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Krentzman AR, Hoeppner SS, Hoeppner BB, Barnett NP. A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209410. [PMID: 38802048 PMCID: PMC11300166 DOI: 10.1016/j.josat.2024.209410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety. METHODS The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator. RESULTS Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators. DISCUSSION Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.
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Affiliation(s)
- Amy R Krentzman
- School of Social Work, University of Minnesota, United States.
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, United States
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Bickel WK, Witkiewitz K, Athamneh LM, Kuhlemeier A. Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39155126 DOI: 10.1111/acer.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/28/2024] [Indexed: 08/20/2024]
Abstract
Recovery from alcohol use disorder (AUD) is a dynamic process that often entails periods of drinking but has been defined primarily by abstinence. Recently, a broader interpretation of recovery was developed, including meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM) remission criteria and improved psychosocial functioning. This new understanding of recovery has facilitated the development of novel theories and methodologies. This paper reviews a new theoretical perspective of recovery, Reinforcer Pathology, and two novel methodological approaches in light of this broader view of recovery. Using this theoretical framework as a foundation, we propose an alternative perspective to explain the recovery process as it relates to environmental factors and valuation of the future; we suggest that changing the environment in which substances are available (e.g., increasing non-alcohol-related activities) and extending one's temporal window are associated with improved recovery outcomes (e.g., remission and quality of life). In this review, we discuss two novel methodological approaches. The first uses latent profile analysis to show that using a measure of Relative Reinforcement Value of Alcohol-Free Activities is associated with a greater likelihood of belonging to a high functioning/infrequent heavy drinking recovery profile. The second developed an online national sample and used an accelerated longitudinal design to study longer-term recovery of up to 12 years over a 5-year study period. Reinforcer Pathology theory, novel methods, and measures may further our understanding of recovery and begin to address critical questions for future studies. Subsequent randomized clinical trials should examine whether the suggested targets and interventions based on the theoretical model improve recovery outcomes prospectively. Measuring and promoting alcohol-free activity engagement may facilitate improved recovery outcomes, while novel methodologies permit an understanding of returning to use or remission across different recovery durations.
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Affiliation(s)
- Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, USA
| | | | - Liqa M Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, USA
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Heilig M, Witkiewitz K, Ray LA, Leggio L. Novel medications for problematic alcohol use. J Clin Invest 2024; 134:e172889. [PMID: 38828724 PMCID: PMC11142745 DOI: 10.1172/jci172889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Alcohol-related harm, a major cause of disease burden globally, affects people along a spectrum of use. When a harmful pattern of drinking is present in the absence of significant behavioral pathology, low-intensity brief interventions that provide information about health consequences of continued use provide large health benefits. At the other end of the spectrum, profound behavioral pathology, including continued use despite knowledge of potentially fatal consequences, warrants a medical diagnosis, and treatment is strongly indicated. Available behavioral and pharmacological treatments are supported by scientific evidence but are vastly underutilized. Discovery of additional medications, with a favorable balance of efficacy versus safety and tolerability can improve clinical uptake of treatment, allow personalized treatment, and improve outcomes. Here, we delineate the clinical conditions when pharmacotherapy should be considered in relation to the main diagnostic systems in use and discuss clinical endpoints that represent meaningful clinical benefits. We then review specific developments in three categories of targets that show promise for expanding the treatment toolkit. GPCRs remain the largest category of successful drug targets across contemporary medicine, and several GPCR targets are currently pursued for alcohol-related indications. Endocrine systems are another established category, and several promising targets have emerged for alcohol indications. Finally, immune modulators have revolutionized treatment of multiple medical conditions, and they may also hold potential to produce benefits in patients with alcohol problems.
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Affiliation(s)
- Markus Heilig
- Center for Social and Affective Neuroscience, Linköping University, and Department of Psychiatry, Linköping University Hospital, Linköping, Sweden
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Lara A. Ray
- Department of Psychology, UCLA, Los Angeles, California, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, NIH, Baltimore and Bethesda, Maryland, USA
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Knapp KS, Linn BK, Stasiewicz PR, Bradizza CM. Daily mindfulness homework completion is associated with reduced drinking during a mindfulness-enriched emotion regulation treatment for alcohol use disorder. Addict Behav 2024; 153:107987. [PMID: 38382409 PMCID: PMC10981533 DOI: 10.1016/j.addbeh.2024.107987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Homework is widely used in cognitive behavioral therapy (CBT) for alcohol use disorder (AUD). Theoretically, homework helps clients generalize skills acquired during treatment to their daily lives. However, clinical trials methodology has typically employed pre- and post-treatment assessments which has made evaluating the contribution of homework to behavior change a challenge. The current study leveraged daily diary data from a clinical trial of CBT for AUD to parse within- and between-person associations of mindfulness homework practice and alcohol consumption. Adults seeking treatment for AUD (N = 97) completed 12 treatment sessions and 84 consecutive daily smartphone surveys. Each day, participants reported on the frequency of prior day's formal and informal mindfulness homework practice, the duration of prior day's formal mindfulness practice, and prior day's alcohol consumption. Multilevel models tested within- and between-person associations of mindfulness homework practice with the odds of drinking and heavy drinking, accounting for prior day's alcohol use. Results revealed that greater-than-usual frequency and duration of formal daily mindfulness homework practice, but not informal mindfulness practice, were associated with lower odds of a drinking day. Further, greater-than-usual duration of formal daily mindfulness homework practice, but not frequency of mindfulness practice (formal or informal), was associated with lower odds of a heavy drinking day. Results suggest that formal daily mindfulness homework practice may be beneficial and extend the literature by demonstrating that it coincides with reduced drinking and heavy drinking odds within-persons during AUD treatment. Apprising AUD clients of the potential value of homework may help boost its uptake.
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Affiliation(s)
- Kyler S Knapp
- School of Social Work, University at Buffalo, Buffalo, NY 14214, United States.
| | - Braden K Linn
- Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, Hershey, PA 17033, United States
| | - Paul R Stasiewicz
- School of Social Work, University at Buffalo, Buffalo, NY 14214, United States
| | - Clara M Bradizza
- School of Social Work, University at Buffalo, Buffalo, NY 14214, United States
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Beaugard CA, Walley AY, Amodeo M. "Everything is kind of the same except my mind is with me": exploring cannabis substitution in a sample of adults in early recovery from an opioid or stimulant addiction. Harm Reduct J 2024; 21:83. [PMID: 38643152 PMCID: PMC11031937 DOI: 10.1186/s12954-024-01002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/06/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Recovery from addiction is frequently equated with abstinence. However, some individuals who resolve an addiction continue to use substances, including via substitution (i.e., increased use of one substance after eliminating/ reducing another). Substitution may play a distinct role during early recovery (≤ 1 year), as this period is marked by dramatic change and adjustment. Cannabis is one of the most used substances and is legal for medical and recreational use in an increasing number of states. Consequently, cannabis an increasingly accessible substitute for substances, like fentanyl, heroin, cocaine and methamphetamine, with higher risk profiles (e.g., associated with risk for withdrawal, overdose, and incarceration). METHODS Fourteen participants reported that they had resolved a primary opioid or stimulant addiction and subsequently increased their cannabis use within the previous 12 months. Using grounded theory, the interviewer explored their experiences of cannabis use during early recovery. Data were analyzed in three stages: line by line coding for all text related to cannabis use and recovery, focused coding, and axial coding to generate a theory about recovery with cannabis substitution. The motivational model of substance use provided sensitizing concepts. RESULTS & DISCUSSION The final sample included eight men and six women ranging in age from 20 to 50 years old. Three participants resolved an addiction to methamphetamine and the remaining 11, an addiction to opioids. Participants explained that cannabis was appealing because of its less harmful profile (e.g., no overdose risk, safe supply, few side effects). Participants' primary motives for cannabis use included mitigation of psychiatric symptoms, withdrawal/ cravings, and boredom. While cannabis was effective toward these ends, participants also reported some negative side effects (e.g., decreased productivity, social anxiety). All participants described typical benefits of recovery (e.g., improved self-concept, better relationships) while continuing to use cannabis. Their experiences with and beliefs about substitution suggest it can be an effective strategy for some individuals during early recovery. CONCLUSIONS Cannabis use may benefit some adults who are reducing their opioid or stimulant use, especially during early recovery. The addiction field's focus on abstinence has limited our knowledge about non-abstinent recovery. Longitudinal studies are needed to understand the nature of substitution and its impact on recovery over time.
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Affiliation(s)
- Corinne A Beaugard
- Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA.
