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Schettini G, Lindner P, Ekström V, Johansson M. A mixed method study exploring similarities and differences in general and social services-specific barriers to treatment-seeking among individuals with a problematic use of alcohol, cannabis, or gambling. BMC Health Serv Res 2024; 24:970. [PMID: 39174983 PMCID: PMC11342637 DOI: 10.1186/s12913-024-11304-5] [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: 03/28/2024] [Accepted: 07/10/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION The treatment gap for addictive disorders is one of the largest in health care. Several studies have investigated barriers to treatment for different addictive disorders, but very few studies conducted have explored whether the barriers differ depending on substance or behavior or if they are common among all addictive disorders. In Sweden, addiction care is provided both by the healthcare and social services, where the latter is common, but also less popular. To our knowledge, there are no studies exploring whether the barriers are different depending on where the treatment is given. AIM The aim was to thoroughly explore both which general and social services-specific barriers to treatment that are common, which barriers that differs, and how the barriers are described among individuals with a problematic use of alcohol, cannabis and/or gambling. METHOD A mixed method convergent parallel design was conducted. For the quantitative measures, surveys including the validated Barriers to Treatment Inventory as well as questions regarding barriers in the Swedish multi-provider landscape, were collected from individuals with a problematic use of alcohol (n = 207), cannabis (n = 51), and gambling (n = 37). In parallel, 17 semi-structured interviews from the same population were conducted and analyzed with thematic analysis. Thereafter, the quantitative and qualitative data was compared, contrasted, and at last, interpreted. RESULTS The quantitative data showed that the largest general barriers in all groups were privacy concern and poor availability, and the largest barriers for seeking help from the social services was stigma, unawareness of what is offered, and fear of consequences for all groups. The qualitative data resulted in five general barriers: stigma, ambivalence, accessibility, fear of consequences, and lack of knowledge about addiction and its' treatments, and three barriers specifically towards social services: social services reputation, fear of meeting acquaintances, and lack of knowledge. The themes were developed from data from all groups, but different aspects of the themes were mentioned by different groups. CONCLUSION There are details and aspects that differentiates both the general and social service-specific barriers to treatment between individuals with a problematic use of alcohol, cannabis, and gambling, but in large they perceive similar barriers.
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Affiliation(s)
- Greta Schettini
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Philip Lindner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Veronica Ekström
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Magnus Johansson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Pautrat M, Barbier E, Lebeau JP. Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review. Prev Med Rep 2024; 38:102610. [PMID: 38375183 PMCID: PMC10874871 DOI: 10.1016/j.pmedr.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Substance use disorders substantially contribute to the global burden of disease. Early detection in primary care is recommended, and numerous screening tests are available. However, barriers to addictive disorder screening exist and the feasibility of using these tests in primary care is unclear. This study aims to identify available addictive disorder screening tests whose feasibility has been evaluated in primary care. This systematic literature review was performed using Pubmed, PsycINFO, and the Cochrane Library databases. The search strategy included four research topics: addictive disorders, screening, primary care, and feasibility. Selection criteria included published studies evaluating the feasibility of an addictive disorder screening test in primary care. Data were extracted for each included article, and each analyzed screening test. Of the 4911 articles selected, 20 were included and 16 screening tests were studied. Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time. Patient feasibility was measured using criteria including "ease of use", comprehension, or format preference. Self-administered formats were preferred, especially electronic versions. Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders. Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference. The criteria synthesized in this review could serve as a basis for screening test feasibility studies in primary care given the absence of feasibility study guidelines.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
| | | | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
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Hofmarcher T, Leppänen A, Månsdotter A, Strandberg J, Håkansson A. Societal costs of illegal drug use in Sweden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104259. [PMID: 38035447 DOI: 10.1016/j.drugpo.2023.104259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. METHODS A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. RESULTS The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. CONCLUSION Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.
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Affiliation(s)
- Thomas Hofmarcher
- IHE - The Swedish Institute for Health Economics, Råbygatan 2, 22361 Lund, Sweden
| | - Anne Leppänen
- Public Health Agency of Sweden, Box 505, 83126 Östersund, Sweden
| | - Anna Månsdotter
- Public Health Agency of Sweden, Box 505, 83126 Östersund, Sweden; Department of Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | | | - Anders Håkansson
- Clinical Addiction Research Unit, Lund University, Universitetssjukhuset, 22184 Lund, Sweden.
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Shmulewitz D, Eliashar R, Levitin MD, Lev-Ran S. Test characteristics of shorter versions of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for brief screening for problematic substance use in a population sample from Israel. Subst Abuse Treat Prev Policy 2023; 18:58. [PMID: 37828494 PMCID: PMC10571312 DOI: 10.1186/s13011-023-00566-7] [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] [Received: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Substance use is a leading cause of preventable morbidity and mortality worldwide. Population-wide screening for problematic substance use in primary health care may mitigate the serious health and socio-economic consequences of such use, but the standard Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.1) may be too long for wide-scale screening. How well validated shorter versions (ASSIST-Lite, ASSIST-FC) perform in identifying those with ASSIST 3.1 problematic use in different settings is unclear. METHODS General population Jewish adults in Israel (N = 2,474) responded to an online survey that included the ASSIST 3.1 and sociodemographics. Across substances (alcohol, tobacco, cannabis, sedatives, prescription stimulants, prescription painkillers), receiver operator characteristic curve analysis determined that ASSIST-FC scores performed better than ASSIST-Lite at identifying those with problematic use, and evaluated differential ASSIST-FC performance by gender or age. Test characteristics and agreement were evaluated for binary ASSIST-FC versions, with ASSIST 3.1 problematic use as the gold standard. RESULTS ASSIST-FC scores showed high ability to identify ASSIST 3.1 problematic use, with minimal differences by gender or age. Binary ASSIST-FC (most substances: threshold 3+; alcohol: 5+) showed high specificity and positive predictive value, acceptable sensitivity, and good agreement. CONCLUSIONS The ASSIST-FC, which assesses frequency of use and other's concerns about use, appears useful for very brief screening in primary care to identify patients who may benefit from intervention. Early identification of those at-risk may prevent more severe consequences and ultimately decrease the significant costs of problematic substance use on the individual and population level.
