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Andersson HW, Nordfjærn T, Mosti MP. The relationship between the Hopkins symptom checklist-10 and diagnoses of anxiety and depression among inpatients with substance use disorders. Nord J Psychiatry 2024; 78:319-327. [PMID: 38421343 DOI: 10.1080/08039488.2024.2323124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The Hopkins Symptom Checklist-10 (HSCL-10) is a self-report inventory of anxiety and depression symptoms that may assist clinicians in screening for clinical conditions among patients with substance use disorder (SUD). We examined the HSCL-10 as a screening tool for anxiety and depressive disorders within a general population of SUD inpatients. METHODS We used data from a cohort study of 611 SUD inpatients. Receiver operating characteristic (ROC) analyses were conducted, with and without covariates, to evaluate the potential of the HSCL-10 as a screening tool. This was explored using any anxiety disorder, especially posttraumatic stress disorder (PTSD), and any mood disorder, especially major depressive disorders, as the outcome criteria. Candidate covariates included gender, age, education, polydrug use and treatment center.Results: The HSCL-10 had a moderate ability to identify caseness (i.e. having or not having a clinical diagnosis) according to each outcome criterion, with the area under the ROC curve (AUC) varying from 0.64 to 0.66. Adding relevant covariates markedly enhanced the instrument's ability to identify those who met the criteria for any anxiety disorder (AUC = 0.77), especially PTSD (AUC = 0.82). CONCLUSION In a real-world clinical setting, the HSCL-10 has fair-to-good clinical utility for identifying SUD inpatients who have comorbid clinical symptoms of anxiety disorders or PTSD, when combined with common background variables. The HSCL-10, a brief self-report screening tool, may serve as an efficient proxy for comprehensive interviews used in research and for clinical anxiety symptom screening among patients with SUD.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Nordfjærn
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mats P Mosti
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
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Leza L, Haro B, López-Goñi JJ, Fernández-Montalvo J. Substance use disorder and lifetime suicidal behaviour: A scoping review. Psychiatry Res 2024; 334:115830. [PMID: 38432115 DOI: 10.1016/j.psychres.2024.115830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Suicidal behaviours are prevalent in substance use disorder (SUD) patients. These behaviours have a negative impact on the psychopathological profile of these patients. However, few studies have evaluated suicide as a continuum (i.e. starting with ideation, followed by attempts and ending with death) and its evolution during treatment. The aim of this scoping review was to explore what is known about suicidal behaviour in individuals undergoing clinical treatment for SUD. METHODS The PsycINFO, Web of Science (Core Collection and MEDLINE), Scopus, and Cochrane Library databases were searched. After screening the records based on eligibility and exclusion criteria, 30 studies were ultimately selected for inclusion. RESULTS Most of the studies were conducted in the USA and Europe. Only three studies evaluated suicidal behaviour with a specific instrument. The prevalence of suicidal ideation (SI) in people being treated for SUD ranged from 20 % to 62.2 %, and the prevalence of suicide attempts (SA) ranged from 15.8 % to 52.1 %. Only one study reported death by suicide. CONCLUSIONS Despite the high prevalence of suicidal behaviours and their harmful consequences, the assessment of this phenomenon is scarce and heterogeneous. There is a need to assess suicidal behaviour with standardized criteria in order to develop tailored SUD treatment.
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Affiliation(s)
- Leire Leza
- Departament of Health Sciences, Universidad Pública de Navarra, Campus de Arrosadía, Pamplona 31006, Spain.
| | - Begoña Haro
- Departament of Health Sciences, Universidad Pública de Navarra, Campus de Arrosadía, Pamplona 31006, Spain
| | - José J López-Goñi
- Departament of Health Sciences, Universidad Pública de Navarra, Campus de Arrosadía, Pamplona 31006, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Javier Fernández-Montalvo
- Departament of Health Sciences, Universidad Pública de Navarra, Campus de Arrosadía, Pamplona 31006, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
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Evans SK, Dopp A, Meredith LS, Ober AJ, Osilla KC, Komaromy M, Watkins KE. Findings from an Organizational Context Survey to Inform the Implementation of a Collaborative Care Study for Co-occurring Disorders. J Behav Health Serv Res 2024; 51:4-21. [PMID: 37537428 PMCID: PMC10733218 DOI: 10.1007/s11414-023-09851-6] [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] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
Primary care is an opportune setting to deliver treatments for co-occurring substance use and mental health disorders; however, treatment delivery can be challenging due multi-level implementation barriers. Documenting organizational context can provide insight into implementation barriers and the adaptation of new processes into usual care workflows. This study surveyed primary care and behavioral health staff from 13 clinics implementing a collaborative care intervention for opioid use disorders co-occurring with PTSD and/or depression as part of a multisite randomized controlled trial. A total of 323 completed an online survey for a 60% response rate. The Consolidated Framework for Implementation Research guided this assessment of multi-level factors that influence implementation. Most areas for improvement focused on inner setting (organizational level) constructs whereas individual-level constructs tended to be strengths. This work addresses a research gap regarding how organizational analyses can be used prior to implementation and provides practical implications for researchers and clinic leaders.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Karen C Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Miriam Komaromy
- Boston Medical Center, Grayken Center for Addiction, One Boston Medical Center Place, Boston, MA, 02118, USA
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Fomiatti R, Pienaar K, Savic M, Keane H, Treloar C. Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104198. [PMID: 37801912 DOI: 10.1016/j.drugpo.2023.104198] [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: 05/24/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023]
Abstract
Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.
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Affiliation(s)
- Renae Fomiatti
- Sociology, School of Humanities and Social Sciences, Deakin University, Burwood, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kiran Pienaar
- Sociology, School of Humanities and Social Sciences, Deakin University, Burwood, Victoria, Australia
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia; Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Helen Keane
- School of Sociology, Research School of Social Sciences, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carla Treloar
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
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Walter ZC, Carlyle M, Kerswell N, Mefodeva V, Nixon RDV, Cobham VE, Hides L. Study protocol: implementing and evaluating a trauma-informed model of care in residential youth treatment for substance use disorders. Front Psychiatry 2023; 14:1169794. [PMID: 37840800 PMCID: PMC10572352 DOI: 10.3389/fpsyt.2023.1169794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Comorbidity between Substance Use Disorders and trauma/post-traumatic stress disorder (PTSD) is common, particularly within residential treatment services. Comorbidity is associated with poorer treatment retention and treatment outcomes. Integrated treatment approaches are increasingly recommended but are still under examined in residential treatment services. This study will implement and evaluate a novel model of trauma-informed care (TIC) in a youth (18-35 years) residential substance use treatment service. Methods and analysis A single-armed, phase 1 implementation trial will be conducted in one residential treatment service. The model, co-developed with staff, incorporates: (i) workforce development in TIC through staff training and clinical supervision; adaptions to the service (ii) policies, procedures, and physical settings and (iii) treatment program adaptions (in delivery style and content) to be more trauma-informed; (iv) client screening and feedback for trauma and PTSD at service entry; and (v) the provision of support, referral and/or trauma-focused therapy to those with PTSD. Service outcomes will include adherence to the TIC model and client treatment completion. Client substance use and mental health measures will be collected at service entry, and 1-, 3-, 6- and 12-months follow up. Staff outcomes, including workplace satisfaction, burnout, and fatigue, as well as perceptions and confidence in delivering TIC will be collected at baseline, and at 3-, 6-, 12- and 18-months following training in the model. The sustainability of the delivery of the TIC model of care will be evaluated for 12 months using service and staff outcomes. Ethics and dissemination The study has received ethical approval by the University of Queensland (Approval number: 2020000949). The results will be disseminated through publication in a peer-reviewed scientific journal, presentations at scientific conferences, and distributed via a report and presentations to the partner organization.Clinical trial registration: ACTRN12621000492853.
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Affiliation(s)
- Zoe C. Walter
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Molly Carlyle
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Nick Kerswell
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Valeriya Mefodeva
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Reg D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Vanessa E. Cobham
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Children’s Health Queensland, Child and Youth Mental Health Service, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
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Osilla KC, Meredith LS, Griffin BA, Martineau M, Hindmarch G, Watkins KE. Design of CLARO+ (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses, Plus): A randomized trial of collaborative care to decrease overdose and suicide risk among patients with co-occurring disorders. Contemp Clin Trials 2023; 132:107294. [PMID: 37454728 PMCID: PMC10528487 DOI: 10.1016/j.cct.2023.107294] [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: 03/30/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The United States is mired in two intertwined epidemics of death from suicide and overdose. Opioid use disorder (OUD) and mental illness contribute to both, and individuals with co-occurring disorders (CODs) are a complex population at high risk. Although universal prevention makes sense from a public health perspective, medical and behavioral health providers often lack the time to proactively address these issues with all patients. In this study, we build upon a parent study called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO), a model of collaborative care in which care coordinators deliver preventative measures to high-risk patients and coordinate care with the patients' care team, with the goal of increasing MOUD retention and decreasing risk of suicide and overdose. METHODS CLARO+ adds intervention components on overdose prevention, recognition, and response training; lethal means safety counseling; and an effort to mail compassionate messages called Caring Contacts. Both CLARO and CLARO+ have been implemented at 17 clinics in New Mexico and California, and this study seeks to determine the difference in effectiveness between the two versions of the intervention. This paper describes the design protocol for CLARO+. CONCLUSION CLARO+ is an innovative approach that aims to supplement existing collaborative care with additional suicide and overdose prevention strategies. CLINICALTRIALS gov: NCT04559893.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304-5590, United States.
