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Gesser N. "I was already there once": Cumulative attempt capital of marginalized women exiting substance use and street prostitution contributes to their recovery capital. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38584519 DOI: 10.1002/ajcp.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/20/2023] [Accepted: 01/03/2024] [Indexed: 04/09/2024]
Abstract
Despite a move to view substance use as a disease of the brain, relapse into drugs is still often viewed as a personal failure. Low recovery capital has been used to explain relapse among certain marginalized populations. Recovery capital is a recent framework that refers to the individual's sum of all internal and external assets that may assist in their recovery process. It includes four categories: physical, human, social, and cultural capital. However, this framework does not relate to the role of actual relapses in the recovery process, despite their common occurrence. To bridge this gap, in-depth interviews with 29 women formerly engaged in substance use and street prostitution in a large urban area were used to probe women about their relapse and recovery experiences. The current study demonstrates the value in repeat recovery setbacks, what I term "cumulative attempt capital": lessons learned from previous recovery attempts. I argue that previous attempts improve women's social and professional networks, help them learn from past mistakes, improve and maintain their health, and provide them with a sense of self-efficacy. This research expands our understanding of the positive role failed attempts play in one's recovery. Such reframing by service providers can alleviate a sense of shame and low self-worth for women in street prostitution and substance use and has implications for policy and program development.
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Affiliation(s)
- Nili Gesser
- Department of Psychology, University of North Dakota, Grand Forks, North Dakota, USA
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2
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Bergsmark T, Engesæter LK, Rasmussen A, Bennet W, Nordin A, Pall V, Line PD, Ericzon BG, Melum E. Long-term survival after liver transplantation for alcohol-related liver disease in the Nordic countries. Scand J Gastroenterol 2023; 58:923-930. [PMID: 36872559 DOI: 10.1080/00365521.2023.2184193] [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] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES Alcohol-related liver disease (ALD) is among the most common indications for liver transplantation (LTX) in Europe and North America, with good five-year survival rates post-LTX. Here we evaluated survival up to and beyond 20 years after LTX for patients with ALD compared to a comparison group. METHODS Patients with ALD and a comparison group transplanted in the Nordic countries between 1982 and 2020 were included. Data were analyzed using descriptive statistics, Kaplan-Meier curves and predictors of survival were assessed with Cox-regressions. RESULTS 831 patients with ALD and 2979 patients in the comparison group were included in the study. Patients with ALD were older at the time of LTX (p < .001) and more likely to be male (p < .001). The estimated median follow-up time was 9.1 years for the ALD-group and 11.1 years for the comparison group. 333 (40.1%) patients with ALD and 1010 (33.9%) patients in the comparison group died during follow-up. The overall survival was impaired for patients with ALD compared to the comparison group (p < .001) and was evident for male and female patients, patients transplanted before and after 2005, and observed in all age-groups except patients over 60 years. Age at transplant, waiting time, year of LTX and country of LTX were associated with decreased survival after LTX for patients with ALD. CONCLUSIONS Patients with ALD have a decreased long-term survival following LTX. This difference was evident in most sub-groups of patients and warrants close follow-up of liver transplanted patients with ALD with focus on risk reduction.
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Affiliation(s)
- Thomas Bergsmark
- Section of Gastroenterology, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Katrine Engesæter
- Section of Gastroenterology, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Liver Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - William Bennet
- Transplant Institute, Sahlgrenska University Hospital, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, University Hospital, Helsinki, Finland
| | - Virge Pall
- Transplantation Centre, Tartu University Hospital, Tartu, Estonia
| | - Pål-Dag Line
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Transplantation Surgery, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Bo-Göran Ericzon
- Division of Transplantation Surgery, Karolinska Institutet, CLINTEC, Stockholm, Sweden
| | - Espen Melum
- Section of Gastroenterology, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Hybrid Technology Hub-Centre of Excellence, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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3
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DiClemente CC, Crisafulli MA. Relapse on the Road to Recovery: Learning the Lessons of Failure on the Way to Successful Behavior Change. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2022; 48:59-68. [PMID: 35464099 PMCID: PMC9014843 DOI: 10.1007/s42843-022-00058-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Among individuals seeking to change health-related behaviors, relapse is a common experience. Whether it occurs very soon after initiating a change attempt or after several years of sustained changed behavior, it can be discouraging for patients and clinicians alike. Although there is a tendency in healthcare to try to ignore failure, we posit that moving on too quickly results in missed opportunities to learn critical lessons that may promote successful change in the future. In this paper, we use addictive behavior as a lens through which to explore the phenomenon of relapse. We review key insights from the Transtheoretical Model (TTM), including the importance of debriefing failure to promote successive approximation learning while recycling through stages of change. We also offer practical, evidence-based strategies for working effectively with relapse in clinical practice, which we suggest creates a more integrated, client-centered, and personalized approach to care.
