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Osilla KC, Manuel JK, Becker K, Nameth K, Burgette L, Ober AJ, DeYoreo M, Lodge BS, Hurley B, Watkins KE. It takes a village: A pilot study of a group telehealth intervention for support persons affected by opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209290. [PMID: 38272117 DOI: 10.1016/j.josat.2024.209290] [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: 03/20/2023] [Revised: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Opioid use disorder (OUD) has devastating effects on individuals, families, and communities. The Community Reinforcement and Family Training (CRAFT) is a Support Person (SP)-focused intervention that aims to increase SPs' communication strategies, positive reinforcement/rewards, and social support. This pilot study, called eINSPIRE (INtegrating Support Persons Into REcovery), adapted CRAFT for delivery via group telehealth. The aims were to evaluate the feasibility, acceptability, and preliminary effectiveness of this intervention on patient buprenorphine retention and SP mental health. METHODS The study recruited patients receiving buprenorphine treatment in a primary care setting across five community health centers with their SP (N = 100 dyads). SP participants were randomly assigned to receive usual care (UC) or the eINSPIRE intervention. We interviewed Patients and SPs at baseline and three months later. The study collected patient buprenorphine retention data from the electronic medical record three months post-baseline. RESULTS About 88 % (656/742) of potentially eligible patients were able to nominate a SP and 69 % (100/145) of nominated SPs were eligible and consented to the study. eINSPIRE groups had low reach (25 % of SPs attended), but high exposure (M = 7 of 10 sessions attended) and acceptability (classes helped them with their patient's OUD). The proportion of eINSPIRE patients (68 %) and UC patients (53 %) retained on buprenorphine at follow-up were similar (p = 0.203). SPs in both conditions reported similar reductions in their depression, anxiety, and impairment symptoms. CONCLUSIONS Preliminary data suggest that eINSPIRE groups may not be feasible in primary care without further adaptations for this population. A future study with a larger sample size is needed to elucidate the observed distribution differences in buprenorphine retention. Future research should also explore methods to reduce barriers to SP session attendance to improve the reach of this evidence-based intervention.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Jennifer K Manuel
- University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 675 18th St, San Francisco, CA 94143, United States; San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, United States
| | - Kirsten Becker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States
| | - Katherine Nameth
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, United States
| | - Lane Burgette
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, United States
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States
| | | | - Brian Hurley
- University of California Los Angeles, Department of Family Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States; County of Los Angeles, Department of Public Health, Bureau of Substance Abuse Prevention and Control 1000 S. Fremont Avenue, Alhambra, CA 91803, United States
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Rushton CM, Kelly PJ, Thomas T, Beck AK, Townsend C, Baker AL, Manning V, Argent A, Deane FP, Hides L, Hitsman B, Velleman R, Velleman G, Larance B. SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another's methamphetamine use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209355. [PMID: 38548059 DOI: 10.1016/j.josat.2024.209355] [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: 04/18/2023] [Revised: 12/20/2023] [Accepted: 03/23/2024] [Indexed: 05/15/2024]
Abstract
INTRODUCTION Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use. METHODS Recruitment for this study occurred between March-October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion. RESULTS Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement. CONCLUSIONS Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy.
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Affiliation(s)
- Clare M Rushton
- School of Psychology, University of Wollongong, Wollongong, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Tamsin Thomas
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alison K Beck
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane, Australia
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Richard Velleman
- Department of Psychology, University of Bath, Bath, UK; Addictions and Related Research Group, Sangath, Goa, India
| | - Gill Velleman
- Addictions and Related Research Group, Sangath, Goa, India
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Siljeholm O, Edvardsson K, Bergström M, Hammarberg A. Community Reinforcement and Family Training versus counselling for parents of treatment-refusing young adults with hazardous substance use: A randomized controlled trial. Addiction 2024; 119:915-927. [PMID: 38225922 DOI: 10.1111/add.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/08/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND AIMS Despite the high prevalence and negative effects of hazardous substance use, few young adults enter treatment. Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, has proved efficacious in promoting treatment entry. The aim of the current trial was to compare the efficacy of CRAFT with an active control for parents of young adults (aged 18-24 years) with hazardous substance use. DESIGN This was a randomized controlled superiority trial comparing CRAFT (n = 58) with an active control group receiving manualized counselling (n = 55), with outcome assessments at 6, 12 and 24 weeks (primary end-point). A sequential design with a stopping rule was added post recruitment commencement. SETTING The study took place in two outpatient clinics for young adults in Stockholm, Sweden, and subsequently via video-conference due to COVID-19. PARTICIPANTS Between October 2018 and May 2021, 113 participants (92% female) who were parents of young adults (87% male) were recruited. Recruitment was discontinued when 70% of the planned sample had been recruited, following an interim analysis of the primary outcome showing no difference between conditions. INTERVENTION AND COMPARATOR Participants were randomized (ratio 1 : 1) to eight manual-based individual CRAFT sessions or five individual manual-based counselling sessions + one voluntary psychoeducative group session, delivered over maximum 14 weeks. MEASUREMENTS The primary outcome measure was the rate of young adult entry in substance use treatment during the trial period (24 weeks). FINDINGS At the 24 weeks follow-up, 19 (33%) of CRAFT participants and 17 (31%) of counselling participants had reported young adult treatment entry, with no difference between conditions (odds ratio CRAFT versus counselling 0.84, 95% confidence interval = 0.35; 1.99, P = 0.700). Both conditions reported clinically relevant reductions in young adult substance use, but no change in participants' levels of depression, anxiety or stress. CONCLUSIONS This trial showed no statistically significant evidence that Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, is more efficacious than manual-based counselling regarding treatment entry for young adults.
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Affiliation(s)
- Ola Siljeholm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kerstin Edvardsson
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Malin Bergström
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Byrne CJ, Sani F, Thain D, Fletcher EH, Malaguti A. Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis. Harm Reduct J 2024; 21:81. [PMID: 38622647 PMCID: PMC11017611 DOI: 10.1186/s12954-024-00999-8] [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: 09/18/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND AND AIMS Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs. METHODS This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised. RESULTS Twenty-six studies were included in the review, with 150,625 participants: of those 3,383-4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose (n = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits. CONCLUSIONS Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK.
| | - Fabio Sani
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
| | - Donna Thain
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Emma H Fletcher
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Amy Malaguti
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
- Tayside Drug and Alcohol Recovery Psychology Service, NHS Tayside, Dundee, UK
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Fishman M, Wenzel K, Gauthier P, Borodovsky J, Murray O, Subramaniam G, Levy S, Fredyma E, McLeman B, Marsch LA. Engagement, initiation, and retention in medication treatment for opioid use disorder among young adults: A narrative review of challenges and opportunities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209352. [PMID: 38494051 DOI: 10.1016/j.josat.2024.209352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Opioid Use Disorder (OUD) is a catastrophic public health problem for young adults (YAs) and their families. While medication for OUD (MOUD) is safe, effective, and recognized as the standard of care, its' uptake and success have been limited in YAs compared to older adults. METHODS This narrative review summarizes the existing literature and highlights select studies regarding barriers to YA MOUD, potential explanations for those barriers, and strategies to overcome them. RESULTS Barriers are prominent along the entire cascade of care, including: treatment engagement and entry, MOUD initiation, and MOUD retention. Hypothesized explanations for barriers include: developmental vulnerability, inadequate treatment system capacity, stigma against MOUD, among others. Interventions to address barriers include: promotion of family involvement, increasing provider capacity, integration of MOUD into primary care, assertive outreach, and others. CONCLUSIONS Integrating an adapted version of family coaching from the Community Reinforcement Approach and Family Training (CRAFT) and other models into YA MOUD treatment serves as an example of an emerging novel practice that holds promise for broadening the funnel of engagement in treatment and initiation of MOUD, and enhancing treatment outcomes. This and other developmentally-informed approaches should be evaluated as part of a high-priority clinical and research agenda for improving OUD treatment for YAs.
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Affiliation(s)
- Marc Fishman
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA; Johns Hopkins University School of Medicine, Dept of Psychiatry, 3800 Frederick Avenue, Baltimore, MD 21229, USA.
| | - Kevin Wenzel
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA
| | - Phoebe Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Owen Murray
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, 301 North Stonestreet Ave, Bethesda, MD 20892, USA
| | - Sharon Levy
- Boston Children's Hospital, Division of Addiction Medicine, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Emma Fredyma
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
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Hellum R, Bilberg R, Mejldal A, Nielsen AS. Potential factors affecting the impact of community reinforcement and family training. Secondary analysis of an RCT. BMC Public Health 2024; 24:213. [PMID: 38233850 PMCID: PMC10795348 DOI: 10.1186/s12889-024-17656-1] [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: 01/10/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND In addition to increasing the quality of life among concerned significant others (CSOs), Community Reinforcement and Family training (CRAFT) aim at helping CSOs motivate treatment-refusing identified patients (IPs) into treatment through a positive reinforcement process. The aim of the present study was to investigate if the following factors, measured at baseline, have an influence on IP future treatment engagement (1) Type of relation between CSO and the IP (2) The amount of time the CSO spend with the IP (3) if the IP knows that the CSOs seeks help, and (4) The CSO's own alcohol use. METHODS A secondary analysis from the Danish CRAFT study. CSOs completed a self-administered questionnaire at baseline, after three months, and six months. To investigate the relationship between the four variables and treatment engagement, logistic regression was used. RESULTS CSO's relation to the IP, the frequency of contact between the CSO and the IP, and the CSO's AUDIT score at the time of the baseline interview were not associated with the IP's treatment engagement. If CSO at baseline had informed the IP that the CSO participated in CRAFT, odds for IP treatment engagement were significantly higher (adjusted OR [(CI)] = 2.29 [1.13; 4.63] (p < 0.05), relative to if IP not being informed. CONCLUSIONS CRAFT has a higher impact on the likelihood for treatment seeking, if the CSOs inform the IP about his or her own help seeking in order to change the situation. The underlying mechanism behind this is needs further investigations.
