European Addiction Research最新文献

Introduction: Buprenorphine, a partial opioid agonist, is widely used as treatment for opioid use disorder. Traditionally, the original opioids are abruptly stopped, whereafter the buprenorphine is titrated over the course of several days. An alternative approach is low-dose buprenorphine initiation (LDBI), where buprenorphine is titrated more gradually, while the original opioids are still being used. Literature suggests LDBI may be associated with less withdrawal symptoms, though no standardized protocol for LDBI currently exists. This study aimed to establish consensus on the application of LDBI in Dutch clinical practice.

Methods: A Delphi method was employed, involving a systematic literature review to develop statements on the application of LDBI. Experts reviewed these statements across three rounds, achieving consensus at a 75% agreement threshold.

Results: Thirteen physicians with demonstrated expertise in LDBI participated, with nine completing all three rounds. Over three consultation rounds, consensus was achieved on 28 statements about indications for LDBI and dosing regimens, though variation in titration procedures was observed. The panel agreed that the starting dose can range between 10 and 20 μg/h for transdermal patches and 0.2-1.0 mg for sublingual tablets; dose can be increased daily with a maximum of 100% of the previous daily dose. Further, the original opioids should not be discontinued before day 7 after LDBI.

Conclusion: Though various protocols for LDBI exist, physicians experienced with LDBI agreed on the range of safe LDBI regimens. Further research is necessary to develop comprehensive guidelines for LDBI in patients with opioid use disorder.

Introduction: Pathological gambling (PG) is characterized by altered decision-making. Even though studies have investigated decision-making in patients with PG, the effects of win-contingent stimuli thereon are not well understood yet.

Methods: Thus, we conducted a study in patients with PG (n = 10) and healthy individuals (n = 14), who performed two versions of a slot machine gambling task with and without win-contingent cues, while decision-making and gaze fixations were assessed using high-resolution eye-tracking.

Results: Patients with PG showed higher rates of high-risk decisions, lower rates of rational choices and showed less visual attention to probability information, but increased visual attention toward gambling cues, compared to healthy individuals. In the presence of win-contingent gambling cues, participants needed significantly more time to decide between high-risk versus low-risk gambles and spent significantly less time watching the probability information.

Conclusion: Findings highlight the relevance of gambling-associated cues in PG. Targeting altered cue-reactivity could contribute to normalizing risky decision-making in patients with PG.

Introduction: Non-prescribed use of opioid agonist treatment (OAT) medications is a public health concern. This study analyzes the prevalence of non-prescribed use and non-fatal overdoses in Norway in 2013 and 2023, a period marked by an increasingly flexible OAT regimen, and examines associations between non-prescribed use and non-fatal overdoses.

Methods: Cross-sectional surveys with two convenience samples (n₁ = 611 in 2013, n₂ = 523 in 2023) of street-recruited individuals, who reported recent use of opioids and/or stimulants but were not currently enrolled in OAT, were employed. The primary outcomes were self-reported non-prescribed use of methadone and buprenorphine and non-fatal overdoses in the past month and past year. Covariates included demographics and substance use characteristics.

Results: Non-prescribed use of OAT medications significantly declined from 39.4% in 2013 to 28.1% in 2023 (p < 0.001), as did frequency of use (p < 0.01). There was no change in non-fatal overdoses in the past month (8.2% in both years), though past-year non-fatal overdoses decreased (23.6% in 2013 vs. 15.9% in 2023, p = 0.001). Multinomial regression analyses showed no significant association between non-prescribed OAT use and increased risk of non-fatal overdoses. Instead, factors such as injecting drug use, frequent heroin use, stimulant use, younger age, and female sex were associated with non-fatal overdose risk.

Conclusion: Even with an increasingly flexible OAT regimen, non-prescribed use declined among street-recruited participants, and no corresponding increase in non-fatal overdoses was observed. These findings challenge the assumption that reduced monitoring in OAT is linked with higher rates of non-prescribed use and adverse outcomes, such as non-fatal overdoses, among individuals not in OAT.

Introduction: Alcohol consumption and tobacco smoking may have synergistic harmful effects when present in combination. This combination is highly prevalent and associated with a multitude of diseases. Brief alcohol intervention (BAI) may be less effective among persons who drink alcohol and smoke tobacco than among persons who drink alcohol and do not smoke. The aim of this study was to find out whether BAI is more effective among adults who do not smoke than among those who smoke.

Methods: This study reports secondary outcome analyses of the randomized controlled trial "Testing a proactive expert system intervention to prevent and to quit at-risk alcohol use." Among municipal office clients, 1,646 who were aged 18-64 and consumed alcohol in the last year participated. Using latent growth curve models, the impact of BAI was compared by incidence rate ratios (IRRs) of self-reported heavy drinking days and the moderating effect of smoking was investigated.

