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Lehmann K, Kuhn S, Baschirotto C, Jacobsen B, Walcher S, Görne H, Backmund M, Scherbaum N, Reimer J, Verthein U. Substitution treatment for opioid dependence with slow-release oral morphine: Retention rate, health status, and substance use after switching to morphine. J Subst Abuse Treat 2021; 127:108350. [PMID: 34134867 DOI: 10.1016/j.jsat.2021.108350] [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: 09/24/2020] [Revised: 12/16/2020] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Since April 2015, slow-release oral morphine (SROM) has been approved for opioid agonist treatment (OAT) in Germany. Experimental studies show that benefits of SROM over methadone include less heroin craving, better tolerability, and higher patient satisfaction and mental stability. The SROMOS study (Efficacy and Tolerability of Slow-Release Oral Morphine in Opioid Substitution Treatment) aims to investigate the long-term effects (effectiveness and safety) of morphine substitution under routine care in Germany. MATERIAL AND METHODS This is a prospective, noninterventional, naturalistic, observational study. Between July 2016 and November 2017, this study recruited patients in OAT who decided to switch to SROM from 23 outpatient addiction treatment centers in Germany. The study collected data on mental health (Brief Symptom Inventory - BSI-18), substance use, somatic health (Opiate Treatment Index Health-Symptoms-Scale - OTI-HSS), opioid craving (visual analogue scale), and withdrawal symptoms (Short Opiate Withdrawal Scale) at baseline (t0) and after 3 (t3), 6 (t6) and 12 (t12) months. Physicians documented side effects as adverse events (AEs) and adverse drug reactions (ADRs). RESULTS Three-quarters of the enrolled study participants (N = 180) were male. The average age was 44.4 years. Patients were opioid-dependent for 23 years and had been in OAT for almost seven years on average. After 12 months, 60.6% were still being treated with SROM. Mental health improved significantly under SROM treatment between t0 and t12. The intention-to-treat (ITT), as well as the per-protocol (PP) analysis, shows a statistically significant improvement of the mean Global Severity Index (GSI) of the BSI-18 value of 20% (ITT) and 24% (PP). Physical health also improved significantly under SROM treatment. There were no statistically significant changes in the use of cannabis, cocaine, amphetamines, and tranquillizers in the past 30 days, but heroin use, intravenous consumption, and the number of drinking days significantly decreased. CONCLUSIONS This study provides some of the first long-term data on OAT with SROM under routine care conditions. SROM treatment is an effective alternative for a subgroup of opioid-dependent patients with an unsatisfactory course of OAT or in cases where undesirable side effects due to alternative substances have occurred. ETHICAL STATEMENT The study protocol was approved by the Ethics Committee of the Chamber of Physicians in Hamburg in March 2016 (No. PV5222). The study was conducted by following the Declaration of Helsinki and is registered with the German Register of Clinical Trials (DRKS, ID: DRKS00010712).
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Affiliation(s)
- Kirsten Lehmann
- Centre for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany.
| | - Silke Kuhn
- Centre for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany.
| | - Cinzia Baschirotto
- University of Florence, Department of Psychiatry, AOU Careggi, Largo Brambilla, 3, 50134 Florence, Italy.
| | - Britta Jacobsen
- Centre for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany.
| | - Stephan Walcher
- CONCEPT, Addiction Medicine Munich, Kaiserstraße 1, 80801 Munich, Germany.
| | - Herbert Görne
- MediZentrum Hamburg, Rahlstedter Str. 29, 22149 Hamburg, Germany.
| | - Markus Backmund
- Ludwig-Maximilians-University and Praxiszentrum im Tal, Tal 9, 80331 Munich, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, University of Duisburg-Essen, Department of Psychiatry and Psychotherapy, Virchowstraße 174, 45147 Essen, Germany.
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany.
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany.
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Schulte B, Schmidt CS, Manthey J, Strada L, Christensen S, Cimander K, Görne H, Khaykin P, Scherbaum N, Walcher S, Mauss S, Schäfer I, Verthein U, Rehm J, Reimer J. Clinical and Patient-Reported Outcomes of Direct-Acting Antivirals for the Treatment of Chronic Hepatitis C Among Patients on Opioid Agonist Treatment: A Real-world Prospective Cohort Study. Open Forum Infect Dis 2020; 7:ofaa317. [PMID: 32875003 PMCID: PMC7452367 DOI: 10.1093/ofid/ofaa317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patient-reported outcomes (PROs) can help to reduce uncertainties about hepatitis C virus (HCV) treatment with direct-acting antivirals (DAAs) among people who inject drugs and increase treatment uptake in this high-risk group. Besides clinical data, this study analyzed for the first time PROs in a real-world sample of patients on opioid agonist treatment (OAT) and HCV treatment with DAAs. Methods HCV treatment data including virological response, adherence, safety, and PROs of 328 German patients on OAT were analyzed in a pragmatic prospective cohort study conducted from 2016 to 2018. Clinical effectiveness was defined as sustained virological response (SVR) at week 12 after end of treatment and calculated in per-protocol (PP) and intention-to-treat (ITT) analyses. Changes over time in PROs on health-related quality of life, physical and mental health, functioning, medication tolerability, fatigue, concentration, and memory were analyzed by repeated-measures analyses of variances (ANOVAs). Results We found high adherence and treatment completion rates, a low number of mainly mild adverse events, and high SVR rates (PP: 97.5% [n = 285]; ITT: 84.5% [n = 328]). Missing SVR data in the ITT sample were mainly caused by patients lost to follow-up after treatment completion. Most PROs showed statistically significant but modest improvements over time, with more pronounced improvements in highly impaired patients. Conclusions This real-world study confirms that DAA treatment among OAT patients is feasible, safe, and effective. PROs show that all patients, but particularly those with higher somatic, mental, and social burden, benefit from DAA treatment.
