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Dowling NA, Rodda SN, Merkouris SS. Applying the Just-In-Time Adaptive Intervention Framework to the Development of Gambling Interventions. J Gambl Stud 2024; 40:717-747. [PMID: 37659031 PMCID: PMC11272684 DOI: 10.1007/s10899-023-10250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
Just-In-Time Adaptive Interventions (JITAIs) are emerging "push" mHealth interventions that provide the right type, timing, and amount of support to address the dynamically-changing needs for each individual. Although JITAIs are well-suited to the delivery of interventions for the addictions, few are available to support gambling behaviour change. We therefore developed GamblingLess: In-The-Moment and Gambling Habit Hacker, two smartphone-delivered JITAIs that differ with respect to their target populations, theoretical underpinnings, and decision rules. We aim to describe the decisions, methods, and tools we used to design these two treatments, with a view to providing guidance to addiction researchers who wish to develop JITAIs in the future. Specifically, we describe how we applied a comprehensive, organising scientific framework to define the problem, define just-in-time in the context of the identified problem, and formulate the adaptation strategies. While JITAIs appear to be a promising design in addiction intervention science, we describe several key challenges that arose during development, particularly in relation to applying micro-randomised trials to their evaluation, and offer recommendations for future research. Issues including evaluation considerations, integrating on-demand intervention content, intervention optimisation, combining active and passive assessments, incorporating human facilitation, adding cost-effectiveness evaluations, and redevelopment as transdiagnostic interventions are discussed.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia.
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia.
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
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André F, Kapetanovic S, Einarsson I, Trebbin Harvard S, Franzén L, Möttus A, Håkansson A, Claesdotter-Knutsson E. Relapse prevention therapy for internet gaming disorder in Swedish child and adolescent psychiatric clinics: a randomized controlled trial. Front Psychiatry 2023; 14:1256413. [PMID: 37928925 PMCID: PMC10623056 DOI: 10.3389/fpsyt.2023.1256413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Objectives To evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD). Design Randomized controlled trial. Setting Three child and adolescent psychiatry (CAP) units in Region Skåne, Sweden. Participants Children aged 13-18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55). Interventions The intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual. Outcome measures Participants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up). Results The repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group -5.1, p < 0.001, 95% CI = - 3.390 to -6.755, mean difference in treatment group -9.9, p < 0.001, 95% CI = -11.746 to -8.105). Conclusion RP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why. Trial registration number ClinicalTrials.gov, NCT05506384 https://clinicaltrials.gov/ct2/show/NCT05506384.
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Affiliation(s)
- Frida André
- Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sabina Kapetanovic
- Department of Social and Behavioral Sciences, University West, Trollhättan, Sweden
| | - Isak Einarsson
- Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Region Skane, Child and Adolescent Psychiatry, Regional Outpatient Care, Lund University Hospital, Lund, Sweden
| | - Sunna Trebbin Harvard
- Civic Centre Children and Youth, The Social Services Administration, Copenhagen, Denmark
| | | | - Annika Möttus
- Region Skane, Child and Adolescent Psychiatry, Regional Outpatient Care, Lund University Hospital, Lund, Sweden
| | - Anders Håkansson
- Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Region Skåne, Malmö Addiction Centre, Gambling Disorder Unit, Malmö, Sweden
| | - Emma Claesdotter-Knutsson
- Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Region Skane, Child and Adolescent Psychiatry, Regional Outpatient Care, Lund University Hospital, Lund, Sweden
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Alibudbud R. Addressing an opportune time to revise the Philippine Comprehensive Dangerous Drugs Act of 2002. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100857. [PMID: 37520161 PMCID: PMC10382915 DOI: 10.1016/j.lanwpc.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
