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Soto-Nevarez A, Abo M, Hudson M, Bobak T, Jason LA. Lived experiences of Oxford House residents prescribed medication-assisted treatment. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2828-2844. [PMID: 36994805 DOI: 10.1002/jcop.23038] [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: 11/21/2021] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Qualitative studies have examined the recovery experiences of individuals prescribed medication-assisted treatment (MAT), including their experiences within treatment facilities. However, the literature lacks qualitative studies exploring the recovery process of individuals prescribed MAT while living in recovery housing, such as Oxford House (OH). The purpose of this study was to explore how OH residents, who are prescribed MAT, make sense of recovery. The fact that OHs are drug-free recovery housing is what makes the issue of using MATs potentially contentious in these settings. Interpretative phenomenological analysis (IPA) was used to document the lived experiences of individuals prescribed MAT in OH. The sample included: five women and three men, prescribed either methadone or Suboxone, that were living in an OH in the United States. Participants were interviewed on four topics: their recovery process, their transition to OH, and their experience living in and outside of an OH. Analysis of results followed the recommendations for IPA from Smith, Flowers, and Larkin. Four general themes emerged from the data: Recovery Process, Managing Logistics of MAT Utilization, Personal Development, and Familial Values. In conclusion, individuals prescribed MAT did benefit from living in an OH to manage their recovery as well as stay compliant with their medication.
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Affiliation(s)
| | - Mary Abo
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Mackenzie Hudson
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ted Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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2
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Rajabi R, Eslami Aliabadi H, Javad Mahdizadeh M, Azzizadeh Forouzi M. A comparative study of religious beliefs, spiritual intelligence and spiritual well-being in two therapies based on education (anonymous drug user) and methadone in drug user in Iran. BMC Res Notes 2023; 16:101. [PMID: 37308965 DOI: 10.1186/s13104-023-06377-0] [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: 08/25/2022] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Prevention of high-risk behaviors has always been considered; According to the researches, a person's religious attitudes and beliefs and intelligence quotient are associated with the prevention of high-risk behaviors such as drug addiction, and religiosity and spirituality also reduce drug addiction; Therefore, this study was conducted to compare religious beliefs, intelligence and spiritual health in two methods of education-based treatment and methadone in people with addiction. RESULTS A comparative study was performed among 184 people on all drug users admitted to these wards that treated with methadone and participants of meetings of anonymous drug users. Four questionnaires were used to collect information. Mean, and standard deviation were used to describe the demographic characteristics of participants. Chi-square and fisher tests were used to compare demographic information in the two groups. The present study was performed following acquisition of the code of ethics (IR.BUMS.REC.1395.156) from Research Ethics Committee of Birjand University of Medical Sciences.
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Affiliation(s)
- Raheleh Rajabi
- Department of Nursing, Zarand School of Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Eslami Aliabadi
- Nursing midwifery school, Assistant Professor of Nursing, Department of Nursing, Ferdows School of Health and Allied Medical Sciences, Birjand university of Medical Sciences, Birjand, Iran
| | - Mohammad Javad Mahdizadeh
- Instructor of Nursing, Nursing Department, Zarand School of Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansooreh Azzizadeh Forouzi
- Medical surgical nursing, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
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3
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Andraka-Christou B, Nguyen T, Harris S, Madeira J, Totaram R, Randall-Kosich O, Atkins DN. A pilot study of U.S. college students' 12-step orientation and the relationship with medications for opioid use disorder. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2383-2391. [PMID: 33577404 DOI: 10.1080/07448481.2020.1865376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
Objective: To examine undergraduate college students' attitudes toward 12-step support group utilization for opioid use disorder (OUD) and associations with previous experience with medications for OUD (MOUD). Participants: A convenience sample of undergraduate students at two major U.S. universities during Fall 2018 and Spring 2019. Method: A cross-sectional online survey of agreement with three 12-step orientation measures, MOUD experience, and demographic variables. Results: 1,281 students responded. Among 12-step orientation measures, respondents were most likely to agree that people with OUD should reach out to others in recovery. MOUD experience was significantly and negatively associated with agreement on each 12-step orientation measure. Religiosity/spirituality was positively associated with agreement that people with OUD should accept lack of control over OUD while placing trust in a higher power. Conclusion: Students with MOUD experience may be aware of anti-MOUD stigma in peer support groups and thus less likely to agree with 12-step orientation measures.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA
| | - Thuy Nguyen
