Journal of Clinical Medicine

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15 pages, 611 KiB

Open AccessArticle

Transdiagnostic or Disorder Specific? Indicators of Substance and Behavioral Addictions Nominated by People with Lived Experience

by Hyoun S. Kim, David C. Hodgins, Benjamin Kim and T. Cameron Wild

J. Clin. Med. 2020, 9(2), 334; https://doi.org/10.3390/jcm9020334 - 24 Jan 2020

Cited by 17 | Viewed by 4199

Abstract

Using a transdiagnostic perspective, the present research examined the prominent indicators of substance (alcohol, cocaine, marijuana, tobacco) and behavioral (gambling, video games, sex, shopping, work, eating) addictions nominated by people with lived experiences. Specifically, we aimed to explore whether the perceived most important [...] Read more.

Using a transdiagnostic perspective, the present research examined the prominent indicators of substance (alcohol, cocaine, marijuana, tobacco) and behavioral (gambling, video games, sex, shopping, work, eating) addictions nominated by people with lived experiences. Specifically, we aimed to explore whether the perceived most important indicators nominated were consistent across the 10 addictions or differed based on the specific addiction. Additionally, we explored gender differences in the perceived most important indicators across addictive behaviors. A large online sample of adults recruited from a Canadian province (n = 3503) were asked to describe the most important signs or symptoms of problems with these substances and behaviors. Open-ended responses were analyzed among a subsample of 2603 respondents (n = 1562 in the past year) who disclosed that they had personally experienced a problem with at least one addiction listed above. Content analyses revealed that dependence (e.g., craving, impairments in control) and patterns of use (e.g., frequency) were the most commonly perceived indicators for both substance and behavioral addictions, accounting for over half of all the qualitative responses. Differences were also found between substance and behavioral addictions regarding the proportion of the most important signs nominated. Consistent with the syndrome model of addiction, unique indicators were also found for specific addictive behaviors, with the greatest proportion of unique indicators found for eating. Supplemental analyses found that perceived indicators across addictions were generally gender invariant. Results provide some support for a transdiagnostic conceptualization of substance and behavioral addictions. Implications for the study, prevention, and treatment of addictions are discussed. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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15 pages, 325 KiB

Open AccessArticle

Design and Measurement Properties of the Online Gambling Disorder Questionnaire (OGD-Q) in Spanish Adolescents

by Joaquín González-Cabrera, Juan M. Machimbarrena, Marta Beranuy, Priscila Pérez-Rodríguez, Liria Fernández-González and Esther Calvete

J. Clin. Med. 2020, 9(1), 120; https://doi.org/10.3390/jcm9010120 - 02 Jan 2020

Cited by 28 | Viewed by 5758

Abstract

Gambling disorder is of great clinical and social relevance since it seriously affects people who suffer from it. More recently, the Internet has exacerbated the problem with online casinos, poker, and sports betting. However, there is little evidence of this problem, and we [...] Read more.

Gambling disorder is of great clinical and social relevance since it seriously affects people who suffer from it. More recently, the Internet has exacerbated the problem with online casinos, poker, and sports betting. However, there is little evidence of this problem, and we know of no diagnostic questionnaire. The main objectives of this study were to develop the Online Gambling Disorder Questionnaire (OGD-Q) for adolescents, evaluate its main psychometric properties, and establish diagnostic criteria to differentiate pathological from non-pathological online gamblers. We conducted a study in 16 schools across seven regions of Spain, sampling 2691 adolescents, 883 of whom had reported some online gambling experience. Of those, 602 were boys (68.2%) and 281 were girls (31.8%) Sampling was non-probabilistic and incidental. Mean age and standard deviation were 14.25 ± 1.55 (11–19 years). Confirmatory factor analysis yielded a one-dimensional model with a good fit. The reliability indicators were satisfactory (>0.94). The scores on the OGD-Q were related to other constructs, such as Internet gaming disorder, problematic Internet use, and nomophobia. Participants classified as having problems or being at risk of online gambling disorder presented significantly more stress, anxiety, and depression. Participants categorized as having online gambling disorder comprised 0.89% (n = 24) of the total sample and 2.71% of those who have gambled at some time. We discuss these findings and their practical implications in this article and propose future lines of research. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

