1
|
Abrantes AM, Browne J, Stein MD, Anderson B, Iacoi S, Barter S, Shah Z, Read J, Battle C. A lifestyle physical activity intervention for women in alcohol treatment: A pilot randomized controlled trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209406. [PMID: 38759733 DOI: 10.1016/j.josat.2024.209406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Compared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women. METHODS Fifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes. RESULTS Higher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC. CONCLUSIONS The LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.
Collapse
Affiliation(s)
- Ana M Abrantes
- Butler Hospital, Providence, RI, United States of America; Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Julia Browne
- Alpert Medical School of Brown University, Providence, RI, United States of America; Research Service, VA Providence Healthcare System, Providence, RI, United States of America
| | - Michael D Stein
- Butler Hospital, Providence, RI, United States of America; Boston University School of Public Health, Boston, MA, United States of America
| | | | - Sydney Iacoi
- Butler Hospital, Providence, RI, United States of America
| | - Sarah Barter
- Butler Hospital, Providence, RI, United States of America
| | - Zainab Shah
- Butler Hospital, Providence, RI, United States of America
| | - Jennifer Read
- University of Buffalo, Buffalo, NY, United States of America
| | - Cynthia Battle
- Butler Hospital, Providence, RI, United States of America; Alpert Medical School of Brown University, Providence, RI, United States of America; Women & Infants' Hospital of Rhode Island, Providence, RI, United States of America
| |
Collapse
|
2
|
Khanra S, Mukherjee A, Munda SK. Sex Differences in Profiles and Treatment-Seeking Among Patients Visiting the Drug Dependence Treatment Center at a Psychiatric Hospital in India. Indian J Psychol Med 2023; 45:201-204. [PMID: 36925486 PMCID: PMC10011850 DOI: 10.1177/02537176221078431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Aniruddha Mukherjee
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sanjay Kumar Munda
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| |
Collapse
|
3
|
Gender Differences in Alcohol Use: a Nationwide Study in a Multiethnic Population. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00921-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AbstractThe increase in alcohol consumption, and the greater consequences of chronic alcohol use among females, as well as the convergence of the gender gap warrants investigation. This paper aims to uncover gender differences in individuals with alcohol use disorder (AUD) in Singapore. The SMHS 2016 was a population-based, cross-sectional, epidemiological study. Recruitment spanned from August 2016 to March 2018, where 6126 respondents were recruited. Similarly to global estimates, lifetime prevalence and 12-month prevalence for AUD were higher in males than females. However, females had a higher prevalence of obsessive–compulsive disorder (OCD) co-morbidity than males. Women also had an earlier onset and age of recovery of AUD than men. Alarmingly, male (94.14%) and female (100%) respondents reported low help-seeking for their AUD. Gender differences in individuals with AUD were identified in Singapore population. Future research should direct its effort to identify barriers to help-seeking for individuals with alcohol use disorder.
Collapse
|
4
|
Frost MC, Matson TE, Richards JE, Lee AK, Achtmeyer CE, Bradley KA, Williams EC. Barriers and facilitators to changing drinking and receiving alcohol-related care: Interviews with Veterans Health Administration primary care patients who indicated interest but did not enroll in an alcohol care management intervention trial. Subst Abus 2022; 43:1197-1206. [PMID: 35657656 PMCID: PMC9555295 DOI: 10.1080/08897077.2022.2074602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Most people with alcohol use disorder do not receive treatment, and primary care (PC)-based management of alcohol use disorder is a key strategy to close this gap. Understanding PC patients' perspectives on changing drinking and receiving alcohol-related care is important for this goal, particularly among those who decline alcohol-related care. This study examined perspectives on barriers and facilitators to changing drinking and receiving alcohol-related care among Veterans Health Administration (VA) PC patients who indicated interest but did not enroll in the Choosing Healthier drinking Options In primary CarE trial (CHOICE), which tested a PC-based alcohol care management intervention. Methods: VA PC patients with frequent heavy drinking who indicated interest in CHOICE but did not enroll were invited to participate. Twenty-seven patients completed in-person, semi-structured interviews. Interview transcripts were analyzed using iterative deductive and inductive content analysis. Results: Participants were mostly men (96%) and White (59%), and the mean age was 48. Seventy-four percent met criteria for alcohol use disorder, and the median number of past-week standard drinks was 41.5. Participants reported fewer alcohol-related problems, lower importance of/readiness to change drinking, and higher confidence in their ability to change than patients who enrolled in the CHOICE trial. Barriers fell into 5 domains: drinking fulfills need(s); reducing drinking or treatment is not needed; treatment is not effective/not acceptable; alcohol-related stigma; and practical barriers. Facilitators fell into 4 domains: reasons to change drinking; social support; treatment is acceptable/meets patients' needs; and practical facilitators. Participants discussed how Veteran identity and military experiences impacted drinking and willingness to receive care, which amplified multiple barriers/facilitators. Conclusions: This study identified barriers and facilitators to changing drinking and receiving alcohol-related care among VA PC patients who indicated interest but did not enroll in an alcohol care management trial. Findings can inform patient-centered interventions and support clinicians in engaging patients in care.