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Senn S, Volken T, Rösner S, Wieber F. What is the relapse risk during treatment? Survivor analysis of single and multiple relapse events in inpatients with alcohol use disorder as part of an observational study. J Subst Abuse Treat 2022; 138:108754. [DOI: 10.1016/j.jsat.2022.108754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/21/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
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Zetterström A, Hämäläinen MD, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. The Clinical Course of Alcohol Use Disorder Depicted by Digital Biomarkers. Front Digit Health 2021; 3:732049. [PMID: 34950928 PMCID: PMC8688853 DOI: 10.3389/fdgth.2021.732049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study introduces new digital biomarkers to be used as precise, objective tools to measure and describe the clinical course of patients with alcohol use disorder (AUD).Methods: An algorithm is outlined for the calculation of a new digital biomarker, the recovery and exacerbation index (REI), which describes the current trend in a patient's clinical course of AUD. A threshold applied to the REI identifies the starting point and the length of an exacerbation event (EE). The disease patterns and periodicity are described by the number, length, and distance between EEs. The algorithms were tested on data from patients from previous clinical trials (n = 51) and clinical practice (n = 1,717).Results: Our study indicates that the digital biomarker-based description of the clinical course of AUD might be superior to the traditional self-reported relapse/remission concept and conventional biomarkers due to higher data quality (alcohol measured) and time resolution. We found that EEs and the REI introduce distinct tools to identify qualitative and quantitative differences in drinking patterns (drinks per drinking day, phosphatidyl ethanol levels, weekday and holiday patterns) and effect of treatment time.Conclusions: This study indicates that the disease state—level, trend and periodicity—can be mathematically described and visualized with digital biomarkers, thereby improving knowledge about the clinical course of AUD and enabling clinical decision-making and adaptive care. The algorithms provide a basis for machine-learning-driven research that might also be applied for other disorders where daily data are available from digital health systems.
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Affiliation(s)
| | | | | | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- Fred Nyberg
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6
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Within-AUD outpatient treatment heavy drinking transitions and associations with long-term outcomes. Drug Alcohol Depend 2021; 228:108968. [PMID: 34560333 DOI: 10.1016/j.drugalcdep.2021.108968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to examine whether changes in heavy drinking occurring within alcohol treatment predict long-term functioning. METHOD Latent profile analyses were conducted using data from Project MATCH and COMBINE. Observed changes in heavy and nonheavy drinking within consecutive 2-week periods over the respective treatment durations were characterized for each participant and were used to identify latent profiles. RESULTS Both data sets revealed 6 profiles: (1) continuous "remission" (nonheavy drinking); (2) transition from heavy drinking ("relapse") to remission; (3) mostly remission, limited relapse; (4) numerous short transitions between relapse and remission; (5) transition to relapse; and (6) continuous relapse. Profiles 1 and 2 had the best long-term outcomes, Profiles 5 and 6 had the worst, and Profiles 3 and 4 fell between these groups. Within-treatment patterns of heavy drinking and nonheavy drinking were also associated with post-treatment patterns of relapse and remission. CONCLUSIONS Patterns of transition between episodes that respectively include heavy and nonheavy drinking predict long-term alcohol use and psychosocial outcomes and seem essential for clinicians to discuss with their patients. Relapses during outpatient treatment do not necessarily indicate treatment failure, provided they are relatively brief and/or infrequent. In addition, some individuals can and do change from transition patterns of heavy drinking within treatment that are predictive of poorer long-term functioning to transition patterns that predict better functioning within the first year post-treatment.
