Alcohol Rehabilitation Research Articles

Effectiveness of Logotherapy Intervention Program in Reducing Drug Cravings and Preventing Relapse among Males with Substance Dependence in Ahvaz

Background: Given that the important characteristics of drug abuse are high relapse rate and craving, the use of new therapeutic interventions that help drug dependents can be very important. The present study aimed to investigate the effectiveness of logotherapy intervention program in reducing drug cravings and preventing relapse among males with substance dependence in Ahvaz in 2019. Methods: The research method was quasi-experimental with a pretest-posttest design and a control group. The statistical population included all the males with addiction disorder who were referred to treatment centers in Ahvaz city during 2018. Using convenience sampling, we selected 30 males with addiction disorder willing to participate in the study and randomly divided them into experimental and control groups (n=15 per group). The research instruments included Gorski's Warning Signs of a Relapse and the Craving Questionnaire. The experimental group underwent eight sessions (90-minute sessions per week) of the logotherapy intervention program. Multivariate analysis of covariance (MANCOVA) was used to analyze the data. SPSS version 22.0 was further used to analyze the data. Results: The mean ± SD of the drug craving for experimental and control groups in the post-test phase was 36.46±6.77 and 49.06±12.95, respectively. The results showed that intervention programs were effective in reducing drug craving and relapse in males with drug addiction (Pvalue= 0.001). Conclusions: Training logotherapy was shown effective in reducing drug cravings and preventing relapse in males with substance dependence, and thus it can be used in drug rehabilitation centers to prevent relapse in clients. Keywords: Logotherapy, Drug craving, Preventing relapse, Drug abuse, Health.

Influence of Drinking related Locus of Control on motivation to change alcohol drinking behavior, as observed in Kathmandu, Nepal.

ABSTRACT Introduction With the ever-increasing prevalence of Alcohol Use Disorder (AUD) in Nepal and elsewhere in Asia, it is imperative to study factors that motivate individuals to change their drinking behavior and aid in the recovery process. Methods The study was conducted among 225 consenting male patients with AUD admitted at various drug and alcohol rehabilitation centers in Kathmandu, Nepal. Self-report questionnaires were used to assess socio-demographic characteristics, drinking-related locus of control (LOC), and motivation to change drinking behavior. Multivariate regression analysis was used to examine the influence of drinking-related LOC on motivation to change drinking behavior. Results Around 75% of patients with AUD were observed to have external LOC. A statistically significant association was found between drinking-related LOC and motivation to change drinking behavior, where those with internal LOC were at least 2.5 times more likely to be better motivated to change their drinking behavior in comparison to those with external LOC. Discussion Interventions with a focus on shifting LOC from external to internal are likely to improve the motivation of patients with AUD and aid in the recovery process. However, studies with a longitudinal design may be needed to further consolidate the findings from this study.

Adolescent Hepatitis C: Prevalence, Impact, and Management Challenges.

The prevalence of Hepatitis C virus infection (HCV), a leading cause of chronic liver disease worldwide, is rising in the United States (US) and other high-income countries, especially among youth and young adults. This surge in cases is closely associated with the opioid crisis and intravenous drug use (IVDU). However, its prevalence and impact on the adolescent population have not been thoroughly studied and therefore is poorly understood. The pediatric population tends to have milder liver disease and progression when compared to adults; however, there is a risk of developing liver cirrhosis, in addition to facing decreased quality of life and stigmatization from the disease. The recent approval of direct-acting antiviral (DAA) regimens for all HCV genotypes and age greater than 3 years has revolutionized its management. Therapy has shifted from the prolonged interferon-based regimens, to shorter duration, once daily oral pills that are highly effective, curative and with fewer side effects. Therapy is now indicated for all adolescents with hepatitis C virus infection, regardless of stage of liver disease, recent IVDU, or coinfection with HIV, therefore eliminating a lifetime risk of chronic liver disease, cirrhosis and hepatocarcinoma. Nonetheless, adolescents are rarely tested or treated for hepatitis C infection, and very few adolescents complete therapy. Implementation of point of care (POC) testing of high-risk youth at drug treatment centers or other juvenile facilities may be a good strategy to increase testing, diagnosis and therapy. This review article aims to educate pediatricians and other primary care providers to help decrease the existing knowledge gap on the subject.

Telemedicine and decentralized hepatitis C treatment as a strategy to enhance retention in care among people attending drug treatment centres.

