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Lambert L, Serre F, Thirioux B, Jaafari N, Auriacombe M. Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment. Drug Alcohol Depend 2022; 234:109391. [PMID: 35306397 DOI: 10.1016/j.drugalcdep.2022.109391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Low clinical insight in psychiatry is defined as poor recognition of one's mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown. OBJECTIVE Our objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment. METHODS Participants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests. RESULTS Lower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033). CONCLUSION Poor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.
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Affiliation(s)
- L Lambert
- University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - F Serre
- University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - B Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, F-86000 Poitiers, France; Université de Poitiers, CNRS 7295, Centre de Recherches sur la Cognition et l'Apprentissage, 86021 Poitiers, France
| | - N Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, F-86000 Poitiers, France; Université de Poitiers, CNRS 7295, Centre de Recherches sur la Cognition et l'Apprentissage, 86021 Poitiers, France
| | - M Auriacombe
- University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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A measure of subjective substance use disorder awareness - Substance Use Awareness and Insight Scale (SAS). Drug Alcohol Depend 2022; 231:109129. [PMID: 35042153 DOI: 10.1016/j.drugalcdep.2021.109129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Impaired illness awareness or inability to recognize that one has a substance use disorder can be a barrier to treatment seeking and rehabilitation. A validated scale is needed to better understand the clinical impact of impaired substance use disorder awareness. This study aimed to examine the psychometric properties of the Substance Use Awareness and Insight Scale (SAS), a novel scale to assess impaired illness awareness in individuals with substance use disorder. METHODS We developed the SAS, a 7-item self-report measure to assess the theoretical constructs of illness awareness in substance use disorder (www.illnessawarenessscales.com). Participants 18 years of age or older with a score of 8 or more on the Drug Use Disorders Identification Test (DUDIT) were included. Data were collected via Dynata, an online survey platform. RESULTS A total of 299 participants were included (mean (SD) age = 47.3-years (15.4), 54% women). The SAS demonstrated good convergent (r = 0.82, p < 0.001) and discriminant validity (r = -0.23, p < 0.001) with a measure of illness recognition and positive affect, respectively. SAS also demonstrated good internal consistency (Cronbach's alpha = 0.86) and one-month test-retest reliability (intra-class correlation = 0.87). An exploratory factor analysis suggested the retention of two components. Separate analyses of the SAS in individuals with cannabis, opioid, and other substance use showed similar results. DISCUSSION The results of this study provide initial support for the psychometric validation of the SAS in adults with substance use disorder. The SAS holds promise for use in research and clinical settings to assess the influence of impaired substance use disorder awareness on treatment outcomes.
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Nkemjika S, Olatunji E, Olwit C, Jegede O, Brown C, Olupona T, Okosun IS. Comorbid Substance Use and Mental Health Disorders: Prior Treatment/Admission as a Predictor of Criminal Arrest Among American Youths. Cureus 2022; 14:e21551. [PMID: 35223322 PMCID: PMC8865602 DOI: 10.7759/cureus.21551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/05/2022] Open
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Maremmani AGI, Aglietti M, Intaschi G, Bacciardi S. Substance Use/Dependence in Psychiatric Emergency Setting Leading to Hospitalization: Predictors of Continuity of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020760. [PMID: 35055582 PMCID: PMC8775711 DOI: 10.3390/ijerph19020760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022]
Abstract
Background: Poor adherence to treatment is a common clinical problem in individuals affected by mental illness and substance use/dependence. In Italy, mental care is organized in a psychiatric service and addiction unit (SERD), characterized by dual independent assets of treatment. This difference, in the Emergency Room setting, leads to a risk of discontinuity of treatment in case of hospitalization. In this study we clinically characterized individuals who decided to attend hospital post-discharge appointments at SERD, in accordance with medical advice. Methods: This is a retrospective study, based on two years of discharged records of patients entering “Versilia Hospital” (Viareggio, Italy) emergency room, with urinalyses testing positive for substance use, and hospitalization after psychiatric consultation. The sample was divided according to the presence or absence of SERD consultation after discharge. Results: In the 2-year period of the present study, 1005 individuals were hospitalized. Considering the inclusion criterion of the study, the sample consisted of 264 individuals. Of these, 128 patients attended post-discharge appointments at SERD showing urinalyses positive to cocaine, opiates, and poly use; they were more frequently diagnosed as personality disorder and less frequently as bipolar disorder. The prediction was higher for patients that had already been treated at SERD, for patients who received SERD consultation during hospitalization, and for patients with positive urinalyses to cocaine and opiates at treatment entry. Conversely, patients who did not attend SERD consultation after discharge were affected by bipolar disorders. Limitations: Small sample size. Demographical data are limited to gender and age due to paucity of data in hospital information systems. SERD is located far from the hospital and is open only on weekdays; thus, it cannot ensure a consultation with all inpatients. Conclusions: Mental illness diagnosis, the set of substance use positivity at hospitalization, and having received SERD consultation during hospitalization appeared to have a critical role in promoting continuity of care. Moreover, to reduce the gap between the need and the provision of the treatment, a more effective personalized individual program of care should be implemented.
