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Kacmarek CN, Smith HC, Kuehn M, Bennett ME, Belcher A, Fitzsimons H, Hall W, Greenblatt A, Li L, Travaglini LE. The impact of chronic pain and depression on medication for opioid use disorder treatment: A mixed-methods analysis. HEROIN ADDICTION AND RELATED CLINICAL PROBLEMS 2024; 26:15. [PMID: 39069987 PMCID: PMC11271030 DOI: 10.62401/2531-4122-2024-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Opioid use disorder (OUD) is associated with significant morbidity and mortality. Medication for opioid use disorder (MOUD) is a cost-effective treatment, but retention rates vary widely. Aim Mixed methods studies are needed to better understand how depression and pain impact the experience of OUD and MOUD treatment experiences. Methods Participants were recruited from an urban addiction treatment center in the United States. Along with demographic characteristics, current pain severity, pain interference, pain catastrophizing, and depression were assessed via self-report. Correlational analyses, multivariable logistic regression models, Fisher exact tests, and Wilcoxon signed rank tests were used to examine the impact of demographic characteristics, physical pain, and depression on multiple treatment outcomes: 90-day treatment engagement (total number of dispensed MOUD doses), retention (yes/no still in treatment at 90 days), and opioid use (positive/negative urinalysis for opioids at 90 days). Ten participants were interviewed about their history with physical pain, depression, opioid use, and OUD treatment experiences. Themes were identified using a rapid analysis, top-down approach. Results Fifty participants enrolled in the study and received buprenorphine (12%) or methadone (88%). Older age was associated with 90-day treatment engagement. Higher depression scores were associated with a positive opioid urinalysis at 90-day follow-up. In interviews, participants reported experiencing chronic physical pain and depression before and during their OUD and an interest in addressing mental and physical health in addiction treatment. Conclusions Addressing co-occurring physical and mental health concerns during MOUD treatment has the potential to improve the treatment experience and abstinence from opioids.
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Affiliation(s)
- Corinne N Kacmarek
- US Department of Veterans Affairs Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Hannah C Smith
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Maxwell Kuehn
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melanie E Bennett
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
- US Department of Veterans Affairs Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Annabelle Belcher
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Heather Fitzsimons
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - William Hall
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aaron Greenblatt
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Letitia E Travaglini
- US Department of Veterans Affairs Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
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Chen Z, Tang X, Xu C, Wang C, Ling L. Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study. Drug Alcohol Depend 2023; 243:109739. [PMID: 36535097 DOI: 10.1016/j.drugalcdep.2022.109739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Clients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout. METHODS This study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients' demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout. RESULTS Among 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR50-80%=0.63, 95% CI: 0.51, 0.79; HR>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR50-80%=0.56, 95% CI: 0.47, 0.68; HR>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout. CONCLUSIONS It is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.
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Affiliation(s)
- Zouxiang Chen
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Xijia Tang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chaofan Xu
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chijie Wang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Li Ling
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
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Stauffer CS, Moschetto JM, McKernan S, Meinzer N, Chiang C, Rapier R, Hsiang E, Norona J, Borsari B, Woolley JD. Oxytocin-enhanced group therapy for methamphetamine use disorder: Randomized controlled trial. J Subst Abuse Treat 2020; 116:108059. [PMID: 32741502 DOI: 10.1016/j.jsat.2020.108059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Methamphetamine (METH) use is a public health crisis that disproportionately affects men who have sex with men (MSM). There are currently no FDA-approved pharmacological interventions to treat methamphetamine use disorder (MUD). MUD is associated with social impairments and extremely high treatment attrition rates. Administration of oxytocin, a neuropeptide involved in social attachment, may be a novel approach to addressing these issues. Moreover, oxytocin administration has shown promise for reducing METH-related addictive behavior in animal models, but has not yet been investigated in clinical trials for MUD. Last, oxytocin is known to modulate stress responsivity via regulation of the autonomic nervous system, which is dysregulated in METH users. We hypothesize that oxytocin, in combination with group psychotherapy, will increase treatment engagement, reduce addiction behavior, and mitigate stress hyperreactivity. METHODS This is a randomized, double blind trial of oxytocin 40-IU (n = 24) or placebo (n = 24) administered intranasally prior to each of six weekly motivational interviewing group therapy (MIGT) sessions for MUD in MSM. PRIMARY OUTCOME (a) session attendance. SECONDARY OUTCOMES (b) group cohesion, (c) anxiety, (d) METH craving, (e) METH use, and (f) in-session cardiac physiology. RESULTS Participants receiving oxytocin had significantly higher group therapy attendance than those receiving placebo, OR 3.26, 95% CI [1.27-8.41], p = .014. There was a small effect of oxytocin on group cohension, but not anxiety or craving. METH use did not change over the six-week MIGT course in either treatment arm. Participants receiving oxytocin had lower average heart rates during MIGT sessions and higher heart rate variability. There were positive main effects of MIGT over Time regardless of study drug. CONCLUSIONS This evidence, and the lack of any serious adverse events, suggests that oxytocin may safely increase treatment attendance. One possible mechanism by which it may do so is its modulation of the autonomic nervous system. Further investigation is warranted.