People attending drug treatment centres have a high burden of hepatitis C virus (HCV) and face barriers to diagnosis and treatment. Dried blood spot (DBS) testing has been proposed to simplify diagnosis, but many patients remain untreated. In this retrospective study, we evaluated the reasons for non-retention in care in an intervention using on-site DBS testing and the effect of telemedicine and decentralized care compared to standard of care among people attending drug treatment centres who were lost to follow-up. In a first phase, retention in care, adherence to treatment, and predictive factors in the DBS testing program of patients in drug treatment centres were analyzed and compared to a cohort of patients treated at the hospital outpatient clinic. Subsequently, in a second phase we evaluated in patients lost to follow-up from drug treatment centres the efficacy of one-step testing and telemedicine linked to a decentralized dispensation of HCV treatment or standard of care. Among 512 patients attending drug treatment centres, 467 (91.2%) agreed to be tested and 53.4% (237 patients/444 valid tests) tested positive (46±9 years, 87.3% male) for HCV antibodies. After excluding patients negative for RNA or under surveillance, 178 patients were scheduled to meet with a specialist. Overall, 44 patients did not attend and 25 did not complete the pre-treatment evaluation. The only factor associated with retention in care was patient's knowledge of HCV infection. Treated patients attending drug treatment centres (n=68) compared to the hospital outpatient clinic cohort (n=135) had lower rates of treatment adherence. Among the patients who attended drug treatment centres that were lost to follow-up (n=69), the proportion of patients who completed the program was significantly higher among those assisted by telemedicine than by standard of care (62.5% vs. 24.3%, p=0.002). Although there was a high participation rate in a DBS testing program in drug treatment centres, non-retention in care is a challenge. Importantly, telemedicine linked to a decentralized dispensation of HCV treatment re-engages patients and may be effective for HCV microelimination.

A Second Chance: Reenactment and Recovery Narratives in a Peruvian Drug Rehabilitation Center.

The following article discusses a collaborative, reenactment film made with the residents of a drug rehabilitation center in Iquitos, Peru. In so doing, it raises questions about narratives of recovery from addiction, and the tensions that emerge between these narratives and the often-ambivalent feelings of the people who tell them. Practices of filmmaking and reenactment generate a collaborative theorization of lived experience-in this case, the multifaceted natures of both addiction and recovery. At the same time, these practices are also attentive to the embodied memories and complex feelings of the film's actors. Further engagement with the filmic materials demonstrates how the film became an active exploration of the ongoing nature of recovery, complicating the therapeutic trajectories of a group of actors struggling to reconcile ambivalent feelings as they attempt to craft new narratives of self.

Feasibility and pilot efficacy of cognitive remediation for people in residential substance use treatment.

There are high rates of cognitive impairment among people seeking treatment for problematic substance use, which is rarely addressed in treatment programs. The aim of this pilot study was to evaluate the feasibility and outcomes of the neuropsychological and educational approach to cognitive remediation (NEAR) in a residential substance treatment setting. A non-randomised trial conducted between November 2018 and November 2019, compared outcomes for 34 residents who received cognitive remediation (CR) plus treatment as usual (TAU) to 31 residents who received TAU only. Number of groups and attendance, and a measure of client satisfaction assessed feasibility. Cognitive function was assessed at baseline (service admission), and at 2 and 6 months post-admission. A total of 95 CR groups were delivered over a 36-week time period with a high degree of treatment fidelity and acceptability to participants. Cognitive outcomes improved across both the CR+TAU and TAU groups by 2 months, which was maintained at 6 months for outcomes related to executive functioning. There were no significant differences between the CR+TAU and TAU groups at 2 or 6 months, although a large effect size and confidence intervals indicated a potentially larger change in cognitive flexibility after receiving CR. This study contributes to our understanding of the implementation of CR in the alcohol and other drug rehabilitation setting. It is feasible to incorporate the NEAR program in treatment. The small sample size and lower than expected treatment dose likely contributed to the lack of significant findings.

Treatment Barriers Associated with Amphetamine-Type Stimulant (ATS) Use in Malaysia

ABSTRACT People who use amphetamine-type stimulant (ATS) are known to face barriers in seeking treatment. We sought to identify these barriers and gender differences in barriers (if any) faced by them. A convenience sample of 386 respondents who use ATS was recruited from five formal drug rehabilitation centers for this cross-sectional study. The majority were male (83%), with 17% being female. The barriers most frequently cited by both men and women were: the perception that ATS use needed no treatment, fears of community discrimination, peer influence, and long waiting time to get into a treatment programme. One-third of the sample held that the mandated treatment programmes were ineffective, based on past experience. In terms of male-female differences, long waiting time discouraged significantly more women than men, whereas more men than women asserted that formal treatment programmes were ineffective. We also found no significant differences in barriers faced by ATS users and those using ATS with other illicit substances. Outreach initiatives to minimize the impact of treatment barriers, coupled with offering separate treatment protocols and facilities, will encourage people who use ATS to seek treatment voluntarily.