Collapse
Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108,Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195
| | - Theresa E. Matson
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108,Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195,Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101
| | - Julie E. Richards
- Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195,Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101
| | - Amy K. Lee
- Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101
| | - Carol E. Achtmeyer
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108
| | - Katharine A. Bradley
- Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195,Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE
Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108,Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195
| |
Collapse
|
5
|
Khanra S, Singh U, Munda SK, Das B. Demographic and clinical profile of women receiving inpatient treatment at a deaddiction unit of a psychiatric hospital in India: Five years' observation. Ind Psychiatry J 2022; 31:177-180. [PMID: 35800856 PMCID: PMC9255629 DOI: 10.4103/ipj.ipj_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Ujjwal Singh
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sanjay Kumar Munda
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| |
Collapse
|
6
|
Goodyear K, Vasaturo-Kolodner TR, Kenna GA, Swift RM, Leggio L, Haass-Koffler CL. Alcohol-related changes in behaviors and characteristics from the baseline to the randomization session for treatment and non-treatment seeking participants with alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:760-768. [PMID: 34582281 PMCID: PMC8711071 DOI: 10.1080/00952990.2021.1961799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Participants who are enrolled in randomized controlled trials (RCTs) may be more motivated to change their behaviors after being enrolled in a study and that motivation may vary by treatment status. OBJECTIVES The objectives of this secondary analysis were to investigate if changes in alcohol-related behaviors/characteristics from the baseline to the randomization session differed overall and to assess those differences between non-treatment and treatment seeking individuals with alcohol use disorder (AUD). METHODS Our sample included participants from eight RCTs conducted at Brown University (N = 281, 34% female). To assess differences across alcohol-related behaviors/characteristics, we investigated changes in craving (obsessive compulsive drinking scale) and alcohol drinking (percent abstinent days, drinks per week (DPW) and percent heavy drinking days (HDD)) overall and between treatment status. RESULTS Results showed that there were baseline differences, such as increased AUD severity and craving for alcohol in treatment seeking participants (p's < .05) in the overall sample. Next, we showed that craving, DPW and HDD decreased and percent abstinent days increased from baseline to randomization (p's < .05). When controlling for treatment status and sociodemographic characteristics, treatment seeking, compared to non-treatment seeking participants, had a greater reduction in alcohol craving (p < .001) and a greater increase in percentage of drinking days (p < .01). CONCLUSIONS These findings demonstrated that alcohol-related behaviors and characteristics changed after enrollment. Severity, craving and drinking behaviors also differed between treatment-seeking status, which can potentially impact medication development stages for AUD such as clinical trial eligibility, enrollment and study outcomes.
Collapse
Affiliation(s)
- Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research; National Institutes of Health, Baltimore and Bethesda, MD, USA
| | - Talia R. Vasaturo-Kolodner
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Department of Neuroscience; Brown University, Providence, RI, USA
| | - George A. Kenna
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Robert M. Swift
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Veterans Affairs Medical Center, Providence, RI, USA
| | - Lorenzo Leggio
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research; National Institutes of Health, Baltimore and Bethesda, MD, USA
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
- Veterans Affairs Medical Center, Providence, RI, USA
| | - Carolina L. Haass-Koffler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research; National Institutes of Health, Baltimore and Bethesda, MD, USA
| |
Collapse
|
7
|
Gender Differences among Sardinians with Alcohol Use Disorder. J Clin Med 2021; 10:jcm10204688. [PMID: 34682808 PMCID: PMC8537954 DOI: 10.3390/jcm10204688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Sardinia is an Italian island in the Mediterranean characterized by secular isolation and the singular genetic characteristics of its inhabitants. Findings obtained in populations with diverse genetic make-up and cultural background indicate gender differences and/or similarities in drinking characteristics of patients with alcohol use disorder (AUD). Knowledge of these characteristics in AUD patients is useful to improve access to treatments. This paper investigated the drinking characteristics of 66 female and 282 male outpatients with AUD, born from 1937 to 1991, living in Sardinia, and compared their characteristics with those of AUD patients living in other countries. Most Sardinian patients were men, approximately 3 years younger than women; women consumed lower amounts of alcohol than men but did not differ from men in the severity of AUD. Men were more often single than women, while a higher proportion of women reported that their mother or spouse was affected by AUD. Anxiety and depression were more prevalent among women while a higher proportion of men were affected by substance use disorders. Women were older than men at the age of first drink, regular drinking, and onset of AUD, and progressed faster than men from regular use to AUD onset. Women did not differ from men in age at first request for care, and in the lapse from AUD onset to first request for care. Women and men waited for more than 8 and 9 years, respectively, before receiving medical treatment. Gender differences progressively decreased among younger patients. Although the scarce number of women in some cohorts limits the strength of these findings, drinking characteristics of Sardinian patients did not vary significantly from those of AUD patients living in other countries. These results suggest that the number of Sardinian women with AUD is increasing and services for treatment of AUD should (a) consider women’s specific needs, and (b) realize effective policies to reduce latency prior to accessing medical treatment for both men and women with AUD.
