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Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, Schmitz JM. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 240:173787. [PMID: 38705285 DOI: 10.1016/j.pbb.2024.173787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
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Affiliation(s)
- Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States of America
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America.
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Huang S, Wahlquist A, Dahne J. Individual Predictors of Response to A Behavioral Activation-Based Digital Smoking Cessation Intervention: A Machine Learning Approach. Subst Use Misuse 2024:1-9. [PMID: 38898605 DOI: 10.1080/10826084.2024.2369155] [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: 06/21/2024]
Abstract
Background: Depression is prevalent among individuals who smoke cigarettes and increases risk for relapse. A previous clinical trial suggests that Goal2Quit, a behavioral activation-based smoking cessation mobile app, effectively increases smoking abstinence and reduces depressive symptoms. Objective: Secondary analyses were conducted on these trial data to identify predictors of success in depression-specific digitalized cessation interventions. Methods: Adult who smoked cigarettes (age = 38.4 ± 10.3, 53% women) were randomized to either use Goal2Quit for 12 weeks (N = 103), paired with a 2-week sample of nicotine replacement therapy (patch and lozenge) or to a Treatment-As-Usual (TAU) control (N = 47). The least absolute shrinkage and selection operator was utilized to identify a subset of baseline variables predicting either smoking or depression intervention outcomes. The retained predictors were then fitted via linear regression models to determine relations to each intervention outcome. Results: Relative to TAU, only individuals who spent significant time using Goal2Quit (56 ± 46 min) were more likely to reduce cigarette use by at least 50% after 12 weeks, whereas those who spent minimal time using Goal2Quit (10 ± 2 min) did not exhibit significant changes. An interaction between educational attainment and treatment group revealed that, as compared to TAU, only app users with an educational degree beyond high school exhibited significant reductions in depression. Conclusions: The findings highlight the importance of tailoring depression-specific digital cessation interventions to individuals' unique engagement needs and educational level. This study provides a potential methodological template for future research aimed at personalizing technology-based treatments for cigarette users with depressive symptoms.
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Affiliation(s)
- Siyuan Huang
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
| | - Amy Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, Tennessee, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
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Krentzman AR, Hoeppner SS, Hoeppner BB, Barnett NP. A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209410. [PMID: 38802048 DOI: 10.1016/j.josat.2024.209410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety. METHODS The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator. RESULTS Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators. DISCUSSION Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.
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Affiliation(s)
- Amy R Krentzman
- School of Social Work, University of Minnesota, United States.
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, United States
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Nikandish Z, Sajjadian I. The effectiveness of behavioral activation therapy on the symptoms of depression, rumination, and social-occupational functioning impairment among women with postpartum depression. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:17. [PMID: 38532913 PMCID: PMC10965035 DOI: 10.4103/jehp.jehp_1783_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/06/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Postpartum depression is caused by a wide range of factors, and women in their postpartum period are highly vulnerable, either physically or emotionally. The present study aimed to investigate the effects of behavioral activation therapy on the symptoms of depression, rumination, and social-occupational functioning impairment among women with postpartum depression (PPD). MATERIALS AND METHODS This quasi-experimental research included a pre-test, a post-test, and a one-month follow-up, as well as experimental and control groups. The participants were screened using Edinburgh Postnatal Depression Scale (EDPS) in 2019. The research included 32 women who had visited Isfahan Healthcare Centers. They were selected using convenience sampling and then randomly divided into experimental (16 individuals) and control groups (16 individuals). Both groups answered the following questionnaires before, immediately after, and one month after the intervention: Beck Depression Inventory (BDI), Nelon, et al. Ruminative Response Scale, and Mundt et al. Work and Social Adjustment Scale (WSAS). The experimental group received behavioral activation therapy for nine 90-minute sessions once a week. The data were analyzed using the statistical method of multivariance analysis of covariance (MANCOVA). RESULT The results showed that behavioral activation therapy had a significant effect on the symptoms of depression (P = 0.001, F = 79.65), postpartum depression (P = 0.001, F = 220.359), rumination (P = 0.001, F = 121.765), and social-occupational functioning impairment (P = 0.001, F = 368.512) among women with postpartum depression. The effects of behavioral activation therapy also lasted in the follow-up stage of the study. CONCLUSION According to the present research, behavioral activation therapy is an effective method that decreases the symptoms of depression, rumination, and occupational-social functioning impairment among women with postpartum depression. Therefore, behavioral activation therapy could be beneficial to intervention designs and treatment of postpartum depression.
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Affiliation(s)
- Zahra Nikandish
- PHD Student, Psychology Department, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Ilnaz Sajjadian
- Department of Clinical Psychology, Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
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Zhang C, Zhang B, Xu Y, Hao W, Tang WK. The impact of depressive symptoms on cognitive impairments in chronic ketamine users. Compr Psychiatry 2024; 129:152448. [PMID: 38160647 DOI: 10.1016/j.comppsych.2023.152448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic ketamine use has been associated with cognitive impairments, while depressive symptoms are commonly observed in individuals using ketamine. However, the influence of depressive symptoms on cognitive impairments in chronic ketamine users remains unclear. This study aimed to examine the impact of depressive symptoms on cognitive function in this population. METHODS A cross-sectional study was conducted with a sample of chronic ketamine users. Participants underwent comprehensive cognitive assessments, including measures of attention, executive function, working memory, verbal and visual memory. Depressive symptoms were assessed using Beck Depression Inventory (BDI) scores. Multivariate analyses were utilized to compare the cognitive performance of individuals who use ketamine, both with and without depressive symptoms, as well as a control group, while controlling for relevant covariates. RESULTS The results revealed a significant negative impact of depressive symptoms on cognitive impairments, particularly in the domains of memory and executive function, among chronic ketamine users. The analysis of partial correlations revealed that among individuals who use ketamine and have depressive symptoms, those with higher levels of depressive symptoms demonstrated poorer cognitive performance compared to individuals with lower levels of depressive symptoms, controlling for potential confounding factors. CONCLUSIONS The findings suggest that depressive symptoms contribute to cognitive impairments, specifically in memory and executive function, in chronic ketamine users. Therefore, it is crucial to evaluate depressive symptoms when considering cognitive enhancement treatment for this population.
