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Wang J, Deane FP, Kelly PJ, Robinson L. A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research. Drug Alcohol Rev 2023; 42:415-426. [PMID: 36633552 PMCID: PMC10108086 DOI: 10.1111/dar.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
ISSUES Assessing drug and alcohol inpatient withdrawal treatment programs is important, as these represent a first step of treatment among people with alcohol and drug problems. However, there are many ways of measuring outcomes making it difficult for service providers to decide which domains and methods to use. This narrative review aims to clarify frequencies of the domains and methods used to assess withdrawal treatment outcomes. APPROACH We reviewed published studies that examined outcomes of inpatient drug and alcohol withdrawal treatment. The types of outcome measures used and the frequency of use were summarised. KEY FINDINGS The review showed that assessment of withdrawal treatment outcomes goes beyond traditional abstinence measures. Outcomes mainly focus on biological and psychological outcomes, with social outcomes rarely measured. Even within outcome domains (e.g., cravings), there were many assessment methods. IMPLICATIONS The review provides service providers with an outline of common outcome domains and measures. Given the importance of social functioning to recovery from alcohol and drug problems, greater emphasis on such measures is desirable. Future research could develop greater consensus on outcome measures for use in withdrawal management services to facilitate clarity around factors associated with treatment success. CONCLUSION Outcome assessment in withdrawal treatment goes beyond abstinence to include holistic measurement of biological, psychological and some social outcomes; but more work needs to be done to cohere the different assessment methods and broaden the scope to include social functioning.
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Affiliation(s)
- Jing Wang
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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2
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Froelich J, Timko C, Woodhead EL. Motives for substance use and 6-month substance use outcomes among detoxification patients with a history of physical or sexual abuse or posttraumatic stress disorder. J Trauma Stress 2022; 35:976-987. [PMID: 35255172 DOI: 10.1002/jts.22806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
Trauma-exposed individuals with a history of physical or sexual abuse or documented posttraumatic stress disorder (PTSD) diagnosis may use substances to address trauma-related symptoms. However, the motives for using substances among adults with a trauma history or PTSD are unclear despite their informative role in treatment planning. Additionally, trauma is associated with poorer substance use outcomes, although this has not been examined among detoxification patients. The current study examined motives for substance use at baseline and substance use outcomes during 6 months postbaseline among 298 veteran detoxification patients (i.e., alcohol, opioids, or both) with and without (a) a history of physical or sexual abuse and (b) a PTSD diagnosis. At baseline, participants with a physical or sexual abuse history were more likely to report the use of substances to temporarily lower stress, forget problems, and avoid uncomfortable feelings than those without this history, ds = 0.25-0.40. Compared with participants without a PTSD diagnosis, participants with diagnosed PTSD were more likely to report using substances to temporarily lower stress, d = 0.25. Longitudinal analyses demonstrated that the baseline characteristics of physical abuse history, sexual abuse history, and diagnosed PTSD were all associated with higher scores on a measure of risk factors for relapse (e.g., cravings, family/social problems) as assessed during the postdetoxification period, φ = .13, .10, and .09, respectively. Detoxification patients with physical and/or sexual abuse histories or PTSD diagnoses may need treatments that better address trauma symptoms to help them sustain abstinence.
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Affiliation(s)
- Jessilyn Froelich
- National Center for PTSD, Veterans Affairs (VA) Health Care System, Menlo Park, California, USA.,Department of Psychology, San José State University, San José, California, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Erin L Woodhead
- Department of Psychology, San José State University, San José, California, USA
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3
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Gardner RL, Baier RR, Cooper EL, Clements EE, Belanger E. Interventions to Reduce Hospital and Emergency Department Utilization Among People With Alcohol and Substance Use Disorders: A Scoping Review. Med Care 2022; 60:164-177. [PMID: 34908009 DOI: 10.1097/mlr.0000000000001676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Substance use disorders (SUDs), prevalent worldwide, are associated with significant morbidity and health care utilization. OBJECTIVES To identify interventions addressing hospital and emergency department utilization among people with substance use, to summarize findings for those seeking to implement such interventions, and to articulate gaps that can be addressed by future research. RESEARCH DESIGN A scoping review of the literature. We searched PubMed, PsycInfo, and Google Scholar for any articles published from January 2010 to June 2020. The main search terms included the target population of adults with substance use or SUDs, the outcomes of hospital and emergency department utilization, and interventions aimed at improving these outcomes in the target population. SUBJECTS Adults with substance use or SUDs, including alcohol use. MEASURES Hospital and emergency department utilization. RESULTS Our initial search identified 1807 titles, from which 44 articles were included in the review. Most interventions were implemented in the United States (n=35). Half focused on people using any substance (n=22) and a quarter on opioids (n=12). The tested approaches varied and included postdischarge services, medications, legislation, and counseling, among others. The majority of study designs were retrospective cohort studies (n=31). CONCLUSIONS Overall, we found few studies assessing interventions to reduce health care utilization among people with SUDs. The studies that we did identify differed across multiple domains and included few randomized trials. Study heterogeneity limits our ability to compare interventions or to recommend one specific approach to reducing health care utilization among this high-risk population.
