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Gratacós-Ginès J, López-Pelayo H, Pose E. Reply: Medications promoting abstinence in alcohol-associated cirrhosis. Hepatology 2024; 79:E100-E101. [PMID: 38193591 DOI: 10.1097/hep.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Hugo López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
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Gratacós-Ginès J, Bruguera P, Pérez-Guasch M, López-Lazcano A, Borràs R, Hernández-Évole H, Pons-Cabrera MT, Lligoña A, Bataller R, Ginès P, López-Pelayo H, Pose E. Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: Results from a systematic review and meta-analysis. Hepatology 2024; 79:368-379. [PMID: 37625154 DOI: 10.1097/hep.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND AND AIMS The role of medications for alcohol use disorder (MAUD) in patients with cirrhosis is not well established. Evidence on the efficacy and safety of these drugs in these patients is scarce. APPROACH AND RESULTS We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines on the efficacy of MAUD in patients with cirrhosis. A search was conducted in PubMed, Embase, and Scopus, including all studies until May 2022. The population was defined as patients with AUD and cirrhosis. The primary outcome was alcohol abstinence. Safety was a secondary outcome. We performed a random-effect analysis and expressed the results as relative risk of alcohol consumption. Heterogeneity was measured by I2 . Out of 4095 unique references, 8 studies on 4 different AUD treatments [baclofen (n = 6), metadoxine (n = 1), acamprosate (n = 1), and fecal microbiota transplant (n = 1)] in a total of 794 patients were included. Four were cohort studies, and 4 were RCTs. Only RCTs were included in the meta-analysis. MAUD was associated with a reduced rate of alcohol consumption [relative risk = 0.68 (CI: 0.48-0.97), P = 0.03], increasing alcohol abstinence by 32% compared to placebo or standard treatment, despite high heterogeneity ( I2 = 67%). Regarding safety, out of 165 serious adverse events in patients treated with MAUD, only 5 (3%) were possibly or probably related to study medications. CONCLUSION MAUD in patients with cirrhosis is effective in promoting alcohol abstinence and has a good safety profile. Larger studies on the effects of MAUD are needed, especially in patients with advanced liver disease.
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Affiliation(s)
- Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Pol Bruguera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
| | - Martina Pérez-Guasch
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ana López-Lazcano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Clinical Health Psychology Section, Institute of Neuroscience (ICN), Hospital Clínic de Barcelona, Catalunya, Spain
| | - Roger Borràs
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
| | | | - Maria T Pons-Cabrera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
| | - Anna Lligoña
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
| | - Ramón Bataller
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
| | - Hugo López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Addictions Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Catalunya, Spain
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Scheibein F, Caballeria E, Taher MA, Arya S, Bancroft A, Dannatt L, De Kock C, Chaudhary NI, Gayo RP, Ghosh A, Gelberg L, Goos C, Gordon R, Gual A, Hill P, Jeziorska I, Kurcevič E, Lakhov A, Maharjan I, Matrai S, Morgan N, Paraskevopoulos I, Puharić Z, Sibeko G, Stola J, Tiburcio M, Tay Wee Teck J, Tsereteli Z, López-Pelayo H. Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise. JMIR Hum Factors 2023; 10:e46678. [PMID: 38085569 PMCID: PMC10751634 DOI: 10.2196/46678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.
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Affiliation(s)
- Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Elsa Caballeria
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Md Abu Taher
- United Nations Office of Drugs and Crime, Dhaka, Bangladesh
| | - Sidharth Arya
- Institute of Mental Health, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte De Kock
- Institute for Social Drug Research, Ghent University, Ghent, Belgium
| | - Nazish Idrees Chaudhary
- International Grace Rehab, Lahore School of Behavioral Sciences, The University of Lahore, Lahore, Pakistan
| | | | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cees Goos
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Rebecca Gordon
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antoni Gual
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Penelope Hill
- The National Centre for Clinical Research on Emerging Drugs, Randwick, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Iga Jeziorska
- Correlation European Harm Reduction Network, Amsterdam, Netherlands
- Department of Public Policy, Institute of Social and Political Sciences, Corvinus University of Budapest, Budapest, Hungary
| | | | - Aleksey Lakhov
- Humanitarian Action Charitable Fund, St Petersburg, Russian Federation
| | | | - Silvia Matrai
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Nirvana Morgan
- Network of Early Career Professionals in Addiction Medicine, Seligenstadt, Germany
| | | | - Zrinka Puharić
- Faculty of Dental Medicine and Health Osijek, Bjelovar University of Applied Sciences, Bjelovar, Croatia
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jan Stola
- Youth Organisations for Drug Action, Warsaw, Poland
| | - Marcela Tiburcio
- Head of the Department of Social Sciences in Health, Directorate of Epidemiological and Psychosocial Research, Mexico City, Mexico
| | - Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Zaza Tsereteli
- Alcohol and Substance Use Expert Group, Northern Dimension Partnership in Public Health and Social Well-Being, Tallinn, Estonia
| | - Hugo López-Pelayo
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Kilian C, Manthey J, Braddick F, López-Pelayo H, Rehm J. Social disparities in alcohol's harm to others: evidence from 32 European countries. Int J Drug Policy 2023; 118:104079. [PMID: 37271071 DOI: 10.1016/j.drugpo.2023.104079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Alcohol use can cause harm not only to the person who consumes it but also to others. Prior research has found that these alcohol-attributable harms to others differ across socioeconomic groups, though several findings have been contradictory. The aim of this contribution was to study the role of individual-level and population-level income inequalities in alcohol's harm to others among women and men. METHODS Logistic regression analysis of cross-sectional survey data from 2021, covering 39,629 respondents from 32 European countries. Harms from others' drinking were defined as experiences of physical harm, involvement in a serious argument, or involvement in a traffic accident, due to another person's drinking, within the past year. We examined the association of individual-level income and country-specific income inequality (Gini index) with harms from a known person's or a stranger's drinking, adjusting for the respondent's age, daily drinking levels, and at least monthly risky single-occasion drinking. RESULTS At the individual level, people with lower incomes had 21% to 47% increased odds of reporting harms from a known person's drinking (women and men) or stranger's drinking (men only) than their same-gender counterparts in the highest income quintile. At the national level, countries with higher income inequality showed increased risks of harms from a known person's drinking among women (OR = 1.09, 95% confidence interval [CI]: 1.05 - 1.14), while among men the risk of harm from strangers' drinking decreased with higher income inequality (OR = 0.86, 95% CI: 0.81 - 0.92). These associations with income inequality were observed among respondents from all but the lowest income groups. CONCLUSION Alcohol can cause harm to others, with women and people with low incomes being disproportionally exposed to these harms. Alcohol control policies targeting high consumption levels, especially among men, as well as upstream policies to reduce inequalities, are needed to lower the health burden of alcohol beyond those who consume it.
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Affiliation(s)
- Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Fleur Braddick
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Manthey J, Jacobsen B, Hayer T, Kalke J, López-Pelayo H, Pons-Cabrera MT, Verthein U, Rosenkranz M. The impact of legal cannabis availability on cannabis use and health outcomes: A systematic review. Int J Drug Policy 2023; 116:104039. [PMID: 37126997 DOI: 10.1016/j.drugpo.2023.104039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND For alcohol, regulating availability is an effective way to reduce consumption and harm. Similarly, the higher availability of medical cannabis dispensaries has been linked to increased cannabis consumption and harm. For recreational cannabis markets, such a link is suspected but still poorly understood. METHODS A systematic literature review (PROSPERO registration number 342357) was conducted on 1 July 2022 in common libraries (Medline, Web of Science, PsycInfo, Psyndex, CINAHL, Embase, SCOPUS, Cochrane) for publications since 2012. Studies linking variations in the availability of legal cannabis products to behavioral outcomes (cannabis use or related health indicators) were included, while studies focusing solely on the legalization of medical cannabis were excluded. The risk of bias was assessed using an adapted version of the Newcastle-Ottawa-Scale. RESULTS After screening n = 6,253 studies, n = 136 were selected for full-text review, out of which n = 13 met the inclusion criteria, reporting on n = 333,550 study participants and n = 855,630 presentations to emergency departments. All studies were conducted in North America, with the majority from Western US states. Using longitudinal (n = 1), cross-sectional (n = 4), or repeated cross-sectional (n = 8) study designs, an increased availability of legal cannabis was linked to increased current cannabis use and health-related outcomes (vomiting, psychosis, or cannabis-involved pregnancies), regardless of the indicator employed to measure availability (proximity or density) among both adults and adolescents. The positive correlation between cannabis availability and consumption is most pronounced among those groups who have been less exposed to cannabis before legalization. The association between the availability of legal cannabis and risky use indicators was less consistent. CONCLUSIONS Groups who have been least exposed to cannabis before legalization may be most susceptible to increased availability. In jurisdictions with legal cannabis markets, restrictions on the number of legal cannabis retailers, especially in densely populated areas, appear warranted.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany.
| | - Britta Jacobsen
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| | - Tobias Hayer
- University of Bremen, Institute of Public Health and Nursing Research, Department for Health and Society, Grazerstr. 2, 28359 Bremen, Germany
| | - Jens Kalke
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| | - Hugo López-Pelayo
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Unitat de Conductes Addictives, Servei de Psiquiatria Psicologia (ICN), Hospital Clínic de Barcelona, Barcelona, Spain; Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Spain
| | - Maria Teresa Pons-Cabrera
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Unitat de Conductes Addictives, Servei de Psiquiatria Psicologia (ICN), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Moritz Rosenkranz
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
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Manthey J, Braddick F, López-Pelayo H, Shield K, Rehm J, Kilian C. Unrecorded alcohol use in 33 European countries: Analyses of a comparative survey with 49,000 people who use alcohol. Int J Drug Policy 2023; 116:104028. [PMID: 37116403 DOI: 10.1016/j.drugpo.2023.104028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Using data from 33 European countries (including all EU member states), this study aimed to 1) estimate the prevalence of unrecorded alcohol use among past-week alcohol users, 2) describe how unrecorded alcohol use is associated with drinking patterns, and 3) estimate the contribution of unrecorded alcohol to the total amount of alcohol consumed annually in these countries. METHODS Data from 25,728 adults who drank alcohol in the past week and self-reported their use of unrecorded alcohol in 2021 were analysed. Prevalence of unrecorded alcohol use in the last week was estimated for those with low, medium, and high risk drinking categorised using the WHO-recommended risk thresholds and definition of risky single occasion drinking. Prevalence estimates were weighted for the country-specific gender, age, and geographical population distribution. An adjusted weighted proportion of unrecorded drinking occasions in total drinking occasions was calculated and compared to 2020 recorded annual per capita consumption estimates. RESULTS Among past-week alcohol users, the average prevalence of past-week unrecorded alcohol use was 12.1% (95% CI: 11.7-12.5%), with considerable difference between countries (min: 2.0% in Malta; max: 27.0% in Greece). Unrecorded alcohol use was much more prevalent among people with high-risk alcohol use in the past week (24.2%, 95% confidence interval [CI]: 22.9-25.5%) compared to people with low- (6.5, 95% CI: 6.0-6.9%) or medium-risk alcohol intake in the past week (13.6%, 95% CI: 12.9-14.3%). Unrecorded alcohol accounted for 7% of per capita consumption in 2020. CONCLUSIONS This is the first comparable assessment of unrecorded alcohol use across EU and affiliated countries. The findings add support to the observation that availability of unrecorded alcohol may contribute to risky drinking in Europe. The observed country variations may be related to differences in country-specific pricing policies and measures to reduce the production and consumption of unrecorded alcoholic beverages.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany.
| | - Fleur Braddick
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, 149-153, 08036 Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, 149-153, 08036 Barcelona, Spain; Addictions Unit, Psychiatry Department, Hospital Clínic; Villarroel 170, 08036 Barcelona, Spain
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 3M1, Canada; Dalla Lana School of Public Health; Institute of Health Policy, Management and Evaluation; & Department of Psychiatry, University of Toronto (UofT), Toronto, Canada; PAHO/WHO Collaborating Centre at CAMH, Toronto, Canada & WHO European Region Collaborating Centre at Public Health Institute of Catalonia, Barcelona, Spain
| | - Jürgen Rehm
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 3M1, Canada; Dalla Lana School of Public Health; Institute of Health Policy, Management and Evaluation; & Department of Psychiatry, University of Toronto (UofT), Toronto, Canada; PAHO/WHO Collaborating Centre at CAMH, Toronto, Canada & WHO European Region Collaborating Centre at Public Health Institute of Catalonia, Barcelona, Spain; Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Carolin Kilian
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, 149-153, 08036 Barcelona, Spain; Addictions Unit, Psychiatry Department, Hospital Clínic; Villarroel 170, 08036 Barcelona, Spain
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Campeny E, López-Pelayo H, Gual A, Balcells-Olivero MDLM. The relevance of patterns of use: A survey to assess cannabis use related harm. Adicciones 2023; 0:1570. [PMID: 36975063 DOI: 10.20882/adicciones.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Lifetime prevalence of cannabis use is estimated 192 million adults worldwide (2017) and has increased by 16% in the last decade. However, data on quantity and frequency of use that can lead to harm is lacking. We have developed a survey to assess patterns of cannabis use and related harms in a sample of cannabis users. This paper focuses on evaluating the feasibility of the survey and the users' satisfaction in a pilot sample. Forty cannabis users were recruited (>18 years old, living in Spain, cannabis use at least once during the last 12 months) between December 2018 and January 2019. Participants answered an online survey (mental health, organic harm and injury) and an ad hoc questionnaire to assess accessibility, feasibility, satisfaction, design and content appropriateness. Of the participants, 93.23% (n = 37.3) were satisfied with the design, 94.92% (n = 38.2) were satisfied with the content, and 94.73% (n = 37.0) were satisfied with the accessibility of the survey; only minor changes were required to improve feasibility and accessibility. Participants used a median of 1.0 Standard Joint Unit per day (Interquartile Range [IQR] 1.0-2.0). Of the sample, 92.5% reported at least one related harm and suffers a median of 4.0 disorders (IQR, 1.25-5.0). The present study allows for designing a feasible online survey to conduct a cross-sectional study with a larger sample.
