Patients In Treatment For Addiction Research Articles

The Impact of COVID-19 on Substance Use and Related Consequences among Patients in Office-Based Opioid Use Disorder Treatment.

The COVID-19 pandemic led to increased substance-related morbidity and mortality and transformed care for opioid use disorder (OUD). We assessed the perceived impacts of the pandemic on substance use and related consequences among patients in office-based addiction treatment (OBAT). We recruited patients with OUD on buprenorphine from July 2021 to July 2022, with data collection at baseline and 6 months. Exposures of interest were the following 6 domains potentially impacted by COVID-19: personal or family infection, difficulty accessing healthcare/medication, economic stressors, worsening physical or mental health, social isolation, and conflicts/disruptions in the home. Outcomes were past 30-day alcohol and other substance use, increased use, and substance-related consequences at baseline and 6 months. Generalized estimating equations Poisson regression models quantified associations between increasing impact domain scores and relative risks of each outcome. All participants (N = 150) reported at least one domain negatively impacted by COVID-19 at both time points. Higher "worsening physical or mental health" domain scores were associated with increased relative risk of recent alcohol or drug use (adjusted risk ratio [aRR] 1.04, 95% confidence interval [CI]: 1.01-1.07). Relative risks of experiencing substance-related consequences increased with higher scores in the domains of economic stressors (aRR 1.07, 95% CI: 1.02-1.13), difficulty accessing healthcare/medication (aRR 1.11, 95% CI: 1.04-1.19), and worsening physical or mental health (aRR 1.08, 95% CI: 1.04-1.12). Among patients with OUD, stressors from COVID-19 were common. Three life domains impacted by COVID-19 appeared to be associated with consequential substance use, highlighting opportunities to address barriers to healthcare access and economic stressors.

Unsupervised short leave in forensic addiction treatment: Is there an influence on treatment progress?

Abstract Short leave is an integral part of forensic addiction treatment in Germany. Individuals with addiction problems who have offended can be admitted to forensic addiction treatment institutions to receive treatment for their addiction disorder and reduce their risk of reoffending. During this treatment, short leave is implemented to allow the practising of an abstinent lifestyle, enhance treatment motivation, and enable the individual to stay connected with the community. A critical step is the unsupervised short leave, which comes with benefits but also risks for the individual and the community. Short leave (especially unsupervised short leave) bears the risk of incidents such as new offences, drug relapses or absconding. This study examines the influence of unsupervised short leave on treatment progress. It builds on the methodology from a previous study of patients in forensic psychiatric hospitals and uses a pre-post design with follow-up. Furthermore, the impact of incidents during short leave on treatment progress is analysed. The sample consists of 157 patients in forensic addiction treatment in Germany. The results suggest that unsupervised short leave can enhance the treatment progress of patients in forensic addiction treatment. However, incidents during short leave can have a negative effect on treatment progress.

New Patients in Treatment for Opioid Addiction in Spain.

Patients seeking first time treatment for opioid consumption reflect the characteristics of the consumer population. This group has not been studied in Spain in decades. The objective of this study was to characterize the opioid user population seeking first time treatment (incidents) and compare them group with those with prior treatment (prevalents). Cross-sectional study (N = 3325) with patients with opioid addiction seeking care at public addiction centers in the Community of Madrid from 2017 through 2019. Differentiation and comparisons were carried out using bivariate analysis, adjusted by sociodemographic characteristics related and those related to substance use consumption in incident and prevalent patients. About 12.2% were incidents. Compared to prevalents, there were more foreigners (34.1% vs 19.1% P < .001), but with a better social network. Regarding opioid use, incidents were less likely to use injection (10.7% compared to 16.8% P = .008), but had greater daily frequency (75.8% vs 52.2%, P < .001). The age of initial consumption was greater (27 years vs 21.3 years, (P < .001)). About 15.5% of incidents sought care for non-heroin opioids, compared to 4.8% of prevalents (P < .001). Women sought care at twice the rate of men (29.3% vs 12.3%; P > .001). New patients presented a profile with many stable characteristics, but which highlighted an increase in the use of other opioids, as occurs in the international context. Surveillance of the new patient characteristics can serve as an early indicator of consumption changes in. Thus, periodic monitoring is important.

Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care Practitioner

Substance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services. To examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of LINKAGE with improved care engagement in the short term. In this post hoc analysis of a nonrandomized controlled trial, participants were assigned to the LINKAGE or usual care (UC) groups using a nonrandomized 3-month alternating off and on strategy over 30 months. Baseline through 5-year follow-up data were collected from April 2011 to October 2018. The trial was conducted at an urban outpatient addiction treatment clinic within a large health system among patients newly enrolled in addiction treatment. Data analysis was conducted from April 2021 to February 2022. The LINKAGE intervention included 6 group-based sessions emphasizing patient agency, skill, and motivation in navigating health care services as well as a facilitated telephone or email connection with a primary care practitioner. The UC group received medical education. Substance use problem discussions with primary care practitioners (by patient self-report at 1-, 2-, and 5-year follow-up interview) and annual use of the electronic patient portal, primary care, and ED based on electronic health records. A total of 503 participants, with a mean (SD) age of 42 (12) years, 346 (69%) male participants and 37 (7%) African American, 34 (7%) Asian, and 101 (20%) Hispanic participants, were assigned to LINKAGE (252 participants) or UC (251 participants). Compared with UC participants, LINKAGE participants were significantly more likely to discuss substance use problems with a primary care practitioner at 1-year follow-up (risk ratio [RR], 1.30; 95% CI, 1.03-1.65; P = .03) and use the electronic patient portal at 1- and 2-year follow-up (eg, messaging clinicians at 2 years: RR, 1.24; 95% CI, 1.04-1.47; P = .02). The LINKAGE group had small, statistically significant 5-year annual increases in primary care use (RR, 1.03; 95% CI, 1.003-1.07; P = .03) and significant annual decreases in substance-related ED use (RR, 0.79; 95% CI, 0.64-0.97; P = .03), relative to UC. The LINKAGE group did not significantly differ from the UC group on other types of ED utilization. In this study, a patient activation intervention embedded in outpatient addiction treatment was associated with sustained improvements in health care engagement beyond previously reported 6-month outcomes and with long-term improvements in health care use patterns. ClinicalTrials.gov Identifier: NCT01621711.

Addiction Treatment and Telehealth: Review of Efficacy and Provider Insights During the COVID-19 Pandemic.

Addiction treatment via telehealth expanded to unprecedented levels during the COVID-19 pandemic. This study aimed to clarify whether the research evidence on the efficacy of telehealth-delivered substance use disorder treatment and the experience of providers using telehealth during the pandemic support continued use of telehealth after the pandemic and, if so, under what circumstances. Data sources included a literature review on the efficacy of telehealth for substance use disorder treatment, responses to a 2020 online survey from 100 California addiction treatment providers, and interviews with 30 California treatment providers and other stakeholders. Eight published studies were identified that compared addiction treatment via telehealth with in-person treatment. Seven found telehealth treatment as effective but not more effective than in-person treatment in terms of retention, therapeutic alliance, and substance use. One Canadian study found that telehealth facilitated methadone prescribing and improved retention. In the survey results reported here, California addiction treatment providers said that more than 50% of their patients were being treated via telehealth for intensive outpatient treatment, individual counseling, group counseling, and intake assessment. They were most confident that individual counseling via telehealth was as effective as in-person individual counseling and less sure about the relative effectiveness of telehealth-delivered medication management, group counseling, and intake assessments. Telehealth may help engage patients in addiction treatment by improving access and convenience. Additional research is needed to confirm that benefit and to determine how best to tailor telehealth to each patient's circumstances and with what mix of in-person and telehealth services.

The Resilient Recovery from Substance Addiction: The Role of Self-transcendence Values and Hope

Background: Substance addiction is a psychosocial problem facing many people today. While the previous trend in addiction treatment was the harm reduction approach, nowadays it is fully recognized the importance of promoting human resources in order to help people to face the rehabilitation process, to prevent the risk of treatment dropout and future relapses, and to positively re-integrate them into the society. During the process of recovery from substance addiction, resilience is one of the most important protective factors against both dropouts and relapses. This study analyzed for the first time whether and the extent to which self-transcendence values (i.e., benevolence and universalism) promote resilience, considering the mediating role of hope, among patients in residential substance abuse treatment. Method: Seventy-six Italian patients in residential treatment for substance addiction (86.5% males and 13.5% females; M age = 40.23, SD = 10.88) participated to the study. Participants were asked to complete the Self-transcendence subscale from the Portrait Values Questionnaire, the Hope Scale, and the Connor Davidson Resilience Scale. Results: Findings showed that self-transcendence values were positively related to resilience and that hope fully mediated (in a positive direction) this relationship. Self-transcendence values promoted resilience through the mediating role of hope. Conclusions: This complex relationship suggests a holistic model of resilience during the process of recovery from substance addiction. Limitations of the study, practical implications, and future research developments are discussed.