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Affiliation(s)
- Angelo Giovanni Icro Maremmani
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy;
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Lucca, Italy
- PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-328-8427217; Fax: +39-0584-6055242
| | - Mirella Aglietti
- SERD (Drug Addiction Service), Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, 55049 Viareggio, Italy; (M.A.); (G.I.)
| | - Guido Intaschi
- SERD (Drug Addiction Service), Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, 55049 Viareggio, Italy; (M.A.); (G.I.)
| | - Silvia Bacciardi
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy;
- PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy
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Neural and Behavioral Correlates of Impaired Insight and Self-awareness in Substance Use Disorder. Curr Behav Neurosci Rep 2021; 8:113-123. [DOI: 10.1007/s40473-021-00240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Rezapour T, Barzegari M, Sharifi E, Malmir N, Ghiasvand H, Salehi M, Noroozi A, Ekhtiari H. Neuroscience-Informed Psychoeducation for Recovery: A Program to Promote Metacognition in People With Substance Use Disorders. Basic Clin Neurosci 2021; 12:597-606. [PMID: 35173914 PMCID: PMC8818120 DOI: 10.32598/bcn.2021.809.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/02/2021] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: A brief neuroscience-informed psychoeducation program (Neuroscience-Informed Psychoeducation for Recovery [NIPER]) was developed to promote awareness (metacognition) in the main cognitive domains affected by drug and alcohol use to increase willingness to invest time and effort in the brain and cognition recovery process. The primary aim of this pilot study was to determine the feasibility and acceptability of the NIPER program and its potential effectiveness in increasing metacognition, psychological wellbeing, and willingness for the brain and cognition recovery programs among patients with Substance Use Disorders (SUDs). Methods: A total of 56 patients with SUDs were recruited from four outpatient treatment centers in Tehran City, Iran. They participated in four 90-min weekly sessions delivered adjunct to their routine treatment. The program’s effectiveness was measured in terms of metacognition and psychological wellbeing at baseline and the end of the program. The rate of adherence and participation and willingness to continue with brain and cognition recovery programs were measured as feasibility outcomes. Results: A total of 51 participants completed the study. Compared to the baseline assessments, patients reported more problems in dimensions of attention, memory, inhibitory control, decision making, motor/speech, interoception, insight, and a higher level of psychological wellbeing (t=4.66; P<0.001). In terms of feasibility outcomes, the adherence and participation rates were found above 85%. Most participants expressed their high willingness to continue the brain and cognition recovery programs (86.2%) and would introduce NIPER to their peers (98%). Conclusion: Considering the pilot results in terms of feasibility and preliminary effectiveness of NIPER in the clinical context of addiction treatment, we think that NIPER is a potentially beneficial intervention to be offered to people with SUD. It would increase their awareness and engage them in the brain and cognition recovery process. However, the clinical efficacy of the intervention should be tested in future randomized clinical trials.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Mohammad Barzegari
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Elham Sharifi
- Department of Sociology, Faculty of Social Science, University of Tehran, Tehran, Iran
| | - Nastaran Malmir
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ghiasvand
- Department of Educational Psychology, Faculty of Social Science, Islamic Azad University, Saveh, Iran
| | - Mohammad Salehi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ekhtiari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA
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Kim J, Amaev A, Quilty LC, Selby P, Shah P, Caravaggio F, Ueno F, Pollock BG, Graff-Guerrero A, Gerretsen P. A Measure to Assess Illness Awareness in Problem Gambling: Gambling Awareness and Insight Scale (GAS). J Gambl Stud 2021; 38:1029-1043. [PMID: 34169396 DOI: 10.1007/s10899-021-10037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