Collapse
|
8
|
Rim SJ, Jo M, Lee JH, Park S. Analyzing Untreated Alcohol Use Disorder and Factors Related to Help-Seeking Status. Psychiatry Investig 2021; 18:936-942. [PMID: 34619821 PMCID: PMC8542744 DOI: 10.30773/pi.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a global burden but is also one of the most undertreated mental disorders. This study estimates the treatment rate (i.e., help-seeking status) of high-risk drinkers and factors associated with not receiving treatment in Korea using nationally representative National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. METHODS Among 1,025,340 participants, we eliminated those under 20 and those who did not respond to the question regarding alcohol consumption. High-risk drinkers were classified based on their frequency and quantity of alcohol consumption (4 or more drinks for women, 5 or more drinks for men per day on average). In total, 32,225 high-risk drinkers were checked for an actual AUD diagnosis to see their treatment-seeking status. RESULTS Among 32,225 high-risk drinkers, only 1.24% had an AUD diagnosis, showing that over 98% of those who could be diagnosed with AUD are not seeking treatment. Factors associated with not seeking treatment were female sex, BMI higher or equal to 18.6, former smoker, middle-aged, and Charlson Comorbidity Index (CCI). CONCLUSION Our data show that many high-risk drinkers do not seek treatment in Korea. Experts, policymakers, and clinicians should promote help-seeking behavior for AUD and pay close attention to those at risk of not receiving treatment for AUD.
Collapse
Affiliation(s)
- Soo Jung Rim
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - MinKyung Jo
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - Junghyun H Lee
- National Center for Disaster and Trauma, Seoul, Republic of Korea
| | - Subin Park
- Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| |
Collapse
|
9
|
Kezer CA, Simonetto DA, Shah VH. Sex Differences in Alcohol Consumption and Alcohol-Associated Liver Disease. Mayo Clin Proc 2021; 96:1006-1016. [PMID: 33714602 DOI: 10.1016/j.mayocp.2020.08.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
Alcohol-associated liver disease is becoming increasingly prevalent throughout the United States. Previously alcohol-associated liver disease was known to affect men more often than women; however, this gap between the sexes is narrowing. Studies show that women develop liver disease with lesser alcohol exposure and suffer worse disease as compared with men. This review article explores the increasing prevalence of alcohol-associated liver disease in women, reasons for changing patterns in alcohol consumption and liver disease development including obesity and bariatric surgery, proposed mechanisms of sex-specific differences in alcohol metabolism that may account for this discrepancy between men and women, and sex differences in treatment enrollment and response. Studies were identified by performing a literature search of PubMed and Google Scholar and through review of the references in retrieved articles. Search terms included alcohol-associated liver disease, alcoholic hepatitis, alcoholic cirrhosis, sex, gender, female, epidemiology, bariatric surgery, obesity, treatment. Due to the paucity of literature on some of the relevant subject matter and inclusion of landmark studies, no date range was selected. Studies were included if their methods were sufficiently robust and they made a comparison between the sexes that is clinically relevant. Understanding of the changing epidemiology and mechanisms of liver disease development unique to women are paramount in creating appropriate and effective interventions for women who represent a rapidly growing subset of patients with alcohol-associated liver disease.
Collapse
Affiliation(s)
| | | | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
10
|
Flanagan JC, Jarnecke AM, Leone RM, Oesterle DW. Effects of couple conflict on alcohol craving: Does intimate partner violence play a role? Addict Behav 2020; 109:106474. [PMID: 32485550 DOI: 10.1016/j.addbeh.2020.106474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Social stress in the form of maladaptive relationship conflict is a common precipitant to alcohol misuse and problems. Research has also established a clear causal association between alcohol misuse and relationship conflict in the form of intimate partner violence (IPV). Despite the robust literature linking relationship conflict and problematic drinking using survey methodology, no laboratory studies have examined the proximal association between relationship conflict and alcohol craving among couples, or the influence of IPV perpetration and victimization on this association. METHOD As part of a larger randomized controlled trial, 30 different-sex community couples with substance misuse completed a laboratory conflict resolution task. Participants reported subjective alcohol craving on a Likert-type scale immediately, before, and after the task. Conflict behaviors were coded by trained observers. Analyses were conducted using a multilevel modeling framework to account for the dyadic nature of the data. RESULTS Findings indicate that psychological and physical IPV perpetration and victimization strengthened the associations between negative and positive conflict behaviors and alcohol craving among men only. Contrary to our hypotheses, no main or moderating effects of conflict behaviors, IPV perpetration, or IPV victimization were found for women. CONCLUSIONS Findings from this exploratory study suggest that in this sample, relationship conflict and IPV in one's current relationship played a more impactful role on acute alcohol craving among men compared to women. Future studies should examine the role of specific conflict behaviors on alcohol craving and relapse risk, and patterns of communication that might increase or reduce risk for exacerbated alcohol craving.
