Substance Abuse and Rehabilitation最新文献

Aim: The present study aimed to study the associations between substance use patterns and types of crimes in prisoners with substance use problems, and specifically whether substance use patterns were different in violent offenders.

Methods: Interview data of prisoners with substance use problems (N=4,202, mean age 33.5 years, SD 9.8), derived from the Addiction Severity Index, were run against criminal register data on main types of crimes in the verdict.

Results: In binary analyses, compared to those with acquisitive and drug crimes, violent offenders had lower prevalence of illicit drugs and homelessness, but higher prevalence of binge drinking, and higher prevalence of sedative use than clients sentenced with drug crimes. Clients with violent crime had lower prevalence of injecting drug use, compared to all other crimes. In logistic regression, binge drinking and sedatives were positively associated with violent crime (as opposed to non-violent crime), whereas heroin, amphetamine, cocaine, and injecting drug use were negatively associated with violent crime. Among violent offenders only, sedatives tended to be associated with fatal violence (p=0.06), whereas amphetamine, homelessness, age, and (marginally significant, p=0.05) heroin were negatively associated with fatal violence, as opposed to non-fatal violence.

Conclusion: Treatment and risk assessment in violent perpetrators with substance use may need to address sedatives and alcohol specifically. Limitations of the study are due to self-reported and cross-sectional data and because a large majority of the prison sample studied here are men.

Deaths due to prescription and illicit opioid overdose have been rising at an alarming rate, particularly in the USA. Although naloxone injection is a safe and effective treatment for opioid overdose, it is frequently unavailable in a timely manner due to legal and practical restrictions on its use by laypeople. As a result, an effort spanning decades has resulted in the development of strategies to make naloxone available for layperson or "take-home" use. This has included the development of naloxone formulations that are easier to administer for nonmedical users, such as intranasal and autoinjector intramuscular delivery systems, efforts to distribute naloxone to potentially high-impact categories of nonmedical users, as well as efforts to reduce regulatory barriers to more widespread distribution and use. Here we review the historical and current literature on the efficacy and safety of naloxone for use by nonmedical persons, provide an evidence-based discussion of the controversies regarding the safety and efficacy of different formulations of take-home naloxone, and assess the status of current efforts to increase its public distribution. Take-home naloxone is safe and effective for the treatment of opioid overdose when administered by laypeople in a community setting, shortening the time to reversal of opioid toxicity and reducing opioid-related deaths. Complementary strategies have together shown promise for increased dissemination of take-home naloxone, including 1) provision of education and training; 2) distribution to critical populations such as persons with opioid addiction, family members, and first responders; 3) reduction of prescribing barriers to access; and 4) reduction of legal recrimination fears as barriers to use. Although there has been considerable progress in decreasing the regulatory and legal barriers to effective implementation of community naloxone programs, significant barriers still exist, and much work remains to be done to integrate these programs into efforts to provide effective treatment of opioid use disorders.

Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.

Objective: To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.

Methods: Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models.

Results: A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period.

Conclusion: Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.

Background: Individuals with substance-use disorder (SUD) often have co-occurring mental health disorders and decreased executive function, both of which are barriers to sustained rehabilitation. Clients with severe SUD can be institutionalized in The Swedish National Board of Institutional Care but are difficult to engage and dropout rates remain high. Recent studies suggest that acceptance and commitment therapy (ACT) is an effective treatment for mental health and SUD.

Objectives: The overall aims of the present pilot study were to explore a manual-based ACT intervention for clients institutionalized for severe SUD and to describe the effects on mental health, psychological flexibility, and executive function. This pilot study is the first to use a manual-based ACT intervention within an inpatient context.

Methods: Eighteen participants received a seven-session ACT intervention tailored for SUD. Statistical analyses were performed for the complete data (n=18) and on an individual level of follow-up data for each participant. In order to follow and describe changes, the strategy was to assess the change in 13 clinical scales from pre-intervention to post-intervention.

Results: Results suggested that there was no change in mental health and a trend implying positive changes for psychological flexibility and for 9 of 10 executive functions (e.g., inhibitory control, task monitoring, and emotional control).