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Affiliation(s)
- Rebekah L Gardner
- Department of Medicine, Alpert Medical School of Brown University
- Healthcentric Advisors
| | - Rosa R Baier
- Center for Long-Term Care Quality & Innovation
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | | | - Erin E Clements
- Public Health Program, Brown University School of Public Health
| | - Emmanuelle Belanger
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
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4
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Medical Detoxification for Nonopioid Substances Is Associated With Lower Likelihood of Subsequent Linkage to Substance Use Disorder Treatment. J Addict Med 2022; 16:653-658. [PMID: 35245917 PMCID: PMC9433460 DOI: 10.1097/adm.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although factors associated with completion of medical detoxification treatment for substance use disorders (SUD) are well described, there is limited information on barriers and facilitators to subsequent linkage to SUD treatment in the community. This study aimed to evaluate correlates of successful linkage to community SUD treatment on discharge. METHODS Data were drawn from 2 prospective cohorts of people who use unregulated drugs in Vancouver, Canada between December 2012 and May 2018. Multivariable generalized estimating equations were used to investigate factors associated with linkage to community SUD treatment in the 6-month period after attending detoxification treatment. RESULTS Of the 264 detoxification treatment encounters contributed by 178 people who use unregulated drugs, these were most often (n = 104, 39%) related to polysubstance use, and the majority (n = 174, 66%) resulted in subsequent linkage to community treatment. In the multivariable analysis, compared to attending detoxification treatment for opioid use, attending detoxification treatment for stimulants (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] : 0.10-0.51) and alcohol (AOR = 0.17, 95% CI: 0.06-0.54) were associated with lower odds of subsequent linkage to community treatment. Conversely, later calendar year of detoxification treatment remained associated with higher odds (AOR = 1.23, 95% CI: 1.06-1.42). CONCLUSIONS Only two-thirds of detoxification treatment encounters in Vancouver were subsequently linked to community SUD treatment, with those related to nonopioid substances being less likely. Findings suggest the need for tailored interventions for specific substances to improve linkage to SUD treatment in the community on discharge.
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Livingston N, Ameral V, Hocking E, Leviyah X, Timko C. Interventions to Improve Post-Detoxification Treatment Engagement and Alcohol Recovery: Systematic Review of Intervention Types and Effectiveness. Alcohol Alcohol 2021; 57:136-150. [PMID: 33791782 DOI: 10.1093/alcalc/agab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Most inpatient alcohol detoxification patients do not seek treatment post-discharge, which increases the risk of relapse and re-hospitalization. To date, there have been no efforts to synthesize the evidence supporting the broad range of available interventions for this critical transition. The current study is a systematic review and evaluation of interventions designed to promote treatment engagement and recovery following alcohol detoxification. METHODS The initial literature search yielded 6419 articles, published since 1999, from PubMed, CINAHL, PsycINFO, Psychology & Behavioral Sciences Collection and PsycARTICLES databases, 49 of which were eligible for full review. Data extraction included in-depth evaluation of intervention types, study and research design features, reported outcomes and study quality/bias indicators. All articles were coded by independent raters and final results were obtained through consensus. RESULTS Interventions included medical/medication, psychological/psychosocial, technological, mutual-help and combined approaches. On average, medical/medication interventions were less, and psychological/psychosocial and technological interventions were more likely to demonstrate efficacy with respect to treatment engagement and recovery. There was significant variability in study quality/bias but no significant differences across intervention types. Studies differed considerably across measured outcomes, internal and external validity, in/exclusion criteria and documentation of co-occurring psychiatric disorders. CONCLUSION Over half of studies reviewed reported empirical support for the intervention(s) evaluated. Although findings slightly favor non-medical interventions, the variability in study design and quality/bias requires more rigorous follow-up research. Recommendations from this review may guide future implementation and intervention development, which are critically needed to improve post-detoxification care and outcomes for patients with alcohol use disorder.