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Monique Martineau
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
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Harvey LR, Hopkins R, Truscott M, Marel C, Slade T, Mills KL. A retrospective chart review of trauma-related documentation in an Australian substance use treatment service. Drug Alcohol Rev 2023; 42:373-383. [PMID: 36377196 PMCID: PMC10947072 DOI: 10.1111/dar.13575] [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: 05/21/2022] [Revised: 09/16/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trauma exposure among clients of substance use treatment services is almost universal and rates of trauma-related symptoms are correspondingly high. This study examined one aspect of clinical care-clinical documentation-and sought to systematically assess the documentation of trauma-related comorbidities and their treatment in a substance use treatment setting. METHODS A retrospective chart review was conducted on a sample of 300 patient records in a public substance use treatment setting. Rates of documentation of trauma-related events, symptoms and treatment, along with variables influencing the documentation of these issues, were examined. RESULTS Trauma-related documentation was present in 45.3% of records. There were documented trauma-related symptoms in 15.3% of records, although treatment activities addressing trauma were only present in 2.3% of records. Being female (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.42, 4.69), having prior mental health treatment (OR 1.82, 95% CI 1.05, 1.12) and having more treatment sessions (OR 1.08, 95% CI = 1.05, 1.12) increased the odds of trauma-related documentation being present, while being in the first episode of treatment (OR 0.49, 95% CI = 0.28, 0.84) decreased the odds. DISCUSSION AND CONCLUSIONS This study highlights significant under documentation of trauma-related comorbidities in substance-use treatment. There is limited evidence of consideration of trauma-related symptoms or diagnoses, and trauma-related comorbidities are rarely included in treatment planning activities. The lack of documented trauma-related information has important clinical and medico-legal implications for patients, and provides evidence to suggest a lack of integration of treatment for trauma-related disorders in substance use settings.
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Affiliation(s)
- Logan R. Harvey
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Rachel Hopkins
- Drug Health, Western Sydney Local Health DistrictSydneyAustralia
| | - Melanie Truscott
- Drug Health, Western Sydney Local Health DistrictSydneyAustralia
| | - Christina Marel
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Katherine L. Mills
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
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Baekkerud SH, Sømhovd MJ, Martinussen LM. Violence - suicide and suicidal ideation as sequelae of trauma in substance use disorder inpatients. Scand J Psychol 2022; 64:288-293. [PMID: 36567137 DOI: 10.1111/sjop.12891] [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: 01/03/2022] [Revised: 10/10/2022] [Accepted: 12/02/2022] [Indexed: 12/27/2022]
Abstract
Experience with psychological trauma is overrepresented among substance use disorder (SUD) patients. SUDs may also be a risk factor for violent behaviors, suicidal ideation and suicide. This study proposes a link between these phenomena. Based on data from the EuropASI clinical interview of 137 SUD inpatients we computed a composite variable of trauma experience from being abused. We report descriptive data and cross tabulated problems controlling violent behavior, suicidal ideation or suicide attempts variables with trauma experience. Hypothesizing an association between experienced trauma and the outcome variables. We also examined the correlation between three outcome variables in inpatients. Our data suggested high incidents of experienced psychological trauma in the sample (66.7%). Chi-square tests suggested a significant difference in controlling violent behavior, suicidal ideation and suicide attempts, dependent on trauma experience. Spearman Roh correlations suggested asscociations between suicdal ideation and suicide attempts, and suicdal ideation and problems controlling violent behavior, but not with suicide attempts. Our data suggests that past trauma is a risk factor for violent and suicidal behaviors in the SUD population. Based on our findings we propose that former trauma should be considered in risk assessments and help guide treatment interventions.
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Affiliation(s)
| | | | - Laila Marianne Martinussen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Giacomucci S, Marquit J, Walsh KM, Saccarelli R. A mixed-methods study on psychodrama treatment for PTSD and depression in inpatient substance use treatment: A comparison of outcomes pre-pandemic and during Covid-19. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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10
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Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractThis scoping review aimed to synthesise the published literature on guiding principles for managing co-occurring alcohol/other drug (AOD) and mental health conditions in AOD treatment settings. Systematic search of key electronic databases (January 1, 2010, to February 17, 2021) produced 4583 articles, and independent title/abstract and full text screening left 43 articles for inclusion. Fifteen guiding principles were identified, most commonly: build a strong therapeutic relationship (n = 24 articles), provide holistic care (n = 12), involve peer support (n = 7), ensure continuity of care (n = 6), support the professional development and competence of workers (n = 6), and provide trauma-informed care (n = 5). Remaining principles were identified in < 5 articles. Limited empirical literature examined the impact of guiding principles on patient- and treatment-related outcomes. This review provides the first comprehensive synthesis of the international literature to derive guiding principles for managing co-occurring AOD and mental health conditions in AOD treatment. Further empirical research is needed to determine the effectiveness of principles at improving outcomes.
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Robinson LD, Kelly PJ, Larance BK, Griffiths S, Deane FP. Eating Disorder Behaviours and Substance Use in Women Attending Treatment for Substance Use Disorders: a Latent Class Analysis. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rabinowitz LG, Zylberberg HM, Yang J, Gold SL, Chesner J, Ji J, Hu L, Dubinsky M. De Novo Ostomy Placement Is Associated with Increased Outpatient Opioid Use In Patients with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:4033-4042. [PMID: 34613501 DOI: 10.1007/s10620-021-07257-y] [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: 05/22/2021] [Accepted: 09/13/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND/AIMS Opioid use is associated with poor outcomes in patients with inflammatory bowel disease (IBD). We aimed to identify novel factors associated with increased outpatient opioid (OPRx) use following IBD-related hospitalization. METHODS This was a retrospective cohort study of IBD patients ≥ 18 years old, hospitalized during 2018. The primary outcome was receiving ≥ 1(OPRx) in the year following index hospitalization (IH), excluding prescriptions written within 2 weeks of discharge. Secondary outcomes included having 1-2 vs ≥ 3 OPRx and rates of healthcare utilization. Univariate and multivariate analyses tested associations with OPRx. RESULTS Of 526 patients analyzed, 209 (40%) received at least 1 OPRx; with a median of 2 [1-3] OPRx. Presence or placement of ostomy at IH, exposure to opioids during IH, ulcerative colitis (UC), mental health comorbidities, admission for surgery and managed on the surgical service, and IBD surgery within 1 year prior to IH were associated with ≥ 1 OPRx on univariate analysis. On multivariable analysis, UC, ostomy placement during IH, anxiety, and inpatient opioid exposure were independently associated with ≥ 1 OPRx. A majority (> 70%) of both inpatient and outpatient opioid prescriptions were written by surgeons. Patients requiring ≥ 3 OPRx had the highest rates of unplanned IBD surgery (56% p = 0.04), all-cause repeat hospitalization (81%, p = 0.003), and IBD-related repeat hospitalization (77%, p = 0.007) in the year following IH. CONCLUSIONS A multimodal approach to pain management for IBD patients, as well as increased recognition that any patient with a de novo ostomy is at particular risk of opioid use, is needed.
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Affiliation(s)
- Loren G Rabinowitz
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Haley M Zylberberg
- Division of Gastroenterology, Department of Medicine, New York Presbyterian Hospital-Columbia University, New York, NY, USA
| | - Jeong Yang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Lauren Gold
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn Chesner
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jiayi Ji
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Liangyuan Hu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marla Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine Mount Sinai, New York, NY, USA
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Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO): process of adapting collaborative care for co-occurring opioid use and mental disorders. Addict Sci Clin Pract 2022; 17:25. [PMID: 35395811 PMCID: PMC8991671 DOI: 10.1186/s13722-022-00302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
Background Opioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders. Methods Our adapted model is called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO). We used the five-step Map of Adaptation Process (McKleroy in AIDS Educ Prev 18:59–73, 2006) to develop the model. For each step, our stakeholder team of research and clinical experts, primary care partners, and patients provided input into adaptation processes (e.g., adaptation team meetings, clinic partner feedback, patient interviews and beta-testing). To document each adaptation and our decision-making process, we used the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman in Implement Sci 14:1–10, 2019). Results We documented 12 planned fidelity-consistent adaptations to collaborative care, including a mix of content, context, and training/evaluation modifications intended to improve fit with the patient population (co-occurring disorders) or the New Mexico setting (low-resource clinics in health professional shortage areas). Examples of documented adaptations include use of community health workers as care coordinators; an expanded consultant team to support task-shifting to community health workers; modified training protocols for Problem-Solving Therapy and Written Exposure Therapy to incorporate examples of treating patients for depression or PTSD with co-occurring OUD; and having care coordinators screen for patients’ social needs. Conclusions We completed the first three steps of the Map of Adaptation Process, resulting in a variety of adaptations that we believe will make collaborative care more acceptable and feasible in treating co-occurring OUD and mental health disorders. Future steps include evaluating the effectiveness of CLARO and documenting reactive and/or planned adaptations to the model that occur during its implementation and delivery. Trial registration NCT04559893, NCT04634279. Registered 08 September 2020, https://clinicaltrials.gov/ct2/show/NCT04559893
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Anastario M, Leston J, Crisp C, Lee C, Rink E. A qualitative study of services accessibility for indigenous persons who use injection drugs across three communities in the United States. J Ethn Subst Abuse 2022; 22:804-826. [PMID: 35266863 DOI: 10.1080/15332640.2022.2043798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aims: This study concerns the perspectives of Indigenous persons who use injection drugs (IPWIDs) and key stakeholders across multiple sectors regarding healthcare service and treatment accessibility in the United States.Methods: Sixty in-depth interviews were undertaken with selected participants (30 people who use injection drugs and 30 stakeholders) across three non-urban locations in the United States. An inductive analytic approach was used to explore perspectives regarding healthcare accessibility gaps.Results: IPWIDs described injecting stimulants, opioids, and diverted medications for opioid use disorder, as well as having unstable access to sterile syringes. Often, the most accessible treatment for IPWID substance use was engagement with punitive aspects of the criminal justice system. While local health and social services were described as providing limited or inadequate services for IPWIDs, human capital deficiencies in those agencies and institutions often reinforced barriers to accessibility for IPWIDs, further aggravating the epidemics of Hepatitis C Virus infection and overdose risk in Indigenous communities. Conclusions: Decolonizing approaches to IPWID-centered services are urgently needed to reduce disparities in transmission of infectious diseases and other health consequences of injection drug use among American Indian people. Potential pathways forward include moving away from punitive treatment of IPWIDs by the criminal justice system and toward local, tribally-centered, culturally appropriate treatment models. We identify an urgent need to provide reliable and local access to sterile injection equipment and opioid substitution treatment on or near reservations.
