Prospective patterns and correlates of quality of life among women in substance abuse treatment

The Impact of Social Support and Social Network Characteristics on Trauma Symptoms Among Violence-Exposed Women with Substance Use Disorders

Background: Women with substance use disorder (SUD) experience higher rates of violence exposure, post-traumatic stress disorder (PTSD), and post-traumatic stress symptoms (PTSS) than their non-substance-using peers. Exposure to violence in women with SUD is associated with PTSS symptom severity and leads to lower rates of treatment adherence, poorer treatment outcomes, and a higher risk for relapse. Little is known about the buffers to PTSS among violence-exposed women with SUD. Methods: A sample of 375 women with SUD were recruited from three inner-city intensive treatment centers, in a midwestern city. Using ordinary least squares regression models, we sought to identify the direct effects of violence, general social support, recovery-specific social support, and social network composition on PTSS. Moderation was also examined using the Bootstrapping function in PROCESS macro for SPSS. Results: General social support, recovery social support, and greater duration of network relationships were associated with lower trauma symptom scores. General social network composition variables were directly associated with lower trauma symptom severity. Recovery-specific social network variables moderated the association between violence exposure and PTSS for Black participants only. Conclusions: These data suggest that providers should target the quality of the client's interpersonal relationships to reduce PTSS among violence-exposed women with SUD. Maintaining social network relationships should be the focus of treatment interventions for women with SUD who have experienced violence.

Using Latent Profile Analysis to Characterize Clinical Heterogeneity and Impulsivity in a Large Residential Addiction Treatment Program

Objectives: Clinical heterogeneity among patients in addiction treatment settings represents a challenge as most of the treatment programs are designed to treat substance use disorders (SUD) generally rather than offering more tailored approaches addressing individual patient needs. Systematic characterization of clinical heterogeneity may permit more individualized care paths toward improving outcomes. Methods: Data were collected from a large inpatient SUD treatment program between April 2018 and March 2020 (n = 1519). Latent profile analysis (LPA) was applied to identify latent clusters based on differences in substance use and co-occurring depression, anxiety, and post-traumatic stress disorder. Results: Five distinct profiles emerged: Profile 1 (38%) exhibited the lowest substance use and lowest psychiatric severity (Overall Low); Profile 2 (39%) exhibited high alcohol and psychiatric severity; Profile 3 (13%) exhibited high opioid severity and low psychiatric severity. Profile 4 (8%) exhibited high cannabis use and high psychiatric severity, and profile 5 (3%) exhibited high polysubstance use other than alcohol and cannabis use. The latter two profiles were younger and exhibited higher self-regulatory deficits. The (High Alc/high psych) and the (High Cann/Psych) profiles exhibited differentially higher psychiatric severity. Profiles showing high polysubstance use, as well as high cannabis use and high psychiatric severity, showed significantly higher impulsive behavior than the others. Conclusions: LPA revealed five clusters of patients varying substantially in terms of SUD and psychiatric severity. Addressing common features of clinical heterogeneity for tailored care paths in a personalized treatment approach may improve treatment outcomes.

STAT: schema therapy for addiction treatment, a proposal for the integrative treatment of addictive disorders

The nature and origins of addictions and of their adjunctive behaviors, as well as their chronicity, call for treatments that conceptualize and treat them as the long-term and complex processes that they are. Addictions are often comorbid with personality problems and with trauma histories. Patients suffering from these disorders often show poor engagement with treatment and high rates of relapse, possibly because available treatments have yet to address the patient suffering from addiction in a more integrated or holistic manner. In particular, comprehensive treatment models for addictive disorders - like treatments for personality disorders or trauma - are likely to require the integration of behavioral, cognitive, and emotion-focused interventions within a facilitative therapeutic relationship. However, most current treatment models, including ones which are highly effective in stabilization or behavioral change, lack one or more components of treatment that could sustain longer term recovery, wellness, and health for a higher percentage of patients. In this article, I propose approaching addictions and their treatment from the perspective of schema therapy, an integrative, developmental model with a strong track record of positive outcomes in addressing personality disorder symptoms and long-standing trauma histories, commonly comorbid with addictive disorders. In advancing this proposal, I begin by providing some background tying together addictions, attachment, and personality, suggesting they be treated simultaneously to achieve improved outcomes. Then, after briefly reviewing the leading approaches to the treatment of addictions, I introduce the idea that schema therapy is well-situated - both theoretically and practically - to address many of the shortcomings of existing treatment options. In particular, I note how addictive and co-occurring colluding behaviors are deeply intertwined with both early and continued frustration of core developmental needs. I illustrate how the addictive cycle is perpetuated through the process of schema reinforcement and through the operation of schema modes. I then demonstrate how these key terms (i.e., needs, schemas, and modes) inform the patient's assessment and case formulation, guiding treatment interventions from a strong therapeutic relationship that focuses on integrating recovery behavior change, healing dysfunctional schemas and modes, and preventing relapse.

Perinatal women in substance use disorder treatment: Interest in partnering with family and friends to support recovery needs

BACKGROUND

Perinatal women treated for substance use disorder (SUD) face considerable barriers to recovery that might be ameliorated through activation of community support.

OBJECTIVES

This descriptive study evaluated the presence of drug-free family and friends in the social networks of perinatal women treated for SUD. It also assessed the interest of these women to partner with network members to mobilize support across several recovery needs.

METHODS

Social network interviews were conducted with 40 pre- and post-partum women treated at the Center for Addiction and Pregnancy (CAP) in Baltimore, Maryland. These interviews also prompted participants to consider which network members to invite to the program to support recovery efforts.

RESULTS

Study participants reported that their personal social networks included 4.4 drug-free adults. An overwhelming majority (80%) of participants reported a willingness to invite at least one person to the CAP program. Participants also endorsed several opportunities for collaboration between the program and community support.

CONCLUSIONS

These findings suggest that treatment program guided activation of network support offers a testable strategy to help perinatal women reduce barriers to recovery and improve treatment outcomes.

A Moderated Mediation Model of Age-Related Decline in Selective Executive Functions and Quality of Life in Men with Substance Use Disorder

Objective

It is known from earlier literature that substance use is associated with diminished executive functioning and decreased quality of life (QoL). The study extended this knowledge by assessing whether selective executive function components would mediate the association between age and QoL domains in young men with substance use disorder and whether family history of substance use would moderate these mediated associations.

Method

A sample of 212 young inpatient men with substance use disorder (105 positive family history and 107 negative family history of substance use disorder) was selected from drug units/wards of government sector hospitals.

Results

The participants with positive family history compared to those with negative family history scored significantly lower on all QoL domains except physical QoL. Mediation analyses revealed that only inhibition but not flexibility mediated the negative association of age with psychological, social, and environmental QoL. Furthermore, family history of substance use moderated all the significant mediated associations with stronger indirect negative associations in participants having a family history of substance use disorder compared to those with no such history.

Conclusions

It is concluded that inhibitory control, which is vulnerable to aging, substance use, and family history of substance use, is an important factor related to QoL in young substance abuser men.

The Impact of Psychological Burdens and Vaccine Worries on Confidence and Adherence to Governmental Policies Against COVID-19 Among Patients with Substance Use Disorder: A Cross-Sectional Study in Taiwan

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has had an impact on patients with substance use disorder (SUD). We aimed to investigate factors associated with confidence and adherence to governmental policies against COVID-19 (social desirability) among patients with SUD.

Methods

This cross-sectional study was conducted during 2020 to 2021. Patients with SUD and healthy controls were recruited. The severity of sleep disturbance, social desirability, drug dependence, vaccine worries, other psychological burdens and demographic variables were collected through self-administrated questionnaires. Differences between the SUD and control groups were estimated. Hierarchical regression analysis was used to identify significant relationships between social desirability and other factors.

