Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital

Background

Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors.

Results

The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X²= 12.525, p=0.014; X²= 12.525, p=0.023; and X²= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse.

Conclusions

Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.

Comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) in predicting the effectiveness of drug treatment programs for pregnant and postpartum women

This study conducts a within-subject comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) to assess change in alcohol and other drug treatment outcomes for pregnant and postpartum women. Data are from 139 women who were pregnant or who had children under 11 months old and were admitted to residential drug treatment, then re-interviewed 6 months postdischarge (83% follow-up rate). The ASI and GAIN change measures were compared on their ability to detect changes in alcohol and drug use, medical and HIV risk issues, employment issues, legal problems, family and recovery environment characteristics, and psychological/emotional issues. The measures were similar in their ability to detect treatment outcomes, and ASI and GAIN change scores were moderately correlated with each other. The GAIN scales had equal or slightly higher coefficient alpha values than the ASI composite scores. The GAIN also includes an HIV risk scale, which is particularly important for pregnant and postpartum women. These results suggest that the GAIN is comparable with the ASI and can be used for treatment research with pregnant and postpartum women.

Examining Concurrent Validity and Predictive Utility for the Addiction Severity Index and Texas Christian University (TCU) Short Forms

Treatment providers need tools which are designed to identify risk, treatment needs, and monitor client engagement. These are essential components in substance abuse treatment for offender populations. This study evaluated a flexible set of 1-page modular assessments known as the TCU Short Forms and compared them with the measures of global domains contained in the Addiction Severity Index (ASI). The sample was based on 540 adult males and females in corrections-based substance abuse treatment services located in Arkansas and Missouri. Results suggest the set of TCU forms and ASI both reliably represent core clinical domains, but TCU Short Forms explained more variance in therapeutic engagement criteria measured during treatment. Similarities and differences of the assessment tools are discussed, along with applications.

Recent status scores for version 6 of the Addiction Severity Index (ASI-6)

AIMS

To describe the derivation of recent status scores (RSSs) for version 6 of the Addiction Severity Index (ASI-6).

DESIGN

118 ASI-6 recent status items were subjected to nonparametric item response theory (NIRT) analyses followed by confirmatory factor analysis (CFA). Generalizability and concurrent validity of the derived scores were determined.

SETTING AND PARTICIPANTS

A total of 607 recent admissions to variety of substance abuse treatment programs constituted the derivation sample; a subset (n = 252) comprised the validity sample.

MEASUREMENTS

The ASI-6 interview and a validity battery of primarily self-report questionnaires that included at least one measure corresponding to each of the seven ASI domains were administered.

FINDINGS

Nine summary scales describing recent status that achieved or approached both high scalability and reliability were derived; one scale for each of six areas (medical, employment/finances, alcohol, drug, legal, psychiatric) and three scales for the family/social area. Intercorrelations among the RSSs also supported the multi-dimensionality of the ASI-6. Concurrent validity analyses yielded strong evidence supporting the validity of six of the RSSs (medical, alcohol, drug, employment, family/social problems, psychiatric). Evidence was weaker for the legal, family/social support and child problems RSSs. Generalizability analyses of the scales to males versus females and whites versus blacks supported the comparability of the findings, with slight exceptions.

CONCLUSIONS

The psychometric analyses to derive Addiction Severity Index version 6 recent status scores support the multi-dimensionality of the Addiction Severity Index version 6 (i.e. the relative independence of different life functioning areas), consistent with research on earlier editions of the instrument. In general, the Addiction Severity Index version 6 scales demonstrate acceptable scalability, reliability and concurrent validity. While questions remain about the generalizability of some scales to population subgroups, the overall findings coupled with updated and more extensive content in the Addiction Severity Index version 6 support its use in clinical practice and research.

Neural correlates of anxiety sensitivity during masked presentation of affective faces

BACKGROUND

Anxiety Sensitivity (AS), the tendency to fear the thoughts, symptoms, and social consequences associated with the experience of anxiety, is associated with increased risk for developing anxiety disorders. Some evidence suggests that higher scores on the Anxiety Sensitivity Index (ASI), a measure of the AS construct, are associated with activation of the anterior insular cortex during overt emotion perception. Although the ASI provides subscale scores measuring Physical, Mental Incapacitation, and Social Concerns of AS, no study has examined the relationship between these factors and regional brain activation during affect processing. We hypothesized that insular responses to fear-related stimuli would be primarily related to the Physical Concerns subscale of the ASI, particularly for a sample of subjects with specific phobias.

METHODS

Adult healthy controls (HC; n = 22) and individuals with specific phobia, small animal subtype (SAP; n = 17), completed the ASI and underwent functional magnetic resonance imaging while engaged in a backward-masked affect perception task that presents emotional facial stimuli below the threshold of conscious perception.

RESULTS

Groups did not differ in ASI, state or trait anxiety scores, or insula activation. Total ASI scores were positively correlated with activation in the right middle/anterior insula for the combined sample and for the HC and SAP groups separately. Multiple regression analysis revealed that the relationship between AS and insular activation was primarily accounted for by Physical Concerns only.