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.

Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions

Introduction: Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment. Objective: The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction. Methods: We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months. Results: A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor. Conclusions: Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.

The Effect of Information Therapy on Treatment Adherence among Patients Referred to Addiction Treatment Centers.

BackgroundThe low level of drug adherence in addicts who are quitting is one of the biggest challenges in the treatment and management of this disease. Therefore, this study aimed to evaluate the effect of information therapy on adherence to treatment among the patients in addiction treatment centers.MethodsThe present quasi-experimental study was performed on 60 patients referred to addiction treatment centers in Jiroft City, Iran. The control and experimental groups were selected using simple random sampling method. The 8-item Morisky Medication Adherence Scale was used for data collection. The level of adherence to treatment was assessed before and after the intervention, which consisted of 6 one-hour training sessions per week.FindingsThe adherence to medication was low in both experimental and control groups before the notification. However, the chi-square value obtained by comparing the frequencies of the experimental and control groups in three variables of adherence level (high, moderate, and low) was 9.84 which was statistically significant (P = 0.007). Therefore, there was a significant difference between the experimental and control groups after information therapy. In fact, the information in the experimental group had a significant and positive effect.ConclusionBecause of the low level of adherence to treatment, it is recommended to use information therapy to give information on timely and correct use of drugs as well as its importance in the treatment of addiction; so that the level of adherence would improve.

An Ultra-Brief Mindfulness-Based Intervention for Patients in Treatment for Opioid Addiction with Buprenorphine: A Primary Care Feasibility Pilot Study.

Objectives: To demonstrate the feasibility and acceptability of a brief mindfulness-based intervention taught by physicians for patients with opioid addiction and to determine if the intervention reduces likelihood of relapse or treatment failure within 6 months. Design: A prospective, feasibility, single-group, cohort pilot study. Setting: A Family Medicine teaching clinic serving a mixed urban and rural population in Bangor, Maine. Subjects: Adult patients initiating outpatient treatment for opioid addiction with buprenorphine (N = 40). Interventions: Study physicians conducted a 10- to 12-min education session for all patients starting treatment during the enrollment period, including a 5-min mindfulness exercise. Enrolled subjects received an MP3 player loaded with six mindfulness audio exercises (5-19 min) and were instructed to practice at least 5 min daily and record their practice in a logbook. Outcome measures: Acceptability and subjective usefulness to recovery were evaluated at 2, 4, and 6 months of follow-up, with qualitative analysis of themes in recorded poststudy interviews. Logbook entries and tablet-based surveys provided data on home mindfulness practice, classified as "high" or "low." Relapse or treatment failure was documented. Results: Feasibility and acceptability were demonstrated with 82% enrollment and 100%, 97%, and 90% completion of follow-up visits at 2, 4, and 6 months, respectively, among those still in treatment. Sustained positive impressions of the intervention and exercises remained at 6 months. Relapse or treatment failure was reduced in the "high" practice uptake group compared with "low" practice uptake (11% vs. 42%, p = 0.033). Conclusions: In contrast to more intensive 8-week models of meditation training, this study demonstrates that even a brief single training session can induce sustained home meditation practice that subjectively helped patients in recovery for opioid addiction and was associated with lower risk of relapse. Brief mindfulness-based interventions may be useful to increase access to mindfulness training in this population.

Compliance with the Very Integrated Program (VIP) for Smoking Cessation, Nutrition, Physical Activity and Comorbidity Education Among Patients in Treatment for Alcohol and Drug Addiction.

Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29–0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00–1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.

