Treatment Program Research Articles

Changes in the Success and Characteristics of Tobacco Dependence Treatment before and during the COVID-19 Pandemic: Clinical Sample Comparisons.

Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy use, and the success rate. The aim of our study was to compare the number of patients who entered tobacco dependence treatment programmes and evaluate the one-year success rate in patients three years before and three years after the COVID-19 pandemic. Materials and Methods: A single-site retrospective cohort study using data from patients treated at the Centre for Tobacco Dependence in Prague, Czech Republic, between 2017 and 2022 (n = 2039) was performed. The one-year abstinence rate was validated by measuring carbon monoxide in exhaled air (6 ppm cut-off). Patients were divided into two groups: the group for which treatment was initiated in 2017-2019 (i.e., before the COVID-19 pandemic, BC; n= 1221) and the group for which treatment was initiated in 2020-2022 (i.e., during the COVID-19 pandemic, DC; n = 818). Results: No significant differences in the success rate of tobacco dependence treatment were found between the two groups (BC group, 40.5% (494/1221) vs. DC group, 42.2% (345/818)) (χ2 (1, N = 2.039) = 0.6, p = 0.440). Furthermore, differences were not found in sex, education level, age at first cigarette, the duration of pharmacotherapy use, or the number of in-person visits. In contrast, there was an increase in the number of telephone contacts between the groups (18.7% (SD = 17.5%) vs. 32.9% (SD = 18.2%), p < 0.001). Conclusions: The number of patients who started treatment during the COVID-19 pandemic decreased by one-third compared to that during the 3-year period before the pandemic. The overall treatment success rate did not change significantly even with the increase in the number of telephone visits with the therapist.

On the Value of Measuring Recent Drug Use by Self-Reports and Urinalysis in Clinical Trials

Background: Valid measurement of drug use in patients enrolled in clinical trials that treat substance use disorder is vital to determine the trial’s outcome. Self-reports are often used but their validity has been studied with mixed results. Urinalysis may sometimes be employed as an alternative or supplement to self-reports. Objectives: This study examined how estimating drug use by either method would affect the results from a randomized clinical trial conducted in a methadone treatment program. At the initial Baseline interview and four follow-up interviews, participants were asked about their drug use history and provided a urine specimen for drug testing. Results: In most cases, the urinalyses detected more drugs than the patients had reported using. A major exception was heroin, whose use was an eligibility criterion for enrollment in the study and methadone treatment. Conclusions: The patients’ self-reports would have led us to conclude that the use of heroin and fentanyl had declined from the initial Baseline interview to the final follow-up interview, while the urinalysis results indicated no change in exposure to heroin and an increase in exposure to fentanyl. Clinical trials would be well served to employ the use of biological tests in addition to self-reports to measure recent drug use and to accurately estimate the efficacy of the experimental protocols and patients’ exposure to drugs.

California's Recovery Incentives Program: Implementation strategies

IntroductionDue to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California's Contingency Management Benefit. MethodsThe Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch. ResultsThe present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program. ConclusionThe California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.

Formulation-based cognitive behavioral therapy compared to an active control and a waitlist in adult inmates with ADHD: study protocol for a randomized controlled trial

BackgroundRecent literature suggests that ADHD is a risk factor for the development of antisocial behavior that is more severe and persistent than in community and other psychiatric populations. The combination of stimulant medication and psychotherapy (particularly cognitive behavioral therapy, CBT) is considered an evidence-based intervention for adults with ADHD. In contrast, few studies have evaluated the efficacy of medication in adult prisoners with ADHD, and the literature on the efficacy of psychotherapy is virtually nonexistent. Therefore, this article presents the protocol of a trial that will assess the efficacy of a formulation-based CBT program for inmates with ADHD.MethodsThe study has a multicenter randomized controlled trial design. After screening and recruitment, participants will be randomly assigned to the CBT intervention, a general offender treatment program, or a waitlist. Pre- and post-treatment self-report and clinician-report assessments, as well as 6- and 12-month follow-up assessments will be conducted. These will include both clinical (e.g., ADHD symptoms, depression and anxiety symptoms, self-esteem, alcohol/drug abuse, treatment adherence, quality of life) and criminological (e.g., recidivism and risk of recidivism) measures. Linear mixed models will be used to assess differences between groups.DiscussionThis study may be the first to evaluate the efficacy of a psychotherapy intervention in adult inmates with ADHD. It is expected that addressing the specific needs of ADHD would not only result in the previously reported clinical improvements (e.g., reduction in ADHD and comorbidity symptoms), but also reduce the risk and rate of recidivism compared to the general intervention or no intervention. However, the design may be limited by the difficulties inherent in the prison setting and in following up the sample after release.Trial registrationClinicalTrials.gov NCT06080373. Registered on October 12, 2023.