Impaired subjective awareness of problem gambling may act as a barrier to help-seeking and treatment adherence. However, the impact of impaired problem gambling awareness on clinical and social outcomes has received little empirical study. The aim of this study was to develop and investigate the psychometric properties of a novel scale that measures impaired illness awareness in individuals with problem gambling. We developed the Gambling Awareness and Insight Scale (GAS), a self-report measure that assesses the core theoretical constructs of illness awareness in problem gambling, namely General Disorder or Problem Awareness, Accurate Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to problem gambling ( www.illnessawarenessscales.com ). Data were acquired from an online survey platform, Dynata, to evaluate the psychometric properties of the GAS. A total of 100 participants aged 18 years or older with problem gambling defined by a score of 4 or more on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Pathological Gambling Diagnostic Form were included. The GAS demonstrated good convergent (r = 0.57, p < 0.001) and discriminant validity (r = - 0.18, p = 0.080). It also demonstrated good internal consistency (Cronbach's α = 0.80) and one-month test-retest reliability (intra-class correlation = 0.86). An exploratory factor analysis suggested retention of two components. The GAS is a novel psychometric tool designed to evaluate impaired subjective illness awareness in problem gambling. Initial evidence suggests that the GAS can be used in research and clinical settings to evaluate the impact of impaired problem gambling awareness on adherence to treatment programs, clinical and psychosocial outcomes. Replication in applied settings is needed.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Aron Amaev
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Fumihiko Ueno
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, ON, Canada.
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada.
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Lagisetty P, Garpestad C, Larkin A, Macleod C, Antoku D, Slat S, Thomas J, Powell V, Bohnert ASB, Lin LA. Identifying individuals with opioid use disorder: Validity of International Classification of Diseases diagnostic codes for opioid use, dependence and abuse. Drug Alcohol Depend 2021; 221:108583. [PMID: 33662670 PMCID: PMC8409339 DOI: 10.1016/j.drugalcdep.2021.108583] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Policy evaluations and health system interventions often utilize International Classification of Diseases (ICD) codes of opioid use, dependence, and abuse to identify individuals with opioid use disorder (OUD) and assess receipt of evidence-based treatments. However, ICD codes may not map directly onto the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) OUD criteria. This study investigates the positive predictive value of ICD codes in identifying patients with OUD. METHODS We conducted a clinical chart review on a national sample of 520 Veterans assigned ICD-9 or ICD-10 codes for opioid use, dependence, or abuse from 2012 to 2017. We extracted evidence of DSM-5 OUD criteria and opioid misuse from clinical documentation in the month preceding and three months following initial ICD code listing, and categorized patients into: 1) high likelihood of OUD, 2) limited aberrant opioid use, 3) prescribed opioid use without evidence of aberrant use, and 4) insufficient information. Positive predictive value was calculated as the percentage of individuals with these ICD codes meeting high likelihood of OUD criteria upon chart review. RESULTS Only 57.7 % of patients were categorized as high likelihood of OUD; 16.5 % were categorized as limited aberrant opioid use, 18.9 % prescribed opioid use without evidence of aberrant use, and 6.9 % insufficient information. CONCLUSIONS Patients assigned ICD codes for opioid use, dependence, or abuse often lack documentation of meeting OUD criteria. Many receive long-term opioid therapy for chronic pain without evidence of misuse. Robust methods of identifying individuals with OUD are crucial to improving access to clinically appropriate treatment.
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Affiliation(s)
- Pooja Lagisetty
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA; Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA.
| | - Claire Garpestad
- University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, USA
| | - Angela Larkin
- Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA
| | - Derek Antoku
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Department of Internal Medicine, University of Michigan Medical School, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI, USA
| | - Victoria Powell
- Department of Geriatrics and Palliative Care, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA; Department of Anesthesiology, University of Michigan Medical School, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
| | - Lewei A Lin
- Center for Clinical Management and Research, North Campus Research Center, Ann Arbor VA, 2800 Plymouth Rd, Bldg 16, Room 243, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Center, 2800 Plymouth Rd, Bldg 16, 2nd Fl, Ann Arbor, MI, USA.
