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Aalsma MC, Adams ZW, Smoker MP, Marriott BR, Ouyang F, Meudt E, Hulvershorn LA. Evidence-based Treatment for Substance Use Disorders in Community Mental Health Centers: the ACCESS Program. J Behav Health Serv Res 2023; 50:333-347. [PMID: 36859743 PMCID: PMC9977479 DOI: 10.1007/s11414-023-09833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
A significant gap remains in the availability and accessibility of evidence-based treatments (EBTs) in community substance use disorder (SUD) treatment. This study describes a 2-year statewide training initiative that sought to address this gap by training community-based therapists in motivational enhancement/cognitive behavioral therapy (MET/CBT). Therapists (N = 93) participated in a 2-day MET/CBT workshop followed by bi-weekly clinical consultation, fidelity monitoring, guided readings, and online resources. Therapists completed pre-training and follow-up assessments measuring knowledge, attitudes, confidence, and implementation barriers. Most therapists attended 10 or more consultation calls. Submission of session recordings for feedback was the least utilized training element. Therapists reported increased confidence in their ability to implement MET/CBT for SUD and demonstrated improvement in MI and CBT knowledge. Therapists reported several implementation barriers, including lack of time and opportunity to treat patients with MET/CBT. Recommendations for future training initiatives and addressing the barriers identified in this study are discussed.
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Affiliation(s)
- Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA.
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Zachary W Adams
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael P Smoker
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brigid R Marriott
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Meudt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie A Hulvershorn
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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2
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A Comparison of Mathematical and Statistical Modeling with Longitudinal Data: An Application to Ecological Momentary Assessment of Behavior Change in Individuals with Alcohol Use Disorder. Bull Math Biol 2022; 85:5. [PMID: 36495364 DOI: 10.1007/s11538-022-01097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
Ecological momentary assessment (EMA) has been broadly used to collect real-time longitudinal data in behavioral research. Several analytic methods have been applied to EMA data to understand the changes of motivation, behavior, and emotions on a daily or within-day basis. One challenge when utilizing those methods on intensive datasets in the behavioral field is to understand when and why the methods are appropriate to investigate particular research questions. In this manuscript, we compared two widely used methods (generalized estimating equations and generalized linear mixed models) in behavioral research with three other less frequently used methods (Markov models, generalized linear mixed-effects Markov models, and differential equations) in behavioral research but widely used in other fields. The purpose of this manuscript is to illustrate the application of five distinct analytic methods to one dataset of intensive longitudinal data on drinking behavior, highlighting the utility of each method.
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Glasner S, Webb J, Michero D, Motschman C, Monico L, Ang A, Pielsticker P. Feasibility, Acceptability, and Preliminary Outcomes of an Integrated Telemedicine Intervention Combining Naltrexone and Cognitive Behavioral Therapy for Alcohol Use Disorder. TELEMEDICINE REPORTS 2022; 3:184-190. [PMID: 36479135 PMCID: PMC9718429 DOI: 10.1089/tmr.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND A small fraction of individuals in need of treatment for alcohol use disorders (AUDs) seek care, owing largely to barriers to accessing treatment. In the present pilot study, we examine the feasibility, acceptability, and preliminary outcomes of an m-health intervention combining cognitive behavioral therapy and pharmacotherapy for individuals with AUD. METHODS Adults with AUD (N = 26) recruited through online, social media-based advertising were enrolled in a 12-week, integrated telemedicine intervention combining psychosocial treatment with medical management: Quit Genius for AUD (QG-A). Feasibility, acceptability, perceived helpfulness, treatment engagement, retention, completion, and clinical outcomes including alcohol use and secondary mental health outcomes were assessed. RESULTS Participants found the QG-A intervention to be acceptable and helpful in facilitating action toward their therapeutic goals concerning alcohol use. Treatment completion, achieved by the majority (85%) of participants, was excellent. On average, participants reduced their past 30-day alcohol use from baseline (mean proportion of days of abstinent = 0.13) to follow-up (M = 0.59), t(19) = -4.97, p < 0.001, and consumed fewer drinks per drinking day from baseline (M = 6.7) to follow-up (M = 2.0), t(19) = 3.61, p < 0.001. Concurrently, reductions were observed in depressive (t[22] = 5.39, p < 0.001) and anxiety (t[22] = 2.87, p < 0.01) symptom severity, from the moderately severe range at baseline to the mild range at treatment-end, with increases in resilience (t[22] = -3.54, p < 0.001). CONCLUSIONS Addressing AUDs using an integrated m-health intervention to deliver evidence-based psychosocial and pharmacological treatment is feasible and may produce improvements in both alcohol use and psychiatric symptoms.
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Affiliation(s)
- Suzette Glasner
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
| | - Jamie Webb
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
| | - Darcy Michero
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
| | - Courtney Motschman
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Laura Monico
- Friends Research Institute, Baltimore, Maryland, USA
| | - Alfonso Ang
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
| | - Peyton Pielsticker
- Department of Clinical Affairs, Digital Therapeutics, Inc., San Francisco, California, USA
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van Amsterdam J, Blanken P, Spijkerman R, van den Brink W, Hendriks V. The Added Value of Pharmacotherapy to Cognitive Behavior Therapy And Vice Versa in the Treatment of Alcohol Use Disorders: A Systematic Review. Alcohol Alcohol 2022; 57:768-775. [PMID: 36085572 DOI: 10.1093/alcalc/agac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIM To explore whether combined interventions i.e. psychotherapeutic plus psychosocial interventions are more effective than monotherapies in the treatment of alcohol use disorders. METHODS Systematic review of the results of randomized controlled trials that compared combined therapies with monotherapies (either pharmacotherapy or psychotherapy). RESULTS The search resulted in 28 eligible studies. Data from these RCTs showed that 10 out of 19 RCTs (53%) demonstrated an added value of combined therapy (psychotherapy + pharmacotherapy) compared to psychotherapy only, whereas only three out of nine RCTs (33%) comparing combined therapy with pharmacotherapy showed a possible added value for combined therapy. CONCLUSIONS Pharmacotherapy is effective to treat AUD with or without psychotherapy and that psychotherapy can best be offered in combination with pharmacotherapy.
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Affiliation(s)
- Jan van Amsterdam
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Peter Blanken
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, The Hague, The Netherlands
| | - Renske Spijkerman
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, The Hague, The Netherlands
| | - Wim van den Brink
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, The Hague, The Netherlands.,Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Gonzales P, Bachireddy C, Grieco A, Ding R, de Leon SJG, Ulrich A, Lama J, Duerr AC, Altice FL. Viral Suppression Levels in Men Who Have Sex With Men and Transgender Women With Newly Diagnosed HIV and Alcohol Use Disorder in Peru: Results From a Randomized, Double-Blind, Placebo-Controlled Trial Using Oral Naltrexone. J Acquir Immune Defic Syndr 2022; 89:462-471. [PMID: 34897226 PMCID: PMC8881312 DOI: 10.1097/qai.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) are common in men who have sex with men (MSM) and transgender women (TGW) in Peru and undermine antiretroviral therapy (ART) adherence. Oral naltrexone (NTX) is an evidence-based treatment for AUD that has not been assessed in cotreating AUD in MSM/TGW with HIV. SETTING AND DESIGN A multi-site, randomized, double-blind, placebo-controlled trial among MSM/TGW with AUD and newly diagnosed with HIV in Lima, Peru. METHODS Newly diagnosed MSM/TGW with HIV and AUD were prescribed a single-treatment regimen of EFV/TDF/FTC from 2014 to 2015 and randomized 2:1 to oral NTX (N = 103) or placebo (N = 53) for 24 weeks. The primary and secondary outcomes were proportion achieving viral suppression (VS: HIV-1 RNA < 400 copies/mL) or maximal viral suppression (MVS: HIV-1 RNA < 40 copies/mL) at 24 weeks. RESULTS There were no significant differences between the arms in VS (81.6% NTX arm vs 75.5% placebo arm; P = 0.37) or MVS (61.2% NTX arm vs 66.0% placebo arm; P = 0.48). Adherence to study medication was low (mean = 34.6%) overall with only 21.4% of participants meeting recommended adherence levels (≥80% daily doses/month). Participants allocated to NTX had significantly lower adherence compared with placebo for both the first and second 12-week study periods, respectively (44.0% vs 35.2%, P = 0.04; 31.4% vs 35.2%, P = 0.03). CONCLUSIONS Findings are inconclusive regarding the use of NTX for treatment of AUD in MSM/TGW newly diagnosed with HIV. VS and MVS levels were high irrespective of allocation. Adherence to study medication was low, requiring further exploration of strategies to optimize adherence to NTX as AUD treatment.
