1
|
Khan BN, Chu C, Brual J, Dang-Nguyen M, Oladimeji A, Kthupi A, Bolea-Alamañac B, Tadrous M, O'Riordan A, Rubenstein D, Carlin K, Longum P, Gibson D, Abejirinde IOO. An Observational Study of a Digital Substance Use and Recovery Program. Psychiatr Serv 2024:appips20230427. [PMID: 38982834 DOI: 10.1176/appi.ps.20230427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. METHODS An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. RESULTS In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. CONCLUSIONS BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.
Collapse
Affiliation(s)
- Bilal Noreen Khan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Cherry Chu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Janette Brual
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Marlena Dang-Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Adetola Oladimeji
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Altea Kthupi
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Blanca Bolea-Alamañac
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Mina Tadrous
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Anne O'Riordan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Donna Rubenstein
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Kathleen Carlin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Philip Longum
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Daryn Gibson
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Ibukun-Oluwa Omolade Abejirinde
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| |
Collapse
|
2
|
Arillotta D, Floresta G, Papanti Pelletier GD, Guirguis A, Corkery JM, Martinotti G, Schifano F. Exploring the Potential Impact of GLP-1 Receptor Agonists on Substance Use, Compulsive Behavior, and Libido: Insights from Social Media Using a Mixed-Methods Approach. Brain Sci 2024; 14:617. [PMID: 38928616 PMCID: PMC11202225 DOI: 10.3390/brainsci14060617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Glucagon-like peptide-1 (GLP-1) is involved in a range of central and peripheral pathways related to appetitive behavior. Hence, this study explored the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on substance and behavioral addictions, including alcohol, caffeine, nicotine, cannabis, psychostimulants, compulsive shopping, and sex drive/libido. Data were collected from various social platforms. Keywords related to GLP-1 RAs and substance/behavioral addiction were used to extract relevant comments. The study employed a mixed-methods approach to analyze online discussions posted from December 2019 to June 2023 and collected using a specialized web application. Reddit entries were the focus here due to limited data from other platforms, such as TikTok and YouTube. A total of 5859 threads and related comments were extracted from six subreddits, which included threads about GLP-1 RAs drugs and associated brand names. To obtain relevant posts, keywords related to potential substance use and compulsive behavior were selected. Further analysis involved two main steps: (1) manually coding posts based on users' references to the potential impact of GLP-1 RAs on substance use and non-substance habits, excluding irrelevant or unclear comments; (2) performing a thematic analysis on the dataset of keywords, using AI-assisted techniques followed by the manual revision of the generated themes. Second, a thematic analysis was performed on the keyword-related dataset, using AI-assisted techniques followed by the manual revision of the generated themes. In total, 29.75% of alcohol-related; 22.22% of caffeine-related; and 23.08% of nicotine-related comments clearly stated a cessation of the intake of these substances following the start of GLP-1 RAs prescription. Conversely, mixed results were found for cannabis intake, and only limited, anecdotal data were made available for cocaine, entactogens, and dissociative drugs' misuse. Regarding behavioral addictions, 21.35% of comments reported a compulsive shopping interruption, whilst the sexual drive/libido elements reportedly increased in several users. The current mixed-methods approach appeared to be a useful tool in gaining insight into complex topics such as the effects of GLP-1 RAs on substance and non-substance addiction-related disorders; some GLP-1 RA-related mental health benefits could also be inferred from here. Overall, it appeared that GLP-1 RAs may show the potential to target both substance craving and maladaptive/addictive behaviors, although further empirical research is needed.
Collapse
Affiliation(s)
- Davide Arillotta
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50121 Florence, Italy
| | - Giuseppe Floresta
- Department of Drug and Health Sciences, University of Catania, 95124 Catania, Italy;
| | - G. Duccio Papanti Pelletier
- Tolmezzo Community Mental Health Centre, ASUFC Mental Health Department, Via Giuliano Bonanni, 2, 33028 Tolmezzo, Italy;
| | - Amira Guirguis
- Pharmacy, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Campus, Swansea SA2 8PP, Wales, UK;
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK; (J.M.C.); (F.S.)
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
- Center for Advanced Studies and Technology (CAST), Institute of Advanced Biomedical Technology (ITAB), University of Chieti-Pescara, Via dei Vestini 21, 66100 Chieti, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK; (J.M.C.); (F.S.)
| |
Collapse
|
3
|
Edwards LM, Chang S, Zeki R, Jamieson SK, Bowman J, Cooper C, Sullivan E. The associations between social determinants of health, mental health, substance-use and recidivism: a ten-year retrospective cohort analysis of women who completed the connections programme in Australia. Harm Reduct J 2024; 21:2. [PMID: 38172944 PMCID: PMC10765932 DOI: 10.1186/s12954-023-00909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Women with substance-use issues are overrepresented in prison. Research on women's recidivism often focuses on offending behaviour rather than the health and social circumstances women are experiencing when reimprisonment occurs. This study examines the relationship between social determinants of health (SDOH), mental health, substance-use and recidivism among women exiting prison with histories of substance-use. METHODS A retrospective cohort study of women exiting prison who completed the transitional support programme "Connections" between 2008 and 2018. Recidivism was measured up to two years post-release. Women's support needs were measured at baseline (4 weeks pre-release) and follow-up (four weeks post-release). Ongoing needs in relation to well-established SDOH were calculated if: (1) at baseline women were identified as having a re-entry need with housing, employment, finances, education, domestic violence, child-custody and social support and (2) at follow-up women reported still needing help in that area. Women's self-reported substance-use and mental health since release were captured at follow-up. Descriptive statistics were calculated for all measures. Associations between SDOH, mental health, substance-use and recidivism were estimated by multiple logistic regression, adjusting for potential confounders. We also evaluated the mediating effects of mental health on the relationship between SDOH and substance-use. RESULTS Substance-use was associated with increased odds of recidivism (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-2.9; p = 0.02). Poor mental health (AOR 2.9, 95% CI 1.9-4.6; p = < 0.01), ongoing social support (AOR 3.0, 95% CI 1.9-5.0; p = < 0.01), child-custody (AOR 1.9, 95% CI 1.0-3.3 p = 0.04), financial (AOR 2.0, 95% CI 1.3-3.2; p = < 0.01) and housing (AOR 1.8, 95% CI 1.1-2.9; p = 0.02) needs were individually associated with increased odds of substance-use. Mediation analysis found mental health fully mediated the effects of ongoing housing (beta efficiency (b) = - 033, standard error (SE) 0.01; p = 0.05), financial (b = 0.15, SE 0.07; p = 0.05), child-custody (b = 0.18, SE 0.01; p = 0.05) and social support (b = 0.36, SE 0.1; p = 0.05) needs onto substance-use, and partially mediated the effects of domestic violence (b = 0.57, SE 0.23; p = 0.05) onto substance-use. CONCLUSION This study underscores the critical importance of addressing the interplay between SDOH, mental health, substance-use and recidivism. An approach that targets SDOH holds the potential for reducing mental distress and substance-use, and related recidivism.
