, three sessions of in-person motivational interviewing (MI) substantially reduced drinking in MSM with HIV. In an effort to enhance the effectiveness and efficiency of this intervention, the present study will test whether MI is more effective than brief intervention when delivered by videoconferencing, whether interactive text messaging (ITM) can enhance the effects of alcohol intervention, and whether extended duration of intervention is more effective than brief duration. METHODS Using a 2 × 2 × 2 factorial design, we will randomly assign 224 heavy-drinking MSM with HIV to: MI or brief intervention (BI); ITM or no ITM; Standard or Extended intervention (EI). All participants will receive intervention immediately after baseline assessment via videoconferencing and at 1-month post baseline via telephone. Participants randomized to EI will receive additional intervention sessions at 3, 6, and 9 months. Participants randomized to ITM will receive daily interactive texts about alcohol use for 1 month, with those randomized to EI receiving weekly interactive texts through 9 months. Alcohol and HIV-related outcomes will be assessed at 6 and 12 months post baseline. CONCLUSION By testing the combinations of interventions that can most effectively reduce alcohol use among MSM with HIV, this study will set the stage for wider-scale implementation of an optimized intervention combination.
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Affiliation(s)
- Christopher W. Kahler
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Anthony Surace
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ayla Durst
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health Boston, MA, USA
- University of Massachusetts - Boston, Boston, MA, USA
| | - Nadine R. Mastroleo
- College of Community and Public Affairs, Binghamton University (SUNY), Binghamton, NY, USA
| | | | - Diego Bueno
- Florida International University, Miami, FL, USA
| | - Tao Liu
- Center for Statistical Sciences and Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Peter M. Monti
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health Boston, MA, USA
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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