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Affiliation(s)
- Rikke Hellum
- The Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws vej 18, Odense C, 5000, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, J.B. Winsløws vej 18, Odense C, 5000, Denmark
| | - Randi Bilberg
- The Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws vej 18, Odense C, 5000, Denmark
- Department for Data, Innovation and Research, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Anna Mejldal
- The Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws vej 18, Odense C, 5000, Denmark
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, J.B. Winsløws vej 9A, Odense C, 5000, Denmark
| | - Anette Søgaard Nielsen
- The Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws vej 18, Odense C, 5000, Denmark.
- Department of Mental Health Odense, Region of Southern Denmark, J.B. Winsløws vej 18, Odense C, 5000, Denmark.
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Binumon KV, Ezhumalai S, Janardhana N, Chand PK. Development and Validation of Brief Family Intervention for Young Adults with Substance Use Disorder: A Qualitative Study. JOURNAL OF PSYCHIATRY SPECTRUM 2024; 3:28-35. [PMID: 38264216 PMCID: PMC10803291 DOI: 10.4103/jopsys.jopsys_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background Substance abuse is more prevalent in young adults, putting them at risk for chronic use and early onset of dependence on substances. A well-documented relationship exists between substance use and poor family functioning. Traditional family intervention approaches are time-consuming. Aim To develop a brief family intervention for parents of young adults with substance use disorder. Methods A qualitative research design was used. Extensive literature searches and key informant interviews (face to face) with young adults (n = 5), their parents (n = 5), and mental health professionals (n = 5) were conducted. The interviews were audio recorded. A thematic analysis was conducted using Braun and Clarke's six-step approach, and intervention strategies were identified by examining the themes. In addition, experts were consulted to ensure the content validity of the BFI. Results The BFI program combines psychoeducation and behavioral techniques for parents. BFI involves seven sessions with parents, 45-60 min each, over one week. The BFI sessions consisted of (1) Engagement and Assessment, (2) Healthy Family Functioning, (3) Psychoeducation, (4) Relapse Prevention, (5) Communication Skill Training, (6) Problem-Solving Skill Training, and (7) Parental Monitoring and Supervision. Conclusion Considering all stakeholders' perspectives, the BFI manual for young adults with substance use disorder has been developed. However, additional research is required to evaluate its feasibility and effectiveness.
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Affiliation(s)
| | - Sinu Ezhumalai
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
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Croak B, Archer M, Harwood H, Stevelink SAM, Greenberg N, Rafferty L. Evaluation of Community Reinforcement and Family Therapy in the UK military community. Eur J Psychotraumatol 2023; 14:2282904. [PMID: 38010161 PMCID: PMC10993804 DOI: 10.1080/20008066.2023.2282904] [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] [Received: 07/10/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Partners and family can play a key role in encouraging military service and ex-service personnel to seek help for their mental health. Community Reinforcement Approach and Family Training (CRAFT) was developed to equip concerned significant others (CSOs) of those experiencing substance use disorders with skills to encourage their loved one to enter treatment and improve their own well-being. It was adapted in the US for CSOs of ex-service personnel with post-traumatic stress disorder (PTSD) (VA-CRAFT).Objective: This study aimed to evaluate an adaptation of VA-CRAFT for use with CSOs of serving and ex-service personnel experiencing PTSD and Common Mental Disorders in the UK (UKV-CRAFT).Method: Acceptability of UKV-CRAFT was assessed with interviews with experts, namely key stakeholders (n = 15) working in support provision for serving and ex-service personnel. In addition, individuals who took part in a small-scale demonstrative trial of UKV-CRAFT (three CSOs and three facilitators who delivered UKV-CRAFT) provided feedback.Results: UKV-CRAFT was viewed positively, with interviewees highlighting that programmes like UKV-CRAFT filled a gap in provision for UK Armed Forces families as most services were only available to the serving or ex-service personnel. Interviewees praised how UKV-CRAFT enhanced CSO well-being and communication with their loved one. Concerns over the confidentiality of taking part in UKV-CRAFT were raised due to the perceived negative effects of highlighting a loved one's mental ill health, especially for CSOs of serving personnel. Ideas for improvement included broadening access to all CSOs regardless of whether their loved one was seeking treatment.Conclusion: Interviewees regarded UKV-CRAFT as a potentially useful intervention suggesting it could be proactively offered universally to support timely help-seeking if required. We recommend further evaluation of UKV-CRAFT on a wider scale, incorporating our recommendations, to assess its effectiveness accurately.
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Affiliation(s)
- Bethany Croak
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Marc Archer
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
- School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, United Kingdom
| | - Hannah Harwood
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Laura Rafferty
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
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Osilla KC, Gore KL, Pedersen ER, Hummer JF, DeYoreo M, Manuel JK, McKay JR, Kim JP, Nameth K. Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners. Contemp Clin Trials 2023; 133:107324. [PMID: 37652360 PMCID: PMC10591961 DOI: 10.1016/j.cct.2023.107324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking. METHODS The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman. DISCUSSION By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. CLINICALTRIALS gov Identifier: NCT05619185.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Kristie L Gore
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA
| | - Eric R Pedersen
- University of Southern California Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Jennifer K Manuel
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - James R McKay
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Crescenz VAMC, Philadelphia, PA, USA
| | - Jane P Kim
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Katherine Nameth
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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10
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Strickland JC, Acuff SF. Role of social context in addiction etiology and recovery. Pharmacol Biochem Behav 2023; 229:173603. [PMID: 37487953 PMCID: PMC10528354 DOI: 10.1016/j.pbb.2023.173603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
While social context has long been considered central to substance use disorder prevention and treatment and many drug-taking events occur in social settings, experimental research on social context has historically been limited. Recent years have seen an emergence of concerted preclinical and human laboratory research documenting the direct impact of social context on substance use, delineating behavioral and neurobiological mechanisms underlying social influence's role. We review this emerging preclinical and human laboratory literature from a theoretical lens that considers distinct stages of the addiction process including drug initiation/acquisition, escalation, and recovery. A key conclusion of existing research is that the impact of the social environment is critically moderated by the drug-taking behavior and drug use history of a social peer. Specifically, while drug-free social contexts can reduce the likelihood of drug use initiation and act as a competitive non-drug alternative preventing escalation, drug-using peers can equally facilitate initiation and escalation through peer modeling as a contingent reward of use. Likewise, social context may facilitate recovery or serve as a barrier that increases the chances of a return to regular use. We conclude by discussing evidence-based treatments and recovery support services that explicitly target social mechanisms or that have identified social context as a mechanism of change within treatment. Ultimately, new areas for research including the expansion of drug classes studied and novel human laboratory designs are needed to further translate emerging findings into clinical practice.
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Affiliation(s)
- Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
| | - Samuel F Acuff
- Department of Psychology, The University of Memphis, 202 Psychology Building, Memphis, TN 38152, USA; Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 152 Merrimac St, Boston MA, 02135 USA
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11
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Moore KE, Wyatt JP, Phillips S, Burke C, Bellamy C, McKee SA. The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis. HEALTH & JUSTICE 2023; 11:25. [PMID: 37191937 PMCID: PMC10186797 DOI: 10.1186/s40352-023-00225-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND People with substance use disorders (SUD) who have been involved in the legal system often experience stigma upon reentry into the community after incarceration. Although substance use treatment can sometimes be a source of stigma, it may also reduce stigma by facilitating connections with providers, reducing distress, or helping people feel more integrated in their community. However, research has rarely examined the potential for treatment to reduce stigma. METHODS This study examined stigma experiences and the degree to which substance use treatment reduced stigma among 24 people with SUDs who were receiving care in an outpatient treatment facility after release from incarceration. Qualitative interviews were conducted and analyzed using a content analysis approach. RESULTS Participants reported negative self-judgements as well as perceiving negative judgments from the community upon reentry. With regard to stigma reduction, themes emerged around substance use treatment repairing strained family relationships and reducing participants' self-stigma. Aspects of treatment that reportedly reduced stigma included the treatment facility having a nonjudgmental atmosphere, patients trusting the staff, and working with peer navigators who had lived experience of SUD and incarceration. CONCLUSIONS Results from this study suggest that substance use treatment has the potential to decrease the negative impacts of stigma upon release from incarceration, which continues to be a major barrier. Though more research on stigma reduction is needed, we suggest some preliminary considerations for treatment programs and providers.
