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Palazón-Llecha A, Caparrós B, Trujols J, Duran-Sindreu S, Batlle F, Madre M, Mallorquí-Bagué N. Predictors of cocaine use disorder treatment outcomes: a systematic review. Syst Rev 2024; 13:124. [PMID: 38720357 PMCID: PMC11077740 DOI: 10.1186/s13643-024-02550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Psychosocial approaches are the first-line treatments for cocaine dependence, although they still present high dropout and relapse rates. Thus, there is a pressing need to understand which variables influence treatment outcomes to improve current treatments and prevent dropout and relapse rates. The aim of this study is to explore predictors of treatment retention and abstinence in CUD. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three databases-PubMed, PsychINFO and Web of Science-for randomized clinical trials (RCTs) published in English and Spanish from database inception through April 1, 2023. We selected all studies that met the inclusion criteria (adults aged ≥ 18, outpatient treatment, CUD as main addiction, and no severe mental illness) to obtain data for the narrative synthesis addressing cocaine abstinence and treatment retention as main outcome variables. After data extraction was completed, risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB-2). RESULTS A total of 566 studies were screened, and, of those, 32 RCTs were included in the synthesis. Younger age, more years of cocaine use, and craving levels were significant predictors of relapse and treatment dropout. Fewer withdrawal symptoms, greater baseline abstinence, greater treatment engagement, and more self-efficacy were all predictors of longer duration of abstinence. The role of impulsivity as a predictor of CUD is unclear due to conflicting data, although the evidence generally suggests that higher impulsivity scores can predict more severe addiction and withdrawal symptoms, and earlier discontinuation of treatment. CONCLUSION Current evidence indicates which variables have a direct influence on treatment outcomes, including well-studied cocaine use-related variables. However, additional variables, such as genetic markers, appear to have a high impact on treatment outcomes and need further study. SYSTEMATIC REVIEW REGISTRATION This systematic review is registered at PROSPERO (ID: CRD42021271847). This study was funded by the Spanish Ministry of Science, Innovation and Universities, Instituto Carlos III (ISCIII) (FIS PI20/00929) and FEDER funds and Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d'acció social 2020).
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Affiliation(s)
- Alba Palazón-Llecha
- Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain
- Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain
- Department of Psychology, University of Girona, Edifici Seminari, Campus Barri Vell, Sant Domènech 9, 17004, Girona, Spain
| | - Beatriz Caparrós
- Department of Psychology, University of Girona, Edifici Seminari, Campus Barri Vell, Sant Domènech 9, 17004, Girona, Spain
| | - Joan Trujols
- Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain
- Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 3-5, Pavellón 11, Planta 0, 28029, Madrid, Spain
| | - Santiago Duran-Sindreu
- Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain
- Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 3-5, Pavellón 11, Planta 0, 28029, Madrid, Spain
| | - Francesca Batlle
- Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain
- Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain
| | - Mercè Madre
- Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain
- Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain
| | - Núria Mallorquí-Bagué
- Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain.
- Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain.
- Department of Psychology, University of Girona, Edifici Seminari, Campus Barri Vell, Sant Domènech 9, 17004, Girona, Spain.
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Minozzi S, Saulle R, Amato L, Traccis F, Agabio R. Psychosocial interventions for stimulant use disorder. Cochrane Database Syst Rev 2024; 2:CD011866. [PMID: 38357958 PMCID: PMC10867898 DOI: 10.1002/14651858.cd011866.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Cabé J, Brousse G, Pereira B, Cabé N, Karsinti E, Zerdazi EH, Icick R, Llorca PM, Bloch V, Vorspan F, De Chazeron I. Influence of Clinical Markers of Dopaminergic Behaviors on Depressive Symptoms During Withdrawal in Cocaine Users. Front Psychiatry 2021; 12:775670. [PMID: 34880796 PMCID: PMC8645893 DOI: 10.3389/fpsyt.2021.775670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background: During cocaine withdrawal, transient depressive symptoms that do not meet the criteria for depression, but promote relapse, are frequently observed. Their temporality could evoke a role of dopamine, especially since the underlying mechanism of these depressive symptoms is not well understood. We hypothesized that variation in the dopaminergic activity profile, modeled from clinical markers, could be implicated in the development of depressive symptoms during cocaine withdrawal. Methods: We compared patients reporting depressive symptoms (RDS+) or not (RDS-) during cocaine withdrawal. We evaluated dopaminergic activity through indirect clinical markers based on the known dopaminergic behaviors. A combined criterion was constructed for hyper and hypo dopaminergic models according to the O'Brien method and illustrated by the Hedges' effect-size and forest-plot graph. A multidimensional factorial analysis was carried out to determine which parameters discriminate RDS+/RDS- patients. Results: 313 patients were included, and 77% reported depressive symptoms during cocaine withdrawal. Hyperdopaminergic variables used to discriminate the two groups had a large overall effect size (-0.669) and included psychotic symptoms (-0.524), hallucinations (-0.548), and delusions (-0.528). The overall effect of the hypodopaminergic component was considerable (-0.604) with a large effect size for the severity of dependence (-0.616), withdrawal symptoms (-0.578), and anhedonia (-0.528). The combined model including hyperdopaminergic and hypodopaminergic components had the largest effect size (-0.785). Conclusion: The dopaminergic activities profile, assessed by indirect clinical markers, seems to characterize patients with depressive symptoms very well during cocaine withdrawal. RDS+ patients reported moreover higher levels of psychotic symptoms and more severe cocaine use disorder than RDS-.
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Affiliation(s)
- Julien Cabé
- Service d'addictologie et pathologies duelles, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Georges Brousse
- Service d'addictologie et pathologies duelles, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et des Innovations, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Cabé
- Normandie University, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Emily Karsinti
- INSERM UMR-S 1144, Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - El-Hadi Zerdazi
- INSERM UMR-S 1144, Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Romain Icick
- INSERM UMR-S 1144, Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Pierre M. Llorca
- Université Clermont Auvergne, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
- Service de Psychiatrie B, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Vanessa Bloch
- INSERM UMR-S 1144, Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique–Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université de Paris, Paris, France
| | - Florence Vorspan
- INSERM UMR-S 1144, Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique–Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université de Paris, Paris, France
| | - Ingrid De Chazeron
- Service d'addictologie et pathologies duelles, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
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Ghosh A, Sharma N, Subodh BN, Basu D, Mattoo SK, Pillai RR. Predictors of Dropout from an Outpatient Treatment Program for Substance Use Disorders in India: a Retrospective Cohort Study of Patients Registered over a 10-Year Period (2009–2018). Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00417-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Papamalis FE. Examining the Relationship of Personality Functioning and Treatment Completion in Substance Misuse Treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820951777. [PMID: 33088177 PMCID: PMC7543119 DOI: 10.1177/1178221820951777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022]
Abstract
Background: Treatment retention is a major factor contributing to favourable outcome in
the treatment of substance misuse, but the literature remains very limited.
