Quality of life as an outcome measure in alcoholism treatment research

Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment - A prospective pre-post study

Background

Globally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment.

Methods

We describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course.

Results

We obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5-6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use-related variables showed a modest, non-significant improvement at T1.

Conclusion

During a 5-month course of outpatient treatment, patients' subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.

Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials

BACKGROUND AND AIMS

Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder.

DESIGN

We conducted a secondary analysis of a pooled dataset of 13 RCTs.

SETTING AND PARTICIPANTS

Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (N = 2062) in a wide range of treatment facilities in the United States.

MEASUREMENTS

We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug-seeking behavior, craving and high-risk behaviors, all assessed at the end of the trial, as well as follow-up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence.

FINDINGS

More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%-64.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%-45.7%), depression severity (39.9%, 95% CI = 30.9%-48.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug-related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow-up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35-0.71).

CONCLUSION

Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches.

Health-related quality of life and recovery capital among recovery residents taking medication for opioid use disorder in Texas

Background

Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL.

Methods

Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted using T-, Chi-squared, and Fisher's exact tests.

Results

Most participants were 35 years/older (50.7%), male (58.9%), non-Hispanic White (68.4%), heterosexual (82.8%), and reported HRQOL problems, mainly anxiety/depression (78.4%) and pain/discomfort (55.7%). Participants who were 35 years/older [mean (SD) = 42.6 (7.3)] were more likely to report mobility and pain/discomfort problems than younger participants. Female participants were more likely to report pain/discomfort problems than male participants. Sexual minorities were more likely to report anxiety/depression problems than heterosexual participants. Married participants and those in committed relationships were more likely to report problems conducting self-care than single/never-married participants. Comorbid conditions were associated with mobility, pain/discomfort, and usual activities problems. Most participants reported high social (65.4%), personal (69.0%), and total (65.6%) RC. Low personal RC was associated with mobility (aOR = 0.43, CI = 0.24-0.76), self-care (aOR = 0.13, CI = 0.04-0.41), usual activities (aOR = 0.25, CI = 0.11-0.57), pain/discomfort (aOR = 0.37, CI = 0.20-0.68), and anxiety/depression (aOR = 0.33, CI = 0.15-0.73) problems. Low total RC was associated with problems conducting self-care (aOR = 0.20, CI = 0.07-0.60), usual activities (aOR = 0.43, CI = 0.22-0.83), pain/discomfort problems (aOR = 0.55, CI = 0.34-0.90), and anxiety/depression (aOR = 0.20, CI = 0.10-0.41) problems. Social RC was not associated with HRQOL.

Conclusion

Personal and total RC and comorbid conditions predict HRQOL. Although the opioid crisis and the increasing prevalence of comorbidities have been described as epidemics, they are currently being addressed as separate public health issues. Our findings underscore the importance of ensuring residents are provided with interprofessional care to reduce the burden of comorbidities, which can negatively impact their OUD recovery. Their RC should be routinely assessed and enhanced to support their recovery and improve HRQOL.

A systematic review of quality of life and health-related quality of life as outcomes in substance and behavioural addictions

ISSUES

Consideration of an individual's quality of life (QoL) can benefit assessment and treatment of addictive disorders, however, uncertainty remains over operationalisation of the construct as an outcome and the appropriateness of existing measures for these populations. This systematic review aimed to identify and evaluate QoL and health-related QoL outcome instruments used in addiction-related risk and harm research and map their conceptualised domains.

APPROACH

Three electronic databases and a specialised assessment library were searched on 1 February 2022 for QoL or health-related QoL outcome instruments used with addiction-related risk and harm populations. PRISMA reporting guidance was followed and included outcome instruments were appraised using mixed methods. Psychometric evidence supporting their use was summarised. The COSMIN risk of bias tool was used to assess validation studies.

KEY FINDINGS

A total of 298 articles (330 studies) used 53 outcome instruments and 41 unique domains of QoL. Eleven instruments' psychometric properties were evaluated. No instrument was assessed for any parameter in at least five studies for meta-analytic pooling. Cronbach's alpha (α) internal consistency was the most widely assessed parameter with the AQoLS, WHOQOL-BREF, ALQoL-9, Q-LES-Q-SF, SF-12, DUQoL, QLI and SF-36 displaying promising statistics (α > 0.70).

IMPLICATIONS AND CONCLUSION

Many instruments have been utilised. However, a significant proportion of studies applied a small number of instruments with minimal high-quality validation evidence supporting their use within addiction-related risk and harm. Promising instruments are recommended, however, the paucity of supporting evidence limits confidence in the reliability and validity of QoL measurement in these populations.

Relationship Between Community Resilience and Quality of Life of Disaster-Affected People: Reinforcement Effects of the Perception of Government Relief Services in South Korea

OBJECTIVE

The occurrence of various forms of disasters has increased worldwide. In South Korea, community resilience is particularly emphasized, especially in response to large-scale disasters in regional and group units. This study investigated the association between community resilience and the quality of life of disaster-affected people, and identified the moderating effects of perception of government relief services.

METHODS

Data from the third long-term survey on the change of life of disaster-affected people conducted in 2018 by the National Disaster Management Research Institute were used. The study selected 1046 participants ages ≥ 19 years from among the disaster-affected people. Statistical analyses were performed using Model 1 of the PROCESS Macro 4.0 in the SPSS program.

RESULTS

Community resilience positively affected disaster-affected people's quality of life. The perception of government relief services significantly strengthened the association between community resilience and quality of life.

CONCLUSIONS

The study highlights the importance of enhancing community resilience to improve disaster-affected people's quality of life and emphasizes the role of perception of government relief services in reinforcing this relationship. Several practical and political measures that focus on improving community resilience and perception of government relief services are suggested to enhance disaster-affected people's quality of life.

Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial

BACKGROUND

Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care.

METHODS

One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment.

DISCUSSION

This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD.

REGISTRY NAME

AAT for Alcohol Use Disorder in Veterans.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.

Quality of life in patients with alcohol use disorders admitted to de-addiction centers using WHOQOL-BREF scale-A cross-sectional study

BACKGROUND

Alcohol use disorders (AUDs) adversely affect a person's general health and the lives of their family and friends. These disorders are also the most undertreated mental illness with severe implications for public health. Hence, the present study aimed to employ the WHOQOL-BREF to assess the quality of life (QoL) of AUDs patients seeking treatment at de-addiction centers and identify the demographic variables associated with the QoL dimension scores.

MATERIALS AND METHODS

A cross-sectional study was conducted among alcohol dependents taking treatment in de-addiction centers in Dakshina Kannada District, Karnataka. The WHOQOL-BREF questionnaire was administered to 124 subjects. Multiple regression analysis was carried out to identify the demographic variables associated with the QoL dimension scores.

RESULTS

The domain mean scores were between 50 and 60 on the 0 to 100 scale. Age, social class, residential area, marital status, and years of drinking were the demographic variables found to be significantly associated with the dimension scores.

CONCLUSIONS

Physicians should monitor the effect of alcoholism on QoL, and a multidisciplinary treatment plan with elements from the medical, social, and psychiatric fields should be used. The demographic variables should be considered while managing patients with AUDs.

