Search Results (14)

Drug-resistant tuberculosis (DR-TB) remains a major cause of illness and death, with personal and non-addiction-related barriers. This study aimed to explore the perspectives of hospital staff on barriers to smoking cessation interventions (SCIs) for in-patients at a DR-TB management hospital in Durban, KwaZulu-Natal, South Africa. In-depth interviews were conducted with a purposive sample of eighteen hospital staff (HS), and the data were analyzed using NVivo 10. Three core themes were identified: patients’ barriers (addiction to tobacco, relapse after improvement in health, and non-disclosure of smoking status to HS), staff personal barriers (poor knowledge of smoking’s effect on treatment outcomes and smoking cessation aids), and institutional barriers (staff shortage, time constraints, lack of pharmacological smoking cessation aids, access to cigarettes around hospital premises, and SCIs not prioritized and not assigned to a specific category of HS). Training on SCIs for HS, assigning SCIs to specific HS, integrating SCIs within existing services, and banning access to cigarettes within the hospital premises are assumed to assist DR-TB patients in smoking cessation, improving their response to TB treatment and overall health outcomes. Full article

We evaluated the impact of Medicaid policies in Virginia (VA), namely the Addiction and Recovery Treatment Services (ARTS) program and Medicaid expansion, on the number of behavioral health acute inpatient admissions from 2016 to 2019. We used Poisson fixed-effect event study regression and compared average proportional differences in admissions over three time periods: (1) prior to ARTS; (2) following ARTS but before Medicaid expansion; (3) post-Medicaid expansion. The number of behavioral health acute inpatient admissions decreased by 2.6% (95% CI [−5.1, −0.2]) in the first quarter of 2018 and this decrease gradually intensified by 4.9% (95% CI [−7.5, −2.4]) in the fourth quarter of 2018 compared to the second quarter of 2017 (beginning of ARTS) in VA relative to North Carolina (NC). Following the first quarter of 2019 (beginning of Medicaid expansion), decreases in VA admissions became larger relative to NC. The average proportional difference in admissions estimated a decrease of 2.7% (95% CI, [−4.1, −0.8]) after ARTS but before Medicaid expansion and a decrease of 2.9% (95% CI, [−6.1, 0.4]) post-Medicaid expansion compared to pre-ARTS in VA compared to NC. Behavioral health acute inpatient admissions in VA decreased following ARTS implementation, and the decrease became larger after Medicaid expansion. Full article

Recovery capital (RC) encompasses the wide range of resources individuals can employ to recover from Substance Use Disorder (SUD). It consists of five subdomains: human, social, cultural, financial, and community RC. Negative recovery capital (NRC) represents the obstacles to recovery. Research on (N)RC in complex multimorbid populations is scarce. This study offers an initial exploration of the viability of (N)RC in three individuals with SUD, psychiatric comorbidities, and an intellectual disability (a triple diagnosis) in inpatient addiction treatment. We collected case file data, ranked recovery goals, and conducted follow-up interviews. The data were subjected to template analysis, using (N)RC domains as codes. All domains were prevalent and relevant, showing dynamic and reciprocal effects, influenced by critical life events acting as catalysts. Notably, during treatment, patients prioritized individual skill development despite challenges in other domains. RC emerges as a valuable concept for mapping recovery barriers and facilitators in individuals with a triple diagnosis, serving as an alternative to the medical model and complementing the biopsychosocial model. It provides a systematic framework to assess critical factors for recovery in complex cases and accordingly align interventions. Future studies should explore the intersections of NRC domains and the dynamic nature of (N)RC to enhance the understanding of the challenges faced by individuals with a triple diagnosis. Full article