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Affiliation(s)
| | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Carolyn Crisp
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Crystal Lee
- University of New Mexico, Albuquerque, NM, USA
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Lopez-Fernandez O, Romo L, Kern L, Rousseau A, Graziani P, Rochat L, Achab S, Zullino D, Landrø NI, Zacarés JJ, Serra E, Chóliz M, Pontes HM, Griffiths MD, Kuss DJ. Perceptions Underlying Addictive Technology Use Patterns: Insights for Cognitive-Behavioural Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010544. [PMID: 35010804 PMCID: PMC8744933 DOI: 10.3390/ijerph19010544] [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: 11/15/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023]
Abstract
Cognitive-Behavioural Therapy (CBT) is considered the 'gold standard' in the treatment of addictive disorders related to excessive technology use. However, the cognitive components of problematic internet use are not yet well-known. The aim of the present study was to explore the cognitive components, that according to problematic users, can lead to potential internet addiction. A total of 854 European adults completed an online survey using a mixed-methods design. Internet problems and attachment styles were assessed, prevalence rates estimated, correlations, chi-squared automatic interaction detection, and content analysis were performed. Self-reported addictions to social networking, internet, and gaming had a prevalence between 1.2% (gaming) to 2.7% (social networking). Self-perception of the addiction problem and preoccupied attachment style were discriminative factors for internet addiction. In an analysis of qualitative responses from self-identified compulsive internet users, a sense of not belonging and feeling of disconnection during life events were perceived as causes for internet addiction. The development depended on a cycle of mixed feelings associated with negative thoughts, compensated by a positive online identity. The severity of this behaviour pattern produced significant impairment in various areas of the participants' functioning, suggesting a possible addiction problem. It is suggested that health professionals administering CBT should target unhealthy preoccupations and monitor mixed feelings and thoughts related to internet use to support coping with cognitive distortions.
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Affiliation(s)
- Olatz Lopez-Fernandez
- Fundación Jiménez Díaz University Hospital Health Research Institute, Fundación Jiménez Díaz University Hospital, Avda. Reyes Católicos 2, 28040 Madrid, Spain
- Correspondence:
| | - Lucia Romo
- CLInique PSYchanalyse Développement (CLIPSYD—EA4430), Université Paris Nanterre, 200 Av. de la République, 92000 Nanterre, France;
- Hôpital Universitaire Raymond Poincaré, AP-HP Garches, CESP, U1018 INSERM UPS UVSQ 2, 104 Bd Raymond Poincaré, 92380 Garches, France
| | - Laurence Kern
- EA 2931, Centre de Recherches sur le Sport et le Mouvement (CESRM), Université Paris Nanterre, 200 Av. de la République, 92000 Nanterre, France;
| | - Amélie Rousseau
- Psychology Department, Centre d’Etudes et Recherches en Psychopathologie et Psychologie de la Santé (EA7411), Université Toulouse Jean Jaurès, 5 All. Antonio Machado, 31058 Toulouse, France;
- Laboratoie VCR, Ecole de Psychologues Praticiens de l’Institut Catholique de Paris, 71, Rue Molière, 69000 Lyon, France
| | - Pierluigi Graziani
- LPS EA 849, Aix-Marseille University, Jardin du Pharo, 58 Boulevard Charles Livon, 13007 Marseille, France;
- Psychologie, Langues, Lettres et Histoire Département, University of Nîmes, Rue de Docteur Georges Salang Cs 13019, 30021 Nîmes, France
| | - Lucien Rochat
- Specialized Facility in Behavioral Addiction ReConnecte, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Sophia Achab
- Psychological and Sociological Research and Training Unit, Department of Psychiatry, University of Geneva, 24 Rue du Général-Dufour, 1211 Geneva, Switzerland; (S.A.); (D.Z.)
- Outpatient Treatment Unit for Addictive Behaviors ReConnecte, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Daniele Zullino
- Psychological and Sociological Research and Training Unit, Department of Psychiatry, University of Geneva, 24 Rue du Général-Dufour, 1211 Geneva, Switzerland; (S.A.); (D.Z.)
- Outpatient Treatment Unit for Addictive Behaviors ReConnecte, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway;
| | - Juan José Zacarés
- Department of Developmental and Educational Psychology, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 Valencia, Spain; (J.J.Z.); (E.S.)
| | - Emilia Serra
- Department of Developmental and Educational Psychology, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 Valencia, Spain; (J.J.Z.); (E.S.)
| | - Mariano Chóliz
- Department of Basic Psychology, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 Valencia, Spain;
| | - Halley M. Pontes
- Department of Organizational Psychology, Birkbeck, University of London, Malet St, London WC1E 7HX, UK;
| | - Mark D. Griffiths
- International Gaming Research Unit, Cyberpsychology Research Group, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK; (M.D.G.); (D.J.K.)
| | - Daria J. Kuss
- International Gaming Research Unit, Cyberpsychology Research Group, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK; (M.D.G.); (D.J.K.)
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Uribe Guajardo MG, Baillie A, Louie E, Giannopoulos V, Wood K, Riordan B, Haber P, Morley K. The evaluation of the role of technology in the pathways to comorbidity care implementation project to improve management of comorbid substance use and mental disorders. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221096977. [PMID: 35586033 PMCID: PMC9106309 DOI: 10.1177/26335565221096977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In substance use treatment settings, comorbid mental health problems can occur in up to 70% of people. An integrated approach for managing comorbidity, implementing evidence-based intervention in drug and alcohol settings, remains problematic. Technology can help in adopting evidence-based practice to implement effective treatment healthcare pathways. This study sought to examine aspects of tailored portal utilization (barriers and facilitators) by participants taking part in a program aimed at improving the implementation of evidence-based practice for comorbidity management Pathways to Comorbidity Care (PCC).
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Affiliation(s)
- Maria Gabriela Uribe Guajardo
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Baillie
- National Health and Medical Research Council Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Eva Louie
- Drug Health Service, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Vicki Giannopoulos
- Drug Health Service, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Katie Wood
- National Health and Medical Research Council Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Ben Riordan
- National Health and Medical Research Council Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Paul Haber
- National Health and Medical Research Council Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia
- Drug Health Service, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Kirsten Morley
- National Health and Medical Research Council Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia
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Wurf G, Swing A. Interventions for benzodiazepine withdrawal: Perceptions of benzodiazepine counsellors. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Vogel L, Koller G, Ehring T. The relationship between posttraumatic stress symptoms and craving in patients with substance use disorder attending detoxification. Drug Alcohol Depend 2021; 223:108709. [PMID: 33892303 DOI: 10.1016/j.drugalcdep.2021.108709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) are highly comorbid. Self-medication hypothesis (SMH) is a seminal theory aiming to account for the relationship between these disorders. The current study examined hypotheses based on SMH in SUD patients during the very first days of detoxification. Based on SMH we expected a positive association between PTSD and craving concurrently as well as on each following day. METHODS A time series with 108 SUD patients used daily self-report questionnaires assessing PTSD symptom severity (PCL-5) and craving (MaCs) for six consecutive days. Daily associations between PTSD symptom severity and craving on the same and on the following day during the first week of detoxification were estimated using linear mixed models. RESULTS There was a significant decrease in PTSD symptom severity during detoxification (ß = -2.06, p < 0.001). Further, PTSD symptom severity predicted craving on the same day (ß = 0.36, p < 0.001) but did not predict craving on the next day (ß = -0.01, p = 0.82). CONCLUSION Results of the current study only partially support assumptions based on SMH, and points towards a more complex and reciprocal relationship between PTSD and SUD.
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Affiliation(s)
- Lea Vogel
- Department of Psychology, LMU Munich, Leopoldstraße 13, 80802, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Leopoldstraße 13, 80802, Munich, Germany.
