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Thompson RA, Johnson D, Ashworth M, Stott M. Establishing Quality and Outcome Measures for Recovery Housing: A Tiered Approach Supporting Service Evolution. Community Ment Health J 2024; 60:681-690. [PMID: 38270727 PMCID: PMC11001738 DOI: 10.1007/s10597-023-01219-6] [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: 08/22/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
With over one-hundred thousand drug overdose deaths in 2021, substance use disorder (SUD) is a public health crisis in the United States. Medical stabilization has been the predominant focus of SUD interventions despite low levels of retention. Consequently, national quality measures for SUD care outside the clinical continuity of care are limited. The expansion of recovery support services addressing social drivers of health outside clinical settings is needed. The current SUD quality measures are not applicable nor feasible for recovery support service providers with limited resource capacities, like the estimated 17,900 recovery housing providers nationwide. Despite widespread support for recovery housing and its documented effectiveness, no universal set of measures has been developed for widespread adoption. In this brief, a matrix of quality measures are proposed to meet the needs of recovery housing providers with various capacities to support service evolution and improve equitable SUD treatment and recovery care.
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Affiliation(s)
- Robin A Thompson
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA.
| | - David Johnson
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA
| | - Madison Ashworth
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA
| | - Milena Stott
- Fletcher Group, Inc., 601 Meyers Baker Road, Suite 238, London, KY, 40741, USA
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Hahn C, Tilstra-Ferrell E, Salim S, Goodrum N, Rheingold A, Gilmore AK, Barber S, Moreland A. Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study. JMIR Form Res 2024; 8:e49557. [PMID: 38358791 PMCID: PMC10905344 DOI: 10.2196/49557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. OBJECTIVE This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. METHODS Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). RESULTS Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. CONCLUSIONS Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.
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Affiliation(s)
- Christine Hahn
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Emily Tilstra-Ferrell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Selime Salim
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Nada Goodrum
- Department of Psychology, University of South Carolina, Charleston, SC, United States
| | - Alyssa Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, Georgia State University, Atlanta, GA, United States
| | - Sara Barber
- South Carolina Coalition Against Domestic Violence and Sexual Assault, Columbia, SC, United States
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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Li D, Wang D, Ren H, Tian Y, Chen J, Zhu R, Li Y, Wang L, Zhang XY. Association between rumination and drug craving in Chinese male methamphetamine use disorder patients with childhood trauma. CHILD ABUSE & NEGLECT 2023; 144:106357. [PMID: 37459735 DOI: 10.1016/j.chiabu.2023.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In China, males make up the majority of methamphetamine (MA) dependent individuals and the majority of treatment seekers. Childhood trauma (CT) and rumination are associated with an increased risk of MA use. However, the association between CT, rumination, and drug craving remains largely unknown. OBJECTIVE The present study aims to explore the association between rumination and drug craving in methamphetamine use disorder (MAUD) patients with CT. PARTICIPANTS AND SETTING This study recruited 404 male participants with MAUD from a male drug rehabilitation center in Southwest China. METHODS Patients with CT were identified by the short form of Childhood Trauma Questionnaire (CTQ-SF). Rumination and drug craving were assessed by the Ruminative Responses Scale (RRS) and the Obsessive Compulsive Drug Use Scale (OCDUS), respectively. RESULTS 188 patients (46.5 %) experienced CT. Patients who had experienced CT showed significantly higher RRS symptom rumination score and OCDUS total score than those who had not. In patients with CT, RRS total and all subscale scores were positively associated with OCDUS interference of drug. Furthermore, the RRS brooding (β = 0.34, p < 0.001) and total scores (β = 0.38, p < 0.001) were determined to be separate contributors to the OCDUS total score in patients with CT. CONCLUSIONS Our study suggests that CT is common in male MAUD patients, and those who have suffered CT may exhibit higher levels of rumination and drug craving. Moreover, CT may play an influential role in the association between rumination and drug craving in patients with MAUD.
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Affiliation(s)
- Deyang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Hengqin Ren
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Logan TK, Cole J. Mental Health and Recovery Needs Among Women Substance Use Disorder Treatment Clients With Stalking Victimization Experiences. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231159307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This study examined mental health and recovery needs at substance use disorder (SUD) program entry and at follow-up ( n = 2064) among: (1) women with no stalking victimization; (2) women with lifetime stalking victimization experiences; and (3) women with recent stalking victimization experiences (within 12 months of program entry). Stalking can be defined as a repeated pattern of behavior that creates fear or concern for safety or extreme emotional distress in the target. Women who experienced any stalking victimization, and particularly recent stalking victimization at program entry, had more recovery needs and increased mental health symptoms. At follow-up, women with any stalking victimization experiences continued to have more recovery needs with few differences between the lifetime and recent stalking victimization groups. Stalking victimization experiences were significantly associated with depression and anxiety symptoms in the multivariate analysis. Addressing stalking victimization during SUD treatment may be important to facilitate recovery.
