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Fiabane E, Scarpina F, Ottonello M, Pistarini C. Spontaneous Changes in Attentional Capabilities and Reasoning After an Alcohol Rehabilitation Treatment: Evidence About the Role of Age and Alcohol Use. Neuropsychiatr Dis Treat 2023; 19:1321-1329. [PMID: 37284250 PMCID: PMC10239759 DOI: 10.2147/ndt.s403217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/30/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose In this study, we evaluated changes in attentional capabilities and reasoning among early abstinent alcohol-dependent individuals after a 28-day residential rehabilitation program (not including cognitive treatment). Furthermore, we explored the role of individual characteristics and disease-related factors (i.e., length of alcohol use, history of polysubstance dependence, severity of alcohol use) on spontaneous cognitive recovery. Patients and Methods Fifty-five patients with a diagnosis of Alcohol Use Disorder (AUD) were consecutively recruited from a residential rehabilitation hospital in Northern Italy. The majority were male (67.3%) with a mean age of 47.83 years (SD = 8.21). The computerized Psychology Experiment Building Language Test Battery was used to assess the performance at the Posner Cueing Test, Go/no-go Task, Trail Making Test (TMT), Tower of London (TOL), and Balloon Analog Risk Scale. The evaluation was performed twice: at the beginning (T0) and at its end (T1, before the hospital discharge). Results We observed statistically improvements over time in the performance at the: 1) TOL in the time amount required to solve the task (p < 0.001); and 2) TMT in the indexes relative to the number of errors (p = 0.003) and the total time required to solve the task (p < 0.001). Age played a significant role on the changes observed in the score relative to the time amount used by participants to solve the task in TMT (test (p = 0.03) and in TOL (p = 0.02). Moreover, the length of alcohol dependence had an effect on the change observed for the time amount to solve the TMT (time) (p = 0.01). Conclusion We found spontaneous recovery after alcohol detoxification on some, but not all, cognitive functions assessed in our study. The neuropsychological assessment and the identification of patients with cognitive impairment and specific risk factors (e.g., older age and longer history of alcohol use) is important to orient cognitive rehabilitation and increase the efficacy of AUD treatments.
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Affiliation(s)
- Elena Fiabane
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Pavia Institute, Pavia, Italy
| | - Federica Scarpina
- Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, VCO, Italy
| | - Marcella Ottonello
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Physical and Rehabilitation Medicine of Pavia Institute, Pavia, Italy
| | - Caterina Pistarini
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurorehabilitation of Pavia Institute, Pavia, Italy
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2
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Cyr L, Bernard L, Pedinielli JL, Cutarella C, Bréjard V. Association Between Negative Affectivity and Craving in Substance-Related Disorders: A Systematic Review and Meta-analysis of Direct and Indirect Relationships. Psychol Rep 2022; 126:1143-1180. [PMID: 35105221 DOI: 10.1177/00332941211061079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A sizeable literature highlighted that negative affectivity and craving are both known to be implicated in relapses. OBJECTIVES The present study synthetized the existing litterature to determine strength of the interaction between negative affectivity and craving for substance-related disorders including illicit drugs, alcohol and tobacco. METHODS We conducted a systematic review in accordance with PRISMA guidelines followed by a meta-analysis. Online computer databases PubMed, PsycINFO and Web of Science were searched systematically and thoroughly. Jamovi 1.8.1 Current version was used to conduct meta-analysis. RESULTS Thirty studies were included in the review, and 14 of these, including 2257 subjects, were used for meta-analysis. The raw correlation ranged from 0.17 to 0.58, which indicated weak to moderate association between negative affects and craving. In total, approximately 90% of the selection revealed a positive correlation between negative affects and craving. Alcohol and tobacco use disorders have received the most attention. Additionally, negative affectivity was often defined as a transient state rather than a stable personality trait. CONCLUSIONS In both of our meta-analyses and in the narratively reported studies, we found that negative affectivity is an important component related to craving, but individual differences in craving reactivity existed.