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Giannopoulos V, Morley KC, Uribe GM, Louie E, Wood K, Teesson M, Baillie A, Haber PS. The role of clinical supervision in implementing evidence-based practice for managing comorbidity. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1909517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kirsten C. Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabriela M. Uribe
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie Wood
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul S. Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Meredith LS, Komaromy MS, Cefalu M, Murray-Krezan C, Page K, Osilla KC, Dopp AR, Leamon I, Tarhuni L, Hindmarch G, Jacobsohn V, Watkins KE. Design of CLARO (Collaboration Leading to Addiction Treatment and Recovery from other Stresses): A randomized trial of collaborative care for opioid use disorder and co-occurring depression and/or posttraumatic stress disorder. Contemp Clin Trials 2021; 104:106354. [PMID: 33713840 DOI: 10.1016/j.cct.2021.106354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) co-occurring with depression and/or posttraumatic stress disorder (PTSD) is common and, if untreated, may lead to devastating consequences. Despite the availability of evidence-based treatments for these disorders, receipt of treatment is low. Even when treatment is provided, quality is variable. Primary care is an important and underutilized setting for treating co-occurring disorders (COD) because OUD, depression and PTSD are frequently co-morbid with medical conditions and most people visit a primary care provider at least once a year. With rising rates of OUD and opioid-related fatalities, this is a critical treatment and quality gap in a vulnerable and stigmatized population. METHODS CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) is a multi-site, randomized pragmatic trial of collaborative care (CC) for co-occurring disorders in 13 rural and urban primary care clinics in New Mexico to improve care for patients with OUD and co-occurring depression and/or PTSD. CC, a service delivery approach that uses multi-faceted interventions, has not been tested with COD. We will enroll and randomize 900 patients to either CC adapted for COD (CC-COD) or enhanced usual care (EUC) and will collect patient data at baseline, 3-, and 6-month follow-up. Our primary outcomes are medications for OUD (MOUD) access, MOUD continuity of care, depression symptoms, and PTSD symptoms. DISCUSSION Although CC is effective for improving outcomes in primary care among patients with mental health conditions, it has not been tested for COD. This article describes the CLARO CC-COD intervention and clinical trial.
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; VA HSR&D Center for Healthcare Innovation, Implementation & Policy, Sepulveda, CA, USA.
| | - Miriam S Komaromy
- Grayken Center for Addiction, Boston Medical Center, Boston, MA 02118, USA
| | - Matthew Cefalu
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | | | - Kimberly Page
- University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Karen Chan Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Lina Tarhuni
- University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Vanessa Jacobsohn
- First Choice Community Healthcare, 2001 North Centro Familiar, Albuquerque, NM 87105, USA
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Abstract
Suicide is a preventable health problem. Multiple definitions and inconsistent use of the term suicidality can result in failure to properly recognize suicide risk and behavior and confuses suicide research. Clarification of the suicidality concept is needed to facilitate the care for individuals at risk for suicide. Using Rodgers' evolutionary concept analysis method, this analysis describes the breadth and scope of the suicidality concept. Findings indicate suicidality covers a spectrum of suicidal risk and levels of emotional suffering and intent. The analysis does not draw definite conclusions, but outlines a direction for further research.
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Affiliation(s)
- Tamara Pike Keefner
- Nursing, South Dakota State University - College of Nursing, Rapid City, South Dakota, USA
| | - Thomas Stenvig
- Graduate Nursing, South Dakota State University - College of Nursing, Brookings, Rapid City, South Dakota, USA
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Meyer J, Price C, Tracey D, Sharpless L, Song Y, Madden L, Elwyn G, Altice F. Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders. Patient Prefer Adherence 2021; 15:1913-1927. [PMID: 34511887 PMCID: PMC8420782 DOI: 10.2147/ppa.s315543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs. METHODS We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months. RESULTS A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05-16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19-7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05). CONCLUSION Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.
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Affiliation(s)
- Jaimie Meyer
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- Correspondence: Jaimie Meyer Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USATel +203 737 6233Fax +203 737 4051 Email
| | - Carolina Price
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | | | - Yue Song
- Yale School of Public Health, New Haven, CT, USA
- Oregon Health Sciences University, Portland, OR, USA
| | - Lynn Madden
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- Scientific Institute for Quality of Healthcare, University Nijmegen Medical Centre, Nijmegen, Netherlands
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Frederick Altice
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Brunault P, Lebigre K, Idbrik F, Maugé D, Adam P, Barrault S, Baudin G, Courtois R, El Ayoubi H, Grall-Bronnec M, Hingray C, Ballon N, El-Hage W. Childhood Trauma Predicts Less Remission from PTSD among Patients with Co-Occurring Alcohol Use Disorder and PTSD. J Clin Med 2020; 9:jcm9072054. [PMID: 32629872 PMCID: PMC7408730 DOI: 10.3390/jcm9072054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/16/2020] [Accepted: 06/27/2020] [Indexed: 01/17/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is highly prevalent among patients hospitalized for an alcohol use disorder (AUD). Hospitalization can improve PTSD and AUD outcomes in some but not all patients, but we lack data on the baseline predictors of PTSD non-remission. This study aimed to determine the baseline risk factors for non-remitted PTSD in patients hospitalized for an AUD. Of 298 AUD inpatients recruited in a rehabilitation center (Le Courbat, France), we included 91 AUD inpatients with a co-occurring PTSD and a longitudinal assessment at baseline (T1) and before discharge (T2: 8 weeks later). Patients were assessed for PTSD diagnosis/severity (PCL-5=PTSD Checklist for DSM-5), different types of trauma including childhood trauma (LEC-5=Life Events Checklist for DSM-5/CTQ-SF=Childhood Trauma Questionnaire, Short-Form), and AUD diagnosis/severity (clinical interview/AUDIT=Alcohol Use Disorders Identification Test). Rate of PTSD remission between T1 and T2 was 74.1%. Non-remitted PTSD at T2 was associated with a history of childhood trauma (physical, emotional or sexual abuse, physical negligence), but not with other types of trauma experienced, nor baseline PTSD or AUD severity. Among patients hospitalized for an AUD with co-occurring PTSD, PTSD remission was more strongly related to the existence of childhood trauma than to AUD or PTSD severity at admission. These patients should be systematically screened for childhood trauma in order to tailor evidence-based interventions.
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Affiliation(s)
- Paul Brunault
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France; (K.L.); (D.M.); (H.E.A.); (N.B.)
- CHRU de Tours, Clinique Psychiatrique Universitaire, 37044 Tours, France; (R.C.); (W.E.-H.)
- UMR 1253, iBrain, Université de Tours, Inserm, 37020 Tours, France
- Qualipsy EE 1901, Université de Tours, 37020 Tours, France; (S.B.); (G.B.)
- Correspondence: ; Tel.: +33-218-370-581
| | - Kevin Lebigre
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France; (K.L.); (D.M.); (H.E.A.); (N.B.)
- CHRU de Tours, Clinique Psychiatrique Universitaire, 37044 Tours, France; (R.C.); (W.E.-H.)
| | - Fatima Idbrik
- Soins de Suite et de Réadaptation en Addictologie “Le Courbat”, 37460 Le Liège, France; (F.I.); (P.A.)
| | - Damien Maugé
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France; (K.L.); (D.M.); (H.E.A.); (N.B.)
- CHRU de Tours, Centre de Soins d’Accompagnement et de Prévention en Addictologie CSAPA-37, 37044 Tours, France
| | - Philippe Adam
- Soins de Suite et de Réadaptation en Addictologie “Le Courbat”, 37460 Le Liège, France; (F.I.); (P.A.)
| | - Servane Barrault
- Qualipsy EE 1901, Université de Tours, 37020 Tours, France; (S.B.); (G.B.)
- CHRU de Tours, Centre de Soins d’Accompagnement et de Prévention en Addictologie CSAPA-37, 37044 Tours, France
| | - Grégoire Baudin
- Qualipsy EE 1901, Université de Tours, 37020 Tours, France; (S.B.); (G.B.)
- Laboratory of Psychopathology and Health Processes EA 4057, University Paris Descartes, Sorbonne Paris Cité, 92100 Boulogne-Billancourt, France
| | - Robert Courtois
- CHRU de Tours, Clinique Psychiatrique Universitaire, 37044 Tours, France; (R.C.); (W.E.-H.)
- Qualipsy EE 1901, Université de Tours, 37020 Tours, France; (S.B.); (G.B.)
| | - Hussein El Ayoubi
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France; (K.L.); (D.M.); (H.E.A.); (N.B.)
- CHRU de Tours, Centre de Soins d’Accompagnement et de Prévention en Addictologie CSAPA-37, 37044 Tours, France
| | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, Hôpital Saint Jacques, University Hospital of Nantes, 85 rue Saint Jacques, Cedex 1, 44093 Nantes, France;
- Inserm, SPHERE U1246 methodS in Patients-Centered Outcomes and HEalth ResEarch, Université de Nantes, Université de Tours, 22 boulevard Benoni Goullin, 44200 Nantes, France
| | - Coraline Hingray
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54520 Laxou, France;
| | - Nicolas Ballon
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France; (K.L.); (D.M.); (H.E.A.); (N.B.)
- CHRU de Tours, Clinique Psychiatrique Universitaire, 37044 Tours, France; (R.C.); (W.E.-H.)
- UMR 1253, iBrain, Université de Tours, Inserm, 37020 Tours, France
| | - Wissam El-Hage
- CHRU de Tours, Clinique Psychiatrique Universitaire, 37044 Tours, France; (R.C.); (W.E.-H.)