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Kaviyani F, Khorrami M, Heydari H, Namvar M. Understanding the laps and relapse process: in-depth interviews with individual who use methamphetamine. Subst Abuse Treat Prev Policy 2023; 18:41. [PMID: 37420278 PMCID: PMC10327377 DOI: 10.1186/s13011-023-00548-9] [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: 04/16/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE The high rate of treatment failure is a common problem in the treatment of methamphetamine use. Therefore, the aim of this research is to identify the most common causes of relapse in methamphetamine users. METHOD This is a qualitative study and of content analysis type. Information was collected using purposeful sampling and through semi-structured interviews and focus group discussions. The statistical population consisted of all people with the methamphetamine-use disorder in 2022 who were in the abstinence phase and participated in the meetings of the Narcotics Anonymous (NA) Center of Bojnord. Theoretical sampling continued until data saturation. A total of 10 one-on-one interviews were conducted, each lasting between 45 to 80 min. Additionally, two focus group interviews were conducted with six members in each group, lasting between 95 to 110 min and data saturation was achieved through these interviews. Data analysis was done using the content analysis method (Sterling). Recoding and Holsti's method were used to measure reliability; validity was then calculated through content validity assessment. FINDINGS The results of the thematic analysis showed that laps and relapse factors were identified and categorized into 5 organizing themes, including negative emotional states, positive emotional states, negative physical states, interpersonal factors, and environmental factors, consisting of 39 basic themes. RESULT Identifying the risk factors leading to laps and relapse in methamphetamine users and increasing the knowledge in this field can lay the groundwork for preventive therapeutic interventions in this community.
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Affiliation(s)
- Faezeh Kaviyani
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammad Khorrami
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | - Hamid Heydari
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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Chopra R, Murthy P, Narayanan G. Early maladaptive schemas in substance use disorders in the Indian context: Theoretical and therapeutic implications. Ind Psychiatry J 2023; 32:452-455. [PMID: 38161451 PMCID: PMC10756602 DOI: 10.4103/ipj.ipj_162_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 01/03/2024] Open
Abstract
Schema theory seems to be a relevant perspective in the overall understanding of substance use disorders (SUDs). Early maladaptive schemas (EMSs) are defined as self-defeating emotional and cognitive patterns that begin early in our development, repeat throughout life, and act as risk factors for mental health problems and substance use (SU). SU behavior acts as a means by which users attempt to avoid triggering the unpleasant and negative emotions inherent in their elevated schema. Thus, SU is often seen as a coping mechanism in schema theory. This has important implications in terms of assessment, treatment, and planning of interventions. Schema therapy would be a valuable addition to the current therapy practice, which emphasizes a dual focus on both SU and EMSs and uses an integrated framework of cognitive, behavioral, and experiential techniques to target and modify EMSs.
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Affiliation(s)
- Ratnesh Chopra
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Gitanjali Narayanan
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Carter T, Heaton K, Merlo LJ, Roche BT, Puga F. Relapse Prevention and Prediction Strategies in Substance Use Disorder: A Scoping Review. J Addict Nurs 2023; 34:146-157. [PMID: 37276204 DOI: 10.1097/jan.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Relapse prevention for those with substance use disorder (SUD) is an evolving practice. Initiatives focused on relapse prevention from other populations may provide the foundation for future considerations and recommendations for recovering anesthesia providers in the workplace. The purpose of this scoping review was to examine what is known about return-to-use prediction and prevention strategies in various populations struggling with SUDs to inform future considerations and implications for recovering anesthesia providers with a history of SUD. METHODS The Arksey and O'Malley framework was used to conduct a scoping review of the literature. A systematic search was conducted across three databases (PubMed, CINAHL, and PsycInfo) for relevant literature. Search terms used were "measures predicting relapse in substance use disorder" and "relapse prevention in substance use disorder AND anesthesia." Data from articles that met the eligibility criteria were extracted and summarized by the primary author. RESULTS The search identified 46 articles highlighting various relapse prediction and prevention strategies related to craving and stress, underlying biological factors, neuroimaging, and mindfulness. Relapse prediction and prevention strategies ranged from cell phone applications, monitoring biological markers, and functional neuroimaging of the brain. CONCLUSIONS Relapse is a concern for individuals with a history of SUD. For anesthesia providers, immediate access to powerful anesthesia medications requires return-to-use prediction and prevention strategies when anesthesia providers return to work after SUD treatment. Although some identified strategies are practical, more research is needed to predict and prevent return to use for recovering anesthesia providers.