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Affiliation(s)
- Chenxi Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Xu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wei Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wai Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, China.
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Luoto KE, Lassila A, Leinonen E, Kampman O. Predictors of short-term response and the role of heavy alcohol use in treatment of depression. BMC Psychiatry 2023; 23:880. [PMID: 38012573 PMCID: PMC10680330 DOI: 10.1186/s12888-023-05366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Depression and alcohol use disorders frequently co-occur. However, research on psychosocial interventions for treating this dual pathology is limited. The Ostrobothnian Depression Study (ODS) aimed to increase the systematic use of evidence-based methods, particularly among patients with comorbid depression and substance use in a naturalistic setting. This is a secondary analysis of the ODS study. The aim of the present study was to explore the predictors of a response to treatment during the first six months of the ODS intervention with a specific focus on the role of comorbid heavy alcohol use. METHODS The study sample (n = 242) comprised psychiatric specialist care patients with depression (Beck Depression Inventory score ≥ 17) at baseline. Patients with a baseline Alcohol Use Disorders Identification Test (AUDIT) score > 10 (n = 99) were assigned to the AUD (Alcohol Use Disorder) group in this study. The ODS intervention comprised behavioral activation (BA) for all and additional motivational interviewing (MI) for those in AUD group. The predictors of response to treatment (minimum of 50% reduction in depressive symptoms) during the first six months were analyzed with logistic regression models. RESULTS In the total sample at six months (n = 150), predictors of response to treatment were more severe depression (OR 1.10, CI 1.02-1.18), larger amounts of alcohol consumed (OR = 1.16, CI 1.03-1.31) and antipsychotic medication "not in use" (OR = 0.17, CI 0.07-0.44). In the non-AUD group (n = 100), more severe depression (OR 1.12, CI 1.01-1.25) and antipsychotics "not in use" (OR 0.20, CI 0.06-0.67) also predicted a positive response. Among AUD group patients (n = 50), larger amounts of alcohol consumed (OR 1.54, CI 1.04-2.27) and antipsychotic medication "not in use" (OR 0.12, CI 0.02-0.60) predicted a response to the treatment intervention. CONCLUSIONS The severity of symptoms and comorbid disorders were found to predict better treatment response, suggesting that the intervention was more effective in patients with severe symptoms. Patients with depression should be treated effectively regardless of having concomitant AUD. The results of this study suggest that BA combined with MI should be one of the treatment options for this dual pathology. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02520271 (11/08/2015).
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Affiliation(s)
- Kaisa E Luoto
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
- Department of Psychiatry, Seinäjoki Central Hospital, The Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
| | - Antero Lassila
- Department of Psychiatry, Seinäjoki Central Hospital, The Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
| | - Esa Leinonen
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Olli Kampman
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Department of Clinical Medicine (Psychiatry), Faculty of Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland
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Rabinowitz JA, Ellis JD, Strickland JC, Hochheimer M, Zhou Y, Young AS, Curtis B, Huhn AS. Patterns of demoralization and anhedonia during early substance use disorder treatment and associations with treatment attrition. J Affect Disord 2023; 335:248-255. [PMID: 37192690 DOI: 10.1016/j.jad.2023.05.029] [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: 09/27/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Although depressive symptoms represent a promising therapeutic target to promote recovery from substance use disorders (SUD), heterogeneity in their diagnostic presentation often hinders the ability to effectively tailor treatment. We sought to identify subgroups of individuals varying in depressive symptom phenotypes (i.e., demoralization, anhedonia), and examined whether these subgroups were associated with patient demographics, psychosocial health, and treatment attrition. METHODS Patients (N = 10,103, 69.2 % male) were drawn from a dataset of individuals who presented for admission to SUD treatment in the US. Participants reported on their demoralization and anhedonia approximately weekly for the first month of treatment, and on their demographics, psychosocial health, and primary substance at intake. Longitudinal latent profile analysis examined patterns of demoralization and anhedonia with treatment attrition as a distal outcome. RESULTS Four subgroups of individuals emerged: (1) High demoralization and anhedonia, (2) Remitting demoralization and anhedonia, (3) High demoralization, low anhedonia, and (4) Low demoralization and anhedonia. Relative to the Low demoralization and anhedonia subgroup, all the other profiles were more likely to discontinue treatment. Numerous between-profile differences were observed in demographics, psychosocial health, and primary substance. LIMITATIONS The racial and ethnic background of the sample was skewed towards White individuals; future research is needed to determine the generalizability of our findings to minoritized racial and ethnic groups. CONCLUSIONS We identified four clinical profiles that varied in the joint course of demoralization and anhedonia. Findings suggest specific subgroups might benefit from additional interventions and treatments that address their unique mental health needs during SUD recovery.