Despite evidence of the association of personality with drug use
experimentation and relapse, surprisingly little is known about its role in
the treatment process. Clients’ personality functioning as measured by
malleable and context sensitive characteristic adaptations in treatment are
of concern. Aims: This study examines whether, and to what extent, personality functioning
contributes to or hinders treatment completion. This paper examined the
extent to which service users’ characteristic adaptations may be potential
determinants of treatment completion. Methodology: A longitudinal multi-site design was utilised, examining the therapy process
in a naturalistic setting in five inpatient treatment units. The study
examined whether service users’ characteristic adaptations (SIPP-118)
predict completion, while controlling psychosocial, motivational and
treatment engagement indicators involving n = 340 participants from 5
inpatient centres. Multivariate regression analyses were
applied to examine the predictive role of characteristic adaptations on
treatment completion. Results: Findings indicated that certain dysfunctional characteristic adaptations
emerged as strong predictors of treatment completion. Dysfunctional levels
on Self-control and Social concordance were significant predictors of drop
out from treatment. Individuals with low capacity to tolerate, use and
control one’s own emotions and impulses were almost three times more likely
to drop-out compared to those without [OR] = 2.73, Wald = 6.09,
P = .014, 95% CI [1.2, 6.0]. Individuals with
dysfunctional levels on the ability to value someone’s identity, withhold
aggressive impulses towards others and work together with
others were 2.21 more times more likely to complete
treatment [OR] = 2.21, Wald = 4.12, P = .042, 95% CI [1.0,
4.7]. The analysis at the facet level provided additional insight.
Individuals with higher adaptive levels on Effortful Control were 46% more
times likely to complete treatment than the group [OR] = 4.67, Wald =
10.231, P = .001, 95% CI [1.81, 12.04], 47% more likely on
Aggression regulation [OR] = 4.76, Wald = 16.68, P <
.001, 95% CI [2.1, 10.3], and 26% more likely on Stable self-image [OR] =
2.62, Wald = 6.75, P < .009, 95% CI [0.9, 3.0]. Conclusions: These findings extend our knowledge of the predictive role of characteristic
adaptations in treatment completion and highlight the clinical utility of
capturing these individual differences early on. Delineating the role of
characteristic adaptations in treatment may provide the basis for enhancing
treatment effectiveness through individualized interventions that are
scientifically driven and may open new avenues for the scientific enquiry of
personality and treatment.
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Grundmann J, Lotzin A, Sehner S, Verthein U, Hiller P, Hiersemann R, Lincoln TM, Hillemacher T, Schneider B, Driessen M, Scherbaum N, Dotten AC, Schäfer I. Predictors of attendance in outpatient group treatment for women with posttraumatic stress disorder and substance use disorder. Psychother Res 2020; 31:632-643. [DOI: 10.1080/10503307.2020.1817604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Johanna Grundmann
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rena Hiersemann
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Hamburg, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Barbara Schneider
- Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Cologne, Cologne, Germany
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, Ev. Klinikum Bielefeld, Bielefeld, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - André C. Dotten
- Department of Psychiatry, Psychotherapy, Psychosomatic and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Petzold J, Weber B, Bassett TR, Bauer M, Bernhardt N, Groß C, Hasler H, Schützwohl M, Pilhatsch M. Effectiveness of the First German-Language Group Psychotherapy Manual to Accompany Short-Term Treatment in Methamphetamine Dependence. Front Psychiatry 2020; 11:130. [PMID: 32180742 PMCID: PMC7059436 DOI: 10.3389/fpsyt.2020.00130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Methamphetamine abuse is expanding in Europe, leading to a shortfall in medical care for related disorders in many regions. Research focusing on the effectiveness and feasibility of methamphetamine-specific treatment programs is scarce, especially in short-term settings. Methods: To this end, we treated 31 patients with methamphetamine dependence using a new group psychotherapy manual added to standard psychiatric care. Trained research assistants recorded demographic, illness and treatment variables using a standardized interview at baseline and a follow-up visit 3 months later. Outcome and process variables for this intervention encompassing 15 modules for qualified detoxification and motivation of patients with methamphetamine dependence are reported. Results: Retention and abstinence rates as well as acceptance and feasibility in daily routine were assessed positively. Patients with an unsuccessful outcome were characterized by longer regular methamphetamine use (t = -2.513, df = 29, p = 0.018) and a shorter abstinence period at baseline (U = 74.500, z = -1.808, p = 0.072). Among the demographic and clinical variables, the only predictor significantly increasing the odds of a successful outcome was a shorter period of regular methamphetamine use (OR = 1.318, CI 95% for OR = 1.021-1.700, b = 0.276, SE = 0.130, p = 0.034). Conclusions: This freely available therapy manual can help counter the shortfall in available psychotherapeutic interventions for patients with methamphetamine dependence in German-speaking countries. The routinely assessed parameters duration of regular methamphetamine use and abstinence before treatment were associated with outcome and may be used to personalize therapeutic strategies.
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Affiliation(s)
- Johannes Petzold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Benjamin Weber
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Tyler Ray Bassett
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cornelius Groß
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Helena Hasler
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Minozzi S, Saulle R, De Crescenzo F, Amato L. Psychosocial interventions for psychostimulant misuse. Cochrane Database Syst Rev 2016; 9:CD011866. [PMID: 27684277 PMCID: PMC6457581 DOI: 10.1002/14651858.cd011866.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psychostimulant misuse is a continuously growing medical and social burden. There is no evidence proving the efficacy of pharmacotherapy. Psychosocial interventions could be a valid approach to help patients in reducing or ceasing drug consumption. OBJECTIVES To assess the effects of psychosocial interventions for psychostimulant misuse in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive); Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science and PsycINFO, from inception to November 2015. We also searched for ongoing and unpublished studies via ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/).All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials comparing any psychosocial intervention with no intervention, treatment as usual (TAU) or a different intervention in adults with psychostimulant misuse or dependence. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 52 trials (6923 participants).The psychosocial interventions considered in the studies were: cognitive behavioural therapy (19 studies), contingency management (25 studies), motivational interviewing (5 studies), interpersonal therapy (3 studies), psychodynamic therapy (1 study), 12-step facilitation (4 studies).We judged most of the studies to be at unclear risk of selection bias; blinding of personnel and participants was not possible for the type of intervention, so all the studies were at high risk of performance bias with regard to subjective outcomes; the majority of studies did not specify whether the outcome assessors were blind. We did not consider it likely that the objective outcomes were influenced by lack of blinding.The comparisons made were: any psychosocial intervention versus no intervention (32 studies), any psychosocial intervention versus TAU (6 studies), and one psychosocial intervention versus an alternative psychosocial intervention (13 studies). Five of included studies did not provide any useful data for inclusion in statistical synthesis.We found that, when compared to no intervention, any psychosocial treatment: reduced the dropout rate (risk ratio (RR): 0.83, 95% confidence interval (CI) 0.76 to -0.91, 24 studies, 3393 participants, moderate quality evidence); increased continuous abstinence at the end of treatment (RR: 2.14, 95% CI 1.27 to -3.59, 8 studies, 1241 participants, low quality evidence); did not significantly increase continuous abstinence at the longest follow-up (RR: 2.12, 95% CI 0.77 to -5.86, 4 studies, 324 participants, low quality evidence); significantly increased the longest period of abstinence: (standardised mean difference (SMD): 0.48, 95% CI 0.34 to 0.63, 10 studies, 1354 participants, high quality evidence). However, it should be noted that the in the vast majority of the studies in this comparison the specific psychosocial treatment assessed in the experimental arm