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Washio Y, Erasmus-Claassen LA, Taylor SN, Zhang Z, Browne FA, Myers B, Wechsberg WM, Parry CDH, Petersen Williams P. An incentive-based text-messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single-arm pilot study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1600-1609. [PMID: 38884353 DOI: 10.1111/acer.15392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive-based text-messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa. METHODS A single-arm pilot trial was conducted over 3 months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three-month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health-related text messaging from an evidence-based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self-reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post-enrollment. RESULTS Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9 days at baseline, on average, to 1-3 days (p-value range: 0.144-0.010) at follow-up timepoints. There were statistically significant increases in the proportions of participants with alcohol-negative urine tests (p < 0.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3 months in the overall sample and among those enrolled postpartum, though these were not significant (p-value range: 0.255-0.147). Maternal depression scores also decreased among participants enrolled postpartum (p = 0.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow-ups in the overall sample (p = 0.032) and among participants enrolled while pregnant (p = 0.015). CONCLUSIONS This study is among the first to pilot test an incentive-based text-messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well-powered, randomized controlled trial.
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Affiliation(s)
- Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lesley-Ann Erasmus-Claassen
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Shantae N Taylor
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Zugui Zhang
- Christiana Care Health System, Institute for Research on Equity and Community Health, Newark, Delaware, USA
| | - Felicia A Browne
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Wendee M Wechsberg
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Charles D H Parry
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Petal Petersen Williams
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Brobbin E, Deluca P, Parkin S, Drummond C. Use of Transdermal Alcohol Sensors in Conjunction With Contingency Management to Reduce Alcohol Consumption in People With Alcohol Dependence Attending Alcohol Treatment Services: Protocol for a Pilot Feasibility Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57653. [PMID: 39083798 DOI: 10.2196/57653] [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: 02/22/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Wearable technology for objective, continuous, and reliable alcohol monitoring has been developed. These are known as transdermal alcohol sensors (TASs). They can be worn on the wrist or ankle with the sensor pressed against the skin and can measure sweat vapors being emitted from the skin, to record transdermal alcohol concentration (TAC). Previous studies have investigated the accuracy and acceptability of the available TAS brands, but there has been little research into their use in people with alcohol use disorders (AUD). OBJECTIVE This feasibility randomized controlled trial aims to explore the feasibility, strengths, and limitations of using a TAS to monitor alcohol consumption in individuals in treatment for AUD with or without contingency management (CM) to promote abstinence or low-level alcohol consumption. METHODS The target sample size is 30 (15 randomized to each group). Participants will be recruited through poster adverts at alcohol services. Both groups (control and CM) will wear the TAS (BACtrack Skyn) for 2 weeks in the context of their usual treatment, meeting with the researcher every other weekday. In the last meeting, the participants will complete a postwear survey on their experience of wearing the TAS. The CM group will also receive small financial incentives for low or no alcohol consumption, as measured by the TAS. On days where the TAC peak is below a set threshold (<115.660 g/L), CM group participants will be rewarded with a £5 (US $6.38) voucher. There are financial bonuses if this target is achieved on consecutive days. The researcher will monitor TAC for each day of the study at each research visit and allocate financial incentives to participants according to a set reinforcement schedule. RESULTS The first participant was enrolled in June 2023, and the last in December 2023. Data analysis is underway and is estimated to be completed by June 2024. A total of 32 participants were enrolled. CONCLUSIONS Most TAS brands have had limited application in clinical settings, and most studies have included healthy adults rather than people with AUD. TAS has the potential to enhance treatment outcomes in clinical alcohol treatment. The accuracy, acceptability, and feasibility of TAS for people with AUD in clinical settings need to be investigated. This is the first study to use TAS in specialized alcohol services with diagnosed AUD individuals currently receiving treatment from a south London alcohol service. TRIAL REGISTRATION ISRCTN Registry ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57653.
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Affiliation(s)
- Eileen Brobbin
- Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paolo Deluca
- Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephen Parkin
- Department of Public Health, Environments and Society at London School of Hygiene and Tropical Medicine, King's College London, London, United Kingdom
| | - Colin Drummond
- Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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3
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Pfund RA, Ginley MK, Boness CL, Rash CJ, Zajac K, Witkiewitz K. Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:136-150. [PMID: 38863566 PMCID: PMC11164545 DOI: 10.1037/cps0000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.
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Affiliation(s)
- Rory A. Pfund
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | | | | | - Carla J. Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Appa A, Miller AP, Fatch R, Kekibiina A, Beesiga B, Adong J, Emenyonu N, Marson K, Getahun M, Kamya M, Muyindike W, McDonell M, Thirumurthy H, Hahn JA, Chamie G, Camlin CS. Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002472. [PMID: 38656992 PMCID: PMC11042709 DOI: 10.1371/journal.pgph.0002472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
Economic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants' experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy. We interviewed 32 DIPT study participants across trial arms to explore their perspectives on this intervention. Participants described 1) satisfaction with incentives of sufficient size that allowed them to purchase items that improved their quality of life, 2) multiple ways in which incentives were motivating, from gamification of "winning" through support of pre-existing desire to improve health to suggesting variable effects of extrinsic and intrinsic motivation, and 3) finding value in learning results of increased clinical monitoring. To build effective incentive programs to support both reduced substance use and increased antimicrobial adherence, we recommend carefully selecting incentive magnitude as well as harnessing both intrinsic motivation to improve health and extrinsic reward of target behavior. In addition to these participant-described strengths, incorporating results of clinical monitoring related to the incentive program that provide participants more information about their health may also contribute to health-related empowerment.
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Affiliation(s)
- Ayesha Appa
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda P. Miller
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Julian Adong
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kara Marson
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Moses Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Michael McDonell
- Department of Psychiatry and Behavioral Sciences, Washington State University, Spokane, Washington, United States of America
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Gabriel Chamie
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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Lu TT, Parent SC, Chaytor N, Amiri S, Palmer K, McPherson S, Jett J, Ries R, McDonell MG, Murphy SM. Budget Impact Tool for Implementing Contingency Management for Co-occurring Alcohol Use Disorders and Serious Mental Illness. Psychiatr Serv 2024; 75:326-332. [PMID: 37855102 PMCID: PMC10984796 DOI: 10.1176/appi.ps.20220547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Contingency management (CM) is a behavioral intervention in which tangible incentives are provided to patients when they achieve a desired behavior (e.g., reducing or abstaining from alcohol use). The authors sought to describe the resource requirements and associated costs of various CM versions (usual, high magnitude, and shaping) tailored to a high-risk population with co-occurring serious mental illness and severe alcohol use disorder. METHODS A microcosting analysis was conducted to identify the resource requirements of the different CM versions. This approach included semistructured interviews with site investigators, who also staffed the intervention. The resource costing method-multiplying the number of units of each resource utilized by its respective unit cost-was used to value the resources from a provider's perspective. All cost estimates were calculated in 2021 U.S. dollars. RESULTS The cost of setting up a CM program was $6,038 per site. Assuming full capacity and 56% of urine samples meeting the requirement for receipt of the CM incentive, the average cost of 16 weeks of usual and shaping CM treatments was $1,119-$1,136 and of high-magnitude CM was $1,848-$1,865 per participant. CONCLUSIONS A customizable tool was created to estimate the costs associated with various levels of treatment success and CM design features. After the trial, the tool will be updated and used to finalize per-participant cost for incorporation into a comprehensive economic evaluation. This costing tool will help a growing number of treatment providers who are interested in implementing CM with budgeting for and sustaining CM in their practices.
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Affiliation(s)
- Thanh T Lu
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina
| | - Sara C Parent
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Naomi Chaytor
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Solmaz Amiri
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle
| | - Katharine Palmer
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Julianne Jett
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City
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6
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Dionisi T, Di Sario G, De Mori L, Spagnolo G, Antonelli M, Tarli C, Sestito L, Mancarella FA, Ferrarese D, Mirijello A, Vassallo GA, Gasbarrini A, Addolorato G. Current treatments of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:127-152. [PMID: 38555114 DOI: 10.1016/bs.irn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Emerging treatments for alcohol dependence reveal an intricate interplay of neurobiological, psychological, and circumstantial factors that contribute to Alcohol Use Disorder (AUD). The approved strategies balancing these factors involve extensive manipulations of neurotransmitter systems such as GABA, Glutamate, Dopamine, Serotonin, and Acetylcholine. Innovative developments are engaging mechanisms such as GABA reuptake inhibition and allosteric modulation. Closer scrutiny is placed on the role of Glutamate in chronic alcohol consumption, with treatments like NMDA receptor antagonists and antiglutamatergic medications showing significant promise. Complementing these neurobiological approaches is the progressive shift towards Personalized Medicine. This strategy emphasizes unique genetic, epigenetic and physiological factors, employing pharmacogenomic principles to optimize treatment response. Concurrently, psychological therapies have become an integral part of the treatment landscape, tackling the cognitive-behavioral dimension of addiction. In instances of AUD comorbidity with other psychiatric disorders, Personalized Medicine becomes pivotal, ensuring treatment and prognosis are closely defined by individual characteristics, as exemplified by Lesch Typology models. Given the high global prevalence and wide distribution of AUD, a persistent necessity exists for development and improvement of treatments. Current research efforts are steadily paving paths towards more sophisticated, effective typology-based treatments: a testament to the recognized imperative for enhanced treatment strategies. The potential encapsulated within the ongoing research suggests a promising future where the clinical relevance of current strategies is not just maintained but significantly improved to effectively counter alcohol dependence.
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Affiliation(s)
- Tommaso Dionisi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Giovanna Di Sario
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Lorenzo De Mori
- Department of Neuroscience, Section of Psychiatry, Catholic University of Rome, Rome, Italy
| | - Giorgia Spagnolo
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Mariangela Antonelli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Sestito
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Antonio Mancarella
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Ferrarese
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | | | - Antonio Gasbarrini
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy.