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Affiliation(s)
- Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane S Schmidt
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Lisa Strada
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Christensen
- Center for Interdisciplinary Medicine Infectious Diseases, Muenster, Germany.,Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany
| | - Konrad Cimander
- Kompetenzzentrum Suchtmedizin, Infektiologie und Cannabis-Therapie, Hannover, Germany
| | - Herbert Görne
- MediZentrum Hamburg, Praxis für Suchtmedizin, Hamburg, Germany
| | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
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Schulte B, Lehmann K, Schmidt CS, Rühling E, Weber B, Schäfer I, Reimer J, Verthein U. Addiction Recovery Among Opioid-Dependent Patients Treated With Injectable Subcutaneous Depot Buprenorphine: Study Protocol of a Non-randomized Prospective Observational Study (ARIDE). Front Psychiatry 2020; 11:580863. [PMID: 33363483 PMCID: PMC7752950 DOI: 10.3389/fpsyt.2020.580863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Once-weekly or once-monthly injectable depot buprenorphine is a new opioid substitution treatment (OST) medication that provides clinically relevant plasma concentrations without daily peaks. Together with a high tolerability and acceptance reported by patients, the prolonged release of injectable depot buprenorphine might have beneficial implications on the patients' quality of life and social participation. The primary objective of this prospective non-interventional observational study is to evaluate the effects of subcutaneous injectable depot buprenorphine on the quality of life of patients in routine OST care in Germany. Secondary outcomes like illicit substance use, psychological distress, social participation and activity are assessed to provide an overall evaluation toward addiction recovery. Methods and Analysis: The present study is a non-randomized prospective observational study with a control group (treatment-as-usual). To ensure comparability between both patient groups, suitable control patients (n = 213) from the same OST unit will be matched pairwise to each patient treated with injectable depot buprenorphine (n = 213). Matching variables are gender, duration of OST, take-home prescription and psychosocial functioning (according to the Global Assessment of Functioning scale). Primary study endpoint is the difference of change in quality of life, assessed with the recently developed Opioid Substitution Treatment Quality of Life scale (OSTQOL), within the depot buprenorphine group between baseline and month 12. The primary analysis will be carried out according to the intention-to-treat principle (ITT) by comparing OSTQOL mean scores using dependent t-tests. For secondary analyses, group comparisons will be done by mixed model approaches with baseline OSTQOL score and the (pairwise) cluster term as covariates. Discussion: The study combines clinical, routine OST care data with relevant patient reported outcome data. The pairwise matching allows conclusions on effects of different OST medications. The study findings will provide new insights in the addiction recovery processes of OST patients treated with depot buprenorphine. Ethics and Dissemination: The study protocol has been approved by the Ethics Committee of the Hamburg Chamber of Physicians (Ärztekammer Hamburg) (reference number: PV7078). The study results will be disseminated through peer-reviewed publications and presentations on scientific conferences. Clinical Trial Registration: German Clinical Trials Register DRKS-ID: DRKS00020797.
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Affiliation(s)
- Bernd Schulte
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten Lehmann
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Sybille Schmidt
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elke Rühling
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Weber
- Praxiszentrum Friedrichsplatz, Competence Center for Addiction Medicine, Kassel, Germany
| | - Ingo Schäfer
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
| | - Uwe Verthein
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Strada L, Schmidt CS, Rosenkranz M, Verthein U, Scherbaum N, Reimer J, Schulte B. Factors associated with health-related quality of life in a large national sample of patients receiving opioid substitution treatment in Germany: A cross-sectional study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:2. [PMID: 30606188 PMCID: PMC6318871 DOI: 10.1186/s13011-018-0187-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/03/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Knowledge of health-related quality of life (HRQOL) of patients receiving opioid substitution treatment (OST) is limited and fragmented. The present study examines the HRQOL of a large national sample of OST patients in Germany and sociodemographic and clinical correlates. METHODS Cross-sectional data on the HRQOL of 2176 OST patients was compared with German general population norms. Patients were recruited from 63 OST practices across Germany. To identify correlates of HRQOL, as measured with the SF-12, we performed bi- and multivariate analyses with sociodemographic and clinical variables, including patient- and clinician-reported outcomes on physical and mental health. RESULTS Patients' HRQOL was significantly poorer than in the general population, especially their mental HRQOL. Factors associated with lower physical HRQOL were older age, longer duration of opioid dependence, hepatitis C virus infection, and HIV infection. Benzodiazepine use was associated with lower mental HRQOL, and amphetamine use with higher physical HRQOL, compared to non-use of these substances. For both mental and physical HRQOL, the factor with the strongest positive association was employment and the factors with the strongest negative associations were physical and mental health symptom severity, psychiatric diagnosis, and psychopharmacological medication. CONCLUSIONS Compared to the general population, we found substantially lower HRQOL in OST patients, especially in their mental HRQOL. OST programs can benefit from further improvement, particularly with regard to mental health services, in order to better serve their patients' needs. Clinicians may consider the use of patient-reported outcome measures to identify patients' subjective physical and psychological needs. Further research is needed to determine if employment is a cause or consequence of improved HRQOL. TRIAL REGISTRATION ClinicalTrials.gov: NCT02395198 , retrospectively registered 16/03/2015.
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Affiliation(s)
- Lisa Strada
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christiane Sybille Schmidt
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Moritz Rosenkranz
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Gesundheit Nord, Kurfürstenallee 130, 28211, Bremen, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Early Therapeutic Alliance, Treatment Retention, and 12-Month Outcomes in a Healthy Lifestyles Intervention for People with Psychotic Disorders. J Nerv Ment Dis 2016; 204:894-902. [PMID: 27575791 DOI: 10.1097/nmd.0000000000000585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Engaging and retaining individuals with psychotic disorders in psychosocial treatments is difficult. Early therapeutic alliance, treatment retention, and 12-month outcomes were examined in a subsample of smokers with a psychotic disorder (N = 178) participating in a healthy lifestyles study comparing a telephone versus face-to-face delivered intervention. Therapeutic alliance was assessed using the Agnew Relationship Measure; primary outcomes were treatment retention and changes in symptoms and health behaviors. Contrary to expectations, early alliance did not predict treatment retention. However, elements of both client- and therapist-rated alliance predicted some clinical outcomes (e.g., higher confidence in the therapeutic alliance at session 1 predicted improvements in 12-month depression). Some modest interactions between early alliance and intervention condition were also identified (e.g., clients initially with lower self-perceived initiative, or higher therapist-perceived bonding benefited preferentially from the telephone-delivered intervention), highlighting the need to further examine the interplay between therapeutic alliance and treatment modality.
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Siemer L, Pieterse ME, Brusse-Keizer MGJ, Postel MG, Ben Allouch S, Sanderman R. Study protocol for a non-inferiority trial of a blended smoking cessation treatment versus face-to-face treatment (LiveSmokefree-Study). BMC Public Health 2016; 16:1187. [PMID: 27881108 PMCID: PMC5122158 DOI: 10.1186/s12889-016-3851-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 11/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking cessation can significantly reduce the risk of developing smoking-related diseases. Several face-to-face and web-based treatments have shown to be effective. Blending of web-based and face-to-face treatment is expected to improve smoking cessation treatment. The primary objective of this study is to compare the prolonged abstinence rate of the blended smoking cessation treatment with the face-to-face treatment. Secondary objectives are to assess the benefits of blended treatment in terms of cost effectiveness and patient satisfaction, and to identify mechanisms underlying successful smoking cessation. METHODS/DESIGN This study will be a single-center randomized controlled non-inferiority-trial with parallel group design. Patients (n = 344) will be randomly assigned to either the blended or the face-to-face group. Both treatments will consist of ten sessions with equal content held within 6 months. In the blended treatment five out of ten sessions will be delivered online. The treatments will cover the majority of behavior change techniques that are evidence-based within smoking cessation counseling. All face-to-face sessions in both treatments will take place at the outpatient smoking cessation clinic of a hospital. The primary outcome parameter will be biochemically validated prolonged abstinence at 15 months from the start of the smoking cessation treatment. DISCUSSION This RCT will be the first study to examine the effectiveness of a blended smoking cessation treatment. It will also be the first study to explore patient satisfaction, adherence, cost-effectiveness, and the clinically relevant influencing factors of a blended smoking cessation treatment. The findings of this RCT are expected to substantially strengthen the base of evidence available to inform the development and delivery of smoking cessation treatment. TRIAL REGISTRATION Nederlands Trialregister NTR5113 . Registered 24 March 2015.