was given in add on to treatment as usual or to another specific psychosocial or pharmacological treatment which was received by both groups. So, many of the control groups in this comparison were not really untreated. Receiving some amount of treatment is not the same as not receiving any intervention, so we could argue that the overall effect of the experimental psychosocial treatment could be smaller if given in add on to TAU or to another intervention than if given to participants not receiving any intervention; this could translate to a smaller magnitude of the effect of the psychosocial intervention when it is given in add on.When compared to TAU, any psychosocial treatment reduced dropout rate (RR: 0.72, 95% CI 0.59 to 0.89, 6 studies, 516 participants, moderate quality evidence), did not increase continuous abstinence at the end of treatment (RR: 1.27, 95% CI 0.94 to 1.72, 2 studies, 224 participants, low quality evidence), did not increase longest period of abstinence (MD -3.15 days, 95% CI -10.35 to 4.05, 1 study, 110 participants, low quality evidence). No studies in this comparison assessed the outcome of continuous abstinence at longest follow-up.There were few studies comparing two or more psychosocial interventions, with small sample sizes and considerable heterogeneity in terms of the types of interventions assessed. None reported significant results.None of the studies reported harms related to psychosocial interventions. AUTHORS' CONCLUSIONS The addition of any psychosocial treatment to treatment as usual (usually characterised by group counselling or case management) probably reduces the dropout rate and increases the longest period of abstinence. It may increase the number of people achieving continuous abstinence at the end of treatment, although this might not be maintained at longest follow-up. The most studied and the most promising psychosocial approach to be added to treatment as usual is probably contingency management. However, the other approaches were only analysed in a few small studies, so we cannot rule out the possibility that the results were not significant because of imprecision. When compared to TAU, any psychosocial treatment may improve adherence, but it may not improve abstinence at the end of treatment or the longest period of abstinence.The majority of the studies took place in the United States, and this could limit the generalisability of the findings, because the effects of psychosocial treatments could be strongly influenced by the social context and ethnicity. The results of our review do not answer the most relevant clinical question, demonstrating which is the most effective type of psychosocial approach.Further studies should directly compare contingency management with the other psychosocial approaches.
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Affiliation(s)
- Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | - Rosella Saulle
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | - Franco De Crescenzo
- Catholic University of the Sacred HeartInstitute of Psychiatry and PsychologyL.go A. Gemelli 8RomeItaly00168
| | - Laura Amato
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
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Dalsbø TK, Hammerstrøm KT, Vist GE, Gjermo H, Smedslund G, Steiro A, Høie B. Psychosocial interventions for retention in drug abuse treatment. Hippokratia 2016. [DOI: 10.1002/14651858.cd008220.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Therese K Dalsbø
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo Norway N-0130
| | - Karianne T Hammerstrøm
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo Norway N-0130
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health Services; Prevention, Health Promotion and Organisation Unit; PO Box 7004 St Olavs Plass Oslo Norway 0130
| | - Hanne Gjermo
- Aker University Hospital; Division of Substance Addiction; Sognsvannsveien 21 Oslo Norway N-0320
| | - Geir Smedslund
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo Norway N-0130
| | - Asbjørn Steiro
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo Norway N-0130
| | - Bjørg Høie
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo Norway N-0130
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Majumder P, Sarkar S, Gupta R, Patra BN, Balhara YPS. Predictors of retention in treatment in a tertiary care de-addiction center. Indian J Psychiatry 2016; 58:27-30. [PMID: 26985101 PMCID: PMC4776577 DOI: 10.4103/0019-5545.174359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Retention in treatment can improve the outcomes of patients with substance use disorders. AIMS This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders. SETTING AND DESIGN This record-based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in Northern India. MATERIALS AND METHODS Patients were classified as being retained in treatment or drop-outs based on follow-up records. STATISTICAL ANALYSIS Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment. RESULTS A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10(th) grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance-related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention. CONCLUSION Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.
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Affiliation(s)
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Rishab Gupta
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Bichitra Nanda Patra
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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Newton-Howes G, Stanley J. Patient characteristics and predictors of completion in residential treatment for substance use disorders. BJPsych Bull 2015; 39:221-7. [PMID: 26755965 PMCID: PMC4706184 DOI: 10.1192/pb.bp.114.047639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To identify the patient characteristics and rates of retention in a residential rehabilitation drug and alcohol service (Springhill) based on an eclectic model of care. Patients were assessed using the Alcohol and Drug Outcome Measure (ADOM), a brief tool designed for the New Zealand setting. We looked at correlations between demographic, social and drug use parameters. Logistic regression assessed the relative impact of each variable on completion. Results The 183 patients who completed the data collection did not differ from 47 non-completers by demographic data; 62.2% of patients completed the programme, with equal number of men and women. One in five participants was Maori, the indigenous minority. Alcohol (51.9%) was the commonest drug of misuse, with methamphetamine (16.4%) and cannabis (14.2%) also significant. Completers were more likely to be Maori, have conflict with family and housing problems, although the last became non-significant in logistic regression. Clinical implications Retention rates are higher in Springhill than in comparable programmes. Ethnicity and family conflict predict completion, although the reasons for this are unclear. ADOM is an effective tool that can be used in a clinical setting to enable analysis of service provision.
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Knapp WP, Soares BGO, Farrell MF, Silva de Lima M. WITHDRAWN: Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev 2015; 2015:CD003023. [PMID: 25835305 PMCID: PMC10687506 DOI: 10.1002/14651858.cd003023.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Review withdrawn as the Cochrane Funding Arbitration Panel found this review non‐compliant with the Cochrane’s commercial sponsorship policy. The new author team will update and replace this review. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
| | - Bernardo GO Soares
- Universidade Federal de São PauloBrazilian Cochrane CentreRua Pedro de Toledo 598São PauloSão PauloBrazil04039‐001
| | - Michael F Farrell
- University of New South WalesNational Drug and Alcohol Research Centre36 King StreetRandwickSydneyNSWAustraliaNSW 2025
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Sánchez-Hervás E, Gómez FJS, Villa RS, García-Fernández G, García-Rodríguez O, Romaguera FZ. Psychosocial Predictors of Relapse in Cocaine-Dependent Patients in Treatment. SPANISH JOURNAL OF PSYCHOLOGY 2013; 15:748-55. [DOI: 10.5209/rev_sjop.2012.v15.n2.38886] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Relapses in cocaine abusers in treatment are an important problem. The majority of patients are incapable of sustaining abstinence over any length of time. To identify the factors associated to relapses risk in the cocaine use can be an optimal choice to improve the treatment strategies. The aim of this study was to analyze relapse-risk factors in cocaine-dependent patients on treatment. Participants were 102 patients who had begun outpatient treatment at a public health center in Spain. Some functional areas and cocaine use are evaluated for a period of six months. A structural equations model was used to identify possible predictive variables. The results show that social-family environment and economic-employment situation were associated with greater risk of relapse. Likewise, the social-family environment was related to severity of addiction. It is concluded that the incorporation of family intervention strategies and vocational/employment counseling may help to reduce relapse rates in cocaine addicts receiving treatment.