Collapse
Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, United States; Ralph H. Johnson VA Medical Center, United States.
| | - Amber M Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, United States
| | - Ruschelle M Leone
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States; Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States
| | - Daniel W Oesterle
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States; Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States
| |
Collapse
|
11
|
Amini-Rarani M, Khedmati Morasae E, Pashaei T, Moeeni M. Redemption from plight: a qualitative study on reasons behind treatment decisions among Iranian male opioid users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:57. [PMID: 32771025 PMCID: PMC7414986 DOI: 10.1186/s13011-020-00299-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Opioid use remains a significant cause of harm to individual health. Perceived motives are of the main factors that help lead a patient into seeking treatment voluntarily to obviate that harm. The current study expands on the literature by exploring when and how male users of opioids become motivated to voluntarily seek treatment services. METHODS In a qualitative study in Isfahan city from January 2018 to March 2019, 55 male participants who had already started a variety of treatment services to withdraw their dependence on opioids were recruited. Selection of participants was based on a maximum variation purposive sampling strategy. Each participant took part in a unstructured interview to identify his motives for seeking opioid use treatment. Interviews were undertaken in eight different treatment centers. An inductive thematic analysis method was used to analyze the interviews. RESULTS The findings highlight that Iranian male opioid users have different motivations to seek treatment. To be precise, the findings illuminate three global themes and six themes as treatment-seeking motives among the participants including; motives related to family (reason for family and reason of family), quality of life (adverse effects on personal lifestyle and health) and economic motives (financial failure and job failure). CONCLUSIONS The findings can improve our understanding of the motives for seeking treatment from the perspective of opioid patients who entered themselves into treatment. Particularly, these findings could help policymakers and treatment providers to better understand opioid-use patient's perceived concerns and fears as motives for treatment-seeking.
Collapse
Affiliation(s)
- Mostafa Amini-Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Tahereh Pashaei
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maryam Moeeni
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Hezar-Jerib Ave, Isfahan, 81746 73461, Iran.
| |
Collapse
|
12
|
Blendberg JM, Àrnadóttir S, Tarp K, Bilberg R. Gender Differences in Alcohol Treatment. Alcohol Alcohol 2020; 59:agaa071. [PMID: 32725125 DOI: 10.1093/alcalc/agaa071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Alcohol consumption is a threat to health worldwide and leads to substantial expenses for society. Previous studies have found differences between women and men regarding drinking behaviour and concluded that women need a more multipart type of alcohol use disorder (AUD) treatment. This study aims to examine the differences in outcome between women and men who have completed public outpatient alcohol treatment. METHODS A total of 3452 patients, who completed AUD treatment from 2006 to 2018, were included in this follow-up study. Data were collected from the Odense Alcohol Treatment Database. Analyses were performed using a χ2 test and multiple logistic regression. RESULTS The calculations showed that women in AUD treatment had a better outcome if they had children (AOR 0.46, P ≤ 0.001) or were living with a partner with AUD (AOR 0.25-0.33, P ≤ 0.001). Women had a worse outcome if they had a higher educational level (AOR 1.40-1.69, P ≤ 0.001) or were employed (AOR 1.66-1.78, P ≤ 0.001). CONCLUSIONS This study found that women had more problems associated with alcohol consumption than men, both before and after completion of AUD treatment. Women with employment or education had a poorer outcome than their male counterparts, whereas childcare responsibilities or having a partner with AUD provided a better outcome.
Collapse
Affiliation(s)
- J Molly Blendberg
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Svanlaug Àrnadóttir
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristine Tarp
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| |
Collapse
|
13
|
Canidate SS, Cook CL, Varma D, Carnaby GD, Ennis N, Stetten NE, Cook RL. Recruitment, experience, and retention among women with HIV and hazardous drinking participating in a clinical trial. BMC Public Health 2020; 20:1169. [PMID: 32718308 PMCID: PMC7385856 DOI: 10.1186/s12889-020-09233-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite efforts by the NIH to enhance the participation of women and minorities in clinical research, women with HIV continue to remain underrepresented in alcohol intervention research. The purpose of this study is to better understand the reasons why women with HIV and hazardous drinking participated in the WHAT-IF? study and to discuss their experience (positive or negative) in the study. The WHAT-IF? study was a randomized clinical trial that evaluated pharmacotherapy for a reduction in drinking among women with HIV. METHODS Convenience and theoretical sampling were used to recruit women with HIV and hazardous drinking to complete qualitative interviews. These women had previously completed a clinical alcohol intervention trial and had consented to be contacted in the future for study-related purposes. The biopsychosocial model was used to frame the interview questions that assessed multiple determinants of drinking behavior and helped explain linkages to broader health constructs. RESULTS A total of 20 women with HIV and hazardous drinking completed the qualitative interview. Several factors were identified by the women as influential in their decision to participate in the WHAT-IF? study, such as the ability to quit or reduce their drinking to nonhazardous levels (biological), the ability to gain knowledge or a greater understanding of the negative effects of hazardous drinking on HIV disease progression (psychological), and peer pressure and monetary compensation (social). Also, the women identified factors (positive or negative) associated with their clinical trial experience, such as the effects of the study medication on the woman's body (biological), thoughts and feelings toward study procedures (i.e. medication, lab work, study assessments) and the length of the study (psychological), and the interactions with the WHAT-IF? study staff (social). CONCLUSION Recruiting and retaining women with HIV in alcohol intervention research remains a challenge. Findings from this study suggest that women with HIV who are hazardous drinkers may benefit from participating in research studies that could help them to reduce or quit their drinking, increase their knowledge about specific behavior changes, and earn monetary compensation. Also, positive staff interactions may be instrumental in retaining minority women in alcohol intervention research.
