Outpatient Addiction Treatment for Problematic Alcohol Use: What Makes Patients Who Dropped Out Different from Those Who Did Not?

BACKGROUND: A minority of individuals with problematic alcohol use effectively seek help. Moreover, dropouts from care are not uncommon. It remains a major concern for health professionals, as adherence to treatment is significantly associated with better physical and psychological outcomes. OBJECTIVES: The main aim of this research was to assess what factors could distinguish patients with problematic alcohol use who dropped out from those who did not. METHODS: The sample included 150 patients followed-up in an outpatient treatment center in France for a problematic alcohol use. Two measurement times were planned: at the first appointment and after six month of treatment. A large set of individual, environmental and institutional variables were considered to compare both subgroups. RESULTS: Patients who dropped out mostly differ from patients who did not with a higher level of alcohol-related problems, ambivalence, inclinations to use the substance, number of missed appointments. Significant results were also observed regarding a lower time gap between the first contact with the center and the first appointment, as well as the season of the last appointment. CONCLUSIONS: Tailored motivational interventions could be offered to ambivalent patients, especially during the beginning of the treatment and some significant periods of the year. A particular focus should be brought on patients presenting such profiles in terms of level of alcohol problems, inclinations to drink and motivation to change. Overall, the study provides elements to better understand what may bring one patient to drop out of the treatment, and to improve the continuity of care.

Mediation of time perspectives on inclinations to use alcohol and motivation to change relationship.

OBJECTIVES: Trajectories of change accompanying alcohol-specialized care can be affected by numerous variables. Massive urges to drink can substantially hamper personal motivation to change. However, time perspective could also play an indirect role in this association. This research explores whether time perspectives mediates the relationship between inclinations to use or not to use alcohol and patients' motivation to change. DESIGN: The sample included 150 outpatients in care for their problematic alcohol use. Models of mediation were planned. RESULTS: At the entry in care, three specific time perspectives, Past Negative, Present Fatalistic, and Future, acted as discrete mediators. CONCLUSIONS: These findings highlight underlying mechanisms connecting inclinations to use or to avoid the substance and the patient's motivation to change. Time perspective could also be an interesting intervention target in existing alcohol-specialized treatment programs.

Initiation of Addiction Treatment and Access to Services: Young Adults' Accounts of Their Help-Seeking Experiences.

Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.

Feasibility of Combining Transcranial Direct Current Stimulation and Active Fully Embodied Virtual Reality for Visual Height Intolerance: A Double-Blind Randomized Controlled Study.

BACKGROUND: Transcranial Direct Current Stimulation (tDCS) and Virtual Reality Exposure Therapy (VRET) are individually increasingly used in psychiatric research. OBJECTIVE/HYPOTHESIS: Our study aimed to investigate the feasibility of combining tDCS and wireless 360° full immersive active and embodied VRET to reduce height-induced anxiety. METHODS: We carried out a pilot randomized, double-blind, controlled study associating VRET (two 20 min sessions with a 48 h interval, during which, participants had to cross a plank at rising heights in a building in construction) with online tDCS (targeting the ventromedial prefrontal cortex) in 28 participants. The primary outcomes were the sense of presence level and the tolerability. The secondary outcomes were the anxiety level (Subjective Unit of Discomfort) and the salivary cortisol concentration. RESULTS: We confirmed the feasibility of the association between tDCS and fully embodied VRET associated with a good sense of presence without noticeable adverse effects. In both groups, a significant reduction in the fear of height was observed after two sessions, with only a small effect size of add-on tDCS (0.1) according to the SUD. The variations of cortisol concentration differed in the tDCS and sham groups. CONCLUSION: Our study confirmed the feasibility of the association between wireless online tDCS and active, fully embodied VRET. The optimal tDCS paradigm remains to be determined in this context to increase effect size and then adequately power future clinical studies assessing synergies between both techniques.

[Process of change in patients with concurrent substance use - mental health problems]. / Processus de changement chez des patients avec une concomitance toxicomanie-santé mentale.

This paper is a retrospective study with a five year follow-up which examines the variations in substance use and the determinants of these variations. This exploratory research studied a sub-sample of 22 participants, selected from an initial sample of 197 patients with concurrent substance use and other mental health disorders. At the quantitative level, the statistical analysis shows an improvement in the problematic use of alcohol and drugs but no change in psychological state, health, family and interpersonals relations, as well as employment. At the qualitative level, the analysis of the participant's subjective view indicates that the two main elements of progression in substance use are the effects and the availability of substances. The main elements of reduction in substance use are the use of services, the personal techniques developed by participants, the family network, physical health, lack of financial resources, "occupational" activities, and a process of maturation.

Factor Structure Evaluation of the French Version of the Digital Natives Assessment Scale.

"Digital natives" concept defines young adults particularly familiar with emerging technologies such as computers, smartphones, or Internet. This notion is still controversial and so far, the primary identifying criterion was to consider their date of birth. However, literature highlighted the need to describe specific characteristics. The purpose of this research was to evaluate the factor structure of a French version of the Digital Natives Assessment Scale (DNAS). The sample of this study includes 590 participants from a 6-week massive open online course and from Web sites, electronic forums, and social networks. The DNAS was translated in French and then back-translated to English. A principal component analysis with orthogonal rotation followed by a confirmatory factorial analysis showed that a 15-item four-correlated component model provided the best fit for the data of our sample. Factor structure of this French-translated version of the DNAS was rather similar than those found in earlier studies. This study provides evidence of the DNAS robustness through cross-cultural and cross-generational validation. The French version of the DNAS appears to be appropriate as a quick and effective questionnaire to assess digital natives. More studies are needed to better define further features of this particular group.

Drinking motives and alcohol consumption behaviors among young French people.

INTRODUCTION: Numerous studies suggest that social, enhancement, conformity and coping drinking motives each lead to unique behavioral patterns related to alcohol consumption. Recently it has been suggested to study specific coping motives that distinguish feelings of anxiety and depression. This study aims primarily to 1) psychometrically validate the recent five factor questionnaire of drinking motives among young French people, 2) explore differences in mean endorsements of motives across age and sex and 3) explore the concurrent validity of drinking motives by studying their associations with alcohol consumption behaviors. METHODS: The French Modified Drinking Motives Questionnaire Revised and the Alcohol Use Disorders Identification Test were administered to 314 university students and 193 high school students. RESULTS: The 5-factor model of drinking motives provided a good fit to the data and a better fit than the 4-factor model. Conformity motives were more strongly endorsed among high school students than among university students (d=0.26). Social motives were more endorsed by men than by women (d=0.47), as were enhancement motives (d=0.48). Our study suggests that each of the studied motives transcribes a specific set of drinking behaviors. CONCLUSIONS: Researchers and practitioners could effectively use this conception of drinking motives in order to better understand and prevent problematic alcohol use among young people.