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Affiliation(s)
- Kelly E Moore
- East Tennessee State University, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN, 37614, USA.
| | - Janan P Wyatt
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Sarah Phillips
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Catherine Burke
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Chyrell Bellamy
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Sherry A McKee
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
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12
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Cambron C, Castillo JT, Frost CJ. Effectiveness of Brief In-person and Virtual Substance Use Disorder Counselor Trainings, 2019-2021. Public Health Rep 2023; 138:56S-62S. [PMID: 37226945 PMCID: PMC10226065 DOI: 10.1177/00333549221123585] [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] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES Paraprofessional substance use disorder counselors (SUDCs) are an important component of expanding access to substance use disorder treatment, but little research on SUDC training currently exists. We evaluated knowledge and self-efficacy gain from brief in-person and virtual workshops for paraprofessional SUDC student-trainees. METHODS Student-trainees (N = 100) enrolled in an undergraduate SUDC training program completed 6 brief workshops from April 2019 to April 2021. Three in-person workshops during 2019 covered clinical assessment, suicide risk and evaluation, and motivational interviewing, and 3 virtual workshops during 2020-2021 covered family engagement and mindfulness-oriented recovery enhancement, as well as screening, brief intervention, and referral to treatment for expectant mothers. Pretest and posttest online surveys measured student-trainee knowledge gain related to all 6 SUDC modalities. Results of paired sample t tests evaluated changes in knowledge and self-efficacy from pretest to posttest. RESULTS All 6 workshops showed a significant gain in knowledge from pretest to posttest. Four workshops showed a significant gain in self-efficacy from pretest to posttest. Hedges g ranged from 0.70 to 1.95 for knowledge gain and from 0.61 to 1.73 for self-efficacy gain across workshops. Common language effect sizes indicating the probability that a participant increased one's score from pretest to posttest ranged from 76% to 93% for knowledge gain and from 73% to 97% for self-efficacy gain across workshops. CONCLUSIONS Results of this study add to the limited research base on training for paraprofessional SUDCs and suggest that in-person learning and virtual learning are both viable brief training tools for students.
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Affiliation(s)
| | - Jason T Castillo
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Caren J Frost
- College of Social Work, University of Utah, Salt Lake City, UT, USA
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13
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Heiden-Rootes K, Meyer D, Mancini M, Ferber M, Eikenberry J, Wang W, Rottnek F, Jung E, Karrir S. Helping families heal in substance use treatment: A qualitative study about the role of peer support specialists with client families. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209024. [PMID: 36963634 DOI: 10.1016/j.josat.2023.209024] [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: 07/14/2022] [Revised: 12/20/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Peer support specialists (PSS) are people with previous psychiatric illness or substance use disorders who use their experience to support those facing similar hardships. PSS offer a range of beneficial outcomes to both the PSS and clients. The most immediate social connections to those seeking treatment are often their families, yet no PSS studies are inclusive of family involvement. Strong theoretical and empirical support exists for family involvement in addiction treatment, but no studies to date on families in substance use treatment include PSS. This study offers a first look at PSS's experiences with client families. We aimed to describe experiences and attitudes of PSS in working with families of those seeking substance use treatment. METHODS This qualitative study included 25 adult PSS with at least 1 year of work experience in substance use treatment and state credentialing board certification. Participants had one interview either in a focus group format or individually. The recruitment and data collection phase lasted from November 2020 to June 2021. The semi-structured interview protocol included six main questions and interviews lasted 60 to 75 min. Upon completion of each interview, the recordings were transcribed and inductively coded. Thematic analysis of the codes identified overarching themes and their implications were described with associated quotes. RESULTS Thematic analysis generated three interrelated themes. First, participants described the various ways they often work with the families of their clients, which seemed to be dependent on the age of the client. Second, participants identified the negative aspects of working with families such as family drama, stress, and co-dependency issues. Last, the third theme identified the ways in which PSS assist families in healing from the effects of addiction. The themes identify a complicated and conflicting approach to work with families. Overall, it seemed PSS were operating on their own experiences or suggestions given by supervisors to guide them with no training on how to approach families. CONCLUSIONS This study highlights a deficit in PSS training on their role with families, family intervention, and the impact of family on substance use treatment for adults and youth. More research needs to establish the PSS role with families and with clients from marginalized backgrounds. Credentialing and national associations that support PSS should develop additional training and education opportunities related to working with families for PSS, supervisors, and organizational leadership who employ PSS for substance use treatment.
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Affiliation(s)
- Katie Heiden-Rootes
- Family and Community Medicine Department, School of Medicine, Saint Louis University, United States of America.
| | - Dixie Meyer
- Family and Community Medicine Department, School of Medicine, Saint Louis University, United States of America
| | - Michael Mancini
- School of Social Work, Saint Louis University, United States of America
| | - Megan Ferber
- Family and Community Medicine Department, School of Medicine, Saint Louis University, United States of America
| | - Jacob Eikenberry
- School of Social Work, Saint Louis University, United States of America
| | - Wenjin Wang
- Family and Community Medicine Department, School of Medicine, Saint Louis University, United States of America
| | - Fred Rottnek
- Family and Community Medicine Department, School of Medicine, Saint Louis University, United States of America
| | - Emily Jung
- ARCHway Institute for Addictive Diseases and Co-existing Mental Health Disorders, Punta Gorda, FL, United States of America
| | - Sania Karrir
- Medical Education, School of Medicine, Saint Louis University, United States of America
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14
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McKowen J, Berger A, Towbin J, Yule AM, Woodward D, Nowinski L, Forchelli G, Meyers RJ, Joshi G, Wilens TE. A Manualized Behavioral Therapy Intervention for Youth with Autism Spectrum Disorder and Substance Use Disorder. Case Rep Psychiatry 2023; 2023:8998160. [PMID: 37038552 PMCID: PMC10082677 DOI: 10.1155/2023/8998160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Research highlights the increasing overlap of autism spectrum disorder and substance use disorders in young people. However, no behavioral treatments exist addressing this comorbidity despite great need. A team of clinicians developed an integrated behavioral protocol addressing substance use in youth with autism spectrum disorder. The multidisciplinary team developed 12 youth, 7 parent, and 3 joint modules based on established evidence-based therapies shown to have effectiveness separately addressing autism spectrum and substance use. Two cases are discussed to illuminate this integrated intervention. Adaptations to the protocol were made during feedback from patients and their parents. Further research is needed to determine the effectiveness of this preliminary protocol.
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Affiliation(s)
- James McKowen
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy Berger
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Joshua Towbin
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, 720 Harrison Avenue, Suite 915, Boston, MA 02118, USA
| | - Diana Woodward
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Lisa Nowinski
- Lurie Center for Autism, Massachusetts General Hospital, 1 Magurie Road, Lexington, MA 02421, USA
| | - Gina Forchelli
- Lurie Center for Autism, Massachusetts General Hospital, 1 Magurie Road, Lexington, MA 02421, USA
| | - Robert J. Meyers
- Center of Alcoholism, Substance Abuse and Addiction, University of New Mexico, 2650 Yale Blvd., NM 87106, USA
| | - Gagan Joshi
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E. Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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15
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Siljeholm O, Ekström V. A shift in focus: Mothers' descriptions of sharing a child with a co-parent with unhealthy alcohol use after participating in a support program. Addict Sci Clin Pract 2023; 18:12. [PMID: 36793090 PMCID: PMC9930315 DOI: 10.1186/s13722-023-00369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use (UAU) affects not only the drinking individual, but also significant others (SOs), such as partners and children. Most of the harm to others caused by alcohol can be attributed to common, moderate drinking patterns, but existing studies have mainly included SOs of individuals with severe UAU. There is a need for increased knowledge regarding SOs of individuals in an earlier stage of UAU and efficacious support programs for this group. The aims of this study were to investigate reasons for seeking support as described by SOs sharing a child with a co-parent with UAU and to investigate how SOs perceived effects of a web-based self-delivered support program. METHODS A qualitative design conducting semi-structured interviews with 13 female SOs sharing a child with a co-parent with UAU. The SOs were recruited from a randomized controlled trial of the web-based program and had completed at least two of four modules in the program. Transcribed interviews were analyzed using conventional qualitative content analysis. RESULTS Regarding reasons for seeking support, we created four categories and two subcategories. Main reasons were wanting validation/emotional support and coping strategies for handling the co-parent, and negative perceptions of available support options for SOs. Regarding perceived effects of the program, we created three categories and three subcategories. Main effects were an improved relationship to their children, increased own positive activities, and less adaptation to the co-parent, though SOs also mentioned what was perceived as missing in the program. We argue that the interviewees represent a population of SOs living with co-parents with slightly less severe UAU than previous studies and therefore provide new insights for future interventions. CONCLUSIONS The web-based approach with potential anonymity was important for facilitating support-seeking. Support for the SOs themselves and coping strategies for co-parent alcohol consumption were more common reasons for seeking help than worry about the children. For many SOs, the program was a first step in seeking further support. Spending more dedicated time with their children and being validated as living under stressful conditions were described by the SOs as particularly helpful. Trial registration The trial was pre-registered at isrctn.com, reference number ISRCTN38702517, November 28, 2017.
