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Mendive F, Giovannetti C, García Arce S. Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:691-704. [PMID: 37948338 DOI: 10.1080/00952990.2023.2264466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.
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Affiliation(s)
| | - Cecile Giovannetti
- Institute of Tropical Medicine and International Health, Charite Universitat Medizin Berlin, Berlin, Germany
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2
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MacKenzie N, Smith DJ, Lawrie SM, M Rome A, McCartney D. Substance use, risk behaviours and well-being after admission to a quasi-residential abstinence-based rehabilitation programme: 4-year follow-up. BJPsych Open 2023; 9:e52. [PMID: 36908252 PMCID: PMC10043999 DOI: 10.1192/bjo.2023.23] [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] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Tackling Scotland's drug-related deaths and improving outcomes from substance misuse treatments, including residential rehabilitation, is a national priority. AIMS To analyse and report outcomes up to 4 years after attendance at a substance misuse residential rehabilitation programme (Lothians and Edinburgh Abstinence Programme). METHOD In total, 145 participants were recruited to this longitudinal quantitative cohort study of an abstinence-based residential rehabilitation programme based on the therapeutic community model; 87 of these participants were followed up at 4 years. Outcomes are reported for seven subsections of the Addiction Severity Index-X (ASI-X), together with frequency of alcohol use, heroin use, injecting drug use and rates of abstinence from substances of misuse. RESULTS Significant improvement in most outcomes at 4 years compared with admission scores were found. Completing the programme was associated with greater rates of abstinence, reduced alcohol use and improvements in alcohol status score (Mann-Whitney U = 626, P = 0.013), work satisfaction score (U = 596, P = 0.016) and psychiatric status score (U = 562, P = 0.007) on the ASI-X, in comparison with non-completion. Abstinence rates improved from 12% at baseline to 48% at 4 years, with the rate for those completing the programme increasing from 14.5% to 60.7% (χ2(2, 87) = 9.738, P = 0.002). Remaining abstinent from substances at follow-up was associated with better outcomes in the medical (U = 540, P < 0.001), psychiatric (U = 273.5, P < 0.001) and alcohol (U = 322.5, P < 0.001) subsections of the ASI-X. CONCLUSIONS Attending this abstinence-based rehabilitation programme was associated with positive changes in psychological and social well-being and harm reduction from substance use at 4-year follow-up, with stability of change from years 1 to 4.
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Affiliation(s)
- Nina MacKenzie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; and NHS Lothian, Edinburgh, UK
| | - Daniel J Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; and NHS Lothian, Edinburgh, UK
| | | | - David McCartney
- Lothian and Edinburgh Abstinence Programme, NHS Lothian, Edinburgh, UK
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3
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Robinson LD, Deane FP. Substance Use Disorder and Anxiety, Depression, Eating Disorder, PTSD, and Phobia Comorbidities Among Individuals Attending Residential Substance Use Treatment Settings. J Dual Diagn 2022; 18:165-176. [PMID: 35790104 DOI: 10.1080/15504263.2022.2090648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.
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Affiliation(s)
- Laura D Robinson
- Centre for Health Psychology Practice and Research, University of Wollongong, Wollongong, Australia.,School of Psychology, Faculty of the Arts, Social Sciences and Humanities University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Centre for Health Psychology Practice and Research, University of Wollongong, Wollongong, Australia.,School of Psychology, Faculty of the Arts, Social Sciences and Humanities University of Wollongong, Wollongong, Australia
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4
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Kelly PJ, Coyte J, Robinson LD, Deane FP, Russell S, Clapham K, Dale E, Longbottom M, Solley R, Baker AL. Evaluating an Aboriginal community controlled residential alcohol and other drug services: Use of benchmarking to examine within treatment changes in wellbeing. Drug Alcohol Rev 2022; 41:953-962. [PMID: 35106858 DOI: 10.1111/dar.13432] [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: 02/13/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aboriginal Community Controlled Organisations (ACCO) have an important role in the Australian health-care sector. However, there has been a lack of research evaluating ACCOs in the treatment of alcohol and other drug (AOD) use. Using a benchmarking approach, the present study examined within treatment changes on measures of wellbeing for people attending a residential AOD ACCO. METHODS The study focused on The Glen, an AOD residential treatment service that is managed by the Ngaimpe Aboriginal Corporation (n = 775). The Glen is a male-only service and provides treatment to both Indigenous and non-Indigenous men. The evaluation focused on measures of wellbeing (i.e. symptom distress and quality of life) collected at intake, 30 and 60 days during the person's stay. Comparative benchmarking was conducted with a cohort of men who were attending non-ACCO residential AOD treatment services (n = 4457). RESULTS The Glen participants demonstrated statistically significant improvements on measures of wellbeing. The Glen participants were more likely to complete treatment than participants attending non-ACCO services. Likewise, Indigenous people attending The Glen were more likely to complete treatment (compared to Indigenous people attending non-ACCO services). Rates of reliable and clinically significant change suggested that changes in quality of life were largely equivalent between The Glen and non-ACCO services, while participants attending The Glen tended to demonstrate larger reductions in symptom distress compared to the non-ACCO services. DISCUSSION AND CONCLUSION The study provides further support for the important role that ACCOs play in supporting Indigenous people in their recovery.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Joe Coyte