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Colpaert K, Vanderplasschen W, De Maeyer J, Broekaert E, De Fruyt F. Prevalence and determinants of personality disorders in a clinical sample of alcohol-, drug-, and dual-dependent patients. Subst Use Misuse 2012; 47:649-61. [PMID: 22288949 DOI: 10.3109/10826084.2011.653427] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study compares the prevalence rates of 12 personality disorders (PDs) among patients with alcohol, drug, and dual dependence through chi-square tests and analyses of variance. It further investigates possible predictors of these PDs through multiple linear regression analyses. Data were gathered in 2007-2008 among 274 patients admitted to intensive, residential substance abuse treatment programs in Belgium, using the ADP-IV (Assessment of DSM-IV Personality Disorders), the EuropASI (European version of the Addiction Severity Index), and the MINI (Mini International Neuropsychiatric Interview). The analyses showed that drug- and dual-dependent patients have higher PD prevalence rates than alcohol-dependent patients. The severity, but not the nature of the dependence, appears as an important predictor for personality pathology.
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Affiliation(s)
- Kathy Colpaert
- Department of Orthopedagogics, Ghent University, Ghent, Belgium.
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Raylu N, Kaur I. Relationships Between Treatment Expectations and Treatment Outcomes Among Outpatients with Substance Use Problems. Int J Ment Health Addict 2011. [DOI: 10.1007/s11469-011-9358-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tate SR, Mrnak-Meyer J, Shriver CL, Atkinson JH, Robinson SK, Brown SA. Predictors of treatment retention for substance-dependent adults with co-occurring depression. Am J Addict 2011; 20:357-65. [PMID: 21679267 DOI: 10.1111/j.1521-0391.2011.00137.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified as a pervasive challenge. We examine predictors of treatment retention in a sample of veterans (N = 253) participating in a clinical trial comparing two types of psychotherapy for co-occurring depression and substance use disorders. The study protocol included 24 weeks of outpatient group psychotherapy in either a newly developed Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy (TSF). Using a model of treatment utilization developed by Aday and Anderson, we analyzed predictors categorized into predisposing factors, enabling resources, need for treatment, and type of treatment received. Outcome included total number of sessions attended (maximum of 36 sessions). Treatment retention did not differ between the two study interventions. Bivariate analyses indicated that predisposing factors were most predictive, with older participants, Caucasians, and those using only alcohol in the month before treatment attending more sessions, and individuals who had recently experienced a health event remained in treatment longer. Importantly, several factors were not related to treatment retention: marital status, education, neuropsychological functioning, financial stress, chronic health problems, treatment motivation, and psychiatric severity. In the combined model of predisposing, enabling and need factors, age and ethnicity were the only significant predictors.
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Affiliation(s)
- Susan R Tate
- VA San Diego Healthcare System, California 92161, USA.
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Öhlin L, Hesse M, Fridell M, Tätting P. Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile. BMC Psychiatry 2011; 11:81. [PMID: 21569440 PMCID: PMC3112080 DOI: 10.1186/1471-244x-11-81] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 05/12/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Continuous abstinence and retention in treatment for alcohol and drug use disorders are central challenges for the treatment providers. The literature has failed to show consistent, strong predictors of retention. Predictors and treatment structure may differ across treatment modalities. In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. METHODS Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients dropped out within the first week. Of the remaining 123 demographic data and psychiatric assessment were used to predict involuntary discharge from treatment and corresponding cumulative abstinence probability. All subjects were administered the Structured Clinical Interview for DSM-IV-TR, and the Symptom Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews. RESULTS Of 123 patients admitted, 86 (70%) remained in treatment after six months and 61 (50%) remained in treatment after 12 months. Of those discharged involuntarily, 34/62 individuals were readmitted after a suspension period of three months. Younger age at intake, poly-substance abuse at intake (number of drugs in urine), and number of conduct disorder criteria on the SCID Screen were independently associated with an increased risk of involuntary discharge. There were no significant differences between dropouts and completers on SCL-90, SSP, SOC or AUDIT. CONCLUSION Of the patients admitted to the programme 50% stayed for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on retention and abstinence.
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Affiliation(s)
- Leif Öhlin
- Department of Psychiatry, St Lars Hospital, Lund, Swedena.
| | - Morten Hesse
- Center for Alcohol and Drug Research, University of Aarhus, Copenhagen, Denmark
| | - Mats Fridell
- Professor, Department of Psychology, Lund University & Linnaeus University, Växjö, Sweden
| | - Per Tätting
- Department of Psychiatry, St Lars Hospital, Lund, Sweden
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del Río EF, Becoña E, Durán AL. Subtypes of smokers who attend psychological treatment in order to stop smoking. Subst Use Misuse 2011; 46:1113-23. [PMID: 21406006 DOI: 10.3109/10826084.2011.561467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study is to identify subtypes of smokers who attended psychological treatment during the period 2006-2008 for smoking cessation from a sample of current smokers (N = 202) from Galicia, Spain. Eight instruments were used for data collection. Demographic variables, smoking variables, and psychopathological characteristics were clustered to establish typologies of smokers. A two-phase cluster analysis identified two subtypes of smokers (141 in Cluster 1 and 61 in Cluster 2). Those in Cluster 2 were younger, and had made an attempt to quit in the last year. They presented higher levels of nicotine dependence and psychopathology than those in Cluster 1. Differences in nicotine withdrawal syndrome, cigarette consumption at the end of the treatment, and adherence to the treatment were significant across the two clusters.
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Affiliation(s)
- Elena Fernández del Río
- Smoking Cessation Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Pretreatment Characteristics as Predictors of Retention in Cocaine-dependent Outpatients. ADDICTIVE DISORDERS & THEIR TREATMENT 2010. [DOI: 10.1097/adt.0b013e3181bff7ec] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hesse M. Psychoeducation for personality disorders as an add‐on to substance abuse treatment versus attention placebo: a controlled trial. DRUGS AND ALCOHOL TODAY 2010. [DOI: 10.5042/daat.2010.0125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dalsbø TK, Hammerstrøm KT, Vist GE, Gjermo H, Smedslund G, Steiro A, Høie B. Psychosocial interventions for retention in drug abuse treatment. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Stulz N, Gallop R, Lutz W, Wrenn GL, Crits-Christoph P. Examining differential effects of psychosocial treatments for cocaine dependence: an application of latent trajectory analyses. Drug Alcohol Depend 2010; 106:164-72. [PMID: 19782480 PMCID: PMC2814930 DOI: 10.1016/j.drugalcdep.2009.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 08/17/2009] [Accepted: 08/18/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND The NIDA Collaborative Cocaine Treatment Study yielded different efficacies for different psychosocial treatments for cocaine dependence. However, substantial heterogeneity of patient outcomes was evident. Longitudinal data analysis techniques can be helpful in examining differential effects of psychosocial interventions on specific subpopulations of patients. METHODS Overall drug and cocaine use of 346 patients diagnosed with DSM-IV cocaine dependence and treated with one of four psychosocial interventions were assessed monthly during 6-month treatment. Growth mixture models were used to identify patient subgroups based on typical patterns of change in substance use during treatment and to evaluate differential treatment effects within these subgroups. RESULTS Three patient subgroups following different change patterns in cocaine and overall drug use were identified irrespective of the treatment type: (a) those with moderate baseline severity of drug use and very rapid reduction of drug use during treatment, (b) those with moderate baseline severity of drug use and moderate reduction of drug use during treatment, and (c) those with severe levels of baseline drug use with moderate reduction of drug use during treatment. Patient baseline characteristics enabled discrimination between these subgroups. Individual drug counseling was most efficacious among those patients with moderate baseline severity and moderate treatment response. There were no differential treatment effects in the two other patient subgroups. CONCLUSIONS The population of treatment-seeking cocaine dependent individuals is heterogeneous. Research on patient subgroups with different change patterns revealed its potential to enable classifications of patients that indicate which treatment is most effective for which type of patient.
