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Lee BP, Witkiewitz K, Mellinger J, Anania FA, Bataller R, Cotter TG, Curtis B, Dasarathy S, DeMartini KS, Diamond I, Diazgranados N, DiMartini AF, Falk DE, Fernandez AC, German MN, Kamath PS, Kidwell KM, Leggio L, Litten R, Louvet A, Lucey MR, McCaul ME, Sanyal AJ, Singal AK, Sussman NL, Terrault NA, Thursz MR, Verna EC, Radaeva S, Nagy LE, Mitchell MC. Designing clinical trials to address alcohol use and alcohol-associated liver disease: an expert panel Consensus Statement. Nat Rev Gastroenterol Hepatol 2024:10.1038/s41575-024-00936-x. [PMID: 38849555 DOI: 10.1038/s41575-024-00936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/09/2024]
Abstract
Most patients with alcohol-associated liver disease (ALD) engage in heavy drinking defined as 4 or more drinks per day (56 g) or 8 (112 g) or more drinks per week for women and 5 or more drinks per day (70 g) or 15 (210 g) or more drinks per week for men. Although abstinence from alcohol after diagnosis of ALD improves life expectancy and reduces the risk of decompensation of liver disease, few studies have evaluated whether treatment of alcohol use disorders will reduce progression of liver disease and improve liver-related outcomes. In November 2021, the National Institute of Alcohol Abuse and Alcoholism commissioned a task force that included hepatologists, addiction medicine specialists, statisticians, clinical trialists and members of regulatory agencies to develop recommendations for the design and conduct of clinical trials to evaluate the effect of alcohol use, particularly treatment to reduce or eliminate alcohol use in patients with ALD. The task force conducted extensive reviews of relevant literature on alcohol use disorders and ALD. Findings were presented at one in-person meeting and discussed over the next 16 months to develop the final recommendations. As few clinical trials directly address this topic, the 28 recommendations approved by all members of the task force represent a consensus of expert opinions.
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Affiliation(s)
- Brian P Lee
- Division of Gastroenterology and Liver Diseases, University of Southern California Keck School of Medicine and Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Jessica Mellinger
- Department of Internal Medicine, Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Frank A Anania
- Division of Hepatology and Nutrition, US Food and Drug Administration, Silver Spring, MD, USA
| | - Ramon Bataller
- Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brenda Curtis
- Technology and Translational Research Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Kelly S DeMartini
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E Falk
- Medications Development Branch, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | | | - Margarita N German
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, MD, USA
| | - Raye Litten
- Division of Treatment and Recovery, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Alexandre Louvet
- Service des maladies de l'appareil digestif, University Hospital of Lille, Lille, France
- Unité INSERM INFINITE, Lille, France
| | - Michael R Lucey
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Arun J Sanyal
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Ashwani K Singal
- Department of Medicine, Division of Gastroenterology Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA
- Department of Medicine, Robley Rex VA Medical Center, Louisville, KY, USA
| | - Norman L Sussman
- DURECT Corporation, Cupertino, CA, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Norah A Terrault
- Division of Gastroenterology and Liver Diseases, University of Southern California Keck School of Medicine and Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Mark R Thursz
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Elizabeth C Verna
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Svetlana Radaeva
- Svetlana Radaeva, Division of Metabolism and Health Effects, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Laura E Nagy
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Mack C Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Möckl J, Manthey J, Murawski M, Lindemann C, Schulte B, Reimer J, Pogarell O, Kraus L. Clustering care pathways of people with alcohol dependence using a data linkage of routine data in Bremen, Germany. BMC Med 2024; 22:219. [PMID: 38816742 PMCID: PMC11140874 DOI: 10.1186/s12916-024-03438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Although many individuals with alcohol dependence (AD) are recognized in the German healthcare system, only a few utilize addiction-specific treatment services. Those who enter treatment are not well characterized regarding their prospective pathways through the highly fragmented German healthcare system. This paper aims to (1) identify typical care pathways of patients with AD and their adherence to treatment guidelines and (2) explore the characteristics of these patients using routine data from different healthcare sectors. METHODS We linked routinely collected register data of individuals with a documented alcohol-related diagnosis in the federal state of Bremen, Germany, in 2016/2017 and their addiction-specific health care: two statutory health insurance funds (outpatient pharmacotherapy for relapse prevention and inpatient episodes due to AD with and without qualified withdrawal treatment (QWT)), the German Pension Insurance (rehabilitation treatment) and a group of communal hospitals (outpatient addiction care). Individual care pathways of five different daily states of utilized addiction-specific treatment following an index inpatient admission due to AD were analyzed using state sequence analysis and cluster analysis. The follow-up time was 307 days (10 months). Individuals of the clustered pathways were compared concerning current treatment recommendations (1: QWT followed by postacute treatment; 2: time between QWT and rehabilitation). Patients' characteristics not considered during the cluster analysis (sex, age, nationality, comorbidity, and outpatient addiction care) were then compared using a multinomial logistic regression. RESULTS The analysis of 518 individual sequences resulted in the identification of four pathway clusters differing in their utilization of acute and postacute treatment. Most did not utilize subsequent addiction-specific treatment after their index inpatient episode (n = 276) or had several inpatient episodes or QWT without postacute treatment (n = 205). Two small clusters contained pathways either starting rehabilitation (n = 26) or pharmacotherapy after the index episode (n = 11). Overall, only 9.3% utilized postacute treatment as recommended. CONCLUSIONS A concern besides the generally low utilization of addiction-specific treatment is the implementation of postacute treatments for individuals after QWT.
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Affiliation(s)
- Justin Möckl
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Monika Murawski
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | - Christina Lindemann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Zentrum Für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Ludwig Kraus
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany.
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Public Health Sciences, Centre for Social Research On Alcohol and Drugs, Stockholm University, Stockholm, Sweden.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
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Perini I, Pabst A, Martinez D, Maurage P, Heilig M. Modeling social cognition in alcohol use disorder: lessons from schizophrenia. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06601-0. [PMID: 38761256 DOI: 10.1007/s00213-024-06601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
A better understanding of social deficits in alcohol use disorder (AUD) has the potential to improve our understanding of the disorder. Clinical research shows that AUD is associated with interpersonal problems and the loss of a social network which impedes response to treatment. Translational research between animal models and clinical research may benefit from a discussion of the models and methods that currently guide research into social cognition in AUD. We propose that research in AUD should harness recent technological developments to improve ecological validity while maintaining experimental control. Novel methods allow us to parse naturalistic social cognition into tangible components, and to investigate previously neglected aspects of social cognition. Furthermore, to incorporate social cognition as a defining element of AUD, it is critical to clarify the timing of these social disturbances. Currently, there is limited evidence to distinguish factors that influence social cognition as a consequence of AUD, and those that precede the onset of the disorder. Both increasing the focus on operationalization of social cognition into objective components and adopting a perspective that spans the clinical spectrum will improve our understanding in humans, but also possibly increase methodological consistency and translational dialogue across species. This commentary underscores current challenges and perspectives in this area of research.
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Affiliation(s)
- Irene Perini
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping, Sweden.
| | - Arthur Pabst
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Place C. Mercier 10, Louvain-la-Neuve, B-1348, Belgium
| | - Diana Martinez
- Columbia University, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Pierre Maurage
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Place C. Mercier 10, Louvain-la-Neuve, B-1348, Belgium
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Richelle L, Dramaix-Wilmet M, Vanderhofstadt Q, Kornreich C. Cluster analysis of medical students' attitudes regarding people who use drugs: a first step to design a tailored education program. BMC MEDICAL EDUCATION 2024; 24:490. [PMID: 38702647 PMCID: PMC11067200 DOI: 10.1186/s12909-024-05380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/31/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION People with substance use disorder (SUD) deal with stigmatization in various areas of life, including healthcare system. In this study, we investigated the attitudes of final-year medical students towards SUD people and attempted to understand their influence. METHODS We conducted a two-stage cluster analysis (hierarchical ascending classification followed by K-means clustering) based on the "beSAAS". We administrated this 23-item questionnaire to 923 final-year medical students in Belgium (response rate = 71,1%). Sociodemographic characteristics were compared between the clusters. RESULTS Four clusters of students with specific characteristics were identified in this study. The first, "The Inclusives" (including 27,9% of respondents) had the least negative attitudes; they wanted to specialize mainly in psychiatry and gynecology. The second, "The Centrists" (23,6%) consisted mainly of male students. They had many private and professional experiences with substance use and considered themselves less healthy than others did. Most wanted to specialize in pediatrics and general practice. Their attitudes were slightly negative towards people with SUD. The third, "The Moralists" (27,6%), were mainly older, from non-European countries, had the least experience with substance use (or contact mainly in hospitals), had the less high mother's level of education and reported excellent health. They were heading toward other specialties. They had the most stereotypes and moralism, and less treatment optimism. The fourth, "The Specialist care-oriented" (20,8%), were the most in favor of specialized treatment. This group had a higher proportion of Belgian, females, and students who had specific contact with this population. They especially intended to specialize in internal medicine. CONCLUSION This study revealed 4 profiles of medical students with different attitudes towards SUD people. "The Moralists", including more than a quarter of the respondents, were characterized by strong stereotypes and moralism and little treatment optimism. These clusters could contribute to the design of a learner-centered program aimed at addressing stigma within the main curriculum.