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7
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Sliedrecht W, Roozen HG, Witkiewitz K, de Waart R, Dom G. The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review. Alcohol Alcohol 2021; 56:637-650. [PMID: 33382416 DOI: 10.1093/alcalc/agaa132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 01/14/2023] Open
Abstract
AIM Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. METHODS A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of 'trait impulsivity'-typically measured by self-report questionnaires-and 'behavioural impulsivity', i.e. 'motor impulsivity', 'impulsive choice' and 'reflection impulsivity, assessed with cognitive-behavioural tasks. RESULTS Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of 'trait impulsivity', and nine studies included 'behavioural impulsivity' measures, from which five studies dealt with the 'impulsive choice' subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. CONCLUSIONS All three included facets of impulsivity ('trait-, motor- and impulsive choice impulsivity') were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico (UNM), MSC 11 6280, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- The University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Ranne de Waart
- Mentrum/Arkin, Domselaerstraat 126, 1093 MB Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
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Lillie KM, Jansen KJ, Dirks LG, Lyons AJ, Alcover KC, Avey JP, Hirchak K, Herron J, Buchwald D, Donovan DM, McDonell MG, Shaw JL. Assessing the Predictive Validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in Alaska Native and American Indian People. J Addict Med 2021; 14:e241-e246. [PMID: 32371661 PMCID: PMC7541407 DOI: 10.1097/adm.0000000000000661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to examine the predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) among Alaska Native and American Indian (ANAI) people with an alcohol use disorder. METHODS The sample was 170 ANAI adults with an alcohol use disorder living in Anchorage, Alaska who were part of a larger alcohol intervention study. The primary outcome of this study was alcohol use as measured by mean urinary ethyl glucuronide (EtG). EtG urine tests were collected at baseline and then up to twice a week for four weeks. We conducted bivariate linear regression analyses to evaluate associations between mean EtG value and each of the three SOCRATES subscales (Recognition, Ambivalence, and Taking Steps) and other covariates such as demographic characteristics, alcohol use history, and chemical dependency service utilization. We then performed multivariable linear regression modeling to examine these associations after adjusting for covariates. RESULTS After adjusting for covariates, mean EtG values were negatively associated with the Taking Steps (P = 0.017) and Recognition (P = 0.005) subscales of the SOCRATES among ANAI people living in Alaska. We did not find an association between mean EtG values and the Ambivalence subscale (P = 0.129) of the SOCRATES after adjusting for covariates. CONCLUSIONS Higher scores on the Taking Steps and Recognition subscales of the SOCRATES at baseline among ANAI people predicted lower mean EtG values. This study has important implications for communities and clinicians who need tools to assist ANAI clients in initiating behavior changes related to alcohol use.
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Affiliation(s)
- Kate M Lillie
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK (KML, KJJ, JPA, JLS); Information School, University of Washington, Box 352840, Mary Gates Hall, Seattle, WA (LGD); Elson S. Floyd College of Medicine, Washington State University, 412 E. Riverpoint BLVD, Spokane, WA (AJL, KCA, MGMD); Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM (KH); Department of Psychology, University of New Mexico, Albuquerque, NM (JH); Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA (DB); Department of Psychiatry and Behavioral Sciences and Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA (DMD)
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9
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Senn S, Odenwald M, Sehrig S, Haffke P, Rockstroh B, Pereyra Kröll D, Menning H, Wieber F, Volken T, Rösner S. Therapeutic success in relapse prevention in alcohol use disorder: the role of treatment motivation and drinking-related treatment goals. J Addict Dis 2020; 39:88-95. [PMID: 33150846 DOI: 10.1080/10550887.2020.1820810] [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: 10/23/2022]
Abstract
Background: Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.Objective: The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.Methods: In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.Results: During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.Conclusions: This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.
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Affiliation(s)
- Smeralda Senn
- Research Department, Forel Clinic, Ellikon an der Thur, Switzerland
| | - Michael Odenwald
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Sarah Sehrig
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Peter Haffke
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | | | - Hans Menning
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Frank Wieber
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Institute for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Thomas Volken
- Institute for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Susanne Rösner
- Research Department, Forel Clinic, Ellikon an der Thur, Switzerland
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Levine JA, Gius BK, Boghdadi G, Connors GJ, Maisto SA, Schlauch RC. Reductions in Drinking Predict Increased Distress: Between- and Within-Person Associations between Alcohol Use and Psychological Distress During and Following Treatment. Alcohol Clin Exp Res 2020; 44:2326-2335. [PMID: 32945567 DOI: 10.1111/acer.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND As the nature of the association between alcohol use disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit 2 competing hypotheses such that treatment for AUD concurrently decreases alcohol use and psychological distress or treatment for AUD decreases alcohol use and increases psychological distress. The current study examined the ways in which psychological distress changed as a function of treatment for AUD, including the relationship between psychological distress and drinking behaviors. METHODS Secondary data analysis was conducted on an existing clinical trial dataset that investigated the effect of cognitive-behavioral therapy and therapeutic alliance feedback on AUDs. Specifically, data collected at baseline, posttreatment, 3-month, 6-month, 9-month, and 12-month follow-up assessments were examined. RESULTS Results indicated decreases in heavy drinking days, increases in percentage of days abstinent, and decreases in overall psychological distress. Findings also revealed that changes in psychological distress did not predict changes in drinking at the next time interval; however, decreases in drinking predicted higher psychological distress at the next assessment. Further, average levels of psychological distress were positively associated with rates of drinking. CONCLUSIONS The current study provides some insight into how psychological distress changes during the course of treatment for AUD, including the relationship between changes in drinking and such symptoms. Future research should continue to explore these relationships, including the ways in which treatment efforts can address what may be seen as paradoxical effects.