Collapse
Affiliation(s)
| | | | - Reem Zeki
- Justice Health and Forensic Mental Health Network, Malabar, Australia
- University of Newcastle Australia, Newcastle, Australia
| | | | - Julia Bowman
- Justice Health and Forensic Mental Health Network, Malabar, Australia
| | - Craig Cooper
- Justice Health and Forensic Mental Health Network, Malabar, Australia
| | - Elizabeth Sullivan
- Justice Health and Forensic Mental Health Network, Malabar, Australia.
- University of Newcastle Australia, Newcastle, Australia.
| |
Collapse
|
4
|
Edmundson C, Croxford S, Emanuel E, Njoroge J, Ijaz S, Hope V, Phipps E, Desai M. Recent increases in crack injection and associated risk factors among people who inject psychoactive drugs in England and Wales. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104262. [PMID: 38030466 DOI: 10.1016/j.drugpo.2023.104262] [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: 06/26/2023] [Revised: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Crack use is higher in the United Kingdom (UK) than other European countries. Crack is a stimulant with a short half-life, requiring frequent injection to maintain its euphoric effects, thus increasing the risk of blood borne viruses (BBVs) and skin and soft tissue infections (SSTIs). We assessed trends in the prevalence of current crack injection among people who inject drugs (PWID) and investigated harms and other factors associated with its use. METHODS We used data from the annual Unlinked Anonymous Monitoring Survey of PWID, which recruits people who have ever injected psychoactive drugs through specialist services. Participants provide a biological sample and self-complete a questionnaire. We included participants from England and Wales who had injected in the past month. We examined trends in crack injection over time (2011-2021) and factors associated with crack injection using multivariable logistic regression (2019-2021). RESULTS The proportion of people self-reporting crack injection in the past month almost doubled between 2011-2020/21, from 34 % (416/1237) to 57 % (483/850). Crack injection was more frequently reported by males than females (adjusted odds ratio 1.46, 95 % confidence interval: 1.15-1.87) and injected alongside heroin (6.67, 4.06-10.97) more frequently than alone. Crack injection was independently associated with injecting equipment sharing (1.64, 1.30-2.07), groin injection (2.03, 1.60-2.56) in the past month, overdosing in the past year (1.90, 1.42-2.53), homelessness in the past year (1.42, 1.14-1.77) and ever having hepatitis C infection (1.64, 1.31-2.06). CONCLUSION Crack injection has increased significantly over the past decade in England and Wales. People injecting crack are more likely to engage in behaviours that increase the risk of BBV and SSTI acquisition, such as needle/syringe sharing, groin injection and polydrug use. Harm reduction and drug treatment services should adapt to support the needs of this growing population of people injecting stimulants.
Collapse
Affiliation(s)
- Claire Edmundson
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Sara Croxford
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Rd, Rainhill, Prescot, L35 5DR, UK
| | - Eva Emanuel
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Jacquelyn Njoroge
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Samreen Ijaz
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Vivian Hope
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; Public Health Institute, Liverpool John Moores University, Henry Cotton Building 15-21 Webster St, Liverpool, L3 2ET, UK
| | - Emily Phipps
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Monica Desai
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| |
Collapse
|
5
|
Günther F, Wong D, Elison-Davies S, Yau C. Identifying factors associated with user retention and outcomes of a digital intervention for substance use disorder: a retrospective analysis of real-world data. JAMIA Open 2023; 6:ooad072. [PMID: 37663407 PMCID: PMC10474970 DOI: 10.1093/jamiaopen/ooad072] [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: 08/10/2022] [Revised: 01/29/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives Successful delivery of digital health interventions is affected by multiple real-world factors. These factors may be identified in routinely collected, ecologically valid data from these interventions. We propose ideas for exploring these data, focusing on interventions targeting complex, comorbid conditions. Materials and Methods This study retrospectively explores pre-post data collected between 2016 and 2019 from users of digital cognitive behavioral therapy (CBT)-containing psychoeducation and practical exercises-for substance use disorder (SUD) at UK addiction services. To identify factors associated with heterogenous user responses to the technology, we employed multivariable and multivariate regressions and random forest models of user-reported questionnaire data. Results The dataset contained information from 14 078 individuals of which 12 529 reported complete data at baseline and 2925 did so again after engagement with the CBT. Ninety-three percent screened positive for dependence on 1 of 43 substances at baseline, and 73% screened positive for anxiety or depression. Despite pre-post improvements independent of user sociodemographics, women reported more frequent and persistent symptoms of SUD, anxiety, and depression. Retention-minimum 2 use events recorded-was associated more with deployment environment than user characteristics. Prediction accuracy of post-engagement outcomes was acceptable (Area Under Curve [AUC]: 0.74-0.79), depending non-trivially on user characteristics. Discussion Traditionally, performance of digital health interventions is determined in controlled trials. Our analysis showcases multivariate models with which real-world data from these interventions can be explored and sources of user heterogeneity in retention and symptom reduction uncovered. Conclusion Real-world data from digital health interventions contain information on natural user-technology interactions which could enrich results from controlled trials.
