Inpatient Detoxification Research Articles

Cannabidiol as a treatment for craving and relapse in individuals with cocaine use disorder: a randomized placebo-controlled trial.

ABSTRACTBackground and AimsCocaine use disorder (CUD) is a significant public health concern for which no efficacious pharmacological interventions are available. Cannabidiol (CBD) has attracted considerable interest as a promising treatment for addiction. This study tested CBD efficacy for reducing craving and preventing relapse in people with CUD.DesignSingle‐site double‐blind randomized controlled superiority trial comparing CBD with placebo.Setting and ParticipantsCentre Hospitalier de l'Université de Montréal, Canada. Seventy‐eight adults (14 women) with moderate to severe CUD participated.InterventionParticipants were randomly assigned (1 : 1) by stratified blocks to daily 800 mg CBD (n = 40) or placebo (n = 38). They first underwent an inpatient detoxification phase lasting 10 days. Those who completed this phase entered a 12‐week outpatient follow‐up.MeasurementsPrimary outcomes were drug–cue‐induced craving during detoxication and time‐to‐cocaine relapse during subsequent outpatient treatment.FindingsDuring drug–cue exposure, craving scores [mean ± standard deviation (SD)] increased from baseline by 4.69 (2.89) versus 3.21 (2.78) points, respectively, in CBD (n = 36) and placebo (n = 28) participants [confidence interval (CI) = −0.33 to 3.04; P = 0.069; Bayes factor = 0.498]. All but three participants relapsed to cocaine by week 12 with similar risk for CBD (n = 34) and placebo (n = 27) participants (hazard ratio = 1.20, CI = 0.65–2.20, P = 0.51; Bayes factor = 0.152). CBD treatment was well tolerated and associated mainly with diarrhoea.ConclusionsCBD did not reduce cocaine craving or relapse among people being treated for CUD.

Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness

Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.

Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial.

Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol-dependent patients are lacking. In this study a 1-year automatic mobile phone-based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual. Multi-center, randomized, controlled, two parallel-group, observer-blinded trial. Primary and secondary care: four hospitals and community (1million residents, 7600km2 area in Germany). A total of 462 patients with alcohol dependence (ICD-10) were included during inpatient detoxification treatment. Patients were randomly assigned (1:1) to an SMS intervention and treatment as usual (SMS+TAU; n=230; mean age: 45.4years; 22.6% women) or TAU alone (n=232 mean age: 44.5years; 22.8% women). Planned, automated messages were sent to patients over 1year to record assistance needs. A 'yes' or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center. The primary end-point was a three-category alcohol consumption measure covering months 10-12 after discharge: abstinence, non-heavy drinking, heavy drinking [men >60g/day; women >40g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption]. Secondary end-points were number of abstinent days over 12months and frequency of abstinence. The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU-only group 32.3%) in months 9-12. This is reflected by an odds ratio (OR)=1.68, 95% confidence interval (CI)=1.11-2.54, P=0.015 for heavy drinking versus non-heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR=1.13). These results were confirmed by models adjusting for randomization strata. In Germany, a 12-month mobile phone short messaging service-based intervention enhanced the reduction in heavy drinking for 1year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.

E-cigarette use and beliefs among adult smokers with substance use disorders

BackgroundWe explored characteristics and beliefs associated with e-cigarette use patterns among cigarette smokers requiring inpatient detoxification for opioid and/or alcohol use disorder(s). MethodsAdult cigarette smokers (≥18 years), admitted to inpatient detoxification for alcohol and/or opioid use disorder(s) in a safety-net tertiary referral center in New York City were surveyed in 2015 (n = 158). Descriptive statistics (proportions) were used to assess for demographic, clinical diagnosis, cigarette smoking patterns (exclusive and dual use of e-cigarettes). Chi-square, t-test statistics, and logistic regression models were used. ResultsAmong our sample of combustible cigarette users, 13.9% (n = 22) reported dual use with electronic cigarettes. Dual use did not differ by demographic or clinical variables. Compared to exclusive smokers, dual users were more likely to have tried to quit in the past year (Adjusted Odds ratio = 8.59; CI: 2.58, 28.35; p < 0.001). Dual smokers had significantly higher mean ratings perceiving that e-cigarettes can help people quit smoking compared to exclusive smokers (M = 3.7, SD= ±1.4 vs. M = 2.7, SD= ±1.5, p = 0.002) respectively. Dual users also preferred e-cigarettes over nicotine patches /gum for quitting (M = 3.7, SD= ±1.7 vs. M = 2.6, SD= ±1.6, p = 0.005). ConclusionsE-cigarette use seems to be appealing to a small proportion of cigarette smokers with SUD. Although, dual smokers seem to use e-cigarettes for its cessation premise, they don’t appear to be actively seeking to quit. E-cigarettes may offer a more effective method for harm reduction, further evaluation of incorporating it within smoking cessation protocols among patients in addiction treatment is needed.