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Affiliation(s)
- Ola Siljeholm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm Riddargatan 1, 114 35, Stockholm, Sweden. .,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Veronica Ekström
- grid.412175.40000 0000 9487 9343Department of Social Sciences, Marie Cederschiöld University College, Sköndal, Sweden
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16
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McCarthy JM, Wood AJ, Shinners MG, Heinrich H, Weiss RD, Mueser KT, Meyers RJ, Carol EE, Hudson JI, Öngür D. Pilot development and feasibility of telehealth Community Reinforcement and Family Training (CRAFT) for early psychosis and substance use. Psychiatry Res 2022; 317:114804. [PMID: 36030701 PMCID: PMC10127150 DOI: 10.1016/j.psychres.2022.114804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
Substance use is associated with poor outcomes for individuals with early psychosis. Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that helps families to reduce substance use, engage in treatment, and improve family wellbeing, but it has not yet been studied for psychosis and substance use. The present study aimed to develop and evaluate a telehealth intervention utilizing CRAFT for families experiencing early psychosis and substance use. Twenty family members completed six to eight telehealth sessions of CRAFT adapted for early psychosis (CRAFT-EP). Participants completed an assessment battery at baseline, mid- and post-intervention, a three-month follow-up, surveys after each session, and a focus group to measure mean percentage of sessions completed, mean program satisfaction ratings, telehealth preference, and qualitative feedback. Participants had 100% session completion, and program satisfaction was at or near excellent for 99% of sessions. Half of participants preferred a primarily virtual hybrid program, whereas 45% preferred exclusively virtual visits. Communication was the most helpful topic, and participants requested additional written examples and resources. CRAFT-EP is feasible and acceptable to serve as the active intervention in a pilot randomized controlled trial comparing treatment as usual plus CRAFT-EP to treatment as usual.
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Affiliation(s)
- Julie M McCarthy
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Andrea J Wood
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - M Grace Shinners
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Hadley Heinrich
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Roger D Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert J Meyers
- Center on Alcoholism, Substance Abuse and Addiction, University of New, Albuquerque, NM, USA
| | - Emily E Carol
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James I Hudson
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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17
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Siljeholm O, Lindner P, Johansson M, Hammarberg A. An online self-directed program combining Community Reinforcement Approach and Family Training and parenting training for concerned significant others sharing a child with a person with problematic alcohol consumption: a randomized controlled trial. Addict Sci Clin Pract 2022; 17:49. [PMID: 36064466 PMCID: PMC9446578 DOI: 10.1186/s13722-022-00332-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an urgent need for interventions helping children affected by parental problematic alcohol consumption (PAC). Such interventions could target partners to individuals with PAC, partners who often themselves show impaired quality of life and mental health. The aim of this study was to investigate the efficacy of an online self-directed intervention combining components from Community Reinforcement Approach and Family Training (CRAFT) with a parenting training program for concerned significant others (CSOs) sharing a child with a co-parent with PAC. METHODS A randomized controlled parallel-group superiority trial compared the efficacy of the online intervention for CSOs sharing a child (3-11 y/o) with a co-parent with PAC (N = 37), to an active control group (N = 39) receiving written psychoeducational material. Assessment of outcomes was conducted at baseline, 3 weeks, 8 weeks and 12 weeks. Primary outcome was children's mental health, while secondary outcomes included parental self-efficacy, CSO mental health and co-parent alcohol consumption and level of dependence. Linear mixed effect models with a factorial time variable were used to model time by group interaction effects. RESULTS Recruitment rate was slow and a vast majority of interested CSOs were excluded at baseline assessment, mainly due experience of co-parent violence. The target sample size was not met. The intention to treat analysis did not show any significant time by group effects on either the primary or secondary outcomes during the follow-up period: the CSOs reported a significant reduction in co-parent alcohol consumption and severity of alcohol dependence and showed significant improvements in parental self-efficacy for how to handle effects of co-parent alcohol consumption, but no differences were found between the two conditions. CONCLUSIONS The current study found no evidence supporting efficacy of a novel, online self-directed intervention on children's mental health, CSO mental health and co-parent alcohol related outcomes. Engaging in a support program or receiving information appears to initiate behavior change in the CSOs which affects the alcohol consumption and severity of dependence for co-parents with PAC. It is suggested that future studies may preferably focus on CSOs in more severely affected contexts. Trial registration The trial was pre-registered at isrctn.com reference number ISRCTN38702517, November 28, 2017.
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Affiliation(s)
- Ola Siljeholm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. .,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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18
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Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am 2022; 45:515-528. [PMID: 36055736 PMCID: PMC9352538 DOI: 10.1016/j.psc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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19
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Orsolini L, Bellagamba S, Volpe U, Kato TA. Hikikomori and modern-type depression in Italy: A new phenotypical trans-cultural characterization? Int J Soc Psychiatry 2022; 68:1010-1017. [PMID: 35723190 DOI: 10.1177/00207640221099408] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Hikikomori is a Japanese term etymologically derived from 'hiku' (i.e. 'to pull back') and 'komoru' (i.e. 'seclude oneself'), which identifies those subjects who deliberately withdraw themselves by social life, remaining confined into their own home/room. The phenomenon is widely diffused in Japan, even though it is currently spread outside the Japanese culture. However, a universally shared and cross-cultural adaptation of Hikikomori definition, phenomenological and psychopathological characterization is still missing. METHODOLOGY An expert-guided opinion paper was here provided to clinical characterize the Hikikomori-like social withdrawal in the Italian context, by considering the transformation from a family-based society to a 'fluid' digital-structured culture, also discussing the concept of modern-type depression. This was provided deepening the principal current studies available in literature and giving an interpretation based on clinical experience in the Italian society. The work was supervised through a consensus by the most international expert of Japanese Hikikomori syndrome. RESULTS Current individual, family and social trajectories may potentially act as a mediator in favouring the occurrence of Hikikomori-like social withdrawal also in western countries, including Italy. Despite the differences between Japanese and Italian society and culture, the recent shaping of family structure and intra-familial dynamics, typical of the current post-modern society, may potentially influence the emergence of psychopathologies not typical of Italian culture. Unemployment and 'Not in Employment Education or Training' (NEET) conditions may represent another potential risk factor for economical/social marginalization of youngsters, together with the recent dramatic emergence of web-based psychopathologies. CONCLUSION A diagnostic culturally-adapted flow-chart is proposed for clinical characterizing Hikikomori in Italian context, which may help in proposing preventive strategies, ensuring early identification and prompt therapeutic interventions, particularly among youngsters.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Bellagamba
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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20
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Osilla KC, Rodriguez LM, Neighbors C, Pedersen ER. Effects of a Web-Based Intervention in Reducing Drinking among Concerned Partners of Military Service Members and Veterans. COUPLE & FAMILY PSYCHOLOGY 2022; 11:4-14. [PMID: 36448033 PMCID: PMC9701542 DOI: 10.1037/cfp0000201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Military personnel and their partners report greater alcohol use and related problems compared to their civilian counterparts. We designed a web-based intervention (WBI) called Partners Connect individualized for a military spouse or partner concerned about their service member/veteran's (SMV) drinking and conducted a secondary data analysis to examine the effect of the WBI on participant drinking and their perceptions of their SMV partner's drinking. Participants were concerned partners (CPs) recruited through social media and randomized to Partners Connect or waitlist control. They completed online surveys at baseline and three months post-intervention. CPs who reported any past-month drinking were included in the current analyses (n=161; 94.4% female, 77% White, 5% Hispanic, 32.0 (SD=6.5) years old). There was no significant effect of the intervention on CP drinking. However, the intervention effect was moderated by CP drinks per week, such that heavier drinking intervention CPs reported significant reductions in their number of drinking days at follow-up. Heavy drinking CPs who reduced their drinking also reported perceived reductions in SMV drinking. Military spouses and partners participated in Partners Connect out of concern for their SMV partner's drinking. In doing so, heavier drinking CPs reduced their own drinking frequency, which was also associated with perceptions of SMV drinking.
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Affiliation(s)
| | | | | | - Eric R Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences
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Tse N, Tse S, Wong P, Adams P. Collective Motivational Interviewing for Substance Use Problems: Concept and Implications. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Edgren R, Pörtfors P, Raisamo S, Castrén S. Treatment for the concerned significant others of gamblers: A systematic review. J Behav Addict 2022; 11:1-25. [PMID: 35044325 PMCID: PMC9109622 DOI: 10.1556/2006.2021.00088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Research recognizes the extent of harm experienced by concerned significant others (CSOs) of gamblers. This systematic review's aims are to examine the interventions for CSOs, evaluate potential benefits, and thematically describe treatment processes. The Stress-Strain-Coping-Support model (SSCS) served as the theoretical framework. METHODS Database searches were conducted in: MEDLINE, CINAHL Complete, Web of Science Core Collection, Social Services Abstracts, Applied Social Science Index and Abstracts, Cochrane Central Register of Controlled Trials, and APA PsycInfo (between 01/Jan 2011-10/Jun 2021). Other search methods were also utilized. Inclusion criteria: interventions for CSOs with CSO specific outcomes. The Evidence Project Risk of Bias Tool was used for assessment. RESULTS 19/768 records were included. Nine interventions were utilized: 3 CSO directed, 4 for couples, and 2 low threshold online interventions. A quantitative synthesis (N = 7 studies) of effect size estimates for depression and anxiety measures didn't indicate any intervention to have better outcomes than others. Core themes in the treatment process identified in the qualitative synthesis (N = 7) included: information and understanding, social support, coping skills, communication, and strain. Limitations in the evidence related to sampling, control-conditions and outcome measurements. DISCUSSION AND CONCLUSION Several interventions were identified, yet no specific interventions appeared more beneficial than others. Using the SSCS model, commonalities and differences in intervention content were identified, along with themes that influence treatment processes. The need for tailored interventions is discussed. Future treatment efficacy research should carefully select study designs and outcome measurements. PROSPERO (CRD42021229408).