- Department of Psychiatry, Boston Medical Center Crosstown Center, 4th Floor 801 Massachusetts Avenue, 02118, Boston, MA, USA.
| | - Alexander Y Walley
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Maryann Amodeo
- Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA
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Garcia CC, Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O’Malley SS, Mann K, Aldridge A, Hoffman M, Anton RF, Witkiewitz K. Reductions in World Health Organization risk drinking level are associated with improvements in sleep problems among individuals with alcohol use disorder. Alcohol Alcohol 2024; 59:agae022. [PMID: 38606931 PMCID: PMC11010310 DOI: 10.1093/alcalc/agae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Among individuals with alcohol use disorder (AUD), sleep disturbances are pervasive and contribute to the etiology and maintenance of AUD. However, despite increased attention toward the relationship between alcohol use and sleep, limited empirical research has systematically examined whether reductions in drinking during treatment for AUD are associated with improvements in sleep problems. METHODS We used data from a multisite, randomized, controlled trial that compared 6 months of treatment with gabapentin enacarbil extended-release with placebo for adults with moderate-to-severe AUD (N = 346). The Timeline Follow-back was used to assess WHO risk drinking level reductions and the Pittsburgh Sleep Quality Index was used to assess sleep quality over the prior month at baseline and the end of treatment. RESULTS Sleep problem scores in the active medication and placebo groups improved equally. Fewer sleep problems were noted among individuals who achieved at least a 1-level reduction (B = -0.99, 95% confidence interval (CI) [-1.77, -0.20], P = .014) or at least a 2-level reduction (B = -0.80, 95% CI [-1.47, -0.14], P = .018) in WHO risk drinking levels at the end of treatment. Reductions in drinking, with abstainers excluded from the analysis, also predicted fewer sleep problems at the end of treatment (1-level: B = -1.01, 95% CI [-1.83, -0.20], P = .015; 2-level: B = -0.90, 95% CI [-1.59, -0.22], P = .010). CONCLUSIONS Drinking reductions, including those short of abstinence, are associated with improvements in sleep problems during treatment for AUD. Additional assessment of the causal relationships between harm-reduction approaches to AUD and improvements in sleep is warranted.
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Affiliation(s)
- Christian C Garcia
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Felicia R Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, United States
| | - Henry R Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA, 19104, United States
| | - Henri-Jean Aubin
- Université Paris-Saclay, Unive Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, Institut national de la santé et de la recherche médicale, Villejuif, France
- APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, 94800, France
| | - Stephanie S O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, United States
| | - Karl Mann
- Zentralinstitut für Seelische Gesundheit (ZI), Mannheim, Baden-Württemberg, 68159, Germany
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International (RTI), Research Triangle Park, NC, 27709, United States
| | - Michaela Hoffman
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Raymond F Anton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
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Jett JD, Beck R, Tyutyunnyk D, Sanchez J, Weeks DL, Javors MA, Hill-Kapturczak N, Lopez-Cruzan M, Kriegel L, Ginsburg BC, Cabassa L, McDonell MG. Feasibility of a telehealth-based contingency management intervention for alcohol use disorders using the phosphatidylethanol (PEth) 16:0/18:1 alcohol biomarker: a pilot randomized trial. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:162-172. [PMID: 38284925 PMCID: PMC11228813 DOI: 10.1080/00952990.2023.2283691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
Background: Phosphatidylethanol (PEth) is a blood-based biomarker for alcohol consumption that can be self-collected and has high sensitivity, specificity, and a longer detection window compared to other alcohol biomarkers.Objectives: We evaluated the feasibility and acceptability of a telehealth-based contingency management (CM) intervention for alcohol use disorder (AUD) using the blood-based biomarker PEth to assess alcohol consumption.Methods: Sixteen adults (7 female, 9 male) with AUD were randomized to Control or CM conditions. Control participants received reinforcers regardless of their PEth levels. CM participants received reinforcers for week-to-week decreases in PEth (Phase 1) or maintenance of PEth consistent with abstinence (<20 ng/mL, Phase 2). Blood samples were self-collected using the TASSO-M20 device. Acceptability was assessed by retention in weeks. Satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8) and qualitative interviews. The primary efficacy outcome was PEth-defined abstinence. Secondary outcomes included the proportion of visits with PEth-defined heavy alcohol consumption, negative urine ethyl glucuronide results, and self-reported alcohol use.Results: Retention averaged 18.6 ± 8.8 weeks for CM participants. CM participants reported high levels of satisfaction (CSQ-8, Mean = 30.3 ± 1.5). Interview themes included intervention positives, such as staff support, quality of life improvement, and accountability. 72% of PEth samples from CM participants were consistent with abstinence versus 34% for Control participants (OR = 5.0, p = 0.007). PEth-defined heavy alcohol consumption was detected in 28% of CM samples and 52% of Control samples (OR = 0.36, p = 0.159). CM participants averaged 1.9 ± 1.7 drinks/day versus 4.2 ± 6.3 for Control participants (p = 0.304).Conclusion: Results support the acceptability and satisfaction of a telehealth PEth-based CM intervention, though a larger study is needed to assess its efficacy [NCT04038021].
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Affiliation(s)
- Julianne D Jett
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachael Beck
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Diana Tyutyunnyk
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Jesus Sanchez
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Douglas L Weeks
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Martin A Javors
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Marisa Lopez-Cruzan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Liat Kriegel
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Brett C Ginsburg
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Leopoldo Cabassa
- Brown School, Washington University St. Louis, St Louis, MO, USA
| | - Michael G McDonell
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Hammarberg SI, Wallhed Finn S, Rosendahl I, Andréasson S, Jayaram-Lindström N, Hammarberg A. Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction 2024; 119:86-101. [PMID: 37658776 DOI: 10.1111/add.16325] [Citation(s) in RCA: 3] [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: 09/14/2022] [Accepted: 07/21/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIMS Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. DESIGN Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion. SETTING Three specialized dependency care clinics in Stockholm, Sweden. PARTICIPANTS Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD. INTERVENTION AND COMPARATOR BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. MEASUREMENTS Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption. CONCLUSIONS A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.
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Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sara Wallhed Finn
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Andréasson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Boness CL, Carlos Gonzalez J, Sleep C, Venner KL, Witkiewitz K. Evidence-Based Assessment of Substance Use Disorder. Assessment 2024; 31:168-190. [PMID: 37322848 PMCID: PMC11059671 DOI: 10.1177/10731911231177252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.
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Affiliation(s)
- Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | | | - Chelsea Sleep
- Cincinnati VA Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | - Kamilla L Venner
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
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Puddephatt JA, Makin H, Gage SH, Jones A, Goodwin L. Understanding alcohol use and changes in drinking habits among people with a severe mental illness: a qualitative framework analysis study. Front Psychol 2023; 14:1282086. [PMID: 38155700 PMCID: PMC10752932 DOI: 10.3389/fpsyg.2023.1282086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Individuals with a severe mental illness (SMI) are more likely to drink at harmful levels or abstain. While it is known that drinking patterns change over time, the reasons for this among those with a SMI are unclear. This study aimed to (i) explore the experiences with alcohol, particularly in relation to mental health symptoms, and (ii) how drinking patterns have changed over time, among individuals who have a SMI diagnosis, who either currently drink alcohol or no longer drink. Methods One-to-one semi-structured telephone interviews were conducted to address the study aims. Current drinkers' alcohol use was assessed using the Alcohol Use Disorder Identification Test. A framework analysis was used to address the study aims with a specific focus on the differences in the experiences with alcohol use between current and former drinkers. Results 16 participants were interviewed, and five themes were developed. The analysis highlighted how alcohol was increasingly used to cope with (i) trauma, (ii) SMI-related symptoms, or (iii) stress. Among those with a SMI, non-drinking was facilitated through declines in SMI-related symptoms, previous negative consequences due to alcohol and changing the social environment. Current drinking habits were facilitated through changes in the reasons for drinking and adopting different alcohol moderation techniques. Discussion Among those with a SMI diagnosis and who either currently drink alcohol or no longer drink, our findings support the self-medication hypothesis and drinking motives model. However, our findings indicate the need for further development of drinking to cope with a focus on symptoms of a SMI and trauma. Our findings also have implications on specialist alcohol and mental health services, the need to improve individuals' understanding of SMI, and the need to identify reasons for drinking among those with a recent diagnosis of a SMI.
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Affiliation(s)
- Jo-Anne Puddephatt
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Harriet Makin
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Suzanne H. Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Jones
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laura Goodwin
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Morris J, Boness CL, Burton R. (Mis)understanding alcohol use disorder: Making the case for a public health first approach. Drug Alcohol Depend 2023; 253:111019. [PMID: 37952353 PMCID: PMC11061885 DOI: 10.1016/j.drugalcdep.2023.111019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
'Alcohol use disorder' (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an 'alcoholism' master narrative in which disease model stereotypes come with multiple costs for prevention and 'recovery'. The persistence of a problematic 'alcoholism' paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and 'other', and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual's essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.
