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Kaufman CC, Rosmarin DH. Spiritually Integrated Group Psychotherapy for First Responders: Forgiveness, Trauma, and Alcohol Use. Int J Group Psychother 2024; 74:217-243. [PMID: 38502106 PMCID: PMC11062829 DOI: 10.1080/00207284.2024.2322500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
First responders (e.g. firefighters, law enforcement, paramedics, corrections officers) experience high rates of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Despite the relevance of both spirituality and forgiveness to PTSD and AUD among first responders, spiritually integrated group interventions for this population are rare. This article discusses a forgiveness session of a spiritually integrated group psychotherapy protocol for first responders (SPIRIT-FR) in acute psychiatric care. This brief group psychotherapy intervention includes (a) psychoeducation about the intersection of PTSD, AUD, and forgiveness (b) discussion of the relevance of forgiveness to PTSD and AUD, and (c) the integration of spiritual beliefs and behaviors to move toward forgiveness. We discuss relevant clinical theory as well as the potential clinical application of this protocol.
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Affiliation(s)
- Caroline. C. Kaufman
- Spirituality and Mental Health Program, McLean Hospital
- Department of Psychiatry, Harvard Medical School
| | - David H. Rosmarin
- Spirituality and Mental Health Program, McLean Hospital
- Department of Psychiatry, Harvard Medical School
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2
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Williams T. Substance Abuse Treatment, Critical Race Theory, and Counter-Storytelling, for the Black Emerging Adult Male. J Racial Ethn Health Disparities 2024; 11:1067-1076. [PMID: 37022598 DOI: 10.1007/s40615-023-01586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023]
Abstract
Black-emerging adult males face many barriers to the effective engagement in substance abuse treatment including stigma, lack of access to resources, and engagement with the criminal justice system. This case study introduces a group therapy and counter-storytelling intervention to understand and effectively mitigate some of these barriers. Counter-storytelling, derived from critical race theory (CRT) framework, focuses on marginalized individuals sharing how various aspects of society impact them, which is often different from the majority narrative. Through this intervention, Black-emerging adult males discussed the challenges they face when engaging in treatment, coping skills for barriers they face, and overcoming stigma of substance abuse recovery. Using a group therapy and counter-storytelling intervention, clinicians can begin to suspend how they traditionally think about treatment for Black-emerging adult males and engage in more effective practices to support this population.
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Affiliation(s)
- Tempestt Williams
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
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Chander KR, Moirangthem S, Patley R, Philip S, Varshney P, Basavaraju V, Parthasarathy R, Krishna PVM, Manjunatha N, Channaveerachari NK, Math SB. A camp approach of community psychiatry in India: Past, present, and the future. Ind Psychiatry J 2022; 31:191-196. [PMID: 36419705 PMCID: PMC9678157 DOI: 10.4103/ipj.ipj_195_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022] Open
Abstract
Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.
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Affiliation(s)
- K Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Mental Health, Government of Karnataka, Bengaluru, Karnataka, India
| | - P V Mohan Krishna
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Simulating the experience of searching for LGBTQ-specific opioid use disorder treatment in the United States. J Subst Abuse Treat 2022; 140:108828. [PMID: 35749919 DOI: 10.1016/j.jsat.2022.108828] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/15/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory). METHODS We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and "special programs/groups" for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; and the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate). RESULTS Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates. CONCLUSIONS The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.
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Paquette CE, Rubalcava DT, Chen Y, Anand D, Daughters SB. A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial. JMIR Form Res 2021; 5:e25749. [PMID: 34730535 PMCID: PMC8600431 DOI: 10.2196/25749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/14/2021] [Accepted: 08/01/2021] [Indexed: 01/22/2023] Open
Abstract
Background Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887
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Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dillon T Rubalcava
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yun Chen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deepika Anand
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,CBT Center of Chicago, Chicago, IL, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Peterson NA, Lardier DT, Powell KG, Mankopf E, Rashid M, Morton CM, Borys S. Psychometric properties of a Recovery Empowerment Scale: Testing emotional, cognitive, behavioral, and relational domains. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2874-2891. [PMID: 33963772 DOI: 10.1002/jcop.22592] [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: 11/11/2020] [Revised: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.