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7
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Jett JD, Beck R, Tyutyunnyk D, Sanchez J, Weeks DL, Javors MA, Hill-Kapturczak N, Lopez-Cruzan M, Kriegel L, Ginsburg BC, Cabassa L, McDonell MG. Feasibility of a telehealth-based contingency management intervention for alcohol use disorders using the phosphatidylethanol (PEth) 16:0/18:1 alcohol biomarker: a pilot randomized trial. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:162-172. [PMID: 38284925 PMCID: PMC11228813 DOI: 10.1080/00952990.2023.2283691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
Background: Phosphatidylethanol (PEth) is a blood-based biomarker for alcohol consumption that can be self-collected and has high sensitivity, specificity, and a longer detection window compared to other alcohol biomarkers.Objectives: We evaluated the feasibility and acceptability of a telehealth-based contingency management (CM) intervention for alcohol use disorder (AUD) using the blood-based biomarker PEth to assess alcohol consumption.Methods: Sixteen adults (7 female, 9 male) with AUD were randomized to Control or CM conditions. Control participants received reinforcers regardless of their PEth levels. CM participants received reinforcers for week-to-week decreases in PEth (Phase 1) or maintenance of PEth consistent with abstinence (<20 ng/mL, Phase 2). Blood samples were self-collected using the TASSO-M20 device. Acceptability was assessed by retention in weeks. Satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8) and qualitative interviews. The primary efficacy outcome was PEth-defined abstinence. Secondary outcomes included the proportion of visits with PEth-defined heavy alcohol consumption, negative urine ethyl glucuronide results, and self-reported alcohol use.Results: Retention averaged 18.6 ± 8.8 weeks for CM participants. CM participants reported high levels of satisfaction (CSQ-8, Mean = 30.3 ± 1.5). Interview themes included intervention positives, such as staff support, quality of life improvement, and accountability. 72% of PEth samples from CM participants were consistent with abstinence versus 34% for Control participants (OR = 5.0, p = 0.007). PEth-defined heavy alcohol consumption was detected in 28% of CM samples and 52% of Control samples (OR = 0.36, p = 0.159). CM participants averaged 1.9 ± 1.7 drinks/day versus 4.2 ± 6.3 for Control participants (p = 0.304).Conclusion: Results support the acceptability and satisfaction of a telehealth PEth-based CM intervention, though a larger study is needed to assess its efficacy [NCT04038021].
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Affiliation(s)
- Julianne D Jett
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachael Beck
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Diana Tyutyunnyk
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Jesus Sanchez
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Douglas L Weeks
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Martin A Javors
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Marisa Lopez-Cruzan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Liat Kriegel
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Brett C Ginsburg
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Leopoldo Cabassa
- Brown School, Washington University St. Louis, St Louis, MO, USA
| | - Michael G McDonell
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Lyons AJ, Hirchak KA, Kordas G, Herron JL, Jansen K, Alcover KC, Bergerson D, Avey JP, Shaw J, Roll J, Buchwald D, McDonell MG. Factors Associated with Child Removal Among American Indian and Alaska Native People in an Alcohol Intervention Study. CHILD MALTREATMENT 2023; 28:599-607. [PMID: 36314509 PMCID: PMC10499114 DOI: 10.1177/10775595221134689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study was a secondary data analysis of factors associated with alcohol-related child removal among American Indian/Alaska Native (AI/AN) adults enrolled in a clinical trial of an alcohol intervention. Among 326 parent participants, 40% reported ever having a child removed from their care in part because of the parent's alcohol use, defined here as alcohol-related child removal. Seventy-five percent of parents reported at least one separation during their own childhood (M = 1.3, SD = 1.0). In a multivariable analysis, alcohol-related child removal was associated with parental boarding school attendance. No relationship was found between alcohol-related child removal and alcohol intervention outcomes. Results may provide evidence of multigenerational child removal impacts of boarding schools on AI/AN adults receiving an alcohol use disorder intervention. Assessment of parental history of child removal by practitioners, strategies to prevent alcohol-related separation and to support reunification should be integrated into addiction treatment in AI/AN communities.
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Affiliation(s)
- Abram J. Lyons
- Behavioral Health Innovations, Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Partnerships for Native Health, Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine A. Hirchak
- Behavioral Health Innovations, Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Partnerships for Native Health, Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Gordon Kordas
- Behavioral Health Innovations, Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Partnerships for Native Health, Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Jalene L. Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | | | - Karl C. Alcover
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | | | | | | | - John Roll
- Behavioral Health Innovations, Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Partnerships for Native Health, Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Behavioral Health Innovations, Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Michael G. McDonell
- Behavioral Health Innovations, Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Partnerships for Native Health, Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
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9
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Launders N, Hayes JF, Price G, Marston L, Osborn DPJ. The incidence rate of planned and emergency physical health hospital admissions in people diagnosed with severe mental illness: a cohort study. Psychol Med 2023; 53:5603-5614. [PMID: 36069188 PMCID: PMC10482715 DOI: 10.1017/s0033291722002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have more physical health conditions than the general population, resulting in higher rates of hospitalisations and mortality. In this study, we aimed to determine the rate of emergency and planned physical health hospitalisations in those with SMI, compared to matched comparators, and to investigate how these rates differ by SMI diagnosis. METHODS We used Clinical Practice Research DataLink Gold and Aurum databases to identify 20,668 patients in England diagnosed with SMI between January 2000 and March 2016, with linked hospital records in Hospital Episode Statistics. Patients were matched with up to four patients without SMI. Primary outcomes were emergency and planned physical health admissions. Avoidable (ambulatory care sensitive) admissions and emergency admissions for accidents, injuries and substance misuse were secondary outcomes. We performed negative binomial regression, adjusted for clinical and demographic variables, stratified by SMI diagnosis. RESULTS Emergency physical health (aIRR:2.33; 95% CI 2.22-2.46) and avoidable (aIRR:2.88; 95% CI 2.60-3.19) admissions were higher in patients with SMI than comparators. Emergency admission rates did not differ by SMI diagnosis. Planned physical health admissions were lower in schizophrenia (aIRR:0.80; 95% CI 0.72-0.90) and higher in bipolar disorder (aIRR:1.33; 95% CI 1.24-1.43). Accident, injury and substance misuse emergency admissions were particularly high in the year after SMI diagnosis (aIRR: 6.18; 95% CI 5.46-6.98). CONCLUSION We found twice the incidence of emergency physical health admissions in patients with SMI compared to those without SMI. Avoidable admissions were particularly elevated, suggesting interventions in community settings could reduce hospitalisations. Importantly, we found underutilisation of planned inpatient care in patients with schizophrenia. Interventions are required to ensure appropriate healthcare use, and optimal diagnosis and treatment of physical health conditions in people with SMI, to reduce the mortality gap due to physical illness.
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Affiliation(s)
- Naomi Launders
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Joseph F. Hayes
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Gabriele Price
- Department of Health and Social Care, Office for Health Improvement and Disparities, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Louise Marston
- Department of Primary Care and Population Health, UCL, Rowland Hill Street, NW3 2PF, London, UK
| | - David P. J. Osborn
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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10
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Edelman EJ, Dziura J, Deng Y, DePhilippis D, Fucito LM, Ferguson T, Bedimo R, Brown S, Marconi VC, Goetz MB, Rodriguez-Barradas MC, Simberkoff MS, Molina PE, Weintrob AC, Maisto SA, Paris M, Justice AC, Bryant KJ, Fiellin DA. Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 131:107242. [PMID: 37230168 PMCID: PMC10460633 DOI: 10.1016/j.cct.2023.107242] [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] [Received: 04/01/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial. METHODS PWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described. CONCLUSIONS The FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH. CLINICALTRIALS gov identifier: NCT03089320.
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Affiliation(s)
- E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
| | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Dominick DePhilippis
- Veterans Affairs Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, DC, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA, USA; Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern Dallas, TX, USA
| | - Sheldon Brown
- James J. Peters Veterans Affairs Medical Center and Manhattan VA Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vincent C Marconi
- Atlanta VAMC, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA; Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Amy C Weintrob
- Washington D.C. Veterans Affairs Medical Center and George Washington University, Washington, DC, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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11
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Hirchak KA, Kordas G, Lyons AJ, Herron J, Jansen K, Shaw J, McPherson SM, Roll J, Buchwald D, McDonell MG. Investigating Secondary Alcohol Outcomes in a Contingency Management Intervention among American Indian and Alaska Native Adults. J Addict Med 2023; 17:e177-e182. [PMID: 37267179 PMCID: PMC10248190 DOI: 10.1097/adm.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the study is to investigate clinically meaningful, secondary outcomes in a randomized trial of a culturally adapted contingency management (CM) intervention for alcohol use in 3 diverse American Indian and Alaska Native communities. METHODS Three American Indian and Alaska Native communities located in the Northern Plains, Alaska, and the Inland Northwest were partnering sites. A total of 158 individuals were randomized to either a 12-week CM intervention or a noncontingent (NC) control group. The CM group received reinforcers for providing alcohol-negative ethyl glucuronide (EtG < 150 ng/mL) urine samples, while the NC group received reinforcers unconditionally. Outcomes included EtG as a continuous measure (range, 0-2,000 ng/mL), EtG > 499 ng/mL (a measure of higher levels of recent alcohol use), longest duration of abstinence, and time-to-first alcohol-positive EtG during the trial. Generalized estimating equations along with Cox proportional hazard and negative binomial regressions were used. RESULTS Participants randomized to the CM group had lower mean EtG levels (-241.9 ng/mL; 95% confidence interval [CI], -379.0 to -104.8 ng/mL) and 45.7% lower odds (95% CI, 0.31 to 0.95) of providing an EtG sample indicating higher levels of alcohol use during the intervention. Longest duration of abstinence was 43% longer for the CM group than the NC group (95% CI, 1.0 to 1.9). Risk of time-to-first drink during treatment did not differ significantly. CONCLUSIONS These secondary outcome analyses provide evidence that CM is associated with reductions in alcohol use and longer durations of abstinence (as assessed by EtG), both clinically meaningful endpoints and analyses that differ from the primary study outcome.
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Affiliation(s)
- Katherine A. Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Gordon Kordas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Abram J. Lyons
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Jalene Herron
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kelley Jansen
- Southcentral Foundation, Anchorage, AK, USA
- University of Montana, Missoula, MT, USA
| | | | - Sterling M. McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - John Roll
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Michael G. McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
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12
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Herron J, Hirchak KA, Venner K, Tofighi D, McDonell MG. Cultural Factors and Alcohol Use in American Indian Adults: Results From a Culturally Tailored Contingency Management Intervention. J Stud Alcohol Drugs 2023; 84:273-280. [PMID: 36971715 PMCID: PMC10171248 DOI: 10.15288/jsad.21-00400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AI/AN) populations experience greater health disparities in alcohol use outcomes compared with the general population. This secondary data analysis examines cultural factors related to alcohol use in reservation-based American Indian (AI) adults (N = 65; 41 males; mean age = 36.7 years) in a randomized controlled trial of a culturally tailored contingency management (CM) program. It was hypothesized that individuals with higher rates of cultural protective factors would have lower rates of alcohol use, whereas individuals with higher rates of risk factors would have higher rates of alcohol use. It was also hypothesized that enculturation would moderate the relationship between treatment group and alcohol use. METHOD Generalized linear mixed modeling was used to calculate odds ratios (ORs) for the repeated measure, biweekly urine tests of the biomarker, ethyl glucuronide (EtG), across 12 weeks. The relationships between alcohol use (abstinence [EtG < 150 ng/ml]) or heavy drinking [EtG > 500 ng/ml]) and culturally relevant protective (enculturation, years lived on the reservation) and risk factors (discrimination, historical loss, historical loss symptoms) were examined. RESULTS There was a negative association between enculturation and probability of submitting a heavy drinking urine sample (OR = 0.973; 95% CI [0.950, 0.996], p = .023), indicating that enculturation may serve as a protective factor against heavy drinking. CONCLUSIONS Cultural factors (e.g., enculturation) may be important constructs to assess and incorporate into treatment planning with AI adults engaged in alcohol treatment.
