Many correlates of poor quality of life among substance users entering treatment are not addiction-specific

Change in substance use among patients in opioid maintenance treatment: baseline to 1-year follow-up

BACKGROUND

Individuals with opioid use disorder (OUD) often have concurrent use of non-opioid substances. When patients enter opioid maintenance treatment (OMT), less is known about outcomes regarding the use of other types of drugs. Here we aimed to investigate changes in substance use among patients entering outpatient OMT, from treatment initiation to 1-year follow-up.

METHODS

We used data from the prospective Norwegian Cohort of Patient in OMT and Other Drug Treatment Study (NorComt). Among 283 patients who entered OMT at participating facilities across Norway, 179 were assessed at follow-up. Of these patients, 131 were in a non-controlled environment, and were included in the present analysis. The main outcome was change in substance use. Logistic regression analysis was applied to identify factors associated with abstinence from all substances (other than agonist medication) at follow-up.

RESULTS

Along with opioid use, most patients reported polysubstance use prior to entering treatment. No significant differences were found in baseline characteristics between the included and non-included groups when examining attrition. At the 1-year follow-up, reduced substance use was reported. While in treatment, around two-thirds of patients continued using other drugs to varying degrees. At follow-up, about one-third of patients reported abstinence from all drugs, apart from the agonist medication. Factors related to abstinence included a goal of abstinence at baseline (OR = 5.26; 95% CI 1.14-19.55; p = 0.013) and increasing age (OR = 1.05; 95% CI 1.00-1.09; p = 0.034).

CONCLUSIONS

The majority of patients entering OMT used other substances in addition to opioids. About one-third of patients reported abstinence at the 1-year follow up. Although the majority of patients continued co-use of other drugs while in treatment, for most substances, less than 10% reported daily use at follow-up, with the exception of cannabis which was used daily/almost daily by about 2 in 10. Higher age and treatment goal at the start of OMT were important factors related to reducing concomitant substance use during treatment. These findings suggest that many patients entering OMT are in need of treatment and support related to the use of other substances, to further improve prognosis.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

SNP-based and haplotype-based genome-wide association on drug dependence in Han Chinese

BACKGROUND

Drug addiction is a serious problem worldwide and is influenced by genetic factors. The present study aimed to investigate the association between genetics and drug addiction among Han Chinese.

METHODS

A total of 1000 Chinese users of illicit drugs and 9693 healthy controls were enrolled and underwent single nucleotide polymorphism (SNP)-based and haplotype-based association analyses via whole-genome genotyping.

RESULTS

Both single-SNP and haplotype tests revealed associations between illicit drug use and several immune-related genes in the major histocompatibility complex (MHC) region (SNP association: log10BF = 15.135, p = 1.054e-18; haplotype association: log10BF = 20.925, p = 2.065e-24). These genes may affect the risk of drug addiction via modulation of the neuroimmune system. The single-SNP test exclusively reported genome-wide significant associations between rs3782886 (SNP association: log10BF = 8.726, p = 4.842e-11) in BRAP and rs671 (SNP association: log10BF = 7.406, p = 9.333e-10) in ALDH2 and drug addiction. The haplotype test exclusively reported a genome-wide significant association (haplotype association: log10BF = 7.607, p = 3.342e-11) between a region with allelic heterogeneity on chromosome 22 and drug addiction, which may be involved in the pathway of vitamin B12 transport and metabolism, indicating a causal link between lower vitamin B12 levels and methamphetamine addiction.

CONCLUSIONS

These findings provide new insights into risk-modeling and the prevention and treatment of methamphetamine and heroin dependence, which may further contribute to potential novel therapeutic approaches.

Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up

BACKGROUND

High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs.

METHODS

We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms.

RESULTS

Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up.

CONCLUSIONS

Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

Profiles of quality of life among patients using emergency departments for mental health reasons

BACKGROUND

This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use.

METHODS

Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them.

RESULTS

Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions.

CONCLUSION

The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

Quality of Life and Use of Complementary and Alternative Medicines among Narcotics Anonymous Patients: A Cross-Sectional Study in Southeast Iran

Background

Addiction, a chronic and recurrent disorder, is associated with lasting changes in the brain and can significantly affect the quality of life of people. Complementary and alternative medicine (CAM) along with modern medical treatments can improve the quality of life of individuals. This study aimed to investigate the relationship between the use of complementary and alternative medicines (CAMs) and quality of life in narcotics anonymous patients.

Methods

This cross-sectional study was performed on 189 narcotics anonymous patients in southeastern Iran. Using questionnaires such as the demographic information, the World Health Organization Quality of Life-BREF (WHOQOL-BREF), CAM, and satisfaction with the use of CAM, the researcher was able to compile a comprehensive picture of the population.

Results

The mean score of overall quality of life and general health was 64.02 ± 23.32. Overall, 66.1 percent (n = 125) of the participants reported using at least one type of CAM in the previous year. Last year, 25.9% of participants used at least one kind of CAM, 22.8% used two types of CAM, 7.9% used three types of CAM, and 4.8% used four to five types of CAM. Thirty-nine point seven percent of them reported using prayer, 36.5% reported using medicinal herbs, 15.3% of participants reported using massage, 14.3% of participants reported using dietary supplements, 12.2% reported using wet cupping, and 8.5% reported using meditation. There were no significant differences in physical, psychological, environmental, and overall quality of life between CAM users and non-CAM users. The prayer users had significantly higher scores in terms of social relationships, environment, and overall quality of life than nonprayer users. Employed participants and opium users had significantly higher overall quality of life than others.

Conclusion

Although there was no difference in quality of life between CAM and non-CAM users, the present study showed that prayer and medicinal herbs were the most commonly used methods among narcotics anonymous patients. However, prayer and religious beliefs were successful in improving the quality of life of these individuals. Physicians and other healthcare providers must advise patients with addiction to use different CAMs in order to improve their quality of life and quit narcotics. Future in-depth studies could help these patients use CAMs and improve their quality of life.

The Correlation between Neck Pain and Disability, Forward Head Posture, and Hyperkyphosis with Opium Smoking: A Cross-Sectional Study from Iran

Opium smoking has been a common practice in Iran for many years, with people often smoking for long hours. During the COVID-19 pandemic, there was an increase in opium smoking due to false beliefs about its protective effects against COVID-19 infection. In this study, we aimed to examine the association between the non-ergonomic positions associated with traditional opium smoking in Iran and the development of neck pain and disability, forward head posture (FHP), and hyperkyphosis (HK). In this cross-sectional, correlational study, a total of 120 individuals who smoked opium were selected based on the inclusion criteria. They were interviewed about their addiction profile using the Lite version of the Addiction Severity Index and the Leeds Dependence Questionnaire. The presence of neck pain and disability was also evaluated using the Visual Analog Scale and the Neck Disability Index. The participants were examined for FHP via side-view photography and for HK using a flexible ruler. Data were analyzed using correlation coefficient tests and stepwise linear regression analysis. Based on the results, homelessness, the lifetime duration of opium smoking (in months), the duration of daily opium smoking (in minutes), and the severity of drug dependence had significant relationships with the severity of neck pain, neck disability, FHP, and HK. Homelessness was the strongest predictor of neck pain and disability (R2 = 0.367, p < 0.001), FHP (R2 = 0.457, p < 0.001), and HK (R2 = 0.476, p < 0.001), followed by the lifetime duration of opium smoking and the duration of daily opium smoking, respectively, in which R2 increased to 0.505 (p = 0.011), 0.546 (p = 0.022), and 0.570 (p = 0.004) with the addition of two other variables. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to neck pain and disability, FHP, and HK due to the non-neutral posture of opium smokers.

