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Aramruang T, Malhotra A, Numthavaj P, Looareesuwan P, Anothaisintawee T, Dejthevaporn C, Sirirutbunkajorn N, Attia J, Thakkinstian A. Prediction models for identifying medication overuse or medication overuse headache in migraine patients: a systematic review. J Headache Pain 2024; 25:165. [PMID: 39363297 PMCID: PMC11450990 DOI: 10.1186/s10194-024-01874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 09/22/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Migraine is a debilitating neurological disorder that presents significant management challenges, resulting in underdiagnosis and inappropriate treatments, leaving patients at risk of medication overuse (MO). MO contributes to disease progression and the development of medication overuse headache (MOH). Predicting which migraine patients are at risk of MO/MOH is crucial for effective management. Thus, this systematic review aims to review and critique available prediction models for MO/MOH in migraine patients. METHODS A systematic search was conducted using Embase, Scopus, Medline/PubMed, ACM Digital Library, and IEEE databases from inception to April 22, 2024. The risk of bias was assessed using the prediction model risk of bias assessment tool. RESULTS Out of 1,579 articles, six studies with nine models met the inclusion criteria. Three studies developed new prediction models, while the remaining validated existing scores. Most studies utilized cross-sectional and prospective data collection in specific headache settings and migraine types. The models included up to 53 predictors, with sample sizes from 17 to 1,419 participants. Traditional statistical models (logistic regression and least absolute shrinkage and selection operator regression) were used in two studies, while one utilized a machine learning (ML) technique (support vector machines). Receiver operating characteristic analysis was employed to validate existing scores. The area under the receiver operating characteristic (AUROC) for the ML model (0.83) outperformed the traditional statistical model (0.62) in internal validation. The AUROCs ranged from 0.84 to 0.85 for the validation of existing scores. Common predictors included age and gender; genetic data and questionnaire evaluations were also included. All studies demonstrated a high risk of bias in model construction and high concerns regarding applicability to participants. CONCLUSION This review identified promising results for MO/MOH prediction models in migraine patients, although the field remains limited. Future research should incorporate important risk factors, assess discrimination and calibration, and perform external validation. Further studies with robust designs, appropriate settings, high-quality and quantity data, and rigorous methodologies are necessary to advance this field.
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Affiliation(s)
- Teerapong Aramruang
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Panu Looareesuwan
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nat Sirirutbunkajorn
- Department of Diagnostic and Therapeutic Radiology, Division of Radiation Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Chang YSG, McMahan VM, Marti XL, Pope E, Wolfe S, Majeski A, Reed G, Walley AY, Coffin PO. Perception and Correlates of Opioid Overdose Risk Among Overdose Survivors Who Use Nonprescribed Opioids in San Francisco and Boston. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:559-567. [PMID: 38456483 DOI: 10.1177/29767342241237202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Understanding opioid overdose risk perception may inform overdose prevention strategies. METHODS We used baseline data from a randomized overdose prevention trial, in San Francisco, CA, and Boston, MA, among people who used nonprescribed opioids, survived an overdose in the past 3 years, and had received naloxone. Participants were asked how likely they were to overdose in the next 4 months. We combined "extremely likely" and "likely" (higher risk perception) and "neutral," "unlikely," and "extremely unlikely" (lower risk perception). We performed bivariate analyses and separate multivariable logistic regression models of risk perception across (1) sociodemographic, (2) substance use, and (3) overdose risk behavior measures. Covariates were selected a priori or significant in bivariate analyses. RESULTS Among 268 participants, 88% reported at least 1 overdose risk behavior; however, only 21% reported higher risk perception. The adjusted odds ratio (AOR) of higher risk perception was 2.41 (95% confidence interval [CI]: 1.10-5.30) among those unhoused in the past 4 months, 2.06 (95% CI: 1.05-4.05) among those using opioids in a new place, and 5.61 (95% CI: 2.82-11.16) among those who had overdosed in the past 4 months. Living in Boston was associated with higher risk perception in all 3 models (AOR = 2.00-2.46, 95% CI: 1.04-4.88). CONCLUSIONS Despite prevalent risk behaviors, a minority of participants perceived themselves to be at higher risk of overdose. Nonetheless, some known risk factors for overdose were appropriately associated with risk perception. Fentanyl has been prevalent in Boston for longer than San Francisco, which may explain the higher risk perception there.
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Affiliation(s)
- Yi-Shin Grace Chang
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Vanessa M McMahan
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Xochitl Luna Marti
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Emily Pope
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Shae Wolfe
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Adam Majeski
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Gabriela Reed
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Phillip O Coffin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
- University of California, San Francisco, San Francisco, CA, USA
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Golshan F, Lysenko R, Nabi Zade M, Alibolandi P, Block H, Masiowski P, O'Connell ME, Sun G, Mickleborough M. Study protocol for a randomized controlled trial of neurofeedback mindfulness in chronic migraines. Contemp Clin Trials Commun 2024; 41:101362. [PMID: 39280788 PMCID: PMC11402407 DOI: 10.1016/j.conctc.2024.101362] [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: 03/17/2024] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/18/2024] Open
Abstract
Chronic migraine is a debilitating headache disorder that is associated with excessive analgesic use. As the long-term use of analgesics could cause additional headaches due to medication overuse, there is a need to probe efficient nonprophylactic alternatives and migraineurs' long-term adherence to such possible treatments. This protocol investigates the integration of neurofeedback and mindfulness which are the two common nonpharmacological therapies for migraines. We offer the use of portable EEG headbands for easy home-based data collection and consistent data access from researchers. In order to evaluate the efficacy of this recommended intervention, this is a protocol for a randomized control trial with a waitlisted group and an intervention group consisting of a daily attention task. The protocol presents important criteria which should be checked for consistency in longitudinal data collection from adults with chronic migraine.
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Affiliation(s)
- Faly Golshan
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Rachel Lysenko
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Monika Nabi Zade
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Parham Alibolandi
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Haley Block
- College of Medicine, University of Saskatchewan, Canada
| | | | - Megan E O'Connell
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Gloria Sun
- College of Medicine, University of Saskatchewan, Canada
| | - Marla Mickleborough
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
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Wells M, Kelly PJ, Mullaney L, Lee ML, Stirling R, Etter S, Larance B. Predictors of alcohol and other drug treatment completion among young people accessing residential and community-based treatment: A retrospective analysis of routinely collected service data. Addiction 2024; 119:1813-1825. [PMID: 38946548 DOI: 10.1111/add.16602] [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: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND AIMS Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people. DESIGN, SETTING AND PARTICIPANTS This study was a retrospective analysis of routinely collected data set in residential- and community-based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10-24 years and accessed treatment between 2012 and 2023 (n = 17 474). MEASUREMENTS Variables included client-related characteristics, service characteristics and baseline measures of clinical severity [Kessler-10 (K10), EUROHIS-QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion. FINDINGS Rates of treatment completion were highest among adolescents in community-based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community-based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth-specific services was associated with higher treatment completion rates among adults in community-based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts. CONCLUSIONS In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity.
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Affiliation(s)
- Megan Wells
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Mei Lin Lee
- School of Psychology, University of Wollongong, Wollongong, Australia
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
| | - Robert Stirling
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Sarah Etter
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Lien L, Bolstad I, Bramness JG. Is smokeless tobacco a healthier option in patients with AUD? A follow-up study during treatment. Harm Reduct J 2024; 21:173. [PMID: 39300439 DOI: 10.1186/s12954-024-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 08/16/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION Smoking is negatively related to mental health, but there is a paucity of research on the relationship between the use of smokeless tobacco, such as snus, and mental health outcomes, especially in people with alcohol use disorders (AUD). The aim of the present study was to examine the development of mental distress and quality of life (QoL) among AUD patients in treatment who did or did not use snus. METHOD The study included 128 AUD patients (27% female) from three rehabilitation clinics in Eastern Norway who were interviewed at admission, at 6 weeks, and after 6 months. Patients were asked about their mental health-related problems, alcohol, and substance use, QoL, and physical activity. Information about tobacco use was gathered with the questions "Do you smoke cigarettes?" and "Do you use snus?", with follow-up questions "How often?". RESULT There were 39 current snus users (31%), of which 20 were also current smokers (dual users). Seventy-five patients (59%) were smokers only, and only 14 (11%) patients were abstainers. Those who used snus only had a lower severity of dependence score than the other groups (p < 0.05). The dual use group reported lower QoL than the no tobacco use group. In a regression model adjusted for sex and age, smokers and dual users, but not users of snus, had higher levels of mental distress and poorer QoL compared to nontobacco users (p < 0.05). There were no differences between tobacco groups at follow-ups. CONCLUSION In this study, among AUD patients, snus users reported QoL and mental distress close to that of non-smokers, indicating a lower problem load among snus users compared to smokers. IMPLICATIONS Previous studies have shown conflicting results regarding the potential harm reduction effect of snus use among patients with AUD who smoke regarding their tobacco use, quality of life and mental health problems. This study suggests that snus use could also be a viable alternative to smoking for patients with addictions.
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Affiliation(s)
- Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.
- Department of Health and Social Science, Inland Norway University of Applied Sciences, Hamarvegen 112, 2406, Elverum, Norway.
| | - Ingeborg Bolstad
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Health and Social Science, Inland Norway University of Applied Sciences, Hamarvegen 112, 2406, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway
- Norwegian Institute of Public Health, Oslo, Norway
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Frankeberger J, Perdue T, Ramirez E, Valdez A, Cepeda A. Correlates of Current Methamphetamine Use and Opioid Co-Use Among Latina Women in a Low-Income Community. J Psychoactive Drugs 2024:1-10. [PMID: 39219334 DOI: 10.1080/02791072.2024.2395494] [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: 10/31/2023] [Revised: 05/13/2024] [Accepted: 06/20/2024] [Indexed: 09/04/2024]
Abstract
Using data from Proyecto SALTO, a 15-year follow-up study of a cohort of Mexican American women in a low-income community in San Antonio, Texas, this study examines emerging patterns of current methamphetamine (MA) use, including opioid co-use, among this understudied population. A bivariate analysis compared individuals with and without current MA use and identified sociodemographic correlates and co-occurring mental health and substance use. A secondary analysis compared those with current MA use, opioid use, and concurrent MA and opioid use. Nineteen percent of the sample had current MA use. MA use was associated with having a lower income (OR = 7.04-1.93, SE = 1.59-5.46), residential instability (OR = 5.19, SE = 1.99), and suicidal ideation (OR = 2.62, SE = 0.93). Participants with MA use had more than four times the odds of using opioids than those without MA use. Women with concurrent MA and opioid use differed in sociodemographics and behavioral risks compared to those with only MA or only opioid use. These findings explore the social, mental health, and structural inequities that exacerbate risks and harms associated with high-risk substance use among marginalized Latino populations. Prevention and intervention strategies should adopt a holistic approach that considers and addresses polysubstance use, mental health, and the sociocultural contexts in which individuals live.