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Affiliation(s)
- Robert Edgren
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, Helsinki, Finland,Corresponding author. E-mail:
| | - Pia Pörtfors
- Finnish Institute for Health and Welfare, Department of Information Services, Health and Social Services Data and Information Management, Helsinki, Finland
| | - Susanna Raisamo
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, Helsinki, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, Helsinki, Finland,University of Turku, Social Sciences Department of Psychology and Speech-Language Pathology, Turku, Finland,University of Helsinki, Department of Medicine, Helsinki, Finland
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Pandit N, Singh A, Thakkar K. Family support is key to overcome alcohol dependence: A social case study. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Månsson V, Samuelsson E, Berman AH, Nilsson A. Treatment for problem gambling and counselors' perception of their clinical competence: a national web survey in Sweden. Addict Sci Clin Pract 2022; 17:70. [PMID: 36494857 PMCID: PMC9733067 DOI: 10.1186/s13722-022-00347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite their crucial role in bridging science and practice, not much is known about counselors offering treatment for Problem Gambling (PG). This study maps current treatment, the type of change techniques that are prioritized in treatment and how counselors perceive their clinical competence in their work with PG clients. METHODS A sample of PG counselors from the healthcare and social services (N = 188, mean age: 49 years, 67% women) completed an online survey. A principal component analysis was conducted to map prioritized types of change techniques, and a multiple regression analysis was carried out to analyze predictors of counselors' role adequacy in their clinical work. RESULTS There was a large variation in the type of treatments offered for PG (mean 3.6). Cognitive Behavioral Therapy (CBT) and Motivational Interviewing were the most common treatments offered and motivation was rated as the most important type of change technique prioritized in the treatment of PG. A principal component analysis identified four components reflecting different types of change techniques prioritized by the counselors: (1) standard CBT, e.g., gambling cognitions, craving management, and finding alternative activities, (2) assessment of PG, (3) family orientation, i.e., involvement of concerned significant others in treatment, and (4) focus on exposure strategies. Counseling more clients monthly was associated with higher levels of willingness, adequacy and legitimacy in their clinical work with clients with PG. Additionally, offering CBT was a predictor for higher role adequacy and providing counseling on the origins of and consequences of PG. CONCLUSION There was a large heterogeneity among the treatments offered and what change techniques that were prioritized among the PG counselors. Clinical experience is of importance for developing competence in treating clients with PG. This finding suggests there could be benefits to establishing specialized, more visible treatment units where PG counselors could gain adequate clinical experience, thus increasing clinical competence for treating PG.
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Affiliation(s)
- Viktor Månsson
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
| | - Eva Samuelsson
- grid.10548.380000 0004 1936 9377Department of Social Work, Department of Public Health Sciences, Centre for Social Research On Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| | - Anne H. Berman
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden ,grid.8993.b0000 0004 1936 9457Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Anders Nilsson
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
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25
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Kelly JF, Bergman BG. A Bridge Too Far: Individuals With Regular and Increasing Very Heavy Alcohol Consumption Cannot be Considered as Maintaining "Recovery" Due to Toxicity and Intoxication-related Risks. J Addict Med 2021; 15:269-271. [PMID: 33060467 DOI: 10.1097/adm.0000000000000759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concept of "recovery" from alcohol use disorders (AUD) has garnered increasing scientific interest in recent years including attempts to explicate and measure its presumed component parts. In general, there is consensus that "recovery" should not be solely about abstinence or quantity-frequency measures of alcohol consumption and should include measures of functioning. Some researchers have taken an even more radical step, however, to suggest that psychosocial functioning should be the sine qua non defining feature of "recovery," seemingly irrespective of how much one drinks; as such, people can be classified as achieving and maintaining successful "recovery" despite engaging in regular very heavy drinking. This commentary argues against this notion, as it goes beyond existing data and largely ignores the more insidious toxicity-related, as well as acute intoxication-related, health risks, known to occur with heavy alcohol exposure that contradict the salubrious intent of the "recovery" construct. Furthermore, classifying someone as being in successful "recovery" due to high functioning but while engaging in very heavy drinking, ignores the potential collateral damage to close significant others (eg, children, partners), whose well-being can be severely impacted by the enduring unpredictability of heavy use. Finally, it is argued that exclusive championing of "functioning," while paying little if any attention to AUD remission or alcohol exposure status, creates a conceptual conundrum whereby someone with low functioning but who is in long-term AUD remission or completely abstinent could be classified as not achieving "recovery," holding such individuals to a higher standard and may be stigmatizing.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Mills Huffnagle S, Brennan G, Wicks K, Holden D, Kawasaki S. A comparison of patients with opioid use disorder receiving buprenorphine treatment with and without peer recovery support services. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1938265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sara Mills Huffnagle
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Grace Brennan
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | | | - Denise Holden
- Recovery Advocacy Service Empowerment (RASE) Project, Harrisburg, Pennsylvania, USA
| | - Sarah Kawasaki
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Ari H, Mari ST. Suicide Motives and Protective Factors - Contributions from a Hikikomori Discussion Board. Issues Ment Health Nurs 2021; 42:417-429. [PMID: 32960648 DOI: 10.1080/01612840.2020.1817209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study describes reasons why hikikomoris or socially withdrawn people consider committing suicide, and factors that prevent them from committing the act.2,644 anonymous messages were collected in May 2020 from a Finnish hikikomori discussion forum and analyzed using netnography and inductive content analysis.Suicides motives involved experiences of failure, loneliness and worthlessness, often combined with mental health problems and triggered by loss of employment or significant relationship. Lack of courage was a common reason for not committing suicide. The role of family in preventing suicide is significant, along with support from professionals. Family and individualized interventions are discussed briefly.
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Affiliation(s)
- Haasio Ari
- Seinäjoki University of Applied Sciences, Seinäjoki, Finland
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Bagley SM, Hadland SE, Schoenberger SF, Gai MJ, Topp D, Hallett E, Ashe E, Samet JH, Walley AY. Integrating substance use care into primary care for adolescents and young adults: Lessons learned. J Subst Abuse Treat 2021; 129:108376. [PMID: 34080547 DOI: 10.1016/j.jsat.2021.108376] [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: 09/03/2020] [Revised: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Substance use disorders are common chronic conditions that often begin and develop during adolescence and young adulthood, yet the delivery of primary care is not developmentally tailored for youth who use substances. Very few primary care-based substance use treatment programs exist in the United States for adolescents and young adults and no clear guidance is available about how to provide substance use treatment in primary care. METHODS We conducted a retrospective evaluation from July 2016 to December 2018 of a newly established primary care-based, multidisciplinary, outpatient program for youth who use substances. Components of the program include primary care, addiction treatment, harm reduction, naloxone distribution, psychotherapy, recovery support, and navigation addressing social determinants of health. We report the following patient characteristics and outcomes: demographics; proportion with substance use and mental health diagnoses; receipt of medications for opioid use disorder; retention in care at three, six, nine, and 12 months; and re-engagement in medical care. RESULTS From July 2016 through December 2018, 148 patients had at least one visit. Demographic characteristics included: median age 21 years; 40.5% female; 94.0% spoke primarily English; 18.3% Black, 14.9% Hispanic, and 60.8% white. One-third of patients (33.8%) were homeless or housing insecure. The most common substance use disorder was opioid use disorder (60.8%), followed by nicotine (37.2%), cannabis (20.9%), and alcohol (18.2%). Overall, 29.7% of patients had depression, 32.4% had anxiety disorder, and 18.9% had post-traumatic stress disorder. Retention in care was 29.7% at six months and 12.2% at 12 months. Among the 90 patients with OUD, 90.0% received medication for OUD, and 35.5% and 15.5% of patients with OUD were retained at six and 12 months, respectively. For patients lost to follow-up (no contact during a three-month period), the median time to re-engagement was 4.8 months, and 33.3% (37/111) of patients re-engaged. The most common reason for re-engagement was to access mental health treatment (59.5%) and primary care (51.4%). CONCLUSIONS Youth who sought care in a primary care-based substance use program presented most commonly with opioid, nicotine, cannabis, and alcohol use disorders. Co-morbid mental health diagnoses were common. While continuous retention at 12 months was low, one in three of the patients who fell out of care re-engaged. For youth receiving substance use care integrated into primary care, key components for pursing optimal retention in substance use treatment are a flexible model that anticipates the need for the treatment of mental health disorders and the use of re-engagement strategies.