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Affiliation(s)
- Jacob A Levine
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
| | - Becky K Gius
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
| | - George Boghdadi
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
| | - Gerard J Connors
- Research Institute on Addictions, (GJC), University at Buffalo, Buffalo, New York, USA
| | - Stephen A Maisto
- Department of Psychology, (SAM), Syracuse University, Syracuse, New York, USA
| | - Robert C Schlauch
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
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11
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Moon SJE, Lee H. Relapse to substance use: A concept analysis. Nurs Forum 2020; 55:523-530. [PMID: 32350881 DOI: 10.1111/nuf.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/25/2022]
Abstract
The concept of relapse is ubiquitous in the health literature related to addiction. Nevertheless, relapse is-and has been-described and measured under various definitions, which precipitates confusion, inconsistency, and stigma. This study aimed to (a) clarify the meaning of relapse and (b) present a comprehensive definition of relapse vis-à-vis substance use. Walker and Avant's method of concept analysis was followed to analyze the relapse using CINAHL, PsychINFO, and PubMed databases. Three key attributes of relapse were identified: (a) interruption of abstinence, (b) vulnerability to uncontrollable substance-related behavior and/or cues, (c) a transition to potential progression or regression. Antecedents and consequences of attributes were identified, followed by the construction of the model and additional cases. Relapse is defined conceptually as either a transition to regression or a progression in the process of recovery, prompted by a return to the previous behavior of substance use, despite the intention to stay abstinent. A standardized definition and understanding of relapse not only minimize confusion, inconsistency, and social and self-stigma associated with the term but also helps provide relapse-sensitive care with accurate methods of assessment and evaluation.
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Affiliation(s)
- Seol Ju Esther Moon
- Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heeyoung Lee
- Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Schlagintweit HE, Lynch MJ, Hendershot CS. A review of behavioral alcohol interventions for transplant candidates and recipients with alcohol-related liver disease. Am J Transplant 2019; 19:2678-2685. [PMID: 31419015 DOI: 10.1111/ajt.15569] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/16/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023]
Abstract
Alcohol-related liver disease (ALD) is a common indication for liver transplantation. Reflecting growing consensus that early transplant (ie, prior to sustained abstinence) can be a viable option for acute alcoholic hepatitis, access to liver transplantation for ALD patients has increased. Prevention of alcohol relapse is critical to pretransplant stabilization and posttransplant survival. Behavioral interventions are a fundamental component of alcohol use disorder treatment, but have rarely been studied in the transplant context. This scoping review summarizes published reports of behavioral and psychosocial alcohol interventions conducted with ALD patients who were liver transplant candidates and/or recipients. A structured review identified 11 eligible reports (3 original research studies, 8 descriptive papers). Intervention characteristics and clinical outcomes were summarized. Interventions varied significantly in orientation, content, delivery format, and timing/duration. Observational findings illustrate the importance of situating alcohol interventions within a multidisciplinary treatment context, and suggest the potential efficacy of cognitive-behavioral and motivational enhancement interventions. However, given extremely limited research evaluating behavioral alcohol interventions among ALD patients, the efficacy of behavioral interventions for pre- and posttransplant alcohol relapse remains to be established.
