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Lane O, Ambai V, Bakshi A, Potru S. Alcohol use disorder in the perioperative period: a summary and recommendations for anesthesiologists and pain physicians. Reg Anesth Pain Med 2024; 49:621-627. [PMID: 38050177 DOI: 10.1136/rapm-2023-104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/26/2023] [Indexed: 12/06/2023]
Abstract
Excessive alcohol consumption and alcohol use disorder (AUD) increase the risk of perioperative morbidity and mortality. Aspiration, malnutrition, coagulopathies, seizures, and hemodynamic alterations are only a few of the major concerns related to acute alcohol intoxication and AUD. There are also numerous physiological effects, changes in medication metabolism and pharmacology, and adverse events related to chronic alcohol consumption. These are all important considerations for the anesthesiologist in the perioperative management of a patient with AUD. Pain perception and thresholds are altered in patients with acute and chronic alcohol use. Medications used to manage AUD symptoms, particularly naltrexone, can have significant perioperative implications. Patients on naltrexone who continue or stop this medication in the perioperative period are at an increased risk for undertreated pain or substance use relapse. This review highlights key considerations for the anesthesiologist and pain physician in the perioperative management of patients with active AUD (or those in recovery). It discusses the effects of acute and chronic alcohol use on pain perception and thresholds, provides guidance on the perioperative management of naltrexone and low-dose naltrexone, and reviews a multimodal approach to pain management.
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Affiliation(s)
- Olabisi Lane
- Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vats Ambai
- Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arjun Bakshi
- Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sudheer Potru
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Eddie D, Prindle J, Somodi P, Gerstmann I, Dilkina B, Saba SK, DiGuiseppi G, Dennis M, Davis JP. Exploring predictors of substance use disorder treatment engagement with machine learning: The impact of social determinants of health in the therapeutic landscape. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209435. [PMID: 38852819 PMCID: PMC11300147 DOI: 10.1016/j.josat.2024.209435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Improved knowledge of factors that influence treatment engagement could help treatment providers and systems better engage patients. The present study used machine learning to explore associations between individual- and neighborhood-level factors, and SUD treatment engagement. METHODS This was a secondary analysis of the Global Appraisal of Individual Needs (GAIN) dataset and United States Census Bureau data utilizing random forest machine learning and generalized linear mixed modelling. Our sample (N = 15,873) included all people entering SUD treatment at GAIN sites from 2006 to 2012. Predictors included an array of demographic, psychosocial, treatment-specific, and clinical measures, as well as environment-level measures for the neighborhood in which patients received treatment. RESULTS Greater odds of treatment engagement were predicted by adolescent age and psychiatric comorbidity, and at the neighborhood-level, by low unemployment and high population density. Lower odds of treatment engagement were predicted by Black/African American race, and at the neighborhood-level by high rate of public assistance and high income inequality. Regardless of the degree of treatment engagement, individuals receiving treatment in areas with high unemployment, alcohol sale outlet concentration, and poverty had greater substance use and related problems at baseline. Although these differences reduced with treatment and over time, disparities remained. CONCLUSIONS Neighborhood-level factors appear to play an important role in SUD treatment engagement. Regardless of whether individuals engage with treatment, greater loading on social determinants of health such as unemployment, alcohol sale outlet density, and poverty in the therapeutic landscape are associated with worse SUD treatment outcomes.
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Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA.
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Paul Somodi
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Isaac Gerstmann
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Bistra Dilkina
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Shaddy K Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Michael Dennis
- Lighthouse Institute, Chestnut Health Systems, Normal, IL, USA
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Mizuno S, Shimane T, Inoura S, Matsumoto T. Situational factors affecting abstinence from drugs: Panel data analysis of patients with drug use disorders in residential drug use treatment. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e174. [PMID: 38868485 PMCID: PMC11114267 DOI: 10.1002/pcn5.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/16/2023] [Accepted: 01/23/2024] [Indexed: 06/14/2024]
Abstract
Aim To identify situational factors that can predict drug abstention in patients with drug use disorders undergoing residential drug use treatment. Methods Patients with drug use disorders admitted to drug addiction rehabilitation centers (DARCs) in 2016 were involved in this study. Longitudinal panel data were used, with eight follow-up surveys over 6 years, approximately every 6 months. Of the 2752 samples from the eight follow-up surveys, 2293 were analyzed as the complete panel data set. The primary outcome was drug abstention for approximately 6 months. The influences of situational factors during this period on the primary outcome were also assessed using a generalized linear mixed model in which inter-individual differences were controlled as variable effects. Results The use of residential DARCs positively influenced the primary outcome (adjusted odds ratio [AOR] 3.33, 95% confidence interval [CI] 1.79-6.21) when compared to no DARC usage. The cessation of drinking also positively affected the primary outcome (AOR 3.10, 95% CI 1.79-4.62), while employment status (AOR 2.22, 95% CI 1.12-4.41) and the cessation of drinking (AOR 4.92, 95% CI 2.77-8.72) positively impacted the primary outcomes of patients not using DARCs. Conclusion The use of residential DARCs and the cessation of drinking positively affected drug abstention rates. Employment and the cessation of drinking for patients who were not using the DARCs also had a positive effect. This information will aid in the development of social recovery strategies for people with drug use disorders.