Collapse
Affiliation(s)
- Franziska Günther
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester M13 9GB, United Kingdom
| | - David Wong
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester M13 9GB, United Kingdom
| | | | - Christopher Yau
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, United Kingdom
- Health Data Research UK, London NW1 2BE, United Kingdom
| |
Collapse
|
6
|
Fletcher R, Regan C, Dizon J, Leigh L. Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis. JMIR Form Res 2023; 7:e44924. [PMID: 37594788 PMCID: PMC10474505 DOI: 10.2196/44924] [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: 12/08/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back "STOP" to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions. OBJECTIVE This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers. METHODS Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021. RESULTS Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included "other reasons" (83/202, 41.1%), followed by "not helpful" (47/202, 23.3%) and "too busy" (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked. CONCLUSIONS Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers' role may be an important consideration in reducing fathers' disengagement.
Collapse
Affiliation(s)
- Richard Fletcher
- School of Health Sciences, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Casey Regan
- School of Health Sciences, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Jason Dizon
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, Australia
| |
Collapse
|
7
|
Amaral RAD. Performance measures for alcohol and other drugs services: a commentary. Int Rev Psychiatry 2023; 35:475-485. [PMID: 38299659 DOI: 10.1080/09540261.2023.2249093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/14/2023] [Indexed: 02/02/2024]
Abstract
Alcohol and other drugs treatment includes a wide range of service and personal characteristics, along with expected and unexpected barriers to treatment. To capture the benefits and the gaps of a designed treatment, one needs to consider process-of-care and outcome measurements. Process-of-care measures are mainly developments of the rationale proposed by The Washington Circle and capture all variants in the process-of-care as proportions. Outcome measures are strongly related to different concepts of recovery and described as simple yes/no answers type to wide levels of response, such as in Likert-type scales. According to the studies collected here, more realistic periods of data-collection for process-of-care measures and a more reliable format to capture outcome particularities should be designed.
Collapse
Affiliation(s)
- Ricardo Abrantes do Amaral
- Perdizes Institute of the Clinical Hospital of School of Medicine of the University of São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
An Y, Hoffmann CJ, Bhoora U, Ndini P, Moyo D, Steiner L, Tshuma S, Mabuto T, Hugo J, Owczarzak J, Marcus TS. Opioid use and HIV treatment services experiences among male criminal justice-involved persons in South Africa: a qualitative study. Harm Reduct J 2023; 20:90. [PMID: 37480041 PMCID: PMC10360229 DOI: 10.1186/s12954-023-00834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 07/17/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) is overrepresented among people with criminal justice involvement; HIV is a common comorbidity in this population. This study aimed to examine how formerly incarcerated men living with HIV and OUD in South Africa experienced HIV and OUD services in correctional facilities and the community. METHODS Three focus group discussions were conducted with 16 formerly incarcerated men living with HIV and OUD in Gauteng, South Africa. Discussions explored available healthcare services in correctional facilities and the community and procedural and practice differences in health care between the two types of settings. Data were analyzed thematically, using a comparative lens to explore the relationships between themes. RESULTS Participants described an absence of medical services for OUD in correctional facilities and the harms caused by opioid withdrawal without medical support during incarceration. They reported that there were limited OUD services in the community and that what was available was not connected with public HIV clinics. Participants perceived correctional and community HIV care systems as readily accessible but suggested that a formal system did not exist to ensure care continuity post-release. CONCLUSIONS OUD was perceived to be medically unaddressed in correctional facilities and marginally attended to in the community. In contrast, HIV treatment was widely available within the two settings. The current model of OUD care in South Africa leaves many of the needs of re-entrants unmet. Integrating harm reduction into all primary care medical services may address some of these needs. Successful HIV care models provide examples of approaches that can be applied to developing and expanding OUD services in South Africa.
Collapse
Affiliation(s)
- Yangxi An
- Krieger School for the Arts and Sciences, Johns Hopkins University, Baltimore, USA
| | - Christopher J Hoffmann
- School of Medicine, Johns Hopkins University, 1550 Orleans St, CRBII 1M11, Baltimore, MD, 21207, USA.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
- Aurum Institute, Johannesburg, South Africa.
| | - Urvisha Bhoora
- Community Oriented Substance Use Programme, Tshwane, South Africa
- Community Oriented Primary Care Research Unit, University of Pretoria, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| | | | | | - Laura Steiner
- School of Medicine, Johns Hopkins University, 1550 Orleans St, CRBII 1M11, Baltimore, MD, 21207, USA
| | - Sukholuhle Tshuma
- Community Oriented Substance Use Programme, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| | | | - Jannie Hugo
- Community Oriented Substance Use Programme, Tshwane, South Africa
- Community Oriented Primary Care Research Unit, University of Pretoria, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| | - Jill Owczarzak
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Tessa S Marcus
- Community Oriented Primary Care Research Unit, University of Pretoria, Tshwane, South Africa
- Department of Family Medicine, University of Pretoria, Tshwane, South Africa
| |
Collapse
|
9
|
Kim CH, Kang KA, Shin S. Healthy lifestyle status related to alcohol and food addiction risk among college students: a logistic regression analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:775-781. [PMID: 35275509 DOI: 10.1080/07448481.2021.1908302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study aimed to determine whether low healthy lifestyle (HL) status was associated with alcohol and food addiction risks among college students. METHOD The data were gathered through an online survey questionnaire from 311 college students. The students were divided into either a lower or a higher HL status group, based on HL mean score, and the major statistical method used was a binary logistic regression. RESULTS There were significant differences in alcohol and food addiction score between the two groups. The lower HL status group showed a 3.06 times higher risk of problematic drinking and a 2.44 times higher risk of food addiction compared with the higher HL status group. CONCLUSIONS The results of this study suggest the importance of HL in the prevention of alcohol and food addiction. HL information can be used to develop health education programs aimed at preventing addiction for college students.