Collapse
Affiliation(s)
- Shantrel S Canidate
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA.
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA.
| | - Christa L Cook
- College of Nursing, University of Central Florida, Orlando, FL, 32816, USA
| | - Deepthi Varma
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Giselle D Carnaby
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, 32816, USA
| | - Nicole Ennis
- College of Medicine, Florida State University, Tallahassee, FL, 32304, USA
| | - Nichole E Stetten
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Robert L Cook
- University of Florida, College of Public Health and Health Professions, 2004 Mowry Road PO Box 100231, Gainesville, FL, 32610-0182, USA
- College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| |
Collapse
|
14
|
Walter TJ, Navarro M, Thiele TE, Pedersen C, Kampov-Polevoy A, Garbutt JC. A Preliminary, Open-Label Study of Naltrexone and Bupropion Combination Therapy for Treating Binge Drinking in Human Subjects. Alcohol Alcohol 2020; 55:56-62. [PMID: 31746964 PMCID: PMC9431639 DOI: 10.1093/alcalc/agz076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS The combination of bupropion and naltrexone has shown efficacy in reducing binge drinking in animal models. This study assessed the tolerability and potential utility of combined naltrexone and bupropion in reducing binge drinking in human subjects. METHODS This preliminary study employed an open-label, single-arm, 12-week, prospective design. Twelve men and women who exhibited a minimum of five (men) or three (women) binge drinking episodes per month over the past 3 months were recruited. All subjects received both bupropion-extended release 300 mg/day and naltrexone 50 mg/day and were monitored throughout the 3-month treatment period. Binge drinking was assessed using the timeline follow-back method. RESULTS Treatment with combined naltrexone and bupropion reduced the average number of drinks per binge drinking day from 7.8 drinks to 6.4 drinks and reduced the average percentage of binge drinking days per month from 19% (5.7 days/month) to 5% (1.5 days/month). Naltrexone and bupropion were generally well tolerated, with insomnia, headache and nausea/diarrhea being the most common side effects. Six subjects elected to stay on medication after the trial. CONCLUSIONS This study suggests that combined naltrexone and bupropion therapy should be further investigated for tolerability and efficacy in reducing binge drinking in humans.
Collapse
Affiliation(s)
- T Jordan Walter
- Pharmacology Department, University of North Carolina, 120 Mason Farm Road, 4010 Genetic Medicine Building, Campus Box 7365, Chapel Hill, NC 27514, USA
| | - Montserrat Navarro
- Psychology & Neuroscience Department, University of North Carolina, 235 E Cameron Ave, Chapel Hill, NC 27599, USA
- Bowles Center for Alcohol Studies, 104 Manning Drive, CB #7178, Chapel Hill, NC 27599, USA
| | - Todd E Thiele
- Psychology & Neuroscience Department, University of North Carolina, 235 E Cameron Ave, Chapel Hill, NC 27599, USA
- Bowles Center for Alcohol Studies, 104 Manning Drive, CB #7178, Chapel Hill, NC 27599, USA
| | - Cort Pedersen
- Psychiatry Department, University of North Carolina, 101 Manning Drive, Ste 7160, Chapel Hill, NC 27514, USA
| | - Alexey Kampov-Polevoy
- Psychiatry Department, University of North Carolina, 101 Manning Drive, Ste 7160, Chapel Hill, NC 27514, USA
| | - J C Garbutt
- Bowles Center for Alcohol Studies, 104 Manning Drive, CB #7178, Chapel Hill, NC 27599, USA
- Psychiatry Department, University of North Carolina, 101 Manning Drive, Ste 7160, Chapel Hill, NC 27514, USA
| |
Collapse
|
15
|
Design of a randomized controlled trial examining the efficacy of oxytocin to enhance alcohol behavioral couple therapy. Contemp Clin Trials 2019; 82:1-8. [PMID: 31063869 DOI: 10.1016/j.cct.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/20/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD.