CONCLUSIONS

Findings support the hypothesized role of the right anterior insula in the visceral/interoceptive aspects of AS, even in response to masked affective stimuli.

Genetic association mapping identifies single nucleotide polymorphisms in genes that affect abscisic acid levels in maize floral tissues during drought

In maize, water stress at flowering causes loss of kernel set and productivity. While changes in the levels of sugars and abscisic acid (ABA) are thought to play a role in this stress response, the mechanistic basis and genes involved are not known. A candidate gene approach was used with association mapping to identify loci involved in accumulation of carbohydrates and ABA metabolites during stress. A panel of single nucleotide polymorphisms (SNPs) in genes from these metabolic pathways and in genes for reproductive development and stress response was used to genotype 350 tropical and subtropical maize inbred lines that were well watered or water stressed at flowering. Pre-pollination ears, silks, and leaves were analysed for sugars, starch, proline, ABA, ABA-glucose ester, and phaseic acid. ABA and sugar levels in silks and ears were negatively correlated with their growth. Association mapping with 1229 SNPs in 540 candidate genes identified an SNP in the maize homologue of the Arabidopsis MADS-box gene, PISTILLATA, which was significantly associated with phaseic acid in ears of well-watered plants, and an SNP in pyruvate dehydrogenase kinase, a key regulator of carbon flux into respiration, that was associated with silk sugar concentration. An SNP in an aldehyde oxidase gene was significantly associated with ABA levels in silks of water-stressed plants. Given the short range over which decay of linkage disequilibrium occurs in maize, the results indicate that allelic variation in these genes affects ABA and carbohydrate metabolism in floral tissues during drought.

Extracellular sensors and extracellular alarmones, which permit cross-talk between organisms, determine the levels of alkali tolerance and trigger alkaliinduced acid sensitivity in Escherichia coli

For several stress responses in Escherichia coli, switching on involves conversion by the stress of an extracellular stress sensor (an extracellular sensing component, ESC) to an extracellular induction component (EIC), the latter functioning as an alarmone and inducing the response. The aim of this study was to establish whether alkali tolerance induction at pH 9.0, alkali sensitisation induced at pH 5.5 and the acid sensitisation induced at pH 9.0 involve sensing of pH changes by ESCs. The techniques involved made use of studies with cell-free culture filtrates. With respect to the inducible responses under test, these filtrates were prepared either from induced or uninduced cultures and filtrates from uninduced cultures were also activated in vitro, by the pH stress, in the absence of bacteria. Tests were then made to examine whether EICs (known to be needed for all these systems) are formed by activation, at the appropriate pH values, of filtrates from pH 7.0-grown cultures (i.e. uninduced culture filtrates); appearance of an EIC on activation would indicate the presence in the uninduced culture filtrate of an ESC. The studies showed that all three systems use ESCs to detect pH changes. Tests involving attempted enzymic and physical inactivation of the ESCs, and attempted removal of the ESCs by dialysis, showed that the ESC involved in alkali sensitisation is a small very heat-resistant protein. Strikingly, protease only partially inactivated the ESCs needed for alkali tolerance induction and for acid sensitisation; each system may be complex, involving both protein and non-protein (RNA?) ESCs, although other explanations are possible. It was also established that appropriate killed cultures can induce all three responses when incubated with pH 7.0-grown living cultures. The occurrence of ESC/EIC pairs for these three responses has led to the evolution of early warning systems for each, the diffusibility of the EICs, and their interaction with non-producers, allowing them to act pheromonally, inducing sensitive organisms to stress tolerance, prior to exposure to stressor.

Benefit-cost analysis of addiction treatment: methodological guidelines and empirical application using the DATCAP and ASI

OBJECTIVE

To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment.

DATA SOURCES/STUDY SETTING

A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines.

STUDY DESIGN

Procedures are outlined for using resource use and cost data collected with the DATCAP. Techniques are described for converting outcome measures from the ASI to economic (dollar) benefits of treatment. Finally, principles are advanced for conducting a benefit-cost analysis and a sensitivity analysis of the estimates.

DATA COLLECTION/EXTRACTION METHODS

The DATCAP was administered at three outpatient drug-free programs in Philadelphia, PA, for 2 consecutive fiscal years (1996 and 1997). The ASI was administered to a sample of 178 treatment clients at treatment entry and at 7-months postadmission.

PRINCIPAL FINDINGS

The DATCAP and ASI appear to have significant potential for contributing to an economic evaluation of addiction treatment. The benefit-cost analysis and subsequent sensitivity analysis all showed that total economic benefit was greater than total economic cost at the three outpatient programs, but this representative application is meant to stimulate future economic research rather than justifying treatment per se.

CONCLUSIONS

This study used previously validated, research-proven instruments and methods to perform a practical benefit-cost analysis of real-world treatment programs. The study demonstrates one way to combine economic and clinical data and offers a methodological foundation for future economic evaluations of addiction treatment.