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Affiliation(s)
- Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yijun Zhou
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea S Young
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Martínez-Loredo V. Critical appraisal of the discussion on delay discounting by Bailey et al. and Stein et al.: A scientific proposal for a reinforcer pathology theory 3.0. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2022.101006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Alexander K, Reed MK, Sterling RC. The interaction of race and age in methadone treatment retention outcomes: A single-center analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209020. [PMID: 36933661 DOI: 10.1016/j.josat.2023.209020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/28/2022] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Early treatment drop-out is due to the unique interplay of the individual and their context, and is associated with overdose death. The objective of this project was to determine if age or race is associated with 6-month treatment retention outcome differences at a single-center opioid treatment program. METHODS The study team performed a retrospective administrative database study from January 2014 to January 2017 using admission data with age and race as predictors of 6-month treatment retention outcomes. RESULTS Of the 457 admissions, 114 were under the age of 30; however, only 4 % of these young adults were Black, Indigenous, and/or People of Color (BIPOC). While retention for BIPOC patients (62 %) was slightly higher than for White patients (57 %), this difference did not reach traditional levels of significance. CONCLUSIONS Once BIPOC enter treatment, their treatment retention is similar to their White counterparts. Young adult BIPOC were less represented in the admission data, but treatment retention across racial groups was similar. An urgent need exists to determine the barriers and facilitators to treatment access among BIPOC young adults.
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Affiliation(s)
| | - Megan K Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, United States of America; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA 19107, United States of America
| | - Robert C Sterling
- Division of Community Substance Abuse Programs, Thomas Jefferson University, United States of America
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Anderson ES, Rusoja E, Luftig J, Ullal M, Shardha R, Schwimmer H, Friedman A, Hailozian C, Herring AA. Effectiveness of Substance Use Navigation for Emergency Department Patients With Substance Use Disorders: An Implementation Study. Ann Emerg Med 2023; 81:297-308. [PMID: 36402631 DOI: 10.1016/j.annemergmed.2022.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE We implemented a whole person care-informed intervention delivered by substance use navigators (SUN) for emergency department (ED) patients with substance use disorders. METHODS This was an implementation study of adult patients discharged from 3 public hospital EDs between September 1, 2021 through January 31, 2022 with cocaine, methamphetamine, alcohol, and opioid use-related diagnoses. The primary effectiveness outcome was treatment engagement within 30 days of ED discharge among patients with and without the SUN intervention. We used logistic regression and nearest neighbor propensity score matching without replacement to control for confounding effects. RESULTS There were 1,328 patients in the cohort, and 119 (9.0%) received the SUN intervention; 50.4% of patients in the SUN intervention group and 15.9% of patients without the SUN intervention were engaged in outpatient treatment within 30 days of ED discharge (difference in proportions: 34.5%, 95% confidence interval [CI] 25.3% to 43.8%). In the unadjusted analysis, the SUN intervention was associated with higher rates of treatment engagement after ED discharge for patients with alcohol, opioid, and cocaine-related diagnoses; patients with methamphetamine-related diagnoses had low engagement rates with or without the SUN intervention. In addition, the SUN intervention was associated with higher odds of treatment engagement in the multivariable model (aOR 3.7, 95% CI 2.4 to 5.8) and in the propensity score-matched analysis (OR 2.1, 95% CI 1.2 to 3.5). CONCLUSION A whole person care-informed intervention delivered by SUNs for ED patients with substance use disorders was strongly associated with higher engagement rates in addiction treatment after discharge.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA; Substance Use Disorder Program, Highland Hospital - Alameda Health System, Oakland, CA.
| | - Evan Rusoja
- Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA; Quality and Performance Improvement Program, Highland Hospital - Alameda Health System, Oakland, CA
| | - Joshua Luftig
- Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA
| | - Monish Ullal
- Substance Use Disorder Program, Highland Hospital - Alameda Health System, Oakland, CA; Division of Hospital Medicine, Department of Medicine, Highland Hospital - Alameda Health System, Oakland, CA
| | - Ranjana Shardha
- Division of Hospital Medicine, Department of Medicine, Highland Hospital - Alameda Health System, Oakland, CA
| | - Henry Schwimmer
- Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA
| | - Alexandra Friedman
- Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA
| | - Christian Hailozian
- School of Pharmacy, University of California San Francisco, San Francisco, CA
| | - Andrew A Herring
- Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, CA; Substance Use Disorder Program, Highland Hospital - Alameda Health System, Oakland, CA
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Karnick AT, Buerke M, Caulfied N, Trussell D, Capron DW, Vujanovic A. Alcohol use in firefighters: A network model of behaviors and transdiagnostic risk. Drug Alcohol Depend 2022; 241:109677. [PMID: 36334469 DOI: 10.1016/j.drugalcdep.2022.109677] [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: 08/26/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Firefighters are at heightened risk for developing alcohol use disorder (AUD), possibly due to chronic stress and exposure to potentially traumatic events. Daily trauma experiences and transdiagnostic risk factors (i.e., anxiety sensitivity and distress intolerance) are related to posttraumatic stress and depressive symptoms, as well as alcohol use severity and alcohol as a coping strategy. Although alcohol use has been identified as a key target for addressing mental health in firefighters, prior research has not fully integrated transdiagnostic vulnerabilities, internalizing symptoms, posttraumatic stress symptoms, alcohol coping, and overall alcohol use into a dynamic network model. METHODS We assessed the symptom structure of overall alcohol use in firefighters with a likely AUD and transdiagnostic risk factors in all firefighters using network analysis. RESULTS Failing to meet expectations (Expected Influence [EI]: 1.32), morning dependence (EI: 1.07), and guilt about drinking (EI: 1.10) were most central to the network model developed for firefighters with a likely AUD. In a transdiagnostic model of use in firefighters overall, anxiety sensitivity cognitive concerns (EI: 1.48) and negative alterations to cognitions and mood related to trauma (EI: 1.87) had the highest influence on the network. Notable correlations were also identified between trauma arousal and overall alcohol use, between depression and alcohol coping motives, and between trauma avoidance and alcohol coping motives. CONCLUSIONS Alcohol use behaviors may follow a unique etiologic pathway in firefighters and intervention strategies should target factors found to be more central to symptom networks.
