Addiction Science & Clinical Practice最新文献

Background: People with HIV (PWH) are disproportionately affected by cigarette use, with a 40 - 70% prevalence rate. Although many express a strong interest in quitting, many PWH who smoke experience lower cessation rates with traditional treatments, in part due to their comorbid anxiety and depressive symptoms. Psilocybin, a classic psychedelic referred to as "breakthrough therapy" by the U.S. Food & Drug Administration (FDA), has been shown to have potential as a therapeutic treatment for psychiatric symptoms, (e.g., anxiety and depression) and substance use disorders, including tobacco dependence. Preliminary evidence has shown that administering psilocybin to people who smoke and have been previously unable to quit with traditional treatments resulted in impressive smoking abstinence rates (80%) at 6-months in a smoking cessation pilot study.

Objective: Explore, using qualitative methods, the perceptions and acceptability of a psilocybin-assisted treatment for smoking cessation among PWH who smoke.

Methods: Semi-structured, in-depth qualitative interviews were conducted with PWH who smoke. Interviews were audio-recorded, transcribed verbatim, and analyzed using rapid thematic analysis.

Results: Twenty-five participants were enrolled: 15 cis male, 9 cis female, and 1 transgender female. Five main themes emerged: varying previous experiences with psilocybin; uncertainty about psilocybin's effects and concern over potential side effects; need for trusted sources of information and testimonials; ultimately willing to try psilocybin-aided therapy for tobacco treatment; and, set and setting of psilocybin use matters.

Conclusions: Psilocybin-assisted smoking cessation treatment appears to be acceptable among PWH who smoke. Participants highlighted the importance of addressing key concerns related to an emerging therapy to increase acceptability and willingness to try it. Further research is needed to evaluate the safety and effectiveness of psilocybin prior to incorporating this emerging therapy for smoking cessation into tobacco treatment clinical services for PWH.

Background: Alcohol consumption is associated with poor health outcomes in people with HIV (PWH). Although various alcohol reduction strategies exist, little is known about PWH's past experiences or future preferences. This study describes the previous strategies PWH had used, their perceived effectiveness, among people who ever drank, and the strategies PWH who endorsed heavy drinking would consider trying in the future. It also examines how these experiences and preferences vary by sociodemographic factors and past 12 month drug use.

Methods: A cross-sectional analysis was conducted on data from 453 PWH enrolled in the Florida Cohort Wave III study (2020-2023; mean age 50 years, 60% men). Participants who attempted to reduce or quit drinking (n = 321) were asked about their use of eight alcohol reduction strategies and rated the effectiveness of each on a 4-point Likert scale. Participants reporting heavy drinking (n = 170) were asked about their willingness to try seven strategies in the future. Chi-square and Fisher's exact tests analyzed differences by sex, age, race/ethnicity, and past 12 month drug use.

Results: Among the 321 who had ever tried to reduce or quit drinking, endorsed strategies including "on my own"/ complete cessation (80%), prayer (61%), Alcoholics Anonymous (AA) (38%), counseling/therapy (31%), inpatient/outpatient detox (23%), self-monitoring (11%), and medication (7%). The strategies with the highest self-reported effectiveness were for prayer (59%), "on my own"/ complete cessation (58%), and in-patient detox (50%). Prayer was significantly more common among females and non-Hispanic Black or Hispanic participants. Those with past 12 month drug use were significantly more likely to have tried most strategies, except medications or prayer. Among 170 who reported heavy drinking, "on my own"/ complete cessation (43%), AA (24%), and counseling/therapy (21%) were the most endorsed strategies they would try in the future. No significant differences in future preferences were found by demographics, but those with past 12 month drug use showed more interest in formal treatment approaches.

Conclusion: Commonly used alcohol reduction strategies among PWH were non-medical, easily accessible, and perceived as very effective. Incorporating safe and effective patient-driven methods into treatment guidelines may improve strategy uptake.