- The Glen, Central Coast Alcohol and Drug Rehabilitation Centre, Ngaimpe Aboriginal Corporation, Chittaway Point, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Sophie Russell
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Elizabeth Dale
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Marlene Longbottom
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Ryan Solley
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Reliable change and the reliable change index: still useful after all these years? COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
In 1984 Jacobson and colleagues introduced the concept of reliable change, viz the amount of change on a measure that an individual needed to show to determine that it exceeded the extent of change likely due to measurement error alone. Establishing reliable change was a pre-requisite for determining clinical significance. This paper summarizes the rationale for determining reliable change as providing an individual-focused, idiographic alternative to the dominant nomothetic approach to clinical outcome research based on group mean data and statistical significance. The conventional computational steps for calculating an individual’s standardized difference (reliable change) score and the minimum raw change score on the measure (a reliable change index) required to classify individuals as reliably positively changed, indeterminate, or reliably deteriorated are described. Two methods for graphically representing reliable change are presented, and a range of possible uses in both research and practice settings are summarized. A number of issues and debates concerning the calculation of reliable change are reviewed. It is concluded that the concept of reliable change remains useful for both cognitive behavioural researchers and practitioners, but that there are options regarding methods of computation. In any use of reliable change, the rationale for selecting among method options and the exact computations used need clear and careful description so that we can continuously judge the utility and appropriateness of the use of reliable change and enhance its value to the field.
Key learning aims
(1)
Recognizing why the concept of reliable change and the reliable change index is still important.
(2)
Understanding the conventional formulas for calculating reliable change and the reliable change index (the Jacobson-Truax (JT) method).
(3)
Seeing key ways that both researchers and practitioners can use reliable change to improve both research and practice.
(4)
Understanding how several issues and debates that have arisen concerning the estimation of reliable change (e.g. how to accommodate practice effects) have progressed.
(5)
Recognizing that there are a range of ways that reliable change may be estimated, and the need to provide full details of the method used in any particular instance of its use.
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Detecting change in psychiatric functioning in clinical trials for cocaine use disorder: sensitivity of the Addiction Severity Index and Brief Symptom Inventory. Drug Alcohol Depend 2021; 228:109070. [PMID: 34600247 PMCID: PMC8595796 DOI: 10.1016/j.drugalcdep.2021.109070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Assessment instruments commonly used in clinical trials to measure functional outcomes in substance users may lack sensitivity to detect change during treatment, potentially limiting findings regarding benefits of reduced drug use. This study evaluated the sensitivity of the Addiction Severity Index (ASI) to detect change in psychiatric functioning among cocaine users. METHODS Data were pooled across five clinical trials for cocaine use disorder (N = 492) that included a 12-week treatment period and 6-month follow-up. Within-person cohen's d' was used to evaluate effect size of change on the Psychiatric Composite Score of the ASI (ASI-Psych) and Global Severity Index (GSI) of the Brief Symptom Inventory, as well as cocaine use. RESULTS Effect sizes were larger for GSI than ASI-Psych from baseline to week 12 (GSI d' = 0.59; ASI-Psych d' = 0.16), and 6-month follow-up (GSI d' = 0.48; ASI-Psych d' = 0.10). For those with non-zero ASI-Psych at baseline (n = 252), medium effect sizes were found over the 12-week period (d' = 0.53) and 6-month follow-up (d' = 0.47). Effect sizes for change in days of cocaine use were most similar to GSI in either sample. CONCLUSIONS The ASI Psychiatric Composite Score may have limited sensitivity to detect change in psychiatric functioning among clinical trial participants who reduce cocaine use. It may be useful for detecting change amongst those reporting some psychiatric problems at the start of treatment. Future research should consider an instrument's sensitivity to change when assessing the potential functional benefits of reducing cocaine use.