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Affiliation(s)
- J Frankeberger
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - T Perdue
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - E Ramirez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - A Valdez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - A Cepeda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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7
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Hoch E, Preuss UW. [Cannabis use and cannabis use disorders]. DER NERVENARZT 2024; 95:781-796. [PMID: 39134752 DOI: 10.1007/s00115-024-01722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 09/05/2024]
Abstract
Cannabis use and cannabis use disorders have taken on a new social significance as a result of partial legalization. In 2021 a total of 4.5 million adults (8.8%) in Germany used the drug. The number of users as well as problematic use have risen in the last decade. Cannabis products with a high delta-9-tetrahydrocannabinol (THC) content and their regular use lead to changes in cannabinoid receptor distribution in the brain and to modifications in the structure and functionality of relevant neuronal networks. The consequences of cannabinoid use are particularly in the psychological functioning and can include intoxication, harmful use, dependence with withdrawal symptoms and cannabis-induced mental disorders. Changes in the diagnostics between ICD-10 and ICD-11 are presented. Interdisciplinary S3 guidelines on cannabis-related disorders are currently being developed and will be finalized shortly.
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Affiliation(s)
- E Hoch
- Klinik und Polyklinik für Psychiatrie und Psychotherapie, Klinik der Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336, München, Deutschland.
- IFT Institut für Therapieforschung, München, Deutschland.
- Charlotte-Fresenius University, München, Deutschland.
| | - U W Preuss
- Universitätsklinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther Universität Halle-Wittenberg, Halle, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
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Poyatos-Pedrosa C, Bernabe-Valero G, Pelacho-Ríos L, Iborra-Marmolejo I. Cannabis and anhedonia: A systematic review. Psychiatry Res 2024; 339:116041. [PMID: 38959579 DOI: 10.1016/j.psychres.2024.116041] [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: 03/17/2023] [Revised: 03/08/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
This paper employs a systematic review to examine the correlation between anhedonia and marijuana use, exploring whether individuals with anhedonia use marijuana as a coping mechanism or if marijuana use plays a role in the onset of anhedonia. The search utilised PubMed and Web of Science databases, following PRISMA guidelines for paper selection. A total of 21 papers were selected to address this inquiry, and assessments were carried out using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. The results revealed that 17 studies exhibited moderate and low risk of bias. The evaluation encompassed a total of 12,427 participants, including both animals and humans. Experimental animal studies focused on exploring the association between cannabidiol (CBD) and anhedonia, while human studies primarily employed observational research, examining various forms of anhedonia in individuals with or without mental disorders such as depression or psychosis. These studies also delved into understanding the effects of anhedonia during adolescence and explored the causal relationship between these concepts. The findings indicate a reciprocal rather than unidirectional relationship, establishing that initial anhedonia predisposes individuals to cannabis use, and subsequent consumption significantly intensifies the anhedonia experienced. Particularly, the studies placed special emphasis on adolescents and individuals with mental disorders.
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Affiliation(s)
- C Poyatos-Pedrosa
- Mind, Emotion and Behavior Laboratory (MEB Lab), Faculty of Psychology, Universidad Católica de Valencia, San Vicente Mártir, Spain
| | - G Bernabe-Valero
- Mind, Emotion and Behavior Laboratory (MEB Lab), Faculty of Psychology, Universidad Católica de Valencia, San Vicente Mártir, Spain.
| | - L Pelacho-Ríos
- Mind, Emotion and Behavior Laboratory (MEB Lab), Faculty of Psychology, Universidad Católica de Valencia, San Vicente Mártir, Spain
| | - I Iborra-Marmolejo
- Mind, Emotion and Behavior Laboratory (MEB Lab), Faculty of Psychology, Universidad Católica de Valencia, San Vicente Mártir, Spain
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Expósito-Álvarez C, Roldán-Pardo M, Gilchrist G, Lila M. Integrated Motivational Strategies for Intimate Partner Violence Perpetrators with Substance Use: A Randomized Controlled Trial. PSYCHOSOCIAL INTERVENTION 2024; 33:187-200. [PMID: 39234359 PMCID: PMC11370286 DOI: 10.5093/pi2024a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/03/2024] [Indexed: 09/06/2024]
Abstract
Objective: Intimate partner violence (IPV) perpetrators with alcohol and/or other drug use problems (ADUPs) have been identified as one of the main high-risk and highly resistant groups of perpetrators requiring special attention in intervention programs for IPV perpetrators. This randomized controlled trial (RCT) aimed to evaluate whether an individualized motivational plan adjusted to ADUPs (IMP-ADUPs) was superior to standard motivational strategies (IMP) in reducing ADUPs, and IPV and increasing treatment adherence in IPV perpetrators. Method: Data from a full sample of IPV perpetrators (n = 140) and a subsample of participants with ADUPs (n = 55) were collected at pre- and post-intervention and 12-month follow-up. Final outcomes included alcohol, cocaine, and cannabis use, self-reported IPV, risk of recidivism assessed by facilitators, and official IPV recidivism. Proximal outcomes included treatment adherence (stage of change, intervention dose, active participation, and dropout). Results: Both intent-to-treat (ITT) and per-protocol (PP) analyses were conducted. The IMP-ADUPs condition was superior to the IMP in reducing alcohol use at post-intervention in both the full sample and ADUPs subsample. The full sample of participants in the IMP-ADUPs condition were in a more advanced stage of change post-intervention and showed increased active participation during the intervention process than IMP participants. All participants were in a more advanced stage of change at post-intervention and reduced their alcohol use and their risk of recidivism at post-intervention and 12-month follow-up. Conclusions: These results underscore the need to develop individualized treatment approaches to address participants' risks and needs and promote their motivation to change.
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Affiliation(s)
- Cristina Expósito-Álvarez
- University of ValenciaFaculty of Psychology and Speech TherapyDepartment of Social PsychologySpainDepartment of Social Psychology, Faculty of Psychology and Speech Therapy, University of Valencia, Spain;
| | - Manuel Roldán-Pardo
- University of ValenciaFaculty of Psychology and Speech TherapyDepartment of Social PsychologySpainDepartment of Social Psychology, Faculty of Psychology and Speech Therapy, University of Valencia, Spain;
| | - Gail Gilchrist
- King’s College LondonNational Addiction Centre, Institute of Psychiatry, Psychology & NeuroscienceUKNational Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - Marisol Lila
- University of ValenciaFaculty of Psychology and Speech TherapyDepartment of Social PsychologySpainDepartment of Social Psychology, Faculty of Psychology and Speech Therapy, University of Valencia, Spain;
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10
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Zoob Carter BN, Boardley ID. Development and validation of dependence and craving measures specific to athletes who use anabolic-androgenic steroids. Front Psychol 2024; 15:1347211. [PMID: 39176050 PMCID: PMC11339692 DOI: 10.3389/fpsyg.2024.1347211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/11/2024] [Indexed: 08/24/2024] Open
Abstract
Background Anabolic-androgenic steroid (AAS) dependence affects approximately 30% of people who use AAS. Presently, measures to assess and diagnose AAS dependence are adapted from scales specific to other forms of drug misuse (e.g., alcohol), containing issues with internal consistency and breadth of construct capture. Additionally, there are no measures available to assess AAS craving, which represents a potentially important coeval factor to AAS dependence. Therefore, this study aimed to develop and provide evidence of validity for measures of AAS dependence and AAS craving. Methods Data were collected from male and female strength athletes who use AAS across two samples (n sample 1 = 206; n sample 2 = 224). Sample 1 completed the new measures alongside instruments assessing theoretically related constructs (Doping Moral Disengagement, Doping Self-Regulatory Efficacy Scale, craving items from the Wisconsin Smoking Withdrawal Scale, AAS adapted Diagnostic and Statistical Manual for Mental Disorder 4th Edition), whereas Sample 2 completed the new instruments. Results Exploratory and Confirmatory Factor Analyses (CFA) with Sample 1 data were used to finalize the item sets for both measures and determine the factorial structures of the AAS Dependence Scale (AASDS) and AAS Craving Scale (AASCS). The AASDS consists of 15-items across five first-order factors that are represented by one second-order factor. The AASCS consists of 16-items across four first-order factors that are represented by one second-order factor. Evidence supporting the concurrent, convergent and discriminant validity of scores obtained with both scales was provided through their associations with the theoretically related variables. CFA with the data from Sample 2 confirmed the factor structures for both scales. Conclusion The AASDS and AASCS represent valid and reliable measures of AAS dependence and AAS craving for use in research with strength athletes who use AAS.
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11
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Lorenzetti V, McTavish E, Broyd S, van Hell H, Thomson D, Ganella E, Kottaram AR, Beale C, Martin J, Galettis P, Solowij N, Greenwood LM. Daily Cannabidiol Administration for 10 Weeks Modulates Hippocampal and Amygdalar Resting-State Functional Connectivity in Cannabis Users: A Functional Magnetic Resonance Imaging Open-Label Clinical Trial. Cannabis Cannabinoid Res 2024; 9:e1108-e1121. [PMID: 37603080 DOI: 10.1089/can.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Introduction: Cannabis use is associated with brain functional changes in regions implicated in prominent neuroscientific theories of addiction. Emerging evidence suggests that cannabidiol (CBD) is neuroprotective and may reverse structural brain changes associated with prolonged heavy cannabis use. In this study, we examine how an ∼10-week exposure of CBD in cannabis users affected resting-state functional connectivity in brain regions functionally altered by cannabis use. Materials and Methods: Eighteen people who use cannabis took part in a ∼10 weeks open-label pragmatic trial of self-administered daily 200 mg CBD in capsules. They were not required to change their cannabis exposure patterns. Participants were assessed at baseline and post-CBD exposure with structural magnetic resonance imaging (MRI) and a functional MRI resting-state task (eyes closed). Seed-based connectivity analyses were run to examine changes in the functional connectivity of a priori regions-the hippocampus and the amygdala. We explored if connectivity changes were associated with cannabinoid exposure (i.e., cumulative cannabis dosage over trial, and plasma CBD concentrations and Δ9-tetrahydrocannabinol (THC) plasma metabolites postexposure), and mental health (i.e., severity of anxiety, depression, and positive psychotic symptom scores), accounting for cigarette exposure in the past month, alcohol standard drinks in the past month and cumulative CBD dose during the trial. Results: Functional connectivity significantly decreased pre-to-post the CBD trial between the anterior hippocampus and precentral gyrus, with a strong effect size (d=1.73). Functional connectivity increased between the amygdala and the lingual gyrus pre-to-post the CBD trial, with a strong effect size (d=1.19). There were no correlations with cannabinoids or mental health symptom scores. Discussion: Prolonged CBD exposure may restore/reduce functional connectivity differences reported in cannabis users. These new findings warrant replication in a larger sample, using robust methodologies-double-blind and placebo-controlled-and in the most vulnerable people who use cannabis, including those with more severe forms of Cannabis Use Disorder and experiencing worse mental health outcomes (e.g., psychosis, depression).