Purpose. The purpose of this research is to test the psychometric properties and factorial structure of the Addiction-like Eating Behaviors Scale (AEBS) in an Italian sample of adults with severe obesity seeking treatment for weight reduction and the general population, and to examine the measurement invariance of the tool by comparing a clinical and a nonclinical sample. Methods. A confirmatory factor analysis (CFA) was initially conducted to test the factorial structure of the Italian version of the AEBS (AEBS-IT) on a total of 953 participants. Following this, the measurement invariance and psychometric properties of the tool AEBS-IT were assessed on both inpatients with severe obesity (n = 502) and individuals from the general population (n = 451). Reliability and convergent validity analysis were also run. Results. CFA revealed a bi-factor structure for the AEBS-IT, which also showed good reliability and positive correlations with food addiction (through the mYFAS2.0 symptom count), binge-eating symptoms, compulsive eating behavior, and dysfunctional eating patterns and the individuals’ body mass index (BMI). Moreover, the tool was invariant across populations. Conclusion. This study provided evidence that the AEBS-IT is a valid and reliable measure of FA in both clinical and nonclinical samples. Full article

Cue reactivity is often used to study alcohol cues brain responses. Standardized image sets are used, but the effect of viewing people interacting with the alcohol drink remains unclear, which is associated with the factors of alcohol cues that influence the degree of response to alcohol stimuli. The present study used fMRI to investigate the reactivity of alcohol dependence (AD) inpatients to alcohol cues with or without human drinking behavior. Cues with a human interacting with a drink were hypothesized to increase sensorimotor activation. In total, 30 AD inpatients were asked to view pictures with a factorial design of beverage types (alcoholic vs. non-alcoholic beverages) and cue types (with or without drink action). Whole-brain analyses were performed. A correlation analysis was conducted to confirm whether the whole-brain analysis revealed cue-related brain activations correlated with problem drinking duration. The left lingual gyrus showed significant beverage types through cue type interaction, and the bilateral temporal cortex showed significant activation in response to alcohol cues depicting human drinking behavior. The right and left lingual gyrus regions and left temporal cortex were positively correlated with problem drinking duration. Sensorimotor activations in the temporal cortex may reflect self-referential and memory-based scene processing. Thus, our findings indicate these regions are associated with alcohol use and suggest them for cue exposure treatment of alcohol addiction. Full article

Temperament and personality traits are important factors underlying the vulnerability for both the initiation and continuation of addictive behaviors. We investigated the influence of reactive and regulative temperament and their interaction in relation to clinical symptomatology and personality disorders (PDs) in a sample of 841 inpatients (68.1% males) with a substance use disorder (SUD). To assess reactive temperament we used the Behavioral Inhibition and Behavioral Activation Scales (BISBAS) and to assess regulative temperament we used the Effortful Control Scale. Clinical symptomatology and personality traits were measured by means of the Symptom Checklist-90 (SCL-90) and the Assessment of ADP-IV Personality Disorders (ADP-IV). Hierarchical regression analyses showed that both, clinical symptomatology and PDs were related to low levels of effortful control (EC). None of the two-way interactions (BIS × EC, BAS × EC) however were significantly related to psychopathology. Current findings highlight the role of effortful control (EC) in the expression of psychopathology in an adult sample of inpatients with SUD. Therapeutic interventions aiming at strengthening EC can possibly result in better treatment outcomes for both the addiction and the comorbid psychopathology. Full article

Background: Poor adherence to treatment is a common clinical problem in individuals affected by mental illness and substance use/dependence. In Italy, mental care is organized in a psychiatric service and addiction unit (SERD), characterized by dual independent assets of treatment. This difference, in the Emergency Room setting, leads to a risk of discontinuity of treatment in case of hospitalization. In this study we clinically characterized individuals who decided to attend hospital post-discharge appointments at SERD, in accordance with medical advice. Methods: This is a retrospective study, based on two years of discharged records of patients entering “Versilia Hospital” (Viareggio, Italy) emergency room, with urinalyses testing positive for substance use, and hospitalization after psychiatric consultation. The sample was divided according to the presence or absence of SERD consultation after discharge. Results: In the 2-year period of the present study, 1005 individuals were hospitalized. Considering the inclusion criterion of the study, the sample consisted of 264 individuals. Of these, 128 patients attended post-discharge appointments at SERD showing urinalyses positive to cocaine, opiates, and poly use; they were more frequently diagnosed as personality disorder and less frequently as bipolar disorder. The prediction was higher for patients that had already been treated at SERD, for patients who received SERD consultation during hospitalization, and for patients with positive urinalyses to cocaine and opiates at treatment entry. Conversely, patients who did not attend SERD consultation after discharge were affected by bipolar disorders. Limitations: Small sample size. Demographical data are limited to gender and age due to paucity of data in hospital information systems. SERD is located far from the hospital and is open only on weekdays; thus, it cannot ensure a consultation with all inpatients. Conclusions: Mental illness diagnosis, the set of substance use positivity at hospitalization, and having received SERD consultation during hospitalization appeared to have a critical role in promoting continuity of care. Moreover, to reduce the gap between the need and the provision of the treatment, a more effective personalized individual program of care should be implemented. Full article