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Affiliation(s)
- Jalene Herron
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Katherine A. Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Kamilla Venner
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Davood Tofighi
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Michael G. McDonell
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - The Honor Study Team
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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13
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Nielsen DG, Andersen K, Nielsen AS, Nielsen F, Behrendt S, Bilberg R, Bogenschutz M, Bühringer G, Mellentin AI. Comparison of self-reported alcohol consumption and ethyl glucuronide in hair in a sample of 60+ year -olds treated for DSM-5 alcohol use disorder. Addict Biol 2022; 27:e13231. [PMID: 36301220 PMCID: PMC9786874 DOI: 10.1111/adb.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 01/24/2023]
Abstract
There is a lack of evidence for the consistency between self-reported alcohol consumption (SRAC) and concentrations of ethyl glucuronide in hair (hEtG) among elderly patients treated exclusively for alcohol use disorder (AUD). Hence, this study assessed the consistency between these two measures in these patients. A total of 190 patients with AUD were assessed for SRAC using Form 90 and hEtG, 14 or 22 weeks after treatment conclusion. Patients were grouped according to SRAC (g/day) and corresponding hEtG concentrations (pg/mg): 0 and <5 (abstinence), 0.1-14.3 and 5.0-9.9 (low consumption), 14.4-21.4 and 10.0-15.9 (moderate consumption), 21.5-59.9 and 16.0-30 (high consumption) and ≥60 and >30 (excessive consumption). The extent of underreporting and overreporting was examined by crosstabulations, and inter-rater reliability was reported by kappa correlations. Associations and effect modification were examined by conditional logistic regression. Due to multitesting, p-values ≤0.01 were considered significant. Underreporting was found in 96 patients (50.5%) and overreporting in 41 patients (21.6%). The kappa coefficients varied between 0.19 and 0.34. HEtG was more likely to detect low, moderate and high alcohol consumption compared with SRAC (ORs between 5.1 and 12.6, all p-values <0.01), but SRAC and hEtG did not differ significantly with respect to identification of abstinence (OR = 1.9, p = 0.05). Inconsistency between the outcome measures was found in a considerable number of the patients. More studies examining the consistency between SRAC and specific direct biomarkers of alcohol in this population seem warranted.
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Affiliation(s)
- Dorthe Grüner Nielsen
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Kjeld Andersen
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,BRIDGE, Brain Research, Inter‐Disciplinary Guided Excellence, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Open, Odense Patient data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,BRIDGE, Brain Research, Inter‐Disciplinary Guided Excellence, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Flemming Nielsen
- Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Silke Behrendt
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Institute for PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Randi Bilberg
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Michael Bogenschutz
- NYU Grossman School of MedicineNew York CityNew YorkUSA,Health Sciences CenterUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Gerhard Bühringer
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany,IFT Institut für TherapieforschungMunichGermany
| | - Angelina Isabella Mellentin
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,BRIDGE, Brain Research, Inter‐Disciplinary Guided Excellence, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Tele‐Psychiatric Center, Region of Southern DenmarkOdenseDenmark
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14
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Hirchak KA, Lyons AJ, Herron JL, Kordas G, Shaw JL, Jansen K, Avey JP, McPherson SM, Donovan D, Roll J, Buchwald D, Ries R, McDonell MG. Contingency management for alcohol use disorder reduces cannabis use among American Indian and Alaska Native adults. J Subst Abuse Treat 2022; 137:108693. [PMID: 34952747 PMCID: PMC9086134 DOI: 10.1016/j.jsat.2021.108693] [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: 05/26/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Determine whether a culturally tailored contingency management (CM) intervention targeting alcohol abstinence resulted in secondary effects on cannabis use among American Indian and Alaska Native (AI/AN) adults. METHODS The research team conducted this secondary data analysis to examine cannabis abstinence using data from a randomized control trial of CM for alcohol use among three AI/AN-serving organizations. One hundred and fifty-eight adults met the randomization criteria (i.e., submission of 50% or more urine samples and one alcohol-positive urine test during a 4-week, pre-randomization, observation period). For 12 weeks after randomization, participants received incentives for submitting a urine test negative for ethyl glucuronide (EtG < 150 ng/mL, CM group) or incentives for submitting a urine sample regardless of abstinence (Non-contingent [NC] Control group). Generalized linear mixed effects models assessed group differences in cannabis abstinence during the intervention, verified by urine tetrahydrocannabinol negative tests (11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid <50 ng/mL). RESULTS At baseline, 42.2% (n = 35) of participants in the NC group and 40.0% (n = 30) of those in the CM group had a cannabis positive urine test. An overall intervention by time interaction was detected for a cannabis negative urine test (χ2 = 13.40, p = 0.001). Compared to the NC group, the CM group had 3.92 (95% CI:1.23-12.46) times higher odds of having a cannabis negative urine test during the intervention period and 5.13 (95% CI:1.57-16.76) times higher odds of having a negative cannabis test at the end of intervention period. CONCLUSION CM addressing alcohol misuse may be an effective strategy for decreasing cannabis use among AI/AN adults. TRIAL REGISTRATION ClinicalTrials.gov number, Identifier: NCT02174315.
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Affiliation(s)
- Katherine A Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Abram J Lyons
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Jalene L Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Gordon Kordas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | | | - Kelley Jansen
- Southcentral Foundation, Anchorage, AK, USA; Department of Psychology, University of Montana, Missoula, MT, USA
| | | | - Sterling M McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA.
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15
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Launders N, Hayes JF, Price G, Osborn DP. Clustering of physical health multimorbidity in people with severe mental illness: An accumulated prevalence analysis of United Kingdom primary care data. PLoS Med 2022; 19:e1003976. [PMID: 35442948 PMCID: PMC9067697 DOI: 10.1371/journal.pmed.1003976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 05/04/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People with severe mental illness (SMI) have higher rates of a range of physical health conditions, yet little is known regarding the clustering of physical health conditions in this population. We aimed to investigate the prevalence and clustering of chronic physical health conditions in people with SMI, compared to people without SMI. METHODS AND FINDINGS We performed a cohort-nested accumulated prevalence study, using primary care data from the Clinical Practice Research Datalink (CPRD), which holds details of 39 million patients in the United Kingdom. We identified 68,783 adults with a primary care diagnosis of SMI (schizophrenia, bipolar disorder, or other psychoses) from 2000 to 2018, matched up to 1:4 to 274,684 patients without an SMI diagnosis, on age, sex, primary care practice, and year of registration at the practice. Patients had a median of 28.85 (IQR: 19.10 to 41.37) years of primary care observations. Patients with SMI had higher prevalence of smoking (27.65% versus 46.08%), obesity (24.91% versus 38.09%), alcohol misuse (3.66% versus 13.47%), and drug misuse (2.08% versus 12.84%) than comparators. We defined 24 physical health conditions derived from the Elixhauser and Charlson comorbidity indices and used logistic regression to investigate individual conditions and multimorbidity. We controlled for age, sex, region, and ethnicity and then additionally for health risk factors: smoking status, alcohol misuse, drug misuse, and body mass index (BMI). We defined multimorbidity clusters using multiple correspondence analysis (MCA) and K-means cluster analysis and described them based on the observed/expected ratio. Patients with SMI had higher odds of 19 of 24 conditions and a higher prevalence of multimorbidity (odds ratio (OR): 1.84; 95% confidence interval [CI]: 1.80 to 1.88, p < 0.001) compared to those without SMI, particularly in younger age groups (males aged 30 to 39: OR: 2.49; 95% CI: 2.27 to 2.73; p < 0.001; females aged 18 to 30: OR: 2.69; 95% CI: 2.36 to 3.07; p < 0.001). Adjusting for health risk factors reduced the OR of all conditions. We identified 7 multimorbidity clusters in those with SMI and 7 in those without SMI. A total of 4 clusters were common to those with and without SMI; while 1, heart disease, appeared as one cluster in those with SMI and 3 distinct clusters in comparators; and 2 small clusters were unique to the SMI cohort. Limitations to this study include missing data, which may have led to residual confounding, and an inability to investigate the temporal associations between SMI and physical health conditions. CONCLUSIONS In this study, we observed that physical health conditions cluster similarly in people with and without SMI, although patients with SMI had higher burden of multimorbidity, particularly in younger age groups. While interventions aimed at the general population may also be appropriate for those with SMI, there is a need for interventions aimed at better management of younger-age multimorbidity, and preventative measures focusing on diseases of younger age, and reduction of health risk factors.
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Affiliation(s)
| | - Joseph F Hayes
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Gabriele Price
- Public Health England, Health Improvement Directorate, London, United Kingdom
| | - David Pj Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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16
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Silva KDS, Sampaio AAS, Miguel ADQC. Contingency Management applied to Alcohol Use Disorder: Systematic Review. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38215.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This systematic review evaluated the efficacy of applying Contingency Management (CM) to Alcohol Use Disorder. We followed the PRISMA recommendation and consulted the following databases: Cochrane Library, MEDLINE Complete, PsycINFO and Pubmed. A total of eight randomized controlled trials were included in this review, all of them with good methodological quality. In seven of these, CM was more efficacious in promoting continuous abstinence. Both trials that evaluated treatment retention found statistically significant results favorable to CM. On two of the three trials presenting follow-up results, CM was more efficacious in promoting abstinence. The large-scale application of CM can promote substantial public health improvements and should be encouraged.
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17
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Bouchard M, Lecomte T, Cloutier B, Herrera-Roberge J, Potvin S. Dropout Rates in Psychosocial Interventions for People With Both Severe Mental Illness and Substance Misuse: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:842329. [PMID: 35633799 PMCID: PMC9133375 DOI: 10.3389/fpsyt.2022.842329] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/07/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Over the years, many psychosocial interventions for individual having both a psychotic spectrum disorder and a substance use disorder diagnoses have been developed and studied. However, there is a high dropout rate among this clinical population. OBJECTIVES This meta-analysis aims to replicate a previous meta-analysis on the effects of psychosocial treatment for dual disorders, while including and determining the dropout rates in those type of interventions. METHOD Based on a Cochrane systematic review conducted in 2019, we conducted a meta-analysis including 40 randomized clinical trials on psychosocial treatment among persons suffering from schizophrenia spectrum disorder and substance use disorder. RESULTS A dropout rate of 27,2% was obtained. Stimulants use significantly affected dropout rates. Age, gender, diagnosis, alcohol and cannabis abuse, and duration of treatment did not affect dropout rates. CONCLUSION The 27,2% rate of dropout from psychosocial treatment highlights the need to engage participants having a dual diagnosis from the start by focusing on therapeutic alliance and motivation for treatment.