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Shana Harris
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA
- Department of Anthropology, University of Central Florida, Orlando, Florida, USA
| | - Jody Madeira
- Maurer School of Law, Indiana University-Bloomington, Bloomington, Indiana, USA
| | - Rachel Totaram
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | | | - Danielle N Atkins
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
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4
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Monico LB, Ludwig A, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Post-residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder. J Subst Abuse Treat 2021; 137:108692. [PMID: 34920900 DOI: 10.1016/j.jsat.2021.108692] [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: 04/30/2021] [Revised: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. METHOD The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. RESULTS Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. CONCLUSION Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Andraka-Christou B, Totaram R, Randall-Kosich O. Stigmatization of medications for opioid use disorder in 12-step support groups and participant responses. Subst Abus 2021; 43:415-424. [PMID: 34214400 DOI: 10.1080/08897077.2021.1944957] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: 12-step groups are the most common approach to managing opioid use disorder (OUD) in the U.S. Medications for OUD (MOUD) are the most effective tool for preventing opioid misuse and relapse. Previous research has identified stigma of MOUD in 12-step groups. Objectives: We sought to identify how MOUD stigma is operationalized in 12-step groups and to identify responses to stigma. Methods: We recruited individuals with both MOUD experience and 12-step group experience from three syringe exchange programs in the U.S. using snowball sampling. We conducted individual telephone semi-structured interviews during 2018 and 2019. We coded data in Dedoose software and conducted thematic analysis using iterative categorization. Results: We recruited 30 individuals meeting our inclusion criteria. The following stigma operationalization methods were identified: prohibiting people using MOUD from speaking at meetings; encouraging shortened duration of MOUD treatment; refusing to sponsor people using MOUD; and refusing to let people using MOUD claim recovery time. Responses to stigma included the following: feeling shame; feeling anger; shopping around for different groups, leaving the group, or forming a new group; not revealing MOUD utilization or only telling a sponsor; speaking out on behalf of MOUD; and using cognitive approaches to avoid stigma internalization. Cognitive approaches included believing that anti-MOUD stigma is contrary to 12-step principles; disregarding statements as inaccurate based on one's experience of MOUD benefits; and accepting that all groups of humans have some ignorant people. Conclusion: Healthcare systems should help address MOUD stigma experienced by patients in 12-step groups, such as by offering non-12-step alternative groups and encouraging MOUD healthcare providers to prepare patients for potential stigma they may face. Some stigma response options, like shopping around for different groups, may not be feasible in rural areas or for participants newer to recovery.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA.,Department of Internal Medicine, University of Central Florida, Orlando, FL, USA
| | - Rachel Totaram
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA
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Recovery From Opioid Problems in the US Population: Prevalence, Pathways, and Psychological Well-Being. J Addict Med 2021; 14:207-216. [PMID: 31385848 DOI: 10.1097/adm.0000000000000561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Research has enhanced our understanding of opioid misuse prevalence and consequences, but few studies have examined recovery from opioid problems. Estimating national recovery prevalence and characterizing individuals who have resolved opioid problems can inform policy and clinical approaches to address opioid misuse. METHODS We conducted a cross-sectional investigation of a nationally-representative sample of US adults who reported opioid problem resolution (OPI). For reference, OPI was compared with an alcohol problem resolution group (ALC). Analyses estimated OPI/ALC prevalence, differences in treatment/recovery service use, and psychological well-being, within 2 recovery windows: <1 year (early recovery) and 1 to 5 years (mid-recovery) since OPI/ALC problem resolution. RESULTS Of those who reported alcohol or drug use problem resolution, weighted problem resolution prevalence was 5.3% for opioids (early recovery 1.2%, mid-recovery 2.2%) and 51.2% for alcohol (early recovery 7.0%, mid-recovery 11.5%). In mid-recovery, lifetime use of formal treatment, pharmacotherapy, recovery support services, mutual help, and current pharmacotherapy were more prevalent in OPI than ALC. Service utilization did not differ between early-recovery OPI and ALC. Common services used by OPI included inpatient treatment (37.8%) and state/local recovery organizations (24.4%) in mid-recovery; outpatient treatment (25.7%) and recovery community centers (27.2%) in early recovery; Narcotics Anonymous (40.2%-57.8%) and buprenorphine-naloxone (15.3%-26.7%) in both recovery cohorts. Regarding well-being, OPI reported higher self-esteem than ALC in early recovery, and lower self-esteem than ALC in mid-recovery. CONCLUSIONS An estimated 1.2 million American adults report resolving an opioid problem. Given the service use outcomes and longer-term problem resolution of mid-recovery OPI, early-recovery OPI may require encouragement to utilize additional or more intensive services to achieve longer-term recovery. OPI beyond recovery-year 1 may need enhanced support to address deficient self-esteem and promote well-being.