- UMR 1253, iBrain, Université de Tours, Inserm, 37020 Tours, France
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Agterberg S, Schubert N, Overington L, Corace K. Treatment barriers among individuals with co-occurring substance use and mental health problems: Examining gender differences. J Subst Abuse Treat 2020; 112:29-35. [PMID: 32199543 DOI: 10.1016/j.jsat.2020.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the narrowing gender gap in the prevalence of substance use disorders, women continue to be vastly underrepresented in substance use services. Relational factors, family responsibilities, mental health, and stigma may present unique barriers encountered by women. AIMS The aims of this study were to examine: (1) gender differences in substance use treatment barriers, (2) gender differences in perceptions of stigmatization for seeking substance use treatment, and symptoms of depression, anxiety, and trauma-related stress, and (3) whether perceived stigmatization and mental health symptoms are associated with greater barriers among women. METHODS One hundred adults (50% self-identified women) from a substance use and concurrent disorders program in Ontario, Canada, completed a questionnaire package containing measures of sociodemographic information, substance use, mental health, perceived stigma, and substance use treatment barriers. RESULTS Women reported more barriers related to family responsibilities, relational factors, and mental health (p < .01), and higher levels of perceived stigma (p < .01) compared to men. CONCLUSIONS Findings from this study contribute to our understanding of treatment barriers and perceived stigmatization among women. This knowledge may be used to aid in the development and delivery of accessible, gender-responsive services that address these barriers and challenge the stigma attached to substance use among women.
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Affiliation(s)
- Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, United States of America.
| | - Nicholas Schubert
- The Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada.
| | - Louise Overington
- The Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada; The Royal's Institute of Mental Health Research, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada.
| | - Kimberly Corace
- The Royal Ottawa Mental Health Centre, Substance Use and Concurrent Disorders Program, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada; The Royal's Institute of Mental Health Research, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada; Faculty of Medicine, Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada.
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Prevalence and Predictors of Symptoms of Depression Among Individuals Seeking Treatment from Australian Drug and Alcohol Outpatient Clinics. Community Ment Health J 2020; 56:107-115. [PMID: 31515714 DOI: 10.1007/s10597-019-00451-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/07/2019] [Indexed: 12/13/2022]
Abstract
This study examined the prevalence of and sociodemographic characteristics associated with elevated symptoms of depression among clients seeking alcohol or other drug (AOD) treatment. Consenting clients attending two AOD outpatient clinics answered demographics, treatment questions and the Patient Health Questionnaire to assess depressive symptoms. Counts and percentages were calculated to determine the prevalence of elevated depressive symptoms. Logistic regression was used to model the odds of having elevated depressive symptoms for client demographics. Of the 203 clients who completed the survey (87% consent rate), 55% (n = 111) demonstrated elevated depressive symptoms. Females were twice as likely to experience elevated symptoms of depression compared to males (OR 2.07; 95% CI 1.05, 4.08; P = 0.037). The high rates of elevated depressive symptoms among individuals seeking AOD treatment highlight the importance of ongoing research to provide effective treatments for this comorbidity. Routine screening and clear treatment pathways may assist with providing high quality care.
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Barrett EL, Adams ZW, Kelly EV, Peach N, Hopkins R, Milne B, Back SE, Mills KL. Service provider perspectives on treating adolescents with co-occurring PTSD and substance use: challenges and rewards. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-07-2019-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur (PTSD+SUD). The onset of these disorders often occurs during adolescence. There is limited understanding of the perspectives of service providers working with this population. The purpose of this paper is to identify the practices, attitudes, experiences and training needs of Australian service providers treating adolescents with PTSD+SUD.
Design/methodology/approach
Service providers in Australia were invited to complete an anonymous online survey regarding their experiences working with adolescents who have PTSD+SUD. Ninety participants completed the 48-item survey that comprised multiple choice and open-ended questions.
Findings
Service providers estimated that up to 60 per cent of their adolescent clients with PTSD also have SUD. They identified case management, engaging with caregivers and difficult client emotions as specific challenges associated with working with this population. Despite this, providers rated treating PTSD+SUD as highly gratifying for reasons such as teaching new coping skills, developing expertise and assisting clients to achieve their goals. There were mixed perspectives on how to best treat adolescents with PTSD+SUD, and all participants identified a need for evidence-based resources specific to this population.
Originality/value
This is the first survey of Australian service providers working with adolescents who experience PTSD+SUD. The findings improve our understanding of the challenges and rewards associated with working with this population, and provide valuable information that can enhance clinical training and guide the development of new treatment approaches for this common and debilitating comorbidity.
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Ruglass LM, Yali AM. Do race/ethnicity and religious affiliation moderate treatment outcomes among individuals with co-occurring PTSD and substance use disorders? J Prev Interv Community 2019; 47:198-213. [PMID: 31081480 DOI: 10.1080/10852352.2019.1603674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effect of race/ethnicity and religious affiliation on treatment outcomes among 107 individuals with co-occurring substance use disorder (SUD) and full or subthreshold posttraumatic stress disorder (PTSD) was examined in a secondary analysis. Participants were randomly assigned to one of three treatment conditions: dual-disorder treatment of PTSD and SUD using prolonged exposure; single-disorder relapse prevention treatment for SUD; or an active monitoring control group. Results revealed no significant interaction between race/ethnicity and treatment on PTSD and substance use frequency. However, compared to Whites, African Americans had significantly lower levels of PTSD over the course of treatment. Religious affiliation moderated the impact of treatment on substance use frequency and was a significant predictor of PTSD scores during treatment. Results highlight the need to explore factors associated with social identity variables such as race and religion that may enhance or attenuate the mechanisms of treatments for PTSD and SUD.
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Affiliation(s)
- Lesia M Ruglass
- a Department of Psychology , The City College of New York , New York , USA
| | - Ann M Yali
- a Department of Psychology , The City College of New York , New York , USA
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Timko C, Below M, Vittorio L, Taylor E, Chang G, Lash S, Festin FED, Brief D. Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes. J Subst Abuse Treat 2019; 99:24-31. [PMID: 30797391 DOI: 10.1016/j.jsat.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/24/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Maureen Below
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
| | - Lisa Vittorio
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA.
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
| | - Grace Chang
- VA Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Steven Lash
- VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153, USA; Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22094, USA; Virgina Tech Carillon School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA.
| | - Fe Erlita D Festin
- VA Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Deborah Brief
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
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Heng S, Jamshidi N, Baillie A, Louie E, Dore G, Phung N, Haber PS, Morley KC. Baclofen Response in Alcohol Dependent Patients Concurrently Receiving Antidepressants: Secondary Analysis From the BacALD Study. Front Psychiatry 2018; 9:576. [PMID: 30524317 PMCID: PMC6262394 DOI: 10.3389/fpsyt.2018.00576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: There is little information with regards to the efficacy of baclofen among alcohol patients concurrently receiving antidepressants (AD). The present study aimed to conduct a secondary analysis of the moderating role of antidepressants in the BacALD trial which evaluated the efficacy of baclofen to reduce alcohol consumption in alcohol dependent patients. Methods: Alcohol dependent patients (N = 104) were treated for 12 weeks with 30 mg/day of baclofen (21 = AD and 15 = no AD), 75 mg baclofen (19 = AD and 16 = no AD) or placebo (17 = AD and 16 = no AD). Patients were included in the trial if they were concurrently receiving anti-depressants upon enrolment but were excluded if they commenced antidepressants 2 months prior to enrolment. Patients were also excluded in the case of concurrent psychotropic medications, active major mental disorder such as bipolar disorder, psychosis, or history of suicide attempt. Predefined primary outcomes included time to lapse (any drinking), relapse (>5 drinks per day in men and >4 in women). Other outcomes included drinks per drinking day, number of heavy drinking days, and percentage days abstinent and frequency of adverse events. Results: For the number of days to first lapse, there was a trend of significance for the interaction baclofen × AD (Log Rank: χ2 = 2.98, P = 0.08, OR: 0.41, 95%CI: 0.15-1.12). For the number of days to relapse, there was a trend of significance for the interaction of baclofen × AD (Log Rank: χ2 = 3.72, P = 0.05, OR: 3.40, 95%CI: 1.01-11.46). Placing significant baseline variables into the models as covariates (tobacco, ALD) weakened these interactions (P's > 0.15). There were no significant effects of ADs on the frequency of adverse events reported (P's > 0.19). Conclusion: Concurrent receipt of ADs commenced more than 2 months prior to baclofen treatment did not negatively impact on drinking outcomes. Future research examining the interaction between commencing ADs during baclofen treatment on alcohol dependent patients is required. Trial Registration: ClinicalTrials.gov, NCT01711125, https://clinicaltrials.gov/ct2/show/NCT01711125.
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Affiliation(s)
- Sovandara Heng
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nazila Jamshidi
- Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Andrew Baillie
- Faculty of Health Sciences, NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Eva Louie
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Glenys Dore
- Herbert Street Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nghi Phung
- Centre for Addiction Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Paul S. Haber
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Kirsten C. Morley
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Price M, Brier ZMF, Mirhashem R, Allen HC. The impact of co-occurring opioid misuse and PTSD on response inhibition. Drug Alcohol Depend 2018; 189:187-192. [PMID: 30049531 DOI: 10.1016/j.drugalcdep.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/09/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) and opioid misuse are commonly co-occurring disorders. Both disorders are associated with deficits in response inhibition; however, these associations have not considered their comorbidity. Response inhibition has not been examined in a sample with comorbid PTSD and opioid misuse. The present study examined the effect of PTSD symptom severity on response inhibition in current and past opioid misusers. METHODS Participants were currently (used within the last month) misusing opioids (56.6%) or in recovery (43.4%). All participants met DSM 5 criteria for PTSD. Response inhibition was measured with the stop signal task. RESULTS Response inhibition was associated with increased PTSD symptom severity for those in recovery but not among current users. Additionally, across both groups, there were deficits in response inhibition when withholding automatic responses for a threatening stimulus compared to a neutral stimulus. CONCLUSIONS PTSD Symptoms may exert a stronger effect on response inhibition among those in recovery as opposed to those who are actively using opioids.