Collapse
Affiliation(s)
- Cheong Hoon Kim
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
| | - Kyung-Ah Kang
- College of Nursing, Sahmyook University, Seoul, South Korea
| | - Sunhwa Shin
- College of Nursing, Sahmyook University, Seoul, South Korea
| |
Collapse
|
10
|
Banandur P, Hasiruvalli Gangappa V, Koujageri JM, Garady L, Arelingaiah M, Ramamurthy SV, Naik V, Rai V, Giboy S, Sajjanar S, Subhash Chandra KL, Rajneesh S, Gopalkrishna G. Youth and suicidality: Correlates among clients attending youth mental health promotion clinics in India. Int J Soc Psychiatry 2023; 69:146-155. [PMID: 35057650 DOI: 10.1177/00207640211070399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicidality among youth is one of the most challenging public health issues. A thorough understanding of the risk factors that contribute to youth suicidality is necessary. The main aim of the study is to estimate the proportion of suicidality and understand factors associated with suicidality amongst clients attending youth mental health promotion clinics in Karnataka, India. METHODS A retrospective cross-sectional case record analysis was performed utilising data from real-time digitised management information system specifically developed for the programme. All case records of clients aged 15 to 35 years who received mental health promotion (MHP) services between January 2017 and December 2020 across 30 districts of Karnataka were included in this analysis. Multivariate logistic regression analysis was performed with suicidality among clients as outcome. Socio-demographic characteristics, issues reported, feelings/emotions that indicate underlying mental health issue/crisis, being aware of suicidality among friends and family and personal habits (smoking/chewing tobacco and drinking alcohol) were considered potential exposure variables. FINDINGS Overall proportion of suicidality among youth presenting to youth mental health promotion clinics in Karnataka was 3.5% (357/10,340). Among factors associated with suicidality, the strongest association was found among those clients who reported attempted suicide among friends (AOR 8.94; 95% CI 5.95-13.45), family members (AOR 5.50; 95% CI 3.66-8.29), being anxious (AOR 4.90; 95% CI 3.43-6.99), inability to trust anyone (AOR 4.07; 95% CI 2.75-6.03), had issues of Gender, Sex and Sexuality (AOR 3.16; 95% CI 1.93-5.17) and relationship issues (AOR 2.77; 95% CI 2.05-3.73). CONCLUSION The results alert all institutions, organisations and departments that cater to services and development of youth, to be sensitive towards risk factors of suicidality. The study advocates youth mental health promotion clinics to be equipped with measures/interventions to identify and manage such risk factors. This study has implications for Youth mental health promotion in India and other similar South-East Asian countries.
Collapse
Affiliation(s)
- Pradeep Banandur
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | | | | | - Lavanya Garady
- International Centre for Public Health Innovations, Ramaiah, Bengaluru, Karnataka, India
| | - Mutharaju Arelingaiah
- SAMA Program, UK-MRC Funded, Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Sathya Velu Ramamurthy
- Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Vani Naik
- Yuva Spandana Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Veeksha Rai
- Life Skills Training and Counselling Services Program, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Shalin Giboy
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Sateesh Sajjanar
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | | | - Shalini Rajneesh
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | - Gururaj Gopalkrishna
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| |
Collapse
|
11
|
Adham D, Afrashteh S, Alimohamadi Y, Maghsodlou-Nejad V, Khodadost B, Abbasi-Ghahramanloo A. Patterns of substance use and predictors of class membership among university male students: a latent class analysis. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2077253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Davoud Adham
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sima Afrashteh
- Department of Public Health, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Yousef Alimohamadi
- Health Research Center, Life Style Institute, Baqiyatollah University of Medical Sciences, Tehran, Iran
| | | | - Behnam Khodadost
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
12
|
Elison-Davies S, Newsome J, Jones A, Davies G, Ward J. Associations between psychosocial risk factors, and changes in substance dependence and psychosocial functioning, during engagement with digital cognitive behavioral therapy for methamphetamine use: use of 'Breaking Free from Substance Abuse' by incarcerated people during the COVID-19 pandemic. HEALTH & JUSTICE 2022; 10:28. [PMID: 36070026 PMCID: PMC9449936 DOI: 10.1186/s40352-022-00190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/30/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND Methamphetamine use can be associated with involvement with correctional services and incarceration. Traditionally, treatments for methamphetamine use have been delivered in-person - however, lockdowns initiated during the COVID-19 pandemic significantly reduced access to such in-person support in prisons. Therefore, in May 2020 a digital cognitive-behavioral therapy (CBT) program for substance use disorders - 'Breaking Free from Substance Abuse' - was made available across prisons in Ohio in order to meet this treatment gap. This represents the first time this digital CBT intervention has been made widely available to incarcerated people residing in prisons or jails in the United States (US). This was a within-subjects study using data from 2187 Ohio prison residents who engaged with this digital CBT program to address their methamphetamine use. RESULTS Participants reported multiple psychosocial risk factors, including moderate to severe substance dependence, depression and anxiety; interpersonal conflict; aggressive behavior; paranoia; and difficulties with work, education and accommodation. Significant reductions in substance dependence, depression/anxiety and biopsychosocial impairment, and improvements in quality of life, were identified in the sample. Risk factors were associated with less positive outcomes, specifically interpersonal conflict and poor mental health. Completion of specific components of the program were associated with more positive outcomes - a dose response was also identified. CONCLUSIONS Digital CBT can be delivered in secure US correctional settings and may help to fill unmet needs for in-person treatment. Specifically, this digital CBT program may support incarcerated individuals to address methamphetamine use, with outcomes being associated with psychosocial risk factors and program engagement.