Background: Text messaging-based interventions (TMIs) have demonstrated effectiveness in reducing tobacco use in many populations. However, such interventions have not been tailored to meet the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). We describe the process of adapting the SmokefreeTXT message library so that it is applicable to all forms of tobacco use, addresses issues specifically facing PLWH who use tobacco, and is culturally appropriate for use in Uganda and Zambia.

Methods/design: Participants were PLWH who currently used tobacco and health services workers recruited from HIV clinics in two regions of Uganda and two regions of Zambia. Eight focus groups (N = 48) were conducted with PLWH tobacco users and four focus groups (N = 28) were conducted with healthcare providers to adapt the TMI content for the cultural context and HIV status. A subsample of PLWH focus group participants (N = 14) provided feedback on the adapted TMI after using it for three weeks on their own phone. Focus group transcripts were analyzed for key themes based on the moderator guides using Dedoose software™. Means and percentages were calculated for survey data to assess the TMI's acceptability and feasibility.

Results: Focus group feedback on facilitators and barriers to quitting tobacco, as well as strengths and limitations of the TMI-based intervention approach, were used to finalize the adapted TMI's content and delivery for usability testing. PLWH identified multiple barriers to quitting tobacco including addiction, lack of support and education, and community perceptions. Health service workers highlighted the need for community-level interventions, improved provider knowledge on tobacco cessation, and tailored support strategies. Usability testing participants rated the TMI as helpful and relevant, emphasizing the interactive features as supportive and beneficial. Further, they reported few problems using it over three weeks, except for difficulty keeping their phone charged.

Conclusions: Results suggest that an adapted version of SmokefreeTXT is a feasible and acceptable option for PLWH in Uganda and Zambia who are interested in quitting tobacco use.

Trial registration: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.

Background: There is a lack of research on which specific factors that predict positive outcomes in support programs for concerned significant others (CSOs) to individuals with substance use disorders (SUDs). The aim of the study was to investigate predictors of positive outcomes among young adults in the areas of: treatment seeking, decreased substance use, and improved parent-young adult relationships. Outcomes were assessed at 24-weeks following a randomized controlled trial (RCT) comparing Community Reinforcement and Family Training (CRAFT) and manualized counselling for parents of young adults (18-24 years) with hazardous substance use.

Methods: A secondary analysis from an RCT including 113 parents (92% female) of young adults (87% male) recruited from two outpatient clinics for young adults in Stockholm, Sweden, subsequently nationwide. Clinical and sociodemographic predictors of treatment entry, substance use, and relationship happiness at 24 weeks follow-up were assessed using linear and logistic mixed-effects models.

Results: Previous young adult treatment engagement and higher parental self-efficacy were significant predictors of treatment entry, explaining 16% of the variance. Baseline alcohol and substance use consistently predicted higher use over time across measures. Parental stress showed complex associations: higher stress predicted reduced substance use in some models but increased use in others. For the measure of relationship happiness, baseline scores were the strongest predictor.

Conclusions: Taken together, the findings suggest promising targets for tailored support programs for parents of young adults with SUD, such as components designed to enhance parental self-efficacy.

Trial registration: ISRCTN12212515 https://www.isrctn.com/ISRCTN12212515 . Submitted November 7th, 2018, registered March 4th, 2019.

Background: People receiving opioid agonist therapy (OAT) face high risk of comorbidities, including cardiovascular and mental health disorders. Integrating exercise programs with OAT may reduce health disparities and improve well-being. This study explored the feasibility and preliminary effects of an integrated exercise program.

Method: This multicentre, mixed-methods pilot study was conducted in Western Norway, recruiting 22 participants receiving OAT from three outpatient clinics. The six-week, group-based exercise program focused on high-intensity endurance and strength training. Changes in aerobic fitness (4-minut step test), psychological distress (10-item Hopkins Symptom Checklist, SCL-10), fatigue (3-items Fatigue Severity Scale, FSS-3), lung function (spirometry), and respiratory symptoms (modified Medical Research Council Dyspnea Scale, mMRC) were assessed, while qualitative interviews provided insights into intervention feasibility.