Effects of 8 months of high-intensity interval training on physical fitness and health-related quality of life in substance use disorder

Objective

This study aimed to investigate the effect of 8 months of high-intensity interval training (HIIT) on physical fitness and health-related quality of life in substance use disorder.

Methods

Sixty substance use disorder were randomly assigned to either the HIIT group or the control group according to a random sampling method. The HIIT group received 8 months of four 60-min sessions per week under supervision. Weight, waist circumference, body fat percentage, heart rate, blood pressure, VO2max, reaction time, grip strength, standing on one foot with eyes closed, sitting forward flexion, and quadrant jumping, standing on one foot with eyes closed, the number of push-ups, quality of life (SF-36) score, and craving (VAS) scored were monitored in the HIIT and control groups at baseline, 4 months, and 8 months. SPSS 22.0 was used to conduct repeated measurement analysis of variance and Pearson correlation analysis on the collected subject data.

Results

Compared with baseline, weight (p < 0.001), waist circumference (p < 0.001), body fat percentage (p < 0.001), heart rate (p < 0.05), Systolic blood pressure (p < 0.01), systolic blood pressure (p < 0.05), reaction time (p < 0.001),PSQI (p < 0.001), Total cholesterol (p < 0.001), Triglyceride (p < 0.001), Blood sugar (p < 0.001) and VAS score (p < 0.001) were significantly decreased after 8 months of exercise intervention. Contrastingly, VO2max (p < 0.05), grip strength (p < 0.05), eyes closed and one foot Standing (p < 0.001), sitting forward flexion (p < 0.001), quadrant jumping (p < 0.001), push-ups (p < 0.001), PCS (p < 0.001), and MCS (p < 0.001) were significantly increased. VO2max was significantly negatively correlated with VAS (r = -0.434, p < 0.001), and significantly positively correlated with PCS (r = 0.425, p < 0.001). There was a positive correlation between standing on one foot with closed eyes and MCS (r = 0.283, p < 0.05).

Conclusion

Eight months of HIIT can comprehensively improve the physical health level and health-related quality of life of men with substance use disorders, reduce the desire for drugs, and lay the foundation for better starting a happy life.

Health-related quality of life and stigma in opioid dependence: Comparison between buprenorphine users and non-users

Objectives

Opioid dependence leads to reduced quality of life (QOL) and stigma. There is scarcity of literature on impact of buprenorphine on QOL of patients with opioid dependence from India. This study reports QOL and stigma in patients taking buprenorphine and compare it with those who were not on any treatment.

Materials and Methods

A cross-sectional, descriptive, comparative study was conducted among three groups (n = 100 each). Group 3 comprised patients who were already taking buprenorphine for at least 3 months from a government outpatient opioid-assisted treatment center. Group 2 comprised patients who were not on any treatment but had come to enrol in buprenorphine treatment and Group 1 comprised patients who had come to get some other treatment and were not willing for buprenorphine. After fulfilling inclusion and exclusion criteria, sociodemographic pro forma, Hindi self-stigma scale, and World Health Organization QOL-BREF Hindi were applied. Appropriate statistical analyses were done.

Results

Patients already taking buprenorphine had significantly better QOL and it improved as the duration of treatment increased. Patients on buprenorphine treatment had significantly lesser stigma than patients not already on treatment. Stigma negatively impacted QOL in the three groups.

Conclusion

QOL and factors affecting it should be an integral part of management of opioid dependence. Efforts should be made to enrol maximum number of patients in treatment to enhance their quality of life and reduce stigma.

The relationship between beliefs in substance craving and quality of life among narcotics anonymous: a cross-sectional study in southeastern Iran

BACKGROUND

Addiction is a chronic and relapsing disorder characterized by compulsive drug seeking and lasting changes in the brain. Low quality of life may influence the substance craving, which leads to relapsing. Therefore, the present study aimed to investigate the relationship between beliefs in substance craving and quality of life among narcotics anonymous.

METHODS

This cross-sectional study was performed on 202 narcotics anonymous in Kerman, southeastern Iran. Convenience sampling was used to select anonymous patients in the Narcotics Anonymous (NA) association in Kerman city. Narcotics anonymous completed the demographic questionnaire, the Craving Beliefs Questionnaire (CBQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression model was used to determine the predictors of craving beliefs. The data were then analyzed using SPSS 22.

RESULTS

The mean age of the participants was 38.48 ± 11.32 years. The majority of the samples were male (86.1%), married (65.4%), educated (93.6%) and urban (86.1%). The mean scores of craving beliefs and overall Quality of Life (QOL) were 77.58 ± 20.70 and 64.42 ± 23.13, respectively. Forty-two-point 1% had high level of craving beliefs. We found a significant negative and weak correlation between beliefs in substance craving, physical health domain (r = -0.16, p = 0.02), and overall quality of life (r = -0.15, p = 0.03). History of crack use, job, and physical health domain of QOL were predictors of beliefs in substance craving among the NAs.

CONCLUSION

Based on the study results, the participants had a high level of substance craving, and some aspects of the quality of life had an impact on the beliefs of addiction. However, it is necessary to conduct more studies in this field; psychological interventions and programs to increase the quality of life may reduce the substance craving.

Physical activity habits and their effects on quality of life in patients with addiction: data from the Czech Republic

Addiction, including substance use disorder (SUD), is a complex condition that can cause serious health problems and negatively affect patient quality of life. Physical activity is known to improve the physical and mental health of patients with SUD. This study aims to determine the relationship between regular physical activity (RPA) and quality of life in SUD patients enrolled in inpatient SUD treatment (n = 159). We divided patients into four groups based on their RPA before and during hospitalization. The SF-36 self-report questionnaire was used to assess quality of life. We found that SUD patients had worse quality of life than a representative sample of the Czech population. Furthermore, we demonstrated that RPA before and during hospitalization and changes during hospitalization affect the perception of quality of life of patients with SUDs. Additionally, physically active patients showed significantly better quality of life than inactive patients. However, patients who initiated RPA during hospitalization reported worse quality of life than those who did not; in addition, this group of patients reported the worst quality of life across the most monitored parameters. We suggest that these patients represent the most vulnerable group. Changes in physical activity habits could be considered an indicator for a more intensive therapeutic focus.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04402-w.