Епідеміологічні дані, етіологія, патогенез, фактори ризику, клінічні прояви, сучасні методи діагностики і лікування, прогнозування перебігу Неходжкінських лімфом (огляд літератури)

Non-Hodgkin lymphoma (NHL) is a group of malignant diseases characterized by clonal proliferation of lymphoid cells corresponding to different stages of differentiation of normal B- and T- lymphocytes or natural killer (NK) cells. NHL is histopathologically and clinically diverse and divided into two groups: B-cell lymphomas and T-cell lymphomas, and subtypes: indolent (slow) and aggressive, classic and extranodal. The etiology of NHL is environmental, infectious, immunological, iatrogenic and genetic factors. The pathogenesis of NHL consists in: 1) translocations of oncogenes; 2) cytogenetic aberrations and mutations of tumor suppressor genes. Clinical manifestations of NHL: 1) lymphadenopathy; 2) symptoms of the presence of an extranodal tumor (abdominal pain; jaundice; shortness of breath and/or pleural effusion; bleeding, symptoms of gastrointestinal obstruction; symptoms associated with infiltration by lymphoma cells of the skin, thyroid gland, salivary glands, etc.; neurological symptoms of central and/or peripheral origin); 3) symptoms of bone marrow infiltration; 4) general symptoms (fever, night sweats, weight loss, fatigue, loss of appetite). Diagnosis of NHL involves: 1) auxiliary research (histological, immunohistochemical, cytogenetic and molecular, use of more specific monoclonal antibodies, immunophenotypic diagnosis, gene sequencing); 2) diagnostic tactics (estimation of stage and determination of prognostic factors according to IPI); 3) differential diagnosis (covers other causes of symptoms). The choice of treatment program for NHL depends on the type of lymphoma and the patient's condition. The main methods of treatment: wait and watch; monotherapy with alkylating drugs; RT; combined РCT; combined РCT with the use of purine analogs; therapy with monoclonal antibodies; PCT+monoclonal antibodies; HDCT+THSC. Survival prognosis for NHL depends on the origin of the tumor and its stage.

Impulsivity, trauma history, and interoceptive awareness contribute to completion of a criminal diversion substance use treatment program for women.

In the US, women are one of the fastest-growing segments of the prison population and more than a quarter of women in state prison are incarcerated for drug offenses. Substance use criminal diversion programs can be effective. It may be beneficial to identify individuals who are most likely to complete the program versus terminate early as this can provide information regarding who may need additional or unique programming to improve the likelihood of successful program completion. Prior research investigating prediction of success in these programs has primarily focused on demographic factors in male samples. The current study used machine learning (ML) to examine other non-demographic factors related to the likelihood of completing a substance use criminal diversion program for women. A total of 179 women who were enrolled in a criminal diversion program consented and completed neuropsychological, self-report symptom measures, criminal history and demographic surveys at baseline. Model one entered 145 variables into a machine learning (ML) ensemble model, using repeated, nested cross-validation, predicting subsequent graduation versus termination from the program. An identical ML analysis was conducted for model two, in which 34 variables were entered, including the Women's Risk/Needs Assessment (WRNA). ML models were unable to predict graduation at an individual level better than chance (AUC = 0.59 [SE = 0.08] and 0.54 [SE = 0.13]). Post-hoc analyses indicated measures of impulsivity, trauma history, interoceptive awareness, employment/financial risk, housing safety, antisocial friends, anger/hostility, and WRNA total score and risk scores exhibited medium to large effect sizes in predicting treatment completion (p < 0.05; ds = 0.29 to 0.81). Results point towards the complexity involved in attempting to predict treatment completion at the individual level but also provide potential targets to inform future research aiming to reduce recidivism.