Results

In total, 58 of patients with SUD and 47 healthy controls were recruited. The patients with SUD had a lower level of social desirability and more severe sleep disturbance than the control group. Older age, more severe sleep disturbance, lower level of drug dependence, and lower level of vaccine worries were significantly associated with a higher level of social desirability among the patients with SUD.

Conclusion

Our results show the importance of timely interventions for drug dependence and to address vaccine worries in patients with SUD.

The impact of spiritual well-being and social support on substance use treatment outcomes within a sample of predominantly Black/African American adults

INTRO

Substance use and associated problems often return following treatment for substance use disorder (SUD), which disproportionally impact Black/African American (AA) individuals. Social support and spiritual well-being are sources of recovery capital identified as particularly important among Black/AA adults. Social support and spiritual well-being are also posited mechanisms in 12-step; thus, this study tested the effects of social support and spiritual well-being on substance use outcomes over time, distinct from 12-step involvement, among Black/AA adults post-SUD treatment. The study hypothesized that social support and spiritual well-being would demonstrate significant interactions with time, respectively, on substance use frequency and substance use consequences, above the effect of 12-step involvement.

METHOD

The study drew data from a study of 262 adults (95.4 % Black/AA) entering residential SUD treatment (NCT#01189552). Assessments were completed at pretreatment and at 3-, 6-, and 12-months posttreatment. Two generalized linear mixed models (GLMM) tested the effects of social support and spiritual well-being, above the effect of 12-step involvement, on substance use frequency and substance use consequences over the course of 12-months posttreatment.

RESULTS

Higher spiritual well-being predicted significantly less frequent substance use during recovery (β = 0.00, p = .03). Greater 12-step involvement predicted significantly fewer substance use consequences during recovery (β = 0.00, p = .02). In post hoc analyses the effect of spiritual well-being and 12-step involvement dissipated by 3.5- and 6.6-months posttreatment, respectively. The study found no significant effects of social support over time.

DISCUSSION

Spiritual well-being and 12-step involvement are associated with lower substance use and substance use consequences, respectively, in the early months of posttreatment recovery among Black/AA adults. These findings contribute to the growing recovery capital literature informing paths to recovery and sources of support outside of 12-step affiliation. However, these effects diminish over time.

Evaluating the Aspects of Quality of Life in Individuals with Substance Use Disorder: A Systematic Review Based on the WHOQOL Questionnaire

Substance Use Disorder (SUD) has become a significant public health concern and it profoundly impacts an individual's quality of life (QOL). This systematic review aimed to assess the QOL among patients with SUD, and to understand the differential impact of SUD on physical, mental, social, and environmental QOL domains, considering a variety of substances and identifying key factors that influence these outcomes. A comprehensive search was conducted in PubMed, Web of Science, Cochrane, and Scopus in January 2023, covering literature published until December 2022. The QOL was assessed using the World Health Organization Quality of Life (WHOQOL) instrument and the brief version of the WHOQOL, identifying the same four domains of QOL (physical, mental, social, and environmental). A total of 19 studies were selected for inclusion in the systematic review, based on individuals' polysubstance use, and excluding those using only nicotine or alcohol. The analysis included 6079 patients, with only 40.3% women, and a mean age of 36.6 years. The substances most commonly involved in SUD were cocaine (47.1%), alcohol (46.3%), and amphetamine (43.6%), considering most individuals being polysubstance users. The highest variability in QOL scores was observed in the physical domain. Mental disorders were reported in 68.3% of the patients, while long-term use of drugs, criminal history, unemployment, and low levels of education were identified as significant predictors for lower QOL by some of the studies. Similarly, sleep problems and teeth decay were also identified as significant worsening factors for QOL. This systematic review highlights that the WHOQOL survey is widely accepted and applicable for individuals with SUD worldwide. The results suggest a substantial negative impact of SUD on the QOL of affected individuals. The findings underscore the need for comprehensive interventions to address the physical, psychological, social, and environmental dimensions of QOL among individuals with SUD.

A systematic review of quality of life and health-related quality of life as outcomes in substance and behavioural addictions

ISSUES

Consideration of an individual's quality of life (QoL) can benefit assessment and treatment of addictive disorders, however, uncertainty remains over operationalisation of the construct as an outcome and the appropriateness of existing measures for these populations. This systematic review aimed to identify and evaluate QoL and health-related QoL outcome instruments used in addiction-related risk and harm research and map their conceptualised domains.

APPROACH

Three electronic databases and a specialised assessment library were searched on 1 February 2022 for QoL or health-related QoL outcome instruments used with addiction-related risk and harm populations. PRISMA reporting guidance was followed and included outcome instruments were appraised using mixed methods. Psychometric evidence supporting their use was summarised. The COSMIN risk of bias tool was used to assess validation studies.

KEY FINDINGS

A total of 298 articles (330 studies) used 53 outcome instruments and 41 unique domains of QoL. Eleven instruments' psychometric properties were evaluated. No instrument was assessed for any parameter in at least five studies for meta-analytic pooling. Cronbach's alpha (α) internal consistency was the most widely assessed parameter with the AQoLS, WHOQOL-BREF, ALQoL-9, Q-LES-Q-SF, SF-12, DUQoL, QLI and SF-36 displaying promising statistics (α > 0.70).

IMPLICATIONS AND CONCLUSION

Many instruments have been utilised. However, a significant proportion of studies applied a small number of instruments with minimal high-quality validation evidence supporting their use within addiction-related risk and harm. Promising instruments are recommended, however, the paucity of supporting evidence limits confidence in the reliability and validity of QoL measurement in these populations.

Quality of life and its correlated factors among patients with substance use disorders: a systematic review and meta-analysis

Background

Patients with substance use disorder (SUD) usually report lower quality of life (QoL) than other patients and as much as patients with other mental disorders. The present study investigated variables associated with QoL domains among patients with SUD.

Methods

Studies in English published before December 1^st 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on factors associated with QoL domains among patients with SUD. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PECO (Participants, Exposures, Comparison and Outcome) criteria: (a) participants: patients with SUD; (b) exposures: sociodemographic factors, clinical, and service use variables; (c) comparison: patient groups without SUD; and (d) outcomes: four domains of QoL (physical, mental, social, and environmental domains). Three researchers recorded the data independently using predefined Excel spreadsheets. The Newcastle–Ottawa Scale (NOS) was used for assessing risk of bias and rated each study in terms of exposure, outcome, and comparability. Pooled odds ratios (ORs) and β coefficient were utilized at a 95% confidence level, and because sampling methods differed between studies’ pooled estimates, a random effects model was utilized.

Results

After the assessment of over 10,230 papers, a total of 17 studies met the eligibility criteria. Five studies (1260 participants) found that patients with SUD who were older were less likely to have a good physical Qol (OR = 0.86, 95% CI = 0.78, 0.95). Two studies (1171 participants) indicated that patients with SUD who were homeless were less likely to have a good environmental Qol (β = -0.47, p = 0.003). However, a better mental QoL was observed in four studies (1126 participants) among those receiving support from their family or friends (social networks) (OR = 1.05, 95% CI = 1.04, 1.07). Two studies (588 participants) showed that those using cocaine were less likely to have a good mental QoL (OR = 0.83, 95% CI = 0.75, 0.93). Two studies (22,534 participants) showed that those using alcohol were less likely to have a good physical QoL (β = -2.21, p = 0.001). Two studies (956 participants) showed that those having severe substance use disorders were less likely to have a good mental (β = -5.44, p = 0.002) and environmental (β = -0.59, p = 0.006) QoL respectively. Four studies (3515 participants) showed that those having mental disorders were less likely to have a good physical QoL (β = -1.05, p = 0.001), and another three studies (1211 participants) that those having mental disorders were less likely to have a good mental QoL (β = -0.33, p = 0.001). Finally, two studies (609 and 682 participants) showed that individuals who experienced trauma symptoms or mental disorders were less likely to have good social and environmental QoL, respectively (OR = 0.78, 95% CI = 0.61, 1.00) and (OR = 0.92, 95% CI = 0.9, 0.94).