Collapse
Affiliation(s)
| | | | - Andrew Jones
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Glyn Davies
- LifeWorks, Manchester Science Park, Manchester, UK
| | | |
Collapse
|
13
|
Chiu CWC, Li CWY, Lai ESK, Law CKM, Lam M. Lifestyle redesign program with motivational enhancement for young people with drug use in Hong Kong: a retrospective study. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2018727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Calvin Wing-Cheong Chiu
- Occupational Therapy Department, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Catherine Wai-Yan Li
- Occupational Therapy Department, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Eric Shek-Kin Lai
- Occupational Therapy Department, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Colin Kwok-Man Law
- Occupational Therapy Department, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Ming Lam
- Department of General Adult Psychiatry, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong
| |
Collapse
|
14
|
Elison-Davies S, Märtens K, Yau C, Davies G, Ward J. Associations between baseline opioid use disorder severity, mental health and biopsychosocial functioning, with clinical responses to computer-assisted therapy treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:360-372. [PMID: 33428458 DOI: 10.1080/00952990.2020.1861618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Increasing rates of opioid-related overdose have been identified globally. Treatment for opioid use disorders (OUD) includes medications for opioid use disorder (MOUD) alongside behavioral support. Novel approaches to behavioral support should be explored, including computer-assisted therapy (CAT) programs.Objectives: Examine differences between baseline and post-treatment measures of opioid use and biopsychosocial functioning for individuals with OUD engaging with the CAT program 'Breaking Free Online,' and the extent to which participant characteristics may be associated with post-treatment measures.Methods: 1107 individuals engaged with CAT and provided baseline and post-treatment data - 724 (65.4%) were male, 383 (34.6%) were female.Results: Significant differences between baseline and post-treatment measures were identified (all p <.0001, effect sizes range:15 -.50). Participant characteristics were associated with post-treatment measures of opioid use, opioid dependence, mental health issues, quality of life, and biopsychosocial impairment (all p <.0001). An aggregated consensus measure of clinical impairment was found to be associated with changes in opioid use and post-treatment biopsychosocial functioning measures, with those participants with greater baseline clinical impairment demonstrating a greater magnitude of improvement from baseline to post-treatment than those with lower clinical impairment.Conclusion: CAT may reduce opioid use and improve biopsychosocial functioning in individuals with OUD. CAT could therefore provide a solution to the global opioid crisis if delivered as combination behavioral support alongside MOUD. Findings also indicate that it may be important for treatment systems to identify individuals with psychosocial complexity who might require behavioral support and MOUD.
Collapse
Affiliation(s)
| | - Kaspar Märtens
- Department of Statistics, University of Oxford, Oxford, UK
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Glyn Davies
- Breaking Free Online, Manchester Science Park, Manchester, UK
| | - Jonathan Ward
- Breaking Free Online, Manchester Science Park, Manchester, UK
| |
Collapse
|
15
|
Muhammad T, Govindu M, Srivastava S. Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross-sectional study. BMC Geriatr 2021; 21:85. [PMID: 33514331 PMCID: PMC7847155 DOI: 10.1186/s12877-021-02027-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/13/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life. METHODS The present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated. RESULTS About 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only. CONCLUSION The encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.
Collapse
Affiliation(s)
- T. Muhammad
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| | - Manideep Govindu
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| | - Shobhit Srivastava
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| |
Collapse
|
16
|
Shams F, Wong JSH, Nikoo M, Outadi A, Moazen-Zadeh E, Kamel MM, Song MJ, Jang KL, Krausz RM. Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review. J Med Internet Res 2021; 23:e20557. [PMID: 33475520 PMCID: PMC7861997 DOI: 10.2196/20557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/10/2020] [Accepted: 12/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. OBJECTIVE We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: "How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?" METHODS A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. RESULTS A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. CONCLUSIONS Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.
Collapse
Affiliation(s)
- Farhud Shams
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ava Outadi
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Mostafa M Kamel
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Tanta University, Tanta, Egypt
| | - Michael Jae Song
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| |
Collapse
|
17
|
Ward J, Elison-Davies S, Davies G, Dugdale S, Jones A. Clinical and demographic patient characteristics, alcohol treatment goal preference and goal attainment during computer-assisted therapy with Breaking Free Online. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1651915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Jonathan Ward
- Breaking Free Group, Manchester Science Park, Manchester, UK
| | | | - Glyn Davies
- Breaking Free Group, Manchester Science Park, Manchester, UK
| | | | - Andrew Jones
- Centre for Epidemiology, University of Manchester, Manchester, UK
| |
Collapse
|
18
|
Reese ED, Conway CC, Anand D, Bauer DJ, Daughters SB. Distress tolerance trajectories following substance use treatment. J Consult Clin Psychol 2019; 87:645-656. [PMID: 31008636 DOI: 10.1037/ccp0000403] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use. METHOD Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task-computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments). RESULTS Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = -.12, p = .03) and 12-month follow-ups (β = -.08, p = .045). CONCLUSIONS DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Elizabeth D Reese
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | - Deepika Anand
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Daniel J Bauer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| |
Collapse
|
19
|
Identifying substance use risk based on deep neural networks and Instagram social media data. Neuropsychopharmacology 2019; 44:487-494. [PMID: 30356094 PMCID: PMC6333814 DOI: 10.1038/s41386-018-0247-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/19/2018] [Accepted: 10/15/2018] [Indexed: 01/10/2023]
Abstract
Social media may provide new insight into our understanding of substance use and addiction. In this study, we developed a deep-learning method to automatically classify individuals' risk for alcohol, tobacco, and drug use based on the content from their Instagram profiles. In total, 2287 active Instagram users participated in the study. Deep convolutional neural networks for images and long short-term memory (LSTM) for text were used to extract predictive features from these data for risk assessment. The evaluation of our approach on a held-out test set of 228 individuals showed that among the substances we evaluated, our method could estimate the risk of alcohol abuse with statistical significance. These results are the first to suggest that deep-learning approaches applied to social media data can be used to identify potential substance use risk behavior, such as alcohol use. Utilization of automated estimation techniques can provide new insights for the next generation of population-level risk assessment and intervention delivery.