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Affiliation(s)
- Matthew Price
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, 2 Colchester Ave, Room 248, Burlington, VT 05405, USA.
| | - Zoe M F Brier
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, 2 Colchester Ave, Room 248, Burlington, VT 05405, USA
| | - Rebecca Mirhashem
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, 2 Colchester Ave, Room 248, Burlington, VT 05405, USA
| | - Holley C Allen
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, 2 Colchester Ave, Room 248, Burlington, VT 05405, USA
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The long-term impact of post traumatic stress disorder on recovery from heroin dependence. J Subst Abuse Treat 2018; 89:60-66. [DOI: 10.1016/j.jsat.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 12/30/2022]
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Louie E, Giannopoulos V, Baillie A, Uribe G, Byrne S, Deady M, Teesson M, Baker A, Haber PS, Morley KC. Translating Evidence-Based Practice for Managing Comorbid Substance Use and Mental Illness Using a Multimodal Training Package. J Dual Diagn 2018; 14:111-119. [PMID: 29488830 DOI: 10.1080/15504263.2018.1437496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Comorbid mental health and substance use problems are highly prevalent in substance use treatment settings and generally lead to poorer treatment outcomes. Pathways to Comorbidity Care (PCC) is a multimodal training program developed to encourage an integrated service approach to improve clinicians capacity to identify and manage comorbid substance use and mental health outcomes within public drug and alcohol treatment settings. METHODS In this paper we describe the concepts underlying the PCC package and the use of implementation science to assess and overcome potential barriers, including clinicians preferences, knowledge about best practice, and professional culture. RESULTS The training components include didactic seminars, group workshops run by a local clinical champion on relevant subjects such as motivational interviewing and cognitive behavioral therapy, individual clinical consultation, and feedback with a senior clinical psychologist. The PCC also includes an online portal containing comorbidity resources including manuals, guidelines, and booster webinars. Finally, we describe the evaluation of PCC implementation. CONCLUSIONS Drug and alcohol services need to be equipped to treat the majority of comorbid mental health conditions in their clients. We anticipate that this multimodal training package, which applies the principles of implementation science, will facilitate effective and integrated care for these vulnerable clients.
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Affiliation(s)
- Eva Louie
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Vicki Giannopoulos
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Andrew Baillie
- b Faculty of Health Sciences , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Gabriela Uribe
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Simon Byrne
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Mark Deady
- c National Drug and Alcohol Research Centre , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, University of New South Wales (UNSW) , Australia
| | - Maree Teesson
- c National Drug and Alcohol Research Centre , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, University of New South Wales (UNSW) , Australia
| | - Amanda Baker
- d School of Medicine and Public Health University of Newcastle , New South Wales , Australia
| | - Paul S Haber
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia.,e Drug Health Services , Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia
| | - Kirsten C Morley
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
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Afzali MH, Sunderland M, Batterham PJ, Carragher N, Slade T. Trauma characteristics, post-traumatic symptoms, psychiatric disorders and suicidal behaviours: Results from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2017; 51:1142-1151. [PMID: 29087229 DOI: 10.1177/0004867416683815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study examined whether trauma characteristics such as the type and number of traumatic events were associated with three suicidal behaviours (i.e. ideation, plan and attempt) after adjusting for sociodemographic factors, post-traumatic symptoms and history of psychiatric disorders. METHOD Data came from the 2007 Australian National Survey of Mental Health and Wellbeing ( N = 8841). Respondents were asked about exposure to 28 traumatic events that occurred during their lifetime. Suicidal behaviours were measured using three statements about whether the person ever seriously thought about or planned or attempted suicide. RESULTS Sexual violence and exposure to multiple traumatic events were particularly associated with suicidal behaviours. The presence of the emotional numbing symptom cluster and co-occurrence of three psychiatric disorders (major depressive disorder, alcohol use disorder and substance use disorder) also increased the odds of suicidal behaviours. Analysis of age of onset revealed that the mean age of traumatic exposure was earlier than the age at which suicidal behaviours emerged. CONCLUSIONS The current study is the first to demonstrate that sexual violence and exposure to multiple traumatic events are associated with suicidal behaviours in a representative sample of Australian adults. The results underline the potential benefits of thorough assessment of trauma history, post-traumatic symptoms and history of psychiatric disorders and their additive contribution in suicide risk among trauma victims. These findings can be used by clinicians and researchers for early intervention programmes.
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Affiliation(s)
- Mohammad H Afzali
- 1 NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, Australia
| | - Matthew Sunderland
- 1 NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, Australia
| | - Philip J Batterham
- 2 National Institute for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Natacha Carragher
- 3 Medical Education and Student Office, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Tim Slade
- 1 NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, Australia
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Misouridou E, Papadatou D. Challenges in Engaging Parents in the Drug and Alcohol Treatment: The Professionals' Perspective. QUALITATIVE HEALTH RESEARCH 2017; 27:1948-1958. [PMID: 27811289 DOI: 10.1177/1049732316673582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Addiction treatment centers often fail to involve families in treatment. The aim of the present study was to explore the challenges that Greek mental health professionals encounter in their work with parents of drug and alcohol abusers. A qualitative study design was adopted, and five focus group discussions were conducted with 27 drug and alcohol professionals. The thematic analysis of their accounts revealed the key difficulties that professionals encounter in their collaboration with parents that included parental lack of involvement or over-engagement in treatment, unrealistic expectations, ambivalence or opposition to change, ethical dilemmas, and alliance issues, as well as collaboration challenges among therapists. Findings highlight the challenges of a family approach in the treatment of addiction, and underscore the value of clinical supervision in addition to specialized training, to help professionals work on their anxiety, anger, guilt, prejudices, and deception, when engaging parents in the treatment of their addicted child.
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Affiliation(s)
- Evdokia Misouridou
- 1 Technological Educational Institute of Athens, Athens, Greece
- 2 Psychiatric Hospital of Attica, Athens, Greece
| | - Danai Papadatou
- 3 National and Kapodistrian University of Athens, Athens, Greece
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Posttraumatic Stress and Distress Tolerance: Associations With Suicidality in Acute-Care Psychiatric Inpatients. J Nerv Ment Dis 2017; 205:531-541. [PMID: 28604417 DOI: 10.1097/nmd.0000000000000690] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma and posttraumatic stress disorder (PTSD) symptomatology have been associated with suicidality, including ideation and behavior. The current investigation evaluated, in acute-care psychiatric inpatients, the mediating role of perceived (self-reported) distress tolerance in the association between PTSD symptom severity and suicidality, defined as a) suicidal ideation, intent, or behavior leading to current psychiatric hospitalization; b) self-reported severity of suicidal desire; and c) percentage of days of suicidality during current hospitalization. Participants were composed of 105 adults (55.2% women; mean age, 33.9; SD, 10.9) admitted to a public psychiatric acute-care inpatient hospital in a large metropolitan area; 52.3% of the participants were hospitalized for suicidality. Results indicated that PTSD symptom severity (and severity of each PTSD symptom cluster) may exert an indirect effect on suicidality, specifically suicidality as a basis for current hospital admission and self-reported severity of suicidal desire, through perceived distress tolerance. Effects were documented after controlling for theoretically relevant covariates.
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Mirhashem R, Allen HC, Adams ZW, van Stolk-Cooke K, Legrand A, Price M. The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems. Addict Behav 2017; 69:98-103. [PMID: 28219827 PMCID: PMC5384831 DOI: 10.1016/j.addbeh.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/12/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Abstract
A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and trauma-related psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity-particularly urgency-and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multi-faceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP.
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Affiliation(s)
- Rebecca Mirhashem
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Holley C Allen
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, United States
| | - Katherine van Stolk-Cooke
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Alison Legrand
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States
| | - Matthew Price
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, United States.
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Schäfer I, Chuey-Ferrer L, Hofmann A, Lieberman P, Mainusch G, Lotzin A. Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: study protocol for a randomized controlled trial. BMC Psychiatry 2017; 17:95. [PMID: 28302084 PMCID: PMC5356401 DOI: 10.1186/s12888-017-1255-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for PTSD. However, it is unclear whether EMDR shows the same effectiveness in patients with substance use disorders (SUD) and comorbid PTSD. In this trial, we examine the effectiveness of EMDR in reducing PTSD symptoms in patients with SUD and PTSD. METHODS/DESIGN We conduct a single-blinded RCT among 158 patients with SUD and comorbid PTSD admitted to a German addiction rehabilitation center specialized for the treatment of patients with SUD and comorbid PTSD. Patients are randomized to receive either EMDR, added to SUD rehabilitation and non-trauma-focused PTSD treatment (TAU), or TAU alone. The primary outcome is change from baseline in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale at 6-month follow-up. Secondary outcomes are change from baseline in substance use, addiction-related problems, depressive symptoms, dissociative symptoms, emotion dysregulation and quality of life. Assessments are carried out by blinded raters at admission, at end of treatment, and at 3- and 6-month follow-up. We expect that EMDR plus TAU will be more effective in reducing PTSD symptoms than TAU alone. Mixed models will be conducted using an intention-to-treat and per-protocol approach. DISCUSSION This study aims to expand the knowledge about the effectiveness of EMDR in patients with SUD and comorbid PTSD. The expected finding of the superiority of EMDR in reducing PTSD symptoms compared to non-trauma-focused PTSD treatment may enhance the use of trauma-focused treatment approaches for patients with SUD and co-morbid PTSD. TRIAL REGISTRATION German Clinical Trials Register: DRKS00009007 ; U1111-1172-9213. Retrospectively registered 01 Juni 2016.