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Affiliation(s)
- Satomi Mizuno
- Department of Drug Dependence ResearchNational Center of Neurology and Psychiatry, National Institute of Mental HealthTokyoJapan
- Department of Forensic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Takuya Shimane
- Department of Drug Dependence ResearchNational Center of Neurology and Psychiatry, National Institute of Mental HealthTokyoJapan
| | - Satoshi Inoura
- Department of Drug Dependence ResearchNational Center of Neurology and Psychiatry, National Institute of Mental HealthTokyoJapan
| | - Toshihiko Matsumoto
- Department of Drug Dependence ResearchNational Center of Neurology and Psychiatry, National Institute of Mental HealthTokyoJapan
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Shoham E, Efodi R, Haviv N, Gross Shader C. Dropout from Treatment and Desistance from Crime among Released Prisoners in Jerusalem Halfway House for Prisoners with Substance Misuse Disorder. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:1109-1133. [PMID: 33899532 DOI: 10.1177/0306624x211010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The study aims to investigate the rates of recidivism among prisoners on parole with a substance misuse disorder who participated in the Jerusalem halfway-house, which combines supervision, employment, and a comprehensive therapeutic program. The study population included all participants who have been treated in the halfway-house (N = 125), whereas the comparison group included all prisoners with a substance misuse disorder who were released after serving their full sentences (N = 321). To reduce possible selection biases, the Propensity Score Matching method was used. Findings show that prisoners, who were treated at the Jerusalem halfway-house, are characterized by higher and frequent rates of recidivism. However, when only completers of the halfway-house were evaluated, it was found that they had lower and slower rates of recidivism. Findings suggest that completing treatment contributes to desistance from crime in the critical post-release years among participants and indicates the importance of optimal diagnostic processes before admitting prisoners to a halfway-house.
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Affiliation(s)
| | - Rotem Efodi
- Prisoner Rehabilitation Authority, Jerusalem, Israel
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Ghetti C, Chen XJ, Brenner AK, Hakvoort LG, Lien L, Fachner J, Gold C. Music therapy for people with substance use disorders. Cochrane Database Syst Rev 2022; 5:CD012576. [PMID: 35532044 PMCID: PMC9082681 DOI: 10.1002/14651858.cd012576.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. OBJECTIVES To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. SEARCH METHODS We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -1.23 to -0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD -0.33, 95% CI -0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI -0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) -0.17, 95% CI -4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI -0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI -0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD -0.04, 95% CI -0.56 to 0.48; 3 studies, 232 participants), depression (MD -1.49, 95% CI -4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes. We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size. AUTHORS' CONCLUSIONS: Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.
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Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy, University of Bergen, Bergen, Norway
| | - Xi-Jing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China
| | - Annette K Brenner
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hospital Innlandet Trust, Brumunddal, Norway
| | - Jorg Fachner
- Cambridge institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
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Walji A, Romano I, Levitt E, Sousa S, Rush B, MacKillop J, Urbanoski K, Costello MJ. Psychometric evaluation of the treatment entry questionnaire to assess extrinsic motivation for inpatient addiction treatment. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100014. [PMID: 36845886 PMCID: PMC9949302 DOI: 10.1016/j.dadr.2021.100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Valid multi-faceted measurement of motivation for substance use disorder (SUD) treatment is needed to help inform treatment approaches and predict outcomes. This study examined evidence of validity for the Treatment Entry Questionnaire (TEQ-9). METHODS Data represented individuals entering inpatient SUD treatment (n = 1455). We used confirmatory factor analysis (CFA) to assess the three-factor structure of the TEQ-9 [identified (i.e., values/personally chooses treatment), introjected (i.e., internally controlled by guilt/shame) and external motivations (i.e., external pressure/demands)], and examined measurement invariance across gender, age, and ethno-racial identity. Correlation with readiness and confidence assessed convergent validity, while correlations with substance use problem severity and previous substance use treatment assessed meaningful group differences. RESULTS A three-factor structure was confirmed with all items loading significantly onto their respective factors (ps < 0.001). Each subscale demonstrated high internal consistency (Identified α = 0.90; Introjected α = 0.79; External α = 0.85). Each subscale demonstrated measurement invariance up to the scalar level across all sub-groups. Readiness, confidence, and substance use problem severity correlated as expected across various substances with the identified (rs = 0.098 - 0.262, ps < 0.05), and external (rs = -0.096 - -0.178, ps < 0.05) subscales. Additionally, the mean Identified subscale score was significantly higher among those who previously engaged in SUD treatment (p < 0.001). Findings for the Introjected subscale were more ambiguous. CONCLUSIONS Findings provide evidence for factorial validity, measurement invariance, convergent validity and group differences of the TEQ-9 in a large clinically mixed inpatient SUD treatment population, providing further support of its clinical and research utility.