Results: Pre- and post-test assessments indicated improvements in aerobic fitness, as measured by the 4-minute step test, with a pre-test mean of 89.4 (SD: 24.7) and a post-test mean of 103.1 (SD: 31.3) step-cycles, despite a modest attendance rate of 28%. Psychological distress, evaluated using the SCL-10, increased in score from 1.85 (SD: 0.66) to 2.03 (SD: 0.59). Fatigue also increased slightly Fss-3: 4.44 (SD:2.38) to 5.07 (SD:2.01), while respiratory symptoms using mMRC, lung capacity with FVC, and expiratory volume FEV1 remained stable. Qualitative findings were categorized into three main themes: (1) The clinic as an arena for physical activity, (2) a modest move with a substantial benefit for participants, (3) challenges and adjustments to the intervention. Participants reported that exercising in connection with the OAT clinic promoted a sense of care and support from clinicians. Many experienced increased self-confidence and social engagement, though attendance was affected by health issues, fluctuating motivation, and logistical challenges.

Conclusion: This pilot study suggests that integrating structured exercise into OAT can be feasible and improve aerobic fitness. However, increased psychological distress and fatigue might indicate the need for additional support. The low attendance rate highlights engagement challenges, emphasizing the need for tailored strategies to enhance participation. Future research should focus on optimizing intervention design to improve attendance and enhance physical and psychological outcomes for individuals in OAT.

Background: The treatment of choice for substance use disorder (SUD) caused by sedatives, hypnotics, and anxiolytics (SHA) is to slowly taper the dose of the implicated substance to the point of abstinence, thereby minimizing withdrawal symptoms. Concomitant pharmacotherapy may be indicated to manage excessive withdrawal or rebound symptoms. This study investigated the use of psychotropic drugs for the treatment of SHA-dependent SUD patients in Germany.

Methods: Data were obtained from the German Drug Safety Program in Psychiatry ("Arzneimittelsicherheit in der Psychiatrie"; AMSP) from 2000 to 2017. SHA SUD was classified using the 10th Edition of the International Classification of Disease (ICD-10).

Results: The present study included 1,015 patients with a primary diagnosis of mental and behavioral disorders due to use of sedatives or hypnotics (F13.1-F13.9). The most common comorbid psychiatric diagnoses were additional SUDs (F1, n = 279), especially alcohol use disorder (F10; n = 124), and mood disorders (F3; n = 201). A total of 95.6% of patients received one or more psychotropic drugs, most commonly antidepressant drugs (63.1% of patients), tranquillizing drugs (55.5%), and antipsychotic drugs (46.7%). The most common combination was an antidepressant drug and a tranquillizing drug (33.0%). Overall, psychotropic drugs with sedating properties (e.g., mirtazapine, quetiapine, doxepin, and trimipramine) were preferred. An increase in use over the 17-year observation period was observed for tranquillizing drugs and, most pronounced, for antipsychotic drugs.

Conclusion: We found high rates of non-SHA drugs among patients treated for SHA-SUD. The prevalent use of psychotropic drugs with strong sedating properties indicates a symptom-oriented treatment approach, which is often "off-label" but may be clinically necessary. Main limitation is the cross-sectional design of the AMSP databank. Therefore, we cannot provide any follow up data on the patient collective especially regarding outcome.

Background: For people with opioid use disorder (OUD), extended-release naltrexone (XR-NTX) is an effective antagonist treatment option. However, successful opioid tapering and abstinence is a prerequisite for XR-NTX induction and has repeatedly been reported as a major barrier to effective treatment. The aims of this study were to describe XR-NTX induction rates, reasons for incomplete induction, and extraordinary complications reported during the induction phase. We also compared sociodemographic and clinical variables among those who did and did not complete induction onto XR-NTX.

