What works in drug addiction?

Correlates of Stigma Severity Among Persons Seeking Opioid Detoxification

INTRODUCTION

Among people with opioid use disorder (OUD), stigma is a known barrier to accessing treatment and has negative impacts on physical and mental health. The purpose of this study was to understand the factors associated with self-stigma and perceived stigma severity among people with OUD entering an inpatient detoxification program.

METHODS

Between December 2015 and August 2016, consecutive persons seeking inpatient opioid detoxification were asked to complete a survey that included sociodemographic, drug use, treatment variables, an 8-item General Self-Stigma scale, and a 3-item Treatment Stigma scale. Correlates of stigma severity were estimated using ordinary least squares regression.

RESULTS

The 407 participants had an average age of 32.4 (±8.79) years, with 72.2% male and 84.5% non-Hispanic White. Two-thirds had ever received medication-assisted treatment for OUD and 323 (79.4%) had ever been admitted to a detoxification program. Adjusted mean General Self-Stigma scores were positively and significantly associated with recent injection drug use (b = 0.262, P = 0.032), and having previously entered detoxification programs (b = 0.330, P = 0.016). Adjusted mean Treatment Stigma scores were positively and significantly associated with years of education (b = 0.142, P = 0.002), having ever been prescribed naltrexone (b = 0.277, P = 0.025) and having previously entered detoxification programs (b = 0.389, P = 0.007).

CONCLUSION

People with OUD presenting for inpatient detoxification struggle with experiences of self and perceived stigma. Strikingly, people with previous detoxification program admission had higher levels of stigma on both scales. Our findings suggest an opportunity for targeted intervention in this group.

Drug misuse in older people: old problems and new challenges

Very little attention has been paid to the invisible epidemic of substance misuse among older people in the UK. This article looks at the prevalence of substance misuse in the people over the age of 60. The reasons for difficulty in diagnosing substance misuse are explored and ways to improve diagnostic ability are discussed. Substance misuse leads to severe physical and psychiatric morbidity that is being managed by meagre resources. The article provides recommendations on specific issues related to interventions, biological and psychosocial, and training of psychiatrists.

Management of drug misuse in pregnancy

Use of both licit and illicit drugs can lead to a range of medical, psychiatric and social problems, and the situation becomes further complicated if the user is pregnant. Prescribed and non-prescribed substances can affect a pregnancy, and substances are seldom used in isolation. In this review we focus on users of illicit drugs (including prescribed drugs used illicitly) during pregnancy and describe some of the issues in managing such cases. We consider the impact of subtance use on the foetus, the mother and the newborn child, and highlight the importance of multidisciplinary working in this area. Space precludes a detailed account of the issues surrounding the use of legal substances such as alcohol and tobacco during pregnancy, but we note their significant impact in this group.

Predictors for retention in treatment with a UK community-based naltrexone programme for opioid dependence

Aims and method

To evaluate the efficacy of naltrexone maintenance therapy in a community-based programme for opioid-dependent patients and to identify predictors for longer-term retention in treatment. A retrospective case-note study was conducted in 142 people dependent on opioids who had undergone detoxification and maintained adherence to naltrexone treatment for a minimum of 4 weeks. Social and clinical demographic factors during treatment were recorded using a standardised naltrexone monitoring scale. Efficacy was measured as retention in treatment, and potential predictors were examined using regression analysis.

Results

Although there was overall low retention of patients in treatment, 55.6% of the patients remained in treatment for 4–8 weeks, and 29.6% of the patients remained in treatment for 17 weeks or more. Enhanced long-term retention in treatment was associated with Asian or other minority ethnic status, employment, parental supervision of naltrexone administration, less boredom, short duration of addiction, younger age, low alcohol intake and no cannabis use in univariate analyses. Short duration of opioid dependence syndrome (3 years) and low alcohol intake (<10 units/week) were significant independent predictors for longer-term retention in treatment in subsequent multivariate analysis.

Clinical implications

Low alcohol intake and shorter duration of addiction were significant independent predictors for longer-term retention in treatment, but retention rates for naltrexone remain low overall. Additional psychosocial support may be needed to address these issues.

The use of ‘drug dogs' in psychiatry

Comorbidity of severe mental illness and substance misuse is now common in general psychiatry (Regier et al, 1990), and perhaps almost standard in forensic psychiatry (Snowden, 2001). It is also reflected in child and adolescent psychiatry (Boys et al, 2003) and even in old age psychiatry (Jolley et al, 2004). The range of hazards associated with substance misuse in people with mental illnesses includes elevated risk of relapse of psychosis (Cantwell & Harrison, 1996), increased frequency of hospitalisation (Bartels et al, 1993), poorer compliance with treatment (Jablensky et al, 1992), higher levels of treatment-resistance (Bowers et al, 1990), impairment of the integrity of therapeutic regimes in hospital settings and in hostels in the community (Sandford, 1995), stress in the community (Drake & Wallach, 1989), higher rates of homelessness (Scheller-Gilkey et al, 1999), increased suicidality (Drake & Wallach, 1989), and increased potential for antisocial behaviour and crime of both an acquisitive and a violent nature (Stewart et al, 2000; Sinha & Easton, 1999). The misuse of substances is therefore a significant obstruction to the effective use of psychiatric treatment, and the financial cost associated with such clinical adversity must run into millions of pounds.