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Affiliation(s)
| | - Chethan Bachireddy
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, USA
| | - Arielle Grieco
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rona Ding
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Samy J. Galvez de Leon
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, USA
| | - Angela Ulrich
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Javier Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ann C Duerr
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Frederick L Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, USA
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, USA
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Wang DF, Zhou YN, Liu YH, Hao YZ, Zhang JH, Liu TQ, Ma YJ. Social support and depressive symptoms: exploring stigma and self-efficacy in a moderated mediation model. BMC Psychiatry 2022; 22:117. [PMID: 35168584 PMCID: PMC8845403 DOI: 10.1186/s12888-022-03740-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although some psychological processes, such as stigma and self-efficacy, affect the complicated relationship between social support and depressive symptoms, few studies explored a similar psychological mechanism among individuals with substance use disorders (SUDs). Hence, this research investigates the mediating effects of stigma and the moderating effects of self-efficacy among the psychological mechanism that social support affects depressive symptoms. METHODS The study included 1040 Chinese participants with SUDs and completed a series of self-report questionnaires. R software was used to organize and clean up data sets and analyze mediation and moderation effects. RESULTS The result showed that stigma partially mediated depressive symptoms, while self-efficacy moderated this relationship. More specifically, less social support increased depression symptoms by bringing about higher stigma. Besides, subjects with higher self-efficacy are less susceptible to stigma and therefore have mild depressive symptoms. Furthermore, clinical and theoretical implications are discussed in our study. CONCLUSIONS Chinese SUDs patients' depressive symptoms were indirectly affected by perceived social support via stigma and less affected by stigma with improved self-efficacy. The theoretical and practical implications of these results are discussed.
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Affiliation(s)
- Dong-Fang Wang
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Ya-Nan Zhou
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 P.R. China
| | - Yue-Heng Liu
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 P.R. China
| | - Yu-Zhu Hao
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 P.R. China
| | - Jun-Hong Zhang
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 P.R. China
| | - Tie-Qiao Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan, 410011, P.R. China.
| | - Yue-Jiao Ma
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan, 410011, P.R. China. .,Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany.
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7
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Richards DK, Pearson MR, Hallgren KA, Heather N, Witkiewitz K. An application of moderated nonlinear factor analysis to develop a commensurate measure of alcohol problems across four alcohol treatment studies. Drug Alcohol Depend 2021; 229:109068. [PMID: 34628095 PMCID: PMC8671250 DOI: 10.1016/j.drugalcdep.2021.109068] [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: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Self-report measures of alcohol problems are commonly included in studies evaluating treatment and recovery from alcohol use disorder (AUD), but no prior study has examined the replicability of the measurement of alcohol problems across studies with various measures and diverse samples. Further, it is unclear which items may be better indicators of alcohol problems for patient subgroups. In the present study, we integrated data from four large alcohol treatment studies to develop a commensurate measure of alcohol problems using moderated nonlinear factor analysis (MNLFA). METHODS Data were from the COMBINE study, Project MATCH, the Relapse Replication and Extension Project (RREP), and the United Kingdom Alcohol Treatment Trial (UKATT), yielding a total sample size of 4414. MNLFA was carried out on the Drinker Inventory of Consequences (COMBINE, MATCH, RREP) and Alcohol Problems Questionnaire (UKATT). RESULTS We successfully created a 78-item commensurate measure of alcohol problems and examined differential item functioning (DIF) by study membership, time, and socio-demographic characteristics. Sixty-two items demonstrated intercept DIF, suggesting differences in rates of item endorsement for clients with the same underlying levels of alcohol problems across patient subgroups. Six items demonstrated loading DIF, suggesting differences in the extent to which the items were indicative of alcohol problems across patient subgroups. CONCLUSIONS The self-reported measurement of alcohol problems replicates across measures and diverse samples. Items with DIF have clinical implications for the treatment of AUD. Finally, MNLFA scores can be used to test substantive research questions across these studies.
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Affiliation(s)
- Dylan K Richards
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States.
| | - Matthew R Pearson
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Nick Heather
- Department of Psychology, Northumbria University, United Kingdom
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States; Department of Psychology, University of New Mexico, United States
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Edelman EJ, Gan G, Dziura J, Esserman D, Morford KL, Porter E, Chan PA, Cornman DH, Oldfield BJ, Yager J, Muvvala SB, Fiellin DA. Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation. J Acquir Immune Defic Syndr 2021; 87:959-970. [PMID: 33675619 PMCID: PMC8192340 DOI: 10.1097/qai.0000000000002666] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. SETTING Four HIV clinics in the northeastern United States. METHODS Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups. RESULTS Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork. CONCLUSIONS Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.
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Affiliation(s)
- E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Geliang Gan
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Denise Esserman
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Kenneth L. Morford
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Philip A. Chan
- Department of Medicine, Brown University, Providence, RI
| | - Deborah H. Cornman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT
| | | | | | - Srinivas B. Muvvala
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - David A. Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Abstract
Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.
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Affiliation(s)
- Barbara S. McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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10
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Social Support Networks and Symptom Severity Among Patients with Co-occurring Mental Health and Substance Use Disorders. Community Ment Health J 2019; 55:768-776. [PMID: 30863904 DOI: 10.1007/s10597-019-00396-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
Patients entering an inpatient psychiatry program (N = 406) with co-occurring mental health and substance use disorders reported on their social support networks (source, type) at treatment intake, and completed symptom measures at baseline and 3-, 9-, and 15-month follow-ups (77%). Longitudinal growth models found aspects of participants' support networks were associated with specific symptoms over time. Less family support (i.e., more conflict) was the most consistent predictor of mental health and substance use outcomes and was associated with greater psychiatric, depression, Post Traumatic Stress Disorder (PTSD), and drug use severity. More peer support (via mutual-help involvement) was associated with greater initial improvement in alcohol use severity. Findings suggest that to facilitate the benefits of social support for patients with a dual diagnosis returning to the community, specific components of support should be assessed and considered in the treatment plan, rather than viewing support as a general and undifferentiated factor affecting recovery.
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11
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Design of a randomized controlled trial examining the efficacy of oxytocin to enhance alcohol behavioral couple therapy. Contemp Clin Trials 2019; 82:1-8. [PMID: 31063869 DOI: 10.1016/j.cct.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/20/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD.