Conclusions

The findings suggest the need for mental health services to improve the QOL among patients with SUD but further study is needed. Cocaine may cause behavioral changes which can increase the possibility of reckless and suicidal behaviors. Therefore, identifying cocaine user access, adherence, and satisfaction with treatment is recommended as an important component of adaptive functioning. Interventions that help patients with SUD get support from people within their social networks who support their recovery are also essential to their QoL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00940-0.

Multidimensional Quality of Life Across the Spectrum of Alcohol Use Behavior

Objective

Quality of life (QoL) is inversely associated with alcohol misuse and is a key measure by which recovery from alcohol use disorder (AUD) might be assessed. Yet, the determinants of QoL are scarcely known. The authors examined three ways through which demographic characteristics, familial and early life factors, and psychopathology conferred risks for QoL, including unique direct effects, developmental pathways, and clinical risk Profiles.

Methods

Cross-sectional data from 1095 adults (50.4% without AUD; 49.6% with AUD) who participated in the NIAAA Natural History Protocol from January 2015 to March 2022 were analyzed. Multivariable regressions, path analysis, and latent Profile analysis were conducted.

Results

AUD was uniquely associated with lower QoL, and adverse effects of child maltreatment history and psychopathology symptoms on QoL were of similar or larger magnitudes. Mediation analysis indicated family history of AUD and child maltreatment history were indirectly associated with lower QoL through higher attention-deficit/hyperactivity disorder symptoms, higher depressive symptoms, and positive AUD diagnosis. Latent Profile analysis of an enriched set of clinical characteristics identified four latent Profiles capturing the full range of alcohol use behavior. Latent Profiles with greater severity of familial and early life factors, psychopathology, and problematic drinking showed dose-response associations with lower levels of physical, psychological, social, and environment QoL.

Conclusions

A constellation of developmental and clinical characteristics disproportionately affects individuals with AUD and is negatively associated with QoL domains. To improve QoL, prevention and intervention need to target multiple factors, including history of child maltreatment, comorbid psychopathology, and problematic drinking itself.

Personal Social Networks and Relapses in Women With Substance Dependence: Application of the Theory of Planned Behavior

OBJECTIVE

Establishing positive network resources and rebuilding drug free networks are key components of recovery process for women with substance use disorder (SUDs). Theory of planned behavior (TPB) posits that behaviors are determined by behavioral intentions, which are determined by three factors: attitude toward the behavior, perceived behavioral control, and subjective norms. The current study applied TPB to examine whether women's personal social network characteristics (as subjective norms) were related to intentions towards, and/or a substance use relapse using prospective research design.

METHODS

Longitudinal data from 300 American women with SUD who received treatment at three county-funded, women-only intensive treatment programs was utilized for the current study.

RESULTS

Bayesian estimation path analyses indicated that attitude and abstinence self-efficacy at intake were not related to intention at the 6-month follow-up, but abstinence self-efficacy was directly related to substance use relapse by 12 months. Personal social network characteristics, number of treatment related persons in personal social network and sobriety support were significantly associated with intention at 6 months. The interaction between the numbers of treatment related persons and density was found on intention, suggesting that density strengthens the relationship between treatment related persons in network and intention. Intention to use substance was associated with relapse to substance use behavior.

CONCLUSION

Our findings support that personal social network characteristics can be considered as subjective norms in the TPB model. Personal social network interventions focusing on rebuilding consistent social norms against drug-using behaviors may decrease intention to use substance, which will lead to abstinence.

The Impacts of Social Support and Relationship Characteristics on Commitment to Sobriety Among People in Opioid Use Disorder Recovery

OBJECTIVE

Despite evidence that social support is beneficial for people living with opioid use disorders (OUDs), research has yet to investigate whether social support within certain relationships is more or less effective. The current study examined whether social support, relationship closeness with a disclosure partner, and/or the history of joint substance use between participants and disclosure partners affect commitment to sobriety among people receiving medications for OUD.

METHOD

Over a period of 3 months (two time points), participants taking OUD medications took part in a mixed-methods egocentric social network study exploring their relationships with disclosure partners before and following OUD disclosure (i.e., first telling a disclosure partner about one's OUD history or treatment). Data included 131 disclosure events/relationships clustered within 106 participants.

RESULTS

Greater relationship closeness was associated with increased commitment to sobriety over time. Further, significant interactions were found between social support and disclosure partner closeness, partner closeness and history of joint substance use, and social support and history of joint substance use. Higher social support was associated with greater commitment to sobriety among those disclosing to close partners. In contrast, receiving social support or disclosing to a close partner with whom there was a history of joint substance use was associated with decreased commitment to sobriety.

CONCLUSIONS

Findings highlight the complexities of social support among people in treatment for OUD and demonstrate that relationship closeness and a history of joint substance use with a disclosure partner may be important factors to consider before disclosure.

Predictors of therapeutic alliance, treatment feedback, and clinical outcomes among African American women in treatment for co-occurring PTSD and SUD

INTRODUCTION

Black women are at heightened risk for trauma exposure, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs), compared to White women and the general population. However, disparities in treatment engagement and retention persist, particularly for Black women with co-occurring PTSD+SUD. Although therapeutic alliance is an important predictor and mediator of treatment retention and outcomes, we know little about predictors of alliance and the mediating role of alliance for PTSD+SUD outcomes among Black women.

METHODS

This study utilized data previously collected for the National Drug Abuse Treatment Clinical Trials Network (CTN) Women and Trauma Study. Participants were 88 Black/African American women (Mage = 41.90, SD = 7.72) participating in a clinical trial comparing Seeking Safety (a cognitive-behavioral intervention for PTSD+SUD) to Women's Health Education (control). This study includes participants from both arms. Measures included the Helping Alliance Questionnaire, Addiction Severity Index-Lite, and Clinician Administered PTSD Scale. Women in the intervention arm also completed the Seeking Safety Feedback Questionnaire.

RESULTS

Stepwise, hierarchical linear regressions indicated that years of education and previous alcohol/drug treatment attempts significantly predicted early alliance in the second week of therapy (β = 0.411, p = .021 and β = 0.383, p = .011, respectively), but not late alliance in the last week of therapy (ps > .794). Greater education and more treatment attempts were associated with higher early alliance. Alliance did not mediate relationships between these significant predictors and treatment outcomes (e.g., attendance, post-treatment PTSD and SUD symptoms) or treatment feedback in the Seeking Safety group.

CONCLUSIONS

Education and prior treatment attempts predicted early alliance among Black/African American women in PTSD+SUD group treatment, and higher education level was associated with poorer Seeking Safety feedback topic ratings. Educational level and treatment history should be considered during alliance building in therapeutic interventions with Black women. Clinicians may consider the integration of pre-treatment alliance-building strategies with Black female patients who have lower levels of education. This study provides insight into the relative impact of several important factors that influence early alliance among Black women with co-occurring PTSD+SUD.

Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital

Background

Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors.

Results

The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X²= 12.525, p=0.014; X²= 12.525, p=0.023; and X²= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse.