15 pages, 2208 KiB

Open AccessArticle

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

by Petra K. Staiger, Paul Liknaitzky, Amelia J. Lake and Stefan Gruenert

J. Clin. Med. 2020, 9(1), 118; https://doi.org/10.3390/jcm9010118 - 01 Jan 2020

Cited by 11 | Viewed by 5071

Abstract

The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment [...] Read more.

The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. Methods: A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. Results: At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. Conclusions: With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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14 pages, 654 KiB

Open AccessArticle

Triple Network Resting State Connectivity Predicts Distress Tolerance and Is Associated with Cocaine Use

by Elizabeth D. Reese, Jennifer Y. Yi, Katlyn G. McKay, Elliot A. Stein, Thomas J. Ross and Stacey B. Daughters

J. Clin. Med. 2019, 8(12), 2135; https://doi.org/10.3390/jcm8122135 - 03 Dec 2019

Cited by 15 | Viewed by 2781

Abstract

Distress tolerance (DT), a predictor of substance use treatment retention and post-treatment relapse, is associated with task based neural activation in regions located within the salience (SN), default mode (DMN), and executive control networks (ECN). The impact of network connectivity on DT has [...] Read more.

Distress tolerance (DT), a predictor of substance use treatment retention and post-treatment relapse, is associated with task based neural activation in regions located within the salience (SN), default mode (DMN), and executive control networks (ECN). The impact of network connectivity on DT has yet to be investigated. The aim of the present study was to test within and between network resting-state functional connectivity (rsFC) associations with DT, and the impact of cocaine use on this relationship. Twenty-nine adults reporting regular cocaine use (CU) and 28 matched healthy control individuals (HC), underwent resting-state functional magnetic resonance imaging followed by the completion of two counterbalanced, computerized DT tasks. Dual-regression analysis was used to derive within and between network rsFC of the SN, DMN, and lateralized (left and right) ECN. Cox proportional-hazards survival models were used to test the interactive effect of rsFC and group on DT. The association between cocaine use severity, rsFC, and DT was tested within the CU group. Lower LECN and higher DMN-SN rsFC were associated with DT impairment. Greater amount of cocaine use per using day was associated with greater DMN-SN rsFC. The findings emphasize the role of neural resource allocation within the ECN and between DMN-SN on distress tolerance. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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15 pages, 506 KiB

Open AccessArticle

Coping Strategies in Male Patients under Treatment for Substance Use Disorders and/or Severe Mental Illness: Influence in Clinical Course at One-Year Follow-Up

by Julia E. Marquez-Arrico, Laura Río-Martínez, José Francisco Navarro, Gemma Prat, Diego A. Forero and Ana Adan

J. Clin. Med. 2019, 8(11), 1972; https://doi.org/10.3390/jcm8111972 - 14 Nov 2019

Cited by 16 | Viewed by 3192

Abstract

Coping strategies have an impact on substance use disorders (SUD), relapses, and clinical variables, but knowledge on this area is scarce. We explored the coping strategies used during treatment in patients with dual diagnosis (DD), SUD, and severe mental illness (SMI), and the [...] Read more.