Alcohol use disorder and associated factors among individuals living with HIV in Hawassa City, Ethiopia: a facility based cross- sectional study

BackgroundIndividuals living with HIV/AIDS with co-occurring harmful alcohol use may require specialized intervention or even multi-disciplinary team follow-up and management. This study was aimed to assess alcohol use disorder and associated factors among people living with HIV/AIDS in Hawassa city, Ethiopia, 2019.MethodsA facility based cross-sectional study was conducted among 195 people living with HIV/AIDS who had follow-up visit at Hawassa University Comprehensive Specialized hospital. A systematic sampling technique was used to recruit the study participants. Alcohol used disorders identification test (AUDIT) was used to measure alcohol consumption, drinking behaviors, and alcohol-related problems. The binary logistic regression model was used to see the association between alcohol use disorder (AUD) and the independent variables. The strength of association was measured by odds ratios with 95% confidence intervals. Statistical significance declared at P < 0.05.ResultsThe mean age of the study participants was 29.88 (±SD = 10.89) years. The magnitude of alcohol use disorder among people living with HIV/AIDS was 31.8%. Being male [AOR = 2.43, (95% CI: 1.76, 5.76)], having poor social support [AOR = 1.34, (95% CI: 1.12, 6.73)], being medication non-adherent [AOR = 1.78, (95% CI: 1.33, 6.79)], current khat chewing [AOR = 1.67, (95% CI: 1.16, 5.45)] and current cigarette smoking [AOR = 3.76, (95% CI: 2.16, 7.54)] had statistically significant association with alcohol use disorder.ConclusionIn the current study, magnitude of alcohol use disorder among people living with HIV was high and, calls for integrating services provided to HIV patients in HIV care and treatment clinic which enhances timely detection and management of AUD cases. This also alerts the stakeholders in HIV prevention and control programs to invest a greater efforts to retain patients in addiction treatment and rehabilitation centers. Lastly, appropriate screening and health education on consequences of alcohol use disorder is warranted.

Effects of an animal-assisted intervention on psychiatric in-patient addiction treatment - a pilot study

Animal-assisted therapies, especially with therapy dogs, are getting increasingly popular in inpatient psychiatric treatment. In the present pilot study, we examined how chronic and comorbid patients in psychiatric addiction treatment assess this form of therapeutic support. Pre-post-evaluation of the intervention variable "therapy dog" in a prospective, naturalistic setting. Without intervention 50 patients, with intervention 52 patients were requested to answer a questionnaire on topics covering social interaction / ward atmosphere, emotional competences and pathological addiction behavior. The two studied groups differed highly significantly in most of the items on the topics social interaction / ward atmosphere, emotionality and addiction pathology, in favor of animal-assisted therapy. Also, the frequency of smoking and dealing with craving were significantly reduced in this group. Effect sizes were medium to high. Patients consider the presence of a therapy dog on a psychiatric addiction ward very positively. Ward atmosphere is experienced as more pleasant and patients see a possibility of behavioral change with respect to social and emotional competences.

Alcohol and Drug Overdose and the Influence of Pain Conditions in an Addiction Treatment Sample.

Overdose from alcohol and/or drugs kills tens of thousands of Americans annually, with a large number of deaths attributed to opioid pain medications. Addiction treatment patients are known to be at high risk for overdose; however, the relationship between pain and overdose history within this group is understudied, especially in relation to alcohol overdoses. In the present study, we evaluated whether nonfatal overdose history was more likely among addiction treatment patients with pain, and examined the characteristics of overdoses among those with and without pain. We analyzed cross-sectional data from 739 patients at a large residential addiction treatment center (median age 37, 25.7% female). We used 2-stepped binary regression models to evaluate whether demographics, pain type (chronic, acute, or both), depression symptoms, and opioid misuse were associated with lifetime history of nonfatal (1) alcohol and (2) drug overdose (lifetime yes/no), and conducted follow-up analyses examining overdose characteristics. In adjusted analyses, history of chronic pain (odds ratio [OR] 2.60, 95% confidence interval [CI] 1.59, 4.27) and illicit drug use (OR 1.99, 95% CI 1.07, 3.68) were associated with an increased likelihood of nonfatal alcohol overdose. Opioid misuse (OR 3.11, 95% CI 2.51, 3.86), depression symptoms (OR 1.33, 95% CI 1.14, 1.55), and younger age (OR 0.96, 95% CI 0.94, 0.97) were associated with increased likelihood of drug overdose. Those with pain reported a higher number of lifetime alcohol overdoses and were more likely to combine numerous drugs with alcohol before overdose. Pain conditions may play an under-recognized role in the overdose epidemic, particularly alcohol-related overdose. Addiction treatment and overdose prevention interventions should incorporate appropriate assessment and treatment of pain including education about the risks of polysubstance use, particularly combining alcohol with sedatives and prescription pain relievers.