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Affiliation(s)
- Lou Richelle
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
| | - Michele Dramaix-Wilmet
- Département d'Epidémiologie et de Biostatistiques, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Quentin Vanderhofstadt
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Charles Kornreich
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Laboratoire de Psychologie Médicale et d'Addictologie, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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5
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Sutherland R, King C, Karlsson A, Treloar C, Broady T, Chandrasena U, Salom C, Dietze P, Peacock A. Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia. Drug Alcohol Rev 2024. [PMID: 38644679 DOI: 10.1111/dar.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION People who inject drugs experience stigma across multiple settings, including when accessing health-care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health-care services. METHODS Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6-month experience of stigma in the above services. Multi-variable regression analyses were performed to determine the socio-demographic, drug use and health factors associated with stigma. RESULTS Experiences of stigma in general health-care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health-care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past-year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. DISCUSSION AND CONCLUSIONS Experiences of stigma when accessing health-care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Cate King
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Antonia Karlsson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Udesha Chandrasena
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Paul Dietze
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychology, University of Tasmania, Hobart, Australia
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Danpanichkul P, Aboona MB, Sukphutanan B, Kongarin S, Duangsonk K, Ng CH, Muthiah MD, Huang DQ, Seko Y, Díaz LA, Arab JP, Yang JD, Chen VL, Kim D, Noureddin M, Liangpunsakul S, Wijarnpreecha K. Incidence of liver cancer in young adults according to the Global Burden of Disease database 2019. Hepatology 2024:01515467-990000000-00835. [PMID: 38598364 DOI: 10.1097/hep.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIMS The worldwide burden of cancer is increasing in younger populations. However, the epidemiology of primary liver cancer remains understudied in young adults compared to other cancer forms. APPROACH AND RESULTS This study analyzed data from the Global Burden of Disease study between 2010 and 2019 to assess the age-standardized incidence, mortality, and disability-adjusted life years associated with primary liver cancer in the young (15-49 y), stratified by region, nation, sociodemographic index, and sex. The study found a global estimate of 78,299 primary liver cancer cases, 60,602 deaths, and 2.90 million disability-adjusted life years in the young population. The Western Pacific region exhibited the highest burden in 2019, showing the most significant increase compared to other regions between 2010 and 2019. More than half of the countries worldwide have undergone an increase in primary liver cancer incidence rates in young adults. Around 12.51% of deaths due to primary liver cancer occur in young individuals. Throughout the study period, there was a significant decline in primary liver cancer mortality due to most etiologies, except for metabolic dysfunction-associated steatotic liver disease-attributable primary liver cancer (annual percentage change + 0.87%, 95% CI: 0.70%-1.05%) and alcohol-attributable primary liver cancer (annual percentage change + 0.21%, 95% CI: 0.01%-0.42%). The limitations of the Global Burden of Disease database include reliance on the quality of primary data and possible underestimation of alcohol consumption. CONCLUSIONS Over the past decade, there has been a marked increase in the burden of primary liver cancer, especially that originating from steatotic liver disease. This trend calls for the development of urgent and comprehensive strategies to mitigate this rising burden globally.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Majd B Aboona
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | | | | | - Kwanjit Duangsonk
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng Han Ng
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Health System, Singapore
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Kurume, Japan
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Q Huang
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- MASLD Research Center, Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
| | - Yuya Seko
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyou-ku, Kyoto, Japan
| | - Luis Antonio Díaz
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Observatorio Multicéntrico de Enfermedades Gastrointestinales, OMEGA, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vincent L Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Suthat Liangpunsakul
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Karn Wijarnpreecha
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
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7
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Hyde A, Johnson E, Bray C, Meier T, Carbonneau M, Spiers J, Tandon P. Understanding Nurse Perceptions of Caring for Patients With Alcohol Use Disorder: A Cross-Sectional Study. J Addict Nurs 2024; 35:76-85. [PMID: 38829997 DOI: 10.1097/jan.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. Individuals with AUD experience high morbidity and increased mortality. Nurses practicing in acute care are ideally positioned to deliver quality interventions to patients with AUD, including screening and brief intervention; formal training and assessment of baseline knowledge, attitudes, and perceptions are necessary. AIMS AND OBJECTIVES The aim of this study was to explore the knowledge, attitudes, and perceptions of acute care nurses caring for patients with AUD. DESIGN This study used a cross-sectional survey design. METHODS The Survey of Attitudes and Perceptions was completed by 93 nurses working in six acute care centers (seven medicine units) across Alberta. Data were analyzed using descriptive and inferential statistics. RESULTS Few participants reported receiving any prior structured training on AUD, with the majority reporting limited knowledge of alcohol and the effects of alcohol consumption. Although most participants said that caring for patients with AUD was a part of their professional role, few felt satisfied or motivated to work with this group of patients. Responses to individual questions or subdomains of the survey did not significantly differ by length of time in professional role, employment status, or sex. CONCLUSION Our results indicate that nurses need to learn more about caring for patients with AUD. Developing tailored educational interventions that are mindful of the importance of knowledge, support, satisfaction, and motivation is necessary to improve the quality of care for patients with AUD.
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Welfordsson P, Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Lidin M, Haugen Löfman I, Scheffel Birath C, Nilsson O, Braunschweig F, Wallhed Finn S. Feasibility of alcohol interventions in cardiology: A qualitative study of clinician perspectives in Sweden. Eur J Cardiovasc Nurs 2024:zvae033. [PMID: 38445448 DOI: 10.1093/eurjcn/zvae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/07/2024]
Abstract
AIM To identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services. METHODS AND RESULTS Qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, assistant nurses) of varying experience levels, and from various clinical settings (high dependency unit, ward, outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including twelve related to capability, nine to opportunity, and 20 to motivation. Four themes were developed: 1. Uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; 2. Cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; 3. Alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; 4. Window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care. CONCLUSION Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services. REGISTRATION OSF (osf.io/hx3ts).
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Affiliation(s)
- Paul Welfordsson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | | | - Caroline Björck
- Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Department of Caring Sciences, University of Gävle, Sweden
| | - Bartosz Grzymala-Lubanski
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Cardiology, Gävle Hospital, Gävle, Sweden
| | | | - Matthias Lidin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ida Haugen Löfman
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Olga Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Stockholm Centre for Dependency Disorders, Sweden
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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9
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Morris J, Rose AK, Cox S, Jones A. Clinical alcohol guidelines are welcome-but upstream action is paramount. Addiction 2024; 119:593-594. [PMID: 38084498 DOI: 10.1111/add.16408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 02/06/2024]
Affiliation(s)
- James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Abigail K Rose
- Department of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK
| | - Andrew Jones
- Department of Psychology, Liverpool John Moores University, Liverpool, UK
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10
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Cunningham JA, Limaksorn J. Perceptions of the Seriousness of Different Addictive Behaviors in the United Kingdom. Subst Use Misuse 2024; 59:1067-1071. [PMID: 38419184 DOI: 10.1080/10826084.2024.2320375] [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: 03/02/2024]
Abstract
Background: Societal beliefs about the seriousness of different addictions were assessed in the United Kingdom (UK). Methods: An online panel, conducted in 2021 and sampled to be representative of the UK general population 18 years and over (N = 1499), was conducted and asked participants their views regarding the seriousness of different societal problems, including various addictive behaviors. Results: Cannabis was ranked as the least serious of the addictive behaviors. Other illicit drug use (cocaine, amphetamine, heroin) was rated as the most serious of addictive behaviors. None of the addictive behaviors were rated as being as serious a problem to society as environmental damage, violent crime, poverty, and the COVID-19 pandemic. Conclusions: Ratings of cannabis use were not as expected and stand in contrast to the current UK policy on cannabis use. In addition, the UK policy on alcohol consumption contrasts with societal concerns about alcohol use.