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Affiliation(s)
- N Andrew Peterson
- Center for Prevention Science, Northeast & Caribbean Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - David T Lardier
- Family and Child Studies, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kristen G Powell
- Center for Prevention Science, Northeast & Caribbean Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Emilie Mankopf
- Center for Prevention Science, Northeast & Caribbean Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Mariam Rashid
- Center for Tobacco Studies, Biomedical Health Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Cory M Morton
- Center for Prevention Science, Northeast & Caribbean Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Suzanne Borys
- New Jersey Division of Mental Health & Addiction Services, Trenton, New Jersey, USA
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Lardier DT, Coakley KE, Holladay KR, Amorim FT, Zuhl MN. Exercise as a Useful Intervention to Reduce Alcohol Consumption and Improve Physical Fitness in Individuals With Alcohol Use Disorder: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:675285. [PMID: 34305729 PMCID: PMC8292965 DOI: 10.3389/fpsyg.2021.675285] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/31/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: This meta-analysis and systematic review examined the effects of exercise interventions on alcohol consumption and binge drinking in individuals with alcohol use disorder (AUD). Data sources: PubMed, Web of Science, Google Scholar, SPORTDiscus, and ERIC databases. Study Inclusion and Exclusion Criteria: Peer-reviewed randomized controlled trials published in English between 1970 and 2021. All studies compared exercise (Ex) and treatment as usual (TAU) to TAU in adults with an alcohol-related diagnosis. All forms of exercise interventions were included (e.g., aerobic exercise, yoga, resistance exercise, etc.). Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols standard and the Meta-Analyses and Systematic Reviews of Observational Studies guidelines were followed. Risk of bias was assessed using the Cochrane risk-of-bias tool as described by the Cochrane Handbook for Systematic Reviews and Interventions. Results: The literature searches retrieved a combined 2527 studies, with 1,034 studies screened after removal of duplicates and 973 (94%) rejected after reviewing titles and abstracts. Full-text review was performed on 61 studies, with seven studies meeting inclusion criteria for qualitative and meta-analysis. Across seven studies (n = 492 participants), a significant effect (Z-value = -3.37; g = -0.30; 95% CI [-0.50--0.09]; p = 0.001) was found for Ex+TAU on drinking volume. There was no effect of Ex+TAU on binge drinking. The effect of Ex+TAU on physical fitness (VO2max, ml•kg-1•min-1) was significant (Z-score = 3.70; g = 0.64; 95% CI [0.19-1.08]; p < 0.001). Conclusions: Exercise interventions may decrease alcohol consumption and improve fitness and can be an effective adjunctive treatment for individuals with alcohol-related diagnoses including AUD.
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Affiliation(s)
- David T. Lardier
- Department of Individual, Family and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, NM, United States
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Kathryn E. Coakley
- Department of Individual, Family and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Kelley R. Holladay
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, NM, United States
- College of Health Sciences, Jacksonville University, Jacksonville, FL, United States
| | - Fabiano T. Amorim
- Department of Health Education and Sports Sciences College of Education and Human Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Micah N. Zuhl
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI, United States
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López G, Orchowski LM, Reddy MK, Nargiso J, Johnson JE. A review of research-supported group treatments for drug use disorders. Subst Abuse Treat Prev Policy 2021; 16:51. [PMID: 34154619 PMCID: PMC8215831 DOI: 10.1186/s13011-021-00371-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/10/2022] Open
Abstract
This paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women's recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.
