Quality of Life in Patients with Substance Use Disorders Admitted to Detoxification Compared with Those Admitted to Hospitals for Medical Disorders: Follow-Up Results

Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment - A prospective pre-post study

Background

Globally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment.

Methods

We describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course.

Results

We obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5-6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use-related variables showed a modest, non-significant improvement at T1.

Conclusion

During a 5-month course of outpatient treatment, patients' subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.

Health-related quality of life and stigma in opioid dependence: Comparison between buprenorphine users and non-users

Objectives

Opioid dependence leads to reduced quality of life (QOL) and stigma. There is scarcity of literature on impact of buprenorphine on QOL of patients with opioid dependence from India. This study reports QOL and stigma in patients taking buprenorphine and compare it with those who were not on any treatment.

Materials and Methods

A cross-sectional, descriptive, comparative study was conducted among three groups (n = 100 each). Group 3 comprised patients who were already taking buprenorphine for at least 3 months from a government outpatient opioid-assisted treatment center. Group 2 comprised patients who were not on any treatment but had come to enrol in buprenorphine treatment and Group 1 comprised patients who had come to get some other treatment and were not willing for buprenorphine. After fulfilling inclusion and exclusion criteria, sociodemographic pro forma, Hindi self-stigma scale, and World Health Organization QOL-BREF Hindi were applied. Appropriate statistical analyses were done.

Results

Patients already taking buprenorphine had significantly better QOL and it improved as the duration of treatment increased. Patients on buprenorphine treatment had significantly lesser stigma than patients not already on treatment. Stigma negatively impacted QOL in the three groups.

Conclusion

QOL and factors affecting it should be an integral part of management of opioid dependence. Efforts should be made to enrol maximum number of patients in treatment to enhance their quality of life and reduce stigma.

Health-related quality of life in patients with substance use disorders enrolled to the residential treatment in Sri Lanka: a retrospective cross-sectional study

PURPOSE

Substance use disorder (SUD) is a serious public health concern that requires continuum care with effective treatment modalities such as residential rehabilitation. Improvement in health-related quality of life (HRQoL) is one of the determinants of treatment and rehabilitation effectiveness. Therefore, a retrospective cross-sectional study was carried out in seven residential rehabilitation centres in Sri Lanka to determine the HRQoL of the rehabilitees with SUD.

METHOD

The HRQoL of 464 individuals at their enrolment and during the rehabilitation period was assessed using EuroQol five-level five-dimensional questionnaire (EQ-5D-5L). Data were analysed using IBM SPSS version 26.

RESULTS

The majority of the participants were Sinhala (n = 419, 90.3%) and Buddhist (n = 368, 79.3%) males (n = 461, 99.4%). Most were unmarried (n = 302, 65.1%), young adults (n = 385, 83.0%) who have pursued secondary or higher education (n = 276, 59.5%) and 87.3% were employed (n = 405). Most of the selected centres use biopsychosocial model (n = 4, 57.1%) as the rehabilitation approach while rest practice therapeutic community (n = 3, 42.9%). The average EQ-5D-5L index [range =( - 0.45)-1.00] of the rehabilitees at their enrolment was 0.52 ± 0.28 and the EQ-5D-5L Visual Analogue Scale (EQ-5D-5L VAS) score (range = 0-100%) was 47.17% ± 23.48%. The values were increased up to 0.83 ± 0.18 (EQ-5D-5L index) and 84.25% ± 16.79% (EQ-5D-5L VAS) during the rehabilitation period. Only 19.4% of the rehabilitees had a normal or upper normal HRQoL (≥ 0.75 EQ-5D-5L Index) at their enrolment and 72.2% of rehabilitees reported normal or upper normal HRQoL during the rehabilitation period.

CONCLUSION

A significant improvement in the HRQoL of the participants was observed during the residential treatment in comparison to the enrolment, despite the differences in the rehabilitation programs.

Perceived family cohesion, social support, and quality of life in patients undergoing treatment for substance use disorders compared with patients with mental and physical disorders

Purpose

Support from family and other social network elements can be important in helping patients to cope with practical and emotional consequences of diseases. The aim of the study was to examine perception of family and social support and quality of life (QoL) in patients undergoing treatment for substance use disorders (SUDs). We compared them with patients in treatment for mental disorders (MDs) and physical disorders (PDs).

Methods

We used data from a national multicenter study that recruited patients (N  =  518) from three treatment domains; SUD treatment units, MD treatment units, and PD treatment units (severe neurological conditions or cancer). Data on family cohesion, social support, and QoL were compared across patient groups. In addition, data on health variables was collected. We used a multiple linear regression procedure to examine how health and support variables were associated with QoL.