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Sharma AK, Shadakshari D, Chand P, Murthy P. Design, development and pilot testing of 'Quest', a smartphone-based relapse prevention app for patients with alcohol dependence. Asian J Psychiatr 2023; 83:103572. [PMID: 37019043 DOI: 10.1016/j.ajp.2023.103572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To design, develop and pilot the 'Quest' app for smartphone-based relapse prevention for patients diagnosed with alcohol dependence syndrome (ADS). METHODS Principles of relapse prevention and motivation enhancement were used to develop the Quest App. Four addiction psychiatrists reviewed the app using the "app evaluation framework". Thirty patients (> 18 yrs age) diagnosed with ADS, who had an Android smartphone, were fluent in writing and reading English and agreed to use the app regularly for the next three months were enrolled in this study. After initial treatment for intoxication/withdrawal and with written consent, patients in the study group (TAUQ) were requested to download the Quest application from a downloadable installation file. The usability and acceptability of Quest App amongst TAUQ patients was evaluated using the usability section of the mHealth App Usability Questionnaire (MAUQ). The short-term effectiveness at the end of three months was compared between TAUQ and comparison group who received Treatment as Usual (TAU). RESULTS Both acceptability (65 %) and usability (5.8 out of 7) of the app were high. The patient groups (with or without Quest app) showed a significant reduction in drinking at 30, 60, and 90 days follow-up compared with their baseline number of drinking days. There was no significant difference between the two groups (with or without Quest App) in the median number of lapses and the median number of days of heavy drinking. CONCLUSIONS This is the first attempt to develop a smartphone app and test its feasibility in preventing relapse among patients with ADS in the Indian population. Further validation of the app after incorporating feedback and testing on a larger sample size and multiple languages is required.
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Affiliation(s)
- Abhishek Kumar Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Darshan Shadakshari
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Prabhat Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
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Strika-Bruneau L, Fauvel B, Dupuis D, Benyamina A. Articulation de la thérapie d’acceptation et d’engagement à la psychothérapie assistée par psychédéliques en addictologie. L'ÉVOLUTION PSYCHIATRIQUE 2023. [DOI: 10.1016/j.evopsy.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Cai W, Wang Y. Family Support and Hope among People with Substance Use Disorder in China: A Moderated Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9786. [PMID: 36011426 PMCID: PMC9408460 DOI: 10.3390/ijerph19169786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Studies have shown that hope is an important protective factor. At present, few of the available studies on hope have been conducted on people undergoing compulsory rehabilitation. This study explores the mediating role of resilience between family support and hope, and whether relapse plays a moderating role between family support, resilience, and hope. A total of 647 people with substance use disorder completed surveys on Perceived Social Support from Family Scale, Connor-Davidson Resilience Scale, and Herth Hope Index. Structural equation modeling was used to examine the moderated mediation analysis. Family support not only has a direct effect on hope, but also has a significant indirect effect on hope through resilience. The indirect effect of family support on hope via resilience was significant among both the non-relapse group and relapse group; in addition, both the association between family support and resilience and the relation between resilience and hope were moderated by relapse experience. The results indicate that interventions targeting resilience might be an effective approach to improving hope among people with substance use disorder in China.