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Affiliation(s)
- Gabriela López
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA
| | - Lindsay M Orchowski
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, 02904, USA.
| | - Madhavi K Reddy
- Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Jessica Nargiso
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jennifer E Johnson
- Division of Public Health, Michigan State University, Flint, MI, 48502, USA
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Ana EJS, LaRowe SD, Gebregziabher M, Morgan-Lopez AA, Lamb K, Beavis KA, Bishu K, Martino S. Randomized controlled trial of group motivational interviewing for veterans with substance use disorders. Drug Alcohol Depend 2021; 223:108716. [PMID: 33873028 PMCID: PMC9011162 DOI: 10.1016/j.drugalcdep.2021.108716] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Motivational interviewing delivered in a group format is understudied yet promising as a treatment for substance use disorders (SUD). We evaluated the efficacy of group motivational interviewing (GMI) relative to a treatment-control (TCC) for enhancing treatment and self-help engagement and decreasing alcohol and drug use among veterans with SUD and co-existing psychiatric disorders. METHOD Veterans (n = 118) with alcohol use disorder were recruited within an outpatient SUD treatment program and randomized to GMI or TCC upon program entry. Alcohol use, SUD treatment, and 12-step session attendance were primary outcomes. Drug use days was the secondary outcome. Participants were assessed at baseline and at one-and three-month follow-up. RESULTS Significant differences were observed between GMI and TCC for binge drinking at both one (RR = .74; 95 % CI [.58, .94]) and three-month follow-up (RR = .74; 95 % CI [.59, .91]). At three-month follow-up, significant differences between treatment conditions were observed for alcohol use days (RR = .79; 95 % CI [.67, .94]), number of SUD treatment sessions (RR = 2.53; 95 % CI [1.99, 3.22]), and 12-step sessions attended (RR = 1.64; 95 % CI [1.35-1.98]). Similarly, we observed significant effects for GMI on reducing alcohol consumption in standard drinks (RR = .49; 95 % CI [.25, .95]). Drug use days declined at each follow-up, with no significant differences between treatment conditions. CONCLUSIONS GMI delivered at SUD treatment program entry enhanced treatment session and 12-step group attendance and lowered alcohol consumption among outpatient Veterans. Future research should study how GMI works and its effectiveness in SUD treatment settings.
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Affiliation(s)
- Elizabeth J. Santa Ana
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee St., Charleston, SC, 29401 USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC, 29425 USA
| | - Steven D. LaRowe
- Mental Health Service Line, James H. Quillen VAMC, 53 Memorial Ave, Johnson City, TN, 37684 USA
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee St., Charleston, SC, 29401 USA,Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St., Charleston, SC, 29425 USA
| | - Antonio A. Morgan-Lopez
- Behavioral Health Research Division, RTI International, Research Triangle Park, 3040 E Cornwallis Rd, Morrisville, NC, 27709 USA
| | - Kayla Lamb
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee St., Charleston, SC, 29401 USA
| | - Katherine A. Beavis
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee St., Charleston, SC, 29401 USA
| | - Kinfe Bishu
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee St., Charleston, SC, 29401 USA,Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425
| | - Steve Martino
- Yale University School of Medicine, Department of Psychiatry, 40 Temple St., New Haven, CT, 06510 USA,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516 USA
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Sokol R, Suter S, Pierce B, Council L, Grossman E, Roland L, Roll D, Mintzer E. A novel transition: Lessons learned during rapid implementation and evolution of telehealth group based opioid treatment (t-GBOT) during the COVID-19 pandemic. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100559. [PMID: 34052621 PMCID: PMC8442539 DOI: 10.1016/j.hjdsi.2021.100559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/02/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Randi Sokol
- Tufts Family Medicine Residency Program at Cambridge Health Alliance, 195 Canal St, Malden, MA, 02148, USA.
| | - Sara Suter
- Primary Care Behavioral Health Integration, Cambridge Health Alliance, 119 Windsor St, Cambridge, MA, 02139, USA.
| | - Brittany Pierce
- Family Medicine, Cambridge Health Alliance, 195 Canal St, Malden, MA, 02148, USA.