Conclusions

Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.

Characterizing Clinical Heterogeneity in a Large Inpatient Addiction Treatment Sample: Confirmatory Latent Profile Analysis and Differential Levels of Craving and Impulsivity

Background:

Individuals with substance use disorders (SUDs) have highly heterogeneous presentations and identifying more homogeneous subgroups may foster more personalized treatment. This study used SUD and other psychiatric indicators to characterize latent subgroups of patients in a large inpatient addiction treatment program. The resulting subgroups were then analyzed with respect to differences on clinically informative motivational mechanisms.

Methods:

Patients (n = 803) were assessed for severity of SUD (ie, alcohol use disorder, drug use disorder), post-traumatic stress disorder, anxiety disorders, and major depressive disorder. Confirmatory latent profile analysis (CLPA) was used to identify latent subgroups, hypothesizing 4 subgroups. Subgroups were then characterized with respect to multiple indicators of impulsivity (ie, delay discounting and impulsive personality traits via the UPPS-P) and craving.

Results:

The CLPA confirmed the hypothesized 4-profile solution according to all indicators (eg, entropy = 0.90, all posterior probabilities ⩾.92). Profile 1 (n = 229 [32.2%], 24.9% female, median age in range of 45-49) reflected individuals with high alcohol severity and low psychiatric severity (HAlc/LPsy). Profile 2 (n = 193 [27.1%], 29.3% female, median age in range of 35-39) reflected individuals with high drug and psychiatric severity (HDrug/HPsy). Profile 3 (n = 160 [22.5%], 37.6% female, median age in range of 45-49) reflected individuals with high alcohol severity and psychiatric severity (HAlc/HPsy). Profile 4 (n = 130 [18.3%], 19.4% female, median age in range of 35-39) reflected individuals with high drug severity and low psychiatric severity (HDrug/LPsy). Both high comorbid psychiatric severity subgroups exhibited significantly higher craving and facets of impulsivity.

Conclusions:

The results provide further evidence of 4 latent subgroups among inpatients receiving addiction treatment, varying by alcohol versus other drugs and low versus high psychiatric comorbidity. Furthermore, they reveal the highest craving and impulsivity in the high psychiatric comorbidity groups, suggesting targets for more intensive clinical intervention in these patients.

Quality of life during a randomized trial of a therapeutic-workplace intervention for opioid use disorder: Web-based mobile assessments reveal effects of drug abstinence and access to paid work

Background

Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder.

Methods

For 12 weeks, participants (n = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones. At enrollment, participants were randomized to work in the Therapeutic Workplace immediately (immediate work group, IWG) or after a 3-week waitlist delay (delayed work group, DWG). Once both groups could work, wage-resetting contingencies were introduced for their opiate- and cocaine-urinalysis. Data were analyzed by (1) access to work with and without contingencies and (2) overall urinalysis-verified opiate- and cocaine-abstinence.

Results

DWG and/or IWG reported improvements in several QOL areas (sleep, transportation, recreation); however, they also reported increased money-related difficulties and less time spent with friends/family. These changes did not coincide with DWG's work access, but some (more sleep, money-related difficulties) coincided with the urinalysis contingencies. Greater opiate- and/or cocaine-abstinence was also associated with several improvements: sleep, paying bills, time spent with friends/family, and exercising. Surprisingly, intermediate cocaine abstinence was associated with reductions in work-capacity satisfaction and recreation.

Conclusions

Participants reported complex QOL differences during their experimental employment and associated with drug abstinence. Future work should help participants address issues that may be relevant to employment generally (e.g., time with friends/family) or contingency management specifically (e.g., money-related issues for non-abstinent participants).

The Influence of Physical Condition on Mental Health and Quality of Life in Patients With Drug Dependence

BACKGROUND

Exercise has been proposed as a good strategy to prevent use and relapse and to improve mental health and quality of life in drug-dependent people. However, it is not known if physical condition per se influences quality of life and mental health.

OBJECTIVE

The aims of this study were to analyze the relationships between physical condition, mental health, and quality of life in patients with drug dependence and to determine whether physical condition could predict levels of mental health and quality of life.

METHOD

Levels of physical condition (Timed Get Up and Go test, Chair Stand Test, six-minute walk test), mental health (Depression Anxiety Stress Scales [DASS-21]), and quality of life (Short Form Health Survey) were measured in a sample of 125 patients with drug dependence. A correlation analysis and a stepwise multiple linear regression analysis were performed.

RESULTS

The physical condition tests predicted all DASS-21 variables: stress (F = 26.30, p < .001), anxiety (F = 18.33, p < .001), depression (F = 27.63, p < .001), total DASS-21 (F = 23.91, p < .001), and all the variables of the Short Form Health Survey for quality of life.

CONCLUSIONS

Physical condition can predict the levels of mental health and quality of life of patients with drug dependence.

Quality of life among people who use drugs living in poor urban communities in the Philippines

BACKGROUND

The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD.

METHODS

A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate.

RESULTS

In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group.

CONCLUSION

A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.

Quality of life and its related factors in women with substance use disorders referring to substance abuse treatment centers

BACKGROUND

Substance-Related Disorders are among the most common social problems caused by using legal and illegal substances. Therefore, this study aimed at determining the quality of life (QoL) and its related factors among women with substance use disorders referring to substance abuse treatment centers in Hamadan, west of Iran.

METHODS

This cross-sectional study was carried out on 120 Iranian female substance users recruited through the census sampling method in 2018. Data collection tools consisted of demographic characteristics and QoL assessment (SF-36). Data were analyzed using SPSS-16 via one-way analysis of variance (ANOVA) and chi-square tests.

RESULTS

The mean age of the participants was 33.2 ± 12.1 years and the mean score of their total QoL was 35.35 ± 13.5. The results of multiple linear regression analysis indicated that using methamphetamine (β =  - 6.62) was the predictor of QoL in women. Moreover, there was a significant association between QoL and age (p < 0.001), educational level (p = 0.011), and age at first use (p < 0.001).

CONCLUSION

According to the results, the participants' QoL was found to be at an unsatisfactory level. So, it is essential to implement educational help-seeking behavior for treatment and effectiveness educational, as well as holding mental health intervention, school-based substance abuse prevention, and harm reduction programs of substance use. This is especially important in adolescents, young, low-educated, early drug use, and methamphetamine user women, as it may increase the QoL.

Quality of life as a predictor of time to heroin relapse among male residents following release from compulsory rehabilitation centres in Vietnam

INTRODUCTION AND AIMS

Quality of life (QOL) is a relevant and quantifiable outcome of drug dependence treatment. We assessed health-related QOL for people released from three centre-based compulsory treatment (CCT) centres in Vietnam, using the EQ-5D. The study aimed to examine the prognostic value of health-related QOL in relation to time to relapse to heroin use among the participants.

DESIGN AND METHODS

Two hundred and eight CCT participants with heroin dependence were interviewed at release, and at 3, 6 and 12 months post-release. Health-related QOL was measured with the EQ-5D. Kaplan-Meier survival models were fitted using Cox modelling to examine the rate, timing and prediction of the number of days to heroin relapse and to examine the predictability of the health-related QOL measures for days to relapse. Relapse was defined as first time of heroin use.

RESULTS

The study found a substantial relapse rate (85.6%) among participants within 12 months following release from CCT centres; the mean number of days to relapse was 57.7 (SD = 31.6). There was no statistically significant change over time in the mean values of health-related QOL (P = 0.11). While the total index score (across the five pre-specified EQ-5D domains) did not have a significant effect in predicting cumulative relapse, lower scores on the Visual Analogue Scale of the EQ-5D were significantly (P < 0.05) predictive of cumulative relapse, with adjusted hazard ratios for relapse of 0.987 (P = 0.013).