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Affiliation(s)
- Marianne Bouchard
- Department of Psychology, University of Montreal, Montréal, QC, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montréal, QC, Canada.,Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, Montreal, QC, Canada
| | - Briana Cloutier
- Department of Psychology, University of Montreal, Montréal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry, University of Montreal, Montreal, QC, Canada
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18
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Silva KDS, Sampaio AAS, Miguel ADQC. Manejo de Contingência Aplicado ao Transtorno por Uso de Álcool: Revisão Sistemática. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38215.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Esta revisão sistemática avaliou a eficácia do Manejo de Contingência (MC) no tratamento do Transtorno por Uso de Álcool. Para isso, foi utilizada a recomendação PRISMA e consultadas as bases de dados: Cochrane Library, MEDLINE Complete, PsycINFO e Pubmed. Foram incluídos oito ensaios clínicos randomizados nesta revisão. Em sete, o MC foi mais eficaz em promover abstinência continuada. Dos dois que avaliaram a retenção no tratamento, ambos encontraram resultados estatisticamente favoráveis ao MC. Dos três que apresentaram resultados de avaliação de seguimento, em dois o MC foi mais eficaz em promover abstinência. Todos apresentaram boa qualidade metodológica. A aplicação do MC em larga escala pode promover melhorias substanciais para a saúde pública e deve ser encorajada.
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19
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Miguel A, Smith C, Perea N, Johnson K, McDonell M, McPherson S. Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study. JMIR Form Res 2021; 5:e25796. [PMID: 34279238 PMCID: PMC8329757 DOI: 10.2196/25796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/12/2021] [Accepted: 05/31/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. OBJECTIVE In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. METHODS Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians' acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians' assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients' usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. RESULTS Recruitment for this study began in January 2021 and is expected to be completed by December 2021. CONCLUSIONS This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas.
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Affiliation(s)
- Andre Miguel
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Crystal Smith
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Nicole Perea
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Kim Johnson
- Managed Health Connections, Spokane, WA, United States
| | - Michael McDonell
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
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20
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McDonell MG, Hirchak KA, Herron J, Lyons AJ, Alcover KC, Shaw J, Kordas G, Dirks LG, Jansen K, Avey J, Lillie K, Donovan D, McPherson SM, Dillard D, Ries R, Roll J, Buchwald D. Effect of Incentives for Alcohol Abstinence in Partnership With 3 American Indian and Alaska Native Communities: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:599-606. [PMID: 33656561 PMCID: PMC7931140 DOI: 10.1001/jamapsychiatry.2020.4768] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022]
Abstract
Importance Many American Indian and Alaska Native communities are disproportionately affected by problems with alcohol use and seek culturally appropriate and effective interventions for individuals with alcohol use disorders. Objective To determine whether a culturally tailored contingency management intervention, in which incentives were offered for biologically verified alcohol abstinence, resulted in increased abstinence among American Indian and Alaska Native adults. This study hypothesized that adults assigned to receive a contingency management intervention would have higher levels of alcohol abstinence than those assigned to the control condition. Design, Setting, and Participants This multisite randomized clinical trial, the Helping Our Native Ongoing Recovery (HONOR) study, included a 1-month observation period before randomization and a 3-month intervention period. The study was conducted at 3 American Indian and Alaska Native health care organizations located in Alaska, the Pacific Northwest, and the Northern Plains from October 10, 2014, to September 2, 2019. Recruitment occurred between October 10, 2014, and February 20, 2019. Eligible participants were American Indian or Alaska Native adults who had 1 or more days of high alcohol-use episodes within the last 30 days and a current diagnosis of alcohol dependence. Data were analyzed from February 1 to April 29, 2020. Interventions Participants received treatment as usual and were randomized to either the contingency management group, in which individuals received 12 weeks of incentives for submitting a urine sample indicating alcohol abstinence, or the control group, in which individuals received 12 weeks of incentives for submitting a urine sample without the requirement of alcohol abstinence. Regression models fit with generalized estimating equations were used to assess differences in abstinence during the intervention period. Main Outcomes and Measures Alcohol-negative ethyl glucuronide (EtG) urine test result (defined as EtG<150 ng/mL). Results Among 1003 adults screened for eligibility, 400 individuals met the initial criteria. Of those, 158 individuals (39.5%; mean [SD] age, 42.1 [11.4] years; 83 men [52.5%]) met the criteria for randomization, which required submission of 4 or more urine samples and 1 alcohol-positive urine test result during the observation period before randomization. A total of 75 participants (47.5%) were randomized to the contingency management group, and 83 participants (52.5%) were randomized to the control group. At 16 weeks, the number who submitted an alcohol-negative urine sample was 19 (59.4%) in the intervention group vs 18 (38.3%) in the control group. Participants randomized to the contingency management group had a higher likelihood of submitting an alcohol-negative urine sample (averaged over time) compared with those randomized to the control group (odds ratio, 1.70; 95% CI, 1.05-2.76; P = .03). Conclusions and Relevance The study's findings indicate that contingency management may be an effective strategy for increasing alcohol abstinence and a tool that can be used by American Indian and Alaska Native communities for the treatment of individuals with alcohol use disorders. Trial Registration ClinicalTrials.gov Identifier: NCT02174315.
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Affiliation(s)
- Michael G. McDonell
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
| | - Katherine A. Hirchak
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Jalene Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque
- Department of Psychology, University of New Mexico, Albuquerque
| | - Abram J. Lyons
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Karl C. Alcover
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | | | - Gordon Kordas
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | | | | | | | | | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Sterling M. McPherson
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
| | | | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - John Roll
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Dedra Buchwald
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
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21
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Pilot Study of an Integrated Smartphone and Breathalyzer Contingency Management Intervention for Alcohol Use. J Addict Med 2021; 14:193-198. [PMID: 31567597 DOI: 10.1097/adm.0000000000000553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Monitoring devices provide a platform for assessing alcohol use and implementing alcohol interventions. This pilot study focused on assessing the early-stage feasibility and usability of a smartphone-based application and breathalyzer used in a contingency management intervention for alcohol use. METHODS Six nontreatment-seeking participants completed a 9-week ABA within-subjects designed intervention targeting alcohol use. Participants submitted 2 to 8 alcohol breathalyzer samples per day and completed self-report drinking measures and usability assessments. During the A phases (weeks 1-3 and 8-9), participants received reinforces for submitting breathalyzer samples, regardless of their results. During the contingency management, B phase (weeks 4-7), and received reinforcers only when negative breathalyzer samples were submitted. Usability assessment of the application was also conducted during weeks 2 and 9. RESULTS Participants in the contingent B phase (49%) were more likely to submit alcohol-negative breathalyzer samples compared with the noncontingent A phases (27%; P < 0.001). Usability assessment of the application varied, and participants noted several technical concerns. CONCLUSION The use of smartphones and breathalyzers may be a practical solution to extend the reach of contingency management during and after treatment.
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22
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Fraser ER, Hill-Kapturczak N, Jett J, Beck R, Oluwoye O, Kriegel LS, Alcover KC, McPherson S, Cabassa LJ, Javors M, McDonell MG. Mixed-methods trial of a phosphatidylethanol-based contingency management intervention to initiate and maintain alcohol abstinence in formerly homeless adults with alcohol use disorders. Contemp Clin Trials Commun 2021; 22:100757. [PMID: 33763620 PMCID: PMC7973861 DOI: 10.1016/j.conctc.2021.100757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Contingency management (CM) is an intervention where incentives are provided in exchange for biochemically confirmed alcohol abstinence. CM is effective at initiating alcohol abstinence, but it is less effective at maintaining long-term abstinence. Phosphatidylethanol (PEth), collected via a finger-stick, can detect alcohol use for 14–28 days. PEth allows for the development of a CM model that includes increasingly less frequent monitoring of abstinence to assist high risk groups, such as formerly homeless individuals, maintain long-term abstinence. Aims Investigate whether PEth-based CM intervention targeting alcohol abstinence in formerly homeless, currently housed individuals with alcohol use disorders is: (1) acceptable and feasible for housing program tenants and personnel; and is associated with increased (2) alcohol abstinence and (3) housing tenure. Methods Acceptability and feasibility will be assessed using a QUAL+quant mixed-methods design using qualitative interviews and quantitative measures of satisfaction and attrition. Effectiveness will be evaluated through a randomized pilot trial of 50 study participants who will receive 6 months of either treatment as usual (TAU) including incentives (e.g., gift cards) for providing blood samples (Control Condition) or TAU and incentives for negative PEth results (PEth-CM Condition). Outcomes will be assessed during the intervention and at a three-month follow-up visit. The trial will be conducted via telehealth as a result of COVID-19. Discussion This protocol seeks to utilize a novel alcohol biomarker to evaluate the acceptability, feasibility, and initial effectiveness of a CM model that encourages long-term abstinence in a high-risk group.
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Affiliation(s)
- Elizabeth R Fraser
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA
| | - Nathalie Hill-Kapturczak
- Biological Psychiatry Analytical Lab, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Julianne Jett
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachael Beck
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA
| | - Oladunni Oluwoye
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Liat S Kriegel
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Karl C Alcover
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Martin Javors
- Biological Psychiatry Analytical Lab, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Michael G McDonell
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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23
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Destoop M, Docx L, Morrens M, Dom G. Meta-Analysis on the Effect of Contingency Management for Patients with Both Psychotic Disorders and Substance Use Disorders. J Clin Med 2021; 10:jcm10040616. [PMID: 33561966 PMCID: PMC7916027 DOI: 10.3390/jcm10040616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Substance use disorders (SUD) are highly prevalent among psychotic patients and are associated with poorer clinical and functional outcomes. Effective interventions for this clinical population are scarce and challenging. Contingency management (CM) is one of the most evidence-based treatments for SUD’s, however, a meta-analysis of the effect of CM in patients with a dual diagnosis of psychotic disorder and SUD has not been performed. Methods: We searched PubMed and PsycINFO databases up to December 2020. Results: Five controlled trials involving 892 patients were included. CM is effective on abstinence rates, measured by the number of self-reported days of using after intervention (95% CI −0.98 to −0.06) and by the number of negative breath or urine samples after intervention (OR 2.13; 95% CI 0.97 to 4.69) and follow-up (OR 1.47; 95% CI 1.04 to 2.08). Conclusions: Our meta-analysis shows a potential effect of CM on abstinence for patients with SUD and (severe) psychotic disorders, although the number of studies is limited. Additional longitudinal studies are needed to confirm the sustained effectivity of CM and give support for a larger clinical implementation of CM within services targeting these vulnerable co-morbid patients.
