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Davis AK, Nickelsen T, Zucker RA, Bonar EE, Walton MA. Acceptability of nonabstinent treatment outcome goals among addiction treatment providers in Ukraine. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:485-495. [PMID: 29648844 DOI: 10.1037/adb0000354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined whether acceptability of nonabstinence treatment outcome goals varied as a function of a patient's severity of diagnosis (ICD-10 harmful use vs. dependence syndrome; World Health Organization, 1992), finality of outcome goal (intermediate vs. final), and type of substance (e.g., tobacco, alcohol, cannabis), among addiction treatment providers in Ukraine. We surveyed 44% of Ukrainian treatment providers (n = 446/1023; Mage = 40.4, SD = 8.6; Male = 67%; MYears Of Experience = 10.2, SD = 7.2). For tobacco use, most respondents (78%-93%) rated nonabstinence as acceptable, regardless of diagnostic severity or finality of outcome goal (i.e., intermediate, final). Most respondents also rated nonabstinence as acceptable as an intermediate or final goal for patients with harmful use of alcohol (70% to 86%) or cannabis (71% to 93%); however, nonabstinence was less commonly indicated by respondents as an intermediate goal for patients with a dependence syndrome (alcohol = 52%; cannabis = 68%). Regarding other drug use, although most rated nonabstinence acceptable as an intermediate goal for patients with harmful use of opioids (68%) or sedatives (64%), fewer rated nonabstinence acceptable as a final goal (26% to 33%), particularly for patients with a dependence syndrome (10% to 27%). Very few providers (5% to 15%) rated nonabstinence acceptable for other substances. Patients in Ukraine who wish to moderate cannabis or tobacco use will find that their provider is typically accepting of this goal; however, providers are mixed regarding whether alcohol and opioid moderation is appropriate, particularly for those with dependence. Findings support education and research efforts to better understand how provider and patient alignment regarding goals impact patient outcomes following substance use treatment in Ukraine. (PsycINFO Database Record
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Tetiana Nickelsen
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan
| | - Robert A Zucker
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan
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Davis AK, Rosenberg H, Rosansky JA. American counselors' acceptance of non-abstinence outcome goals for clients diagnosed with co-occurring substance use and other psychiatric disorders. J Subst Abuse Treat 2017; 82:29-33. [PMID: 29021112 DOI: 10.1016/j.jsat.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/08/2017] [Accepted: 08/25/2017] [Indexed: 12/11/2022]
Abstract
Previous research has examined clinicians' acceptance of non-abstinence for clients who have a substance use disorder (SUD), but many SUD clients also present with a psychiatric disorder. To evaluate the acceptability of non-abstinence as a final outcome goal for clients with co-occurring diagnoses, we recruited a nationwide sample of 751 American substance abuse counselors to complete a web-based questionnaire. Respondents rated the acceptability of limited/moderate consumption by clients diagnosed with each of 18 co-occurring disorders: three psychiatric disorders (Major Depressive Disorder, Post-Traumatic Stress Disorder, Social Phobia) x three substances (alcohol, cannabis, opioids) x two levels of severity (DSM-5 Moderate SUD, DSM-5 Severe SUD). On average, non-abstinence was rated as unacceptable for clients with any of the 18 diagnostic pairs, although one-fourth to almost one-third rated limited/moderate use of cannabis somewhat or completely acceptable for clients diagnosed with a Moderate Cannabis Use Disorder when paired with any of the three psychiatric disorders. Furthermore, small proportions of respondents (13% to 20%) rated non-abstinence at least somewhat acceptable even when clients were diagnosed with a Severe SUD for any of the three substances and any co-occurring psychiatric disorder. Based on our findings, clients with co-occurring disorders who want to moderate their substance use will typically find their counselor does not accept that outcome goal. Because supporting non-abstinence respects client autonomy, could attract and retain clients in counseling, and is consistent with a recovery-oriented treatment model, we encourage continuing education about the benefits of non-abstinence as a treatment goal for clients with co-occurring disorders.