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Affiliation(s)
- Lutz Siemer
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Postbus 70.000, 7500KB, Enschede, The Netherlands. .,Centre for eHealth and Well-being Research, University of Twente, Enschede, The Netherlands.
| | - Marcel E Pieterse
- Centre for eHealth and Well-being Research, University of Twente, Enschede, The Netherlands
| | | | - Marloes G Postel
- Centre for eHealth and Well-being Research, University of Twente, Enschede, The Netherlands.,Tactus, Enschede, The Netherlands
| | - Somaya Ben Allouch
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Postbus 70.000, 7500KB, Enschede, The Netherlands
| | - Robbert Sanderman
- Centre for eHealth and Well-being Research, University of Twente, Enschede, The Netherlands
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'Better Health Choices' by telephone: a feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders. Psychiatry Res 2014; 220:63-70. [PMID: 25078563 DOI: 10.1016/j.psychres.2014.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 11/23/2022]
Abstract
The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aimed at improving diet and physical activity in people diagnosed with psychotic disorders. Twenty participants diagnosed with a non-acute psychotic disorder were recruited. The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use (as appropriate). F&V frequency and variety, and overall diet quality (measured by the Australian Recommended Food Score, ARFS), leisure screen time, overall sitting and walking time, smoking, alcohol consumption, mood, quality of life, and global functioning were examined before and 4-weeks post-treatment. Nineteen participants (95%) completed all intervention sessions, and 17 (85%) completed follow-up assessments. Significant increases from baseline to post-treatment were seen in ARFS fruit, vegetable and overall diet quality scores, quality of life and global functioning. Significant reductions in leisure screen time and overall sitting time were also seen. Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis. A randomized controlled trial is warranted to replicate and extend these findings.
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ter Huurne ED, Postel MG, de Haan HA, DeJong CAJ. Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial. BMC Psychiatry 2013; 13:310. [PMID: 24238630 PMCID: PMC3840645 DOI: 10.1186/1471-244x-13-310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 11/11/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified. METHODS/DESIGN This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants' motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs. DISCUSSION This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified. TRIAL REGISTRATION The protocol for this study is registered with the Netherlands Trial Registry NTR2415.
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Affiliation(s)
- Elke D ter Huurne
- Tactus Addiction Treatment, Institutenweg1, P,O, Box 154, Enschede, PH, 7521, The Netherlands.
| | - Marloes G Postel
- Tactus Addiction Treatment, Institutenweg1, P.O. Box 154, Enschede, PH, 7521, The Netherlands,Department of Psychology Health & Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Hein A de Haan
- Tactus Addiction Treatment, Institutenweg1, P.O. Box 154, Enschede, PH, 7521, The Netherlands,Nijmegen Institute for Scientist Practitioners in Addiction, Toernooiveld 5, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands
| | - Cor AJ DeJong
- Nijmegen Institute for Scientist Practitioners in Addiction, Toernooiveld 5, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands,Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Yates R. Bad mouthing, bad habits and bad, bad, boys: an exploration of the relationship between dyslexia and drug dependence. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/17523281.2012.699460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Reimer J, Verthein U, Karow A, Schäfer I, Naber D, Haasen C. Physical and mental health in severe opioid-dependent patients within a randomized controlled maintenance treatment trial. Addiction 2011; 106:1647-55. [PMID: 21489005 DOI: 10.1111/j.1360-0443.2011.03463.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate physical and mental health and compare treatment outcomes in opiate-dependent patients substituted either with heroin or methadone. DESIGN Twelve-month open-label randomized controlled trial. SETTING Out-patient substitution clinics in seven German cities. PARTICIPANTS A total of 1015 opiate-dependent individuals. MEASUREMENTS Opiate Treatment Index-Health Scale Score (OTI), Body Mass Index (BMI), serology for infectious diseases such as hepatitis B, C and human immunodeficiency virus as well as tuberculosis, Karnofsky Performance Scale (KPS), electrocardiogram (ECG), echocardiogram, Symptom Checklist 90-R (SCL-90-R), Global Assessment of Functioning (GAF), Modular System for Quality of Life and study medication-related serious adverse events (SAE). FINDINGS Improvements were found in both heroin and methadone substituted patients regarding OTI, BMI, KPS, SCL-90-R, and GAF, but they were more pronounced for the heroin group (analysis of variance, all P = 0.000). The frequency of pathological echocardiograms decreased in the heroin group and increased in the methadone group (χ(2) test, <0.05). Markers for infectious diseases and frequencies of pathological ECGs did not differ between baseline and 12 months, or between treatment groups. Study medication-related serious adverse events, all of which were treated successfully, occurred 2.5 times more often in the heroin group. The majority of heroin-related SAEs (41 of 58) occurred within a few minutes of the injections. CONCLUSIONS The integration of severe injection drug users either in methadone or heroin-assisted maintenance treatment has positive effects on most physical and mental change-sensitive variables, with heroin showing superior results. Due to medication-related adverse events, patients should be observed for 15 minutes after a heroin injection.
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Affiliation(s)
- Jens Reimer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.
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Verthein U, Haasen C, Reimer J. Switching from methadone to diamorphine: 2-year results of the german heroin-assisted treatment trial. Subst Use Misuse 2011; 46:980-91. [PMID: 21235340 DOI: 10.3109/10826084.2010.540624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several international clinical studies have found diamorphine treatment for opioid-dependent patients to show significantly better effects compared with methadone maintenance treatment. AIMS This analysis of the German trial of heroin-assisted treatment investigates the effects on patients' health and drug use after switching from 12-month methadone to 12-month diamorphine treatment under similar study conditions. METHODS For a period of 24 months, the state of health was explored using the Opiate Treatment Index (OTI) health scale and the Symptom Checklist-90-R (SCL-90-R), while drug use and social situation by an extended version of the European Addiction Severity Index (EuropASI) every 6 months. Changes in these criteria were tested for significance by repeated measures analyses. Of the 434 patients, who started the 2nd year of study treatment, 90 were methadone-diamorphine switchers, and 344 received diamorphine for 2 years. RESULTS In the 2nd year, the methadone-diamorphine switchers succeed in catching up with the diamorphine patients. After switching to diamorphine, significant improvements in health and use of street heroin and cocaine were achieved during 1 year of diamorphine treatment. CONCLUSIONS The results of the course of methadone-diamorphine switchers are a methodologically independent contribution toward confirming the positive effects of diamorphine treatment for difficult-to-treat opioid-dependent patients. This study supports the hypothesis that changing from optimized methadone treatment under the conditions of the clinical trial to diamorphine treatment is associated with improvements in health and drug use behavior. The study's limitations are noted.