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Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39402, USA.
| | - Morgan Buerke
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39402, USA
| | - Nicole Caulfied
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39402, USA
| | - Dylan Trussell
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39402, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39402, USA
| | - Anka Vujanovic
- Department of Psychology, University of Houston, Houston, TX 77204, USA.
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Anvari MS, Hampton T, Tong MP, Kahn G, Triemstra JD, Magidson JF, Felton JW. Behavioral Activation Disseminated by Non-Mental Health Professionals, Paraprofessionals, and Peers: A Systematic Review. Behav Ther 2022; 54:524-538. [PMID: 37088508 DOI: 10.1016/j.beth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
There is a striking disparity between the number of individuals with significant mental health concerns and those who are able to access care globally. One promising solution to expanding the mental health taskforce is task-sharing, or employing nonspecialists in the delivery of evidence-based interventions. Behavioral activation (BA), a brief intervention that focuses on scheduling rewarding activities into one's daily life, may have promise for delivery using task-sharing approaches due to its straightforward, flexible nature. The aim of this systematic review was to examine the current state of the literature on non-specialist-delivered BA and evaluate the evidence base of this approach. Three databases (Pubmed, PsycInfo, and Cochrane) were searched, and all articles were screened for inclusion criteria by two research assistants, included the review of titles, abstracts, and full-text. The final dataset consisted of 13 research studies, represented through 15 articles. A meta-analysis was conducted to examine the overall pooled effects of peer-delivered BA on depressive symptoms (the most widely examined clinical outcome). Studies reported on effectiveness and implementation outcomes of non-specialist-delivered BA for depression, substance use, loneliness, trauma survivors, and individuals with comorbid physical health conditions. Results provide initial support for the effectiveness of BA utilizing a task-sharing approach, and highlight the feasibility and acceptability of using nonspecialists to deliver BA in a variety of contexts, including low-resource settings.
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Affiliation(s)
| | - Tessa Hampton
- Center for Health Policy & Health Services Research, Henry Ford Health
| | | | - Geoffrey Kahn
- Center for Health Policy & Health Services Research, Henry Ford Health
| | - Justin D Triemstra
- Spectrum Health, Helen DeVos Children's Hospital; College of Medicine, Michigan State University
| | | | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit
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13
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Vilca LW, Chambi-Mamani EL, Quispe-Kana ED, Hernández-López M, Caycho-Rodríguez T. Functioning of the EROS-R Scale in a Clinical Sample of Psychiatric Patients: New Psychometric Evidence from the Classical Test Theory and the Item Response Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10062. [PMID: 36011696 PMCID: PMC9407833 DOI: 10.3390/ijerph191610062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
Reliable and valid assessment instruments that can be applied briefly and easily in clinical and outpatient settings that provide information about the sources of reinforcement that the patient finds in his life are especially relevant in therapy. The study aimed to evaluate the psychometric properties of the Environmental Reward Observation Scale (EROS-R) in a sample of psychiatric patients. A sample of 228 psychiatric patients of both sexes (56.1% men and 43.9% women) aged between 18 and 70 years was selected. Along with the EROS-R, other instruments were administered to assess depression and anxiety. The results show that the scale fits a unidimensional model, presenting adequate fit indices (RMSEA = 0.077 (IC 90% 0.055−0.100); SRMR = 0.048; CFI = 0.98; TLI = 0.98). It was also shown that the degree of reward provided by the environment (EROS-R) correlates negatively with the level of depression (ρ = −0.54; p < 0.01) and anxiety (ρ = −0.34; p < 0.01). From the IRT perspective, all the items present adequate discrimination indices, where item 4 is the most precise indicator to measure the degree of environmental reward. All this leads us to conclude that the EROS-R is an instrument with robust psychometric guarantees from TCT and IRT’s perspectives, making it suitable for use in clinical contexts.
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Affiliation(s)
- Lindsey W. Vilca
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15011, Peru
| | | | | | | | - Tomás Caycho-Rodríguez
- Facultad de Ciencias de la Salud, Carrera de Psicología, Universidad Privada del Norte, Lima 15314, Peru
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14
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Applying the Addictions Neuroclinical Assessment to derive neurofunctional domains in individuals who use methamphetamine. Behav Brain Res 2022; 427:113876. [PMID: 35378110 DOI: 10.1016/j.bbr.2022.113876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022]
Abstract
The Addictions Neuroclinical Assessment (ANA) was proposed as a neuroscience-informed clinical framework to understand heterogeneity in addiction encompassing dysfunction in three domains: incentive salience, negative emotionality, and executive functions. The ANA has been validated in the alcohol field but has not been extended to other substances. Thus, the objective of the current study was to replicate and extend the ANA framework to methamphetamine use disorder. Non-treatment seeking individuals (N = 185) who reported regular methamphetamine use completed a deep phenotyping battery comprising self-report and behavioral measures that assessed methamphetamine craving and emotional withdrawal symptoms, mood and anxiety symptomatology, risk-taking behaviors, working memory, attention, and impulsivity. Factor analytic techniques were used in an iterative manner to derive latent factors that explained biobehavioral variation in the sample. The relationship between factor scores and demographic and clinical indicators of methamphetamine use were examined to assess the construct validity of the latent factors. Deep phenotyping combined with factor analytic techniques implicated three intercorrelated neurofunctional domains that map on to the proposed ANA domains: incentive salience, negative emotionality, and executive function. Each of the domains were associated with demographic and clinical indicators of methamphetamine use providing initial support for their construct validity. The ANA framework holds promise for explaining heterogeneity in addiction by identifying neuroscience-informed phenotypes. Knowledge from the ANA framework may be applied to advance precision medicine and inform medications development for a host of substance use disorders, particularly those with no approved pharmacotherapy such as methamphetamine.