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Center, School of Health and Behavioral Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Eugene McTavish
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Center, School of Health and Behavioral Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Samantha Broyd
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Hendrika van Hell
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Diny Thomson
- Turner Institute for Brain and Mental Health, School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Eleni Ganella
- Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, Carlton South, Victoria, Australia
- Orygen, the National Center of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Akhil Raja Kottaram
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Center, School of Health and Behavioral Sciences, Australian Catholic University, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, Carlton South, Victoria, Australia
| | - Camilla Beale
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jennifer Martin
- John Hunter Hospital, Newcastle, New South Wales, Australia
- Center for Drug Repurposing and Medicines Research, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
| | - Peter Galettis
- Center for Drug Repurposing and Medicines Research, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
| | - Lisa-Marie Greenwood
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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González-Saiz F, Vergara-Moragues E, Trujols J, Alcaraz S, Siñol N, Pérez de Los Cobos J. Assessing predictors of adequate individual buprenorphine maintenance dosage for the treatment of opioid use disorder: Listening to the patient. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104519. [PMID: 39024687 DOI: 10.1016/j.drugpo.2024.104519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/27/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Dose optimization plays a key role in determining clinical outcomes in patients on opioid agonist treatment (OAT). The objective of this study was to identify the variables independently associated with buprenorphine/naloxone (B/N) dose adequacy in patients with opiate use disorder (OUD). METHOD Cross-sectional study of a convenience sample of patients with OUD treated with B/N (n = 315) in four regions in Spain. The Opiate Dosage Adequacy Scale (ODAS) was used to determine B/N dose adequacy. The ODAS evaluate the six components of the "dose adequacy" construct, as follows: continued use of heroin; narcotic blockade or crossed tolerance; objective opioid withdrawal symptoms (OWS); subjective OWS; craving for heroin; and overmedication. A binomial logistic regression analysis was performed to identify the variables associated with the condition "ODAS Adequate B/N dose". Participants completed a battery of instruments to assess sociodemographic, substance use, clinical, and treatment variables. RESULTS The B/N dose was considered adequate in 231 of the 315 participants (73.3 %). Two variables, satisfaction with B/N as a medication (OR=5.764, 95 % CI=2.211-15.030) and patient-perceived participation in B/N dose decisions (OR=1.790, 95 % CI=1221-2623), were independently, significantly, and positively associated with the "ODAS Adequate B/N dose" condition. While the severity of heroin dependence was significantly associated with buprenorphine dose adequacy in the bivariate analyses, significance was lost in the full regression model. CONCLUSION Satisfaction with B/N as a medication and patient-perceived involvement in the dose decision are associated with clinician-assessed dose adequacy. In the context of good clinical practice, it is important to take into account both of these variables to individualize the prescribed dose through a shared decision-making process.
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Affiliation(s)
- Francisco González-Saiz
- Unidad de Hospitalización de Salud Mental, UGC Salud Mental, Hospital Universitario de Jerez, Servicio Andaluz de Salud, Spain; Departamento de Neurociencias, Área de Psiquiatría, Universidad de Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | | | - Joan Trujols
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Saul Alcaraz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Núria Siñol
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - José Pérez de Los Cobos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autonoma de Barcelona, Bellaterra, Spain
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Tabares Tabares M, Vélez Álvarez C, Bernal Salcedo J, Murillo Rendón S. Anxiety in young people: Analysis from a machine learning model. Acta Psychol (Amst) 2024; 248:104410. [PMID: 39032273 DOI: 10.1016/j.actpsy.2024.104410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
The study addresses the detection of anxiety symptoms in young people using artificial intelligence models. Questionnaires such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) are used to collect data, with a focus on early detection of anxiety. Three machine learning models are employed: Support Vector Machine (SVM), K Nearest Neighbors (KNN), and Random Forest (RF), with cross-validation to assess their effectiveness. Results show that the RF model is the most efficient, with an accuracy of 91 %, surpassing previous studies. Significant predictors of anxiety are identified, such as parental education level, alcohol consumption, and social security affiliation. A relationship is observed between anxiety and personal and family history of mental illness, as well as with characteristics external to the model, such as family and personal history of depression. The analysis of the results highlights the importance of considering not only clinical but also social and family aspects in mental health interventions. It is suggested that the sample size be expanded in future studies to improve the robustness of the model. In summary, the study demonstrates the usefulness of artificial intelligence in the early detection of anxiety in young people and highlights the relevance of addressing multidimensional factors in the assessment and treatment of this condition.
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Affiliation(s)
| | - Consuelo Vélez Álvarez
- Grupo Promoción de la Salud y Prevención de la Enfermedad, Universidad de Caldas, Colombia.
| | | | - Santiago Murillo Rendón
- Grupo Inteligencia Artificial, Universidad de Caldas, Colombia; Grupo Ingeniería de Software, Universidad Autónoma de Manizales, Colombia.
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Zertal A, Alami Marrouni K, Arbour N, Jutras-Aswad D, Pomey MP, Rouleau I, Prat A, Larochelle C, Beaulieu P, Chamelian L, Sylvestre MP, Morin D, Ouellette JS, Fréjeau N, Duquette P. Efficacy of cannabinoids compared to the current standard treatments on symptom relief in persons with multiple sclerosis (CANSEP trial): study protocol for a randomized clinical trial. Front Neurol 2024; 15:1440678. [PMID: 39114536 PMCID: PMC11303178 DOI: 10.3389/fneur.2024.1440678] [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: 05/29/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system. More than 90,000 Canadians are affected; a cure is yet to be found. Available treatments to manage the disease course are only partially effective. For many years, persons with MS (PwMS) have used cannabis to relax, to reduce pain and spasticity, or to improve sleep and daily functioning, despite the lack of scientific evidence on the efficacy of specific cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD)] on these MS symptoms. The purpose of this clinical trial is to assess the effectiveness of different doses of these cannabinoids, alone or combined, on spasticity relief, compared to placebo. Moreover, we aim to determine which treatment is best effective to address other key MS conditions. Methods A double-blinded, randomized, factorial, placebo-controlled trial will be performed. We intend to include up to 250 PwMS aged over 21 recruited from the Centre hospitalier de l'Université de Montréal MS Clinic. PwMS will be randomly assigned on a 1:1:1:1 ratio to one of the trial arms: THC alone, CBD alone, THC/CBD combination, or placebo, using stratified blocked randomization, with random blocks within each stratum. The primary outcome is a self-assessment of spasticity using the mean Numeric Rating Scale score over 7 days. The main outcome will be the difference in this score at 4 weeks compared to baseline. Secondary outcomes include assessments of spasticity as measured by a clinician, pain, fatigue, sleep, bowel, bladder, and sexual dysfunction, restless legs syndrome, mental health, quality of life, mobility, cognitive functioning, and adverse events. Treatment responders are eligible for a 12-week extension phase, using the same treatment allocation and assessments. Discussion Previous clinical studies examined the efficacy of cannabis-based medicines in PwMS, mostly using products with 1:1 THC/CBD ratio. The major barrier to effectively use cannabis in real-world clinical settings is the lack of evidence on benefits of specific cannabinoids and information on possible related risks. The CANSEP study will contribute to overcome these limitations and identify the risks and benefits of cannabis-based treatments in PwMS. Clinical trial registration ClinicalTrials.Gov, NCT05092191.
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Affiliation(s)
- Amel Zertal
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Kanza Alami Marrouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Arbour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychiatrie et d’addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
- Centre d’Excellence sur le Partenariat avec les Patients et le Public, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Rouleau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychologie, Faculté des Sciences Humaines, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Catherine Larochelle
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre Beaulieu
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
- Département d'anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Laury Chamelian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada
| | - Danielle Morin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Jean-Sylvain Ouellette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- MS Canada, Toronto, ON, Canada
| | - Nathalie Fréjeau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
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Khan BN, Chu C, Brual J, Dang-Nguyen M, Oladimeji A, Kthupi A, Bolea-Alamañac B, Tadrous M, O'Riordan A, Rubenstein D, Carlin K, Longum P, Gibson D, Abejirinde IOO. An Observational Study of a Digital Substance Use and Recovery Program. Psychiatr Serv 2024:appips20230427. [PMID: 38982834 DOI: 10.1176/appi.ps.20230427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. METHODS An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. RESULTS In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. CONCLUSIONS BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.
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Affiliation(s)
- Bilal Noreen Khan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Cherry Chu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Janette Brual
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Marlena Dang-Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Adetola Oladimeji
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Altea Kthupi
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Blanca Bolea-Alamañac
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Mina Tadrous
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Anne O'Riordan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Donna Rubenstein
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Kathleen Carlin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Philip Longum
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Daryn Gibson
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Ibukun-Oluwa Omolade Abejirinde
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
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Siefried KJ, Bascombe F, Clifford B, Liu Z, Middleton P, Kay-Lambkin F, Freestone J, Herman D, Millard M, Steele M, Acheson L, Moller C, Bath N, Ezard N. Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e55663. [PMID: 38959499 PMCID: PMC11255525 DOI: 10.2196/55663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 05/10/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine. OBJECTIVE We aim to determine whether a self-administered smartphone-based intervention, the "S-Check app" can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement. METHODS This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics. RESULTS In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [β] -0.04, P=.02). CONCLUSIONS The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true.
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Affiliation(s)
- Krista J Siefried
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - Florence Bascombe
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- Institute for Global Health, University College London, London, United Kingdom
- Central and North-West London NHS Foundation Trust, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brendan Clifford
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Ministry of Health, Sydney, Australia
| | - Zhixin Liu
- Healthdirect Australia, Sydney, Australia
| | - Peter Middleton
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Ministry of Health, Sydney, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Jack Freestone
- ACON, Sydney, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Maureen Steele
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
| | - Liam Acheson
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - Carl Moller
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
| | - Nicky Bath
- LGBTIQ+ Health Australia, Sydney, Australia
| | - Nadine Ezard
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Ministry of Health, Sydney, Australia
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Basu A, Bhad R, Bharadwaj B, Bharti A, Choudhury S, Das P, Dinesh M, Guin A, Joshi T, Krishnan V, Kumar P, Mansoori S, Mishra AK, Nebhinani N, Rajpurohit SS, Ranjan R, Sarkar S, Shekhar S, Singh P, Sood E, Swami MK. Assessment of Severity of Substance use for Outcomes Research and Treatment (ASSORT): A substance use severity scale developed and validated across six tertiary care centers in India. Indian J Psychiatry 2024; 66:614-620. [PMID: 39257510 PMCID: PMC11382747 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_949_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 09/12/2024] Open
Abstract
Background and Aims Assessment of the severity of substance use disorders (SUDs) in a culture-sensitive manner can help gauge the current condition of the substance user and assess change with time. The present study aimed to develop a scale for the assessment of the severity of SUDs in the Indian clinical context. Methods Based upon the review of literature on previously available instruments and a consultative meeting of experts, a clinician-rated scale was developed that finally comprised 41 items. A briefer 5-item scale with current and lifetime versions was also developed. The scales were applied to patients with SUDs at six different clinical sites. Results The instrument was applied to 720 patients (98.2% males, mean age: 34.6 years). The Cronbach's alpha of the full scale was 0.852. The inter-rater reliability Pearson correlation coefficient of the full-scale was r = 0.821 (P < 0.001), and the intra-class correlation coefficient single measure was 0.800 (95% confidence interval: 0.724-0.956). A four-factor solution was suggested to be the most tenable. The mean application duration of the full scale was 13.4 minutes, and that of the briefer version was 2 minutes. Conclusion This validated scale could be a potentially useful assessment measure for the severity of SUDs in the Indian context. The utility lies in the simplicity of administration and scoring and the balance between brevity and thorough assessment.
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Affiliation(s)
- Aniruddha Basu
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Bharadwaj
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ayushi Bharti
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shinjini Choudhury
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prioma Das
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - M Dinesh
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Aparajita Guin
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Tanmay Joshi
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vijay Krishnan
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Saba Mansoori
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surendra S Rajpurohit
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rajeev Ranjan
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Siddharth Sarkar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Shekhar
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Pranshu Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Esha Sood
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh K Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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18
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McGrew SJ, Thai JM, Woller SJ, Smit T, Rogers AH, Vujanovic AA, Zvolensky MJ. Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy. Subst Use Misuse 2024; 59:1695-1702. [PMID: 38914534 PMCID: PMC11421956 DOI: 10.1080/10826084.2024.2369164] [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] [Indexed: 06/26/2024]
Abstract
BACKGROUND Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting. OBJECTIVE The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability. METHOD The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication. RESULTS Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability. CONCLUSION The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.