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Affiliation(s)
- Eugènia Campeny
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Grup Recerca Addiccions Clinic (GRAC-GRE) Departamento de Psiquiatría, Instituto de Neurociencias, Hospital Clínic, Universitat de Barcelona.
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López-Pelayo H, Caballeria E, Gual A, Matrai S, Schaub MP. Editorial: Using digital solutions for Brief Interventions in Alcohol, Tobacco, other drug use, and gambling: From the present to the future. Front Digit Health 2023; 5:1123942. [PMID: 36815172 PMCID: PMC9939890 DOI: 10.3389/fdgth.2023.1123942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023] Open
Affiliation(s)
- Hugo López-Pelayo
- Unitat de Conductes Addictives, Hospital Clínic Barcelona, Barcelona, Spain,Addictions Research Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain,Correspondence: Hugo López-Pelayo
| | - Elsa Caballeria
- Addictions Research Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Antoni Gual
- Addictions Research Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Silvia Matrai
- Addictions Research Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Michael P. Schaub
- Swiss Research Institute of Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland
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Anmella G, Sanabra M, Primé-Tous M, Segú X, Cavero M, Morilla I, Ruiz V, Grande I, Mas A, Martín-Villalba I, Caballo A, Esteva JP, Rodríguez-Rey A, Piazza F, Valdesoiro FJ, Rodriguez-Torrella C, Espinosa M, Sorroche C, Virgili G, Ruiz A, Solanes A, Radua J, Also MA, Sant E, Murgui S, Sans-Corrales M, H Young A, Vicens V, Blanch J, Caballeria E, López-Pelayo H, López C, Olivé V, Pujol L, Quesada S, Solé B, Martínez-Aran A, Torrent C, Guarch J, Navinés R, Murru A, Fico G, De Prisco M, Oliva V, Pio C, Amoretti S, Fernández-Canseco M, Villegas M, Vieta E, Hidalgo-Mazzei D. Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout in primary care and healthcare professionals: development, feasibility, and potential effectiveness studies. J Med Internet Res 2023; 25:e43293. [PMID: 36719325 PMCID: PMC10131622 DOI: 10.2196/43293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem and digital tools have been proposed as a solution. OBJECTIVE We present the development, feasibility, and potential effectiveness studies of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers. METHODS User-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. Healthy controls (HCs) tested Vickybot for reliability. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different clinical situations. (2) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined from both subjective and objective user-engagement Indicators (UEIs). Potential effectiveness was measured using paired t-tests or the Wilcoxon signed-rank test for the change in self-assessment scores. RESULTS 40 HCs tested Vickybot simultaneously, and data was transmitted and registered reliably. (1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) received 98.8% of the expected modules according to each simulation. Suicidal alerts were correctly received. (2) Feasibility and potential effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after two weeks of use. No significant differences were found between the scores of the first and second self-assessments for anxiety [t(8) = 1.000, P = .34] or depressive [t(8) = .40, P = .70] symptoms. However, work-related burnout scores were moderately reduced (Z = -2.07, P = 0.038, r = .32). There was a non-significant trend towards higher reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Three patients (8.8%) activated the suicide alert, and the research team intervened promptly with successful outcomes. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement). Feasibility was moderate. CONCLUSIONS The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and detecting suicidal risk. Potential effectiveness was shown in reducing work-related burnout, but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required. CLINICALTRIAL
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Affiliation(s)
- Gerard Anmella
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Miriam Sanabra
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Mireia Primé-Tous
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Xavier Segú
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Myriam Cavero
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ivette Morilla
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Victoria Ruiz
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Iria Grande
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ariadna Mas
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Inés Martín-Villalba
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Alejandro Caballo
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Julia-Parisad Esteva
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Arturo Rodríguez-Rey
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Flavia Piazza
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Francisco José Valdesoiro
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Claudia Rodriguez-Torrella
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Marta Espinosa
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Carlota Sorroche
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Giulia Virgili
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Alicia Ruiz
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Aleix Solanes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, ES
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, ES
| | - María Antonieta Also
- CAP Casanova, Consorci Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Elisenda Sant
- CAP Casanova, Consorci Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Sandra Murgui
- CAP Borrell, Consorci d'Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Mireia Sans-Corrales
- CAP Borrell, Consorci d'Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, GB
| | - Victor Vicens
- Chief Medical Officer and co-founder of Abi Global Health, Barcelona, ES
| | - Jordi Blanch
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Elsa Caballeria
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Hugo López-Pelayo
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Clara López
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Victoria Olivé
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Laura Pujol
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Sebastiana Quesada
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Brisa Solé
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Anabel Martínez-Aran
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Carla Torrent
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Joana Guarch
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ricard Navinés
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Andrea Murru
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Giovanna Fico
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Michele De Prisco
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Vicenzo Oliva
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Casimiro Pio
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Silvia Amoretti
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - María Fernández-Canseco
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Marta Villegas
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Eduard Vieta
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Diego Hidalgo-Mazzei
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
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Lorenzetti V, Hindocha C, Petrilli K, Griffiths P, Brown J, Castillo-Carniglia Á, Caulkins JP, Englund A, El Sohly MA, Gage SH, Groshkova T, Gual A, Hammond D, Lawn W, López-Pelayo H, Manthey J, Mokrysz C, Liccardo Pacula R, van Laar M, Vandrey R, Wadsworth E, Winstock A, Hall W, Curran HV, Freeman TP. The iCannTookit: a consensus-based, flexible framework for measuring contemporary cannabis use. Addiction 2022; 117:2558-2560. [PMID: 35603918 DOI: 10.1111/add.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health, Australian Catholic University, Melbourne, Australia
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Portugal
| | - Jamie Brown
- Behavioural Science and Health Institute of Epidemiology and Health, University College London, London, UK
| | - Álvaro Castillo-Carniglia
- Society and Health Research Center and School of Public Health, Universidad Mayor, Chile.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mahmoud A El Sohly
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA.,Department Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Teodora Groshkova
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Portugal
| | - Antoni Gual
- Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, RTA, Barcelona, Spain
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Will Lawn
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Hugo López-Pelayo
- Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, RTA, Barcelona, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Rosalie Liccardo Pacula
- USC Sol Price School of Public Policy, USC Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elle Wadsworth
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Adam Winstock
- Behavioural Science and Health Institute of Epidemiology and Health, University College London, London, UK.,Global Drug Survey, London, UK
| | - Wayne Hall
- National Addiction Centre, King's College London, London, UK.,National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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López-Pelayo H, Balcells-Oliveró M, Gual A, Matrai S, Oliveras C. Standard Units for Cannabis Dose: Why is it Important to Standardise Cannabis Dose for Drug Policy and How Can we Enhance its Place on the Public Health Agenda? Eur Psychiatry 2022. [PMCID: PMC9566880 DOI: 10.1192/j.eurpsy.2022.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Regular cannabis use is associated with several adverse health outcomes including psychosis and cannabis use disorders. In the last decade, prevalence of last-month cannabis use increased by 27% and rate of treatment demand rose from 27 to 35.1 per 100000 inhabitants in Europe. Cannabis legal status is changing worldwide, and recently two European countries (Malta and Luxembourg) legalized its production, sales and use. Even United Nations withdrew cannabis from Schedule IV of the Single Convention on Narcotic Drugs (retained in Schedule I). This new scenario aligns cannabis more closely with alcohol, prescribed drugs or tobacco than illegal drugs. Implementing prevention and harm reduction strategies will be even more relevant in the nearly future. Based on the history with alcohol or tobacco, frequency of use alone misestimates the risks due to limited capture of variations of quantity per day of use on regular users. Standardisation of cannabis use has been proposed in the literature as an instrument to assessing the level of risk. In the Lisbon Addictions Conference (2019) a group of 32 professionals from 13 countries and 10 disciplines participated in a back-casting foresight exercise aiming to addresses challenges of implementation of SJU. They proposed three key steps in the implementation of SJU: 1) constitution of task-force for an evidence-based approach to SJU; 2) expanding the available data on cannabis-related risks; 3) examining the relationship between ‘risky use’ and SJU.
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12
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Gual A, López-Pelayo H, Bruguera P, Miquel L. Sodium Oxybate: a Substitute for Alcohol? Eur Psychiatry 2022. [PMCID: PMC9564223 DOI: 10.1192/j.eurpsy.2022.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a neurotransmitter found naturally in the human brain. Sodium oxybate (SO) is the sodium salt of GHB. In 2000 GHB was classified a Schedule I controlled substance, while SO became a Schedule III controlled substance for medicinal use under the Controlled Substances Act. SO and alcohol share a similar pharmacological profile. GHB acts on GABAB receptors and extrasynaptic GABAA receptors resulting in alcohol-mimetic effects in several CNS actions. It substitutes the discriminative stimulus effects of alcohol in rats, and has cross tolerance with alcohol. All together, this leads to think of SO as a substitution therapy for alcohol use disorders. SO was initially studied in the prevention of alcohol withdrawal, and it showed similar efficacy to benzodiacepines. The studies on relapse prevention were developed later and the results are mixed and more complex to understand. While open label studies show a positive effect, RCTs have not been able to show a significant effect for the whole sample. Nevertheless, post-hoc analysis show a robust effect in the subsample of patients with high risk drinking levels, that would be the preferred target for a substitution treatment. The potential for abuse of GHB is well documented, which should be no surprise for a substitution treatment. Nevertheless, when correctly prescribed the risk of abuse of SO remains very low, as shown both in clinical trials and in the pharmacovigilance database, with more than 260000 cases documented. SO can be considered a substitution treatment, effective in patients with high risk drinking levels.
Disclosure
I was investigator in the SMO study on sodium oxybate, funded by D&A Pharma.
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Jiménez-Fernández B, Calomarde-Gómez C, López-Lazcano A, Lligoña A, Gual A, López-Pelayo H. Systematic review on the clinical management of chronic pain and comorbid opioid use disorder. Adicciones 2022; 0:1680. [PMID: 35472158 DOI: 10.20882/adicciones.1680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The crisis caused by prescribed opioids and their related side effects are a public health problem worldwide. Most of these are prescribed for coping with chronic pain. The coexistence of opioid use disorder (OUD) in patients with chronic pain represents a complex challenge due to the need for managing both pain and OUD. The aim of this systematic review is to evaluate the efficacy of feasible treatments for this population with OUD and comorbid chronic pain for both conditions. A systematic database search has been performed using Cochrane Library, MEDLINE, PsycINFO and ClinicalTrials.gov in compliance with PRISMA guidelines. Eligible articles addressed the outcomes in chronic pain patients with comorbid opioid use disorder after treatment interventions were applied. Of 593 identified articles, nine were eligible for qualitative review (n = 7 pharmacological interventions; n = 2 psychological interventions). Methadone, buprenorphine, cognitive-behavioral and mindfulness showed promising results, but data were inconclusive (<2 RCT with low risk of bias). It is unclear whether the opioid agonist treatment should be maintained or tapered and which drug should be prescribed for the opioid substitution therapy (methadone or buprenorphine/naloxone). Mindfulness and cognitive behavioral therapy have a discrete effect on improving negative affect but not pain. The therapeutic approach might be individualized under a shared decision-making basis.
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Manthey J, Carr S, Anderson P, Bautista N, Braddick F, O’Donnell A, Jané-Llopis E, López-Pelayo H, Medina P, Mejía-Trujillo J, Pérez-Gómez A, Piazza M, Rehm J, Solovei A, Rey GN, de Vries H, Schulte B. Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico. J Glob Health 2022; 12:05002. [PMID: 35356652 PMCID: PMC8932607 DOI: 10.7189/jogh.12.05002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background During the COVID-19 pandemic, an increase of heavy alcohol use has been reported in several high-income countries. We examined changes in alcohol use during the pandemic among primary health care (PHC) patients in two middle income countries, Colombia and Mexico. Methods Data were collected during routine consultations in 34 PHC centres as part of a large-scale implementation study. Providers measured patients’ alcohol consumption with the three item ‘Alcohol Use Disorders Identification Test’ (AUDIT-C). Generalized linear mixed models were performed to examine changes in two dependent variables over time (pre-pandemic and during pandemic): 1) the AUDIT-C score and 2) the proportion of heavy drinking patients (8+ on AUDIT-C). Results Over a period of more than 600 days, data from N = 17 273 patients were collected. During the pandemic, the number of patients with their alcohol consumption measured decreased in Colombia and Mexico. Each month into the pandemic was associated with a 1.5% and 1.9% reduction in the mean AUDIT-C score in Colombia and Mexico, respectively. The proportion of heavy drinking patients declined during the pandemic in Colombia (pre-pandemic: 5.4%, 95% confidence interval (CI) = 4.8% to 6.0%; during the pandemic: 0.8%, 95% CI = 0.6% to 1.1%) but did not change in Mexico. Conclusions Average consumption levels declined and the prevalence of heavy drinking patterns did not increase. In addition to reduced opportunities for social drinking during the pandemic, changes in the population seeking PHC and restrictions in alcohol availability and affordability are likely drivers for lower levels of alcohol use by patients in this study.