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7
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Haynes CJ, Deane FP, Kelly PJ. Suicidal ideation predicted by changes experienced from pre-treatment to 3-month postdischarge from residential substance use disorder treatment. J Subst Abuse Treat 2021; 131:108542. [PMID: 34172341 DOI: 10.1016/j.jsat.2021.108542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/16/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Individuals with substance use disorders (SUD) are at an elevated risk for suicide. Abstinence and drug-related treatment outcomes remain integral to SUD treatment, but recovery incorporates more than just the absence of substance use or mental illness and including positive mental health indices in assessment and treatment of suicidality is needed. AIMS The current study investigates the role of traditional indicators of recovery, as well as positive psychology constructs, in predicting suicidal ideation following residential SUD treatment. METHOD The study utilized a longitudinal design with baseline and 3-month postdischarge follow-up assessments of 791 individuals who attended residential SUD treatment in Australia. RESULTS Rates of suicidal ideation decreased from baseline to follow-up, and the magnitude of change in most indices was associated with suicidal ideation at follow-up assessment. In a hierarchical logistic regression, baseline suicidal ideation, as well as a reduction in psychological distress, increase in refusal self-efficacy, and increase in self-forgiveness, emerged as significant predictors of follow-up suicidal ideation. The final model correctly classified 98.8% of participants as not experiencing SI, and 8.7% of participants as experiencing SI at follow-up, resulting in a total predictive accuracy of 86.9%. CONCLUSIONS The results suggested that changes in traditional recovery indices may facilitate reductions in suicidality. As a whole, changes in positive psychology indices did not add to the ability to predict suicidal ideation once traditional indices had been accounted for, but this does not preclude the importance of these indices to SUD treatment and suicide prevention efforts.
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Affiliation(s)
- Chloe J Haynes
- School of Psychology, University of Wollongong, Australia.
| | - Frank P Deane
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), Australia
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8
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Predictors of consent and engagement to participate in telephone delivered continuing care following specialist residential alcohol and other drug treatment. Addict Behav 2021; 117:106840. [PMID: 33556669 DOI: 10.1016/j.addbeh.2021.106840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND AIMS Although continuing care programs have been shown to improve alcohol and other drug (AOD) treatment outcomes, uptake of continuing care has been low. The current study aimed to determine predictors of participants' who both re-confirmed consent to engage in telephone-based continuing care and commenced continuing care once they left residential AOD treatment. These participants had initially consented to partake in continuing care during the course of their residential stay. METHODS Participants were 391 individuals (232 males, 59% and 158 females, 40%) accessing therapeutic communities for AOD treatment provided by The Australian Salvation Army and We Help Ourselves (WHOS). Measures at baseline, collected during residential treatment, included demographics, primary substance of concern, abstinence goal, refusal self-efficacy, cravings for substances, mental health diagnoses, psychological distress, quality of life and feelings of loneliness. All measures were used as predictor variables to determine characteristics of participants who re-confirmed consent to engage in continuing care and commenced continuing care following residential AOD treatment. RESULTS Completing residential treatment, being unmarried, and higher levels of loneliness predicted re-confirmation of consent to participate in continuing care following discharge from residential treatment. Participants who were Aboriginal and/or Torres Strait Islander were less likely to provide re-confirmation of consent. Participants were more likely to commence continuing care if they completed residential treatment, were older, and had longer years of substance use. CONCLUSIONS Tailoring continuing care programs to reach a broader array of individuals such as Indigenous populations and persons who exit treatment services early is needed to ensure these programs can reach all individuals who might need them.
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9
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Healthy recovery: A stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential alcohol and other drug treatment. Drug Alcohol Depend 2021; 221:108557. [PMID: 33714901 DOI: 10.1016/j.drugalcdep.2021.108557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Unhealthy lifestyle behaviours contribute to the poor health of people attending alcohol and other drug (AOD) treatment. Healthy Recovery is an 8-session group-based intervention that targets smoking, diet and physical inactivity as part of an integrated healthy lifestyle approach. The current study aimed to examine the effectiveness of Healthy Recovery when delivered within residential AOD treatment settings. METHODS The study design was a stepped-wedge cluster randomised trial. Participants were 151 current smokers attending residential AOD programs provided by the Australian Salvation Army (n = 71, Control condition; n = 80, Intervention condition). The primary outcome was number of cigarettes smoked per day. Secondary outcomes examined other smoking behaviours (7-day point prevalence, use of nicotine replacement therapy [NRT]), diet (servings and variety of fruit and vegetables), and physical activity. RESULTS The mean number of cigarettes smoked per day was significantly lower in the Intervention condition at 2-, 5-, and 8-month follow-up. There were also significant differences in favour of the Intervention condition for number of quit attempts, use of NRT and variety of fruit. There were no other significant differences for other dietary or physical activity variables. CONCLUSIONS Healthy Recovery had a positive impact on smoking behaviours. Future research should consider strategies to further promote smoking cessation (e.g. promoting longer-term use of NRT), as well as addressing physical activity and dietary behaviours. The introduction of broader organisational approaches (e.g. smoke free policies, organised group exercise and cooking activities) might help to enhance healthy lifestyle approaches within AOD treatment settings.