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Affiliation(s)
- John A Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jirapart Limaksorn
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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11
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Binder A, Kilian C, Hanke S, Banabak M, Berkenhoff C, Petersen KU, Batra A. Stigma and self-stigma among women within the context of the german "zero alcohol during pregnancy" recommendation: A qualitative analysis of online forums and blogs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104331. [PMID: 38241887 DOI: 10.1016/j.drugpo.2024.104331] [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: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND In many countries, including Germany, it is recommended to abstain from alcohol during pregnancy to avoid harm to the baby. In this qualitative research study, analysis of online forums was conducted to explore women's perception of the German "zero alcohol during pregnancy" recommendation with regard to stigma and self-stigma. METHODS We used a grounded theory approach to analyze online forum discussions on alcohol use during pregnancy. Data consisted of 9 discussion threads from 5 different forums and blogs involving 115 participants in total. We used key concepts developed during analysis and the theory of stigma to interpret the posts. RESULTS We identified five key themes: (1) Low alcohol health literacy as a breeding ground for stigmatization; (2) The widespread assumption that maternal abstinence is a prerequisite for being considered a "good mother"; (3) Interpersonal role conflicts and a guilty conscience as a result of stigmatization or self-stigmatization; (4) Paying little attention to the role of psychosocial factors in alcohol consumption, especially regarding partner responsibility during pregnancy.; (5) Understanding the "zero alcohol during pregnancy" recommendation as a complete ban, associated with loss of autonomy. CONCLUSION The current method of communicating the "zero alcohol during pregnancy" recommendation may have unintended consequences. Specifically, misconceptions about the harm associated with low alcohol consumption and setting high expectations of motherhood are factors that can contribute to stigma or self-stigma and potentially undermine self-efficacy, help-seeking behavior, and overcoming the barriers to alcohol health literacy.
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Affiliation(s)
- Annette Binder
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany; DZPG (German Center for Mental Health), partner site Tübingen, Tübingen, Germany.
| | - Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sara Hanke
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Meryem Banabak
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Clara Berkenhoff
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Kay Uwe Petersen
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Anil Batra
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany; DZPG (German Center for Mental Health), partner site Tübingen, Tübingen, Germany
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12
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Russell AM, Montemayor BN, Ndulue EB, Barry AE, Massey PM. Alcohol Use Disorder Narratives in U.S. Digital News Coverage and Engagement on Social Media. HEALTH COMMUNICATION 2023; 38:2986-2992. [PMID: 36178062 PMCID: PMC10060439 DOI: 10.1080/10410236.2022.2129314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Social media regularly serves as a source of news and health-related information subsequently shaping public opinion and behavior. We examined mainstream digital news narratives about alcohol use disorder (AUD), including coverage of solutions to AUD, and associations between narratives and engagement on social media. AUD-related articles (N = 339) published in top U.S. newspapers and digital native news sources in 2019 were analyzed by trained coders with a structured codebook (κ = 0.75), examining characteristics of stories highlighting specific individuals affected by AUD and solution-framing of AUD. Facebook shares were used as a proxy measure for an article's potential "reach" on social media. Of articles focused on individuals (72.0%), most (62.7%) depicted individuals affected by AUD as criminals, as opposed to engaging with alcohol treatment or being in recovery (31.1%). These criminal depictions received over eight times as many FB shares, compared to alcohol use treatment or recovery depictions. Law enforcement solutions (63.9%) were depicted most often, followed by AUD-treatment oriented solutions (40.1%), and prevention-oriented solutions (15.8%). Law enforcement solutions received more than five times as much social media engagement than AUD-treatment oriented solutions and over twenty-nine times more engagement than prevention-oriented solutions. There is a need to increase news coverage featuring depictions of individuals who have successfully engaged with alcohol treatment and recovery, reflecting the millions of Americans who have resolved a significant past alcohol problem. News coverage of AUD should also incorporate more depictions of evidence-based prevention-oriented and treatment-oriented solutions to AUD.
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Affiliation(s)
- Alex M. Russell
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Ben N. Montemayor
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | | | - Adam E. Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Philip M. Massey
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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13
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Thurfjell Å, Sandlund C, Adami J, Hasselström J, Hagströmer M, Lundh L. GPs' experiences of phosphatidylethanol in treatment of hypertension: a qualitative study. BJGP Open 2023; 7:BJGPO.2023.0037. [PMID: 37463721 DOI: 10.3399/bjgpo.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Hazardous alcohol use increases the risk of hypertension but is underdetected in primary healthcare (PHC) patients. Use of the biomarker phosphatidylethanol (PEth), which reflects the last 2-3 weeks of alcohol consumption, is increasing in Swedish PHC, but studies exploring its use for hypertension are scarce or missing. AIM To explore GPs' experiences of using PEth to identify hazardous alcohol use in the context of managing hypertension. DESIGN & SETTING A qualitative study of GPs (n = 12) experienced in using PEth in hypertension management who were recruited at Swedish primary healthcare centres (PHCC) in 2021. METHOD The GPs participated in five focus group interviews. A questioning route was used. The interviews were audio-recorded, transcribed verbatim, and analysed with inductive qualitative content analysis. RESULTS 'I don't hesitate anymore' was the overall theme, which reflected both the disappearance of GPs' fear that the PEth result might upset the patient, as this rarely occurred, and that the positive effects of PEth predominated in the findings. The theme is underpinned by the following four sub-themes: serving as an eye-opener; improving the dialogue; using with care; and learning by doing. CONCLUSION PEth is a useful tool that changed GPs' routines for addressing alcohol and identifying hazardous alcohol use in patients with hypertension managed in PHC. The GPs advocated adopting PEth as a routine test in the treatment of hypertension. However, PEth needs to be used with care to maximise benefit and minimise harm.
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Affiliation(s)
- Åsa Thurfjell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Christina Sandlund
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Maria Hagströmer
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Lena Lundh
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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Morris J, Boness CL, Burton R. (Mis)understanding alcohol use disorder: Making the case for a public health first approach. Drug Alcohol Depend 2023; 253:111019. [PMID: 37952353 PMCID: PMC11061885 DOI: 10.1016/j.drugalcdep.2023.111019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
'Alcohol use disorder' (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an 'alcoholism' master narrative in which disease model stereotypes come with multiple costs for prevention and 'recovery'. The persistence of a problematic 'alcoholism' paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and 'other', and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual's essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.
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Affiliation(s)
- James Morris
- London South Bank University, Centre for Addictive Behaviours Research, UK.
| | - Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, USA
| | - Robyn Burton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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15
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Barré T, Di Beo V, Roux P, Mourad A, Verger P, Fressard L, Herault T, Buyck JF, Beck F, Carrieri P. Screening for alcohol use in primary care: assessing French general practitioner practices. Alcohol Alcohol 2023; 58:672-682. [PMID: 37818974 DOI: 10.1093/alcalc/agad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Vincent Di Beo
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Abbas Mourad
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Faculté des Sciences Médicales et Paramédicales, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Faculté des Sciences Médicales et Paramédicales, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Thomas Herault
- Union Régionale des Médecins Libéraux des Pays de La Loire, 13 rue de la Loire, Bâtiment C2, 44230 Saint Sébastien-sur-Loire, Nantes, France
| | - Jean-François Buyck
- Observatoire Régional de La Santé Des Pays de La Loire, 2 Rue de la Loire, 44200 Nantes, France
| | - François Beck
- Santé Publique France, 12, rue du Val d'Osne 94 415 Saint-Maurice cedex, France
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Inserm U1018, Université Paris-Saclay, Université Paris-Sud, Université Versailles Saint-Quentin (UVSQ), 16 Av. Paul Vaillant Couturier, 94800 Villejuif, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
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16
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Wallhed Finn S, Mejldal A, Baskaran R, Nielsen AS. Effects of media campaign videos on stigma and attitudes towards treatment seeking for alcohol use disorder: a randomized controlled study. BMC Public Health 2023; 23:1919. [PMID: 37794390 PMCID: PMC10552234 DOI: 10.1186/s12889-023-16811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Alcohol Use Disorder (AUD) is one of the most stigmatized diagnosis, and stigma imposes a major barrier to treatment seeking. There is a need to develop interventions that can reduce stigma and increase treatment seeking. Little is known about the effects of video materials. The aim of this study was to investigate effects of different videos. The primary outcome was public stigma, and secondary outcomes were: self-stigma, and motivation to change own alcohol use; talking to someone else about their alcohol use; seeking information about AUD treatment or seeking AUD treatment. METHODS This is a three-armed double blind randomized controlled study. The study included 655 Danish adults. Data was collected at a study webpage, and the survey could be completed anywhere with Internet access. After informed consent and completing baseline measures, participants were randomized, 1:1:1 ratio, to a video (video 1 n = 228; video 2 n = 198; video 3 n = 229). Video 1 and 2 have been used in a national mass media campaign and video 3 was recorded for use in the present study. Immediately after exposure, follow-up measures were completed. Outcomes were analyzed with mixed effects linear regression. RESULTS In total n = 616 completed follow-up (video 1 n = 215; video 2 n = 192; video 3 n = 209). Randomization to video 1 and 3 decreased public stigma measured with "Difference, Disdain & Blame Scales", while video 2 increased stigma. Video 2 compared to 1: 2.262 (95% CI 1.155; 3.369) p < 0.001. Video 3 compared to 1: -0.082 (95% CI -1.170; 1.006) p = 0.882. Video 3 compared to 2: -2.344 (95% CI -3.455; -1.233) p = 0.882. All videos reduced motivation to change own alcohol use. Participants with hazardous alcohol use, were more sensitive to the different videos, compared to low-risk alcohol use. Video 2 decreased motivation to seek information about treatment. No effects were seen on motivation to seek treatment, motivation to talk to someone else or self-stigma. CONCLUSIONS Videos can have an immediate effect on level of public stigma. Other types of interventions are needed to increase motivation and reduce self-stigma. To avoid adverse effects in future interventions, the use of theoretical frameworks and stakeholder involvement is emphasized.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
| | - Ruben Baskaran
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
- SDU Health informatics and technology, Faculty of engineering, The Maersk Mc-Kinney Moller institute, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
- Psychiatric Hospital, University Function, Region of Southern, Odense, Denmark
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Hannan SM, Wells TT. A Broad Examination of Mental Health Literacy Among College Students in the United States. Health Lit Res Pract 2023; 7:e207-e214. [PMID: 37935382 PMCID: PMC10629906 DOI: 10.3928/24748307-20231023-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND High levels of mental health literacy (MHL) have been linked to the ability to correctly recognize certain problems as mental health issues, which then may lead to effective help-seeking behaviors. Most research on MHL has focused on a limited number of psychiatric diagnoses, using Australian samples. OBJECTIVE This study aimed to investigate various components of MHL in a large sample of undergraduate students in the United States. METHODS We conducted a vignette-based study with 843 undergraduate students. Six psychiatric diagnoses (and two "non-disordered" scenarios) were represented in distinct vignettes. Participants rated the severity of each vignette character's problem, the helpfulness of numerous treatment options, and the likelihood that different etiological factors contributed to the character's problem. KEY RESULTS Across all clinical vignettes, therapy/counseling was perceived to be the most helpful treatment. Participants rated "personal weakness/lack of willpower" as contributing the most to the alcohol use disorder (AUD) character's problems. Our hypothesis related to how perceptions of etiology may impact participants' perceptions of different types of treatment was partially supported for the depression character. When participants described the depression character as having a "psychological/mental health problem," they were more likely to perceive therapy/counseling as being helpful compared to medication. CONCLUSIONS Participants recognized most of the psychiatric diagnoses as a mental health problem, acknowledged the seriousness of the presenting problems, and recommended effective help-seeking behavior. However, undergraduate U.S. students could benefit from increased MHL specifically related to AUD. [HLRP: Health Literacy Research and Practice. 2023;7(4):e207-e214.].
