RESUMEN
INTRODUCTION: Sleep disturbance is common during methamphetamine (MA) use and withdrawal; however, the feasibility of combined subjective-objective measurement of sleep-wake has not been shown in this population. Actigraphy is a well-established, non-invasive measure of sleep-wake cycles with good concordance with polysomnography. This study aimed to investigate the feasibility and utility of using actigraphy and sleep diaries to investigate sleep during MA withdrawal. METHODS: We conducted a feasibility and utility study of actigraphy and sleep diaries during a clinical trial of lisdexamfetamine for MA withdrawal. Participants were inpatients for 7 days, wore an actigraph (Philips Actiwatch 2) and completed a modified Consensus Sleep Diary each morning. Participants were interviewed between days 3-5. RESULTS: Ten participants (mean age 37 years, 90% male) were enrolled. No participant removed the device prematurely. Participants interviewed (n = 8) reported that the actigraph was not difficult or distracting to wear or completion of daily sleep diary onerous. Actigraphic average daily sleep duration over 7 days was 568 min, sleep onset latency 22.4 min, wake after sleep onset (WASO) 75.2 min, and sleep efficiency 83.6%. Sleep diaries underreported daily sleep compared with actigraphy (sleep duration was 56 min (p = 0.008) and WASO 47 min (p < 0.001) less). Overall sleep quality was 4.4 on a nine-point Likert scale within the diary. CONCLUSIONS: Continuous actigraphy is feasible to measure sleep-wake in people withdrawing from MA, with low participant burden. We found important differences in self-reported and actigraphic sleep, which need to be explored in more detail.
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Dimesilato de Lisdexanfetamina , Síndrome de Abstinencia a Sustancias , Humanos , Masculino , Adulto , Femenino , Estudios de Factibilidad , Dimesilato de Lisdexanfetamina/efectos adversos , Sueño , Polisomnografía , Actigrafía , Síndrome de Abstinencia a Sustancias/diagnóstico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológicoRESUMEN
BACKGROUND: This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth). METHODS: At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30-35 for those with and without a history of methamphetamine use prior to age 30. RESULTS: After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03-1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02-1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21-6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use. CONCLUSION: Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.
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Trastornos Relacionados con Anfetaminas , Metanfetamina , Psicosis Inducidas por Sustancias , Trastornos Psicóticos , Recién Nacido , Humanos , Niño , Adulto , Metanfetamina/efectos adversos , Psicosis Inducidas por Sustancias/epidemiología , Psicosis Inducidas por Sustancias/etiología , Cohorte de Nacimiento , Nueva Zelanda/epidemiología , Factores de Riesgo , Trastornos Relacionados con Anfetaminas/epidemiología , Trastornos Relacionados con Anfetaminas/complicaciones , Trastornos Psicóticos/etiología , Trastornos Psicóticos/complicaciones , Estudios LongitudinalesRESUMEN
Background: Methamphetamine is a highly addictive central nervous stimulant associated with numerous adverse health, psychological, and social impacts. Family and friends of people who use methamphetamine often take on a crucial caregiving role in supporting their loved one. Consequently, they can experience a range of psychosocial challenges themselves. This review aimed to identify and assess the effectiveness of interventions designed to support caregivers of people who use methamphetamine. Methods: A systematic search of relevant literature published in the English language was conducted. Of 2257 records identified, only 2 evaluation studies examined interventions specifically designed for caregivers of people who use methamphetamine. Additionally, four qualitative accounts described experiences of caring for people who use methamphetamine. These accounts were summarized narratively to provide a more complete picture of family and caregiver experiences and coping strategies. Results: Effective treatment components included tending to caregiver concerns and providing training to enhance informational support and problem-solving skills. Qualitative accounts uncovered a range of challenges experienced by caregivers, such as emotional distress, concern for the person using methamphetamine, disrupted family structures, and financial difficulties. Coping strategies included attempts at managing and supporting the person using methamphetamine while protecting the overall cohesion and wellbeing of the family unit. Conclusions: This review highlighted a lack of evidence-based interventions for caregivers of people who use methamphetamine. More research is needed to clarify concerns that may be particularly relevant for those in a caregiving role.
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Cuidadores , Metanfetamina , Adaptación Psicológica , Cuidadores/psicología , Familia/psicología , Amigos/psicología , Humanos , Metanfetamina/efectos adversosRESUMEN
BACKGROUND: Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs. AIMS: This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined. METHOD: A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders. RESULTS: The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04-0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results. CONCLUSIONS: A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.