Coping strategies have an impact on substance use disorders (SUD), relapses, and clinical variables, but knowledge on this area is scarce. We explored the coping strategies used during treatment in patients with dual diagnosis (DD), SUD, and severe mental illness (SMI), and the relation with clinical course and relapses at one-year follow-up. A sample of 223 patients was divided into three groups depending on diagnosis: DD (N = 80; SUD with comorbid schizophrenia or major depressive disorder), SUD only (N = 80), and SMI only (N = 63; schizophrenia or major depressive disorder). MANCOVA analyses reflected differences in self-criticism and problem avoidance, with a higher use of these in the DD and SUD groups. The coping strategies used differed depending on the presence/absence of a SUD, but not depending on psychiatric diagnosis. At one-year follow-up, social support was the only strategy that predicted the presence of relapses in DD patients with schizophrenia (positively), and in SMI patients with major depressive disorder (negatively). Thus, social support was associated with relapses, but the relationship was different depending on psychiatric diagnosis. Further studies should analyze the implications of social support as a coping strategy in different mental disorders, as well as its usefulness in individualized interventions. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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15 pages, 706 KiB

Open AccessArticle

The Reciprocal Association between Problem Gambling and Mental Health Symptoms/Substance Use: Cross-Lagged Path Modelling of Longitudinal Cohort Data

by Nicki A. Dowling, Carla A. Butera, Stephanie S. Merkouris, George J. Youssef, Simone N. Rodda and Alun C. Jackson

J. Clin. Med. 2019, 8(11), 1888; https://doi.org/10.3390/jcm8111888 - 06 Nov 2019

Cited by 13 | Viewed by 3657

Abstract

To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous [...] Read more.

To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous alcohol use, daily tobacco use, and drug use) using cross-lagged path models in a prospective general population cohort sample; and (2) determine whether these associations are moderated by age and gender. This study involved secondary data analysis from 1109 respondents who provided data during Wave 2 or 3 (12-months apart) of the Tasmanian Longitudinal Gambling Study (Australia). Depression (odds ratio (OR) = 2.164) and generalized anxiety (OR = 2.300) at Wave 2 were found to have cross-lagged associations with the subsequent development of any-risk gambling (low-risk, moderate-risk, or problem gambling) at Wave 3. Hazardous alcohol use, daily tobacco use, and drug use at Wave 2 were not associated with the development of any-risk gambling at Wave 3. Any-risk gambling at Wave 2 was not associated with the subsequent development of any mental health symptoms or substance use variables at Wave 3. Age and gender failed to be significant moderators in the associations between any-risk gambling and mental health symptoms or substance use variables. Future longitudinal and event-level research is required to further substantiate these prospective relationships, with a view to developing targeted preventions and interventions. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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20 pages, 1021 KiB

Open AccessArticle

Smartphone Apps Targeting Hazardous Drinking Patterns among University Students Show Differential Subgroup Effects over 20 Weeks: Results from a Randomized, Controlled Trial

by Anne H. Berman, Claes Andersson, Mikael Gajecki, Ingvar Rosendahl, Kristina Sinadinovic and Matthijs Blankers

J. Clin. Med. 2019, 8(11), 1807; https://doi.org/10.3390/jcm8111807 - 28 Oct 2019

Cited by 9 | Viewed by 3554

Abstract

Overconsumption of alcohol, from hazardous to excessive, heavy, and harmful levels, is common among university students. Consenting Swedish students were assigned to one of two smartphone apps offering feedback on estimated blood alcohol concentration (eBAC; Promillekoll/PartyPlanner) or assessment only (n = 2166; [...] Read more.

Overconsumption of alcohol, from hazardous to excessive, heavy, and harmful levels, is common among university students. Consenting Swedish students were assigned to one of two smartphone apps offering feedback on estimated blood alcohol concentration (eBAC; Promillekoll/PartyPlanner) or assessment only (n = 2166; 1:1:1 ratio). App participants with excessive drinking according to public health criteria (>9/>14 drinks/week for women/men, respectively) at a 7 week follow-up were additionally assigned to the skills-based TeleCoach app or waitlist (n = 186; 1:1 ratio). All participants were followed at 14 and 20 weeks. At 7 weeks, Promillekoll users showed higher risk of excessive drinking (odds ratio (OR) = 1.83; p ≤ 0.01; n = 1558). Students in eBAC app groups with only hazardous use showed fewer binge drinking occasions at 14 weeks and lower eBAC levels up to 20 weeks compared to controls (n = 1157). Also, more highly motivated participants at baseline in both eBAC app groups drank less compared to controls at 7 and 20 weeks. Hidden Markov model analysis revealed a frequent-heavy drinking group (n = 146; 4.6 days/week, SD = 1.4), where those with access to TeleCoach had fewer drinking days compared to assessment-only controls (p < 0.001). eBAC apps showed positive effects up to 20 weeks, particularly for motivated students, and a skills-based app can reduce consumption for those with frequent-heavy drinking patterns. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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19 pages, 967 KiB