Quality of life and its correlated factors among patients with substance use disorders: a systematic review and meta-analysis

Background

Patients with substance use disorder (SUD) usually report lower quality of life (QoL) than other patients and as much as patients with other mental disorders. The present study investigated variables associated with QoL domains among patients with SUD.

Methods

Studies in English published before December 1^st 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on factors associated with QoL domains among patients with SUD. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PECO (Participants, Exposures, Comparison and Outcome) criteria: (a) participants: patients with SUD; (b) exposures: sociodemographic factors, clinical, and service use variables; (c) comparison: patient groups without SUD; and (d) outcomes: four domains of QoL (physical, mental, social, and environmental domains). Three researchers recorded the data independently using predefined Excel spreadsheets. The Newcastle–Ottawa Scale (NOS) was used for assessing risk of bias and rated each study in terms of exposure, outcome, and comparability. Pooled odds ratios (ORs) and β coefficient were utilized at a 95% confidence level, and because sampling methods differed between studies’ pooled estimates, a random effects model was utilized.

Results

After the assessment of over 10,230 papers, a total of 17 studies met the eligibility criteria. Five studies (1260 participants) found that patients with SUD who were older were less likely to have a good physical Qol (OR = 0.86, 95% CI = 0.78, 0.95). Two studies (1171 participants) indicated that patients with SUD who were homeless were less likely to have a good environmental Qol (β = -0.47, p = 0.003). However, a better mental QoL was observed in four studies (1126 participants) among those receiving support from their family or friends (social networks) (OR = 1.05, 95% CI = 1.04, 1.07). Two studies (588 participants) showed that those using cocaine were less likely to have a good mental QoL (OR = 0.83, 95% CI = 0.75, 0.93). Two studies (22,534 participants) showed that those using alcohol were less likely to have a good physical QoL (β = -2.21, p = 0.001). Two studies (956 participants) showed that those having severe substance use disorders were less likely to have a good mental (β = -5.44, p = 0.002) and environmental (β = -0.59, p = 0.006) QoL respectively. Four studies (3515 participants) showed that those having mental disorders were less likely to have a good physical QoL (β = -1.05, p = 0.001), and another three studies (1211 participants) that those having mental disorders were less likely to have a good mental QoL (β = -0.33, p = 0.001). Finally, two studies (609 and 682 participants) showed that individuals who experienced trauma symptoms or mental disorders were less likely to have good social and environmental QoL, respectively (OR = 0.78, 95% CI = 0.61, 1.00) and (OR = 0.92, 95% CI = 0.9, 0.94).

Conclusions

The findings suggest the need for mental health services to improve the QOL among patients with SUD but further study is needed. Cocaine may cause behavioral changes which can increase the possibility of reckless and suicidal behaviors. Therefore, identifying cocaine user access, adherence, and satisfaction with treatment is recommended as an important component of adaptive functioning. Interventions that help patients with SUD get support from people within their social networks who support their recovery are also essential to their QoL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00940-0.

A Qualitative Assessment among Personnel Working in Community-Led Development Program Settings Regarding Sexualized Substance Use

Sexualized substance use (SSU) is the practice of psychotropic substance use before or during sex to increase sexual pleasure. The growing use of SSU has a strong association with sexually transmitted infections (STIs). Community health mobilizers (CHMs) are agents who assist in decreasing the global burden of disease in the communities they serve. They work as unit managers, counselors, or field workers. The managers and counselors have a minimum of a bachelor’s degree, and field workers have a minimum of a higher secondary education. This study aimed to qualitatively assess the knowledge gaps regarding SSU among CHMs. In-depth interviews (IDIs) were conducted in New Delhi, India with nineteen CHMs. Majority of the CHMs were men (n = 9, 47%) followed by transgender (TG) persons (TG females n = 5, 26.3%; TG males n = 1, 5.2%), and women (n = 4, 21.1%). Knowledge gaps were identified among the CHMs regarding different types of sexualized substances, drug procurement, human immunodeficiency virus (HIV) infection prevention, and complex health issues associated with SSU. It suggested the need for periodic workshops and training for upgradation of existing knowledge and practices among the CHMs. This formative research may help social scientists to develop protocols for conducting multi-centric, community-based studies across the country for further validation and exploration.

High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders

BACKGROUND

Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation.

METHODS

We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation.

RESULTS

High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit.

CONCLUSION

As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.

Mental health-related quality of life by sex and sexual identity among U.S. adults with alcohol and tobacco use disorder

INTRODUCTION

Alcohol use disorder (AUD) and tobacco use disorder (TUD) are more severe among some sexual minority subgroups. It is less understood whether mental health indicators also differ by sexual identity among those with more severe forms of AUD and TUD. We examined differences in mental health-related QoL by sex-specific sexual identity subgroup among those meeting criteria for moderate-to-severe AUD or moderate-to-severe TUD.

METHODS

We analyzed data from the National Epidemiologic Study of Alcohol and Related Conditions-III (2012-2013; n = 36,309). Our analyses focused on those meeting criteria for past-year moderate-to-severe AUD (n = 2341) and past-year moderate-to-severe TUD (n = 3675). Using multivariable linear regression, we examined associations of sex-specific sexual identity subgroups with mental health-related QoL, while controlling for (a) sociodemographic characteristics, (b) disorder severity, and (c) risk and protective factors (adverse childhood experiences, parental history of substance misuse, stressful life events, and social support).

RESULTS

Among those with past-year moderate-to-severe AUD, gay men and heterosexual, bisexual, and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual men in fully adjusted models. Among those with past-year moderate-to-severe TUD, gay men and heterosexual and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual women. Bisexual and heterosexual women were not significantly different in fully adjusted models.

DISCUSSION

Clinicians should consider the variability in mental health-related QoL among those with moderate-to-severe AUD and TUD particularly for women and sexual minorities. Consideration of current and past stressors and the degree of social support may be beneficial when conducting assessments and forming treatment plans.

Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital

Background

Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors.

Results

The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X²= 12.525, p=0.014; X²= 12.525, p=0.023; and X²= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse.

Conclusions

Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.

Gender Differences in Depression and Quality of Life in Current and Abstinent Ketamine Users

Ketamine use has become of increasing concern because it has spread in many parts of the world during the past few years. Substance users usually have depression and a lower quality of life (QoL). The aim of this study was to explore depression and QoL in ketamine users, and to further examine the role of gender in relation to differences in depression and QoL in ketamine users. This study recruited 204 current ketamine users, 102 abstinent ketamine users and 102 healthy controls. The demographic data, severity of depression and QoL were recorded. Analysis of Variance (ANOVA) was employed to compare the associations of ketamine use status with depression and QoL. Gender differences were examined by moderator analysis. The current ketamine users with and without ketamine use disorder, in addition to the abstinent ketamine users with ketamine use disorder, have more severe depression and a lower QoL than healthy controls. There were significant gender differences in depression and QoL in abstinent ketamine users with ketamine use disorder. Ketamine users have more severe depression and a lower QoL. In particular, depression and a lower QoL are still prominent in abstinent ketamine users. The gender differences in depression and QoL are significant in abstinent ketamine users.

