Substance Abuse and Rehabilitation最新文献

Addiction disorders/substance use disorders (SUD) are on the rise. However, many mental health care providers have never experienced SUD themselves, leading to higher chances of poor patient care through stigma, judgement, and the misunderstanding of patients. An alternative approach to understanding patients with addictive behaviors using a comparison of sex is discussed in this paper. Since most health care providers will have experienced sex, this analog can help mental health workers with no lived experience of SUD better understand their patients. This can help reduce stigma, misunderstanding, countertransference feeling, and the judgment of patients, thereby leading to better patient care.

Background: Patients with alcohol use disorders (AUD) vary significantly in many clinically important characteristics making them a heterogenous group. AUD patients with comorbid antisocial personality disorder (ASPD) form an important sub-group, and studies indicate that these patients may have poorer treatment outcomes. Therefore, we aimed to investigate the characteristics of AUD inpatients with comorbid ASPD and identify predictors of early relapse or treatment drop-out in these patients.

Methods: In a longitudinal study of AUD patients (n = 113; 30 females; aged 27 to 72 years) in treatment at three residential rehabilitation clinics in Norway, we used interviews and self-report questionnaires to collect data on alcohol use, mental health, and trauma experience. In addition, we assessed biochemical parameters. The patients were followed up at 6 weeks to identify early relapse or drop-out.

Results: Prevalence of ASPD among AUD patients was 15%. AUD patients with comorbid ASPD were exclusively male, of younger age, and reported more childhood trauma, and adult attention-deficit-hyperactivity-disorder symptoms. They reported more hazardous drinking behavior and more often had dependence on substances in addition to alcohol. The presence of ASPD did not predict early relapse or drop-out. However, early relapse or drop-out in ASPD patients was associated with childhood and adult trauma, younger age of drinking debut, and higher baseline prolactin levels.

Conclusion: AUD patients with ASPD had different clinical characteristics to other AUD patients and they had specific predictors of early relapse or drop-out. Our findings indicate that the early relapse or drop-out among AUD patients with ASPD may be attributed to environmental and possibly biological vulnerability. However, further studies with larger sample size are warranted to confirm these preliminary associations.

Purpose: To assess the prevalence and determinants of current tobacco use among reproductive-age women in Ethiopia.

Methods: A cross-sectional study was conducted by utilizing secondary data taken from the Ethiopian Demographic Health Survey of 2016. Descriptive statistics and logistic regressions were used to analyze the data. The odds ratio with a 95% confidence interval was considered to interpret associations and a significant association was stated at a p-value < 0.05.

Results: The overall magnitude of current tobacco use was 1.4% (n= 217). Majority of them 59.91% (n= 130) smoke cigarettes and followed by smoking gaya 43.32% (n= 94). Higher prevalence was found among participants from Gambella 44.24% (n= 96), Benishangul.59% (n= 36) and afar regions 13.36% (n= 29). Age group of 25-34 years [AOR = 2.78; 95% CI: 1.69, 4.57)], age group of ≥ 35 years [AOR = 4.24; 95% CI: 2.54, 7.07)], followers of protestant religion [AOR = 2.36; 95% CI: 4.17, 9.42], Islamic religion [AOR = 3.92; 95% CI: 2.16, 7.11], and traditional religion [AOR = 16.23; 95% CI: 8.33, 31.61], being in poorest wealth index [AOR = 15.78; 95% CI: 7.38, 33.70], poorer wealth index [AOR = 5.85; 95% CI: 2.64, 12.97], middle wealth index [AOR = 3.61; 95% CI: 1.57, 8.29], and richer wealth index [AOR = 2.48; 95% CI: 1.10, 5.85], who were never in union [AOR = 0.31; 95% CI: 0.14, 0.67], ever drinking alcohol [AOR = 5.44; 95% CI: 3.71, 7.95] and ever chewing khat [AOR = 7.59; 95% CI: 4.99, 11.55] were factors associated with current tobacco use.

Conclusion: Women used tobacco in different forms, and its distribution varies across Ethiopian regional states. The concerned body needs to give attention to the identified associated factors and regions with higher tobacco use.