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Sinclair Carr
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Huipulco, Ciudad de México, CDMX, Mexico
| | - Fleur Braddick
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Barcelona, Spain
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Univ. Ramon Llull, ESADE, Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
| | - Hugo López-Pelayo
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Perla Medina
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Huipulco, Ciudad de México, CDMX, Mexico
| | | | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Huipulco, Ciudad de México, CDMX, Mexico
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
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Sagué-Vilavella M, López-Pelayo H, Arbelo N, Cámara M, Gomes S, Madero S, Pons-Cabrera MT, Pintor L. Clozapine toxicity and coronavirus disease 2019: A case report. Schizophr Res 2022; 240:184-185. [PMID: 35030448 PMCID: PMC8743391 DOI: 10.1016/j.schres.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/02/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Maria Sagué-Vilavella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Hugo López-Pelayo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Néstor Arbelo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Mercè Cámara
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Susana Gomes
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Santiago Madero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Maria Teresa Pons-Cabrera
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
| | - Luis Pintor
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Catalonia, C/ Villarroel - 170, 08036 Barcelona, Spain.
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16
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Manthey J, Freeman TP, Kilian C, López-Pelayo H, Rehm J. Public health monitoring of cannabis use in Europe: prevalence of use, cannabis potency, and treatment rates. Lancet Reg Health Eur 2021; 10:100227. [PMID: 34806072 PMCID: PMC8589728 DOI: 10.1016/j.lanepe.2021.100227] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Cannabis is one of the most widely used substances worldwide. Heavy use is associated with an increased risk of cannabis use disorders, psychotic disorders, acute cognitive impairment, traffic injuries, respiratory problems, worse pregnancy outcomes, and there are indications for genotoxic and epigenotoxic adverse effects. International regulation of medical and non-medical cannabis use is changing rapidly and substantially, highlighting the importance of robust public health monitoring. This study aimed to describe the trends of key public health indicators in European Union (27 member states + UK, Norway and Turkey) for the period 2010 to 2019, their public health implications, and to identify the steps required to improve current practice in monitoring of cannabis use and harm in Europe. Methods Data on four key cannabis indicators (prevalence of use, prevalence of cannabis use disorder [CUD], treatment rates, and potency of cannabis products) in Europe were extracted from the United Nations Office on Drugs and Crime, European Monitoring Centre for Drugs and Drug Addiction and the Global Burden of Disease study. For prevalence of use and CUD, the first and last available estimate in each country were compared. For treatment rates and cannabis potency, linear regression models were conducted. Findings Between 2010 and 2019, past-month prevalence of cannabis use increased by 27% in European adults (from 3·1 to 3·9%), with most pronounced relative increases observed among 35-64 year-olds. In 13 out of 26 countries, over 20% of all past-month users reported high-risk use patterns. The rate of treatment entry for cannabis problems per 100,000 adults increased from 27·0 (95% CI: 17·2 to 36·8) to 35·1 (95% CI: 23·6 to 46·7) and has mostly plateaued since 2015. Modest increases in potency were found in herbal cannabis (from 6·9% to 10·6% THC) while median THC values tripled in cannabis resin (from 7·6% to 24·1% THC). Interpretation In the past decade, cannabis use, treatment rates and potency levels have increased in Europe highlighting major concerns about the public health impact of cannabis use. Continued monitoring and efforts to improve data quality and reporting, including indicators of high-risk use and cannabis-attributable harm, will be necessary to evaluate the health impact of international changes in cannabis regulation. Funding This study received no specific funding.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, United Kingdom
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Jürgen Rehm
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1.,Program on Substance Abuse & WHO CC in designation, Public Health Agency of Catalonia, 81-95 Roc Boronat St., 08005, Barcelona, Spain.,Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada, M5T 3M7Department of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 3M1, Canada.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Street 8, b. 2, Moscow, 119991, Russian Federation
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17
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Bruguera P, Barrio P, Manthey J, Oliveras C, López-Pelayo H, Nuño L, Miquel L, López-Lazcano A, Blithikioti C, Caballeria E, Matrai S, Rehm J, Vieta E, Gual A. Mid and long-term effects of a SBIRT program for at-risk drinkers attending to an emergency department. Follow-up results from a randomized controlled trial. Eur J Emerg Med 2021; 28:373-379. [PMID: 33709997 DOI: 10.1097/mej.0000000000000810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND IMPORTANCE SBIRT programs (Screening Brief Intervention and Referral to Treatment) for at-risk drinkers in emergency departments (ED) have shown to be effective, particularly at short term. In this article, we report mid and long-term follow-up results of a specialized SBIRT program. A short-term follow-up after 1.5 months showed encouraging results, with more than a 20% greater reduction of at-risk drinking in the intervention group and more than double of successful referrals to specialized treatment. OBJECTIVE We aimed to evaluate the mid and long-term efficacy of an SBIRT program conducted by psychiatrist specialists in addictive disorders and motivational interviewing in the ED of a tertiary hospital. DESIGN, SETTINGS AND PARTICIPANTS We conducted a secondary analysis of a previously published randomized controlled trial of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the AUDIT-C scale. INTERVENTION OR EXPOSURE Patients were randomized into two groups, with the control group receiving two leaflets: one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. OUTCOMES MEASURE AND ANALYSIS Long-term assessment primary outcome was the proportion of at-risk alcohol use measured by AUDIT-C scale. The main effectiveness analysis at 18 weeks and 12 months' follow-up was conducted with multilevel logistic regression analyses. Missing values were imputed with the last observation carried forward. MAIN RESULTS Of 200 patients included in the study, 133 (66.5%) and 131 (65.5%) completed 18 weeks and 1-year follow-up respectively. Although the proportion of risky drinkers was substantially lower in the intervention group (38.5 vs. 57.4% at 4.5 months and 58.5 vs 68.2% at 1 year), these results did not reach statistical significance (OR = 2.15; CI, 0.87-5.33). CONCLUSIONS In this secondary analysis for mid- and long-term effects of a specialized SBIRT program, there was no significant difference in the reduction of risky drinkers at 18 weeks and 1 year. The small size of the studied sample and the low retention rate precluded any significant conclusion, although point estimates suggest a positive effect. Overall, SBIRT programs are an effective tool to reduce alcohol use at short time and to refer patients to specialized treatment; however, its effects seem to decay over time.
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Affiliation(s)
- Pol Bruguera
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Pablo Barrio
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Jakob Manthey
- Center for Clinical Epidemiology and Longitudinal Studies, Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Clara Oliveras
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Hugo López-Pelayo
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laura Nuño
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laia Miquel
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Ana López-Lazcano
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Chrysanthi Blithikioti
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Elsa Caballeria
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Silvia Matrai
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Jürgen Rehm
- Center for Clinical Epidemiology and Longitudinal Studies, Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
- Dalla Lana School of Public Health, Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Eduard Vieta
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Centro de Investigación en Red de Salud mental (CIBERSAM), Madrid
| | - Antoni Gual
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
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18
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Arbelo N, López-Pelayo H, Sagué M, Madero S, Pinzón-Espinosa J, Gomes-da-Costa S, Ilzarbe L, Anmella G, Llach CD, Imaz ML, Cámara MM, Pintor L. Psychiatric Clinical Profiles and Pharmacological Interactions in COVID-19 Inpatients Referred to a Consultation Liaison Psychiatry Unit: a Cross-Sectional Study. Psychiatr Q 2021; 92:1021-1033. [PMID: 33411128 PMCID: PMC7788550 DOI: 10.1007/s11126-020-09868-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) can affect mental health in different ways. There is little research about psychiatric complications in hospitalized patients with COVID-19. The aim of the study was to describe the psychiatric clinical profile and pharmacological interactions in COVID-19 inpatients referred to a Consultation-Liaison Psychiatry (CLP) unit. This is a cross-sectional study, carried out at a tertiary hospital in Spain, in inpatients admitted because of COVID-19 and referred to our CLP Unit from March 17,2020 to April 28,2020. Clinical data were extracted from electronic medical records. The patients were divided in three groups depending on psychiatric diagnosis: delirium, severe mental illness (SMI) and non-severe mental illness (NSMI). Of 71 patients included (median [ICR] age 64 [54-73] years; 70.4% male), 35.2% had a delirium, 18.3% had a SMI, and 46.5% had a NSMI. Compared to patients with delirium and NSMI, patients with SMI were younger, more likely to be institutionalized and were administered less anti-COVID19 drugs. Mortality was higher among patients with delirium (21.7%) than those with SMI (0%) or NSMI (9.45%). The rate of side effects due to interactions between anti-COVID19 and psychiatric drugs was low, mainly drowsiness (4.3%) and borderline QTc prolongation (1.5%). Patients affected by SMI were more often undertreated for COVID-19. However, the rate of interactions was very low, and avoidable with a proper evaluation and drug-dose adjustment. Half of the patients with SMI were institutionalized, suggesting that living conditions in residential facilities could make them more vulnerable to infection.
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Affiliation(s)
- Nestor Arbelo
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Hugo López-Pelayo
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Fundació Clínic Recerca Biomèdica (FCRB), RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170 08036, Barcelona, Spain
| | - María Sagué
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Santiago Madero
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Justo Pinzón-Espinosa
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
- Department of Clinical Psychiatry, School of Medicine, University of Panama, Panama City, Panama
| | - Susana Gomes-da-Costa
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Lidia Ilzarbe
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Gerard Anmella
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Cristian-Daniel Llach
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - María-Luisa Imaz
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - María-Mercé Cámara
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Luis Pintor
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
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19
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López-Pelayo H, Matrai S, Balcells-Olivero M, Campeny E, Braddick F, Bossong MG, Cruz OS, Deluca P, Dom G, Feingold D, Freeman TP, Guzman P, Hindocha C, Kelly BC, Liebregts N, Lorenzetti V, Manthey J, Matias J, Oliveras C, Pons MT, Rehm J, Rosenkranz M, Swithenbank Z, van Deurse L, Vicente J, Vuolo M, Wojnar M, Gual A. Standard units for cannabis dose: Why is it important to standardize cannabis dose for drug policy and how can we enhance its place on the public health agenda? Int J Drug Policy 2021; 97:103350. [PMID: 34246016 DOI: 10.1016/j.drugpo.2021.103350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain.
| | - Silvia Matrai
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Mercè Balcells-Olivero
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Eugènia Campeny
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Fleur Braddick
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Matthijs G Bossong
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Olga S Cruz
- University Institute of Maia - ISMAI and Interdisciplinary Research Centre for Human Rights - JusGov, University of Minho- Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal and JusGov - Escola de Direito, Campus de Gualtar, Braga 4710-057, Portugal
| | - Paolo Deluca
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8BB, United Kingdom
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Belgium. European Federation of Addiction Societies (EUFAS), Belgium
| | | | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, United Kingdom
| | - Pablo Guzman
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, University College London, London WC1E 7HB, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Brian C Kelly
- Departament of Sociology, Purdue University, United States
| | - Nienke Liebregts
- Bonger Institute of Criminology, University of Amsterdam, the Netherlands
| | | | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, Dresden 01187, Germany; Center for Interdisciplinary Addiction Research of Hamburg University (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, Leipzig 04103, Germany
| | - João Matias
- European Monitoring Centre for Drugs and Drug Addiction, Portugal
| | - Clara Oliveras
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Maria Teresa Pons
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Canada; Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany; Department of International Health Projects, Institute for Leadership and HealthManagement, I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Moritz Rosenkranz
- Center for Interdisciplinary Addiction Research (ZIS) of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg 20246, Germany
| | - Zoe Swithenbank
- Public Health Institute, Liverpool John Moores University, Exchange Station Tithebarn Street, Liverpool L2 2QP, United Kingdom
| | - Luc van Deurse
- Student Governance and Leadership in European Public Health, Maastricht University, the Netherlands
| | - Julian Vicente
- European Monitoring Centre for Drugs and Drug Addiction, Portugal
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, United States
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; University of Michigan, Ann Arbor, MI, United States
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona 08036, Spain
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20
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Caballeria E, Maier M, Balcells-Oliveró M, López-Pelayo H, Oliveras C, Rubio Ballester B, Verschure PFMJ, Gual A. Rehabilitation Gaming System for Alcohol-Related Cognitive Impairment: A Pilot Usability Study. Alcohol Alcohol 2021; 57:595-601. [PMID: 34212185 DOI: 10.1093/alcalc/agab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/13/2021] [Accepted: 06/01/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Cognitive impairment in patients with alcohol use disorder (AUD) is highly prevalent, and it negatively impacts treatment outcome. However, this condition is neither systematically assessed nor treated. Thus, we aimed to explore the usability of a virtual reality-based protocol ('Rehabilitation Gaming System', RGS) for patients with AUD. METHODS Twenty AUD patients (50% also cognitive impairment) underwent a single session of the RGS protocol (four cognitive training tasks, 10 minutes each). System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) were applied to assess the RGS usability and patients' satisfaction with it. Also, the Perceived Competence Scale was administered to assess the patients' feelings of competence when using the training protocol. Comparisons of the responses to these questionnaires were performed between AUD patients with cognitive impairment and those without cognitive impairment. RESULTS RGS usability was very positively rated (median SUS score = 80, Interquartile Range, IQR = 68.13-86-88). No significant differences were found in the median SUS scores for any of the sociodemographic or clinical variables, excepting for gender (women median score = 85; IQR = 80-94.38 vs. men median score = 71.25; IQR = 61.25-89.25; P-value = 0.035). The quality of the information provided by the RGS training scenarios and the usability were positively rated (PSSUQ), and patients experienced high feelings of competence. CONCLUSIONS The RGS has been found to be usable in the short term and patients with AUD stated to be satisfied with it. Future larger, randomized trials are needed to explore the effectiveness of this tool to help overcome the cognitive deficits in AUD patients.