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Affiliation(s)
- TK Logan
- University of Kentucky, Lexington, KY, USA
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Paris R, Herriott AL, Holt M. Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning. Infant Ment Health J 2023; 44:228-239. [PMID: 36808618 DOI: 10.1002/imhj.22040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023]
Abstract
Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.
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Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractThis scoping review aimed to synthesise the published literature on guiding principles for managing co-occurring alcohol/other drug (AOD) and mental health conditions in AOD treatment settings. Systematic search of key electronic databases (January 1, 2010, to February 17, 2021) produced 4583 articles, and independent title/abstract and full text screening left 43 articles for inclusion. Fifteen guiding principles were identified, most commonly: build a strong therapeutic relationship (n = 24 articles), provide holistic care (n = 12), involve peer support (n = 7), ensure continuity of care (n = 6), support the professional development and competence of workers (n = 6), and provide trauma-informed care (n = 5). Remaining principles were identified in < 5 articles. Limited empirical literature examined the impact of guiding principles on patient- and treatment-related outcomes. This review provides the first comprehensive synthesis of the international literature to derive guiding principles for managing co-occurring AOD and mental health conditions in AOD treatment. Further empirical research is needed to determine the effectiveness of principles at improving outcomes.
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Logan TK, Cole J. Firearm-related threat exposure and associated factors among men and women entering a supportive housing substance use disorder recovery program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:367-377. [PMID: 35157534 DOI: 10.1080/00952990.2021.2007259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Exposure to firearm victimization has often been overlooked as a sequela of substance use disorders (SUD).Objectives: The overall objective of this study was to explore firearm-related victimization and associated factors among men and women entering a supportive housing SUD recovery program.Methods: This study used program intake information from men (n = 1,758) and women (n = 1,066) clients entering a SUD recovery program.Results: Results found that almost half (49.3%) of the clients entering the program had ever been threatened with a firearm or held at gunpoint, and one-quarter of those clients had experienced firearm-related threats in the 6 months before entering the program. Economic vulnerability, mental health problems, polysubstance use, interpersonal victimization, and early use of drugs and alcohol were associated with firearm-related threat exposure. Many of the factors associated with firearm-related threat exposure were similar for men and women. Multivariate results found that polysubstance use (OR 1.16 men and 1.13 women), number of adverse childhood events (OR 1.13 men and 1.09 women), and interpersonal victimization (OR 3.41 men and 2.05 women) in the 6 months before program entry were significantly associated with ever being threatened with a firearm. Suicidality (OR 1.53 men and 1.80 women) and interpersonal victimization (OR 6.38 men and 6.08 women) were associated with being threatened with a firearm in the 6 months before program entry for both men and women.Conclusion: Results suggest there is a need for firearm-related risk reduction interventions for individuals in SUD recovery programs.
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Affiliation(s)
- T K Logan
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Jennifer Cole
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Riccardi E, Blasi E, Zwergel C, Mai A, Morena M, Campolongo P. Sex-dependent Effects of the Drugs of Abuse Amphetamine and the Smart Drug 3,4-Methylenedioxypyrovalerone on Fear Memory Generalization in Rats. Neuroscience 2021; 497:107-117. [PMID: 34968670 DOI: 10.1016/j.neuroscience.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022]
Abstract
In recent years there has been an increase in the development of new synthetic drugs, among which the "bath salt" 3,4-methylenedioxypyrovalerone (MDPV), a psychostimulant with a mechanism of action similar to those of cocaine and amphetamine, stands out. Drugs of abuse have been consistently shown to affect memory function in male rodents. We have recently shown that amphetamine and MDPV induce generalization of fear memory in an inhibitory avoidance discrimination task in male rats. Although abuse of illicit drugs is more prevalent in men than in women, several studies have demonstrated that females are more vulnerable to the effects of drugs of abuse than males and the effects caused by substance dependence on memory in females are still under-investigated. Thus, we examined the effects of subchronic amphetamine or MDPV administrations on memory in a contextual fear conditioning/generalization paradigm in adult male and female rats. Animals were given daily subchronic injections of the drugs, starting 6 days prior the beginning of the behavioral procedures until the end of the paradigm. On day 1 of the experimental protocol, all rats were exposed to a safe context and, the day after, to a slightly different chamber where they received an unsignaled footshock. Twenty-four and forty-eight hours later, freezing behavior and emission of 22 kHz-ultrasonic vocalizations (USVs) were measured in the two different contexts to assess fear memory retention and generalization. Our results indicate that MDPV treatment altered freezing in both sexes, USVs were affected by amphetamine in males while by MDPV in females.
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Affiliation(s)
- Eleonora Riccardi
- Dept. of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; European Center for Brain Research (CERC), Santa Lucia Foundation, 00143 Rome, Italy
| | - Eleonora Blasi
- Dept. of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; European Center for Brain Research (CERC), Santa Lucia Foundation, 00143 Rome, Italy
| | - Clemens Zwergel
- Dept. of Drug Chemistry & Technologies, Sapienza University of Rome, 00185 Rome, Italy; Dept. of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Antonello Mai
- Dept. of Drug Chemistry & Technologies, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Morena
- Dept. of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; European Center for Brain Research (CERC), Santa Lucia Foundation, 00143 Rome, Italy
| | - Patrizia Campolongo
- Dept. of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; European Center for Brain Research (CERC), Santa Lucia Foundation, 00143 Rome, Italy.
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Lortye SA, Will JP, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry 2021; 21:442. [PMID: 34493253 PMCID: PMC8423329 DOI: 10.1186/s12888-021-03366-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. METHODS In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. DISCUSSION This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. TRIAL REGISTRATION Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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Cabanis M, Outadi A, Choi F. Early childhood trauma, substance use and complex concurrent disorders among adolescents. Curr Opin Psychiatry 2021; 34:393-399. [PMID: 33993169 DOI: 10.1097/yco.0000000000000718] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW To highlight the interdependence between early childhood trauma, substance use and complex concurrent disorders among adolescents and discuss the delayed response and gaps in the healthcare system. RECENT FINDINGS High-risk behavior such as suicidality, self-harm and hazardous substance use including overdose and the use of psychotropic substances for self-medication of mental health challenges is a growing concern. These symptoms are often related to early childhood trauma, substance use and complex concurrent disorders. Most countries do not have a youth mental healthcare system, there are no specific guidelines and only few programs addressing high-risk substance use are in place. SUMMARY In addition to the significance of traumatic experience for high-risk substance use and addiction, most parts of the system of care ignore the trauma aspect in treatment of substance use and focus on abstinence. There are hardly any early intervention programs, broader prevention strategies or evidence-based or target-group-oriented treatment offers.
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Affiliation(s)
- Maurice Cabanis
- Center of Mental Health, Hospital for Addiction and Addictive Behavior, Klinikum Stuttgart, Prießnitzweg, Germany
| | - Ava Outadi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Hammersley R, Reid M, Dalgarno P, Wallace J, Liddell D. Trauma, violence and recovery in the life stories of people who have injected drugs. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2020. [DOI: 10.4081/qrmh.2020.9073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper reports qualitative data about violence and trauma amongst drug injectors in Scotland, collected using a life story method with 55 drug injectors currently in recovery. It focusses on different types of violence and trauma that occurred whilst using drugs. Stories told of very severe and repeated traumas often involving extreme violence. One motive for escalating and continuing drug use was avoidant coping to deaden the emotions and thoughts regarding these traumas. Many traumas were due partly to the criminal drug milieu, so respondents were in a vicious cycle of using opiates and other sedative drugs to cope with the consequences of being involved in a lifestyle of using, supplying and obtaining illegal sedative drugs. Drugs were used as a dynamic method of self-medication or avoidant coping to cope with life in a criminal milieu. Traumatic events were more often described as worsening the lifestyle than as being motives for quitting. Amongst the traumas recounted were many incidents of extreme violence. Using drugs to block the psychological effects of such traumas may help explain why people persist using opiates despite experiencing evident serious harms. Interventions need to recognise this, be trauma-aware and appreciate that violence and trauma have severe adverse effects on drug injectors even when they are themselves hardened and violent.
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Fantuzzi C, Mezzina R. Dual diagnosis: A systematic review of the organization of community health services. Int J Soc Psychiatry 2020; 66:300-310. [PMID: 31957528 DOI: 10.1177/0020764019899975] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dual diagnosis (DD), as the co-occurrence of a substance use disorder and a psychiatric disorder, is underestimated, under-diagnosed and often poorly treated throughout the world, although it is highly prevalent in people suffering from a mental disorder. AIMS AND METHODS This review analyzed 48 studies from a PubMed and PsycINFO databases search, in order to verify the state of the art regarding the organization of community health services for DD treatment. RESULTS Four macro-themes have been identified: service organization, critical issues, assessment tools and evidence-based interventions. An effective service recognizes the complexity of DD, promotes a common staff culture, and tailors the organization to local needs. The main critical issues in its implementation include the lack of specific staff training, the poor management of resources and the need for greater personalization of care plans, with attention to psychosocial interventions. Integrated service assessment tools can be used as a benchmark measure at the program level for implementation planning and at the national level to affect policy change. The integrated treatment model for DD should also aim to improve access to care and offer treatments based on scientific evidence. It is also evident that the integration of services can improve outcomes but it is not a guarantee for it. CONCLUSION There is an urgent need to improve networking between mental health and addiction services in order to deal with DD and create new integrated intervention models, paying attention to an approach to the whole person, seen in his/her absolute uniqueness.