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15
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Pott SL, Kellett SC, Green S, Daughters S, Delgadillo J. Behavioral activation for depression delivered by drug and alcohol treatment workers: A pilot randomized controlled trial. J Subst Abuse Treat 2022; 139:108769. [DOI: 10.1016/j.jsat.2022.108769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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16
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Hune ND, McGovern TF. A Perspective on Neurobiological and Intersubjective Connectedness in Coexisting Schizophrenia and Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2021.1996302] [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)
- Nicole D. Hune
- Center for Collegiate Community Recoveries, Texas Tech University, Lubbock, TX, USA
| | - Thomas F. McGovern
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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17
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Magidson JF, Belus JM, Seitz-Brown CJ, Tralka H, Safren SA, Daughters SB. Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS. AIDS Behav 2022; 26:102-115. [PMID: 34173895 PMCID: PMC8808422 DOI: 10.1007/s10461-021-03354-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
There is a need for parsimonious behavioral interventions to support HIV and substance use treatment outcomes for low-income, Black/African American individuals living with HIV. This randomized clinical trial (N = 61) evaluated Act Healthy (AH), an integrated behavioral intervention to reduce substance use and improve medication adherence, compared to supportive counseling (SC) plus Life-Steps medication adherence counseling on substance use, craving, adherence-related outcomes, and depression over one year. Participants in AH had significantly steeper decreases in cravings compared to SC, but no significant differences in substance use. Across both groups, there was a significant increase in probability of being on antiretroviral therapy (ART) (86% on ART at 12 months vs. 56% at baseline), and a significant decrease in medication nonadherence. Findings provide preliminary support for an intervention to reduce cravings and strategies to improve ART use in a hard-to-reach, vulnerable population at high risk for poor treatment outcomes and ongoing HIV transmission. TRIAL REGISTRATION: ClinicalTrials.gov trial registration number: identifier: NCT01351454. Retrospectively registered on May 10, 2011.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA.
| | - Jennifer M Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - Hannah Tralka
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, UNC Chapel-Hill, Chapel Hill, NC, USA
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18
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Quinn MH, Olonoff M, Bauer AM, Fox E, Jao N, Lubitz SF, Leone F, Gollan JK, Schnoll R, Hitsman B. History and Correlates of Smoking Cessation Behaviors Among Individuals With Current or Past Major Depressive Disorder Enrolled in a Smoking Cessation Trial. Nicotine Tob Res 2022; 24:37-43. [PMID: 34259871 PMCID: PMC8666119 DOI: 10.1093/ntr/ntab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking among adults with major depressive disorder (MDD) is at least double that of the general US population. More effective smoking cessation interventions for depressed smokers may be facilitated through a better understanding of the smoking and depression-related characteristics of this population. METHODS We used baseline data from 300 participants enrolled in randomized clinical trial for smokers with current or past MDD. We described history of smoking cessation behaviors (ie, quit attempts, quit motivation, and cessation treatment utilization) and used multivariate regression to identify demographic and depression-related correlates of these behaviors. RESULTS Sixty-eight percent of participants reported at least one quit attempt in the past year, nearly 51% reported motivation to quit in the subsequent 30 days, and 83% reported prior use of a nicotine replacement therapy. A greater readiness to quit smoking was associated with increased age (p = .04) and lower cigarettes per day (p = .01). Greater use of smoking cessation medication was associated with greater education and nicotine dependence, minority race, and greater use of complementary reinforcers (eg, activities associated with increased reinforcing value of smoking; p's < .05). CONCLUSIONS These data indicate that smokers with current or past MDD are highly motivated to quit smoking and have a history of engaging in efforts to quit. Interventions to promote smoking cessation behaviors should address younger and lighter smokers, who may perceive less risk from tobacco use, and efforts to promote smoking cessation medications and counseling should address minority smokers who are engaging in complementary reinforcers. IMPLICATIONS These data are inconsistent with the assumption that smokers with serious mental illness are not willing to quit smoking and suggest the need for studies that test behavioral interventions that address complementary reinforcers to treat tobacco use in this community.
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Affiliation(s)
- Mackenzie Hosie Quinn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Olonoff
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anna-Marika Bauer
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Fox
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nancy Jao
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Su Fen Lubitz
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frank Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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19
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Rabat Y, Sibon I, Berthoz S. Implication of problematic substance use in poststroke depression: an hospital-based study. Sci Rep 2021; 11:13324. [PMID: 34172774 PMCID: PMC8233374 DOI: 10.1038/s41598-021-92639-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown. Our aims were to: (1) estimate the proportion of stroke patients with a problematic substance use as defined by clinical screening scales; (2) determine the proportion of PSD at three months of follow-up; (3) explore if the baseline severity in substance use and its evolution are independent predictors of PSD. A cohort of first-ever non-severe stroke adult patients was screened at baseline and three months post-stroke using recommended cut-off scores of standardized scales for tobacco, alcohol and cannabis abuse. PSD was defined using the Center of Epidemiological Studies Depression scale score. Out of the 244 eligible patients, 74 (30.3%) presented a problematic substance use, including 21 (8.6%) polydrug abusers. Among these patients, the prevalence of PSD was 50.8%, including 29.5% of severe depression. The severity of tobacco dependence at baseline was found to double the risk (OR 1.59, 95% CI 1.05–2.43) of presenting a PSD, independently of previously reported risk factors. We found no significant evidence for an effect of the evolution in substance use at follow-up. Addictive disorders are part of the critical unmet needs that should be addressed in the management of PSD.