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Affiliation(s)
- Shelby J. McGrew
- Department of Psychological & Brain Sciences, Texas A&M University
| | | | | | - Tanya Smit
- Department of Psychology, University of Houston
| | - Andrew H. Rogers
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, WA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
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Poliakova N, Shrier LA, Harris SK, Bélanger RE. Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products. Tob Use Insights 2024; 17:1179173X241259603. [PMID: 38846268 PMCID: PMC11155328 DOI: 10.1177/1179173x241259603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.
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Affiliation(s)
- Natalia Poliakova
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Lydia A. Shrier
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sion Kim Harris
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard E. Bélanger
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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20
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Patel A, Corman M, de Oliveira C, Mason J, Somé N, Downie D, Jain E, Patterson M, Cunningham JA, George TP, Le Foll B, Quilty LC. Computer-Based Training for Cognitive Behavioural Therapy for Substance Use Disorder: A Randomized Controlled Trial Including Quantitative and Qualitative Health and Economic Outcomes: Formation informatisée pour la thérapie cognitivo-comportementale pour les troubles liés à l'usage de substances : un essai randomisé contrôlé y compris les résultats quantitatifs et qualitatifs en matière de santé et d'économie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241255100. [PMID: 38783836 DOI: 10.1177/07067437241255100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Heavy alcohol and drug use is reported by a substantial number of Canadians; yet, only a minority of those experiencing substance use difficulties access specialized services. Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT) offers a low-cost method to deliver accessible and high-quality CBT for substance use difficulties. To date, CBT4CBT has primarily been evaluated in terms of quantitative outcomes within substance use disorder (SUD) samples in the United States. A comparison between CBT4CBT versus standard care for SUDs in a Canadian sample is critical to evaluate its potential for health services in Canada. We conducted a randomized controlled trial of CBT4CBT versus standard care for SUD. METHODS Adults seeking outpatient treatment for SUD (N = 50) were randomly assigned to receive either CBT4CBT or treatment-as-usual (TAU) for 8 weeks. Measures of substance use and associated harms and quality of life were completed before and after treatment and at 6-month follow-up. Qualitative interviews were administered after treatment and at follow-up, and healthcare utilization and costs were extracted for the entire study period. RESULTS Participants exhibited improvements on the primary outcome as well as several secondary outcomes; however, there were no differences between groups. A cost-effectiveness analysis found lower healthcare costs in CBT4CBT versus TAU in a subsample analysis, but more days of substance use in CBT4CBT. Qualitative analyses highlighted the benefits and challenges of CBT4CBT. DISCUSSION Findings supported an overall improvement in clinical outcomes. Further investigation is warranted to identify opportunities for implementation of CBT4CBT in tertiary care settings.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03767907.
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Affiliation(s)
- Alina Patel
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Ontario, Canada
| | - Michael Corman
- School of Culture, Media, and Society, University of the Fraser Valley, Abbotsford, British Columbia, Canada
- University Studies, Northern Lakes College, Alberta, Canada
| | - Claire de Oliveira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nibene Somé
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute of Evaluative Sciences, Toronto, Ontario, Canada
| | - Danielle Downie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Ontario, Canada
| | - Esha Jain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michelle Patterson
- University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - John A Cunningham
- Department of Psychology, University of Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Addictions Sciences, Kings College London, London, UK
| | - Tony P George
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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21
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Bjørnestad ED, Vederhus JK, Clausen T. Change in substance use among patients in opioid maintenance treatment: baseline to 1-year follow-up. Harm Reduct J 2024; 21:101. [PMID: 38790008 PMCID: PMC11127449 DOI: 10.1186/s12954-024-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) often have concurrent use of non-opioid substances. When patients enter opioid maintenance treatment (OMT), less is known about outcomes regarding the use of other types of drugs. Here we aimed to investigate changes in substance use among patients entering outpatient OMT, from treatment initiation to 1-year follow-up. METHODS We used data from the prospective Norwegian Cohort of Patient in OMT and Other Drug Treatment Study (NorComt). Among 283 patients who entered OMT at participating facilities across Norway, 179 were assessed at follow-up. Of these patients, 131 were in a non-controlled environment, and were included in the present analysis. The main outcome was change in substance use. Logistic regression analysis was applied to identify factors associated with abstinence from all substances (other than agonist medication) at follow-up. RESULTS Along with opioid use, most patients reported polysubstance use prior to entering treatment. No significant differences were found in baseline characteristics between the included and non-included groups when examining attrition. At the 1-year follow-up, reduced substance use was reported. While in treatment, around two-thirds of patients continued using other drugs to varying degrees. At follow-up, about one-third of patients reported abstinence from all drugs, apart from the agonist medication. Factors related to abstinence included a goal of abstinence at baseline (OR = 5.26; 95% CI 1.14-19.55; p = 0.013) and increasing age (OR = 1.05; 95% CI 1.00-1.09; p = 0.034). CONCLUSIONS The majority of patients entering OMT used other substances in addition to opioids. About one-third of patients reported abstinence at the 1-year follow up. Although the majority of patients continued co-use of other drugs while in treatment, for most substances, less than 10% reported daily use at follow-up, with the exception of cannabis which was used daily/almost daily by about 2 in 10. Higher age and treatment goal at the start of OMT were important factors related to reducing concomitant substance use during treatment. These findings suggest that many patients entering OMT are in need of treatment and support related to the use of other substances, to further improve prognosis. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).
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Affiliation(s)
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, Oslo, N-0407, Norway
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22
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Hebert FO, Mongeau-Pérusse V, Rizkallah E, Mahroug A, Bakouni H, Morissette F, Brissette S, Bruneau J, Dubreucq S, Jutras-Aswad D. Absence of Evidence for Sustained Effects of Daily Cannabidiol Administration on Anandamide Plasma Concentration in Individuals with Cocaine Use Disorder: Exploratory Findings from a Randomized Controlled Trial. Cannabis Cannabinoid Res 2024. [PMID: 38770686 DOI: 10.1089/can.2023.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background: Cannabidiol (CBD) has been proposed to have a therapeutic potential over a wide range of neuropsychiatric disorders, including substance use disorders. Pre-clinical evidence suggests that CBD can increase anandamide (AEA) plasma concentration, possibly mediating some of its therapeutic properties. Whether CBD exerts such an effect on AEA in individuals with cocaine use disorder (CUD) remains unknown. Aims: To explore the sustained effects of daily CBD administration on AEA plasma concentrations compared with placebo in CUD. Methods: We used data from a randomized, double-blind, placebo-controlled trial evaluating CBD's efficacy in CUD. Seventy-eight individuals were randomized to receive a daily oral dose of 800 mg CBD (n = 40) or a placebo (n = 38). Participants stayed in an inpatient detoxification setting for 10 days, after which they were followed in an outpatient setting for 12 weeks. AEA plasma concentration was measured at baseline and at 23-h post CBD ingestion on day 8 and week 4. A generalized estimating equation model was used to assess CBD's effects on AEA, and sensitivity analyses were computed using Bayesian linear regressions. Results: Sixty-four participants were included in the analysis. Similar mean AEA plasma concentrations in both treatment groups (p = 0.357) were observed. At day 8, mean AEA plasma concentrations (± standard deviation) were 0.26 (± 0.07) ng/mL in the CBD group and 0.29 (± 0.08) ng/mL in the placebo group (p = 0.832; Bayes factor [BF] = 0.190). At week 4, they were 0.27 (± 0.09) ng/mL in the CBD group and 0.30 (± 0.09) ng/mL in the placebo group (p = 0.181; BF = 0.194). Conclusion: While not excluding any potential acute and short-term effect, daily CBD administration did not exert a sustained impact on AEA plasma concentrations in individuals with CUD compared with placebo. Registration: clinicaltrials.gov (NCT02559167).
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Affiliation(s)
| | - Violaine Mongeau-Pérusse
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Elie Rizkallah
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Amani Mahroug
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Hamzah Bakouni
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Florence Morissette
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Suzanne Brissette
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Simon Dubreucq
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, Canada
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23
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Redeł A, Binkowska AA, Obarska K, Marcowski P, Szymczak K, Lewczuk K, Solich K, Banaszak M, Woronowicz B, Nowicka M, Skorko M, Gola M, Bielecki M. Evaluating the effectiveness of a mobile app-based self-guided psychological interventions to reduce relapse in substance use disorder: protocol for a randomized controlled trial. Front Psychiatry 2024; 15:1335105. [PMID: 38784165 PMCID: PMC11113013 DOI: 10.3389/fpsyt.2024.1335105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Background Substance Use Disorder (SUD) persists as a significant public health challenge worldwide, with an estimated prevalence of approximately 10-15% across the global populace. This condition is characterized by a notably high risk of lapses and relapses, even subsequent to treatment interventions. Mobile health interventions, owing to their widespread accessibility, emerge as a promising approach to diminish the risk of relapse post-treatment and to broaden the scope of care, especially in regions with a scarcity of trained medical professionals. Method This study is designed to assess the effectiveness of mobile interventions in mitigating cravings and preventing lapses among individuals diagnosed with SUD. Employing a two-armed, randomized controlled trial framework, the study will evaluate a self-administered psychological intervention delivered through a mobile application, Nałogometr 2.0. Over a period of three months, participants will engage with intervention modules that primarily incorporate mindfulness techniques and Cognitive Behavioral Therapy (CBT) principles. Ecological Momentary Assessment (EMA) will be utilized to gather longitudinal data on a range of variables that are indicative of craving intensity and the risk of lapse. In addition to this, a monthly-administered battery of questionnaires will be employed to gauge the severity of substance dependence, as well as to measure levels of anxiety, depression, and overall life satisfaction. Results Results will be submitted for publication in peer-reviewed journals. Clinical trial registration https://clinicaltrials.gov/, identifier [NCT05730504].
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Affiliation(s)
- Anna Redeł
- PredictWatch, Białystok, Poland
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Alicja Anna Binkowska
- PredictWatch, Białystok, Poland
- Institute of Psychology, Humanitas University, Sosnowiec, Poland
| | - Katarzyna Obarska
- PredictWatch, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Karol Szymczak
- PredictWatch, Białystok, Poland
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Karol Lewczuk
- PredictWatch, Białystok, Poland
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | | | - Maria Banaszak
- PredictWatch, Białystok, Poland
- Monar Association, Warsaw, Poland
| | - Bohdan Woronowicz
- PredictWatch, Białystok, Poland
- Consulting Center Akmed, Warsaw, Poland
| | | | - Maciej Skorko
- PredictWatch, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Mateusz Gola
- PredictWatch, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Maksymilian Bielecki
- PredictWatch, Białystok, Poland
- Institute of Psychology, SWPS University, Warsaw, Poland
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De Meyer F, Zerrouk A, De Ruysscher C, Vanderplasschen W. Exploring indicators of natural recovery from alcohol and drug use problems: findings from the life in recovery survey in Flanders. Subst Abuse Treat Prev Policy 2024; 19:22. [PMID: 38610049 PMCID: PMC11015601 DOI: 10.1186/s13011-024-00604-y] [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: 12/19/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Research has established natural recovery (NR) as an important pathway to substance use recovery. Studies investigating correlates of NR have mainly focused on demographic and substance use variables rather than life circumstances. This study seeks to better understand the phenomenon of natural recovery by (i) validating the international scientific literature concerning demographic and substance use indicators of NR in Flanders and (ii) assessing the additional explanatory power of recovery strengths and barriers during active addiction, controlling for demographic and substance use covariates. METHODS A total of 343 persons in recovery from alcohol or drug use problems (≥ 3 months) completed an online cross-sectional survey in Flanders. Participants in NR and in recovery after following treatment were compared using multivariate linear regression models. Reasons for not following treatment were analyzed using inductive thematic analysis. RESULTS Higher education level, lower severity of dependence, and cannabis use as the main problem substance (vs. alcohol) were statistically significant (p < 0.05) correlates of NR. When scores for the number of barriers and strengths associated with active addiction were added, barriers (but not strengths) were significantly associated with NR. When barrier items were individually tested, having untreated emotional or mental health problems, having a driver's license revoked and damaging property were statistically significant correlates. The most reported reason for not entering treatment was not experiencing any need to do so. CONCLUSION The results highlight the importance of a holistic approach to recovery support across multiple life domains. Limitations and opportunities for further research are discussed.