Effects of opioid rotation to buprenorphine/naloxone on pain, pain thresholds, pain tolerance, and quality of life in patients with chronic pain and opioid use disorder

ABSTRACT

Long-term opioid use in patients with chronic noncancer pain (CNCP) can lead to opioid use disorder (OUD) and has been associated with hyperalgesia and reduced quality of life (QoL). Studies suggest antihyperalgesic properties of buprenorphine, and buprenorphine or naloxone (BuNa) has shown beneficial effects on QoL in patients with OUD without CNCP. This study investigated the added value of BuNa in patients with CNCP with OUD on self-reported pain, pain thresholds, pain tolerance, and QoL. In the current study, 43 outpatients with CNCP and OUD were included for inpatient conversion from full μ-receptor agonist opioids to BuNa. Self-reported pain, pain thresholds, pain tolerance, and QoL were determined at baseline and after 2 months of follow-up, using, respectively, a Visual Analogue Scale (VAS-pain and VAS-QoL), quantitative sensory testing, and EuroQol-5 dimensions. In total, 37 participants completed the protocol, and their data were analyzed. The mean VAS-pain score decreased from 51.3 to 37.2 (27.5%, F = 3.3; P = 0.044), whereas the pressure pain threshold and electric pain threshold or tolerance increased after substitution (F = 7.8; P = 0.005 and F = 44.5; P < 0.001, respectively), as well as QoL (EuroQol-5 dimensions questionnaire: F = 10.4; P = 0.003 and VAS-QoL: F = 4.4; P = 0.043). We found that conversion of full μ-receptor agonists to BuNa, in patients with CNCP with OUD, was accompanied with lower self-reported pain, higher pain thresholds, higher pain tolerance, and improved QoL. Despite several study limitations, these data suggest that BuNa might be of value in patients with CNCP with OUD. Future studies should investigate long-term effects of BuNa in randomized trials.

A Qualitative Exploration of Women's Lives and Resilience in Substance Use Disorder Recovery

OBJECTIVE

This study sought to explore constructs of the Whole Health resilience model to identify potential intervention and local research opportunities as a precursor to intervention development, as well as to describe women's resilience in Substance Use Disorder (SUD) recovery including current strengths, coping, self-care, needs and priorities in the context of their everyday lives.

METHODS

Qualitative data were collected from December 2018 to January 2020 in the Mid-South United States. In-depth interviews of 17 women age 25 to 65 years in SUD recovery for 2 weeks or longer were conducted in 9 different settings including a Medication Assisted Treatment (MAT) hospital setting, a MAT pilot program in a community corrections setting, an incarceration re-entry residential program, community-based peer support organizations (eg, Narcotics Anonymous, Alcoholics Anonymous), a residential SUD treatment facility and a yoga teachers' online group. These data were analyzed with a hybrid approach (inductive and deductive coding).

RESULTS

The major themes that emerged from the analysis included social support, individual-level cognitive and spiritual strategies; self-care; stressors, priorities, needs, and self-care barriers and trauma. In this context, women needed a wide range of support including treatment of severe physical injuries, professional psychological support, help with restoring relationships, SUD treatment and recovery services, job training and coaching, health insurance advice, transportation, intimate partner violence (IPV) counseling and housing. Peer-support groups and faith communities were instrumental in many (but not all) of these women's lives in recovery-a gap was identified for women who did not have social support from these groups.

CONCLUSION

These data highlight the need for developing interventions for women in SUD recovery that take a holistic view of resilience life areas, as well as integrate professional services, family support, community support and approach care as wrap-around support that includes integration of social services to meet women's basic needs.

Modelling the Effects of Roselle Extract, Potato Peel Flour, and Beef Fat on the Sensory Properties and Heterocyclic Amines Formation of Beef Patties Studied by Using Response Surface Methodology

Heterocyclic amines (HCAs) are compounds with carcinogenic potential formed during high-temperature processing of meat and meat products. Vegetables or their extracts with high antioxidant capacity can be incorporated into the meat matrix to reduce their formation, but it is necessary to find the optimal levels to achieve maximum inhibition without affecting the sensory properties. The objective of this study was to evaluate the effects of roselle extract (RE, 0-1%), potato peel flour (PP, 0-2%), and beef fat (BF, 0-15%) on the sensory properties and formation of HCAs in beef patties using response surface methodology. IQx, IQ, MeIQx, MeIQ, 4,8-DiMeIQx, and PhIP were identified and quantified by HPLC. Regression models were developed to predict sensory properties and HCAs' formation. All models were significant (p < 0.05) and showed a R2 > 0.70. Roselle extract and beef fat had a negative linear effect on the formation of the total HCAs, while PP had a positive linear effect. The optimal formula that minimizes the formation of HCAs included 0.63% RE, 0.99% PP, and 11.96% BF. RE and PP are foods that can be used as ingredients in low-fat beef patties to minimize the formation of HCAs without affecting their sensory properties.

Quality of life among people who use drugs living in poor urban communities in the Philippines

BACKGROUND

The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD.

METHODS

A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate.

RESULTS

In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group.

CONCLUSION

A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.

Quality of life and its related factors in women with substance use disorders referring to substance abuse treatment centers

BACKGROUND

Substance-Related Disorders are among the most common social problems caused by using legal and illegal substances. Therefore, this study aimed at determining the quality of life (QoL) and its related factors among women with substance use disorders referring to substance abuse treatment centers in Hamadan, west of Iran.

METHODS

This cross-sectional study was carried out on 120 Iranian female substance users recruited through the census sampling method in 2018. Data collection tools consisted of demographic characteristics and QoL assessment (SF-36). Data were analyzed using SPSS-16 via one-way analysis of variance (ANOVA) and chi-square tests.

RESULTS

The mean age of the participants was 33.2 ± 12.1 years and the mean score of their total QoL was 35.35 ± 13.5. The results of multiple linear regression analysis indicated that using methamphetamine (β =  - 6.62) was the predictor of QoL in women. Moreover, there was a significant association between QoL and age (p < 0.001), educational level (p = 0.011), and age at first use (p < 0.001).

CONCLUSION

According to the results, the participants' QoL was found to be at an unsatisfactory level. So, it is essential to implement educational help-seeking behavior for treatment and effectiveness educational, as well as holding mental health intervention, school-based substance abuse prevention, and harm reduction programs of substance use. This is especially important in adolescents, young, low-educated, early drug use, and methamphetamine user women, as it may increase the QoL.

Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients

Objectives

To describe and explore somatic disease burdens of ageing long-term patients in opioid maintenance treatment (OMT), a unique population emerging in countries offering OMT as a long-term treatment.

Methods

We used data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). 156 patients enrolled for at least three of the past five years provided data during structured interviews, including on chronic conditions, somatic treatment received, mental distress (SCL-25), and treatment satisfaction. A somatic disease burden was calculated from a list measuring the recent severity of 16 somatic complaints. A hierarchical multiple linear regression analysis identified correlates of somatic disease burden.

Results

Over half of patients reported at least seven somatic complaints. Reported somatic disease burden was associated with higher mental distress, more chronic conditions, fewer years in OMT, and treatment dissatisfaction. Age was unrelated, and there were few gender differences. These five variables explained 43.6% of the variance in disease burden.

Conclusion

Long-term OMT patients experience a large range of somatic complaints, and at non-acute levels. As OMT secures longevity for opioid-dependent persons, the clinical focus must be adjusted from acute to chronic care. Providers must address how to optimize health and quality of life while in treatment, as treatment may last for many years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-020-00311-4.

A Systematic Review of Quality of Life Assessments of Offenders

Strength-based theories of rehabilitation emphasize the importance of opportunities for offenders to achieve "good lives" to not re-offend. The extent to which these groups feel enabled to achieve a good life may be measured through subjective, overall quality of life (QoL). The aim is to systematically review the QoL instruments used among detained offenders and synthesize the factors related to their QoL. A systematic literature review was conducted to retrieve articles that assessed the overall QoL of a sample of detained offenders using a validated instrument. The instruments' specificity, dimensionality, and respondent and administrator burden were assessed, and factors reported as significantly related to QoL were summarized. In total, 41 articles were included in the review: 20 reported on forensic samples and 20 on prisoners, with one study randomly assigning offenders to either forensic treatment or prison. Among the included articles, 12 validated instruments were utilized. Only one instrument, the Forensic Inpatient Quality of Life Questionnaire, was specifically developed for and validated in forensic patients. Detained offending populations reported lower QoL than the general population, and those with untreated mental illness reported the lowest. The most consistent predictors of QoL longitudinally were social factors, while substance use and detention-specific variables were not consistently related. In general, the relationships between poor mental health, loneliness, and poor QoL seen in offenders are also seen among other marginalized populations. To improve the evidence base for QoL assessment in this vulnerable group, current gold standard QoL instruments should be validated in detained populations.

Impact of extended release naltrexone on health-related quality of life in individuals with legal involvement and opioid use disorders

BACKGROUND

Understanding the impact of medications for opioid use disorder on health related quality of life (QOL) may help to explain why few individuals with legal involvement remain in treatment, specifically those receiving opioid antagonists. QOL is an established predictor of treatment retention and has been shown to improve with some treatment for opioid use disorder. Yet limited research has examined QOL with opioid antagonists. We examined the impact of extended release naltrexone (XR-NTX) on QOL and retention in treatment in a randomized, multi-site trial of individuals with legal involvement. Methods: The participants were 308 community-dwelling adults with current or recent legal involvement with opioid dependence at five site across United States. They were randomized to receive XR-NTX or treatment as usual for 6 months. QOL was measured every 2 weeks using Euro QOL individual items, summary index score, and health state today metric. Results: No significant difference in QOL scores were observed between the two groups at the completion of active treatment or on follow up at 52 and 78 weeks. There were no time effects of treatment on scores. Contrary to expectation, baseline and average QOL did not predict retention in treatment. Conclusion: In contrast to prior research, our findings did not demonstrate significant changes (improvements or decreases) in QOL associated with XR-NTX treatment. Clinicians may consider that individuals receiving XR-NTX may not experience changes in perceived well-being in response to treatment and consider discussing with patients that they may not necessarily perceive improvement in their QOL. This may help to ground patient's expectations about the effects of treatment and potentially reduce attrition from treatment with opioid antagonists.

Validation and psychometric properties of the drug users' quality of life scale in Iranian population

INTRODUCTION

Drug dependence and the resultant problems notably decrease the quality of life (QOL). Measuring the QOL in persons who use drugs (PWUD_s) and planning to improve it can be helpful for rehabilitation programs. Given the absence of a standard tool to measure the quality of life of PWUD, the present study is an attempt to validate psychometric and cultural characteristics of non-injection drug users' QOL scale.

METHOD

The study was carried out as a validation and methodological work. The study population consisted of 273 PWUDs in Kermanshah-based drug clinics including outgoing and hospitalized patients. The participants were selected through convenient-quota sampling. After securing the required permission from the copyright owner of the tool, it was forward/backward translated. Face validity and content validity were determined quantitatively and qualitatively. To examine construct validity of the tool, explorative factor analysis and confirmatory factor analysis were used. Internal consistency was measured using Cronbach's alpha and statistical analyses were performed using SPSS (v.25) and LISREL (v.8).

RESULTS

Explorative factor analysis (EFA) and confirmatory factor analysis (CFA) results supported the tool with one factor and 22 items. The R2 index in the model was equal to 0.99, which means that 99% of the variation of dependent variable (total score of QOL) is attributed to independent variable (22 statements). In other words, 99% of the variation of dependent variable is due to the independent variables in the model. The main indices of the model based on CFA all were higher than 0.9, which indicates goodness of fit of the model (χ2/DF = 2.18, CFI, NFI, TLI = 0.93 GF = 0.84, REMSEA = 0.066, R2 = 0.99). The correlative coefficient was significant (p < 0.05). The reliability of the tool based on internal consistency (Cronbach's alpha) for the subscales ranged from 0.84 to 0.85 and equal to 0.84 for the whole tool.

CONCLUSION

The Farsi version of non-injection drug users' QOL scale had acceptable indices and it was applicable to assess QOL in the target population. The tool can be used in different fields of drug addiction.

Managing Substance Use Disorder through a Walking/Running Training Program

While emerging studies have demonstrated the benefit of exercise in Substance Use Disorder (SUD) recovery outcomes, lack of motivation to engage in exercise has been indicated as one of many perceived barriers that contribute to low recruitment and adherence rates in SUD treatment. The current study aimed to explore participants' perceptions of attending a supervised exercise program (boot camp workouts, walking/running practice, and a race event) while in treatment for SUD. A total of 109 participants were recruited to a 14-week exercise training program and 61 chose to participate in, and completed, a race at the close of the program. Interviews were conducted during weeks 6 through 14 and data were examined using Thematic Analysis. Three main themes were identified: (1) pushing forward recovery through running, (2) gaining a sense of achievement by crossing the finish line, and (3) building a sense of belonging in the program. Implications for SUD recovery programs are discussed.