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Affiliation(s)
- Hera E Schlagintweit
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marie-Josée Lynch
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christian S Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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13
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Witkiewitz K, Wilson AD, Pearson MR, Montes KS, Kirouac M, Roos CR, Hallgren KA, Maisto SA. Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers? Addiction 2019; 114:69-80. [PMID: 30063267 PMCID: PMC6289769 DOI: 10.1111/add.14403] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Recovery from alcohol use disorder (AUD) is often narrowly defined by abstinence from alcohol and improvements in functioning (e.g. mental health, social functioning, employment). This study used latent profile analysis to examine variability in recovery outcomes, defined by alcohol use, alcohol-related problems and psychosocial functioning at 3 years following treatment. Secondary analysis investigated pre-treatment, post-treatment and 1- and 3-year post-treatment covariate predictors of the latent profiles. DESIGN Secondary analysis of data from a randomized clinical trial. SETTING United States. PARTICIPANTS We used data from the out-patient arm of Project MATCH (n = 806; 29.7% female, 22.2% non-white). MEASUREMENTS Recovery was defined by latent profile analyses including measures of psychosocial functioning and life satisfaction (Psychosocial Functioning Inventory), unemployment and mental health (Addiction Severity Index), alcohol and other drug use (Form 90) and alcohol-related consequences (Drinker Inventory of Consequences) 3 years following treatment. Mixture modeling was used to examine correlates of profiles. FINDINGS We identified four profiles at 3 years following treatment: (1) poor functioning frequent heavy drinkers, (2) poor functioning infrequent heavy drinkers, (3) high functioning occasional heavy drinkers and (4) high-functioning infrequent non-heavy drinkers. There were relatively few differences on indicators of functioning and treatment-related variables between the high functioning infrequent non-heavy drinkers and the high-functioning occasional heavy drinkers, other than high-functioning occasional heavy drinkers having lower alcohol dependence severity [odds ratio (OR) = 0.94, 95% confidence interval (CI) = 0.90, 0.98], fewer post-treatment coping skills (OR = 0.54, 95% CI = 0.32, 0.90) and lower 3-year post-treatment abstinence self-efficacy (OR = 0.37, 95% CI = 0.28, 0.49) and Alcoholics Anonymous (AA) involvement (OR = 0.87, 95% CI = 0.85, 0.99). The two high-functioning profiles showed the greatest improvements in functioning from baseline through the 3-year follow-up, whereas the low-functioning profiles showed the least amount of improvement. High-functioning occasional heavy drinkers had higher purpose in life than the poor-functioning profiles. CONCLUSIONS Some individuals who engage in heavy drinking following treatment for alcohol use disorder may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction and mental health.
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Anterior Insular Cortex is Critical for the Propensity to Relapse Following Punishment-Imposed Abstinence of Alcohol Seeking. J Neurosci 2018; 39:1077-1087. [PMID: 30509960 DOI: 10.1523/jneurosci.1596-18.2018] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/15/2018] [Accepted: 11/04/2018] [Indexed: 11/21/2022] Open
Abstract
Humans with alcohol use disorder typically abstain because of the negative consequences associated with excessive drinking, and exposure to contexts previously associated with alcohol use can trigger relapse. We used a rat model that captures a characteristic of this human condition: namely voluntary abstinence from alcohol use because of contingent punishment. There is substantial variability in the propensity to relapse following extended periods of abstinence, and this is a critical feature preventing the successful treatment of alcohol use disorder. Here we examined relapse following acute or prolonged abstinence. In male alcohol preferring P rats, we found an increased propensity to relapse in Context B, the punishment context after prolonged abstinence. Next, we found that neither alcohol intake history nor the motivational strength of alcohol predicted the propensity to relapse. We next examined the putative circuitry of context-induced relapse to alcohol seeking following prolonged abstinence using Fos as a marker of neuronal activation. The anterior insular cortex (AI) was the only brain region examined where Fos expression correlated with alcohol seeking behavior in Context B after prolonged abstinence. Finally, we used local infusion of GABAA and GABAB receptor agonists (muscimol + baclofen) to show a causal role of the AI in context-induced relapse in Context B, the punishment context after prolonged abstinence. Our results show that there is substantial individual variability in the propensity to relapse in the punishment-associated context after prolonged abstinence, and this is mediated by activity in the AI.SIGNIFICANCE STATEMENT A key feature of alcohol use disorder is that sufferers show an enduring propensity to relapse throughout their lifetime. Relapse typically occurs despite the knowledge of adverse consequences including health complications or relationship breakdowns. Here we use a recently developed rodent model that recapitulates this behavior. After an extended period of abstinence, relapse propensity is markedly increased in the "adverse consequence" environment, akin to humans with alcohol use disorder relapsing in the face of adversity. From a circuitry perspective, we demonstrate a causal role of the anterior insular cortex in relapse to alcohol seeking after extended abstinence following punishment imposed voluntary cessation of alcohol use.