Mobile methadone dispensing in Delhi, India: implementation research.

ObjectiveTo assess the implementation of a mobile dispensing service to improve opioid users’ access to methadone maintenance therapy.MethodsIn March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service.FindingsThe number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients’ adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites.ConclusionIt is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic.

The influence of cigarette consumption as a trigger of relapse tendency in productive drug abusers

One of the effects of globalization in Indonesia is the increase in drug abusers. In the last 3 years, there has been an increase in drug abusers and tobacco consumption in the productive age group. At the Drug Rehabilitation Centre, National Narcotics Boards in 2015 until 2018, there was an increase in abusers to relapse from 5% to 6.3%. This study aims to analyze the influence of smoking behaviors on the tendency of relapse and to compare smoking and non-smoking on the decline in drugs abusers in the Rehabilitation Center. This research uses a quantitative approach. The sample of this research is 162 respondents who were drug abusers undergoing rehabilitation. A questionnaire collected data. Factor analysis is used to process the data of the independent variables. Coping was the most dominant factor in relapse tendencies. Results indicate that smoking behavior can reduce the tendency of relapse in drug abusers in the Drug Rehabilitation Center. We recommend conducting further research on what kind of coping is suitable for drug abusers to reduce the tendency to relapse and review the smoking cessation policy at the Drug Rehabilitation Center. Another suggestion is to taper the dose of cigarette use on drug abusers.

Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study

ObjectiveTo estimate the prevalence of HIV testing and examine factors associated with recent HIV testing among people who use drugs (PWUD) in Cambodia.DesignCross-sectional study.SettingTwelve major provinces with a high burden...

Fronto-temporal cortical atrophy in ‘nyaope’ combination heroin and cannabis use disorder

Sub-Saharan Africa is one of the top three regions with the highest rates of opioid-related premature mortality. Nyaope is the street name for what is believed to be a drug cocktail in South Africa although recent research suggests that it is predominantly heroin. Nyaope powder is most commonly smoked together with cannabis, a drug-use pattern unique to the region. Due to the increasing burden of this drug in low-income communities and the absence of human structural neuroimaging data of combination heroin and cannabis use disorder, we initiated an important cohort study in order to identify neuroanatomical sequelae.Twenty-eight male nyaope users and thirty healthy, matched controls were recruited from drug rehabilitation centers and the community, respectively. T1-weighted MRI images were obtained using a 3 T General Electric Discovery and cortical thickness was examined and compared.Nyaope users displayed extensive grey matter atrophy in the right hemispheric medial orbitofrontal, rostral middle frontal, superior temporal, superior frontal, and supramarginal gyri (two-sided t-test, p < 0.05, corrected for multiple comparisons). Our findings indicate cortical abnormality in nyaope users in regions involved in impulse control, decision making, social- and self-perception, and working memory. Importantly, affected brain regions show large overlap with the pattern of cortical abnormalities shown in heroin use disorder.

Hepatitis C Rapid Point-of-Care Testing and Laboratory-based Non-invasive Assessment of Liver Fibrosis among Drug Abusers: An Experience from Iran.

People who use drugs, particularly injection drug users (IDUs) are known as the major source of hepatitis C virus (HCV) infection. This study was performed to determine the prevalence of HCV infection using rapid point-of-care testing and to assess liver fibrosis by non-invasive lab tests among addict populations of Mashhad, Iran. In this cross-sectional study, drug users who referred to drug treatment and harm reduction centers of Mashhad were enrolled during March and December 2019. A rapid test kit was used to assess the presence of anti-HCV antibodies and a real-time PCR was performed to confirm the infection. The AST-platelet ratio index (APRI) and fibrosis-4 (FIB-4) score were used to investigate liver fibrosis in patients with positive HCV RNA. A P value <0.05 was considered as significant. A total of 390 drug users aged 15-74 years were assessed. Sixty-four individuals showed positive results for anti-HCV (16.4%), of whom 58 blood samples were available for PCR test. The viremic rate among the latter group was calculated at 84.5% (49/58); the total viremia prevalence was 12.8% (49/384). Multivariate analysis revealed that being single (P = 0.040) or divorced/ widow (P = 0.011) and history of drug injection (P<0.001) and tattoos (P = 0.021) were significantly associated with current HCV infection. Using APRI and FIB-4 indices, significant liver fibrosis was identified in 14.3% and 18.4% of cases, respectively. HCV infection screening using rapid tests and examining liver fibrosis by non-invasive lab tests appear to be practicable and useful among poor populations in settings such as drug treatment centers.