Targeting emotion dysregulation in depression: an intervention mapping protocol augmented by participatory action research

BackgroundDepression is a highly prevalent and often recurrent condition; however, treatment is not always accessible or effective in addressing abnormalities in emotional processing. Given the high prevalence of depression worldwide, identifying and mapping out effective and sustainable interventions is crucial. Emotion dysregulation in depression is not readily amenable to improvement due to the complex, time-dynamic nature of emotion; however, systematic planning frameworks for programs addressing behavioral changes can provide guidelines for the development of a rational intervention that tackles these difficulties. This study proposes an empirical and theoretical art-based emotion regulation (ER) intervention using an integrated approach that combines intervention mapping (IM) with participatory action research (PAR).MethodsWe used the IM protocol to identify strategies and develop an intervention for patients with major depressive disorder (MDD). As applied in this study, IM comprises six steps: (a) determining the need for new treatments and determinants of risk; (b) identifying changeable determinants and assigning specific intervention targets; (c) selecting strategies to improve ER across relevant theories and research disciplines; (d) creating a treatment program and refining it based on consultations with an advisory group; (e) developing the implementation plan and conducting a PAR study to pilot-test it; and (f) planning evaluation strategies and conducting a PAR study for feedback on the initial testing.ResultsFollowing the steps of IM, we developed two frameworks for an art-based ER intervention: an individual and an integrative framework. The programs include four theory- and evidence-based ER strategies aimed mainly at decreasing depressive symptoms and improving ER in patients with MDD. We also developed a plan for evaluating the proposed intervention. Based on our preliminary PAR studies, the intervention was feasible and acceptable for adoption and implementation in primary care settings.ConclusionThe application of IM incorporated with PAR has resulted in an intervention for improving ER in depression. While changing behavior is perceived as a challenging and elaborate task, this method can be useful in offering a clear structure for developing rational interventions. Further refinement is necessary through rigorous research.

"My addiction doesn't define me": Healing from the stigma of addiction for mothers with opioid use disorder.

About 1 in 8 children under age 17 live with a parent who has a substance use disorder. Research on treatment access identifies stigma as a significant barrier to treatment, particularly among mothers with young children. Well-meaning but punitive state policies further perpetuate stigma, which harms families and children. Explore the experiences of the stigma of addiction on mothers before, during and after treatment for substance use disorder. Procedures/data/observations: Descriptive Phenomenology was used to describe the experiences of stigma of mothers with opioid use disorder (OUD) through all stages of treatment and recovery. Mothers (n=20) participating in an outpatient treatment program interviewed. A semi-structured interview schedule was used to guide the interviews and thematic analysis was used identify themes related to stigma. Our analysis identified several main themes and subthemes related to internal and external sigma, including stigma against medication for opioid use dis order, stigma from the public and healthcare professionals, internalized shame, and how mothers learned to recover and heal from stigma.

Legal framework for health policy to reduce the level of substance abuse in the United States

The purpose of this study was to identify and legally assess the key legal instruments and strategies employed in the United States of America to combat substance abuse and their impact on the development of national health policy in this area. The study used quantitative and qualitative methods of analysis, including the processing of statistical data on the financing of addiction prevention and treatment programmes, analysis of federal and regional legislative acts, and comparative analysis of the policies of different states on the regulation of psychoactive substances. The key findings showed a significant evolution of the legal approach to the problem of substance abuse. The study revealed a gradual shift from a purely punitive approach to a balanced strategy that combines elements of prevention, treatment, and harm reduction. Furthermore, the analysis of funding showed a 35% increase in federal support for prevention programmes between 2018 and 2022, which led to improved access to healthcare for drug users and the development of recovery programmes. The results of a comparative analysis of state policies on the regulation of psychoactive substances showed a considerable difference in approaches, specifically regarding the legalisation of marijuana, which creates legal and regulatory challenges due to contradictions between federal and local laws. Specifically, in states where marijuana is legalised for medical or recreational use, the level of trafficking offences has decreased, but questions arise concerning the regulation of cultivation and distribution. It was also found that the introduction of telemedicine has significantly increased the effectiveness of drug treatment in a pandemic, allowing more patients to be reached, but this approach needs further improvement in the field of regulation and control. The findings of the study point to the need for closer integration of prevention, healthcare, and legal measures at all levels of government, unification of legislation on the regulation of psychoactive substances at the federal and state levels, as well as decriminalisation of drugs for personal use, which can reduce the level of criminalisation of society and contribute to a more effective fight against substance abuse

Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation

BackgroundChildhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT). MethodCM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ). ResultsLinear mixed models showed no predictor or moderator effects for the CTQ total score (all p > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, p = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, p = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all p > .28). LimitationsLimitations include small sample sizes for some of the subsamples. ConclusionChildhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA. Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).