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Affiliation(s)
- Elsa Caballeria
- Grup Recerca Addicions Clínic (GRAC-GRE), Addictions Unit, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS, RTA (RETICS), Villarroel, 170, Barcelona 08036, Spain
| | - Martina Maier
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, Barcelona 08930, Spain
| | - Mercedes Balcells-Oliveró
- Grup Recerca Addicions Clínic (GRAC-GRE), Addictions Unit, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS, RTA (RETICS), Villarroel, 170, Barcelona 08036, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addicions Clínic (GRAC-GRE), Addictions Unit, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS, RTA (RETICS), Villarroel, 170, Barcelona 08036, Spain
| | - Clara Oliveras
- Grup Recerca Addicions Clínic (GRAC-GRE), Addictions Unit, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS, RTA (RETICS), Villarroel, 170, Barcelona 08036, Spain
| | - Belén Rubio Ballester
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, Barcelona 08930, Spain
| | - Paul F M J Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, Barcelona 08930, Spain.,Institució Catalana de Recerca I Estudis Avançats (ICREA), Passeig de Lluís Companys, 23, Barcelona 08010, Spain
| | - Antoni Gual
- Grup Recerca Addicions Clínic (GRAC-GRE), Addictions Unit, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS, RTA (RETICS), Villarroel, 170, Barcelona 08036, Spain
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21
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López-Lazcano AI, López-Pelayo H, Balcells-Oliveró M, Segura L, Gual Solé A. Validation of the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in acute psychiatric inpatients. Adicciones 2021; 34:259-272. [PMID: 34171103 DOI: 10.20882/adicciones.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of this study were to examine the psychometric properties of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in psychiatric inpatients, due to the scarcity of screening instruments validated in this population. Patients from Hospital Clínic's psychiatric ward (n = 202) completed: ASSIST, Addiction Severity Index (ASI), MINI-International Neuropsychiatric Interview (MINI), Alcohol Use Disorders Identification Test (AUDIT), Fagerström Test for Nicotine Dependence (FTND), Severity of Dependence Scale (SDS), and Drug Abuse Screening Test (DAST). Reliability and validity evidences based on internal structure (Exploratory and Confirmatory Factor Analyses) and on the relation to other variables were obtained. Excellent internal consistency was found for Total Substance Involvement (TSI) (α = .92 and ω = .93) and for Specific Substance Involvement (SSI) scores (α = .88 - .96 and ω = .89 - .95). Analysis of internal structure for tobacco, alcohol and cannabis subscales resulted in unidimensional models with adequate goodness-of-fit indices. ASSIST scores were significantly correlated with those of ASI (r = .795 to r = .953), AUDIT (r = .864), FTND (r = .808), DAST (r = .831), SDS (r = .519) and with "number of diagnoses of abuse/dependence" in MINI-Plus (TSI: r = .857 to r = .862; SSI: r = .646 to r = .834). Receiver operating characteristic analysis (ROC) and Mann-Whitney's U test found good discriminative validity evidences. ASSIST scores showed good reliability and there were validity evidences that support its use for identifying risk levels of tobacco, alcohol and other substance use in psychiatric patients.
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22
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Arbelo N, Sagué M, López-Pelayo H, Madero S, Pinzón-Espinosa J, Anmella G, Gomes-Da-Costa S, Ilzarbe L, Llach C, Cámara M, Imaz M, Pintor L. Psychiatric clinical profiles and pharmacological interactions in COVID-19 inpatients referred to a consultation liaison psychiatry unit. Eur Psychiatry 2021. [PMCID: PMC9470826 DOI: 10.1192/j.eurpsy.2021.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The Coronavirus Disease 2019 (COVID-19) can affect mental health in different ways. There is little research about psychiatric complications in hospitalized patients with COVID-19. Objectives The aim of the study was to describe the psychiatric clinical profile and pharmacological interactions in COVID-19 inpatients referred to a Consultation-Liaison Psychiatry (CLP) unit. Methods This is a cross-sectional retrospective study, carried out at a tertiary hospital in Spain, in inpatients admitted because of COVID-19 and referred to our CLP Unit from March 17,2020 to April 28,2020. Clinical data were extracted from electronic medical records. The patients were divided in three groups depending on psychiatric diagnosis: delirium, severe mental illness (SMI) and non-severe mental illness (NSMI). Results Of 71 patients included (median [ICR] age 64 [54-73] years; 70.4% male), 35.2% had a delirium, 18.3% had a SMI, and 46.5% had a NSMI. Compared to patients with delirium and NSMI, patients with SMI were younger, more likely to be institutionalized and were administered less anti-COVID19 drugs. Mortality was higher among patients with delirium (21.7%) than those with SMI (0%) or NSMI (9.45%). The rate of side effects due to interactions between anti-COVID19 and psychiatric drugs was low, mainly drowsiness (4.3%) and borderline QTc prolongation (1.5%). Conclusions Patients affected by SMI were more often undertreated for COVID-19. However, the rate of interactions was very low, and avoidable with a proper evaluation and drug-dose adjustment. Half of the patients with SMI were institutionalized, suggesting that living conditions in residential facilities could make them more vulnerable to infection. Disclosure No significant relationships.
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23
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Casajuana Kögel C, López-Pelayo H, Oliveras C, Colom J, Gual A, Balcells-Oliveró MM. The relationship between motivations for cannabis consumption and problematic use. Adicciones 2021; 33:31-42. [PMID: 31018002 DOI: 10.20882/adicciones.1221] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Systematic screening of problematic cannabis use does not include the motivations that lead to consumption, although from a person-centered perspective this is fundamental. The present study explores the motivations for cannabis use in adults and its relationship with cannabis use patterns and problematic use. METHOD Adult cannabis users (previous 60 days) were recruited in the province of Barcelona (n = 468). Information on their sociodemographic data, cannabis use pattern, Cannabis Abuse Screening Test (CAST) and the main motivation for use were collected. Motivations were categorized a posteriori according to the Marijuana Motives Measures (MMM). A descriptive and inferential analysis was carried out to link the motivations to sociodemographic variables, consumption pattern and probability of suffering problematic cannabis use (CAST). RESULTS Using cannabis to heighten positive feelings (35%), out of habit (29%) and to cope with negative feelings (25%) were the most frequent motivations. In comparison to other motivations, coping is related to a greater quantity of cannabis used (4 vs 3 joints per day, p = 0.005), higher probability of problematic cannabis use (77% vs 64%, p = 0.05), and greater social vulnerability (unemployment 56% vs 37%, p = 0.001; and low educational level 14% vs 8%, p = 0.042). CONCLUSIONS Coping as a motivation for cannabis use is present in one out of four users and is a marker of social vulnerability, greater quantity of cannabis used and higher risk of problematic use. Patient-centered care together with preventive (emotional and social education) and clinical strategies (psychotherapy) can be useful for this population at higher risk.
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López-Pelayo H, Campeny E, Oliveras C, Rehm J, Manthey J, Gual A, Balcells-Olivero MDLM. Early, Chronic, and Acute Cannabis Exposure and Their Relationship With Cognitive and Behavioral Harms. Front Psychiatry 2021; 12:643556. [PMID: 34434125 PMCID: PMC8381725 DOI: 10.3389/fpsyt.2021.643556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining risky cannabis use criteria. Methods: Adults living in Spain who used cannabis at least once during the last year answered an online survey about cannabis use and health-related harms. Cannabis use was assessed in five dimensions: quantity on use days during the last 30 days (AE), frequency of use in the last month (AE), years of regular use (YRCU) (CE), age of first use (AOf) (EE), and age of onset of regular use (AOr) (EE). CBH indicators included validated instruments and custom-made items. Pearson correlations were calculated for continuous variables, and Student's t-tests for independent samples were calculated for categorical variables. Effect sizes were calculated for each of the five dimensions of use (Cohen's d or r Pearson correlation) and harm outcome. Classification and Regression Trees (CART) analyses were performed for those dependent variables (harms) significantly associated with at least two dimensions of cannabis use patterns. Lastly, logistic binary analyses were conducted for each harm outcome. Results: The mean age of participants was 26.2 years old [standard deviation (SD) 8.5]. Out of 2,124 respondents, 1,606 (75.6%) reported at least one harm outcome (mean 1.8 and SD 1.5). In our sample, using cannabis on 3 out of 4 days was associated with an 8-fold probability of scoring 4+ on the Severity Dependence Scale (OR 8.33, 95% CI 4.91-14.16, p <0.001), which is indicative of a cannabis use disorder. Also, a start of regular cannabis use before the age of 25 combined with using cannabis at least once per month was associated with a higher probability of risky alcohol use (OR 1.33, 95% CI 1.12-1.57, p = 0.001). Besides, a start of regular cannabis use before the age of 18 combined with a period of regular use of at least 7.5 years was associated with a higher probability of reporting a motor vehicle accident (OR 1.81, 95% CI 1.41-2.32, p < 0.0001). Results were ambiguous regarding the role that age of first use and milligrams of THC per day of use might play regarding cannabis-related harms. Conclusions: The relationship among AE, CE, and EE with CBH indicators is a complex phenomenon that deserves further studies. The pattern of cannabis use should be carefully and widely evaluated-(not just including frequency but also other dimensions of pattern of use)-in research (preferably in longitudinal studies) to assess cannabis-related harms.
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Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eugènia Campeny
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Clara Oliveras
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jürgen Rehm
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Dalla Lana School of Public Health, University of Toronto (UofT), Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jakob Manthey
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Antoni Gual
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria de Las Mercedes Balcells-Olivero
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
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25
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López-Pelayo H, Matrai S, Balcells-Olivero M, Campeny E, Braddick F, Bossong MG, Cruz OS, Deluca P, Dom G, Feingold D, Freeman TP, Guzman P, Hindocha C, Kelly BC, Liebregts N, Lorenzetti V, Manthey J, Matias J, Oliveras C, Pons MT, Rehm J, Rosenkranz M, Swithenbank Z, van Deurse L, Vicente J, Vuolo M, Wojnar M, Gual A. Supporting Future Cannabis Policy - Developing a Standard Joint Unit: A Brief Back-Casting Exercise. Front Psychiatry 2021; 12:675033. [PMID: 34093282 PMCID: PMC8172797 DOI: 10.3389/fpsyt.2021.675033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/06/2021] [Indexed: 01/05/2023] Open
Abstract
The standardization of cannabis doses is a priority for research, policy-making, clinical and harm-reduction interventions and consumer security. Scientists have called for standard units of dosing for cannabis, similar to those used for alcohol. A Standard Joint Unit (SJU) would facilitate preventive and intervention models in ways similar to the Standard Drink (SD). Learning from the SD experiences allows researchers to tackle emerging barriers to the SJU by applying modern forecasting methods. During a workshop at the Lisbon Addictions Conference 2019, a back-casting foresight method was used to address challenges and achieve consensus in developing an SJU. Thirty-two professionals from 13 countries and 10 disciplines participated. Descriptive analysis of the workshop was carried out by the organizers and shared with the participants in order to suggest amendments. Several characteristics of the SJU were defined: (1) core values: easy-to use, universal, focused on THC, accurate, and accessible; (2) key challenges: sudden changes in patterns of use, heterogeneity of cannabis compounds as well as in administration routes, variations over time in THC concentrations, and of laws that regulate the legal status of recreational and medical cannabis use); and (3) facilitators: previous experience with standardized measurements, funding opportunities, multi-stakeholder support, high prevalence of cannabis users, and widespread changes in legislation. Participants also identified three initial steps for the implementation of a SJU by 2030: (1) Building a task-force to develop a consensus-based SJU; (2) Expanded available national-level data; (3) Linking SJU consumption to the concept of "risky use," based on evidence of harms.