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10
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Paulus DJ, Capron DW, Zvolensky MJ. Understanding hazardous drinking and suicidal ideation and suicide risk among college students: anxiety sensitivity as an explanatory factor. Cogn Behav Ther 2020; 50:378-394. [DOI: 10.1080/16506073.2020.1840622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Daniel J. Paulus
- Department of Neuroscience, Medical University of South Carolina, Charlestion, SC, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Daniel W. Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Health Institute, University of Houston, Houston, TX, USA
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11
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Patterson T, Macleod E, Hobbs L, Egan R, Cameron C, Gross J. Measuring both primary and secondary outcomes when evaluating treatment effectiveness in alcohol and drug treatment programmes. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tess Patterson
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand,
| | - Emily Macleod
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand,
| | - Linda Hobbs
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand,
| | - Richard Egan
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand,
| | - Claire Cameron
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand,
| | - Julien Gross
- Department of Psychology, University of Otago, Dunedin, New Zealand,
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12
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Kelly PJ, Deane FP, Davis EL, Hudson S, Robinson LD, Keane CA, Hatton EL, Larance B. Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase. Drug Alcohol Rev 2020; 40:540-552. [PMID: 33155315 DOI: 10.1111/dar.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. DESIGN AND METHODS ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). RESULTS Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. DISCUSSION AND CONCLUSIONS The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Esther L Davis
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Suzie Hudson
- Network of Alcohol and other Drug Agencies, Sydney, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Carol A Keane
- School of Psychology, University of Wollongong, Wollongong, Australia.,School of Health, Medical and Applied Science, Central Queensland University, Rockhampton, Australia
| | - Emma L Hatton
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
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13
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Paulus DJ, Rogers AH, Asmundson GJG, Zvolensky MJ. Pain severity and anxiety sensitivity interact to predict drinking severity among hazardous drinking college students. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:795-804. [PMID: 32931714 DOI: 10.1080/00952990.2020.1804921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Hazardous alcohol use among college students is a growing problem. Alcohol is commonly used in the context of pain due to acute analgesic effects, although the role of pain among hazardous drinkers has not been examined. Little is known regarding factors that may moderate pain-alcohol relations. One factor is anxiety sensitivity, which reflects the fear of physiological sensations. Pain severity and anxiety sensitivity may interact such that those with high anxiety sensitivity may have stronger pain-alcohol relations.Objectives: The current study examined interactive associations of pain severity and anxiety sensitivity in relation to hazardous drinking severity, alcohol consumption, and alcohol problems among hazardous drinking college students (n = 370; 78.1% female).Methods: Self report measures of alcohol use, pain severity, and anxiety sensitivity were collected and moderation analyses were conducted.Results: There was a significant interaction of pain severity and anxiety sensitivity in relation to hazardous drinking severity (β = 0.25, p = .037); pain severity was significantly related to hazardous drinking for high (β = 0.28, p < .001) but not low (β = 0.09, p = .202) anxiety sensitivity. There was a similar interaction for alcohol consumption (β = 0.35, p = .008). For alcohol problems, there was no significant interaction, but there were unique main effects of both pain severity (β = 0.23, p < .001) and anxiety sensitivity (β = 0.34, p < .001).Conclusions: These findings suggest that drinkers with high anxiety sensitivity may use alcohol hazardously (and in greater quantities) in the context of pain. If replicated with longitudinal samples, the findings may inform clinical practice in terms of screening for and treatment of anxiety sensitivity.