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Affiliation(s)
- Niklaus Stulz
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
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Laudet AB, Stanick V, Sands B. What could the program have done differently? A qualitative examination of reasons for leaving outpatient treatment. J Subst Abuse Treat 2009; 37:182-90. [PMID: 19339133 PMCID: PMC2716417 DOI: 10.1016/j.jsat.2009.01.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 12/22/2008] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
Abstract
Attrition from treatment for substance abuse disorders is a persistent challenge that severely limits the effectiveness of services. Although a large body of research has sought to identify predictors of retention, the perspective of clients of services is rarely examined. This exploratory qualitative study presents clients' stated reasons for leaving outpatient treatment (n = 135, 54% of the sample of 250) and their views of what could have been done differently to keep them engaged in services. Obstacles to retention fell into program- and individual-level factors. Program-level barriers include dissatisfaction with the program, especially counselors; unmet social services needs; and lack of flexibility in scheduling. Individual-level barriers to retention were low problem recognition and substance use. Study limitations are noted, and the implications of findings for research and practice are discussed, emphasizing the need to understand and address clients' needs and expectations starting at intake to maximize treatment retention and the likelihood of positive outcomes.
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Affiliation(s)
- Alexandre B Laudet
- Center for the Study of Addictions and Recovery at National Development and Research Institutes, Inc., (NDRI), NYC, NY 10010, USA.
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Evans E, Li L, Hser YI. Client and program factors associated with dropout from court mandated drug treatment. EVALUATION AND PROGRAM PLANNING 2009; 32:204-12. [PMID: 19150133 PMCID: PMC2703685 DOI: 10.1016/j.evalprogplan.2008.12.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 11/17/2008] [Accepted: 12/04/2008] [Indexed: 05/05/2023]
Abstract
To examine why court mandated offenders dropout of drug treatment and to compare their characteristics, treatment experiences, perceptions, and outcomes with treatment completers, we analyzed self-reported and administrative data on 542 dropouts (59%) and 384 completers (41%) assessed for Proposition 36 treatment by thirty sites in five California counties during 2004. At intake, dropouts had lengthier criminal histories, lower treatment motivation, more severe employment and psychiatric problems, and more were using drugs, especially heroin. Relatively fewer dropouts received residential treatment and their retention was much shorter. A similar proportion of dropouts received services as completers and the mean number of services received per day by dropouts was generally more, especially to address psychiatric problems, during the first three months of treatment. The most commonly offender-reported reasons for dropout included low treatment motivation (46.2%) and the difficulty of the Proposition 36 program (20.0%). Consequences for dropout included incarceration (25.3%) and permission to try treatment again (24.0%). Several factors predicting drug treatment dropout were identified. Both groups demonstrated improved functioning at one-year follow-up, but fewer dropouts had a successful outcome (34.5% vs. 59.1%) and their recidivism rate was significantly higher (62.9% vs. 28.9%) even after controlling for baseline differences. Understanding factors associated with drug treatment dropout can aid efforts to improve completion rates, outcomes, and overall effectiveness of California's Proposition 36 program. Findings may also aid a broader audience of researchers and policy analysts who are charged with designing and evaluating criminal-justice diversion programs for treating drug-addicted offenders.
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Affiliation(s)
- Elizabeth Evans
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 1640 S. Sepulveda Blvd., Los Angeles, CA 90025, USA.
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Meier PS, Barrowclough C. Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630701741030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Graff FS, Morgan TJ, Epstein EE, McCrady BS, Cook SM, Jensen NK, Kelly S. Engagement and retention in outpatient alcoholism treatment for women. Am J Addict 2009; 18:277-88. [PMID: 19444731 PMCID: PMC3137894 DOI: 10.1080/10550490902925540] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Reviews of the dropout literature note significant attrition from addiction treatment. However, consistent predictors have not been identified and few studies have examined factors related to retention and engagement for women in gender-specific treatment. The current study consisted of 102 women and their partners randomized to individual or couples outpatient alcoholism treatment. Women attended more treatment sessions if they were assigned to individual treatment, older, had fewer symptoms of alcohol dependence, had more satisfying marital relationships, had spouses who drank, and had matched preference for treatment condition. Women were more engaged in treatment (ie, completed more assigned homework) if they had fewer children at home, fewer alcohol dependence symptoms, later age of onset of alcohol diagnosis, more satisfying marital relationships, and spouses who accepted or encouraged their drinking. Results highlight important associations of treatment and relationship variables with treatment retention and engagement.
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Affiliation(s)
- Fiona S Graff
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854-8001, USA.
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Palmer RS, Murphy MK, Piselli A, Ball SA. Substance user treatment dropout from client and clinician perspectives: a pilot study. Subst Use Misuse 2009; 44:1021-38. [PMID: 19938942 PMCID: PMC3678276 DOI: 10.1080/10826080802495237] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Reasons for premature termination of outpatient substance user treatment were evaluated from client and clinician perspectives using qualitative (focus groups) and quantitative (survey) methods in a pilot study (N = 44). The sample consisted of clients (n = 22), the majority of whom were male (73%) and African American (50%) or Caucasian (41%). The sample of clinicians (n = 22) were predominantly female (64%), and Caucasian (52%) or African American (24%). The most frequently endorsed reasons for leaving treatment were related to individual rather than program characteristics with heavy drug or alcohol use, transportation or financial problems, and ambivalence about abstinence being highly rated by both clinicians and clients. Survey results indicated that clinicians more frequently attributed treatment dropout to individual- or client-level factors than did clients. Focus group ratings indicated that clinicians felt client motivation and staff connection issues were primary reasons for dropout, whereas clients indicated social support and staff connection issues. The findings suggest that the development of early therapeutic alliance and active problem solving of potential barriers to treatment attendance may influence treatment retention.
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Affiliation(s)
- Rebekka S Palmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA.