Very Integrated Project (VIP): Smoking and other lifestyles, co-morbidity and quality of life in patients undertaking treatment for alcohol and drug addiction in Sweden

Background Most patients with alcohol and drug addiction have other risky lifestyles and non-communicable diseases (NCDs), adding to their morbidity and pre-mortality. Those are, however, potentially preventable. The aim was to identify and compare the patients in treatment for alcohol and drug addiction and identify important factors for high risk. Methods Data was collected prospectively by interviews, questionnaires, examinations and laboratory tests regarding demographics, smoking, overweight, malnutrition, sedentary lifestyle, heart, lung and liver diseases, diabetes and quality of life. High-risk was identified by &gt;2 NCDs and risky lifestyles. Results 322 (192 and 130) patients participated, aged 52 years in median (ranging 24-80) and 67% men. Only 7% had no other risky lifestyles and NCDs. 62% were smokers, 11% in risk of malnutrition, 36% physical inactive and BMI was 27 (17-50). Furthermore, 41% had cardiovascular illness, 27% liver and 25% respiratory diseases, and 7% diabetes. After adjustment for confounders, drug addiction was significantly associated to younger age (46 vs. 56 years; OR 0.92 [CI 0.89-0.94]), unemployment (85% vs 66%; 0.35 [0.17-0.72]) and liver disease (49% vs. 12%; 0.21 [0.11-0.40]). The high-risk group was significantly older and more often unemployed. Health-related quality of life was not different between the groups. Conclusion The large majority of patients in treatment for alcohol and drug addiction have common risky lifestyles and NCD comorbidity. They also have similar conditions, including quality of life. This may be important when planning a future very intergrated program (VIP) of health promotion.

Use of non-pharmacological strategies for pain relief in addiction treatment patients with chronic pain

We examined use of non-pharmacological treatments for pain in addiction treatment patients. Patients in addiction treatment with chronic pain (N = 501) were classified based on use of non-pharmacological pain treatments. Demographic and clinical correlates were compared. A total of 49% (N = 243) of patients used a non-pharmacological treatment in the past year versus 72% (N = 361) who used opioids. Non-pharmacological treatment users were more likely to use opioids and other pain medications. Non-pharmacological treatments are less commonly used than opioids by addiction treatment patients. Findings highlight the need to better understand pain treatment decision-making among addiction treatment patients. (Am J Addict 2017;26:564-567).

Linking Infectious and Narcology Care (LINC) in Russia: design, intervention and implementation protocol.

BackgroundRussia and Eastern Europe have one of the fastest growing HIV epidemics in the world. While countries in this region have implemented HIV testing within addiction treatment systems, linkage to HIV care from these settings is not yet standard practice. The Linking Infectious and Narcology Care (LINC) intervention utilized peer-led strengths-based case management to motivate HIV-infected patients in addiction treatment to obtain HIV care. This paper describes the protocol of a randomized controlled trial evaluating the effectiveness of the LINC intervention in St. Petersburg, Russia.Methods/designParticipants (n = 349) were recruited from the inpatient wards at the City Addiction Hospital in St. Petersburg, Russia. After completing a baseline assessment, participants were randomly assigned to receive either the LINC intervention or standard of care. Participants returned for research assessments 6 and 12 months post-baseline. Primary outcomes were assessed via chart review at HIV treatment locations.DiscussionLINC holds the potential to offer an effective approach to coordinating HIV care for people who inject drugs in Russia. The LINC intervention utilizes existing systems of care in Russia, minimizing adoption of substantial infrastructure for implementation.Trial Registration NCT01612455

Commentary on Guydish et al. (2016): The continuing deadly threat of tobacco use in addiction treatment.