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Affiliation(s)
- Daniel J Paulus
- Department of Neuroscience, Medical University of South Carolina , Charlestion, SC, USA.,Department of Psychology, University of Houston , Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston , Houston, TX, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston , Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, TX, USA.,Health Institute, University of Houston , Houston, TX, USA
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14
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Paulus DJ, Zvolensky MJ. The prevalence and impact of elevated anxiety sensitivity among hazardous drinking college students. Drug Alcohol Depend 2020; 209:107922. [PMID: 32088590 PMCID: PMC7536785 DOI: 10.1016/j.drugalcdep.2020.107922] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/15/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
Hazardous drinking is prevalent among college students, yet few seek treatment. Anxiety sensitivity AS is one factor with relevance to drinking. Yet, there are no known estimates of the prevalence of elevated AS among hazardous drinkers. The current study sought to estimate the prevalence of elevated AS among hazardous drinking college students and to examine relations between AS and hazardous drinking. Data from 1257 students Mage = 22.08; 80.4 % female; 76.8 % racial/ethnic minorities was employed. Approximately one third (30.7 %) of the sample met criteria for hazardous drinking. Among hazardous drinkers, 77.5 % had clinically elevated AS; similar rates were evidenced across sex and race/ethnicity. Hazardous drinkers reported significantly greater AS scores than moderate drinkers and non-drinkers (p < 0.001; η2 = 0.09). Those with elevated AS were more than three times more likely to be hazardous drinkers (p < 0.001). Among hazardous drinkers, those with elevated AS had more severe drinking levels (p < 0.001; Cohen's d=0.07) as well as greater likelihood, number, and disturbance related to use of other substances (p's from <0.001-0.005; Cohen's d's from 0.01 to 0.02). Findings from this study suggest that most hazardous drinkers have elevated AS, and that elevated AS is associated with a substantially higher likelihood of being a hazardous drinker. Hazardous drinkers with elevated AS report more severe drinking and other substance use than those with normative AS. There may be practical clinical benefit of implementing focus on AS to reduce hazardous drinking in college settings.
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Affiliation(s)
- Daniel J. Paulus
- Medical University of South Carolina, Department of Neuroscience, Charlestion, SC 29403
- University of Houston, Department of Psychology, Houston, TX, 77204
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology, Houston, TX, 77204
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030
- Health Institute, University of Houston, Houston, TX 77204
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15
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Kelly P, Deane F, Baker A, Byrne G, Degan T, Osborne B, Townsend C, McKay J, Robinson L, Oldmeadow C, Lawson K, Searles A, Lunn J. Study protocol the Continuing Care Project: a randomised controlled trial of a continuing care telephone intervention following residential substance dependence treatment. BMC Public Health 2020; 20:107. [PMID: 31992258 PMCID: PMC6986107 DOI: 10.1186/s12889-020-8206-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A priority area in the field of substance dependence treatment is reducing the rates of relapse. Previous research has demonstrated that telephone delivered continuing care interventions are both clinically and cost effective when delivered as a component of outpatient treatment. This protocol describes a NSW Health funded study that assesses the effectiveness of delivering a telephone delivered continuing care intervention for people leaving residential substance treatment in Australia. METHODS/DESIGN All participants will be attending residential alcohol and other drug treatment provided by The Salvation Army or We Help Ourselves. The study will be conducted as a randomised controlled trial, where participants will be randomised to one of three treatment arms. The treatment arms will be: (i) 12-session continuing care telephone intervention; (ii) 4-session continuing care telephone intervention, or (iii) continuing care plan only. Baseline assessment batteries and development of the participants' continuing care plan will be completed prior to participants being randomised to a treatment condition. Research staff blind to the treatment condition will complete follow-up assessments with participants at 3-months and 6-months after they have been discharged from their residential service. DISCUSSION This study will provide comprehensive data on the effect of delivering the continuing care intervention for people exiting residential alcohol and other drug treatment. If shown to be effective, this intervention can be disseminated to improve the rates of relapse among people leaving residential alcohol and other drug treatment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618001231235. Registered on 23rd July 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375621&isReview=true.
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Affiliation(s)
- Peter Kelly
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.
| | - Frank Deane
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Amanda Baker
- University of Newcastle, University Drive, School of Medicine and Public Health, Callaghan, New South Wales, 2308, Australia
| | - Gerard Byrne
- The Salvation Army, Chalmers Street, Redfern, New South Wales, 2016, Australia
| | - Tayla Degan
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Briony Osborne
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - James McKay
- University of Pennsylvania, Market Street, Philadelphia, PA, 19104, USA
| | - Laura Robinson
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Joanne Lunn
- We Help Ourselves, Rozelle, New South Wales, 2039, Australia
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16
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Staiger PK, Liknaitzky P, Lake AJ, Gruenert S. Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence. J Clin Med 2020; 9:jcm9010118. [PMID: 31906337 PMCID: PMC7020066 DOI: 10.3390/jcm9010118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. METHODS A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. RESULTS At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. CONCLUSIONS With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.
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Affiliation(s)
- Petra K. Staiger
- School of Psychology, Deakin University, Geelong 3220, Australia; (P.L.); (A.J.L.)