Collapse
|
20
|
Elison-Davies S, Davies G, Ward J, Dugdale S, Weston S, Jones A, Brides M, Weekes J. Protocol for a randomized controlled trial of the Breaking Free Online Health and Justice program for substance misuse in prison settings. HEALTH & JUSTICE 2018; 6:20. [PMID: 30392125 PMCID: PMC6755620 DOI: 10.1186/s40352-018-0078-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Substance misuse, including problematic drug and alcohol use, are significant issues in society that can have multiple detrimental effects. Many people access support for their substance misuse during prison sentences, due to the associations between substance misuse and offending, and the high proportion of the prison population who have drug and alcohol issues. Breaking Free Online Health and Justice is a computer-assisted therapy program that has been developed to support substance-involved offenders to address their substance misuse and associated offending within prison settings. METHODS This will be a parallel-group randomized controlled trial of 4-week Breaking Free Online Health and Justice program as an adjunct to standard treatment for substance misuse, in comparison to standard treatment only, in a male Category D open prison. Interventional and control groups will be compared in terms of the changes in their scores on multiple measures from baseline to post-treatment assessment at 4-weeks, and then 3- and 6-months follow-up. Participants will be adult male offenders serving sentences in prison in England who have demonstrable difficulties with drugs and/or alcohol for at least the past 12-months. The primary outcome measure will be self-reported substance misuse, with secondary outcomes being standardized psychometric assessments of substance dependence, mental health, biopsychosocial functioning, quality of life and post-release offending. Other secondary measures will include frequency of completion of specific intervention strategies in the program. DISCUSSION This study will examine whether Breaking Free Online Health and Justice as an adjunct to standard substance misuse interventions in prisons, improves outcomes for substance-involved offenders receiving interventions in custodial settings. Findings from the study will be used to inform further developments of the program and potential improvements to custodial treatment. TRIALS REGISTRATION ISRCTN09846981 .
Collapse
Affiliation(s)
| | - Glyn Davies
- Breaking Free Group, Manchester Science Park, Manchester, M15 6LR UK
| | - Jonathan Ward
- Breaking Free Group, Manchester Science Park, Manchester, M15 6LR UK
| | - Stephanie Dugdale
- Breaking Free Group, Manchester Science Park, Manchester, M15 6LR UK
| | - Samantha Weston
- University of Keele, School of Social Science and Public Policy, Staffordshire, ST5 5BG UK
| | - Andrew Jones
- University of Manchester, Centre for Epidemiology, Manchester, M13 6PL UK
| | - Michelle Brides
- Spectrum Community Health, HMP Preston, 2 Ribbleton Lane, Preston, PR1 5AB UK
| | - John Weekes
- Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3 Canada
- Department of Psychology, Carleton University, Ottawa, ON K1S 5B6 Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8 Canada
| |
Collapse
|
21
|
Breaking Free from Smoking: A Novel Digital Smoking Cessation Intervention for Offenders in UK Prisons. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: The level of smoking cessation support across UK prisons is variable, with most offering pharmacological support, such as nicotine replacement therapy. However, with a complete smoking ban in prisons in England now imminent, additional standardised behavioural support is necessary to help offenders go smoke-free.Aims: This study used the Behaviour Change Wheel to aim to develop the content of an online smoking cessation intervention for offenders, with consideration of their capability, motivation and opportunity for behaviour change.Methods: This was an intervention development study. The Behaviour Change Wheel was used to map cognitive, behavioural, physiological and social targets for the intervention, onto appropriate intervention techniques for inclusion in the smoking cessation programme for offenders.Results: Psychological capability, social opportunity and reflective and automatic motivation were identified through deductive thematic analysis as areas of change required to achieve smoking cessation. A total of 27 behavioural change techniques were chosen for this smoking cessation intervention and were mapped onto the Lifestyle Balance Model which provided the theoretical basis on which the components of the programme are conceptualised. This included strategies around increasing motivation to quit, anticipating smoking triggers, modifying smoking-related thoughts, regulating emotions, managing cravings, replacing smoking and rewarding nicotine abstinence and adopting a healthier lifestyle.Conclusions: Through the utilisation of the Behaviour Change Wheel, the development process of this digital smoking cessation intervention was achieved. Further research is planned to evaluate the clinical effectiveness of this intervention and to explore how the programme is implemented in practice within prison settings.
Collapse
|
22
|
Brown AM, Bohler R. Achieving a 15% Relapse Rate: A Review of Collegiate Recovery and Physician Health Programs. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1424595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, Georgia
| | - Robert Bohler
- Center for Addiction Recovery, Georgia Southern University, Statesboro, Georgia
| |
Collapse
|
23
|
Abstract
BACKGROUND Teenage substance use is a global challenge, and youths residing in Kuwait are not immune from it. Tobacco products are licit; however, alcohol and other mood-altering illicit substance are prohibited with severe penalties including imprisonment. Youths residing in Kuwait are being initiated into the use of mood-altering substances like tobacco at an early age, and it is postulated that, as they grow older, they may progress into using alcohol and other prohibited illicit drugs. AIMS The aim of this study was to determine licit and illicit substance use by teenagers residing in Kuwait. The study will also explore their awareness of substance use among their peers. DESIGN A cross-sectional survey using a snowball sampling technique was used to recruit 190 teenagers aged 15-18 years residing in Kuwait. Data were collected using the 130-item questionnaire adapted from 1998 New Jersey Triennial Public High School Survey of Drug and Alcohol Use. Data collection was from September 2012 to June 2013. DATA ANALYSIS The Statistical Package for Social Sciences Version 22 for Windows was used. Pearson's chi-square, Kruskal-Wallis, and Mann-Whitney U tests were used to test the hypotheses. RESULTS Tobacco was the most commonly used substance by these teenagers; 8.4% were current smokers, and 50% had experimented. Age of initiation for 21% was before 14 years old. Hashish (marijuana) was the most commonly used illicit drug, with 3.7% current users and 5.3% claiming to have used it. More male than female teenagers in Grade 9 were using tobacco products (χ = 27.428, df = 5, p < .001). CONCLUSION The use and abuse of mood/mind-altering licit and illicit substances appear to be increasing among older teenagers. Intensifying campaigns about the hazards of substance use and drug testing should start from the primary school level.
Collapse
|
24
|
Ashford RD, Brown A. Bridging the gaps: Intergenerational findings from the substance use disorder and recovery field. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2017. [DOI: 10.1080/15350770.2017.1368326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Robert D Ashford
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Austin Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, Georgia, USA
| |
Collapse
|
25
|
Rodriguez-Morales L. In Your Own Skin: The Experience of Early Recovery from Alcohol-Use Disorder in 12-Step Fellowships. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1355204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
26
|
Elison S, Ward J, Williams C, Espie C, Davies G, Dugdale S, Ragan K, Chisnall L, Lidbetter N, Smith K. Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of 'Living Life to the Full Interactive', 'Sleepio' and 'Breaking Free Online' at 'Self Help Services'. BMJ Open 2017; 7:e016392. [PMID: 28729322 PMCID: PMC5541623 DOI: 10.1136/bmjopen-2017-016392] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services. Therefore, this service evaluation reports on feasibility and outcomes from an eTherapy mental health service. SETTING 'Self Help Services', an Increasing Access to Psychological Therapies (IAPT) eTherapy service in Greater Manchester. PARTICIPANTS 1068 service users referred to the service for secondary care for their mental health difficulties. INTERVENTIONS Participants were triaged into one of three eTherapy programmes: 'Living Life to the Full Interactive' for low mood, stress and anxiety; 'Sleepio' for insomnia; and 'Breaking Free Online' for substance misuse, depending on clinical need. PRIMARY OUTCOMES MEASURES Standardised psychometric assessments of depression, anxiety and social functioning, collected as part of the IAPT Minimum Data Set, were conducted at baseline and post-treatment. RESULTS Data indicated baseline differences, with the Breaking Free Online group having higher scores for depression and anxiety than the Living Life to the Full Interactive (depression CI 1.27 to 3.21, p<0.0001; anxiety CI 077 to 1.72, p<0.0001) and Sleepio (depression CI 1.19 to 4.52, p<0.0001; anxiety CI 2.16 to 5.23, p<0.0001) groups. Promising improvements in mental health scores were found within all three groups (all p<0.0001), as were significant reductions in numbers of service users reaching clinical threshold scores for mental health difficulties (p<0.0001). Number of days of engagement was not related to change from baseline for the Living Life to the Full or Sleepio programmes but was associated with degree of change for Breaking Free Online. CONCLUSION Data presented provide evidence for feasibility of this eTherapy delivery model in supporting service users with a range of mental health difficulties and suggest that eTherapies may be a useful addition to treatment offering in community-based services.
Collapse
Affiliation(s)
| | | | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Colin Espie
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | | | | | | | | | | | | |
Collapse
|
27
|
Dugdale S, Elison S, Davies G, Ward J. Applying Behavior Change Theories and Qualitative Methods in Substance Misuse Implementation Research: Conceptualizing the Adoption of Breaking Free Online in Real-World Clinical Practice. QUALITATIVE HEALTH RESEARCH 2017; 27:1049-1059. [PMID: 28818021 DOI: 10.1177/1049732316683379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is insufficient research examining the implementation of complex novel interventions within health care. This may be due to a lack of qualitative research providing subjective insights into these implementation processes. The authors investigate the advantages of applying behavior change theories to conceptualize qualitative data describing the processes of implementation of complex interventions. Breaking Free Online (BFO), a digital treatment intervention for substance misuse, is described as an example of a complex intervention. The authors review previous qualitative research which explored initial diffusion, or spread, of the BFO program, and its subsequent normalization as part of standard treatment for substance misuse within the health and social care charity, "Change, Grow, Live" (CGL). The use of behavior change models to structure qualitative interview findings enabled identification of facilitators and barriers to the use of BFO within CGL. These findings have implications for the development of implementation research in novel health care interventions.
Collapse
|
28
|
Dugdale S, Ward J, Hernen J, Elison S, Davies G, Donkor D. Using the Behavior Change Technique Taxonomy v1 to conceptualize the clinical content of Breaking Free Online: a computer-assisted therapy program for substance use disorders. Subst Abuse Treat Prev Policy 2016; 11:26. [PMID: 27449786 PMCID: PMC4957914 DOI: 10.1186/s13011-016-0069-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, research within the field of health psychology has made significant progress in terms of advancing and standardizing the science of developing, evaluating and reporting complex behavioral change interventions. A major part of this work has involved the development of an evidence-based Behavior Change Technique Taxonomy v1 (BCTTv1), as a means of describing the active components contained within such complex interventions. To date, however, this standardized approach derived from health psychology research has not been applied to the development of complex interventions for the treatment of substance use disorders (SUD). Therefore, this paper uses Breaking Free Online (BFO), a computer-assisted therapy program for SUD, as an example of how the clinical techniques contained within such an intervention might be mapped onto the BCTTv1. METHOD The developers of BFO were able to produce a full list of the clinical techniques contained within BFO. Exploratory mapping of the BCTTv1 onto the clinical content of the BFO program was conducted separately by the authors of the paper. This included the developers of the BFO program and psychology professionals working within the SUD field. These coded techniques were reviewed by the authors and any discrepancies in the coding were discussed between all authors until an agreement was reached. RESULTS The BCTTv1 was mapped onto the clinical content of the BFO program. At least one behavioral change technique was found in 12 out of 16 grouping categories within the BCTTv1. A total of 26 out of 93 behavior change techniques were identified across the clinical content of the program. CONCLUSION This exploratory mapping exercise has identified the specific behavior change techniques contained within BFO, and has provided a means of describing these techniques in a standardized way using the BCTTv1 terminology. It has also provided an opportunity for the BCTTv1 mapping process to be reported to the wider SUD treatment community, as it may have real utility in the development and evaluation of other psychosocial and behavioral change interventions within this field.