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Affiliation(s)
- Nicholas Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Victoria Ameral
- Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road Bedford, MA 01730, USA
| | - Elise Hocking
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Xenia Leviyah
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Christine Timko
- VA Palo Alto Health Care System, 3801 Miranda AvenuePalo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
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Kikuchi M, Matsutani N, Ishihara R, Sugihara M, Mizuno Y, Chiba C, Ohta T, Yamada E, Oguro S, Sato Y, Bessho H, Horie Y. Inter-professional and inter-departmental alcoholism rehabilitation program. Clin Mol Hepatol 2020; 26:626-632. [PMID: 33053935 PMCID: PMC7641577 DOI: 10.3350/cmh.2020.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/07/2020] [Accepted: 08/15/2020] [Indexed: 11/05/2022] Open
Abstract
A 3-month alcoholism rehabilitation program at psychiatric hospitals is common in Japan for patients with alcohol use disorder (AUD). However, many AUD patients are often hospitalized for the treatment of digestive disorders due to alcohol-related liver diseases and pancreatitis. In this sense, AUD patients need to be better supported by professionals and departments in general hospitals. Here we analyzed the problems in alcohol-related medical care in Japan and examined the measures to be taken at general hospitals.
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Affiliation(s)
- Masahiro Kikuchi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naomi Matsutani
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Ryota Ishihara
- Department of Psychiatry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masako Sugihara
- Department of Psychiatry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yuuki Mizuno
- Department of Medical Welfare, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Chiyo Chiba
- Department of Psychiatry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takahiro Ohta
- Department of Pharmacy, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Eri Yamada
- Department of Nutrition, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Sota Oguro
- Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yasuko Sato
- Department of Nursing, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hiroki Bessho
- Department of Dentistry, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoshinori Horie
- Department of Gastroenterology, Shonan Keiiku Hospital, Kanagawa, Japan
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Martínez-González JM, Caracuel A, Vilar-López R, Becoña E, Verdejo-García A. Evaluation of Motivation for the Treatment of Drug Addicts with Personality Disorders. THE SPANISH JOURNAL OF PSYCHOLOGY 2020; 23:e15. [PMID: 32613926 DOI: 10.1017/sjp.2020.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lack of motivation for the treatment of drug addiction is associated with dropout and relapses. Further, personality disorders (PD) have traditionally been linked to low motivation and therapeutic failure. Thus, the present study aims to analyze the structure of the Motivation for Treatment Questionnaire (MTQ-8), as well as to determine differences in motivation due to the presence of PD and the impact of psychological adjustment on motivation. The sample included 125 patients (84% male) who started a treatment for their addiction to cocaine and alcohol. Rasch analysis was applied for the first objective, and means contrast and regression analysis for the others. The two subscales of the MTQ-8 fit the Rasch model, with appropriate psychometric characteristics when merging Items 5 and 7. The presence of PD was not associated with reduced motivation. Motivation for treatment was greater when abstinence was less than three weeks, and psychological distress predicted motivation for treatment. The present study confirms that MTQ-8 subscales are suitable for measuring motivation for treatment and readiness for change in drug-dependent patients. It is noted that the presence of PD should not be associated with a lower level of motivation, and that psychological distress influences motivation.
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Hides L, Quinn C, Stoyanov S, Kavanagh D, Baker A, Cochrane Drugs and Alcohol Group. Psychological interventions for co-occurring depression and substance use disorders. Cochrane Database Syst Rev 2019; 2019:CD009501. [PMID: 31769015 PMCID: PMC6953216 DOI: 10.1002/14651858.cd009501.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.