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Affiliation(s)
- Florian De Meyer
- Department of Special Needs Education, Ghent University, Henri-Dunantlaan 1, Ghent, 9000, Belgium.
| | - Amine Zerrouk
- Department of Special Needs Education, Ghent University, Henri-Dunantlaan 1, Ghent, 9000, Belgium
| | - Clara De Ruysscher
- Department of Special Needs Education, Ghent University, Henri-Dunantlaan 1, Ghent, 9000, Belgium
| | - Wouter Vanderplasschen
- Department of Special Needs Education, Ghent University, Henri-Dunantlaan 1, Ghent, 9000, Belgium
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Sibley AL, Klein E, Cooper HLF, Livingston MD, Baker R, Walters SM, Gicquelais RE, Ruderman SA, Friedmann PD, Jenkins WD, Go VF, Miller WC, Westergaard RP, Crane HM. The relationship between felt stigma and non-fatal overdose among rural people who use drugs. Harm Reduct J 2024; 21:77. [PMID: 38582851 PMCID: PMC10998326 DOI: 10.1186/s12954-024-00988-x] [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: 06/13/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. METHODS Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. RESULTS 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). CONCLUSIONS Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Emma Klein
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Robin Baker
- OHSU-PSU School of Public Health, Oregon Health & Science University, 1810 SW 5th Ave, Suite 510, Portland, OR, 97201, USA
| | - Suzan M Walters
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, 180 Madison, New York, NY, 10016, USA
| | - Rachel E Gicquelais
- School of Nursing, University of Wisconsin-Madison, 4257 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Stephanie A Ruderman
- Department of Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main St, Springfield, MA, 01199, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - William C Miller
- Department of Epidemiology, UNC Gillings School of Global Public Health, CB#8050, 3rd Floor Carolina Square, Chapel Hill, NC, 27516, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Mail Stop 359931, Seattle, WA, 98104, USA
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26
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Phillips JG, Van Gemmert AWA, Hughes B. Incompatibility Influences Cursor Placement When Pointing to Images of Cups. HUMAN FACTORS 2024; 66:1004-1016. [PMID: 35971754 DOI: 10.1177/00187208221121203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE As images are used within graphical user interfaces to signify menu selection, it is important to understand how image properties can influence cursor placement online. BACKGROUND Objects have multiple dimensions that create potential ambiguity and Stroop-like confusions for the operator if a previously habitual response conflicts with the required response. METHODS To examine the impact of compatibility and other contextual factors, 41 participants used a computer Mouse or touch screen to place the cursor upon images of full or empty cups that varied in size, and direction of handle. RESULTS Cursor placements took longer using the Mouse than touch screen. Although participants were placing the cursor on images, the size of the cup, whether it was empty or full, and the handle orientation interacted in their effects upon response duration and cursor placement. The effects of cup size reversed for empty cups or those with incompatible handles. CONCLUSION Context can influence cursor placement. Perceived spillability influenced precision requirements, and the cup handle can serve as target or a flanking distractor. APPLICATION Image content can influence screen hotspots. As performance can change with cup spillability, this bodes well for attempts to detect intent from cursor trajectories.
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Peddireddy SR, Livingston MD, Young AM, Freeman PR, Ibragimov U, Komro KA, Lofwall MR, Oser CB, Staton M, Cooper HLF. Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209262. [PMID: 38103835 PMCID: PMC10947911 DOI: 10.1016/j.josat.2023.209262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. METHODS The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. RESULTS The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. CONCLUSIONS There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA.
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Umedjon Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Michelle R Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carrie B Oser
- Department of Sociology, University of Kentucky College of Arts & Sciences, Lexington, KY, USA
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
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Whelan J, Noller G, Ward RD. Harm reduction behaviours and harm experiences of people who use 3,4-methylenedioxymethamphetamine (MDMA) in Aotearoa New Zealand. Harm Reduct J 2024; 21:67. [PMID: 38515184 PMCID: PMC10956294 DOI: 10.1186/s12954-024-00979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND 3,4-Methylenedioxymethamphetamine (MDMA) is drug of high prevalence in Aotearoa New Zealand and is the primary drug analysed by legal drug checking services. We aimed to address the gap in literature pertaining to MDMA-related harm reduction behaviour and harm experiences within the country. METHODS An online survey was used to assess the harm reduction behaviours (e.g., limiting consumption, planning use, seeking information) of people who use MDMA, in addition to their use of reagent testing and the major national drug checking and harm reduction service, KnowYourStuffNZ. RESULTS In total, 915 people completed the survey (60.7% females, aged 18-65, median = 24, IQR = 20-28). Frequency of various MDMA-related harm reduction behaviours differed, although these were carried out relatively frequently by most participants. Those who reported experiencing harm (physical, psychological, spiritual, social) from MDMA, or another drug presumed to be MDMA, reported less frequent harm reduction behaviours than non-harmed consumers. Reagent testing of MDMA had been conducted by 42.3% of the sample. Approximately 27% of the sample had used KnowYourStuffNZ services. Of KnowYourStuffNZ clients, 95.9% reported learning about harm reduction, and 53.3% reported changing their behaviour because of the service. Reasons for not using the KnowYourStuffNZ service were primarily lack of availability in local area (32.8%) or at relevant events (51.8%), and lack of concern with substance quality (29.8%). MDMA harm was reported by 14.4% of the sample, whilst reported harm was more common from consumption of presumably non-MDMA substances, self-reported as being mistaken for MDMA. Harm was primarily physical or psychological. Potential MDMA dependence was apparent in 6.9% of the sample. CONCLUSIONS The findings highlight potential targets for harm reduction education and interventions and emphasize the need for greater availability of readily accessible drug checking services in Aotearoa New Zealand.
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Affiliation(s)
- Jai Whelan
- Deparment of Psychology, The University of Otago, William James Building, Level 1, 275 Leith Walk, Ōtepoti/Dunedin, New Zealand.
| | - Geoff Noller
- Department of General Practice and Rural Health, Dunedin School of Medicine, The University of Otago, Ōtepoti/Dunedin, New Zealand
| | - Ryan D Ward
- Deparment of Psychology, The University of Otago, William James Building, Level 1, 275 Leith Walk, Ōtepoti/Dunedin, New Zealand
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Basit T, Toombs M, Santomauro D, Whiteford H, Ferrari A. Correlates of mental disorder and harmful substance use in an indigenous Australian urban sample: an analysis of data from the Queensland Urban Indigenous Mental Health Survey. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02648-8. [PMID: 38506954 DOI: 10.1007/s00127-024-02648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/03/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Limited data exists on the relationship between sociodemographic and cultural variables and the prevalence of specific mental and substance use disorders (MSDs) among Indigenous Australians, using diagnostic prevalence data. This paper utilises data from the Queensland Urban Indigenous Mental Health Survey (QUIMHS), a population-level diagnostic mental health survey, to identify socioeconomic and cultural correlates of psychological distress and specific MSDs in an urban Indigenous Australian sample. METHODS Using a mixture of household sampling (door-knocking) and snowball sampling (promotion of the survey in the community), 406 participants aged 18 to 89 were recruited across key locations in Southeast Queensland. The study investigated various demographic, socioeconomic, and cultural factors as predictors of psychological distress (measured by the Kessler-5) and MSD diagnoses (utilising the Composite International Diagnostic Interview, CIDI 3.0) using a series of univariate logistic regressions. RESULTS Individuals in unstable housing (homeless, sleeping rough) and those reporting financial distress were more likely to experience an MSD in the past 12 months and throughout their lifetime. Individuals reporting lower levels of connection and belonging, limited participation in cultural events, and lower empowerment were more likely to have a lifetime mental disorder. CONCLUSION This data emphasises the importance of addressing systemic and social determinants of health when designing and delivering community mental health services and underscores the need for holistic approaches when working with Indigenous communities.
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Affiliation(s)
- Tabinda Basit
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia.
- School of Public Health, The University of Queensland, Herston, QLD, Australia.
| | - Maree Toombs
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Damian Santomauro
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Harvey Whiteford
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Alize Ferrari
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Li DJ, Huang JJ, Hsu ST, Wu HC, Hsieh KY, Lin GG, Wu PJ, Liu CL, Chou FHC. The Impact of Psychological Burdens and Vaccine Worries on Confidence and Adherence to Governmental Policies Against COVID-19 Among Patients with Substance Use Disorder: A Cross-Sectional Study in Taiwan. Neuropsychiatr Dis Treat 2024; 20:597-606. [PMID: 38496324 PMCID: PMC10944137 DOI: 10.2147/ndt.s453238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has had an impact on patients with substance use disorder (SUD). We aimed to investigate factors associated with confidence and adherence to governmental policies against COVID-19 (social desirability) among patients with SUD. Methods This cross-sectional study was conducted during 2020 to 2021. Patients with SUD and healthy controls were recruited. The severity of sleep disturbance, social desirability, drug dependence, vaccine worries, other psychological burdens and demographic variables were collected through self-administrated questionnaires. Differences between the SUD and control groups were estimated. Hierarchical regression analysis was used to identify significant relationships between social desirability and other factors. Results In total, 58 of patients with SUD and 47 healthy controls were recruited. The patients with SUD had a lower level of social desirability and more severe sleep disturbance than the control group. Older age, more severe sleep disturbance, lower level of drug dependence, and lower level of vaccine worries were significantly associated with a higher level of social desirability among the patients with SUD. Conclusion Our results show the importance of timely interventions for drug dependence and to address vaccine worries in patients with SUD.
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Affiliation(s)
- Dian-Jeng Li
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Joh-Jong Huang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Su-Ting Hsu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hui-Ching Wu
- Department of Social Work, Taiwan Social Resilience Center, National Taiwan University, Taipei, Taiwan
| | - Kuan-Ying Hsieh
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Guei-Ging Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Pei-Jhen Wu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chin-Lien Liu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Ataiants J, Wong CF, Odejimi OA, Fedorova EV, Conn BM, Lankenau SE. Medicinal cannabis use among young adults during California's transition from legalized medical use to adult-use: a longitudinal analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:229-241. [PMID: 38407837 PMCID: PMC11225712 DOI: 10.1080/00952990.2024.2308098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024]
Abstract
Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults.Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021.Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18-26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors - cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups.Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) - low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) - low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) - high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01).Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational - but not medicinal - cannabis use.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn F. Wong
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Omolola A. Odejimi
- Department of Educational Psychology, Leadership and Higher Education, College of Education, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ekaterina V. Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Bridgid M. Conn
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Bjørnestad ED, Vederhus JK, Clausen T. Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up. BMC Psychiatry 2024; 24:149. [PMID: 38383345 PMCID: PMC10882792 DOI: 10.1186/s12888-024-05590-w] [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: 08/18/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. METHODS We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. RESULTS Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. CONCLUSIONS Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).