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Affiliation(s)
- Hugo López-Pelayo
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Silvia Matrai
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mercè Balcells-Olivero
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eugènia Campeny
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Fleur Braddick
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Matthijs G Bossong
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Olga S Cruz
- Social Sciences Department, Instituto Universitário da Maia (ISMAI), Maia, Portugal.,University Interdisciplinary Research Centre for Human Rights - JusGov, University of Minho, Maia, Portugal and JusGov - Escola de Direito, Braga, Portugal
| | - Paolo Deluca
- Addictions Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Geert Dom
- Adult Psychiatry Department, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.,European Federation of Addiction Societies, Boechout, Belgium
| | | | - Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, United Kingdom
| | - Pablo Guzman
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, University College London, London, United Kingdom.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Brian C Kelly
- Departament of Sociology, Purdue University, West Lafayette, IN, United States
| | - Nienke Liebregts
- Bonger Institute of Criminology, University of Amsterdam, Amsterdam, Netherlands
| | - Valentina Lorenzetti
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - João Matias
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Clara Oliveras
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Teresa Pons
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Canada Epidemiological Research Unit, Canada Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), Toronto, ON, Canada.,Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Moritz Rosenkranz
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Zoe Swithenbank
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Luc van Deurse
- Student Governance and Leadership in European Public Health, Maastricht University, Maastricht, Netherlands
| | - Julian Vicente
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, OH, United States
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Antoni Gual
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
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Calomarde-Gómez C, Jiménez-Fernández B, Balcells-Oliveró M, Gual A, López-Pelayo H. Motivational Interviewing for Cannabis Use Disorders: A Systematic Review and Meta-Analysis. Eur Addict Res 2021; 27:413-427. [PMID: 33965941 DOI: 10.1159/000515667] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cannabis is one of the most used drugs worldwide. There is no gold standard treatment for cannabis use disorder (CUD). Motivational interviewing (MI) has shown efficacy in some substance use disorders. Therefore, a systematic review was conducted to assess the effectiveness of MI in CUD. METHODS Randomized controlled trials or open-label studies published until September 2019 from 3 different databases (Pubmed, Scopus, and PsycINFO) were included, following the PRISMA guidelines and a predetermined set of criteria for article selection. Meta-analyses were conducted. The end point was determined as month 3, and 4 outcomes were analysed (abstinence rates, reduction in frequency of use, reduction in quantity of use, and reduction in cannabis use disorder symptoms) in 2 populations (adolescents and adults). RESULTS Forty studies were identified, of which 24 were performed in adults and 16 in adolescents. MI showed efficacy in achieving abstinence in both adults (odds ratio [OR] = 3.84, 95% confidence interval [CI] 2.40-6.16, p < 0.0001) and adolescents (OR = 2.02, 95% CI 1.42-2.89, p < 0.0001). MI showed efficacy in reducing frequency and quantity of use in adults but not in adolescents. Those adults who were in the MI group consumed less joints per day than those in the control group (mean difference = -0.69 joints per day, 95% CI -0.84 to -0.53, p < 0.001), and they consumed on less days per month (mean difference = -3.9 days per month, 95% CI -7.47 to -0.34, p = 0.0317) than those in the control group. CONCLUSIONS MI is an effective intervention to reduce cannabis use and achieve abstinence, especially among adults and patients with no prior history of psychotic disorder. Further investigation is needed to assess the effect on CUD symptoms. MI should be included in guidelines for treating cannabis use disorder as one of the essential psychological interventions.
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Affiliation(s)
| | | | - Mercedes Balcells-Oliveró
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
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27
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Caballeria E, Oliveras C, Nuño L, Balcells-Oliveró M, Gual A, López-Pelayo H. A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions. Psychol Med 2020; 50:2113-2127. [PMID: 32840195 DOI: 10.1017/s0033291720002925] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.
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Affiliation(s)
- Elsa Caballeria
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Clara Oliveras
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Laura Nuño
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Mercedes Balcells-Oliveró
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
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Madero S, Oliveras C, Pons MT, Sague M, López-Pelayo H, Gual A, Balcells M. Cannabis use the week before admission to psychiatric in-patient service as a marker of severity. J Psychiatr Res 2020; 129:40-46. [PMID: 32563776 DOI: 10.1016/j.jpsychires.2020.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate if cannabis dose recorded as standard joint unit (SJU) consumed before admission and other related factors have an influence on psychiatric inpatient's symptom severity and clinical outcomes. METHODS Cross-sectional study in an acute psychiatric inpatient unit including 106 individuals. Quantity of cannabis was measured as SJU and symptoms severity through the Brief Psychiatric Rating Scale (BPRS). Secondary outcomes (e.g. length of stay) were also assessed. Bivariate analyses and multivariate analyses were performed to determine the effect of SJU consumed before admission on measures of clinical severity. RESULTS Point prevalence of cannabis use before admission was 25.5%. Mean BPRS score was 55.8 (SD = 16.1); and 62.9 (SD = 11.1) among cannabis users. A low degree positive correlation between SJU consumed the week before admission and BPRS score (rs = 0.28, p = 0.03) was found. In the multivariate analyses both main diagnostic group, Schizophrenia and other psychotic disorders vs. others (Bipolar and Unipolar Affective Disorders and Addictive disorders) (B = 8.327; 95% CI 4.976-11.677) and need of PRN ("pre re nata" or when necessary) administration of antipsychotics and benzodiazepines (B = 12.13; 95% CI 6.868-17.393) were significant predictors, both increasing BPRS score. CONCLUSIONS The study did not find a correlation between SJU consumed last week and psychiatric severity. On the other hand, individuals with psychotic disorders reported a higher prevalence of cannabis use the week before admission and displayed higher BPRS scores, which points to the need for the development of tailored interventions for high-risk groups. The SJU is a useful quantification tool suitable for further clinical research.
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Affiliation(s)
- S Madero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
| | - C Oliveras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M T Pons
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - M Sague
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - H López-Pelayo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - A Gual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M Balcells
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
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Anmella G, Arbelo N, Fico G, Murru A, Llach C, Madero S, Gomes-da-Costa S, Imaz M, López-Pelayo H, Vieta E, Pintor L. COVID-19 inpatients with psychiatric disorders: Real-world clinical recommendations from an expert team in consultation-liaison psychiatry. J Affect Disord 2020; 274:1062-1067. [PMID: 32663933 PMCID: PMC7836977 DOI: 10.1016/j.jad.2020.05.149] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions. METHODS We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. CASE-CENTERED RECOMMENDATIONS Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated. LIMITATIONS Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking. CONCLUSIONS Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.
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Affiliation(s)
- G. Anmella
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - N. Arbelo
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - G. Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - A. Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - C.D. Llach
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - S. Madero
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - S. Gomes-da-Costa
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - M.L. Imaz
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - H. López-Pelayo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain,GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, IDIBAPS, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - E. Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - L. Pintor
- Consultation Liaison Psychiatry Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain,Corresponding author
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López-Lazcano AI, Gual A, Colmenero J, Caballería E, Lligoña A, Navasa M, Crespo G, López E, López-Pelayo H. Active Smoking Before Liver Transplantation in Patients with Alcohol Use Disorder: Risk Factors and Outcomes. J Clin Med 2020; 9:jcm9092710. [PMID: 32825794 PMCID: PMC7564808 DOI: 10.3390/jcm9092710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and after liver transplant (LT). An observational retrospective cohort study with 314 ALD patients undergoing LT from January 2004 to April 2016. Recipients were followed until April 2017 or death. Kaplan-Meier and Cox proportional hazards regression analyses were used to assess risk of mortality according to smoking status before LT. Smokers had a 79% higher risk of dying than those who had never smoked or quit smoking before LT. Ex-smokers had a greater survival probability (96.2%, 93.8%, 86.9%, and 83.1% at 1, 3, 5, and 10 years after LT) than active smokers until LT (96.0%, 85.6%, 80.0%, and 70.4%). Active smokers before LT with poor toxicity awareness had more than a twofold higher risk of mortality (Cox HR = 2.20, 95% CI: 1.05-4.58, p = 0.04) than ex-smokers. Younger age (OR = 94), higher Model for End-Stage Liver Disease (MELD) (OR = 1.06), and comorbid substance use disorder (OR = 2.35) were predictors of smoking until LT. Six months or less of alcohol abstinence (OR = 3.23), and comorbid substance use disorder (OR = 4.87) were predictors of active smoking after LT. Quitting smoking before transplantation improved survival. Evidence based smoking cessation interventions should be offered before and after LT.
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Affiliation(s)
- Ana Isabel López-Lazcano
- Grup Recerca Addicions Clínic (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. RTA (RETICS). Villarroel, 170, 08036 Barcelona, Spain; (A.G.); (E.C.); (A.L.); (H.L.-P.)
- Correspondence:
| | - Antoni Gual
- Grup Recerca Addicions Clínic (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. RTA (RETICS). Villarroel, 170, 08036 Barcelona, Spain; (A.G.); (E.C.); (A.L.); (H.L.-P.)
| | - Jordi Colmenero
- Liver Unit, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. CIBERehd. Villaroel 170, 08036 Barcelona, Spain; (J.C.); (M.N.); (G.C.); (E.L.)
| | - Elsa Caballería
- Grup Recerca Addicions Clínic (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. RTA (RETICS). Villarroel, 170, 08036 Barcelona, Spain; (A.G.); (E.C.); (A.L.); (H.L.-P.)
| | - Anna Lligoña
- Grup Recerca Addicions Clínic (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. RTA (RETICS). Villarroel, 170, 08036 Barcelona, Spain; (A.G.); (E.C.); (A.L.); (H.L.-P.)
| | - Miquel Navasa
- Liver Unit, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. CIBERehd. Villaroel 170, 08036 Barcelona, Spain; (J.C.); (M.N.); (G.C.); (E.L.)
| | - Gonzalo Crespo
- Liver Unit, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. CIBERehd. Villaroel 170, 08036 Barcelona, Spain; (J.C.); (M.N.); (G.C.); (E.L.)
| | - Eva López
- Liver Unit, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. CIBERehd. Villaroel 170, 08036 Barcelona, Spain; (J.C.); (M.N.); (G.C.); (E.L.)
| | - Hugo López-Pelayo
- Grup Recerca Addicions Clínic (GRAC-GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, IDIBAPS. RTA (RETICS). Villarroel, 170, 08036 Barcelona, Spain; (A.G.); (E.C.); (A.L.); (H.L.-P.)
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López-Pelayo H, Aubin HJ, Drummond C, Dom G, Pascual F, Rehm J, Saitz R, Scafato E, Gual A. "The post-COVID era": challenges in the treatment of substance use disorder (SUD) after the pandemic. BMC Med 2020; 18:241. [PMID: 32731868 PMCID: PMC7392642 DOI: 10.1186/s12916-020-01693-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Citizens affected by substance use disorders are high-risk populations for both SARS-CoV-2 infection and COVID-19-related mortality. Relevant vulnerabilities to COVID-19 in people who suffer substance use disorders are described in previous communications. The COVID-19 pandemic offers a unique opportunity to reshape and update addiction treatment networks. MAIN BODY Renewed treatment systems should be based on these seven pillars: (1) telemedicine and digital solutions, (2) hospitalization at home, (3) consultation-liaison psychiatric and addiction services, (4) harm-reduction facilities, (5) person-centered care, (6) promote paid work to improve quality of life in people with substance use disorders, and (7) integrated addiction care. The three "best buys" of the World Health Organization (reduce availability, increase prices, and a ban on advertising) are still valid. Additionally, new strategies must be implemented to systematically deal with (a) fake news concerning legal and illegal drugs and (b) controversial scientific information. CONCLUSION The heroin pandemic four decades ago was the last time that addiction treatment systems were updated in many western countries. A revised and modernized addiction treatment network must include improved access to care, facilitated where appropriate by technology; more integrated care with addiction specialists supporting non-specialists; and reducing the stigma experienced by people with SUDs.
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Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Rosselló 149, 08036, Barcelona, Spain. .,Socidrogalcohol (Spanish Society of Drug and Alcohol Specialists), Barcelona, Spain.