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Maisto SA, Hallgren KA, Roos CR, Witkiewitz K. Course of remission from and relapse to heavy drinking following outpatient treatment of alcohol use disorder. Drug Alcohol Depend 2018; 187:319-326. [PMID: 29705545 PMCID: PMC5959805 DOI: 10.1016/j.drugalcdep.2018.03.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND We sought to understand alcohol behavior change as a process over time by identifying patterns of relapse and remission after outpatient treatment and evaluating how these patterns predict longer-term clinical outcomes. METHOD We conducted latent profile analyses using data from the outpatient arm in Project MATCH. Relapse and remission episodes were defined by the number of consecutive 14-day periods that included any heavy drinking days and no heavy drinking days. Indicators of each profile were: initial 2-week post-treatment remission/relapse status, number of remission/relapse transitions in the first year after treatment, duration of remission episodes, and duration of relapse episodes. RESULTS We identified 6 profiles: 1) "remission," 2) "transition to remission", 3) "few long transitions," 4) "many short transitions," 5) "transition to relapse," and 6) "relapse." Profile 1 had the best long-term outcomes. Long-term outcomes were not uniform among individuals with at least some heavy drinking (profiles 2 through 6; ∼75% of the sample). Individuals who transitioned back to and sustained periods of remission (profiles 2-4) had better long-term outcomes than those who failed to transition out of relapse (profiles 5-6) following treatment. CONCLUSIONS Post-treatment change in alcohol use is a process in which individuals variably transition in and out of "relapse" and "remission" statuses. "Any heavy drinking" following treatment is not necessarily a sign of treatment failure. A more nuanced look at the process of AUD change by considering whether individuals are able to transition to and sustain periods of remission seems warranted.
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Affiliation(s)
- Stephen A. Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, United States
| | - Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Seattle, Washington, United States
| | - Corey R. Roos
- Department of Psychology, University of New Mexico, Logan Hall MSC03-2220, 1 University of New Mexico, Albuquerque, NM, United States
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Logan Hall MSC03-2220, 1 University of New Mexico, Albuquerque, NM, United States
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Froehlich JC, Nicholson ER, Dilley JE, Filosa NJ, Rademacher LC, Smith TN. Varenicline Reduces Alcohol Intake During Repeated Cycles of Alcohol Reaccess Following Deprivation in Alcohol-Preferring (P) Rats. Alcohol Clin Exp Res 2017; 41:1510-1517. [PMID: 28617959 DOI: 10.1111/acer.13432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most alcoholics experience periods of voluntary alcohol abstinence or imposed alcohol deprivation followed by a return to alcohol drinking. This study examined whether varenicline (VAR) reduces alcohol intake during a return to drinking after periods of alcohol deprivation in rats selectively bred for high alcohol drinking (the alcohol preferring or "P" rats). METHODS Alcohol-experienced P rats were given 24-hour access to food and water and scheduled access to alcohol (15% and 30% v/v) for 2 h/d. After 4 weeks, rats were deprived of alcohol for 2 weeks, followed by reaccess to alcohol for 2 weeks, and this pattern was repeated for a total of 3 cycles. Rats were fed either vehicle (VEH) or VAR, in doses of 0.5, 1.0, or 2.0 mg/kg BW, at 1 hour prior to onset of the daily alcohol reaccess period for the first 5 days of each of the 3 alcohol reaccess cycles. RESULTS Low-dose VAR (0.5 mg/kg BW) reduced alcohol intake during the 5 days of drug treatment in alcohol reaccess cycles 1 and 2. Higher doses of VAR (1.0 mg/kg BW and 2.0 mg/kg BW) reduced alcohol intake during the 5 days of treatment in all 3 alcohol reaccess cycles. The decrease in alcohol intake disappeared with termination of VAR treatment in all alcohol reaccess cycles. CONCLUSIONS The results demonstrate that VAR decreases alcohol intake during multiple cycles of alcohol reaccess following alcohol deprivation in rats and suggests that it may prevent a return to heavy alcohol drinking during a lapse from alcohol abstinence in humans with alcohol use disorder.
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Affiliation(s)
| | | | - Julian E Dilley
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Nick J Filosa
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Teal N Smith
- Indiana University School of Medicine, Indianapolis, Indiana
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DiClemente CC, Crisafulli MA. Alcohol Relapse and Change Needs a Broader View than Counting Drinks. Alcohol Clin Exp Res 2016; 41:266-269. [PMID: 28029170 DOI: 10.1111/acer.13288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Carlo C DiClemente
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Michele A Crisafulli
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
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