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Affiliation(s)
- Susan M. Hannan
- Address correspondence to Susan M. Hannan, PhD, Department of Psychology, Lafayette College, Oechsle Hall, 350 Hamilton Street, Easton, PA 18042;
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18
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Eék N, Sundström C, Kraepelien M, Lundgren J, Kaldo V, Berman AH. High- versus low-intensity internet interventions for alcohol use disorders (AUD): A two-year follow-up of a single-blind randomized controlled trial. Internet Interv 2023; 33:100630. [PMID: 37293578 PMCID: PMC10244691 DOI: 10.1016/j.invent.2023.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and ≥ 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24-month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both high- and low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38-1.04 and heavy drinking days effect sizes varied between g = 0.65-0.94]. Compared to post-treatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.
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Affiliation(s)
- Niels Eék
- University of Gothenburg, Department of Psychology, Sweden
| | - Christopher Sundström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | | | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
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19
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Wyant K, Moshontz H, Ward SB, Fronk GE, Curtin JJ. Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study. JMIR Mhealth Uhealth 2023; 11:e41833. [PMID: 37639300 PMCID: PMC10495858 DOI: 10.2196/41833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/14/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. OBJECTIVE We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. METHODS Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants' choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. RESULTS Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). CONCLUSIONS These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement.
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Affiliation(s)
- Kendra Wyant
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Hannah Moshontz
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Stephanie B Ward
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Gaylen E Fronk
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - John J Curtin
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
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20
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Germani G, D’Arcangelo F, Grasso M, Burra P. Advances and Controversies in Acute Alcohol-Related Hepatitis: From Medical Therapy to Liver Transplantation. Life (Basel) 2023; 13:1802. [PMID: 37763206 PMCID: PMC10532507 DOI: 10.3390/life13091802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Alcohol-related hepatitis (AH) is a clinical syndrome characterized by recent-onset jaundice in the context of alcohol consumption. In patients with severe AH "unresponsive" to steroid therapy, mortality rates exceed 70% within six months. According to European and American guidelines, liver transplantation (LT) may be considered in highly selected patients who do not respond to medical therapy. The aim of this narrative review is to summarize current knowledge from medical therapy to liver transplantation in acute alcohol-related hepatitis. Due to the impossibility to guarantee six-month abstinence, LT for AH is controversial. Principal concerns are related to organ scarcity in the subset of stigma of "alcohol use disorder" (AUD) and the risk of relapse to alcohol use after LT. Return to alcohol use after LT is a complex issue that cannot be assessed as a yes/no variable with heterogeneous results among studies. In conclusion, present data indicate that well-selected patients have excellent outcomes, with survival rates of up to 100% at 24 and 36 months after LT. Behavioral therapy, ongoing psychological support, and strong family support seem essential to improve long-term outcomes after LT and reduce the risk in relapse of alcohol use.
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Affiliation(s)
- Giacomo Germani
- Multivisceral Transplant Unit, Azienda Ospedale—Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Francesca D’Arcangelo
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale—Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.D.); (M.G.); (P.B.)
| | - Marco Grasso
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale—Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.D.); (M.G.); (P.B.)
| | - Patrizia Burra
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale—Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.D.); (M.G.); (P.B.)
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21
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Montgomery C, Atkinson A, Jones A, Sumnall H. Little Evidence for the Role of Disgust Sensitivity in Implicit Disgust to Images of White People Engaged in Injecting Drug Use (IDU). Subst Use Misuse 2023; 58:1722-1733. [PMID: 37602746 DOI: 10.1080/10826084.2023.2247054] [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: 08/22/2023]
Abstract
Background: Previous research has shown that People Who Inject Drugs (PWID) are subject to public stigma, which affects access to, and provision and quality of, treatment and support services. Less is known about the socio-cognitive processes that support the development and maintenance of public stigma toward PWID. The present study investigated the role of disgust sensitivity in implicit disgust to injecting drug use. Methods: 126 participants took part in an online Implicit Association Task (IAT) measuring implicit disgust to pictorial stimuli of injecting drug use or medical injecting. Participants also completed The Disgust Scale Revised, Injecting Phobia Scale (Short Form), Attitudes to People Who Use Drugs (PWUD) scale and a substance use inventory. Results: Average IAT score was negative indicating significantly higher implicit disgust to injecting drug use. Hierarchical linear regression found that injecting phobia predicted implicit disgust to injecting drug use. Questionnaire measures of disgust did not predict implicit disgust. While animal reminder disgust and injecting phobia were significantly correlated with each other, animal reminder disgust did not predict implicit disgust scores. Conclusions: On the basis of our findings, stigma toward PWID may not be a result of feelings of disgust toward injecting drug use. We discuss findings in the context of the underlying cortical processes supporting implicit and explicit representations of disgust. Future research should seek to investigate neurophysiological evidence for disgust to and stigmatization of injecting drug use and the potential role of domains of disgust in this.