Collapse
|
16
|
Flanagan JC, Yonce S, Calhoun CD, Back SE, Brady KT, Joseph JE. Preliminary development of a neuroimaging paradigm to examine neural correlates of relationship conflict. Psychiatry Res Neuroimaging 2019; 283:125-134. [PMID: 30581042 PMCID: PMC6379119 DOI: 10.1016/j.pscychresns.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/02/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023]
Abstract
Social stress in the form of conflict between romantic partners is a salient correlate of substance use disorders (SUD), and also plays an integral role in SUD treatment outcomes. Neuroimaging has advanced the study of social stress on SUD etiology, course, and treatment. However, no neuroimaging paradigms have yet been developed to examine neural responses to conflict among romantic couples. In order to fill this gap in the literature, the goal of this exploratory study was to examine the preliminary feasibility of a novel relationship conflict fMRI paradigm. We compared the effects of an auditory relationship conflict versus a neutral cue on functional connectivity in corticolimbic brain regions, and the associations between neural activities and self-report ratings of relationship adjustment, substance use problems, and intimate partner violence. We also explored sex differences in neural correlates of relationship conflict versus neutral cues. Participants demonstrated increased functional connectivity between the amygdala and the prefrontal cortex during the relationship conflict cue compared to the neutral cue. Intimate partner violence was associated with functional connectivity. Sex differences emerged in neural responses to the relationship conflict cue compared to the neutral cue. Collectively, the findings demonstrate preliminary validity of this novel neuroimaging paradigm for couples.
Collapse
Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA.
| | - Shayla Yonce
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Casey D Calhoun
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
17
|
McQuaid RJ, Dell C. Life in Recovery from Addiction in Canada: Examining Gender Pathways with a Focus on the Female Experience. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1502642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Robyn J. McQuaid
- The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Canada
| | - Colleen Dell
- Centennial Enhancement Chair in One Health and Wellness, Department of Sociology & School of Public Health, University of Saskatchewan, Canada
| |
Collapse
|
18
|
Rhodes BE, Gottfredson NC, Hill LM. Desistance and Treatment Seeking Among Women With Substance Use Disorders. QUALITATIVE HEALTH RESEARCH 2018; 28:1330-1341. [PMID: 29671376 PMCID: PMC7470472 DOI: 10.1177/1049732318767637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Addiction rates are rising faster among women than men. However, women with substance use disorders are less likely to enter treatment than males. This study seeks to understand how turning-point events and other maturational processes affect "life course persistent" women's motivations for seeking treatment for their disorder. We conducted semi-structured in-depth interviews with 30 women who were receiving treatment for addiction using thematic analysis. Recurring themes were as follows: experiences of rock-bottom events prior to entering treatment, feeling "sick and tired" in regard to both their physical and mental health, and shifting identities or perceptions of themselves. We discuss the importance of motivating shifts in identity to prevent women from entering treatment as a result of more traumatic mechanisms as well as the possibility of intercepting women with substance dependence and chronic health conditions in primary care or hospital settings with the aim of encouraging treatment.
Collapse
Affiliation(s)
- Blythe E. Rhodes
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nisha C. Gottfredson
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren M. Hill
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
19
|
Flanagan JC, Fischer MS, Nietert PJ, Back SE, Maria MMS, Snead A, Brady KT. Effects of oxytocin on cortisol reactivity and conflict resolution behaviors among couples with substance misuse. Psychiatry Res 2018; 260:346-352. [PMID: 29232576 PMCID: PMC5988859 DOI: 10.1016/j.psychres.2017.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 12/02/2017] [Accepted: 12/02/2017] [Indexed: 11/15/2022]
Abstract
Social stress, particularly in the form of dyadic conflict, is a well-established correlate of substance use disorders (SUD). The neuropeptide oxytocin can enhance prosocial behavior and mitigate addictive behaviors. These effects may be, in part, a result of oxytocin's ability to attenuate hypothalamic-pituitary-adrenal (HPA) axis dysregulation. However, only one study to date has examined the effects of oxytocin on neuroendocrine reactivity or conflict resolution behavior among couples. Participants (N = 33 couples or 66 total participants) were heterosexual couples in which one or both partners endorsed substance misuse. Using a double-blind, placebo-controlled, repeated-measures design and an evidence-based behavioral coding system, we compared the impact of oxytocin (40 IU) vs. placebo on cortisol reactivity and conflict resolution behaviors. Among women, oxytocin attenuated cortisol response following the task. Oxytocin was also associated with increased Distress Maintaining Attributions and decreased Relationship Enhancing Attributions. Among men, oxytocin was associated with decreased Distress Maintaining Attributions, and both oxytocin and placebo yielded declines in Relationship Enhancing Attributions. The findings support emerging hypotheses that oxytocin may have differential effects in men and women, and indicate the need for future efforts to translate oxytocin's positive neurobiological effects into therapeutic behavioral changes.