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Affiliation(s)
- Yolaine Rabat
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France.
| | - Igor Sibon
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France.,Stroke Unit, Department of Neurology, CHU Bordeaux, Bordeaux, France
| | - Sylvie Berthoz
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France.,Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
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20
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Is behavioral activation an effective and acceptable treatment for co-occurring depression and substance use disorders? A meta-analysis of randomized controlled trials. J Subst Abuse Treat 2021; 132:108478. [PMID: 34146994 DOI: 10.1016/j.jsat.2021.108478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/28/2020] [Accepted: 05/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Depression often co-occurs with substance use problems and is associated with poor treatment outcomes. While the efficacy of behavioral activation (BA) has been tested in clinical trials with substance users, outcomes have not yet been quantitatively synthesized. METHODS The study team performed a random effects meta-analysis of the randomized clinical trial evidence base. We compared outcomes for individual or group BA against passive or active controls. We also compared attendance and dropout rates. The meta-analysis used a grading of recommendations assessment, development, and evaluation (GRADE) approach to assess the quality of each meta-analytic comparison. RESULTS We included five trials in the meta-analysis (N = 195). The analysis found no significant differences between BA and controls with regard to depression (Post-treatment: k = 5; N = 195; SMD: 0.19, CI -0.10 to 0.49; p = 0.20; GRADE = Low; Follow-up: k = 5; N = 195; SMD: -0.10, CI -0.51 to -0.30; p = 0.62; GRADE = Low) or substance use (post-treatment: k = 4; N = 151; SMD: 0.14, CI -0.33 to -0.6; p = 0.57, GRADE = Low; Follow-up: k = 4; N = 151; SMD: 0.17, CI -0.34 to 0.69; p = 0.51, GRADE = Low) and there was little evidence of publication bias. The average session attendance rate for BA was 72%. An average dropout rate of 35% was reported for both BA and comparator conditions. CONCLUSION BA does not emerge as a differentially efficacious treatment for comorbid depression and substance use disorders, although it does appear to be an acceptable treatment option. Our confidence in the results are limited by the number and quality of the original studies and the possibility of the effect of small study bias. We make suggestions for improving the methodological quality and direction of future BA trials.
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21
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Fleming CB, Mason WA, Stevens AL, Jaffe AE, Cadigan JM, Rhew IC, Lee CM. Antecedents, concurrent correlates, and potential consequences of young adult solitary alcohol use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:553-564. [PMID: 33507788 DOI: 10.1037/adb0000697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Research on young adults has found solitary alcohol use to be positively associated with negative emotions, coping motives for drinking, and negative alcohol-related consequences, but most research has been cross-sectional and based on samples of college students. We examined associations across multiple time points within a sample that was diverse with respect to educational status and age. METHODS A community sample (N = 754, ages 18-26; 56% female) completed surveys at baseline, monthly for 2 years, and at 30-month postbaseline. Multilevel and single-level regression models assessed longitudinal and concurrent associations between solitary drinking and potential correlates, adjusting for frequency of alcohol use. RESULTS Moderate depressive symptoms at baseline were associated with a greater likelihood of solitary drinking in drinking months in the subsequent 2 years (Adjusted Odds Ratio [AOR] = 2.22, 95% CI [1.54-3.20]). During those 2 years, both depressive symptoms and coping motives were positively concurrently associated with solitary drinking at the between- and within-person level. Although solitary drinking in a particular month had a small and nonsignificant association with negative alcohol-related consequences, the proportion of drinking months that involved solitary drinking was positively associated with negative alcohol-related consequences across months. More solitary drinking during monthly data collection was associated with greater likelihoods of hazardous drinking and moderate depressive symptoms at 30-month follow-up, but these associations were not statistically significant after adjusting for earlier measures of drinking and depressive symptoms. CONCLUSIONS The findings point to the importance of considering the drinking context when screening and providing treatment for alcohol misuse. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Charles B Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - W Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center
| | - Amy L Stevens
- Boys Town Child and Family Translational Research Center
| | - Anna E Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Jennifer M Cadigan
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington
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22
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Le TM, Wang W, Zhornitsky S, Dhingra I, Chen Y, Zhang S, Li CSR. The Neural Processes Interlinking Social Isolation, Social Support, and Problem Alcohol Use. Int J Neuropsychopharmacol 2020; 24:333-343. [PMID: 33211853 PMCID: PMC8059487 DOI: 10.1093/ijnp/pyaa086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/19/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Subjective feeling of social isolation, as can be measured by perceived burdensomeness (PB), is a major risk factor for alcohol misuse. Heightened PB is associated with elevated stress response and diminished cognitive control, both of which contribute to problem drinking. Here, we sought to identify the neural substrates underlying the relationship between PB and alcohol misuse. METHODS We employed resting-state functional magnetic resonance imaging data collected from 61 problem drinkers to characterize the functional connectivity of the hypothalamus and ventral striatum (VS) in relation to PB. We specifically examined whether the connectivities of the hypothalamus and VS were differentially influenced by PB to produce contrasting effects on alcohol use. Finally, we evaluated how individual differences in social support modulate the inter-relationships of social isolation, neural connectivity, and the severity of problem drinking. RESULTS Whole-brain multiple regressions show a positive relationship between PB and hypothalamic connectivity with the hippocampus and an inverse pattern for VS connectivity with the middle frontal gyrus. Difference in strength between the 2 connectivities predicted the severity of problem drinking, suggesting an imbalance involving elevated hypothalamic and diminished prefrontal cortical modulation in socially isolated problem drinkers. A path analysis further revealed that the lack of social support was associated with a bias toward low prefrontal connectivity, which in turn increased PB and facilitated problem drinking. CONCLUSIONS Altered hypothalamus and VS connectivity may underlie problem drinking induced by social isolation. The current findings also highlight the important role of social support as a potential protective factor against alcohol misuse.