| | - Lora Council
- Primary Care, Cambridge Health Alliance, 230 Highland Ave, Somerville, MA, 02143, USA.
| | - Ellie Grossman
- Primary Care / Behavioral Health Integration, Cambridge Health Alliance, 236 Highland Avenue, Somerville, MA, 02143, USA.
| | - Lolita Roland
- Office Based Addiction Treatment (OBAT) Care Manager, Cambridge Health Alliance, Cambridge Clinics and Outpatient Addiction Service, 26 Central Street, Somerville, MA, 02143, USA.
| | - David Roll
- CHA Revere Primary Care, 454 Broadway, Revere, MA, 02151, USA.
| | - Erica Mintzer
- Malden Family Medicine Center, Cambridge Health Alliance, 195 Canal St, Malden, MA, 02148, USA.
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Howard KA, Rennert L, Pericot-Valverde I, Heo M, Norton BL, Akiyama MJ, Agyemang L, Litwin AH. Utilizing patient perception of group treatment in exploring medication adherence, social support, and quality of life outcomes in people who inject drugs with hepatitis C. J Subst Abuse Treat 2021; 126:108459. [PMID: 34116813 DOI: 10.1016/j.jsat.2021.108459] [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: 08/26/2020] [Revised: 01/15/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV). Group treatment is a practical option for addressing barriers to treatment in this population. Prior research on group treatment has resulted in mixed conclusions about its effectiveness in addressing barriers to treatment. A patient's perception of the group environment may help to explain this variability. This study sought to explore the association between indicators of group treatment environment and improved outcomes in HCV-infected PWID. This secondary analysis of a randomized controlled trial exploring different models of treatment for HCV in a PWID population consisted of 42 participants randomized to the group treatment branch of the trial. Independent variables consisted of group sessions attended and group climate constructs of engagement, conflict, and avoidance. Dependent variables consisted of medication adherence, social support, and health-related quality of life. The study implemented generalized estimating equations to assess associations with the outcomes at the end of treatment. Factors indicative of group treatment environment were related to medication adherence and other barriers to health for HCV-infected PWID: social support and health-related quality of life. Perceptions of conflict or avoidance were associated with worse outcomes, while increased session attendance was generally associated with better outcomes. The study attests to the importance of examining group environment factors during treatment interventions. Although preliminary, the study provides specific indicators of treatment success for HCV-infected PWID and practical implications to improve patients' health outcomes and better tailor treatment to the patient.
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Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Irene Pericot-Valverde
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew J Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Linda Agyemang
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA; University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
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12
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Karsberg SH, Pedersen MU, Hesse M, Thylstrup B, Pedersen MM. Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial. BMC Public Health 2021; 21:413. [PMID: 33637061 PMCID: PMC7913269 DOI: 10.1186/s12889-021-10271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alcohol and other drug use disorders contribute substantially to the global burden of illness. The majority of people with substance use disorders do not receive any treatment for their problems, and developing treatments that are attractive and effective to patients should be a priority. However, whether treatment is best delivered in a group format or an individual format has only been studied to a very limited degree. The COMDAT (Combined Drug and Alcohol Treatment) trial evaluates the feasibility, acceptability, and cost effectiveness of MOVE group (MOVE-G) treatment versus MOVE individual (MOVE-I) treatment in four community-based outpatient treatment centres in Denmark. METHODS A two-arm non-inferiority trial comparing MOVE-I (Pedersen et al., Drug Alcohol Depend 218:108363, 2020) with MOVE-G a combined group treatment for both alcohol use disorder and drug use disorder. The primary objective is to examine whether MOVE-G is non-inferior to MOVE-I in relation to abstinence from drug and/or alcohol, number of sessions received, and completion of treatment as planned. All participants will receive treatment based on cognitive behavioral therapy and motivational interviewing, vouchers for attendance and text reminders, as well as medication as needed (MOVE). Participants (n = 300) will be recruited over a one-year period at four public treatment centers in four Danish municipalities. A short screening will determine eligibility and randomization status. Hereafter, participants will be randomized to the two treatment arms. A thorough baseline assessment will be conducted approximately 1 week after randomization. Follow-up assessments will be conducted at 9 months post-randomization. In addition, patients' use of drugs and alcohol, and patients' wellbeing will be measured in all sessions. The main outcome measures are drug and alcohol intake at 9 months follow-up, number of sessions attended, and dropout from treatment. DISCUSSION The present study will examine the potential and efficacy of combined groups (patients with alcohol and drug disorders in the same group) versus individually based treatment both based on the treatment method MOVE (Pedersen et al., Drug Alcohol Depend 218:108363, 2020). TRIAL REGISTRATION ISRCTN88025085 , registration date 30/06/2020.