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12
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Gilbert PA, Pro G, Zemore SE, Mulia N, Brown G. Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample. Alcohol Clin Exp Res 2019; 43:722-731. [PMID: 30807660 PMCID: PMC6443428 DOI: 10.1111/acer.13965] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of adults with alcohol use disorders do not obtain help, and women are less likely to utilize alcohol services than men. We sought to quantify gender differences in alcohol services utilization, overall and by type, using national longitudinal data and to explore potential gender differences in perceived need for help and reasons for not seeking help. METHODS We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions from White, African American, and Hispanic adults (n = 2,592) who met DSM-IV criteria for alcohol abuse or dependence at Wave 1 (2000 to 2001). We tested gender differences in Wave 2 (2004 to 2005) services utilization, perceived need for help, and treatment barriers using Rao-Scott chi-square tests and assessed predictors of outcomes in multivariable logistic regression, adjusting for problem severity, co-occurring disorders, and demographics. RESULTS Women had much lower odds than men of utilizing any alcohol service (adjusted odds ratio [aOR] 0.53; 95% confidence interval [95% CI]: 0.33, 0.86), specialty services (aOR 0.41; 95% CI 0.19, 0.87), and 12-step groups (aOR 0.39; 95% CI 0.21, 0.71). Perceived need for help among those who had not used any services was very low (5%), with no gender difference. Further, men and women reported equivalent numbers of treatment barriers and the same rank order for the most frequently endorsed barriers. However, women were twice as likely as men to think a problem would get better by itself-the most frequent reason for not seeking help (47% vs. 24%, p < 0.001), and men were more likely than women to report unsuccessful past help-seeking and not thinking anyone could help (19% vs. 3%, p < 0.001 and 17% vs. 5%, p = 0.001, respectively). CONCLUSIONS Consistent with previous studies, women were less likely to utilize alcohol services than men. Future interventions should address low problem recognition, and tailoring to gender-specific barriers may help close the disparity in services utilization.
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Affiliation(s)
- Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - George Pro
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Sarah E Zemore
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Grant Brown
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
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Kim Y, Hack LM, Ahn ES, Kim J. Practical outpatient pharmacotherapy for alcohol use disorder. Drugs Context 2018; 7:212308. [PMID: 29445407 PMCID: PMC5804871 DOI: 10.7573/dic.212308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 12/20/2022] Open
Abstract
Alcohol use disorder (AUD) is commonly encountered in clinical practice. A combination of psychosocial intervention and pharmacotherapy is the cornerstone of AUD treatment. Despite their efficacy, safety and cost-effectiveness, clinicians are reluctant to prescribe medications to treat individuals with AUD. Given the high rate of relapse with psychosocial intervention alone, increasing patient access to this underutilized treatment has the potential to improve clinical outcome in this difficult-to-treat population. Herein, we provide practical pharmacotherapy strategies to improve treatment outcome for AUD. We review the efficacy and side effects of both on- and off-label agents with a particular focus on clinical applicability. Recommendations are supported by findings from randomized controlled trials (RCT) and meta-analyses selected to be representative, where possible, of current treatment guidelines. The goal of this paper is to help readers use pharmacotherapy with greater confidence when treating patients with AUD.
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Affiliation(s)
- Youngjung Kim
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura M Hack
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth S Ahn
- Department of Psychiatry, University of Florida School of Medicine, Gainesville, FL, USA
| | - Jungjin Kim
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
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Houston RJ, Schlienz NJ. Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:30-40. [PMID: 29397076 DOI: 10.1016/j.bpsc.2017.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/21/2022]
Abstract
Substance use disorders (SUDs) are one of the most prevalent psychiatric conditions and represent a significant public health concern. Substantial research has identified key processes related to reinforcement and cognition for the development and maintenance of SUDs, and these processes represent viable treatment targets for psychosocial and pharmacological interventions. Research on SUD treatments has suggested that most approaches are comparable in effectiveness. As a result, recent work has focused on delineating the underlying mechanisms of behavior change that drive SUD treatment outcome. Given the rapid fluctuations associated with the key neurocognitive processes associated with SUDs, high-temporal-resolution measures of human brain processing, namely event-related potentials (ERPs), are uniquely suited to expand our understanding of the underlying neural mechanisms of change during and after SUD treatment. The value of ERPs in the context of SUD treatment are discussed along with work demonstrating the predictive validity of ERPs as biomarkers of SUD treatment response. Example associations between multiple ERP components and psychosocial and/or pharmacological treatment outcome include the P3a and P3b (in response to neutral and substance-related cues), the attention-related negativities (e.g., N170, N200), the late positive potential, and the error-related negativity. Also addressed are limitations of the biomarker approach to underscore the need for research programs evaluating mechanisms of change. Finally, we emphasize the advantages of ERPs as indices of behavior change in SUD treatment and outline issues relevant for future directions in this context.
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Affiliation(s)
- Rebecca J Houston
- Health and Addictions Research Center, Department of Psychology, Rochester Institute of Technology, Rochester, New York.
| | - Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Viability of the World Health Organization quality of life measure to assess changes in quality of life following treatment for alcohol use disorder. Qual Life Res 2017. [PMID: 28647889 DOI: 10.1007/s11136-017-1631-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Quality of life is an outcome often examined in treatment research contexts such as biomedical trials, but has been studied less often in alcohol use disorder (AUD) treatment. The importance of considering QoL in substance use treatment research has recently been voiced, and measures of QoL have been administered in large AUD treatment trials. Yet, the viability of popular QoL measures has never been evaluated in AUD treatment samples. Accordingly, the present manuscript describes a psychometric examination of and prospective changes in the World Health Organization Quality of Life measure (WHOQOL-BREF) in a large sample (N = 1383) of patients with AUD recruited for the COMBINE Study. METHODS Specifically, we examined the construct validity (via confirmatory factor analyses), measurement invariance across time, internal consistency reliability, convergent validity, and effect sizes of post-treatment changes in the WHOQOL-BREF. RESULTS Confirmatory factor analyses of the WHOQOL-BREF provided acceptable fit to the current data and this model was invariant across time. Internal consistency reliability was excellent (α > .9) for the full WHOQOL-BREF for each timepoint; the WHOQOL-BREF had good convergent validity, and medium effect size improvements were found in the full COMBINE sample across time. CONCLUSIONS These findings suggest that the WHOQOL-BREF is an appropriate measure to use in samples with AUD, that the WHOQOL-BREF scores may be examined over time (e.g., from pre- to post-treatment), and the WHOQOL-BREF may be used to assess improvements in quality of life in AUD research.
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Pearson MR, Kirouac M, Witkiewitz K. Questioning the validity of the 4+/5+ binge or heavy drinking criterion in college and clinical populations. Addiction 2016; 111:1720-6. [PMID: 27605077 PMCID: PMC5017312 DOI: 10.1111/add.13210] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/24/2015] [Accepted: 10/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The terms 'binge drinking' and 'heavy drinking' are both operationalized typically as 4+/5+ standard drinks per occasion for women/men, and are used commonly as a proxy for non-problematic (<4/<5) versus problematic (4+/5+) drinking in multiple research contexts. The Food and Drug Administration in the United States recently proposed the 4+/5+ criterion as a primary efficacy end-point in their guidance for trials examining new medications for alcohol use disorders (AUDs). Internationally, similar cut-offs have been proposed, with the European Medicines Agency having identified reductions in the number of heavy drinking days (defined as 40/60 g pure alcohol in women/men) as a primary end-point for efficacy trials with a harm reduction goal. ANALYSIS AND EVIDENCE We question the validity of the 4+/5+ cut-off (and other similar cut-offs) on multiple accounts. The 4+/5+ cut-off has not been shown to have unique predictive validity or clinical utility. The cut-off has been created based on retrospective self-reports and its use demonstrates ecological bias. Given strong evidence that the relationship between alcohol consumption and problems related to drinking is at least monotonic, if not linear, there is little existing evidence to support the 4+/5+ cut-off as a valid marker of problematic alcohol use. CONCLUSIONS There is little empirical evidence for the 4+/5+ standard drinks per occasion threshold for 'binge' or 'heavy' drinking in indexing treatment efficacy. Further consideration of an appropriate threshold seems to be warranted.