The Influence of COMBI Method on Stunting Incidents in Pamekasan Regency

Introduction: Stunting should be forestalled by coordinated treatment programs that incorporate designated and delicate healthful intercessions. These projects require cross-area collaboration and coordination at all administrative, private, and social levels. To quit stunting, an incorporated COMBI (Communication for Behavioral Impact) technique is required. The ineffectively planned plan set up makes it trying to facilitate, simply decide, and consider individuals responsible. The 20 individuals from the Union Group for the Speed increase of Lessening Stunting act as the populace and test for this review. The motivation behind this study is to learn what the COMBI approach means for the rate at which stunting episodes happen in Pamekasan Regency in 2024. Methods: This sort of study utilizes an example size of 20 respondents and a semi trial nonequivalent benchmark group plan. approaches for get-together information that utilization pre-and post. In the event that there was a massive contrast between the treatment gathering's and the benchmark group's posttest scores, the information was examined utilizing a free t test and the Standardize Quality Test (N-Gain score). Results: In light of the exploration discoveries, the COMBI method affects the information level of the stunting union group for the situation and control bunches in Pamekasan Regency (Sig. 0.042 &lt;0.05). It likewise affects the disposition of the case and control bunch stunting union group in Pamekasan Regency (Sig. 0.042 &lt;0.05). At long last, there is no impact of the COMBI method of Conduct Change Communication System with the activities of the stunting union group for the case and control bunches in Pamekasan Regency (Sig esteem). 0.061 &gt; 0.05. Conclusions: The COMBI approach, communication technique, and changing on a surface level all affect bringing issues to light and changing mentalities about rushing the decrease of stunting. This is seen from the remarkable decrease in stunting in the Pamekasan area.

Balance Impairment in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis.

Balance weaknesses related to mobility and fall risk in patients with rheumatic diseases are well-known. Vestibular dysfunction could negatively contribute to the balance ability of this patient population. This study aims to investigate the effects of Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS), among the most common rheumatic diseases, on postural balance related to vestibular function. Seventy-eight participants were grouped as RA (n=34, 43%), AS (n=24, 30.7%), and the control group consisted of healthy individuals (n=20, 25.6%). Cervical Vestibular Evoked Myogenic Potentials (cVEMP) test, which assesses the vestibular function objectively, Dizziness Handicap Inventory (DHI), which evaluates vertigo subjectively, and Berg Balance Scale (BBS) were performed. Different degrees of VEMP latency prolongations were found in the AS and RA groups. Right, and left ear N1 latencies were significantly longer in the AS group than in RA and control. Right ear P1 latency prolongation was statistically significant in the RA group. Amplitude asymmetry ratio (AAR) was found to be considerably higher in the RA and AS groups than in the control group (p<0.05). The mean BBS score in the AS group was below the fall risk score of 45. A negative statistically significant effect was observed between latency prolongation and BBS in AS groups. The abnormal VEMP findings in individuals with RA and AS shows inner ear vestibular system dysfunction. This vestibular impairment strictly contributes to their postural imbalance and requires a focused vestibular rehabilitation program for balance treatment.

Preservation of Muscle during Treatment for Obesity in Adults with Intellectual Disabilities.

Adults with intellectual disabilities will frequently experience sedentary behavior and excessive weight, which may cause or exacerbate a multitude of medical and behavioral problems. This study examined a program to encourage increased activity and weight loss in an outpatient service for adults with intellectual disabilities. Behavioral methods were used to treat obesity in 33 male and 21 female adults with intellectual disabilities for a mean of 9 months. They were retrospectively analyzed to determine the effects of treatment on muscle and adiposity using body composition analysis. The 54 participants of the original 122 (44.3%) who did not drop out were divided into three groups: weight loss ≥3 kg/3% (n = 20, 37%), weight loss <3 kg/3% (n = 17, 31.5%), and no weight loss or weight gain (n = 17, 31.5%). Only men and women who lost ≥3 kg/3%, demonstrated significant gain of relative muscle mass. Those who gained weight lost muscle mass. If motivation remains high and follow-up is reasonably long, then a multicomponent obesity treatment program can lead to significant weight loss with preservation of muscle in adults with intellectual disabilities.