An alternative analysis of illicit opioid use during treatment in a randomized trial of extended-release naltrexone versus buprenorphine-naloxone: A per-protocol and completers analysis

BackgroundThe distinct pharmacological properties and clinical uses of extended-release naltrexone (XR-NTX) and sublingual buprenorphine-naloxone (BUP-NX) present challenges in analyzing patient outcomes. MethodsWe conducted a secondary analysis of a multi-site randomized trial comparing XR-NTX with sublingual BUP-NX treatment for opioid use disorder initiated during inpatient detoxification and continued in outpatient treatment. Urine testing data for non-study opioids from the last 22 weeks of the 24-week trial were analyzed in both a per-protocol sample (n = 474 participants who received at least one dose of medication) and a completers sample (n = 211 participants who received all XR-NTX doses or all BUP-NX prescriptions). The present analyses sought to identify differences in the weekly percentages of opioid-positive urine tests between participants treated with the two medications. ResultsThe proportion of opioid-positive tests in both conditions was less than 20 % for 21 of the 22 weeks in the per-protocol sample and all 22 weeks in the completers sample. Generalized linear mixed model analyses revealed a significant treatment (XR-NTX vs. BUP-NX) X week (weeks 3–24) interaction in the per-protocol sample but not the completers sample. In the per-protocol analysis, the BUP-NX, compared to XR-NTX, had significantly greater proportions of opioid-positive tests in 14 out of the 22 weeks. ConclusionsLongitudinal modeling approaches that utilize flexible procedures for handling missing data can offer a different perspective on study findings. Results from the present analyses suggest that XR-NTX appeared to be somewhat more effective than BUP-NX in reducing illicit opioid use in the per-protocol sample.

Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor?

Background: For cannabis-dependent subjects, the relationship between cannabis withdrawal syndrome (CWS) severity and the urine cannabinoid concentrations are unclear; we investigated this using a commercial point-of-care (POC) enzyme immunoassay detecting 11-nor-9-carboxy-Delta-9-tetrahydrocannabinol (THC-COOH).Methods: Observational study of 78 adult chronic cannabis-dependent subjects assessed over a 24-day inpatient detoxification treatment, with 13 serial measurement days. Repeated Measures Correlation and Multilevel Linear Models were employed.Results: Absolute urinary THC-COOH levels significantly correlated with Marijuana Withdrawal Checklist (MWC) scores across the entire study duration (r = 0.248; p < 0.001). Correlation between serial creatinine-adjusted THC-COOH ratios and serial MWC scores emerged as significant only in the sample with higher MWC scores (>11 points) at admission (n = 21; r = 0.247; p = 0.002). The aforementioned significant relationships have persisted when replacing the absolute THC-COOH-levels with the (relative) day-to-day change in urinary THC-COOH levels. MWC scores were significantly correlated with the Clinical Global Impression-Severity (CGI-S; r = 0.812; p < 0.001). Females showed a significantly slower decline in urine THC-COOH levels and prolonged CWS course characterized by substantial illness severity (per CGI-S), occurring in nearly 30% of cases.Conclusion: Urine cannabinoid levels (THC-COOH) determined by POC assay significantly predicted CWS severity (moderate correlation), guiding detoxification treatment duration. In patients with MWC > 11 points upon admission, creatinine-adjusted THC-COOH ratios also significantly predicted CWS severity—again with moderate effect size. Females showed prolonged urinary THC-COOH elimination and cannabis withdrawal.

Factors associated with the absence of cocaine craving in treatment-seeking individuals during inpatient cocaine detoxification

ABSTRACT Background Anecdotal evidence suggests a substantial proportion of individuals with cocaine use disorder do not report craving during inpatient detoxification. Objective To examine prevalence and clinical correlates of consistent absence of cocaine craving among inpatients during detoxification. We hypothesized that craving absence would be associated with less severity of cocaine use, depression, and anxiety. Alternative explanations were also explored. Methods Craving absence (i.e., non-cravers) was defined as a daily score of zero across two separate craving visual analogue scales in each of the inpatient days. Participants scoring ≥1 on ≥1 day were considered cravers. Severity of cocaine use disorder as well as in-treatment depression and anxiety were assessed. Alternative contributors included presence of cocaine and other substances in urine at admission, in-treatment prescription of psychotropic medications, treatment motivation, executive function, interoception, and social desirability. Results Eighty-seven participants (78.2% males) met criteria as either non-cravers (n = 29; 33.3%) or cravers (n = 58; 66.7%). Mean length of admission in non-cravers and cravers was, respectively, 10.83 and 13.16 days. Binary logistic regression model showed that non-cravers scored significantly lower than cravers on cocaine use during last month before treatment (OR, 95% CI; 0.902, 0.839–0.970), in-treatment depression (OR, 95% CI; 0.794, 0.659–0.956), and in-treatment prescribing of antipsychotics (OR, 95% CI; 0.109, 0.014–0.823). Model prediction accuracy was 88.9%. Conclusions One in three patients undergoing inpatient detoxification experienced absence of craving, linked to less pretreatment cocaine use, better mood, and decreased administration of antipsychotics. Findings may inform pretreatment strategies and improve treatment cost-effectiveness.

Associations between Childhood Abuse and Chronic Pain in Adults with Substance Use Disorders

Background: Both childhood abuse and chronic pain are common in people with substance use disorders (SUDs). Studies have found that exposure to childhood abuse is associated with chronic pain in adulthood; however, few studies have examined this association in people with SUDs. Objectives: This study aimed to characterize the association between childhood abuse and chronic pain presence and severity in adults with SUDs. Methods: Data were obtained from 672 treatment-seeking participants with SUDs on an inpatient detoxification unit. Regression models evaluated whether childhood physical or sexual abuse was associated with the likelihood of chronic pain and severity of several pain-related characteristics: pain catastrophizing, pain severity, and pain interference. Results: Childhood physical and sexual abuse were significantly associated with a greater likelihood of chronic pain in adulthood. In the adjusted analyses, childhood physical abuse was associated with worse pain severity, whereas childhood sexual abuse was associated with greater pain catastrophizing and worse pain interference. Conclusions: Childhood physical and sexual abuse were associated with a greater likelihood of chronic pain in adults with SUDs. Among those with chronic pain, exposure to childhood abuse was associated with a more severe symptom profile, characterized by greater pain severity, more catastrophic interpretations of pain, and more pain-related interference with daily life. People with SUDs and a history of childhood abuse may benefit from screening for pain and interventions to reduce pain catastrophizing. These findings highlight the importance of longitudinal research to understand mechanisms linking childhood abuse exposure to later pain and substance misuse.

High lifetime, but low current, prevalence of new psychotropic substances (NPS) use in German drug detoxification treatment young inpatients

BackgroundOver the last 15 years, a large number of new psychoactive substances (NPS) has been identified, with their use being associated with a range of acute medical and psychopathological complications. Conversely, NPS addictive liability levels have not been systematically assessed in clinical populations. Aims of the studyInvestigating the lifetime and current prevalence of NPS use in a sample of substance use disorder (SUD) patients admitted to an inpatient detoxification treatment centre. MethodsAssessment of previous/current NPS intake carried out with the means of standardised questionnaire based on the European version of Addiction Severity Index. ResultsSome 206 patients (males 77.1%; average age: 30.7 years-old; most typical diagnosis: opioid/polydrug dependence) participated to the survey. Roughly half (e.g. 111/206; 53.9%) of them reported a lifetime use of NPS, most typically synthetic cannabinoids. Conversely, the current prevalence of NPS use was 2.9%; no NPS dependence condition was diagnosed. Among NPS users, 56.3% reported severe side-effects such as heavy anxiety or psychotic experience, and 64% reported an aversion of ever using the respective NPS again, whilst 84.3% of those reporting a single NPS intake reported an aversion. DiscussionThe sharp contrast between lifetime prevalence of NPS use and prevalence of current use might be explained by the high frequency of severe side effects reported by NPS users.

Health-related quality of life and opioid use disorder pharmacotherapy: A secondary analysis of a clinical trial

ObjectiveTo examine the health-related quality-of-life (HRQoL) of persons with opioid use disorder (OUD) seeking treatment in an inpatient detoxification or short-term residential setting; continuing treatment as outpatients. MethodsWe conducted a secondary analysis of data from a clinical trial (N = 508) where participants were randomized to extended-release naltrexone or buprenorphine-naloxone for the prevention of opioid relapse. We used a generalized structural equation regression mixture model to identify associations of HRQoL (EQ-5D) trajectories, including latent characteristics, over the 24-week trial and 36-week follow-up period, among participants who reported HRQoL beyond baseline. This novel framework accounted for baseline and time-varying characteristics, while simultaneously identifying latent classes. ResultsWe identified two subpopulations: HRQoL "pharmacotherapy responsive" (82.3 %) and HRQoL "characteristic sensitive" (17.7 %). The pharmacotherapy responsive subpopulation was characterized by a shortterm HRQoL improvement and then stable HRQoL over time, and by a positive association between HRQoL and receiving pharmacotherapy in the past 30 days. The characteristic sensitive subpopulation was characterized by an initial improvement in HRQoL with a gradual decline over time, and no significant HRQoL response to pharmacotherapy. HRQoL changes over time in this subpopulation were more influenced by baseline demographic, socioeconomic, and psychosocial characteristics. ConclusionOur findings suggest that while HRQoL may be improved and sustained through targeted efforts to promote use of pharmacotherapy for many persons with OUD, an identifiable subpopulation may require additional services that address socioeconomic and psychosocial issues to achieve HRQoL benefits. Our analysis provides insight for improving individualized care for persons with opioid use disorder seeking treatment.

An Observational Study of Serum Brain Derived Neurotrophic Factor Levels in Patients with Alcohol Dependence during Withdrawal

ABSTRACT Brain-Derived Neurotrophic Factor (BDNF) is a neuropeptide that plays an important role in Central Nervous System development, plasticity, learning, and memory. Its role has been explored in alcohol-dependent patients, though the results have been inconclusive. Thus, we aimed to compare serum BDNF levels in alcohol-dependent patients during withdrawal with age and gender matched controls, and assess changes in BDNF levels in the initial abstinence period. BDNF levels of alcohol-dependent patients (n = 25) were compared with controls (n = 25) at baseline. Additionally, BDNF levels were measured in cases on days 5 and 10 of inpatient detoxification. BDNF levels of controls did not differ with cases on day 1, 5, or 10. But BDNF levels increased significantly during alcohol abstinence from baseline to day 10 (Pillai’s Trace F = 3.753, p = .039, partial η2 = 0.246), which may suggest its protective role. Thus, serum BDNF values may be potentially used as a biomarker to assess the abstinence state. However, longitudinal studies in different body samples is essential to better understand the role of BDNF in alcohol dependence.

Kratom Dependence and Treatment Options: A Comprehensive Review of the Literature.

Kratom, or Mitragyna speciosa Korth., is a tropical plant prevalent in Southeast Asia, and it is utilized as a traditional remedy for symptomatic relief of various illnesses. It has been labeled as an atypical opioid with significant narcotic-like properties, capable of inducing kratom dependence among those who misuse or abuse it. The prevalence of kratom use has drastically increased worldwide, raising concerns among healthcare providers, particularly regarding the availability of efficacious treatment options for kratom dependence. This manuscript provides a comprehensive narrative review of literature focusing on the psychoactive alkaloids of kratom, the possible neurobiological and pathophysiological models underlying the occurrence of kratom dependence, and the clinical presentations and effective treatment options available for kratom dependence. The psychoactive alkaloids of kratom, such as mitragynine (MG) and 7-hydroxymitragynine (7-HMG), act as partial mu opioid agonists and induce kratom dependence. As a result, regular kratom use leads to withdrawal symptoms on abstinence, along with craving, tolerance, and cross-tolerance to morphine. The psychological withdrawal symptoms reported include depressed mood, anxiety, restlessness, irritability, and feeling tense, while the physical withdrawal symptoms are myalgia and body ache, joint pain, lacrimation, running nose, yawning, insomnia, diarrhea, feverish sensation, loss of appetite, tremors, itching over the body, loss of concentration, and chills. Neonatal withdrawal symptoms, such as oral intolerance, restlessness, irritability, and vomiting, are also reported in newborns of women who are on regular kratom use. Sublingual buprenorphine-naloxone (Suboxone) is reported as a promising treatment for detoxification and maintenance replacement therapy for kratom-dependent users. Alternative treatments for in-patient detoxification include intravenous clonidine and a combination of oral dihydrocodeine and lofexidine. We conclude by adding a note on the research gap concerning kratom dependence, which future studies should focus on.

Measuring the Effectiveness of Benzodiazepine Prescriptions Control in Community Setting Using Prescription Drug Monitoring Program (PDMP).

Benzodiazepines have been widely prescribed for several years for the treatment of anxiety, insomnia, and post-traumatic stress disorder (PTSD). Benzodiazepines were meant to be for short term use but in clinical settings long term use has been the "norm" for the treatment. Benzodiazepines are known for addiction potential and have been involved in accidental overdose deaths. According to the National Institute on Drug Abuse (NIDA), there has been a tenfold increase in the number of deaths due to overdose from 1999 to 2017. Benzodiazepines contributed to staggering high figures of 11,537 deaths in 2017 alone. Kentucky was ranked 4th in overdose related deaths in 2015 by CDC. Seeing this rise in overdose deaths, our community mental health clinics (CMHC) took the initiative to protect the community by removing benzodiazepines from the approved formulary in all adult outpatient community mental health clinics (total six clinics) in 2016. This project was initiated to protect the community from overdose deaths. In order to see the decrease in the benzodiazepine prescriptions, we did a quarterly Kentucky All Schedule Prescription Electronic Reporting (KASPER) prescriber's reports to see the trend. The goal of this project was to monitor the trend of benzodiazepine prescription control in CMHC. Our hypothesis was implementation of CMHC "No Benzodiazepine" policy would decrease in the number of prescriptions. To implement this change, we made a committee to educate staff including physicians, APRN's and therapists. Patients were also educated and informed regarding benzodiazepine free policy. Education materials were posted in the clinics and handed over to patients. Patients were offered individual and group therapy sessions to learn coping skills to cope with their anxiety. Patients had the option of inpatient detoxification, if clinically indicated. No new patients were started on benzodiazepines and patients who were already on benzodiazepines were slowly titrated off. Slow titration over the course of a few months was done as needed and tolerated. Quarterly, prescriber's prescription reports were generated with the help of KASPER (KASPER is PDMP in the state of Kentucky). After analyzing quarterly reports over the span of 2years, we concluded that there was a total of 89% decrease in benzodiazepine prescriptions. We are hoping to reach close to 100% in the next few years. We conduct a Mental Health Statistics Improvement Program (MHSIP) which is a general patient satisfaction survey done annually. We used this data to monitor the change with this new policy. Open patients report was run to monitor any change in case load before and after the implementation of the policy. After compilation of the KASPER/ PDMP data of all the prescribers- MD's and APRN's, we found an 89% decrease in the number of benzodiazepines prescriptions over the span of 2years. We did the open patients report and did not find any decrease in case load. In 2016, there were 10,359 open patients and in 2018 there were 12,266 open patients. We reviewed the MHSIP general patient satisfaction survey that is done annually, and we did not find any major difference in overall satisfaction as compared to previous years. These practice- based interventions implementing harm reduction strategies suggest that, although it was a difficult task, with strict adherence to no benzodiazepine policy, we were able to achieve a stark drop in the number of benzodiazepine prescriptions, in the span of 2years, and have been able to continue to maintain the low numbers of benzodiazepine prescriptions.

Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment.

BackgroundAbout 15 years ago, a diverse group of new recreational psychotropic substances began to emerge, which were marketed for example as “legal highs,” “research chemicals,” or “designer drugs.” These substances were later subsumed under the label “Novel Psychoactive Substances” (NPS). Important NPS classes are cathinones, synthetic cannabimimetics, phenethylamines, and herbal drugs. The health care system for psychotropic substance use disorders (SUDs) traditionally focused on a few substances, such as alcohol, heroin, cocaine, amphetamines, or cannabis. Users of illicit substances often engage in polydrug use. However little is known about the prevalence of NPS use within the group of “classical” illicit substance users.ObjectiveWe investigated lifetime and recent use of NPS and other drugs in patients who underwent in-patient detoxification treatment from illicit drugs in Germany.MethodsIn a multicenter study with eight participating facilities, patients admitted to treatment underwent a standardized interview at admission, concerning their past and current substance use. The interview comprised classical substances of abuse, NPS, and rarely used substances such as LSD. In addition, participating sites had the opportunity to analyze their patients’ routine drug screenings by means of gas chromatography/mass spectrometry (GC/MS), which permitted detection of NPS.ResultsInterviews from 295 patients could be analyzed. Most patients were opiate dependent and multiple substance users. About 32% reported use of synthetic cannabimimetics during lifetime, but usually only a few times. An important reason for their use was that NPS were not detected by drug testing in prisons or drug treatment facilities. Cathinones, herbal drugs or other NPS had rarely been used during lifetime. NPS use during the last 30 days before admission was nearly zero. This was confirmed by urine analysis results. In contrast, lifetime and current use of opiates, alcohol, cocaine, benzodiazepines, and cannabis was high. In addition, 18% reported of regular unprescribed pregabalin use during lifetime, and 20% had recently used pregabalin.ConclusionPatients admitted to drug detoxification treatment showed multiple substance use, but this did not include NPS use. The diversion of legal medications such as pregabalin in this group is a serious concern.

Isolating the isolated: Implications of COVID-19 quarantine measures on in-patient detoxification treatment for substance use disorders

Isolating the isolated: Implications of COVID-19 quarantine measures on in-patient detoxification treatment for substance use disorders

Anxiety sensitivity and grit as mediators between childhood abuse and relapse risk for substance use

BackgroundChildhood abuse is prevalent in those with substance use disorders (SUDs), and can lead to adverse consequences, including relapse to substance use following treatment. ObjectiveTo determine whether anxiety sensitivity (AS) and grit mediate associations between childhood abuse and substance use relapse risk. Participants and settingPatients on an inpatient detoxification and stabilization unit seeking treatment for SUDs (N = 702). MethodsParticipants were administered self-report measures assessing childhood physical and sexual abuse (CPA/CSA), AS, grit, and relapse risk. A parallel mediation model was used to investigate the association between childhood abuse and relapse risk as mediated by AS and grit. ResultsAnxiety sensitivity was associated with greater relapse risk (β = 0.29, t = 8.24, p < 0.001). Indirect effects of CPA and CSA on relapse risk through AS were statistically significant (CPA: β = 0.05, 95 % C.I. = 0.02−0.08; CSA: β = 0.04, 95 % C.I. = 0.01−0.07), indicating AS significantly mediated effects of both CPA and CSA on relapse risk. Grit was not a mediator, however, higher grit score was significantly associated with decreased relapse risk (β = −0.17, t = −4.90, p < 0.001). ConclusionsAnxiety sensitivity may be an important construct linking child abuse to relapse risk. Although grit may not mediate the effect of child abuse on relapse risk, it may be clinically relevant to relapse risk. As this sample consisted of treatment-seeking adults, the generalizability of results to other populations is uncertain. Future studies should investigate interventions targeting these constructs in this population.

Clinical characteristics and treatment outcomes of women with heroin dependence in Johannesburg, South Africa.

There has been a steady increase in the number of women with heroin dependence in South Africa (SA). Data from developed countries suggest that women with substance use disorder have unique treatment needs. There are limited SA data on women with heroin dependence and their response to treatment. To describe the clinical and psychosocial characteristics of women entering inpatient rehabilitation for heroin dependence, determine the outcomes of treatment 3 and 9 months after rehabilitation, and compare these findings with male heroin users. We conducted a longitudinal study of 44 women with heroin dependence who were admitted to a rehabilitation facility in the West Rand Municipality of Gauteng Province, SA. The participants were assessed during admission and 3 and 9 months after leaving inpatient rehabilitation. Structured interviews measured changes in drug use, psychopathology, social functioning, injecting and sexual behaviour, criminality and general health. Statistical analysis of these outcomes and comparison between women and men at 3 months and 9 months was performed by a generalised estimating equation. Fixed and time-varying covariates were included in the models. At baseline, 40% of female participants were HIV-positive, 50% engaged in sex work, 27% were injecting heroin users, and 75% were diagnosed with a comorbid mental illness. Thirty-seven (84%) and 30 (68%) were re-interviewed at the 3- and 9-month follow-up points, respectively. Of these, 6 were abstinent from all substances at 3 months and 2 at 9 months. Compared with males, females had a higher prevalence of HIV infection (p=0.006) and mental illness (p=0.0002) at enrolment. At 9 months, women had similar levels of drug use and criminality to men but scored significantly worse in terms of general health, social function and risky sexual behaviour. Women with heroin dependence in Johannesburg have high rates of HIV infection and comorbid mental illness and low rates of abstinence after inpatient detoxification and psychosocial therapy. Women fared worse than men in many domains of treatment outcome. This study builds evidence for the need for gender-sensitive substance rehabilitation facilities in SA.

Methadone-Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness.

Treatment guidelines emphasize patients' readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone-assisted withdrawal in all settings. Time 2 (T2) was a 6-month follow-up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. At T1, inpatients had higher self-efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self-efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. Self-efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. These findings advance existing literature and knowledge by highlighting the importance of self-efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry). (Am J Addict 2021;30:11-20).

A Short History of Managing Problematic Users of Alcohol in Western Australia by Mental Health Services

Abstract. Aims: This paper examines the role that mental health services (MHS) performed in the management and provision of medical care and treatment of problematic users of alcohol in Western Australia (WA) over the period since 1900. Methods: The research involved an examination of legislative enactments and regulations, records of parliamentary debates in Hansard, administrative records in the State Records Office, and other sources of public information, such as departmental annual reports, reviews of services, studies and newspapers. Results: This research identified three eras of policy involving problematic users. The first, from 1900 to the mid 1970s, focussed on controls in inebriates and lunacy legislation to create a regime of civil commitment, designed to confine and compel ‘inebriates’, as well as ‘convicted inebriates,’ to ‘dry out’ and rehabilitate. The second, between 1975 and the late 1990s, involved the creation of a state-wide system of specialist service providers to provide treatment and recovery for problematic users. The system involved a spectrum of services that included a detoxification hospital, outpatient clinics and community-based regional services established and operated by a statutory public health agency, the Alcohol and Drug Authority (ADA). The third era, which commenced in the late 1990s, involved the transfer of all community-based services from the ADA to ‘not-for-profit’ non-government organisations (NGOs). The end result of this devolution was the ADA retained only a limited treatment role, as the operator of the inpatient detoxification facility. The balance of its functions were redefined in relation to the prevention of the use of alcohol and other drugs, primarily through support of mass public education programs, as well as oversight of funded NGO programs. The paper concludes with a consideration of a recent major development which involved administrative and legislative actions in 2015 to abolish the statutory body which had operated since 1975 and transfer administrative responsibility for drug and alcohol services into the Mental Health Commission.

Comparing views on civil commitment for drug misuse and for mental illness among persons with opioid use disorder

Despite the growing use of civil commitment for drug use disorders, little is known about attitudes among individuals who might be subject to civil commitment. This study examined attitudes of persons with opioid use disorder toward civil commitment for drug misuse and for psychiatric illness. Consecutive persons entering a brief, inpatient opioid detoxification (n = 254) were surveyed regarding their attitudes about civil commitment for mental illness and for drug use, and responses were compared by commitment type and by individual history of being civilly committed for opioid misuse. Participants endorsed high support for civil commitment (both psychiatric and drug misuse-related) when used to address risk of harm to self, to others, and of criminal activity. Respondents were more likely to support civil commitment for psychiatric disorders than for drug misuse, expressing higher support for civil commitment in general, higher agreement with the criteria used to justify civil commitment, and greater perceived efficacy of commitment. Individuals previously committed for opioid misuse were less likely to support drug misuse-related commitment on the basis of its perceived efficacy. These results suggest individuals with opioid use disorder hold more favorable views toward civil commitment for mental health disorders than for drug misuse, and reinforce the need for more research on the procedures and outcomes related to civil commitment for drug misuse.