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Affiliation(s)
- James Morris
- London South Bank University, Centre for Addictive Behaviours Research, UK.
| | - Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, USA
| | - Robyn Burton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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12
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Russell AM, Montemayor BN, Chiang SC, Milaham PJ, Barry AE, Lin HC, Bergman BG, Massey PM. Characterizing Twitter chatter about temporary alcohol abstinence during "Dry January". Alcohol Alcohol 2023; 58:589-598. [PMID: 37652745 PMCID: PMC10642608 DOI: 10.1093/alcalc/agad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
With roots as a public health campaign in the United Kingdom, "Dry January" is a temporary alcohol abstinence initiative encouraging participants to abstain from alcohol use during the month of January. Dry January has become a cultural phenomenon, gaining increasing news media attention and social media engagement. Given the utility of capturing naturalistic discussions around health topics on social media, we examined Twitter chatter about Dry January and associated temporary abstinence experiences. Public tweets were collected containing the search terms "dry january" or "dryjanuary" posted between 15 December and 15 February across 3 years (2020-2). A random subsample stratified by year (n = 3145) was pulled for manual content analysis by trained coders. Final codebook accounted for user sentiment toward Dry January, user account type, and themes related to Dry January participation. Engagement metadata (e.g. likes) were also collected. Though user sentiment was mixed, most tweets expressed positive or neutral sentiment toward Dry January (74.7%). Common themes included encouragement and support for Dry January participation (14.1%), experimentation with and promotion of nonalcoholic drinks (14.0%), and benefits derived from Dry January participation (10.4%). While there is promise in the movement to promote positive alcohol-related behavior change, increased efforts to deliver the campaign within a public health context are needed. Health communication campaigns designed to inform participants about evidence-based treatment and recovery support services proven to help people quit or cut down on their drinking are likely to maximize benefits.
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Affiliation(s)
- Alex M Russell
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac St., Floor 4, Boston, MA 02114, United States
| | - Ben N Montemayor
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, United States
| | - Shawn C Chiang
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, United States
| | - Plangkat J Milaham
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, United States
| | - Adam E Barry
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, United States
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN 47405, United States
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac St., Floor 4, Boston, MA 02114, United States
| | - Philip M Massey
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA 90095, United States
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Stull SW, Linden-Carmichael AN, Scott CK, Dennis ML, Lanza ST. Time-varying effect modeling with intensive longitudinal data: Examining dynamic links among craving, affect, self-efficacy and substance use during addiction recovery. Addiction 2023; 118:2220-2232. [PMID: 37416972 DOI: 10.1111/add.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/22/2023] [Indexed: 07/08/2023]
Abstract
Time-varying effect modeling (TVEM), a statistical technique for modeling dynamic patterns of change, presents new opportunities to study biobehavioral health processes. TVEM is particularly useful when applied to intensive longitudinal data (ILD) because it permits highly flexible modeling of outcomes over continuous time, as well as of associations between variables and moderation effects. TVEM coupled with ILD is ideal for the study of addiction. This article provides a general overview of using TVEM, particularly when applied to ILD, to better enable addiction scientists to conduct novel analyses that are important to realizing the dynamics of addiction-related processes. It presents an empirical example using ecological momentary assessment data from participants throughout their first 90 days of addiction recovery to estimate the (1) associations between morning craving and same-day recovery outcomes, (2) association between morning positive and negative affect and same-day recovery outcomes and (3) time-varying moderation effects of affect on the association between morning craving and recovery outcomes. We provide a didactic overview in implementing and interpreting the aims and results, including equations, computer syntax and reference resources. Our results highlight how affect operates as both a time-varying risk and protective factor on recovery outcomes, particularly when considered in combination with experiences of craving (i.e. dynamic moderation). We conclude by discussing our results, recent innovations and future directions of TVEM for advancing addiction science, including how 'time' can be operationalized to probe new research questions.
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Affiliation(s)
- Samuel W Stull
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Ashley N Linden-Carmichael
- The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, University Park, PA, USA
| | | | | | - Stephanie T Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, University Park, PA, USA
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Ford MM, George BE, Van Laar VS, Holleran KM, Naidoo J, Hadaczek P, Vanderhooft LE, Peck EG, Dawes MH, Ohno K, Bringas J, McBride JL, Samaranch L, Forsayeth JR, Jones SR, Grant KA, Bankiewicz KS. GDNF gene therapy for alcohol use disorder in male non-human primates. Nat Med 2023; 29:2030-2040. [PMID: 37580533 PMCID: PMC10602124 DOI: 10.1038/s41591-023-02463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/15/2023] [Indexed: 08/16/2023]
Abstract
Alcohol use disorder (AUD) exacts enormous personal, social and economic costs globally. Return to alcohol use in treatment-seeking patients with AUD is common, engendered by a cycle of repeated abstinence-relapse episodes even with use of currently available pharmacotherapies. Repeated ethanol use induces dopaminergic signaling neuroadaptations in ventral tegmental area (VTA) neurons of the mesolimbic reward pathway, and sustained dysfunction of reward circuitry is associated with return to drinking behavior. We tested this hypothesis by infusing adeno-associated virus serotype 2 vector encoding human glial-derived neurotrophic factor (AAV2-hGDNF), a growth factor that enhances dopaminergic neuron function, into the VTA of four male rhesus monkeys, with another four receiving vehicle, following induction of chronic alcohol drinking. GDNF expression ablated the return to alcohol drinking behavior over a 12-month period of repeated abstinence-alcohol reintroduction challenges. This behavioral change was accompanied by neurophysiological modulations to dopamine signaling in the nucleus accumbens that countered the hypodopaminergic signaling state associated with chronic alcohol use, indicative of a therapeutic modulation of limbic circuits countering the effects of alcohol. These preclinical findings suggest gene therapy targeting relapse prevention may be a potential therapeutic strategy for AUD.
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Affiliation(s)
- Matthew M Ford
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Psychology, Lewis & Clark College, Portland, OR, USA
| | - Brianna E George
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Victor S Van Laar
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA
| | - Katherine M Holleran
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jerusha Naidoo
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Piotr Hadaczek
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Lauren E Vanderhooft
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Emily G Peck
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Monica H Dawes
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Kousaku Ohno
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - John Bringas
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jodi L McBride
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Lluis Samaranch
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - John R Forsayeth
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Sara R Jones
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Kathleen A Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA.
| | - Krystof S Bankiewicz
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.
- Department of Neurological Surgery, University of California, San Francisco, CA, USA.
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15
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Caudle MM, Klaming R, Fong C, Harlé K, Taylor C, Spadoni A, Bomyea J. Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:499. [PMID: 37438722 PMCID: PMC10337098 DOI: 10.1186/s12888-023-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. METHODS One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. DISCUSSION This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. REGISTRY NAME AAT for Alcohol Use Disorder in Veterans. TRIAL REGISTRATION ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
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Affiliation(s)
- M M Caudle
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - R Klaming
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - C Fong
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - K Harlé
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - C Taylor
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - A Spadoni
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - J Bomyea
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA.
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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16
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Pinedo M, Castro Y, Gilbert PA, Caetano R, Zemore SE. Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale. Drug Alcohol Depend 2023; 248:109895. [PMID: 37156194 PMCID: PMC10802933 DOI: 10.1016/j.drugalcdep.2023.109895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment. METHODS In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model. RESULTS The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers. CONCLUSION Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.
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Affiliation(s)
- M Pinedo
- Kinesiology & Health Education, UT Austin, United States.
| | - Y Castro
- Steve Hicks School of Social Work, UT Austin, United States
| | - P A Gilbert
- College of Public Health, University of Iowa, United States
| | - R Caetano
- Pacific Institute for Research and Evaluation, United States
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17
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Dykstra RE, Beadnell B, Rosengren DB, Schumacher JA, Daugherty R. A Lifestyle Risk Reduction Model for Preventing High-Risk Substance Use Across the Lifespan. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:863-875. [PMID: 37269468 PMCID: PMC10409837 DOI: 10.1007/s11121-023-01549-7] [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] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
While effective models of alcohol and drug prevention exist, they often focus solely on youth or young adults. This article describes the Lifestyle Risk Reduction Model (LRRM), an approach applicable across the lifespan. The intent behind the LRRM is to guide the development of prevention and treatment programs provided to individuals and small groups. The LRRM authors' goals are to help individuals reduce risk for impairment, addiction, and substance use's negative consequences. The LRRM identifies six key principles that conceptualize the development of substance-related problems by drawing parallels with health conditions, such as heart disease and diabetes, which often result from combined effects of biological risk and behavioral choices. The model also proposes five conditions that describe important steps for individuals as they progress toward greater perception of risk and lower risk behavior. One LRRM-based indicated prevention program (Prime For Life) shows positive results in cognitive outcomes and in impaired driving recidivism for people across the lifespan. The model emphasizes common elements across the lifespan, responds to contexts and challenges that change across the life course, complements other models, and is usable for universal, selective, and indicated prevention programs.