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Affiliation(s)
- Alan K Davis
- University of Michigan, United States; Bowling Green State University, United States.
| | - Harold Rosenberg
- University of Michigan, United States; Bowling Green State University, United States
| | - Joseph A Rosansky
- University of Michigan, United States; Bowling Green State University, United States
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Klingemann J. Acceptance of Reduced-Risk Drinking as a Therapeutic Goal within the Polish Alcohol Treatment System. Alcohol Alcohol 2016; 51:436-41. [DOI: 10.1093/alcalc/agv141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/28/2015] [Indexed: 11/14/2022] Open
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Körkel J. Kontrolliertes Trinken bei Alkoholkonsumstörungen: Eine systematische Übersicht. SUCHT 2015. [DOI: 10.1024/0939-5911.a000367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hintergrund: Verhaltenstherapeutische Behandlungen zum selbstkontrollierten Trinken (KT) wurden in den letzten 50 Jahren vielfältig erforscht. Eine aktuelle Übersicht über den gegenwärtigen Status dieses Ansatzes liegt nicht vor. Fragestellung: Es wird ein systematischer Überblick über die Konzept- und Forschungsgeschichte des KT (Definition, theoretische Wurzeln, Behandlungsmethoden), Wirksamkeit von KT-Behandlung (inkl. Prognosefaktoren) sowie Implementierung von KT in das Behandlungssystem (Akzeptanz und Verbreitung) vorgenommen. Methodik: Gemäß den PRISMA Richtlinien wurde in den Datenbanken PsycINFO, Medline und Psyndex nach psychologischen Behandlungen zum selbstkontrollierten Alkoholkonsum bei Menschen mit klinisch relevanten Alkoholproblemen recherchiert und 676 einschlägige Beiträge identifiziert. Ergebnisse: KT wird als regelgeleitet-planvoller Alkoholkonsum definiert. Seine theoretischen Wurzeln reichen von Lerntheorien bis zur Psychologie der Selbstregulation. In der Behandlung haben Behavioral Self-Control Trainings frühere Methoden (z. B. aversive Konditionierung, Kontingenzmanagement und Reizexposition) abgelöst. Einzel und Gruppenbehandlungen sowie Selbsthilfemanuale zum KT erweisen sich über das gesamte Spektrum des problematischen Alkoholkonsums als kurz- und langfristig wirksam zur Reduktion des Alkoholkonsums und alkoholassoziierter Probleme wie auch zur Förderung des Übergangs zur Abstinenz. Prognostisch bedeutsam sind v. a. der Zielentscheid des Patienten pro KT und seine Zuversicht in die Realisierbarkeit von KT. Akzeptanz und Verbreitung von KT haben in den letzten Jahrzehnten zugenommen und variieren u. a. länderspezifisch. Schlussfolgerungen: Angesichts der Wirksamkeit von KT-Behandlungen sowie gesundheitspolitischer, ethischer, therapeutischer und ökonomischer Überlegungen sollten Reduktionsbehandlungen gleichrangig neben Abstinenzbehandlungen in ein zieloffen ausgerichtetes Behandlungssystem integriert werden.