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Affiliation(s)
- Claudia Fantuzzi
- Dipartimento di Salute Mentale, ASUI Trieste, WHO Collaborating Centre for Research and Training, Trieste, Italy
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, ASUI Trieste, WHO Collaborating Centre for Research and Training, Trieste, Italy
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McKee SA, Hilton NZ. Co-Occurring Substance Use, PTSD, and IPV Victimization: Implications for Female Offender Services. TRAUMA, VIOLENCE & ABUSE 2019; 20:303-314. [PMID: 29333981 DOI: 10.1177/1524838017708782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The co-occurrence of substance use disorders (SUDs) and post-traumatic stress disorder (PTSD) among women who have been the victims of intimate partner violence (IPV) is complex and causal associations cannot be assumed. Although the presence of co-occurring disorders among IPV victims is a well-established research finding, there is a need for improved understanding of their prevalence and related mental health treatment requirements among female offenders. We review research indicating that service providers working with IPV victims can expect to encounter women with extensive concurrent problems and examine evidence for integrated treatment for SUD, PTSD, and IPV. We propose an outline for assessing and treating SUD and PTSD among female offenders who have experienced IPV victimization. We intend this review to build on previous calls in the co-occurring disorders literature and help integrate the research and treatment evaluation literatures in a way that points to practical implications for policy and practice in female offender services.
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Affiliation(s)
- Shari A McKee
- 1 Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- 2 University of Toronto, Toronto, Ontario, Canada
| | - N Zoe Hilton
- 1 Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- 2 University of Toronto, Toronto, Ontario, Canada
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Machtinger EL, Davis KB, Kimberg LS, Khanna N, Cuca YP, Dawson-Rose C, Shumway M, Campbell J, Lewis-O'Connor A, Blake M, Blanch A, McCaw B. From Treatment to Healing: Inquiry and Response to Recent and Past Trauma in Adult Health Care. Womens Health Issues 2018; 29:97-102. [PMID: 30606467 DOI: 10.1016/j.whi.2018.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/23/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Edward L Machtinger
- Division of General Internal Medicine, Women's HIV Program and Center to Advance Trauma-informed Health Care, University of California, San Francisco, San Francisco, California.
| | - Katy B Davis
- Division of Infectious Diseases, Women's HIV Program and Center to Advance Trauma-informed Health Care, University of California, San Francisco, San Francisco, California
| | - Leigh S Kimberg
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California; Positive Women's Network-USA, Oakland, California
| | - Naina Khanna
- Positive Women's Network-USA, Oakland, California; School of Nursing, University of California, San Francisco, San Francisco, California
| | - Yvette P Cuca
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Martha Shumway
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | | | | | - Mary Blake
- Substance Abuse and Mental Health Services Administration, Rockville, Maryland
| | - Andrea Blanch
- Campaign for Trauma-informed Policy and Practice, Washington, District of Columbia
| | - Brigid McCaw
- Family Violence Prevention Program, Kaiser Permanente, Oakland, California
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Sheppard VB, Walker R, Phillips W, Hudson V, Xu H, Cabling ML, He J, Sutton AL, Hamilton J. Spirituality in African-American Breast Cancer Patients: Implications for Clinical and Psychosocial Care. JOURNAL OF RELIGION AND HEALTH 2018; 57:1918-1930. [PMID: 29627925 DOI: 10.1007/s10943-018-0611-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Spirituality has been shown to be important to many individuals dealing with a cancer diagnosis. While African-American breast cancer survivors have been reported to have higher levels of spirituality compared to White women, little is known about how levels of spirituality may vary among African-American breast cancer survivors. The aims of this study were to examine factors associated with spirituality among African-American survivors and test whether spirituality levels were associated with women's attitudes about treatment or health care. The primary outcome, spirituality, was nine-item scale (Cronbach's α = .99). Participants completed standardized telephone interviews that captured sociocultural, healthcare process, and treatment attitudes. Medical records were abstracted post-adjuvant therapy for treatment and clinical information. In bivariate analysis, age was not correlated with spirituality (p = .40). Married/living as married women had higher levels of spirituality (m = 32.1) than single women (m = 30.1). Contextual factors that were associated with higher levels spirituality were: collectivism (r = .44; p < 0.0001, Afrocentric worldview (r = .185; p = .01), and self-efficacy scale (r = .17; p = .02). In multivariable analysis, sociodemographic factors were not significant. Collectivism remained a robust predictor (p < 0.0001). Attitudes about the efficacy of cancer treatment were not associated with spirituality. The high levels of spirituality in African-American survivors suggest consideration of integrating spiritual care within the delivery of cancer treatment. Future studies should consider how spirituality may contribute to positive coping and/or behaviors in African-American women with high levels of spirituality.
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Affiliation(s)
- Vanessa B Sheppard
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA.
| | | | | | | | - Hanfei Xu
- Georgetown University Medical Center, Washington, DC, USA
| | | | - Jun He
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
| | - Arnethea L Sutton
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
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Copoeru I. Portraying addiction as a disease: A phenomenological answer. J Eval Clin Pract 2018; 24:1101-1106. [PMID: 30133053 DOI: 10.1111/jep.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
This paper stems from the concern that, in certain situations, categorization may lead to the annihilation of the subject. It attempts to answer the question whether there is a way of framing addiction without necessarily putting the addicted persons in categories that hurt them. After showing, in the first section, how stigma is part of the process of becoming (and remaining) addicted, I will turn to the phenomenological tradition in order to re-consider the main descriptive categories that have been used so far to capture addiction as a "pathological" or "deviant" experience. The second section addresses addiction as an experience of hetero-transformation of the psycho-physical unity of the individual, which presupposes a genuine sense of the power of the bodily subject, while the third focuses on the modifications of temporality in addiction, especially in the horizon of trauma. The paper concludes that understanding addiction depends on framing the experience of addiction primarily as a non-pathological form of expression and looking at it as an attempt to restore the capabilities of a vulnerable subject.