Methods: This naturalistic, multicenter, and open-label Norwegian study of XR-NTX included men and women aged 18-65 who had severe OUD. Most participants were referred to inpatient medically managed opioid withdrawal and received individualized pharmacological and psychosocial treatment according to clinical assessment and national guidelines. After opioid withdrawal, the participants underwent a minimum of three opioid-free days prior to XR-NTX induction. Variables were collected through baseline assessments and a retrospective patient chart review. XR-NTX induction completers and non-completers were compared via bivariate and logistic regression analyses.

Results: Of 129 participants with recent opioid use at inclusion, 106 (82%) completed XR-NTX induction. Induction was initiated in an inpatient setting for 116 participants (90%) and extraordinary complications were noted for 19 (15%) patients. Withdrawal symptoms and ambivalence were the most common reasons for non-completion, each noted in 75% of the cases. As compared with those who successfully completed induction, non-completers more often reported lifetime hepatitis (78% vs. 52%, p = 0.017), had a longer period of current substance use (mean 119 vs. 54 months, p = 0.001), and more frequently used methadone prior to study inclusion (43% vs. 8%, p < 001). In logistic regression analyses, methadone use was the only significant factor and was negatively associated with completion (odds ratio 0.20, 95% confidence interval = 0.05-0.72, p = 0.014).

Conclusion: The results demonstrate the safety, efficacy and tolerability of a Norwegian opioid withdrawal and XR-NTX induction procedure. Although the present induction rate was high, our findings indicate that methadone users need special attention and tailored interventions regarding opioid withdrawal management and XR-NTX induction.

Trial registration: The study is registered at clinicaltrials.gov (NCT03647774).

Background: Substance use disorder (SUD) is a growing public health concern in Sweden. Various treatments for SUD exist, with motivational treatment, cognitive behavioral therapy, and relapse prevention being the nationally recommended approaches. Attachment theory and the salutogenic theory with its core concept, sense of coherence (SOC) provides valuable insights into individuals' available personal resources and their potential for adherence to treatment. The aims of the present study were to examine attachment styles (secure, insecure-avoidant, and insecure-anxious) and SOC (overall and dimensional - comprehensibility, manageability, and meaningfulness- scores) in individuals with SUD; to explore potential correlations between these constructs ; and to assess their predictive value for treatment completion.

Methods: Clinical data were collected between 2014 and 2023 from 164 clients at a Swedish outpatient clinic for addiction who initiated the intensive, integrated treatment program. The sample comprised 109 men and 55 women, aged 18 to 72 years (M = 40.71). Data were gathered using validated self-report instruments (the Attachment Style Questionnaire and the Sense of Coherence Questionnaire). Statistical analyses included descriptive statistics, correlation analysis, and logistic regression.

Results: Individuals with SUD predominantly exhibited an insecure-avoidant attachment style. The four dimensions reflecting insecure attachment (discomfort with relationships, relationships as secondary, need for approval, and preoccupation with relationships) were negatively correlated with overall SOC and its three components.  In contrast the secure attachment dimension (confidence in self and others) showed  positive association with SOC. The strongest associations were found between the manageability component of SOC and all attachment dimensions. The insecure-anxious attachment style showed the strongest association with early dropout from treatment, while higher manageability was significantly associated with  an increased likelihood of treatment completion.

Conclusion: The predominance of an insecure-avoidant attachment style among clients undergoing intensive, integrated treatment for SUD underscores the importance of reinforcing a secure attachment and strengthening SOC to facilitate treatment completion. These findings highlight the need for comprehensive, integrated social and psychiatric care for individuals with SUD.

Background: Contingency management (CM) that is delivered by peer recovery support specialists and incentivizes harm reduction goals among people not seeking treatment for stimulant use has not been tested. The Peers Expanding Engagement in Stimulant Harm Reduction with Contingency Management (PEER-CM) study compares the effectiveness of two peer-facilitated CM interventions: (1) an experimental approach incentivizing achievement of client-identified harm reduction goals and (2) an enhanced standard of care approach incentivizing peer visit attendance.