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Affiliation(s)
- Laura Cyr
- LPCPP, 128791Aix Marseille University, Aix-en-Provence, France; Clinique Saint-Barnabé, 52806Ramsay Santé, Marseille, France
| | - Laura Bernard
- LPCPP, 128791Aix Marseille University, Aix-en-Provence, France; Clinique Saint-Barnabé, 52806Ramsay Santé, Marseille, France
| | | | | | - Vincent Bréjard
- LPCPP, 128791Aix Marseille University, Aix-en-Provence, France
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3
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Neural and Behavioral Correlates of Impaired Insight and Self-awareness in Substance Use Disorder. Curr Behav Neurosci Rep 2021; 8:113-123. [DOI: 10.1007/s40473-021-00240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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4
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Deutsch AR, Lustfield R, Hanson JD. Where there's a will, there's a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention. Alcohol Clin Exp Res 2021; 45:2383-2395. [PMID: 34585745 DOI: 10.1111/acer.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. METHODS One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. RESULTS Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. CONCLUSION Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Sioux Falls, South Dakota, USA.,School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Rebecca Lustfield
- Avera Research Institute, Sioux Falls, South Dakota, USA.,School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Jessica D Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, Minnesota, USA
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5
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Coccini T, Ottonello M, Spigno P, Malovini A, Fiabane E, Roda E, Signorini C, Pistarini C. Biomarkers for alcohol abuse/withdrawal and their association with clinical scales and temptation to drink. A prospective pilot study during 4-week residential rehabilitation. Alcohol 2021; 94:43-56. [PMID: 33887366 DOI: 10.1016/j.alcohol.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/30/2022]
Abstract
A bulk of evidence in the field of translational medicine applied to clinical toxicology and rehabilitation has highlighted the possibility of using biomarkers as a support in the diagnosis of alcohol-related diseases and in monitoring of alcohol withdrawal. In a cohort of 55 subjects admitted to a 4-week residential rehabilitation period for alcohol detoxification, we applied a complementary approach correlating novel and conventional peripheral blood and urine parameters in combination with clinical and functional evaluation, contextually considered with the patient's history. Biomarkers of oxidative, inflammatory, hepatic, and neurochemical effects paralleled by alcohol craving and clinical scale measurements were determined at two specific time points, i.e., admission and discharge. Concerning the post-discharge assessment (i.e., relapse evaluation one month after discharge), a follow-up oral interview during a clinical examination was applied to evaluate alcohol abstinence.Selected biomarkers, i.e., MCP1, F2-IsoPs, and SOD1, were altered in chronic alcoholics at admission, and then showed a clearly changing trend during hospitalization. Our findings demonstrated that these specific non-traditional biomarkers, measured together with more conventional ones (e.g., CDT, EtG, IL8, ALT, AST, GGT), could represent novel key parameters for monitoring alcohol use disorders and withdrawal, being also suggestive of the complexity of the psychoneuroimmune response to alcohol. A general improvement in psychological functioning (i.e., decreases in anxiety, depression, and psychological distress) was also revealed during the 4-week rehabilitation treatment, paralleled by an increase of well-being and positive changes in terms of scores. Moreover, a positive association between SOD1 and drink craving at admission was evidenced. Notably, both SOD1 and well-being displayed a significant relation with lower risk of alcohol relapse one month after discharge, indicating that SOD1 is a good predictor of reduced relapse probability. This 4-week residential rehabilitation protocol represents a sound strategy enabling identification of alcohol use disorders and monitoring of alcohol addiction state and withdrawal. However, it has to be emphasized that results derived from this pilot study need to be extensively validated in large and independent cohorts of subjects.