| | - Henri-Jean Aubin
- Département de psychiatrie et d'addictologie, Université Paris-Saclay, Route de l'Orme aux Merisiers - RD 128 91190 Saint-Aubin, Paris, France.,Centre de Recherche en Epidémiologie et Santé des Populations (CESP), INSERM 1018, Paris, France.,Groupe Hospitalo-Universitaire AP-HP, Paris, France
| | - Colin Drummond
- Addiction Psychiatry, Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King's College, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK.,European Federation of Addiction Societies (EUFAS), 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK
| | - Geert Dom
- Antwerp University (UA, CAPRI), Antwerp, Belgium.,Belgian Professional Psychiatry Association, Antwerp, Belgium.,European Federation of Addiction Societies (EUFAS), Antwerp, Belgium.,European Psychiatric Association (EPA), Prinsstraat 13, 2000, Antwerp, Belgium
| | - Francisco Pascual
- SOCIDROGALCOHOL, Barcelona, Spain.,CAARFE, Valencia, Spain.,Departamento de Biología Aplicada, Alicante, Spain.,UCA, Alcoy, Alicante, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), 155 College St., Toronto, Canada.,Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie and Psychotherapie, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Richard Saitz
- Department of Community Health Sciences (CHS), Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.,Medicine, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.,Grayken Center on Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Emanuele Scafato
- WHO Collaborating Centre on Research and Health-Osservatorio Nazionale Alcol, Promotion on Alcohol and Alcohol-related Health, Problems (ITA-79), Istituto Superiore di Sanità, Rome, Italy.,Società Italiana di Alcologia - SIA, EUFAS Istituto Superiore di Sanità, Rome, Italy
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Rosselló 149, 08036, Barcelona, Spain.,International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA), Barcelona, Spain
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Jané-Llopis E, Anderson P, Piazza M, O'Donnell A, Gual A, Schulte B, Pérez Gómez A, de Vries H, Natera Rey G, Kokole D, V Bustamante I, Braddick F, Mejía Trujillo J, Solovei A, Pérez De León A, Kaner EF, Matrai S, Manthey J, Mercken L, López-Pelayo H, Rowlands G, Schmidt C, Rehm J. Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasiexperimental study (SCALA study). BMJ Open 2020; 10:e038226. [PMID: 32723746 PMCID: PMC7390229 DOI: 10.1136/bmjopen-2020-038226] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Eva Jané-Llopis
- ESADE Business School, Ramon Llull University, Barcelona, Catalunya, Spain
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
| | - Peter Anderson
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marina Piazza
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Antoni Gual
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Guillermina Natera Rey
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, DF, Mexico
| | - Daša Kokole
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ines V Bustamante
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fleur Braddick
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | | | - Adriana Solovei
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Alexandra Pérez De León
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, DF, Mexico
| | - Eileen Fs Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Silvia Matrai
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Liesbeth Mercken
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hugo López-Pelayo
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Gillian Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christiane Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Pastor N, Khalilian E, Caballeria E, Morrison D, Sanchez Luque U, Matrai S, Gual A, López-Pelayo H. Remote Monitoring Telemedicine (REMOTE) Platform for Patients With Anxiety Symptoms and Alcohol Use Disorder: Protocol for a Case-Control Study. JMIR Res Protoc 2020; 9:e16964. [PMID: 32579124 PMCID: PMC7381016 DOI: 10.2196/16964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 12/29/2022] Open
Abstract
Background Monitoring mental health outcomes has traditionally been based on heuristic decisions, often based on scarce, subjective evidence, making the clinical decisions made by professionals, as well as the monitoring of these diseases, subject to flaws. However, the digital phenotype, which refers to the analysis of data collected by measuring human behavior with mobile sensors and smart bracelets, is a promising tool for filling this gap in current clinical practice. Objective The objectives of this study are to develop the digital phenotyping of patients with alcohol use disorder and anxiety symptoms using data collected from a mobile device (ie, smartphone) and a wearable sensor (ie, Fitbit) and to analyze usability and patient satisfaction with the data collection service provided by the app. Methods We propose to conduct a study among a group of 60 participants split into two subgroups—experimental and control—of 30 participants each. The experimental group will be recruited by physicians from the Hospital Clínic de Barcelona, and the control group will be recruited on a volunteer basis through fliers and social media. All participants will go through pretraining to ensure technological capability and understanding of tasks, then each participant will download the HumanITcare app and will be given a wearable sensor (ie, Fitbit). Throughout the 4-month period, participants will be monitored on a range of factors, including sleep cycle, heart rate, movement patterns, and sociability. All data from the wearable sensors and the mobile devices will be saved and sent to the HumanITcare server. Participants will be asked to complete weekly questionnaires about anxiety, depression, and alcohol use disorder symptoms. Research assistants will ensure timely responses. The data from both sensors will then be compared to the questionnaire responses to determine how accurately the devices can predict the same symptoms. Results The recruitment phase was completed in November 2019 and all the data were collected by the end of December 2019. Data are being processed; this process is expected to be completed by October 2020. Conclusions This study was created and conducted as a pilot study with the Hospital Clínic de Barcelona, with the purpose of exploring the feasibility of our approach. The study is focused on patients diagnosed with anxiety and alcohol use disorder, but participants were also monitored for depressive symptoms throughout the trial, although these were not part of the initial inclusion criteria. A limitation to our study was the exclusive use of Android smartphones over iOS devices; this could result in a potential selection bias, due to the accessibility and affordability of Android phones as opposed to iOS-based phones. Another limitation might be that reviews of usability and satisfaction could be confounded by factors such as age and familiarity. An additional function that we might add in future studies is the ability for patients to manage their own data. International Registered Report Identifier (IRRID) DERR1-10.2196/16964
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Affiliation(s)
| | | | - Elsa Caballeria
- Grup Recerca Addiccions Clinic, Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, Barcelona, Spain
| | | | | | - Silvia Matrai
- Grup Recerca Addiccions Clinic, Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clinic, Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clinic, Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, Barcelona, Spain
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Campeny E, López-Pelayo H, Nutt D, Blithikioti C, Oliveras C, Nuño L, Maldonado R, Florez G, Arias F, Fernández-Artamendi S, Villalbí JR, Sellarès J, Ballbè M, Rehm J, Balcells-Olivero MM, Gual A. The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms. Eur Neuropsychopharmacol 2020; 33:1-35. [PMID: 32165103 DOI: 10.1016/j.euroneuro.2020.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.
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Affiliation(s)
- E Campeny
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain.
| | - H López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - D Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - C Blithikioti
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - C Oliveras
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - L Nuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - R Maldonado
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - G Florez
- Hospital Universitario de Ourense, Ourense, Spain
| | - F Arias
- Hospital Doce de Octubre, Madrid, Spain
| | | | - J R Villalbí
- Public Health Agency of Barcelona, Barcelona, Spain
| | - J Sellarès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - M Ballbè
- Catalan Institute of Oncology, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - J Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, (CAMH), Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), Canada; Department of Psychiatry, Faculty of Medicine, UofT, Canada; Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - M M Balcells-Olivero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Gual
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
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López-Pelayo H, Zuluaga P, Caballeria E, Van den Brink W, Mann K, Gual A. Safety of nalmefene for the treatment of alcohol use disorder: an update. Expert Opin Drug Saf 2019; 19:9-17. [PMID: 31868031 DOI: 10.1080/14740338.2020.1707802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Reduced drinking has been debated as a treatment goal for heavy drinking alcohol-dependent patients, in whom treatment based on abstinence is not always an option. Nalmefene was the first drug approved by the European Medicines Agency (2013) with the indication of reduced drinking in high drinking risk level alcohol-dependent patients. Six years after its introduction in Europe, data from clinical experience can be compared with those from preclinical studies and pivotal registration studies to evaluate what nalmefene has added to the treatment of AUD.Areas covered: Systematic review of efficacy and safety data of nalmefene use in humans from preclinical, phase III and phase IV studies, including systematic reviews, meta-analyses, cost-effectiveness analyses, and other secondary analyses.Expert opinion: Nalmefene introduces a paradigm change in the treatment of AUD that makes it appealing to patients that are reluctant to embrace abstinence, and facilitate patient-centered care in heavy users. However, information regarding safety data in special populations (e.g., patients with alcohol-related diseases, pregnancy, psychiatric disease), and direct comparisons with other potential drugs for alcohol reduction are further needed. Despite the promising role of nalmefene, there are still some factors that limit its wide prescription further than in specialized settings.
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Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Paola Zuluaga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elsa Caballeria
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Wim Van den Brink
- Department of Psychiatry, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karl Mann
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
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Lombardo-Quezada J, Colmenero J, López-Pelayo H, Gavotti C, Lopez A, Crespo G, Lopez E, Gual A, Lligoña A, Navasa M. Prediction of Alcohol Relapse Among Liver Transplant Candidates With Less Than 6 Months of Abstinence Using the High-Risk Alcoholism Relapse Score. Liver Transpl 2019; 25:1142-1154. [PMID: 30920118 DOI: 10.1002/lt.25460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/16/2019] [Indexed: 01/13/2023]
Abstract
The selection of liver transplantation (LT) candidates with alcohol-use disorder (AUD) is influenced by the risk of alcohol relapse (AR) after LT. We aimed to investigate the risk factors of AR after LT and its impact on graft and recipient outcomes. A retrospective study was conducted that included all consecutive patients with AUD undergoing LT from January 2004 to April 2016 (n = 309), excluding patients with alcoholic hepatitis. Odds ratios (ORs) and 95% confidence intervals (CIs) for AR were analyzed by multinomial logistic regression. Cox regression with time-dependent covariates was used to analyze patient survival and graft cirrhosis. There were 70 (23%) patients who presented AR (median follow-up, 68 months), most of them (n = 44, 63%) presenting heavy AR. The probability of heavy AR was 2.3%, 7.5%, 12%, and 29% at 1, 3, 5, and 10 years after LT, respectively. The independent risk factors for heavy AR included a High-Risk Alcoholism Relapse (HRAR) score ≥3 (OR, 2.39; 95% CI, 1.02-5.56; P = 0.04) and the duration of abstinence (months) before LT (OR, 0.81; 95% CI, 0.66-0.98; P = 0.03). In recipients with <6 months of abstinence before LT, the probability of heavy AR after LT was higher in patients with an HRAR score ≥3 than in those with an HRAR score <3 (20%, 36.7%, and 47% versus 6.8%, 12.4%, and 27% at 1, 3, and 5 years, respectively; log-rank 0.013). The risk of graft cirrhosis was increased in patients with heavy AR (hazard ratio, 3.44; 95% CI, 1.58-7.57; P = 0.002) compared with nonrelapsers, with no differences in patient survival. In conclusion, the HRAR score is helpful in identifying the risk of harmful AR after LT in candidates with <6 months of alcohol abstinence without alcoholic hepatitis. These patients could benefit from a longterm integrative patient-centered approach after LT until lifestyle changes are implemented.
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Affiliation(s)
- Julissa Lombardo-Quezada
- Liver Transplant Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordi Colmenero
- Liver Transplant Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carolina Gavotti
- Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Lopez
- Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gonzalo Crespo
- Liver Transplant Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eva Lopez
- Liver Transplant Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Anna Lligoña
- Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Navasa
- Liver Transplant Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Grup de Recerca en Addiccions Clínic, Red de Trastornos Adictivos, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
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López-Pelayo H, Caballeria E, Díaz E, Sánchez A, Segura L, Colom J, Wallace P, Gual A. Digital brief interventions for risky drinkers are not the panacea: A pilot study exploring barriers for its implementation according to professionals' perceptions. Health Informatics J 2019; 26:925-933. [PMID: 31213133 DOI: 10.1177/1460458219855177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Digital brief interventions have emerged as an instrument to improve the implementation of Screening, Brief Intervention and Referral to Treatment programs for risky drinkers. However, trials in Catalonia have been unsuccessful. This study was aimed at researching professionals' perceptions regarding the usefulness of digital brief interventions in overcoming traditional barriers of face-to-face Screening, Brief Intervention and Referral to Treatment and new barriers posed by the use of digital brief interventions. Professionals who participated in the Effectiveness of primary care based Facilitated Access to alcohol Reduction website (EFAR)digital brief intervention clinical trial were surveyed on April 2017 on the following areas: (1) satisfaction, (2) usefulness, (3) perceived ability of digital interventions on overcoming traditional barriers and (4) perceived new barriers of digital interventions. Sixty-eight professionals completed the survey. Univariate and multivariate analyses were performed using the level of professional engagement with the project as the dependent variable, barriers as independent variables and socio-demographic characteristics as covariables. Of all professionals, 79.4 percent were satisfied with their participation in the project, but only 26.5 percent perceived the website as useful. Low engagement was associated with the perceived lack of feedback (0.22; 95% confidence interval: 0.05 -0.88), perception that it was difficult to use among the elderly(0.22; 95 confidence interval: 0.05 -0.091) and among low socioeconomic population (0.14; 95% confidence interval: 0.03 -0.64). The majority of the participants indicated that digital brief intervention for risky drinkers succeeded in overcoming most of the traditional barriers. However, new barriers emerged as difficulties for implementing digital brief interventions in the Catalan Primary Health Care System. Usefulness perception is a key factor, which must be addressed in any proposed intervention in primary care.
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López-Pelayo H, Wallace P, Miquel L, Segura L, Baena B, Barrio P, Colom J, Gual A. Factors affecting engagement of primary health care professionals and their patients in facilitated access to online alcohol screening and brief intervention. Int J Med Inform 2019; 127:95-101. [PMID: 31128838 DOI: 10.1016/j.ijmedinf.2019.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 02/08/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Understanding the impact of Level of Information and Communication Technology Use, computer self-efficacy and perceived product usability of healthcare professionals regarding an alcohol consumption reduction website on facilitated access defined as referring patients to the webpage. METHODS 52 nurses and 41 general practitioners were assessed before patient recruitment started, using a questionnaire designed to assess socio-demographic characteristics, professional engagement to the website, Level of Information and Communication Technology Use, Computer self-efficacy ("the judgment of one's capability to use a computer") and Perceived product usability ("the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use"). Dependent variable was the self-report of number of brochures distributed to patients. RESULTS Professionals' engagement with facilitated access measured by brochures handed out was not predicted by Perceived product usability, Level of Information and Communication Technology Use or Computer self-efficacy. Professionals who had actively engaged with the website (customization) provided significantly more brochures compared with those who had not (Coefficient B 15.7 CI95% 3.5-27.8). Professional's socio-demographic characteristics did not predict engagement in facilitated access. CONCLUSION Professionals' Perceived product usability, Level of Information and Communication Technology Use and Computer self-efficacy were not associated to facilitated access. Active early engagement of health professionals with the website (customization) is a key predictor of subsequent engagement with facilitated access. PRACTICE IMPLICATIONS Computer Self-Efficacy, Level of Information and Communication Technology Use and Perceived Product Usability are irrelevant for facilitated access and efforts should be focused on taking time to collaborate with providers and convincing them about the usefulness of the intervention (including customization). Website customization by health care professionals is a promising predictor of engagement.
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Affiliation(s)
- Hugo López-Pelayo
- GRAC. Addictions Unit. Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Fundació Clínic Recerca Biomèdica (FCRB), RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel 170, 08026, Barcelona, Spain.
| | - Paul Wallace
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, London, UK.
| | - Laia Miquel
- GRAC. Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETICS (Red de Trastornos Adictivos), University of Barcelona, Villarroel 170, 08026, Barcelona, Spain.
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Roc Boronat 81-95, 08005, Barcelona, Spain.
| | - Begoña Baena
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Roc Boronat 81-95, 08005, Barcelona, Spain
| | - Pablo Barrio
- GRAC. Addictions Unit. Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Fundació Clínic Recerca Biomèdica (FCRB), RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel 170, 08026, Barcelona, Spain.
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Roc Boronat 81-95, 08005, Barcelona, Spain.
| | - Antoni Gual
- GRAC. Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETICS (Red de Trastornos Adictivos), University of Barcelona, Villarroel 170, 08026, Barcelona, Spain.
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López-Pelayo H, Coma A, Gual A, Zara C, Lligoña A. Call for Action: Benzodiazepine Prescription Prevalence Analysis Shows Off-Label Prescription in One in Eleven Citizens. Eur Addict Res 2019; 25:320-329. [PMID: 31494655 DOI: 10.1159/000502518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Benzodiazepines have a good safety profile. Nevertheless, off-label use of these drugs may increase the risk of falls, dependence, and memory loss. Off-label prescription use is not highly prevalent. Studies have not researched the factors that influence off-label prescription use. We aim to identify the prevalence of off-label use of benzodiazepines in Barcelona and explore sociodemographic factors that may be involved for professionals and patients. METHOD A cross-sectional study in Barcelona was carried out. Data from professionals were obtained from the Medical Official College of Barcelona. Patients' healthcare data were extracted from the electronic prescription system DataMart and from the Catalan Health System Observatory (catchment of 97% of the prescription system). Two multivariate analyses were performed to identify risk factors of off-label prescription use; one focused on the patients' characteristics and the other focused on professionals' characteristics. RESULTS In total, 9.7% of Barcelona's citizens used benzodiazepine prescriptions; 96.1% of them were off-label uses. The most common reason was long-term use (95.8%). Elderly patients were the most common demographic that was exposed to off-label use (OR 1.05, 95% CI 1.04-1.05). Family doctors (B = 38.87, 95% CI 25.25-35.50) and psychiatrists (B = 16.93; 95% CI 11.50-22.35) were the largest groups of off-label prescribers. CONCLUSIONS The prevalence of benzodiazepine off-label prescriptions in our environment is very high, especially when the length of the treatment is considered. Implementation of evidenced-based strategies to facilitate more effective prescription practices is required.
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Affiliation(s)
- Hugo López-Pelayo
- Addiction Research Group (GRC, GRAC), IDIBAPS, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Red de Trastornos Adictivos (RTA-RETICS), Barcelona, Spain,
| | - Anna Coma
- Pharmacy Department of Barcelona Health Region, Catalan Health Service (CatSalut), Barcelona, Spain
| | - Antoni Gual
- Addiction Research Group (GRC, GRAC), IDIBAPS, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Red de Trastornos Adictivos (RTA-RETICS), Barcelona, Spain
| | - Corinne Zara
- Pharmacy Department of Barcelona Health Region, Catalan Health Service (CatSalut), Barcelona, Spain
| | - Anna Lligoña
- Addiction Research Group (GRC, GRAC), IDIBAPS, Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Red de Trastornos Adictivos (RTA-RETICS), Barcelona, Spain
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López-Pelayo H, Oliveras C, Segura L, Colom J, Díaz E, Wallace P, Gual A. Quality of life role in risky alcohol use research: should it be a more relevant outcome in any study? Adicciones 2018; 30:301-303. [PMID: 30059591 DOI: 10.20882/adicciones.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Letter to the editor.
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Miquel L, López-Pelayo H, Nuño L, Arbesú JÁ, Zarco J, Manthey J, Rehm J, Gual A. Barriers to implement screening for alcohol consumption in Spanish hypertensive patients. Fam Pract 2018; 35:295-301. [PMID: 29106526 DOI: 10.1093/fampra/cmx107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol intake and hypertension (HT) are interrelated public health problems with cost-effective interventions at the primary care level that, to date, are poorly implemented. OBJECTIVE This study aims to explore the barriers to implementing alcohol interventions for people with HT in primary care. METHODS As part of the project BASIS (Baseline Alcohol Screening and Intervention Survey), an internet survey from five European countries was developed to determine the role of alcohol in the management of HT in primary care practice. The survey contained 28 core items and 7 country-specific items. We present answers from Spanish general practitioners (GPs), who were reached through the main professional and scientific societies via e-mail and asked to take the online survey. RESULTS In total, 867 GPs answered the survey (65.1% women, 70.4% > 30 years old). As indicated by the Alcohol Use Disorders Identification Test-C scores, 12.4% of GPs who responded were risky drinkers (21.3% of men versus 7.1% of women). GPs reported considering alcohol relatively unimportant in HT treatment, as well as a difficult condition to deal with. The three main barriers to implement screening for alcohol consumption in HT patients were the lack of time (50.0%), considering alcohol unimportant for HT (28.4%) and stigma (16.5%). CONCLUSIONS GPs did not consider alcohol consumption a relevant factor for HT and, additionally, found it difficult to deal with alcohol problems. Some of the barriers for alcohol screening could be overcome through structural changes in the health system, such as empowering GPs to treat alcohol use disorders (rather than a single focus on implementing preventive strategies) by enhancing training in alcohol diagnosis and treatment.
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Affiliation(s)
- Laia Miquel
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laura Nuño
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - José Ángel Arbesú
- Área de Neurociencias de Semergen, Primary Health Care Center Eria, Oviedo, Spain
| | - José Zarco
- Primary Health Care Center Ibiza, Servicio Madrileño de Salud, Madrid, Spain.,Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Madrid, Spain.,Departamento Medicina Interna, Universidad Complutense de Madrid, Madrid, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität, Dresden, Germany.,Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
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Casajuana Köguel C, López-Pelayo H, Balcells-Olivero MM, Colom J, Gual A. Psychoactive constituents of cannabis and their clinical implications: a systematic review. Adicciones 2018; 30:140-151. [PMID: 28492950 DOI: 10.20882/adicciones.858] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective This systematic review aims to summarize current evidence on which naturally present cannabinoids contribute to cannabis psychoactivity, considering their reported concentrations and pharmacodynamics in humans. Design Following PRISMA guidelines, papers published before March 2016 in Medline, Scopus-Elsevier, Scopus, ISI-Web of Knowledge and COCHRANE, and fulfilling established a-priori selection criteria have been included. Results In 40 original papers, three naturally present cannabinoids (∆-9-Tetrahydrocannabinol, ∆-8-Tetrahydrocannabinol and Cannabinol) and one human metabolite (11-OH-THC) had clinical relevance. Of these, the metabolite produces the greatest psychoactive effects. Cannabidiol (CBD) is not psychoactive but plays a modulating role on cannabis psychoactive effects. The proportion of 9-THC in plant material is higher (up to 40%) than in other cannabinoids (up to 9%). Pharmacodynamic reports vary due to differences in methodological aspects (doses, administration route and volunteers' previous experience with cannabis). Conclusions Findings reveal that 9-THC contributes the most to cannabis psychoactivity. Due to lower psychoactive potency and smaller proportions in plant material, other psychoactive cannabinoids have a weak influence on cannabis final effects. Current lack of standard methodology hinders homogenized research on cannabis health effects. Working on a standard cannabis unit considering 9-THC is recommended.
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Casajuana Köguel C, López-Pelayo H, Balcells-Olivero MM, Colom J, Gual A. Psychoactive constituents of cannabis and their clinical implications: a systematic review. Adicciones 2018. [PMID: 28492950 DOI: 10.20882/adicciones] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Objective This systematic review aims to summarize current evidence on which naturally present cannabinoids contribute to cannabis psychoactivity, considering their reported concentrations and pharmacodynamics in humans. Design Following PRISMA guidelines, papers published before March 2016 in Medline, Scopus-Elsevier, Scopus, ISI-Web of Knowledge and COCHRANE, and fulfilling established a-priori selection criteria have been included. Results In 40 original papers, three naturally present cannabinoids (∆-9-Tetrahydrocannabinol, ∆-8-Tetrahydrocannabinol and Cannabinol) and one human metabolite (11-OH-THC) had clinical relevance. Of these, the metabolite produces the greatest psychoactive effects. Cannabidiol (CBD) is not psychoactive but plays a modulating role on cannabis psychoactive effects. The proportion of 9-THC in plant material is higher (up to 40%) than in other cannabinoids (up to 9%). Pharmacodynamic reports vary due to differences in methodological aspects (doses, administration route and volunteers' previous experience with cannabis). Conclusions Findings reveal that 9-THC contributes the most to cannabis psychoactivity. Due to lower psychoactive potency and smaller proportions in plant material, other psychoactive cannabinoids have a weak influence on cannabis final effects. Current lack of standard methodology hinders homogenized research on cannabis health effects. Working on a standard cannabis unit considering 9-THC is recommended.
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Casajuana C, López-Pelayo H, Miquel L, Balcells-Oliveró MM, Colom J, Gual A. Quantitative Criteria to Screen for Cannabis Use Disorder. Eur Addict Res 2018; 24:109-117. [PMID: 29949807 DOI: 10.1159/000488346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Standard Joint Unit (1 SJU = 7 mg of 9-Tetrahydrocannabinol) simplifies the exploration of risky patterns of cannabis use. This study proposes a preliminary quantitative cutoff criterion to screen for cannabis use disorder (CUD). METHODOLOGY Socio-demographical data and information on cannabis quantities, frequency of use, and risk for CUD (measured with the Cannabis Abuse Screening Test (CAST) of cannabis users recruited in Barcelona (from February 2015 to June 2016) were collected. CAST scores were categorized into low, moderate, and high risk for CUD, based on the SJU consumed and frequency. Receiver operating characteristic (ROC) analysis related daily SJU with CUD. RESULTS Participants (n = 473) were on average 29 years old (SD = 10), men (77.1%), and single (74.6%). With an average of 4 joints per smoking day, 82.5% consumed cannabis almost every day. Risk for CUD (9.40% low, 23.72% moderate, 66.88% high) increased significantly with more frequency and quantities consumed. The ROC analyses suggest 1.2 SJU per day as a cutoff criterion to screen for at least moderate risk for CUD (sensitivity 69.4%, specificity 63.6%). CONCLUSION Frequency and quantity should be considered when exploring cannabis risks. A 1 SJU per day is proposed as a preliminary quantitative-based criterion to screen users with at least a moderate risk for CUD.
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Affiliation(s)
- Cristina Casajuana
- Department of Psychiatry, Grup de Recerca en Adiccions Clínic (GRAC), Addictions Unit, Clinical Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Red de Trastornos Adictivos (RTA), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Hugo López-Pelayo
- Department of Psychiatry, Grup de Recerca en Adiccions Clínic (GRAC), Addictions Unit, Clinical Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Red de Trastornos Adictivos (RTA), Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
| | - Laia Miquel
- Department of Psychiatry, Grup de Recerca en Adiccions Clínic (GRAC), Addictions Unit, Clinical Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Red de Trastornos Adictivos (RTA), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Mercedes Balcells-Oliveró
- Department of Psychiatry, Grup de Recerca en Adiccions Clínic (GRAC), Addictions Unit, Clinical Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Red de Trastornos Adictivos (RTA), Barcelona, Spain
| | - Joan Colom
- Agència de Salut Pública de Catalunya, Departament de Drogodependències, Generalitat de Catalunya, Barcelona, Spain
| | - Antoni Gual
- Department of Psychiatry, Grup de Recerca en Adiccions Clínic (GRAC), Addictions Unit, Clinical Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Red de Trastornos Adictivos (RTA), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Altamirano J, López-Pelayo H, Michelena J, Jones PD, Ortega L, Ginès P, Caballería J, Gual A, Bataller R, Lligoña A. Alcohol abstinence in patients surviving an episode of alcoholic hepatitis: Prediction and impact on long-term survival. Hepatology 2017. [PMID: 28646515 DOI: 10.1002/hep.29338] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease. Most studies have focused on short-term prognosis, whereas factors associated with long-term survival are largely unknown. The aims of our study were to (1) determine the impact of complete abstinence from alcohol on long-term survival and (2) identify prognostic factors at admission capable of predicting abstinence during long-term follow-up in patients with AH. One hundred forty-two patients with biopsy-proven AH that survived the first episode were included. Demographic, psychiatric, and biochemical variables at admission and drinking status during follow-up were obtained. Cox regression, logistic regression, and classification and regression trees (CART) analyses were used for statistical analysis. Overall mortality was 38% with a median follow-up of 55 months. During follow-up, complete abstinence was reported in 39% and was associated with better long-term survival (hazard ratio, 0.53; P = 0.03). After adjustment for baseline prognostic scoring systems (Model for End-Stage Liver Disease and age, bilirubin, international normalized ratio, creatinine scores), complete abstinence was independently associated with survival (P < 0.05). Age and lack of past alcoholism treatments were independently associated with complete abstinence (P < 0.001 and P = 0.02, respectively) during follow-up. CART analysis generated a simple and practical algorithm based on the combination of past alcoholism treatments and age. Using CART analysis, we stratified 2 subgroups of patients with high (65%) and low (26%-29%) rates of complete abstinence after an episode of AH. CONCLUSION Complete abstinence after an episode of AH positively impacts long-term survival. The combination of 2 variables easily obtained at admission might be useful to predict long-term abstinence after an episode of AH. Strategies aimed at promoting alcohol abstinence in these patients are necessary. (Hepatology 2017;66:1842-1853).