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Affiliation(s)
- Ingo Schäfer
- 0000 0001 2180 3484grid.13648.38Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, University of Hamburg, Martinistr. 52, Hamburg, D-20246 Germany
| | | | - Arne Hofmann
- EMDR-Institute Germany, Bergisch Gladbach, Germany
| | | | | | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, University of Hamburg, Martinistr. 52, Hamburg, D-20246, Germany.
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Darke S, Torok M, Ross J. Developmental trajectories to heroin dependence: Theoretical and clinical issues. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2017. [DOI: 10.1111/jasp.12434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney New South Wales 2052 Australia
| | - Michelle Torok
- Black Dog Institute; University of New South Wales; Sydney New South Wales 2052 Australia
| | - Joanne Ross
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney New South Wales 2052 Australia
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Jaconis M, Santa Ana EJ, Killeen TK, Badour CL, Back SE. Concurrent treatment of PTSD and alcohol use disorder via telehealth in a female Iraq veteran. Am J Addict 2017; 26:112-114. [PMID: 28118514 DOI: 10.1111/ajad.12481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/06/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A growing literature provides evidence for the use of integrated treatments (e.g., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure; COPE); however, no known studies have applied COPE via telehealth. METHOD COPE was delivered via telehealth to treat one black female veteran with combat trauma and alcohol use disorder. RESULTS The patient demonstrated significant reductions in alcohol consumption and PTSD and depressive symptoms. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Although preliminary, findings demonstrate that integrated treatment via telehealth is feasible and effective, and may be useful for female veterans reluctant to seek services at male-dominated VAMCs. (Am J Addict 2017;26:112-114).
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Affiliation(s)
- Maryanne Jaconis
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Department of Psychology, University of Wyoming, Laramie, Wyoming.,VA Portland Health Care System, Portland, Oregon
| | - Elizabeth J Santa Ana
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Therese K Killeen
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Christal L Badour
- Department of Psychology, University of Kentucky, Lexington, Kentucky
| | - Sudie E Back
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Mills KL, Barrett EL, Merz S, Rosenfeld J, Ewer PL, Sannibale C, Baker AL, Hopwood S, Back SE, Brady KT, Teesson M. Integrated Exposure-Based Therapy for Co-Occurring Post Traumatic Stress Disorder (PTSD) and Substance Dependence: Predictors of Change in PTSD Symptom Severity. J Clin Med 2016; 5:jcm5110101. [PMID: 27854264 PMCID: PMC5126798 DOI: 10.3390/jcm5110101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/26/2016] [Accepted: 11/08/2016] [Indexed: 11/26/2022] Open
Abstract
This paper examines factors associated with change in PTSD symptom severity among individuals randomised to receive an integrated exposure-based psychotherapy for PTSD and substance dependence–Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Outcomes examined include change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS), and the reliability and clinical significance of change in PTSD symptom severity. Factors examined include patient baseline characteristics, treatment characteristics, and events over follow-up. The mean difference in CAPS score was 38.24 (SE 4.81). Approximately half (49.1%) demonstrated a reliable and clinically significant improvement in PTSD symptom severity. No one was classified as having demonstrated clinically significant worsening of symptoms. Three independent predictors of reductions in PTSD symptom severity were identified: baseline PTSD symptom severity (β 0.77, SE 0.23, p = 0.001), number of traumas experienced prior to baseline (β −0.30, SE 0.15, p = 0.049), and number of sessions attended (β 2.05, SE 0.87, p = 0.024). The present study provides further evidence regarding the safety of the COPE treatment and factors associated with improvement in PTSD symptom severity. The identification of only a small number of predictors of the outcome points to the broad applicability of the COPE treatment to PTSD and substance use disorder (SUD) patients.
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Affiliation(s)
- Katherine L Mills
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Emma L Barrett
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Sabine Merz
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Julia Rosenfeld
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Philippa L Ewer
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Claudia Sannibale
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan 2308, NSW, Australia.
| | - Sally Hopwood
- School of Psychology, University of New South Wales, Sydney 2052, NSW, Australia.
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Maree Teesson
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia.
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney 2052, NSW, Australia.
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Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2016; 36:527-539. [PMID: 27786426 DOI: 10.1111/dar.12448] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/25/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
ISSUES The aim of this paper was to conduct a systematic review of the prevalence of comorbid mental health conditions in people accessing treatment for substance use in Australia. APPROACH A systematic review identified studies meeting the following eligibility criteria: reporting original data published in English; sample presenting for substance use treatment in Australia; assessing the prevalence of mental health and substance use conditions and reporting the percentage of participants with co-occurring mental health and substance use conditions. A narrative analysis was conducted because of the heterogeneity of methods used to assess key outcome variables and small number of studies assessing particular mental health outcomes. The abstracts of 1173 records were screened, and 59 full articles were assessed for eligibility. Eighteen studies were included in the review. KEY FINDINGS Prevalence estimates of current mental disorders in substance use treatment clients varied (47 to 100%). Mood and anxiety disorders were particularly prevalent, with the prevalence of current depression ranging from 27 to 85% and current generalised anxiety disorder ranging from 1 to 75%. IMPLICATIONS The high prevalence of mood and anxiety disorders in substance use treatment settings indicates a need for clinicians to screen and assess for these disorders as part of routine clinical care, and be familiar with evidence-based management and treatment strategies. CONCLUSION Although further studies are required to determine the prevalence of the full range of mental health disorders in this population, these findings emphasise the high prevalence of comorbid mental disorders are among individuals accessing substance use treatment in Australia. [Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2017;36:527-539].
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Affiliation(s)
- Rosemary E F Kingston
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Christina Marel
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Katherine L Mills
- Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Goodhew M, Salmon AM, Marel C, Mills KL, Jauncey M. Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC). Harm Reduct J 2016; 13:29. [PMID: 27733167 PMCID: PMC5062820 DOI: 10.1186/s12954-016-0117-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) can do so legally, under health professional supervision. The majority of clients have low levels of education and employment, high rates of incarceration and unstable housing and poor social networks, and 70 % do not access local health services. These factors increase the risk of poor mental health, and it has been documented that PWID have elevated rates of mood, anxiety, personality and psychotic disorders; post-traumatic stress disorder (PTSD); and higher rates of trauma exposure, suicidality and self-harm. The current study is the first to investigate the mental health among clients of a SIF. Validated instruments to examine clients' mental health, social networks and trauma histories were administered to 50 frequently attending clients by a mental health nurse. The majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem, but only 24 % report they were receiving treatment. Respondents had poor social networks, had poorer mental health symptoms compared to US inpatients and had experienced multiple traumatic events, and a high number of respondents had scores indicative of PTSD. These results highlight the need for mental health clinicians to be employed in SIFs and other drug consumption rooms (DCRs) to assist clients to address their mental health and psychosocial needs, particularly in light of the fact that these services are often the only places these PWID engage with in an ongoing way.
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Affiliation(s)
- Mark Goodhew
- Sydney Medically Supervised Injecting Centre, PO Box 293, Kings Cross, Sydney, NSW, 1340, Australia.
| | - Allison M Salmon
- Sydney Medically Supervised Injecting Centre, PO Box 293, Kings Cross, Sydney, NSW, 1340, Australia
| | - Christina Marel
- Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Katherine L Mills
- Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Marianne Jauncey
- Sydney Medically Supervised Injecting Centre, PO Box 293, Kings Cross, Sydney, NSW, 1340, Australia
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Vujanovic AA, Meyer TD, Heads AM, Stotts AL, Villarreal YR, Schmitz JM. Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:402-415. [PMID: 27494547 DOI: 10.1080/00952990.2016.1199697] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously. OBJECTIVES The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity. RESULTS Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression. CONCLUSION Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.
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Affiliation(s)
- Anka A Vujanovic
- a Department of Psychology, University of Houston , Houston , TX , USA.,b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Thomas D Meyer
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Angela M Heads
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Angela L Stotts
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Yolanda R Villarreal
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Joy M Schmitz
- b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA
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Mills KL. The importance of providing trauma-informed care in alcohol and other drug services. Drug Alcohol Rev 2016; 34:231-3. [PMID: 25944454 DOI: 10.1111/dar.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katherine L Mills
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Agley J, Crabb DW, Harris LE, Gassman RA, Gerke SP. An Assessment of SBIRT Prescreening and Screening Outcomes by Medical Setting and Administration Methodology. Health Serv Res Manag Epidemiol 2015; 2:2333392815612476. [PMID: 28462268 PMCID: PMC5266453 DOI: 10.1177/2333392815612476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious prevention practice. However, little research has assessed differences in prescreening outcomes between inpatient and outpatient primary care or among different prescreening administration methods. This study tested whether administration method (self-administered vs interview) and setting (inpatient versus outpatient) predicted prescreening outcomes in a large sample of primary care patients. Then, among patients who prescreened positive, it tested whether full screening scores differed by administration method and setting. METHODS Researchers used binomial logistic regression to assess predicted prescreening outcomes and analysis of variance to assess differences in SBIRT screening scores across a total of 14 447 unique patient visits in 10 outpatient sites and 1 centrally located hospital. RESULTS Controlling for gender, depression, and other substance use, both medical setting and method of prescreening, predicted prescreening results. Among patients who prescreened positive for alcohol, setting also was associated with mean screening scores. However, outcomes were not uniform by substance (eg, alcohol vs other drugs). CONCLUSION The results support previous studies on this topic that had utilized cross-study comparison or that were not specific to SBIRT prescreening/screening mechanisms. At the same time, nuanced findings were observed that had not previously been reported and suggest the need for further research in this area.