Collapse
Affiliation(s)
| | | | - Paul J Nietert
- Medical University of South Carolina, Charleston, SC, USA
| | - Sudie E Back
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | | | - Kathleen T Brady
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| |
Collapse
|
20
|
Emiliussen J, Andersen K, Nielsen AS. How do family pressure, health and ambivalence factor into entering alcohol treatment? Experiences of people aged 60 and older with alcohol use disorder. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:28-42. [PMID: 32934465 PMCID: PMC7450845 DOI: 10.1177/1455072516682639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022] Open
Abstract
Aim: This qualitative study is concerned with the motivations that lead older adults to enter treatment for alcohol problems. There is a need to expand our understanding of the unique characteristics and problems of this population to be able to devise specialised and effective treatments and preventive measures. Method: We conducted an analysis of secondary findings from interview data collected in a qualitative interpretative phenomenological analysis (IPA) study. Our participants were 12 elderly people aged 60 years or more who had experienced late-onset alcohol use disorder. Transcription, categorisation, collapsing and analysis were conducted rigorously in accordance with the IPA standards. Findings: Family can function as a pressure structure in terms of fostering motivation for treatment. Participants were to a certain extent ambivalent about treatment, which led them to devaluing treatment and its effects. Our results are on par with comparable results from other studies. Conclusion: Older adults who experience very-late-onset of alcohol use disorder experience familial pressure and health concerns which lead them to enter treatment. Our participants seemed ambivalent about treatment and its necessity, which seems to lead to a devaluation of therapy.
Collapse
|
21
|
Heterogeneity in pathways to abstinence among women in treatment for alcohol use disorder. J Subst Abuse Treat 2017; 75:1-9. [PMID: 28237048 DOI: 10.1016/j.jsat.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although many providers recommend alcohol abstinence as an initial step in the treatment of alcohol use disorders (AUD), there is a scarcity of research on specific behavioral strategies to achieve this step. The current study examined efficacy of a unique abstinence planning intervention for alcohol in a cognitive behavioral therapy (CBT) outpatient protocol. DESIGN 128 women enrolled in a randomized controlled trial of CBT for AUD at a university-based clinic comprised the sample. MEASUREMENTS Session 1 manual-guided interventions included an abstinence planning discussion in which each woman chose a specific plan for achieving initial abstinence in collaboration with her therapist. Drinking data were collected via participant logs during the 16week within-treatment period and via Timeline Follow-Back interview at 12month follow-up. FINDINGS For 32.8% (n=42) of women who stopped drinking during the pre-treatment assessment period, their abstinence plan was to maintain abstinence (MA). 18.0% (n=23) of women chose a "cold turkey" approach (CT, abrupt cessation without medical assistance), and 46.1% (n=59) chose a "winding down" approach (WD, systematic reduction of drinking toward a specified quit date). Generalized Estimating Equations (GEE) analyses showed that type of abstinence plan chosen was differentially associated with percent days drinking (PDD) in later treatment (weeks 7-16) (p<0.01) and during 12month follow-up (p<0.01). Women in the WD group had the highest PDD for both time frames and women in the CT group drank more frequently during later treatment compared to those in the MA group. The association between plan and PDD during follow-up was moderated by early treatment PDD (weeks 1-7; p<0.01), such that women in the MA and WD groups had lower follow-up PDD if they were able to decrease their drinking during early treatment. CONCLUSIONS Women who were maintaining abstinence at treatment entry or had planned to stop using alcohol abruptly (i.e., "cold turkey") after starting treatment had better overall drinking outcomes than those who chose to wind down. A plan to wind-down drinking appeared to be the most appealing option to women in the study and, among those who were able to successfully execute this winding down approach, was related to positive long-term drinking outcomes.
Collapse
|
22
|
Bold KW, Epstein EE, McCrady BS. Baseline health status and quality of life after alcohol treatment for women with alcohol dependence. Addict Behav 2017; 64:35-41. [PMID: 27543832 PMCID: PMC5143167 DOI: 10.1016/j.addbeh.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research suggests that women with alcohol use disorders (AUDs) experience more severe medical and social consequences from alcohol use compared to men, but little is known about health improvements following alcohol treatment. METHODS This study sought to characterize the pre-treatment health status of 138 alcohol dependent women enrolled in 12 sessions of female-specific group or individual outpatient treatment and examine the degree to which alcohol treatment might promote positive quality of life changes. Quality of life was assessed using the World Health Organization Quality of Life measure at baseline and 3months later at the end of treatment. RESULTS The most common health problems at baseline were: smoking cigarettes (34.1%), hypertension (31.2%), obesity (27.5%), arthritis (21.0%), high cholesterol (17.4%), heart problems (8.7%), and a history of cancer (7.2%). Significant improvements across physical, t(117)=4.67, p<0.001, d=0.42; psychological, t(117)=7.31, p<0.001, d=0.62; social, t(117)=3.18, p=0.002, d=0.28; and environmental, t(117)=2.39, p=0.018, d=0.17; quality of life domains were seen after treatment. Percent days abstinent during treatment was positively associated with overall health satisfaction and psychological health at the end of treatment. CONCLUSIONS Women presenting for outpatient treatment for alcohol use disorders report many comorbid negative health problems. Thus, it is important for both substance use and health care providers to consider the overlap of alcohol use problems and health domains. Furthermore, female-specific cognitive behavioral treatment for alcohol use disorders positively impacted multiple health domains for women, suggesting a potential transdiagnostic intervention to target co-occurring health and substance use problems.