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Affiliation(s)
- Wenqiang Cai
- School of Public Administration, Hohai University, Nanjing 211100, China
- Department of Public Security Management, Jiangsu Police Institute, Nanjing 210031, China
| | - Yijie Wang
- School of Public Administration, Hohai University, Nanjing 211100, China
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Dowling NA, Merkouris SS, Youssef GJ, Lubman DI, Bagot KL, Hawker CO, Portogallo HJ, Thomas AC, Rodda SN. GAMBLINGLESS IN-THE-MOMENT: Protocol for a micro-randomised trial of a gambling Just-In-Time Adaptive Intervention (Preprint). JMIR Res Protoc 2022; 11:e38958. [PMID: 35998018 PMCID: PMC9449828 DOI: 10.2196/38958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID) PRR1-10.2196/38958
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | | | - Dan I Lubman
- Turning Point and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Chloe O Hawker
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Anna C Thomas
- School of Psychology, Deakin University, Geelong, Australia
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
- School of Population Health, University of Auckland, Grafton, New Zealand
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Hill-Bowen LD, Riedel MC, Poudel R, Salo T, Flannery JS, Camilleri JA, Eickhoff SB, Laird AR, Sutherland MT. The cue-reactivity paradigm: An ensemble of networks driving attention and cognition when viewing drug and natural reward-related stimuli. Neurosci Biobehav Rev 2021; 130:201-213. [PMID: 34400176 PMCID: PMC8511211 DOI: 10.1016/j.neubiorev.2021.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
The cue-reactivity paradigm is a widely adopted neuroimaging probe engendering brain activity linked with attentional, affective, and reward processes following presentation of appetitive stimuli. Given the multiple mental operations invoked, we sought to decompose cue-related brain activity into constituent components employing emergent meta-analytic techniques when considering drug and natural reward-related cues. We conducted coordinate-based meta-analyses delineating common and distinct brain activity convergence across cue-reactivity studies (N = 196 articles) involving drug (n = 133) or natural (n = 63) visual stimuli. Across all studies, convergence was observed in limbic, cingulate, insula, and fronto-parieto-occipital regions. Drug-distinct convergence was observed in posterior cingulate, dorsolateral prefrontal, and temporo-parietal regions, whereas distinct-natural convergence was observed in thalamic, insular, orbitofrontal, and occipital regions. We characterized connectivity profiles of identified regions by leveraging task-independent and task-dependent MRI datasets, grouped these profiles into subnetworks, and linked each with putative mental operations. Outcomes suggest multifaceted brain activity during cue-reactivity can be decomposed into elemental processes and indicate that while drugs of abuse usurp the brain's natural-reward-processing system, some regions appear distinct to drug cue-reactivity.
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Affiliation(s)
- Lauren D Hill-Bowen
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Michael C Riedel
- Department of Physics, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Ranjita Poudel
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Taylor Salo
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Jessica S Flannery
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Julia A Camilleri
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52425, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52425, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Angela R Laird
- Department of Physics, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States.
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Shanmugam B, Das B, Bhattacharjee D, Ezhumalai S. Expressed Emotions and Coping among Relapsed Persons with Alcohol Dependence Syndrome: A Comparative Study. INDIAN JOURNAL OF MENTAL HEALTH 2021; 8:429-434. [PMID: 35036570 PMCID: PMC8757773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Alcohol dependence is a global public health issue; it is a chronic and relapsing illness. Relapse is multifaceted by both neurobiological and psychosocial processes. AIM To examine the expressed emotions and coping among persons with alcohol dependence. METHODS The study was descriptive and hospital-based. A purposive sampling technique was used. This study was conducted at the Centre for Addiction Psychiatry, CIP, Ranchi. The total sample size was 50. Twenty-five persons with alcohol dependence who relapsed within six months following treatment formed a study group. Another 25 persons with alcohol dependence who were abstinent for a minimum period of six months after treatment formed a comparative group. Ways of coping questionnaire and the level of expressed emotions scale were used, and informed consent was taken from the participants. Chi-square and independent sample 't' test, Pearson's correlation was used to analyse the data. RESULTS Mean age of relapsed patients was 35.3 years (S.D±7.6), and abstinent patients were 35.4 yrs (S.D±6.8), years of education of relapsed patients score was 12 yrs ±2.63 and 11.6 yrs ±3.26 in abstinent patients. A majority (60% )of relapsed patients were from rural background, 92% in the abstinent group were employed. 60% of abstinent patients had a family history of alcohol dependence. Abstinent patients had scored significantly high in all the domains of ways of coping. Relapse patients had higher scores in perceived lack of emotional support, perceived irritability, perceived intrusiveness, and perceived criticism compared to abstinent patients. CONCLUSION The study provided further evidence that coping and perceived expressed emotions significantly influenced relapse among persons with alcohol dependence.