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Affiliation(s)
- Endre Dahlen Bjørnestad
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway.
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway.
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
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Minozzi S, Saulle R, Amato L, Traccis F, Agabio R. Psychosocial interventions for stimulant use disorder. Cochrane Database Syst Rev 2024; 2:CD011866. [PMID: 38357958 PMCID: PMC10867898 DOI: 10.1002/14651858.cd011866.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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McCoy J, Nielsen S, Bruno R. Development and validation of a brief screening tool for over-the-counter codeine dependence. Res Social Adm Pharm 2024; 20:182-189. [PMID: 38071124 DOI: 10.1016/j.sapharm.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Low-dose codeine is sold without a prescription in countries like the UK, Ireland, and South Africa. Due to misuse concerns, exploring pharmacy screening tools to identify those at risk and needing additional support is vital. OBJECTIVES The study aims to develop and validate a brief screening tool that assesses the risk of codeine dependence with language appropriate for routine use in community pharmacies. METHOD Scale development and validation occurred over two studies. In Study 1, scale item generation was based on structured analyses of psychosocial and pharmacy variables from frequent over-the-counter codeine consumers (N = 795). CFA was used to assess the cohesiveness of the resultant four-item Codeine Dependence Scale (CDS). ROC analyses were used to assess the performance of the CDS against risk cases identified by the Severity of Dependence Scale; identifying an optimal cut-off value of ≥2 as representing individuals at risk of codeine dependence. In Study 2, this CDS threshold was assessed against positive DSM-5 Opioid Use Disorder (OUD) cases related to codeine use assessed using the AUDADIS-IV. RESULTS With a cut-off score of ≥2, the CDS has sensitivity and specificity of 76% and 48%, respectively, against a DSM-5 codeine-related OUD diagnosis using the AUDADIS-IV. For identification of any codeine-related OUD (as measured by the AUDADIS-IV) 15 months after baseline, the CDS achieved an overall correct classification rate of 52%; 72% for positive cases. CONCLUSIONS The CDS exhibits reasonable cross-sectional and longitudinal sensitivity but low specificity, partly due to its brevity. However, the inclusive nature of the CDS is not a negative for application as a screening tool in a pharmacy setting as individual CDS items represent critical conversation points with a pharmacist, regardless of the screening outcome. The non-confronting nature of CDS items make the scale a viable option for pharmacy-based SBI in countries where codeine remains OTC.
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Affiliation(s)
- Jacqui McCoy
- University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia.
| | - Suzanne Nielsen
- Monash University, Wellington Rd, Clayton, VIC, 3800, Australia.
| | - Raimondo Bruno
- University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia.
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Amundsen EJ, Melsom AKM, Eriksen BO, Løchen ML. No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:111-130. [PMID: 38356787 PMCID: PMC10863554 DOI: 10.1177/14550725231195413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Karine M Melsom
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Chesney E, Lawn W, McGuire P. Assessing Cannabis Use in People with Psychosis. Cannabis Cannabinoid Res 2024; 9:49-58. [PMID: 37971872 PMCID: PMC10874830 DOI: 10.1089/can.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Introduction: Cannabis use is common in people with psychotic disorders and is associated with the exacerbation of symptoms, poor treatment adherence, and an increased risk of relapse. Accurate assessment of cannabis use is thus critical to the clinical management of psychosis. Discussion: Cannabis use is usually assessed with self-report questionnaires that were originally developed for healthy individuals or people with a cannabis use disorder. Compared to these groups, the pattern of cannabis use and the associated harms in patients with psychosis are quite different. Moreover, in people with psychosis, the accuracy of self-reported use may be impaired by psychotic symptoms, cognitive deficits, and a desire to conceal use when clinicians have advised against it. Although urinary screening for delta-9-tetrahydrocannabinol is sometimes used in the assessment of acute psychotic episodes, it is not used in routinely. Cannabis use could be assessed by measuring the concentration of cannabinoids in urine and blood, but this is rarely done in either clinical settings or research. Conclusion: Using quantitative biological measures could provide a more accurate guide to the effects of use on the disorder than asking patients or using questionnaires.
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Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Bramness JG, Lien L, Moe JS, Toft H, Pandey S, Lid TG, Strømmen M, Andersen JR, Bolstad I. Bariatric surgery patients in AUD treatment in Norway-an exploratory cross-sectional study. Alcohol Alcohol 2024; 59:agae007. [PMID: 38369663 PMCID: PMC11445783 DOI: 10.1093/alcalc/agae007] [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: 10/16/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
AIMS Patients who have undergone some forms of bariatric surgery have increased risk of developing alcohol use disorder (AUD). In the present observational study, we compared patients with AUD who themselves reported to having undergone bariatric surgery with other patients in treatment for AUD. MATERIALS One-hundred-and-six consecutively enrolled patients in residential treatment for AUD were asked if they had undergone bariatric surgery. Sociodemographics, mental health-related, and alcohol use-related parameters were compared between those who had and those who had not undergone bariatric surgery. RESULTS Of the 106 patients with AUD, seven (6.6%; 95% confidence interval, 2.7%-13.1%) had undergone bariatric surgery. Six of seven patients had undergone such surgery were women (P < .001). The patients with AUD who had undergone bariatric surgery were similar to other patients with AUD on most other parameters, the exception being a larger number of alcohol units ingested to feel an effect of alcohol (adjusted odds ratio 7.1; 95% confidence interval 2.0-12.2; P = .007). CONCLUSION The high number of patients with AUD that reported having undergone bariatric surgery emphasizes the risks following such a procedure. The overrepresentation of women may reflect than more women undergo such procedures. The unexpected finding that patients with AUD having undergone bariatric surgery seemed to need more alcohol to feel intoxicated warrants further research.
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Affiliation(s)
- Jørgen G Bramness
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, 0213 Oslo, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud kompetansesenter, Løvstadveien 7, 2312 Ottestad, Innlandet Hospital Trust, Brumunddal, Norway
- Institute Clinical of Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud kompetansesenter, Løvstadveien 7, 2312 Ottestad, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O.Box 400 Vestad, 2418 Elverum, Norway
| | - Jenny S Moe
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, 0213 Oslo, Norway
- Institute Clinical of Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Helge Toft
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O.Box 400 Vestad, 2418 Elverum, Norway
| | - Susmita Pandey
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud kompetansesenter, Løvstadveien 7, 2312 Ottestad, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torgeir G Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Telegrafdirektør Heftyes vei 73, 4021 Stavanger, Norway
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - John R Andersen
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
- Førde Hospital Trust, P.O. Box 1000, 6807 Førde, Norway
| | - Ingeborg Bolstad
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O.Box 400 Vestad, 2418 Elverum, Norway
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Daros AR, Guimond TH, Yager C, Palermo EH, Wilks CR, Quilty LC. Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50399. [PMID: 38227362 PMCID: PMC10828941 DOI: 10.2196/50399] [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: 08/26/2023] [Revised: 11/02/2023] [Accepted: 11/24/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. Although dialectical behavioral therapy is effective for SUDs, it is often difficult to access. Self-guided, internet-delivered dialectical behavioral therapy (iDBT) allows for expanded availability, but few studies have rigorously evaluated it in individuals with SUDs. OBJECTIVE This study examines the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, acceptable, and engaging to people with SUDs. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time. METHODS A 12-week, single-blinded, parallel-arm, randomized controlled trial was implemented, with assessments at baseline and at 4 (acute), 8, and 12 weeks (follow-up). A total of 72 community adults aged 18 to 64 years were randomized. The immediate group (n=38) received access to iDBT at baseline, and the delayed group (n=34) received access after 4 weeks. The intervention (Pocket Skills 2.0) was a self-guided iDBT via a website, with immediate access to all content, additional text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed using self-report questionnaires. RESULTS iDBT was perceived as a credible and acceptable treatment. In terms of feasibility, 94% (68/72) of the participants started iDBT, 13% (9/68) were early dropouts, 35% (24/68) used it for the recommended 8 days in the first month, and 50% (34/68) were still active 4 weeks later. On average, the participants used iDBT for 2 hours and 24 minutes across 10 separate days. In the acute period, no greater benefit was found for the immediate group on substance dependence, although we did find lower depression (b=-2.46; P=.02) and anxiety (b=-2.22; P=.02). At follow-up, there were greater benefits in terms of reduced alcohol (b=-2.00; P=.02) and nonalcoholic substance (b=-3.74; P=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence in the acute (b=-1.73; P<.001) and follow-up period (b=-2.09; P<.001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotional dysregulation, and functional disability. CONCLUSIONS iDBT is a feasible and acceptable intervention for patients with SUDs, although methods for improving engagement are warranted. Although results did not support efficacy for the primary outcome at 4 weeks, findings support reductions in substance dependence and other mental health concerns at 12 weeks. Notwithstanding the limitations of this study, the results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions. TRIAL REGISTRATION ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440.
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Affiliation(s)
- Alexander R Daros
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Timothy H Guimond
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Christina Yager
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emma H Palermo
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Chelsey R Wilks
- Department of Psychological Science, University of Missouri-St Louis, St. Louis, MO, United States
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Maes M, Altufaili MF, Alhaideri AF, Moustafa SR, Stoyanova K, Niu M, Zhou B, Li J, Al-Hakeim HK. The General Neurocognitive Decline in Patients with Methamphetamine Use and Transient Methamphetamine-induced Psychosis is Primarily Determined by Oxidative and AGE-RAGE Stress. Curr Top Med Chem 2024; 24:1816-1828. [PMID: 38984578 DOI: 10.2174/0115680266320808240709061445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Chronic Methamphetamine (MA) usage is linked to oxidative and AGE (advanced glycation end products) - RAGE (receptors for AGEs) stress, changes in magnesium, calcium, and copper, increased psychotic symptoms, and neurocognitive deficits. Nevertheless, it is still unclear whether these biological pathways mediate the latter impairments. OBJECTIVE This study aimed to investigate the relationships between neurocognition, the aforementioned biomarkers, and psychotic symptoms. METHODS We recruited 67 participants, namely 40 patients diagnosed with MA-substance use and 27 healthy controls, and assessed the Brief Assessment of Cognition in Schizophrenia (BACS), symptoms of psychosis, excitation, and formal thought disorders, oxidative toxicity (computed as the sum of myeloperoxidase (MPO), oxidized high-density lipoprotein (HDL), oxidized low-DL, and malondialdehyde), antioxidant defenses (catalase, glutathione peroxidase, total antioxidant capacity, zinc, and HDL), and increased AGEs and RAGEs. RESULTS We were able to extract one validated latent vector from the Mini-Mental State Examination score and the BACS test results (including executive functions, verbal fluency, and attention), labeled general cognitive decline (G-CoDe). We found that 76.1% of the variance in the G-CoDe was explained by increased oxidative toxicity, lowered antioxidant defenses, number of psychotic episodes, and MA dose. In patients with MA use, MPO was significantly associated with the GCoDe. CONCLUSION The use of MA induced mild cognitive impairments through MA-induced activation of detrimental outcome pathways, including oxidative and AGE-RAGE stress, and suppression of protective antioxidant pathways. Increased MPO, oxidative, and AGE-RAGE stress are new drug targets to prevent neurocognitive deficits and psychosis due to MA use.