How, when, and to what degree do people with alcohol dependence recover their psychological wellbeing and quality of life? The Madrid Recovery Project

Introduction

The consensus on recovery from alcohol use disorder (AUD) has shifted toward encompassing psychological wellbeing and quality of life dimensions. However, few studies have explored the long-term recovery process and its dimensions, timing, styles, and modes. The aim of this study was to investigate the extent, timing, and process of psychological wellbeing and quality of life recovery in alcohol use disorder (AUD) patients, as well as the relationship with classic dimensions of AUD recovery.

Method

A cross-sectional study has been carried out with 348 participants with AUD, in different abstinence periods (1 month-28 years), and 171 control subjects. Participants underwent a psychological evaluation, which included self-informed measures of psychological wellbeing, quality of life, negative emotionality, and coping strategies related to alcohol consumption avoidance. Statistical analysis included linear and non-linear regression models between psychological dimensions and maintenance of abstinence, as well as matching the scores of the sample with AUD to those of controls. Scatter plots were used to explore inflection points. In addition, mean comparison tests were performed between participants with AUD and controls and by gender.

Results

In general, according to the regression models, there were pronounced increases in indices of wellbeing and coping strategies (and pronounced decreases in negative emotionality) during the first 5 years of abstinence, followed by less pronounced improvements. The matching of AUD subjects in wellbeing and negative emotionality indices with controls occurs at different times: (a) 1 year or less: physical health; (b) 1-4 years: psychological health; (c) 4-10 years: social relationships, wellbeing, and negative emotionality; and (d) more than 10 years: autonomy and self-acceptance. There are statistically significant differences by gender for the negative emotionality and physical health variables.

Conclusion

Recovery from AUD is a long process that involves improvements in wellbeing and quality of life. Four stages can be described in this process, with the most pronounced changes occurring during the first 5 years of abstinence. However, AUD patients take more time to obtain similar scores to controls in several psychological dimensions.

The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally.

Insufficient Physical Activity Is a Global Marker of Severity in Alcohol Use Disorder: Results from a Cross-Sectional Study in 382 Treatment-Seeking Patients

Improving physical activity (PA) in patients with alcohol use disorder (AUD) has recently emerged as an important component of the global treatment strategy to improve drinking outcomes and quality of life. However, this new approach should focus on AUD patients with insufficient baseline PA and requires this subgroup to be better characterized. In a population of 382 treatment-seeking AUD patients, PA was assessed using the International Physical Activity Questionnaire, and participants were divided into two groups: insufficient PA group and sufficient PA group. The severity of the AUD was assessed using the DSM-5 criteria, the Alcohol Use Disorder Identification Test, and the Severity of Alcohol Dependence Questionnaire. In logistic regression models, individuals with insufficient PA were more likely than other AUD individuals to present a higher Body Mass Index (p < 0.001), a higher number of AUD DSM-5 criteria (p < 0.05), more frequent opioid use (p < 0.05), higher scores at the Fagerström Test for Nicotine Dependence (p < 0.001), State-Trait Anxiety Inventory (p < 0.001), impulsivity scale (p < 0.05), Pittsburgh Sleep Quality Inventory (p < 0.05), and lower WHO Quality of Life (p < 0.001) scores. In AUD, an insufficient baseline PA is associated with several markers of severity, and physical exercise interventions should be part of a multimodal treatment program integrating the global impairments of patients.

Psychometrische Evaluation der deutschen Version des Substance Use Recovery Evaluator (SURE)

Zusammenfassung. Konsumvariablen und Abstinenz scheinen unzureichend zur Erfassung der Genesung bei Personen mit einer Alkoholkonsumstörung. Stattdessen rücken patientenzentrierte Indikatoren wie die Lebensqualität zunehmend in den Vordergrund. Um den Forderungen adäquater Messinstrumente gerecht zu werden, wurde der Substance Use Recovery Evaluator von Neale et al. (2016 ) übersetzt und in verschiedenen Stichproben mit Alkoholkonsumstörung nach Entzugsbehandlung psychometrisch evaluiert. In der ersten Teilstichprobe ( n = 135) wurde explorativ die Faktorenstruktur identifiziert sowie Reliabilitäts- und Validitätsmaße (Zusammenhänge mit Alkoholkonsum, Craving und gesundheitsbezogener Lebensqualität) berechnet. In der zweiten Stichprobe ( n = 120) wurde die gefundene Struktur konfirmatorisch geprüft. Das Verfahren erwies sich als reliabel und valide. Die im Original vorgeschlagene fünffaktorielle Struktur zeigte einen guten Fit, wenn auch in der vorliegenden Studie eine dreifaktorielle Struktur etwas geeigneter erschien. Diese Ergebnisse wurden in einer dritten Stichprobe ( n = 224) größtenteils gestützt. Trotz Limitationen (z. B. kleine Stichprobe) erwies sich der deutsche SURE als psychometrisch abgesicherter Indikator der Genesung von einer Alkoholkonsumstörung.

Alcohol Intake Influences the Occurrence and Progression of Periodontitis Differently According to Sex and Country Sociodemographic Development: A Two-Stage Systematic Review

AIMS

To conduct an overview and systematic evaluation of prospective cohort studies on whether alcohol intake is associated with the incidence and progression of periodontitis.

METHODS

Nine databases were searched by two independent reviewers up to November 2021 according to prespecified eligibility criteria. Risk of Bias in Systematic Reviews and Risk of Bias in Non-Randomized Studies of Interventions were used for risk of bias assessment and certainty of evidence was assessed using the GRADE approach. Random-effects pair-wise meta-analyses were performed with data from cohort studies on the effects of higher levels of alcohol intake compared with current non-drinking to determine risk ratios (RR) and confidence intervals of periodontitis.

RESULTS

The four systematic reviews were at high risk of bias and concluded that alcohol intake is associated with periodontitis regardless of the study design. Five reports from seven cohort studies contributed to the meta-analyses and no statistically significant differences were found for higher levels of consumption regarding the risk of periodontitis, except for men from countries with low- and high-middle socio-demographic index (RR = 1.30, 95% CI: 1.13-1.46), with low certainty evidence.

CONCLUSION

Higher levels of alcohol consumption seem to be part of the causal mechanism of periodontitis when cooccurring with male sex in underdeveloped countries. No conclusion can be drawn regarding alcohol use disorders or patterns of consumption.

An examination of the reliability and validity of the recovery capital questionnaire (RCQ)

AIMS AND BACKGROUND

Recovery capital refers to the resources people can call upon to initiate and sustain alcohol and drug problem resolution. Measuring this phenomenon could help an individual better understand their strengths as well as gauge the impact of any interventions designed to improve recovery capital and / or reduce addiction severity. This study aimed to test the internal consistency, stability reliability, criterion-related concurrent validity and content validity of the Recovery Capital Questionnaire (RCQ).

SETTING AND PARTICIPANTS

Participants (n = 173) accessing community based addiction treatment (n = 108) and residential treatment (n = 65) in England and Scotland completed the RCQ at two time-points one week apart (n = 102) to test stability reliability, and also completed the RCQ alongside measures of quality of life and resilience (n = 152). Content validity was assessed by seven subject matter experts with content validity ratio and index calculated.