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Affiliation(s)
- Ion Copoeru
- Department of Philosophy, Babeş-Bolyai University from Cluj-Napoca, 1. Kogalniceanu Street, 40081, Cluj-Napoca, Romania.,ICUB, University of Bucharest, 36-46 Bd. M. Kogalniceanu, 5th District, 050107, Bucharest, Romania
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Luciano MT, McDevitt-Murphy ME, Acuff SF, Bellet BW, Tripp JC, Murphy JG. Posttraumatic stress disorder symptoms improve after an integrated brief alcohol intervention for OEF/OIF/OND veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:459-465. [PMID: 29939060 DOI: 10.1037/tra0000378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although brief alcohol interventions (BAIs) that incorporate personalized feedback demonstrate efficacy for reducing the frequency and quantity of alcohol consumption in veteran samples, little research has explored the influence of BAIs in reducing symptoms of posttraumatic stress disorder (PTSD). The goal of this investigation was to understand whether PTSD symptom severity and diagnostic status changed after exposure to an intervention that targeted alcohol misuse and integrated feedback on PTSD. METHOD Sixty-eight combat veterans (8.8% female; 27.9% African American) who screened positive for hazardous drinking were recruited from a Veterans Affairs Medical Center. Participants received a 1-session brief intervention that primarily targeted alcohol misuse but also included personalized feedback and psychoeducation on PTSD symptoms and coping. Participants were randomized to receive personalized written feedback either with or without a motivational interview. RESULTS A mixed-model repeated measures analysis revealed that PTSD symptom severity was significantly lower at the 6-week (M = 41.47, SD = 28.94) and 6-month (M = 35.56 SD = 26.99) follow-up appointments relative to baseline (M = 51.22, SD = 26.67), F(2, 127.24) = 38.32, p < .001. Regression analyses demonstrate that the percent change in alcohol use was related to the change in PTSD severity. Further, results indicated that a motivational-interviewing-style counseling session accompanying the feedback was not significantly more efficacious than receiving feedback only. CONCLUSION A brief alcohol intervention that integrates information on PTSD has the potential to reduce PTSD severity. Personalized alcohol and PTSD feedback may be useful as an opportunistic intervention for OEF/OIF veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Bedard-Gilligan M, Garcia N, Zoellner LA, Feeny NC. Alcohol, cannabis, and other drug use: Engagement and outcome in PTSD treatment. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:277-288. [PMID: 29595297 PMCID: PMC9377391 DOI: 10.1037/adb0000355] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and substance use is related to poorer outcome and increased dropout from trauma-focused treatment. Investigating PTSD and substance use can inform the intervention approaches. Exploring cannabis use in particular is especially important because rates of cannabis use have been increasing with recent legalization trends. A better understanding of how substance use is associated with treatment processes and outcome for individuals with PTSD is needed to enhance care. In this study, both lifetime diagnoses of alcohol and drug use disorders and current alcohol and drug use severity were examined in 200 men and women with chronic PTSD who received either prolonged exposure (PE) or sertraline. No lifetime or current alcohol use variables predicted dropout, adherence, or poorer outcome. However, lifetime diagnosis of both an alcohol and drug disorder (OR = 3.42) and recent cannabis use (OR = 3.38) strongly predicted higher dropout. Recent cannabis use and drug use severity predicted poorer adherence to PE (β = -.22 to -.29) but not to sertraline. Drug use severity (β = -.22) also predicted worse treatment outcome, as did lifetime diagnosis of an alcohol and drug disorder (β = -.48). Overall, patients with drug use improved with treatment but had less treatment retention, adherence, and symptom reduction. Strategies to increase engagement and retention may be indicated for these patients. Individuals who are using cannabis or other drugs may be at higher risk for not completing PTSD treatment, potentially prolonging the cycle of PTSD and substance use. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Norah C Feeny
- Department of Psychology, Case Western Reserve University
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Johansen AB, Tavakoli S, Bjelland I, Lumley M. Constructivist Simultaneous Treatment of Borderline Personality Disorder, Trauma, and Addiction Comorbidity: A Qualitative Case Study. QUALITATIVE HEALTH RESEARCH 2017; 27:236-248. [PMID: 26701963 DOI: 10.1177/1049732315618659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This qualitative case study explored one client's recovery from borderline personality disorder, trauma, and problem gambling. The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data. We identified three phases to treatment. First, alliance formation and normalization appeared as mechanisms, and the client experienced dependence. Second, working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation. Third, external controls and increased opportunity appeared as mechanisms, and "moving into the world" was the client experience. The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts.