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Affiliation(s)
- Uwe Verthein
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research, Hamburg, Germany.
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Karow A, Verthein U, Pukrop R, Reimer J, Haasen C, Krausz M, Schäfer I. Quality of life profiles and changes in the course of maintenance treatment among 1,015 patients with severe opioid dependence. Subst Use Misuse 2011; 46:705-15. [PMID: 21047149 DOI: 10.3109/10826084.2010.509854] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Studies indicate that different areas of mental, physical, social and daily life functioning need to be considered in order to improve intervention outcomes in substance user patients. The aim of the study was to assess health-related quality of life (HRQOL) in patients diagnosed with opioid dependence as compared to healthy controls and patients diagnosed with depression and schizophrenia. METHODS A total of 1,015 outpatients diagnosed with opioid dependence were investigated during 12 months of maintenance treatment. HRQOL (MSQoL), addiction (EUROP-ASI), and sociodemographic characteristics were assessed. RESULTS HRQOL in opioid dependence improved significantly (p < .001), but was lower as compared to that of healthy controls and patients diagnosed with schizophrenia. HRQOL in opioid dependence comprises addiction-specific aspects, most importantly low material satisfaction, physical health, and social stability. CONCLUSIONS HRQOL measurement provides valuable information for course and outcome in opioid dependence treatment.
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Affiliation(s)
- A Karow
- University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
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Karow A, Reimer J, Schäfer I, Krausz M, Haasen C, Verthein U. Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence. Drug Alcohol Depend 2010; 112:209-15. [PMID: 20728288 DOI: 10.1016/j.drugalcdep.2010.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 03/22/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is increasing evidence that health-related quality of life (HRQOL) is associated with a successful treatment and better outcome in opioid addiction. The aim of the present study was the longitudinal investigation of HRQOL in patients with severe opioid dependence, who were randomly assigned to four groups of medical and psychosocial treatment: heroin (diacetylmorphine) versus methadone and case management (CM) versus psychoeducation (PSE) respectively. METHODS HRQOL (MSQoL) and physical health (OTI) were investigated in 938 subjects, who participated in the German multi-centre study examining the effects of heroin-assisted treatment in patients with severe opioid dependence. Data for the present analysis were taken from baseline and 12-month follow up. RESULTS Under both forms of maintenance and psychosocial treatment HRQOL improved significantly during the observation period. HRQOL improvement under maintenance with heroin exceeded improvement under methadone, especially with regard to subjective physical health. HRQOL improvement was significantly associated with better expert-rated physical health. Further analyses showed significant better improvement of HRQOL in subjects treated with PSE compared with CM. CONCLUSIONS The advantage of heroin with regard to the improvement of HRQOL may be partially explained by a better improvement of physical health under maintenance with heroin compared with methadone, which highlights the importance of a comprehensive model of health care for patients with severe opioid dependence. Future studies need to investigate the benefits of PSE for patients in maintenance therapy.
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Affiliation(s)
- A Karow
- University Medical Centre Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, 20246 Hamburg, Germany.
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DARKE SHANE, TOROK MICHELLE, KAYE SHARLENE, DUFLOU JOHAN. Cardiovascular disease risk factors and symptoms among regular psychostimulant users. Drug Alcohol Rev 2010; 29:371-7. [DOI: 10.1111/j.1465-3362.2009.00158.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Crome IB. Young people and substance problems—from image to imagination. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.3109/09687639709017408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Effects of heroin-assisted treatment on alcohol consumption: findings of the German randomized controlled trial. Alcohol 2009; 43:259-64. [PMID: 19375884 DOI: 10.1016/j.alcohol.2009.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/12/2009] [Accepted: 02/24/2009] [Indexed: 01/11/2023]
Abstract
Alcohol has been suggested to be a risk factor for opioid-dependent patients in methadone maintenance treatment (MMT). Literature shows that MMT has limited effects on alcohol use. Nevertheless, a decrease in alcohol use was detected in the Swiss heroin-assisted treatment (HAT) study. In this article, we carry out an in-depth analysis of the German HAT trial with the aim of determining whether alcohol use was affected among patients undergoing HAT and MMT. Analysis was carried out using self-reported data on consumption units of alcohol used (CU), Addiction Severity Index composite scores (ASI CSs), and carbohydrate-deficient transferrin (CDT) measures. Results suggest significant reduction of CU and CDT in both groups, yet larger effects in the HAT group. ASI CS significantly decreased in the HAT but not in the MMT group. The greater benefit of HAT in reducing alcohol use may be due to the greater daily frequency of dispensing heroin coupled with a requirement of sobriety at each dosing occasion.
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Kaye S, Darke S. Injecting and non-injecting cocaine use in Sydney, Australia: physical and psychological morbidity. Drug Alcohol Rev 2009; 23:391-8. [PMID: 15763743 DOI: 10.1080/09595230412331324518] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study aimed to examine the physical and psychological harms of cocaine use and investigate the role of injecting versus non-injecting routes of administration in the severity of such harms. Two hundred and twelve cocaine users from inner-city and south-western Sydney were administered a structured interview containing sections on demographics, drug treatment history, drug use history, cocaine use patterns, cocaine dependence and physical and psychological problems associated with cocaine use. Serious physical and psychological symptoms were prevalent among both injecting and non-injecting cocaine users. The prevalence and extent of symptoms was greater among injecting cocaine users, however route of administration did not prove to be a significant independent predictor of harm when other factors, such as frequency of use and level of dependence, were taken into account. While the level of physical and psychological harm was greater among cocaine injectors, it would appear that factors engendered by injecting, such as more frequent use and higher levels of dependence, result in higher levels of harm, rather than the route of administration per se. Physical and psychological problems were also reported among infrequent users, suggesting that cocaine can cause harm irrespective of frequency or method of use. Harm reduction initiatives should be targeted towards all cocaine users, not just those who seek treatment for dependence or present with acute medical complications.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre University of New South Wales, Australia.
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18
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Adelekan M, Metrebian N, Tallack F, Stimson GV, Shanahan W. Who should collect Opiate Treatment Index data in opiate treatment outcome monitoring: clinic staff or researchers? Drug Alcohol Rev 2009; 15:65-71. [PMID: 16203353 DOI: 10.1080/09595239600185681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Opiate Treatment Index (OTI), an instrument designed to monitor treatment outcome of opioid users, is becoming increasingly popular among clinicians and researchers in the United Kingdom. This study was designed to examine how the OTI would perform when administered by clinic staff compared to externally contracted researchers in clinical settings. In a confidential setting, the OTI was administered twice to 55 opioid users from two London clinics, in a random fashion, once by trained clinic staff and once by researchers within a 2-week period. The data generated by both groups were similar with respect to social functioning, physical health and psychological adjustment. Where differences occurred, in almost all the cases they were not statistically significant. Clients reported slightly higher levels of drug use episodes, injecting behaviour and criminal activity to researchers. In both groups, none of the clients admitted to paid sex, and low levels of criminal activity and illicit drug use are reported-findings which are most probably related to the stability of these patients rather than systematic under-reporting. Although this cross-sectional study showed that the OTI could be applied equally effectively by clinic staff and researchers in clinical settings, further research is needed to examine whether the situation would hold true in routine outcome monitoring. To ensure that reliable and valid data are generated in routine monitoring of treatment programmes, several issues relating to clinic staff (e.g. motivation, time); clients (e.g. co-operation, confidentiality) and researchers (e.g. cost) need to be addressed.