FINDINGS

Cronbach's Alpha values (internal consistency) included: social α = 0.52 (0.40-62); physical α = 0.73 (0.66-0.78); human α = 0.85 (0.82-0.88); community α = 0.85 (0.82-0.88); RCQ Total α = 0.88 (0.85-90). RCQ stability reliability (r = 0.89) and ICC (0.88) were calculated. Content Validity Index statistic of 0.91 was calculated. Correlations between relevant domains within the RCQ and WHOQOL Bref were found to include: r = 0.44, 0.59, 0.66 and 0.40. Correlations between RCQ and CD-RISC scores were calculated (r = 0.65).

CONCLUSION

The Recovery Capital Questionnaire was found to possess good overall internal consistency and stability reliability. Content validity was found to be strong and the RCQ demonstrated good concurrent validity with a measure of quality of life and a measure of resilience.

Health-related quality of life in outpatients with substance use disorder: evolution over time and associated factors

Background

Health-related quality of life (HRQoL) is an important element of patient care and clinical research. The aim of this study was to describe HRQoL changes and identify associated factors during a 6-month follow-up of outpatients starting care for alcohol or opioid dependence.

Methods

HRQoL was measured at baseline and 3 and 6 months later using the SF-12. Data on the patients’ sociodemographics, clinical characteristics and levels of anxiety and depression were collected using the Hospital Anxiety and Depression Scale (HADS). Repeated-measures analyses were performed to assess factors associated with global HRQoL differences and the evolution of HRQoL indicated by both physical and mental scores (PCS and MCS, respectively).

Results

The mean PCS and MCS scores were initially low at 45.4 (SD = 8.6) and 36.0 (SD = 10.9), respectively. The improvement in HRQoL was rapid in the first 3-month period and then slowed and remained stable over the subsequent 3-month period. Being employed (p = 0.012), having no comorbidities (p = 0.014) and having no depression (p = 0.004) were associated with significant differences in the average PCS scores at the 3 time points. Patients who had lower overall HRQoL MCS scores on average were those for whom a medication was initiated (p = 0.009), as was the case for patients with anxiety (p < 0.001) and depression (p < 0.001). Patients with depression at baseline were also those for whom a significantly greater increase in MCS score during the 6 months of follow-up was observed.

Conclusion

Our findings highlight the importance of screening early psychological distress and considering other factors associated with HRQoL changes in outpatients after the first 3-month period of treatment for substance use disorder.

Abstinence versus moderation recovery pathways following resolution of a substance use problem: Prevalence, predictors, and relationship to psychosocial well-being in a U.S. national sample

BACKGROUND

Many people who report resolving an alcohol or other drug (AOD) problem continue some level of substance use. Little information exists, however, regarding the prevalence of this resolution pathway, or how continued substance use after resolving an AOD problem, relative to abstinence, relates to functioning, quality of life, and happiness (i.e., well-being). Greater knowledge of the prevalence and correlates of non-abstinent AOD problem resolution could inform public health messaging and clinical guidelines, while encouraging substance use goals likely to maximize well-being and reduce risks.

METHODS

We analyzed data from a nationally representative sample of individuals who endorsed having resolved an AOD problem (N = 2002). Analyses examined: (1) The prevalence of various substance use statuses coded from lowest to highest risk: (a) continuous abstinence from all AOD since problem resolution; (b) current abstinence from all AOD with some use since problem resolution; (c) current use of a substance reported as a secondary substance; (d) current use of the individual's primary substance only; or, (e) current use of a secondary and primary substance; (2) relationships between substance use status and demographic, clinical, and service use history measures; and (3) the relationship between substance use status and well-being. Weighted, controlled, regression analyses examined the influence of independent variables on substance use status.

RESULTS

(1) Prevalence: In this sample, 20.3% of patients endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed current use of a primary substance; and 8.8% endorsed current use of both a secondary and a primary substance. (2) Correlates: Lower-risk substance use status was associated with the initiation of regular substance use at an older age, more years since problem resolution, and fewer lifetime psychiatric diagnoses. (3) Well-Being: Controlling for pertinent confounds, lower-risk substance use status was independently associated with greater self-esteem, happiness, quality of life and functioning, and recovery capital, as well as less psychological distress.

CONCLUSIONS

About half of Americans who self-identify as having resolved an AOD problem continue to use AOD in some form. It appears that, although for many abstinence is not necessary to overcome an AOD problem, it is likely to lead to better functioning and greater well-being. Further, people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution.

The Effectiveness of Exercise as an Adjunct Intervention to Improve Quality of Life and Mood in Substance Use Disorder: A Systematic Review

Introduction: Quality of life and affective outcomes offer a perspective of the burden of disease experienced by people with substance use disorder. This can be considered an alternative measure of substance use disorder severity. This review aims to evaluate the impact of exercise as a novel intervention on quality of life and affect in substance use disorder. Method: Medline, CINAHL, Amed, Web of Science core collections, Embase, PsychINFO and SportDISCUS databases were searched from inception to August 2021 for studies that assessed the impact of exercise on mood, depression, anxiety and quality of life outcomes in substance use disorder. Exercise interventions of any duration were included. Results: Forty-two studies met the inclusion criteria. Quality of life scores improved with larger effects seen in studies with two or more sessions per week. Depression and anxiety scores decreased, with 19 of the 25 data sets reporting a reduction in depression (effect size 0.2-1.86) and 13 of the 17 data sets reporting a reduction in anxiety (effect sizes 0.2-1.42). Mood improved in six of the seven data sets reviewed with effect sizes ranging from 0.34 to 1.13. Discussion: Included studies had numerous methodological flaws therefore results need to be interpreted with caution. Further research needs to be completed with more rigorous methodologies to support these results. Conclusions: Results indicate promising responses to exercise as a novel intervention for quality of life and mood in substance use disorder, however further research of high methodological quality is needed to confirm.

Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital

Background

Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors.

Results

The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X²= 12.525, p=0.014; X²= 12.525, p=0.023; and X²= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse.

Conclusions

Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.

A population-wide perspective on the reach of substance use disorders: Parental exposure, diagnostic remission, and current disorders

BACKGROUND AND OBJECTIVES

Parental substance use disorder (SUD) increases the risk for childhood adversities. Lifetime and current SUDs are associated with functional impairment and psychiatric comorbidity. Research shows that these abate with diagnostic remission. However, a hierarchically ordered heuristic profile of adult subpopulations affected by SUDs has not been explored.

METHODS

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III; N = 36,309) to compare four subpopulations defined by the following hierarchy: (1) neither parental nor lifetime SUD (un-affected group); (2) parental SUD but no personal SUD; (3) past but not current SUD (diagnostic remission); and (4) current SUD. We conducted bivariate comparisons and multivariable-adjusted logistic regression to identify characteristics independently differentiating each group.

RESULTS

Almost half of the US adult population (108.9 million) were at risk from SUDs. Relative to the unaffected group (56.1%), the parental-exposure-only group (13.9%) experienced diverse parental and childhood adversities and increased risk for psychiatric disorders. Compared to the parental-exposure-only group those in the remitted group (14.1%) were more likely to report behavioral problems and lifetime psychiatric multimorbidities. Those with current SUD (15.9%) had a poorer mental health-related quality of life.

DISCUSSION AND CONCLUSIONS

This heuristic SUD hierarchy is associated with increasing adversities affecting almost half the US population, although only 15.9% meet the criteria for a current disorder.

SCIENTIFIC SIGNIFICANCE

Our findings provide a rigorous population-based estimate of the staggering public health impact of SUDs in the United States and suggest that almost half of the US population is either directly or indirectly affected by SUDs.