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Affiliation(s)
- Thang M Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA,Correspondence: Thang M. Le, PhD, Connecticut Mental Health Center, S105, 34 Park Street, New Haven, CT 06519-1109, USA ()
| | - Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isha Dhingra
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yu Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chiang-Shan R Li
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut, USA,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, Connecticut, USA
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23
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McPhee MD, Keough MT, Rundle S, Heath LM, Wardell JD, Hendershot CS. Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic. Front Psychiatry 2020; 11:574676. [PMID: 33192708 PMCID: PMC7661794 DOI: 10.3389/fpsyt.2020.574676] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Behavioral theories of depression and alcohol self-medication theories suggest that greater social/environmental constraints and increased psychological distress during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals: (1) to examine self-reported changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in self-reported changes in depression and alcohol use during the early weeks of the COVID-19 pandemic. Methods: Participants (n = 833) were U.S. residents recruited for participation in a single online survey. The cross-sectional survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes. Outcomes were assessed via retrospective self-report for two timeframes in the single survey: the 30 days prior to state-mandated social distancing ("pre-social-distancing"), and the 30 days after the start of state-mandated social distancing ("post-social-distancing"). Results: Depression severity, coping motives, and some indices of alcohol consumption (e.g., frequency of binge drinking, and frequency of solitary drinking) were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to pre-social-distancing. Behavioral economic indices (alcohol demand) were variable with regard to change. Mediation analyses suggested a significant indirect effect of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking. Discussion: Results provide early cross-sectional evidence regarding the relation of environmental reward, depression, and COVID-19-related psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Results are largely consistent with predictions from behavioral theories of depression and alcohol self-medication frameworks. Future research is needed to study prospective associations among these outcomes.
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Affiliation(s)
- Matthew D. McPhee
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | | | - Samantha Rundle
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Laura M. Heath
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Jeffrey D. Wardell
- Department of Psychology, York University, Toronto, ON, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Christian S. Hendershot
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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24
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Christie GIG, Cheetham A, Lubman DI. Interventions for Alcohol and Drug Use Disorders in Young People: 10 Key Evidence-Based Approaches to Inform Service Delivery. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00336-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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25
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Lyon KA, Juhasz G, Brown LJE, Elliott R. Big Five personality facets explaining variance in anxiety and depressive symptoms in a community sample. J Affect Disord 2020; 274:515-521. [PMID: 32663984 DOI: 10.1016/j.jad.2020.05.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/26/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Personality traits are risk and protective factors in affective disorders. However, few studies have investigated the role of narrow personality facets, with existing research yielding contradictory results. Previous research has mostly focused on simple correlations. Several studies have performed separate multiple regressions within each trait, and have used non-standard measures of personality, making it difficult to determine how individual facets make unique contributions. METHOD This study performed secondary analysis of the NewMood data set (collected 2004-2009), comprising 264 participants from Greater Manchester. Participants provided self-reports of all NEO-PI-R personality facets, and semi-structured questionnaires of clinical depression and anxiety. All personality facets were entered into multiple regressions to explain variance in depression and anxiety. RESULTS Variance in both anxiety and depression were explained by a small number of personality facets, namely facet depression (referring to demotivation), facets positive emotion and assertiveness in extroversion, and facet competence in conscientiousness. LIMITATIONS This study relies on cross-sectional data and cannot determine causation. This study uses a mostly female sample, and the results were not stratified by sex due to the small sample. CONCLUSION Previous studies suggest that broad trait neuroticism positively associates with affective disorders; this study adds that the effect of neuroticism is limited to facet depression (related to demotivation). Contrary to previous studies, no facet of agreeableness or openness explained variance in affective disorders, and facet assertiveness positively associated with affective disorder scores. These findings may help to improve treatment matching and explain the mechanisms through which affective disorders develop.
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Affiliation(s)
- K A Lyon
- Division of Neuroscience and Experimental Psychology, University of Manchester, G.803 Stopford Building Oxford Road, M13 9PG, United Kingdom.
| | - G Juhasz
- Division of Neuroscience and Experimental Psychology, University of Manchester, G.803 Stopford Building Oxford Road, M13 9PG, United Kingdom; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - L J E Brown
- Division of Psychology and Mental Health, University of Manchester, M13 9PL, United Kingdom
| | - R Elliott
- Division of Neuroscience and Experimental Psychology, University of Manchester, G.803 Stopford Building Oxford Road, M13 9PG, United Kingdom
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Paulus MP, Stewart JL. Neurobiology, Clinical Presentation, and Treatment of Methamphetamine Use Disorder: A Review. JAMA Psychiatry 2020; 77:959-966. [PMID: 32267484 PMCID: PMC8098650 DOI: 10.1001/jamapsychiatry.2020.0246] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The prevalence of and mortality associated with methamphetamine use has doubled during the past 10 years. There is evidence suggesting that methamphetamine use disorder could be the next substance use crisis in the United States and possibly worldwide. OBSERVATION The neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation. Similarly, the clinical picture extends beyond the acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by the clinician. Although there are no pharmacologic treatments for methamphetamine use disorder, cognitive behavioral therapy, behavioral activation, and contingency management show modest effectiveness. CONCLUSIONS AND RELEVANCE There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets. Parsing the disorder into different processes (eg, craving or mood-associated alterations) and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions. Finally, mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use disorder.