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Affiliation(s)
- Leanne Hides
- The University of QueenslandSchool of PsychologySt Lucia, BrisbaneQueenslandAustralia4072
| | - Catherine Quinn
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Stoyan Stoyanov
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - David Kavanagh
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Amanda Baker
- University of Newcastle, CallaghanCentre for Brain and Mental Health ResearchNewcomen Street, James Fletcher HospitalNewcastleNew South WalesAustralia2300
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Ostergaard M, Seitz R, Jatzkowski L, Speidel S, Höcker W, Odenwald M. Changes of Self-reported PTSD and Depression Symptoms During Alcohol Detoxification Treatment. J Dual Diagn 2019; 15:123-129. [PMID: 31156059 DOI: 10.1080/15504263.2019.1620398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: There is a lack of empirical knowledge on how different comorbid disorders and symptoms change in the course of initial abstinence and withdrawal. The aim of this study is to replicate previous findings on the symptom course using a larger sample and up-to-date psychometric instruments. Methods: During inpatient alcohol detoxification, we measured comorbid depression (Beck Depression Inventory second revision; BDI-II) and posttraumatic stress disorder (PTSD Checklist for DSM-5; PCL-5) symptoms twice among 87 participants within a 10-day interval. Results: Significant decreases occurred for symptoms of reexperiencing (p < .001, d = .27), avoidance (p < .001, d = .41), negative cognitions (p = .03, d = .22), alteration in arousal (p < .001, d = .37), and the PCL-5 total score (p < .001, d = .35). Depression scores also significantly declined with a greater effect size (p < .001, d = .53). Depression screening was not stable, while posttraumatic stress disorder screening was revealed to be stable through alcohol detoxification. Interaction effects were detected, indicating the higher symptom decrease for patients who initially had positive posttraumatic stress disorder and depression screenings, F(1, 84) = 23.01, p < .001 and F(1, 84) = 10.01, p < .01, respectively. Conclusions: Patients in the first stage of alcohol treatment show high levels of comorbid psychopathology. These symptoms change during detoxification, especially for patients having a higher initial symptomatic burden. More research is needed to guide practitioners to make reliable comorbid diagnoses in this early treatment phase as this can motivate patients to pursue subsequent treatments.
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Affiliation(s)
- Mathias Ostergaard
- Department of Psychology, University of Konstanz , Konstanz , Germany.,Forel Clinic , Ellikon an der Thur , Switzerland
| | - Raffaela Seitz
- Department of Psychology, University of Konstanz , Konstanz , Germany
| | - Leonie Jatzkowski
- Clinic for Psychiatry, Furtbachkrankenhaus Stuttgart , Stuttgart , Germany
| | | | - Wolfgang Höcker
- Clinic for Psychiatry, Furtbachkrankenhaus Stuttgart , Stuttgart , Germany.,Centre of Psychiatry Reichenau , Reichenau , Germany
| | - Michael Odenwald
- Department of Psychology, University of Konstanz , Konstanz , Germany.,Clinic for Psychiatry, Furtbachkrankenhaus Stuttgart , Stuttgart , Germany.,Centre of Psychiatry Reichenau , Reichenau , Germany
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10
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Abstract
PURPOSE OF REVIEW To provide an update of treatment for substance use in patients with co-occurring substance use disorders (SUD) and mental health disorders (dual diagnosis) with a focus on both pharmacological and psychosocial interventions. RECENT FINDINGS A total of 1435 abstracts were identified, of which we selectively reviewed 43 for this narrative review. There is emerging evidence, both clinical and neurobiological, that clozapine is a more efficacious antipsychotic in treatment of individuals with schizophrenia and SUD. The use of depot atypical antipsychotic paliperidone palmitate in this population is also promising. Although valproate remains the treatment of choice in individuals with bipolar disorder and SUD, present evidence suggests that lithium and quetiapine may not be effective in this population. Naltrexone is the most effective anticraving agent in individuals with severe mental illness (SMI) and comorbid alcohol use disorders. The use of opioid substitution therapy in individuals with SMI and comorbid opioid use disorders is also associated with favorable outcomes. Varenicline shows promise in patients with SMI who smoke tobacco. Psychosocial interventions should be instituted early in the course of treatment. They should ideally be high intensity and based on established therapies used for SUD. SUMMARY The paucity of systematic studies in individuals with co-occurring mental health disorders and SUD remains a concern, given the enormous burden that they pose. However, there are a number of studies which have evaluated interventions, both psychosocial and pharmacological, which show promise and can guide clinical practice. VIDEO ABSTRACT: http://links.lww.com/YCO/A49.
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