Results: There was no significant difference between intervention and control in reducing heavy drinking days in persons who never smoked (IRR 1.01, 95% confidence interval [CI] 0.92-1.10, p = 0.847), formerly smoked (IRR 0.91, CI 0.77-1.07, p = 0.234), currently smoked less than daily (IRR 0.98, CI 0.86-1.12, p = 0.782) and persons who currently smoked daily (IRR 1.09, CI 0.98-1.22, p = 0.125).

Conclusion: The effect of BAI did not differ among study participants who currently smoked as among participants who did not. Although not statistically significant, persons who formerly smoked tended to benefit. Persons who currently smoked did not benefit.

Introduction: Patient-reported outcome measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The substance use recovery evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking patients with SUD.

Methods: The original SURE questionnaire was translated from English to Dutch using forward-backward translation. A total of N = 171 participants were recruited as part of a naturalistic multicenter study in inpatient (N = 149) and outpatient (N = 22) SUD treatment centers. We examined the factorial structure, reliability, and concurrent and discriminant validity of the SURE-NL.

Results: The original 5-factor structure of the SURE showed acceptable fit for the SURE-NL, and internal consistencies of the subscales ranged from 0.61 to 0.76; internal consistency of the total score was 0.83. Concurrent validity was confirmed through positive correlations of the SURE-NL total and subscale scores with the WHOQoL-BREF subscales, but correlations varied depending on subscale and treatment setting, with higher correlations for the outpatient compared to the inpatient subgroup. Discriminant validity was confirmed through low, mostly non-significant correlations between the SURE-NL and the DASS-21.

Conclusions: Although the SURE was originally designed for outpatient settings, our findings in a predominantly inpatient sample indicate that the SURE-NL is suitable for assessing personal recovery and recovery capital in Dutch-speaking Belgian patients with SUD. However, subscales should be used and interpreted with caution. Further research is needed with larger Dutch-speaking outpatient samples and the development of a tailored SURE for inpatient settings should be considered.

Introduction: Patient-reported outcome measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The substance use recovery evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking pat

Introduction: This study aimed to evaluate effects of three machine learning based adjustments made to an eHealth intervention for mild alcohol use disorder, regarding (a) early dropout, (b) participation duration, and (c) success in reaching personal alcohol use goals. Additionally, we aimed to replicate earlier machine learning analyses.

Methods: We used three cohorts of observational log data from the Jellinek Digital Self-help intervention. First, a cohort before implementation of adjustments (T0; n = 320); second, a cohort after implementing two adjustments (i.e., sending daily emails in the first week and nudging participants towards a "no alcohol use" goal; T1; n = 146); third, a cohort comprising the prior adjustments complemented with eliminated time constraints to reaching further in the intervention (T2; n = 236).

Results: We found an increase in participants reaching further in the intervention, yet an increase in early dropout after implementing all adjustments. Moreover, we found that more participants aimed for a quit goal, whilst participation duration declined at T2. Intervention success increased, yet not significantly. Lastly, machine learning demonstrated reliability for outcome prediction in smaller datasets of an eHealth intervention.

Conclusion: Strong correlates as indicated by machine learning analyses were found to affect goal setting and use of an eHealth program for alcohol use problems.

Introduction: The treatment efficacy of extended-release naltrexone (XR-NTX) for opioid use disorder (OUD) has been demonstrated in several studies, but not in naturalistic settings where opioid agonist treatment (OAT) is freely accessible. This study aimed to examine the different treatment outcomes of XR-NTX in a setting where the participants freely chose XR-NTX as a treatment option instead of OAT.

Methods: This was a 24-week open-label clinical prospective cohort study conducted in an outpatient setting at five hospitals in Norway. The study included 161 participants aged 18-65 years with OUD. Intramuscular injections of XR-NTX were administered every 4 weeks for 24 weeks. Measurements included retention in treatment, reasons for treatment discontinuation, days of use of opioids, other illicit substances and alcohol, level of heroin craving, treatment satisfaction, and adverse events (AEs).

Results: Of 161 included participants, the mean age was 38 years, and 24% were women; 138 received at least one dose of the study medication (modified intention-to-treat [MITT] population), and mean time in treatment was 18.1 weeks (95% CI: 16.8-19.4). The majority of the MITT population (84; 60.9%) completed 24 weeks of treatment in the study. There was a significant decrease in the overall use of opioids (p < 0.001) and the use of alcohol, and other illicit substances were low. The participants generally reported high treatment satisfaction and low heroin cravings. Those who completed the 24 weeks of treatment reported significantly fewer days of opioid use (p < 0.001) and higher treatment satisfaction (p < 0.001) than those who discontinued treatment before 24 weeks. No serious AEs were directly related to XR-NTX use.