- Deakin University Centre for Drug Use, Addictive and Antisocial Behaviour Research (CEDAAR), Burwood 3125, Australia
- Correspondence: ; Tel.: +61-3-924-46876
| | - Paul Liknaitzky
- School of Psychology, Deakin University, Geelong 3220, Australia; (P.L.); (A.J.L.)
- Odyssey House Victoria, Melbourne 3121, Australia;
| | - Amelia J. Lake
- School of Psychology, Deakin University, Geelong 3220, Australia; (P.L.); (A.J.L.)
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria 3051, Australia
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17
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Prevalence and Predictors of Symptoms of Depression Among Individuals Seeking Treatment from Australian Drug and Alcohol Outpatient Clinics. Community Ment Health J 2020; 56:107-115. [PMID: 31515714 DOI: 10.1007/s10597-019-00451-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/07/2019] [Indexed: 12/13/2022]
Abstract
This study examined the prevalence of and sociodemographic characteristics associated with elevated symptoms of depression among clients seeking alcohol or other drug (AOD) treatment. Consenting clients attending two AOD outpatient clinics answered demographics, treatment questions and the Patient Health Questionnaire to assess depressive symptoms. Counts and percentages were calculated to determine the prevalence of elevated depressive symptoms. Logistic regression was used to model the odds of having elevated depressive symptoms for client demographics. Of the 203 clients who completed the survey (87% consent rate), 55% (n = 111) demonstrated elevated depressive symptoms. Females were twice as likely to experience elevated symptoms of depression compared to males (OR 2.07; 95% CI 1.05, 4.08; P = 0.037). The high rates of elevated depressive symptoms among individuals seeking AOD treatment highlight the importance of ongoing research to provide effective treatments for this comorbidity. Routine screening and clear treatment pathways may assist with providing high quality care.
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18
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de Andrade D, Elphinston RA, Quinn C, Allan J, Hides L. The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug Alcohol Depend 2019; 201:227-235. [PMID: 31254749 DOI: 10.1016/j.drugalcdep.2019.03.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/18/2019] [Accepted: 03/27/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Residential treatment is a standard treatment for individuals with severe and complex substance use problems. However, there is limited evidence on best practice approaches to treatment in these settings. This review provides a comprehensive update on the evidence base for residential treatment, and directions for future research and clinical practice. METHOD A systematic review of all studies published between January 2013 and December 2018 was conducted. Public health and psychology databases (Medline, CINAHL, PsycARTICLES and PsycINFO) were systematically searched, and forward and backward snowballing were used to identify additional studies. Studies were included if they were quantitative, assessed the effectiveness of residential substance treatment programs for adults, were published in the English language and in peer-reviewed journals. The Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies was used to assess methodological quality. RESULTS Our search identified 23 studies. Eight were rated as methodologically strong, five as moderate and ten rated as weak. Quality ratings were impacted by attrition at follow-up and research design. Despite limitations, results provide moderate quality evidence for the effectiveness of residential treatment in improving outcomes across a number of substance use and life domains. CONCLUSION With caution, results suggest that best practice rehabilitation treatment integrates mental health treatment and provides continuity of care post-discharge. Future research and practice should focus on better collection of outcome data and conducting data linkage of key health, welfare and justice agency administrative data to enhance understanding of risk and recovery trajectories.
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Affiliation(s)
- Dominique de Andrade
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia.
| | - Rachel A Elphinston
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia
| | - Catherine Quinn
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia
| | - Julaine Allan
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia; Lives Lived Well, Level 1/55 Little Edward St, Spring Hill, 4000, Queensland, Australia
| | - Leanne Hides
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia
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19
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Kelly PJ, Robinson LD, Baker AL, Deane FP, Osborne B, Hudson S, Hides L. Quality of life of individuals seeking treatment at specialist non-government alcohol and other drug treatment services: A latent class analysis. J Subst Abuse Treat 2018; 94:47-54. [DOI: 10.1016/j.jsat.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
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20
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Childhood maltreatment severity and alcohol use in adult psychiatric inpatients: The mediating role of emotion regulation difficulties. Gen Hosp Psychiatry 2017; 48:42-50. [PMID: 28917394 DOI: 10.1016/j.genhosppsych.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Emotion regulation difficulties are a potentially key mechanism underlying the association between childhood maltreatment and alcohol use in adulthood. The current study examined the mediating role of emotion regulation difficulties in the association between childhood maltreatment severity (i.e., Childhood Trauma Questionnaire total score) and past-month alcohol use severity, including alcohol consumption frequency and alcohol-related problems (i.e., number of days of alcohol problems, ratings of "bother" caused by alcohol problems, ratings of treatment importance for alcohol problems). METHOD Participants included 111 acute-care psychiatric inpatients (45.0% female; Mage=33.5, SD=10.6), who reported at least one DSM-5 posttraumatic stress disorder Criterion A traumatic event, indexed via the Life Events Checklist for DSM-5. Participants completed questionnaires regarding childhood maltreatment, emotion regulation difficulties, and alcohol use. RESULTS A significant indirect effect of childhood maltreatment severity via emotion regulation difficulties in relation to alcohol use severity (β=0.07, SE=0.04, 99% CI [0.01, 0.21]) was documented. Specifically, significant indirect effects were found for childhood maltreatment severity via emotion regulation difficulties in relation to alcohol problems (β's between 0.05 and 0.12; all 99% bootstrapped CIs with 10,000 resamples did not include 0) but not alcohol consumption. CONCLUSION Emotion regulation difficulties may play a significant role in the association between childhood maltreatment severity and alcohol outcomes. Clinical implications are discussed.