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Affiliation(s)
- Backiyaraj Shanmugam
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Sinu Ezhumalai
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Sureshkumar K, Dalal PK, Kailash SZ, Rudhran V. Relapse in opioid dependence: Role of psychosocial factors. Indian J Psychiatry 2021; 63:372-376. [PMID: 34456350 PMCID: PMC8363893 DOI: 10.4103/psychiatry.indianjpsychiatry_383_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/12/2020] [Accepted: 07/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although our understanding about neurobiology of opioid dependence and availability of pharmacological treatment has gone a long way in the last few decades, psychosocial interventions play a pivotal role in the prevention of relapse owing to reasons such as less treatment-seeking behavior and poor penetrance of opioid substitution treatment. There are many studies assessing psychosocial factors in alcohol and nicotine dependence, yet the availability of such studies for opioid dependence is sparse. This study aimed at evaluating the association of relapse in opioid dependence with various psychosocial factors. MATERIALS AND METHODS This was a cross-sectional study with two groups of opioid dependence patients: In abstinence (N = 28) and relapse (N = 33). Psychosocial variables such as high-risk situations, coping behavior, stressful life events, self-efficacy, and social support were assessed in the two groups and analyzed for the association with opioid relapse. RESULTS This study reports that more high risk situations (odds ratio [OR] =1.58; 95% confidence interval [CI] =1.22-2.03; P = 0.017), especially negative mood state and undesirable stressful life events (OR = 2.08; 95% CI = 1.28-3.37; P = 0.05) were significantly associated with higher odds of relapse in patients of opioid dependence. Further, higher self-efficacy (OR = 0.92; 95% CI = 0.87-0.96; P = 0.017) was significantly associated with lower odds of relapse. CONCLUSION Psychosocial factors such as high risk situations, undesirable stressful life events, and self-efficacy were significantly associated with relapse in opioid dependence. Hence, practice of a holistic, multimodal, and individualized treatment plan addressing these factors might help in reducing the relapse rates in them.
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Affiliation(s)
- Kailash Sureshkumar
- Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Pranab Kumar Dalal
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Shabeeba Z. Kailash
- Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
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Dowling NA, Merkouris SS, Spence K. Ecological Momentary Assessment of the Relationship between Positive Outcome Expectancies and Gambling Behaviour. J Clin Med 2021; 10:1709. [PMID: 33921069 PMCID: PMC8071390 DOI: 10.3390/jcm10081709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/04/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
Relapse prevention models suggest that positive outcome expectancies can constitute situational determinants of relapse episodes that interact with other factors to determine the likelihood of relapse. The primary aims were to examine reciprocal relationships between situational positive gambling outcome expectancies and gambling behaviour and moderators of these relationships. An online survey and a 28 day Ecological Momentary Assessment (EMA) were administered to 109 past-month gamblers (84% with gambling problems). EMA measures included outcome expectancies (enjoyment/arousal, self-enhancement, money), self-efficacy, craving, negative emotional state, interpersonal conflict, social pressure, positive emotional state, financial pressures, and gambling behaviour (episodes, expenditure). Pre-EMA measures included problem gambling severity, motives, psychological distress, coping strategies, and outcome expectancies. No reciprocal relationships between EMA outcome expectancies and gambling behaviour (episodes, expenditure) were identified. Moderations predicting gambling episodes revealed: (1) cravings and problem gambling exacerbated effects of enjoyment/arousal expectancies; (2) positive emotional state and positive reframing coping exacerbated effects of self-enhancement expectancies; and (3) instrumental social support buffered effects of money expectancies. Positive outcome expectancies therefore constitute situational determinants of gambling behaviour, but only when they interact with other factors. All pre-EMA expectancies predicted problem gambling severity (OR = 1.61-3.25). Real-time interventions addressing gambling outcome expectancies tailored to vulnerable gamblers are required.
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Affiliation(s)
- Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (K.S.)