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Affiliation(s)
- Christopher S Stauffer
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America; Portland Veterans Affairs Medical Center & Oregon Health and Science University, United States of America.
| | - Jenna M Moschetto
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | - Scott McKernan
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | | | - Chavy Chiang
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Rachel Rapier
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Elaine Hsiang
- University of California, San Francisco, United States of America
| | - Jerika Norona
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Brian Borsari
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | - Joshua D Woolley
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
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Dreyer J, Pooe JM, Dzikiti L, Krüger C. Factors associated with the successful completion of a substance rehabilitation programme at a psychiatric training hospital. S Afr J Psychiatr 2020; 26:1255. [PMID: 32161678 PMCID: PMC7059449 DOI: 10.4102/sajpsychiatry.v26i0.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Comorbid psychiatric and substance use disorders are common and present several treatment challenges. Aim The aim of this study was to determine which patient and substance factors are associated with the completion of a substance rehabilitation programme in psychiatric inpatients. Setting The study was conducted at the Substance Rehabilitation Unit (SRU) at Weskoppies Hospital, a psychiatric training hospital in South Africa, which offers a 6-week programme at the hospital for psychiatric inpatients. Methods This descriptive, retrospective hospital-based study was carried out comparing completers and non-completers of the SRU programme with respect to patient and substance factors. All patients accepted into the SRU during 2013–2014 were included (n = 119). Data were collected over a year (2016–2017) from the clinical files, SRU referral forms, SRU attendance register, hospital computerised demographic records, nursing notes and administration files using a data collection sheet designed by the researchers for this study. Comparison between completers and non-completers was performed using Chi-Square or Fisher’s Exact tests. Results The SRU accepted 119 patients from January 2013 to December 2014. The majority of the sample were involuntary patients (n = 39), 30–49 years old (n = 57), male (n = 89), unmarried (n = 112), never having received a disability grant (n = 27), unemployed (n = 96) and with a Grade 8–11 education (n = 49). Substance-induced psychotic disorders (n = 39), schizophrenia (n = 29) and bipolar disorders (n = 22) were found to be common. Frequent medical comorbidities included head injury (n = 27), cardiovascular disease (n = 18) and HIV reactivity (n = 7). Cannabis (n = 98), alcohol (n = 94) and nicotine (n = 90) were the most frequently used substances. Level of education (p = 0.004), disability grant status (p = 0.004), Nyaope use (p = 0.001) and nicotine use (p = 0.049) were statistically seen to be significantly associated with completion. Psychiatric diagnoses and general medical comorbidity were not associated with completion. Conclusions This study has yielded several results in areas that have not yet been well researched in South Africa. Risk factors for non-completion may include lower levels of education, being on a disability grant and using Nyaope or nicotine, but may vary in different settings. Future research should focus on identifying further factors that may affect completion of substance rehabilitation in psychiatric inpatients, the role of disability grants in patients with co-occurring disorders and the effect of Nyaope and nicotine use on treatment outcomes in this population. Effective and accessible interventions to assist vulnerable patients also need to be identified.