Drug and alcohol addiction: new pharmacotherapies

Over the past decade, important research has been performed into the therapeutic use of dihydrocodeine, injectable opioids (diamorphine) and supervised disulfiram in addiction treatment. There have also been interesting developments regarding baclofen for alcohol problems and use of stimulants in adult Attention-deficit hyperactivity disorder (ADHD). However, evidence for the effectiveness of medication to promote alcohol abstinence remains modest at best.

Factors associated with inability to access addiction treatment among people who inject drugs in Vancouver, Canada

BACKGROUND

Addiction treatment is an effective strategy used to reduce drug-related harm. In the wake of recent developments in novel addiction treatment modalities, we conducted a longitudinal data analysis to examine factors associated with inability to access addiction treatment among a prospective cohort of persons who inject drugs (PWID).

METHODS

Data were derived from two prospective cohorts of PWID in Vancouver, Canada, between December 2005 and November 2013. Using multivariate generalized estimating equations, we examined factors associated with reporting an inability to access addiction treatment.

RESULTS

In total, 1142 PWID who had not accessed any addiction treatment during the six months prior to interview were eligible for this study, including 364 women (31.9 %). Overall, 188 (16.5 %) reported having sought but were ultimately unsuccessful in accessing addiction treatment at least once during the study period. In multivariate analysis, factors independently and positively associated with reporting inability to access addiction treatment included: binge drug use (Adjusted Odds Ratio [AOR] = 1.65), being a victim of violence (AOR = 1.77), homelessness (AOR = 1.99), and having ever accessed addiction treatment (AOR = 2.33); while length of time injecting was negatively and independently associated (AOR = 0.98) (all p < 0.05).

CONCLUSIONS

These findings suggest that sub-populations of PWID were more likely to report experiencing difficulty accessing addiction treatment, including those who may be entrenched in severe drug addiction and vulnerable to violence. It is imperative that additional resources go into ensuring treatment options are readily available when requested for these target populations.

Drug and alcohol addiction: do psychosocial treatments work?

Methodological issues such as social desirability bias, subjective outcome measures, therapist enthusiasm and fidelity to the intervention remain a major problem in assessing the effectiveness of psychosocial treatments for substance misuse. Alcoholics Anonymous and other 12-step programmes are still widely used, although it is difficult to formally assess their effectiveness. Motivational interviewing is perhaps the most commonly used professional psychosocial treatment for substance misuse, but brief interventions based on this technique report a disappointing effect size (∼0.2). Contingency management is perhaps the most effective reported modality, although it remains politically controversial. Cognitive—behavioural therapy and community reinforcement have been widely studied, but the results are often disappointing (effect sizes seldom exceed 0.5, despite very large trials). Residential rehabilitation remains an established treatment, but patient selection prevents formal cost-effectiveness studies.

Drop-out from addiction treatment: a systematic review of risk factors

Completion of addiction treatment is one of the most consistent factors associated with a favorable treatment outcome. Unfortunately, it is more common for a patient to drop-out of addiction treatment than to complete the treatment. To prevent drop-out, risk factors must be identified. This box-score review focuses on studies investigating the risk factors associated with drop-out from addiction treatment published in peer-reviewed journals from 1992 to 2013. A total of 122 studies involving 199,331 participants met the inclusion criteria. Contrary to recommendations from previous reviews, 91% of the included studies focused primarily on enduring patient factors, mainly demographics. The most consistent risk factors across the different study designs, samples, and measurement methods were cognitive deficits, low treatment alliance, personality disorder, and younger age. With the exception of younger age, none of the demographic factors emerged as consistent risk factors. Further research on the relationship between simple demographic factors and drop-out risk is of limited value. However, little is known about the potential risk factors related to treatment programs and to the treatment processes. Based on the review, clinical recommendations include assessing cognitive functioning and personality disorders at baseline and continuous monitoring of treatment alliance.

Development of polytoxicomania in function of defence from psychoticism

INTRODUCTION

Polytoxicomanic proportions in subpopulations of youth have been growing steadily in recent decades, and this trend is pan-continental. Psychoticism is a psychological construct that assumes special basic dimensions of personality disintegration and cognitive functions. Psychoticism may, in general, be the basis of pathological functioning of youth and influence the patterns of thought, feelings and actions that cause dysfunction.

OBJECTIVE

The aim of this study was to determine the distribution of basic dimensions of psychoticism for commitment of youth to abuse psychoactive substances (PAS) in order to reduce disturbing intrapsychic experiences or manifestation of psychotic symptoms.

METHODS

For the purpose of this study, two groups of respondents were formed, balanced by age, gender and family structure of origin (at least one parent alive). The study applied a DELTA-9 instrument for assessment of cognitive disintegration in function of establishing psychoticism and its operationalization. The obtained results were statistically analyzed. From the parameters of descriptive statistics, the arithmetic mean was calculated with measures of dispersion. A cross-tabular analysis of variables tested was performed, as well as statistical significance with Pearson's chi2-test, and analysis of variance.

RESULTS

Age structure and gender are approximately represented in the group of polytoximaniacs and the control group. Testing did not confirm the statistically significant difference (p > 0.5). Statistical methodology established that they significantly differed in most variables of psychoticism, polytoxicomaniacs compared with a control group of respondents. Testing confirmed a high statistical significance of differences of variables of psychoticism in the group of respondents for p < 0.001 to p < 0.01.

CONCLUSION

A statistically significant representation of the dimension of psychoticism in the polytoxicomaniac group was established. The presence of factors concerning common executive dysfunction was emphasized.