Background: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). Results: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group. Full article

Background: Naltrexone, a medication for addiction treatment (MAT), is an FDA-approved medication recommended for the treatment of alcohol use disorder (AUD). Despite the high prevalence of AUD and efficacy of naltrexone, only a small percentage of individuals with AUD receive treatment. Objectives: To identify trends for the prescription of naltrexone in AUD admissions in substance use treatment centers across the U.S. Methods: Data from the 2000–2018 U.S. Treatment Episode Data Set: Admissions (TEDS-A) were used in temporal trend analysis of naltrexone prescription in admissions that only used alcohol. Data from the 2019 National Survey of Substance Abuse Treatment Services (N-SSATS) were also used to characterize medication use among AUD clients across different treatment service settings. Results: Treatment of AUD with naltrexone was 0.49% in 2000 and tripled from 0.53% in 2015 to 1.64% in 2018 in AUD admissions (p < 0.0001 for the Cochran–Armitage trend test). Women, middle-aged adults, and admissions for clients living in the Northeast U.S. were more likely to be prescribed naltrexone than their respective counterparts, as were admissions with prior treatment episodes and referrals through alcohol/drug use care providers, who paid for treatment primarily through private insurance, used alcohol daily in the month prior to admission, and waited 1–7 days to enter treatment. Naltrexone was more commonly prescribed by AUD admissions compared to acamprosate and disulfiram and was more frequently prescribed in residential and outpatient services as opposed to hospital inpatient services. Conclusions: Naltrexone remains underutilized for AUD, and factors that influence prescription of medication are multifaceted. This study may contribute to the creation of effective interventions aimed at reducing naltrexone disparities for AUD. Full article

This mixed methods research paper explores health literacy (HL) in individuals with alcohol addiction by using the 47-item version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and semi-structured interviews concerning health-related competencies (access, understand, appraise, and apply health information), and determines the limitations of the HLS-EU-Q47 when used under specific conditions of clinical practice. The questionnaire survey and the interviews were conducted with individuals of different health literacy levels who were undergoing inpatient alcohol addiction treatment. The findings indicate that individuals with alcohol addiction might require different types of health information according to their health literacy level in terms of quantity and quality of information to recover from alcohol addiction and improve their overall health. The implications for the clinical practice of addiction treatment as well as recommendations for national and regional policy are also discussed. Full article

Background: Sleep disorders are often associated with drug use. Nearly 70% of patients admitted for detoxification report sleep problems. Dual disorder (DD) is the comorbidity between mental disorders in general and disorders related to psychoactive substance use. The association between substance use and sleep disorders (SD) appears to be bidirectional. Our objective is to analyze the association between sleep disturbance history and drug use pattern (alcohol, cannabis, opioids, and cocaine). Methods: Analysis of data in the first interview at the Addictions Unit of the Department of Psychiatry at the University of Salamanca Health Care Complex between October 2017 and January 2020. The sample consists of 398 patients. We studied the association between different variables: origin of patients (Inpatient Dual Diagnosis Detoxification Unit (IDDDU) vs. Outpatient Drug Clinic (ODC), presence of affective disorder, psychotic disorder, type of drug used, and treatment. Results: Of patients with DD, 62% had more delayed sleep induction, sleep fragmentation, early awakening, and nightmares. Outpatients had more difficulty falling asleep because, in many cases, they had not previously sought any medical assistance. On the other hand, 67% of the patients with insomnia presented depression. Conclusions: There is evidence of a harmful association between DD and SD. Full article

Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-blinded pilot randomized trial will be conducted. A total of 30 participants will be randomized to receive either the conventional application or the newly designed co-designed application. In order to identify these 30 participants, 60 participants will be recruited and screened to determine if they have baseline biases. Participants will be recruited from the inpatient unit at the National Addictions Management Service (NAMS) Singapore. All participants who are enrolled into the trial will complete a baseline assessment task, and a bias modification assessment and modification task daily. They will have to complete a baseline demographic and clinical information questionnaire, as well as a cravings rating scale before and after the intervention daily. Perspectives—that of self-reported experiences—will be sought from the participants following their completion of three intervention tasks. Descriptive statistical analyses will be performed, and chi-square and ANOVA analyses will be performed. Qualitative analyses will be undertaken for the perspectives shared. Ethics and Dissemination: Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (DSRB) (approval number that of 2019/00934). The findings arising from this study will be disseminated by means of conferences and publications. Full article

The Norwegian health authorities buy one third of their addiction treatment from private institutions run by organizations and trusts. Several of these are founded on religious values. The aim of the study was to investigate such value-based treatment and the patients’ experiences of spirituality and religiousness as factors of meaning-making in rehabilitation. The study was performed in an explorative qualitative design. Data were collected through focus-group interviews among therapists and in-patients at a religiously founded substance misuse service institution. The analysis was carried out by content analysis through systematic text-condensation. Through different activities and a basic attitude founded on religious values, the selected institution and the therapists facilitated a treatment framework which included a spiritual dimension and religious activity. The patients appreciated their free choice regarding treatment approaches, which helped them to make meaning of life in various collective and individual settings. Rituals and sacred spaces gave peace of mind and confidence in a situation that up to now had been chaotic and difficult. Sermons and wording in rituals contributed to themes of reflection and helped patients to revise attitudes and how other people were met. Private confessions functioned for several patients as turning point experiences influencing patients’ relations to themselves and their surroundings. Spirituality and religious activity contributed to meaning-making among patients with substance use disorder and had significance for their rehabilitation. Full article

Objective: To demonstrate the usefulness of the Addiction Severity Index Japanese Version (ASI-J) in Japanese alcohol-dependent individuals. The ASI is a frequently used clinical and research instrument that measures severities in seven functional domains in people with substance abuse disorders. Methods: A total of 370 male inpatients with a history of alcohol dependence participated in the study. Forty-nine participants were excluded in the final analysis due to lack of reliability (i.e., patient misrepresentation or inability to understand). We used the ASI-J and a series of indexes that determined patient states during and post-treatment. Results: The correlations between ASI Composite Scores (CSs), which were calculated through a weighted formula and indicated the severity of each problem area, were significant but low in eight relations and not significant in 13 relations, indicating substantial independence of the problem areas. Significant differences were found in Family/Social CSs between abstinent and relapsed alcohol-dependent individuals. The questions of undesirable attitude were significantly related to the CSs of Employment, Drug use, Family/Social, and Psychiatric sections. Significant differences were observed in patient demographics, CS, and ASI Severity Rating (SR) and interviewer’s subjective scoring between alcohol-dependent individuals and drug abusers. CSs in Japanese alcohol-dependent individuals were generally similar to corresponding CSs in individuals from other countries, with the exception of The Netherlands. Conclusions: This study demonstrated that the ASI-J is useful for understanding individual profiles of problems for each patient and planning customized treatment. The ASI-J served as a predictive tool for relapse and compliance to treatment afterward and was shown to be useful as a comparison tool in clarifying similarities and differences between substance abuser groups. Full article