DISCUSSION AND CONCLUSIONS

EQ-5D Visual Analogue Scale score is a useful predictor of cumulative heroin relapse among participants released from CCT centres.

Measuring health-related quality of life in patients treated for substance dependence: differences among instruments and methods of eliciting preferences

BACKGROUND

Measuring the health-related quality of life is an essential estimation in cost-utility studies. In this research, we provide new evidence about comparing utility scores - in the field of substance dependence. Although the main objective is to compare the EQ-5D-5L and SF-6D with paired gamble, evidence about the SF-6D with standard gamble is also provided.

METHODS

Ninety-four patients with substance dependence were recruited; the SF-6D and the EQ-5D-5L were administered at the beginning of treatment and 6 months thereafter. Differences in treatment effect were estimated by comparing utility gains. All analyses were reproduced for two subgroups of severity.

RESULTS

Both the baseline scores and the treatment effect are sensitive to the instrument used. For severe states, the SF-6D with paired gamble (SF-6D with standard gamble) estimates the lowest (highest) utility. With regard to the impact of treatment, the EQ-5D-5L and SF-6D with paired gamble estimate strongly similar effects for severe states (and both estimate greater effects than does the SF-6D with standard gamble).

CONCLUSIONS

These findings have implications for cost-utility analyses. The incremental cost-utility ratio of treatments intended for severe states is barely sensitive to the choice of EQ-5D-5L or SF-6D with paired gamble.

Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model

PURPOSE

This study (a) assessed quality of life (QoL) in a patient sample with severe mental illness in an integrated psychiatric care (IC) programme in selected regions in Germany, (b) compared QoL among diagnostic groups and (c) identified socio-demographic, psychiatric anamnestic and clinical characteristics associated with QoL.

METHODS

This cross-sectional study included severely mentally ill outpatients with substantial impairments in social functioning. Separate dimensions of QoL were assessed with the World Health Organisation's generic 26-item quality of life (WHOQOL-BREF) instrument. Descriptive analyses and analyses of variance (ANOVAs) were conducted for the overall sample as well as for diagnostic group.

RESULTS

A total of 953 patients fully completed the WHOQOL-BREF questionnaire. QoL in this sample was lower than in the general population (mean 34.1; 95% confidence interval (CI) 32.8 to 35.5), with the lowest QoL in unipolar depression patients (mean 30.5; 95% CI 28.9 to 32.2) and the highest in dementia patients (mean 53.0; 95% CI 47.5 to 58.5). Main psychiatric diagnosis, living situation (alone, partner/relatives, assisted), number of disease episodes, source of income, age and clinical global impression (CGI) scores were identified as potential predictors of QoL, but explained only a small part of the variation.

CONCLUSION

Aspects of health care that increase QoL despite the presence of a mental disorder are essential for severely mentally ill patients, as complete freedom from the disorder cannot be expected. QoL as a patient-centred outcome should be used as only one component among the recovery measures evaluating treatment outcomes in mental health care.

Quality of Life in Patients With Methamphetamine Use Disorder: Relationship to Impulsivity and Drug Use Characteristics

BACKGROUND

The quality of life (QOL) of patients with methamphetamine use disorder (MAUD) is increasingly recognized as an important outcome. Previous studies have found that impulsivity is negatively associated with QOL in mental disorders, but this relationship is rarely confirmed in patients with MAUD. We hypothesized that impulsivity is negatively correlated with QOL in patients with MAUD based on previous findings. In addition, a variety of drug use characteristics of patients that may potentially affect their QOL need to be further explored. Therefore, the purpose of this study was to explore the relationship between impulsivity, multiple drug use characteristics, and QOL in patients with MAUD.

METHODS

A total of 379 patients with MAUD were recruited, and the majority of them were male (85.5%), with an average age of 33.93 ± 7.08 years. Two psychiatrists conducted semi-structured interviews with methamphetamine (MA) users in two compulsory drug rehabilitation centers to obtain their demographics and drug use characteristics. The Barratt Impulsiveness Scale-11 (BIS-11) and Brief WHO Quality of Life Assessment (WHOQOL-BREF) were used to assess patients' impulsivity and QOL, respectively. Correlation and univariate regression analysis were used to explore the relationships between impulsivity, a series of drug use characteristics and patients' QOL in different domains. Further multiple linear regression analysis was used to identify what extent the above clinical variables explained the variations in patients' QOL.

RESULTS

Age, marital status, employment, and various drug use characteristics were significantly associated with at least one QOL domain. Among them, married and full-time job were positively correlated with QOL, while others were negatively correlated with QOL. The total score of BIS-11 was significantly negatively correlated with all four domains of QOL. Impulsivity, a range of drug use characteristics and certain demographic characteristics collectively explained varying degrees of variation in different domains of QOL.

CONCLUSIONS

Impulsivity and various drug use characteristics can significantly predict QOL in all fields of MAUD patients. In addition, we have also found differences in the predictors of QOL in different domains. Overall, this study provides clinical guidance for the treatment of MAUD patients, that is, management of impulsivity in patients with MAUD may help improve their QOL and even sustain their drug rehabilitation.

Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review

INTRODUCTION AND AIMS

Quality of life (QOL) is increasingly recognised as an important treatment indicator in the alcohol and other drug (AOD) sector, particularly in treatment modalities providing 'whole of life programmes', such as residential rehabilitation. However, it is currently unclear how studies conducted in AOD residential rehabilitation settings have operationally defined and measured QOL. This study therefore aimed to determine current practices in defining and measuring the QOL of residential rehabilitation clients.

DESIGN AND METHODS

A systematic review of studies examining the QOL of AOD residential rehabilitation clients was conducted. Potential studies published in English between 1990 and 2018 were identified through a search of electronic databases (e.g. PsycINFO and PubMed), search engines (Google Scholar) and article reference lists.

RESULTS

The search identified a total of 1267 records, of which 16 met the inclusion criteria. Less than half of the included studies provided an operational definition of QOL. QOL was generally understood to be a subjective, multidimensional, client assessment construct. Twelve different instruments were used to assess QOL, of which two enabled clients to identify QOL dimensions important to themselves.

DISCUSSION AND CONCLUSIONS

QOL has been inconsistently measured in studies of AOD residential rehabilitation clients. As a result, the comparability and validity of research in this field may be weakened. There is a need to develop a consensual operational definition of QOL, including a core set of domains relevant to and endorsed by residential rehabilitation clients. Appropriate tools to measure client QOL need to be identified and disseminated.

Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use

People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (‘Patient Pathways’), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of “SUD treatment success” (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p < 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL; however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use.

Confirming the factor structure of a generic quality of life instrument among pre-treatment substance use disorder patients

Background

Quality of life (QoL) is a patient-reported outcome of increasing importance in the substance use disorder (SUD) treatment field, and impaired QoL may be an important impetus for treatment uptake. Instruments and methodologies abound, precluding comparison, as does a dearth of population norms. The QOL10 is a generic, overall QoL tool containing ten items and with simple scoring procedures. It is therefore a potential alternative to the gold standard WHOQOL-BREF. This study aimed to assess the two-factor structure of the QOL10 that has been suggested by a previous exploratory factor analysis.

Methods

Adults entering 21 participating inpatient or outpatient SUD treatment were recruited to join a national longitudinal cohort study. 531 completed the QOL10 at treatment entry and were included in the analysis. Structural equation modelling (SEM) was used to confirm the model fit of a two-factor structure, and the scaling qualities of the QOL10 were reported.