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Affiliation(s)
- Matthew R. Pearson
- Corresponding Author: Matthew R. Pearson, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, MSC 11-6280, Albuquerque, NM 87106. , Phone: 1-505-925-2322
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Kleczkowska P, Smaga I, Filip M, Bujalska-Zadrozny M. Are Alcohol Anti-relapsing and Alcohol Withdrawal Drugs Useful in Cannabinoid Users? Neurotox Res 2016; 30:698-714. [PMID: 27484692 DOI: 10.1007/s12640-016-9655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
Cannabinoids are still classified as illegal psychoactive drugs despite their broad and increasingly acknowledged therapeutic potential. These substances are most famous for their wide recreational use, particularly among young adults to either alter the state of consciousness, intensify pleasure induced by other psychoactive substances or as an alternative to the previously abused drugs. It is important to emphasize that cannabinoids are often taken together with a variety of medications intended for the treatment of alcohol use disorder (AUD) or alcohol withdrawal syndrome (AWS). These medications include disulfiram, acamprosate, and naltrexone. In this paper, we summarize recent advances in the knowledge of possible beneficial effects and interactions between cannabinoids and drugs commonly used for treatment of AUD and AWS either comorbid or existing as a separate disorder.
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Affiliation(s)
- Patrycja Kleczkowska
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, 1B Banacha Str, 02-097, Warsaw, Poland.
| | - Irena Smaga
- Faculty of Pharmacy, Medical College, Jagiellonian University, Medyczna 9, 30-688, Kraków, Poland
| | - Małgorzata Filip
- Laboratory of Drug Addiction Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, 1B Banacha Str, 02-097, Warsaw, Poland
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Worley MJ, Witkiewitz K, Brown SA, Kivlahan DR, Longabaugh R. Social network moderators of naltrexone and behavioral treatment effects on heavy drinking in the COMBINE study. Alcohol Clin Exp Res 2016; 39:93-100. [PMID: 25623409 DOI: 10.1111/acer.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 10/14/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral naltrexone is an efficacious medication for treatment of alcohol dependence, but small effect sizes and variability in outcomes suggest the presence of person-level moderators of naltrexone response. Identification of contextual or psychosocial moderators may assist in guiding clinical recommendations. Given the established importance of social networks in drinking outcomes, as well as the potential effects of naltrexone in reducing cue reactivity which may be especially important among those with more heavy drinkers and more alcohol cues in their networks, we examined pretreatment social network variables as potential moderators of naltrexone treatment effects in the COMBINE study. METHODS The sample included all COMBINE study participants in medication conditions with full data on the Important People Inventory (IPI) and covariates at intake (N = 1,197). The intake IPI assessed whether participants had any frequent drinkers in their network and the average frequency of contact with these drinkers. The effects of treatment condition, pretreatment network variables, and their interactions on percent heavy drinking days were tested in hierarchical linear models, controlling for demographics and baseline clinical covariates. RESULTS In treatment conditions involving medical management and combined behavioral intervention (CBI), the effects of active naltrexone on heavy drinking were significantly greater for individuals with frequent drinkers in their network (z = -2.66, p < 0.01) and greater frequency of contact with those drinkers (z = -3.19, p < 0.01). These network variables did not moderate the effects of active naltrexone without CBI. CONCLUSIONS When delivered in conjunction with behavioral interventions, naltrexone can be more potent for alcohol-dependent adults who have greater contact with frequent drinkers prior to treatment, which may indicate patterns of environmental exposure to alcohol. Contextual, social risk factors are a potential avenue to guide personalized treatment of alcohol dependence.
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Affiliation(s)
- Matthew J Worley
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
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19
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Moyers TB, Houck J, Rice SL, Longabaugh R, Miller WR. Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project. J Consult Clin Psychol 2016; 84:221-9. [PMID: 26795938 DOI: 10.1037/ccp0000074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Common factors such as therapist empathy play an important role in treatment for addictive behaviors. The present study was a secondary analysis designed to evaluate the relation between therapist empathy and alcohol treatment outcomes in data from a large, multisite, randomized controlled trial. METHOD Audio-recorded psychotherapy sessions for 38 therapists and 700 clients had been randomly selected for fidelity coding from the combined behavioral intervention condition of Project COMBINE. Sessions were evaluated by objective raters for both specific content (coping with craving, building social skills, and managing negative mood) and relational components (empathy level of the therapist). Multilevel modeling with clients nested within therapists evaluated drinks per week at the end of treatment. RESULTS Approximately 11% of the variance in drinking was accounted for by therapists. A within-therapist effect of empathy was detected (B = -0.381, SE = 0.103, p < .001); more empathy than usual was associated with subsequent decreased drinking. The Social and Recreational Counseling module (B = -0.412, SE = 0.124, p < .001), Coping with Cravings and Urges module (B = -0.362, SE = 0.134, p < .01), and the Mood Management module (B = -0.403, SE = 0.138, p < .01) were also associated with decreased drinking. No between-therapist effect was detected, and the Empathy × Module Content interactions were not significant. CONCLUSIONS The results of the study appear consistent with the hypothesis that skills building and therapist empathy are independent contributions to the overall benefit derived from the combined behavioral intervention.
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Affiliation(s)
| | - Jon Houck
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico
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Magill M, Kiluk BD, McCrady BS, Tonigan JS, Longabaugh R. Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later. Alcohol Clin Exp Res 2015; 39:1852-62. [PMID: 26344200 PMCID: PMC4592447 DOI: 10.1111/acer.12848] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current review revisits the article entitled: "Active Ingredients: How and Why Evidence-Based Alcohol Behavioral Treatment Interventions Work" published in Alcoholism: Clinical and Experimental Research. This work summarized proceedings from a 2004 Symposium of the same name that was held at the Annual Meeting of the Research Society on Alcoholism (RSA). A decade has passed, which provides occasion for an evaluation of progress. In 2014, an RSA symposium titled Active Treatment Ingredients and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later did just that. METHODS The current review revisits state-of-the-art research on the 3 treatments examined 10 years ago: cognitive behavioral therapy, alcohol behavior couples therapy, and 12-step facilitation. Because of its empirically validated effectiveness and robust research agenda on the study of process outcome, motivational interviewing has been selected as the fourth treatment modality to be discussed. For each of these 4 treatments, the reviewers provide a critical assessment of current theory and research with a special emphasis on key recommendations for the future. RESULTS Noteworthy progress has been made in identifying active ingredients of treatments and mechanisms of behavior change in these 4 behavioral interventions for alcohol and other drug use disorders. Not only have we established some of the mechanisms through which these evidence-based treatments work, but we have also uncovered some of the limitations in our existing frameworks and methods. CONCLUSIONS Further progress in this area will require a broader view with respect to conceptual frameworks, analytic methods, and measurement instrumentation.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Brian D Kiluk
- Yale University School of Medicine, New Haven, Connecticut
| | - Barbara S McCrady
- Center on Substance Abuse, Alcoholism, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - J Scott Tonigan
- Center on Substance Abuse, Alcoholism, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
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Loheswaran G, Soklaridis S, Selby P, Le Foll B. Screening and Treatment for Alcohol, Tobacco and Opioid Use Disorders: A Survey of Family Physicians across Ontario. PLoS One 2015; 10:e0124402. [PMID: 25923976 PMCID: PMC4414580 DOI: 10.1371/journal.pone.0124402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 03/13/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION As a primary point of contact within the health care system, family physicians are able to play a vital role in identifying individuals with substance use disorders and connecting them to the appropriate treatment. However, there is very little data available on whether family physicians are actively screening for and treating substance use disorders. The objective of the current survey was to assess whether family physicians in Ontario are screening for alcohol, opioid and tobacco use disorders, using validated tools and providing treatment. METHODS An online survey consisting of a series of 38 primarily close-ended questions was circulated to family physicians in Ontario. Rates of screening for alcohol, opioid and tobacco dependence, use of validated tools for screening, providing treatment for dependent individuals and the current barriers to the prescription of pharmacotherapies for these drug dependences were assessed. RESULTS The use of validated screening tools was limited for all three substances. Screening by family physicians for the substance use disorders among adolescents was much lower than screening among adults. Pharmacotherapy was more commonly used as an intervention for tobacco dependence than for alcohol and opioid dependence. This was explained by the lack of knowledge among family physicians on the pharmacotherapies for alcohol and opioid dependence. CONCLUSIONS Findings from the current study suggest there is a need for family physicians to integrate screening for substance use disorders using validated tools into their standard medical practice. Furthermore, there is a need for increased knowledge on pharmacotherapies for alcohol and opioid use disorders. It is important to note that the low response rate is a major limitation to this study. One possible reason for this low response rate may be a lack of interest and awareness among family physicians on the importance of screening and treatment of substance use disorders in Ontario.