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Deutsch AR, Chau E, Motabar N, Jalali MS. Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States. SYSTEM DYNAMICS REVIEW 2023; 39:207-238. [PMID: 38107548 PMCID: PMC10723070 DOI: 10.1002/sdr.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/05/2023] [Indexed: 12/19/2023]
Abstract
The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | | | - Nikki Motabar
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Mohammad S Jalali
- University of California Santa Barbara, Santa Barbara, CA, USA
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
- Sloan School of Management, Massachusetts, Institute of Technology, Cambridge, MA, USA
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Boness CL, Votaw VR, Schwebel FJ, Moniz-Lewis DI, McHugh RK, Witkiewitz K. An Evaluation of Cognitive Behavioral Therapy for Substance Use Disorder: A Systematic Review and Application of the Society of Clinical Psychology Criteria for Empirically Supported Treatments. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:129-142. [PMID: 37840853 PMCID: PMC10572095 DOI: 10.1037/cps0000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Cognitive behavioral therapy (CBT) is a commonly used treatment for substance use disorders (SUDs) but has not been evaluated using the American Psychological Association's "Tolin Criteria" for determining the empirical basis of psychological treatments. The current systematic review evaluated five meta-analyses of CBT for SUD. One meta-analysis had sufficient quality to be considered in the evaluation of effect sizes. CBT produced small to moderate effects on substance use when compared to inactive treatment and was most effective at early follow-up (1-6 months post-treatment) compared to late follow-up (8+ months post-treatment). Sensitivity analyses including all five meta-analyses found similar results. A "strong recommendation" was provided for CBT as an empirically supported treatment for SUD, based on effects on substance use, quality of evidence, and consideration of contextual factors (e.g., efficacy in diverse populations).
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Affiliation(s)
- Cassandra L. Boness
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
| | - Victoria R. Votaw
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
- Department of Psychology, University of New Mexico
| | - Frank J. Schwebel
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
| | | | | | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
- Department of Psychology, University of New Mexico
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Wallhed Finn S, Mejldal A, Nielsen AS. The impact of an annual mass media campaign on treatment seeking for alcohol use disorders in the Danish population: An interrupted time-series analysis. Drug Alcohol Depend 2023; 248:109910. [PMID: 37224672 DOI: 10.1016/j.drugalcdep.2023.109910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION A minority of individuals with alcohol use disorder (AUD) seek treatment. In Denmark, a mass media campaign, "RESPEKT", aiming to increase treatment seeking, has been broadcasted nationwide since 2015. The campaign is unique from an international perspective. Similar interventions have, up until now, not been scientifically evaluated. AIM To investigate whether there was an association between campaign periods and treatment seeking for AUD. A secondary aim was to investigate possible gender differences. The hypotheses were that treatment seeking would increase during the campaign periods, and that men would increase their treatment seeking more compared to women. METHOD Study design: Interrupted time-series analysis. PARTICIPANTS Adults aged 18 years and above in the Danish population seeking AUD treatment. EXPOSURE Campaign periods year 2015-2018. OUTCOME Changes in treatment seeking defined as treatment entry respectively filled prescription of AUD pharmacotherapy. DATA National Alcohol Treatment Register on treatment entries for specialist addiction care and National Prescription Registry for filled prescriptions on AUD pharmacotherapies 2013-2018. ANALYSIS Segmented negative binomial regression, including the full cohort and stratified by sex. RESULTS The results show no association between campaign periods and treatment seeking. Nor were there any gender differences in treatment seeking. The hypotheses were not confirmed. CONCLUSION The campaign periods showed no association with treatment seeking. Eventual future campaigns should possibly focus on earlier steps of the treatment seeking process, as problem recognition, to increase treatment seeking. There is a great need to develop other ways to narrow the treatment gap for AUD.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark; Department of Global Public Health, Karolinska Institutet, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense5000, Denmark
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21
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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22
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Kermel-Schiffman I, Afuta M, Zur A, Gavriel-Fried B. Recovery from Alcohol Use Disorder among Older Adults: A Scoping Review. J Appl Gerontol 2023; 42:1137-1150. [PMID: 36609180 DOI: 10.1177/07334648221149284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Alcohol Use Disorder (AUD) among older people is under-diagnosed even though the population of older people is rising. Recovery from AUD among older people is a challenging process. A scoping review of the literature on recovery from AUD among older people was conducted to characterize the main topics in recovery. A systematic search was conducted in five databases: Psycinfo, Medline, CINHAL, WoS, and Embase from January 2000 to May 2021 using the PRISMA-ScR. Twenty-five studies met the inclusion criteria. The concept of recovery was defined in 20 studies, where the most frequent term was "abstinence." 16 studies described treatment programs with different types of interventions. Six studies described specific programs for older people; five reported positive outcomes. Future studies should implement a broader definition of recovery that reflects the dimensions of the concept and refers to different age groups, to enable interdisciplinary professionals to develop holistic interventions.
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Affiliation(s)
| | - May Afuta
- The Bob Shapell School of Social Work, 26745Tel Aviv University, Israel
| | - Amit Zur
- The Bob Shapell School of Social Work, 26745Tel Aviv University, Israel
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Frone MR, Casey Chosewood L, Osborne JC, Howard JJ. Workplace Supported Recovery from Substance Use Disorders: Defining the Construct, Developing a Model, and Proposing an Agenda for Future Research. OCCUPATIONAL HEALTH SCIENCE 2022; 6:475-511. [PMID: 37206918 PMCID: PMC10193449 DOI: 10.1007/s41542-022-00123-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 05/21/2023]
Abstract
Substance use disorders (SUDs) represent a critical public and occupational health issue. Therefore, understanding the process of SUD recovery has become an issue of growing importance among substance use and recovery professionals. Nonetheless, despite the acknowledged importance of employment for SUD recovery, little conceptual or empirical work exists on how the workplace might support or undermine SUD recovery. In this article, we address this limitation in several ways. First, to promote a better understanding of SUD recovery for occupational health researchers, we provide a brief overview of the nature of a SUD, prior definitions of SUD recovery, and general themes associated with the recovery process. Second, we develop a working definition of workplace supported recovery. Third, we present a heuristic conceptual model showing how the workplace might impact the SUD recovery process. Fourth, using this model and research from the substance use and occupational health literatures, we develop a series of general research propositions. These propositions highlight broad directions requiring more detailed conceptualization and empirical research to understand better how work conditions may support or undermine the process of employee SUD recovery. Our overarching goal is to motivate innovative conceptualization and research on workplace supported recovery from SUDs. Such research may inform the development and evaluation of workplace interventions and policies supporting SUD recovery and highlight the benefits of workplace supported SUD recovery for employees, employers, and communities. Research on this issue may allow occupational health researchers to impact a significant societal and occupational health issue.
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Affiliation(s)
- Michael R. Frone
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - L. Casey Chosewood
- Office of the Director, Office for Total Worker Health®, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, GA, United States
| | - Jamie C. Osborne
- Office of the Director, Office for Policy, Planning and Evaluation, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, GA, United States
| | - John J. Howard
- Office of the Director, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC, United States
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Davis CN, O’Neill SE. Treatment of Alcohol Use Problems Among Rural Populations: a Review of Barriers and Considerations for Increasing Access to Quality Care. CURRENT ADDICTION REPORTS 2022; 9:432-444. [DOI: 10.1007/s40429-022-00454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
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Leonhard A, Leonhard C, Sander C, Schomerus G. The effect of alcohol use disorder symptom and recovery narratives on problem-recognition: A randomized online trial. Addict Behav 2022; 134:107426. [PMID: 35870440 DOI: 10.1016/j.addbeh.2022.107426] [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: 04/25/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Low problem recognition is a barrier to seeking treatment for alcohol use disorder ("AUD"). Promoting continuum belief narratives, which conceptualize AUD as a spectrum, together with narratives that promote non-abstinence recovery may boost self-recognition of risky drinking. This experimental study examines the effect of dichotomous vs continuous symptom narratives and non-abstinence vs abstinence recovery narratives on self-recognition of risky drinking among students. METHODS N = 489 participants were randomized to one of four interventions combining a continuous vs dichotomous AUD symptom narrative with an abstinence vs moderated drinking AUD recovery narrative in a 2×2 design. Participants completed demographic and alcohol use (AUDIT-C) preintervention measures and postintervention measures assessing self-recognition of risky drinking and endorsement of continuum beliefs. RESULTS Moderate drinking recovery narratives resulted in higher endorsement of continuum beliefs (F (1, 485) = 16.27, p <.001, η2p =.032 90 % CI [0.01, 0.06]). Recognizing own risky drinking behavior was unaffected by the interventions. However, in a subgroup of participants without prior AUD experience who met AUDIT-C criteria for risky drinking, the combination of a continuous symptom narrative and moderated drinking recovery narrative resulted in higher problem recognition (F (1, 48) = 5.79, p =.020, η2p =.10, 90 % CI [0.01, 0.25]). CONCLUSIONS Exposure to moderated drinking recovery narratives may help develop an awareness in young adults that problematic alcohol use exists on a spectrum. Among those at increased risk for AUD, exposure to narratives that promote a continuous model of AUD and non-abstinence recovery may increase problem recognition.