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28
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Hesse M, Pedersen MK. Protocol: Personality assessment as a support for referral and case-work in treatment for substance use disorders (PASRC-study). BMC Psychiatry 2008; 8:30. [PMID: 18439244 PMCID: PMC2377244 DOI: 10.1186/1471-244x-8-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of co-morbid personality disorders in substance use disorders may lead to important insights concerning individual patients. However, little is known about the potential value of routine personality disorder assessment in a clinical context. METHODS Patients are adults with past-year substance dependence seeking treatment at a centralized intake unit for substance abusers in the City of Copenhagen. A randomized controlled trial of assessment of personality disorders and individual feedback vs. a general life situation interview. Patients are followed at 3 and 6 months post-treatment DISCUSSION If routine personality assessment improves outcomes of substance abuse treatment, the clinical implication is to increase the use of personality disorder assessment in substance abuse treatment settings. TRIAL REGISTRATION Current controlled trials ISRCTN39851689.
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Affiliation(s)
- Morten Hesse
- University of Aarhus, Centre for Alcohol and Drug Research, Købmagergade 26E, 1150 Copenhagen C, Denmark.
| | - Mads K Pedersen
- University of Aarhus, Centre for Alcohol and Drug Research, Købmagergade 26E, 1150 Copenhagen C, Denmark
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29
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Graff FS, Griffin ML, Weiss RD. Predictors of dropout from group therapy among patients with bipolar and substance use disorders. Drug Alcohol Depend 2008; 94:272-5. [PMID: 18162331 PMCID: PMC2268018 DOI: 10.1016/j.drugalcdep.2007.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 10/30/2007] [Accepted: 11/01/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bipolar and substance use disorders frequently co-occur. Integrated treatment for these disorders has been shown to be effective at reducing substance use, but no study has examined attrition from dual diagnosis group therapy. The current study identified baseline demographic and clinical characteristics that predict treatment dropout among patients with co-occurring bipolar and substance use disorders. METHOD Using binary and multivariate analyses, baseline data were analyzed as part of a randomized controlled trial of integrated group therapy for bipolar and substance use disorders. RESULTS Cigarette smoking, recent mood episode, and lack of a college education were strong predictors of dropout after controlling for demographic and substance use variables. CONCLUSIONS Given the strength of smoking as a predictor of dropout as well as the high rate of smoking among this population, a greater focus on the relationship between smoking and bipolar disorder is warranted.
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Affiliation(s)
- Fiona S Graff
- Department of Psychiatry, Harvard Medical School and McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
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30
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Streeter CC, Terhune DB, Whitfield TH, Gruber S, Sarid-Segal O, Silveri MM, Tzilos G, Afshar M, Rouse ED, Tian H, Renshaw PF, Ciraulo DA, Yurgelun-Todd DA. Performance on the Stroop predicts treatment compliance in cocaine-dependent individuals. Neuropsychopharmacology 2008; 33:827-36. [PMID: 17568399 DOI: 10.1038/sj.npp.1301465] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment dropout is a problem of great prevalence and stands as an obstacle to recovery in cocaine-dependent (CD) individuals. Treatment attrition in CD individuals may result from impairments in cognitive control, which can be reliably measured by the Stroop color-word interference task. The present analyses contrasted baseline performance on the color-naming, word-reading, and interference subtests of the Stroop task in CD subjects who completed a cocaine treatment trial (completers: N=50) and those who dropped out of the trial before completion (non-completers: N=24). A logistic regression analysis was used to predict trial completion using three models with the following variables: the Stroop task subscale scores (Stroop model); the Hamilton depression rating scale (HDRS) scores (HDRS model); and both the Stroop task subscale scores and HDRS scores (Stroop and HDRS model). Each model was able to significantly predict group membership (completers vs non-completers) better than a model based on a simple constant (HDRS model p=0.02, Stroop model p=0.006, and Stroop and HDRS model p=0.003). Models using the Stroop preformed better than the HDRS model. These findings suggest that the Stroop task can be used to identify cocaine-dependent subjects at risk for treatment dropout. The Stroop task is a widely available, reliable, and valid instrument that can be easily employed to identify and tailor interventions of at risk individuals in the hope of improving treatment compliance.
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Affiliation(s)
- Chris C Streeter
- Division of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA.
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Stotts AL, Mooney ME, Sayre SL, Novy M, Schmitz JM, Grabowski J. Illusory predictors: Generalizability of findings in cocaine treatment retention research. Addict Behav 2007; 32:2819-36. [PMID: 17543472 PMCID: PMC2249556 DOI: 10.1016/j.addbeh.2007.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 03/09/2007] [Accepted: 04/25/2007] [Indexed: 11/29/2022]
Abstract
Treatment retention is of paramount importance in cocaine treatment research as treatment completion rates are often 50% or less. Failure to retain cocaine patients in treatment has both significant research and clinical implications. In this paper we qualitatively and quantitatively demonstrate the inconsistency found across analyses of retention predictors in order to highlight the problem. First, a qualitative review of the published literature was undertaken to identify the frequency of predictors studied and their relations to treatment retention. Second, an empirical demonstration of predictor stability was conducted by testing a common set of variables across three similar 12-week cocaine clinical trials conducted by the same investigators in the same research clinic within a five-year period. Results of the literature review indicated inconsistently selected variables of convenience, widely varying statistical procedures, and discrepant findings of significance. Further, quantitative analyses resulted in discrepancies in variables identified as significant predictors of retention among the three studies. Potential sources of heterogeneity affecting the consistency of findings across studies and recommendations to improve the validity and generalizability of predictor findings in future studies are proposed.
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Knapp WP, Soares BGO, Farrel M, Lima MS. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev 2007:CD003023. [PMID: 17636713 DOI: 10.1002/14651858.cd003023.pub2] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The consumption of psychostimulants for non-medical reasons probably occurs because of their euphoriant and psychomotor-stimulating properties. Chronic consumption of these agents results in development of stereotyped behaviour, paranoia, and possibly aggressive behaviour. Psychosocial treatments for psychostimulant use disorder are supposed to improve compliance, and to promote abstinence. Evidence from randomised controlled trials in this subject needs to be summarised. OBJECTIVES To conduct a systematic review of all RCTs on psychosocial interventions for treating psychostimulant use disorder. SEARCH STRATEGY Electronic searches of Cochrane Library, EMBASE, MEDLINE, and LILACS (to may 2006); reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of psychostimulants abuse/ dependence. SELECTION CRITERIA All randomised-controlled trials focusing on psychosocial interventions for treating psychostimulants abuse/ dependence. DATA COLLECTION AND ANALYSIS Three authors extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated, when possible. The reviewers assumed that people who died or dropped out had no improvement (intention to treat analysis) and tested the sensitivity of the final results to this assumption. MAIN RESULTS Twenty-seven randomised controlled studies (3663 participants) fulfilled inclusion criteria and had data that could be used for at least one of the main comparisons. There was a wide heterogeneity in the interventions evaluated: this did not allow to provide a summary estimate of effect and results cannot be summarised in a clear cut way. The comparisons between different type of Behavioural Interventions showed results in favour of treatments with some form of Contingency management in respect to both reducing drop outs and lowering cocaine use.. AUTHORS' CONCLUSIONS Overall this review reports little significant behavioural changes with reductions in rates of drug consumption following an intervention. Moreover, with the evidence currently available, there are no data supporting a single treatment approach that is able to comprise the multidimensional facets of addiction patterns and to significantly yield better outcomes to resolve the chronic, relapsing nature of addiction, with all its correlates and consequences.