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Affiliation(s)
| | - Roi Eliashar
- Israel Center on Addiction, 2 HaTzoran Street, Netanya, Israel
| | | | - Shaul Lev-Ran
- Israel Center on Addiction, 2 HaTzoran Street, Netanya, Israel
- Lev Hasharon Medical Center, Netanya, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pautrat M, Renard C, Riffault V, Ciolfi D, Edeline A, Breton H, Brunault P, Lebeau JP. Cross-analyzing addiction specialist and patient opinions and experiences about addictive disorder screening in primary care to identify interaction-related obstacles: a qualitative study. Subst Abuse Treat Prev Policy 2023; 18:12. [PMID: 36803797 PMCID: PMC9938560 DOI: 10.1186/s13011-023-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/04/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Promptly identifying individuals with addictive disorders reduces mortality and morbidity and improves quality of life. Although screening in primary care with the Screening, Brief Intervention and Referral Treatment strategy has been recommended since 2008, it remains underutilized. This may be due to barriers including lack of time, patient reluctance or perhaps the timing and approach for discussing addiction with their patients. OBJECTIVE This study aims to explore and cross-analyze patient and addiction specialist experiences and opinions about early addictive disorder screening in primary care to identify interaction-related screening obstacles. DESIGN AND PARTICIPANTS Qualitative study with purposive maximum variation sampling among nine addiction specialists and eight individuals with addiction disorders conducted between April 2017 and November 2019 in Val-de-Loire, France. MAIN MEASURES Using a grounded theory approach, verbatim data was collected from face-to-face interviews with addiction specialists and individuals with addiction disorders. These interviews explored their opinions and experiences with addiction screening in primary care. Initially, two independent investigators analyzed the coded verbatim according to the data triangulation principle. Secondly, convergences and divergences between addiction specialist and addict verbatim categories were identified, analyzed, and conceptualized. KEY RESULTS Four main interaction-related obstacles to early addictive disorder screening in primary care were identified and conceptualized: the new concepts of shared self-censorship and the patient's personal red line, issues not addressed during consultations, and opposition between how physicians and patients would like to approach addictive disorder screening. CONCLUSIONS To continue analysis of addictive disorder screening dynamics, further studies to examine the perspectives of all those involved in primary care are required. The information revealed from these studies will provide ideas to help patients and caregivers start discussing addiction and to help implement a collaborative team-based care approach. TRIAL REGISTRATION This study is registered with the Commission Nationale de l'Informatique et des Libertés (CNIL) under No. 2017-093.
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Affiliation(s)
- Maxime Pautrat
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France.
- Department of General Practice, Tours Regional University Hospital, Tours, France.
| | - Caroline Renard
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Vincent Riffault
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - David Ciolfi
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Agathe Edeline
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Hervé Breton
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Paul Brunault
- Department of General Practice, Tours Regional University Hospital, Tours, France
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Qualipsy EE 1901, University of Tours, Tours, France
- Équipe de Liaison et de Soins en Addictologie, CHRU de Tours, Service d'Addictologie Universitaire, Tours, France
| | - Jean Pierre Lebeau
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
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Subramaniam M, Abdin E, Kong AMC, Vaingankar JA, Jeyagurunathan A, Shafie S, Sambasivam R, Fung DSS, Verma S, Chong SA. Differences in the Prevalence and Profile of DSM-IV and DSM-5 Alcohol Use Disorders-Results from the Singapore Mental Health Study 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:285. [PMID: 36612604 PMCID: PMC9819399 DOI: 10.3390/ijerph20010285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for alcohol use disorders (AUD) was a significant shift from the historical DSM-IV Text Revised version. Following this shift in diagnostic criteria, a difference in the prevalence of AUD was expected. The current study aimed to evaluate the consequences of the modification of the diagnostic criteria from DSM-IV to DSM-5 AUD using lifetime diagnosis in Singapore's multi-ethnic population using data from a nationwide epidemiological study. METHODS Respondents were assessed for lifetime mental disorders using the Composite International Diagnostic Interview (CIDI) administered through face-to-face interviews. Lifetime DSM-IV AUD diagnoses were compared with DSM-5 AUD diagnoses generated by modifying the criteria and the addition of the craving criterion. Sociodemographic correlates of lifetime DSM-IV/DSM-5 AUD were examined using multiple logistic regression analysis. Associations between DSM-IV/DSM-5 AUD, chronic conditions, and the HRQOL summary scores were examined using logistic and linear regression after controlling for significant sociodemographic factors. RESULTS The lifetime prevalence of DSM-IV AUD was 4.6% (0.5% for dependence and 4.1% for abuse) in the adult population, while the lifetime prevalence of DSM-5 AUD was 2.2%. Younger age, male gender, and lower education were associated with higher odds of both DSM-IV and DSM-5 AUD. However, those who were economically inactive (versus employed) (AOR, 0.4; 95% CI 0.2-0.9) and had a higher monthly household income (SGD 4000-5999 versus below SGD 2000) had lower odds of DSM-IV AUD (AOR, 0.4; 95% CI 0.2-0.7), but this was not observed among those with DSM-5 AUD. Both DSM-IV and DSM-5 AUD were associated with significant comorbidities in terms of other mental disorders; however, those diagnosed with lifetime GAD had significantly higher odds of having DSM-5 AUD (AOR, 5; 95% CI 1.9-13.2) but not DSM-IV AUD. CONCLUSIONS While using the DSM-5 criteria would result in a lower prevalence of AUD in Singapore, it remains a highly comorbid condition associated with a poor health-related quality of life that is largely untreated, which makes it a significant public health concern.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | | | | | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | | | | | - Swapna Verma
- Medical Board, Institute of Mental Health, Singapore 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
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Anderson P, Kokole D, Jané Llopis E, Burton R, Lachenmeier DW. Lower Strength Alcohol Products—A Realist Review-Based Road Map for European Policy Making. Nutrients 2022; 14:nu14183779. [PMID: 36145155 PMCID: PMC9500668 DOI: 10.3390/nu14183779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 12/16/2022] Open
Abstract
This paper reports the result of a realist review based on a theory of change that substitution of higher strength alcohol products with lower strength alcohol products leads to decreases in overall levels of alcohol consumption in populations and consumer groups. The paper summarizes the results of 128 publications across twelve different themes. European consumers are increasingly buying and drinking lower strength alcohol products over time, with some two fifths doing so to drink less alcohol. It tends to be younger more socially advantaged men, and existing heavier buyers and drinkers of alcohol, who take up lower strength alcohol products. Substitution leads to a lower number of grams of alcohol bought and drunk. Although based on limited studies, buying and drinking lower strength products do not appear to act as gateways to buying and drinking higher strength products. Producer companies are increasing the availability of lower strength alcohol products, particularly for beer, with extra costs of production offset by income from sales. Lower strength alcohol products tend to be marketed as compliments to, rather than substitutes of, existing alcohol consumption, with, to date, the impact of such marketing not evaluated. Production of lower strength alcohol products could impair the impact of existing alcohol policy through alibi marketing (using the brand of lower strength products to promote higher strength products), broadened normalization of drinking cultures, and pressure to weaken policies. In addition to increasing the availability of lower strength products and improved labelling, the key policy that favours substitution of higher strength alcohol products with lower strength products is an alcohol tax based on the dose of alcohol across all products.