Open AccessArticle

Laxer Clinical Criteria for Gaming Disorder May Hinder Future Efforts to Devise an Efficient Diagnostic Approach: A Tree-Based Model Study

by Halley M. Pontes, Bruno Schivinski, Magdalena Brzozowska-Woś and Vasileios Stavropoulos

J. Clin. Med. 2019, 8(10), 1730; https://doi.org/10.3390/jcm8101730 - 18 Oct 2019

Cited by 22 | Viewed by 4287

Abstract

Internet Gaming Disorder (IGD) has been recognized in May 2013 and can be evaluated using the criteria developed by American Psychiatric Association (APA). The present study investigated the role each IGD criteria plays in diagnosing disordered gaming. A total of 3377 participants (mean [...] Read more.

Internet Gaming Disorder (IGD) has been recognized in May 2013 and can be evaluated using the criteria developed by American Psychiatric Association (APA). The present study investigated the role each IGD criteria plays in diagnosing disordered gaming. A total of 3377 participants (mean age 20 years, SD = 4.3 years) participated in the study. The data collected was scrutinized to detect patterns of IGD using Conditional Inference Tree (Ctree), a sophisticated machine algorithm. Participants provided basic sociodemographic information and completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF). The results identified classes of IGD-related symptoms, indicating that endorsing ‘withdrawal’ and ‘loss of control’ increases the probability of disordered gaming by 77.77% while endorsement of ‘withdrawal’, ‘loss of control’ and ‘negative consequences’ increases the probability of disordered gaming by 26.66%. Moreover, lack of endorsement of ‘withdrawal’ and endorsement of ‘preoccupation’ increases the likelihood of disordered gaming by 7.14%. Taken together, the results obtained illustrate that different IGD criteria can present with different clinical weighing as unique diagnostic roles in the development of disordered gaming can be evidenced by each criterion. Moreover, the present findings help inform future revisions of diagnostic manuals and helps enhancing the assessment of IGD in the future. Additional research and clinical implications are discussed. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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18 pages, 325 KiB

Open AccessArticle

Psychopathological Symptoms and Gaming Motives in Disordered Gaming—A Psychometric Comparison between the WHO and APA Diagnostic Frameworks

by Christian Montag, Bruno Schivinski, Rayna Sariyska, Christopher Kannen, Zsolt Demetrovics and Halley M. Pontes

J. Clin. Med. 2019, 8(10), 1691; https://doi.org/10.3390/jcm8101691 - 15 Oct 2019

Cited by 93 | Viewed by 7232

Abstract

Background: ‘Gaming Disorder’ (GD) has received increased medical attention and official recognition from both the American Psychiatric Association (APA) and the World Health Organization (WHO). Although these two medical organizations have independently developed promising clinical diagnostic frameworks to assess disordered gaming, little is [...] Read more.