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Andraka-Christou B, Atkins DN. Whose opinion matters about medications for opioid use disorder? A cross-sectional survey of social norms among court staff. Subst Abus 2020; 42:735-750. [DOI: 10.1080/08897077.2020.1846666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
- Department of Internal Medicine, University of Central Florida, Orlando, Florida, USA
| | - Danielle N. Atkins
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
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8
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Mokhtari MR, Alavi M, Pahlavanzadeh S, Weimand BM, Visentin D, Cleary M. Comparison of the effectiveness of a 12 step substance use recovery program on quality of life. Nurs Health Sci 2019; 22:390-397. [PMID: 31828941 DOI: 10.1111/nhs.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
Substance-related disorders can adversely impact quality of life. This study assessed a 12 step program on health-related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi-experimental, two group, three stage, pre- and post-test design and collected data at baseline, and at 1 and 3 months' post-intervention. The treatment group comprised 35 participants in a 12 step program with a non-equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality-of-life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health-related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions - physical functioning and role limitations due to emotional problems - at 1 month post-intervention. There were additional improvements at 3 months' follow up in six of eight quality-of-life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life.
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Affiliation(s)
- Mohammad Reza Mokhtari
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Pahlavanzadeh
- Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bente M Weimand
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Evidence and Social Innovation, School of Nursing and Midwifery, Queens University, Belfast, Ireland.,Department of Research and Development Mental Health, Akershus University Hospital, Lørenskog, Norway
| | - Denis Visentin
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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Day E, Kirberg S, Metrebian N. Affiliation to alcoholics anonymous or narcotics anonymous among patients attending an English specialist addiction service. DRUGS AND ALCOHOL TODAY 2019. [DOI: 10.1108/dat-05-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Attendance at alcoholics anonymous (AA) or narcotics anonymous (NA) meetings and affiliation with the fellowship has potential benefits for people with alcohol or drug use disorders. This effect is present whether or not the individual attends professional treatment services, but the two process can have a synergistic effect. Limited information exists about the extent to which people attending UK specialist treatment services also attend AA/NA and their views about such attendance. The paper aims to discuss these issues.
Design/methodology/approach
A cross-sectional survey of 200 consecutive attendees at the specialist treatment service in an English region was conducted between January and April 2018. A measure of past attendance and affiliation with AA/NA (AAAS) and a scale designed to quantify future readiness to attend (Survey of Readiness for Alcoholics Anonymous Participation) were administered and anonymously linked to data supplied to the National Drug Treatment Monitoring Service (NDTMS).
Findings
A minority of the sample had ever attended an AA meeting (31 per cent, n=59) or an NA meeting (41 per cent, n=79), and only 14 per cent (n=27) and 24 per cent (n=45) had attended an AA or NA meeting, respectively, in the past year. Only two variables significantly predicted level of readiness to attend AA or NA in a regression model: attended more AA/NA meetings in the past (ß=0.149, p=0.036) and previous level of participation (AAAS score) (ß=0.409, p < 0.001).
Practical implications
A significant proportion of attendees of a specialist drug and alcohol treatment service had never attended AA/NA, despite many positive views about their potential benefits. Given the established benefits of attending AA/NA meetings and participating in the AA or NA fellowship, these results suggest that professional treatment services should do more to explain the process and challenge preconceived ideas about how they operate.
Originality/value
The authors are not aware of any published research that captures the rates of attendance of and participation in both AA and NA groups in a UK-based community treatment sample. These results may therefore provide a baseline for evaluating the impact of interventions to increase attendance/participation, and also provide some insight into the potential barriers to attendance in this population.