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Affiliation(s)
- Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA 02119, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America.
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA 02119, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Samantha F Schoenberger
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America
| | - Mam Jarra Gai
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America
| | - Deric Topp
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America
| | - Eliza Hallett
- Center for the Urban Child and Healthy Family, Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Erin Ashe
- Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, United States of America
| | - Jeffrey H Samet
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
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Hadland SE, Yule AM, Levy SJ, Hallett E, Silverstein M, Bagley SM. Evidence-Based Treatment of Young Adults With Substance Use Disorders. Pediatrics 2021; 147:S204-S214. [PMID: 33386323 PMCID: PMC7879425 DOI: 10.1542/peds.2020-023523d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among adolescents and young adults, in this special article, we review principles of care related to SUD treatment of young adults. SUDs are most commonly diagnosed during young adulthood, but most of the evidence guiding the treatment of this population has been obtained from older adult study participants. Extrapolating evidence from older populations, the expert group asserted the following principles for SUD treatment: It is important that clinicians who work with young adults effectively identify and address SUD to avert long-term addiction and its associated adverse health outcomes. Young adults receiving addiction treatment should have access to a broad range of evidence-based assessment, psychosocial and pharmacologic treatments, harm reduction interventions, and recovery services. These evidence-based approaches should be tailored to young adults' needs and provided in the least restrictive environment possible. Young adults should enter care voluntarily; civil commitment to treatment should be a last resort. In many settings, compulsory treatment does not use evidence-based approaches; thus, when treatment is involuntary, it should reflect recognized standards of care. Continuous engagement with young adults, particularly during periods of relapse, should be considered a goal of treatment and can be supported by care that is patient-centered and focused on the young adult's goals. Lastly, substance use treatments for young adults should be held to the same evidence and quality standards as those for other chronic health conditions.
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Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Amy M Yule
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sharon J Levy
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
- Adolescent Substance Use and Addiction Program and Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Eliza Hallett
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Michael Silverstein
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Sarah M Bagley
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
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EÉk N, Romberg K, Siljeholm O, Johansson M, Andreasson S, Lundgren T, Fahlke C, Ingesson S, Bäckman L, Hammarberg A. Efficacy of an Internet-Based Community Reinforcement and Family Training Program to Increase Treatment Engagement for AUD and to Improve Psychiatric Health for CSOs: A Randomized Controlled Trial. Alcohol Alcohol 2020; 55:187-195. [PMID: 31912156 PMCID: PMC7082489 DOI: 10.1093/alcalc/agz095] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 10/09/2019] [Accepted: 10/24/2019] [Indexed: 12/04/2022] Open
Abstract
Aims Community Reinforcement Approach and Family Training (CRAFT) is a support program for concerned significant others (CSOs) to identified persons (IPs) with alcohol use disorders, with the purpose of engaging IPs to treatment and to improve CSO functioning. The purpose of the present study was to investigate the efficacy of an internet-based version of CRAFT (iCRAFT). Methods Randomized controlled trial comparing iCRAFT with a wait-list (WL) condition with a nation-wide uptake in Sweden. A total of 94 CSOs to a treatment refusing IP, who described the IP according to DSM-IV criteria for alcohol dependence or abuse, were included in the study. iCRAFT consisted of five weekly administered therapist-guided modules with the following content: (a) improve CSOs’ own mental health, (b) improve the CSOs skills in asking the IP to seek treatment, (c) positive communication skills training, (d) contingency management of IP drinking behavior. Main outcome measure was IPs initiative to seek treatment measured at 24 weeks. Secondary outcomes were IP’s daily alcohol consumption, CSOs mental health, quality of life and relational satisfaction. Results Of 94 participants, 15 CSOs reported IP treatment initiative during the study period. Of these, 10 belonged to the iCRAFT condition and five to the WL condition. The difference between conditions was nonsignificant, and the results were inconclusive. Participants in iCRAFT showed short-term improvements regarding depressive symptoms, quality of life and relational happiness. Conclusion This study was unable to demonstrate substantial changes in the iCRAFT program regarding IP treatment seeking or CSO mental health.
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Affiliation(s)
- Niels EÉk
- Department of Psychology, University of Gothenburg, PO Box 500, SE405 30 Gothenburg, Sweden
| | - Karin Romberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, SE171 77 Stockholm, Sweden.,Stockholm Health Care Services , Stockholm County Council, Solnavägen 1E, SE113 65, Stockholm, Sweden
| | - Ola Siljeholm
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, SE171 77 Stockholm, Sweden.,Stockholm Health Care Services , Stockholm County Council, Solnavägen 1E, SE113 65, Stockholm, Sweden
| | - Magnus Johansson
- Department of Public Health Sciences, Karolinska Institutet, SE171 77 Stockholm, Sweden
| | - Sven Andreasson
- Department of Public Health Sciences, Karolinska Institutet, SE171 77 Stockholm, Sweden
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, SE171 77 Stockholm, Sweden.,Stockholm Health Care Services , Stockholm County Council, Solnavägen 1E, SE113 65, Stockholm, Sweden
| | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, PO Box 500, SE405 30 Gothenburg, Sweden
| | - Stina Ingesson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, SE171 77 Stockholm, Sweden.,Stockholm Health Care Services , Stockholm County Council, Solnavägen 1E, SE113 65, Stockholm, Sweden
| | - Lisa Bäckman
- Sahlgrenska University Hospital, The Clinic for Addictions and Dependency, SE413 45, Gothenburg, Sweden
| | - Anders Hammarberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, SE171 77 Stockholm, Sweden.,Stockholm Health Care Services , Stockholm County Council, Solnavägen 1E, SE113 65, Stockholm, Sweden
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Correlates of Expressed Emotion Among Family Members of Individuals Who Sought Treatment for Opioid Use. J Nerv Ment Dis 2020; 208:870-875. [PMID: 32773612 DOI: 10.1097/nmd.0000000000001220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Expressed emotion has been robustly associated with negative mental health outcomes. Understanding correlates of expressed emotion by family members of individuals with opioid use disorder is important, as this group faces high levels of stress and can play an important role in their loved ones' treatment. Thus, immediate family members of individuals who sought treatment for opioid problems (N = 195) completed a web-based survey that included measures of expressed emotion, self-stigma, social support, and demographic characteristics. Multiple linear regression analyses were conducted to examine correlates of two types of expressed emotion-criticism and emotional overinvolvement. Results indicated that higher self-stigma and lower social support were significantly associated with higher emotional overinvolvement. Higher self-stigma and having experienced debt related to a family member's opioid use were associated with higher criticism. Thus, self-stigma and financial burden may exacerbate likelihood of expressed emotion, whereas social support may buffer against expressed emotion.
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Rodriguez LM, Webster GD. The Three-Item Thinking about Your Partner's Drinking Scale (TPD-3): Item Response Theory, Reliability, and Validity. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:471-488. [PMID: 31355961 DOI: 10.1111/jmft.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Interdependence is a defining feature of close relationships, and alcohol use is one domain where one person's motivations and behaviors can affect a partner's well-being. Concern about partner drinking is a gauge that determines whether a partner's alcohol use has the potential to be problematic to the relationship, and brief and efficient measurement of this construct can be used to serve clinicians, scientists, and practitioners. Across four studies (N = 1,807), we use item response theory analysis to present a 3-item brief screening tool assessing concern about partner drinking: Thinking about your Partner's Drinking-3 (TPD-3). The TPD-3 revealed strong test-retest reliability and expected patterns of convergent, concurrent, and incremental validity with perceived partner drinking and alcohol-related consequences, behavioral responses to partner drinking, and relationship well-being. We present the TPD-3 as a useful screening tool and for measurement of concern about partner drinking when efficient assessment is desired.
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Kalsås ØR, Selbekk AS, Ness O. ["I get a whole different view": Professionals experiences with family-oriented practice in addiction treatment]. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:243-261. [PMID: 35308315 PMCID: PMC8899265 DOI: 10.1177/1455072520914207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
Aim: Family members’ lives and health are seriously affected by alcohol- and drug addiction in close relationships, and research on addiction treatment shows that outcome of treatment is better when family is involved, both for the patient and family member. In Norway, there are clear political and professional guidelines in favour of involvement of family/significant others in the course of treatment, however, there are few addiction treatment services in Norway who comprehensively do so. The aim of this study is to explore therapists’ experiences from involving family and significant others in interdisciplinary specialised addiction treatment (TSB), within an in-patient clinic in Norway. The research question is: What significance do therapists emphasise from involving family members within interdisciplinary specialised inpatient addiction treatment, and which professional and ethical challenges arise with such involvement? Method: The data was gathered through two focus-group interviews and analysed with thematic analysis. Results: The main findings of the analysis are: (1) “A solid treatment structure for family involvement is central to family-oriented work”, (2) “Substantial positive effects for both patient, family member and therapist are attributed to family-oriented treatment focus”, and (3) “New dilemmas and challenges arise as a consequence of emphasising family-oriented work”. Conclusion: The article gives insights in how treatment practice that involves family and network members can be organised, what can be achieved with such involvement, which challenges and dilemmas can arise, and discusses how these insights challenges language, ethics and judicial framework for addiction treatment.