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Affiliation(s)
- Alyna Walji
- Homewood Research Institute, Guelph, ON, Canada
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Isabella Romano
- Homewood Research Institute, Guelph, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Emily Levitt
- Homewood Research Institute, Guelph, ON, Canada
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen Urbanoski
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Canadian Institute for Substance Use Research, University of Victoria, BC, Canada
- School of Public Health and Social Policy, University of Victoria, BC, Canada
| | - Mary Jean Costello
- Homewood Research Institute, Guelph, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Ingram I, Kelly PJ, Carradus LJ, Deane FP, Baker AL, Byrne G, McKay JR, Osborne B, Meyer JM, Nunes JL, Robinson LD, Lunn J. Continuing care following residential alcohol and other drug treatment: Continuing care worker perceptions. Drug Alcohol Rev 2022; 41:88-95. [PMID: 34134173 DOI: 10.1111/dar.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Little is known about the experiences of continuing care workers (CCW) in the implementation of continuing care programs. The current study sought to understand CCWs and supervisor perceptions of the successes and challenges of implementing a telephone-based continuing care intervention following residential alcohol and other drug treatment services. It also aimed to provide recommendations for treatment providers wishing to integrate continuing care into their treatment model, including the resources, training and supervision needs of CCWs. METHODS The participants were eight CCWs and two independent supervisors who completed semi-structured interviews. Interview coding and analysis was guided by Iterative Categorisation procedures and an implementation framework. The Consolidated Framework for Implementation Research was used. RESULTS Telephone delivery was advantageous, but even more enhanced, when there was a face-to-face session first to build rapport. Other key successes included CCWs who were confident and competent, as well as a match between the organisation's values and the philosophy of the continuing care program. Key challenges faced by CCWs related to a perceived lack of support from managers, difficulties accessing quiet office spaces and participant disengagement. DISCUSSION AND CONCLUSIONS Interviews revealed several factors that may influence successful delivery of continuing care as part of alcohol and other drug treatment. These included features of the intervention (e.g. telephone delivery, evidence-based content), characteristics of the individual CCWs (e.g. flexibility in delivery of the intervention while maintaining fidelity), organisational culture (e.g. alignment of organisational values with continuing care) and resources (e.g. office space, flexible work schedules).
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Affiliation(s)
- Isabella Ingram
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Lenna J Carradus
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Gerard Byrne
- The Salvation Army, Sydney, Australia
- We Help Ourselves, Sydney, Australia
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Briony Osborne
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Johanna M Meyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Jason L Nunes
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Laura D Robinson
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
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Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population. BJPsych Open 2021. [PMCID: PMC8444048 DOI: 10.1192/bjo.2021.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.
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Zolnikov TR, Hammel M, Furio F, Eggleston B. Barriers for homeless with dual diagnosis: lessons learned from intensive mobile psychosocial assertive community treatment program. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-09-2020-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis.
Design/methodology/approach
A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis.
Findings
The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis.
Originality/value
This study adds to the growing body of literature showing that patient-centered care allows for more effective treatment and ultimately, improved health outcomes.
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Stanojlović M, Davidson L. Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:1178221820976988. [PMID: 34211275 PMCID: PMC8216338 DOI: 10.1177/1178221820976988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/31/2020] [Indexed: 11/15/2022]
Abstract
Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client’s disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes.
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Affiliation(s)
- Milena Stanojlović
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
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Predictors of consent and engagement to participate in telephone delivered continuing care following specialist residential alcohol and other drug treatment. Addict Behav 2021; 117:106840. [PMID: 33556669 DOI: 10.1016/j.addbeh.2021.106840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND AIMS Although continuing care programs have been shown to improve alcohol and other drug (AOD) treatment outcomes, uptake of continuing care has been low. The current study aimed to determine predictors of participants' who both re-confirmed consent to engage in telephone-based continuing care and commenced continuing care once they left residential AOD treatment. These participants had initially consented to partake in continuing care during the course of their residential stay. METHODS Participants were 391 individuals (232 males, 59% and 158 females, 40%) accessing therapeutic communities for AOD treatment provided by The Australian Salvation Army and We Help Ourselves (WHOS). Measures at baseline, collected during residential treatment, included demographics, primary substance of concern, abstinence goal, refusal self-efficacy, cravings for substances, mental health diagnoses, psychological distress, quality of life and feelings of loneliness. All measures were used as predictor variables to determine characteristics of participants who re-confirmed consent to engage in continuing care and commenced continuing care following residential AOD treatment. RESULTS Completing residential treatment, being unmarried, and higher levels of loneliness predicted re-confirmation of consent to participate in continuing care following discharge from residential treatment. Participants who were Aboriginal and/or Torres Strait Islander were less likely to provide re-confirmation of consent. Participants were more likely to commence continuing care if they completed residential treatment, were older, and had longer years of substance use. CONCLUSIONS Tailoring continuing care programs to reach a broader array of individuals such as Indigenous populations and persons who exit treatment services early is needed to ensure these programs can reach all individuals who might need them.
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Ghetti C, Chen XJ, Brenner AK, Hakvoort LG, Lien L, Fachner J, Gold C. Music therapy for people with substance use disorders. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd012576.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy; University of Bergen; Bergen Norway
| | - Xi-Jing Chen
- CAS Key Laboratory of Mental Health; Institute of Psychology, Chinese Academy of Science; Beijing China
| | - Annette K Brenner
- GAMUT - The Grieg Academy Music Therapy Research Centre; NORCE Norwegian Research Centre AS; Bergen Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders; Hospital Innlandet Trust; Brumunddal Norway
| | - Jorg Fachner
- Music and Perfoming Arts; Anglia Ruskin University; Cambridge UK
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre; NORCE Norwegian Research Centre AS; Bergen Norway
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Gatti F, Walderhaug E, Kern-Godal A, Lysell J, Arnevik EA. Complementary horse-assisted therapy for substance use disorders: a randomized controlled trial. Addict Sci Clin Pract 2020; 15:7. [PMID: 32019584 PMCID: PMC7001193 DOI: 10.1186/s13722-020-0183-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs. METHODS Fifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment. RESULTS The multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some unforeseen challenges were encountered in the study: a high number of subjects transferred to another treatment, variable attendance at cHAT sessions, and long temporary exits. Nevertheless, 44% of participants in the cHAT group completed their treatment, compared with 32% in the TAU-only group; this observation encourages further investigation in a larger sample. CONCLUSIONS Though no association was identified between cHAT and treatment retention or completion, our study may have been underpowered. Further work in a larger clinical population is needed; observational studies with repeated measures may also be useful for investigating whether cHAT increases retention in treatment or rates of completion, two important factors for successful SUD treatment. Trial registration The trial was registered and approved on 14 October 2011 by the Regional Committee for Medical and Health Research Ethics with registration number 2011/1642 and registered at ClinicalTrials.gov on 21 February 2013 with registration number NCT01795755.