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Affiliation(s)
- Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
- Correspondence:
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Eva Jané Llopis
- ESADE Business School, Ramon Llull University, 08034 Barcelona, Spain
| | - Robyn Burton
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Straße 3, 76187 Karlsruhe, Germany
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Zhang L, Lopes S, Lavelle T, Jones KO, Chen L, Jindal M, Zinzow H, Shi L. Economic Evaluations of Mindfulness-Based Interventions: a Systematic Review. Mindfulness (N Y) 2022; 13:2359-2378. [PMID: 36061089 PMCID: PMC9425809 DOI: 10.1007/s12671-022-01960-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/16/2022]
Abstract
Objectives This study includes a systematic review of cost-effectiveness analyses (CEAs) and cost–benefit analyses (CBAs) of mindfulness-based interventions (MBIs). Methods A literature search was conducted using PubMed, Web of Science, JSTOR, and CINAHL for studies published between January 1985 and September 2021, including an original cost-related evaluation of an MBI. A qualitative assessment of bias was performed using the Drummond checklist. Results Twenty-eight mindfulness-based intervention studies (18 CEAs and 10 CBAs) were included in this review. Mindfulness-based stress reduction (MBSR) was less costly and more effective when compared with the usual care of cognitive behavioral therapy among patients with chronic lower back pain, fibromyalgia, and breast cancer. MBSR among patients with various physical/mental conditions was associated with reductions in healthcare costs. Mindfulness-based cognitive therapy (MBCT) was also less costly and more effective than the comparison group among patients with depression, medically unexplained symptoms, and multiple sclerosis. MBCT’s cost-effectiveness advantage was also identified among breast cancer patients with persistent pain, non-depressed adults with a history of major depressive disorder episodes, adults diagnosed with ADHD, and all cancer patients. From a societal perspective, the cost-saving property of mindfulness training was evident when used as the treatment of aggressive behaviors among persons with intellectual/developmental disabilities in mental health facilities. Conclusions Based on this review, more standardized MBI protocols such as MBSR and MBCT compare favorably with usual care in terms of health outcomes and cost-effectiveness. Other MBIs may result in cost savings from both healthcare and societal perspectives among high-risk patient populations.
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Gual A, Drummond C. Killing me softly: Alcohol addiction today. Eur Neuropsychopharmacol 2022; 57:30-32. [PMID: 35030481 DOI: 10.1016/j.euroneuro.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Antoni Gual
- Emeritus Researcher. GRAC (Grup Recerca Addiccions Clínic). IDIBAPS. Hospital Clínic, Barcelona, Spain; Past President of EUFAS (European Federation of Addiction Societies), EU.
| | - Colin Drummond
- Professor of Addiction Psychiatry. Addictions Department. National Addiction Centre. Institute of Psychiatry, Psychology and Neuroscience. King's College London. 4 Windsor Walk. London SE5 8AF U.K.; President of EUFAS (European Federation of Addiction Societies), EU
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Łyszczarz B, Sowa K. Production losses due to mortality associated with modifiable health risk factors in Poland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:33-45. [PMID: 34236544 PMCID: PMC8882090 DOI: 10.1007/s10198-021-01345-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epidemiological burden of modifiable mortality risk factors is recognized in literature; however, less is known on the economic losses due to a range of such risks. AIM To estimate production losses (indirect cost) of mortality associated with risk factors as classified in Global Burden of Disease 2019 Study in Poland in years 2000, 2010, and 2017. METHODS We relied on the human capital method and societal perspective and used sex-, age-, region-, and risk-specific data on mortality due to modifiable risk factors and a set of socio-economic measures. RESULTS The production losses due to mortality attributable to all investigated risk factors accounted for 19.6-21.0 billion PLN (Polish zloty; 2017 exchange rate: 1€ = 4.26 PLN) and 1.44-2.45% of gross domestic product, depending on year. Behavioural factors were the most important contributor to overall burden (16.7-18.2 billion PLN), followed by metabolic factors (6.8-7.6 billion PLN) and environmental and occupational factors (3.0-3.5 billion PLN). Of disaggregated risks, alcohol and tobacco, high systolic blood pressure, and dietary risks proved to lead to the highest losses. Cost per death was greatest for child and maternal malnutrition, followed by intimate partner violence and childhood sexual abuse and bullying. Moreover, a notable regional variation of indirect cost was identified with losses ranging from 1.21 to 1.81% of regional gross domestic product in 2017. CONCLUSION Our findings provide economically hierarchised list of modifiable risk factors and they contribute to inform policy-makers in prioritizing programmes to improve health.