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Affiliation(s)
| | - Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
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Gul M, Aqeel M. Acceptance and commitment therapy for treatment of stigma and shame in substance use disorders: a double-blind, parallel-group, randomized controlled trial. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1846803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mahvia Gul
- Department of psychology, Foundation University, Islamabad, Pakistan
| | - Muhammad Aqeel
- Department of psychology, Foundation University, Islamabad, Pakistan
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14
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McCormick R, Rosenblad SR, Newmeyer M. Untapped Therapeutic Potential: Using Sandtray in Substance Abuse Treatment Groups. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2020. [DOI: 10.1080/15401383.2020.1789016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael McCormick
- Serenity House Substance Abuse Treatment Facility, Abilene, Texas, USA
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15
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Williams EC, Matson TE, Harris AHS. Strategies to increase implementation of pharmacotherapy for alcohol use disorders: a structured review of care delivery and implementation interventions. Addict Sci Clin Pract 2019; 14:6. [PMID: 30744686 PMCID: PMC6371480 DOI: 10.1186/s13722-019-0134-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/30/2019] [Indexed: 06/05/2023] Open
Abstract
Background Effective medications for treating alcohol use disorders (AUD) are available but underutilized. Multiple barriers to their provision have been identified, and optimal strategies for addressing and overcoming barriers to use of medications for AUD treatment remain elusive. We conducted a structured review of published care delivery and implementation studies evaluating interventions that aimed to increase medication treatment for patients with AUD to identify interventions and component strategies that were most effective. Methods We reviewed literature through May 2018 and used networking to identify intervention studies with AUD medication receipt reported as a primary or secondary outcome. Studies were identified as care delivery studies, characterized by patient-level recruitment and willingness to be randomized to candidate treatment options, and implementation studies, characterized by inclusion of all patients treated at sites involved in the study. Each identified study was independently coded by two investigators for strategies used, guided by a published taxonomy of implementation strategies. All authors reviewed coding discrepancies and revised codes based on consensus. After reaching internal consensus, we solicited feedback from lead investigators on studies to code additional strategies. We reviewed implementation strategies used across studies to assess their relationship with medication receipt, as well as alcohol use outcomes, as available. Results Nine studies were identified: four RCTs of care delivery interventions, four quasi-experimental evaluations of large-scale implementation interventions, and one quasi-experimental evaluation of a targeted single-site implementation intervention. Implementation strategies used were variable across studies; no strategy was universally used. Effects of the interventions on receipt of AUD pharmacotherapy and alcohol use outcomes also varied. Three of four care delivery interventions resulted in increased receipt of AUD medications, but only one of these three improved alcohol use outcomes. One large-scale and one single-site implementation intervention were associated with increased AUD medication receipt, and these studies did not assess alcohol use outcomes. Patterns of implementation strategies did not clearly distinguish studies that successfully increased use of pharmacotherapy versus those that did not. Conclusions Our review did not reveal strategies most effective for implementing AUD medications. Interventions designed to overcome identified barriers may have missed the mark, or differences in the intensity or targets of strategies may matter more than differences in strategies. Further research is needed to understand effective implementation methods and to better understand patient-level perspective, preferences and barriers to receipt of medications.