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Affiliation(s)
- Francesca Gatti
- Department of Addiction Treatment, Oslo University Hospital HF, P.O 4959, 0424, Nydalen, Oslo, Norway
| | - Espen Walderhaug
- Department of Addiction Treatment, Oslo University Hospital HF, P.O 4959, 0424, Nydalen, Oslo, Norway
| | - Ann Kern-Godal
- Department of Addiction Treatment, Oslo University Hospital HF, P.O 4959, 0424, Nydalen, Oslo, Norway
| | - Jeanette Lysell
- Department of Addiction Treatment, Oslo University Hospital HF, P.O 4959, 0424, Nydalen, Oslo, Norway
| | - Espen Ajo Arnevik
- Department of Addiction Treatment, Oslo University Hospital HF, P.O 4959, 0424, Nydalen, Oslo, Norway.
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Kelly P, Deane F, Baker A, Byrne G, Degan T, Osborne B, Townsend C, McKay J, Robinson L, Oldmeadow C, Lawson K, Searles A, Lunn J. Study protocol the Continuing Care Project: a randomised controlled trial of a continuing care telephone intervention following residential substance dependence treatment. BMC Public Health 2020; 20:107. [PMID: 31992258 PMCID: PMC6986107 DOI: 10.1186/s12889-020-8206-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A priority area in the field of substance dependence treatment is reducing the rates of relapse. Previous research has demonstrated that telephone delivered continuing care interventions are both clinically and cost effective when delivered as a component of outpatient treatment. This protocol describes a NSW Health funded study that assesses the effectiveness of delivering a telephone delivered continuing care intervention for people leaving residential substance treatment in Australia. METHODS/DESIGN All participants will be attending residential alcohol and other drug treatment provided by The Salvation Army or We Help Ourselves. The study will be conducted as a randomised controlled trial, where participants will be randomised to one of three treatment arms. The treatment arms will be: (i) 12-session continuing care telephone intervention; (ii) 4-session continuing care telephone intervention, or (iii) continuing care plan only. Baseline assessment batteries and development of the participants' continuing care plan will be completed prior to participants being randomised to a treatment condition. Research staff blind to the treatment condition will complete follow-up assessments with participants at 3-months and 6-months after they have been discharged from their residential service. DISCUSSION This study will provide comprehensive data on the effect of delivering the continuing care intervention for people exiting residential alcohol and other drug treatment. If shown to be effective, this intervention can be disseminated to improve the rates of relapse among people leaving residential alcohol and other drug treatment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618001231235. Registered on 23rd July 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375621&isReview=true.
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Affiliation(s)
- Peter Kelly
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.
| | - Frank Deane
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Amanda Baker
- University of Newcastle, University Drive, School of Medicine and Public Health, Callaghan, New South Wales, 2308, Australia
| | - Gerard Byrne
- The Salvation Army, Chalmers Street, Redfern, New South Wales, 2016, Australia
| | - Tayla Degan
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Briony Osborne
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - James McKay
- University of Pennsylvania, Market Street, Philadelphia, PA, 19104, USA
| | - Laura Robinson
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South, Wales, 2305, Australia
| | - Joanne Lunn
- We Help Ourselves, Rozelle, New South Wales, 2039, Australia
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15
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Costello MJ, Li Y, Remers S, MacKillop J, Sousa S, Ropp C, Roth D, Weiss M, Rush B. Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment. Addict Behav 2019; 98:106055. [PMID: 31357071 DOI: 10.1016/j.addbeh.2019.106055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/22/2019] [Accepted: 07/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuing care is increasingly prioritized in the treatment of substance use disorders (SUDs). Ongoing engagement in continuing care, including mutual support (e.g., 12-step groups) and/or professional outpatient services, may enhance treatment outcomes and facilitate recovery. OBJECTIVE This study investigates how engagement in 12-step mutual support and professional outpatient services is associated with short-term substance use outcomes in a sample of patients who completed inpatient SUDs treatment. METHODS As part of the Recovery Journey Project - a longitudinal cohort study - participants completed questionnaires upon admission to an inpatient SUDs treatment program, and at 1- and/or 3-months post-discharge (n = 379). Baseline data were collected by self-administered, electronic questionnaires. Follow up data were collected by phone or email. Analyses involved multivariate Generalized Estimating Equations separately modelling self-reported abstinence and percent days abstinent (PDA) over the three time periods. RESULTS Overall, rates of self-reported abstinence and PDA increased significantly from baseline to 1- and 3-months follow up. Engagement in 12-step activities (i.e., attended 30 meetings in 30 days, had a home group, had a sponsor, did service work) and professional outpatient substance use support were each significantly associated with abstinence and PDA. Participants who reported a higher degree of 12-step involvement (defined as engagement in more 12-step activities) were also more likely to report being abstinence and greater PDA. CONCLUSIONS Engagement in continuing care, including 12-step activities and professional outpatient substance use support, was highly associated with substance use. Clinical teams should encourage participation in such activities to optimize treatment outcomes.