An Indigenous-led buprenorphine-naloxone treatment program to address opioid use in remote Northern Canada

Background/purposeIn response to the opioid use challenges exacerbated from the COVID-19 pandemic, Fort Albany First Nation (FAFN), a remote Cree First Nation community situated in subarctic Ontario, Canada, implemented a buprenorphine-naloxone program. The newly initiated program was collaboratively developed by First Nations' nurses and community leaders, driven by the community's strengths, resilience, and forward-thinking approach. Using the First Nations Information Governance Centre strengths-based model, this article examines discussions with four community leaders to identify key strengths and challenges that emerged during the implementation of this program. Methodsthis qualitative study amplify the positive aspects and community strengths through the power of oral narratives. We conducted 20 semi-structured face-to-face interviews with community members who helped lead FAFN's COVID-19 pandemic response. Utilizing the Medicine Wheel framework, this work introduces a holistic model for the buprenorphine-naloxone program that addresses the cognitive, physical, spiritual, and emotional dimensions of well-being. ResultsRecommendations to support this initiative included the need for culturally competent staff, customized education programs, and the expanding of the program. Additionally, there is a pressing need for increased funding to support these initiatives effectively and sustainably. The development of this program, despite challenges, underscores the vital role of community leadership and cultural sensitivity to address the opioid crisis in a positive and culturally safe manner. ConclusionThe study highlights the successes of the buprenorphine-naloxone program, which was developed in response to the needs arising from the pandemic, specifically addressing community members suffering from opioid addiction. The timely funding for this program came as the urgent needs of community members became apparent due to pandemic lockdowns and isolation. Holistic care, including mental health services and fostering community relations, is important. By centering conversations on community strengths and advocating for culturally sensitive mental health strategies that nurture well-being, resilience, and empowerment, these findings can be adapted and expanded to support other Indigenous communities contending with opioid addiction.

Community-Based Medications First for Opioid Use Disorder - Care Utilization and Mortality Outcomes.

A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access. Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data. 825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days' supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine (all results p<0.05). Months with an emergency department overdose did not change. Months with an inpatient hospital stay increased (p<0.05). The annual death rate in the first year for the intervention group was 0.45% (3 out of 664) versus 2.2% (222 out of 9893) in the comparison group in the 12 months; a relative risk of 0.323 (95% CI 0.11-0.94). Findings indicated a significant increase in MOUD for the intervention group and a lower mortality rate relative to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical-fentanyl may have lessened the intervention impact as measured in the cohort analysis. Study findings support expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.

Impact of an 8-Week, Intensive Summer Treatment Program on Improving Coercive Caregiver-Child Interactions Among Children With and Without Callous Unemotional Traits

The coercive process is the primary explanatory mechanism implicated in the maintenance of disruptive behavior disorders (DBDs), and understanding the coercive cycle may be especially important for caregivers with children with elevated callous-unemotional (CU) traits. The purpose of the current pilot study is twofold. First, we assessed whether the Summer Treatment Program (STP), an established intensive behavioral intervention for children with DBDs, reduced coercive caregiver-child interactions using a novel parent-report measure of coercive interactions. We then sought to assess whether the STP improved coercive caregiver-child interactions among children with elevated CU traits (i.e., moderated the effect). Thirty-three caregivers and their children who had been diagnosed with DBDs participated in the STP, which involved the children receiving behavior modification for 9 hours per day and caregivers attending a weekly behavioral parent training group session over the course of 8 weeks. Children (Mage = 8.51 years old, SD = 1.70, range 6–12) were primarily male (78.5%) and Hispanic/Latine (84.8%). A linear multilevel model revealed a statistically significant improvement in caregiver-child coercive interactions from pre- to posttreatment. However, child pretreatment CU traits moderated this effect such that families with children with elevated CU traits did not show improvement in caregiver-child coercive cycles following treatment. Results suggest the benefits of intensive behavioral treatment on the caregiver-child coercive cycle for many families, but the need to modify the intensity or dose of treatments for those with children with DBDs and elevated CU traits.