"It's hard for me to tell my story" the experiences of Aboriginal and Torres Strait Islander male clients at a residential drug and alcohol rehabilitation centre using primary health care.

Aboriginal males who use drug and alcohol may experience unique barriers accessing primary health care. This study explores the perceptions of Aboriginal males in treatment for drug and alcohol use around their experiences accessing primary health care, and barriers to access. Twenty male Aboriginal clients at a fee-paying residential drug and alcohol rehabilitation centre completed semi-structured interviews about their primary health care experiences before their stay. Interpretative phenomenological analysis was used to inductively develop themes. About half the males had regular General Practitioners at a mainstream primary health care service or Aboriginal Medical Service. Positive experiences included having medical needs met or understanding the health information provided; and negative experiences included inefficient health service or system processes or experiencing cultural bias or racism. Barriers included limited access to appointments or to the same GP regularly, long wait times, lack of access to transport, worry or fear about their health or the visit or their complex lives taking priority. This research showed that the participants sought out health care and identified barriers to accessing care and potential improvements. SO WHAT?: Access to a regular General Practitioner, continuity of care and culturally appropriate and comprehensive communication techniques are important to facilitate access to primary health care by Aboriginal males. Efforts to enhance access may focus on inherent strengths within Aboriginal communities including focusing on relationships between clinicians and families, providing a welcoming environment and encouraging clients to bring a trusted family member to appointments.

Dhikrullah Vibration as Emotional Counseling Amongs the Aceh Community

Dhikrullah is an Islamic teaching to get calm has not been used in emotional counseling. The relationship between sound vibrations and emotions is still being studied in the acoustic room. M. J. Griffin has analyzed the benefits of vibration for humans. Neuroscience explains that emotional stability can help increase one's awareness. This paper discusses the role of dhikrullah vibration as emotional counseling among Acehnese people from a scientific approach. Qualitative data was sourced from 10 dhikrullah leaders in North Aceh and 3 dhikrullah leaders in Medan, North Sumatra. For quantitative data obtained through the Electro Encephalo Graph in order to get a sample of 10 subjects. The first finding, the vibration of dhikrullah. Second, dhikrullah as counseling and third, dhikrullah as emotional counseling among the Aceh Temun people from this study will contribute to four aspects. First, the development of Islamic mysticism. Second, increasing public awareness of dhikrullah as emotional therapy in the brain. Third, to explain dhikrullah as a legacy of Sufism scholars. Fourth, to resolve the incomplete mental problems in Aceh. The government can adopt the results of this study into public policy as social capital to strengthen the application of Islamic values in Aceh. The government can recommend a dhikrullah counseling approach to mental hospitals, prisons, nursing homes, trauma rehabilitation centers and drug rehabilitation centers.

An audit of the cervical screening programme in the National Drug Treatment Centre (NDTC).

BackgroundWomen diagnosed with substance use disorders (SUDs) have higher rates of major medical conditions compared to women without SUDs. Cervical cancer is the second leading cause of cancer death in women aged 20–39 years worldwide and women with SUDs have an increased risk of cervical cancer compared to women without SUD. The National Drug Treatment Centre (NDTC) cervical screening programme, derived from the national CervicalCheck programme, offers free cervical screening to patients attending for treatment of SUDs.AimsThis study aimed to audit adherence to the NDTC Cervical Screening guidelines before and after the implementation of an awareness-raising educational intervention.MethodsThe electronic clinical records of women aged between 25 and 60 years attending the lead consultant’s (M.S.) outpatient clinic were reviewed for documentary evidence indicating that information about the cervical screening programme had been discussed. This was completed before and one month after the implementation of an awareness-raising educational intervention.ResultsAll women (n = 46, mean age 36.3 (SD = 6.5) years) had an opioid use disorder; 85% had a benzodiazepine use disorder, and 24% had an alcohol use disorder. Of these, 80% had at least one chronic medical condition, 76% had a psychiatric disorder, and 59% were homeless. Adherence to the NDTC cervical screening guideline, as indicated by documentary evidence in clinical records, was 33% (14/43) at baseline, and rose to 88% (36/41) (p < 0.0001) one month after the intervention.ConclusionsThis completed audit cycle shows that an awareness-raising educational intervention can significantly improve adherence to a cervical screening programme in women with SUDs.