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Trastornos Relacionados con Anfetaminas , Metanfetamina , Psicosis Inducidas por Sustancias , Trastornos Psicóticos , Adulto , Trastornos Relacionados con Anfetaminas/complicaciones , Trastornos Relacionados con Anfetaminas/diagnóstico , Trastornos Relacionados con Anfetaminas/epidemiología , Australia/epidemiología , Femenino , Humanos , Metanfetamina/efectos adversos , Estudios Prospectivos , Psicosis Inducidas por Sustancias/epidemiología , Psicosis Inducidas por Sustancias/etiología , Trastornos Psicóticos/psicologíaRESUMEN
We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.
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Anfetaminas/efectos adversos , Trastornos Relacionados con Cocaína/mortalidad , Cocaína/efectos adversos , Adolescente , Adulto , Anfetaminas/uso terapéutico , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/mortalidad , Estimulantes del Sistema Nervioso Central/uso terapéutico , Trastornos Relacionados con Cocaína/epidemiología , Trastornos Relacionados con Cocaína/prevención & control , Inhibidores de Captación de Dopamina/efectos adversos , Femenino , Infecciones por VIH/inducido químicamente , Infecciones por VIH/mortalidad , Hepatitis C/inducido químicamente , Hepatitis C/mortalidad , Humanos , Incidencia , Masculino , Trastornos Mentales/inducido químicamente , Trastornos Mentales/mortalidad , Persona de Mediana Edad , Prevalencia , Virosis/sangre , Virosis/inducido químicamente , Virosis/mortalidad , Adulto JovenRESUMEN
BACKGROUND: Positive psychotic symptoms have consistently been associated with methamphetamine use but the presence of a negative symptom cluster remains unclear. We used exploratory factor analysis to examine whether a discrete negative syndrome could be delineated among methamphetamine users, and to examine the clinical correlates of this syndrome. METHOD: Participants (Nâ¯=â¯154) were people who used methamphetamine at least monthly and did not meet DSM-IV diagnostic criteria for lifetime schizophrenia. Scores on the Brief Psychiatric Rating Scale for the past month were subject to exploratory factor analysis. Latent class analysis was applied to resultant factor scores to determine whether negative and positive factors were experienced by the same participants. Past-month substance use measures were days of use for each drug type and methamphetamine dependence assessed using the Severity of Dependence Scale. RESULTS: We articulated a three-factor model including 'positive/activation symptoms' (e.g. suspiciousness, hallucinations, conceptual disorganisation, tension), 'affective symptoms' (e.g. depression, anxiety) and 'negative symptoms' (e.g. blunted affect, motor retardation). Positive-activation and affective symptoms (but not negative symptoms) were positively correlated with past month days of methamphetamine use (râ¯=â¯0.16; râ¯=â¯0.25) and severity of dependence (râ¯=â¯0.24; râ¯=â¯0.41). Negative symptoms were correlated with heroin (râ¯=â¯0.24) and benzodiazepine use (râ¯=â¯0.21). Latent class analysis revealed a three-class model comprising a positive-symptom class (44%, high positive-activation, low negative symptoms), a negative-symptom class (31%, low positive-activation, high negative symptoms), and a low-symptom class (38%, low on all factors). CONCLUSIONS: A negative symptom syndrome exists among people who use methamphetamine, but this appears related to polysubstance use rather than forming a part of the psychotic syndrome associated with methamphetamine use. Overlooking the role of polysubstance use on negative symptoms may conflate the profiles of methamphetamine-associated psychosis and schizophrenia.