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Affiliation(s)
- José Altamirano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic of Barcelona, Red de Trastornos Adictivos (RTA), Barcelona, Spain
| | - Javier Michelena
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia D Jones
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL
| | - Lluisa Ortega
- Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic of Barcelona, Red de Trastornos Adictivos (RTA), Barcelona, Spain
| | - Pere Ginès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Liver Unit, CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Institució Catalana de Recerca i Estudis Avançats (ICREA), Universitat de Barcelona, Barcelona, Spain
| | - Juan Caballería
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Liver Unit, CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Institució Catalana de Recerca i Estudis Avançats (ICREA), Universitat de Barcelona, Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic of Barcelona, Red de Trastornos Adictivos (RTA), Barcelona, Spain
| | - Ramón Bataller
- Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Liver Center, Pittsburgh, PA
| | - Anna Lligoña
- Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic of Barcelona, Red de Trastornos Adictivos (RTA), Barcelona, Spain
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Casajuana C, López-Pelayo H, Mercedes Balcells M, Miquel L, Teixidó L, Colom J, Gual A. Working on a Standard Joint Unit: A pilot test. Adicciones 2017; 29:227-232. [PMID: 27749977 DOI: 10.20882/adicciones.721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Assessing cannabis consumption remains complex due to no reliable registration systems. We tested the likelihood of establishing a Standard Joint Unit (SJU) which considers the main cannabinoids with implication on health through a naturalistic approach. Methodology. Pilot study with current cannabis users of four areas of Barcelona: universities, nightclubs, out-patient mental health service, and cannabis associations. We designed and administered a questionnaire on cannabis use-patterns and determined the willingness to donate a joint for analysis. Descriptive statistics were used to analyze the data. RESULTS Forty volunteers answered the questionnaire (response rate 95%); most of them were men (72.5%) and young adults (median age 24.5 years; IQR 8.75 years) who consume daily or nearly daily (70%). Most participants consume marihuana (85%) and roll their joints with a median of 0.25 gr of marihuana. Two out of three (67.5%) stated they were willing to donate a joint. CONCLUSION Obtaining an SJU with the planned methodology has proved to be feasible. Pre-testing resulted in an improvement of the questionnaire and retribution to incentivize donations. Establishing an SJU is essential to improve our knowledge on cannabis-related outcomes.
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Holloway AS, Ferguson J, Landale S, Cariola L, Newbury-Birch D, Flynn A, Knight JR, Sherritt L, Harris SK, O’Donnell AJ, Kaner E, Hanratty B, Loree AM, Yonkers KA, Ondersma SJ, Gilstead-Hayden K, Martino S, Adam A, Schwartz RP, Wu LT, Subramaniam G, Sharma G, McNeely J, Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A, Mitchell AM, Finnell D, Savage CL, Mahmoud KF, Riordan BC, Conner TS, Flett JAM, Scarf D, McRee B, Vendetti J, Gallucci KS, Robaina K, Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas I, Burnham EL, Aagaard L, Cook PF, Harris BR, Yu J, Wolff M, Rogers M, Barbosa C, Wedehase BJ, Dunlap LJ, Mitchell SG, Dusek KA, Gryczynski J, Kirk AS, Oros MT, Hosler C, O’Grady KE, Brown BS, Angus C, Sherborne S, Gillespie D, Meier P, Brennan A, de Vargas D, Soares J, Castelblanco D, Doran KM, Wittman I, Shelley D, Rotrosen J, Gelberg L, Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Deng Y, Dziura J, Fiellin LE, O’Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA, Giles EL, Coulton S, Deluca P, Drummond C, Howel D, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Vale L, Alabani V, Atkinson A, Boniface S, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Ramsey A, Stanley G, Clephane J, Gardiner D, Holmes J, Martin N, Shevills C, Soutar M, Chi FW, Weisner C, Ross TB, Mertens J, Sterling SA, Shorter GW, Heather N, Bray J, Cohen HA, McPherson TL, Adam C, López-Pelayo H, Gual A, Segura-Garcia L, Colom J, Ornelas IJ, Doyle S, Donovan D, Duran B, Torres V, Gaume J, Grazioli V, Fortini C, Paroz S, Bertholet N, Daeppen JB, Satterfield JM, Gregorich S, Alvarado NJ, Muñoz R, Kulieva G, Vijayaraghavan M, Adam A, Cunningham JA, Díaz E, Palacio-Vieira J, Godinho A, Kushir V, O’Brien KHM, Aguinaldo LD, Sellers CM, Spirito A, Chang G, Blake-Lamb T, LaFave LRA, Thies KM, Pepin AL, Sprangers KE, Bradley M, Jorgensen S, Catano NA, Murray AR, Schachter D, Andersen RM, Rey GN, Vahidi M, Rico MW, Baumeister SE, Johansson M, Sinadinovic C, Hermansson U, Andreasson S, O’Grady MA, Kapoor S, Akkari C, Bernal C, Pappacena K, Morley J, Auerbach M, Neighbors CJ, Kwon N, Conigliaro J, Morgenstern J, Magill M, Apodaca TR, Borsari B, Hoadley A, Scott Tonigan J, Moyers T, Fitzgerald NM, Schölin L, Barticevic N, Zuzulich S, Poblete F, Norambuena P, Sacco P, Ting L, Beaulieu M, Wallace PG, Andrews M, Daley K, Shenker D, Gallagher L, Watson R, Weaver T, Bruguera P, Oliveras C, Gavotti C, Barrio P, Braddick F, Miquel L, Suárez M, Bruguera C, Brown RL, Capell JW, Paul Moberg D, Maslowsky J, Saunders LA, McCormack RP, Scheidell J, Gonzalez M, Bauroth S, Liu W, Lindsay DL, Lincoln P, Hagle H, Wallhed Finn S, Hammarberg A, Andréasson S, King SE, Vargo R, Kameg BN, Acquavita SP, Van Loon RA, Smith R, Brehm BJ, Diers T, Kim K, Barker A, Jones AL, Skinner AC, Hinman A, Svikis DS, Thacker CL, Resnicow K, Beatty JR, Janisse J, Puder K, Bakshi AS, Milward JM, Kimergard A, Garnett CV, Crane D, Brown J, West R, Michie S, Rosendahl I, Andersson C, Gajecki M, Blankers M, Donoghue K, Lynch E, Maconochie I, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Stewart MT, Quinn AE, Brolin M, Evans B, Horgan CM, Liu J, McCree F, Kanovsky D, Oberlander T, Zhang H, Hamlin B, Saunders R, Barton MB, Scholle SH, Santora P, Bhatt C, Ahmed K, Hodgkin D, Gao W, Merrick EL, Drebing CE, Larson MJ, Sharma M, Petry NM, Saitz R, Weisner CM, Young-Wolff KC, Lu WY, Blosnich JR, Lehavot K, Glass JE, Williams EC, Bensley KM, Chan G, Dombrowski J, Fortney J, Rubinsky AD, Lapham GT, Forray A, Olmstead TA, Gilstad-Hayden K, Kershaw T, Dillon P, Weaver MF, Grekin ER, Ellis JD, McGoron L, McGoron L. Proceedings of the 14th annual conference of INEBRIA. Addict Sci Clin Pract 2017. [PMCID: PMC5606215 DOI: 10.1186/s13722-017-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gual A, Ángel Arbesú J, Zarco J, Balcells-Oliveró MDLM, López-Pelayo H, Miquel L, Bobes J. Risky Drinkers Underestimate their Own Alcohol Consumption. Alcohol Alcohol 2017; 52:516-517. [PMID: 28498886 DOI: 10.1093/alcalc/agx029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/26/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Antoni Gual
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS,Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - José Ángel Arbesú
- Médico de Familia,Coordinador Área de Neurociencias de Semergen, Centro de Salud de la Eria,Oviedo, Spain
| | - José Zarco
- Médico de Familia,Coordinador Grupo de Intervención en Drogas semFYC, CS Ibiza, SERMAS, Spain
| | - María de Las Mercedes Balcells-Oliveró
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS,Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS,Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laia Miquel
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS,Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Julio Bobes
- Área de Psiquiatría,Universidad de Oviedo, Centro de Investigación Biomédica en Red área de Salud Mental (CIBERSAM), Oviedo, Spain
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Abstract
UNLABELLED Although cannabis is widely used, it remains unclear which consumption patterns are more likely to produce future consequences (risky/hazardous use) or current damage (problematic/harmful use). This unresolved issue contributes to cannabis public health implications. In order to facilitate further consensus, this review analyzes previously used definitions in the literature. METHODS This systematic review was performed following the PRISMA guidelines. Articles published before October 2015 in the Medline, Scopus-Elsevier, ISI-Web of Knowledge and Cochrane databases and fulfilling a-priori decided criteria were retrieved. Definitions in preselected websites of national and international organizations addressing drug problems were also included. RESULTS Definitions identified in articles (n = 46) and official websites (n = 3) widely varied from each other. Weekly cannabis use was mostly considered risky. Problematic cannabis use was mostly described with the Cannabis Abuse and Screening Test. Evidence-based definitions as well as information on quantities consumed, time-frames and special considerations for risky groups were very limited. CONCLUSIONS Working on official definitions is highly necessary as criteria used remain incomplete, leading to increased confusion in the field. Recommendations to improve existing definitions are given.
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Affiliation(s)
- Cristina Casajuana
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,d Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Hugo López-Pelayo
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,e Fundació Clínic per la Recerca Biomédica , Barcelona , Spain
| | - María Mercedes Balcells
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain
| | - Laia Miquel
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,d Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Joan Colom
- f Departament de Drogodependències , Agència de Salut Pública de Catalunya , Barcelona , Spain
| | - Antoni Gual
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,d Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
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Watson R, Morris J, Isitt J, Barrio P, Ortega L, Gual A, Conner K, Stecker T, Maisto S, Paroz S, Graap C, Grazioli VS, Daeppen JB, Collins SE, Bertholet N, McNeely J, Kushnir V, Cunningham JA, Crombie IK, Cunningham KB, Irvine L, Williams B, Sniehotta FF, Norrie J, Melson A, Jones C, Briggs A, Rice P, Achison M, McKenzie A, Dimova E, Slane PW, Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB, Baggio S, Dupuis M, Studer J, Gmel G, Magill M, Grazioli VS, Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK, Renko E, Mitchell SG, Lounsbury D, Li Z, Schwartz RP, Gryczynski J, Kirk AS, Oros M, Hosler C, Dusek K, Brown BS, Finnell DS, Holloway A, Wu LT, Subramaniam G, Sharma G, Wallhed Finn S, Andreasson S, Dvorak RD, Kramer MP, Stevenson BL, Sargent EM, Kilwein TM, Harris SK, Sherritt L, Copelas S, Knight JR, Mdege ND, McCambridge J, Bischof G, Bischof A, Freyer-Adam J, Rumpf HJ, Fitzgerald N, Schölin L, Toner P, Böhnke JR, Veach LJ, Currin O, Dongre LZ, Miller PR, White E, Williams EC, Lapham GT, Bobb JJ, Rubinsky AD, Catz SL, Shortreed S, Bensley KM, Bradley KA, Milward J, Deluca P, Khadjesari Z, Watson R, Fincham-Campbell S, Drummond C, Angus K, Bauld L, Baumann S, Haberecht K, Schnuerer I, Meyer C, Rumpf HJ, John U, Gaertner B, Barrault-Couchouron M, Béracochéa M, Allafort V, Barthélémy V, Bonnefoi H, Bussières E, Garguil V, Auriacombe M, Saint-Jacques M, Dorval M, M’Bailara K, Segura-Garcia L, Ibañez-Martinez N, Mendive-Arbeloa JM, Anoro-Perminger M, Diaz-Gallego P, Piñar-Mateos MA, Colom-Farran J, Deligianni M, Yersin B, Adam A, Weisner C, Chi F, Lu W, Sterling S, Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Korthuis PT, Edelman EJ, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O’Connor PG, Maisto SA, Bedimo R, Gilbert C, Marconi VC, Rimland D, Rodriguez-Barradas M, Simberkoff M, Justice AC, Bryant KJ, Berman AH, Shorter GW, Bray JW, Barbosa C, Johansson M, Hester R, Campbell W, Souza Formigoni MLO, Andrade ALM, Sartes LMA, Sundström C, Eék N, Kraepelien M, Kaldo V, Fahlke C, Hernandez L, Becker SJ, Jones RN, Graves HR, Spirito A, Diestelkamp S, Wartberg L, Arnaud N, Thomasius R, Gaume J, Grazioli V, Fortini C, Malan Z, Mash B, Everett-Murphy K, Grazioli VS, Studer J, Mohler-Kuo M, Bertholet N, Gmel G, Doi L, Cheyne H, Jepson R, Luna V, Echeverria L, Morales S, Barroso T, Abreu Â, Aguiar C, Stewart D, Abreu A, Brites RM, Jomar R, Marinho G, Parreira P, Seale JP, Johnson JA, Henry D, Chalmers S, Payne F, Tuck L, Morris A, Gonçalves C, Besser B, Casajuana C, López-Pelayo H, Balcells MM, Teixidó L, Miquel L, Colom J, Hepner KA, Hoggatt KJ, Bogart A, Paddock SM, Hardoon SL, Petersen I, Hamilton FL, Nazareth I, White IR, Marston L, Wallace P, Godfrey C, Murray E, Sovinová H, Csémy L. Proceedings of the 13th annual conference of INEBRIA. Addict Sci Clin Pract 2016; 11:13. [PMID: 27654147 PMCID: PMC5032602 DOI: 10.1186/s13722-016-0062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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