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Affiliation(s)
- Justine Dreyer
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jacobeth M Pooe
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Loveness Dzikiti
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Christa Krüger
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Frederickson J, DenDooven B, Abbass A, Solbakken OA, Rousmaniere T. Pilot study: An inpatient drug rehabilitation program based on intensive short-term dynamic psychotherapy. J Addict Dis 2019; 37:195-201. [PMID: 31507253 DOI: 10.1080/10550887.2019.1658513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Addiction programs are plagued with high dropout and relapse rates. A large proportion of patients suffering from addiction also suffer from personality disorders. A 30-day inpatient program based on intensive short-term dynamic psychotherapy was developed to address features of personality disorders such as anxiety regulation, emotion recognition, and handling of fear responses and projective processes. The hypothesis was that addressing comorbid symptoms of personality disorder might improve recovery from drug addiction. We used a pilot randomized controlled trial design with six-month follow-up of both cases and controls. Rates of remission, relapse and drop out were recorded at each time point. N-1 chi-squared (χ2) tests were conducted to examine the statistical significance of differences in outcomes in patients receiving the experimental treatment and controls. A control group of 20 patients and an experimental group of 42 patients were treated. Dropout: control group 40%; experimental group 23.8%. Sobriety at six months: control group 17.6%, experimental group 48.8%. Future study is warranted to examine intensive short-term dynamic psychotherapy's long-term effects, study moderators of effects, and study its efficacy using a randomized controlled design.
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Affiliation(s)
| | - Bonnie DenDooven
- Bridges Drug Rehabilitation Center, Bridges Network, Prescott, AZ, USA
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Ole Andre Solbakken
- Department of Psychology, Universitetet i Oslo Det Samfunnsvitenskapelige Fakultet, Oslo, Norway
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Castine BR, Albein-Urios N, Lozano-Rojas O, Martinez-Gonzalez JM, Hohwy J, Verdejo-Garcia A. Self-awareness deficits associated with lower treatment motivation in cocaine addiction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:108-114. [PMID: 30183371 DOI: 10.1080/00952990.2018.1511725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuals with cocaine use disorder (CUD) often display behaviours that are paradoxically misaligned with their situation. Typical examples include poor treatment motivation and inconsistent self-reported craving. These behaviours may reflect impairments in the awareness of one's own behaviour. OBJECTIVES We examined whether impaired self-awareness of addiction-related frontostriatal dysfunction (i.e., symptoms of apathy, disinhibition, and executive dysfunction) was associated with treatment motivation and craving. METHODS Sixty-five outpatients with CUD (57 male) and their informants (those who knew the patient well) completed parallel self and informant versions of the Frontal Systems Behaviour Scale. Self-awareness was indexed through the discrepancy between self and informant scores in the three sub-scales; apathy, disinhibition and executive dysfunction. The University Rhode Island Change Assessment Scale assessed treatment motivation. Self-reported craving was assessed using a visual analogue scale. Multiple linear regression models examined associations between self-awareness and treatment motivation and craving, adjusting for sociodemographic factors and lifetime drug use. RESULTS We found an inverse relationship between self-awareness of symptoms of disinhibition and treatment motivation maintenance. Although impaired awareness of disinhibition was also correlated with craving, this association was not significant after adjusting for sociodemographic factors and drug use. The apathy and executive dysfunction awareness scores were not associated with treatment motivation or craving. CONCLUSION We show that people with lower insight into their disinhibition problems (e.g., impulsivity, mood instability) have more problems maintaining motivation when initiating treatment. Findings suggest that self-awareness interventions could be useful to prevent premature treatment dropout and improve addiction treatment outcomes.