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Affiliation(s)
- Jon Agley
- Institute for Research on Addictive Behavior, School of Public Health, Indiana University, Bloomington, IN, USA
| | - David W. Crabb
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa E. Harris
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ruth A. Gassman
- Institute for Research on Addictive Behavior, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Steven P. Gerke
- Indiana University School of Medicine, Indianapolis, IN, USA
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Zhou X, Qin B, Del Giovane C, Pan J, Gentile S, Liu Y, Lan X, Yu J, Xie P. Efficacy and tolerability of antidepressants in the treatment of adolescents and young adults with depression and substance use disorders: a systematic review and meta-analysis. Addiction 2015; 110:38-48. [PMID: 25098732 DOI: 10.1111/add.12698] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/01/2014] [Accepted: 07/25/2014] [Indexed: 11/28/2022]
Abstract
AIMS To measure the effectiveness of antidepressants for adolescents and young adults with co-occurring depression and substance use disorder. DESIGN, SETTING AND PARTICIPANTS Meta-analysis of randomized controlled clinical trials. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science and PsychINFO was conducted (from 1970 to 2013). Prospective, parallel groups, double-blind, controlled trials with random assignment to an antidepressant or placebo on young patients (age ≤ 25 years) who met diagnostic criteria of both substance use and unipolar depressive disorder were included. Five trials were selected for this analysis and included 290 patients. MEASUREMENTS Our efficacy outcome measures were depression outcomes (dichotomous and continuous measures) and substance-use outcomes (change of frequency or quantity of substance-use). Secondary analysis was conducted to access the tolerability of antidepressant treatment. FINDINGS For dichotomous depression outcome, antidepressants group was significantly more effective than placebo group [risk ratio (RR) = 1.21; 95% confidence interval (CI) 1.01-1.45], with low heterogeneity (I(2) = 0%). Although no statistically significant effects for continuous depression outcome [standardized mean differences (SMD) = -0.13; 95% CI, -0.55 to 0.30] were found with moderate heterogeneity (I(2) = 63%), subgroup analysis showed that the medicine group with a sample size of more than 50 showed statistically significant efficacy compared with the placebo group (SMD -0.53, 95% CI -0.82 to -0.25). Moreover, there was no significant difference for substance-use outcomes and tolerability outcomes between the medication and placebo groups. CONCLUSIONS Antidepressant medication has a small overall effect in reducing depression in young patients with combined depressive and substance-use disorders, but does not appear to improve substance use outcomes.
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Affiliation(s)
- Xinyu Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ewer PL, Teesson M, Sannibale C, Roche A, Mills KL. The prevalence and correlates of secondary traumatic stress among alcohol and other drug workers in Australia. Drug Alcohol Rev 2014; 34:252-8. [DOI: 10.1111/dar.12204] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 08/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Philippa L. Ewer
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- NHMRC Centre of Research Excellence in Mental Health and Substance Use; University of New South Wales; Sydney Australia
| | - Maree Teesson
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- NHMRC Centre of Research Excellence in Mental Health and Substance Use; University of New South Wales; Sydney Australia
| | - Claudia Sannibale
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- Drug Health Services; Royal Prince Alfred Hospital; Sydney Local Health District; Sydney Australia
| | - Ann Roche
- National Centre for Education and Training on Addiction; Flinders University; Adelaide Australia
| | - Katherine L. Mills
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- NHMRC Centre of Research Excellence in Mental Health and Substance Use; University of New South Wales; Sydney Australia
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Stephens JR, Heffner JL, Adler CM, Blom TJ, Anthenelli RM, Fleck DE, Welge JA, Strakowski SM, DelBello MP. Risk and protective factors associated with substance use disorders in adolescents with first-episode mania. J Am Acad Child Adolesc Psychiatry 2014; 53:771-9. [PMID: 24954826 PMCID: PMC4288812 DOI: 10.1016/j.jaac.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 03/31/2014] [Accepted: 05/01/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Adolescents with bipolar disorder (BD) are more likely to develop substance use disorders (SUDs) than adolescents without psychiatric disorders; however, to our knowledge, specific risk factors underlying this relationship have not been prospectively examined. The purpose of this study was to identify predictors of developing SUDs after a first manic episode. METHOD Participants aged 12 to 20 years and hospitalized with their first manic episode associated with bipolar I disorder (BP-I) were recruited as part of the University of Cincinnati First-Episode Mania Study and prospectively evaluated for patterns of substance use. Follow-up ranged between 17 and 283 weeks (mean = 113 weeks, SD = 71.9 weeks). Demographic and clinical variables were compared between adolescents with and without SUDs. RESULTS Of the 103 adolescents with BD, 49 (48%) either had a SUD at baseline or developed one during follow-up. Of the 71 participants who did not have a SUD at study entry, 17 (24%) developed one during follow-up (median = 40 weeks). Later onset of BD, manic (versus mixed) mood episode, and comorbid disruptive behavior disorders were associated with an increased risk of developing a SUD in univariate analyses. Adolescents treated with psychostimulant treatment before their first manic episode were significantly less likely to develop a SUD independent of attention-deficit/hyperactivity disorder (ADHD) diagnosis. Comorbid posttraumatic stress disorder (PTSD) and psychotic symptoms were the strongest predictors of SUD development. CONCLUSION Our results confirm high rates of SUD in adolescents with BD. In addition, our findings identify potential risk factors associated with SUDs in adolescents with BD. These data are preliminary in nature and should be explored further in future studies.
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Affiliation(s)
- Jacob R. Stephens
- Research, Observation, Service, Education (ROSE) Program and the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jaimee L. Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, and the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Caleb M. Adler
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Thomas J. Blom
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Robert M. Anthenelli
- University of California at San Diego, San Diego, CA and the VA San Diego Healthcare System, San Diego, CA
| | - David E. Fleck
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Jeffrey A. Welge
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Stephen M. Strakowski
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Melissa P. DelBello
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
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Abadi MH, Shamblen SR, Courser M, Johnson KW, Thompson K, Young L, Browne T. Gender differences in Afghan drug-abuse treatment: an assessment of treatment entry characteristics, dropout, and outcomes. ETHNICITY & HEALTH 2014; 20:453-473. [PMID: 24920072 DOI: 10.1080/13557858.2014.921898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The current study examines gender differences in drug-abuse treatment (DAT) entry, dropout, and outcomes in seven DAT centers in Afghanistan. This is the first study to examine gender differences in DAT programming in Afghanistan. DESIGN A prospective cohort design of 504 women and men in seven DAT centers in Afghanistan was used in this study and the analyses examined whether gender differences exist for patients (1) at treatment entry, (2) at treatment dropout, and (3) for treatment outcomes. RESULTS Gender differences were found at baseline for patient characteristics, drug use, crime, and social and occupational functioning. Results showed a trend that women remained in treatment longer than men. Looking at gender differences in treatment success, results showed greater reductions in drug use and crime, and greater social functioning among women. CONCLUSION Results provide preliminary evidence for potential treatment success of women-tailored DAT programming in Afghanistan. Results also indicate that DAT appears to be successful among Afghan men; however, lower positive outcomes for men when compared to women suggest that more efforts should focus on tailoring DAT programming to the specific needs of Afghan men as well. Study limitations are addressed, and important policy implications are discussed.
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Mills KL, Ewer P, Dore G, Teesson M, Baker A, Kay-Lambkin F, Sannibale C. The feasibility and acceptability of a brief intervention for clients of substance use services experiencing symptoms of post traumatic stress disorder. Addict Behav 2014; 39:1094-9. [PMID: 24657001 DOI: 10.1016/j.addbeh.2014.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/18/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trauma exposure and post traumatic stress disorder (PTSD) are common among clients of substance use services. Existing treatments for these co-occurring conditions tend to be lengthy, treatment retention is relatively poor, and they require extensive training and clinical supervision. The aim of the present study was to conduct a preliminary examination of the feasibility and acceptability of a brief intervention for PTSD symptoms among individuals seeking substance use treatment. METHODS An uncontrolled open-label pilot study was conducted among 29 inpatients of a medicated detoxification unit in Sydney, Australia. All participants completed a baseline interview followed by the brief intervention. The intervention consists of a single, one-hour manualised session providing psychoeducation pertaining to common trauma reactions and symptom management. PTSD and substance use outcomes were assessed at 1-week, 1-month and 3-month post-intervention. RESULTS PTSD symptom severity (assessed using the Clinicians Administered PTSD Scale) decreased significantly from baseline to 1-week follow up (β -10.87, 95%CI: -19.75 to -1.99) and again between the 1-week and 3-month follow-ups (β -15.38, 95%CI: -23.20 to -7.57). Despite these reductions, the majority of participants continued to meet criteria for a diagnosis of PTSD and there was no change in participants' negative post-traumatic cognitions. Participants expressed high levels of satisfaction with the intervention. CONCLUSIONS Brief psychoeducation for traumatised clients attending substance use services appears to be feasible, acceptable, and may be of some benefit in reducing PTSD symptoms. However, participants continued to experience symptoms at severe levels; thus, brief intervention may best be conceptualised as a "stepping stone" to further trauma treatment.
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