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC 3053, Australia
- School of Psychology, Faculty of Health, Melbourne Burwood Campus, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | | | - Kimberley Spence
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (K.S.)
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15
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Kabisa E, Biracyaza E, Habagusenga JD, Umubyeyi A. Determinants and prevalence of relapse among patients with substance use disorders: case of Icyizere Psychotherapeutic Centre. Subst Abuse Treat Prev Policy 2021; 16:13. [PMID: 33526066 PMCID: PMC7851925 DOI: 10.1186/s13011-021-00347-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relapse to substance use after successful detoxication and rehabilitation is a public health concern worldwide. Forty to sixty percent of persons in general relapsed after completing detoxication and rehabilitation treatments. Although substance use remains a burden in Rwanda, very little is known about relapse among people with substance use disorder (SUD). Hence, this study aimed to examine prevalence and the factors associated with relapse to substance use at Icyizere Psychotherapeutic Centre (IPC), Rwanda. METHODS Retrospective, cross-sectional survey was conducted among 391 patients with SUD at IPC. Multiple logistic regression models using STATA version 13 were used to determine the factors associated with relapse among the patients with SUD. RESULTS Majority (84.1 %) of the participants were males. More than half (54.1 %) of them were aged between 18 and 30 years with the age average of 33 years (SD = 11.9 years). The results showed a higher prevalence of relapse among patients with SUD (59.9 %). The multivariate analyses indicated that people with SUD living only with their mothers had a greater risk of relapse compared to those with both biological parents [OR = 1.9, 95 % CI (1.02-3.6), p = 0.04]. Patients that were hospitalized between one to three months were more likely (11.2 times) to relapse after treatments compared to those who spent more than three months in hospitalization [OR = 9.2, 95 % CI (1.1-77.6), p = 0.02]. Furthermore, people that used more than two substances had 1.5 greater risk to relapse than those who consumed one substance. Participants were more likely to relapse if they lived with their peers [OR = 2.4, 95 % CI: (1.2-7.8), p = 0.01] or if they lived in a family with conflicts [OR = 2.1, 95 % CI (1.05-9.7), p = 0.02]. CONCLUSIONS This study is conducted at one institution caring for patients with SUD. The prevalence was 59.9 %. Future studies are recommended to investigate the effectiveness of the existing relapse prevention programs in order to adjust prevention strategies.
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Affiliation(s)
- Eric Kabisa
- Rwanda Palliative Care and Hospice Organization (RPCHO), Kigali, Rwanda.
- Department of Health Policy, Economics and Management, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Emmanuel Biracyaza
- Department of Health Policy, Economics and Management, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Programme of Sociotherapy, Prison Fellowship Rwanda (PFR), Kigali, Rwanda
| | - Jean d'Amour Habagusenga
- Department of Health Policy, Economics and Management, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aline Umubyeyi
- Department of Epidemiology and Biostatistics, School of Public health, College of Medicine and Health Sciences, Kigali, Rwanda
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16
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Sahu P, Mathur A, Ganesh A, Nair S, Chand P, Murthy P. Acceptance of e-consult for Substance Use Disorders during the COVID 19 pandemic: A study from India. Asian J Psychiatr 2020; 54:102451. [PMID: 33271730 PMCID: PMC7557176 DOI: 10.1016/j.ajp.2020.102451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The COVID 19 pandemic has created challenges in providing timely care for patients and families with Substance Use disorders (SUDs). With the difficulties in face-to-face consultations because of social distancing measures, telepsychiatry services can be beneficial. The study proposes implementing an e-consult for SUD management and measuring its acceptability among the health care providers (HCPs) in India. METHODS The mobile-based e-consult for SUD, connecting HCPs with addiction specialists, was implemented during the COVID lockdown period in India from 25 March to 31 May (71 days). A total of 153 HCPs, i.e., doctors, nurses, counselors, consulted for 110 cases of SUD. Sixty-eight provided feedback by filling the survey form derived from the Service User Technology Acceptability Questionnaire (SUTAQ). RESULT More than 60% of HCPs reported overall high satisfaction. More than 98% providers reported high acceptability concerning"access to specialist care," "trusted to work appropriately", "saving time," "would like torecommend to others," easier to get touch with a specialist." The doctors reported significantly high acceptability about "access to specialist care," "satisfied with recommendations,"recommend to others" compared to other HCPs. CONCLUSION During COVID 19 pandemic lockdown in India, e-consult was an acceptable tool in managing SUDs. The majority of HCPs could discuss their cases with addiction experts. There is a need to expand this further in other mental health conditions.