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21
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Vujanovic AA, Dutcher CD, Berenz EC. Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients. J Anxiety Disord 2017; 48:45-53. [PMID: 27605231 DOI: 10.1016/j.janxdis.2016.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
Distress tolerance (DT), the actual or perceived capacity to withstand negative internal states, has received increasing scholarly attention due to its theoretical and clinical relevance to posttraumatic stress disorder (PTSD). Past studies have indicated that lower self-reported - but not behaviorally observed - DT is associated with greater PTSD symptoms; however, studies in racially and socioeconomically diverse clinical samples are lacking. The current study evaluated associations between multiple measures of DT (self-report and behavioral) and PTSD symptoms in an urban, racially and socioeconomically diverse, acute-care psychiatric inpatient sample. It was hypothesized that lower self-reported DT (Distress Tolerance Scale [DTS]), but not behavioral DT (breath-holding task [BH]; mirror-tracing persistence task [MT]), would be associated with greater PTSD symptoms, above and beyond the variance contributed by trauma load, substance use, gender, race/ethnicity, and subjective social status. Participants were 103 (41.7% women, Mage=33.5) acute-care psychiatric inpatients who endorsed exposure to potentially traumatic events consistent with DSM-5 PTSD Criterion A. Results of hierarchical regression analyses indicated that DTS was negatively associated with PTSD symptom severity (PCL-5 Total) as well as with each of the four DSM-5 PTSD symptom clusters (p's<0.001), contributing between 5.0%-11.1% of unique variance in PTSD symptoms across models. BH duration was positively associated with PTSD arousal symptom severity (p<0.05). Covariates contributed between 21.3%-40.0% of significant variance to the models. Associations between DT and PTSD in this sample of acute-care psychiatric inpatients are largely consistent with those observed in community samples.
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22
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Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2016; 36:527-539. [PMID: 27786426 DOI: 10.1111/dar.12448] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/25/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
ISSUES The aim of this paper was to conduct a systematic review of the prevalence of comorbid mental health conditions in people accessing treatment for substance use in Australia. APPROACH A systematic review identified studies meeting the following eligibility criteria: reporting original data published in English; sample presenting for substance use treatment in Australia; assessing the prevalence of mental health and substance use conditions and reporting the percentage of participants with co-occurring mental health and substance use conditions. A narrative analysis was conducted because of the heterogeneity of methods used to assess key outcome variables and small number of studies assessing particular mental health outcomes. The abstracts of 1173 records were screened, and 59 full articles were assessed for eligibility. Eighteen studies were included in the review. KEY FINDINGS Prevalence estimates of current mental disorders in substance use treatment clients varied (47 to 100%). Mood and anxiety disorders were particularly prevalent, with the prevalence of current depression ranging from 27 to 85% and current generalised anxiety disorder ranging from 1 to 75%. IMPLICATIONS The high prevalence of mood and anxiety disorders in substance use treatment settings indicates a need for clinicians to screen and assess for these disorders as part of routine clinical care, and be familiar with evidence-based management and treatment strategies. CONCLUSION Although further studies are required to determine the prevalence of the full range of mental health disorders in this population, these findings emphasise the high prevalence of comorbid mental disorders are among individuals accessing substance use treatment in Australia. [Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2017;36:527-539].