Background: ‘Gaming Disorder’ (GD) has received increased medical attention and official recognition from both the American Psychiatric Association (APA) and the World Health Organization (WHO). Although these two medical organizations have independently developed promising clinical diagnostic frameworks to assess disordered gaming, little is known about how these frameworks compare at different psychometric levels in terms of producing consistent outcomes in the assessment of GD. Methods: A sample of 1429 German gamers (Mean_age = 29.74 years; SD = 12.37 years) completed an online survey including measures on different psychopathological symptoms (depression, loneliness and attention problems), gaming motives and disordered gaming according to the WHO and APA frameworks. Results: The findings suggest the existence of minor discrepancies in the estimation of prevalence rates of GD according among the two frameworks. Nevertheless, both diagnostic frameworks are fairly consistent in the psychometric prediction of GD in relation to gaming motives and psychopathological symptoms. The findings underscore the role of key gaming motives as risk factors and protective factors across both diagnostic frameworks. Finally, the study provides support for the WHO diagnostic framework for GD and its measurement with the German Gaming Disorder Test (GDT). The findings and their implications are further discussed in terms of clinical relevance. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

7 pages, 229 KiB

Open AccessArticle

Decreased Level of Blood MicroRNA-133b in Men with Opioid Use Disorder on Methadone Maintenance Therapy

by Chih-Wei Hsu, Tiao-Lai Huang and Meng-Chang Tsai

J. Clin. Med. 2019, 8(8), 1105; https://doi.org/10.3390/jcm8081105 - 25 Jul 2019

Cited by 11 | Viewed by 2284

Abstract

Although previous animal studies have indicated that certain micro ribonucleic acids (microRNAs) play a part in the pathway of opioid addiction, whether such findings extend to human models is yet unknown. This study aims to investigate the important microRNA expressions in patients with [...] Read more.

Although previous animal studies have indicated that certain micro ribonucleic acids (microRNAs) play a part in the pathway of opioid addiction, whether such findings extend to human models is yet unknown. This study aims to investigate the important microRNA expressions in patients with opioid use disorder (OUD) on methadone maintenance treatment (MMT) compared to healthy controls and analyze the correlation between microRNAs and opioid characteristics among the patients. We recruited 50 patients and 25 controls, and both groups were matched regarding gender, age, and body mass index. Serum microRNAs (miR-133b, miR-23b, miR-190, miR-206, miR-210, and miR-21) were measured. The age of OUD onset, duration of MMT participation, and recent daily methadone dosage were considered the opioid characteristics. We adopted the t-test to compare the difference between patients and controls and Pearson’s correlation to evaluate the association between microRNAs and opioid profiles. Only the level of miR-133b in OUD patients on MMT was significantly lower than that in healthy controls. We did not detect differences of any other microRNA expressions between the two groups. Furthermore, we found no evidence to support the association between microRNAs and opioid characteristics. This study indicates that miR-133b values may be decreased in OUD patients on MMT. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

13 pages, 1793 KiB

Open AccessArticle

Clinical Characteristics of Diagnosis for Internet Gaming Disorder: Comparison of DSM-5 IGD and ICD-11 GD Diagnosis

by Yeong Seon Jo, Soo Young Bhang, Jung Seok Choi, Hae Kook Lee, Seung Yup Lee and Yong-Sil Kweon

J. Clin. Med. 2019, 8(7), 945; https://doi.org/10.3390/jcm8070945 - 28 Jun 2019

Cited by 141 | Viewed by 11812

Abstract

The American Psychiatric Association (APA) included internet game disorder (IGD) in section III of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) on the condition that it guaranteed more clinical research and experience. The World Health Organization (WHO) also included Game [...] Read more.