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Affiliation(s)
- Benjamin R Castine
- a Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton, Melbourne , VIC , Australia
| | | | - Oscar Lozano-Rojas
- c Departamento de Psicología Clínica, Experimental y Social , Universidad de Huelva , Huelva , Spain
| | | | - Jakob Hohwy
- e Department of Philosophy, Faculty of Arts , Monash University , Clayton, Melbourne , VIC , Australia
| | - Antonio Verdejo-Garcia
- a Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton, Melbourne , VIC , Australia
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Khazaee-Pool M, Moeeni M, Ponnet K, Fallahi A, Jahangiri L, Pashaei T. Perceived barriers to methadone maintenance treatment among Iranian opioid users. Int J Equity Health 2018; 17:75. [PMID: 29890990 PMCID: PMC5996552 DOI: 10.1186/s12939-018-0787-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background Opioid use is a severe problem in Iran. Despite methadone maintenance treatment (MMT) programs being one of the most important treatment strategies for reducing individual and public harms associated with opioid use, a large proportion of Iranian patients refuse to participate in such treatment programs. Methods The present study aims to explore the beliefs and attitudes toward MMT programs of opioid-dependent patients who were participating or had participated in methadone therapy. In-depth interviews were conducted with 23 opioid users between 27 and 58 years of age from Kurdistan provinces. Results Overall, six themes were discovered to be key barriers relating to methadone treatment, including financial barriers related to methadone treatment, lack of awareness about methadone treatment, negative attitudes regarding using methadone, worries about methadone’s side effects, social stigma ascribed to methadone therapy, and systemic barriers to methadone treatment. Conclusion Our study revealed that the cost of treatment is a major obstacle to attending and continuing at MMT programs and that addicts and their families are not always accurately informed about the duration of MMT programs and the side effects of methadone treatment.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maryam Moeeni
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
| | - Arezoo Fallahi
- Enviromental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Science, Sanandaj, Iran
| | - Leila Jahangiri
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tahereh Pashaei
- Enviromental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Science, Sanandaj, Iran. .,Department of Public Health, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Characteristics of clients using a community-based drug treatment service (‘CAPS-AD’) in Brazil: An exploratory study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:99-103. [DOI: 10.1016/j.drugpo.2016.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/24/2015] [Accepted: 01/22/2016] [Indexed: 11/22/2022]
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Fortier E, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ, Bruneau J, Grebely J. The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1094-102. [DOI: 10.1016/j.drugpo.2015.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/11/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022]
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Jackson LA, McWilliam S, Martin F, Dingwell J, Dykeman M, Gahagan J, Karabanow J. Key challenges in providing services to people who use drugs: The perspectives of people working in emergency departments and shelters in Atlantic Canada. DRUGS-EDUCATION PREVENTION AND POLICY 2014; 21:244-253. [PMID: 24954982 PMCID: PMC4046876 DOI: 10.3109/09687637.2013.870534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims Many people who use drugs (PWUD) have multiple health and social needs, and research suggests that this population is increasingly accessing emergency departments (EDs) and shelters for health care and housing. This qualitative study explored the practices of those working in EDs and shelters when providing services to PWUD, with a particular focus on key challenges in service provision. Methods EDs and shelters were conceptualized as ‘micro environments’ with various components (i.e. social, physical and resource). One-on-one interviews were conducted with 57 individuals working in EDs and shelters in Atlantic Canada. Findings The social, physical and resource environments within some EDs and shelters are key forces in shaping the challenges facing those providing services. For example, the social environments within these settings are focused on acute health care in the case of EDs, and housing in the case of shelters. These mandates do not encompass the complex needs of many PWUD. Resource issues within the wider community (e.g. limited drug treatment spaces) further contribute to the challenges. Conclusions Structural issues, internal and external to EDs and shelters need to be addressed to reduce the challenges facing many who work in these settings when providing services to PWUD.
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Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Dalhousie University , Halifax, NS , Canada ; Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada
| | - Susan McWilliam
- Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada
| | - Fiona Martin
- Department of Sociology and Social Anthropology, Dalhousie University , Halifax, NS , Canada
| | | | - Margaret Dykeman
- Faculty of Nursing, University of New Brunswick , Fredericton, NB , Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University , Halifax, NS , Canada ; Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada
| | - Jeff Karabanow
- School of Social Work, Dalhousie University , Halifax, NS , Canada
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Watson HJ, Fursland A, Byrne S. Treatment engagement in eating disorders: who exits before treatment? Int J Eat Disord 2013; 46:553-9. [PMID: 23436476 DOI: 10.1002/eat.22085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Traditionally, drop-out has been investigated subsequent to treatment entry; yet some individuals "exit early," attending assessment but failing to commence the treatment offered. Early exit burdens administrative and clinical resources and means that individuals may not receive the care needed for recovery. This study aimed to describe the prevalence and characteristics associated with early exit at a statewide, outpatient eating disorder service. METHOD From a pool of 972 consecutive referrals of adults and youth (16+ years), two groups were formed; an "early exit" group of individuals who attended assessment but chose to exit the service prior to treatment entry and a "non-early exit" group that attended assessment and entered treatment. The groups were compared on sociodemographic, clinical, and administrative features. RESULTS The prevalence of early exit was 18.7%. The early exit group exhibited less pathology compared with the non-early exit group; specifically, a lower presence of Axis I comorbidity (p = .04) and self-induced vomiting (p = .04). DISCUSSION The findings, considered in the context of previous research, suggest that there are no measured features to date that are robustly associated with early exit from outpatient eating disorder services. Future research should investigate decision-making processes at assessment, to inform patient-centered approaches that optimize transition to treatment.