Collapse
Affiliation(s)
- Krysten W Bold
- Rutgers, the State University of New Jersey, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States; Yale School of Medicine, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, United States.
| | - Elizabeth E Epstein
- Rutgers, the State University of New Jersey, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States; University of Massachusetts School of Medicine, Department of Psychiatry, Biotech One, 365 Plantation Street, Worcester, MA 01605, United States
| | - Barbara S McCrady
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale SE, Albuquerque, NM 87106, United States
| |
Collapse
|
23
|
Abstract
Women, alcohol, and alcohol use disorders are underresearched topics when compared with the plethora of literature exploring male alcohol consumption and its related harms. It is time to change the fact that women are underrepresented in research and programs targeting alcohol use disorders. Given the changing patterns of alcohol consumption by women, coupled with the fact that women experience a telescoping effect in alcohol-related harms, it is time that increasing attention be paid to the way gender influences the experience of alcohol-related harms, including the development of alcohol use disorders. Recovery-orientated systems are not possible without the voices of the consumers being heard. With this in mind, the purposes of this article are to explore factors that lead to alcohol-related harm in women and to highlight the gender-specific barriers to service engagement.
Collapse
|
24
|
Doty-Sweetnam K, Morrissette P. Alcohol abuse recovery through the lens of Manitoban First Nations and Aboriginal women: A qualitative study. J Ethn Subst Abuse 2016; 17:237-254. [DOI: 10.1080/15332640.2016.1138268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
Villegas NA, Chodhury SM, Mitrani VB, Guerra J. Mothers in Substance Abuse Recovery: Perspectives on Motivators, Challenges and Family Involvement. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 6. [PMID: 30873391 PMCID: PMC6412135 DOI: 10.5812/ijhrba.32558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Most women in substance abuse treatment are of childbearing age, and many of them have children who both are affected by and influence the mother's substance abuse and treatment behaviors. Objectives This qualitative study (n = 13) was conducted in two drug treatment centers in southern Florida and explored the perspectives of mothers currently or recently in substance abuse treatment regarding their recovery motivators and challenges, as well as their attitudes and preferences regarding family involvement in their treatment. Patients and Methods We used a qualitative descriptive approach. In-depth interviews were conducted with the participants and centered on 3 major themes: (a) motivators for recovery, (b) challenges for recovery, and (c) attitudes and preferences for family involvement in recovery. Results Findings revealed that family plays an important role in the recovery of these mothers, and that mothers are willing to incorporate their families in their recovery process. Women expressed a positive attitude towards family therapy, and they believed that it could benefit their recovery, and their relationship with their children and families. Conclusions The findings of this study can contribute to the development of a family-based substance abuse treatment aftercare intervention that might benefit women in substance abuse treatment.
Collapse
Affiliation(s)
- Natalia A. Villegas
- School of Nursing and Health Studies, University of Miami, Miami, USA
- Corresponding author: Natalia A. Villegas, School of Nursing and Health Studies, University of Miami, 5030 Brunson Ave, Miami, USA. Tel: +1-3052849069,
| | | | | | - Jessica Guerra
- School of Nursing and Health Studies, University of Miami, Miami, USA
| |
Collapse
|
26
|
Fergus TA, Bardeen JR, Gratz KL, Fulton JJ, Tull MT. The Contribution of Health Anxiety to Retrospectively-Recalled Emergency Department Visits within a Sample of Patients in Residential Substance Abuse Treatment. Cogn Behav Ther 2014; 44:1-8. [DOI: 10.1080/16506073.2014.946077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
27
|
Morse DS, Cerulli C, Bedell P, Wilson JL, Thomas K, Mittal M, Lamberti JS, Williams G, Silverstein J, Mukherjee A, Walck D, Chin N. Meeting health and psychological needs of women in drug treatment court. J Subst Abuse Treat 2013; 46:150-7. [PMID: 24074850 DOI: 10.1016/j.jsat.2013.08.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/09/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
Abstract
We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: (1) intrapersonal challenges participants termed an "evil cycle" of relapse, recidivism, trauma, and life challenges; (2) interpersonal context of parenting and stigma involving features of this "evil cycle"; (3) institutions with logistical barriers to legal and medical assistance; (4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model.
Collapse
Affiliation(s)
- Diane S Morse
- Departments of Psychiatry and Medicine, University of Rochester School of Medicine, Women's Initiative Supporting Health, Center for Community Health, Rochester, NY 14642, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|