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Affiliation(s)
- Genane Loheswaran
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- CAMH Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ambulatory Care and Structured Treatments, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ambulatory Care and Structured Treatments, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Evidence-Based Treatments for Substance Use Disorders. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The multi-site prescription opioid addiction treatment study: 18-month outcomes. J Subst Abuse Treat 2014; 48:62-9. [PMID: 25189089 DOI: 10.1016/j.jsat.2014.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 11/20/2022]
Abstract
Despite the high prevalence of prescription opioid dependence in the U.S., little is known about the course of this disorder and long-term response to treatment. We therefore examined 18-month post-randomization outcomes of participants in the Prescription Opioid Addiction Treatment Study, a multi-site, randomized controlled trial examining varying durations of buprenorphine-naloxone treatment and different intensities of counseling for prescription opioid dependence. Thus the current follow-up study provides a unique contribution to the field by reporting longer-term outcomes of a well-characterized population of treatment-seeking prescription opioid dependent patients. Participants from the treatment trial (N=252/653) completed an 18-month follow-up telephone assessment. Multivariable analyses examined associations between participant characteristics and key indicators of month-18 status: opioid abstinence, DSM-IV opioid dependence, and opioid agonist treatment. Overall, participants showed improvement from baseline to month 18: 49.6% were abstinent in the previous 30 days, with only 16.3% opioid-dependent. Some participants, however, had initiated past-year heroin use (n=9) or opioid injection (n=17). Most participants (65.9%) engaged in substance use disorder treatment during the past year, most commonly opioid agonist therapy (48.8%). Of particular interest in this population, multivariable analysis showed that greater pain severity at baseline was associated with opioid dependence at 18 months. In conclusion, although opioid use outcomes during the treatment trial were poor immediately following a buprenorphine-naloxone taper compared to those during 12 weeks of buprenorphine-naloxone stabilization, opioid use outcomes at 18-month follow-up showed substantial improvement over baseline and were comparable to the rate of successful outcomes during buprenorphine-naloxone stabilization in the treatment trial.
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Berner MM, Wahl S, Brueck R, Frick K, Smolka R, Haug M, Hoffmann S, Reinhard I, Leménager T, Gann H, Batra A, Mann K. The place of additional individual psychotherapy in the treatment of alcoholism: a randomized controlled study in nonresponders to anticraving medication-results of the PREDICT study. Alcohol Clin Exp Res 2013; 38:1118-25. [PMID: 24255998 DOI: 10.1111/acer.12317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/09/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Goal of the presented study is to evaluate whether alcohol-dependent patients given additional individual psychotherapy after a heavy relapse during pharmacotherapy remain abstinent for longer than those who continue with pharmacotherapy alone. METHODS In a randomized, multicenter study, 109 alcohol-dependent patients who had suffered a heavy relapse either while receiving anticraving medication or placebo were randomized into 2 groups. One group received medication, medical management, and additional individual, disorder-specific, cognitive-behavioral psychotherapy, while the control group received medication and medical management only. Main outcome was defined as days until first heavy relapse. RESULTS Fifty-four patients were randomized to the psychotherapy group, 55 to the control group. Intention-to-treat and completer analyses found no differences between groups, whereas as-treated analyses (patients who actually received psychotherapy compared with those who did not) found a significant effect of psychotherapy. CONCLUSIONS Our data indicate that patients that are willing to attend psychotherapy benefit from receiving psychotherapy in addition to pharmacotherapy. We suggest that it may be beneficial to consider patients' preferences concerning psychotherapy at an earlier stage during treatment.
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Affiliation(s)
- Michael M Berner
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany
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Mann K, Lemenager T, Hoffmann S, Reinhard I, Hermann D, Batra A, Berner M, Wodarz N, Heinz A, Smolka MN, Zimmermann US, Wellek S, Kiefer F, Anton RF. Results of a double-blind, placebo-controlled pharmacotherapy trial in alcoholism conducted in Germany and comparison with the US COMBINE study. Addict Biol 2013; 18:937-46. [PMID: 23231446 DOI: 10.1111/adb.12012] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The results of placebo-controlled trials (RCTs) with acamprosate or naltrexone vary substantially. Those differences have been attributed to differing patient characteristics, recruitment strategies, treatment settings and remuneration systems. We tested these assumptions by comparing a new double-blind, placebo-controlled randomized trial conducted in Germany (called PREDICT Study) with data from the US COMBINE Study. PREDICT was designed according to the protocol of the COMBINE Study. A total of 426 alcohol-dependent patients were compared to 459 COMBINE Study patients corresponding to the treatment cells in PREDICT. All patients received acamprosate, naltrexone or placebo for 3 months (PREDICT) or 4 months (COMBINE). Biweekly manualized 'medical management' to enhance compliance was delivered in both studies. Time until the first occurrence of heavy drinking was the main outcome measure. PREDICT found neither acamprosate nor naltrexone to supply any additional benefit compared with placebo, which is at variance with a positive naltrexone effect being reported in the COMBINE Study. A secondary comparison between both studies showed better overall treatment outcomes in PREDICT, although these patients had been more severely affected than their COMBINE counterparts. The divergence in results may be attributable to basic differences in the treatment environments (such as in-patient pre-treatment versus primary outpatient care). We suggest that identically designed RCTs conducted in different parts of the world may help improve the external validity of RCTs. This approach could be called 'comparative efficacy research'.
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Affiliation(s)
- Karl Mann
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Tagrid Lemenager
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Sabine Hoffmann
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Iris Reinhard
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Derik Hermann
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Anil Batra
- University Hospital for Psychiatry & Psychotherapy; University of Tuebingen; Germany
| | - Michael Berner
- Department of Psychiatry & Psychotherapy; University of Fribourg; Germany
| | - Norbert Wodarz
- Department of Psychiatry & Psychotherapy; University of Regensburg; Germany
| | - Andreas Heinz
- Department of Psychiatry & Psychotherapy; University of Berlin, Charité; Germany
| | - Michael N. Smolka
- Department of Psychiatry & Psychotherapy; Technische Universität Dresden; Germany
| | - Ulrich S. Zimmermann
- Department of Psychiatry & Psychotherapy; Technische Universität Dresden; Germany
| | - Stefan Wellek
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Falk Kiefer
- Central Institute of Mental Health; Medical Faculty Mannheim; University of Heidelberg; Germany
| | - Raymond F. Anton
- Center for Drug & Alcohol Programs; Medical University of South Carolina; Charleston SC USA
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Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:388-406. [PMID: 23731427 PMCID: PMC3753025 DOI: 10.1080/19371918.2013.774673] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Epidemiological studies find that psychiatric disorders, including mental disorders and substance use disorders, are common among adults and highly comorbid. Integrated treatment refers to the focus of treatment on two or more conditions and to the use of multiple treatments such as the combination of psychotherapy and pharmacotherapy. Integrated treatment for comorbidity has been found to be consistently superior compared to treatment of individual disorders with separate treatment plans. This article focuses on a review of the risks for developing comorbid disorders and the combinations of treatments that appear to be most effective for clients with particular comorbid disorders.