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Affiliation(s)
- Marianne Destoop
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium; (L.D.); (M.M.); (G.D.)
- Multiversum, Provinciesteenweg 408, 2530 Boechout, Belgium
- Correspondence:
| | - Lise Docx
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium; (L.D.); (M.M.); (G.D.)
- Multiversum, Provinciesteenweg 408, 2530 Boechout, Belgium
| | - Manuel Morrens
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium; (L.D.); (M.M.); (G.D.)
- University Psychiatric Hospital Antwerp, Campus Duffel, 2570 Antwerp, Belgium
| | - Geert Dom
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium; (L.D.); (M.M.); (G.D.)
- Multiversum, Provinciesteenweg 408, 2530 Boechout, Belgium
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24
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McDonell MG, Skalisky J, Burduli E, Foote A, Granbois A, Smoker K, Hirchak K, Herron J, Ries RK, Echo-Hawk A, Barbosa-Leiker C, Buchwald D, Roll J, McPherson SM. The rewarding recovery study: a randomized controlled trial of incentives for alcohol and drug abstinence with a rural American Indian community. Addiction 2020; 116:1569-1579. [PMID: 33220122 PMCID: PMC8131263 DOI: 10.1111/add.15349] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/10/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
AIMS To test if contingency management (CM) interventions for alcohol and drug abstinence were associated with increased alcohol and drug abstinence among American Indian adults with alcohol dependence who also use drugs. DESIGN In this 2 × 2 factorial randomized controlled trial, American Indian adults with alcohol dependence who also used drugs were randomized to four conditions: (1) incentives for submission of urine samples only (control condition), (2) CM incentives for alcohol abstinence, (3) CM incentives for drug abstinence or (4) CM incentives for abstinence from both alcohol and drugs. SETTING A Northern Plains Reservation in the United States. PARTICIPANTS A total of 114 American Indian adults aged 35.8 years (standard deviation = 10.4); 49.1% were male. INTERVENTION AND COMPARATOR Participants received incentives if they demonstrated abstinence from alcohol (CM for alcohol, n = 30), abstinence from their most frequently used drug (CM for drugs, n = 27) or abstinence from both alcohol and their most frequently used drug (CM for alcohol and drugs, n = 32) as assessed by urine tests. Controls (n = 25) received incentives for submitting urine samples only. MEASUREMENTS Primary outcomes were urine ethyl glucuronide (alcohol) and drug tests conducted three times per week during the 12-week intervention period. Data analyses included listwise deletion and multiple imputation to account for missing data. FINDINGS The three CM groups were significantly (P < 0.05) more likely to submit alcohol-abstinent urine samples compared with the control condition, with odds ratios ranging from 2.4 to 4.8. The CM for drugs (OR = 3.2) and CM for alcohol and drugs (OR = 2.5) were significantly more likely to submit urine samples that indicated drug abstinence, relative to the control condition (P < 0.05). However, these differences were not significant in multiple imputation analyses (P > 0.05). CONCLUSIONS Contingency management (CM) incentives for abstinence were associated with increased alcohol abstinence in American Indian adults diagnosed with alcohol dependence who also used drugs, living on a rural reservation. The effect of CM incentives on drug abstinence was inconclusive.
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Affiliation(s)
- Michael G McDonell
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Program for Excellence in Addiction Research, Washington State University, Spokane, WA, USA.,For correspondence: Elson S Floyd College of Medicine, Washington State University, 412 E, Spokane Falls Blvd, Spokane, WA 99202 USA, (509) 368-6967,
| | - Jordan Skalisky
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ekaterina Burduli
- Program for Excellence in Addiction Research, Washington State University, Spokane, WA, USA.,College of Nursing, Washington State University, Spokane, WA, USA
| | - Albert Foote
- Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, Spokane, WA, USA
| | - Alexandria Granbois
- Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, Spokane, WA, USA
| | - Kenneth Smoker
- Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, Spokane, WA, USA
| | - Katherine Hirchak
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Jalene Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Celestina Barbosa-Leiker
- Program for Excellence in Addiction Research, Washington State University, Spokane, WA, USA.,College of Nursing, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - John Roll
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Program for Excellence in Addiction Research, Washington State University, Spokane, WA, USA
| | - Sterling M McPherson
- Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Program for Excellence in Addiction Research, Washington State University, Spokane, WA, USA
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25
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Archibald L, Brunette MF, Wallin DJ, Green AI. Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder. Alcohol Res 2019; 40:arcr.v40.1.06. [PMID: 31886105 PMCID: PMC6927747 DOI: 10.35946/arcr.v40.1.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Schizophrenia and schizoaffective disorder are schizophrenia spectrum disorders that cause significant disability. Among individuals who have schizophrenia or schizoaffective disorder, alcohol use disorder (AUD) is common, and it contributes to worse outcomes than for those who do not have co-occurring substance use disorder. Common neurobiological mechanisms, including dysfunction in brain reward circuitry, may explain the high rates of co-occurrence of schizophrenia and AUD or other substance use disorders. Optimal treatment combines pharmacologic intervention and other therapeutic modalities to address both the psychotic disorder and AUD. Further research on the etiology of these co-occurring disorders and on treatment of affected individuals is needed.
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Affiliation(s)
- Luke Archibald
- Luke Archibald, M.D., is an assistant professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Mary F Brunette
- Mary F. Brunette, M.D., is an associate professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Diana J Wallin
- Diana J. Wallin, Ph.D., is a postdoctoral fellow in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Alan I Green
- Alan I. Green, M.D., is the Raymond Sobel Professor of Psychiatry, a professor in the Department of Molecular and Systems Biology, and the chair of the Department of Psychiatry, Geisel School of Medicine at Dartmouth, as well as the director, Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, New Hampshire
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26
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Desrosiers JJ, Tchiloemba B, Boyadjieva R, Jutras-Aswad D. Implementation of a contingency approach for people with co-occurring substance use and psychiatric disorders: Acceptability and feasibility pilot study. Addict Behav Rep 2019; 10:100223. [PMID: 31828202 PMCID: PMC6889619 DOI: 10.1016/j.abrep.2019.100223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The prevalence of co-occurrent substance use and psychiatric disorders is high. Contingency-based interventions have been shown to be effective in promoting adherence to treatment for people with substance use disorders but are among the least used evidence-based interventions for clients with comorbid psychiatric disorders, related to acceptability issues. Objective The present implementation study aims to evaluate the acceptability and feasibility of a contingency approach in co-occurring disorders specialized treatment services. Methodology Focus groups were conducted with health professionals and service users recruited from a specialized co-occurring disorder program (COD). Pre-intervention focus groups were conducted to select preferred modalities to implement the program. Post-intervention focus groups were conducted to document the satisfaction and benefits of the intervention. Throughout the study, program monitoring was conducted systematically to determine the gaps between planned and actual interventions. Results Both health professionals consulted and service users agreed that the contingency approach could be integrated within usual co-occurring disorders treatment. In general, patients more readily accepted the contingency approach than health professionals. The higher functioning level group reported several benefits from the approach and implementation in its group sessions went as planned. Contingency approach was described by all participants as consistent with general treatment goals and led to patient's awareness about their group attendance. Conclusion This study highlights several challenges related to the implementation of a contingency approach. It also suggests that implementation of this approach could benefit from taking into account the needs and perspectives of service users.
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Affiliation(s)
| | - Bianief Tchiloemba
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Quebec, Canada
| | - Rositsa Boyadjieva
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Quebec, Canada
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Hunt GE, Siegfried N, Morley K, Brooke‐Sumner C, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019; 12:CD001088. [PMID: 31829430 PMCID: PMC6906736 DOI: 10.1002/14651858.cd001088.pub4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months) No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence). AUTHORS' CONCLUSIONS We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area.
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Affiliation(s)
- Glenn E Hunt
- The University of SydneyDiscipline of PsychiatryConcord Centre for Mental HealthHospital RoadSydneyNSWAustralia2139
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Kirsten Morley
- The University of SydneyAddiction MedicineSydneyAustralia
| | - Carrie Brooke‐Sumner
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Michelle Cleary
- University of TasmaniaSchool of Nursing, College of Health and MedicineSydney, NSWAustralia
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van de Luitgaarden IAT, Beulens JWJ, Schrieks IC, Kieneker LM, Touw DJ, van Ballegooijen AJ, van Oort S, Grobbee DE, Bakker SJL. Urinary Ethyl Glucuronide Can Be Used as a Biomarker of Habitual Alcohol Consumption in the General Population. J Nutr 2019; 149:2199-2205. [PMID: 31268139 PMCID: PMC6887922 DOI: 10.1093/jn/nxz146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Alcohol consumption is a frequently studied risk factor for chronic diseases, but many studies are hampered by self-report of alcohol consumption. The urinary metabolite ethyl glucuronide (EtG), reflecting alcohol consumption during the past 72 h, is a promising objective marker, but population data are lacking. OBJECTIVE The objective of this study was to assess the reliability of EtG as a marker for habitual alcohol consumption compared with self-report and other biomarkers in the general population. METHODS Among 6211 participants in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort, EtG concentrations were measured in 24-h urine samples. EtG was considered positive when concentrations were ≥100 ng/mL. Habitual alcohol consumption was self-reported by questionnaire (categories: no/almost never, 1-4 units per month, 2-7 units per week, 1-3 units per day or ≥4 units per day). Plasma HDL cholesterol concentration, erythrocyte mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltransferase (GGT) were determined as indirect biomarkers of alcohol consumption. Sensitivity, specificity, positive and negative predictive value, and proportions of agreement between reported consumption and EtG were calculated. To test the agreement of EtG concentration and alcohol consumption in categories, linear regression analysis was performed. In addition, the association between EtG concentrations and indirect biomarkers was analyzed. RESULTS Mean age was 53.7 y, and 52.9% of participants men. Of the self-reported abstainers, 92.3% had an EtG concentration <100 ng/mL. Sensitivity was 66.3%, positive predictive value was 96.3%, and negative predictive value was 47.4%. The proportion of positive agreement was 78.5%, and the proportion of negative agreement was 62.7%. EtG concentrations were linearly associated with higher categories of alcohol consumption (P-trend < 0.001), adjusted for age, sex, and renal function. EtG was positively related to MCV, HDL cholesterol, and GGT but not to AST and ALT concentrations. CONCLUSIONS This study shows that urinary EtG is in reasonable agreement with self-reported alcohol consumption and therefore can be used as an objective marker of habitual alcohol consumption in the general population.