The American Psychiatric Association (APA) included internet game disorder (IGD) in section III of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) on the condition that it guaranteed more clinical research and experience. The World Health Organization (WHO) also included Game Disorder (GD) in the 11th final revision of the International Classification of Diseases (ICD-11) and recently recognized it as a diagnosis code. This study aims to compare clinical characteristics and gaming behavior patterns between the IGD diagnosis criteria proposed by the DSM-5 and the GD diagnosis criteria proposed by the ICD-11 based on clinical cohort data (c-CURE: clinic-Cohort for Understanding of internet addiction Rescue factors in Early life) obtained in the Republic of Korea. Psychologists and psychiatrists conducted semi-structured interviews with children/adolescents and their caregivers to identify IGD (Diagnostic Interview for Internet, Game, SNS, etc. Addiction, DIA), and comorbid psychiatric disorders (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean version, K-SADS-PL). The cohort was divided into three IGD diagnosis groups (Normal, DSM5, DSM5 + ICD11) based on DSM-5 and ICD-11 diagnosis criteria. Internet usage pattern and addiction characteristics and psychiatric comorbidities were compared among the three IGD diagnosis groups. The Normal group consisted of 115 subjects, the DSM5 group contained 61 subjects, and the DSM5 + ICD11 group amounted to 12 subjects. The DSM5 + ICD11 group had a lower age of starting use of Internet/games/smartphones than other groups and the average time of Internet/game/smartphone use during weekdays/weekends was the highest. Also, in the eight items scored, excluding ‘deceiving’ and ‘craving’, the rate of threshold was highest in the DSM5 + ICD11 group, followed by the DSM5 group and the Normal group. On the other hand, ‘deceiving’ and ‘craving’ were the highest in DSM5, followed by DSM5 + ICD11 and Normal. The DSM5 + ICD11 group had significantly higher rates of depressive disorder, oppositional defiant disorder (ODD) and conduct disorder (CD) compared to other groups. This study provides implications for the clinical characteristics of IGD diagnosis in the field by comparing the DSM-5 IGD diagnosis criteria with the ICD-11 GD diagnosis criteria. Furthermore, this study provides empirical evidence that ICD-11 GD emphasizes serious symptoms such as functional impairment caused by excessive Internet/game/smartphone use over a long time, and it supports the validity of the ICD-11 GD diagnosis. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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13 pages, 575 KiB

Open AccessPerspective

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

by Erin Oldenhof, Jane Anderson-Wurf, Kate Hall and Petra K. Staiger

J. Clin. Med. 2019, 8(12), 2143; https://doi.org/10.3390/jcm8122143 - 04 Dec 2019

Cited by 12 | Viewed by 3226

Abstract

Internationally there is an escalation of prescription-related overdose deaths, particularly related to benzodiazepine use. As a result, many countries have implemented prescription monitoring programs (PMPs) to increase the regulation of benzodiazepine medications. PMPs centralize prescription data for prescribers and pharmacists and generate alerts [...] Read more.

Internationally there is an escalation of prescription-related overdose deaths, particularly related to benzodiazepine use. As a result, many countries have implemented prescription monitoring programs (PMPs) to increase the regulation of benzodiazepine medications. PMPs centralize prescription data for prescribers and pharmacists and generate alerts to high-doses, risky combinations, or multiple prescribers with the aim to reduce inappropriate prescribing and subsequently the potential of patient harm. However, it has become clear that prescribers have been provided with minimal guidance and insufficient training to effectively integrate PMP information into their decision making around prescribing these medications. Accordingly, this paper discusses how PMPs have given rise to a range of unintended consequences in those who have been prescribed benzodiazepines (BDZs). Given that a gradual taper is generally required to mitigate withdrawal from BDZs, there are concerns that alerts from PMPs have resulted in BDZs being ceased abruptly, resulting in a range of unintended harms to patients. It is argued that best practice guidelines based upon a patient-centered framework of decision-making, need to be developed and implemented, in order to curtail the unintended consequences of PMPs. This paper outlines some key considerations when starting the conversation with patients about their BDZ use. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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10 pages, 235 KiB

Open AccessBrief Report

Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use

by Victoria Manning, Joshua B. B. Garfield, Tina Lam, Steve Allsop, Lynda Berends, David Best, Penny Buykx, Robin Room and Dan I. Lubman

J. Clin. Med. 2019, 8(9), 1407; https://doi.org/10.3390/jcm8091407 - 06 Sep 2019

Cited by 20 | Viewed by 4551

Abstract

People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study [...] Read more.

People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (‘Patient Pathways’), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of “SUD treatment success” (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p < 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL; however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use. Full article

(This article belongs to the Special Issue Understanding and Treating Addictive Behaviors: From Etiology to Clinical Interventions)

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