Introduction: Prolonged-release buprenorphine (PRB), administered by weekly or monthly injection, for opioid dependence (OD) treatment offers the potential to address some limitations of oral therapy including stigma, difficulty in achieving consistent appropriate dosing, risk of diversion of medications, risk of overdose, and continuing use of other drugs. Patient-reported outcomes (PRO) and experiences are important in the evaluation of OD therapy success. This work aimed to document PRO during PRB therapy to guide future treatment decision-making.

Methods: Qualitative interviews were completed with people on PRB OD treatment. Twenty individuals from four treatment services in England and Wales were asked to participate. A structured interview was developed guided by a person with OD lived experience. Interviews were transcribed, coded and analyzed using iterative categorization.

Results: Fifteen of 20 individuals approached agreed to participate, and 14 completed interviews. The average age of participants was 42 (range 33-54) years, 13 males and 1 woman, the history of problematic opioid use was 14 years (3-25 years), time in treatment was 7 years (1-20 years), and duration on treatment with PRB was 4 months (range 1-8 months). Participants reported treatment experiences leading to coding of 277 unique comments: therapy effectiveness (77% indicated a benefit of, or satisfaction with, PRB therapy, 7% neutral/general, 16% indicated concern or questions about PRB therapy), convenience (81% benefit, 7% neutral/general, 12% concern), and overall satisfaction (81% benefit, 3% neutral/general, 16% concern). Reported benefits include cravings reduction of 10 (71%), self-care improvement of 10 (71%), relationships improvement of 9 (64%), resources management of 6 (43%), positive outlook on life of 12 (86%). Participants reported a range of positive personal experiences; challenges reported included temporary injection discomfort at treatment initiation.

Discussion: In this small, focused population, there was generally a positive level of treatment satisfaction with PRB. These experiences provide insights to explain potential treatment benefit to others and are useful in guiding therapy choices for others in the future.

Purpose: High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances.

Aim: This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class.

Methods: Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2.

Results: Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study.

Conclusion: This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.

Background: Variations between male and female populations are previously reported in classes of harmfully used/misused drugs, severity of substance use disorder and risk of relapse. The aim of this study was to provide a review of bedside medical toxicologist managed, sex-specific poisonings in adults that present with harmful drug use/misuse.

Methods: ToxIC Registry cases ≥19 and ≤65 years old, with harmful drug use or misuse during the timeframe June 2010-December 2016, were studied. Demographics, primary agents of toxic exposure, administration route and complications were analyzed. Descriptive methods were used in the analysis.

Results: The database included 51,440 cases. Of these, 3426 cases were analyzed in which the primary reason for the encounter was harmful substance use/misuse. Females were found to harmfully use/misuse pharmaceutical drugs (N=806, 65.6%) more than nonpharmaceutical drugs (N=423, 34.4%). Males more frequently used nonpharmaceutical drugs (N=1189, 54.1%) than pharmaceutical drugs (1008, 45.9%). Analgesics were used by females (N= 215, 18.2%) and males (N=137, 6.6%). Sedative hypnotics were used by females (N=165, 14%) and males (N=160, 7.8%). Psychoactive agents were used by males (N=325, 15.8%) and females (N=67, 5.7%). Sympathomimetics were used by males (N=381, 18.5%) and females (N=151, 12.8%). The majority of both male and female participants, 1712 (57.9%), utilized an oral route of administration. However, 312 (16.5%) of males utilized inhalation vs 73 (6.8%) of females inhaled their substance.

Conclusion: There were sex-specific differences among patients evaluated for harmful substance use/misuse by toxicologists. Considering these differences in regards to management and preventive approaches may be indicated.

[This corrects the article DOI: 10.2147/SAR.S155843.].

Purpose: Opioid maintenance treatment reduces a person's use of heroin. However, frequent substance use in treatment is a problem.

Aim: To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment.

Patients and methods: Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants' social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life.

Results: There was a significant negative association between time in treatment and use of opioids, b =-0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =-0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = -0.62, SE = 0.23, p = < 0.01. Social dimensions, participants' adverse experiences, and social resources were not associated with polydrug or opioid use.

Conclusion: Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients' opioid use.

Background: Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.

Methods: 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.

Results: Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.

Conclusion: After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.