To Explore the Rule and Mechanism of Traditional Chinese Medicine in the Treatment of Postmenopausal Osteoporosis Based on Data Mining, Network Pharmacology and Molecular Docking Technology

Postmenopausal osteoporosis (PMOP) is an important part of primary osteoporosis, and the current clinical treatment program for PMOP is easily limited by side effects and adverse reactions, so it is particularly important to seek more efficient, safe, and economical drug treatment for PMOP. In recent years, with the change of disease treatment mode and the gradual deepening of Traditional Chinese medicine (TCM) research on PMOP, a review of the literature reveals that there is a huge number of studies on the use of TCM in the treatment of PMOP, but there are no relevant systematic studies on the rules of its formulas and the specific mechanisms by which the core drugs exert their therapeutic effects. Therefore, in this study, we collected a total of 141 formulas used by TCM clinicians to treat PMOP, statistically analyzed their high-frequency medications, Four Qi, Five Flavors, meridians, and efficacies, and analyzed the core medications based on the association rules, which were Rehmanniae Radix Praeparata, Epimedium, Eucommia ulmoides, Rhizoma Drynariae, Angelica sinensis, Achyranthes, Astragalus propinquus, Psoralen, Cornus officinalis and licorice. A total of 87 drug pairs were obtained from the correlation analysis, and a total of 8 groups of potential core combination drugs and 4 potential new prescriptions were derived based on the cluster analysis. Subsequently, a network pharmacological analysis of the core drugs was conducted to obtain 173 active ingredients in the core drugs, including kaempferol, β-sitosterol, quercetin, etc. 298 targets of action, including MAPK3, STAT1, HSP90AA1, etc. 170 signaling pathways including AGE-RAGE, PI3 K/Akt, TNF, HIF-1 and others. The molecular docking results showed that 11 key active ingredients in the core drugs had stable binding to the target targets. This study showed that TCM treatment of PMOP is mainly based on “reinforcing liver and kidney, warmly invigorating spleen and stomach, activating blood and resolving stasis.” Core drugs therapy for PMOP is a comprehensive intervention through multi-component, multi-target, and multi-pathway approaches. The minimum binding energies between the 11 key active ingredients and the 11 key targets were calculated in a comprehensive analysis, which shows that the core drugs have good binding activities to their therapeutic targets, proving that the predictions of this study are reliable. In the future, it will provide certain medication basis and data support for TCM treatment of PMOP.

Ethical Issues in Treating Substance Use Disorders: Counselor Perspectives

ABSTRACT Ethical issues arise frequently in the treatment of substance use disorders (SUD). Counselors need guidance to navigate ethical dilemmas but receive limited training in resolving ethical issues. To narrow the gap between the ethical dilemmas counselors face and their training, this qualitative study assessed ethical issues that counselors encounter, how they resolve them, and desired training. We conducted qualitative individual interviews with 20 front-line counselors working in two SUD treatment programs, presenting brief vignettes that depicted the ethics code of the national organization representing SUD counselors. The interviews asked open-ended questions about how counselors dealt with issues and their ideas for future ethics training. All participants had encountered ethical dilemmas. Areas of concern included confidentiality and privacy, mandatory reporting, fairness/equity, client-counselor boundaries, tensions between workplace and client welfare, and meeting clients’ complex needs. Ways participants resolved ethical issues included consultations, using direct approaches to resolve ethical dilemmas, and commitment to providing client-centered care. Useful training in the workplace was sparse. Participants expressed needs for ongoing support to resolve workplace ethical dilemmas. Although the importance of ethical issues is widely acknowledged in treating SUD, this study underscores the need for ongoing and interactive training and supervision about ethical issues.

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting

IntroductionThe Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide...

Efficacy of a Meichenbaum-Based Treatment Program for Enhancing Psychological Immunity and Reducing Social Anxiety in Secondary School Students

Objective: The purpose of this study was to design a psychological treatment program based on Meyer's theory to increase psychological resilience and reduce social anxiety among secondary school students in Riyadh. Methods: A total of 973 secondary school students participated in the initial assessment, which revealed a 24.8% decrease in psychological resilience and a 23.7% increase in social anxiety. Out of this group, 28 students between 16 and 20 years (= 17 years) were randomly selected and divided into an experimental group and a control group. The treatment program was made for the current experiment only for the experimental group. Results: This proved to be true through the differences noted in the scores on the dimensional assessments, where the experimental group had increased extents of psychological resilience and reduced social anxiety. As a result, there were no statistically significant differences between the dimensional and follow-up assessments of psychological resilience as well as social anxiety levels within the experimental group. Conclusion: The study's outcomes demonstrated a positive impact of the intended psychological treatment program, leading to an increase in psychological readiness among the secondary school students in the group and a decrease in social anxiety levels. It presents an opportunity that supports developmental, preventive, and therapeutic approaches towards students' mental health and disorders, specifically severe social anxiety.