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Affiliation(s)
- Prashant Sahu
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India
| | - Akanksha Mathur
- Virtual Knowledge Network-NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India
| | - Aurobind Ganesh
- Virtual Knowledge Network-NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India
| | - Shruti Nair
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India
| | - Prabhat Chand
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India; Virtual Knowledge Network-NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India.
| | - Pratima Murthy
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India; Virtual Knowledge Network-NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 29, India
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17
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Dellazizzo L, Potvin S, Luigi M, Dumais A. Evidence on Virtual Reality-Based Therapies for Psychiatric Disorders: Meta-Review of Meta-Analyses. J Med Internet Res 2020; 22:e20889. [PMID: 32812889 PMCID: PMC7468638 DOI: 10.2196/20889] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)–based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders. Objective This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies. Methods A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence. Results The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia. Conclusions VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Stéphane Potvin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Mimosa Luigi
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,University of Montreal, Montreal, QC, Canada.,Institut national de psychiatrie légale Philippe-Pinel, Montreal, QC, Canada
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18
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Villavasso S, Shaw C, Skripnikova E, Shah K, Davis JF, Sirohi S. Nutritional Contingency Reduces Alcohol Drinking by Altering Central Neurotransmitter Receptor Gene Expression in Rats. Nutrients 2019; 11:E2731. [PMID: 31717954 PMCID: PMC6893745 DOI: 10.3390/nu11112731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022] Open
Abstract
We have previously shown that 6 weeks of intermittent high-fat diet (Int-HFD) pre-exposure significantly reduced alcohol drinking in rats, providing preliminary evidence of the effectiveness of a dietary intervention in reducing alcohol intake. However, the functional framework and underlying neurobiological mechanisms of such dietary intervention are unknown. Here, we examined the impact of Int-HFD pre-exposure duration on alcohol drinking, plasma feeding peptides, and central neurotransmitter receptors gene expression. Male Long Evans rats (n = 6-7/group) received no pre-exposure, 1 or 2 weeks pre-exposure to Int-HFD and alcohol drinking (two-bottle choice) was evaluated. We observed HFD pre-exposure-dependent decrease in alcohol drinking, with a significant decrease observed following 2 weeks of Int-HFD pre-exposure. No significant between-group differences in plasma feeding peptides (i.e., ghrelin, leptin, insulin) were detected. A PCR array revealed that the expression of several neurotransmitter receptors was significantly (p < 0.05 and ≥2-fold) altered in the striatum and ventral tegmental area compared to controls. These data suggest that pre-exposure to a palatable diet is critical to reduce alcohol drinking in rats, possibly through genetic alterations in the brain reward circuitry. Importantly, the present study is a step forward in identifying the critical framework needed to evaluate the therapeutic potential of nutritional contingency in the management of alcoholism.
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Affiliation(s)
- Starr Villavasso
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (S.V.); (C.S.); (E.S.); (K.S.)
| | - Cemilia Shaw
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (S.V.); (C.S.); (E.S.); (K.S.)
| | - Elena Skripnikova
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (S.V.); (C.S.); (E.S.); (K.S.)
| | - Krishna Shah
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (S.V.); (C.S.); (E.S.); (K.S.)
| | - Jon F. Davis
- Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, WA 99164, USA;
| | - Sunil Sirohi
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (S.V.); (C.S.); (E.S.); (K.S.)