Quality of life during a randomized trial of a therapeutic-workplace intervention for opioid use disorder: Web-based mobile assessments reveal effects of drug abstinence and access to paid work

Background

Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder.

Methods

For 12 weeks, participants (n = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones. At enrollment, participants were randomized to work in the Therapeutic Workplace immediately (immediate work group, IWG) or after a 3-week waitlist delay (delayed work group, DWG). Once both groups could work, wage-resetting contingencies were introduced for their opiate- and cocaine-urinalysis. Data were analyzed by (1) access to work with and without contingencies and (2) overall urinalysis-verified opiate- and cocaine-abstinence.

Results

DWG and/or IWG reported improvements in several QOL areas (sleep, transportation, recreation); however, they also reported increased money-related difficulties and less time spent with friends/family. These changes did not coincide with DWG's work access, but some (more sleep, money-related difficulties) coincided with the urinalysis contingencies. Greater opiate- and/or cocaine-abstinence was also associated with several improvements: sleep, paying bills, time spent with friends/family, and exercising. Surprisingly, intermediate cocaine abstinence was associated with reductions in work-capacity satisfaction and recreation.

Conclusions

Participants reported complex QOL differences during their experimental employment and associated with drug abstinence. Future work should help participants address issues that may be relevant to employment generally (e.g., time with friends/family) or contingency management specifically (e.g., money-related issues for non-abstinent participants).

Impact of Alcohol Abuse on Susceptibility to Rare Neurodegenerative Diseases

Despite the prevalence and well-recognized adverse effects of prenatal alcohol exposure and alcohol use disorder in the causation of numerous diseases, their potential roles in the etiology of neurodegenerative diseases remain poorly characterized. This is especially true of the rare neurodegenerative diseases, for which small population sizes make it difficult to conduct broad studies of specific etiological factors. Nonetheless, alcohol has potent and long-lasting effects on neurodegenerative substrates, at both the cellular and systems levels. This review highlights the general effects of alcohol in the brain that contribute to neurodegeneration across diseases, and then focuses on specific diseases in which alcohol exposure is likely to play a major role. These specific diseases include dementias (alcohol-induced, frontotemporal, and Korsakoff syndrome), ataxias (cerebellar and frontal), and Niemann-Pick disease (primarily a Type B variant and Type C). We conclude that there is ample evidence to support a role of alcohol abuse in the etiology of these diseases, but more work is needed to identify the primary mechanisms of alcohol's effects.

Effects of an integrated intervention program for alcoholism (IIPA) on learning, memory and quality of life (QOL) in persons with alcohol dependence at the Centre for Addiction Medicine, Bengaluru, India

Purpose

This study aims to examine the effectiveness of an integrated intervention program for alcoholism (IIPA) for improving verbal encoding and memory, visuospatial construction, visual memory and quality of life (QoL) in persons with alcohol dependence.

Design/methodology/approach

The sample comprised treatment-seeking alcohol-dependent persons (n = 50), allotted into two groups: (1) the treatment as usual (TAU) group (n = 25) and (2) the treatment group (n = 25)]. The groups were matched on age (±1 year) and education (±1 year). The TAU group received standard pharmacological treatment, psychotherapeutic sessions on relapse prevention and yoga for 18 days, while the treatment group received IIPA sessions in addition to the usual treatment. Auditory verbal learning test, complex figure test and QoL scale were administered at pre- and post-treatment along with screening measures.

Findings

The two groups were comparable on demographic variables, clinical characteristics and outcome measures at baseline. Pre- to post-treatment changes (gain scores) comparison between the treatment and TAU groups revealed a significant difference in verbal encoding, verbal and visual memory, verbal recognition, visuospatial construction and QoL.

Research limitations/implications

This study suggests that IIPA is effective for improving learning and memory in both modality (verbal and visual) and QoL in persons with alcoholism. The IIPA may help in better treatment recovery.

Practical implications

The IIPA may help in treatment for alcoholism and may enhance treatment efficacy.

Originality/value

IIPA is effective for improving learning and memory in both modalities and QoL in persons with alcohol dependence. The IIPA may help in better treatment recovery.

Effect of chronic alcohol intake on motor functions on the elderly

Alcohol use disorder (AUD) is a chronic and progressive disease influenced by genetic, psychosocial, and environmental factors. The consequences of alcohol consumption involve alterations in neural circuits of emotion and cognition, as well as in the motor planning circuit. Furthermore, during the natural aging process, several biochemical and functional alterations are also observed with neurological consequences. Thus, considering the consequences of chronic alcohol consumption on neural systems and natural aging process, we aimed to analyze the degree of motor and functional impairment in elderly with chronic alcohol consumption. Sixty elderly underwent an analysis of alcohol consumption profile (Alcohol Use Disorders Identification Test - AUDIT) that divided them into a control group (CON) and an alcohol group (ALC). The analysis of quality of life was performed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the analysis of motor function was performed using the Borg Scale, the Six-Minute Walk Test (6MWT) and the Motor Scale for Elderly (MSE). We were able to conclude that the misuse of alcohol by the elderly promotes significant physical limitations. These limitations result in a worsening of functional capacity of walking and various dimensions of motor ability: fine motor skill, global coordination, balance, body scheme, spatial organization, temporal organization, and general motor aptitude. Besides the physical limitations caused by alcohol use, the quality of life in their physical, mental, and social aspects was reduced. Thus, actions are required to help the elderly understand these losses and exercise control over alcohol misuse.

The Continuum of Recovery from Alcohol Dependence: From Addiction Remission to Complete Mental Health

BACKGROUND

Few representative studies have examined optimal mental health among those with a history of alcohol dependence (AD).

OBJECTIVES

In a representative sample of Canadians with a history of AD, to determine prevalence of, and factors associated with 1) remission from AD, 2) the absence of Substance Dependence and Psychiatric Disorders (SDPD) in the past year, and 3) complete mental health (CMH).

METHOD

Secondary analysis of a publicly available Statistics Canada database, the 2012 Canadian Community Health Survey-Mental Health (820 adults with AD history; 19,945 without AD). Lifetime AD, past-year remission from AD, and previous 12-month absence of SDPD were determined using World Health Organisation Composite International Diagnostic Interview (WHO-CIDI) measures. Individuals are classified as being in CMH if they possessed social and psychological well-being, happiness or life satisfaction and absence of SDPD.

RESULTS

Over 70% of those with a history of AD were in remission, 52% were without past-year SDPD, and 38% of respondents were in CMH. Positive outcomes were more common among married respondents, older individuals, those with higher level of social support, and those who had never had major depressive disorders or generalised anxiety disorders.

CONCLUSION

The majority of Canadians with a history of AD achieve remission and a significant proportion achieve CMH. However, targeted outreach is warranted for the most vulnerable with a history of alcohol dependence, including younger respondents and those with low levels of social support or a history of mental illness.

Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922451.

Sex and Gender Effects in Recovery From Alcohol Use Disorder

The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.

Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta-analysis of cohort studies

BACKGROUND AND AIMS

Alcohol use disorders (AUD) are often comorbid with depressive symptoms. Cohort studies on the association between AUD and subsequent depressive symptoms have produced inconsistent results. Moreover, regarding alcohol intake, the risk of developing depressive symptoms might vary with alcohol intake level. We aimed to investigate the association between AUD, alcohol intake and subsequent depressive symptoms.