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Affiliation(s)
- W P Knapp
- Universidade Federal do Rio Grande do Sul, Psychiatry, Avenue Paulo Gama 110, Porto Alegre, Brazil.
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Chawdhary A, Sayre SL, Green C, Schmitz JM, Grabowski J, Mooney ME. Moderators of delay tolerance in treatment-seeking cocaine users. Addict Behav 2007; 32:370-6. [PMID: 16713126 DOI: 10.1016/j.addbeh.2006.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 03/21/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
A substantial amount of attrition in cocaine dependence treatment studies occurs between the initial telephone contact and the first evaluative clinic visit. While decreasing the wait to first visit can significantly reduce pre-intake attrition (PIA), little is known about other factors that moderate delay tolerance for first clinic visit. The current report uses data from 833 subjects who completed a first-contact telephone interview prior to an intake evaluation visit for cocaine use treatment research. Hierarchical logistic regression was used to assess three successive models to predict PIA, with the most inclusive model testing interactions between delay interval and seven predictors: age, gender, treatment motivation, recency of cocaine, alcohol, and tobacco use, and self-reported depression. Consistent with previous reports, greater delay to first clinic visit predicted PIA. However, no evidence for the moderating role of the selected factors was found. Overall, the utility of the logistic models, built on basic demographic and psychiatric factors, was poor, as evaluated using receiver-operator characteristic curves. Alternative factors must be examined to identify predictors that will increase probability of initial enrolment in cocaine-dependence clinical trials.
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Affiliation(s)
- Ayesha Chawdhary
- University of Texas Health Science Center-Houston Substance Abuse Research Center, USA
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Meier PS, Donmall MC, McElduff P, Barrowclough C, Heller RF. The role of the early therapeutic alliance in predicting drug treatment dropout. Drug Alcohol Depend 2006; 83:57-64. [PMID: 16298088 DOI: 10.1016/j.drugalcdep.2005.10.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 10/20/2005] [Accepted: 10/21/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the role of the therapeutic alliance in predicting length of retention in residential drug treatment. METHODS The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and the average total scores of client and counsellor ratings on the WAI-S (obtained during weeks 1-3) were use as the alliance measure. Length of retention and treatment completion (stay beyond 90 days) were used as measures of retention. RESULTS Clients with weak counsellor rated alliances dropped out of treatment significantly sooner than clients with strong counsellor rated therapeutic alliances, whether or not the model adjusted for individual counsellor effects and potential confounders including psychological well-being, treatment motivation and readiness, coping strategies, and attachment style. The client rated alliance did not predict length of retention. Apart from the alliance, pre-treatment crack use, secure attachment style and better coping strategies were associated with shorter retention, whereas greater confidence in treatment, older client age and better education predicted treatment completion. Counsellors with greater experience of delivering drug counselling retained clients longer. CONCLUSIONS The findings of this study stress the importance of treatment professionals attending to the therapeutic alliance in drug treatment, as counsellors' alliance ratings were found to be amongst the strongest predictors of dropout. Using alliance measures as clinical tools may help treatment practitioners to become aware of the risk of disengagement early on. Prospective studies are needed to evaluate whether strategies of reallocating clients with poor alliances to different counsellors lead to improvements in retention.
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Affiliation(s)
- Petra S Meier
- Department of Psychology, Manchester Metropolitan University, UK.
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35
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McKellar J, Kelly J, Harris A, Moos R. Pretreatment and during treatment risk factors for dropout among patients with substance use disorders. Addict Behav 2006; 31:450-60. [PMID: 15979244 DOI: 10.1016/j.addbeh.2005.05.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 05/17/2005] [Accepted: 05/17/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to use pretreatment and treatment factors to predict dropout from residential substance use disorder program and to examine how the treatment environment modifies the risk for dropout. METHOD This study assessed 3649 male patients at entry to residential substance use disorder treatment and obtained information about their perceptions of the treatment environment. RESULTS Baseline factors that predicted dropout included younger age, greater cognitive dysfunction, more drug use, and lower severity of alcohol dependence. Patients in treatment environments appraised as low in support or high in control also were more likely to drop out. Further, patients at high risk of dropout were especially likely to dropout when treated in a highly controlling treatment environment. CONCLUSION Better screening of risk factors for dropout and efforts to create a less controlling treatment environment may result in increased retention in substance use disorder treatment.
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Affiliation(s)
- John McKellar
- Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, (152), 795 Willow Road, Menlo Park, CA 94025, USA.
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Simpson DD, Joe GW. A longitudinal evaluation of treatment engagement and recovery stages. J Subst Abuse Treat 2004; 27:89-97. [PMID: 15450643 DOI: 10.1016/j.jsat.2004.03.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2003] [Revised: 02/18/2004] [Accepted: 03/15/2004] [Indexed: 11/25/2022]
Abstract
Recent methodological advancements for structural equation modeling were used to test a comprehensive version of the TCU Treatment Model, especially for addressing the hypothesized sequential relationships of early engagement components (participation and therapeutic relationship) and early recovery (psychosocial and behavioral changes) that contribute to retention and posttreatment recovery. Relationships among pretreatment patient motivation, treatment process elements, a cognitive-based treatment strategy, retention, and drug use outcomes were estimated using intake, during treatment, and 1-year followup data for 711 patients in outpatient methadone treatment. Hypothesized sequential elements representing treatment process and patient functioning were supported, and relationships between these components were estimated also as odds ratios as an aid for translating the findings and increasing their clinical usefulness to treatment settings.
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Affiliation(s)
- D Dwayne Simpson
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA.
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Wong CJ, Anthony S, Sigmon SC, Mongeon JA, Badger GJ, Higgins ST. Examining interrelationships between abstinence and coping self-efficacy in cocaine-dependent outpatients. Exp Clin Psychopharmacol 2004; 12:190-9. [PMID: 15301636 DOI: 10.1037/1064-1297.12.3.190] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Initial abstinence and self-efficacy predict treatment outcome in cocaine-dependent outpatients. Associations between abstinence and coping self-efficacy were examined among cocaine-dependent outpatients (N=126). Abstinence was verified by urinalysis. Coping self-efficacy was measured using a modified Situational Confidence Questionnaire (SCQ). The modified SCQ had good validity and reliability, and scores increased during treatment. In bivariate analyses, early abstinence and SCQ scores each predicted subsequent abstinence and confidence during treatment and posttreatment follow-up. Based on structural equation modeling, early confidence was a significant predictor of later confidence but not of later abstinence, whereas early abstinence was a significant predictor of later abstinence and confidence. Results suggest a unidirectional relationship wherein prior abstinence predicts subsequent abstinence and confidence.
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Affiliation(s)
- Conrad J Wong
- University of Vermont, Department of Psychology, Burlington, VT, USA.