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Affiliation(s)
- Thomas M Kelly
- The Center for Psychiatric and Chemical Dependency Services, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Abstract
This article reviews the spectrum of alcohol use disorders. The pharmacologic properties of ethanol and its metabolism, and the historical, physical, and laboratory elements that may help diagnose an alcohol use disorder are examined. The concepts of motivational interviewing and stages of change are mentioned, along with the American Society of Addiction Medicine patient placement criteria, to determine the best level of treatment for alcoholism. Various therapeutic management options are reviewed, including psychological, pharmacologic, and complementary/alternative choices. This article provides a basic understanding of available tools to diagnose and treat this cunning and baffling brain and multisystem disease.
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Affiliation(s)
- Anthony P Albanese
- Hepatology and Chemical Dependency, VA Northern California Healthcare System, University of California Davis School of Medicine, Sacramento, CA, USA.
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Manning V, Gomez B, Koh PK, Ng A, Guo S, Kandasami G, Wong KE. Treatment outcome and its predictors among Asian problem drinkers. Drug Alcohol Rev 2012; 32:178-86. [PMID: 23043535 DOI: 10.1111/j.1465-3362.2012.00518.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/31/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Evidence of treatment effectiveness for alcohol use disorders (AUD) have emerged predominantly from Western studies, using highly controlled trials that may not reflect real-world settings. This paper examines treatment outcome and its predictors among Asian problem drinkers participating in a treatment outcome monitoring program at an addiction treatment centre in Singapore. DESIGN AND METHODS Data were collected at intake and 3, 6 and 12 months, although the focus of this paper is on reliable change at 3 months among the 70% who were followed up. Five hundred and forty-one AUD-diagnosed outpatients presenting for treatment, over a 2-year period, were assessed on drinking behaviours and administered the Addiction Severity Index-Lite, Personal Wellbeing Index (PWI) and Treatment Perceptions Questionnaire. RESULTS At 3 months, drinking days, alcohol units and alcohol use severity had more than halved and 69% were either abstinent or had reliably reduced their drinking days. Baseline drinking days and treatment satisfaction predicted 3-month drinking frequency but not severity. Positive alcohol outcomes observed at 3 months were sustained among those followed up until 12 months. Mean PWI score improved significantly and fell within the 'normal' range. Treatment satisfaction also emerged as the only significant predictor of reliable positive change in both drinking days and PWI score. DISCUSSION AND CONCLUSIONS Significant reductions in drinking frequency and severity are possible for Asian problem drinkers after 12 weeks of outpatient treatment. The identified predictors suggest that more frequent drinkers and patients with past/current psychiatric comorbidities may require a more intensive treatment approach to optimise treatment outcomes.
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Affiliation(s)
- Victoria Manning
- National Addictions Management Service, Institute of Mental Health, Singapore.
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Lingford-Hughes AR, Welch S, Peters L, Nutt DJ. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 2012; 26:899-952. [PMID: 22628390 DOI: 10.1177/0269881112444324] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
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Worley MJ, Trim RS, Roesch SC, Mrnak-Meyer J, Tate SR, Brown SA. Comorbid depression and substance use disorder: longitudinal associations between symptoms in a controlled trial. J Subst Abuse Treat 2012; 43:291-302. [PMID: 22406052 DOI: 10.1016/j.jsat.2011.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 12/14/2011] [Accepted: 12/22/2011] [Indexed: 11/18/2022]
Abstract
This study examined the longitudinal association between substance use and depressive symptoms in veterans receiving outpatient treatment for comorbid substance use disorder and major depression. Veterans (N = 237, mean age = 48.2 years, 90% male, 70% Caucasian) received either 6 months of group integrated cognitive-behavioral therapy or twelve-step facilitation. Hamilton Depression Rating Scale scores and percent days using any substance were assessed every 3 months up to 1 year posttreatment. Greater substance use predicted time-varying elevations in depression above individual patterns of change in depression. Moreover, change in depressive symptoms was associated with change in both the likelihood of any substance use and the frequency of use during the treatment and follow-up periods. Changes in these symptoms appear to be linked, such that individuals with greater reductions in substance use have greater reductions in depressive symptoms (and vice versa).
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Affiliation(s)
- Matthew J Worley
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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32
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Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav 2012; 37:11-24. [PMID: 21981788 DOI: 10.1016/j.addbeh.2011.09.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/29/2011] [Accepted: 09/06/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients. METHOD Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity. RESULTS Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions. CONCLUSIONS Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.
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Hartzler B, Witkiewitz K, Villarroel N, Donovan D. Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:269-78. [PMID: 21443293 DOI: 10.1037/a0022869] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Empirically-supported treatments for alcohol dependence exist, yet understanding of influences contributing to the intended behavior change is limited. The current study, a secondary analysis of the recent multisite COMBINE trial (The COMBINE Study Research Group, 2003), tested a mediational model wherein change in client self-efficacy for abstinence was examined as a potential mediator of associations between client report of the therapeutic bond and one-year outcomes of drinking frequency, drinking consequences, and psychiatric functioning. For analyses, the 1383 COMBINE trial participants were grouped as follows: 1) those receiving study medications (naltrexone, acamprosate, naltrexone + acamprosate, placebo) and enrolled in medication management (MM) only (n = 607), 2) those receiving study medications/MM and also enrolled in a combination behavioral intervention (CBI) as well (n = 619), and 3) those enrolled in CBI only (n = 157). Mediation analyses using the product-of-coefficients approach indicated self-efficacy change during treatment significantly mediated associations between the therapeutic bond with the CBI therapist and each of the three one-year outcomes among those exclusively receiving CBI, but failed to do so among those receiving pills/MM (with or without CBI). Effect sizes were small, but indicated that variance in bond-outcome associations was partially mediated by self-efficacy change for trial participants. Findings advance understanding of proximal client change processes during delivery of treatments for alcohol dependence.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Witkiewitz K, Villarroel NA, Hartzler B, Donovan DM. Drinking outcomes following drink refusal skills training: differential effects for African American and non-Hispanic White clients. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:162-7. [PMID: 21443311 DOI: 10.1037/a0022254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, Washington State University-Vancouver, Vancouver, WA 98686, USA.
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Olive MF, Cleva RM, Kalivas PW, Malcolm RJ. Glutamatergic medications for the treatment of drug and behavioral addictions. Pharmacol Biochem Behav 2011; 100:801-10. [PMID: 21536062 DOI: 10.1016/j.pbb.2011.04.015] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/28/2011] [Accepted: 04/15/2011] [Indexed: 12/22/2022]
Abstract
Historically, most pharmacological approaches to the treatment of addictive disorders have utilized either substitution-based methods (i.e., nicotine replacement or opioid maintenance) or have targeted monoaminergic or endogenous opioidergic neurotransmitter systems. However, substantial evidence has accumulated indicating that ligands acting on glutamatergic transmission are also of potential utility in the treatment of drug addiction, as well as various behavioral addictions such as pathological gambling. The purpose of this review is to summarize the pharmacological mechanisms of action and general clinical efficacy of glutamatergic medications that are currently approved or are being investigated for approval for the treatment of addictive disorders. Medications with effects on glutamatergic transmission that will be discussed include acamprosate, N-acetylcysteine, d-cycloserine, gabapentin, lamotrigine, memantine, modafinil, and topiramate. We conclude that manipulation of glutamatergic neurotransmission is a relatively young but promising avenue for the development of improved therapeutic agents for the treatment of drug and behavioral addictions.
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Affiliation(s)
- M Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA.
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Grosshans M, Loeber S, Kiefer F. Implications from addiction research towards the understanding and treatment of obesity. Addict Biol 2011; 16:189-98. [PMID: 21371174 DOI: 10.1111/j.1369-1600.2010.00300.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recent research indicates similarities between obesity and addictive disorders on both the phenomenological and neurobiological level. In particular, neuroendocrine and imaging studies suggest a close link between the homeostatic regulation of appetite on the on hand, and motivation and reward expectancy on the other. In addition, findings from neuropsychological studies additionally demonstrate alterations of cognitive function in both obesity and addictive disorders that possibly contribute to a lack of control in resisting consumption. In this review, recent findings on overlapping neurobiological and phenomenological pathways are summarized and the impact with regard to new treatment approaches for obesity is discussed.