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Affiliation(s)
- M Adelekan
- The Centre for Research on Drugs and Health Behaviour, Department of Psychiatry, Charing Cross and Westminister Medical School, London, UK
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19
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Freeman K. Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme. Drug Alcohol Rev 2009; 22:409-16. [PMID: 14660130 DOI: 10.1080/09595230310001613921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Given the centrality of drug treatment to the drug court framework, the proliferation of drug courts in the United States, and their emergence more recently in Australia, it is surprising that such little attention has been given to assessing their therapeutic effect. This evaluation aimed to assess the health and well-being of drug-dependent offenders diverted to the New South Wales Drug Court, and monitor changes in their health and well-being throughout 12 months of programme participation. The study consisted of baseline interviews with 202 offenders accepted into the programme between February 1999 and April 2000, and follow-up interview at 4, 8 and 12 months with participants who remained on the programme. Health and well-being was assessed at each follow-up using the Short Form-36 Health Survey (SF-36) the OTI social functioning scale, and self-reported spending as a proxy for illicit drug use. The health of male Drug Court participants prior to commencing the programme was significantly poorer than Australian population norms. The results provided evidence of significant and sustained improvements in health and well-being for the 51 participants who competed each follow-up interview. Furthermore, significant improvements were found for offenders who remained on the programme for at least 4 months but less than 12 months. However, the positive health outcomes are limited by the low programme retention rate. These results indicate that significant health outcomes can be achieved for at least some heavily drug-dependent, recidivist offenders through the drug court model. [Freeman K. Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme.
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Affiliation(s)
- Karen Freeman
- NSW Bureau of Crime Statistics and Research, Sydney, New South Wales, Australia
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Adelekan M, Green A, Dasgupta N, Tallack F, Stimson GV, Wells B. Reliability and validity of the Opiate Treatment Index among a sample of opioid users in the United Kingdom. Drug Alcohol Rev 2009; 15:261-70. [PMID: 16203381 DOI: 10.1080/09595239600186001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To validate the Opiate Treatment Index (OTI) for use in the United Kingdom, 72 subjects attending two methadone clinics in London completed confidential interviews with two researchers at two points in time, 1-2 weeks apart. About half the interviews were conducted by the same interviewer on both occasions, and the remaining by different interviewers. These research designs enabled an estimation of the test-retest and inter-rater reliability of the instrument. Subjects' responses were validated against key worker reports and self-reported drug use against urinalysis results. The majority of the respondents were males (65%) and their mean age was 34.2 years (range 21-52; SD 8.5). Test-retest reliability coefficients were high for all the scales (range 0.77-0.86) in both the same and different interviewer situations. The internal reliability of the scales was generally high (Cronbach's alpha: range 0.34-0.93). The correlation with key workers' reports was high with the percentage agreement on the items ranging 74-100 (mean 87). The percentage agreement of self-reported drug use with urinalysis results was high (range 69-95; mean 89). These findings are similar to those obtained among Australian subjects and suggest a high cross-cultural validity for the OTI. Minor changes to the OTI have been incorporated into a modified version for use in the UK.
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Affiliation(s)
- M Adelekan
- The Centre for Research on Drugs and Health Behaviour, London, UK
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21
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Löbmann R, Verthein U. Explaining the effectiveness of heroin-assisted treatment on crime reductions. LAW AND HUMAN BEHAVIOR 2009; 33:83-95. [PMID: 18594954 DOI: 10.1007/s10979-008-9138-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 04/11/2008] [Indexed: 05/26/2023]
Abstract
This study examines the relationship between heroin-assisted treatment versus methadone maintenance and the criminal activity of 1,015 individuals participating in a German model project. The main objective is to investigate how these treatments contribute to a decline of criminal behavior. The analyses are based upon self-reported criminal offence and police data on alleged criminals. Logistic regression is employed to explain the variance in the 12-month prevalence 1 year after program admission. The results clearly show a decline of criminal offences among participants receiving maintenance treatment; this decline was significantly greater in the heroin group with respect to property crimes and drug offences. The multivariate analysis reveals that the effects are due to a decrease of illegal drug use and absence from the drug scene.
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Affiliation(s)
- Rebecca Löbmann
- Criminological Research Institute of Lower Saxony, Hanover, Germany.
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22
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Verthein U, Bonorden-Kleij K, Degkwitz P, Dilg C, Köhler WK, Passie T, Soyka M, Tanger S, Vogel M, Haasen C. Long-term effects of heroin-assisted treatment in Germany. Addiction 2008; 103:960-6; discussion 967-8. [PMID: 18422829 DOI: 10.1111/j.1360-0443.2008.02185.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Trials in Switzerland, the Netherlands and Spain have found that heroin-assisted treatment (HAT) as maintenance treatment for opioid-dependent patients reduces illicit drug use. A German trial also found diamorphine treatment to be superior to methadone treatment. The present study describes the association between 2 years of heroin treatment and improvements in health and social stabilization, as well as illicit drug use. DESIGN A prospective cohort study design. PARTICIPANTS A total of 515 patients were assigned to diamorphine treatment; 278 patients remained in the study treatment for the entire period of 24 months (54.8%). MEASUREMENTS The results on physical (Opiate Treatment Index Health Symptoms Scale) and mental (Symptom Checklist 90-Revised Global Severity Index) health and illicit drug use (number of days with drug use within the last month-European Addiction Severity Index) were examined by repeated-measures analyses. FINDINGS Symptoms of physical (Pillai's trace = 0.837, df = 4, P < 0.001) and mental health (Pillai's trace = 0.450, df = 4, P < 0.001) improved during treatment. Street heroin use declined rapidly (Pillai's trace = 0.836, df = 4, P < 0.001), as did cocaine use (Pillai's trace = 0.280, df = 4, P < 0.001). CONCLUSIONS HAT is associated with improvements in mental and physical health in the long term.
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Affiliation(s)
- Uwe Verthein
- Centre for Interdisciplinary Addiction Research of Hamburg University, CIAR, Hamburg, Germany.