Conclusion: The pilot study suggests clinical gains in psychological flexibility and executive functions both at the Institution regulated by the Care of Alcoholics and Drugabuser Act (also known as LVM home) and at the individual level. Since the sample size does not provide adequate statistical power to generalize and to draw firm conclusions concerning intervention effects, findings are descriptive and preliminary in nature. Further development and implementation of ACT on a larger scale study, including the maintenance phase and a follow-up, is needed.

Objective: The goal of this study was to determine whether the 50-item Assessment of Recovery Capital scale represents a single general measure or whether multiple domains might be psychometrically useful for research or clinical applications.

Methods: Data are from a cross-sectional de-identified existing program evaluation information data set with 1,138 clients entering substance use disorder treatment. Principal components and iterated factor analysis were used on the domain scores. Multiple group factor analysis provided a quasi-confirmatory factor analysis.

Results: The solution accounted for 75.24% of the total variance, suggesting that 10 factors provide a reasonably good fit. However, Tucker's congruence coefficients between the factor structure and defining weights (0.41-0.52) suggested a poor fit to the hypothesized 10-domain structure. Principal components of the 10-domain scores yielded one factor whose eigenvalue was greater than one (5.93), accounting for 75.8% of the common variance. A few domains had perceptible but small unique variance components suggesting that a few of the domains may warrant enrichment.

Conclusion: Our findings suggest that there is one general factor, with a caveat. Using the 10 measures inflates the chance for Type I errors. Using one general measure avoids this issue, is simple to interpret, and could reduce the number of items. However, those seeking to maximally predict later recovery success may need to use the full instrument and all 10 domains.

The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.

Objective: The purpose of the present study is to explore the stability of the Alcohol Use Disorders Identification Test (AUDIT) in a clinical setting by comparing prescreening heavy drinking questions and AUDIT scores over time. Because instrument stability is equal to test-retest reliability at worst, investigating the stability of the AUDIT would help better understand patient behavior change in context and the appropriateness of the AUDIT in a clinical setting.

Methods: This was a retrospective exploratory analysis of Visit 1 to Visit 2 AUDIT stability (n=1,099; male [75.4%], female [24.6%]) from all patients with first-time and second-time records in the Iowa Screening, Brief Intervention, and Referral to Treatment project, October 2012 to July 7, 2015 (N=17,699; male [40.6%], female [59.4%]).

Results: The AUDIT demonstrated moderate stability (intraclass correlation=0.56, 95% confidence interval: 0.52-0.60). In a multiple regression predicting the (absolute) difference between the two AUDIT scores, the participants' age was highly significant, t(1,092)=6.23, p<0.001. Younger participants clearly showed less stability than their older counterparts. Results are limited/biased by the observational nature of the study design and the use of clinical service data.

Conclusion: The present findings contribute to the literature by demonstrating that the AUDIT changes are moderately dependable from Visit 1 to Visit 2 while taking into account patient drinking behavior variability. It is important to know the stability of the AUDIT for continued use in Screening, Brief Intervention, and Referral to Treatment programming.

The National Acupuncture Detoxification Association (NADA)-standardized 3- to 5-point ear acupuncture protocol, born of a community-minded response to turbulent times not unlike today, has evolved into the most widely implemented acupuncture-assisted protocol, not only for substance abuse, but also for broad behavioral health applications. This evolution happened despite inconsistent research support. This review highlights the history of the protocol and the research that followed its development. Promising, early randomized-controlled trials were followed by a mixed field of positive and negative studies that may serve as a whole to prove that NADA, despite its apparent simplicity, is neither a reductive nor an independent treatment, and the need to refine the research approaches. Particularly focusing on the last decade and its array of trials that elucidate aspects of NADA application and effects, the authors recommend that, going forward, research continues to explore the comparison of the NADA protocol added to accepted treatments to those treatments alone, recognizing that it is not a stand-alone procedure but a psychosocial intervention that affects the whole person and can augment outcomes from other treatment modalities.