Patient Characteristics Predicting Abstinence in Substance Use Disorder Patients With Comorbid Mental Disorders

Exploring the relationship between proactive e-alcohol therapy and symptoms of anxiety or/and depression: Post-hoc analyses from a randomized controlled trial

Background

Individuals with problematic alcohol use often face anxiety and depressive symptoms, which can hinder treatment engagement, compliance, and effectiveness. Psychosocial therapy through video conference (e-alcohol therapy) may reduce these barriers. We explored whether 1) anxiety or/and depressive symptoms modify the effect of proactive e-alcohol therapy on treatment initiation, compliance, and alcohol intake, 2) proactive e-alcohol therapy impacts anxiety or/and depressive symptoms compared to standard care.

Methods

Participants with problematic alcohol use were recruited online and randomly assigned to proactive e-alcohol therapy or standard care. Problematic alcohol use was defined by an 8+ score on the Alcohol Use Disorders Identification Test. Anxiety and depressive symptoms were measured using the Patient Health Questionnaire-4.

Results

356 individuals participated; 133 showed moderate-severe symptoms of anxiety and depression at baseline. There were no significant differences between individuals with and without moderate-severe anxiety or/and depressive symptoms in the effect of proactive e-alcohol therapy versus standard care on treatment initiation (3 mo: p = 0.64; 12 mo: p = 0.97), compliance (3 mo: p = 0.40; 12 mo: p = 0.58), or alcohol intake (3 mo: p = 0.86; 12 mo: p = 0.90). No significant differences were found in the proportion of participants with moderate-severe anxiety and depressive symptoms between the two intervention groups after 3 months (OR 0.6; 95 % CI 0.3 to 1.4; p = 0.27).

Conclusions

We found no evidence that anxiety or/and depressive symptoms modify the effect of proactive e-alcohol therapy on treatment initiation, compliance, or alcohol intake. Proactive e-alcohol therapy matched standard care in reducing anxiety or/and depressive symptoms over a 3-month follow-up.

Correlates and consequences of anxiety and depressive symptom trajectories during early treatment for alcohol use

We investigated whether latent trajectories of anxiety and depressive symptoms were associated with clinically relevant variables including treatment attrition among individuals seeking treatment for alcohol use. Participants were drawn from 78 addiction treatment centers and included individuals in treatment for alcohol use, had in-treatment data, and screened positive for anxiety (n = 6147) or depressive symptoms (n = 6197) at intake. Anxiety and depressive symptoms were measured weekly during the first month of treatment. Three trajectories of anxiety symptoms (i.e., Persistent Moderate Anxiety Symptoms, Remitting Moderate Anxiety Symptoms, and Remitting Mild Anxiety Symptoms) and depressive symptoms (i.e., Increasing Moderate Depressive Symptoms, Persistent Moderate Depressive Symptoms, and Remitting Mild Depressive Symptoms) were identified. Women, younger individuals, and individuals who endorsed greater past month benzodiazepine use and depressive symptoms at intake were more likely to be in the Persistent Moderate Anxiety Symptoms trajectory relative to the Remitting Mild Anxiety Symptoms subgroup. Women, individuals who screened positive for anxiety at intake, and individuals reporting past month heroin use were more likely to be in the Increasing Moderate Depressive Symptoms trajectory relative to the Remitting Mild Depressive Symptom trajectory. Trajectories characterized by persistent moderate anxiety and depressive symptoms during the first month of treatment were more likely to drop out of treatment compared to individuals who reported low symptom levels. Findings indicate heterogeneity in the clinical course of anxiety and depressive symptoms among individuals in treatment for alcohol use and highlight that persistently high anxiety and depressive symptoms may pose an impediment to successful treatment completion. Results also demonstrate the importance of considering demographic and clinical characteristics at treatment intake as they may have significant implications for the unfolding of anxiety and depressive symptoms during treatment and subsequent outcomes.

A short review of acculturation and addiction among immigrant and refugee communities in the United States and abroad

PURPOSE

To summarize recent evidence of the relationship between acculturation and substance use addiction among foreign-born persons living in the United States (U.S.) and abroad.

RECENT FINDINGS

Foreign-born populations are increasing in many countries as a result of immigration and global refugee displacement. Acculturation and discrimination toward both populations have been related to the initiation of illicit substance use. The "immigrant paradox" may serve as a protective factor against the initiation and worsening prognosis of substance use disorders. Improving multilingual accessibility and frequency of use of clinical screeners may enhance addiction risk factor identification and potential interventions for foreign-born populations living in countries of emigration, such as the U.S.

SUMMARY

Foreign-born persons compose a significant proportion of nurse-patient interactions in the U.S. and abroad. The unique sociological phenomenon of the immigrant paradox may serve as a protective factor for foreign-born persons despite the increased risk for adverse childhood events, acculturation, and discrimination. Due to conflicting evidence, future studies should examine longitudinal outcomes of substance use exclusively among foreign-born persons as well as protective and risk factors associated with immigrants and refugees, respectively.

CLINICAL RELEVANCE

Foreign-born persons may experience unique risk factors associated with addiction. Future studies should focus on foreign-born populations to explore if social constructs surrounding addiction can be extrapolated into other populations, including their second-generation offspring. Differences surrounding migration contexts between immigrants and refugees may be important for clinical researchers to understand when designing research studies centered on these experiences. Nurses can play a significant role in identifying patients at risk for substance use by advocating for inclusive and comprehensive multilingual screeners.

Dual Diagnosis in Adolescents with Problematic Use of Video Games: Beyond Substances

The technological revolution has led to the birth of new diagnoses, such as gaming disorder. When any addiction, including this one, is associated with other mental disorders, it is considered a dual diagnosis. The objectives of this current work were to estimate the prevalence of dual diagnoses in the adolescent general population while also considering the problematic use of video games and substance addiction and assessing its psychosocial risk factors. Thus, we carried out a cross-sectional study with a sample of 397 adolescents; 16.4% presented problematic videogame use and 3% presented a dual diagnosis. Male gender increased the probability of both a dual diagnosis (OR [95% CI] = 7.119 [1.132, 44.785]; p = 0.036) and problematic video game use (OR [95% CI] = 9.85 [4.08, 23.77]; p < 0.001). Regarding personality, low conscientiousness, openness, and agreeableness scores were predictors of a dual diagnosis and problematic videogame use, while emotional stability predicted a dual diagnosis (OR [95% CI] = 1.116 [1.030, 1.209]; p = 0.008). Regarding family dynamics, low affection and communication increased both the probability of a dual diagnosis (OR [95% CI] = 0.927 [0.891, 0.965]; p < 0.001) and problematic video game use (OR [95% CI] = 0.968 [0.945, 0.992]; p = 0.009). Regarding academic performance, bad school grades increased the probability of a dual diagnosis. In summary, male gender, certain personality traits, poor communication, and poor affective family dynamics should be interpreted as red flags that indicate an increased risk of a dual diagnosis in adolescents, which could require early intervention through specific detection programs.