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Affiliation(s)
| | - Amanda Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Andrew Jones
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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22
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Wallhed Finn S, Mejldal A, Nielsen AS. The associations between public stigma and support for others' help-seeking for alcohol use disorder: a cross sectional study in the general Danish population. Addict Sci Clin Pract 2023; 18:46. [PMID: 37542352 PMCID: PMC10403820 DOI: 10.1186/s13722-023-00400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND A minority of all individuals with alcohol use disorders (AUD) seek treatment, where stigma is one prominent barrier. Social support is important to facilitate health and increase treatment-seeking. Whether there is an association between stigma and attitudes towards others' help-seeking for AUD is unknown. The aim of this study was to investigate the associations between stigma and support towards others' help-seeking for AUD, also to explore possible gender differences. METHOD Cross-sectional study, n = 2895, including Danish adults aged 30-65 in the general population. Year 2020, an online questionnaire was administrated, which covered demographics, attitudes towards others' help-seeking for AUD, and stigma measured with the Difference, Disdain & Blame Scales. Analyses were performed with Restricted Cubic Spline models, and odds ratios were calculated. RESULTS Lower level of stigma was associated with a higher probability for endorsing an "active support strategy". Level of stigma was not associated with "not knowing what to say or do" or "sharing my concern with others". There were few gender differences: among men, higher level of stigma was associated with a higher probability of "avoidance". Among women, lower level of stigma was associated with a lower probability of "avoidance". CONCLUSION There is a clear association between stigma and attitudes towards supporting others' help-seeking for AUD. The results highlight the need to reduce stigma and promote engagement towards others' treatment-seeking.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, 5000, Odense, Denmark.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, 5000, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, 5000, Odense, Denmark
- Psychiatric Hospital, University Function, Region of Southern Denmark, Odense, Denmark
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23
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Binder A, Fenchel J, Lang I, Batra A. The dual role dilemma of liver transplantation health care professionals. BMC Med Ethics 2023; 24:46. [PMID: 37403151 DOI: 10.1186/s12910-023-00923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Similar to many other countries, in Germany patients with alcohol-related liver disease are obliged to prove their abstinence before being accepted on a waitlist for liver transplantation. Health care professionals (HCPs) must both treat patients and ensure that patients have proven their abstinence. The aim of this exploratory study was to develop a deeper understanding of how HCPs deal with this dual role. METHODS The study used semi-structured interviews as the source of data. 11 healthcare professionals from ten of the 22 German transplant centers were interviewed. After transcription, a qualitative content analysis was performed. RESULTS We found that these HCPs faced an ethical dilemma, as they must balance the roles of being both a treatment provider (the therapist role) and an assessor (the monitoring role). To solve this dilemma, the strategy seems to be a tendency for the HCPs to take on one dominant role amongst these two roles. HCPs who prefer to take on the therapist role seem to feel burdened by the 6-month abstinence rule and the obligation to monitor their patients. HCPs who prefer to take on the monitoring role tend to have negative assumptions about the patients. HCPs also reported the impression that patients perceive HCPs as more involved in monitoring and less open to the therapeutic role. From this it can be deduced that current regulations and structures lead both to stress for HCPs and to suboptimal therapy for those affected. CONCLUSIONS The results showed that current transplantation guidelines can have a negative impact on both patient care and the burdens on the HCPs. From our point of view, there are various changes that could be made to the current clinical practice that would help solve this dilemma. For instance, integrating other assessment criteria that are more closely adapted to the health status trajectory and psychosocial background of the individual patient would be both possible and would lead to improvements in practice.
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Affiliation(s)
- Annette Binder
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany.
| | - Julia Fenchel
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Immanuel Lang
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Anil Batra
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
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24
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Sinclair JMA, Aslan B, Agabio R, Anilkumar A, Brosnan M, Day E, Dowling NA, Flood C, Grant JE, Halliday R, Hofvander B, Howes L, Moseley R, Myers B, O'Connor V, Shaya G, Thomas S, Robinson J, Chamberlain SR. Identifying the most important research, policy and practice questions for substance use, problematic alcohol use and behavioural addictions in autism (SABA-A): A priority setting partnership. Compr Psychiatry 2023; 124:152393. [PMID: 37210935 PMCID: PMC7614597 DOI: 10.1016/j.comppsych.2023.152393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Autistic people are more likely to report problematic alcohol and other substance use when compared to the general population. Evidence suggests that up to one in three autistic adults may have an alcohol or other substance use disorder (AUD/SUD), although the evidence base for behavioural addictions is less clear. Autistic people may use substances or engage in potentially addictive behaviours as a means of coping with social anxiety, challenging life problems, or camouflaging in social contexts. Despite the prevalence and detrimental effects of AUD, SUD and behavioural addictions in community samples, literature focusing on the intersection between autism and these conditions is scarce, hindering health policy, research, and clinical practice. METHODS We aimed to identify the top 10 priorities to build the evidence for research, policy, and clinical practice at this intersection. A priority-setting partnership was used to address this aim, comprising an international steering committee and stakeholders from various backgrounds, including people with declared lived experience of autism and/or addiction. First, an online survey was used to identify what people considered key questions about Substance use, alcohol use, or behavioural addictions in autistic people (SABA-A). These initial questions were reviewed and amended by stakeholders, and then classified and refined to form the final list of top priorities via an online consensus process. OUTCOMES The top ten priorities were identified: three research, three policy, and four practice questions. Future research suggestions are discussed.
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Affiliation(s)
| | - Betul Aslan
- Faculty of Medicine, University of Southampton, UK
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy; Neuroscience Institute, Section of Cagliari, National Research Council, Italy
| | | | - Mark Brosnan
- Centre for Applied Autism Research, University of Bath, UK
| | - Ed Day
- Institute of Mental Health, University of Birmingham, UK
| | - Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia; Melbourne Graduate School of Education, University of Melbourne, Australia
| | | | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | | | - Björn Hofvander
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Denmark
| | | | - Rachel Moseley
- Department of Psychology, Bournemouth University, Poole, UK
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health sciences, Curtin University, Perth, Western Australia, Australia; Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research council, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Shane Thomas
- Vice Chancellor's Office, Federation University, Australia; Centre for Research on Ageing, Health and Wellbeing, Australian National University, Australia
| | - Janine Robinson
- Chitra Sethia Autism Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridge, UK
| | - Samuel R Chamberlain
- Faculty of Medicine, University of Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK.
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25
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Manthey J, Kilian C, Schäfer I, Wirth M, Schulte B. Changes in the alcohol-specific disease burden during the COVID-19 pandemic in Germany: interrupted time series analyses. Eur J Public Health 2023:ckad103. [PMID: 37365723 PMCID: PMC10393477 DOI: 10.1093/eurpub/ckad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has been linked to changes in alcohol consumption, access to healthcare services and alcohol-attributable harm. In this contribution, we quantify changes in alcohol-specific mortality and hospitalizations at the onset of the COVID-19 pandemic in March 2020 in Germany. METHODS We obtained monthly counts of deaths and hospital discharges between January 2013 and December 2020 (n = 96 months). Alcohol-specific (International Classification of Diseases, tenth revision codes: F10.X; G31.2, G62.1, G72.1, I42.6, K29.2, K70.X, K85.2, K86.0, Q86.0, T51.X) diagnoses were further split into codes reflective of acute vs. chronic harm from alcohol consumption. To quantify the change in alcohol-specific deaths and hospital discharges, we performed sex-stratified interrupted time series analyses using generalized additive mixed models for the population aged 45-74. Immediate (step) and cumulative (slope) changes were considered. RESULTS Following March 2020, we observed immediate increases in alcohol-specific mortality among women but not among men. Between the years of 2019 and 2020, we estimate that alcohol-specific mortality among women has increased by 10.8%. Hospital discharges were analyzed separately for acute and chronic conditions. The total number of hospital discharges fell by 21.4% and 25.1% for acute alcohol-specific conditions for women and men, respectively. The total number of hospital discharges for chronic alcohol-specific conditions fell by 7.4% and 8.1% for women and men, respectively. CONCLUSIONS Increased consumption among people with heavy drinking patterns and reduced utilization of addiction-specific healthcare services during the pandemic might explain excess mortality. During times of public health crises, access to addiction-specific services needs to be ensured.
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Affiliation(s)
- Jakob Manthey
- Centre for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Carolin Kilian
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marielle Wirth
- Centre for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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26
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Janiuk K, Maleki N. Exposure to Alcohol-Related Content on Social-Media. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 5:93-104. [PMID: 37711755 PMCID: PMC10499190 DOI: 10.1176/appi.prcp.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 09/16/2023] Open
Abstract
Objective Exposure to alcohol-related content is unavoidable on social media. In this study level of exposure to alcohol marketing content on Twitter and Instagram for those in recovery was examined, and the effectiveness of privacy settings to mitigate exposing content was assessed. Methods Four fictitious accounts were created on Instagram and Twitter in a case-control design in Spring 2022. All accounts followed 19 alcohol brands, with two accounts (1 male, 1 female) following only alcohol brand accounts while the other two (1 male, 1 female) additionally followed recovery resources. Four weeks of data collection were done with default privacy and advertisement settings, followed by two additional weeks of data collection with advertisement and privacy settings for blocking alcohol content. Results Privacy settings did not help with blocking the alcoholic brand-related photographic content on either platform, meaning that the accounts received the same amount of alcohol-related content from the accounts they were following with and without changing the privacy settings. However, Twitter algorithms were more effective in suppressing alcohol-related content for accounts following recovery resources and alcohol brands. Conclusions These results suggest that risks of exposure to triggering/cueing photographic alcohol content may outweigh the benefits of social media for social connection if an individual is considering seeking recovery.
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Affiliation(s)
- Kathryn Janiuk
- Psychiatric Neuroimaging DivisionDepartment of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Nasim Maleki
- Psychiatric Neuroimaging DivisionDepartment of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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27
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Hu D, Primc N. Should responsibility be used as a tiebreaker in allocation of deceased donor organs for patients suffering from alcohol-related end-stage liver disease? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:243-255. [PMID: 36780062 PMCID: PMC10175331 DOI: 10.1007/s11019-023-10141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 05/13/2023]
Abstract
There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns.
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Affiliation(s)
- Diehua Hu
- Department of Philosophy, Central South University, 410075, Changsha, China
| | - Nadia Primc
- Institute of History and Ethics of Medicine, Medical Department, Heidelberg University, Im Neuenheimer Feld 327, 69120, Heidelberg, Germany.