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Affiliation(s)
- Inge A T van de Luitgaarden
- Julius Center for Health Sciences and Primary Care of the University Medical Center Utrecht, Utrecht, Netherlands
- Julius Clinical, Zeist, Netherlands
| | - Joline W J Beulens
- Julius Center for Health Sciences and Primary Care of the University Medical Center Utrecht, Utrecht, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Ilse C Schrieks
- Julius Center for Health Sciences and Primary Care of the University Medical Center Utrecht, Utrecht, Netherlands
- Julius Clinical, Zeist, Netherlands
| | - Lyanne M Kieneker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daan J Touw
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Adriana J van Ballegooijen
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
- Department of Nephrology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Sabine van Oort
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care of the University Medical Center Utrecht, Utrecht, Netherlands
- Julius Clinical, Zeist, Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Oluwoye O, Kriegel L, Alcover KC, McPherson S, McDonell MG, Roll JM. The dissemination and implementation of contingency management for substance use disorders: A systematic review. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:99-110. [PMID: 31259569 DOI: 10.1037/adb0000487] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is one of the most effective behavioral interventions for substance use. However, the implementation of contingency management has not been as widespread as might be expected given its efficacy. This review summarizes literature that examines the dissemination and implementation of contingency management for substance use in community (e.g., specialized substance use treatment) and clinical (e.g., primary care) settings. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases including Google Scholar, World of Knowledge, PsycINFO, and PubMed were searched. Search results yielded 100 articles and after the screening of titles and abstracts 44 were identified. Full-text articles were examined for eligibility and yielded 24 articles that were included in this review. Of the 24 articles included in the review, the majority (n = 11) focused on implementing contingency management in methadone clinics and opioid treatment programs. Training methods, implementation strategies, fidelity assessments, and attitudes toward the implementation of contingency management are discussed in greater detail. These findings highlight the importance of organizational input and ongoing supervision and consultation, and the need for additional research that is guided by theoretical frameworks and use rigorous study designs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Liat Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Karl C Alcover
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane
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30
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Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension. Curr Hypertens Rep 2019; 21:59. [DOI: 10.1007/s11906-019-0966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Leickly E, Skalisky J, Angelo FA, Srebnik D, McPherson S, Roll JM, Ries RK, McDonell MG. Perspectives on a contingency management intervention for alcohol use among consumers with serious mental illness. Psychiatr Rehabil J 2019; 42:26-31. [PMID: 30475006 PMCID: PMC6506435 DOI: 10.1037/prj0000330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study describes the perspectives of outpatients with serious mental illness (SMI) and alcohol dependence on their participation in a contingency management (CM) intervention for alcohol use. METHODS Thirty-five adults with SMI and alcohol dependence participated in a randomized trial of CM for alcohol use, where they were rewarded with prizes contingent on abstinence from alcohol. All participants were interviewed regarding their participation in CM with a consistent structure that included nine open-ended questions. Favored and disliked aspects of CM, perception of alcohol biomarker accuracy, and interest in participating in similar CM interventions provided by treatment centers, rather than researchers, were explored. RESULTS Participants spoke enthusiastically about receiving prizes, as well as how CM increased their awareness of drinking and helped support their abstinence from alcohol. Most participants felt the ethyl glucuronide biomarker urine tests used to measure alcohol use were accurate, and they were interested in enrolling in CM if it was offered as a clinical program. Research staff who implemented the intervention were well regarded by participants, and interactions with research staff were perceived positively. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Adults with SMI and alcohol dependence participating in a trial of CM for alcohol use reported overall positive perceptions of and experiences with CM. Receiving small tangible prizes and having positive interpersonal interactions with study staff were reported as especially impactful. These findings indicate that CM is well received by consumers, in addition to its empirical and practical benefits as an evidence-based, low-cost intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University
| | | | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University
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32
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Oluwoye O, Monroe-DeVita M, Burduli E, Chwastiak L, McPherson S, McClellan JM, McDonell MG. Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study. Early Interv Psychiatry 2019; 13:142-146. [PMID: 29356438 PMCID: PMC6684200 DOI: 10.1111/eip.12542] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/14/2017] [Accepted: 12/17/2017] [Indexed: 01/03/2023]
Abstract
AIM The primary aim of this study was to examine the effect of recent tobacco, alcohol and cannabis use on treatment outcomes among participants experiencing first episode psychosis (FEP). METHODS Secondary data analyses were conducted on 404 participants enrolled in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study. RAISE-ETP investigated the effectiveness of a coordinated specialty care (CSC) intervention for FEP in community mental health agencies in the United States. Generalized estimating equations were used to examine whether recent tobacco smoking, alcohol, and cannabis use at baseline were associated with illness severity, number of antipsychotic pills missed, psychiatric symptoms and quality of life during the 24-month treatment period, after controlling for duration of untreated psychosis and treatment group. RESULTS At baseline, roughly 50% (n = 209) of participants reported recent tobacco, 28% (n = 113) alcohol and 24% (n = 95) cannabis use. Tobacco smokers had higher levels of illness severity (β = .24; P < .005), a higher number of missed pills (β = 2.89; P < .05), higher psychiatric symptoms and lower quality of life during treatment relative to non-smokers. Alcohol users had a higher number of missed pills (β = 3.16; P < .05) during treatment and cannabis users had higher levels of illness severity (β = .18; P < .05) and positive symptoms (β = 1.56; P < .05) relative to non-users. CONCLUSIONS Tobacco, alcohol and cannabis use are common in youth seeking treatment for FEP. Tobacco smoking was associated with more negative clinical outcomes. These findings have implications for including interventions targeting these areas of substance use within current CSC models.
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Affiliation(s)
- Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioural Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Ekaterina Burduli
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioural Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington.,Department of Psychiatry and Behavioural Sciences, University of Washington School of Medicine, Seattle, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Providence Medical Research Centre, Providence Health Care, Spokane, Washington
| | - Jon M McClellan
- Department of Psychiatry and Behavioural Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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Edwards AC, Ohlsson H, Svikis DS, Sundquist J, Sundquist K, Kendler KS. Protective Effects of Pregnancy on Risk of Alcohol Use Disorder. Am J Psychiatry 2019; 176:138-145. [PMID: 30486670 PMCID: PMC6358475 DOI: 10.1176/appi.ajp.2018.18050632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The authors sought to clarify the etiology of the association between pregnancy and reduced risk of alcohol use disorder. METHODS The authors used data from longitudinal population-wide Swedish medical, pharmacy, and criminal registries to evaluate whether rates of alcohol use disorder are lower during pregnancy. They compared pregnant women born between 1975 and 1992 (N=322,029) with matched population controls, with female relatives discordant for pregnancy, and with pre- and postpregnancy periods within individuals. They further compared rates of alcohol use disorder between pregnant women and their partners. RESULTS Pregnancy was inversely associated with alcohol use disorder across all analyses (odds ratios, 0.17-0.32). In co-relative analyses, the strength of the association increased among more closely related individuals. Within individuals, rates of alcohol use disorder were substantially decreased during pregnancy relative to the prepregnancy period (odds ratios, 0.25-0.26), and they remained reduced during postpartum periods (odds ratios, 0.23-0.31). Results were similar for second pregnancies (odds ratio, 0.23). The partners of pregnant women also exhibited reductions in alcohol use disorder (odds ratio, 0.45). Among women who became pregnant at earlier ages and those with a history of criminal behavior, the negative association between pregnancy and alcohol use disorder was especially pronounced, but no moderation was observed for a personal or maternal parental history of alcohol use disorder. CONCLUSIONS The findings suggest that pregnancy plays a critical, and likely causal, motivational role in reducing alcohol use disorder risk among women and, to a lesser extent, their partners. These results extend our understanding of the relationship between pregnancy and alcohol use, demonstrating that even a severe condition such as alcohol use disorder is subject to the protective effects of pregnancy.
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Affiliation(s)
- Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US,Corresponding author: Alexis C. Edwards; VCU, PO Box 980126, Richmond, VA, 23298-0126; Ph: +1 804-828-8591; Fax: +1 804-828-1471;
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Dace S. Svikis
- Departments of Psychology, Psychiatry, and Obstetrics/Gynecology, Virginia Commonwealth University, Richmond, VA, US
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden,Icahn School of Medicine at Mount Sinai, New York, NY, US,These authors jointly supervised this work
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US,These authors jointly supervised this work
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Hirchak KA, Herron J, Murphy SM, Donovan D, Roll JM, Buchwald D, McDonell MG, McPherson SM. Assessing the Interest and Cultural Congruence of Contingency Management as an Intervention for Alcohol Misuse Among Younger American Indian Adults. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2019; 26:38-57. [PMID: 31743414 PMCID: PMC6925541 DOI: 10.5820/aian.2603.2019.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A qualitative study was conducted to assess interest in contingency management (CM) for younger American Indian (AI) adults (18-29 years old), how to culturally and developmentally adapt CM for younger AI adults, and interest in CM relative to culturally grounded treatment approaches. We conducted a total of four focus groups with younger adults and families in two AI communities: a rural reservation and an urban Indian health clinic (n = 32). Four overarching themes emerged suggesting that offering prizes, cultural activities, and activities that capture the attention of younger adults integrated into the CM intervention is ideal for enhancing engagement.
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Affiliation(s)
- Katherine A. Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jalene Herron
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Sean M. Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John M. Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Department of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G. McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Department of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Sterling M. McPherson
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Department of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Providence Medical Research Center, Providence Health Care, Spokane, WA, USA
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Ray LA, Bujarski S, Grodin E, Hartwell E, Green R, Venegas A, Lim AC, Gillis A, Miotto K. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:124-140. [PMID: 30373394 DOI: 10.1080/00952990.2018.1528265] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. OBJECTIVE This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. METHOD This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. SCIENTIFIC SIGNIFICANCE One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.