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Affiliation(s)
- Hunna J Watson
- Centre for Clinical Interventions, Department of Health in Western Australia, Perth, Australia; Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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12
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Drop-out from addiction treatment: a systematic review of risk factors. Clin Psychol Rev 2013; 33:1010-24. [PMID: 24029221 DOI: 10.1016/j.cpr.2013.07.007] [Citation(s) in RCA: 336] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/13/2013] [Accepted: 07/17/2013] [Indexed: 12/12/2022]
Abstract
Completion of addiction treatment is one of the most consistent factors associated with a favorable treatment outcome. Unfortunately, it is more common for a patient to drop-out of addiction treatment than to complete the treatment. To prevent drop-out, risk factors must be identified. This box-score review focuses on studies investigating the risk factors associated with drop-out from addiction treatment published in peer-reviewed journals from 1992 to 2013. A total of 122 studies involving 199,331 participants met the inclusion criteria. Contrary to recommendations from previous reviews, 91% of the included studies focused primarily on enduring patient factors, mainly demographics. The most consistent risk factors across the different study designs, samples, and measurement methods were cognitive deficits, low treatment alliance, personality disorder, and younger age. With the exception of younger age, none of the demographic factors emerged as consistent risk factors. Further research on the relationship between simple demographic factors and drop-out risk is of limited value. However, little is known about the potential risk factors related to treatment programs and to the treatment processes. Based on the review, clinical recommendations include assessing cognitive functioning and personality disorders at baseline and continuous monitoring of treatment alliance.
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Lorenzoni V, Curzio O, Karakachoff M, Saponaro A, Sanza M, Mariani F, Molinaro S. The effects of the macro-environment on treatment retention for problem cocaine users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:52-9. [PMID: 22884542 DOI: 10.1016/j.drugpo.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/14/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Client dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the "macro-environment" - effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention. METHODS A retrospective longitudinal study of an admission cohort among drug services in Vasta Romagna in Emilia Romagna Region, Italy (up to 8 years of treatment or until discharge) was conducted to determine the effect of macro-environmental variables on retention among first time admitted cocaine-dependent clients in different treatment settings. The sample consisted of 1178 clients meeting DSM-IV-R criteria for cocaine dependence. RESULTS The joint effect of individual and system factors had a significant impact on dropout rates. In particular, lower rates of dropout were observed for those treated in prison and those who had a stable home, HR: 0.09 (0.02-0.48), or lived in rehabilitation units, HR: 0.36 (0.15-0.88), and among clients referred by the local authority and those living with parents, HR: 0.60 (0.38-0.95). CONCLUSION The combined effect of individual and system factors on retention in treatment sets a critical background necessary to assess any impact of organizational dynamics and delineate the trajectory for future interventions.
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Cox J, Allard R, Maurais E, Haley N, Small C. Predictors of methadone program non-retention for opioid analgesic dependent patients. J Subst Abuse Treat 2012; 44:52-60. [PMID: 22538172 DOI: 10.1016/j.jsat.2012.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/07/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
This study evaluates loss to follow-up in a methadone maintenance treatment (MMT) program for patients dependent on opioid analgesics in a community in eastern Canada. Data were collected using the Addiction Severity Index Lite. The probability of loss to follow-up was evaluated using a time-to-event analysis. Involuntary and voluntary program discharges were treated separately as the outcomes of interest. Multivariate Cox proportional hazards models were used to explore the role of various patient-related attributes. The probabilities of involuntary and voluntary discharges at 1 year were 20% and 14%, respectively. In this exploratory analysis, determinants of loss to follow-up were characteristics related to drug use history (e.g., use of sedatives) and its consequences (e.g., number of lifetime arrests), and differed for each outcome. Some determinants of involuntary discharge were modified by sex. Understanding predictors of specific loss to follow-up outcomes may help MMT programs improve patient retention.
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Affiliation(s)
- Joseph Cox
- Mental Health and Addiction Services, Cape Breton District Health Authority, Sydney, Nova Scotia, Canada B1P 1P3.
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15
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Notley C, Maskrey V, Holland R. The needs of problematic drug misusers not in structured treatment – a qualitative study of perceived treatment barriers and recommendations for services. DRUGS-EDUCATION PREVENTION AND POLICY 2011. [DOI: 10.3109/09687637.2011.570384] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Lin C, Wu Z, Detels R. Opiate users' perceived barriers against attending methadone maintenance therapy: a qualitative study in China. Subst Use Misuse 2011; 46:1190-8. [PMID: 21417558 PMCID: PMC3392119 DOI: 10.3109/10826084.2011.561905] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Methadone maintenance therapy (MMT) in China is facing challenges such as high relapse rates and low coverage. The study assessed factors influencing MMT utilization among opiate users. In-depth interviews were conducted among 30 opiate users in 2008 to ascertain the barriers against seeking MMT. Data were analyzed using ATLAS.ti. Barriers to the treatment included requirement of registration with police, perceived discrimination, logistic difficulties, side effects, fear of being addicted to another drug, lack of additional services, and economic burden. The result suggests the need for structural changes such as improving comprehensive services, simplifying application procedure, and enhancing referral system. The study's limitations are noted.
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Affiliation(s)
- Chunqing Lin
- Semel Institute Center for Community Health, University of California, Los Angeles, California, USA.
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Lin C, Wu Z, Rou K, Yin W, Wang C, Shoptaw S, Detels R. Structural-level factors affecting implementation of the methadone maintenance therapy program in China. J Subst Abuse Treat 2010; 38:119-27. [PMID: 20015606 PMCID: PMC2814942 DOI: 10.1016/j.jsat.2009.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 09/01/2009] [Accepted: 09/20/2009] [Indexed: 11/21/2022]
Abstract
This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented.
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Affiliation(s)
- Chunqing Lin
- Department of Epidemiology, School of Public Health, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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18
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Evans E, Li L, Hser YI. Client and program factors associated with dropout from court mandated drug treatment. EVALUATION AND PROGRAM PLANNING 2009; 32:204-12. [PMID: 19150133 PMCID: PMC2703685 DOI: 10.1016/j.evalprogplan.2008.12.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 11/17/2008] [Accepted: 12/04/2008] [Indexed: 05/05/2023]
Abstract
To examine why court mandated offenders dropout of drug treatment and to compare their characteristics, treatment experiences, perceptions, and outcomes with treatment completers, we analyzed self-reported and administrative data on 542 dropouts (59%) and 384 completers (41%) assessed for Proposition 36 treatment by thirty sites in five California counties during 2004. At intake, dropouts had lengthier criminal histories, lower treatment motivation, more severe employment and psychiatric problems, and more were using drugs, especially heroin. Relatively fewer dropouts received residential treatment and their retention was much shorter. A similar proportion of dropouts received services as completers and the mean number of services received per day by dropouts was generally more, especially to address psychiatric problems, during the first three months of treatment. The most commonly offender-reported reasons for dropout included low treatment motivation (46.2%) and the difficulty of the Proposition 36 program (20.0%). Consequences for dropout included incarceration (25.3%) and permission to try treatment again (24.0%). Several factors predicting drug treatment dropout were identified. Both groups demonstrated improved functioning at one-year follow-up, but fewer dropouts had a successful outcome (34.5% vs. 59.1%) and their recidivism rate was significantly higher (62.9% vs. 28.9%) even after controlling for baseline differences. Understanding factors associated with drug treatment dropout can aid efforts to improve completion rates, outcomes, and overall effectiveness of California's Proposition 36 program. Findings may also aid a broader audience of researchers and policy analysts who are charged with designing and evaluating criminal-justice diversion programs for treating drug-addicted offenders.
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Affiliation(s)
- Elizabeth Evans
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 1640 S. Sepulveda Blvd., Los Angeles, CA 90025, USA.
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