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Affiliation(s)
- Błażej Łyszczarz
- Department of Health Economics, Nicolaus Copernicus University in Toruń, Toruń, Poland.
| | - Karolina Sowa
- Department of Analyses and Strategies, Ministry of Health, Warsaw, Poland
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Rodríguez-Míguez E, Mosquera Nogueira J. Willingness to pay vs lottery equivalent to value the impact of alcohol misuse on quality of life. Expert Rev Pharmacoecon Outcomes Res 2021; 22:835-844. [PMID: 34779322 DOI: 10.1080/14737167.2022.2004124] [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: 10/19/2022]
Abstract
OBJECTIVES To estimate the impact of alcohol disorders using lottery equivalent (LE) and willingness to pay (WTP) methods and compute the WTP for a QALY (WTP-Q) derived from these values. METHODS Two samples of 300 people valued nine states of alcohol misuse. LE and WTP were used in sample 1 and 2, respectively. The ability to discriminate between methods was tested. Regression models were performed to estimate the preference weights of dimensions. Several values of WTP-Q were obtained by combining the estimated values from both samples. RESULTS LE and WTP produce the same ranking of states but LE is more sensitive. The estimated impact of the nine states ranges between 0.91 and 0.22 QALYs, and the WTP for avoiding them ranges between €10,444 and €4132. WTP-Q varies between €11,473 and €19,092 when the mean values of the states are used. The WTP-Q tends to decrease with the severity. CONCLUSIONS Although LE and WTP provide values for cost-utility and cost-benefit analyses, respectively, LE seems to be preferable for measuring the impact of alcohol disorders. As the lower sensitivity of WTP seems to explain a WTP-Q decrease with severity, more research is needed before recommending the use of different WTP-Q values.
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12
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Martínez-Loredo V, González-Roz A, Secades-Villa R, Fernández-Hermida JR, MacKillop J. Concurrent validity of the Alcohol Purchase Task for measuring the reinforcing efficacy of alcohol: an updated systematic review and meta-analysis. Addiction 2021; 116:2635-2650. [PMID: 33338263 PMCID: PMC9186155 DOI: 10.1111/add.15379] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/09/2020] [Accepted: 12/09/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS An early meta-analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol's relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta-analysis sought to: (1) estimate the relationships between trait-based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects. METHODS A meta-analysis of 50 cross-sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg-Mazumdar, Egger's and Duval & Tweedie's trim-and-fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol-related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), Omax (i.e. maximum expenditure), Pmax (i.e. price associated to Omax ) and breakpoint (i.e. price at which consumption ceases). RESULTS All alcohol demand indices were significantly associated with all alcohol-related outcomes (r = 0.132-0.494), except Pmax , which was significantly associated with alcohol-related problems only (r = 0.064). The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between Omax and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small-study effects was limited. CONCLUSIONS The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and Omax are the most relevant indices to account for alcohol involvement.
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Affiliation(s)
- Victor Martínez-Loredo
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain,Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology, University of the Balearic Islands, Research Institute on Health Sciences, Palma de Mallorca, Spain,Department of Psychology, University of Oviedo, Oviedo, Spain
| | | | | | - James MacKillop
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton/McMaster University, Hamilton, ON, Canada
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Manthey J, Hassan SA, Carr S, Kilian C, Kuitunen-Paul S, Rehm J. What are the Economic Costs to Society Attributable to Alcohol Use? A Systematic Review and Modelling Study. PHARMACOECONOMICS 2021; 39:809-822. [PMID: 33970445 PMCID: PMC8200347 DOI: 10.1007/s40273-021-01031-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Alcohol-attributable costs to society are captured by cost-of-illness studies, however estimates are often not comparable, e.g. due to the omission of relevant cost components. In this contribution we (1) summarize the societal costs attributable to alcohol use, and (2) estimate the total costs under the assumption that all cost components are considered. METHODS A systematic review and meta-analyses were conducted for studies reporting costs from alcohol consumption for the years 2000 and later, using the EMBASE and MEDLINE databases. Cost estimates were converted into 2019 international dollars (Int$) per adult and into percentage of gross domestic product (GDP). For each study, weights were calculated to correct for the exclusion of cost indicators. RESULTS Of 1708 studies identified, 29 were included, and the mean costs of alcohol use amounted to 817.6 Int$ per adult (95% confidence interval [CI] 601.8-1033.4), equivalent to 1.5% of the GDP (95% CI 1.2-1.7%). Adjusting for omission of cost components, the economic costs of alcohol consumption were estimated to amount to 1306 Int$ per adult (95% CI 873-1738), or 2.6% (95% CI 2.0-3.1%) of the GDP. About one-third of costs (38.8%) were incurred through direct costs, while the majority of costs were due to losses in productivity (61.2%). DISCUSSION The identified cost studies were mainly conducted in high-income settings, with high heterogeneity in the employed methodology. Accounting for some methodological variations, our findings demonstrate that alcohol use continues to incur a high level of cost to many societies. REGISTRATION PROSPERO #CRD42020139594.
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Syed Ahmed Hassan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
- Institute of Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Sinclair Carr
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01309, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation
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Aleixandre-Benavent R, Agulló-Calatayud V, Alonso-Arroyo A, Bueno-Cañigral FJ, Castelló-Cogollos L, Lucas-Domínguez R, Melero-Fuentes D, Sixto-Costoya A, Vidal-Infer A, Valderrama-Zurián JC. Investigación española en las áreas de adicciones y de trastornos de la alimentación: análisis de la producción, colaboración e impacto científico (1962-2017). REVISTA ESPANOLA DE DOCUMENTACION CIENTIFICA 2021. [DOI: 10.3989/redc.2021.3.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Las adicciones y los trastornos de la alimentación constituyen uno de los principales problemas de salud en la sociedad contemporánea al que se destinan gran cantidad de recursos destinados a la investigación para su prevención y tratamiento. Objetivos. Analizar la investigación española en el área de adicciones y trastornos de la alimentación desde que se publicó el primer trabajo recogido en bases de datos bibliográficas y desde una perspectiva bibliométrica. Metodología. Para obtener la información necesaria se consultaron las bases de datos Web of Science, Scopus y bases de datos del CSIC. Se elaboró un perfil de búsqueda específico. Se obtuvieron indicadores bibliométricos de producción, colaboración e impacto científico. Se utilizó el análisis de redes sociales para identificar las redes de investigadores y sus relaciones de colaboración, así como la red de co-palabras clave. Resultados. La producción científica aumentó progresivamente durante los casi 50 años analizados. Los trabajos se publicaron en una gran variedad de revistas nacionales y extranjeras, entre las que destacaron Adicciones, Revista Española de Drogodependencias, Trastornos Adictivos y Salud y Drogas. Conclusiones. La producción, colaboración e impacto de la investigación ha sido creciente y las adicciones más estudiadas fueron el tabaquismo, alcoholismo, consumo de cocaína y consumo de anfetaminas.