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Affiliation(s)
- Emily C Williams
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
| | - Theresa E Matson
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Lo Coco G, Melchiori F, Oieni V, Infurna MR, Strauss B, Schwartze D, Rosendahl J, Gullo S. Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. J Subst Abuse Treat 2019; 99:104-116. [PMID: 30797382 DOI: 10.1016/j.jsat.2019.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS From residential programs to outpatient services, group therapy permeates the clinical field of substance misuse. While several group interventions for substance use disorders (SUDs) have demonstrated effectiveness, the existing evidence on group therapy has not been systematically reviewed. The current meta-analysis aims to provide estimates of the efficacy of group therapy for SUDs in adults using rigorous methods. METHODS We included studies comparing group psychotherapy to no treatment control groups, individual psychotherapy, medication, self-help groups, and other active treatments applying no specific psychotherapeutic techniques for patients with substance use disorder. The primary outcome was abstinence, and the secondary outcomes were frequency of substance use and symptoms of substance use disorder, anxiety, depression, general psychopathology, and attrition. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, and PsycINFO, complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS Thirty-three studies were included. Significant small effects of group therapy were found on abstinence compared to no treatment, individual therapy, and other treatments. Effects on substance use frequency and SUD symptoms were not significant, but significant moderately sized effects emerged for mental state when group therapy was compared to no treatment. There were no differences in abstinence rates between group therapy and control groups. These results were robust in sensitivity analyses and there was no indication of publication bias. CONCLUSIONS The current findings represent the best available summary analysis of group therapy for SUDs in adults, however cautious interpretation is warranted given the limitations of the available data.
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Affiliation(s)
- Gianluca Lo Coco
- University of Palermo, Department of Psychology, Educational Sciences and Human Movement, Palermo, Italy.
| | | | | | | | - Bernhard Strauss
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Dominique Schwartze
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Jenny Rosendahl
- University Hospital Jena, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
| | - Salvatore Gullo
- University of Palermo, Department of Psychology, Educational Sciences and Human Movement, Palermo, Italy
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Wendt DC, Gone JP. Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients. Int J Group Psychother 2018; 68:608-628. [PMID: 31527925 DOI: 10.1080/00207284.2018.1442225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.
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Wendt DC, Gone JP. Complexities with group therapy facilitation in substance use disorder specialty treatment settings. J Subst Abuse Treat 2018; 88:9-17. [PMID: 29606227 DOI: 10.1016/j.jsat.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 11/17/2022]
Abstract
In spite of increased attention to research-based interventions for substance use disorders (SUDs), a formidable research-practice gap impedes the implementation of evidence-based treatments (EBTs). An underappreciated dimension of this gap is a mismatch in treatment modality: Whereas clinical trial and implementation research has focused primarily on individual therapy, the majority of SUD specialty treatment is in group format, with open-enrolling groups being most common. This study aims to narrow this research-practice gap by exploring clinicians' perspectives on complexities with group therapy facilitation in SUD specialty treatment settings. Semi-structured interviews were conducted with 13 group clinicians from among three outpatient SUD specialty clinics-diverse in their operational structures, treatment philosophies, clientele, and services-located in the same Midwestern U.S. metropolitan area. Interview questions addressed organizational characteristics, services provided, group therapy curricula, and use of EBTs or other structured treatments. Clinicians emphasized the importance of having flexibility in facilitating groups, through built-in group processes and clinicians' own adaptions and accommodations; this flexibility was especially emphasized for the use of EBTs or manualized interventions. Clinicians also had difficulties with group facilitation generally, as evidenced by their reported difficulty in managing complex group dynamics, their limited group therapy experience and training, and their reliance on educational groups. We discuss specific strategies for improved innovation and implementation of EBTs for SUD group therapy.
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Affiliation(s)
- Dennis C Wendt
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109, USA.
| | - Joseph P Gone
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109, USA.
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