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16
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Stuebing MD, Lorenz H, Littlefield LM. Literacy-Free 12 Step Expressive Arts Curriculum Enhances Engagement and Treatment Outcomes for Dually Diagnosed Substance Use and Mental Health Disorders. ALCOHOLISM TREATMENT QUARTERLY 2019. [DOI: 10.1080/07347324.2019.1681331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Hjördis Lorenz
- Department of Psychology, Washington College, Chestertown, Maryland, USA
- Oxford Centre for Anxiety Disorders and Trauma, Department of Experimental Psychology, University of Oxford, Oxford, UK
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Lima DR, Gonçalves PD, Ometto M, Malbergier A, Amaral RA, Dos Santos B, Cavallet M, Chaim-Avancini T, Serpa MH, Ferreira LRK, Duran FLDS, Zanetti MV, Nicastri S, Busatto GF, Andrade AG, Cunha PJ. The role of neurocognitive functioning, substance use variables and the DSM-5 severity scale in cocaine relapse: A prospective study. Drug Alcohol Depend 2019; 197:255-261. [PMID: 30875646 DOI: 10.1016/j.drugalcdep.2019.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD). METHODS 128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge. RESULTS Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse. CONCLUSIONS Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.
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Affiliation(s)
- Danielle Ruiz Lima
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil.
| | - Priscila Dib Gonçalves
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Mariella Ometto
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Andre Malbergier
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Ricardo Abrantes Amaral
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Bernardo Dos Santos
- Escola de Enfermagem, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cerqueira César, 05403-000, Sao Paulo, SP, Brazil
| | - Mikael Cavallet
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Tiffany Chaim-Avancini
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Mauricio Henriques Serpa
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Luiz Roberto Kobuti Ferreira
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Fabio Luis de Souza Duran
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Marcus Vinicius Zanetti
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Sergio Nicastri
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Geraldo Filho Busatto
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Arthur Guerra Andrade
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Departmento de Neurociencias, Escola de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, 09060-870, Santo Andre, SP, Brazil
| | - Paulo Jannuzzi Cunha
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
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Agyapong VIO, Juhás M, Mrklas K, Hrabok M, Omeje J, Gladue I, Kozak J, Leslie M, Chue P, Greenshaw AJ. Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients. J Subst Abuse Treat 2018; 94:74-80. [PMID: 30243421 DOI: 10.1016/j.jsat.2018.08.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/09/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022]
Abstract
AIMS To evaluate the effectiveness of an addiction-related supportive text messaging mobile intervention to improve treatment outcomes for patients with alcohol use disorder (AUD). METHODS A single-rater-blinded randomized trial was conducted involving 59 AUD patients who completed a residential addiction treatment program. Patients in the intervention group (n = 29) received supportive text messages for three months following discharge. Patients in the control group (n = 30) received a text message thanking them for participating in the study. The primary outcome of this study was the three months Cumulative Abstinence Duration (CAD); secondary outcomes (units of alcohol per drinking day, numbers of days to first drink) and exploratory outcomes (health utilization) were evaluated. Subgroup analyses were also done. The enrollment rate in the study was 84%, and of those who enrolled, 73% were retained. RESULTS When primary and secondary outcome measures were examined via effect size analysis, the number of days to first drink was longer in the intervention than control group (large effect size, although not statistically significant). The intervention group's mean first day to drink was over twice the length of the control group (e.g., approximately 60 vs. 26 days, respectively, with a mean difference of 34.97 and 95% CI of -5.87-75.81). Small to moderate effects were found for CAD and units of alcohol per drinking day. Small to negligible effects were found for health utilization. On subgroup analyses, the participants who received text messages, among those who did not attend follow-up outpatient counselling, showed a longer CAD. CONCLUSIONS The results suggest text messaging is a feasible and effective opportunity for follow-up care in patients discharged from residential AUD treatment.
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Affiliation(s)
- Vincent I O Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health, Alberta Health Services, Fort McMurray, Alberta, Canada.