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Affiliation(s)
| | | | - Ottar Ness
- Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway
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Archer M, Harwood H, Stevelink S, Rafferty L, Greenberg N. Community reinforcement and family training and rates of treatment entry: a systematic review. Addiction 2020; 115:1024-1037. [PMID: 31770469 DOI: 10.1111/add.14901] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/29/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry. METHOD Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe. RESULTS A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP-CSO relationship, CRAFT modality and integration of treatment for IP. Meta-analysis found CRAFT to be twice as effective as controls/comparison groups. Multi-modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5-71%), group (60%) and self-directed workbook (13.3-40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5-23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated. CONCLUSIONS Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success.
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Affiliation(s)
- Marc Archer
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Hannah Harwood
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Sharon Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK.,Department of Psychological Medicine, King's College London, De Crespigny Park, London, UK
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK.,Academic Department of Military Mental Health, King's College London, Weston Education Centre, London, UK
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Ameral V, Yule A, McKowen J, Bergman BG, Nargiso J, Kelly JF. A Naturalistic Evaluation of a Group Intervention for Parents of Youth with Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2019; 38:379-394. [PMID: 32863559 PMCID: PMC7451897 DOI: 10.1080/07347324.2019.1633978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Parents of youth with substance use disorders (SUDs) often play a vital role in successful treatment, yet little is known about interventions designed to help them cope with the stress of this role, especially as delivered in real-world settings. Evaluations of such interventions could potentially inform adaptations to enhance their clinical utility. Parents of youth with SUDs attending a clinician-led group based on the CRAFT model completed measures at intake, 4- and 8-weeks. Parents (n=545) attended an average of 3.7 sessions; 12% completed all 8 weeks. Analysis of demographic predictors of retention indicated that older parents attended more sessions on average. Overall stress did not change across time points (p>0.05). However, parents reported improvement in parent empowerment as measured by the Parent Empowerment Scale, a novel measure of parent empowerment in coping with their child's SUD (p<0.001). Clinician led evidence-informed group services may improve parents' perceived ability to help their child with their SUD. Low retention rates highlight the need to better understand the factors contributing to retention, and the potential value of adaptations to shorten the intervention. Programs serving youth with SUDs may wish to consider integrating such group services to support parents.
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Affiliation(s)
- Victoria Ameral
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130
- Department of Psychiatry, Boston University School of Medicine, 72 E Concord St., Boston, MA 02118
| | - Amy Yule
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
| | - James McKowen
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, Suite 601, Boston, MA 02114
| | - Jessica Nargiso
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
| | - John F Kelly
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, Suite 601, Boston, MA 02114
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Rodriguez LM, Neighbors C, Osilla KC, Trail TE. The longitudinal effects of military spouses' concern and behaviors over partner drinking on relationship functioning. Alcohol 2019; 76:29-36. [PMID: 30553122 DOI: 10.1016/j.alcohol.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/11/2018] [Accepted: 07/11/2018] [Indexed: 12/12/2022]
Abstract
Among those in close relationships, the perception that one's partner has a drinking problem is more strongly related to detriments in relationship quality than are the actual rates of the partner's drinking. The current study extends this work by examining the effects of this perception on relationship functioning longitudinally and whether this association is mediated by changes in how one behaves in response to their partner's drinking. Spouses and partners of military service members who were concerned about their partner's drinking (n = 234) completed a baseline survey and a follow-up assessment five months later. Structural equation modeling was used to prospectively examine the association between concern about partner drinking and relationship functioning (i.e., relationship quality, conflict, communication patterns), and the mediated effect of regulation strategies. Results suggested that changes in participant concern were related to changes in relationship functioning, and these changes were mediated by changes in punishment and rewarding sobriety regulation strategies. This research suggests that concern about partner drinking is linked with poorer relationship functioning partly because of the increased use of punishment and the decreased use of rewarding sobriety.
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DeBeer BB, Matthieu MM, Kittel JA, Degutis LC, Clafferty S, Qualls N, Morissette SB. Quality Improvement Evaluation of the Feasibility and Acceptability of Adding a Concerned Significant Other to Safety Planning for Suicide Prevention With Veterans. ACTA ACUST UNITED AC 2019. [DOI: 10.17744/mehc.41.1.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide among veterans remains a serious public health issue, and poor social support is identified as a robust risk factor for suicide. The U.S. Department of Veterans Affairs uses a standard safety planning procedure for suicide prevention. While this intervention can help veterans identify social support sources, it does not directly incorporate a concerned significant other (CSO). Research suggests that veterans prefer a family member or friend to help shoulder the burden of a potential crisis. This qualitative feasibility project examined the role of CSOs in safety planning with veterans. Interviews were conducted with 29 veterans and four CSOs to investigate whether veterans wanted a CSO involved in their safety plan and to investigate associated logistical issues for implementation. Overwhelmingly, veterans (79.13%) reported that having a CSO directly involved in their safety plan would be helpful. Qualitative data are presented highlighting practical concerns for mental health providers developing safety plans with veterans.
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Sarkar S, Kaloiya G. Family-based interventions for substance use disorders must look at the local needs and service delivery. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2019. [DOI: 10.4103/jmhhb.jmhhb_53_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim HS, Hodgins DC. Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions. Front Psychiatry 2018; 9:406. [PMID: 30233427 PMCID: PMC6127248 DOI: 10.3389/fpsyt.2018.00406] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/10/2018] [Indexed: 11/16/2022] Open
Abstract
Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated. However, we argue that a more effective and efficient treatment approach is to conceptualize behavioral and substance use addictions as different expressions of a common underlying disorder and, in treatment, to address the underlying mechanisms common to both. To this end, the article presents a developing transdiagnostic treatment model of addictions that targets underlying similarities between behavioral and substance use addictions, called the component model of addiction treatment (CMAT). The CMAT is transdiagnostic in that it can be used in the treatment of both behavioral and substance use addictions. It is pragmatic in that it targets component vulnerabilities, which are enduring, yet malleable, individual psychological, cognitive, and neurobiological characteristics that are common to all addictive disorders and have been demonstrated to be modifiable. A working model of CMAT is presented, including proposed component vulnerabilities: lack of motivation, urgency, maladaptive expectancies, deficits in self-control, deficits in social support, and compulsivity, as well as their potential intervention possibilities. Future directions and potential implications of the CMAT are discussed.
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Affiliation(s)
- Hyoun S. Kim
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
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Lindner P, Siljeholm O, Johansson M, Forster M, Andreasson S, Hammarberg A. Combining online Community Reinforcement and Family Training (CRAFT) with a parent-training programme for parents with partners suffering from alcohol use disorder: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e020879. [PMID: 30099390 PMCID: PMC6089295 DOI: 10.1136/bmjopen-2017-020879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Partners and children of individuals with alcohol use disorder (AUD) present with impaired quality of life and mental health, yet seldom seek or participate in traditional supportive interventions. Engaging the parent/partner without AUD in treatment is a promising way of supporting behavioural change in both the child and the parent with AUD. Universal parent-training (PT) programmes are effective in increasing children's well-being and decreasing problem behaviours, but have yet to be tailored for children with a parent with AUD. Community Reinforcement Approach And Family Training (CRAFT) programmes are conceptually similar, and aim to promote behavioural change in individuals with AUD by having a concerned significant other change environmental contingencies. There has been no study on whether these two interventions can be combined and tailored for partners of individuals with AUD with common children, and delivered as accessible, online self-help. METHODS AND ANALYSIS: n=300 participants with a child showing mental health problems and partner (co-parent) with AUD, but who do not themselves present with AUD, will be recruited from the general public and randomised 1:1 to either a four-module, online combined PT and CRAFT programme or a psychoeducation-only comparison intervention. Primary outcome will be the child's mental health. Additional outcomes will cover the partner's drinking, the participants own mental health and drinking, the child's social adjustment, treatment seeking in all three parties and parental self-efficacy. Measures will be collected preintervention, mid-intervention and postintervention, and three times during a 2-year follow-up period. Data will be analysed using mixed-effects modelling. ETHICS AND DISSEMINATION This study has been approved by the Stockholm Regional Ethical Review Board (2016/2179-31). The results will be presented at conferences and published as peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN38702517; Pre-results.