Results

According to the SEM analysis, the QOL10 was comprised of one latent variable measuring social QoL, and one measuring global QoL, and all ten items were retained. Goodness of fit tests included: root mean square of approximation = 0.063, 90% CI 0.050–0.076; normed-fit index = 0.919; and comparative fit index = 0.943.

Conclusions

The QOL10 should be considered when clinicians in the SUD treatment field need a short, valid instrument that measures both global QoL and social QoL, with minimum respondent and administrator burden. The social domain is of particular utility and may be used as a stand-alone instrument. Test-retest reliability should be established in future studies.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1152-7) contains supplementary material, which is available to authorized users.

Quality of life in substance use disorder patients with and without attention deficit hyperactivity disorder 12 months after treatment: a naturalistic follow-up study

There is sparse research on quality of life (QoL) as an outcome measure in patients with substance use disorders (SUD), with or without attention deficit hyperactivity disorder (ADHD). We aimed to investigate whether SUD patients with and without ADHD (SUD + ADHD vs. SUD - ADHD) differed in QoL at baseline and at a 12-month follow-up after SUD treatment. The groups were additionally compared with data from a national population sample (NPS). From a sample of 16 SUD + ADHD and 87 SUD - ADHD patients originally recruited between 2010 and 2012, eight SUD + ADHD (50.0%) and 28 SUD - ADHD (32.2%) patients were reached at follow-up. QoL was measured with the short version of the World Health Organization QoL instrument (WHOQOL-BREF). Cross-sectional data on QoL from NPS was utilized. Compared to NPS, SUD patients reported significantly lower QoL at baseline and follow-up. Furthermore, QoL was similar at baseline in SUD + ADHD and SUD - ADHD patients. At a 12-month follow-up after SUD treatment, SUD + ADHD patients 'QoL had improved, however, not significantly differing from SUD - ADHD patients or the NPS. SUD - ADHD patients' QoL remained significantly lower. At follow-up, SUD + ADHD patients' QoL improved nominally compared to SUD - ADHD patients, but not the NPS. The clinical and functional relevance of these findings should be investigated further.

Emotional Well-Being and Public Health: Proposal for a Model National Initiative

In 2011, the National Prevention, Health Promotion, and Public Health Council named mental and emotional well-being as 1 of 7 priority areas for the National Prevention Strategy. In this article, we discuss emotional well-being as a scientific concept and its relevance to public health. We review evidence that supports the association between emotional well-being and health. We propose a national emotional well-being initiative and describe its 6 components: systematic measurement of emotional well-being, identification of the drivers of emotional well-being, formation of partnerships with diverse stakeholders, implementation and dissemination of evidence-based interventions to promote emotional well-being and its drivers, development of public health messaging, and identification of and strategies to address disparities in emotional well-being and its drivers. Finally, we discuss ways in which a national emotional well-being initiative would complement current public health efforts and the potential challenges to such an initiative.

Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon

BACKGROUND

Opioid agonist therapy has been widely used to reduce harms among individuals with opioid use disorder but its effectiveness has not been evaluated in the Middle East North African (MENA) region. This study aims to evaluate the effectiveness of a program using opioid agonist therapy in combination with psychosocial support on improving psychological and social well-being, reducing arrest, and reducing risky behavior in individuals with opioid use disorder in Lebanon.

METHODS

A one-group pre-test post-test design study was performed at SKOUN Lebanese Addiction Centre between January 2013 and December 2014. Eighty-six out of 181 patients agreed to participate and completed the 3-month assessment and 38 concluded the 12-month assessment. Psychological (depression and anxiety, quality of life), substance dependence/abuse, behavioral (injecting behavior, sharing needles and paraphernalia), and social outcomes were evaluated at baseline, 3, and 12 months post-treatment.

RESULTS

Remarkable statistical significance improvements were observed 3 months after treatment in most outcome variables including quality of life, anxiety, substance dependence, overdose, employment, and injecting behavior. Improvements were sustained 12 months after treatment.

CONCLUSION

Results support expanding the access to opioid agonist therapy in other MENA countries to treat substance dependence and reduce harms among individuals with opioid use disorder.

Association between severity of illicit drug dependence and quality of life in a psychosocial care center in BRAZIL: cross-sectional study

Background

Quality of life must be one of the main purposes for the treatment of drug users, requiring a better understanding of the association between the quality of life and the severity of dependency. This study aimed to investigate the correlation between severity of substance use in various areas of human functioning and quality of life of illicit drug users in a psychosocial care center for alcohol and drugs.

Methods

This cross-sectional study included 60 participants – illicit drug users – treated at a psychosocial care center for alcohol and drugs. Participants were evaluated with the short version of World Health Organization Quality of Life (WHOQOL-Bref) instrument to measure the quality of life, the 6th version of Addiction Severity Index (ASI-6) to assess the severity of dependence in several areas and the Mini International Neuropsychiatric Interview (MINI) to identify the presence of psychiatric disorders. Pearson and Spearman correlation tests and linear regression were applied to verify the association between the severity of dependence and the quality of life, and Student’s t-test to compare the mean quality of life between individuals with and without psychiatric comorbidities.

Results

Negative correlation was found between the severity of dependence on the drugs dimensions: alcohol, psychiatric, medical, legal, family/social support and family/social problems of ASI-6, and the quality of life domains measured by the WHOQOL-Bref. The evidence was strongest in the psychiatric and medical dimensions. There was a significant difference in the quality of life mean among participants presenting or not presenting psychiatric comorbidities, for the psychological domain in anxiety disorders, and for the physical and psychological domains in mood disorders.

Conclusion

The quality of life decreased as the severity of dependence increased, with different results in the various areas of the participant’s life. This result emphasizes the need for training the professional team which works in the substance use disorders area for more comprehensive diagnostic evaluations and more appropriate therapeutic interventions for each area. The associations were more evident in the medical and psychiatric fields, indicating the need for greater attention to be paid in relation to medical and psychiatric comorbidities.

Electronic supplementary material

The online version of this article (10.1186/s12955-017-0795-5) contains supplementary material, which is available to authorized users.

Building abstinent networks is an important resource in improving quality of life

AIMS

To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment.

DESIGN

Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment.

SETTING

Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later.

METHODS

The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI.

FINDINGS

Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system.

CONCLUSIONS

Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.

Quality of life of adolescents and young people arrive at an addiction treatment centers upon their admission, and 1, 4 and 8 months after methadone maintenance therapy

BACKGROUND

Drug abuse influences the quality of life significantly. Thus, the present study is designed to compare the quality of life of adolescents and young adults who have voluntarily referred to addiction treatment centers at different time slots of upon admission, and 1, 4, and 8 months after maintenance therapy.

METHODS

The present paper is a longitudinal study on 141 of adolescents and young adults who had referred to various addiction treatment centers throughout Isfahan voluntarily. The population was selected through convenience sampling method and 137 of adolescents and young adults continued the research until the end. The results were analyzed using descriptive and analytic statistics (frequency, mean, standard deviation, repeated measure test, and post-hoc test) in SPSS 17.

RESULTS

Results showed that the average of quality of life total score was sequential and not the same in the 4 times slots under study. The total quality of life score upon admission was significantly different from 1, 4, and 8 months after maintenance treatment. However, quality of life at 1-month was not significantly different to that at 4 and 8 months after the treatment; quality of life at 4 months after the treatment was not significantly different to that at 8 months after.

DISCUSSION

According to the present study, it can be concluded that the quality of life of adolescents and young adults referring to addiction treatment centers increases 1-month after the treatment; nevertheless, it is worth to note that the degree of quality of life increase in 4 and 8 months after the treatment is not as much as that in 1-month after the treatment.