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Affiliation(s)
- Rosemary E F Kingston
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Christina Marel
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Katherine L Mills
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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23
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Puvimanasinghe TS, Price IR. Healing through giving testimony: An empirical study with Sri Lankan torture survivors. Transcult Psychiatry 2016; 53:531-50. [PMID: 27330026 DOI: 10.1177/1363461516651361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sri Lanka has recently emerged from a three decade long civil war between government forces and the Liberation Tigers of Tamil Eelam. Behind the actual arena of conflict, forms of organised violence were often perpetrated on ordinary Sri Lankans who came into contact with law enforcement officials and other state authorities. The effects of these encounters on mental health, well-being, and community participation can be severe and long-lasting. Considering the generally poor availability of mental health services in many low-income countries, brief efficient interventions are required to enhance the lives of individuals and their families affected by torture, trauma, or displacement. In this context, the present study evaluated the effectiveness of testimonial therapy in ameliorating the distress of Sri Lankan survivors of torture and ill-treatment. The results indicated that over a 2- to 3-month period, psychosocial functioning was significantly enhanced in the therapy group compared to the waitlist control group. The general benefits of testimonial therapy, the ease with which it can be incorporated into ongoing human rights activities, and its application by trained nonprofessionals encourage greater use of the approach.
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24
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Turner B, Deane FP. Length of stay as a predictor of reliable change in psychological recovery and well being following residential substance abuse treatment. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-09-2015-0022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Longer length of stay (LOS) in residential alcohol and other drug treatment has been associated with more favourable outcomes, but the optimal duration has yet to be determined for reliable change indices. Optimal durations are likely to be a function of participant and problem characteristics. The purpose of this paper is to determine whether LOS in a residential therapeutic community for alcohol and other drug treatment community independently predicts reliable change across a range of psychological recovery and well-being measures.
Design/methodology/approach
In total, 380 clients from Australian Salvation Army residential alcohol and other drug treatment facilities were assessed at intake and three months post-discharge using the Addiction Severity Index 5th ed., The Depression, Anxiety and Stress Scale, The Recovery Assessment Scale, the Mental Health Continuum-Short Form and The Life Engagement Test.
Findings
The findings confirm LOS as an independent predictor of reliable change on measures of well-being and client perceived assessment of recovery. The mean LOS that differentiated reliable change from no improvement was 37.37 days.
Originality/value
The finding of LOS as a predictor of reliable change and the identification of an estimated time requirement may be useful for residential drug treatment providers in modifying treatment durations.
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25
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Anxiety Sensitivity and Alcohol Use Among Acute-Care Psychiatric Inpatients: The Mediating Role of Emotion Regulation Difficulties. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9792-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Kelly PJ, Baker AL, Deane FP, Callister R, Collins CE, Oldmeadow C, Attia JR, Townsend CJ, Ingram I, Byrne G, Keane CA. Study protocol: a stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential substance abuse treatment. BMC Public Health 2015; 15:465. [PMID: 25935830 PMCID: PMC4433090 DOI: 10.1186/s12889-015-1729-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease and cancer are leading causes of mortality for people with a history of alcohol or other substance use disorders. These chronic diseases share the same four primary behavioural risk factors i.e. excessive alcohol use, smoking, low intake of fruit and vegetables and physical inactivity. In addition to addressing problematic alcohol use, there is the potential for substance abuse treatment services to also address these other behaviours. Healthy Recovery is an 8-session group-based intervention that targets these multiple behavioural health risk factors and was developed specifically for people attending substance abuse treatment. This protocol describes a Cancer Institute NSW funded study that assesses the effectiveness of delivering Healthy Recovery for people who are attending residential alcohol and other substance abuse treatment. METHODS/DESIGN The study uses a stepped wedge randomised controlled design, where randomisation occurs at the service level. Participants will be recruited from residential rehabilitation programs provided by The Australian Salvation Army. All participants who (1) currently smoke tobacco and (2) are expected to be in the residential program for the duration of the 5-week intervention will be asked to participate in the study. Those participants residing at the facilities assigned to the treatment condition will complete Healthy Recovery. The intervention is manual guided and will be delivered over a 5-week period, with participants attending 8 group sessions. All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based, modified therapeutic community. Participants in the control condition will complete treatment as usual. Research staff blind to treatment allocation will complete the primary and secondary outcome assessments at baseline and then at weeks 8, 20 and 32 weeks post intervention. DISCUSSION This study will provide comprehensive data on the effect of delivering a healthy lifestyle intervention (i.e. Healthy Recovery) within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12615000165583. Registered 19(th) February 2015.
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Affiliation(s)
- Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia.
| | - Frank P Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine and Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, 2308, Australia.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine and Medicine and Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, 2308, Australia.
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, 2305, Australia.
| | - John R Attia
- Clinical Research Design, IT and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia.
| | - Camilla J Townsend
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.
| | - Isabella Ingram
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.
| | - Gerard Byrne
- Recovery Services, Australia Eastern Territory, The Salvation Army, Elizabeth Street, Sydney, 2000, Australia.
| | - Carol A Keane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.
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