Methods: Applying a hybrid type 1 effectiveness-implementation framework and stepped-wedge design across 14 community-based peer services sites across Oregon, the PEER-CM study trains peers to conduct CM. All sites implement the standard CM approach of incentivizing peer visit attendance. Every 2 months, two sites are randomly assigned to initiate the experimental CM condition of incentives for achieving client-directed harm reduction activities. Peers monitor progress and manage incentives. In the experimental approach, peers facilitate client progress on goal-related activities (selected from a standardized list of goals) to support the primary study outcome of reducing opioid overdoses and stimulant overamping. The intended study enrollment is approximately 80 clients per site (N = 1,120). Peer specialists participate in skills-focused coaching-to-criterion coaching process to document proficient CM delivery skills. This includes a series of group coaching sessions and an individual assessment with a standardized patient, observed and rated according to core dimensions of the Contingency Management Competence Scale.

Results: The primary study outcome is time until peer-reported fatal or first participant-reported non-fatal overdose or overamp (acute stimulant toxicity). Secondary outcomes include achievement of client-identified harm reduction goals and engagement in substance use disorder treatment. We will also demonstrate the feasibility of our coaching-to-criterion process by documenting peer proficiency in CM skills. Qualitative interviews with peers and their clients will explore the optimal context and implementation strategies for peer-facilitated CM.

Conclusion: PEER-CM is among the first trials to test the effectiveness of peer-facilitated CM for achieving harm reduction goals and reducing overdose in non-treatment-seeking people who use stimulants. The findings will generate evidence for peer-facilitated delivery of CM and application of CM to client-identified harm reduction goals.

Trial registration: This study is registered at ClinicalTrials.gov (NCT05700994).

Background: High-risk opioid prescribing (e.g., high daily dose opioids, concurrent opioid-sedatives) is prevalent in hospitals and linked to adverse outcomes. Opioid stewardship programs (OSP) have the potential to reduce high-risk opioid prescribing through audit-and-feedback recommendations.

Methods: We evaluated an audit-and-feedback based OSP implemented in January 2020 at a Vancouver, Canada tertiary care hospital using interrupted time series analysis. An electronic health record (EHR) system with computerized provider order entry (CPOE) was simultaneously operationalized. The main outcome was: any high-risk opioid prescribing (based on 10 evidence-based indicators), including high daily dose of morphine milligram equivalent (MME) prescribing (> 90MME), long opioid prescription duration (> 5 days post-admission), and concurrent opioid-sedative prescribing.

Results: Between January 2018 and March 2022, 5,477 active opioid patient encounters were included. While no significant change occurred in overall high-risk opioid prescribing post-OSP (p > 0.05), a significant reduction was seen in the level of high daily dose of MME prescriptions (estimate: -0.044; 95% confidence interval [CI]: -0.082, -0.006). Conversely, the trend in long opioid duration increased (estimate: 0.006; 95%CI: 0.000, 0.011), likely due to the removal of automatic stop dates with the implementation of the EHR with CPOE. Post-OSP intervention, we initially saw an acute increase in concurrent opioid-sedative prescriptions (estimate: 0.013; 95%CI: 0.005, 0.020). A benzodiazepine ordering intervention implemented in May 2021 reversed this trend, reducing both the level (estimate: 0.874; 95%CI: 0.374, 1.375) and slope (estimate: -0.022, 95%CI: -0.034, -0.011) of concurrent prescriptions.

Conclusion: The implementation of a new EHR concordant with that of the OSP may have impacted our study's results. While our research suggests the OSP reduced high-dose opioid prescribing, other indicators impacted by the EHR system did not benefit as highly from the OSP. Nevertheless, the OSP proved able to rapidly respond to unintended consequences by introducing interventions to reduce concurrent opioid and sedative prescribing.