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Affiliation(s)
- Lara A Ray
- a Department of Psychology , University of California , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Spencer Bujarski
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Erica Grodin
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Emily Hartwell
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - ReJoyce Green
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Alexandra Venegas
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Aaron C Lim
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Artha Gillis
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Karen Miotto
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
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Burduli E, Skalisky J, Hirchak K, Orr MF, Foote A, Granbois A, Ries R, Roll JM, Buchwald D, McDonell MG, McPherson SM. Contingency management intervention targeting co-addiction of alcohol and drugs among American Indian adults: Design, methodology, and baseline data. Clin Trials 2018; 15:587-599. [PMID: 30156433 DOI: 10.1177/1740774518796151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS American Indian adults have some of the highest alcohol abstinence rates compared to the overall US population. Despite this, many American Indian people are more likely to concurrently use alcohol and illicit drugs and are less likely to participate and remain in outpatient treatment for alcohol and other drug use compared to the general US population. There is limited knowledge about effective interventions targeting alcohol and drug co-addiction among American Indian adults. Contingency management is a behavioral intervention designed to increase drug abstinence by offering monetary incentives in exchange for drug and alcohol negative urine samples. We aim to evaluate and describe a culturally tailored contingency management intervention to increase alcohol and other drug abstinence among American Indian adults residing in a Northern Plains reservation. METHODS This 2 × 2 factorial, randomized controlled trial currently includes 114 American Indian adults with alcohol and/or drug dependence who are seeking treatment. Participants were randomized into one of four groups that received (1) contingency management for alcohol, (2) contingency management for other drug, (3) contingency management for both substances, or (4) no contingency management for either substance. We present descriptive, baseline data to characterize the sample and describe the modified contingency management approach that is specific to the community wherein this trial was being conducted. RESULTS The sample is 49.1% male, with an average age of 35.8 years (standard deviation = 10.4 years). At baseline, 43.0% of the sample tested positive for ethyl glucuronide, 50.9% of participants self-reported methamphetamine as their most used drug, 36.8% self-reported cannabis, and 12.3% self-reported prescription opiates as their most used drug. Among randomized participants, 47.4% tested positive for cannabis, 28.1% tested positive for methamphetamine, 16.7% tested positive for amphetamines, and 2.1% tested positive for opiates. CONCLUSION This is the first study to examine a culturally tailored contingency management intervention targeting co-addiction of two substances among American Indian adults. By establishing a tribal-university partnership to adapt, implement, and evaluate contingency management, we will increase the literature on evidence-based addiction treatments and research, while improving trust for addiction interventions among American Indian communities through ongoing collaboration. Moreover, results have implications for the use of contingency management as an intervention for co-addiction in any population.
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Affiliation(s)
- Ekaterina Burduli
- 1 College of Nursing, Washington State University, Spokane, WA, USA.,2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA
| | - Jordan Skalisky
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA
| | - Katherine Hirchak
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA
| | - Michael F Orr
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA
| | - Albert Foote
- 5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA
| | | | - Richard Ries
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,6 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John M Roll
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- 4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G McDonell
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Sterling M McPherson
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,6 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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McPherson SM, Burduli E, Smith CL, Herron J, Oluwoye O, Hirchak K, Orr MF, McDonell MG, Roll JM. A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Subst Abuse Rehabil 2018; 9:43-57. [PMID: 30147392 PMCID: PMC6095117 DOI: 10.2147/sar.s138439] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This review of contingency management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.
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Affiliation(s)
- Sterling M McPherson
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Ekaterina Burduli
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - Crystal Lederhos Smith
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Jalene Herron
- Programs of Excellence in Addictions Research, Washington State University,
- Behavioral Health Interventions (BHI), Washington State University, Spokane, WA, USA
| | - Oladunni Oluwoye
- Programs of Excellence in Addictions Research, Washington State University,
- Behavioral Health Interventions (BHI), Washington State University, Spokane, WA, USA
| | - Katherine Hirchak
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Michael F Orr
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - Michael G McDonell
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - John M Roll
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
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Orr MF, Lederhos Smith C, Finlay M, Martin SC, Brooks O, Oluwoye OA, Leickly E, McDonell M, Burduli E, Barbosa-Leiker C, Layton M, Roll JM, McPherson SM. Pilot investigation: randomized-controlled analog trial for alcohol and tobacco smoking co-addiction using contingency management. Behav Pharmacol 2018; 29:462-468. [PMID: 29561290 PMCID: PMC6035091 DOI: 10.1097/fbp.0000000000000379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Contingency management (CM) is associated with decreases in off-target drug and alcohol use during primary target treatment. The primary hypothesis for this trial was that targeting alcohol use or tobacco smoking would yield increased abstinence in the opposite, nontargeted drug. We used a 2 [CM vs. noncontingent control (NC) for alcohol]×2 (CM vs. NC for smoking tobacco) factorial design, with alcohol intake (through urinary ethyl glucuronide) and tobacco smoking (through urinary cotinine) as the primary outcomes. Thirty-four heavy-drinking smokers were randomized into one of four groups, wherein they received CM, or equivalent NC reinforcement, for alcohol abstinence, smoking abstinence, both drugs, or neither drug. The CM for alcohol and tobacco group had only two participants and therefore was not included in analysis. Compared with the NC for alcohol and tobacco smoking group, both the CM for the tobacco smoking group [odds ratio (OR)=12.03; 95% confidence interval (CI): 1.50-96.31] and the CM for the alcohol group (OR=37.55; 95% CI: 4.86-290.17) submitted significantly more tobacco-abstinent urinalyses. Similarly, compared with the NC for the alcohol and tobacco group, both the CM for smoking (OR=2.57; 95% CI: 1.00-6.60) and the CM for alcohol groups (OR=3.96; 95% CI: 1.47-10.62) submitted significantly more alcohol-abstinent urinalyses. These data indicate cross-over effects of CM on indirect treatment targets. Although this is a pilot investigation, it could help to inform the design of novel treatments for alcohol and tobacco co-addiction.
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Affiliation(s)
- Michael F Orr
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Crystal Lederhos Smith
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Myles Finlay
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Samantha C Martin
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Olivia Brooks
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Oladunni A Oluwoye
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
| | - Emily Leickly
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
| | - Michael McDonell
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
| | - Ekaterina Burduli
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
| | - Celestina Barbosa-Leiker
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Matt Layton
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
| | - John M Roll
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
| | - Sterling M McPherson
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine
- Programs of Excellence in Addictions Research
- Translational Addictions Research Center
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Point-of-Care Urine Ethyl Glucuronide Testing to Detect Alcohol Use Among HIV-Hepatitis B Virus Coinfected Adults in Zambia. AIDS Behav 2018; 22:2334-2339. [PMID: 29336004 DOI: 10.1007/s10461-018-2030-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In an HIV-hepatitis B virus (HIV-HBV) coinfection cohort in Zambia, we piloted a qualitative point-of-care (POC) test for urine Ethyl glucuronide (uEtG), assessed concordance between uEtG and alcohol use disorders identification test-consumption (AUDIT-C), and identified epidemiological factors associated with underreporting (defined as uEtG-positivity with last reported drink > 7 days prior). Among 211 participants (40.8% women), there were 44 (20.8%) lifetime abstainers, 32 (15.2%) former drinkers, and 135 (64.0%) current drinkers, including 106 (50.2%) with unhealthy drinking per AUDIT-C. Eighty-seven (41.2%) were uEtG-positive including 64 of 65 (98.5%) who drank ≤ 3 days prior and 17 of 134 (12.7%) underreported, all of whom admitted to recent drinking when results were discussed. uEtG was moderately concordant with AUDIT-C. Past drinking (versus lifetime abstinence) and longer time on antiretrovirals (≥ 12 months) were associated with underreporting. These data support further use of POC alcohol biomarkers in HIV and hepatitis research and clinical settings.
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Oluwoye O, Skalisky J, Burduli E, Chaytor NS, McPherson S, Murphy SM, Herron J, Hirchak K, Burley M, Ries RK, Roll JM, McDonell MG. Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness. Contemp Clin Trials 2018; 69:92-98. [PMID: 29680318 PMCID: PMC5995562 DOI: 10.1016/j.cct.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG >349ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders. AIMS To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative to those who receive typical low-magnitude abstinence based CM (Usual CM). Additionally, variables in the Addictions Neuroclinical Assessment model will be examined as treatment response moderators. METHODS Participants (N=400) will be recruited from two urban mental health organizations and complete a 4-week induction period where they will be reinforced for submitting samples for uEtG testing. Participants who attain a mean uEtG >349mg/mL will be randomized to receive either Usual CM, High-Magnitude CM, or Shaping CM for 16weeks. Differences in abstinence, assessed by uEtG, will be examined during treatment and during a 12-month follow-up. Measures of negative emotionality, alcohol reinforcer salience, and executive functioning will be gathered at study intake and used to predict treatment outcomes. DISCUSSION This novel approach to CM will use an alcohol biomarker to identify those at risk for treatment non-response and determine if adaptations to CM might improve outcomes for this group.
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Affiliation(s)
- Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Ekaterina Burduli
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; College of Nursing, Washington State University, Spokane, WA, United States
| | - Naomi S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Providence Medical Research Center, Providence Health Care, Spokane, WA, United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Sean M Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medical College, NY, New York, United States
| | - Jalene Herron
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Katherine Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Mason Burley
- Health Policy and Administration, Washington State University, Spokane, WA, United States
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.
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Oluwoye O, Leickly E, Skalisky J, McPherson S, Hirchak K, Srebnik D, Roll JM, Ries RK, McDonell MG. Serious Mental Illness in Heavy Drinkers Is Associated with Poor Treatment Outcomes in Outpatients with Co-occurring Disorders. Int J Ment Health Addict 2018; 16:672-679. [PMID: 29973859 PMCID: PMC6027641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
The objective of this study was to determine whether the interaction between type of serious mental illness (SMI) and pre-treatment drinking severity, assessed by ethyl glucuronide (EtG), predicts EtG-positive urine samples submitted during treatment in outpatients with co-occurring alcohol dependence and SMI. Seventy-nine participants were randomized to treatment-as-usual or treatment-as-usual and contingency management (CM) targeting alcohol abstinence. Generalized estimating equations were used to assess the interaction of pre-treatment drinking (heavy drinking or light drinking) and SMI diagnosis (major depression, bipolar, or schizophrenia-spectrum disorders) across a 12-week treatment period. In the overall sample, the interaction of drinking severity and SMI diagnosis (p = 0.006) was associated with alcohol abstinence. Exploratory analyses of the interaction term among participants randomized to CM (n = 40; p = 0.008) were associated with alcohol abstinence during CM. Type of SMI diagnosis was associated with treatment outcomes in individuals who engaged in heavy drinking, but not light drinking, prior to treatment.
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Affiliation(s)
- Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Emily Leickly
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA 99210-1495, USA
- Providence Medical Research Center, Providence Health Care, Spokane, WA, USA
| | - Katherine Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John M Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA 99210-1495, USA
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA 99210-1495, USA
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Oluwoye O, Hirchak K, Leickly E, Skalisky J, McPherson S, Srebnik D, Roll JM, Ries RK, McDonell MG. Interaction between pre-treatment drug use and heterogeneity of psychiatric diagnosis predicts outcomes in outpatients with co-occurring disorders. Psychiatry Res 2018; 260:233-235. [PMID: 29220679 PMCID: PMC5975078 DOI: 10.1016/j.psychres.2017.11.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/06/2017] [Accepted: 11/25/2017] [Indexed: 11/30/2022]
Abstract
We examined whether the interaction of baseline stimulant use, assessed by urine drug tests, and type of serious mental illness (SMI) diagnosis predicted stimulant use in a trial of contingency management (CM). The interaction between baseline stimulant use and SMI diagnoses was significant in the overall sample (p=0.002) when controlling for the main effects of treatment condition, baseline stimulant use, and SMI diagnosis. Similar results were also found within the CM sample. Individuals with bipolar disorder were more or less likely, depending on their baseline stimulant-drug test results, to use stimulants during treatment compared to those with other SMI diagnoses.