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Effect of transcranial direct current stimulation on decision making and cognitive flexibility in gambling disorder. Eur Arch Psychiatry Clin Neurosci 2019; 269:275-284. [PMID: 30367243 DOI: 10.1007/s00406-018-0948-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022]
Abstract
Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F1,16 = 8.128, p = 0.01, ɳp2 =0.33) and better cognitive flexibility (F1,16 =8.782, p = 0.009, ɳp2 = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder.Trial registration: Clinicaltrials.gov NCT03477799.
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Bhad R, Gupta R, Balhara YPS. A study of pathways to care among opioid dependent individuals seeking treatment at a community de-addiction clinic in India. J Ethn Subst Abuse 2019; 19:490-502. [PMID: 30633657 DOI: 10.1080/15332640.2018.1542528] [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] [Indexed: 10/27/2022]
Abstract
Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18-60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.
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Affiliation(s)
- Roshan Bhad
- All India Institute of Medical Sciences, New Delhi, India
| | - Rishab Gupta
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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What Have We Learned From the Agonist Opioid Treatment of Dual Disorder Heroin Addicts? ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Hengartner MP, Passalacqua S, Heim G, Andreae A, Rössler W, von Wyl A. Factors influencing patients' recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1667-1677. [PMID: 27600381 DOI: 10.1007/s00127-016-1282-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 08/30/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme. METHODS RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18-64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU). RESULTS Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU. CONCLUSIONS According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients' social networks. FUNDING This study was supported by a private foundation. TRIAL REGISTRATION ISRCTN58280620.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland.
| | - Silvia Passalacqua
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland
| | - Gisela Heim
- Integrated Psychiatric Clinic of Winterthur and Zurich Unterland (Ipw), Winterthur, Switzerland
| | - Andreas Andreae
- Integrated Psychiatric Clinic of Winterthur and Zurich Unterland (Ipw), Winterthur, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paolo, Sao Paulo, Brazil
| | - Agnes von Wyl
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland
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Pandria N, Kovatsi L, Vivas AB, Bamidis PD. Resting-state Abnormalities in Heroin-dependent Individuals. Neuroscience 2016; 378:113-145. [PMID: 27884551 DOI: 10.1016/j.neuroscience.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/19/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022]
Abstract
Drug addiction is a major health problem worldwide. Recent neuroimaging studies have shed light into the underlying mechanisms of drug addiction as well as its consequences to the human brain. The most vulnerable, to heroin addiction, brain regions have been reported to be specific prefrontal, parietal, occipital, and temporal regions, as well as, some subcortical regions. The brain regions involved are usually linked with reward, motivation/drive, memory/learning, inhibition as well as emotional control and seem to form circuits that interact with each other. So, along with neuroimaging studies, recent advances in resting-state dynamics might allow further assessments upon the multilayer complexity of addiction. In the current manuscript, we comprehensively review and discuss existing resting-state neuroimaging findings classified into three overlapping and interconnected groups: functional connectivity alterations, structural deficits and abnormal topological properties. Moreover, behavioral traits of heroin-addicted individuals as well as the limitations of the currently available studies are also reviewed. Finally, in need of a contemporary therapy a multimodal therapeutic approach is suggested using classical treatment practices along with current neurotechonologies, such as neurofeedback and goal-oriented video-games.
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Affiliation(s)
- Niki Pandria
- Neuroscience of Cognition and Affection Group, Laboratory of Medical Physics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Leda Kovatsi
- Laboratory of Forensic Medicine and Toxicology, Medical School, Thessaloniki, Greece.
| | - Ana B Vivas
- Cognitive Psychology and Neuropsychology Lab, Department of Psychology, City College, The University of Sheffield International Faculty, Thessaloniki, Greece.
| | - Panagiotis D Bamidis
- Neuroscience of Cognition and Affection Group, Laboratory of Medical Physics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Abstract
In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning-referred to as anosognosia-has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.
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Roncero C, Szerman N, Terán A, Pino C, Vázquez JM, Velasco E, García-Dorado M, Casas M. Professionals' perception on the management of patients with dual disorders. Patient Prefer Adherence 2016; 10:1855-1868. [PMID: 27698553 PMCID: PMC5034926 DOI: 10.2147/ppa.s108678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.