Combat exposure, emotional and physical role limitations, and substance use among male United States Army Reserve and National Guard soldiers

PURPOSE

Combat-exposed soldiers are at an increased risk for health problems that diminish quality of life (QOL) and substance use. We explored the cross-sectional associations between combat exposure and two measures of QOL, and the effect of substance use on those associations.

METHODS

Data are from the baseline wave of Operation: SAFETY, an ongoing survey-based study of United States Army Reserve/National Guard (USAR/NG) soldiers and their partners. Our sample consisted of male USAR/NG soldiers with a history of deployment (N = 248). Limitations in usual activity due to physical and emotional problems were assessed using the 36-Item Short-Form Health Survey (SF-36).

RESULTS

Greater combat exposure was independently associated with limitations in usual activity due to physical (regression coefficient = -0.35, 95% CI -0.55 to -0.16, R ² = 0.09; p < 0.01) and emotional (regression coefficient = -0.32, 95% CI -0.56 to -0.09, R ² = 0.09; p < 0.01) problems. Combat exposure had a significant interaction with frequent heavy drinking on physical role limitations (regression coefficient = -0.65, 95% CI -1.18 to -0.12, R ² = 0.12; p < 0.05) and emotional role limitations (regression coefficient = -0.83, 95% CI -1.46 to -0.19, R ² = 0.12; p < 0.05). Combat exposure also had a significant interaction with lifetime non-medical use of prescription drugs on physical role limitations (regression coefficient = 0.81, 95% CI 0.18-1.45, R ² = 0.11; p < 0.05).

CONCLUSION

Combat is an unmodifiable risk factor for poor QOL among soldiers; however, frequent heavy drinking and non-medical use of prescription drugs modifies the relationship between combat exposure and QOL. Therefore, substance use is a potential point of intervention to improve QOL among soldiers.

Viability of the World Health Organization quality of life measure to assess changes in quality of life following treatment for alcohol use disorder

PURPOSE

Quality of life is an outcome often examined in treatment research contexts such as biomedical trials, but has been studied less often in alcohol use disorder (AUD) treatment. The importance of considering QoL in substance use treatment research has recently been voiced, and measures of QoL have been administered in large AUD treatment trials. Yet, the viability of popular QoL measures has never been evaluated in AUD treatment samples. Accordingly, the present manuscript describes a psychometric examination of and prospective changes in the World Health Organization Quality of Life measure (WHOQOL-BREF) in a large sample (N = 1383) of patients with AUD recruited for the COMBINE Study.

METHODS

Specifically, we examined the construct validity (via confirmatory factor analyses), measurement invariance across time, internal consistency reliability, convergent validity, and effect sizes of post-treatment changes in the WHOQOL-BREF.

RESULTS

Confirmatory factor analyses of the WHOQOL-BREF provided acceptable fit to the current data and this model was invariant across time. Internal consistency reliability was excellent (α > .9) for the full WHOQOL-BREF for each timepoint; the WHOQOL-BREF had good convergent validity, and medium effect size improvements were found in the full COMBINE sample across time.

CONCLUSIONS

These findings suggest that the WHOQOL-BREF is an appropriate measure to use in samples with AUD, that the WHOQOL-BREF scores may be examined over time (e.g., from pre- to post-treatment), and the WHOQOL-BREF may be used to assess improvements in quality of life in AUD research.

Quality of life improvement in Latinas receiving combined substance use disorders and trauma-specific treatment: a cohort evaluation report

BACKGROUND

This study evaluates the benefits of integrating behavioral health and trauma services for Latinas with a history drug use. Changes in quality of life (QOL) domains were documented after participation in a manualized intervention in a cohort of Latinas.

METHODS

Participants were part of a prospective cohort study of 136 Latinas with co-occurring disorders (COD) who may have experienced trauma and receiving services in our outpatient treatment facility in Bayamón, Puerto Rico. The WHOQOL-BREF Spanish version was used to score physical, psychological, social, and environmental QOL domains, at intake and after six months. Sociodemographic variables, alcohol, drug use, mental health disorders, and severity of substance use disorders (as defined by the DSM-5) were also tabulated. Descriptive statistics and paired t test or the Wilcoxon signed-rank test were computed for comparison.

RESULTS

A median age of 39 years was seen and with 76% high school education or higher degree. The majority were unemployed (95.9%). A diagnosis of severe cocaine use (51.4%) was present and almost half (49.5%) had three or more DSM-5 diagnoses. Mean QOL scores were higher at six months with statistically significant differences in each domain. Women with neurodevelopmental disorders and schizophrenia yielded higher mean QOL scores for each domain at six months except for the social domain. Women with polydrug use and women who reported exposure to trauma and depressive disorder experienced statistically significant increments in the physical, psychological and social domains in comparison to counterpart women.

CONCLUSIONS

Significant and positive changes in QOL were found in each domain. Latinas who reported traumatic events had lower scores in the physical and psychological QOL domains. There was a high prevalence of diminished physical and mental functioning in Latinas with COD. The exposure to trauma and the lack of social support negatively affect treatment access and retention for Latinas.

Stereotype threat and social function in opioid substitution therapy patients

OBJECTIVES

People with a history of substance abuse are subject to widespread stigmatization. It seems likely that this societal disapproval will result in feelings of stereotype threat, or the belief that one is the target of demeaning stereotypes. If so, stereotype threat has the potential to contribute to functional difficulties including poor social outcomes.

METHODS

Eighty drug users on opioid substitution therapy and 84 demographically matched controls completed measures of mental health and social function. The opioid substitution therapy group were additionally asked to complete a measure that focused on their feelings of stereotype threat in relation to their drug use history. Bivariate correlations and hierarchical regression analyses were conducted to establish the magnitude and specificity of the relationship between stereotype threat and social functioning.

RESULTS

Relative to controls, the opioid substitution therapy group reported higher levels of negative affect and schizotypy, and poorer social functioning, with all three of these indices significantly correlated with their feelings of stereotype threat. The results also showed that stereotype threat contributed significant unique variance to social functioning in the opioid substitution therapy group, even after taking into account other background, clinical, and mental health variables.

CONCLUSIONS

Social functioning is an important aspect of recovery, yet these data indicate that people with a history of drug abuse who believe they are the target of stereotypical attitudes have poorer social functioning. This relationship holds after controlling for the impact of other variables on social functioning, including mental health. The theoretical and practical implications of these findings are discussed.

PRACTITIONER POINTS

Concerns about being stereotyped can shape the social experiences of opioid substitution therapy patients. Opioid substitution therapy patients who feel negatively stereotyped experience greater social function deficits, and this relationship emerges after controlling for important clinical and mental health variables. Understanding the relationship between feeling stereotyped and social function may assist practitioners in their treatment. The study is cross-sectional, and thus, experimental or longitudinal research is required to determine the causal direction between stereotype threat and social function.

Family Risk Factors Among Women With Addiction-Related Problems: An Integrative Review

CONTEXT

Recent years have produced many articles about women's addiction and its risk factors and the consequences of substance use and misuse in the emotional, social, psychological, and economic domains of life. Family vulnerabilities are one of the most important variables contributing to addiction among women. Thus, the purpose of this article is to investigate areas of family life that lead to women's taking up and maintaining drug and alcohol abuse.

EVIDENCE ACQUISITION

A database search of PubMed, ScienceDirect, Springer, and Google Scholar was conducted using the following keywords: "women and addiction", "women addiction and family", "addiction", "substance abuse" and "family". For the first step, we chose studies that were conducted between 2000 and 2015, and for the second step, studies conducted before 2000. We categorized all search results into three main groups: processes related to family disturbances, factors related to parenting styles, and variables related to partners.