Results

Family cohesion and social support in the SUD and MD groups were rated at similarly low levels, substantially lower than in the PD group. The SUD group exhibited a somewhat lower QoL than did the PD group, but their QoL was still in the near-to-normal range. In contrast, the MD group had markedly low QoL. When examining factors associated with QoL, we found that greater family cohesion and social support were positively associated with QoL. Mental distress was the strongest factor, and was negatively associated with QoL (beta − 0.15, 95% CI  =  − 0.17/− 0.14, p  <  0.001).

Conclusion

Service providers need to be aware of the weaker networks and less regulatory family and/or social support available to patients with SUDs. Providers should focus consistently on the social networks of patients and include patients’ families in treatment processes.

Validation and psychometric properties of the drug users' quality of life scale in Iranian population

INTRODUCTION

Drug dependence and the resultant problems notably decrease the quality of life (QOL). Measuring the QOL in persons who use drugs (PWUD_s) and planning to improve it can be helpful for rehabilitation programs. Given the absence of a standard tool to measure the quality of life of PWUD, the present study is an attempt to validate psychometric and cultural characteristics of non-injection drug users' QOL scale.

METHOD

The study was carried out as a validation and methodological work. The study population consisted of 273 PWUDs in Kermanshah-based drug clinics including outgoing and hospitalized patients. The participants were selected through convenient-quota sampling. After securing the required permission from the copyright owner of the tool, it was forward/backward translated. Face validity and content validity were determined quantitatively and qualitatively. To examine construct validity of the tool, explorative factor analysis and confirmatory factor analysis were used. Internal consistency was measured using Cronbach's alpha and statistical analyses were performed using SPSS (v.25) and LISREL (v.8).

RESULTS

Explorative factor analysis (EFA) and confirmatory factor analysis (CFA) results supported the tool with one factor and 22 items. The R2 index in the model was equal to 0.99, which means that 99% of the variation of dependent variable (total score of QOL) is attributed to independent variable (22 statements). In other words, 99% of the variation of dependent variable is due to the independent variables in the model. The main indices of the model based on CFA all were higher than 0.9, which indicates goodness of fit of the model (χ2/DF = 2.18, CFI, NFI, TLI = 0.93 GF = 0.84, REMSEA = 0.066, R2 = 0.99). The correlative coefficient was significant (p < 0.05). The reliability of the tool based on internal consistency (Cronbach's alpha) for the subscales ranged from 0.84 to 0.85 and equal to 0.84 for the whole tool.

CONCLUSION

The Farsi version of non-injection drug users' QOL scale had acceptable indices and it was applicable to assess QOL in the target population. The tool can be used in different fields of drug addiction.

Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence

Background

Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients’ HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence.

Methods

HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients’ levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively).

Results

Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (β = 5.5; p = 0.001) and a lower baseline PCS score (β = − 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (β = − 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (β = 0.1; p = 0.02) and a lower baseline MCS score (β = − 0.7; p < 0.0001) were associated with significant MCS improvement.

Conclusion

The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients’ early satisfaction to identify areas of improvement and thus improve HRQoL.

Quality of Life in Patients With Methamphetamine Use Disorder: Relationship to Impulsivity and Drug Use Characteristics

BACKGROUND

The quality of life (QOL) of patients with methamphetamine use disorder (MAUD) is increasingly recognized as an important outcome. Previous studies have found that impulsivity is negatively associated with QOL in mental disorders, but this relationship is rarely confirmed in patients with MAUD. We hypothesized that impulsivity is negatively correlated with QOL in patients with MAUD based on previous findings. In addition, a variety of drug use characteristics of patients that may potentially affect their QOL need to be further explored. Therefore, the purpose of this study was to explore the relationship between impulsivity, multiple drug use characteristics, and QOL in patients with MAUD.

METHODS

A total of 379 patients with MAUD were recruited, and the majority of them were male (85.5%), with an average age of 33.93 ± 7.08 years. Two psychiatrists conducted semi-structured interviews with methamphetamine (MA) users in two compulsory drug rehabilitation centers to obtain their demographics and drug use characteristics. The Barratt Impulsiveness Scale-11 (BIS-11) and Brief WHO Quality of Life Assessment (WHOQOL-BREF) were used to assess patients' impulsivity and QOL, respectively. Correlation and univariate regression analysis were used to explore the relationships between impulsivity, a series of drug use characteristics and patients' QOL in different domains. Further multiple linear regression analysis was used to identify what extent the above clinical variables explained the variations in patients' QOL.

RESULTS

Age, marital status, employment, and various drug use characteristics were significantly associated with at least one QOL domain. Among them, married and full-time job were positively correlated with QOL, while others were negatively correlated with QOL. The total score of BIS-11 was significantly negatively correlated with all four domains of QOL. Impulsivity, a range of drug use characteristics and certain demographic characteristics collectively explained varying degrees of variation in different domains of QOL.

CONCLUSIONS

Impulsivity and various drug use characteristics can significantly predict QOL in all fields of MAUD patients. In addition, we have also found differences in the predictors of QOL in different domains. Overall, this study provides clinical guidance for the treatment of MAUD patients, that is, management of impulsivity in patients with MAUD may help improve their QOL and even sustain their drug rehabilitation.