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Affiliation(s)
- Teresa Coccini
- Laboratory of Clinical and Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
| | - Marcella Ottonello
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa - SB, Institute of G Nervi, Genoa, Italy
| | - Paola Spigno
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa - SB, Institute of G Nervi, Genoa, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa - SB, Institute of G Nervi, Genoa, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisa Roda
- Laboratory of Clinical and Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy; Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Cinzia Signorini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Caterina Pistarini
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa - SB, Institute of G Nervi, Genoa, Italy
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6
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Loganathan K, Ho ETW. Value, drug addiction and the brain. Addict Behav 2021; 116:106816. [PMID: 33453587 DOI: 10.1016/j.addbeh.2021.106816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/17/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022]
Abstract
Over the years, various models have been proposed to explain the psychology and biology of drug addiction, built primarily around the habit and compulsion models. Recent research indicates drug addiction may be goal-directed, motivated by excessive valuation of drugs. Drug consumption may initially occur for the sake of pleasure but may transition to a means of escaping withdrawal, stress and negative emotions. In this hypothetical paper, we propose a value-based neurobiological model for drug addiction. We posit that during dependency, the value-based decision-making system in the brain is not inactive but has instead prioritized drugs as the reward of choice. In support of this model, we consider the role of valuation in choice, its influence on pleasure and punishment, and how valuation is contrasted in impulsive and compulsive behaviours. We then discuss the neurobiology of value, beginning with the dopaminergic system and its relationship with incentive salience before moving to brain-wide networks involved in valuation, control and prospection. These value-based neurobiological components are then integrated into the cycle of addiction as we consider the development of drug dependency from a valuation perspective. We conclude with a discussion of cognitive interventions utilizing value-based decision-making, highlighting not just advances in recalibrating the valuation system to focus on non-drug rewards, but also areas for improvement in refining this approach.
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Affiliation(s)
- Kavinash Loganathan
- Centre for Intelligent Signal & Imaging, Universiti Teknologi PETRONAS, Perak, Malaysia.
| | - Eric Tatt Wei Ho
- Centre for Intelligent Signal & Imaging, Universiti Teknologi PETRONAS, Perak, Malaysia; Dept of Electrical & Electronics Engineering, Universiti Teknologi PETRONAS, Perak, Malaysia
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7
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Schott T, Haarig F, Burkhardt M, Barth T. Lohnt es sich an meiner Sucht zu arbeiten? SUCHTTHERAPIE 2020. [DOI: 10.1055/a-1240-6438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Fragestellung Ein vorzeitiger Behandlungsabbruch stellt eines der
häufigsten Probleme in der stationären Entgiftungsbehandlung
dar. Die vorliegende Studie ist der Frage nach der Rolle motivationaler Faktoren
nachgegangen.
Methode Es wurden 85 PatientInnen neben den routinemäßig
erhobenen Befunddaten, zum Zeitpunkt der Aufnahme als auch der Entlassung
verschiedene Fragebögen zur Symptomschwere psychischer
Störungen, Funktionsbeeinträchtigungen sowie
Veränderungsmotivation vorgelegt.
Ergebnisse PatientInnen, die die Behandlung abgeschlossen haben, gaben
eine signifikant höhere Veränderungsmotivation an, als
PatientInnen, die die Behandlung vorzeitig abgebrochen haben. Dabei hatte die
Contemplations-Phase einen prädiktiven Wert (OR: 3,472) auf einen
Behandlungsabbruch. Eine erfolgreich absolvierte Behandlung reduziert
signifikant die Symptomschwere psychischer Störungen sowie
Funktionsbeeinträchtigungen. Auf der Ebene der
Veränderungsmotivation zeichnet sich ein signifikanter Zuwachs.
Schlussfolgerung Neben den bekannten Risiken für einen Abbruch
scheint die messbare Veränderungsmotivation zu Beginn der Behandlung
einen möglichen Marker für den Behandlungsverlauf darzustellen.
Implikationen für die klinische Praxis werden abgeleitet.