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Affiliation(s)
- Anya Leonhard
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany.
| | - Christoph Leonhard
- The Chicago School of Professional Psychology at Xavier University of Louisiana, 1 Drexel Dr, New Orleans, LA 70125, USA
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
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Hagman BT, Falk D, Litten R, Koob GF. Defining Recovery From Alcohol Use Disorder: Development of an NIAAA Research Definition. Am J Psychiatry 2022; 179:807-813. [PMID: 35410494 DOI: 10.1176/appi.ajp.21090963] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this article is to provide an operational definition of recovery from alcohol use disorder (AUD) to facilitate the consistency of research on recovery and stimulate further research. The construct of recovery has been difficult to operationalize in the alcohol treatment and recovery literature. Several formal definitions of recovery have been developed but have limitations because 1) they require abstinence from both alcohol and substance use, 2) they do not include the DSM-5 diagnostic criteria for AUD as part of the recovery process (i.e., no focus on remission from AUD), 3) they do not link remission and cessation from heavy drinking to improvements in biopsychosocial functioning and quality-of-life constructs, and 4) they do not distinguish between alcohol and other drug use. The authors present a newly developed National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from DSM-5 AUD based on qualitative feedback from key recovery stakeholders (e.g., researchers, clinicians, and recovery specialists). The definition views recovery as both a process of behavioral change and an outcome and incorporates two key components of recovery, namely, remission from DSM-5 AUD and cessation from heavy drinking, a nonabstinent recovery outcome. The NIAAA definition of recovery also emphasizes the importance of biopsychosocial functioning and quality of life in enhancing recovery outcomes. This new NIAAA definition of recovery is an operational definition that can be used by diverse stakeholders to increase consistency in recovery measurement, stimulate research to better understand recovery, and facilitate the process of recovery.
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Affiliation(s)
- Brett T Hagman
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
| | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md
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Reichl D, Enewoldsen N, Berking M, Fuhrmann L, Lang C, Saur S, Weisel KK, Steins-Loeber S. Psychometrische Evaluation der deutschen Version des Substance Use Recovery Evaluator (SURE). DIAGNOSTICA 2022. [DOI: 10.1026/0012-1924/a000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Konsumvariablen und Abstinenz scheinen unzureichend zur Erfassung der Genesung bei Personen mit einer Alkoholkonsumstörung. Stattdessen rücken patientenzentrierte Indikatoren wie die Lebensqualität zunehmend in den Vordergrund. Um den Forderungen adäquater Messinstrumente gerecht zu werden, wurde der Substance Use Recovery Evaluator von Neale et al. (2016 ) übersetzt und in verschiedenen Stichproben mit Alkoholkonsumstörung nach Entzugsbehandlung psychometrisch evaluiert. In der ersten Teilstichprobe ( n = 135) wurde explorativ die Faktorenstruktur identifiziert sowie Reliabilitäts- und Validitätsmaße (Zusammenhänge mit Alkoholkonsum, Craving und gesundheitsbezogener Lebensqualität) berechnet. In der zweiten Stichprobe ( n = 120) wurde die gefundene Struktur konfirmatorisch geprüft. Das Verfahren erwies sich als reliabel und valide. Die im Original vorgeschlagene fünffaktorielle Struktur zeigte einen guten Fit, wenn auch in der vorliegenden Studie eine dreifaktorielle Struktur etwas geeigneter erschien. Diese Ergebnisse wurden in einer dritten Stichprobe ( n = 224) größtenteils gestützt. Trotz Limitationen (z. B. kleine Stichprobe) erwies sich der deutsche SURE als psychometrisch abgesicherter Indikator der Genesung von einer Alkoholkonsumstörung.
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Affiliation(s)
- Daniela Reichl
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Otto-Friedrich-Universität Bamberg, Deutschland
| | - Niklas Enewoldsen
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Otto-Friedrich-Universität Bamberg, Deutschland
| | - Matthias Berking
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Lukas Fuhrmann
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Catharina Lang
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Sebastian Saur
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Kiona K. Weisel
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Sabine Steins-Loeber
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Otto-Friedrich-Universität Bamberg, Deutschland
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Epskamp S, van der Maas HLJ, Peterson RE, van Loo HM, Aggen SH, Kendler KS. Intermediate stable states in substance use. Addict Behav 2022; 129:107252. [PMID: 35182945 DOI: 10.1016/j.addbeh.2022.107252] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
Many people across the world use potentially addictive legal and illegal substances, but evidence suggests that not all use leads to heavy use and dependence, as some substances are used moderately for long periods of time. Here, we empirically examine, the stability of and transitions between three substance use states: zero-use, moderate use, and heavy use. We investigate two large datasets from the US and the Netherlands on yearly usage and change of alcohol, nicotine, and cannabis. Results, which we make available through an extensive interactive tool, suggests that there are stable moderate use states, even after meeting criteria for a positive diagnosis of substance abuse or dependency, for both alcohol and cannabis use. Moderate use of tobacco, however, was rare. We discuss implications of recognizing three states rather than two states as a modeling target, in which the moderate use state can both act as an intervention target or as a gateway between zero use and heavy use.
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Affiliation(s)
- Sacha Epskamp
- University of Amsterdam, Department of Psychology, Psychological Methods Program Group, Amsterdam, The Netherlands; University of Amsterdam, Centre for Urban Mental Health, Amsterdam, The Netherlands.
| | - Han L J van der Maas
- University of Amsterdam, Department of Psychology, Psychological Methods Program Group, Amsterdam, The Netherlands
| | - Roseann E Peterson
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA
| | - Hanna M van Loo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Steven H Aggen
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA
| | - Kenneth S Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA
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Stinson L, Liu Y, Dallery J. Ecological Momentary Assessment: A Systematic Review of Validity Research. Perspect Behav Sci 2022; 45:469-493. [PMID: 35719870 PMCID: PMC9163273 DOI: 10.1007/s40614-022-00339-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/23/2023] Open
Abstract
Ecological momentary assessment (EMA) is a self-report method that involves intensive longitudinal assessment of behavior and environmental conditions during everyday activities. EMA has been used extensively in health and clinical psychology to investigate a variety of health behaviors, including substance use, eating, medication adherence, sleep, and physical activity. However, it has not been widely implemented in behavior analytic research. This is likely an example of the empirically based skepticism with which behavioral scientists view self-report measures. We reviewed studies comparing electronic, mobile EMA (mEMA) to more objective measures of health behavior to explore the validity of mEMA as a measurement tool, and to identify procedures and factors that may promote the accuracy of mEMA. We identified 32 studies that compared mEMA to more objective measures of health behavior or environmental events (e.g., biochemical measures or automated devices such as accelerometers). Results showed that the correspondence rates varied considerably across individuals, behavior, and studies (agreement rates ranged from 1.8%-100%), and no unifying variables could be identified across the studies that found high correspondence. The findings suggest that mEMA can be an accurate measurement tool, but further research should be conducted to identify procedures and variables that promote accurate responding.
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Affiliation(s)
- Lesleigh Stinson
- Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL 32601 USA
| | - Yunchao Liu
- Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL 32601 USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL 32601 USA
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Kim M, Byrne AM, Jeon J. The Effect of Vocational Counseling Interventions for Adults with Substance Use Disorders: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4674. [PMID: 35457542 PMCID: PMC9027488 DOI: 10.3390/ijerph19084674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
The authors reviewed the research literature evaluating the effectiveness of vocational counseling interventions focused on employment for consumers with substance use disorders. This review included 11 articles related to vocational counseling interventions, which are either incorporated with substance use treatment or not. The results of this review revealed that vocational counseling services have been highly efficacious in resulting in part-time and full-time jobs. The study designs had some limitations, and few studies employed randomized control trials (RCT).
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Affiliation(s)
- Min Kim
- Department of Social Welfare, Incheon National University, Incheon 22012, Korea;
| | - Andrew M. Byrne
- School of Education, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
| | - Jihye Jeon
- Department of Social Welfare, Incheon National University, Incheon 22012, Korea;
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Eddie D, Bergman BG, Hoffman LA, Kelly JF. Abstinence versus moderation recovery pathways following resolution of a substance use problem: Prevalence, predictors, and relationship to psychosocial well-being in a U.S. national sample. Alcohol Clin Exp Res 2022; 46:312-325. [PMID: 34931320 PMCID: PMC8858850 DOI: 10.1111/acer.14765] [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: 07/13/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many people who report resolving an alcohol or other drug (AOD) problem continue some level of substance use. Little information exists, however, regarding the prevalence of this resolution pathway, or how continued substance use after resolving an AOD problem, relative to abstinence, relates to functioning, quality of life, and happiness (i.e., well-being). Greater knowledge of the prevalence and correlates of non-abstinent AOD problem resolution could inform public health messaging and clinical guidelines, while encouraging substance use goals likely to maximize well-being and reduce risks. METHODS We analyzed data from a nationally representative sample of individuals who endorsed having resolved an AOD problem (N = 2002). Analyses examined: (1) The prevalence of various substance use statuses coded from lowest to highest risk: (a) continuous abstinence from all AOD since problem resolution; (b) current abstinence from all AOD with some use since problem resolution; (c) current use of a substance reported as a secondary substance; (d) current use of the individual's primary substance only; or, (e) current use of a secondary and primary substance; (2) relationships between substance use status and demographic, clinical, and service use history measures; and (3) the relationship between substance use status and well-being. Weighted, controlled, regression analyses examined the influence of independent variables on substance use status. RESULTS (1) Prevalence: In this sample, 20.3% of patients endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed current use of a primary substance; and 8.8% endorsed current use of both a secondary and a primary substance. (2) Correlates: Lower-risk substance use status was associated with the initiation of regular substance use at an older age, more years since problem resolution, and fewer lifetime psychiatric diagnoses. (3) Well-Being: Controlling for pertinent confounds, lower-risk substance use status was independently associated with greater self-esteem, happiness, quality of life and functioning, and recovery capital, as well as less psychological distress. CONCLUSIONS About half of Americans who self-identify as having resolved an AOD problem continue to use AOD in some form. It appears that, although for many abstinence is not necessary to overcome an AOD problem, it is likely to lead to better functioning and greater well-being. Further, people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution.
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Affiliation(s)
- David Eddie
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
| | - Brandon G. Bergman
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
| | - Lauren A. Hoffman
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
| | - John F. Kelly
- Recovery Research Institute Center for Addiction Medicine Massachusetts General HospitalHarvard Medical School Boston Massachusetts USA
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Interim opioid agonist treatment for opioid addiction: a systematic review. Harm Reduct J 2022; 19:7. [PMID: 35090475 PMCID: PMC8800211 DOI: 10.1186/s12954-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Opioid use disorder is a public health problem and treatment variability, coverage and accessibility poses some challenges. The study’s objective is to review the impact of interim opioid agonist treatment (OAT), a short-term approach for patients awaiting standard OAT, in terms of treatment retention, access to standard OAT, quality of life and satisfaction with treatment. Method We conducted a systematic review searching MEDLINE, EMBASE, PsycINFO, and CENTRAL up to May 2020. Due to variability between studies and outcome measurements, we did not pool effect estimates and reported a narrative synthesis of findings rating their certainty according to GRADE. Results We identified 266 unique records and included five randomized trials with some limitations in risk of bias and one observational study limited by selection bias. The studies assessed similar approaches to interim OAT but were compared to three different control conditions. Four studies reported on treatment retention at 4 months or less with no significant differences between interim OAT and waiting list or standard OAT. Two studies reported treatment retention at 12 months with no differences between interim OAT and standard OAT. Two trials assessed access to standard OAT and showed significant differences between interim OAT and waiting list for standard OAT. We rated the quality of evidence for these outcomes as moderate due to the impact of risk of bias. Data on quality of life or satisfaction with treatment was suboptimal. Conclusions Interim OAT is likely more effective than a waiting list for standard OAT in access to treatment, and it is probably as effective as standard OAT regarding treatment retention. PROSPERO registration CRD42018116269. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00592-x.
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Reichl D, Enewoldsen N, Weisel KK, Fuhrmann L, Lang C, Saur S, Berking M, Zink M, Ahnert A, Falkai P, Kraus T, Hillemacher T, Müller FN, Kornhuber J, Bönsch D, Kerkemeyer L, Steins-Loeber S. Association of impulsivity with quality of life and well-being after alcohol withdrawal treatment. J Clin Psychol 2022; 78:1451-1462. [PMID: 35045188 DOI: 10.1002/jclp.23316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health-related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health-related quality of life and well-being in alcohol use disorder. METHODS Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self-report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health-related quality of life and well-being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes. RESULTS Craving was associated with health-related quality of life and well-being 6 weeks after withdrawal. Likewise, non-planning and attentional impulsivity were associated with well-being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health-related quality of life 6 weeks thereafter. CONCLUSION Impulsivity seems to be negatively related to health-related quality of life and well-being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process.
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Affiliation(s)
- Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Lukas Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Mathias Zink
- Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik, Klinikum am Europakanal, Erlangen, Germany
| | - Andreas Ahnert
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU-Klinikum, München, Germany
| | - Thomas Kraus
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Frankenalb-Klinik Engelthal, Engelthal, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Felix-N Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Johannes Kornhuber
- Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dominikus Bönsch
- Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Bezirkskrankenhaus Lohr, Lohr am Main, Germany
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Berlin, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
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Manrique-Ruiz Tapia MA, Macías-López MP, Murcia-Casas DZ, Lozada Ramírez G, Torres Barreto K, Bohórquez Torres LC, Riveros Munevar F, Dillon Soares-Filho PS. Adaptation and Psychometric Properties of the Electronic Cigarette Dependence Index (ECDI) in a Colombian Sample. Int J Psychol Res (Medellin) 2022; 15:20-29. [PMID: 36199525 PMCID: PMC9529285 DOI: 10.21500/20112084.5297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/20/2021] [Accepted: 10/07/2021] [Indexed: 11/06/2022] Open
Abstract
Electronic cigarettes had become a public health concern, generating the need of having standardized instruments to evaluate the consequences of their use. Objective The goal of this study was to adapt and evaluate the validity and reliability of the Electronic Cigarette Dependence Index (ECDI) to a Colombian sample. Method In this instrumental quantitative research, the instrument was adapted to the Spanish language, evaluated by expert judges and contested by 128 adult regular electronic cigarettes users. Results The results suggest a single factor structure with reliable goodness of fit measures and values of internal consistency between acceptable and adequate. Conclusion These results suggest the ECDI as a valid and reliable index to be used in Colombian samples.
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Affiliation(s)
| | - Maria Paula Macías-López
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Debby Zamara Murcia-Casas
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Geraldine Lozada Ramírez
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Karen Torres Barreto
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Leidy Carolina Bohórquez Torres
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
| | - Fernando Riveros Munevar
- Universidad de La Sabana, Chía, Colombia. Universidad de la Sabana Universidad de La Sabana Chía Colombia
| | - Paulo Sergio Dillon Soares-Filho
- Universidad de San Buenaventura, Bogotá, Colombia. Universidad de San Buenaventura Universidad de San Buenaventura Bogotá Colombia
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Bowen E, Irish A, LaBarre C, Capozziello N, Nochajski T, Granfield R. Qualitative insights in item development for a comprehensive and inclusive measure of recovery capital. ADDICTION RESEARCH & THEORY 2022; 30:403-413. [PMID: 36721868 PMCID: PMC9886235 DOI: 10.1080/16066359.2022.2055002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Item specification is foundational to measurement development but rarely reported in depth. We address this gap by explicating our use of qualitative methods to ground and develop items for a new recovery capital measure, the Multidimensional Inventory of Recovery Capital. METHOD We recruited a diverse sample of service providers (n = 9) and people in recovery from alcohol problems (n = 23) to provide feedback on an item pool assessing social, human, physical, community, and cultural capital. Using applied qualitative analysis, we coded findings from interviews and focus groups and made final decisions by consensus regarding item elimination, retention, or revision. This process yielded a 49-item draft measure. RESULTS Only nine items from an initial 90-item list were retained in their original form. Participant feedback guided item elimination, addition, and revision for linguistic or conceptual clarity. We detected little systematic variation in feedback based on income or race; however, there were stark divergences on particular items based on recovery pathway (i.e. 12-step versus other approaches). CONCLUSIONS The high degree of alteration to the item pool highlights the importance of establishing validity with respondents. Response variation based on recovery pathway suggests the need for broad heterogeneity in respondents. Measures that are sensitive, psychometrically sound, and aligned with theory are critical for advancing research on recovery capital and related disparities for diverse populations.