Perceived Social Support and its Influence on Motivation to Change Drinking Behavior: An Observation from Kathmandu, Nepal

ABSTRACT In the context of traditional use of alcohol among various ethnic groups in Nepal, there appears to be a need to better understand if perceived social support provided by family and friends aids in the recovery process. The objective of the study was to examine the association between perceived social support and the motivation to change drinking behavior among 225 consenting male patients who screened positive for alcohol use disorder (AUD) in eight alcohol and drug rehabilitation centers in Kathmandu, Nepal. The results of the study concluded that more than 50% were ambivalent toward the process of change and indicated that social support is likely to benefit those in the recovery process by improving their motivation to change.

Youth self-construction processes in a drug treatment center on the periphery of Mexico City

In this paper, I reflect on the various forms of masculinity narrated by young women and men participating in non-mixed workshops in a peripheral evangelical drug treatment center in Mexico City, and how these masculinities are perpetrated by the institutions central to their lives. Through the collective space of the workshops, youths expressed a subjective experience of conflict filled with shame and the feeling of vulnerability, expressions that are differentiated by gender roles: that is, what is considered feminine and masculine and shapes the relationship between men and women. This creates and conditions forms of behaviour (for example, the use of violence and docility); priorities which affects their expectations and dreams - whether the search for status or motherhood; and, access to specific social positions (within or outside the institutions). Youths contrasted the experience of being locked up in a drug treatment center with the liberty they experienced on the street; they described their bodies before and after the treatment and following the institutional discourse, they qualify themselves as "sick" because of their addiction. Yet, their drawings and narratives also express self-construction projects and dreams free of violence, where they describe themselves as being supported by a network of care which includes God, kinship figures, and institutional role models.

Tuberculosis Case Finding and Case Holding Practices In Selected Drug Abuse Treatment and Rehabilitation Centers (DATRCS) In Luzon, Philippines

Background and Objectives. Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs. Methods. Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country. Results. Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs. Conclusion. Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.

The Healthy Addiction Treatment Recovery Model: Developing a Client-Driven, Nurse-Led Addiction Nursing Model.

The current model of nursing within international addiction services has been described as task oriented and reactive. Yet, it is known that nursing models should be led by client need and operate within the domain of the client and their wider environment. The aim of this study was to address this gap within addiction nursing and to develop an evidence-based addiction nursing model.To objectively assess the needs of clients, a cross-sectional survey was implemented within a representative selection of six drug treatment clinics and a sample of clients in receipt of opiate agonist treatment in Dublin, Ireland. The Opiate Treatment Index with the General Health Questionnaire embedded was used to measure heroin use, polydrug use, infectious disease risk, physical health, psychological adjustment, criminality and social well-being. To develop the addiction model, a mapping of relevant features of potential nursing models was conducted by nurses working in addiction services.The key finding from the client assessments was a lack of psychological adjustment; a cutoff score of 4 was recommended. The mean score among women was 11 (95% CI [8, 14]), and that among men was 8 (95% CI [6, 10]). Findings from the mapping of models highlighted the benefits of the BRENDA, FRAMES, and Tidal models. A focus on practical implementation and measurable outcomes was stressed. Results informed the development of the Healthy Addiction Treatment Recovery Model. The model refocused services on clients' objective needs and eradicated entrenched practices.

Opioid dependence growing concern: A profile of a tertiary care hospital in North India

Background: It is well-known that opioids are one of the world's most challenging substances which are growing rapidly. India too has a considerable problem of opioid use. State Drug Dependence and Treatment Center, Rohtak is only center in Haryana proving treatment with opioid substitution therapy.Aim: The present study was aimed to draw a profile of the patients attending this treatment facility.Methods: It was a retrospective secondary data-based study for the year 2018–2019. All the data records were reviewed and tabulated for the interpretation.Results: The present study found that maximum (46%) of the participants were from the age group of 20–29, almost males married and unmarried both were seeking treatment, 70% of them were educated at least up to secondary slandered but maximum (42%) were unemployed. Age of initiation was vary from 10 to 29 years and 74.2% were reported addiction of heroin. Chasing was the most popular method of consumption followed by oral and intravenous. Support from family was reflected in the referrals, and it can be considered as good for the better outcome and reduction of relapse.Conclusion: Opioid use is growing among adult males that need immediate attention of care.