Examining Recovery Program Participants by Gender: Program Completion, Relapse, and Multidimensional Status 12 Months After Program Entry

This study examined individual-level characteristics and factors associated with program completion, relapse, and multidimensional status at follow-up for 213 men and 248 women who entered one of 17 peer-led recovery programs and who completed a follow-up interview 12 months later. Study results found that although there were some significant gender differences at program entry among participants entering Recovery Kentucky, there were few gender differences at follow-up. In addition, although participants had significant psychosocial problems, polysubstance use patterns, and severe substance use disorder (SUD), the majority of both men and women reported completing the program (80.3%), a small minority reported relapse (9.5%), and about one third had worse multidimensional status about 12 months after program entry. Lower quality of life rating at program entry was associated with program completion and with better multidimensional status at follow-up. Study results suggest the recovery program provides an important option for some of the most vulnerable individuals with SUD.

Sleep disturbance, associated symptoms, and quality of life in adults living with HIV in Jakarta, Indonesia

Adverse symptom experiences, including sleep disturbances, are important negative predictors of quality of life (QoL), but few studies conducted in low-income countries have examined the impact of poor sleep and its associated symptoms on QoL among people living with HIV (PLWH). To this end, 200 PLWH who were receiving treatment with antiretroviral therapy (ART) were recruited through a community nongovernment organization in Jakarta, Indonesia. Validated instruments measured QoL, sleep disturbance, fatigue, pain, ART adherence, substance use, drug use severity, and methadone treatment. Descriptive statistics, bivariate correlations, and multivariate linear regression were conducted to identify independent correlates of QoL. Overall, participants perceived their QoL as being good to very good (mean = 105.70, standard deviation = 14.7) and higher among women than men (p < 0.05). After adjusting for sex, education, drug-use severity, and ART adherence, QoL was negatively associated with fatigue, insomnia, and pharmacological treatment with methadone. Along with other known symptoms of HIV, sleep problems and their complications are important to clinically address and research more fully to assure satisfying QoL among PLWH.

Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence

Background

Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients’ HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence.

Methods

HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients’ levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively).

Results

Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (β = 5.5; p = 0.001) and a lower baseline PCS score (β = − 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (β = − 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (β = 0.1; p = 0.02) and a lower baseline MCS score (β = − 0.7; p < 0.0001) were associated with significant MCS improvement.

Conclusion

The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients’ early satisfaction to identify areas of improvement and thus improve HRQoL.

Quality of Life in Patients With Methamphetamine Use Disorder: Relationship to Impulsivity and Drug Use Characteristics

BACKGROUND

The quality of life (QOL) of patients with methamphetamine use disorder (MAUD) is increasingly recognized as an important outcome. Previous studies have found that impulsivity is negatively associated with QOL in mental disorders, but this relationship is rarely confirmed in patients with MAUD. We hypothesized that impulsivity is negatively correlated with QOL in patients with MAUD based on previous findings. In addition, a variety of drug use characteristics of patients that may potentially affect their QOL need to be further explored. Therefore, the purpose of this study was to explore the relationship between impulsivity, multiple drug use characteristics, and QOL in patients with MAUD.

METHODS

A total of 379 patients with MAUD were recruited, and the majority of them were male (85.5%), with an average age of 33.93 ± 7.08 years. Two psychiatrists conducted semi-structured interviews with methamphetamine (MA) users in two compulsory drug rehabilitation centers to obtain their demographics and drug use characteristics. The Barratt Impulsiveness Scale-11 (BIS-11) and Brief WHO Quality of Life Assessment (WHOQOL-BREF) were used to assess patients' impulsivity and QOL, respectively. Correlation and univariate regression analysis were used to explore the relationships between impulsivity, a series of drug use characteristics and patients' QOL in different domains. Further multiple linear regression analysis was used to identify what extent the above clinical variables explained the variations in patients' QOL.

RESULTS

Age, marital status, employment, and various drug use characteristics were significantly associated with at least one QOL domain. Among them, married and full-time job were positively correlated with QOL, while others were negatively correlated with QOL. The total score of BIS-11 was significantly negatively correlated with all four domains of QOL. Impulsivity, a range of drug use characteristics and certain demographic characteristics collectively explained varying degrees of variation in different domains of QOL.

CONCLUSIONS

Impulsivity and various drug use characteristics can significantly predict QOL in all fields of MAUD patients. In addition, we have also found differences in the predictors of QOL in different domains. Overall, this study provides clinical guidance for the treatment of MAUD patients, that is, management of impulsivity in patients with MAUD may help improve their QOL and even sustain their drug rehabilitation.

Aerobic Exercise Interventions for Patients in Opioid Maintenance Treatment: A Systematic Review

Background:

Opioid maintenance treatment (OMT) is the standard for treatment of opioid use disorder, but some individuals on OMT experience disrupted sleep, heightened sensitivity to pain, and continued relapse to non-medical opioid use. An adjunctive treatment that has potential to address these shortcomings of OMT is aerobic exercise.

Objective:

The aim of the present review was to identify and evaluate components of aerobic exercise interventions targeting OMT patients.

Methods:

For this PROSPERO-registered review (ID CRD42020139626), studies were identified via electronic bibliographic databases, funded research (NIH RePORTER) and clinical trials databases (ClinicalTrials.gov), and reference sections of relevant manuscripts. Studies that evaluated the effects of an aerobic exercise intervention using a comparison condition or pretest-posttest design in adult OMT patients were included.

Results:

Of 2971 unique records, three primary studies and one supplemental manuscript comprised the final sample. All studies were randomized trials involving supervised exercise interventions enrolling small samples of middle-aged OMT patients. Exercise interventions included a variety of aerobic and non-aerobic activities (e.g. flexibility exercises), and none controlled the dose of aerobic exercise. Few studies used objective measures of physical activity or cardiorespiratory fitness and there were no significant effects of adjunctive exercise on substance use outcomes, but tests of the latter were likely underpowered.

Conclusions:

Though early in the accumulation of evidence, interventions targeting aerobic exercise for OMT patients appear feasible, acceptable to patients, and beneficial. Longer-term studies that employ larger samples, include assessments of behavioral and biological mechanisms of change, more rigorous measurement of physical activity, and controlled doses of aerobic activity are warranted.

Confirming the factor structure of a generic quality of life instrument among pre-treatment substance use disorder patients

Background

Quality of life (QoL) is a patient-reported outcome of increasing importance in the substance use disorder (SUD) treatment field, and impaired QoL may be an important impetus for treatment uptake. Instruments and methodologies abound, precluding comparison, as does a dearth of population norms. The QOL10 is a generic, overall QoL tool containing ten items and with simple scoring procedures. It is therefore a potential alternative to the gold standard WHOQOL-BREF. This study aimed to assess the two-factor structure of the QOL10 that has been suggested by a previous exploratory factor analysis.

Methods

Adults entering 21 participating inpatient or outpatient SUD treatment were recruited to join a national longitudinal cohort study. 531 completed the QOL10 at treatment entry and were included in the analysis. Structural equation modelling (SEM) was used to confirm the model fit of a two-factor structure, and the scaling qualities of the QOL10 were reported.