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28
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Garcia R. Understanding Alcohol Use Disorder. Nurs Clin North Am 2023; 58:133-140. [PMID: 37105649 DOI: 10.1016/j.cnur.2023.02.006] [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: 04/29/2023]
Abstract
Alcohol consumption has been a significant influence on varying social cultures for thousands of years. From its use in medicinal settings, social environments, industry, and more, alcohol has rooted itself deeply into society despite drastic attempts to curtail its popularity. As we continue to move forward in the advancements of science and medicine, it is becoming vastly apparent how impactful and consequential alcohol consumption is in many aspects of our everyday lives.
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Affiliation(s)
- Rodrigo Garcia
- Parkdale Center for Professionals, 350 Indian Boundary Road, Chesterton, IN 46304, USA.
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29
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Manthey J, Kokole D, Riedel-Heller S, Rowlands G, Schäfer I, Schomerus G, Soellner R, Kilian C. Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany. Addict Sci Clin Pract 2023; 18:28. [PMID: 37161561 PMCID: PMC10169338 DOI: 10.1186/s13722-023-00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example. METHODS A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC). RESULTS Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88). CONCLUSIONS Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Steffi Riedel-Heller
- Public Health Sciences Institute, Campus for Ageing & Vitality, Westgate Rd, Newcastle Upon Tyne, NE4 6BE, UK
| | - Gill Rowlands
- Institute of Social Medicine, Medical Faculty, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Renate Soellner
- Institute for Psychology, University of Hildesheim, Universitätsplatz 1, 34414, Hildesheim, Germany
| | - Carolin Kilian
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research (IMHPR), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
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Garcia SC, Sanzari CM, Blau LE, Coffino JA, Hormes JM. Stigmatization of binge eating disorder in men: Implicit associations with weight status and femininity. Eat Behav 2023; 49:101733. [PMID: 37121131 DOI: 10.1016/j.eatbeh.2023.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Eating disorders are highly stigmatized, but stigma against binge eating disorder (BED) specifically is relatively understudied, especially in men. We compared perceptions of a male target with BED to one with alcohol use disorder (AUD), which shares the key characteristic of subjective loss of control over consumption. We also investigated how participants' eating and alcohol use behaviors and attitudes towards psychotherapy influence perceptions of these disorders. METHODS Participants (n = 402) viewed vignettes describing a male target engaged in excess alcohol use or binge eating and rated the target on various attributes and as being responsible for or in control of their behavior and suffering from an addiction warranting treatment. Participants completed the Alcohol Use Disorders Identification Test, Binge Eating Scale, and questions about attitudes towards and experience with psychological treatment. RESULTS The BED target was rated as significantly less "thin," more "overweight" and "obese", and higher on several positive attributes and traits traditionally associated with femininity; the AUD target was thought more likely to be suffering from an addiction and in need of psychological treatment (all p < .05), with no differences between targets in ratings of responsibility for or control over the problematic behavior. Ratings were unrelated to participants' attitudes towards or experience with psychological treatment and personal alcohol consumption or binge eating behaviors. CONCLUSIONS BED in men appears less stigmatized than AUD but is implicitly associated with weight status and femininity, which may increase reluctance to seek treatment. Both AUD and BED were generally recognized as pathological and warranting intervention.
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Affiliation(s)
- Susana Cruz Garcia
- Department of Psychology, University at Albany, State University of New York, United States of America
| | - Christina M Sanzari
- Department of Psychology, University at Albany, State University of New York, United States of America
| | - Lauren E Blau
- Department of Psychology, University at Albany, State University of New York, United States of America; Department of Psychiatry at the Ichan School of Medicine at Mount Sinai, United States of America
| | - Jaime A Coffino
- Department of Psychology, University at Albany, State University of New York, United States of America; Department of Population Health, New York University Grossman School of Medicine, United States of America
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, United States of America.
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Finn SW, Mejldal A, Nielsen AS. Perceived barriers to seeking treatment for alcohol use disorders among the general Danish population - a cross sectional study on the role of severity of alcohol use and gender. Arch Public Health 2023; 81:65. [PMID: 37087483 PMCID: PMC10122805 DOI: 10.1186/s13690-023-01085-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND A minority of all individuals with alcohol use disorders (AUD) seek treatment. Since the suffering from AUD has severe consequences for both the individual and for society, it is important to improve the understanding of barriers to seeking treatment. Most studies of barriers thus far have been conducted in the United States of America or the United Kingdom. There is a need for studies from other contexts. The overall aim is to investigate barriers to treatment seeking for AUD. The specific aims are to: 1) describe barriers to AUD treatment at different levels of alcohol use. 2) compare gender differences regarding barriers to AUD treatment. METHODS Study design: Cross-sectional. PARTICIPANTS 1594 representative Danish adults from the general population aged 30-65 years. An online questionnaire was administrated by a market research company. The questionnaire covered demographic data, barriers to treatment and level of alcohol use. Analyses were performed by means of chi-2 test and logistic regression. RESULTS The most common barriers were related to stigma and shame: admitting to others of having a problem, being labelled, fear of the consequences and that others would find out. Participants with higher severity of alcohol use were more likely to endorse a wish to handle alcohol problems themselves and to report barriers related to treatment services. Women with high severity of alcohol use, endorsed higher level of fear of the consequences than men. CONCLUSIONS There is an urgent need to reduce stigma around AUD. Individuals with higher severity of alcohol use report a lower willingness to seek professional treatment if a problem occurs. Especially among individuals with high severity of alcohol use there is a need to address gender specific barriers.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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Brown SA. Are the “Big 5” Personality Traits Associated With Substance Use Self-Stigma? JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231163801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Self-stigma among individuals with substance use problems is notably high, but not all individuals with substance use problems experience elevated self-stigma. Unfortunately, there is limited research to account for such variation. A few studies have examined the association between personality traits from the five-factor model (FFM; “Big 5”) and self-stigma among those with mental illness, but no research exists among individuals with substance use disorders. Based on data from 125 individuals residing in a substance use treatment unit, the FFM personality traits collectively account for 33% to 56% of the variance across four components of self-stigma. More specifically, individuals with high neuroticism, low conscientiousness, and/or low extraversion experience greater self-stigma. The identification of at-risk individuals, via personality traits, could allow for development of targeted interventions to address self-stigma, and ultimately improve treatment retention and outcomes.
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Affiliation(s)
- Seth A. Brown
- Department of Psychology, University of Northern Iowa, Cedar Falls, IA, USA
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Allison MED, Verne J, Bernal W, Clayton M, Cox S, Dhanda A, Dillon JF, Ferguson J, Foster G, Gilmore I, Hebditch V, Jones R, Masson S, Oates B, Richardson P, Sinclair J, Wendon J, Wood D. Deaths from alcohol-related liver disease in the UK: an escalating tragedy. Lancet 2023; 401:418-420. [PMID: 36549316 DOI: 10.1016/s0140-6736(22)02583-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Michael E D Allison
- Liver Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals Foundation Trust, Cambridge CB2 0QQ, UK.
| | - Julia Verne
- National Liver Disease Intelligence Network, Office for Health Improvement and Disparities, Department of Health and Social Care, UK Government, London, UK
| | - William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, London, UK
| | | | - Sam Cox
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, UK Government, London, UK
| | - Ashwin Dhanda
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - James Ferguson
- University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Graham Foster
- Blizard Institute, Queen Mary University of London, London, UK
| | | | | | | | - Steven Masson
- Liver Unit, Freeman Hospital, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | | | - Paul Richardson
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK; University Hospital, Southampton, Southampton, UK
| | - Julia Wendon
- King's College Hospital, King's College London, London, UK; London Critical Care ODN, London, UK
| | - David Wood
- Clinical Toxicology Department, St Thomas' Hospital, London, UK
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35
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Mental Health Public Stigma in US Jewish Communities. J Nerv Ment Dis 2023; 211:131-140. [PMID: 36044705 DOI: 10.1097/nmd.0000000000001578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Stigma is a multifaceted barrier for individuals living with mental illness, contributing to negative stereotypes, prejudice, and discrimination, and is underinvestigated in minority ethnic groups. This study examines the stigma within the US Jewish communities, specifically the following: a) differences in public stigma dimensions based on mental illness ( e.g. , major depressive disorder, anxiety disorder, schizophrenia, or alcohol use disorder) and sex; and b) whether participant characteristics influence the public stigma. A community-based sample of 317 self-identified Jewish individuals participated in an experimental randomized vignette survey on stigma and help-seeking beliefs toward various mental illness. Findings indicate differences in stigma based on stigmatized individuals' sex and diagnosis as well as participants' demographics. Schizophrenia and alcohol use disorder were stigmatized similarly, with lower stigma for depression and the least stigma toward anxiety. Of interest, younger males have the most treatability and professional efficacy stigma, and tailored stigma-reducing interventions are recommended.