Comprehensive oral care improves treatment outcomes in male and female patients with high-severity and chronic substance use disorders

BACKGROUND

Using data from a workforce training program funded by the Health Resources and Services Administration, the authors de-identified pre- and posttreatment assessments of high-severity and chronic substance use disorders (SUDs) to test the effect of integrated comprehensive oral health care for patients with SUDs on SUD therapeutic outcomes.

METHODS

After 1 through 2 months of treatment at a SUD treatment facility, 158 male self-selected (First Step House) or 128 randomly selected sex-mixed (Odyssey House) patients aged 20 through 50 years with major dental needs received integrated comprehensive dental treatment. The SUD treatment outcomes for these groups were compared with those of matched 862 male or 142 sex-mixed patients, respectively, similarly treated for SUDs, but with no comprehensive oral health care (dental controls). Effects of age, primary drug of abuse, sex, and SUD treatment facility-influenced outcomes were determined with multivariate analyses.

RESULTS

The dental treatment versus dental control significant outcomes were hazard ratio (95% confidence interval [CI]) 3.24 (2.35 to 4.46) increase for completion of SUD treatment, and odds ratios (95% CI) at discharge were 2.44 (1.66 to 3.59) increase for employment, 2.19 (1.44 to 3.33) increase in drug abstinence, and 0.27 (0.11 to 0.68) reduction in homelessness. Identified variables did not contribute to the outcomes.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Improvement in SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health care of major dental problems significantly improves treatment outcomes in patients whose disorders are particularly difficult to manage, such as patients with SUDs.

Confirming the factor structure of a generic quality of life instrument among pre-treatment substance use disorder patients

Background

Quality of life (QoL) is a patient-reported outcome of increasing importance in the substance use disorder (SUD) treatment field, and impaired QoL may be an important impetus for treatment uptake. Instruments and methodologies abound, precluding comparison, as does a dearth of population norms. The QOL10 is a generic, overall QoL tool containing ten items and with simple scoring procedures. It is therefore a potential alternative to the gold standard WHOQOL-BREF. This study aimed to assess the two-factor structure of the QOL10 that has been suggested by a previous exploratory factor analysis.

Methods

Adults entering 21 participating inpatient or outpatient SUD treatment were recruited to join a national longitudinal cohort study. 531 completed the QOL10 at treatment entry and were included in the analysis. Structural equation modelling (SEM) was used to confirm the model fit of a two-factor structure, and the scaling qualities of the QOL10 were reported.

Results

According to the SEM analysis, the QOL10 was comprised of one latent variable measuring social QoL, and one measuring global QoL, and all ten items were retained. Goodness of fit tests included: root mean square of approximation = 0.063, 90% CI 0.050–0.076; normed-fit index = 0.919; and comparative fit index = 0.943.

Conclusions

The QOL10 should be considered when clinicians in the SUD treatment field need a short, valid instrument that measures both global QoL and social QoL, with minimum respondent and administrator burden. The social domain is of particular utility and may be used as a stand-alone instrument. Test-retest reliability should be established in future studies.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1152-7) contains supplementary material, which is available to authorized users.

Performance of the WHOQOL-BREF among Norwegian substance use disorder patients

BACKGROUND

Quality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables.

METHODS

107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL.

RESULTS

Three out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL.

CONCLUSIONS

After one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.

Perceived quality of life in partners of patients undergoing treatment in somatic health, mental health, or substance use disorder units: a cross-sectional study

BACKGROUND

This study explores (1) differences in socio-demographic, social/familial, and health variables and perceived quality of life (QoL) among partners of patients with somatic illness, mental illness, or substance use disorder (SUD); and (2) identifies factors associated with QoL.

METHODS

Participants (N = 213) in this cross-sectional study were recruited from inpatient or outpatient services in five hospitals in Norway, 2013-2014. QoL was measured by the QoL-5, a generic five-item questionnaire. Differences between groups were examined using Chi-square for categorical variables and Kruskal-Wallis for contiuous variables. Multiple linear regression analyses were used to examine factors associated with QoL.

RESULTS

The mean QoL score was similar to that of a general population sample, and 13% of the sample had a markedly low QoL. Partners in the SUD group experienced worse socio-demographic conditions in terms of occupation and income, but QoL did not differ significantly among the three groups. In a regression model, perceived family cohesion was positively associated with QoL while psychological distress (Symptom Checklist-10) was negatively related to it. The model explained 56% of the variance in QoL.

CONCLUSIONS

When patients are ill, clinicians should consider the partners' QoL, and brief QoL tools can be used to identify those who are struggling most. Reduced QoL is associated with higher psychological distress and lower family cohesion. Treatment initiatives focusing on these themes may serve as preventive measures to help the most vulnerable families cope with their difficult life situation.