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Affiliation(s)
- Elizabeth Bowen
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Andrew Irish
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Charles LaBarre
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Nicole Capozziello
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Thomas Nochajski
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Robert Granfield
- Vice Provost for Faculty Affairs, University at Buffalo – State University of New York, Buffalo, NY, USA
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Zetterström A, Hämäläinen MD, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. The Clinical Course of Alcohol Use Disorder Depicted by Digital Biomarkers. Front Digit Health 2021; 3:732049. [PMID: 34950928 PMCID: PMC8688853 DOI: 10.3389/fdgth.2021.732049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study introduces new digital biomarkers to be used as precise, objective tools to measure and describe the clinical course of patients with alcohol use disorder (AUD).Methods: An algorithm is outlined for the calculation of a new digital biomarker, the recovery and exacerbation index (REI), which describes the current trend in a patient's clinical course of AUD. A threshold applied to the REI identifies the starting point and the length of an exacerbation event (EE). The disease patterns and periodicity are described by the number, length, and distance between EEs. The algorithms were tested on data from patients from previous clinical trials (n = 51) and clinical practice (n = 1,717).Results: Our study indicates that the digital biomarker-based description of the clinical course of AUD might be superior to the traditional self-reported relapse/remission concept and conventional biomarkers due to higher data quality (alcohol measured) and time resolution. We found that EEs and the REI introduce distinct tools to identify qualitative and quantitative differences in drinking patterns (drinks per drinking day, phosphatidyl ethanol levels, weekday and holiday patterns) and effect of treatment time.Conclusions: This study indicates that the disease state—level, trend and periodicity—can be mathematically described and visualized with digital biomarkers, thereby improving knowledge about the clinical course of AUD and enabling clinical decision-making and adaptive care. The algorithms provide a basis for machine-learning-driven research that might also be applied for other disorders where daily data are available from digital health systems.
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Affiliation(s)
| | | | | | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- Fred Nyberg
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Haeny AM, Oluwoye O, Cruz R, Iheanacho T, Jackson AB, Fisher S, Crouch M, O'Malley S. Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III. J Subst Abuse Treat 2021; 131:108569. [PMID: 34393011 PMCID: PMC9084614 DOI: 10.1016/j.jsat.2021.108569] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults. METHODS The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups. RESULTS Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment. CONCLUSIONS Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | | | - Rick Cruz
- Utah State University, United States
| | - Theddeus Iheanacho
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Asti B Jackson
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | | | - Maria Crouch
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States; University of Alaska Anchorage, United States
| | - Stephanie O'Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
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Moe FD, Moltu C, McKay JR, Nesvåg S, Bjornestad J. Is the relapse concept in studies of substance use disorders a 'one size fits all' concept? A systematic review of relapse operationalisations. Drug Alcohol Rev 2021; 41:743-758. [PMID: 34792839 DOI: 10.1111/dar.13401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
ISSUES Relapse is a theoretical construct and empirical object of inquiry. It is unclear how relapse is operationalised with regard to the various phases in substance use disorders (SUD). The aim was to investigate relapse operationalisations in SUDs studies after short- and long-term abstinence and remission, recovery and slip/lapse. APPROACH Systematic review using the following databases: Epistemonikos, Cochrane Central Register of Controlled Trials (CENTRAL and DARE), MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science and PsycINFO. Search returned 3426 articles, with 276 meeting the following inclusion criteria: empirical study published in English in a peer-reviewed journal; samples meet diagnostic criteria for dependence syndrome or moderate-severe drug use disorder or alcohol use disorder; reports relapse, abstinence, recovery, remission, slip or lapse. Review protocol registration: PROSPERO (CRD42020154062). KEY FINDINGS Thirty-two percent of the studies had no definition of 'relapse'. Most relapse operationalisations were defined according to measure (26%), time (17%), use (26%) and amount and frequency (27%). Of the 16 studies with a follow-up duration of up to 2 years, one (6%) contained a definition of 'long-term abstinence'. Of the 64 studies with a follow-up duration of more than 2 years, four (6%) contained a definition of 'long-term abstinence'. Of those, one (2%) mentioned 'early relapse' and one (2%) mentioned 'late relapse'. IMPLICATIONS Future research is needed to explore the possible difference between early and late relapse. Moreover, working to increase consensus on relapse operationalisations in SUD research is warranted. CONCLUSIONS We identified no consensus on relapse operationalisations nor agreement on the differentiation between early and late relapse. The clinical utility of current relapse operationalisations seems low and may compromise knowledge accumulation about relapse and implementation of research into treatment.
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Affiliation(s)
- Fredrik D Moe
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Philadelphia VA Medical Center, Philadelphia, USA.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Sverre Nesvåg
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
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The phenotype of recovery VII: Delay discounting mediates the relationship between time in recovery and recovery progress. J Subst Abuse Treat 2021; 136:108665. [PMID: 34895955 PMCID: PMC8940660 DOI: 10.1016/j.jsat.2021.108665] [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: 06/22/2021] [Revised: 09/02/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) remain challenging maladies to treat in the United States and impose significant societal costs. Despite these challenges, a significant number of individuals endorse being in recovery from SUD. The scientific understanding of SUD recovery has evolved to include not only improvements in substance use but also improvements in personal wellness and psychosocial functioning. The devaluation of future rewards (delay discounting; DD) is broadly associated with SUD inception and outcomes. We sought to investigate the relationship between DD, time in recovery, and recovery progress. METHODS We conducted an online assessment of 127 individuals in recovery from SUD who the study recruited via the International Quit and Recovery Registry (IQRR). The research team obtained measures of recovery progress via the Addiction Recovery Questionnaire (ARQ) and the Treatment Effectiveness Assessment (TEA). Additionally, the study collected measures of DD, time in recovery, and endorsement of abstinence in recovery (i.e., requiring abstinence vs. not). We utilized linear regression to test for associations among these variables and performed a mediation analysis to test the role of DD in mediating the relationship between time in recovery and measures of recovery progress. RESULTS Time in recovery was positively associated with the ARQ (p < .001) and TEA (p < .001). Furthermore, an individual's delay discounting rate mediated the relationship between time in recovery and ARQ/TEA. Of the participants, 66% endorsed recovery requiring total abstinence from alcohol and drugs. Last, through an exhaustive model selection, the study did not find an individual's endorsement of abstinence in recovery to be a primary predictor of recovery progress. CONCLUSIONS This study presents evidence that, for individuals in recovery, the temporal view (i.e., focus on immediate vs. future rewards) is a significant influence on recovery progress. Additionally, an individual's endorsement of abstinence in recovery was not significantly associated with recovery progress, suggesting the importance of a holistic view of SUD recovery. These findings contribute to the understanding of recovery as a multidimensional process and provide further support for DD as a behavioral marker of addiction.
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Witkiewitz K, Morris J, Tucker JA. Commentary on Henssler et al.: The public health case for promoting and valuing drinking reductions in the treatment of alcohol use disorder. Addiction 2021; 116:1988-1989. [PMID: 33554367 DOI: 10.1111/add.15429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Jalie A Tucker
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, USA
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Witkiewitz K, Wilson AD, Roos CR, Swan JE, Votaw VR, Stein ER, Pearson MR, Edwards KA, Tonigan JS, Hallgren KA, Montes KS, Maisto SA, Tucker JA. Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment. J Addict Med 2021; 15:303-310. [PMID: 33060466 PMCID: PMC8044251 DOI: 10.1097/adm.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment. METHODS Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n = 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr. RESULTS Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years. CONCLUSIONS Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.
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Affiliation(s)
- Katie Witkiewitz
- University of New Mexico, Albuquerque, NM (KW, ADW, JES, VRV, ERS, MRP, KAE, JST), Yale University, New Haven, CT (CRR), University of Washington, Seattle, WA (KAH), California State University Dominquez Hills, Carson, CA (KSM), Syracuse University, Syracuse, NY (SAM), University of Florida, Gainesville, FL (JAT)
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Bellaert L, Martinelli TF, Vanderplasschen W, Best D, van de Mheen D, Vander Laenen F. Chasing a pot of gold: an analysis of emerging recovery-oriented addiction policies in Flanders (Belgium) and The Netherlands. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1915250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Lore Bellaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Thomas F. Martinelli
- IVO Research Institute, The Hague, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - David Best
- Department of Criminology, University of Derby, Derby, UK
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Freya Vander Laenen
- Department of Criminology, Penal Law, and Social Law, Ghent University, Ghent, Belgium
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Wittenberg E, Barbosa C, Hein R, Hudson E, Thornburg B, Bray JW. Health-related quality of life of alcohol use disorder with co-occurring conditions in the US population. Drug Alcohol Depend 2021; 221:108558. [PMID: 33556660 PMCID: PMC8026697 DOI: 10.1016/j.drugalcdep.2021.108558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) commonly co-occurs with other health conditions or other substance use, complicating our understanding of the health-related quality of life (HRQoL) of AUD. We described the HRQoL of alcohol use disorder in the presence of co-occurring conditions and identified the contribution of each. METHODS Secondary analysis of National Epidemiologic Survey on Alcohol and Related Conditions III data, consisting of 36,309 non-institutionalized US adults; descriptive and regression analysis. HRQoL measured via the SF-6D; AUD via the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5); physical, mental health, and substance use disorders/conditions as reported or assessed via AUDADIS-5. RESULTS AUD was independently associated with lower HRQoL for individuals experiencing co-occurring conditions. Compared to no AUD, past year AUD reduced SF-6D score by 0.0304 (SE = 0.0027) and prior-to-past-year AUD reduced SF-6D by 0.0163 (SE = 0.0023). AUD's co-occurring conditions were independently associated with lower HRQoL, beyond the reduction from AUD: any co-occurring physical health condition was associated with a 0.062 point reduction in SF-6D score (SE = 0.0023), any mental health condition with a 0.084 point reduction (SE = 0.0025), and any substance use disorder with a 0.038 point reduction (SE = 0.0023). CONCLUSIONS AUD's association with diminished HRQoL may be explained in large part by the presence of co-occurring conditions among individuals reporting AUD, as these co-occurring conditions are associated with substantial decrements in HRQoL-often eclipsing the magnitude of the decrements associated with AUD alone. Alcohol use interventions endeavoring to improve HRQoL should consider the entirety of an individual to design patient-centered care.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard TH Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
| | - Carolina Barbosa
- RTI International, 230 West Monroe Street, Suite 2100, Chicago, IL, 60606, USA.