| | - Michal Juhás
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Mrklas
- System Innovation and Programs, Strategic Clinical Networks™, Alberta Health Services, Alberta, Canada
| | - Marianne Hrabok
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Joy Omeje
- Department of Public Health, Alberta Health Services, Fort McMurray, Alberta, Canada
| | - Irene Gladue
- Northern Addiction Treatment Centre, Grande Prairie, Alberta, Canada
| | - Jody Kozak
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Maureen Leslie
- Northern Addiction Treatment Centre, Grande Prairie, Alberta, Canada
| | - Pierre Chue
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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Kelly PJ, Kyngdon F, Ingram I, Deane FP, Baker AL, Osborne BA. The Client Satisfaction Questionnaire-8: Psychometric properties in a cross-sectional survey of people attending residential substance abuse treatment. Drug Alcohol Rev 2017; 37:79-86. [PMID: 28480521 DOI: 10.1111/dar.12522] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND AIMS The Client Satisfaction Questionnaire (CSQ-8) is one of a limited number of standardised satisfaction measures that have been used widely across mental health services. This study examined the CSQ-8 as a measure of general satisfaction within residential substance abuse treatment. It compared the CSQ-8 with another established measure of client satisfaction that was developed for substance abuse treatment settings (Treatment Perceptions Questionnaire, TPQ). It also sought to examine the relationship between the CSQ-8 and commonly used process measures. DESIGN AND METHODS Cross-sectional data was collected from across 14 Australian residential medium-to-long term alcohol and other drug treatment facilities (N = 1378). Demographic, substance abuse and mental health characteristics were collected, as well as process measures of craving, general functioning, self-perceptions, recovery and symptom distress. RESULTS A confirmatory factory analysis established that the CSQ-8 retains a single factor. The scale was strongly correlated with the TPQ, suggesting high concurrent validity. However, while the TPQ was normally distributed, the CSQ-8 was highly negatively skewed. Significant associations were found between the CSQ-8 and cross-sectional process measures. DISCUSSION AND CONCLUSIONS Results suggest that that CSQ-8 is an appropriate measure to be used in residential substance abuse treatment settings. However, because of the high levels of negative skew, it is likely that the TPQ is more accurate in capturing clients' dissatisfaction than the CSQ-8. Future research should include longitudinal studies of satisfaction in order to examine how changes in satisfaction may be related to client characteristics, outcome measures, dropout or re-engagement in treatment. [Kelly PJ, Kyngdon F, Ingram I, Deane FP, Baker AL, Osborne BA. The Client Satisfaction Questionnaire-8: Psychometric properties in a cross-sectional survey of people attending residential substance abuse treatment. Drug Alcohol Rev 2018;37:79-86].
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Affiliation(s)
- Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Felicity Kyngdon
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Isabella Ingram
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Briony A Osborne
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, Australia
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20
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Ghetti C, Chen XJ, Fachner J, Gold C. Music therapy for people with substance use disorders. Hippokratia 2017. [DOI: 10.1002/14651858.cd012576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Claire Ghetti
- University of Bergen; GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy; Postboks 7805 Bergen Norway 5020
| | - Xi-Jing Chen
- Institute of Psychology, Chinese Academy of Science; CAS Key Laboratory of Mental Health; Beijing China
| | - Jorg Fachner
- Anglia Ruskin University; Music and Perfoming Arts; East Road Cambridge Cambridgeshire UK CB1 1PT
| | - Christian Gold
- Uni Research; GAMUT - The Grieg Academy Music Therapy Research Centre, Uni Research Health; Lars Hilles gate 3 Bergen Norway 5015
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21
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Manuel JI, Yuan Y, Herman DB, Svikis DS, Nichols O, Palmer E, Deren S. Barriers and facilitators to successful transition from long-term residential substance abuse treatment. J Subst Abuse Treat 2016; 74:16-22. [PMID: 28132695 DOI: 10.1016/j.jsat.2016.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 11/17/2022]
Abstract
Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals' basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment.
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Affiliation(s)
- Jennifer I Manuel
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003, United States.
| | - Yeqing Yuan
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003, United States.
| | - Daniel B Herman
- Silberman School of Social Work at Hunter College, 2180 Third Avenue @ 119th St., New York, NY 10035, United States.
| | - Dace S Svikis
- Virginal Commonwealth University Department of Psychology, 806 West Franklin Street, Richmond, Virginia 23284-2018, United States.
| | - Obie Nichols
- Services for the UnderServed, Inc., 305 Seventh Avenue, 10th Floor, New York, NY 10001, United States.
| | - Erin Palmer
- Services for the UnderServed, Inc., 305 Seventh Avenue, 10th Floor, New York, NY 10001, United States.
| | - Sherry Deren
- New York University Rory Meyers College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, United States.
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22
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Azuar J, Questel F, Hispard E, Scott J, Vorspan F, Bellivier F. Hospital Stay and Engagement in Outpatient Follow-Up After Alcohol Emergency Detox: A 1-Year Comparison Study. Alcohol Clin Exp Res 2016; 40:418-21. [DOI: 10.1111/acer.12962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Julien Azuar
- Service de Médecine Addictologique; Hôpital Fernand Widal, AP-HP; Paris France
- Faculté de Médecine; Université Paris Diderot; Paris France
| | - Frank Questel
- Service de Médecine Addictologique; Hôpital Fernand Widal, AP-HP; Paris France
| | - Eric Hispard
- Service de Médecine Addictologique; Hôpital Fernand Widal, AP-HP; Paris France
| | - Jan Scott
- Department of Academic Psychiatry; Institute of Neuroscience; Newcastle University; United Kingdom
| | - Florence Vorspan
- Service de Médecine Addictologique; Hôpital Fernand Widal, AP-HP; Paris France
- Faculté de Médecine; Université Paris Diderot; Paris France
- INSERM U1144; Université Paris Descartes; Université Paris Diderot; PRES Sorbonne Paris Cité; Paris France
| | - Frank Bellivier
- Service de Médecine Addictologique; Hôpital Fernand Widal, AP-HP; Paris France
- Faculté de Médecine; Université Paris Diderot; Paris France
- INSERM U1144; Université Paris Descartes; Université Paris Diderot; PRES Sorbonne Paris Cité; Paris France
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23
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Mohammad Ahmadi Soleimani S, Ekhtiari H, Cadet JL. Drug-induced neurotoxicity in addiction medicine: From prevention to harm reduction. PROGRESS IN BRAIN RESEARCH 2015; 223:19-41. [PMID: 26806769 DOI: 10.1016/bs.pbr.2015.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurotoxicity is considered as a major cause of neurodegenerative disorders. Most drugs of abuse have nonnegligible neurotoxic effects many of which are primarily mediated by several dopaminergic and glutamatergic neurotransmitter systems. Although many researchers have investigated the medical and cognitive consequences of drug abuse, the neurotoxicity induced by these drugs still requires comprehensive attention. The science of neurotoxicity promises to improve preventive and therapeutic strategies for brain disorders such as Alzheimer disease and Parkinson's disease. However, its clinical applications for addiction medicine remain to be defined adequately. This chapter reviews the most commonly discussed mechanisms underlying neurotoxicity induced by common drugs of abuse including amphetamines, cocaine, opiates, and alcohol. In addition, the known factors that trigger and/or predispose to drug-induced neurotoxicity are discussed. These factors include drug-related, individual-related, and environmental insults. Moreover, we introduce some of the potential pharmacological antineurotoxic interventions deduced from experimental animal studies. These interventions involve various targets such as dopaminergic system, mitochondria, cell death signaling, and NMDA receptors, among others. We conclude the chapter with a discussion of addicted patients who might benefit from such interventions.