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Affiliation(s)
- Joachim Körkel
- Evangelische Hochschule Nürnberg, Institut für innovative Suchtbehandlung und Suchtforschung, Nürnberg
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van den Brink W, Sørensen P, Torup L, Mann K, Gual A. Long-term efficacy, tolerability and safety of nalmefene as-needed in patients with alcohol dependence: A 1-year, randomised controlled study. J Psychopharmacol 2014; 28:733-44. [PMID: 24671340 DOI: 10.1177/0269881114527362] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated the long-term efficacy and safety of nalmefene treatment in reducing alcohol consumption. We randomised (1:3) 675 alcohol-dependent patients ≥ 18 years of age to 52 weeks of as-needed treatment with placebo or nalmefene 18 mg/day: A total of 112 patients (68%) in the placebo group and 310 (62%) in the nalmefene group completed the study. At month 6, the co-primary outcome variables showed no statistically-significant differences between the treatment groups; but at month 13, nalmefene was more effective than placebo, both in the reduction of the number of heavy drinking days (HDDs) (- 1.6 days/month (95% CI - 2.9; - 0.3); p = 0.017) and the reduction of total alcohol consumption (TAC) (- 6.5 g/day last month (95% CI - 12.5; - 0.4); p = 0.036). In a subgroup analysis of patients with high/very high drinking risk levels at screening and at randomisation (the target population), there was a significant effect in favour of nalmefene on TAC at month 6, and on both HDD and TAC at month 13. Improvements in Clinical Global Impression and liver enzymes were greater with nalmefene, compared to placebo. Most adverse events were mild or moderate, and transient; adverse events, including those leading to dropout, were more common with nalmefene. This study provides evidence for the long-term safety and efficacy of nalmefene as-needed in alcohol-dependent patients whom continue to drink heavily, following a brief intervention.
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Affiliation(s)
- Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Karl Mann
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Antoni Gual
- Neurosciences Institute, Hospital Clinic, Barcelona, Spain
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Acceptance of Controlled Drinking Among Treatment Specialists of Alcohol Dependence in Japan. Alcohol Alcohol 2014; 49:447-52. [DOI: 10.1093/alcalc/agu036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rosenberg H, Davis AK. Differences in the acceptability of non-abstinence goals by type of drug among American substance abuse clinicians. J Subst Abuse Treat 2014; 46:214-8. [DOI: 10.1016/j.jsat.2013.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/13/2013] [Accepted: 07/02/2013] [Indexed: 11/26/2022]
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van Amsterdam J, van den Brink W. Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence. J Psychopharmacol 2013; 27:987-97. [PMID: 23824247 DOI: 10.1177/0269881113495320] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review describes and discusses studies related to reduced-risk drinking as an additional treatment option for patients with problematic alcohol use and alcohol dependence. The review provides some empirical support for the following statements: (a) reduced-risk drinking is a viable option for at least some problem and dependent drinkers; (b) abstinence and non-abstinence-based treatments appear to be equally effective; (c) allowing patients to choose their treatment goal increases the success rate. The relatively short follow-up period (1-2 years) of the studies hampers a proper evaluation of the added value of the reduced-risk drinking approach.
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Affiliation(s)
- Jan van Amsterdam
- 1Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
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The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2012; 7:17. [PMID: 22559788 PMCID: PMC3487873 DOI: 10.1186/1747-597x-7-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/04/2012] [Indexed: 11/13/2022]
Abstract
Background Cognitive factors associated with drinking behavior such as positive alcohol expectancies, self-efficacy, perception of impaired control over drinking and perception of drinking problems are considered to have a significant influence on treatment effects and outcome in alcohol-dependent patients. However, the development of a rating scale on lack of perception or denial of drinking problems and impaired control over drinking has not been substantial, even though these are important factors in patients under abstinence-oriented treatment as well as participants in self-help groups such as Alcoholics Anonymous (AA). The Drinking-Related Cognitions Scale (DRCS) is a new self-reported rating scale developed to briefly measure cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment, including positive alcohol expectancies, abstinence self-efficacy, perception of impaired control over drinking, and perception of drinking problems. Here, we conducted a prospective cohort study to explore the predictive validity of DRCS. Methods Participants in this study were 175 middle-aged and elderly Japanese male patients who met the DSM-IV Diagnostic Criteria for Alcohol Dependence. DRCS scores were recorded before and after the inpatient abstinence-oriented treatment program, and treatment outcome was evaluated one year after discharge. Results Of the 175 participants, 30 were not available for follow-up; thus the number of subjects for analysis in this study was 145. When the total DRCS score and subscale scores were compared before and after inpatient treatment, a significant increase was seen for both scores. Both the total DRCS score and each subscale score were significantly related to total abstinence, percentage of abstinent days, and the first drinking occasion during the one-year post-treatment period. Therefore, good treatment outcome was significantly predicted by low positive alcohol expectancies, high abstinence self-efficacy, high perception level of impaired control over drinking, and high perception level of drinking problems measured by DRCS. Conclusions The DRCS was considered to have satisfactory predictive validity, which further supports our previous findings. It was suggested that DRCS is a promising rating scale for evaluating multidimensional cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment.