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Affiliation(s)
- Martin Grosshans
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Germany
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Falk D, Wang XQ, Liu L, Fertig J, Mattson M, Ryan M, Johnson B, Stout R, Litten RZ. Percentage of Subjects With No Heavy Drinking Days: Evaluation as an Efficacy Endpoint for AlcoholClinical Trials. Alcohol Clin Exp Res 2010; 34:2022-34. [DOI: 10.1111/j.1530-0277.2010.01290.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Longabaugh R, Wirtz PW, Zywiak WH, O'malley SS. Network support as a prognostic indicator of drinking outcomes: the COMBINE Study. J Stud Alcohol Drugs 2010; 71:837-46. [PMID: 20946740 PMCID: PMC2965482 DOI: 10.15288/jsad.2010.71.837] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 04/28/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To increase understanding of the interrelationship between a patient's social network and patient drinking, the Important People and Activities (IPA) instrument was developed. To meet the aims of the COMBINE (Combining Medications and Behavioral Interventions) Study, the IPA was modified to create the Important People Inventory (IPI), which was used to measure the contextual influence of the patient's social network on patient outcomes and treatment effects. The aims of the present article were to describe the IPI and its differences from the IPA and to test the relationship of network support as measured by the IPI in predicting drinking during and following treatment. METHOD Alcohol-dependent patients (N = 1,373) seeking outpatient treatment in the COMBINE randomized clinical trial were administered the IPI before treatment. Six network constructs were tested for predicting patient drinking. RESULTS As unique effects, alcohol-specific support, as measured by network drinking and opposition to patient drinking, is predictive of patient abstinent days during and following treatment and heavy drinking days following treatment. Other measures of network support have variable relationships to patient drinking at different phases: Some are predictive of patient drinking during treatment but diminish, whereas others are unrelated to drinking during treatment but become increasingly predictive of drinking as time from treatment increases. CONCLUSIONS The IPI is a useful instrument for describing network support of alcohol-use disorder patients entering treatment. Measures of alcohol-specific support are prognostic of drinking outcomes. The patient's network support should be systematically assessed prior to tailored treatment planning.
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Affiliation(s)
- Richard Longabaugh
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Philip W. Wirtz
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - William H. Zywiak
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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Witkiewitz K, Maisto SA, Donovan DM. A comparison of methods for estimating change in drinking following alcohol treatment. Alcohol Clin Exp Res 2010; 34:2116-25. [PMID: 20860611 DOI: 10.1111/j.1530-0277.2010.01308.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The ultimate goal of alcohol treatment research is to develop interventions that help individuals reduce their alcohol use. To determine whether a treatment is effective, researchers must then evaluate whether a particular treatment affects changes in drinking behavior after treatment. Importantly, drinking following treatment tends to be highly variable between individuals and within individuals across time. METHOD Using data from the COMBINE study (COMBINE Study Group, 2003), the current study compared 3 commonly used and novel methods for analyzing changes in drinking over time: latent growth curve (LGC) analysis, growth mixture models, and latent Markov models. Specifically, using self-reported drinking data from all participants (n = 1,383, 69% male), we were interested in examining how well the 3 estimated models were able to explain observed changes in percent heavy drinking days during the 52 weeks following treatment. RESULTS The results from all 3 models indicated that the majority of individuals were either abstinent or reported few heavy drinking days during the 52-week follow-up and only a minority of individuals (10% or fewer) reported consistently frequent heavy drinking following treatment. All 3 models provided a reasonably good fit to the observed data with the latent Markov models providing the closest fit. The observed drinking trajectories evinced discontinuity, whereby individuals seem to transition between drinking and nondrinking across adjacent follow-up assessment points. The LGC and growth mixture models both assumed continuous change and could not explain this discontinuity in the observed drinking trajectories, whereas the latent Markov approach explicitly modeled transitions between drinking states. CONCLUSIONS The 3 models tested in the current study provided a unique look at the observed drinking among individuals who received treatment for alcohol dependence. Latent Markov modeling may be a highly desirable methodology for gaining a better sense of transitions between positive and negative drinking outcomes.
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Affiliation(s)
- Katie Witkiewitz
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington, USA.
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40
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Qureshi I, Fang Y. Socialization in Open Source Software Projects: A Growth Mixture Modeling Approach. ORGANIZATIONAL RESEARCH METHODS 2010. [DOI: 10.1177/1094428110375002] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The success of open source software (OSS) projects depends heavily on the voluntary participation of a large number of developers. To remain sustainable, it is vital for an OSS project community to maintain a critical mass of core developers. Yet, only a small number of participants (identified here as ‘‘joiners’’) can successfully socialize themselves into the core developer group. Despite the importance of joiners’ socialization behavior, quantitative longitudinal research in this area is lacking. This exploratory study examines joiners’ temporal socialization trajectories and their impacts on joiners’ status progression. Guided by social resource theory and using the growth mixture modeling (GMM) approach to study 133 joiners in 40 OSS projects, the authors found that these joiners differed in both their initial levels and their growth trajectories of socialization and identified four distinct classes of joiner socialization behavior. They also found that these distinct latent classes of joiners varied in their status progression within their communities. The implications for research and practice are correspondingly discussed.
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Affiliation(s)
- Israr Qureshi
- Department of Management and Marketing, Hong Kong Polytechnic University, Hong Kong, China,
| | - Yulin Fang
- Department of Information Systems, City University of Hong Kong, Hong Kong, China
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41
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Chatterjee S, Bartlett SE. Neuronal nicotinic acetylcholine receptors as pharmacotherapeutic targets for the treatment of alcohol use disorders. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2010; 9:60-76. [PMID: 20201817 DOI: 10.2174/187152710790966597] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/13/2009] [Indexed: 12/20/2022]
Abstract
Alcohol use disorders (AUDs) are complex, and developing effective treatments will require the combination of novel medications and cognitive behavioral therapy approaches. Epidemiological studies have shown there is a high correlation between alcohol consumption and tobacco use, and the prevalence of smoking in alcoholics is as high as 80% compared to about 30% for the general population. Both preclinical and clinical data provide evidence that nicotine administration increases alcohol intake and non-specific nicotinic receptor antagonists reduce alcohol-mediated behaviors. As nicotine interacts specifically with the neuronal nicotinic acetylcholine receptor (nAChR) system, this suggests that nAChRs play an important role in the behavioral effects of alcohol. In this review, we discuss the importance of nAChRs for the treatment of AUDs and argue that the use of FDA approved nAChR ligands, such as varenicline and mecamylamine, approved as smoking cessation aids may prove to be valuable treatments for AUDs. We also address the importance of combining effective medications with behavioral therapy for the treatment of alcohol dependent individuals.
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Affiliation(s)
- S Chatterjee
- Ernest Gallo Clinic and Research Center at the University of California San Francisco, 5858 Horton Street, Suite 200 Emeryville, CA 94608, USA
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Bradizza CM, Maisto SA, Vincent PC, Stasiewicz PR, Connors GJ, Mercer ND. Predicting post-treatment-initiation alcohol use among patients with severe mental illness and alcohol use disorders. J Consult Clin Psychol 2010; 77:1147-58. [PMID: 19968390 DOI: 10.1037/a0017320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few investigators studying alcohol abuse among individuals with a severe mental illness (SMI) have examined predictors of posttreatment alcohol outcomes. In the present study, a multivariate approach based on a theoretical model was used to study the relationship between psychosocial factors and post-treatment-initiation alcohol use. Predictors of alcohol use outcomes were examined in 278 individuals diagnosed with a current schizophrenia-spectrum or bipolar disorder and an alcohol use disorder (AUD). At 6-months follow-up, 144 of 228 available participants (63%) had good clinical outcomes. The results of structural equation modeling indicated that type of pretreatment residential setting was directly related to treatment, with participants who lived in supervised settings (41%) reporting significantly more days of treatment (beta = .34, p < .001). In addition, participants with more psychiatric symptoms, as assessed with the Brief Symptom Inventory and Structured Clinical Interview for the Positive and Negative Syndrome Scale, reported significantly fewer treatment days (beta = -.20, p < .001). Number of days that participants attended treatment was indirectly associated with alcohol use outcomes and was mediated by use of alcohol-specific coping skills, such that more frequent use of such skills was associated with less post-treatment-initiation alcohol use (beta = -.34, p < .001). This study emphasizes the favorable prognosis for alcohol outcomes among treated individuals with SMI and AUD and the importance of psychosocial interventions, particularly those that result in better alcohol-specific coping skills.