RESULTS

Partners, parenting styles, and family disturbances are three main factors affecting children growing up in a family and their inclination toward addiction. Some of these pathways are complicated and indirect, and some are straightforward.

CONCLUSIONS

Future research should pay more attention to the mechanisms and pathways mediating or moderating the relationship between family risk factors and addiction in women. Clinicians and researchers should keep in mind these vulnerabilities and take into consideration factors special to processes related to addiction in women.

Neurofeedback Training as a New Method in Treatment of Crystal Methamphetamine Dependent Patients: A Preliminary Study

This study aimed to compare the effectiveness of neurofeedback (NFB) plus pharmacotherapy with pharmacotherapy alone, on addiction severity, mental health, and quality of life in crystal methamphetamine-dependent (CMD) patients. The study included 100 CMD patients undergoing a medical treatment who volunteered for this randomized controlled trial. After being evaluated by a battery of questionnaires that included addiction severity index questionnaire, Symptoms Check List 90 version, and World Health Organization Quality of Life, the participants were randomly assigned to an experimental or a control group. The experimental group received thirty 50-min sessions of NFB in addition to their usual medication over a 2-month period; meanwhile, the control group received only their usual medication. In accordance with this study's pre-test-post-test design, both study groups were evaluated again after completing their respective treatment regimens. Multivariate analysis of covariance showed the experimental group to have lower severity of addiction, better psychological health, and better quality of life in than the control group. The differences between the two groups were statistically significant. These finding suggest that NFB can be used to improve the effectiveness of treatment results in CMD patients.

Many correlates of poor quality of life among substance users entering treatment are not addiction-specific

Background

Quality of life (QoL) is an important measure and outcome within chronic disease management and treatment, including substance use disorders (SUD). The aim of this paper was to investigate correlates of poorer QoL of individuals entering SUD treatment in Norway, in order to identify subgroups that may most benefit from different interventions.

Methods

Twenty-one treatment facilities invited all incoming patients to participate. Five hundred forty-nine patients who enrolled between December 2012 and April 2015 are analyzed. QoL, substance use, mental and physical comorbidities, and exercise behaviors were measured. Multinomial regression analysis was used to determine variables significantly associated with poorer QoL.

Results

The majority of both genders (75 %) reported “poor” or “very poor” QoL at intake. Depression showed a strong association with poor QoL (relative risk ratio [RRR] 3.3, 95 % confidence interval [CI] 1.0–10.3) and very poor QoL (RRR 3.8, 1.2–11.8) among women. Physical inactivity among men was associated with very poor QoL (RRR 2.0, 1.1–3.7), as was reporting eating most meals alone (RRR 2.6, 1.4–4.8). Evaluating one’s weight as too low was also associated with poor QoL (RRR 2.0, 1.0-3.9) and very poor QoL (RRR 2.0, 1.1–3.7) among men. Consuming methadone/buprenorphine was a protective factor for men reporting poor QoL (RRR 0.5, 0.3–0.9) and very poor QoL (RRR 0.4, 0.2–0.9), as well as for women reporting very poor QoL (RRR 0.2, 0.0–0.6).

Conclusions

Factors associated with poorer QoL among other healthy and clinical populations, such as impaired social and physical well-being and psychological distress, were also seen associated in this sample. Treatment should be targeted towards patients with these particular vulnerabilities in addition to focusing on substance-related factors, and interventions proven to improve the QoL of other populations with these vulnerabilities should be explored in a SUD context.

Changes in Quality of Life following Buprenorphine Treatment: Relationship with Treatment Retention and Illicit Opioid Use

Studies of substance abuse treatment outcomes that give priority to cessation of all drug use may obscure other tangible benefits of treatment that are important to patients. The aim of this study was to examine the association between changes in quality of life (QoL) and: (1) retention in treatment; and (2) opioid use as measured by self-report and urine testing. Participants were 300 African American men and women starting outpatient buprenorphine treatment. Participants completed assessments at baseline, three and six months consisting of the World Health Organization's Quality of Life brief scale, Addiction Severity Index, and urine testing for opioids. There were statistically significant increases over time across all four QoL domains: physical, psychological, environmental, and social. Self-reported frequency of opioid use was negatively associated with psychological QoL, but opioid urine test results were not significantly associated with any QoL domains. Continued treatment enrollment was significantly associated with higher psychological QoL and environmental QoL. Patients entering buprenorphine treatment experience improvements in QoL, which are amplified for patients who remain in treatment. Point-prevalence opiate urine test results obtained at each assessment were not associated with any of the QoL domains and may not accurately reflect improvements perceived by patients receiving buprenorphine treatment.

Personal network recovery enablers and relapse risks for women with substance dependence

We examined the experiences of women in treatment for substance dependence and their treatment providers about personal networks and recovery. We conducted six focus groups at three women's intensive substance abuse treatment programs. Four coders used thematic analysis to guide the data coding and an iterative process to identify major themes. Coders identified social network characteristics that enabled and impeded recovery and a reciprocal relationship between internal states, relationship management, and recovery. Although women described adding individuals to their networks, they also described managing existing relationships through distancing from or isolating some members to diminish their negative impact on recovery. Treatment providers identified similar themes but focused more on contextual barriers than the women. The focus of interventions with this population should be on both internal barriers to personal network change such as mistrust and fear, and helping women develop skills for managing enduring network relationships.

The relationship between recovery and health-related quality of life

Building upon recommendations to broaden the conceptualization of recovery and to assess its relationship with health-related quality of life (HRQoL), this study addressed three primary aims. These included: 1) testing the model fit of a hypothesized latent measure of recovery, 2) examining the extent to which this multidimensional measure of recovery was associated with concurrently measured HRQoL, and 3) examining the extent to which this multidimensional measure of recovery predicted changes in HRQoL during the subsequent year. Data were from 1,008 adults who completed follow-up assessments at 15 and 16 years post-intake. Confirmatory factor analysis indicated a good fit for a hypothesized recovery measure (CFI=.98; RMSEA=.06). Additionally, structural equation modeling suggested that this recovery measure was not only concurrently associated with HRQoL (β=.78, p<.001), but was also a significant predictor of changes in HRQoL during the subsequent year (β=.25, p<.001).

Effectiveness of mindfulness-based stress reduction intervention for health-related quality of life in drug-dependent males

BACKGROUND

Nowadays drug dependence has become one of the main concerns worldwide. Indeed, drug dependence and abuse have become personal, social and, health problems that intensively threat human resources.

OBJECTIVES

This study aimed to examine the effect of mindfulness-based stress reduction (MBSR) on health-related quality of life (HRQOL) in drug-dependent males.

PATIENTS AND METHODS

An experimental research with pretest/posttest design and a control group was conducted on 49 drug-dependent males. The selected individuals were randomly allocated to the study groups (24 to the experimental and 25 to the control groups). Afterwards, the Short Form Health Survey for HRQOL (SF-36) questionnaire was completed by participants. Subsequently, the experiment group experienced eight 90-minute sessions of training in MBSR. At the end of the training, the subjects were evaluated once again by SF-36. The independent-samples t test and analysis of covariance (ANCOVA) were used to analyses data.

RESULTS

The results suggested that the mean differences between groups regarding scales of role emotional, vitality, mental health, social functioning, and bodily pain were statistically significant (P < 0.05).

CONCLUSIONS

Using MBSR is recommended for improving HRQOL in drug-dependent males who are undergoing treatment for their drug dependence in addiction treatment center; however, more studies concerning different drugs as well as drug dependence in women must be performed.