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Affiliation(s)
- S Mohammad Ahmadi Soleimani
- Neurocognitive Laboratory, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamed Ekhtiari
- Neurocognitive Laboratory, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Translational Neuroscience Program, Institute for Cognitive Science Studies (ICSS), Tehran, Iran; Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, DHHS/NIH/NIDA Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.
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24
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Hall T, Chassler D, Blom B, Grahn R, Blom-Nilsson M, Sullivan L, Lundgren L. Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden: descriptive study. EVALUATION AND PROGRAM PLANNING 2015; 49:153-162. [PMID: 25577663 DOI: 10.1016/j.evalprogplan.2014.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n=4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR=1.28, narcotic users OR=1.16), gender [males were nearly 3 times more likely to die among narcotics users (p<.000) and 1.6 times more likely to die among alcohol users (p<.01)] and reporting serious health problems (for alcohol users p<.000, for narcotics users p<.05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.
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Affiliation(s)
- Taylor Hall
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
| | - Deborah Chassler
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Björn Blom
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
| | - Robert Grahn
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
| | | | - Lisa Sullivan
- Boston University School of Public Health, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Lena Lundgren
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
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25
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Kendra MS, Weingardt KR, Cucciare MA, Timko C. Satisfaction with substance use treatment and 12-step groups predicts outcomes. Addict Behav 2015; 40:27-32. [PMID: 25218068 DOI: 10.1016/j.addbeh.2014.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/27/2014] [Accepted: 08/13/2014] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Satisfaction is a critical component of patient-centered care, yet little is known about the degree to which patient satisfaction is linked to subsequent outcomes, especially in substance use disorder (SUD) treatments and 12-step groups. The current study assessed the degree to which satisfaction with Department of Veterans Affairs (VA) outpatient SUD treatment and with 12-step groups, both measured at 6 months after treatment initiation, was associated with additional treatment utilization and better substance-related outcomes during the next 6 months, that is, up to 1 year after treatment initiation. METHODS Participants were 345 patients entering the VA SUD treatment program. RESULTS More satisfaction with treatment and with 12-step groups at 6 months was associated with less alcohol use severity and more abstinence at 1 year. More treatment satisfaction was related to less subsequent medical severity, whereas more 12-step group satisfaction was related to less subsequent psychiatric severity. More 12-step group satisfaction was related to subsequent increases in 12-step group attendance and involvement. A single item assessing overall satisfaction appeared best related to subsequent outcomes. CONCLUSIONS Satisfied SUD treatment patients and 12-step mutual help members appeared to have better subsequent service utilization patterns and treatment outcomes. SUD treatments can improve outcomes by monitoring and enhancing patient satisfaction.
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Affiliation(s)
- Matthew S Kendra
- Center for Innovation to Implementation, Veterans Affairs Health Care System, 795 Willow Rd., Menlo Park, CA 94204, USA; Stanford University School of Medicine, Palo Alto, CA 94304, USA.
| | - Kenneth R Weingardt
- Center for Innovation to Implementation, Veterans Affairs Health Care System, 795 Willow Rd., Menlo Park, CA 94204, USA; Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Michael A Cucciare
- Center for Innovation to Implementation, Veterans Affairs Health Care System, 795 Willow Rd., Menlo Park, CA 94204, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas, Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs Health Care System, 795 Willow Rd., Menlo Park, CA 94204, USA; Stanford University School of Medicine, Palo Alto, CA 94304, USA
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26
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Valencia JG, Méndez Villanueva MP. [Factors Associated With the Temporary Abandonment of Treatment for Disorders Due to Substance Abuse in an Institution in Medellin, Colombia]. REVISTA COLOMBIANA DE PSIQUIATRIA 2014; 43:7-17. [PMID: 26573251 DOI: 10.1016/s0034-7450(14)70037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/21/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the frequency and factors associated withtreatment drop-out in patients from a Substance User Treatment Center in Medellín, Colombia. METHODS A case-control study was conducted, with patients with an early treatment dropout as cases, and patients who completed the treatment as controls. Demographic data, substance use pattern, concomitant diseases, and the decision to initiate treatment were compared between cases and controls. RESULTS The frequency of early drop-out was 59%, but a high proportion of this drop-out (47.5%) occurred in the transition period between the program stages. The variables associated with drop-out were: psychotic disorder (OR=0.32; 95% CI, 0.11-0.91), bipolar disorder (OR=0.31; 95% CI, 0.12-0.77), heroin as the principal substance compared to alcohol (OR=6.68; 95% CI, 1.52-29.4), decision to initiate the treatment by the family compared to personal decision (OR=3.02; 95% CI, 1.28-7.17), and previous treatments (OR=1.87; 95% CI, 1.02-3.44). CONCLUSIONS The drop-out frequency is similar to those reported in other studies. Associated factors were found, which could be considered in order to plan strategies to improve the program results.