DESIGN AND SETTING

We conducted a systematic search in PubMed, Embase and PsycINFO for cohort studies on the association between AUD or alcohol intake and subsequent depressive symptoms.

PARTICIPANTS

We included 338 426 participants from 42 studies. Six and four studies analyzed only females and males, respectively.

MEASUREMENTS

We combined risk estimates for developing depressive symptoms using a random-effects model. We divided alcohol intake into abstinence, light (0-84 g/week), moderate (85-168 g/week) and heavy drinking (> 168 g/week or > 48 g/day at least weekly). We conducted a categorical analysis to compare the risk of depressive symptoms between abstinence and different intake categories. Further, we conducted a dose-response analysis to investigate the alcohol-depression association.

FINDINGS

We analyzed 42 studies (follow-up time: 1-40 years). AUD was associated with significantly increased risk of subsequent depressive symptoms [relative risk (RR) = 1.57, 95% confidence interval (CI) = 1.41-1.76]. Regarding alcohol intake, heavy drinking had an increased risk of depressive symptoms; however, the association was only significant when controls were limited to non-heavy drinkers (RR = 1.13, 95% CI = 1.05-1.22). Taking into consideration the possibility of publication bias and confounding factors made the association non-significant. We observed J-shaped associations in both categorical and dose-response analyses where light-moderate drinking had a significantly decreased risk of depression, while heavy drinking did not show a significant association with depressive symptoms compared with non-drinkers.

CONCLUSION

Alcohol use disorders are associated with increased the risk of subsequent depressive symptoms. Heavy drinking does not significantly predict occurrence of depressive symptoms after adjusting for potential confounders.

The Influence of Alexithymia on Alcohol Craving, Health-Related Quality of Life and Gender in Alcohol-Dependent Outpatients

Alexithymia is a vulnerability factor for physical and mental illness that can significantly influence the daily function of alcohol-dependent patients. The aim of this study was to examine the indirect effect of obsessive thoughts and compulsive behaviors involving alcohol craving on the relationship between alexithymia, quality of life (QoL) of psychological well-being and health status. Three hundred and eighty-one outpatients (263 males and 118 females) in treatment for alcohol dependence completed self-report measures of alexithymia, alcohol craving, GHQ-28 (QoL-psychological well-being) and SF-36 (QoL-health status). Males scored significantly higher than females on aspects of alexithymia, and females reported significantly higher levels of alcohol craving. Path analysis showed an indirect effect of alcohol craving on the relationship between alexithymia, QoL-psychological well-being and self-reported QoL-health status for males only. The current study provides important new information about impaired self-reported health status and well-being among male alcohol-dependent treatment seekers with alexithymia.

Comparison of the Effectiveness of Acceptance and Commitment Therapy and Quality of Life Improvement Training on Distress Tolerance and Self-Destructive Behaviors in Substance Abusers

Introduction: Drug addiction is one of the most serious psychological, social, economic, and health hazards that needs prevention and treatment considering its serious consequences for the individual and human society. The purpose of this study was to compare the effectiveness of acceptance and commitment therapy (ACT) and quality of life improvement training (QOLT) on distress tolerance and self-destructive behaviors in substance abusers. Methods: This was a quasi-experimental study with pre- and post-test design and a control group. The statistical population included men over 20 years old referred to addiction treatment centers in Mashhad. The sample consisted of 45 volunteers who were selected by purposive sampling method and were divided into 3 groups (two experimental and one control group). Experimental groups received ACT and skills training based on the quality of life, while the control group did not receive any experimental intervention. The Distress Tolerance Scale (Simons and Gaher) and Self-destructive Behavior Questionnaire (Owens) were used as research tools in the study. Data were analyzed by multivariate analysis of covariance using SPSS version 24.0 software. Results: The results of the analysis of covariance showed that the therapeutic methods used in this study were effective in improving distress tolerance and self-destructive behaviors in men with substance abuse (P<0.001). Moreover, according to the Bonferroni follow-up test, there was no significant difference between the two treatments. Conclusion: ACT and QOLT significantly improved distress tolerance and self-destructive behaviors in substance abusers.

Alcohol Use Disorder Among Adults Recovered From Substance Use Disorders

BACKGROUND AND OBJECTIVES

Alcohol use is often overlooked and underestimated among patients recovered from substance dependence. The prevalence and correlates of alcohol use disorder (AUD) among adults recovered from substance use disorders (SUDs) are estimated in this study.

METHODS

A nationally representative cross-sectional analysis of the National Epidemiological Survey on Alcohol and Related Conditions Wave-III was used in this study. Survey respondents, aged 18 or older, who recovered from SUDs, based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria (n = 2061 unweighted), were included. A total of three comparison groups were identified using DSM-5 criteria (1) current AUD, (2) former AUD, and (3) never had AUD. The prevalence of these groups was estimated; medical and psychiatric comorbidities and health-related quality of life were compared; and factors associated with having a current AUD when compared with those with former AUD and those who never had AUD were examined, controlling for other covariates.

RESULTS

About 5.7% of US adults, nationally representative of 14.2 million, have been reported to have recovered from past SUDs. Of these, 28.9% met criteria for current AUD and 48.4% had former AUD. When compared with those who never had AUD, factors associated with having a current AUD included the following: living in urban areas (P = .019), having a bipolar 1 disorder (P < .001), and a history of lifetime incarceration (P = .004).

DISCUSSION AND CONCLUSION

Nearly one-third of adults recovered from SUDs had current AUD, and several behavioral factors were associated with having a current AUD when compared with those who never had AUD.

SCIENTIFIC SIGNIFICANCE

Our study highlights the substantial risk of AUD in adults who have successfully recovered from SUDs. (Am J Addict 2020;00:00-00).

Socioeconomic resources and quality of life in alcohol use disorder patients: the mediating effects of social support and depression

BACKGROUND

Quality of life (QoL) has recently attracted increased attention as a major indicator of the recovery from alcohol use disorder (AUD). This study investigated the mediating effects of social support and depression for the relationship between socioeconomic resources and QoL among people with AUD in South Korea.

METHODS

Patients across South Korea who had been diagnosed with AUD in the previous year (n = 404) and were registered at hospitals and addiction management centers were surveyed. The participants ranged in age from 19 to 65 years. Structural equation modeling was performed, using stable residence, income, stable employment, social support, depression, and QoL as predictors. Bootstrapping analysis was performed to test for mediating effects.

RESULTS

The socioeconomic resources income (β = .297, p < .001), stable employment (β = .131, p < .01), and stable residence (β = .091, p < .05) showed statistically significant and positive relationships with social support. However, none of these were significantly related to depression. Social support showed a significant and negative relationship with depression (β = -.172, p < .001). Income positively and directly influenced QoL (β = .148, p < .001). All three socioeconomic resources indirectly influenced depression through social support, which, in turn, influenced QoL. This suggests that socioeconomic resources directly influence QoL and indirectly influence it through social support.

CONCLUSION

These findings suggest that social support has an important role in improving the QoL of people with AUD. Furthermore, socioeconomic resources, such as having a stable residence, employment, and income, are necessary for recovery from alcohol addiction.

Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence

Background

Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients’ HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence.