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Möckl J, Lindemann C, Manthey J, Schulte B, Reimer J, Pogarell O, Kraus L. Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage. Front Psychiatry 2023; 14:1002526. [PMID: 36778636 PMCID: PMC9909027 DOI: 10.3389/fpsyt.2023.1002526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In Germany, most individuals with alcohol dependence are recognized by the health care system and about 16% per year receive addiction-specific care. This paper aimed to analyze the prevalence and treatment utilization rate of people with alcohol dependence by type of addiction-specific care in the federal state of Bremen using routine and survey data. METHODS The number of individuals with alcohol dependence was estimated using data from the 2018 Epidemiological Survey of Substance Abuse (ESA). Furthermore, linked routine data of two statutory health insurances (SHIs), the German pension insurance (GPI), and the communal hospital group Gesundheit Nord - Bremen Hospital Group (GeNo), from 2016/2017, were analyzed. Based on SHI data, the administrative prevalence of various alcohol-related diagnoses according to the International Classification of Diseases (ICD-10), in various treatment settings, was extrapolated to the total population of Bremen. Based on all routine data sources, treatment and care services for individuals with alcohol dependence were also extrapolated to Bremen's total population. Care services included outpatient addiction care visits and addiction-specific treatments, [i.e., qualified withdrawal treatment (QWT), outpatient pharmacotherapy as relapse prevention, and rehabilitation treatment]. RESULTS Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.4% (n = 11,427) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal state (F10.3-4). One in 10 individuals with alcohol dependence (n = 1,577) used one or more addiction-specific care services during the observation period. Specifically, 3.7% (n = 675) received outpatient addiction care, 3.9% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 2.6% (n = 405) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients. CONCLUSION Although more than half of the individuals with alcohol dependence are documented in the health system, utilization rates of addiction-specific treatments are low. These low utilization rates suggest that there are existing barriers to transferring patients with alcohol dependence into addiction-specific care. Strengthening primary medical care provision in dealing with alcohol-related disorders and improving networking within the addiction support system appear to be particularly appropriate.
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Affiliation(s)
- Justin Möckl
- Department of Epidemiology and Diagnostics, Institut für Therapieforschung (IFT), Centre for Mental Health and Addiction Research, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Christina Lindemann
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Ludwig Kraus
- Department of Epidemiology and Diagnostics, Institut für Therapieforschung (IFT), Centre for Mental Health and Addiction Research, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, Eötvös Loránd University (ELTE), Budapest, Hungary
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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Wyler H, Maisch A, Berger T, Kieser U, Schleifer R, Liebrenz M. Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists. Subst Abuse Treat Prev Policy 2022; 17:69. [PMID: 36303216 PMCID: PMC9615404 DOI: 10.1186/s13011-022-00495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.
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Affiliation(s)
- Helen Wyler
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Anja Maisch
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Thomas Berger
- grid.5734.50000 0001 0726 5157Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ueli Kieser
- grid.15775.310000 0001 2156 6618Institute for Legal Studies and Legal Practice, University of St. Gallen, St. Gallen, Switzerland
| | - Roman Schleifer
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Michael Liebrenz
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
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Blended-eLearning Impact on Health Worker Stigma Toward Alcohol, Tobacco, and Other Psychoactive Substance Users. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00914-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
This study evaluated factors affecting the completion of blended-eLearning courses for health workers and their effect on stigma. The two courses covered the screening and management of harmful alcohol, tobacco, and other substance consumption in a lower-middle-income country setting. The courses included reading, self-reflection exercises, and skills practice on communication and stigma. The Anti-Stigma Intervention-Stigma Evaluation Survey was modified to measure stigma related to alcohol, tobacco, or other substances. Changes in stigma score pre- and post-training period were assessed using paired t-tests. Of the 123 health workers who registered, 99 completed the pre- and post-training surveys, including 56 who completed the course and 43 who did not. Stigma levels decreased significantly after the training period, especially for those who completed the courses. These findings indicate that blended-eLearning courses can contribute to stigma reduction and are an effective way to deliver continuing education, including in a lower-middle-income country setting.
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Gender Differences in Alcohol Use: a Nationwide Study in a Multiethnic Population. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00921-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AbstractThe increase in alcohol consumption, and the greater consequences of chronic alcohol use among females, as well as the convergence of the gender gap warrants investigation. This paper aims to uncover gender differences in individuals with alcohol use disorder (AUD) in Singapore. The SMHS 2016 was a population-based, cross-sectional, epidemiological study. Recruitment spanned from August 2016 to March 2018, where 6126 respondents were recruited. Similarly to global estimates, lifetime prevalence and 12-month prevalence for AUD were higher in males than females. However, females had a higher prevalence of obsessive–compulsive disorder (OCD) co-morbidity than males. Women also had an earlier onset and age of recovery of AUD than men. Alarmingly, male (94.14%) and female (100%) respondents reported low help-seeking for their AUD. Gender differences in individuals with AUD were identified in Singapore population. Future research should direct its effort to identify barriers to help-seeking for individuals with alcohol use disorder.
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Schomerus G, Leonhard A, Manthey J, Morris J, Neufeld M, Kilian C, Speerforck S, Winkler P, Corrigan PW. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol 2022; 77:516-524. [PMID: 35526787 DOI: 10.1016/j.jhep.2022.04.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.
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Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
| | - Anya Leonhard
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Jakob Manthey
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - Maria Neufeld
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sven Speerforck
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Essau CA. Addictive problems among young people in low- and middle-income countries: A call for more research. Addict Behav Rep 2022; 16:100442. [PMID: 36570611 PMCID: PMC9772246 DOI: 10.1016/j.abrep.2022.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Johnson E, Ghosh SM, Daniels VJ, Wild TC, Tandon P, Hyde A. Clinicians' perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis. Addict Sci Clin Pract 2022; 17:9. [PMID: 35139919 PMCID: PMC8827145 DOI: 10.1186/s13722-022-00292-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of pharmacotherapy for relapse prevention. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. The aim of this paper is to summarize these findings to inform the development of an educational intervention. Methods We used a qualitative descriptive approach to explore the experiences of clinicians who care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. Results Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified four themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, (iii) Balancing the complexity of cirrhosis and AUD, and (iv) Acknowledging the influence of provider perceptions on care. Conclusion This article presents the perspectives of clinicians who care for people who have AUD and cirrhosis. Significant barriers exist, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered will be used to develop an educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.
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Affiliation(s)
- Emily Johnson
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sumantra Monty Ghosh
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vijay John Daniels
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Ashley Hyde
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Wallhed Finn S, Mejldal A, Baskaran R, Søgaard Nielsen A. The Danish RESPEKT Campaign: Impact of a National Mass Media Campaign Aiming to Increase Treatment Seeking for Alcohol Use Disorders. Subst Use Misuse 2022; 57:1082-1096. [PMID: 35422189 DOI: 10.1080/10826084.2022.2063897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: A minority of all with alcohol use disorders seek treatment. In Denmark, a media campaign, "RESPEKT," has been broadcast nationwide since 2015. The campaign is unique from an international perspective and aims to increase treatment-seeking. Similar interventions have, up until now, not been scientifically evaluated.Aim: To investigate campaign awareness, understanding, attitudes, and information-seeking pre- and post the campaign period. Also, associations to demographic factors and year of campaign will be investigated.Method: Study design: Repeated cross-sectional studyParticipants: Adults aged 30-70 years, in total n = 9169.Data: Pre- and post the campaign period between 2017 and 2020, an online questionnaire was administered by a market research company. The questionnaire covered demographic data, campaign awareness, understanding, attitudes, and information-seeking about treatment for alcohol use disorders. In addition, complete-case logistic regression was performed to model dichotomous outcomes, and odds ratios were calculated.Results: Campaign awareness varied between 8 and 40% over the different years. Understanding of the main message was high and received higher endorsements over the study period. A majority expressed positive attitudes toward the campaign and support for the main message regarding free treatment. However, very few self-reported seeking information about AUD treatment. Female sex was associated with higher awareness of the campaign, higher understanding and more positive attitudes toward the campaign.Conclusion: The campaign evoked positive attitudes and had an impact on increasing knowledge and changing attitudes. However, no effect on self-reported information seeking about treatment was found.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ruben Baskaran
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, The Faculty of Engineering, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Hospital, University Function, Odense, Denmark
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Topkaya N, Şahin E, Krettmann AK, Essau CA. Stigmatization of people with alcohol and drug addiction among Turkish undergraduate students. Addict Behav Rep 2021; 14:100386. [PMID: 34938844 PMCID: PMC8664964 DOI: 10.1016/j.abrep.2021.100386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Females were more fearful of people with alcohol, marijuana and heroin addiction than males. Younger compared to older participants perceived those with substance addiction as more dangerous. Younger participants were more fearful of people with substance addiction than older participants. Younger than older participants had higher social distance towards people who are addicted to alcohol and marijuana. Perceived dangerousness and fearfulness partially mediated the relationship between stigma and social distance.