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Affiliation(s)
- Philip Lindner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ola Siljeholm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sven Andreasson
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Edwards M, Best D, Irving J, Andersson C. Life in Recovery: A Families’ Perspective. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1488553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Michael Edwards
- Department of Law & Criminology, Sheffield Hallam University, Sheffield, United Kingdom
| | - David Best
- Department of Law & Criminology, Sheffield Hallam University, Sheffield, United Kingdom
| | - James Irving
- Department of Law & Criminology, Sheffield Hallam University, Sheffield, United Kingdom
| | - Catrin Andersson
- Department of Law & Criminology, Sheffield Hallam University, Sheffield, United Kingdom
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Abstract
: Approximately 21 million people in the United States have a substance use disorder (SUD); the number of family members impacted by a loved one's SUD is exponentially greater. Affected family members of individuals with SUDs are at high risk for developing chronic medical and psychiatric health conditions, are high utilizers of the health care system, and have high health care expenditures. Family members play a central role in the lives of many individuals with SUDs; information given to family members can have a significant impact on persons with addiction and therefore the SUD treatment that an individual might receive. Evidence-based interventions targeting affected family members have been shown to: improve health outcomes for all family members, result in better addiction treatment outcomes, and prevent adolescent substance use. Despite mounting evidence, the health care system has been hesitant to engage families in a meaningful way. Health care providers should consider how implicit and explicit assumptions about the role of family members in SUD development, treatment, and recovery may contribute to this underlying reluctance. Antiquated policies and procedures that alienate family members should be modified (e.g., limiting phone access). Family members have a right to receive professional treatment and to be educated about the difference between mutual/peer support and evidence-based treatment options. Despite the potential for family members to move the needle on the country's current addiction crisis they remain an underutilized resource. A paradigm shift will be required to get the current SUD care continuum to adopt a family-centric model.
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Osilla KC, Trail TE, Pedersen ER, Gore KL, Tolpadi A, Rodriguez LM. Efficacy of a Web-based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:292-306. [PMID: 28972265 PMCID: PMC5882610 DOI: 10.1111/jmft.12279] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Concerned partners (CPs) of service members and veterans who misuse alcohol face help-seeking barriers and mental health problems. We used multiple regression to evaluate the efficacy of Partners Connect, a four-session web-based intervention (WBI) to address military CPs' mental health and communication. We randomized 312 CPs to the WBI or a control group. Five months later, WBI CPs reported significant reductions in their anxiety and increases in their social support compared to control CPs. Intervention dose was also associated with improved WBI CP outcomes. Partners Connect appears to fill a need for families who face help-seeking barriers and provides an alternative to traditional care for those who may not otherwise seek help.
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Abstract
Alcohol use disorders (AUD) are a significant and growing public health problem in India. However, health services for AUD remain largely confined to large institutions and a significant proportion of people with AUD do not having access to help for their alcohol related problems. One way of changing this status quo is making evidence based psychosocial interventions available in communities and closer to people's homes. There is extensive evidence supporting the effectiveness of a range of psychosocial interventions for AUDs. This is further augmented by the growing evidence for the effectiveness of contextually appropriate psychosocial interventions, such as Counselling for Alcohol Problems (CAP) from India, that are designed to increase access to care through delivery by non-specialist health workers. The effective implementation of such interventions integrated into collaborative care models will go a long way in reducing the treatment gap for AUDs in India.
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Rane A, Church S, Bhatia U, Orford J, Velleman R, Nadkarni A. Psychosocial interventions for addiction-affected families in Low and Middle Income Countries: A systematic review. Addict Behav 2017; 74:1-8. [PMID: 28554034 DOI: 10.1016/j.addbeh.2017.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
AIM To review the literature on psychosocial interventions for addiction affected family members in Low and Middle Income Countries (LMIC). METHODS A systematic review with a detailed search strategy focussing on psychosocial interventions directed towards people affected by addiction without any gender, year or language specifications was conducted. Identified titles and abstracts were screened; where needed full papers retrieved, and then independently reviewed. Data was extracted based on the aims of the study, to describe the modalities, acceptability, feasibility and effectiveness of the interventions. RESULTS Four papers met our selection criteria. They were published between 2003 and 2014; the total sample size was 137 participants, and two studies were from Mexico and one each from Vietnam and Malaysia. The predominantly female participants comprised of parents, spouses and siblings. The common components of all the interventions included providing information regarding addiction, teaching coping skills, and providing support. Though preliminary these small studies suggests a positive effect on affected family members (AFM). There was lowering of psychological and physical distress, along with a better understanding of addictive behaviour. The interventions led to better coping; with improvements in self-esteem and assertive behaviour. The interventions, mostly delivered in group settings, were largely acceptable. CONCLUSIONS The limited evidence does suggest positive benefits to AFMs. The scope of research needs to be extended to other addictions, and family members other than spouse and female relatives. Indigenous and locally adapted interventions are needed to address this issue keeping in mind the limited resources of LMIC. This is a field indeed in its infancy and this under recognised and under-served group needs urgent attention of researchers and policy makers.
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Affiliation(s)
- Anil Rane
- Institute of Psychiatry and Human Behaviour, Goa, India.
| | - Sydney Church
- School of Oriental and African Studies, UK; Addictions Research Group, Sangath, Goa, India
| | | | - Jim Orford
- School of Psychology, University of Birmingham, UK
| | - Richard Velleman
- Addictions Research Group, Sangath, Goa, India; University of Bath, Bath, UK
| | - Abhijit Nadkarni
- Addictions Research Group, Sangath, Goa, India; South London & Maudsley NHS Foundation Trust, London, UK
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Kirby KC, Benishek LA, Kerwin ME, Dugosh KL, Carpenedo CM, Bresani E, Haugh JA, Washio Y, Meyers RJ. Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:818-827. [PMID: 28836796 DOI: 10.1037/adb0000306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all 6 components of CRAFT are necessary. In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12-14 sessions of the full CRAFT intervention, 4-6 sessions focused on Treatment Entry Training (TEnT), or 12-14 sessions of Al-Anon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO's mood and functioning. Data were collected at baseline and 4, 6, and 9 months after the baseline. We found significant reductions in time to treatment entry (χ(2)2 = 8.89, p = .01) and greater treatment entry rates for CRAFT (62%; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.1-6.9) and TEnT (63%; OR = 2.9, 95% CI = 1.2-7.5) compared with ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR = 1.1, 95% CI = 0.4-2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277) = 13.47, p < .0001). Similarly, CSO mood and functioning did not differ between the 3 conditions but improved over time (p < .0001 for all significant measures). We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | | | | | - Yukiko Washio
- Department of Obstetrics and Gynecology, Christiana Health Care System/University of Delaware
| | - Robert J Meyers
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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Psychosocial relationship status and quality as predictors of exercise intervention adherence and substance use outcomes: Results from the STRIDE (CTN-0037) study. Psychiatry Res 2017; 254:332-339. [PMID: 28525788 PMCID: PMC5563976 DOI: 10.1016/j.psychres.2017.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 04/12/2017] [Accepted: 04/27/2017] [Indexed: 11/24/2022]
Abstract
Social/intimate relationship status and quality are associated with health-promoting behaviors, while living alone or being isolated are adversely associated with physical and mental health outcomes. Limited work has investigated how particular components of one's social environment - usual living arrangements, satisfaction with those arrangements, and global social and family discord - are related to substance use reduction and intervention adherence. We investigated these questions in 270 individuals receiving study intervention for stimulant abuse/dependence through the multi-site Stimulant Reduction Intervention using Dosed Exercise (CTN-0037) trial. Using mixed effects modeling, results indicated that individuals with baseline social discord used stimulants on more days throughout the intervention period than those without social discord (d=0.39). An interaction between gender, usual living arrangements, and satisfaction with those arrangements indicated that women who lived alone and were dissatisfied with that arrangement reported greater days of stimulant use compared to several other groups (d≥1.46). Finally, individuals who reported usually living with a non-partner over the past three years attended a greater percentage of intervention sessions compared to those usually living with a partner (d=0.34). These results identify sample subgroups with adverse stimulant use and intervention adherence outcomes and suggest areas for future inquiry/intervention.
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Griffin JM, Malcolm C, Wright P, Hagel Campbell E, Kabat M, Bangerter AK, Sayer NA. U.S. Veteran Health Care Utilization Increases after Caregivers' Use of National Caregiver Telephone Support Line. HEALTH & SOCIAL WORK 2017; 42:e111-e119. [PMID: 28371802 DOI: 10.1093/hsw/hlx016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/23/2016] [Indexed: 06/07/2023]
Abstract
The U.S. Department of Veterans Affairs (VA) established the national Caregiver Support Line (CSL) in February 2011. The CSL is operated by licensed master's degree social workers who provide caregivers of veterans with information about caregiver benefits and services, counseling, and referrals to a caregiver support coordinator at the nearest VA medical center. The authors compared differences in veteran health care utilization patterns in the six months before and after a caregiver call to the CSL, hypothesizing that veterans with caregivers using the CSL had improved access to health care services and improved access increased utilization of health care. A pre- and posttest design was used. CSL calls that resulted in referrals to VA health care services or to local VA caregiver support coordinators were included in the sample. Data were extracted from the CSL database and matched to veteran care utilization data using veteran medical record data. Veteran inpatient stays for general medicine, hospice, respite, and long-term care significantly increased after the CSL call, but other inpatient stays (surgery, neurology) did not. Outpatient services for home health, respite, and mental health all significantly increased. Caregivers' use of the national CSL may help facilitate access for veterans to needed care services.
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Affiliation(s)
- Joan M Griffin
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
| | - Cari Malcolm
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
| | - Pamela Wright
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
| | - Emily Hagel Campbell
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
| | - Margaret Kabat
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
| | - Ann K Bangerter
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
| | - Nina A Sayer
- Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis
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McPherson C, Boyne H, Willis R. The Role of Family in Residential Treatment Patient Retention. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9712-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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