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Affiliation(s)
- Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Katherine Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Emily Leickly
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Providence Medical Research Center, Providence Health Care, Spokane, WA, USA.
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.
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Vilardaga R, Rizo J, Zeng E, Kientz JA, Ries R, Otis C, Hernandez K. User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness. JMIR Serious Games 2018; 6:e2. [PMID: 29339346 PMCID: PMC5790963 DOI: 10.2196/games.8881] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/10/2017] [Accepted: 11/25/2017] [Indexed: 01/14/2023] Open
Abstract
Background Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content.
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Affiliation(s)
- Roger Vilardaga
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Javier Rizo
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Emily Zeng
- Design Use Build, Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Design Use Build, Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Chad Otis
- Chad Otis Illustration & Design, Seattle, WA, United States
| | - Kayla Hernandez
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
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Leickly E, Skalisky J, Oluwoye O, McPherson SM, Srebnik D, Roll JM, Ries RK, McDonell MG. Homelessness predicts attrition but not alcohol abstinence in outpatients experiencing co-occurring alcohol dependence and serious mental illness. Subst Abus 2017; 39:271-274. [PMID: 29161228 DOI: 10.1080/08897077.2017.1391926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adults experiencing homelessness and serious mental illnesses (SMI) are at an increased risk of poor mental health and treatment outcomes compared with stably housed adults with SMI. The additional issue of alcohol misuse further complicates the difficulties of those living with homelessness and SMI. In this secondary data analysis, the authors investigated the impact of homelessness on attrition and alcohol use in a contingency management (CM) intervention that rewarded alcohol abstinence in outpatients with SMI. METHODS The associations between housing status and attrition and alcohol abstinence during treatment, as assessed by ethyl glucuronide (EtG) urine tests, were evaluated in 79 adults diagnosed with alcohol dependence and SMI. RESULTS Thirty-nine percent (n = 31) of participants reported being homeless at baseline. Individuals who were homeless were more likely to drop out of CM (n = 10, 62.5%) than those who were housed (n = 4, 16.7%), χ2(1) = 8.86, P < .05. Homelessness was not associated with attrition in the noncontingent control group. Accounting for treatment group and prerandomization EtG levels, neither the effect of housing status nor the interaction of housing status and group were associated with EtG-assessed alcohol abstinence during treatment. CONCLUSIONS Individuals experiencing homelessness and co-occurring alcohol dependence and SMI receiving CM had higher rates of attrition, relative to those who were housed. Homelessness was not associated with differences in biologically assessed alcohol abstinence.
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Affiliation(s)
- Emily Leickly
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA.,d Department of Psychology , Portland State University , Portland , Oregon , USA
| | - Jordan Skalisky
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
| | - Oladunni Oluwoye
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
| | - Sterling M McPherson
- b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA.,e Providence Medical Research Center, Providence Health Care , Spokane , Washington, USA
| | - Debra Srebnik
- f Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine , Seattle , Washington, USA
| | - John M Roll
- b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
| | - Richard K Ries
- b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,f Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine , Seattle , Washington, USA
| | - Michael G McDonell
- a Initiative for Research and Education to Advance Community Health, Washington State University , Spokane , Washington , USA.,b Elson S. Floyd College of Medicine, Washington State University , Spokane , Washington , USA.,c Program of Excellence in Addiction Research, Washington State University , Spokane , Washington , USA
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Serious Mental Illness in Heavy Drinkers Is Associated with Poor Treatment Outcomes in Outpatients with Co-occurring Disorders. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9821-4] [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: 10/18/2022] Open
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Skalisky J, Leickly E, Oluwoye O, McPherson SM, Srebnik D, Roll JM, Ries RK, McDonell MG. Prevalence and Correlates of Cannabis Use in Outpatients with Serious Mental Illness Receiving Treatment for Alcohol Use Disorders. Cannabis Cannabinoid Res 2017; 2:133-138. [PMID: 28861513 PMCID: PMC5569619 DOI: 10.1089/can.2017.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: People with serious mental illness (SMI) use cannabis more than any other illicit drug. Cannabis use is associated with increased psychotic symptoms and is highly comorbid with alcohol use disorders (AUDs). Despite the national trend toward decriminalization, little is known about the prevalence, correlates, and impact of cannabis use on those with SMI receiving treatment for substance use disorders, a group at high risk for the negative effects of cannabis use. Methods: In this secondary data analysis, cannabis use prevalence, correlates, and impact on treatment outcomes were examined in 121 adults with cooccurring SMI and AUDs receiving outpatient addiction treatment in a randomized trial of contingency management (CM) for alcohol. Prevalence and frequency of cannabis use were calculated across the 7-month study period using self-report and urine tests. Cannabis users were compared with nonusers by SMI diagnosis, psychiatric symptoms, medical problems, legal problems, and HIV-risk behavior. The relationship between cannabis use and longest duration of alcohol abstinence in participants randomized to CM (n=40) was assessed. Results: Fifty-seven (47%) of participants submitted at least one cannabis-positive urine sample during the study. Out of the 2834 total samples submitted, 751 (27%) were positive for cannabis. Cannabis users were 2.2 times more likely to submit an alcohol-positive sample, and 2.5 times more likely to submit a cocaine-positive sample at baseline, relative to noncannabis users (p=0.01). Cannabis users were more likely to engage in risky sexual behavior (p=0.01) and to report being homeless (p=0.03) than nonusers. When controlling for pretreatment alcohol use, the relationship between comorbid cannabis use and alcohol abstinence during CM was not significant (p=0.77). Conclusion: Rates of comorbid cannabis use were high in this sample of adults with SMI and AUDs. Cannabis use was correlated with recent alcohol and cocaine use, risky sexual behavior, and homelessness, but not with alcohol abstinence during CM.
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Affiliation(s)
- Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Program for Excellence in Addiction Research, Washington State University, Spokane, Washington
| | - Emily Leickly
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Program for Excellence in Addiction Research, Washington State University, Spokane, Washington
| | - Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Program for Excellence in Addiction Research, Washington State University, Spokane, Washington
| | - Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Program for Excellence in Addiction Research, Washington State University, Spokane, Washington.,Providence Medical Research Center, Providence Health Care, Spokane, Washington
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Program for Excellence in Addiction Research, Washington State University, Spokane, Washington
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.,Program for Excellence in Addiction Research, Washington State University, Spokane, Washington
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McDonell MG, Leickly E, McPherson S, Skalisky J, Hirchak K, Oluwoye O, Srebnik D, Roll JM, Ries RK. Pretreatment ethyl glucuronide levels predict response to a contingency management intervention for alcohol use disorders among adults with serious mental illness. Am J Addict 2017; 26:673-675. [PMID: 28833832 DOI: 10.1111/ajad.12558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/24/2017] [Accepted: 04/20/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study investigated if pretreatment ethyl glucuronide (EtG) levels corresponding to light (100 ng/mL), heavy (500 ng/mL), and very heavy (1,000 ng/mL) drinking predicted longest duration of alcohol abstinence (LDA) and proportion of EtG-negative urine tests in outpatients receiving a 12-week EtG-based contingency management (CM) intervention for alcohol dependence. METHODS Participants were 40 adults diagnosed with alcohol use disorders and serious mental illness who submitted up to 12 urine samples for EtG analysis during a 4-week observation period and were then randomized to 12-weeks of CM for alcohol abstinence and addiction treatment attendance. Alcohol use outcomes during CM as assessed by EtG and self-report were compared across those who did and did not attain a pre-treatment average EtG level of 500 ng/mL-a level that equates to frequent heavy drinking. RESULTS Only the 500 ng/mL cutoff was associated with significant differences in LDA and proportion of EtG-negative samples during CM. Those with a pre-treatment EtG < 500 ng/mL attained a LDA 2.3 (alcohol) to 2.9 (drugs) weeks longer than pre-treatment heavy drinkers. DISCUSSION AND CONCLUSIONS The EtG biomarker can be used to determine who will respond to a CM intervention for alcohol use disorders and could inform future trials that are designed to be tailored to individual patients. SCIENTIFIC SIGNIFICANCE Results suggest pre-treatment EtG cutoffs equivalent to heavy and very heavy drinking predict outcomes in CM. (Am J Addict 2017;26:673-675).
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Affiliation(s)
- Michael Gerard McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Department of Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Emily Leickly
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Sterling McPherson
- Department of Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington.,Providence Medical Research Center, Providence Health Care, Spokane, Washington
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Katherine Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - John Michael Roll
- Department of Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Richard Kirkland Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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McDonell MG, Skalisky J, Leickly E, Orr MF, McPherson S, Roll J, Hill-Kapturczak N, Javors M. Pilot investigation of a phosphatidylethanol-based contingency management intervention targeting alcohol use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:608-613. [PMID: 28714726 DOI: 10.1037/adb0000293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Phosphatidylethanol (PEth) can be detected in blood from 14 to as many as 28 days after alcohol consumption, depending on the amount and frequency of alcohol consumed. PEth may have utility for verifying abstinence in a contingency management (CM) intervention for alcohol use, particularly in settings where frequent verification of abstinence is impossible or impractical. Five nontreatment-seeking heavy drinkers (40% men) participated in an 11-week, ABA-phased within-subject experiment for which they submitted blood spots for PEth measurement, urine samples for ethyl glucuronide (EtG) testing, and self-report drinking data weekly. Participants received reinforcers for submitting samples throughout the A phases. During the B phase (CM phase), they received additional reinforcers when their PEth level was reduced from the previous week and was verified by a negative EtG (<150 ng/ml) urine test and self-report. PEth, EtG, and self-report outcomes were compared between A phases (Weeks 1-3, 8-11) and B phases (Weeks 4-7). During the A phases, 23% of PEth results indicated alcohol abstinence, whereas 53% of PEth samples submitted during the CM (B phase) indicated alcohol abstinence. Participants were more likely to submit EtG-negative urine samples and report lower levels of drinking and heavy drinking during the B phase, relative to the A phases. We also explored the ability of PEth to detect self-reported drinking. The combined PEth homologs (16:0/18:1 and 16:0/18:2) predicted self-reported drinking with area under the curve from 0.81 (1 week) to 0.80 (3 weeks). Results support the initial feasibility of a Peth-based CM intervention. (PsycINFO Database Record
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Affiliation(s)
- Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University
| | - Emily Leickly
- Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University
| | - Michael F Orr
- Program for Excellence in Addiction Research, Washington State University
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and Program for Excellence in Addiction Research, Washington State University
| | - John Roll
- Elson S. Floyd College of Medicine and Program for Excellence in Addiction Research, Washington State University
| | | | - Martin Javors
- Department of Psychiatry, University of Texas Health Science Center at San Antonio
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