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Affiliation(s)
- Michael Maes
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Fitness and Biopsychological Technology Research Unit, Faculty of Medicine Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
- Research and Innovation Program for the Development of MU - PLOVDIV-(SRIPD-MUP), Creation of a Network of Research Higher Schools, National Plan for Recovery and Sustainability, European Union - NextGenerationEU
| | | | | | - Shatha Rouf Moustafa
- Clinical Analysis Department, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Kristina Stoyanova
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research and Innovation Program for the Development of MU - PLOVDIV-(SRIPD-MUP), Creation of a Network of Research Higher Schools, National Plan for Recovery and Sustainability, European Union - NextGenerationEU
| | - Mengqi Niu
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
| | - Bo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
| | - Jing Li
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, 610072, China
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Coronado-Montoya S, Abdel-Baki A, Côté J, Crockford D, Dubreucq S, Fischer B, Lachance-Touchette P, Lecomte T, L'Heureux S, Ouellet-Plamondon C, Roy MA, Tatar O, Tibbo P, Villeneuve M, Wittevrongel A, Jutras-Aswad D. Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial. JMIR Res Protoc 2023; 12:e53094. [PMID: 38109196 PMCID: PMC10758938 DOI: 10.2196/53094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. OBJECTIVE Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients' preferences supporting harm reduction interventions, we developed a mobile app-based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. METHODS This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use-related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. RESULTS Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. CONCLUSIONS CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. TRIAL REGISTRATION ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53094.
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Affiliation(s)
- Stephanie Coronado-Montoya
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - José Côté
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - David Crockford
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Simon Dubreucq
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Addiction and Mental Health, Simon Fraser University, Vancouver, BC, Canada
- Research & Graduate Studies Division, University of the Fraser Valley, Abbotsford, BC, Canada
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
- School of Population Health, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tania Lecomte
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Sophie L'Heureux
- Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale, Centre Intégré Universitaire de Soins et Services Sociaux de la Capitale Nationale, Québec, QC, Canada
- Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
- Centre de Recherche CERVO, Québec, QC, Canada
| | - Ovidiu Tatar
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Phillip Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Anne Wittevrongel
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- University Institute on Addictions, Montreal, QC, Canada
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Binkowska AA, Obarska K, Marcowski P, Szymczak K, Lewczuk K, Sollich K, Banaszak M, Woronowicz B, Nowicka M, Skorko M, Gola M. Evaluating the effectiveness of mobile app-based self-guided psychological intervention to reduce craving and lapse risk in problematic substance use and behaviors: Protocol for a randomized control trial in the general population. Contemp Clin Trials Commun 2023; 36:101180. [PMID: 37720591 PMCID: PMC10500479 DOI: 10.1016/j.conctc.2023.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/11/2023] [Accepted: 07/02/2023] [Indexed: 09/19/2023] Open
Abstract
Background The prevalence of substance and behavioral addiction is estimated between 10 and 15% of the global population and remains a severe public health concern. Moreover, addiction treatment has several barriers, such as a lack of access to professional treatment or stigmatization. Mobile health interventions emerge as a promising solution. Methods This two-armed randomized controlled trial (RCT) aims to assess the efficacy of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic behaviors and substance use compared to a control condition. Participant recruitment and data collection will start in June 2022 and end in September 2022. Due to the nature of the study, i.e., a nationwide study of problematic substance use and behaviors, we will aim to recruit all individuals willing to participate. The four-week intervention condition includes short-term and long-term modules based mainly on mindfulness and cognitive behavioral therapy. Longitudinal data on several variables related to craving and lapse risk are collected daily using ecological momentary assessment (EMA). The primary outcomes of interest will be the self-reported number of lapses and craving level in daily EMA. Moreover, a questionnaire battery assessment is administered at baseline in the first week following onboarding, after five weeks, and after six months. The secondary outcome measures will include the severity of problematic substance use or behaviors, anxiety and depression, and life satisfaction. Results Results will be submitted for publication in peer-reviewed journals. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT054 34,429].
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Affiliation(s)
- Alicja Anna Binkowska
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- DrugsTeam, NeuroCognitive Research Center, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Katarzyna Obarska
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Karol Szymczak
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Karol Lewczuk
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | | | - Maria Banaszak
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Monar Association, Warsaw, Poland
| | - Bohdan Woronowicz
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Consulting Center Akmed, Warsaw, Poland
| | | | - Maciej Skorko
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Mateusz Gola
- PredictWatch, Upalna 1A/76, 15-668, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Craft S, Austin A, Tooth T, Glover C, Garrett T, Blagbrough IS, Sunderland P, Pudney CR, Freeman TP. Synthetic cannabinoid use in an adult male prison in the UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104219. [PMID: 37813081 DOI: 10.1016/j.drugpo.2023.104219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Synthetic cannabinoids (i.e. Spice) are a major public health problem in UK prisons, however, research in this area is limited. Here we aimed to draw comparisons between people with and without experience of using synthetic cannabinoids in prison, to characterise the features of, and motivations for use within this setting and evaluate support for different treatment interventions. METHOD Questionnaires were administered to 122 people in a category-B prison for adult males in England between July 2022 and March 2023. Participants were asked questions related to their sociodemographic and custodial characteristics, use of synthetic cannabinoids (and other drugs) inside and outside of prison and psychological distress was measured via the Brief Symptom Inventory (BSI-18). Those that had ever used synthetic cannabinoids in prison completed additional questions related to features of use, motivations for use and support for various interventions. RESULTS In total 46.7 % (n = 57) of participants reported use of synthetic cannabinoids in prison and this group experienced significantly greater levels of psychological distress compared to those reporting no use (mean (± standard deviation) BSI-18 scores = 23.7 (±16.7) vs 12.8 (±13.6), p < 0.001). Participants mostly reported using paper-based preparations (77.4 %) and use via e-cigarettes (75.9 %). The most strongly endorsed motivations for use included to alleviate boredom (91.1 % strongly agree/agree), to make the sentence pass faster (89.3 % strongly agree/agree) and to cope with stress (80.4 % strongly agree/agree). The interventions that received most support were strategies to better manage time and medication to manage withdrawal. CONCLUSIONS The use of synthetic cannabinoids in UK prisons typically involves the use of paper-based preparations via e-cigarettes, and use is associated with greater levels of psychological distress. Motivations for use were mostly pragmatic (e.g. to alleviate boredom or cope with stress) and interventions should prioritise increasing the time individuals spend out of cells and in meaningful activity.
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Affiliation(s)
- Sam Craft
- Addiction and Mental Health Group, Department of Psychology, University of Bath, UK.
| | - Alice Austin
- Addiction and Mental Health Group, Department of Psychology, University of Bath, UK
| | - Tom Tooth
- HM Prison and Probation Service (HMPPS), London, UK
| | - Catherine Glover
- Royal College of General Practitioners Secure Environments Group, London, UK
| | - Tina Garrett
- Office of Health Improvements and Disparities (OHID), London, UK
| | | | | | | | - Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, UK
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Hall NY, Le L, Abimanyi-Ochom J, Mihalopoulos C. Measuring the importance of different barriers to opioid agonist treatment using best-worst scaling in an Australian setting. Health Policy 2023; 138:104939. [PMID: 37949002 DOI: 10.1016/j.healthpol.2023.104939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Opioid agonist treatment (OAT) is an effective treatment for opioid use disorder (OUD), however several client barriers to OAT are reported. Client importance of these barriers using economic preference elicitation measures have not been identified. This paper determines the most important OAT barriers using best-worst scaling (BWS) and compares the results of BWS to Likert scale. METHODS Cross-sectional self-completed survey with 191 opioid dependent clients who attended Australian needle and syringe sites. Participants were presented 15 Likert scale barriers and 15 BWS barrier scenarios. The BWS data was presented using count analysis, multinomial logit and mixed logit models. The ranking of barrier items was completed using three BWS methods and one Likert scale method, with share preference results (BWS) or mean scores (Likert) used to rank the 15 barriers. RESULTS The most important client barriers were 'enjoy using opioids', 'lack of support services' and 'hard to access'. The four ranking methods produced different barrier rankings for the most important barriers, but similar results for the least important barriers. CONCLUSION Policies around OAT as a harm reduction approach, increased support services and increased availability of OAT services would be beneficial in improving OAT uptake. Comparing BWS and Likert methods produced different highest ranked barriers, indicating the method used to identify preferences has significant implications on the type of intervention prioritised.
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Affiliation(s)
| | - Long Le
- Public Health and Preventative Medicine, Monash University, Australia
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44
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Ohtani Y, Ueno F, Kimura M, Matsushita S, Mimura M, Uchida H. Highly endorsed screening and assessment scales for alcohol problems: A systematic review. Neuropsychopharmacol Rep 2023; 43:470-481. [PMID: 37392159 PMCID: PMC10739151 DOI: 10.1002/npr2.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Problems associated with alcohol use are multidimensional with psychiatric, psychological, physical, and social aspects, which makes it challenging to choose appropriate assessment scales. However, there has been no systematic evaluation of existing alcohol scales. METHODS A systematic literature search was conducted for articles that assessed the psychometric properties of scales for alcohol use disorder on March 19, 2023, using Medline, EMBASE, and PsycINFO. Only scales whose original development papers were cited more than 20 times were included. The methodological quality and psychometric properties of the scales were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments. The overall rating of the scales were assessed with a score ranging from 0 to 18. RESULTS In total, 314 studies and 40 scales were identified. These scales differ widely in measurement methods, target populations, and psychometric properties. The overall mean score was 6.3, and only the following three scales received >9 points suggesting a moderate level of evidence: Alcohol Use Disorders Identification Test (AUDIT), Alcohol Dependence Scale (ADS), and Short Alcohol Dependence Data Questionnaire (SADD). Measurement error and responsiveness were not evaluated or reported in the included scales. CONCLUSIONS Although the AUDIT, ADS, and SADD were rated the highest among the 40 scales, they showed, at most, a moderate level of evidence. These findings underscore the need to accumulate further evidence to assure the quality of the scales. It may be advisable to select and combine scales to meet the purpose of the assessment.
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Affiliation(s)
- Yohei Ohtani
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Fumihiko Ueno
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Mitsuru Kimura
- Department of PsychiatryNational Hospital Organization Kurihama Medical and Addiction CenterYokosukaJapan
| | - Sachio Matsushita
- Department of PsychiatryNational Hospital Organization Kurihama Medical and Addiction CenterYokosukaJapan
| | - Masaru Mimura
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
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Norton LS, Dibb B. "I'm Not the Same Person Anymore": Thematic Analysis Exploring Experiences of Dependence to Prescribed Analgesics in Patients with Chronic Pain in the UK. Pain Ther 2023; 12:1427-1438. [PMID: 37751058 PMCID: PMC10616007 DOI: 10.1007/s40122-023-00553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION The rising issue of dependence to prescribed pain medication for patients with chronic pain has been highlighted in the literature; however, there is a dearth of research exploring the patient perspective of this dependence in the United Kingdom (UK). This exploratory qualitative study aimed to investigate experiences of prescribed analgesic dependence in patients with chronic pain in the UK. METHODS Semi-structured interviews were conducted with nine UK-based participants (eight females, one male) with a mean age of 44, who experienced chronic pain and identified as dependent to their prescribed pain medication. The interviews were recorded and transcribed verbatim and the data analysed using thematic analysis. RESULTS Three main themes emerged, including perceptions of dependence, interactions with others, and interactions with medical professionals. The findings revealed how the experiences focused on the participants' own perception of their dependence, such as its perceived impact on their life and how the dependence began, and the relation of the dependence to their social environment, for example, doctor-patient relations. CONCLUSIONS These findings suggest practical implications for the management of dependence such as, raising awareness of the risks of dependence with these medications in the UK, and stricter observation of those taking the medications to identify dependence issues early.