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Affiliation(s)
- Jenny García Valencia
- Médica, Especialista en Psiquiatría, Magíster en Epidemiología, Doctora en Epidemiología; Coordinadora de Investigación, Samein S.A.S; Profesora asociada, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia.
| | - María Paulina Méndez Villanueva
- Médica, Especialista en Psiquiatría; Coordinadora, Centro de Atención de Drogodependencias de Samein S.A.S., Medellín, Antioquia, Colombia
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27
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ARBOUR SIMONE, GAVRYSH IRYNA, HAMBLEY JANICEM, TSE ADRIAN, HO VICTORIA, BELL MLINDA. Addiction Treatment and Work-Related Outcomes: Examining the Impact of Employer Involvement and Substance of Choice on Absenteeism, Tardiness, and Productivity. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2014. [DOI: 10.1080/15555240.2014.866478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Acquavita SP, Stershic S, Sharma R, Stitzer M. Client incentives versus contracting and staff incentives: how care continuity interventions in substance abuse treatment can improve residential to outpatient transition. J Subst Abuse Treat 2013; 45:55-62. [PMID: 23375361 DOI: 10.1016/j.jsat.2012.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/11/2012] [Accepted: 12/19/2012] [Indexed: 11/30/2022]
Abstract
Interventions for improving transition from short-term residential to outpatient treatment were examined. Usual care (UC; n=114) was referral to a preferred outpatient program with advance appointment optional. Client incentive (CI; n=97) offered up to $100 in gift cards for intake and attendance during the first 30days of treatment. Contracting with staff incentives (CSI; n=49) consisted of meeting with an outpatient counselor prior to residential discharge, signing an attendance contract, receiving an appointment and payment to staff if clients attended. CSI significantly improved rates of successful transition (84%) and admission (74%) compared to UC (64% contact; 49% admitted). CI did not result in significantly improved outcomes (74%; 60%). CSI was likely mediated by the reliability (92 versus 52% in UC) and immediacy (1.0 versus 3.9days) of appointment scheduling. This study supports use of CSI for improving rates of transition between residential and outpatient continuing care treatment.
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Affiliation(s)
- Shauna P Acquavita
- University of Cincinnati, School of Social Work, Cincinnati, OH 45221-0108, USA.
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29
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Duffy P, Baldwin H. Recovery post treatment: plans, barriers and motivators. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:6. [PMID: 23363550 PMCID: PMC3573929 DOI: 10.1186/1747-597x-8-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 01/16/2013] [Indexed: 11/17/2022]
Abstract
Background The increasing focus on achieving a sustained recovery from substance use brings with it a need to better understand the factors (recovery capital) that contribute to recovery following treatment. This work examined the factors those in recovery perceive to be barriers to (lack of capital) or facilitators of (presence of capital) sustained recovery post treatment. Methods A purposive sample of 45 participants was recruited from 11 drug treatment services in northern England. Semi-structured qualitative interviews lasting between 30 and 90 minutes were conducted one to three months after participants completed treatment. Interviews examined key themes identified through previous literature but focused on allowing participants to explore their unique recovery journey. Interviews were transcribed and analysed thematically using a combination of deductive and inductive approaches. Results Participants generally reported high levels of confidence in maintaining their recovery with most planning to remain abstinent. There were indications of high levels of recovery capital. Aftercare engagement was high, often through self referral, with non substance use related activity felt to be particularly positive. Supported housing was critical and concerns were raised about the ability to afford to live independently with financial stability and welfare availability a key concern in general. Employment, often in the substance use treatment field, was a desire. However, it was a long term goal, with substantial risks associated with pursuing this too early. Positive social support was almost exclusively from within the recovery community although the re-building of relationships with family (children in particular) was a key motivator post treatment. Conclusions Addressing internal factors and underlying issues i.e. ‘human capital’, provided confidence for continued recovery whilst motivators focused on external factors such as family and maintaining aspects of a ‘normal’ life i.e. ‘social and physical capital’. Competing recovery goals and activities can leave people feeling under pressure and at risk of taking on or being pushed to do too much too soon. The breadth of re-integration and future plans at this stage is limited primarily to the recovery community and treatment sector. Services and commissioners should ensure that this does not become a limiting factor in individuals’ long term recovery journeys.
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Affiliation(s)
- Paul Duffy
- Criminal Justice Manager, Centre for Public Health, Liverpool John Moores University, 2nd Floor, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2ET, UK.
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