Results

According to the SEM analysis, the QOL10 was comprised of one latent variable measuring social QoL, and one measuring global QoL, and all ten items were retained. Goodness of fit tests included: root mean square of approximation = 0.063, 90% CI 0.050–0.076; normed-fit index = 0.919; and comparative fit index = 0.943.

Conclusions

The QOL10 should be considered when clinicians in the SUD treatment field need a short, valid instrument that measures both global QoL and social QoL, with minimum respondent and administrator burden. The social domain is of particular utility and may be used as a stand-alone instrument. Test-retest reliability should be established in future studies.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1152-7) contains supplementary material, which is available to authorized users.

Identification of Factors Affecting the Quality of Life Among Patients With Addiction in Lebanon

Our objective was to assess factors associated with the physical (Short-Form 12-physical component summary [SF-12-PCS]) and mental (Short-Form 12-mental component summary [SF-12-MCS]) quality of life (QOL) in the Lebanese population. A cross-sectional study, conducted between July and September 2017, enrolled 57 patients with substance use disorder from the Psychiatric Hospital of the Cross. The SF-12 scale was used to assess the QOL among participants. A first stepwise linear regression, using the SF-12-PCS score as the dependent variable, showed that females compared with males (β = -4.86) and having a family history of substance use disorder (β = -4.70) were associated with lower physical QOL (lower SF-12-PCS scores). A second stepwise linear regression, using the SF-12-MCS score as the dependent variable, showed that having a generalized anxiety disorder (β = -10.52) and having suicidal ideation (β = -8.05) were associated with lower mental QOL (lower SF-12-MCS scores). Strategic interventions are needed to manage the health-related QOL in those with substance abuse.

Performance of the WHOQOL-BREF among Norwegian substance use disorder patients

BACKGROUND

Quality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables.

METHODS

107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL.

RESULTS

Three out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL.

CONCLUSIONS

After one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.

Inmates with Harmful Substance Use Increase Both Exercise and Nicotine Use Under Incarceration

Exercise is increasingly understood as an important resource for people who engage in harmful substance use, including those in prison. Little is known about how inmates adopt various health behaviors during incarceration, without interventions. This cross-sectional study analyzed self-reports from 1464 inmates in Norwegian prisons in 2013–2014, compared them according to harmful substance use pre-incarceration, and explored changes in exercise and nicotine use during incarceration. Results were presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inmates with harmful substance use reported higher rates of smoking, smokeless tobacco, and physical inactivity pre-incarceration than inmates without harmful use. However, inmates with harmful use also exhibited more behavioral changes: they adopted exercise, ceased smoking, and adopted smokeless tobacco at higher rates during incarceration than the non-harmful group, to the extent that inmates with harmful use exercised during incarceration more. Exercise is being taken up by a significant proportion of inmates, and may in particular be a replacement behavior for substance use. However, unhealthy behaviors also begin or are maintained. If prisons were used as an arena to facilitate healthy behaviors, the public health benefits to a marginalized group such as substance-using inmates could be substantial.

Proactive community support tailored to holistic needs: A cohort study

Background

It is increasingly internationally recognized that a cancer diagnosis impacts on people practically and financially as well as physically and psychologically. It is less clear what to do about this. This study introduces an original community service designed to mitigate this wider impact. Nonclinical “link officers” use holistic needs assessment (HNA) to help newly diagnosed people identify and quantify the severity of their physical, psychological, practical, financial, and social concerns. A care plan is then agreed, usually involving community interventions from partner agencies. Following intervention, assessment is repeated. The primary aim of this study was to establish whether there was a significant difference between initial assessment and follow‐up, postintervention. Secondary aim was to identify potential predictors of increased levels of concern at baseline and follow‐up.

Method

Pre‐ and postintervention observational cohort study. Paired t test examined the difference in mean (SD) concern severity between baseline and follow‐up. Multiple linear regression models were computed to hypothesize potential predictors of initial concern severity and severity change.

Results

The service saw 2413 people 2014‐2017. Participants identified average 5.5 (4.7) concerns, financial concerns being most frequent. Mean severity at baseline was 7.12 (out of 10) (2.50), reducing to 3.83 (3.49) post‐treatment, paired t(4454) = 64.68, P < 0.0001, reduction of 3.31 (95% CI 3.21‐3.41). Factors associated with higher initial concern included unemployment and caring responsibilities. Unemployment was also associated with a smaller reduction of concern severity at follow‐up.

Conclusion

Patient level of concern went from a level associated with specialist referral to a much more manageable level. This original finding is internationally significant because it extends Khera et al's (2017) “provocative idea” that all patients should be screened for financial problems to show that they can be helped with all their concerns. This article describes a successful, transferable model of community care.

Alcohol consumption, Quality of Life and Brief Intervention among Nursing university students

ABSTRACT Objective: To evaluate nursing university students’ alcohol consumption patterns, Brief Intervention and Quality of Life (QoL). Method: This is a prospective and longitudinal study containing sociodemographic, economic information concerning alcoholic beverages, BI and QoL evaluation among 281 nursing university students. Since surveys have been applied, seminars have been given and consumption patterns have been discussed, an educational material was delivered after university students’ revaluation and BI reinforcement. Descriptive and analytical statistics have been conducted. Results: 90% of the students have already consumed alcohol and 20.6% that consumed for the first time and abused alcohol were minors. After the implementation of BI, the alcohol consumption has decreased among university students. Besides the vitality, generate state of health, and emotional aspects have decreased, mental health was substantially low among the students that used to drink. Conclusion: BI contributes to decrease alcoholic beverages consumption and promotes health.

Incremental predictive validity of the Addiction Severity Index psychiatric composite score in a consecutive cohort of patients in residential treatment for drug use disorders

BACKGROUND

The Addiction Severity Index (ASI) is a widely used assessment instrument for substance abuse treatment that includes scales reflecting current status in seven potential problem areas, including psychiatric severity. The aim of this study was to assess the ability of the psychiatric composite score to predict suicide and psychiatric care after residential treatment for drug use disorders after adjusting for history of psychiatric care.

METHODS

All patients treated for drug use disorders in residential treatment centers in Denmark during the years 2000-2010 with complete ASI data were followed through national registers of psychiatric care and causes of death (N=5825). Competing risks regression analyses were used to assess the incremental predictive validity of the psychiatric composite score, controlling for previous psychiatric care, length of intake, and other ASI composite scores, up to 12years after discharge.

RESULTS

A total of 1769 patients received psychiatric care after being discharged from residential treatment (30.3%), and 27 (0.5%) committed suicide. After adjusting for all covariates, psychiatric composite score was associated with a higher risk of receiving psychiatric care after residential treatment (subhazard ratio [SHR]=3.44, p<0.001), and of committing suicide (SHR=11.45, p<0.001).

CONCLUSIONS

The ASI psychiatric composite score has significant predictive validity and promises to be useful in identifying patients with drug use disorders who could benefit from additional mental health treatment.