Introduction Stigmatization of people with substance use problems have been reported to be high among young adults in Western countries. It is not clear if this finding could be replicated among emerging adults in non-Western countries. Thus, the aim of this study was to firstly explore stigmatizing attitudes of undergraduate students in Turkey towards people with alcohol, marijuana and heroin addiction, and then test a mediation model to explain stigmatizing attitudes among college students. Method A total of 513 undergraduate students participated in the study. They completed a set of questionnaires to measure perceived stigma towards substance use, perceived danger and feeling fearful towards people with substance addiction (i.e., alcohol, heroin, marijuana), and a willingness to engage in relationships with people who are addicted to these three substances. Results Females, compared to males, reported being more fearful of people who are addicted to alcohol, marijuana and heroin. Younger compared to older participants perceived people who are addicted to these substances as more dangerous. Younger participants also had higher social distance towards people who are addicted to alcohol and marijuana than older participants. Perceived dangerousness and fearfulness partially mediated the relationship between perceived stigma and social distance in alcohol, marijuana and heroin. Conclusion Research findings may help determine potential correlates of stigmatizing attitudes as well as developing models to explain stigmatizing attitudes among Turkish college students.
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Affiliation(s)
- Nursel Topkaya
- Department of Guidance and Psychological Counseling, Faculty of Education, Ondokuz Mayıs University, Atakum, Samsun 55139, Turkey
| | - Ertuğrul Şahin
- Department of Child and Youth Services, Sabuncuoğlu Şerefeddin Health Services Vocational School, Amasya University, Tokat Yolu Üzeri İpekköy, Amasya 05100, Turkey
| | - Anna K Krettmann
- Centre for Applied Research and Assessment in Child and Adolescent Wellbeing, London, UK
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Hadjistavropoulos HD, Chadwick C, Beck CD, Edmonds M, Sundström C, Edwards W, Ouellette D, Waldrop J, Adlam K, Bourgeault L, Nugent M. Improving internet-delivered cognitive behaviour therapy for alcohol misuse: Patient perspectives following program completion. Internet Interv 2021; 26:100474. [PMID: 34722165 PMCID: PMC8536539 DOI: 10.1016/j.invent.2021.100474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
Although Internet-delivered cognitive behaviour therapy (ICBT) for alcohol misuse is efficacious in research trials, it is not routinely available in practice. Moreover, there is considerable variability in engagement and outcomes of ICBT for alcohol misuse across studies. The Alcohol Change Course (ACC) is an ICBT program that is offered free of charge by an online clinic in Saskatchewan, Canada, which seeks to fill this service gap, while also conducting research to direct future improvements of ICBT. As there is limited qualitative patient-oriented research designed to improve ICBT for alcohol misuse, in this study, we describe patient perceptions of the ACC post-treatment. Specifically, post-treatment feedback was obtained from 191 of 312 patients who enrolled in the ACC. Qualitative thematic analysis was used to examine post-treatment written comments related to what patients liked and disliked about the course, which skills were most helpful for them, and their suggestions for future patients. The majority of patients endorsed being very satisfied or satisfied with the course (n = 133, 69.6%) and 94.2% (n = 180) perceived the course as being worth their time. Worksheets (n = 61, 31.9%) and reflections of others (n = 40, 20.9%) received the most praise. Coping with cravings (n = 63, 33.0%), and identifying and managing risky situations (n = 46, 24.1%) were reported as the most helpful skills. Several suggestions for refining the course were provided with the most frequent recommendation being a desire for increased personal interaction (n = 24, 12.6%) followed by a desire for wanting more information (n = 22, 11.5%). Many patients offered advice for future ACC patients, including suggestions to make a commitment (n = 47, 24.6%), do all of the work (n = 29, 15.2%), and keep a consistent approach to the course (n = 24, 12.6%). The results provide valuable patient-oriented directions for improving ICBT for alcohol misuse.
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Affiliation(s)
| | - Carly Chadwick
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Cynthia D. Beck
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Michael Edmonds
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | | | - Wendy Edwards
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Dianne Ouellette
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Justin Waldrop
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Kelly Adlam
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Lee Bourgeault
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Marcie Nugent
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
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Melia C, Kent A, Meredith J, Lamont A. Constructing and negotiating boundaries of morally acceptable alcohol use: A discursive psychology of justifying alcohol consumption. Addict Behav 2021; 123:107057. [PMID: 34385073 DOI: 10.1016/j.addbeh.2021.107057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Abstract
UK society has a complex relationship with alcohol; it is ever-present within social activities, yet alcohol problems are heavily stigmatised. As such, the nuance of acceptability is a key focus for understanding societal perceptions and understandings of alcohol. This research explored how the boundary between acceptable and problematic alcohol use was negotiated in justifying drinking behaviors. The paper draws upon data from two World Cafés and five focus groups conducted in the UK with 76 participants including 25 males and 51 females aged 18 to 82. Data was analysed using discursive psychology with a focus on how participants disclosed and accounted for alcohol consumption. The analysis highlighted two key discursive patterns: 1) Speakers created an interactionally-specific boundary of acceptable alcohol use. 2) Speakers built upon this boundary, justifying and portraying their own drinking as socially acceptable. The boundary of acceptable alcohol use was locally constructed and shifted between speakers and contexts. This locally occasioned boundary demonstrates the challenge of objective guidance - such as the UK Chief Medical Officer's unit guidelines - in relation to individualistic behaviors. Implications are discussed for how alcohol policy, health campaigns, and alcohol practitioners may consider this orientation to justifying drinking behaviors to make alcohol reduction efforts more effective.
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Abstract
Zusammenfassung. Hintergrund: Qualitative Methoden ermöglichen bei unterschiedlichen Fragestellungen vertieften Erkenntnisgewinn im Feld der Suchtforschung. Allerdings ist der Zugang zu den entsprechenden Methoden nicht einfach, da ihre Komplexität und Vielfalt nicht leicht zu überblicken ist und die Umsetzung umfangreiches theoretisches und methodologisches Wissen erfordert. Bisher scheint der Einsatz qualitativer Methoden in der deutschen Suchtforschung nicht ausreichend methodisch untermauert zu sein. Wir fordern daher eine fundierte, reflektierte und methodisch korrekte Nutzung qualitativer Methoden im Feld der Suchtforschung. Ziel: Ziel dieses Artikels ist, anhand von Methodenliteratur und Originalarbeiten, in denen qualitative Methoden angewandt wurden, aufzuzeigen, wie qualitative Forschungsdesigns verstanden werden können, um Forschende zu ermutigen und zu befähigen, qualitative Methoden in angemessener Weise zu nutzen. In diesem Artikel werden mögliche Einsatzgebiete und grundlegende methodologische Überlegungen für die Entwicklung eines qualitativen Forschungsdesigns dargestellt. Dabei wird zusätzlich auf diverse Erhebungsmethoden sowie ethische Aspekte im Rahmen der Datengenerierung eingegangen.
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Affiliation(s)
- Annette Binder
- Sektion Suchtmedizin und Suchtforschung, Universitätsklinik für Psychiatrie und Psychotherapie Universitätsklinikum Tübingen
| | - Christine Preiser
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen
- Zentrum für Öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen
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Sumnall H, Atkinson A, Gage S, Hamilton I, Montgomery C. Less than human: dehumanisation of people who use heroin. HEALTH EDUCATION 2021. [DOI: 10.1108/he-07-2021-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PurposeStigma reduction is an important public health challenge because of the large morbidity and mortality associated with some forms of substance use. Extreme stigma can lead to dehumanisation of target groups, who are ascribed with lesser humanity. The authors examined whether there was blatant and subtle dehumanisation of people who use heroin, and if these were associated with levels of support for non-discriminatory drug policy.Design/methodology/approachA cross-sectional online study using a UK convenience sample (n = 307 [75.2% female, mean age 28.6 ± 12.2 years]) was conducted. Participants completed assessments of blatant (Ascent of Humans [AoH] scale) and subtle (an emotion attribution task) dehumanisation and a bespoke measure assessing support for non-discriminatory drug policies. Other measures controlled for stigma towards people who use drugs (PWUD) and moral disgust.FindingsThere was greater blatant dehumanisation of people who used heroin compared to the general population and other potentially stigmatised reference groups, including people who use cannabis. The authors also found evidence of subtle dehumanisation, and people who used heroin were rated as being less likely to feel uniquely human emotions, less likely to feel positive emotions and more likely to feel negative emotions. Blatant dehumanisation was associated with significantly lower probability of support for non-discriminatory drug policy.Social implicationsDehumanisation may present significant challenges for stigma reduction initiatives and in fostering public support for drug policy and treatment. Denial of the humanity of this group could be used to justify discriminatory policies or relative deprioritisation of support services in funding decisions. Activities that seek to “rehumanise” PWUD, including social inclusion, and encouraging compassionate media representations that portray the lived experiences of substance use may be useful areas of future work.Originality/valueThis is the first study to investigate blatant and subtle dehumanisation of people who use heroin, and how this relates to public support for drug policy.
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