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Affiliation(s)
- Carlos Roncero
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
- Correspondence: Carlos Roncero, Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain, Tel +34 93 489 4294, Fax +34 93 489 4587, Email
| | - Néstor Szerman
- Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Terán
- Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain
| | - Carlos Pino
- Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain
| | - José María Vázquez
- Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain
| | - Elena Velasco
- Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain
| | | | - Miguel Casas
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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Maremmani AGI, Pani PP, Trogu E, Vigna-Taglianti F, Mathis F, Diecidue R, Kirchmayer U, Amato L, Ghibaudi J, Camposeragna A, Saponaro A, Davoli M, Faggiano F, Maremmani I. The impact of psychopathological subtypes on retention rate of patients with substance use disorder entering residential therapeutic community treatment. Ann Gen Psychiatry 2016; 15:29. [PMID: 27833645 PMCID: PMC5101731 DOI: 10.1186/s12991-016-0119-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A specific psychopathology of addiction has been proposed and described using the self-report symptom inventory (SCL-90), leading to a 5-factor aggregation of psychological/psychiatric symptoms: 'worthlessness and being trapped', 'somatic symptoms', 'sensitivity-psychoticism', 'panic-anxiety' and 'violence-suicide' in various populations of patients with heroin use disorder (HUD) and other substance use disorders (SUDs). These clusters of symptoms, according to studies that have highlighted the role of possible confounding factors (such as demographic and clinical characteristics, active heroin use, lifetime psychiatric problems and kind of treatment received by the patients), seem to constitute a trait rather than a state of the psychological structure of addiction. These five psychopathological dimensions defined on the basis of SCL-90 categories have also been shown to be correlated with the outcomes of a variety of agonist opioid treatments. The present study aims to test whether the 5-factor psychopathological model of addiction correlates with the outcome (retention rate) of patients with SUDs entering a therapeutic community (TC) treatment. METHODS 2016 subjects with alcohol, heroin or cocaine dependence were assigned to one of the five clusters on the basis of the highest SCL-90 factor score shown. Retention in treatment was analysed by means of the survival analysis and Wilcoxon statistics for comparison between the survival curves. The associations between the psychopathological subtypes defined by SCL-90 categories and length of retention in treatment, after taking into account substance of abuse and other sociodemographic and clinical variables, were summarized using Cox regression. RESULTS Patients with cocaine use disorder (CUD) showed poorer outcomes than those with heroin dependence (HUD). Prominent symptoms of "worthlessness-being trapped" lead to a longer retention in treatment than in the case of the other four prominent psychopathological groups. At the multivariate level, age, detoxified status and total number of psychopathological symptoms proved to influence outcome negatively, especially in CUD. Somatic symptoms and violence-suicide symptoms turned out to correlate with dropout from residential treatment. CONCLUSIONS The SCL-90 5-factor dimensions can be appropriately used as a prognostic tool for drug-dependent subjects entering a residential treatment.
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Affiliation(s)
- Angelo G I Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy
| | - Pier Paolo Pani
- Social and Health Services, Cagliari Public Health Trust (ASL Cagliari), Cagliari, Italy
| | - Emanuela Trogu
- Department of Psychiatry, Cagliari Public Health Trust (ASL Cagliari), Cagliari, Italy
| | - Federica Vigna-Taglianti
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Turin, Italy ; Department of Clinical and Biological Sciences, San Luigi Gonzaga University, Turin, Italy
| | - Federica Mathis
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASLTO3, Grugliasco, Turin, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Joli Ghibaudi
- National Coordination Hospitality Communities (CNCA), Rome, Italy
| | | | - Alessio Saponaro
- Regional Epidemiological Observatory, Emilia Romagna Regional Health Service, Bologna, Italy
| | - Marina Davoli
- Department of Epidemiology, Latium Regional Health Service, Rome, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy ; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy ; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