Conclusion: This study demonstrated high retention rates, decreased opioid use, and low use of other illicit substances and alcohol. Participants also reported low cravings for heroin and high treatment satisfaction. Completion of the full 24-week treatment resulted in lower opioid use and increased treatment satisfaction compared to those who discontinued treatment before 24 weeks. The observed higher retention and reduced opioid use, compared to other studies, may be attributed to participants' strong motivation for opioid abstinence facilitated by XR-NTX treatment.

Introduction: A minority of addiction patients receive appropriate treatment directly from trained professionals in addiction medicine. Most countries have not recognized addiction medicine (AM) as a specialty in its own right or within psychiatry/other specialties. Therefore, the effectiveness and organization of AM training around the world need to be improved. Unfortunately, standard instruments are rarely used in most studies to assess training needs. This study aimed to determine international competencies in AM among professionals in as many countries as possible using a standard instrument such as the AM Training Needs Assessment (AM-TNA).

Method: We examined competencies in AM with the AM-TNA using an online survey. A General Competency Level in Addiction Medicine (GLOCIAM30) was calculated by dividing the total score by the number of 30 items. This GLOCIAM30 was used to measure the general level of competency in AM and to compare individual competencies.

Results: One hundred ninety-nine respondents from 45 countries completed the survey. Ninety-five of the 199 respondents (49.0%) had a GLOCIAM30 higher or equal to 4 (fairly competent). The highest skill level was found for the competency "Assessing substance use problems by taking the patient's history." Nine of the 45 countries had 8 or more respondents (n = 129). After post hoc analysis, there was no difference between these countries. Respondents could reasonably estimate whether the competency level in their country was higher or lower than the world average.

Conclusions: This study is the first international attempt to examine competencies in AM. Although a much larger study population is needed to establish an overall goal for competencies in AM, our study provided an initial direction for such a gold standard in benchmarking procedures.

Introduction: Gamma-hydroxybutyrate (GHB) dependence has been associated with a potentially fulminant withdrawal syndrome. As GHB withdrawal symptoms can rapidly progress from mild to more severe, close monitoring during detoxification is important. However, a concise, GHB-specific withdrawal scale is currently lacking. The aim of this study was to compose a concise GHB-specific withdrawal scale as monitoring instrument.

Methods: This study used monitoring data from 285 patients with GHB use disorder (GUD) admitted for inpatient detoxification. A six-step plan for shortening measurement scales was applied. Only subjective GHB withdrawal symptoms were used. To identify the factor structure, a principal component analysis (PCA) with Direct Oblimin Rotation was performed. The pattern matrix was used to assess the factor loading per item. Item selection was based on factor loadings >0.4 and clinical relevance of the symptoms. Multiple lists were created whose psychometric qualities (concurrent validity, convergent validity, reliability) were compared.

Results: The PCA resulted in eight components (eigenvalue >1.0). Item selection resulted in five candidate lists with 8, 9, 16 (2x), and 27 items. All lists showed good concurrent and convergent validity. Only one with 16 items combined good psychometric properties with the need for a shortened questionnaire combined with all clinically relevant items.

Conclusion: We recommend a novel 16-item GHB Withdrawal Symptoms Questionnaire (GWSQ) to monitor withdrawal during detoxification in patients with GUD. This concise, GHB-specific scale is likely less time-consuming to administer, sensitive to rapid changes in GHB withdrawal symptoms and aids clinicians in their decision-making during GHB titration and tapering. Implementation of this scale should be evaluated to determine its validity and usefulness in clinical practice.

Introduction: The medical profession plays a crucial role in preventing and treating substance use disorders. However, the quality of addiction-focused medical education, considering only graduate medical education (GME) and continuing medical education (CME) programs, varies across countries. This study aimed to explore the variety of published programs and curriculum components in competency-based approach to addiction medicine education for physicians and to highlight key areas in this field.

Methods: This study involves a systematic review of literature to identify quality standards for competency-based education in GME and CME related to addiction. Electronic databases were searched, including PubMed, EBSCO, SCOPUS, and Web of Science, for relevant key terms following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology. Studies included any English language text addressing educational competency-based models and standards for education within GME or CME in the UA and European Union. The process included identifying, screening, and reviewing articles and studies for relevance. The goal was to delineate existing competency-based training programs and highlight quality standards in education and training for physicians in a field of GME and CME.

Results: The result of this work led to the evaluation of curriculum topic standardization and agreement on core competencies to ensure that education in GME and CME is professionally consistent across states and universities. Our study included 55 articles describing models and standards for training programs in addiction medicine. In the final sample, articles that included specific information according to set criteria were included (n = 9).

Conclusions: The description of specific competing interest educational evidence-based models and standards in GME and CME in addiction medical education is not sufficiently represented in published texts and is generally referred to general standards and models of individual institutions or universities.