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Luquiens A, Reynaud M, Aubin H. Is Controlled Drinking an Acceptable Goal in the Treatment of Alcohol Dependence? A Survey of French Alcohol Specialists. Alcohol Alcohol 2011; 46:586-91. [DOI: 10.1093/alcalc/agr083] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eversman MH. High and low threshold service provision in drug-free settings: Practitioner views. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:501-6. [DOI: 10.1016/j.drugpo.2010.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/05/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022]
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Heather N, Adamson SJ, Raistrick D, Slegg GP. Initial Preference for Drinking Goal in the Treatment of Alcohol Problems: I. Baseline Differences Between Abstinence and Non-Abstinence Groups. Alcohol Alcohol 2010; 45:128-35. [DOI: 10.1093/alcalc/agp096] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hobden KL, Cunningham JA. Barriers to the dissemination of four harm reduction strategies: a survey of addiction treatment providers in Ontario. Harm Reduct J 2006; 3:35. [PMID: 17169151 PMCID: PMC1764412 DOI: 10.1186/1477-7517-3-35] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 12/14/2006] [Indexed: 11/30/2022] Open
Abstract
A sample of service providers at addictions agencies' in Ontario were interviewed by telephone to assess attitudes toward, anticipated internal and external barriers to implementing, and expected benefits of four harm reduction strategies: needle exchange, moderate drinking goals, methadone treatment, and provision of free condoms to clients. Respondents were also asked to define harm reduction, list its most important elements, and describe what they find most troubling and most appealing about harm reduction. Attitudes toward harm reduction in general and the services provided at each agency were also assessed. Results indicated that the service providers surveyed had positive attitudes toward each of the four harm reduction strategies and harm reduction in general, and the majority of respondents were aware of the benefits associated with each strategy. Almost all of the agencies surveyed allowed for moderate drinking outcomes in the treatment of alcohol problems, and most agencies provided free condoms to clients. In terms of barriers, anticipated negative community reaction to needle exchange, methadone treatment, and free condoms was a major concern for the majority of respondents. Lack of staff, of funding, or anticipated staff resistance were also cited as potential barriers to introducing these strategies. In the case of methadone maintenance, the unavailability of a qualified physician was listed as the primary constraint. Implications for future efforts directed at encouraging the adoption of these strategies and suggestions for future research are discussed.
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Affiliation(s)
- Karen L Hobden
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health and Departments of Psychology and of Public Health Services, University of Toronto, Toronto, Ontario, Canada
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Abstract
Reduced-risk drinking as a treatment goal for clients with alcohol problems has received limited acceptance in the United States. The majority of literature addressing reduced-risk drinking has focused on debates between proponents of traditional abstinence treatment and those supporting nonabstinence treatment. Proportionately little attention has been given to objective consideration of the potential advantages of integrating both abstinence and nonabstinence goals as part of a comprehensive continuum of treatment for clients with alcohol problems. Further, there is a lack of guidelines available to assist clinicians in treating and supporting clients with nonabstinence goals. The purpose of this article is to review the potential advantages of reduced-risk drinking for clients with alcohol problems and to forward strategies designed to assist clinicians in safely treating clients who wish to reduce rather than abstain from drinking alcohol. Current gaps in the literature and implications for future research are identified.
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Affiliation(s)
- Janet A Ambrogne
- Department of Psychosocial and Community Health Nursing, University of Washington, Seattle, WA 98195-9551, USA.
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