Guydish and colleagues document the high prevalence of tobacco use among addiction treatment patients in many countries. Tobacco accounts for widespread premature mortality among individuals with addiction disorders, yet smoking cessation does not receive the attention it deserves in treatment settings. The bidirectional linkages between cigarette use and illicit substance use are well established. Tobacco misuse is a powerful marker for other substance use disorders in many populations, such as pregnant women 1. Tobacco use disorders are also pervasive comorbidities that accompany many other forms of substance use. Among US respondents in the 2013 National Survey of Drug Use and Health (NSDUH), 55% of those who reported illicit substance use in the past month also reported tobacco use during the same period. Smoking prevalence is higher among individuals who satisfy the criteria for alcohol and illicit drug disorders. The current systematic review by Guydish and colleagues underscores the importance of these linkages in a global context 2. These authors find a particularly high prevalence among patients receiving opiate addiction treatment, but find a high prevalence in almost all treatment populations for which data are systematically collected. Smoking cessation poses difficult challenges in addiction treatment, partly because smoking is so deeply embedded within these settings. Partly for that reason, tobacco use comprises a leading threat to life and health among individuals who experience a wide range of substance use disorders. Hurt and colleagues followed a cohort of in-patient addiction treatment patients. One hundred and nine of 214 attributable deaths occurred from tobacco-related causes 3 In similar fashion, Hser and colleagues performed a 24-year follow-up study of a patient cohort admitted to addiction treatment in 1964. The death rate among smokers was four times that found among non-smokers 4. Despite these findings, in many treatment organizations smoking cessation does not appear to be a high priority. High smoking prevalence among staff, passive staff attitudes regarding the intractability of smoking behaviors and limited access to smoking cessation treatments remain key obstacles to quitting within treatment populations 5. Cookson and colleagues’ survey of clients and staff associated with the South London and Maudsley NHS Foundation Trust underscores these difficulties. Eighty-eight per cent of clients and 45% of staff were current smokers. Fifty-six per cent of clients had never received assistance from clinicians with smoking cessation. Only 15% of clients received smoking cessation support during their current treatment stay, even though 79% expressed a desire to quit. Treatment staff rated smoking cessation as markedly less important than addressing clients’ use of other substances alongside their primary addiction 6 This pattern persists, despite evidence that smoking cessation interventions can be effective with this population within treatment settings without compromising other treatment goals 7. Analyzing 2004–05 US data, Friedmann and colleagues reported that only 41% of US out-patient treatment facilities offered smoking cessation counseling or pharmacotherapy 8; 38% offered individual/group counseling, and only 17% provided pharmacotherapy. Analyzing 2012 data, Shi and colleagues found similar results. Only 47% of the organizations surveyed offered behavioral counseling or pharmacotherapy for smoking cessation 9. Public policies can influence these practices. Shi and colleagues find that treatment facilities in US states that adopted strong tobacco control measures were more likely to offer smoking cessation services. Clinical guidelines and accreditation bodies can also play a helpful role 7. Policy findings in many other national settings are more sparse. Regulatory policies requiring addiction treatment providers to pay greater attention to smoking cessation deserve high priority in both services research and tobacco control policy. Guydish and collaborators perform an important service by drawing attention to this issue. The treatment community must improve its efforts to address this deadly and pervasive comorbidity. Millions of patients with addiction disorders seek help from the treatment system; whatever their treatment course and whatever their primary diagnosis, most have serious tobacco issues that are typically unaddressed. As a result, many will die prematurely of tobacco-related causes. We as a field can do much better. None.

Prevalence and differential profile of patients with drug addiction problems who commit intimate partner violence.

The objectives of this study were, first, to explore the prevalence of aggressors with lifetime intimate partner violence (IPV) among patients in the Proyecto Hombre of Navarra (Spain) addiction treatment programme; and second, to know the specific and differential characteristics of patients presenting IPV as aggressors. A sample of 162 patients (119 men and 43 women) was assessed. Data on socio-demographic and substance consumption characteristics, IPV variables, psychopathological symptoms, and personality variables were obtained. The profiles of patients in addiction treatment with and without a history of violence towards their partners were compared. The results showed that 33.6% of people in treatment for addiction had committed violence against their partners. This prevalence was significantly higher (χ(2) = 15.6, p < .001) in women (63.3%) than in men (24.2%). In the 98.4% of the cases the IPV was bidirectional. Patients with a history of IPV perpetration showed greater severity in substance consumption variables, psychopathological symptoms, and personality traits. Gender, the family scale on the European version of the Addiction Severity Index (EuropASI), and the aggressive-sadistic scale on the Millon Clinical Multiaxial Inventory (MCMI-III) were the main variables related to the presence of IPV as aggressors. There was a differential profile in patients with IPV perpetration, showing more psychopathological and personality symptoms. Moreover, in this study being a woman was one of the main predictors of committing IPV.

Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain

ObjectivesStudies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance. MethodsPatients in residential addiction treatment with comorbid pain (N=501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories. Results72% (N=360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid (AOR 0.50, 95% CI 0.38–0.68 for a one SD increase in pain acceptance) and heroin use (AOR 0.57, 95% CI 0.44–0.75 for a one SD increase in pain acceptance). ConclusionsProblematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders.