Alcohol Rehabilitation Research Articles

Progress Towards Elimination of Hepatitis C Infection Among People Who Inject Drugs in Australia: The ETHOS Engage Study.

Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia. The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid). Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68; .48-.95), participants who were homeless (.59; .38-.96), and those injecting daily or more (.51; .31-.89). People aged ≥45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment. Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment.

Medicaid Policy and Liver Transplant for Alcohol-Associated Liver Disease.

In some states, liver transplantation (LT) for alcohol-associated liver disease (ALD) is covered by Medicaid only with documentation of abstinence and/or alcohol rehabilitation. Different Medicaid policies may affect the distribution of LT for ALD, particularly post-2011, as centers have adopted early (i.e., specific abstinence period not required) LT practices. We surveyed Medicaid policies in all states actively performing LT and linked state policies to prospectively collected national registry data on LT recipients from 2002 to 2017 with ALD as the primary listing diagnosis. We categorized Medicaid policies for states as "restrictive" (requiring documentation of a specific abstinence period and/or rehabilitation) versus "unrestrictive" (deferring to center eligibility policies). Difference-of-differences analysis, comparing 2002-2011 versus 2012-2017, evaluated whether restrictive policies were associated with decreased proportion of LTs paid by Medicaid among patients with ALD post-2011. We performed sensitivity analyses to account for any differences by diagnosis of hepatocellular carcinoma, hepatitis C virus, nonalcoholic steatohepatitis, or Medicare insurance. We also performed a sensitivity analysis to account for any difference by prevalence of ALD among restrictive versus unrestrictive states. Of 10,836 LT recipients in 2002-2017, 7,091 were from 24 states in the restrictive group and 3,745 from 14 states in the unrestrictive group. The adjusted proportion (95% confidence interval) of LTs paid by Medicaid among restrictive versus unrestrictive states between 2002 and 2011 was 17.6% (15.4%-19.8%) versus 18.9% (15.4%-22.3%) (P=0.54) and between 2012 and 2017, 17.2% (14.7%-19.7%) versus 23.2% (19.8%-26.6%) (P=0.005). In difference-of-differences analysis, restrictive (versus unrestrictive) policies were associated with a 4.7% (0.8%-8.6%) (P=0.02) absolute lower adjusted proportion of LTs for ALD paid by Medicaid post-2011. Restrictive Medicaid policies are present in most states with active LT centers and are associated with lower proportions of LTs for ALD paid by Medicaid post-2011 compared to states with unrestrictive Medicaid policies. Reevaluation of Medicaid alcohol use policies may be warranted, to align more closely with contemporary center-level practices.

Strong families: a new family skills training programme for challenged and humanitarian settings: a single-arm intervention tested in Afghanistan

BackgroundChildren living in challenged humanitarian settings (including those in rural/underserved areas, the displaced, refugees, in conflict/post conflict situations) are at greater risk of mental health difficulties or behavioural problems, with caregivers acting as their main protective factors. While many family skills programmes exist, very few were developed for, or piloted in, low resource settings (settings with limited infrastructure, typical of humanitarian settings). We therefore designed a brief and light programme; the Strong Families (SF) programme, consisting of 5 h contact time over 3 weeks. We conducted a pilot study with the aim to test the feasibility of implementation, and a preliminary look at the effectiveness of SF, in improving child behaviour and family functioning in families living in Afghanistan.MethodsWe recruited female caregivers and children aged 8–12 years through schools and drug treatment centres in Afghanistan and enrolled them in the SF programme. Demographic data, emotional and behavioural difficulties of children and parental skills and family adjustment measures were collected from caregivers before, 2 and 6 weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire), assessing children’s behavioural, emotional, and social issues, and PAFAS (Parenting and Family Adjustment Scales), measuring parenting practices and family functioning.ResultsWe enrolled 72 families in the programme with a 93.1% retention rate (n = 67) for data collection 6 weeks post intervention. Mean age of caregivers was 36.1 years, they had 3.8 children on average and 91.7% of them had experienced war/armed conflict in their past. The average total difficulty score of the SDQ (ranging from 0 to 40, with scores above 16 being indicative of high problems) of the 72 children reduced significantly, from 17.8 at pre-test to 12.9 at post-test and 10.6 at second follow-up, with no difference in gender and most noticeably amongst those with the highest scores at baseline. Likewise, PAFAS scores decreased significantly after the programme, again with caregivers with the highest scores at baseline improving most.ConclusionsThe implementation of a brief family skills programme was seemingly effective and feasible in a resource-limited setting and positively improved child mental health and parenting practices and family adjustment skills. These results suggest the value of such a programme and call for further validation through other methods of impact assessment and outcome evaluation.Trial registrationISRCTN76509384. Retrospectively registered on March 9, 2020.

Assessment of Canadian policies regarding liver transplant candidacy of people who use alcohol, tobacco, cannabis, and opiates

BACKGROUND: When last assessed in 2013, all Canadian liver transplant programs required 6 months of abstinence from alcohol. New studies have questioned the validity of this policy. Moreover, with recreational cannabis now legal in Canada, more transplant candidates may use cannabis. Given these changes, our objective was to obtain an understanding of current Canadian practices regarding liver transplantation and candidates with addiction or alcohol, tobacco, cannabis, or opiate use. METHODS: Electronic surveys were distributed to the medical directors of all seven adult liver transplant programs in Canada. Questions were based on either a Likert-scale ranking or free response. The complete data set was aggregated to provide a national perspective on this topic and ensure each individual program remained anonymous. RESULTS: All seven programs responded to the survey. Of these programs, 43% always require 6-month abstinence from alcohol, 29% usually require it, and 14% sometimes require it. Formal alcohol rehabilitation is mandatory in two programs. The majority (57%) of programs never or rarely consider transplant for patients with acute alcoholic hepatitis; 29% require smoking cessation before consideration for transplant; and 71% felt that cannabis use is rarely or never a contraindication to liver transplantation. CONCLUSIONS: Significantly more Canadian programs now perform liver transplant for patients who have less than 6 months abstinence from alcohol, and alcoholic hepatitis is no longer an absolute contraindication in Canada. Policies on smoking and opiates are quite variable. Further study and discussion are critical for development of national policies to obtain equitable access to liver transplant for all.

Development and psychometric validation of the Inventory of Drug Use Determinants amongst Iranian University Students (IDUD-US) in Tabriz, Iran

ABSTRACT Objective: To develop and psychometrically testing the Inventory of Drug Use Determinants among University Students (IDUD-US) to ascertain precipitating factors of drug use by the Iranian university students. Methods: The preliminary item pool generated through an extensive literature review and a panel of experts was solicited to assess its face and content validity. The study sample included 214 registered current or former drug users who had initiated the harmful behavior since their student-life. They were recruited through approaching the private/non-private Drug Treatment Centers (DTC) from November 2015 to June 2016 in the greater city of Tabriz, Iran. Results: The structural indicators of the Kaiser-Meyer-Olkin (0.725) and Bartlett test of sphericity (P < .0001) verified interpretability of the exploratory factor analysis (EFA) output. The internal consistency measure of the scale was in the vicinity of acceptable range (α = 0.782). Having an addicted friend, pursuit of pleasure and easy purchasability of illegal substances were main trigger for commencement of drug use by 69.6, 64.5, and 61.7% of the respondents consequently. Conclusion: Psychometric consistency of the constructed instrument was verified for use in Iranian university students.

The Relationship Between Anger and Aggression among Drug-Dependent Males

Anger and anger regulation problems that result in aggressive behavior pose a serious problem for society. Therefore, this study aims to investigate the relationship between anger and aggression among drug-dependent males. Besides, this study also aims to investigate the differences between anger and aggression based on marital status and ethnicity. A total of 184 drug-dependent males from a drug rehabilitation center were involved in this study. The drug-dependent males were randomly selected to answer the questionnaire. The Novaco Anger Scale (NAS) was used to measure anger and anger regulation, while the Aggression Questionnaire (AQ) was used to measure aggression. Data were analyzed using Pearson's correlation, t-test, and one-way ANOVA. The results revealed that there was a positive relationship between anger and aggression. There was also a negative relationship between anger regulation and aggression. Next, a negative relationship existed between anger regulation and anger aggression subscale, physical aggression subscale and hostility aggression subscale. In addition, there were significant differences in anger aggression and physical aggression subscales between married and unmarried drug-dependents. Nevertheless, there were no differences in anger, anger regulation, aggression, and the four subscales of aggression- anger aggression, physical aggression, hostility aggression and verbal aggression among ethnic groups. The implication of this study will be discussed further.

The impact of motivational interviewing on relapse to substance use among women in Iran: a randomized clinical trial

BackgroundWomen in Iran are in great need of effective substance abuse services. The current study was conducted to investigate the effectiveness of motivational interviewing (MI) for women in treatment for drug use in Iran.MethodThe sample (N = 60) included women in a drug treatment center in Qazvin (Iran) from August to December of 2017. The research sample included 60 female drug users randomly assigned to MI or Standard Care (SC). Prior to randomization women completed a baseline questionnaire and the Relapse Prediction Scale (RPS), which measures desire (urge) to use and probability of using/not using in risky situations (self-efficacy). MI consisted of eight 60-min group sessions over a 1-month period, twice weekly. At 2-months follow-up, data were gathered using a questionnaire similar to baseline. Mixed Model Analysis were used to determine group differences.ResultsMean age of participants was 30 years and average addiction duration was 7 years. Although the scores of the desire to use and the probability of drug use were not significant before the intervention, after the intervention, scores on desire to use and probability of use improved about 81.1% (F: 2230.15, P < 0.001, degrees of freedom: 63, 15) and 81.9%, (F: 749.39, P < 0.001, degrees of freedom: 79, 77), respectively, compared to those of control group.ConclusionThe results showed that motivational interviewing could decrease desire to use and probability of use among female drug users. Motivational interviewing could play an important role in improving women’s health in Iran.Trial registrationIRCT registration number: IRCT20140907019077N4Registration date: 2017-12-12, 1396/09/21Registration timing: registered_while_recruitingLast update: 2017-12-12, 1396/09/21

Abstinence from alcohol and alcohol rehabilitation therapy in alcoholic liver disease: a population-based study

Objective: Abstinence from alcohol is recommended in patients diagnosed with alcoholic hepatitis (AH) and alcoholic cirrhosis (AC). We aimed to determine the impact of alcohol abstinence on prognosis of patients with AC and AH.Methods: All incident AC and AH patients in Iceland 2001–2016 were identified. Cirrhosis was confirmed clinically, biochemically, with imaging and histologically. Abstinence, alcohol rehabilitation and survival were analyzed.Results: Overall, 169 patients with AC and/or AH were identified. Eleven died during index hospitalization, leaving 158 patients for final analysis, median (IQR) age 56 years (48–65), 72% males. Over all 61 patients (39%) had AC, 40 (25%) AH and 57 (36%) features of both. Thirty-nine percent of patients remained abstinent during follow-up and 63% underwent alcohol rehabilitation. Moderate to severe ascites at diagnosis (odds ratio (OR): 3.05, 95% confidence interval (CI): 1.37–7.02) and lack of alcoholic rehabilitation (OR: 5.28, 95% CI: 2.24– 14.11) were independent predictors of abstinence. Abstinence at one year of follow-up was not related to increased survival. Patients surviving one year, abstinence during follow-up was related to increased survival for both groups.Conclusion: Abstinence from alcohol following AC/AH diagnosis was achieved in 39% of patients. Abstinence was not related to increased survival for alcoholic liver disease patients at one-year, which might partly indicate that this might be a marker that some patients were ‘too sick to drink’. AC and AH patients who survived one year and remained abstinent had a favorable long-term prognosis.

Elbasvir and grazoprevir for hepatitis C virus genotype 1 infection in people with recent injecting drug use (DARLO-C): An open-label, single-arm, phase 4, multicentre trial.

Background and AimsDirect‐acting antiviral therapy for hepatitis C virus (HCV) is effective, but few prospective studies among people with ongoing injecting drug use exist. This study evaluated the efficacy of elbasvir/grazoprevir in people with HCV genotype 1/4 (G1/4) infection and recent injecting drug use. An exploratory aim evaluated the feasibility of fingerstick point‐of‐care HCV RNA testing prior to and following treatment.MethodsDARLO‐C (http://clinicaltrials.gov: NCT02940691) is an open‐label phase 4 trial. Participants were recruited between May 2017 and March 2018 from two drug treatment clinics, two hospital clinics, and one community clinic in Australia. Inclusion criteria included recent injection drug use (previous 6 months) and HCV G1/4 infection. Exclusion criteria included prior HCV treatment and decompensated liver disease. Participants received elbasvir/grazoprevir once‐daily for 12 weeks. The primary endpoint was undetectable HCV RNA 12 weeks post‐treatment (SVR). Fingerstick whole‐blood samples were tested using the Xpert HCV Viral Load Fingerstick (Xpert HCV VL Fingerstick) assay and compared to the Aptima HCV Quant Dx Assay on plasma samples.ResultsOf a planned 150 participants, 32 were enrolled due to slower than anticipated recruitment [median age 46 years, 10 (31%) female, 29 (91%) G1a]. Eighteen (56%) were receiving opioid agonist therapy and 29 (91%) injected in the previous month. Twenty‐six (81%) of 32 completed treatment (lost to follow‐up, n = 5; incarceration, n = 1). There were no virological failures. Twenty‐four (75%, 95% CI 59%‐91%) of 32 achieved SVR. Two participants who completed treatment did not have SVR (loss to follow‐up, n = 1; refused test, n = 1). Among paired samples (n = 36), sensitivity of the Xpert HCV VL Fingerstick assay for HCV RNA detection was 100.0% (95% CI 75.3%‐100.0%) and specificity was 95.7% (95% CI 78.1%‐99.9%).ConclusionElbasvir/grazoprevir is effective among people with HCV G1 with recent injecting drug use. Implementation of point‐of‐care HCV RNA testing was feasible, but the high error rate requires investigation.

ITTREAT (Integrated Community Test - Stage - TREAT) Hepatitis C service for people who use drugs: Real-world outcomes.

Direct-acting antivirals (DAAs) provide an unprecedented opportunity for a "find-and-treat strategy." We aimed to report real-world clinical, patient reported and health economic outcomes of community-based hepatitis C virus (HCV) screening/treatment in people who use drugs (PWUDs). Project ITTREAT (2013-2021), established at a drug and alcohol treatment centre, offered a comprehensive service. Generic (SF-12v2 and EQ-5D-5L) and liver-specific (SFLDQoL) health-related quality of life (HRQoL) were assessed before and after HCV treatment. Costs/case detected and cured were calculated. Primary outcome measure was sustained virological response (SVR) (intention to treat). Till March 2018, 573 individuals recruited, 462 (81%) males, mean age 40.5±10.0years. Of the 125 treated, 115 (92%) had past/current history of injecting drug use, 88 (70%) were receiving opioid agonist treatment and 50 (40%) were homeless. Twenty-six per cent received interferon-based and 74% DAA-only regimens. SVR (ITT) was 87% (90% with DAAs). Service uptake/HCV treatment completion rates were >95%, HCV reinfection being 2.63/100 person years (95% CI 0.67-10.33). HRQoL improved significantly at end of treatment (EOT) in those with SVR: SFLDQoL (symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (P</=.011); SF-12 v2 physical and mental health domains (P<.001); and EQ-5D-5L composite profile score (P=.009) and visual analogue scale, P<.001. Cost (British pounds 2018) per case detected was £171; mean cost per cure (excluding medication) was £702±188. Excellent real-world SVRs in PWUDs with significant improvement in HRQoL can be achieved at modest costs. Project ITTREAT endorses community-based integrated services to help achieve HCV elimination.

The Journey of Drug Dependent Persons Cared by Jail Nurses

Nurses are hired to care for drug dependents who undergone rehabilitation. These nurses do not have sufficient training to care for the drug dependents. Having exposed to an environment where nurses are not competent in drug-dependent care may cause the drug-dependent persons to react and behave differently. Hence, this study is would like to explore live experience of drug-dependent persons cared by nurses in drug rehabilitation centers. Utilizing qualitative research design specifically the descriptive phenomenological approach, the investigation revealed the following interpretive themes which aroused from their lived experiences: (a) concerned/thoughtful nurse emanates from counselling, instructing, and solicitous nurse, (b) upholding professionalism that stems from safeguarding care, warranting care, and comforting care, (c) depicting a robust behaviour that derives from reinforcing, ranting and raspy behaviour, and (d) dedicated nurse that comes from devoted, steadfast, and warm-heartedness. These lived experiences of drug-dependents shows the significant essences that may convey drug-dependent persons being cared by jail nurses.

Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England.

People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres in England. HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. England-specific epidemic with 40% prevalence of chronic HCV among PWID. PWID attending drug treatment centres. Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway. Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding. Over 50years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030. Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.

An exploratory study of culture in treatment for Aboriginal Australian men in residential drug and alcohol rehabilitation services

The objectives of the research are to describe the cultural activities offered in residential drug and alcohol rehabilitation for Aboriginal Australian men, along with client perceptions of the benefits associated with these cultural activities. Participants were 101 Australian Aboriginal male clients attending five residential drug and alcohol rehabilitation services in New South Wales. Participants completed a semi-structured interview and questionnaires that included the Growth and Empowerment Measure, the Aboriginal Cultural Engagement Survey, Clinical Global Impressions, and two questionnaires regarding cultural engagement while in treatment. Service users indicated that the most beneficial cultural activities offered within services were traditional art/craft, culturally-focused talks/meetings, and being on the land. Hierarchical multiple regression analysis indicated that cultural engagement in everyday life significantly predicted empowerment but not other measures of mental ill-health. The opinions of service users are presented, and recommendations are made regarding ways to enhance the effectiveness of cultural activities within drug and alcohol rehabilitation programs.

Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review.

BackgroundMore than 18 million Americans are currently suffering from alcohol use disorder (AUD): a compulsive behavior of alcohol use as a result of a chronic, relapsing brain disease. With alcohol-related injuries being one of the leading causes of preventable deaths, there is a dire need to find ways to assist those suffering from alcohol dependence. There still exists a gap in knowledge as to the potential of telemedicine in improving health outcomes for those patients suffering from AUD.ObjectiveThe purpose of this systematic review was to evaluate the measures of effectiveness, efficiency, and quality that result from the utilization of telemedicine in the management of alcohol abuse, addiction, and rehabilitation.MethodsThis review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles used in this analysis were gathered using keywords inclusive of both telemedicine and alcohol abuse, which were then searched in the Cumulative Index to Nursing and Allied Health Literature, Cochrane, and MEDLINE (PubMed) databases. A total of 22 articles were chosen for analysis.ResultsThe results indicated that telemedicine reduced alcohol consumption. Other common outcomes included reduced depression (4/35, 11%), increased patient satisfaction (3/35, 9%), increase in accessibility (3/35, 9%), increased quality of life (2/35, 6%), and decreased cost (1/35, 3%). Interventions included mobile health (11/22, 50%), electronic health (6/22, 27%), telephone (3/33, 14%), and 2-way video (2/22, 9%). Studies were conducted in 3 regions: the United States (13/22, 59%), the European Union (8/22, 36%), and Australia (1/22, 5%).ConclusionsTelemedicine was found to be an effective tool in reducing alcohol consumption and increasing patients’ accessibility to health care services or health providers. The group of articles for analysis suggested that telemedicine may be effective in reducing health care costs and improving the patient’s quality of life. Although telemedicine shows promise as an effective way to manage alcohol-related disorders, it should be further investigated before implementation.

High Accuracy Ultra Wideband Real Time Location System for Drug Rehabilitation Center

High Accuracy Ultra Wideband Real Time Location System for Drug Rehabilitation Center

Narrating the Unspeakable

The use of psychedelic substances has been described as an ‘unspeakable primary experience,’ one that is personal and ultimately indescribable. The ineffable quality of such an experience, however, does not prohibit or invalidate attempts to explain it. The struggle to narrate one’s experience is instead an important endeavor. But, how does narration work if the psychedelic experience is truly unspeakable? What kind of narratives are possible? What kinds of narrative work do psychedelics foreclose? This article addresses these questions by analyzing narratives generated about the use of psychedelics for drug treatment. Drawing on 16 months of ethnographic research at drug treatment centers in Baja California, Mexico, this article examines what narration looks like in the context of a psychedelic-based drug treatment modality. It pays particular attention to how people in treatment retell – or struggle to retell – their experiences with psychedelics to make sense of them and then articulate them for the researcher. I argue that psychedelic experiences pose a unique challenge for the anthropological study of these substances, particularly their therapeutic use. I show how these experiences resist narrativization in multiple ways, presenting both ethnographic and epistemological obstacles to the production of anthropological knowledge.

Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial.

Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8weeks and 6.5months follow-up. Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016. Thirty-two eligible services (provided face-to-face client sessions to ≥50 clients/year) in Australia were randomized to control (usual care; n=15) or intervention (n=17) groups by an independent blinded biostatistician. Eligible participants (≥ 16years, current smoker) completed surveys at the service at baseline (n=896) and telephone follow-up surveys (conducted by blinded assessors) at 8weeks (n=471; 53%) and 6.5months (n=427; 48%). Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent. At 8weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR)=1.72, 95% confidence interval (CI)=0.5-5.7, P=0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8weeks [incidence rate ratio (IRR)=0.88, 95% CI=0.8-0.95, P=0.001] but were similar at 6.5 months (IRR=0.96, 95% CI=0.9-1.02, P=0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use. Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.

The Community Resiliency Model®: a Pilot of an Interoception Intervention to Increase the Emotional Self-Regulation of Women in Addiction Treatment

Addiction is associated with trauma, and a body-based approach may help attenuate the long-term impacts of trauma, including addiction and mental disorders. The Community Resiliency Model® (CRM) is a novel, simple, body-based set of sensory awareness skills, which focus on “felt-sense” or interoception. We provided a single 5-h Community Resiliency Model® class in an urban drug treatment center for impoverished women in the Southeastern US. Using a pre-post mixed methods design, we collected data from 20 women on well-being, physical symptoms, anger, depression, anxiety, and spirituality. The post-test revealed that participant somatic complaints, anger, and anxiety symptoms had declined significantly, with a moderate to large effect size; well-being increased significantly, with a small effect size. Participants found the skills and concepts of CRM helpful and shared them with others. CRM is a feasible, inexpensive, and acceptable training that may be valuable for persons with addictions.

Psychosocial Problems and Its Associated Factors among Individual Residing in Drug and Alcohol Rehabilitation Centers

Introduction: Psychosocial problems among substance abusers are one of the important, challenging public health problems in a worldwide context which is often remain unrecognized and left untreated. This study aims to identify the psychosocial problems and its associated factors among individuals residing in drug and alcohol rehabilitation centers.&#x0D; Methods : A cross-sectional analytical study was conducted among 271 participants from January to July 2019 who are residing in four different rehabilitation centers in Kathmandu. A standard tool ‘Drug Use Screening Inventory – Revised (DUSI-R)’ was used to assess psychosocial problem with face to face interview method. Data were entered in Epi-Data and analyzed using SPSS.&#x0D; Results: Majority of the participants (54.2%) had secondary level education. Most of the participants (43.5%) were unemployed and were found to be involved in substance abuse. The majority of the family member of the participant (62.7%) didn't use alcohol. The starting age of most of the participants (94.5%) who were using drugs was less than 25 years. The mean score of DUSI-R tools was found to be 48.89. The majority of the participants were using alcohol, which was easily available in the market. It was also found that the psychosocial problem was associated with age and education. The psychological problem is seen in less than half (46.1%) of the participant and found to be more prevail in below 30 years of age group and mostly who are in secondary level of education.&#x0D; Conclusions: About half of the participants residing in rehabilitation center had psychosocial problem. Secondary level education period is a crucial time to be more aware where students are at greater risk of having substance abuse including psychosocial problem.

Cognitive Distortion and Resilience Among Female Muslim Clients at A Drug Treatment and Rehabilitation Centre in Kelantan

The unhealthy style of thinking affects the behavior of an individual. Having low self-esteem is also one of the causes for many women getting caught up in drug addiction issues. It is particularly alarming that women's involvement in the issue of drug addiction in Malaysia is increasing. Hence, this quatitative study involving 123 subjects was conducted to examine the level of Cognitive Distortion and Resilience among Muslim female clients in a drug treatment and rehabilitation center in Kelantan. The findings of this study showed that clients who have cognitive distortion were low and moderate while self-esteem was at high and moderate levels. It was found that there was no significant mean difference of CDS and resilience based on Al-Quran reading competence and academic qualification. It was also found that there was an indirect insignificant correlation between cognitive distortion and resilience.It is hoped that this study will provide awareness to the community about the importance of choosing a healthy mindset in facing any challenge. It is hoped that this study will also inspire the drug treatment and rehabilitation centers to focus more on counseling towards positive thinking and enhancing resilience of clients in order to reduce their relapse rate.