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Affiliation(s)
- Ayna B Johansen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Centre for Study of Mind in Nature, University of Oslo, Oslo, Norway
| | | | - Ingerid Bjelland
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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20
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Tompkins CNE, Neale J. Delivering trauma-informed treatment in a women-only residential rehabilitation service: Qualitative study. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1235135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Charlotte N. E. Tompkins
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK and
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK and
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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Catchpole REH, Brownlie EB. Characteristics of Youth Presenting to a Canadian Youth Concurrent Disorders Program: Clinical Complexity, Trauma, Adaptive Functioning and Treatment Priorities. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2016; 25:106-15. [PMID: 27274746 PMCID: PMC4879950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 04/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study describes clinical characteristics of youth presenting for service at a Canadian youth concurrent mental health and substance use disorders (SUD) program. METHOD Participants were 100 adolescents and emerging adults (aged 14-25) who attended a Canadian concurrent mental health and substance use disorders outpatient program. SUDs were assigned using the Structured Clinical Interview for DSM-IV. Self-reported mental health symptoms, trauma exposure and adaptive functioning were also assessed. RESULTS Eighty-three percent of participants scored over the clinical cut-off on at least one mental health scale and 33% reported at least one suicide attempt. Sixty-six percent met criteria for a current SUD; 96% met lifetime criteria. Exposure to adverse events was nearly universal (94%). Almost half of female (46%) and almost a third of male (31%) participants endorsed symptoms consistent with posttraumatic stress disorder (PTSD). Youth reported impairment and need for support in multiple domains of functioning, including school, peer, family and mental health. Substance use was least likely to be identified as a treatment priority. CONCLUSIONS High rates of adverse events and PTSD highlight the need for trauma-informed care when providing services to this vulnerable population. Functional impairment in domains related to developmental transitions and tasks underscores the need for a developmental lens and integrated treatment that goes beyond mental health and SUD symptoms and addresses developmentally relevant domains during this transitional age.
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Affiliation(s)
- Rosalind E. H. Catchpole
- Outpatient Psychiatry Department, BC Children’s Hospital, Vancouver, British Columbia
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - E. B. Brownlie
- Child, Youth, and Family Service, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Gielen N, Krumeich A, Tekelenburg M, Nederkoorn C, Havermans RC. How patients perceive the relationship between trauma, substance abuse, craving, and relapse: A qualitative study. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1063717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mental health care in post-genocide Rwanda: evaluation of a program specializing in posttraumatic stress disorder and substance abuse. Glob Ment Health (Camb) 2016; 3:e18. [PMID: 27610238 PMCID: PMC5012309 DOI: 10.1017/gmh.2016.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Following the genocide, millions of Rwandans are likely living with posttraumatic stress disorder (PTSD). Le Centre Psychothérapeutique Icyizere provides the only specialized treatment for PTSD in the Rwandan healthcare system. METHODS Demographics, diagnosis, treatment, outcomes, and scores on assessments of functioning and PTSD were recorded from clinical charts of all patients receiving care between October 2013 and 2014. Descriptive statistics and within-group t tests comparing functional impairment and PTSD symptoms at intake to discharge and follow-up were calculated. RESULTS A total of 719 patients (55.08% male) received care. Patients were more educated, more likely to live in the capital, and less likely to be married than the general population. Patients reported high desire for, and strong satisfaction with, care. Most patients (55.60%) were still in care by the end of the program evaluation. Functioning improved from intake to discharge (p < 0.001), and improvements were sustained at follow-up (p < 0.001). Most adults were diagnosed with psychotic disorders, substance use disorders, or depression. Only 20 patients were diagnosed with PTSD, and symptoms were improved at discharge (p = 0.003). CONCLUSIONS This program evaluation demonstrated the utility of a low-resource information management system to provide clarity about the patient population and outcomes. Results suggest that services are effective and sustainable, although people with PTSD were not the primary recipients of care. Disparities in care by diagnosis, education, marital status, and geography are discussed. Results have contributed to changes in service delivery and care and efforts to increase access to care.
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Kelley ML, Brancu M, Robbins AT, D'Lima GM, Strauss JL, Curry JF, Fairbank JA, Runnals J. Drug use and childhood-, military- and post-military trauma exposure among women and men veterans. Drug Alcohol Depend 2015; 152:201-8. [PMID: 25957156 DOI: 10.1016/j.drugalcdep.2015.03.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/26/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The current study was undertaken to examine whether posttraumatic stress symptoms (PTSS) and depressive symptoms mediated the association between trauma exposure (combat-related trauma and non-combat traumas occurring before, during, and after military service), and drug abuse symptoms use among male and female veterans. METHODS Participants were 2304 (1851 male, 453 female) veterans who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC). Path analytic models were used to determine the association between problematic past-year drug use and combat-related and non-combat trauma experienced before, during, or after the military and whether current post-traumatic stress symptoms or depressive symptoms mediated these associations. RESULTS For both male and female veterans, depressive symptoms significantly mediated the effects of pre- and post-military trauma on drug abuse symptoms. CONCLUSION Mental health providers who work with trauma-exposed Iraq and Afghanistan era veterans should assess for drug use, depressive symptoms, and life-span trauma (i.e., not only combat-related traumas) as part of a thorough trauma-based assessment for both men and women.
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Affiliation(s)
- Michelle L Kelley
- Department of Psychology, Old Dominion University, 5115 Hampton Boulevard, Norfolk, VA 23529, USA.
| | - Mira Brancu
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Allison T Robbins
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA 23504, USA.
| | - Gabrielle M D'Lima
- Department of Psychology, Old Dominion University, 5115 Hampton Boulevard, Norfolk, VA 23529, USA.
| | - Jennifer L Strauss
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA; Mental Health Services, Department of Veterans Affairs, Washington, DC 20420, USA.
| | - John F Curry
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - John A Fairbank
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Jennifer Runnals
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
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Hien DA, Levin FR, Ruglass LM, López-Castro T, Papini S, Hu MC, Cohen LR, Herron A. Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial. J Consult Clin Psychol 2015; 83:359-69. [PMID: 25622199 DOI: 10.1037/a0038719] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The current study marks the first randomized controlled trial to test the benefit of combining Seeking Safety (SS), a present-focused cognitive-behavioral therapy for co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), with sertraline, a front-line medication for PTSD shown to also impact drinking outcomes. METHOD Sixty-nine participants (81% female; 59% African American) with primarily childhood sexual (46%) and physical (39%) trauma exposure, and drug dependence in addition to AUD were randomized to receive a partial-dose (12 sessions) of SS with either sertraline (n = 32; M = 7 sessions) or placebo (n = 37; M = 6 sessions). Assessments conducted at baseline, end-of-treatment, 6- and 12-months posttreatment measured PTSD and AUD symptom severity. RESULTS Both groups demonstrated significant improvement in PTSD symptoms. The SS plus sertraline group exhibited a significantly greater reduction in PTSD symptoms than the SS plus placebo group at end-of-treatment (M difference = -16.15, p = .04, d = 0.83), which was sustained at 6- and 12-month follow-up (M difference = -13.81, p = .04, d = 0.71, and M difference = -12.72, p = .05, d = 0.65, respectively). Both SS groups improved significantly on AUD severity at all posttreatment time points with no significant differences between SS plus sertraline and SS plus placebo. CONCLUSION Results support the combining of a cognitive-behavioral therapy and sertraline for PTSD/AUD. Clinically significant reductions in both PTSD and AUD severity were achieved and sustained through 12-months follow-up, Moreover, greater mean improvement in PTSD symptoms was observed across all follow-up assessments in the SS plus sertraline group. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | - Mei-Chen Hu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | - Abigail Herron
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
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Kelsall HL, Wijesinghe MSD, Creamer MC, McKenzie DP, Forbes AB, Page MJ, Sim MR. Alcohol Use and Substance Use Disorders in Gulf War, Afghanistan, and Iraq War Veterans Compared With Nondeployed Military Personnel. Epidemiol Rev 2015; 37:38-54. [DOI: 10.1093/epirev/mxu014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Siegel JP. Emotional Regulation in Adolescent Substance Use Disorders: Rethinking Risk. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2014. [DOI: 10.1080/1067828x.2012.761169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Gielen N, Krumeich A, Havermans RC, Smeets F, Jansen A. Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study. Eur J Psychotraumatol 2014; 5:22821. [PMID: 24511368 PMCID: PMC3916674 DOI: 10.3402/ejpt.v5.22821] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/20/2013] [Accepted: 01/02/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so. OBJECTIVE This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients. METHOD A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer. RESULTS Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported. CONCLUSIONS It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD.
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Affiliation(s)
- Nele Gielen
- Mondriaan, MAIAR, Heerlen, The Netherlands
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anja Krumeich
- Department of Health, Ethics & Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Remco C. Havermans
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Feikje Smeets
- Department of Psychiatry & Psychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Back SE, Killeen TK, Teer AP, Hartwell EE, Federline A, Beylotte F, Cox E. Substance use disorders and PTSD: an exploratory study of treatment preferences among military veterans. Addict Behav 2014; 39:369-73. [PMID: 24199930 DOI: 10.1016/j.addbeh.2013.09.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 09/15/2013] [Accepted: 09/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and Post Traumatic Stress Disorder (PTSD) frequently co-occur among Veterans and are associated with poor treatment outcomes. Historically, treatments for SUDs and PTSD have been delivered sequentially and independently. More recently, however, integrated treatments have shown promise. This study investigated Veterans' perceptions of the interrelationship between SUDs and PTSD, as well as treatment preferences. METHODS Participants were 35 Veterans of recent military conflicts in Iraq and Afghanistan, and prior operations, who completed the Treatment Preferences Questionnaire as well as an in-depth interview. RESULTS The majority (94.3%) perceived a relationship between their SUD and PTSD symptoms. Veterans reported that PTSD symptom exacerbation was typically (85.3%) associated with an increase in substance use, and PTSD symptom improvement was typically (61.8%) followed by a decrease in substance use (p<.01). Approximately 66% preferred an integrated treatment approach. CONCLUSIONS Although preliminary, the findings provide clinically-relevant information that can be used to enhance the development and provision of care for Veterans with SUDs and PTSD.