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19
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Park MJ, Green J, Jung HS, Park YS. Trajectories of change after a health-education program in Japan: decay of impact in anxiety, depression, and patient-physician communication. PeerJ 2019; 7:e7229. [PMID: 31341730 PMCID: PMC6637923 DOI: 10.7717/peerj.7229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background Health education can benefit people with chronic diseases. However, in previous research those benefits were small, and reinforcement to maintain them was not effective. A possible explanation is that the benefits appeared to be small and reinforcement appeared to be ineffective because those analyses mixed data from two latent groups: one group of people who needed reinforcement and one group of people who did not. The hypothesis is that mixing the data from those two different groups caused the true effects to be “diluted.” Methods To test that hypothesis we used data from the Chronic Disease Self-Management Program in Japan, focusing on anxiety, depression, and patient-physician communication. To identify latent trajectories of change after the program, we used growth-mixture modeling. Then, to find out which baseline factors were associated with trajectory-group membership, we used logistic regression. Results Growth-mixture modeling revealed two trajectories—two groups that were defined by distinct patterns of change after the program. One of those patterns was improvement followed by backsliding: decay of impact. On anxiety and depression the decay of impact was large enough to be clinically important, and its prevalence was as high as 50%. Next, logistic regression analysis revealed that being in the decay-of-impact group could be predicted from multimorbidity, low self-efficacy, and high scores on anxiety or depression at baseline. In addition, one unexpected finding was an association between multimorbidity and better patient-physician communication. Conclusions These results support the hypothesis that previous findings (i.e., apparently small effect sizes and apparently ineffective reinforcement) actually reflect “dilution” of large effects, which was caused by mixing of data from distinct groups. Specifically, there was one group with decay of impact and one without. Thus, evaluations of health education should include analyses of trajectory-defined groups. These results show how the group of people who are most likely to need reinforcement can be identified even before the educational program begins. Extra attention and reinforcement can then be tailored. They can be focused specifically to benefit the people with the greatest need.
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Affiliation(s)
- Min Jeong Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea.,Department of Health Communication, University of Tokyo, Tokyo, Japan
| | - Joseph Green
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hun Sik Jung
- College of Global Business, Konyang University, Nonsan, South Korea
| | - Yoon Soo Park
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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20
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Kumar R, Kumar KJ, Benegal V, Roopesh BN, Ravi GS. Effectiveness of an Integrated Intervention Program for Alcoholism (IIPA) for enhancing self-regulation: Preliminary evidence. Asian J Psychiatr 2019; 43:37-44. [PMID: 31078094 DOI: 10.1016/j.ajp.2019.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/07/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Alcoholism could be a core problem of self-regulatory failure. Several neurocognitive theories have hypothesized hypo-functioning or dysfunction of reflective (executive) system and heightened functioning of reactive (impulsive) system in self-regulatory failure implicated in drug addiction. Similarly, stress and affect dysregulation may breakdown self-regulation. The present study aimed to develop an Integrated Intervention Program for Alcoholism (IIPA) to enhance self-regulation and to test its effectiveness in the treatment of alcoholism. METHOD Individuals with early onset alcoholism (n = 50) were recruited after getting written informed consent. The study used randomized case control design. The participants were matched on age (+/-1 year) and education (+/-1 year). The TAU group received usual treatment for alcoholism which included pharmacotherapy, 6 sessions/week yoga and 3 sessions/week group therapy on relapse prevention. The intervention group received IIPA for 18 days along with usual treatment (except yoga sessions). The IIPA included several cognitive remediation tasks and mind-body exercise (Qigong and Tai Chi Chuan). Both groups were assessed on executive function tests and affect regulation scale at pre and post-intervention. The subjects were also followed up for 6 months to compare the abstinence between groups. RESULTS Both groups were comparable at baseline. At post-intervention, the IIPA group showed a significant improvement compared to the TAU group on executive functioning and affect regulation. Follow-up results showed lower relapses in six months in the IIPA group. CONCLUSION Preliminary evidence showed that IIPA is effective in facilitating self-regulation. Further study may examine its utility and feasibility in other clinical conditions.
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Affiliation(s)
- Rajesh Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
| | - Keshav J Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
| | - Bangalore N Roopesh
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
| | - Girikematha S Ravi
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
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