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Saar I, Koitla H. Quantifying the social costs and benefits of tobacco in Estonia. Tob Control 2021; 30:286-292. [PMID: 32381681 DOI: 10.1136/tobaccocontrol-2019-055419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/27/2020] [Accepted: 03/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The tobacco cost literature has predominantly focused on estimating direct healthcare costs and productivity losses from morbidity and mortality. This study places a greater focus on the effects that arise through the fiscal system, illicit trade and fire accidents to estimate the social costs and benefits of tobacco use in Estonia in 2018. METHODS A prevalence-based cost-of-illness approach was used, relying on data from the 2017-2018 period. Age-specific tobacco-attributable fractions were employed to estimate the costs and benefits of tobacco-related morbidity and mortality. Data on mortality, morbidity and healthcare costs were received from the National Institute of Health Development and the Estonian Health Insurance Fund. We used data for offences and fires from the Estonian Rescue Board and the Estonian Tax and Customs Board. RESULTS It was estimated that the total social cost attributable to tobacco in Estonia in 2018 was €174 million, representing 0.67% of the nation's GDP. If future benefits are also considered, the net social cost is €78 million. While the greatest cost components are productivity losses from mortality and morbidity, the level of tobacco-related law enforcement costs are comparable to direct healthcare costs, both of which exceed €10 million annually. CONCLUSIONS Despite the substantial social benefits arising through the fiscal system, tobacco-related costs outweighed these benefits in Estonia in 2018. In addition, a considerable portion of the economic burden of tobacco is associated with illicit trade. Therefore, the healthcare and law enforcement sectors would both benefit from effective tobacco control policies.
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Affiliation(s)
- Indrek Saar
- Financial College, Estonian Academy of Security Sciences, Tallinn, Harjumaa, Estonia
- School of Governance, Law and Society, Tallinn University, Tallinn, Harjumaa, Estonia
| | - Helle Koitla
- Financial College, Estonian Academy of Security Sciences, Tallinn, Harjumaa, Estonia
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Manthey J, Hassan SA, Carr S, Kilian C, Kuitunen-Paul S, Rehm J. Estimating the economic consequences of substance use and substance use disorders. Expert Rev Pharmacoecon Outcomes Res 2021; 21:869-876. [PMID: 33899647 DOI: 10.1080/14737167.2021.1916470] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This contribution gives an overview on estimating the economic impact of substance use (SU) and substance use disorders (SUDs) from a societal perspective. AREAS COVERED In this Expert Review, we first discuss the scope of the economic costs of SU to society and the methods used to estimate them. In general, cost studies should not be limited to SUDs, but should also include costs related to the consequences of any type of SU to achieve a comprehensive picture of the societal burden. Further, estimating potentially avoidable costs will increase the value of cost studies. Importantly, methodologically sound cost studies shed light on the magnitude of societal problems related to SU and can be used as a reference point to evaluate regulatory policies and other preventive measures. The area of estimating potential economic benefits of SU is understudied and lacks a theoretical and methodological framework. EXPERT OPINION Overall, economic studies on the impact of SU and SUDs can strongly contribute to better-informed decision-making in the creation of regulatory and control policies. The least developed area of research refers to a consensus methodology that could be used in studies which compare economic costs to potential economic benefits.
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Syed Ahmed Hassan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | - Sinclair Carr
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.,WHO Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Casal B, Rodríguez-Míguez E, Rivera B. Measuring intangible cost-of-morbidity due to substance dependence: implications of using alternative preference-based instruments. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1039-1048. [PMID: 32419059 DOI: 10.1007/s10198-020-01196-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Drug and/or alcohol dependence (DAD) generates substantial costs to society. One of the main consequences of DAD is its negative impact on health-related quality of life (HRQoL). The main objective of this study is to analyse the impact of using EQ-5D-5L, SF-6DSG (SF-6D using standard-gamble as the preference-eliciting method) and SF-6DPG (SF-6D using a paired-gamble method), to estimate the HRQoL burden, attributable to DAD, within the cost-of-illness framework. METHODS A convenience sample of 109 patients with a diagnosis of substance use disorder was recruited. SF-6D and EQ-5D-5L were administered and then the utility scores were computed. The impact of employing different instruments to estimate the HRQoL burden was assessed by comparing the utility scores of patients and general population after controlling for sex and age through regression analysis. The analysis was reproduced for two subgroups of severity. RESULTS All instruments detect that DAD significantly affects the HRQoL. However, the estimated impact changes, according to the instrument used, whose pattern varies by severity group. Nonetheless, regardless of severity, SF-6DPG always estimates a higher or equal DAD burden than the other instruments considered. These results are compatible with the presence of the floor effect in SF-6DSG, the ceiling effect in EQ-ED-5L, and a smaller presence of both biases in SF-6DPG. CONCLUSIONS The SF-6DPG instrument emerges as a good candidate to avoid under-estimating intangible costs within the cost-of-illness framework. However, further research is needed to assess the validity of our results in the context of other health problems.
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Affiliation(s)
- Bruno Casal
- Department of Economics, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain
| | - Eva Rodríguez-Míguez
- Department of Applied Economics, University of Vigo, Campus As Lagoas-Marcosende, 36310, Vigo, Spain
| | - Berta Rivera
- Department of Economics, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain.
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López-Pelayo H, Zuluaga P, Caballeria E, Van den Brink W, Mann K, Gual A. Safety of nalmefene for the treatment of alcohol use disorder: an update. Expert Opin Drug Saf 2019; 19:9-17. [PMID: 31868031 DOI: 10.1080/14740338.2020.1707802] [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: 10/25/2022]
Abstract
Introduction: Reduced drinking has been debated as a treatment goal for heavy drinking alcohol-dependent patients, in whom treatment based on abstinence is not always an option. Nalmefene was the first drug approved by the European Medicines Agency (2013) with the indication of reduced drinking in high drinking risk level alcohol-dependent patients. Six years after its introduction in Europe, data from clinical experience can be compared with those from preclinical studies and pivotal registration studies to evaluate what nalmefene has added to the treatment of AUD.Areas covered: Systematic review of efficacy and safety data of nalmefene use in humans from preclinical, phase III and phase IV studies, including systematic reviews, meta-analyses, cost-effectiveness analyses, and other secondary analyses.Expert opinion: Nalmefene introduces a paradigm change in the treatment of AUD that makes it appealing to patients that are reluctant to embrace abstinence, and facilitate patient-centered care in heavy users. However, information regarding safety data in special populations (e.g., patients with alcohol-related diseases, pregnancy, psychiatric disease), and direct comparisons with other potential drugs for alcohol reduction are further needed. Despite the promising role of nalmefene, there are still some factors that limit its wide prescription further than in specialized settings.
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Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Paola Zuluaga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elsa Caballeria
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Wim Van den Brink
- Department of Psychiatry, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karl Mann
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
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Production Losses Associated with Alcohol-Attributable Mortality in the European Union. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193536. [PMID: 31546662 PMCID: PMC6801817 DOI: 10.3390/ijerph16193536] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022]
Abstract
The economic aspects of alcohol misuse are attracting increasing attention from policy makers and researchers but the evidence on the economic burden of this substance is hardly comparable internationally. This study aims to overcome this problem by estimating production losses (indirect costs) associated with alcohol-attributable mortality in 28 European Union (EU) countries in the year 2016. This study applies the prevalence-based top-down approach, societal perspective and human capital method to sex- and age-specific data on alcohol-related mortality at working age. The alcohol-attributable mortality data was taken from estimates based on the Global Burden of Disease Study 2016. Uniform data on labor and economic measures from the Eurostat database was used. The total production losses associated with alcohol-related deaths in the EU in 2016 were €32.1 billion. The per capita costs (share of costs in gross domestic product (GDP)) were €62.88 (0.215%) for the whole EU and ranged from €17.29 (0.062%) in Malta to €192.93 (0.875%) in Lithuania. On average, 81% of the losses were associated with male deaths and mortality among those aged 50-54 years generated the highest burden. Because alcohol is a major avoidable factor for mortality, public health community actions aimed at limiting this substance misuse might not only decrease the health burden but also contribute to the economic welfare of European societies.
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Tanabe J, Regner M, Sakai J, Martinez D, Gowin J. Neuroimaging reward, craving, learning, and cognitive control in substance use disorders: review and implications for treatment. Br J Radiol 2019; 92:20180942. [PMID: 30855982 PMCID: PMC6732921 DOI: 10.1259/bjr.20180942] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 01/17/2023] Open
Abstract
Substance use disorder is a leading causes of preventable disease and mortality. Drugs of abuse cause molecular and cellular changes in specific brain regions and these neuroplastic changes are thought to play a role in the transition to uncontrolled drug use. Neuroimaging has identified neural substrates associated with problematic substance use and may offer clues to reduce its burden on the patient and society. Here, we provide a narrative review of neuroimaging studies that have examined the structures and circuits associated with reward, cues and craving, learning, and cognitive control in substance use disorders. Most studies use advanced MRI or positron emission tomography (PET). Many studies have focused on the dopamine neurons of the ventral tegmental area, and the regions where these neurons terminate, such as the striatum and prefrontal cortex. Decreases in dopamine receptors and transmission have been found in chronic users of drugs, alcohol, and nicotine. Recent studies also show evidence of differences in structure and function in substance users relative to controls in brain regions involved in salience evaluation, such as the insula and anterior cingulate cortex. Balancing between reward-related bottom-up and cognitive-control-related top-down processes is discussed in the context of neuromodulation as a potential treatment. Finally, some of the challenges for understanding substance use disorder using neuroimaging methods are discussed.
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Affiliation(s)
| | - Michael Regner
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Joseph Sakai
- Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Diana Martinez
- Department of Psychiatry, Columbia University, New York, USA
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What Do Real Alcohol Outpatients Expect about Alcohol Transdermal Sensors? J Clin Med 2019; 8:jcm8060795. [PMID: 31195625 PMCID: PMC6616615 DOI: 10.3390/jcm8060795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 01/14/2023] Open
Abstract
Objective: Little is known about the potential acceptability of alcohol transdermal sensors among alcohol-dependent outpatients in routine clinical settings. The aim of the present study was to investigate patients’ attitudes towards alcohol transdermal sensors, as well as features associated with enhanced acceptability and usability. Methods: A cross-sectional survey among routine alcohol outpatients was conducted. The Drug Attitude Inventory (DAI-10) was adapted to the field of alcohol transdermal sensors for attitudes assessment. Likert-type and multiple-choice questions were used for acceptability and usability evaluation. Results: 68 patients completed the questionnaire, and the DAI-10 mean score was 3 (standard deviation (SD) = 6.5). Internal consistency revealed a Cronbach alpha of 0.613. The score of a single The score of a single Likert-type question about overall perceived value was 7.4 (SD = 2.6). Its correlation with mean DAI-10 scores was r = 0.633, with p < 0.001. Relapse prevention and a stricter treatment control from therapists were the main reported advantages. Perceived stigma was the main disadvantage. Features increasing device discretion would enhance its acceptability. Conclusions: The data suggest that transdermal sensors could play a role in the clinical treatment of alcohol outpatients and concerns regarding stigma should be taken into account. Future designs should try to minimize size and visibility and stigma concerns should be discussed with patients.
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Barrio P, Roncero C, Ortega L, Guardia J, Yuguero L, Gual A. The More You Take It, the Better It Works: Six-Month Results of a Nalmefene Phase-IV Trial. J Clin Med 2019; 8:jcm8040471. [PMID: 30959893 PMCID: PMC6518219 DOI: 10.3390/jcm8040471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/23/2019] [Accepted: 04/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Alcohol use disorders remain a major health problem. Reduced drinking has been increasingly recognized as a valuable alternative to abstinence. Nalmefene has shown in previous, experimental studies to be a useful tool to aid reduced drinking. However, more data from routine practice settings are needed in order to obtain evidence with high external validity. The aim of this study was to conduct a single-arm phase-IV study with alcohol-dependent outpatients starting with nalmefene for the first time. Here, we present the main effectiveness analysis, scheduled at six months. METHODS This was an observational, multisite, single-arm, phase-IV study conducted among adult alcohol-dependent outpatients who received nalmefene for the first time. The study consisted of four visits: Baseline, 1 month, 6 months, and 12 months. At each visit, drinking variables were obtained from the time-line follow-back regarding the previous month. Satisfaction with medication was also assessed from both patients and professionals with the Medication Satisfaction Questionnaire. A repeated measures mixed model was performed for effective analysis regarding drinking outcomes (reduction in total alcohol consumption and the number of heavy drinking days). Regression analyses were performed in order to find predictors of responses to nalmefene. RESULTS From a total of 110 patients included, 63 reported data at the six-month visit. On average, patients took nalmefene 69% of days during the month previous to the 6-month assessment. Compared to the one month results, the number of heavy drinking days and total alcohol consumption increased. Still, they were significantly lower than baseline values (outcome evolution over time was from 13.5 to 6.8 to 9.4 days/month, and from 169 to 79 to 116 units/month). A total of 23 patients were considered medication responders. The number of days of taking nalmefene was significantly associated in the regression analysis. Satisfaction was globally high for both professionals and patients and, overall, nalmefene was well-tolerated with no serious adverse events reported. CONCLUSION The data provided by this phase-IV study suggest that nalmefene is an effective, well-tolerated treatment for alcohol-dependence in real world, clinical settings.
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Affiliation(s)
- Pablo Barrio
- Addictive Behaviors Unit, Clinic Hospital, University of Barcelona, Barcelona 08036, Spain.
| | - Carlos Roncero
- Psychiatry Service. University of Salamanca Health Care Complex, Institute of Biomedicine. University of Salamanca, Salamanca 37007, Spain.
| | - Lluisa Ortega
- Addictive Behaviors Unit, Clinic Hospital, University of Barcelona, Barcelona 08036, Spain.
| | - Josep Guardia
- Addictive Behavior Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona 08041, Spain.
| | - Lara Yuguero
- Addictive Behaviors Unit, Germanes Hospitalàries, Sant Boi, Barcelona 08830, Spain.
| | - Antoni Gual
- Addictive Behaviors Unit, Clinic Hospital, University of Barcelona, Barcelona 08036, Spain.
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Jadhav KS, Peterson VL, Halfon O, Ahern G, Fouhy F, Stanton C, Dinan TG, Cryan JF, Boutrel B. Gut microbiome correlates with altered striatal dopamine receptor expression in a model of compulsive alcohol seeking. Neuropharmacology 2018; 141:249-259. [DOI: 10.1016/j.neuropharm.2018.08.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 02/06/2023]
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Systematic review of guidelines in estimating social costs on drugs. GACETA SANITARIA 2018; 32:481-487. [DOI: 10.1016/j.gaceta.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 11/22/2022]
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Synthetic Cannabinoid use in a Case Series of Patients with Psychosis Presenting to Acute Psychiatric Settings: Clinical Presentation and Management Issues. Brain Sci 2018; 8:brainsci8070133. [PMID: 30011896 PMCID: PMC6071094 DOI: 10.3390/brainsci8070133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Novel Psychoactive Substances (NPS) are a heterogeneous class of synthetic molecules including synthetic cannabinoid receptor agonists (SCRAs). Psychosis is associated with SCRAs use. There is limited knowledge regarding the structured assessment and psychometric evaluation of clinical presentations, analytical toxicology and clinical management plans of patients presenting with psychosis and SCRAs misuse. Methods: We gathered information regarding the clinical presentations, toxicology and care plans of patients with psychosis and SCRAs misuse admitted to inpatients services. Clinical presentations were assessed using the PANSS scale. Vital signs data were collected using the National Early Warning Signs tool. Analytic chemistry data were collected using urine drug screening tests for traditional psychoactive substances and NPS. Results: We described the clinical presentation and management plan of four patients with psychosis and misuse of SCRAs. Conclusion: The formulation of an informed clinical management plan requires a structured assessment, identification of the index NPS, pharmacological interventions, increases in nursing observations, changes to leave status and monitoring of the vital signs. The objective from using these interventions is to maintain stable physical health whilst rapidly improving the altered mental state.
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Ranaweera S, Amarasinghe H, Chandraratne N, Thavorncharoensap M, Ranasinghe T, Karunaratna S, Kumara D, Santatiwongchai B, Chaikledkaew U, Abeykoon P, De Silva A. Economic costs of alcohol use in Sri Lanka. PLoS One 2018; 13:e0198640. [PMID: 29879178 PMCID: PMC5991751 DOI: 10.1371/journal.pone.0198640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023] Open
Abstract
Aim Alcohol related disease conditions are responsible for a significant proportion of morbidity and mortality in Sri Lanka. This study quantified the economic cost of selected alcohol related disease conditions in Sri Lanka in 2015. Methods This study uses the prevalence-based cost of illness methodology specified by the World Health Organization, and uses the gross costing approach. The direct costs includes the costs of curative care (inpatient and outpatient care borne by the state and out of pocket expenditure borne by patients) for alcohol related diseases, weighted by the respective population attributable fractions. Indirect costs consist of lost earnings due to absenteeism of the patient and carers due to seeking care and recuperation, and the loss of income due to mortality. Data form the Ministry of Health, Registrar General’s Department, Department of Census and Statistics and the National Cancer Registry was used. Systemic and house costs and population attributable fractions were obtained from research studies. Economists, Public Health Experts, Medical Administrators and Clinical Specialists were iteratively consulted during the estimation and validation of the costs and the results. Results The estimated present value of current and future economic cost of the alcohol-related conditions for Sri Lanka in 2015 was USD 885.86 million, 1.07% of the GDP of that year. The direct cost of alcohol related disease conditions was USD 388.35 million, which was 44% of the total cost, while the indirect cost was USD 497.50 million, which was 66% of the total cost. Road Injury cost was the highest cost category among the conditions studied. Conclusion Addressing alcohol use and its harms through effective implementation of evidence-based polices and interventions is urgently required to address the economic costs of alcohol use in Sri Lanka as it imposes a significant burden to the country.
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Affiliation(s)
| | - Hemantha Amarasinghe
- Sri Lanka Medical Association, Colombo, Sri Lanka
- Ministry of Health, Nutrition and Indigenous Medicine, Institute of Oral Health, Maharagama, Sri Lanka
| | | | | | | | - Sumudu Karunaratna
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Dinesh Kumara
- Ministry of Health, Nutrition and Indigenous Medicine, National Authority on Tobacco and Alcohol, Battaramulla, Sri Lanka
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Usa Chaikledkaew
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Palitha Abeykoon
- Ministry of Health, Nutrition and Indigenous Medicine, National Authority on Tobacco and Alcohol, Battaramulla, Sri Lanka
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Bruguera P, Barrio P, Oliveras C, Braddick F, Gavotti C, Bruguera C, López‐Pelayo H, Miquel L, Segura L, Colom J, Ortega L, Vieta E, Gual A. Effectiveness of a Specialized Brief Intervention for At-risk Drinkers in an Emergency Department: Short-term Results of a Randomized Controlled Trial. Acad Emerg Med 2018; 25:517-525. [PMID: 29418049 DOI: 10.1111/acem.13384] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/19/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs have been developed, evaluated, and shown to be effective, particularly in primary care and general practice. Nevertheless, effectiveness of SBIRT in emergency departments (EDs) has not been clearly established. OBJECTIVE We aimed to evaluate the feasibility and efficacy of an SBIRT program conducted by highly specialized professionals in the ED of a tertiary hospital. METHODS We conducted a randomized controlled trial to study the feasibility and efficacy of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the three-item version of the Alcohol Use Disorder Identification Test (AUDIT-C). Patients were randomized to two groups, with the control group receiving two leaflets-one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. The primary outcomes were the proportion of at-risk alcohol use measured by AUDIT-C scale and the proportion of patients attending specialized treatment at 1.5 months. RESULTS Of 3,027 patients presenting to the ED, 2,044 (67%) were potentially eligible to participate, 247 (12%) screened positive for at-risk drinking, and 200 agreed to participate. Seventy-two percent of the participating sample were men, and the mean (±SD) age was 43 (±16.7) years. Follow-up rates were 76.5%. At 1.5 months, the intervention group showed greater reductions in alcohol consumption and fewer patients continuing with at-risk alcohol use (27.8% vs. 48.1%; p = 0.01). The SBIRT program also increased the probability of attending specialized treatment, compared to the control condition (23% vs. 9.8%, p = 0.0119) CONCLUSION: The SBIRT program in the ED was found to be feasible and effective in identifying at-risk drinkers, reducing at-risk alcohol use, and increasing treatment for alcohol problems.
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Affiliation(s)
- Pol Bruguera
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Pablo Barrio
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Clara Oliveras
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
| | - Fleur Braddick
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
| | - Carolina Gavotti
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
| | - Carla Bruguera
- Program on Substance Abuse Public Health Agency Government of Catalonia Barcelona Spain
| | - Hugo López‐Pelayo
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Laia Miquel
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Lídia Segura
- Program on Substance Abuse Public Health Agency Government of Catalonia Barcelona Spain
| | - Joan Colom
- Program on Substance Abuse Public Health Agency Government of Catalonia Barcelona Spain
| | - Lluisa Ortega
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Eduard Vieta
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM) Madrid Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Antoni Gual
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
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Witkiewitz K, Vowles KE. Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol Clin Exp Res 2018; 42:478-488. [PMID: 29314075 PMCID: PMC5832605 DOI: 10.1111/acer.13594] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Abstract
The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid-related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder (AUD) are a highly prevalent public health problem associated with considerable individual and societal costs. This study provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on AUD and OUD treatment outcomes, respectively, the role of pain in the co-use of alcohol and opioids, and treatment of comorbid OUD and AUD. Heavy drinking, opioid misuse, and chronic pain individually represent significant public health problems. Few studies have examined co-use of alcohol and opioids, but available data suggest that co-use is common and likely contributes to opioid overdose-related morbidity and mortality. Co-use of opioids and alcohol is related to worse outcomes in treatment for either substance. Finally, chronic pain frequently co-occurs with use (and co-use) of alcohol and opioids. Opioid use and alcohol use are also likely to complicate the treatment of chronic pain. Research on the interactions between alcohol and opioids, as well as treatment of the comorbid disorders is lacking. Currently, most alcohol research excludes patients with OUD and there is lack of measurement in both AUD and OUD research in relation to pain-related functioning. Research in those with chronic pain often assesses opioid use, but rarely assesses alcohol use or AUD. New research to examine the nexus of alcohol, opioids, and pain, as well as their treatment, is critically needed.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM
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Pedersen CA. Oxytocin, Tolerance, and the Dark Side of Addiction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 136:239-274. [PMID: 29056153 DOI: 10.1016/bs.irn.2017.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Substance use disorders blight the lives of millions of people and inflict a heavy financial burden on society. There is a compelling need for new pharmacological treatments as current drugs have limited efficacy and other major drawbacks. A substantial number of animal and recent clinical studies indicate that the neuropeptide, oxytocin, is a particularly promising therapeutic agent for human addictions, especially alcohol use disorders. In preliminary trials, we found that oxytocin administered by the intranasal route, which produces some neuropeptide penetration into the CNS, potently blocked withdrawal and reduced alcohol consumption in heavy drinkers. A considerable body of earlier animal studies demonstrated that oxytocin inhibits tolerance to alcohol, opioids, and stimulants as well as withdrawal from alcohol and opioids. Based on these preclinical findings and our clinical results, we hypothesize that oxytocin may exert therapeutic effects in substance dependence by the novel mechanism of diminishing established tolerance. A newer wave of studies has almost unanimously found that oxytocin decreases self-administration of a number of addictive substances in several animal models of addiction. Reduction of established tolerance should be included among the potential explanations of oxytocin effects in these studies and changes in tolerance should be examined in future studies in relationship to oxytocin influences on acquisition and reinstatement of self-administration as well as extinction of drug seeking. Oxytocin efficacy in reducing anxiety and stress responses as well as established tolerance suggests it may be uniquely effective in reducing negative reinforcement (Koob's "dark side" of addiction) that maintains chronic substance use.
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Affiliation(s)
- Cort A Pedersen
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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