Methods

HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients’ levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively).

Results

Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (β = 5.5; p = 0.001) and a lower baseline PCS score (β = − 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (β = − 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (β = 0.1; p = 0.02) and a lower baseline MCS score (β = − 0.7; p < 0.0001) were associated with significant MCS improvement.

Conclusion

The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients’ early satisfaction to identify areas of improvement and thus improve HRQoL.

Quality of Life and Its Correlates in Alcohol Use Disorder Patients With and Without Depression in China

Objective: Alcohol use disorder (AUD) is a serious issue worldwide and frequently co-occurs with depression. However, the quality of life (QOL) of AUD patients with and without depression is not well studied in the Chinese Han population. The aim of this study was to investigate QOL and its correlates in AUD patients with and without depression in China. Methods: Five hundred and fifteen psychiatric patients diagnosed with AUD were recruited. All these patients completed the Beck Depression Inventory (BDI) to assess depression, the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) to evaluate QOL and the Alcohol Use Disorders Identification Test (AUDIT) to measure the severity of drinking. Results: Compared with AUD patients without depression, those with depression had a lower QOL in all eight domains of the SF-36 (all P < 0.001), but were more willing to have alcohol-related treatment (P < 0.05). Negative correlations were noted between (i) the BDI total score and all eight domains of the SF-36 (all P < 0.001); and (ii) between the AUDIT total score and six domains of the SF-36 (all P < 0.05). Conclusions: Depression impairs QOL in patients with AUD in China. Early intervention in comorbid depression to improve QOL is needed.

Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review

INTRODUCTION AND AIMS

Quality of life (QOL) is increasingly recognised as an important treatment indicator in the alcohol and other drug (AOD) sector, particularly in treatment modalities providing 'whole of life programmes', such as residential rehabilitation. However, it is currently unclear how studies conducted in AOD residential rehabilitation settings have operationally defined and measured QOL. This study therefore aimed to determine current practices in defining and measuring the QOL of residential rehabilitation clients.

DESIGN AND METHODS

A systematic review of studies examining the QOL of AOD residential rehabilitation clients was conducted. Potential studies published in English between 1990 and 2018 were identified through a search of electronic databases (e.g. PsycINFO and PubMed), search engines (Google Scholar) and article reference lists.

RESULTS

The search identified a total of 1267 records, of which 16 met the inclusion criteria. Less than half of the included studies provided an operational definition of QOL. QOL was generally understood to be a subjective, multidimensional, client assessment construct. Twelve different instruments were used to assess QOL, of which two enabled clients to identify QOL dimensions important to themselves.

DISCUSSION AND CONCLUSIONS

QOL has been inconsistently measured in studies of AOD residential rehabilitation clients. As a result, the comparability and validity of research in this field may be weakened. There is a need to develop a consensual operational definition of QOL, including a core set of domains relevant to and endorsed by residential rehabilitation clients. Appropriate tools to measure client QOL need to be identified and disseminated.

The Auckland alcohol detoxification outcome study: Measuring changes in quality of life in individuals completing a medicated withdrawal from alcohol in a detoxification unit

AIM

To measure outcomes in Quality of Life in alcohol dependent patients' following a medicated withdrawal from alcohol.

METHODS

79 patients that were admitted to a detoxification unit in Auckland, New Zealand between March 2016 and September 2016 were assessed for severity of alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependency Questionnaire (SADQ) and Quality of Life (QOL) using the World Health Organisation Quality of Life-abbreviated version of the WHOQOL 100 New Zealand version (WHOQOL-BREF NZ). Patients were followed up at three months and 12 months and an estimate of drinking behavior and the WHO-QOL BREF NZ were completed via telephone interview. QOL domain scores were assessed from baseline to three months and baseline to 12 months in both relapse and abstinent groups. At three months, a single question was asked in order to collect qualitative data.

RESULTS

At baseline, the study population had statistically significantly lower mean QOL domain scores than scores reported from the general population. QOL improved in patients following detoxification at three months and 12 months in both the relapse and abstinent groups; however, the change in scores from baseline was greater in the abstinent group compared to the relapse group. The majority of patients reported that the admission had been a positive experience.

CONCLUSION

QOL improves in individuals following a medicated withdrawal from alcohol regardless of whether individual's relapse; however, those that remain abstinent have greater improvements in quality of life.

Understanding profiles of student binge drinking and eating: The importance of motives

Binge drinking and binge eating occur frequently in undergraduates; however, the mechanism driving their co-occurrence is not well-understood. Several theories support the role of motives in driving drinking and eating behavior, especially motivations related to affect regulation (i.e., enhancement/pleasure and coping). This study used a person-centered approach to identify classes of students based on eating and drinking motives and past-month binge behavior and examined class differences in psychopathology, emotion regulation, and impulsivity. Undergraduates (N = 776) completed a drinking timeline follow-back and surveys assessing motives, binge eating, psychopathology, emotion regulation, impulsivity, and quality of life. Mixture modeling was used to group students based on presence/absence of past-month binge eating, binge drinking, and motives for eating and drinking. The analysis resulted in 4 classes: Binge Drinking (with relatively high social and enhancement drinking motives), Binge Eating (with overall high eating motives), Both Bingeing (with high drinking motives, especially coping, and high eating motives), and Low Bingeing (with low motives for both behaviors). ANOVA and post-hoc analyses suggested that the Binge Eating and Both Bingeing groups were most impaired, while the Binge Drinking class rarely differed from the Low Bingeing group across measures of psychological distress. Notably, classes with high eating/drinking motives displayed significant impairment despite not all class members endorsing binge behavior. Findings suggest that binge drinking in addition to binge eating may not imply more psychological impairment and support the importance of assessing motives for eating/drinking among undergraduates and potentially trying to challenge these motives through early intervention.

Quality of life and disability in males with alcohol dependence syndrome

AIM

The aim is to study the quality of life (QoL) and disability in persons with alcohol dependence syndrome (ADS).

MATERIALS AND METHODS

This cross-sectional, analytical, case-control study in a tertiary hospital in a suburb of Maharashtra included 100 cases of ADS and equal number of age- and sex-matched healthy controls fulfilling the various inclusion and exclusion criteria.

RESULTS

The study revealed that individuals commonly initiate drinking alcohol between 20 and 30 years and first present to the hospital for seeking medical attention in the age group of 30-40 years after 10-12 years of drinking when they are moderately or severely dependent on alcohol. Alcohol dependence is associated with lower educational levels and lower levels of employment. Many have problems in their marital and intimate relations, making it difficult for them to stay in long-term relationships. As a consequence of their frequent aggressive and violent behaviors, they are more commonly involved in legal matters. Having a positive family history of alcohol dependence and familial psychiatric disorders makes them have a higher chance of developing alcohol dependence. As the number of years of drinking increases, so does the dependency level.

CONCLUSION

Alcohol dependence is associated with lower QoL and higher levels of disability levels. The severity of alcohol dependence is inversely proportional to the QoL experienced by them and directly proportional to their disabilities.

Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trial

BACKGROUND

Little is known about the impact of brief alcohol interventions on mental and general health. The aim was to investigate whether brief interventions for general hospital inpatients with at-risk drinking can improve mental and general health over 2 years; and whether effects are dependent on how they are delivered: in-person or through computer-generated feedback letters (CO).