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Kelly S, Epstein EE, McCrady BS. Pretreatment attrition from couple therapy for male drug abusers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2004; 30:1-19. [PMID: 15083551 DOI: 10.1081/ada-120029861] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study tracked pretreatment attrition of 120 callers, 84 of whom were potentially eligible for outpatient couple treatment for male drug abuse. Demographic, significant other, substance use, and access related variables were examined as predictors of intake and treatment entry. Results were similar to other findings regarding variables associated with initiation of individual substance use treatment, and 29% of eligible callers entered treatment. Men whose partners did not use substances or who used in moderation were more likely to attend the intake session, and couples who received referrals were more likely to enter treatment than those who responded to a newspaper advertisement.
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Affiliation(s)
- Shalonda Kelly
- Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854-8085, USA.
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Patkar AA, Murray HW, Mannelli P, Gottheil E, Weinstein SP, Vergare MJ. Pre—Treatment Measures of Impulsivity, Aggression and Sensation Seeking Are Associated with Treatment Outcome for African—American Cocaine—Dependent Patients. J Addict Dis 2004; 23:109-22. [PMID: 15132346 DOI: 10.1300/j069v23n02_08] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated whether measures of impulsivity, aggression and sensation seeking differed between cocaine-dependent subjects and controls, and whether these measures were related to treatment-outcome for cocaine patients. Pre-treatment assessments of impulsivity (Barratt Impulsivity Scale [BIS]), aggression (Buss-Durkee Hostility Inventory [BDHI]) and sensation seeking (Zuckerman Sensation Seeking Scale [SSS]) were obtained for 141 African-American cocaine-dependent patients entering a 12-week, intensive outpatient treatment program and 60 controls. The outcome measures were number of negative urine drug screens, days in treatment, dropout rates and number of treatment sessions. Cocaine patients reported significantly higher scores on the SSS, the BIS and the BDHI than controls. Furthermore, the SSS scores showed a significantly negative correlation with days in treatment and negative urines, and a significant positive correlation with the dropout rate. The BIS and the BDHI scores were significantly associated with days in treatment and dropout rates respectively. A combination of the three variables contributed significantly toward predicting retention and abstinence. Higher levels of pretreatment impulsivity and aggression and sensation seeking seem to associated with poor treatment outcome for cocaine dependent patients receiving intensive outpatient treatment. Combining these behavioral measures with other clinical predictors may help in early identification of 'poor responders' who may benefit from additional or alternative treatment approaches.
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Affiliation(s)
- Ashwin A Patkar
- Division of Substance Abuse Programs, Department of Psychiatry and Human Behavior, Thomas Jefferson University, 833 Chestnut Street East, Suite 210E, Philadelphia, PA 19107, USA.
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40
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King AC, Canada SA. Client-related predictors of early treatment drop-out in a substance abuse clinic exclusively employing individual therapy. J Subst Abuse Treat 2004; 26:189-95. [PMID: 15063912 DOI: 10.1016/s0740-5472(03)00210-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Revised: 10/15/2003] [Accepted: 11/16/2003] [Indexed: 10/26/2022]
Abstract
The present study examined predictors of early drop-out in a heterogeneous male and female outpatient sample enrolled in an addiction program. Clients who failed to attend five or more individual therapy sessions were considered "non treatment-engaged." Sixty-four percent of the sample engaged in initial treatment, compared to 36% who were early drop-outs. The latter group, compared to the former group, was significantly less educated and was more likely to be African American, female, report cocaine as the primary drug of choice, and be referred from outside the larger medical center (p <.05). In multivariate models, female gender and African American ethnicity were independent predictors of early treatment drop-out (p <.00001). Although substance-related factors influenced treatment outcomes, their effects were weakened when taken into consideration with demographic factors such as gender and ethnicity. Continued examination of ethnicity, gender, and other potential negative prognostic factors for attendance in various addiction treatment milieus may aid in provision of appropriate services especially for high-risk clients.
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Affiliation(s)
- Andrea C King
- Department of Psychiatry, University of Chicago, 5841 South Maryland Avenue, MC-3077, Chicago, IL 60637, USA.
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Borrelli B, Hogan JW, Bock B, Pinto B, Roberts M, Marcus B. Predictors of quitting and dropout among women in a clinic-based smoking cessation program. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2002; 16:22-7. [PMID: 11934082 DOI: 10.1037/0893-164x.16.1.22] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Most cessation studies assume that dropouts are smokers. Instead, the authors analyzed these outcomes separately using multinomial regression to model the relative risk of quitting versus continued smoking and dropping out. Female (N = 281) smokers were randomly assigned to a 12-week smoking cessation program plus either a 3-times-per-week exercise program or a contact control wellness program. Higher body mass index and longer prior quit attempts predicted cessation. Self-efficacy was associated with a lower likelihood of dropout. Greater nicotine dependence and lower education predicted continued smoking or dropout versus quitting among exercisers. Patterns of smoking, dropping out, and quitting between Weeks 5 and 12 were different between exercisers and controls. Dropouts should be considered as a separate category from smokers.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Providence, Rhode Island 02903, USA.
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Claus RE, Kindleberger LR. Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout. J Psychoactive Drugs 2002; 34:25-31. [PMID: 12003110 DOI: 10.1080/02791072.2002.10399933] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
High attrition continues to be an important issue for substance abuse treatment providers. This study examined factors contributing to treatment entry and dropout after referral from centralized assessment. Univariate analysis showed that individuals with a shorter wait after assessment were more likely to attend an initial treatment appointment, while those who reported a history of physical or sexual abuse or were on probation were significantly more likely to drop out of treatment early. Multivariate analysis revealed, first, that persons with a comorbid psychiatric diagnosis and those referred to outpatient rather than residential care were less likely to enter treatment; and, second, that persons on probation and with a history of physical or sexual abuse were more likely to be early treatment dropouts. Findings suggest that decisions to seek help and to accept help are distinct, and that program factors play a substantial role in treatment engagement and retention.
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Affiliation(s)
- Ronald E Claus
- Missouri Institute of Mental Health, St. Louis 63139, USA.
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Sofuoglu M, Brown S, Dudish-Poulsen S, Hatsukami DK. Individual differences in the subjective response to smoked cocaine in humans. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2000; 26:591-602. [PMID: 11097194 DOI: 10.1081/ada-100101897] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The individual variables that determine the effects of cocaine in humans are not well understood. In this study, we examined the relationship between the subjective response to cocaine and selected individual variables in cocaine-dependent participants. A single 0.4-mg/kg dose of smoked cocaine was received by 75 smoked cocaine users. The variables associated with increased subjective response to cocaine were male sex, presence of alcohol use, higher baseline Beck Depression Inventory (BDI) scores, and duration of cocaine use. The change in heart rate and diastolic blood pressure in response to cocaine delivery were also positively associated with the subjective response to cocaine. In contrast, body weight, years of schooling, and the change in the heart rate with the expectation of cocaine delivery were associated with a diminished subjective response to cocaine. The importance of these variables in maintaining the cocaine use behavior needs to be studied further.
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Affiliation(s)
- M Sofuoglu
- Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA.
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