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Affiliation(s)
- Tobias Schott
- Institut für klinische Psychologie und Psychotherapie, TU
Dresden
- Klinikum Chemnitz, Klinik für Psychiatrie, Verhaltensmedizin
und Psychosomatik
| | | | - Markus Burkhardt
- Fakultät für Human- und Sozialwissenschaften, Institut
für Psychologie, TU Chemnitz
| | - Thomas Barth
- Klinikum Chemnitz, Klinik für Psychiatrie, Verhaltensmedizin
und Psychosomatik
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8
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Caneva S, Ottonello M, Torselli E, Pistarini C, Spigno P, Fiabane E. Cognitive Impairments in Early-Detoxified Alcohol-Dependent Inpatients and Their Associations with Socio-Demographic, Clinical and Psychological Factors: An Exploratory Study. Neuropsychiatr Dis Treat 2020; 16:1705-1716. [PMID: 32764946 PMCID: PMC7369414 DOI: 10.2147/ndt.s254369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Cognitive impairment is common among patients with alcohol use disorder (AUD). However, neuropsychological assessment is not usually included as routine practice in alcohol rehabilitation programs. The aim of this study was to describe qualitatively the cognitive deficits in early-detoxified AUD patients undergoing rehabilitation and to explore relevant associations with socio-demographic, clinical and psychological factors. PATIENTS AND METHODS Forty-one patients with a diagnosis of AUD were consecutively recruited from a residential rehabilitation hospital in Northern Italy. Cognitive impairment was assessed using the Brief Neuropsychological Examination 2 (ENB-2). Anxiety, depression and severity of alcohol dependence were also evaluated using validated self-report questionnaires. Alcohol relapse was investigated 1 month after discharge. RESULTS Overall, 31.7% of AUD patients showed cognitive impairments according to the global score scale. However, 70.7% had an impaired performance on at least one test of the ENB-2, with particular regard to executive function, visuospatial and memory domains. Age, education and abstinence at admission were the most relevant factors associated with cognitive deficits in this clinical population. CONCLUSION The detection of cognitive impairments is essential in order to adapt alcohol rehabilitation treatment to patients with cognitive deficits and enhance clinical outcomes.
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Affiliation(s)
- Stefano Caneva
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy
| | - Marcella Ottonello
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy
| | - Elisa Torselli
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy.,Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy
| | - Caterina Pistarini
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Scientific Institute of Pavia, Genoa, Italy
| | - Paola Spigno
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy
| | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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9
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Martino F, Caselli G, Fiabane E, Felicetti F, Trevisani C, Menchetti M, Mezzaluna C, Sassaroli S, Albery IP, Spada MM. Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study. Addict Behav 2019; 95:70-76. [PMID: 30856546 DOI: 10.1016/j.addbeh.2019.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.
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10
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Frequency and Predictors of Alcohol-Related Outcomes Following Alcohol Residential Rehabilitation Programs: A 12-Month Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050722. [PMID: 30823386 PMCID: PMC6427603 DOI: 10.3390/ijerph16050722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 01/12/2023]
Abstract
Excessive use of alcohol has been identified as a major risk factor for diseases, injury conditions and increased mortality. The aims of this study were to estimate the frequency of success (abstinence and no alcohol related hospitalization) at 6- and 12-month follow-up after hospital discharge, and to identify the predictors of success. In 2009, a total of 1040 patients at their first admission in one of the 12 Residential Alcohol Abuse Rehabilitation Units (RAARUs) participating in the CORRAL (COordinamento of Residenzialità Riabilitative ALcologiche) project were included in the study. Several socio-demographic and clinical variables, and the number of treatments' strategies during the rehabilitation were collected. Information on alcohol abstinence and no alcohol related hospitalization was assessed through a phone interview using a health worker-administered structured questionnaire at six and 12 months after discharge. An inverse probability weighted, repeated measures Poisson regression model with robust variance was applied to estimate the association between patients' characteristics and the study's outcomes, accounting for non-responders status. The frequencies of abstinence and non-alcohol related hospitalization were 68.38% and 90.73% at six months, respectively, and 68.65% and 87.6% at 12 months, respectively. Patients that were already abstainers in the month before RAARUs' admission have an increased probability of being abstainers after discharge (relative risk: RR 1.20, 95% confidence interval: 95%CI 1.08⁻1.33) and of having an alcohol related hospitalization at 12 months. Subjects undergoing more than four treatment strategies (RR 1.19; 95% CI 1.01⁻1.40) had a higher abstinence probability and lower probability of no alcohol related hospitalizations after 12 months. Finally, patients with dual diagnosis (co-occurrence of alcohol abuse/dependence and psychiatric disorders) have a decreased probability of not being hospitalized for alcohol-related problems (RR 0.95; 95% CI 0.91⁻0.99). The results of this study suggest that specific attention should be paid to the intensity of treatment, with particular regard to a multidisciplinary rehabilitation in order to respond to the complexity of alcohol dependent patients.