METHODS

Three-arm randomized controlled trial with 6-, 12-, 18-, and 24-month follow-ups. Data were collected on 13 general hospital wards from four medical departments (internal medicine, surgical medicine, trauma surgery, and ear-nose-throat) of one university hospital in northeastern rural Germany. A consecutive sample of 961 18- to 64-year-old general hospital inpatients with at-risk alcohol use was recruited through systematic screening. Inpatients with particularly severe alcohol problems were excluded. Participants were allocated to: in-person counseling (PE), CO, and assessment only (AO). PE and CO included three contacts: on the ward, 1, and 3 months later. Mental and general health were assessed using the five-item mental health inventory (0-100) and a one-item general health measure (0, poor - 4, excellent).

RESULTS

Latent growth models including all participants revealed: after 24 months and in contrast to AO, mental and general health were improved in PE (change in mean difference, ΔMmental = 5.13, p = 0.002, Cohen's d = 0.51; ΔMgeneral = 0.20, p = 0.005, d = 0.71) and CO (ΔMmental = 6.98, p &lt; 0.001, d = 0.69; ΔMgeneral = 0.24, p = 0.001, d = 0.86). PE and CO did not differ significantly.

CONCLUSIONS

Beyond drinking reduction, PE and CO can improve general hospital inpatients' self-reported mental and general health over 2 years.

The effect of exercise as adjunctive treatment on quality of life for individuals with alcohol use disorders: a randomized controlled trial

Background

A physically active lifestyle contributes to the prevention of lifestyle diseases, promotion of physical health, and reduction of pain, among other benefits. Being physically active also promotes mental health for many individuals, in the form of improved mood, increased self-efficacy and reduced risk of depression. Alcohol-dependent individuals may experience a better quality of life when supplementing their treatment with physical exercise. This study aimed to evaluate the effect of exercise on Quality of Life among patients with alcohol use disorder in a large randomized controlled trial.

Methods

The study had three arms: Patients were allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise two days a week of one hour each, (C) treatment as usual and individual physical exercise minimum two days a week. Duration of the intervention was six months. Data on values of Quality of Life were collected at baseline (before treatment start and at time of enrollment in the study), and at follow-up (at six months after enrollment in the study) using the EQ-5D questionnaire and the EQ-VAS. The sample consisted of 117 consecutive patients, and the follow-up rate was 66.6%. Intention-to-treat analyses were conducted to evaluate the effect of exercise on quality of life.

Results

Although not statistically significant, a substantial portion of the participants in the individual exercise condition reported that they had no pain or discomfort (one of the five quality of life dimensions measured by EQ-5D questionnaire) compared to the controls at follow-up. No difference was found between the groups regarding the EQ-VAS.

Conclusion

The exercise intervention had no effect on quality of life for patients with alcohol use disorder, nor was quality of life improved across the total sample. More research in how to improve quality of life for patients with alcohol use disorder is needed.

Trial registration

ISRCTN74889852 (retrospectively registered, date: 16/05/2013).

Feasibility, acceptability and preliminary outcomes of a mindfulness-based relapse prevention program in a naturalistic setting among treatment-seeking patients with alcohol use disorder: a prospective observational study

OBJECTIVES

Cultural differences between the USA and France led us to examine the feasibility, acceptability and preliminary efficacy data on craving, quality of life and psychological flexibility of the add-on Mindfulness-Based Relapse Prevention (MBRP) programme in alcohol use disorder (AUD) in France.

DESIGN

We conducted a prospective observational study with a 6-month follow-up.

SETTING

The study was performed in a naturalistic setting with adult outpatients from an addiction department.

PARTICIPANTS

We included all patients with a current AUD who participated in the MBRP programme (n=52). There was no non-inclusion criterion.

INTERVENTIONS

The intervention was an 8-week MBRP programme, combining elements of traditional relapse prevention cognitive behavioural therapy and mindfulness meditation training. This was an eight-session closed-group programme.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were the number of attended treatment sessions, home practice frequency and dropout rate. Secondary outcomes were changes in craving, quality of life, psychological flexibility, drinking outcomes, depression, anxiety and mindfulness levels.

RESULTS

The average number of completed sessions was 6.6 (SD: 1.9). Most participants introduced mindfulness meditation into their everyday lives: 69% and 49% of included patients maintained formal practice at 3 and 6 months, respectively, and 80% and 64% maintained informal practice at 3 and 6 months, respectively. Most participants used mindfulness techniques to face high-risk situations (56% at 6 months). Participants reported a significant reduction in craving, days of alcohol use, depression and anxiety and an increase in mindfulness and psychological flexibility at 6 months.

CONCLUSIONS

The MBRP programme showed good acceptability and feasibility. MBRP seemed to improve craving, mindfulness and psychological flexibility. Comparative studies are needed to evaluate the programme's efficacy in AUD.

TRIAL REGISTRATION NUMBER

2200863 v 0.

Integrated treatment program for alcohol related problems in community hospitals, Songkhla province of Thailand: A social return on investment analysis

OBJECTIVES

To estimate the impacts and social value relative to the cost of the Integrated Management of Alcohol Intervention Program in the Health Care System (i-MAP) on direct beneficiaries, using a Social Return on Investment (SROI) analysis.

METHOD

A mixed-method approach was conducted among stakeholders and 113 drinkers (29 low-risk, 43 high-risk, and 41 dependent drinkers) who consecutively received i-MAP at four community hospitals in Songkhla province of Thailand. Resources for program implementation as well as drinking and a list of psychosocial outcomes, selected through stakeholder interviews, were measured among participants during and at the sixth month after participation, respectively. SROI (societal benefit-to-cost) ratio of i-MAP was estimated over a 5-year time horizon and shown in 2017 Thai baht, where US$1.00 = 33.1 baht. One-way and probabilistic sensitivity analyses of key parameters were performed among treatment subgroups.

RESULTS

Baseline estimates of the annual cost and 5-year social value of i-MAP were 25.5 and 51.0 million baht, respectively, yielding an estimated SROI ratio of 2.0, with a possible range of 1.3 to 2.4. Value created by the program was mostly attributed to broader gains to society (productivity gains and averted crime costs) and drinkers. Subgroup analyses suggested that the SROI ratio for high-risk drinkers was twice that for dependent drinkers (2.8 vs. 1.5). The probabilistic sensitivity analysis showed that more than 99% of the simulated treatments for both high-risk and dependent groups yielded benefits beyond the corresponding costs.

CONCLUSIONS

By considering societal perspective, the i-MAP program has demonstrated its social value is twice its investment cost and potential for the program to be implemented nationwide.

Quality of Life and its Relationship with Perceived Stigma among Opioid Use Disorder Patients: An Exploratory Study

BACKGROUND

In view of recent global opioid epidemic and scarcity of literature assessing the quality of life (QoL) and stigma among opioid use disorder (OUD) patients, this study aimed to assess the overall QoL and examine its relationship with perceived stigma among them.

MATERIALS AND METHODS

This cross-sectional study assessed patients with OUD at a tertiary care centre. QoL was assessed using the World Health Organization Quality of Life-brief version, whereas perceived stigma was measured using the Perceived Stigma of Substance Abuse Scale (PSAS).