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23
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Deering DE, Sellman JD, Adamson SJ, Horn J, Frampton CMA. Development of a brief treatment instrument for routine clinical use with methadone maintenance treatment clients: the methadone treatment index. Subst Use Misuse 2008; 43:1666-80. [PMID: 18752159 DOI: 10.1080/10826080802116098] [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: 10/21/2022]
Abstract
Routine measurement of treatment outcome between clinician and client in alcohol and drug user treatment services is an important quality improvement initiative. It is particularly important for clients receiving long-term treatment such as methadone maintenance treatment, as fluctuations in substance use, functioning, and health are to be expected. Although there are a number of standardized alcohol and drug user treatment outcome instruments available for research and clinical use, a key challenge is to develop clinical instruments that will actually be used routinely in busy practice settings by a range of staff. Such instruments need to be brief, acceptable to staff and clients, easy to use, provide immediate feedback, and meet adequate psychometric requirements. This report describes development work undertaken in three studies of the Methadone Treatment Index (MTI). The MTI is a brief instrument comprising measures of recent substance use, aspects of social and behavioral functioning, and physical and psychological health. The MTI was designed in consultation with clinicians and clients for use in monitoring treatment progress with clients receiving methadone maintenance treatment. Key findings were that the MTI was acceptable to clients, produced clinically relevant information, and has satisfactory psychometric properties, although it was not used to measure change in this study. Further evaluation of the MTI on a longitudinal basis is supported.
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Affiliation(s)
- Daryle E Deering
- National Addiction Centre (NAC), Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
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Kariminia A, Butler T, Levy M. Aboriginal and non-Aboriginal health differentials in Australian prisoners. Aust N Z J Public Health 2007; 31:366-71. [PMID: 17725019 DOI: 10.1111/j.1753-6405.2007.00089.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Compare the self-reported physical and mental health of Aboriginal and non-Aboriginal prisoners in New South Wales (NSW). DESIGN Cross-sectional random sample. SETTING Twenty-nine correctional centres (27 male and two female) in NSW. PARTICIPANTS 747 men (227 Aboriginal) and 167 women (29 Aboriginal) in full-time custody. METHODS Face to-face interviews were used to record self-reported health status. RESULTS Aboriginal prisoners differed significantly from non-Aboriginal inmates in several socio-demographic and criminographic factors. However, few differences were observed in health status between Aboriginal and non-Aboriginal men and women. After adjusting for age, Aboriginal men were more likely to report high blood pressure and diabetes. No differences were found in chronic health conditions in the female group. Aboriginal men had higher SF-36 scores than non-Aboriginal men on general health, vitality, and mental health. Aboriginal women had lower scores than non-Aboriginal women on social functioning and role-emotional but scored higher on the role-physical dimension. Aboriginal inmates were more likely to report seeing certain health professionals (doctors, dentists, drug and alcohol counsellors, and optometrists) in prison compared with the community. CONCLUSIONS The health of Aboriginal and non-Aboriginal prisoners is remarkably similar in this population group. Few differences were observed in self-reported chronic health conditions. Aboriginal prisoners report using prison health services more while in prison compared with the community. This highlights that for many, prison is a rare opportunity to contact health services.
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Affiliation(s)
- Azar Kariminia
- Centre for Health Research in Criminal Justice (Justice Health), New South Wales
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Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D. Heroin-assisted treatment for opioid dependence: randomised controlled trial. Br J Psychiatry 2007; 191:55-62. [PMID: 17602126 DOI: 10.1192/bjp.bp.106.026112] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Heroin-assisted treatment has been found to be effective for people with severe opioid dependence who are not interested in or do poorly on methadone maintenance. AIMS To study heroin-assisted treatment in people on methadone who continue intravenous heroin and in those who are heroin dependent but currently not in treatment. METHOD In an open-label multicentre randomised controlled trial, 1015 people with heroin dependence received a variable dose of injectable heroin (n=515) or oral methadone (n=500) for 12 months. Two response criteria, improvement of physical and/or mental health and decrease in illicit drug use, were evaluated in an intent-to-treat analysis. RESULTS Retention was higher in the heroin (67.2%) than in the methadone group (40.0%) and the heroin group showed a significantly greater response on both primary outcome measures. More serious adverse events were found in the heroin group, and were mainly associated with intravenous use. CONCLUSIONS Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment. Despite a higher risk, it should be considered for treatment resistance under medical supervision.
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Affiliation(s)
- Christian Haasen
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Centre Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Butler T, Allnutt S, Yang B. Mentally ill prisoners in Australia have poor physical health. Int J Prison Health 2007. [DOI: 10.1080/17449200701321431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thein HH, Butler T, Krahn M, Rawlinson W, Levy MH, Kaldor JM, Dore GJ. The effect of hepatitis C virus infection on health-related quality of life in prisoners. J Urban Health 2006; 83:275-88. [PMID: 16736376 PMCID: PMC2527173 DOI: 10.1007/s11524-005-9015-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hepatitis C virus (HCV) infection in prisoners represents an important public health problem. However, there is very little information about HCV-related health-related quality of life (HRQOL). We examined the effect of HCV antibody positivity, HCV viremia, and being a prisoner on prisoners'' HRQOL. Population-based health surveys incorporating HCV screening were conducted among prisoners at New South Wales (NSW), Australia, correctional centers in 1996 and 2001. HCV antibody and HCV RNA status were determined from venous blood sampling. HRQOL and mood status were assessed using the Short Form-36 (SF-36) Health Survey and Beck Depression Inventory (BDI). Comparison of HRQOL scores between HCV antibody negative, HCV antibody positive/non-viremic, and HCV antibody positive/viremic and assessment of temporal change in HRQOL between 1996 and 2001 within groups were made using ANCOVA adjusting for confounders. Factors associated with HRQOL were determined in linear regression models. Analyses between HCV antibody negative (n = 423), HCV positive/non-viremic (n = 89), and HCV positive/viremic (n = 178) prisoners found no measurable effect of HCV on HRQOL, including that attributable to HCV viremia. Compared to uninfected Australian population norms, prisoners had lower HRQOL irrespective of HCV status. The prevalence of 'moderate' to 'severe' depressive symptoms was greater in the HCV antibody positive/viremic group than the HCV antibody positive/non-viremic group or the HCV antibody negative group. Selected demographic factors (age), co-morbidity, severity of depressive symptoms and medical care utilization influenced HRQOL. There was evidence to support the effect of knowledge of HCV status on HRQOL. In conclusion, our findings contrast with previous studies in non-prisoner groups in which HCV infection appears to decrease overall HRQOL. Non-HCV factors may override HCV-specific HRQOL impairment in this population. Targeted management strategies are required to improve HRQOL of prisoners.