Collapse
|
29
|
Celorrio D, Muñoz X, Amiano P, Dorronsoro M, Bujanda L, Sánchez MJ, Molina-Montes E, Navarro C, Chirlaque MD, MaríaHuerta J, Ardanaz E, Barricarte A, Rodriguez L, Duell EJ, Hijona E, Herreros-Villanueva M, Sala N, Alfonso-Sánchez MA, de Pancorbo MM. Influence of Dopaminergic System Genetic Variation and Lifestyle Factors on Excessive Alcohol Consumption. Alcohol Alcohol 2015; 51:258-67. [PMID: 26447226 DOI: 10.1093/alcalc/agv114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/30/2015] [Indexed: 01/13/2023] Open
Abstract
AIMS To examine the role of genetic and environmental factors in the pathogenesis of alcohol dependence in a Spanish cohort of women and men. METHODS We analyzed the relationship between 56 genetic variants in 7 genes associated with the dopaminergic reward pathway and excessive alcohol consumption. The study sample (N = 1533, of which 746 were women) consisted of 653 heavy consumers and 880 very low consumers from the Spanish subcohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Single nucleotide polymorphisms (SNPs) were genotyped using a customized array. Lifestyle variables were also examined to assess associations between genetic and environmental factors. RESULTS No statistically significant differences were found between cases and controls for the allele frequencies in five genes: TH, SLC18A2, DRD1, DRD3 and COMT. Conversely, some alleles of the 12 SNPs from the DRD2 locus and the 5 from the MAOA locus showed significant associations with excessive alcohol consumption. Namely, rs10891556 (DRD2) proved to be the only SNP positively correlated with excessive alcohol consumption in both sexes. DRD2 rs1800497 and rs877138 were significantly associated in men, whereas DRD2 rs17601612 and rs4936271 and MAOA rs5906898 were associated with excessive alcohol consumption in women. A correspondence analysis provided an overall lifestyle profile of excessive drinkers, who were predominantly men who smoked, had large intakes of meat, small intakes of fruit and vegetables, whose jobs did not require high education levels and who engaged in little physical activity. CONCLUSIONS It has shown the influence of dopaminergic pathway in the genetics of alcohol dependence with differences between men and women and providing a lifestyle profile of excessive drinkers.
Collapse
Affiliation(s)
- David Celorrio
- BIOMICs Research Group, 'Lucio Lascaray' Center for Research and Advanced Studies (CIEA), University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Xavier Muñoz
- Molecular Epidemiology Group, Translational Research Laboratory, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain Unit of Nutrition, and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
| | - Pilar Amiano
- Public Health Division of Gipuzkoa, Department of Health of the Regional Government of the Basque Country, Donostia, Spain BIODonostia Research Institute, San Sebastián, Spain CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain
| | - Miren Dorronsoro
- Public Health Division of Gipuzkoa, Department of Health of the Regional Government of the Basque Country, Donostia, Spain BIODonostia Research Institute, San Sebastián, Spain CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain
| | - Luis Bujanda
- Departmenet of Gastroenterology, Donostia Hospital-Instituto Biodonostia, University of the Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), San Sebastian, Spain
| | - María-José Sánchez
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Andalusian School of Public Health, Granada, Spain
| | - Esther Molina-Montes
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Andalusian School of Public Health, Granada, Spain
| | - Carmen Navarro
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Department of Epidemiology, Murcia Health Council, Murcia, Spain
| | - M Dolores Chirlaque
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Department of Epidemiology, Murcia Health Council, Murcia, Spain
| | - José MaríaHuerta
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Department of Epidemiology, Murcia Health Council, Murcia, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Public Health Institute of Navarra, Pamplona, Spain
| | - Aurelio Barricarte
- CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain Public Health Institute of Navarra, Pamplona, Spain
| | | | - Eric J Duell
- Unit of Nutrition, and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
| | - Elizabeth Hijona
- Departmenet of Gastroenterology, Donostia Hospital-Instituto Biodonostia, University of the Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), San Sebastian, Spain
| | - Marta Herreros-Villanueva
- Departmenet of Gastroenterology, Donostia Hospital-Instituto Biodonostia, University of the Basque Country (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), San Sebastian, Spain
| | - Núria Sala
- Molecular Epidemiology Group, Translational Research Laboratory, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain Unit of Nutrition, and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
| | - Miguel A Alfonso-Sánchez
- BIOMICs Research Group, 'Lucio Lascaray' Center for Research and Advanced Studies (CIEA), University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Marian M de Pancorbo
- BIOMICs Research Group, 'Lucio Lascaray' Center for Research and Advanced Studies (CIEA), University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| |
Collapse
|
30
|
Elison S, Weston S, Davies G, Dugdale S, Ward J. Findings from mixed-methods feasibility and effectiveness evaluations of the “Breaking Free Online” treatment and recovery programme for substance misuse in prisons. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1090397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah Elison
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| | - Samantha Weston
- School of Sociology and Criminology, University of Keele, Keele, Staffs, Staffs, UK
| | - Glyn Davies
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| | | | - Jonathan Ward
- Breaking Free Group, 274 Deansgate, Manchester, UK and
| |
Collapse
|
31
|
Elison S, Davies G, Ward J. Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users. JMIR Ment Health 2015; 2:e13. [PMID: 26543918 PMCID: PMC4607383 DOI: 10.2196/mental.4355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/11/2015] [Accepted: 03/14/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help. OBJECTIVE The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO. METHODS Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined. RESULTS Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001). CONCLUSIONS Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.
Collapse
Affiliation(s)
| | - Glyn Davies
- Breaking Free Online Manchester United Kingdom
| | | |
Collapse
|