Health outcomes among detoxification patients: The role of chronic pain.

Understanding associations between chronic pain and health outcomes among detoxification patients may help improve treatment outcomes and abstinence rates. Exercise is a modifiable lifestyle factor that may reduce the effect of pain on outcomes in this population. The current study examined whether baseline pain, exercise, and their interaction were associated with psychiatric and medical severity, and abstinence self-efficacy, over six months following detoxification. Participants were veteran patients in alcohol or opioid detoxification treatment (N = 298) who were followed for six months (91.1%). Psychiatric severity and abstinence self-efficacy improved over the six months after detoxification; medical severity was stable. More intense pain at baseline was associated with poorer psychiatric and medical outcomes during the post-detoxification period. Regular exercise at baseline was associated with less psychiatric severity and more abstinence self-efficacy during the post-detoxification period. A significant pain by exercise interaction at baseline indicated that regular exercise was associated with more abstinence self-efficacy during the post-detoxification period only among participants with less intense pain. Pain by exercise interactions was not significant for the outcomes of psychiatric and medical severity. Among detoxification patients, exercise may be beneficial in improving outcomes among those with less intense pain.

Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes.

Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.

Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review.

Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes.

The effects of alcohol expectancy priming on group bonding.

According to alcohol expectancy theory, drinking-related information is stored in memory and, when cue activated, influences alcohol-related behavior. Priming of alcohol cues and expectancies has been shown to elicit both drinking and nonconsumptive behavior associated with alcohol consumption, such as willingness to meet with a stranger and aggression. These social influence effects have been shown to be moderated by individual differences in alcohol expectancies. In the present study, we tested whether an alcohol prime would facilitate social group bonding even in the absence of consumption, and whether such group bonding would be moderated by individually held social expectancies. One hundred twenty undergraduates (75% female) completed an alcohol expectancy measure prior to participation. Participants were primed with either alcohol or neutral beverage words and completed a collaborative group activity followed by questionnaires measuring perceived group cohesion. Several interactions were found between condition and expectancy reflecting that those in the alcohol prime condition with higher social alcohol expectancies reported greater cohesion on task-related, but not emotion-related, group measures. These findings underscore the complexity of the impact of expectancy and social behavior on drinking: the priming of alcohol expectancies may activate aspects of pro-social behavior, which may influence drinking, which in turn may feedback to positively reinforce social expectancies.

Explicit and implicit measures of expectancy and related alcohol cognitions: a meta-analytic comparison.

Implicit measures assess the influence of past experience on present behavior in the absence of respondents' awareness of that influence. Application of implicit measurement to expectancy and related alcohol cognition research has helped elucidate the links between alcohol-related experiences, the functioning of alcohol-related memory, and alcohol-related behavior. Despite these advances, a coherent picture of the role of implicit measurement has been difficult to achieve because of the diversity of implicit measures used. Two central questions have emerged: Do implicit measures assess a distinct aspect of the alcohol associative memory domain not accessible via explicit measurement; when compared with explicit measurement, do they offer unique prediction of alcohol consumption? To address these questions, the authors conducted a meta-analysis of studies using both implicit and explicit measures of alcohol expectancy and other types of alcohol-related cognition. Results indicate that implicit and explicit measures are weakly related, and although they predict some shared variance in drinking, each also contributes a unique component. Results are discussed in the context of the theoretical distinction made between the 2 types of measures.