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Affiliation(s)
- Clara M Bradizza
- Research Institute on Addictions, University at Buffalo, 1021 Main Street, Buffalo, NY 14203-1016, USA.
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Abstract
This paper is the 31st consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2008 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY 11367, United States.
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Longabaugh R, Wirtz PW, Gulliver SB, Davidson D. Extended naltrexone and broad spectrum treatment or motivational enhancement therapy. Psychopharmacology (Berl) 2009; 206:367-76. [PMID: 19639303 DOI: 10.1007/s00213-009-1615-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 07/06/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Randomized clinical trials on the effectiveness of naltrexone (NTX) in the treatment of alcohol dependence have produced conflicting results. One possible explanation for these discrepancies may lie in the various psychosocial treatments for which NTX is an adjunct. The goal of this study was to examine the interplay between psychosocial treatment and duration of NTX. METHODS One hundred and seventy-four alcohol-dependent outpatients participated in a double-blind trial where they were randomly assigned to 12 vs. 24 weeks NTX duration and to one of two psychosocial treatments: motivational enhancement therapy (MET) and broad spectrum treatment (BST), a cognitive behavioral therapy tailored to the patient's specific needs. After an initial 12-week period of NTX and psychosocial treatment, half of each psychotherapy condition was assigned to continue NTX for an additional 12 weeks while the other half was assigned to placebo. Patient drinking outcomes were measured for the year following treatment completion. It was hypothesized that the combination of extended duration of NTX and the moderate intensity of BST would be predictive of longer time to a first heavy drinking day than any of the three alternative combinations: MET with short or extended NTX administration or BST with short NTX administration. RESULTS The median time to first drink and time to first heavy drinking day were found to be significantly longer for patients who received BST and extended NTX than for patients in the other three groups. CONCLUSIONS These results may suggest that the kind of psychosocial treatment delivered in combination with duration of NTX administration may partially explain the inconsistent findings regarding the efficacy of NTX in the treatment of alcohol dependence.
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Affiliation(s)
- Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Acamprosate and naltrexone treatment effects on ethanol and sucrose seeking and intake in ethanol-dependent and nondependent rats. Psychopharmacology (Berl) 2009; 204:335-48. [PMID: 19153715 PMCID: PMC2864152 DOI: 10.1007/s00213-009-1465-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
RATIONALE Two pharmacotherapies are approved for treating alcohol craving (acamprosate and naltrexone), but both have shown mixed findings in animals and humans. OBJECTIVES The present experiments utilized a "reinforcer blocking" approach (i.e., rats were able to consume ethanol during treatment) to better understand the efficacy of these treatments for ethanol seeking and drinking using ethanol-dependent and nondependent rats. MATERIALS AND METHODS In "nondependent" experiments, drugs (acamprosate 50, 100, and 200 mg/kg; naltrexone 0.1, 0.3, and 1.0 mg/kg) were administered over 3-week periods prior to operant sessions with a low response requirement to gain access to reinforcers for 20 min. For "dependent" experiments, rats were made dependent in vapor/inhalation chambers. RESULTS Acamprosate and naltrexone had similar effects on intake in nondependent and dependent rats; neither drug was selective for ethanol over sucrose drinking. In nondependent animals, naltrexone was more efficacious at more doses than acamprosate, and acamprosate's effects were limited to a dose that also had adverse effects on body weight. Both pharmacotherapies showed more selectivity when examining reinforcer seeking. In nondependent rats, acamprosate and naltrexone had response-attenuating effects in ethanol, but not sucrose, groups. In dependent animals, acamprosate had selective effects limited to a decrease in sucrose seeking. Naltrexone, however, selectively decreased ethanol-seeking in nondependent rats. CONCLUSIONS The naltrexone-induced decreases in seeking suggested a change in incentive motivation which was selective for ethanol in nondependent rats. The "nondependent" paradigm may model early stages of "problem drinking" in humans, and the findings suggest that naltrexone could be a good intervention for this level of alcohol abuse and relapse prevention.
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LoCastro JS, Youngblood M, Cisler RA, Mattson ME, Zweben A, Anton RF, Donovan DM. Alcohol treatment effects on secondary nondrinking outcomes and quality of life: the COMBINE study. J Stud Alcohol Drugs 2009; 70:186-96. [PMID: 19261230 DOI: 10.15288/jsad.2009.70.186] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the full range of alcohol treatment effectiveness, it is important to assess secondary nondrinking outcome dimensions in addition to primary alcohol consumption outcomes. METHOD We used a large sample (n=1,226) of alcohol-dependent participants entering the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions) Study, a multisite clinical trial of pharmacological (naltrexone [ReVia] and acamprosate [Campral]) and behavioral interventions, to examine the effects of specific treatment combinations on nondrinking functional outcomes. We assessed the outcomes at baseline and at the end of 16 weeks of alcohol treatment and again at the 26-week and/or 52-week postrandomization follow-ups. RESULTS (1) Drinking and secondary outcomes were significantly related, especially at the follow-up periods. A higher percentage of heavy drinking days, more drinks per drinking day, and lower percentage of days abstinent were associated with lower quality-of-life measures. (2) All nondrinking outcomes showed improvement at the end of 16 weeks of treatment and most maintained improvement over the 26-week and 52-week follow-ups. Only two measures returned to pretreatment levels at 52 weeks: percentage of days paid for work and physical health. Improvements of nondrinking outcomes remained even after adjusting for posttreatment heavy drinking status. (3) Although nondrinking outcomes showed overall improvement, specific pharmacological and behavioral treatment combinations were not differentially effective on specific secondary outcomes. CONCLUSIONS In the current study, changes that resulted from treatment were multidimensional, and improvements in nondrinking outcomes reflected the overall significant improvement in drinking but they were not differentiated between treatment combination groups. Findings from this study support the importance of including secondary nondrinking outcomes in clinical alcohol-treatment trials.
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Affiliation(s)
- Joseph S LoCastro
- Department of Psychiatry, Boston University School of Medicine and Veterans Affairs Boston Healthcare System, Boston, Massachusetts 02130, USA.
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Abstract
A 44-year-old businessman with a history of hypertension presents for evaluation with a report of being under stress at work and home, which has led to “unsatisfactory” sleep. Although there is some despondency, screening for depression is negative. His blood pressure is 158/98 mm Hg. Laboratory results include a mean corpuscular volume of 102 fl (normal range, 80 to 100), an alanine aminotransferase level of 60 U per liter (normal range, 7 to 41), an aspartate aminotransferase level of 45 U per liter (normal range, 12 to 38), and a γ-glutamyltransferase level of 110 U per liter (normal range, 9 to 58). His physician asks about alcohol consumption, and the patient admits that perhaps he drinks “more than he should,” since he often wakes up with a hang-over and arrives late to work. After weekend golf outings, he comes home intoxicated, leading to arguments with his wife and embarrassment in front of his children. He has been quietly wondering about the need to cut down or stop drinking and wants some advice. His physician discusses medication or a referral to an alcohol clinic for further evaluation. Naltrexone is proposed as a treatment option.
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Affiliation(s)
- Raymond F Anton
- Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston 29425, USA.
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