RESULTS

Among 168 patients with OUD, all the four domain-wise scores of physical health (r = 0.79, P < 0.01), psychological health (r = 0.87, P < 0.01), social relationships (r = 0.78, P < 0.01) and environment (r = 0.80, P < 0.01) QoL correlated significantly with average score, with maximum impairment noted in the social domain. The mean PSAS score was 21.19 ± 2.99, with perceived stigma found to be significantly associated with impairments in the physical (β = -0.28, P < 0.01), psychological (β = -0.27, P < 0.01) and environment (β = -0.21, P < 0.01) domains of QoL. Furthermore, being employed was significantly associated with impairment in the social domain of QoL (β = -0.17, P = 0.02).

CONCLUSION

OUD similarly affects all the four domains of QoL, with a higher level of perceived stigma associated with significantly poorer QoL in the physical, psychological and environment domains. However, future studies assessing different forms of stigma and QoL among patients with OUD are needed to confirm and better characterise the findings of this study.

Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature

BACKGROUND

The comorbidity of mood and anxiety disorders (MD and AD) with substance use disorders (SUD) is common. One explanation for this comorbidity is the self-medication hypothesis, which posits that individuals with MD or AD use substances to cope with the difficult symptoms associated with the disorder. Over time, self-medication (SM) can develop into an independent SUD. This narrative review will present the prevalence and correlates of SM with alcohol and/or drugs for MD and AD and the relationship between SM and subsequent SUD using both cross-sectional and longitudinal epidemiological data.

METHODS

Scopus and PsycINFO were searched from January 1997 to April 2018 to identify original research articles that examined the prevalence and correlates of SM and the temporal relationship between MD/AD and SUD in the general population (n = 22).

RESULTS

The prevalence of SM with alcohol and/or drugs among those with MD or AD ranged from 21.9% to 24.1%. Male sex, younger age, being separated, divorced or widowed, and being Caucasian were characteristics associated with higher proportions of respondents endorsing SM with alcohol/drugs for MD and AD. Longitudinal data supports the temporal onset of primary MD/AD and secondary SUD among those who self-report SM.

CONCLUSION

Providing and promoting alternate coping strategies for those with MD/AD may reduce SM, the development of SUD, and the comorbidity of MD/AD with SUD. The concurrent treatment of MD/AD and substance use is the current "gold standard" model of care, and the results of this review support its use.

Psychiatric comorbidity and quality of life in South African alcohol use disorder patients

BACKGROUND

Understanding the psychopathology accompanying alcohol use disorder (AUD) is important as it impacts negatively on quality of life (QoL) with subsequent implications for treatment and recovery. We evaluated the association of psychiatric comorbidity with QoL among treatment-seeking South African AUD patients.

METHODS

Cross-sectional assessment of 101 (Male, n = 65; 64.5%) patients with AUD was done using the World Health Organisation Quality of Life (WHOQoL)-Bref, the World Health Organisation Disability Assessment Scale (WHODAS) and Mini-International Neuropsychiatric Interview (MINI) to collect QoL, disability and psychopathology data, respectively.

RESULTS

Psychiatric comorbidity was noted in 63 (62.3%) of the patients with most (55.6%) having more than one disorder. Mood (39; 61.9%) and anxiety (33; 52.4%) were the most common co-occurring disorders. Disability scores were not significantly different between comorbidity and gender groups However, QoL scores were significantly lower for participants with comorbidity in three of the four WHOQOL domains and declined with increasing number of psychiatric disorders. Focussing on the two main psychopathologies, participants with anxiety alone consistently had the lowest QoL scores compared to those with neither or both disorders (p < 0.05).

CONCLUSION

The results confirm the well-known high rate of psychiatric comorbidity in patients with AUD and the negative impact it has on QoL. The results should alert clinicians managing AUD patients to screen for comorbid psychopathology and include findings into their treatment plan as this may impact on the patient's QoL.

Relationship of hope, sense of community, and quality of life

This study examined the role of hope and community in achieving and/or maintaining a successful recovery, and their relationships to quality of life for individuals in recovery. The sample included 229 participants in 42 Oxford House sober living homes in 3 locations in the United States. In this cross-sectional investigation, we assessed whether hope and sense of community were predictors of quality of life for individuals living in recovery homes. Findings indicated that both hope and sense of community were predictors supporting contextual as well as individual characteristics as possible influences on recovery trajectories. These findings have implications for both individual and systems-level resource or competency-based interventions, and they suggest one of the important functions of a recovery residence is in the creation of a sense of community.

The role of personal and household members' substance use in health-related quality of life in women living with HIV/AIDS

Advances in HIV treatments have led to a greater focus on health-related quality of life (HRQOL) among people living with HIV/AIDS. The current study examined factors associated with HRQOL among 378 women in HIV care. HRQOL was measured using a modified version of the 12-Item Short Form Health Survey; scores were derived for the mental and physical composite summaries (MCS and PCS). We measured personal alcohol use and drug use. Household members' substance use were assessed by asking participants about the alcohol/drug status of persons with whom they live. Multivariate generalized linear models were used to estimate the linear association between MCS and PCS scores and personal and household members' alcohol and drug use. We found lower MCS scores were significantly associated with personal alcohol use and living with someone with alcohol or/and drug problems. Lower PCS scores were not significantly associated with personal alcohol use or living with someone with alcohol or/and drug problems. Findings suggest that universal screening and targeted interventions for alcohol use by the patient or household members may offer potential strategies for improving mental health quality of life among women living with HIV/AIDS.

Beyond Abstinence: Changes in Indices of Quality of Life with Time in Recovery in a Nationally Representative Sample of U.S. Adults

BACKGROUND

Alcohol and other drug (AOD) treatment and recovery research typically have focused narrowly on changes in alcohol/drug use (e.g., "percent days abstinent") with little attention on changes in functioning or well-being. Furthermore, little is known about whether and when such changes may occur, and for whom, as people progress in recovery. Greater knowledge would improve understanding of recovery milestones and points of vulnerability and growth.

METHODS

National, probability-based, cross-sectional sample of U.S. adults who screened positive to the question, "Did you used to have a problem with alcohol or drugs but no longer do?" (Response = 63.4% from 39,809; final weighted sample n = 2,002). Linear, spline, and quadratic regressions tested relationships between time in recovery and 5 measures of well-being: quality of life, happiness, self-esteem, recovery capital, and psychological distress, over 2 temporal horizons: the first 40 years and the first 5 years, after resolving an AOD problem and tested moderators (sex, race, primary substance) of effects. Locally Weighted Scatterplot Smoothing regression was used to explore turning points.

RESULTS

In general, in the 40-year horizon there were initially steep increases in indices of well-being (and steep drops in distress), during the first 6 years, followed by shallower increases. In the 5-year horizon, significant drops in self-esteem and happiness were observed initially during the first year followed by increases. Moderator analyses examining primary substance found that compared to alcohol and cannabis, those with opioid or other drugs (e.g., stimulants) had substantially lower recovery capital in the early years; mixed race/native Americans tended to exhibit poorer well-being compared to White people; and women consistently reported lower indices of well-being over time than men.

CONCLUSIONS

Recovery from AOD problems is associated with dynamic monotonic improvements in indices of well-being with the exception of the first year where self-esteem and happiness initially decrease, before improving. In early recovery, women, certain racial/ethnic groups, and those suffering from opioid and stimulant-related problems appear to face ongoing challenges that suggest a need for greater assistance.