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11
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Nagpal AS, Eckmann M, Weinstein SM. Maintaining Opioid Prescription for Chronic Back Pain: Pro Versus Con. PM R 2018; 10:83-89. [PMID: 29413121 DOI: 10.1016/j.pmrj.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ameet S Nagpal
- Departments of Anesthesiology and PM&R, UT Health San Antonio, 7703 Floyd Curl Dr, MC 7838, San Antonio, TX 78209.,Departments of Anesthesiology and PM&R, UT Health San Antonio, San Antonio, TX.,Department of Rehabilitation Medicine, Orthopaedic Surgery and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, WA
| | - Maxim Eckmann
- Departments of Anesthesiology and PM&R, UT Health San Antonio, 7703 Floyd Curl Dr, MC 7838, San Antonio, TX 78209.,Departments of Anesthesiology and PM&R, UT Health San Antonio, San Antonio, TX.,Department of Rehabilitation Medicine, Orthopaedic Surgery and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, WA
| | - Stuart M Weinstein
- Departments of Anesthesiology and PM&R, UT Health San Antonio, 7703 Floyd Curl Dr, MC 7838, San Antonio, TX 78209.,Departments of Anesthesiology and PM&R, UT Health San Antonio, San Antonio, TX.,Department of Rehabilitation Medicine, Orthopaedic Surgery and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, WA
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12
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Torselli E, Ottonello M, Franceschina E, Palagi E, Bertolotti G, Fiabane E. Cognitive and metacognitive factors among alcohol-dependent patients during a residential rehabilitation program: a pilot study. Neuropsychiatr Dis Treat 2018; 14:1907-1917. [PMID: 30104877 PMCID: PMC6074777 DOI: 10.2147/ndt.s166669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aims of this pilot study were to examine cognitive factors (brooding and craving) together with positive/negative metacognitive beliefs about alcohol during a residential program for alcohol addiction and to explore relationships with psychological variables at discharge, with the scope of identifying predictive factors of psychological outcome and patients at greatest risk of relapse. METHODS Thirty patients underwent a brief semistructured interview on admission to a 28-day rehabilitation program for alcohol addiction, and completed at admission and discharge the following five self-report questionnaires: 1) brooding (Brooding subscale of Ruminative Response Scale [B-RRS]), 2) craving (Penn Alcohol Craving Scale [PACS]), 3) positive beliefs about alcohol use (Positive Alcohol Metacognitions Scale [PAMS]), 4) negative beliefs about alcohol use (Negative Alcohol Metacognitions Scale [NAMS]), and 5) the psychophysical state of health (Cognitive Behavioral Assessment - Outcome Evaluation [CBA-OE]). RESULTS Significant changes were found between admission and discharge in CBA-OE, B-RRS, and PACS. Brooding at admission was a significant predictor of post-treatment psychological variables of "anxiety", "depression", and "psychological distress", whereas craving at admission was a good predictor of "perception of positive change" at discharge. CONCLUSION Our results confirm the importance of brooding in mood regulation and its role in the development and maintenance of problem drinking. In addition, craving was negatively associated with the perception of positive change in the post-treatment outcomes and was a predictor of this psychological variable, which includes features related to the individual's resilience and strength. The changes in metacognitive beliefs regarding alcohol use were not statistically significant, but we found a reduction in positive metacognitions and an increase in negative alcohol-related beliefs; future studies are needed to further explore this issue.
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Affiliation(s)
- Elisa Torselli
- Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy
| | - Marcella Ottonello
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy,
| | | | - Emanuele Palagi
- Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy
| | | | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy, .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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