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Affiliation(s)
| | | | | | | | | | | | - Gregory J. Dore
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Level 2, 376 Victoria Street, Darlinghurst, NSW 2010 Australia
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Abstract
OBJECTIVE To assess the hearing health of New South Wales prison inmates. METHODS The method of testing hearing chosen was the rapid click-evoked otoacoustic emissions technique, from which two key variables were evaluated for early status of ear damage. Hearing variables, including hearing history and self-reported symptoms, were incorporated in a multivariate analysis of other health and demographic variables in the prison sample. RESULTS The analysis shows that the hearing acuity of prisoners is poor compared with the general Australian population. Variables significantly related to the hearing scores were history of hearing problems or having arthritis or diabetes. In this sample hearing did not interact with alcohol or drugs. Those testing positive for Hepatitis B Core-Antibody were also found to have poorer hearing than those without. CONCLUSIONS AND IMPLICATIONS Prisoners in general have poorer hearing than a normative Australian population. Some conditions have a significant impact on hearing, which may be due to associated medications. A previous history of ear problems was found to be significantly related to hearing acuity as was a history of exposure to noise. Health screening programs within the correctional system may need to include hearing loss prevention programs and medical follow-ups in relation to hearing health.
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Butler T, Kariminia A, Levy M, Murphy M. The self-reported health status of prisoners in New South Wales. Aust N Z J Public Health 2005; 28:344-50. [PMID: 15704699 DOI: 10.1111/j.1467-842x.2004.tb00442.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the physical health of the New South Wales prisoner population. DESIGN Cross-sectional random sample of adult men and women prisoners. SETTING 29 New South Wales correctional centres (27 male and two female). PARTICIPANTS 747 men and 167 women. MAIN RESULTS Despite the comparatively young population, 81% of women and 65% of men had at least one chronic health condition; 41% of men and 59% of women reported multiple health problems. The most common conditions were back problems, poor eyesight, arthritis, high blood pressure and asthma. Chronic conditions were more prevalent among women prisoners. Thirty-seven per cent of women and 28% of men rated their health as either 'poor' or 'fair' compared with 16% of women and 15% of men in the general NSW community. Psychiatric medication was more commonly prescribed to women than men (25% vs. 13%; p < 0.001). Similarly, methadone maintenance was more common among women than men (39% vs. 13%; p < 0.001). CONCLUSION Men and women prisoners in NSW have multiple chronic health conditions. While not desirable, incarceration presents an opportunity to initiate treatment to improve the health of this disadvantaged group.
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Affiliation(s)
- T Butler
- Centre for Health Research in Criminal Justice (Corrections Health Service), Eastgardens, New South Wales.
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Abstract
AIM To investigate the frequency of non-fatal cocaine overdose, and responses to overdoses, among injecting and non-injecting cocaine users. DESIGN Cross-sectional study. SETTING Sydney, Australia. PARTICIPANTS Two hundred current cocaine users. MEASUREMENTS Structured interview. FINDINGS Thirteen per cent of the sample had overdosed on cocaine, 7% in the preceding 12 months. Cocaine injectors were more likely to have overdosed, both ever (17 v 6%) and in the preceding 12 months (9 v 3%). The most common symptoms of overdose were palpitations (68%), intense sweating (44%) and seizures (40%). The use of other drugs in combination with cocaine prior to the most recent overdose was prevalent (64%), most commonly opioids (40%), alcohol (24%) and cannabis (24%). Those who had overdosed were more likely to be female, had longer cocaine use careers, had used more cocaine in the preceding month and preceding 6 months, had higher levels of cocaine dependence and more extensive polydrug use. Twenty-four per cent had witnessed a cocaine overdose, 13% in the preceding 12 months. Injectors were more likely to have witnessed overdoses, both ever (35% v 8%) and in the preceding 12 months (20% v 3%). CONCLUSIONS Experience of, and exposure to, overdose were not rare events. Cocaine users need to be aware of the possibility and nature of overdose, and that cocaine overdose can occur irrespective of method of use. There is a need to emphasise the potential danger of combining cocaine with other drugs.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
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Gossop M, Stewart D, Browne N, Marsden J. Methadone treatment for opiate dependent patients in general practice and specialist clinic settings: Outcomes at 2-year follow-up. J Subst Abuse Treat 2003; 24:313-21. [PMID: 12867205 DOI: 10.1016/s0740-5472(03)00040-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Few studies have investigated methadone treatment of opiate dependent patients in primary health care settings. Using a prospective cohort design, the study investigated outcomes at 1 and 2 years for 240 patients treated by general practitioners (n = 79) or drug clinics (n = 161) at sites across England. Mean daily methadone dose for both groups was 50 mg. Reductions in illicit drug use, injecting, sharing injecting equipment, psychological and physical health problems, and crime, were found in both groups at follow-up. Patients treated in general practitioner (GP) settings reported less frequent benzodiazepine and stimulant use, and fewer psychological health problems at follow-up. Alcohol use outcomes were poor for both groups. Differences in treatment practices were found for GPs and clinics. Results show substantial reductions in a range of problems behaviours, among unselected samples of opiate dependent patients treated in GP and in clinic settings, which are sustained to 1-year and 2-year follow-up.
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Affiliation(s)
- Michael Gossop
- National Addiction Centre, Mausdley Hospital/Institute of Psychiatry, 4 Windsor Walk, SE5 8AF, London, UK
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Stewart D, Gossop M, Marsden J, Kidd T, Treacy S. Similarities in outcomes for men and women after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS). Drug Alcohol Rev 2003; 22:35-41. [PMID: 12745357 DOI: 10.1080/0959523021000059811] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The National Treatment Outcome Research Study (NTORS) is a prospective, multi-site treatment outcome study of drug misusers in the UK. This paper reports the characteristics and problems of male and female clients at intake to treatment, and changes in substance use, health problems, and criminal behaviour at follow-up. The sample comprised 753 subjects (552 men and 201 women) followed-up 1 year after starting treatment in 54 programmes chosen to be representative of the main national treatment modalities. Men and women presented to treatment with different problems and characteristics. Women reported more frequent cocaine use, greater health problems, and were more likely to have a drug-using partner and be responsible for children. Despite different profiles of problems, men and women both made significant reductions in their problem behaviours following treatment. At 1-year follow-up, men and women reported reductions in drug use, health problems and criminal behaviour. However, women did not reduce their alcohol consumption significantly, and improvements in crime were less pronounced than for men. After controlling for pretreatment differences, gender was not predictive of any of the outcome measures reported.
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Gossop M, Stewart D, Browne N, Marsden J. Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses. Addiction 2002; 97:1259-67. [PMID: 12359030 DOI: 10.1046/j.1360-0443.2002.00227.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS This study investigates factors associated with abstinence, lapse or relapse to heroin use after residential treatment and, specifically, the extent to which changes in cognitive, avoidance and distraction coping responses were related to heroin use and other drug use outcomes. DESIGN, SETTING, PARTICIPANTS The sample comprised 242 clients from 23 residential programmes in the NTORS project, who used heroin before treatment and who were followed-up after treatment during the first 12 months of the study. MEASUREMENTS Data on client characteristics and problems, coping responses, drug use and other outcomes, were collected by structured face-to-face interviews. FINDINGS Many clients (60%) used heroin after treatment, with the first occasion of heroin use usually occurring very soon after leaving treatment: 40% remained abstinent from heroin. Analyses were conducted for three groups based upon heroin outcome status (abstinent, lapsed, relapsed). Clients who avoided a full relapse to heroin use (abstinent and lapse groups) consistently made more use of cognitive, avoidance and distraction coping strategies at follow-up than at intake. Treatment completion was related to better outcome. The lapse and relapse groups reported higher rates of use of illicit drugs other than heroin after treatment than the abstinent group. CONCLUSIONS Despite generally satisfactory drug use outcomes, the lapses and relapses to heroin use give rise to concern. Treatment services should develop further and strengthen relapse prevention and relapse coping skills among drug misusers.
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Abstract
AIMS To estimate the range and severity of heroin overdose related morbidity. DESIGN Cross-sectional survey. SETTING Sydney, Australia. PARTICIPANTS 198 heroin users. FINDINGS Sixty-nine per cent had experienced a heroin overdose, 28% in the preceding 12 months. Of those who had overdosed, 79% had experienced at least one overdose-related morbidity symptom. An ambulance had attended overdoses for 59% of subjects, 33% had required hospital treatment for overdose, and 14% had experienced overdose-related complications of sufficient severity to be admitted to a hospital ward. Indirect overdose-related morbidity included: physical injury sustained when falling at overdose (40%), burns (24%) and assault while unconscious (14%). Direct overdose-related morbidity included: peripheral neuropathy (49%), vomiting (33%), temporary paralysis of limbs (26%), chest infections (13%) and seizure (2%). CONCLUSIONS There appears to be extensive morbidity associated with non-fatal overdose. This is clearly an area that requires more research to document the prevalence and nature of these harms, and factors associated with them.
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Affiliation(s)
- Matthew Warner-Smith
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
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35
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Gossop M, Marsden J, Stewart D, Treacy S. Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK). Addict Behav 2002; 27:155-66. [PMID: 11817759 DOI: 10.1016/s0306-4603(00)00174-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society.
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Affiliation(s)
- Michael Gossop
- National Addiction Centre, The Maudsley/Institute of Psychiatry, London, England, UK.
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36
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Gossop M, Marsden J, Stewart D, Treacy S. Reduced injection risk and sexual risk behaviours after drug misuse treatment: results from the National Treatment Outcome Research Study. AIDS Care 2002; 14:77-93. [PMID: 11798407 DOI: 10.1080/09540120220097955] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper investigates injecting, shared use of needles/syringes and sexual risk behaviours at intake to treatment and at one-year follow-up among 753 drug users recruited to the National Treatment Outcome Research Study (NTORS). Injecting, sharing and having unprotected sex were substantially reduced among clients admitted to methadone programmes and among those admitted to residential treatments. The overall levels of risk fell after treatment, and the majority of those who were engaged in high risk behaviours at intake had stopped at follow-up. The results also show the variability of individual outcomes. A minority persisted with their risk behaviour, and others who were not at risk at intake who had started to engage in risky behaviours at follow-up. The behaviour of these clients creates a focal point for risk as well as being a threat to public health. Several social and psychological factors were predictive of health risk behaviours. These included frequency and duration of heroin use, polydrug use, alcohol use, gender, ethnicity, having a drug-using partner, anxiety and depression. The results indicate the important role that can be played by treatment services in helping to reduce the risk of blood-borne infections. We suggest that risk reduction interventions are an important and effective component of treatment programmes.
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Affiliation(s)
- M Gossop
- National Addiction Centre, The Maudsley, London, UK
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Gossop M, Marsden J, Stewart D. Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction 2002; 97:169-78. [PMID: 11860388 DOI: 10.1046/j.1360-0443.2002.00028.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter-relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance-related problems. DESIGN, SETTING, PARTICIPANTS The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers. MEASUREMENTS Data were collected by structured face-to-face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS). FINDINGS Three groups of drinkers were identified: non-alcohol-dependent drug misusers (63%); low-dependence (19%); and high-dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High-dependence drinkers were more likely to drink extra-strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated. CONCLUSIONS Alcohol use is an important and under-rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol-related problems and severity of alcohol dependence.
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Stewart D, Gossop M, Marsden J. Reductions in non-fatal overdose after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS). J Subst Abuse Treat 2002; 22:1-9. [PMID: 11849902 DOI: 10.1016/s0740-5472(01)00206-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Few studies have reported changes in rates of overdose after drug misuse treatment. This paper investigates changes in non-fatal overdose between treatment intake and 1 year follow-up among a sample of 753 clients recruited to the National Treatment Outcome Research Study (NTORS). A relatively high rate of overdose (15%) was reported during the 3 months prior to treatment. Variables predictive of overdose at intake to treatment included injecting, frequency of benzodiazepine and cocaine use, quantity of alcohol consumption, and levels of anxiety. At 1 year follow-up, the rate of non-fatal overdose had fallen to 6%. Reduced rates of non-fatal overdose were found for clients treated in both residential and community treatment settings. Reductions in overdose were linked to improvements in frequency of drug use and lower rates of injecting. Clients who overdosed at follow-up showed no improvements in their substance use, except for frequency of crack cocaine use. The risk of non-fatal overdose at 1 year was associated with injecting and multiple drug use. These findings support the view that treatment an important role can play in reducing deaths among drug misusers.
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Affiliation(s)
- Duncan Stewart
- National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8AF, UK.
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Marsden J, Gossop M, Stewart D, Rolfe A, Farrell M. Psychiatric symptoms among clients seeking treatment for drug dependence. Intake data from the National Treatment Outcome Research Study. Br J Psychiatry 2000; 176:285-9. [PMID: 10755078 DOI: 10.1192/bjp.176.3.285] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many people with substance use disorders are vulnerable to other psychiatric disorders and present to addiction treatment services with comorbid psychiatric symptoms. AIMS To describe the prevalence of recent psychiatric treatment and current psychiatric symptoms and explore links between substance misuse, personal/social functioning and symptom severity. METHOD Subjects were 1075 adults recruited to the National Treatment Outcome Research Study (NTORS), of whom 90% were opiate-dependent. Psychiatric symptoms at intake were recorded using sub-scales from the Brief Symptom Inventory. RESULTS Recent psychiatric treatment was reported by one in five subjects. Psychiatric symptom levels were high and females had elevated scores on all scales. Symptoms were elevated among opiate users who were also frequent users of benzodiazepines, alcohol and, in particular, stimulants. Gender, physical health, drug dependence and personal relationship problems were more powerful predictors of psychiatric symptoms than substance use. CONCLUSIONS Addictions service providers should be vigilant to psychiatric problems among their clients at intake to treatment. Psychiatric symptoms are more closely linked to polydrug use than to opiate use in this population.
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Affiliation(s)
- J Marsden
- National Addiction Centre, Institute of Psychiatry/Maudsley Hospital, London.
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Darke S, Wodak A, Hall W, Heather N, Ward J. Prevalence and predictors of psychopathology among opioid users. BRITISH JOURNAL OF ADDICTION 1992; 87:771-6. [PMID: 1591528 DOI: 10.1111/j.1360-0443.1992.tb02723.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
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