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Affiliation(s)
- Sudie E Back
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, United States.
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Siegel JP. An expanded approach to batterer intervention programs incorporating neuroscience research. TRAUMA, VIOLENCE & ABUSE 2013; 14:295-304. [PMID: 23978773 DOI: 10.1177/1524838013495982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Batterer Intervention Programs have been critiqued for failing to incorporate treatment strategies that are supported by neurobiology research. This article reviews findings that have informed the treatment of disorders that are strongly represented among perpetrators of intimate violence, such as addiction, posttraumatic stress disorder, mood, anxiety, and personality disorders. The article argues for an expanded perspective that recognizes the relationships among childhood trauma, emotional regulation impairment, and intimate partner violence. Recommendations and ways to draw on emerging knowledge to invigorate existing programs are provided.
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Affiliation(s)
- Judith P Siegel
- 1Silver School of Social Work, New York University, New York, NY, USA
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Waldrop AE, Cohen BE. Trauma exposure predicts alcohol, nicotine, and drug problems beyond the contribution of PTSD and depression in patients with cardiovascular disease: data from the Heart and Soul Study. Am J Addict 2013; 23:53-61. [PMID: 24313242 DOI: 10.1111/j.1521-0391.2013.12053.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/04/2013] [Accepted: 01/19/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the role of lifetime trauma exposure in a longitudinal study of adults with cardiovascular disease to determine the unique contribution of trauma exposure to risk for drug and alcohol problems and smoking. METHODS Data were drawn from the Heart and Soul Study, a prospective cohort study designed to determine the mechanisms of associations between psychological factors and increased risk of cardiovascular events in high-risk patients (n = 1,022). RESULTS Lifetime exposure to a higher number of trauma types predicted substance use outcomes beyond risk explained by PTSD and depression. In addition, across trauma types, interpersonal traumas were most strongly associated with substance use problems. CONCLUSIONS Our results suggest that, though PTSD and depression play a role in the association between trauma exposure and substance use, many other factors also contribute; therefore focusing on these psychological comorbidities alone is not sufficient. SCIENTIFIC SIGNIFICANCE The integration of mental health care and/or case management support with primary and specialty medical care may improve detection and treatment for patients with substance use and comorbid mental and physical health problems. Screening for trauma exposure is an important part of good clinical care.
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Affiliation(s)
- Angela E Waldrop
- San Francisco VA Medical Center, San Francisco, California; University of California, San Francisco, San Francisco, California
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Breckenridge J, Salter M, Shaw E. Use and abuse: understanding the intersections of childhood abuse, alcohol and drug use and mental health. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17523281.2012.703224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Potthast N, Catani C. Trauma und Sucht: Implikationen für die Psychotherapie. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2012. [DOI: 10.1024/0939-5911.a000191] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ziel: Die vorliegende narrative Übersichtsarbeit geht der Frage nach, welche Rolle traumatische Lebenserfahrungen und damit assoziierte Traumafolgestörungen bezüglich der Ätiologie und Pathogenese von Suchterkrankungen spielen und welche Implikationen sich daraus für die therapeutische Praxis ableiten. Ergebnisse: Die aktuelle empirische Befundlage belegt ein gehäuftes gemeinsames Auftreten von traumatischen Erfahrungen und substanzbezogenen Störungen sowie eine erhöhte Komorbidität von Posttraumatischer Belastungsstörung und Suchterkrankungen. Befunde aus Interview- und Fragebogenstudien sowie aus experimentellen Untersuchungen mit komorbiden Patienten zeigen, dass Betroffene psychotrope Substanzen als Selbstmedikation einsetzen, um ihre traumabedingte Symptomatik zu lindern. Es entsteht ein komplexes, sich gegenseitig aufrechterhaltendes Wechselspiel zwischen Traumafolge- und Suchtsymptomatik, welches die Behandlung deutlich erschwert. Schlussfolgerungen: Zur Unterbrechung dieses Wechselspiels erscheint ersten Befunden zufolge ein von Beginn an integrativer, traumafokussierter Behandlungsansatz besonders geeignet. Auch wenn diesbezüglich erste erfolgsversprechende traumakonfrontative Therapieansätze entwickelt wurden, stehen größere prospektive Untersuchungen sowie randomisiert kontrollierte Therapiestudien diesbezüglich noch aus und sollten einen Schwerpunkt zukünftiger Forschung auf diesem Gebiet bilden.
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Affiliation(s)
- Nadine Potthast
- Klinische Psychologie, Fakultät für Psychologie, Universität Bielefeld
- Christoph-Dornier-Stiftung Bielefeld
| | - Claudia Catani
- Klinische Psychologie, Fakultät für Psychologie, Universität Bielefeld
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