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Affiliation(s)
- Martin P. Paulus
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
| | - Jennifer L. Stewart
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
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Martínez-Vispo C, Martínez Ú, López-Durán A, Del Río EF, Becoña E. Correction to: Effects of behavioural activation on substance use and depression: a systematic review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:37. [PMID: 32475348 PMCID: PMC7262747 DOI: 10.1186/s13011-020-00274-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Carmela Martínez-Vispo
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Úrsula Martínez
- Tobacco Research and Intervention Program, Department of Health Outcomes and Behaviour, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Ana López-Durán
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Elisardo Becoña
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Magidson JF, Andersen LS, Satinsky EN, Myers B, Kagee A, Anvari M, Joska JA. "Too much boredom isn't a good thing": Adapting behavioral activation for substance use in a resource-limited South African HIV care setting. Psychotherapy (Chic) 2020; 57:107-118. [PMID: 31670529 PMCID: PMC7069775 DOI: 10.1037/pst0000257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South
African Medical Research Council; Division of Addiction Psychiatry, Department of
Psychiatry and Mental Health, University of Cape Town
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University
| | - Morgan Anvari
- Department of Psychology, University of Maryland, College
Park
| | - John A. Joska
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
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Menear M, Dugas M, Careau E, Chouinard MC, Dogba MJ, Gagnon MP, Gervais M, Gilbert M, Houle J, Kates N, Knowles S, Martin N, Nease DE, Zomahoun HTV, Légaré F. Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. J Affect Disord 2020; 263:528-539. [PMID: 31744737 DOI: 10.1016/j.jad.2019.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients and families are often referred to as important partners in collaborative mental health care (CMHC). However, how to meaningfully engage them as partners remains unclear. We aimed to identify strategies for engaging patients and families in CMHC programs for depression and anxiety disorders. METHODS We updated a Cochrane review of CMHC programs for depression and anxiety disorders. Searches were conducted in Cochrane CCDAN and CINAHL, complemented by additional database searches, trial registry searches, and cluster searches for 'sibling' articles. Coding and data extraction of engagement strategies was an iterative process guided by a conceptual framework. We used narrative synthesis and descriptive statistics to report on findings. FINDINGS We found 148 unique CMCH programs, described in 578 articles. Most programs (96%) featured at least one strategy for engaging patients or families. Programs adopted 15 different strategies overall, with a median of two strategies per program (range 0-9 strategies). The most common strategies were patient education (87% of programs) and self-management supports (47% of programs). Personalized care planning, shared decision making, and family or peer supports were identified in fewer than one third of programs. LIMITATIONS Our search strategy was designed to capture programs evaluated in clinical trials and so other innovative programs not studied in trials were likely missed. CONCLUSION Most CMHC programs for depression and anxiety disorders adopted a limited number of strategies to engage patients and families in their care. However, this review identifies numerous strategies that can be used to strengthen the patient- and family-centeredness of collaborative care.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada.
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Emmanuelle Careau
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada; Department of Rehabilitation, Laval University, Quebec, Canada
| | | | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | | | - Michel Gervais
- Centre intégré universitaire en santé et en services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Michel Gilbert
- National Centre for Excellence in Mental Health, Quebec, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Sarah Knowles
- NIHR Collaboration for Leadership in Applied Health Research an Care (CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
| | | | - Donald E Nease
- Department of Family Medicine, University of Colorado Denver, Denver, US
| | | | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
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Fazzino TL, Bjorlie K, Lejuez C. A systematic review of reinforcement-based interventions for substance use: Efficacy, mechanisms of action, and moderators of treatment effects. J Subst Abuse Treat 2019; 104:83-96. [DOI: 10.1016/j.jsat.2019.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023]
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Martínez-Vispo C, Rodríguez-Cano R, López-Durán A, Senra C, Fernández del Río E, Becoña E. Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial. PLoS One 2019; 14:e0214252. [PMID: 30958831 PMCID: PMC6453447 DOI: 10.1371/journal.pone.0214252] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/07/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Behavioral Activation is a behavioral-based treatment that has been proposed as suitable for smoking cessation, as it simultaneously addresses reinforcement-related variables and also mood management. The aim of this study was to compare the effects of a cognitive-behavioral smoking cessation treatment with components of behavioral activation (SCBSCT-BA) with a standard cognitive-behavioral treatment (SCBSCT), and a wait-list control group (WL). Method The sample was comprised of 275 adults smokers (61.4% females, mean age = 45.36, SD = 10.96). After baseline assessment sessions, participants were randomized (ratio: 2.2.1.) to SCBSCT-BA, SCBSCT, or WL. Active groups received 8 weekly 1-hour face-to-face group sessions. Biochemically verified smoking abstinence and depressive symptoms were assessed at the end of treatment, and at 3-, 6-, and 12-month follow-ups. Results Significant treatment effects in 7-dayspoint prevalence abstinence rates were found for both active groups at the end of treatment. Abstinence rates at 12-months follow-up were 30% for SCBSCT-BA, and 18% for SCBSCT. Using Multiple Imputation for missing data, regression analysis showed significantly greater ORs for the SCBSCT-BA condition (vs. SCBSCT) at the end of treatment and at 3-months follow-up. At 6-, and 12-months follow-ups, ORs for the SCBSCT-BA condition, although greater, did not reach statistical significance. Multilevel analysis showed that abstinence was related to reductions in depressive symptoms. Conclusions SCBSCT-BA obtained positive results at short and medium term. Participants who quit smoking experienced a significant reduction in depressive symptoms. Findings support the benefit of adding BA to a cognitive-behavioral smoking cessation treatment. Trial registration www.clinicaltrials.govNCT02844595.
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Affiliation(s)
- Carmela Martínez-Vispo
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
- * E-mail:
| | - Rubén Rodríguez-Cano
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Ana López-Durán
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Carmen Senra
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | | | - Elisardo Becoña
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
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