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10
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Treating Opioid Dependence: Pain Medicine Physiology of Tolerance and Addiction. Clin Obstet Gynecol 2019; 62:87-97. [DOI: 10.1097/grf.0000000000000422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Krawczyk N, Negron T, Nieto M, Agus D, Fingerhood MI. Overcoming medication stigma in peer recovery: A new paradigm. Subst Abus 2018; 39:404-409. [PMID: 29432086 DOI: 10.1080/08897077.2018.1439798] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Treatment for opioid use disorder involving opioid-based pharmacotherapies is considered most effective when accompanied by psychosocial interventions. Peer-led support groups are widely available and have been described by many as fundamental to the recovery process. However, some individuals using medications face stigma in these settings, which can be contradictory and counterproductive to their recovery. METHODS This paper describes the development of the "Ability, Inspiration and Motivation" or "AIM" group, an alternative peer support group that aims to remove medication stigma from peer recovery. Qualitative interviews with staff, peers, and clients of a community-based buprenorphine treatment program were used to establish the core components of the curriculum to support client needs. RESULTS Staff, peers, and clients of the buprenorphine program indicated a need and desire to establish a peer recovery group that recognizes persons on medication as being in recovery and destigmatizes use of medication to treat opioid addiction. A respectful environment, holistic perspective on health, spirituality, sharing, and celebration were all established as necessary pillars of the AIM group curriculum. CONCLUSIONS The community-based effort to establish and develop the AIM group demonstrates that combining the strengths of a peer support with evidence-based medication treatment is both possible and desirable. Shifting the culture of peer recovery groups to support the use of medications may have implications for improving treatment retention and should be considered as a potential strategy to reduce the burden of the opioid epidemic.
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Affiliation(s)
- Noa Krawczyk
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Behavioral Health Leadership Institute , Baltimore , Maryland , USA
| | - Tianna Negron
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Maia Nieto
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Deborah Agus
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Behavioral Health Leadership Institute , Baltimore , Maryland , USA
| | - Michael I Fingerhood
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,c Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
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12
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Day E, Mitcheson L. Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism? Addiction 2017; 112:1329-1336. [PMID: 28044376 DOI: 10.1111/add.13644] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based treatments beyond 'routine counselling'. ANALYSIS We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice. CONCLUSION The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions.
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Affiliation(s)
- Ed Day
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Solihull Integrated Addiction Service, Solihull, UK
| | - Luke Mitcheson
- South London and Maudsley NHS Foundation Trust, London, UK
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Galanter M. Combining medically assisted treatment and Twelve-Step programming: a perspective and review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:151-159. [PMID: 28387530 DOI: 10.1080/00952990.2017.1306747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. OBJECTIVE To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. METHOD Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. RESULTS The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.
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Affiliation(s)
- Marc Galanter
- a Department of Psychiatry , NYU School of Medicine , New York , NY , USA
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White W, Galanter M, Humphreys K, Kelly J. The Paucity of Attention to Narcotics Anonymous in Current Public, Professional, and Policy Responses to Rising Opioid Addiction. ALCOHOLISM TREATMENT QUARTERLY 2016. [DOI: 10.1080/07347324.2016.1217712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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A Pressing Need for Pharmacotherapy Development to Treat Drug Addiction: An Editorial from a Legal Perspective. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016. [PMID: 27055610 DOI: 10.1016/bs.irn.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Only three FDA-approved pharmacological treatments exist for treating opiate dependence, all of which are underprescribed and underused. No FDA-approved pharmacological treatments exist for cocaine or methamphetamine dependence. More evidence-based, FDA-approved treatments are needed for treating drug dependence, but pharmaceutical companies are unlikely to pursue such research without government incentives. Today pharmaceutical companies primarily conduct research and development (R&D) related to "blockbuster" and rare diseases; drug dependence does not fall into either category. Further compounding the problem, pharmaceutical companies have been recently slashing risky areas of research, rather than adopting new areas. Fortunately, the government has a number of options to incentivize pharmaceutical R&D relating to drug dependence treatment, including the following: market exclusivity for new medications, tax breaks, priority review vouchers, liability reduction, and an advanced market commitment.
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