Building abstinent networks is an important resource in improving quality of life

AIMS

To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment.

DESIGN

Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment.

SETTING

Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later.

METHODS

The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI.

FINDINGS

Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system.

CONCLUSIONS

Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.

Comparison of health-related quality of life among men with different co-existing severe mental disorders in treatment for substance use

BACKGROUND

Patient-perceived health-related quality of life has become an important outcome in health care as an indicator of treatment effectiveness and recovery for patients with substance use disorder. As no study has assessed health-related quality of life among male patients with substance use disorder and co-existing severe mental illness, we compared health-related quality of life among patients with substance use disorder and the following severe mental illness diagnosis in Barcelona, Spain: schizophrenia, bipolar disorder, major depressive disorder, and examined the associations with clinically related variables. Additionally, we compared results for health-related quality of life in patients with substance use disorder and severe mental illness, with Spanish population norms.

METHODS

We assessed 107 substance use disorder male patients using the 36-Item Short Form Health Survey comparing results across three groups with: comorbid schizophrenia (n = 37), comorbid bipolar disorder (n = 34), and comorbid major depressive disorder (n = 36). Multiple analyses of variance were performed to explore health-related quality of life by the type of co-existing SMI and linear regression analyses examined clinical correlates for the 36-Item Short Form Health Survey dimensions for each group.

RESULTS

There were differences in Physical Functioning, Vitality and the Physical Composite Scale among groups. Poorer Physical Functioning was observed for patients with comorbid schizophrenia (80.13±3.27) and major depressive disorder (81.97±3.11) compared with comorbid bipolar disorder patients (94.26±1.93). Patients with substance use disorder and schizophrenia presented lower scores in Vitality (41.6±2.80) than those with co-existing bipolar disorder (55.68±3.66) and major depressive disorder (53.63±2.92). Finally, results in the Physical Composite Scale showed lower scores for patients with comorbid schizophrenia (51.06±1.41) and major depressive disorder (51.99±1.87) than for those with bipolar disorder (60.40±2.17). Moreover, all groups had poorer health-related quality of life, especially Social Functioning, Role-Emotional and Mental Health, compared with population norms. Different clinical variables (e.g. medical disease comorbidity, severity of addiction, psychiatric symptomatology, suicide attempts, drug relapses) were related to different health-related quality of life dimensions depending on the co-existing severe mental illness.

CONCLUSIONS

Among male patients with substance use disorder, co-existing severe mental illness may influence some health-related quality of life dimensions and clinically related variables. Such differences may require tailored therapeutic interventions.

Quality of life improvement in Latinas receiving combined substance use disorders and trauma-specific treatment: a cohort evaluation report

BACKGROUND

This study evaluates the benefits of integrating behavioral health and trauma services for Latinas with a history drug use. Changes in quality of life (QOL) domains were documented after participation in a manualized intervention in a cohort of Latinas.

METHODS

Participants were part of a prospective cohort study of 136 Latinas with co-occurring disorders (COD) who may have experienced trauma and receiving services in our outpatient treatment facility in Bayamón, Puerto Rico. The WHOQOL-BREF Spanish version was used to score physical, psychological, social, and environmental QOL domains, at intake and after six months. Sociodemographic variables, alcohol, drug use, mental health disorders, and severity of substance use disorders (as defined by the DSM-5) were also tabulated. Descriptive statistics and paired t test or the Wilcoxon signed-rank test were computed for comparison.

RESULTS

A median age of 39 years was seen and with 76% high school education or higher degree. The majority were unemployed (95.9%). A diagnosis of severe cocaine use (51.4%) was present and almost half (49.5%) had three or more DSM-5 diagnoses. Mean QOL scores were higher at six months with statistically significant differences in each domain. Women with neurodevelopmental disorders and schizophrenia yielded higher mean QOL scores for each domain at six months except for the social domain. Women with polydrug use and women who reported exposure to trauma and depressive disorder experienced statistically significant increments in the physical, psychological and social domains in comparison to counterpart women.

CONCLUSIONS

Significant and positive changes in QOL were found in each domain. Latinas who reported traumatic events had lower scores in the physical and psychological QOL domains. There was a high prevalence of diminished physical and mental functioning in Latinas with COD. The exposure to trauma and the lack of social support negatively affect treatment access and retention for Latinas.

Attention Deficit Hyperactivity Disorder Symptoms are Common in Patients in Opioid Maintenance Treatment

INTRODUCTION AND AIMS

Knowledge of attention deficit hyperactivity disorder (ADHD) symptoms among patients in opioid maintenance treatment (OMT) is important for treatment optimization and yet limited. We investigated the prevalence of ADHD symptoms, and factors associated with high ADHD symptom burden in a group of Norwegian OMT patients.

METHODS

We interviewed individuals entering OMT across Norway in 2 steps between 2012 and 2016. ADHD symptoms were measured by the Adult ADHD Self-Report Scale (ASRS; n = 175). We compared 2 groups of individuals who scored above or below the clinical cutoff score. Mental distress was measured with the General Symptom Index (GSI) of the Hopkin's Symptom Check-List-25.

RESULTS

A total of 33% of the OMT patients screened positively for ADHD on the ASRS. Participants who scored above the clinical cutoff were younger, and reported more severe substance use and mental distress. When controlling for other significant variables in a logistic regression analysis, scoring above cutoff on the ASRS was associated with higher GSI (OR 1.61; 95% CI 1.03-2.50) and use of stimulants (OR 2.55; 1.13-5.76).

CONCLUSIONS

ADHD symptoms were common in these OMT patients. High ADHD symptom burden was associated with higher mental distress and use of stimulants. This underlines a need of more systematic focus on ADHD in OMT to plan treatment accordingly.

Exercise as an Adjunctive Treatment for Substance Use Disorders: Rationale and Intervention Description

Substance use disorders (SUDs) are maladaptive patterns of substance use that are associated with psychiatric comorbidity, unhealthy lifestyle choices, and high rates of relapse. Exercise is associated with a wide range of acute and long-term benefits for both mental and physical health and is presently being investigated as a promising adjunctive treatment for SUD. Despite positive effects of regular physical activity on treatment outcomes and risk factors for relapse, low adherence and high attrition rates limit the benefits derived from exercise interventions. Lack of motivation is one of many perceived barriers to initiating exercise that contributes to poor adherence to interventions. In the present article, we describe the protocol for a novel, integrated exercise intervention that combines motivational interviewing (MI), a client-centered approach designed to enhance intrinsic motivation and resolve ambivalence toward change, and contingency management (CM), a behavioral treatment that provides monetary incentives for the completion of target behaviors. The protocol seeks to address the challenges surrounding initiation and maintenance of an exercise program at a level consistent with public health guidelines, particularly for sedentary patients. We conclude with considerations for the implementation of the intervention in SUD specific clinics.