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Koechl B, Danner SM, Jagsch R, Brandt L, Fischer G. Health-related and legal interventions: A comparison of allegedly delinquent and convicted opioid addicts in Austria. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/2050324514528449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In Austria, judges can offer quasi-compulsory treatment options (in- and outpatient settings) as an alternative to imprisonment for drug-related delinquencies. A standard assessment of medical, psychological and legal data on the implementation of health-related and legal interventions in Austria was applied in 96 opioid-dependent individuals (10.4% female) undergoing quasi-compulsory treatment, receiving health-related measures. Additional data from the official prison registry were collected (data of 228 imprisoned individuals sentenced for drug-related crimes; 14.5% female) to gain comparable information to in- and outpatient health-related measure groups. Health-related measures were offered significantly more often to individuals charged with solely narcotics possession and/or trade, whereas imprisonment was filed significantly more often when concomitant property or violent crimes were committed in addition to drug possession/dealing (p < 0.001). Both cohorts had high prevalences of previous convictions (health-related measure 84.4%, prison 93.9%). The majority of patients in health-related measures suffered at the time of investigation from severe depression (62.5%), anxiety disorders (58.3%) and had a high loading of suicidal ideation (45.8%). Women showed a higher prevalence of affective disorders (p = 0.042), with higher administration rates of psychopharmacological medication (p = 0.045), whereas male offenders scored significantly higher in violent behaviour (p = 0.004). Inpatients showed a significantly higher burden of comorbid disorders compared to outpatients and reported a higher need for psychiatric treatment and legal counselling (all p < 0.001). The inpatient sample had a longer duration of opioid use (p = 0.024), a higher lifetime prevalence of intravenous drug use (p < 0.001) and a higher rate of hepatitis C infections (p = 0.012). Results confirm that imprisonment is sentenced to a vast extent for severe crimes, and health-related measure is well accepted among judges. However, based on patients’ high loading of previous convictions and alarmingly high burden of comorbidities, quality improvement and assurance in health-related measure are required when patients have their first contact with the criminal justice system. Continuous focus on applying diversion procedures is also required to reduce societal costs.
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Affiliation(s)
| | - Simon M Danner
- Medical University of Vienna, Austria
- Vienna University of Technology, Austria
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Meshesha LZ, Tsui JI, Liebschutz JM, Crooks D, Anderson BJ, Herman DS, Stein MD. Days of heroin use predict poor self-reported health in hospitalized heroin users. Addict Behav 2013; 38:2884-7. [PMID: 24045030 DOI: 10.1016/j.addbeh.2013.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/23/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
This study examined associations between substance use behaviors and self-reported health among hospitalized heroin users. Of the 112 participants, 53 (47%) reported good or better health. In multivariable logistic regression models, each day of heroin use in the last month was associated with an 8% lower odds of reporting health as good or better (OR=.92; 95% CI 0.87, 0.97, p<.05). Cocaine, cannabis, cigarettes, alcohol use, unintentional overdose, nor injection drug use was associated with health status.
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Dell'osso L, Carmassi C, Stratta P, Massimetti G, Akiskal KK, Akiskal HS, Maremmani I, Rossi A. Gender Differences in the Relationship between Maladaptive Behaviors and Post-Traumatic Stress Disorder. A Study on 900 L' Aquila 2009 Earthquake Survivors. Front Psychiatry 2012; 3:111. [PMID: 23293608 PMCID: PMC3537190 DOI: 10.3389/fpsyt.2012.00111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 12/12/2012] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) represents one of the most frequently psychiatric sequelae to earthquake exposure. Increasing evidence suggests the onset of maladaptive behaviors among veterans and adolescents with PTSD, with specific gender differences emerging in the latter. Aims of the present study were to investigate the relationships between maladaptive behaviors and PTSD in earthquake survivors, besides the gender differences in the type and prevalence of maladaptive behaviors and their association with PTSD. METHODS 900 residents of the town of L'Aquila who experienced the earthquake of April 6th 2009 (Richter Magnitude 6.3) were assessed by means of the Trauma and Loss Spectrum-Self Report (TALS-SR). RESULTS Significantly higher maladaptive behavior prevalence rates were found among subjects with PTSD. A statistically significant association was found between male gender and the presence of at least one maladaptive behavior among PTSD survivors. Further, among survivors with PTSD significant correlations emerged between maladaptive coping and symptoms of re-experiencing, avoidance and numbing, and arousal in women, while only between maladaptive coping and avoidance and numbing in men. CONCLUSIONS Our results show high rates of maladaptive behaviors among earthquake survivors with PTSD suggesting a greater severity among men. Interestingly, post-traumatic stress symptomatology appears to be a better correlate of these behaviors among women than among men, suggesting the need for further studies based on a gender approach.
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Affiliation(s)
- Liliana Dell'osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa Pisa, Italy
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