| | - Riley Hein
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
| | - Emma Hudson
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
| | - Benjamin Thornburg
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
| | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
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Mellor R, Lancaster K, Ritter A. Examining untreated and treated alcohol problem resolution in an Australian online survey sample. Drug Alcohol Rev 2021; 40:1037-1046. [PMID: 33647176 DOI: 10.1111/dar.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION While treatment is an effective way to resolve alcohol problems, many people resolve their alcohol problems in the absence of treatment. Just how many do so is not known and may vary based on the definition of treatment. Various estimates of untreated alcohol problem resolution were calculated in this study, and the differences between people who resolve their alcohol problems with or without treatment were explored in relation to sociodemographic variables, levels of alcohol consumption in the past 12 months and lifetime alcohol problem severity. METHODS A cross-sectional online survey was administered to 719 people who had resolved an alcohol problem in Australia. Convenience sampling was used through a recruitment strategy targeted towards the general population via Facebook. RESULTS Almost half (49.8%) of all people who resolved their alcohol problem did so in the absence of alcohol treatment, whether specialist alcohol treatment, mutual-aid services or digital support services. When accessing mental health treatment is included under the scope of 'treatment', this estimate dropped to 12.8%. The estimated odds of having accessed treatment increased with age and lifetime alcohol problem severity. Other sociodemographic variables, or levels of alcohol consumption in the past 12 months, were not significantly associated with treatment status. DISCUSSION AND CONCLUSIONS It might be beneficial to expand the scope of 'treatment' to include mental health services and focus on the development of cost-effective and less intrusive standalone activities, which can expedite and support alcohol problem resolution for those who choose not to access specialist treatment.
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Affiliation(s)
- Richard Mellor
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
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Williams IL. An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language. Subst Use Misuse 2021; 56:1079-1094. [PMID: 33970771 DOI: 10.1080/10826084.2021.1892134] [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: 10/21/2022]
Abstract
BACKGROUND The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach. OBJECTIVES This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism. RESULTS Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.
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Palzes VA, Kline-Simon AH, Satre DD, Sterling S, Weisner C, Chi FW. Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data. J Stud Alcohol Drugs 2020. [PMID: 32800079 DOI: 10.15288/jsad.2020.81.436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder (AUD). METHOD We conducted a longitudinal study of 4,078 adults with AUD who screened positive for unhealthy drinking between October 1, 2015, and September 30, 2016. We extracted EHR data up to 3 years after screening until October 1, 2018. We used survival analysis to examine associations between remission (i.e., reporting abstinence or low-risk drinking at a subsequent screening) and patient characteristics, comorbidities, and treatment utilization. RESULTS The median time to remission from unhealthy drinking was 1.7 years. Factors significantly associated with greater odds of remitting from unhealthy drinking during follow-up were female gender; older age (50-64 years); Black or Latino/Hispanic race/ethnicity; having more medical comorbidities; not having a comorbid drug use disorder; lower alcohol consumption levels; and receiving addiction medicine treatment before the index screening. In the first follow-up year, individuals with mental health comorbidities were more likely to remit, but those in psychiatric treatment were less likely. Receiving addiction treatment during follow-up was not associated with remission. CONCLUSIONS Ethnic minorities and individuals with mental illness were more likely to remit, which is encouraging given the health disparities observed among these clinically important subgroups and warrants further research. Our findings may inform research on AUD recovery and clinical practice, as remission from unhealthy drinking is a crucial component of the early stages of recovery.
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Affiliation(s)
- Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Abstract
The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Research and Education, VA Central Western Massachusetts, Leeds, Massachusetts
| | - Michael Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education, and Clinical Center and Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
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Abstract
Almost one-third of the U.S. population meets alcohol use disorder (AUD) criteria on a lifetime basis. This review provides an overview of recent research on the prevalence and patterns of alcohol-related improvement and selectively reviews nationally representative surveys and studies that followed risk groups longitudinally with a goal of informing patients with AUD and AUD researchers, clinicians, and policy-makers about patterns of improvement in the population. Based on the research, alcohol use increases during adolescence and early adulthood and then decreases beginning in the mid-20s across the adult life span. Approximately 70% of persons with AUD and alcohol problems improve without interventions (natural recovery), and fewer than 25% utilize alcohol-focused services. Low-risk drinking is a more common outcome in untreated samples, in part because seeking treatment is associated with higher problem severity. Sex differences are more apparent in help-seeking than recovery patterns, and women have lower help-seeking rates than men. Whites are proportionately more likely to utilize services than are Blacks and Hispanics. Improving recovery rates will likely require offering interventions outside of the health care sector to affected communities and utilizing social networks and public health tools to close the longstanding gap between need and utilization of AUD-focused services.
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Affiliation(s)
- Jalie A Tucker
- Department of Health Education and Behavior and the Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida
| | - Susan D Chandler
- Department of Health Education and Behavior and the Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida
| | - Katie Witkiewitz
- Department of Psychology and the Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
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49
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Vest N, Sox-Harris A, Ilgen M, Humphreys K, Timko C. Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with co-occurring Conditions: A Longitudinal Parallel Growth Mixture Model. Alcohol Clin Exp Res 2020; 44:2570-2578. [PMID: 33104268 DOI: 10.1111/acer.14474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses. METHODS Participants were adults with cooccurring disorders (n = 406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up. RESULTS A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3 months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment. CONCLUSIONS These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.
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Affiliation(s)
- Noel Vest
- From the, Department of Psychiatry and Behavioral Sciences (NAV, KH, CT), Stanford University School of Medicine, Stanford, California, USA
| | - Alex Sox-Harris
- Veterans Affairs Palo Alto Health Care System, (AHSH, KH, CT), Palo Alto, California, USA.,Department of Surgery (AHSH), Stanford University School of Medicine, Stanford, California, USA
| | - Mark Ilgen
- Department of Psychiatry, (MI), University of Michigan, Ann Arbor, Michigan, USA.,VA Center for Clinical Management Research (CCMR), (MI), Ann Arbor, Michigan, USA
| | - Keith Humphreys
- From the, Department of Psychiatry and Behavioral Sciences (NAV, KH, CT), Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, (AHSH, KH, CT), Palo Alto, California, USA
| | - Christine Timko
- From the, Department of Psychiatry and Behavioral Sciences (NAV, KH, CT), Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, (AHSH, KH, CT), Palo Alto, California, USA
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50
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Abstract
Alcohol use disorder (AUD) is among the most prevalent psychiatric disorders and is associated with enormous public health costs. Although AUD and other addictive behaviors have been described as chronic relapsing conditions, most individuals who develop AUD will eventually recover. This narrative review provides an overview of definitions of recovery, with a focus on recovery from AUD. The definitions reviewed include those developed by key stakeholder groups, as well as definitions derived from recent quantitative and qualitative studies of individuals who meet criteria for AUD and attempt to resolve their problems with or without treatment or who self-identify as pursuing or achieving recovery. The literature reviewed supports a definition of recovery as an ongoing dynamic process of behavior change characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. The review concludes that definitions of recovery that rely solely on abstinence from alcohol and the absence of AUD symptoms fail to capture the multidimensional and heterogeneous pathways to recovery that are evident among individuals in general population and clinical samples.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Kevin S Montes
- Department of Psychology, California State University Dominguez Hills, Carson, California
| | - Frank J Schwebel
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Jalie A Tucker
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida
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