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Affiliation(s)
- Louise S Norton
- University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
| | - Bridget Dibb
- University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
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Darharaj M, Roshanpajouh M, Amini M, Shrier LA, Habibi Asgarabad M. The effectiveness of mobile-based ecological momentary motivational enhancement therapy in reducing craving and severity of cannabis use disorder: Study protocol for a randomized controlled trial. Internet Interv 2023; 34:100669. [PMID: 37746638 PMCID: PMC10514405 DOI: 10.1016/j.invent.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
Objective This study aims to investigate the effectiveness of Ecological Momentary Motivational Enhancement Therapy (EM-MET) in reducing craving and severity of Cannabis Use Disorder (CUD) among young adults. Methods This multicenter, single-blinded randomized controlled trial (RCT) will be conducted over a period of 11 weeks. Eighty patients with CUD will be randomly assigned to two equal-sized parallel groups, either the Motivational Enhancement Therapy (MET) group or the EM-MET group. All participants will receive four individual face-to-face sessions of MET (twice a week). The MET group will not receive any other treatments after these sessions; however, in the EM-MET group, the top triggers of patients will be assessed using mobile-based Ecological Momentary Assessment (EMA) five times a day within three weeks (after face-to-face sessions) and they will receive a call from the therapist who provides them with EM-MET (in the form of an emergency telephone helpline) as soon as they report experiencing triggers of cannabis use that are assessed using EMA in their everyday lives. Primary outcomes including CUD severity and the severity of craving will be evaluated using the Leeds Dependence Questionnaire and the Self-efficacy and Temptation Scale, respectively. These assessments will be conducted at pre-treatment, post-treatment, and a six-week follow-up. Discussion If proven feasible and effective, the results of this study will offer clinicians an evidence-based treatment approach to address craving and dependency in patients with CUD. Moreover, these patients will receive effective treatment in real time and in real life, when and where it is most needed. However, it is important to consider the limitations of this study, such as the specific population studied in Tehran, Iran, which may affect the generalizability of the results. Nevertheless, the implementation of Ecological Momentary Interventions (EMIs) in real-life settings holds promise for timely and effective treatment.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials on 21 February 2023. Registry No. IRCT20221224056908N1.
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Affiliation(s)
- Mohammad Darharaj
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Roshanpajouh
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Amini
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Positive Youth Development Lab, Human Development & Family Sciences, Texas Tech University, TX, USA
- Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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Wang YF, Tzeng YS, Yu CC, Ling YH, Chen SP, Lai KL, Chen WT, Wang SJ. Sex differences in the clinical manifestations related to dependence behaviors in medication-overuse headache. J Headache Pain 2023; 24:145. [PMID: 37907887 PMCID: PMC10619252 DOI: 10.1186/s10194-023-01685-z] [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: 09/03/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE The present study aimed to compare sex differences in the clinical manifestations related to dependence behaviors in medication-overuse headache (MOH). METHODS Consecutive patients with newly diagnosed chronic migraine (CM) with and without MOH based on the Third Edition of International Classification of Headache Disorders (ICHD-3) were enrolled prospectively from the headache clinic of a tertiary medical center. Demographics and clinical profiles were collected by using a questionnaire, which included current use of tobacco, alcohol, and caffeinated beverages, the Leeds Dependence Questionnaire (LDQ), the Severity of Dependence Scale (SDS), the Headache Impact Test-6 (HIT-6), and the Pittsburgh Sleep Quality Index (PSQI). RESULTS In total, 1419 CM patients (1135F/284 M, mean age 41.7 ± 13.9 years) were recruited, including 799 with MOH (640F/159 M, mean age 42.5 ± 13.2 years) (56.3%). Smoking was associated with an increased risk for MOH in men (odds ratio [OR] = 3.60 [95% confidence interval = 1.73-7.50], p = 0.001), but not in women (OR = 1.34 [0.88-2.04], p = 0.171) (p = 0.021 for interaction). Hypnotic use ≥ 3 days/week was a risk factor for MOH (OR = 2.55 [95% confidence interval = 2.00-3.24], p < 0.001), regardless of sex. By using receiver operating characteristics (ROC) curves, the cutoff scores of the LDQ for MOH were determined at 7 for women and 6 for men, and those for the SDS were 5 and 4, respectively (area under curve all ≥ 0.83). Among patients with MOH, the male sex was associated with a shorter latency between migraine onset and CM onset (12.9 ± 11.1 vs. 15.4 ± 11.5 years, p = 0.008), despite less average headache intensity (6.7 ± 1.9 vs. 7.2 ± 1.9, p = 0.005), functional impacts (HIT-6: 63.4 ± 8.3 vs. 65.1 ± 8.0, p = 0.009), and sleep disturbances (PSQI: 10.9 ± 4.4 vs. 12.2 ± 4.3, p = 0.001). CONCLUSIONS The current study identified an association between smoking and MOH in men, as well as sex-specific cutoffs of the LDQ and the SDS, for MOH. MOH was characterized by a shorter latency between migraine onset and CM onset in men and a more severe phenotype in women. Sex should be considered as an important factor in the evaluation of MOH.
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Grants
- 109-2314-B-075 -054 and 110-2314-B-075 -041 -MY3 Taiwan National Science and Technology Council
- 104-2314-B-010-015-MY2, 106-2321-B-010-009, 107-2321-B-010-001, 108-2321-B-010-014 -MY2, 108-2321-B-010 001, 108-2314-B-010-023-MY3, and 110-2321-B-010-005 Taiwan National Science and Technology Council
- V108C-092, V109C-096, V110C-111, V111C-161, V112C-078, and V112D67-003-MY3-1 Taipei Veterans General Hospital
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Affiliation(s)
- Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yi-Shiang Tzeng
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan
| | - Chia-Chun Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan
| | - Yu-Hsiang Ling
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Ministry of Health and Welfare Keelung Hospital, Keelung, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Bei-Tou District, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Hall NY, Le L, Abimanyi-Ochom J, Teesson M, Mihalopoulos C. Identifying the most common barriers to opioid agonist treatment in an Australian setting. Aust J Prim Health 2023; 29:445-454. [PMID: 36934460 DOI: 10.1071/py22269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients. METHODS A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups). RESULTS The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers. CONCLUSIONS Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, Burwood, Vic., Australia
| | - Long Le
- Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
| | - Julie Abimanyi-Ochom
- School of Health and Social Development, Deakin University, Burwood, Vic., Australia
| | - Maree Teesson
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Cathy Mihalopoulos
- Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
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49
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Towe SL, Tang R, Gibson MJ, Zhang AR, Meade CS. Longitudinal changes in neurocognitive performance related to drug use intensity in a sample of persons with and without HIV who use illicit stimulants. Drug Alcohol Depend 2023; 251:110923. [PMID: 37598454 PMCID: PMC10538396 DOI: 10.1016/j.drugalcdep.2023.110923] [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: 03/09/2023] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Illicit stimulant use remains a public health concern that has been associated with multiple adverse outcomes, including cognitive deficits. The effects of stimulant use on cognition may be particularly deleterious in persons with HIV. Stimulant use intensity may be an important factor in the magnitude of observed deficits over time. METHODS We completed neurocognitive testing in a sample of people who use stimulants with (n = 84) and without HIV (n = 123) at baseline and up to 4 follow-up time points over approximately 1 year. Participants reported on substance use at each visit, including frequency of use and stimulant dependence. Mixed effects models examined the relationship between stimulant-related factors and neurocognitive function over time. RESULTS Participants were mostly male (57%), African American (86%), and 47.41 years old on average. All participants actively used stimulants at enrollment and use remained prevalent throughout the follow-up period, with an average of ≥24 days of use in the past 90 days at all time points. Retention was excellent, with 86% completing all 4 follow-up assessments. Mixed effects models showed that stimulant dependence was associated with lower neurocognitive performance independent of HIV status (p = 0.002), whereas frequency of use had a greater negative impact on performance in participants with HIV compared to those without HIV (p = 0.045). CONCLUSIONS Our key finding is that stimulant-related factors are associated with neurocognitive performance over time, but in complex ways. These findings have important implications for harm reduction approaches, particularly those that target cognitive function.
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Affiliation(s)
- Sheri L Towe
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Durham, NC 27708, USA.
| | - Runshi Tang
- University of Wisconsin-Madison, Department of Statistics, Madison, WI 53706, USA
| | - Matthew J Gibson
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Durham, NC 27708, USA
| | - Anru R Zhang
- Duke University School of Medicine, Department of Biostatistics & Bioinformatics, Durham, NC 27708, USA
| | - Christina S Meade
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Durham, NC 27708, USA
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50
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Günther F, Wong D, Elison-Davies S, Yau C. Identifying factors associated with user retention and outcomes of a digital intervention for substance use disorder: a retrospective analysis of real-world data. JAMIA Open 2023; 6:ooad072. [PMID: 37663407 PMCID: PMC10474970 DOI: 10.1093/jamiaopen/ooad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/29/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives Successful delivery of digital health interventions is affected by multiple real-world factors. These factors may be identified in routinely collected, ecologically valid data from these interventions. We propose ideas for exploring these data, focusing on interventions targeting complex, comorbid conditions. Materials and Methods This study retrospectively explores pre-post data collected between 2016 and 2019 from users of digital cognitive behavioral therapy (CBT)-containing psychoeducation and practical exercises-for substance use disorder (SUD) at UK addiction services. To identify factors associated with heterogenous user responses to the technology, we employed multivariable and multivariate regressions and random forest models of user-reported questionnaire data. Results The dataset contained information from 14 078 individuals of which 12 529 reported complete data at baseline and 2925 did so again after engagement with the CBT. Ninety-three percent screened positive for dependence on 1 of 43 substances at baseline, and 73% screened positive for anxiety or depression. Despite pre-post improvements independent of user sociodemographics, women reported more frequent and persistent symptoms of SUD, anxiety, and depression. Retention-minimum 2 use events recorded-was associated more with deployment environment than user characteristics. Prediction accuracy of post-engagement outcomes was acceptable (Area Under Curve [AUC]: 0.74-0.79), depending non-trivially on user characteristics. Discussion Traditionally, performance of digital health interventions is determined in controlled trials. Our analysis showcases multivariate models with which real-world data from these interventions can be explored and sources of user heterogeneity in retention and symptom reduction uncovered. Conclusion Real-world data from digital health interventions contain information on natural user-technology interactions which could enrich results from controlled trials.
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Affiliation(s)
- Franziska Günther
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester M13 9GB, United Kingdom
| | - David Wong
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester M13 9GB, United Kingdom
| | | | - Christopher Yau
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, United Kingdom
- Health Data Research UK, London NW1 2BE, United Kingdom
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