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Trastornos Relacionados con Anfetaminas/diagnóstico , Trastornos Relacionados con Anfetaminas/psicología , Estimulantes del Sistema Nervioso Central/efectos adversos , Metanfetamina/efectos adversos , Psicosis Inducidas por Sustancias/diagnóstico , Psicosis Inducidas por Sustancias/psicología , Adulto , Escalas de Valoración Psiquiátrica Breve , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Alucinaciones/inducido químicamente , Alucinaciones/diagnóstico , Alucinaciones/psicología , Humanos , Masculino , Persona de Mediana Edad , SíndromeRESUMEN
OBJECTIVES: The psychiatric symptom profile of methamphetamine-associated psychosis (MAP) has varied considerably across studies of different research designs. We performed a systematic review to examine the available evidence for specific psychotic symptoms associated with MAP, including the clinical course and longitudinal changes in this symptom profile. METHODS: Five key electronic databases were searched to identify studies that examined the symptom profile or clinical course of MAP in individuals identified as having MAP. The reporting of specific psychiatric symptoms, and duration of symptoms where available, was recorded for each study. RESULTS: Ninety-four articles were identified (n = 7387), including case-control (k = 29), cross-sectional (k = 20), experimental (k = 6), case report (k = 29), and longitudinal (k = 20) studies. Persecutory delusions, auditory and visual auditory hallucinations were by far the most commonly reported symptoms (reported in 65-84% of studies). Hostility, conceptual disorganization, and depression were reported in a large proportion of studies (31-53%). Negative symptoms were mostly absent (<20%). The median percentage of participants with persistent psychotic symptoms (>1 month duration) across studies was 25% (excluding case reports). CONCLUSION: Persecutory delusions, auditory and visual hallucinations, hostility, depression and conceptual disorganization are central to MAP, whereas negative psychotic symptoms are typically absent. An overrepresentation of institutionalized or male participants may have overemphasized negative symptoms and underreported affective symptoms in past research. Symptoms of MAP may persist beyond one month after drug cessation in some individuals. Clinicians are encouraged to manage affective symptoms in MAP individuals, and monitor for the development of chronic psychotic symptoms.
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Trastornos Relacionados con Anfetaminas/psicología , Metanfetamina/efectos adversos , Psicosis Inducidas por Sustancias/psicología , Trastornos Relacionados con Anfetaminas/complicaciones , Trastornos Relacionados con Anfetaminas/diagnóstico , Humanos , Psicosis Inducidas por Sustancias/complicaciones , Psicosis Inducidas por Sustancias/diagnósticoRESUMEN
OBJECTIVE: Chronic methamphetamine use is commonly associated with the development of psychotic symptoms. The predictors and correlates of methamphetamine-associated psychosis are poorly understood. We sought to systematically review factors associated with psychotic symptoms in adults using illicit amphetamine or methamphetamine. METHODS: A systematic literature search was performed on MEDLINE (OVID), PsycINFO and EMBASE databases from inception to 8 December 2016. The search strategy combined three concept areas: methamphetamine or amphetamine, psychosis and risk factors. Included studies needed to compare adults using illicit methamphetamine or amphetamine, using a validated measure of psychosis, on a range of risk factors. Of 402 identified articles, we removed 45 duplicates, 320 articles based on abstract/title and 17 ineligible full-text articles, leaving 20 included studies that were conducted in 13 populations. Two co-authors independently extracted the following data from each study: country, setting and design; participant demographic and clinical details; sample size; measure/s used and measures of association between psychosis outcomes and risk factors. Individual study quality was assessed using a modified Newcastle-Ottawa Scale, and strength of evidence was assessed using GRADE criteria. RESULTS: Frequency of methamphetamine use and severity of methamphetamine dependence were consistently found to be associated with psychosis, and sociodemographic factors were not. There was inconsistent evidence available for all other risk factors. Individual study quality was low-moderate for the majority of studies. Heterogeneity in study outcomes precluded quantitative synthesis of outcomes across studies. CONCLUSION: The most consistent correlates of psychotic symptoms were increased frequency of methamphetamine use and dependence on methamphetamine. The findings of this review highlight the need for targeted assessment and treatment of methamphetamine use in individuals presenting with psychosis.
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Trastornos Relacionados con Anfetaminas/complicaciones , Estimulantes del Sistema Nervioso Central/efectos adversos , Metanfetamina/efectos adversos , Psicosis Inducidas por Sustancias , Humanos , Psicosis Inducidas por Sustancias/epidemiología , Psicosis Inducidas por Sustancias/etiología , Factores de RiesgoRESUMEN
There is disagreement in the literature as to whether biological attribution increases or decreases stigma. This study investigated the effect of an online biological intervention on stigma and help-seeking intentions for depression among adolescents. A three-arm, pre-post test, double-blind randomised controlled trial (RCT) was used to compare the effects of a biological and a psychosocial intervention delivered online. Participants comprised secondary school students (N = 327) aged 16-19 years. Outcome measures included anticipated self-stigma for depression (primary), personal stigma, help-seeking intention for depression, and biological and psychosocial attribution. Neither the biological nor the psychosocial educational intervention significantly reduced anticipated self-stigma or personal stigma for depression relative to the control. However, a small increase in help-seeking intention for depression relative to the control was found for the biological educational condition. The study was undertaken over a single session and it is unknown whether the intervention effect on help-seeking intentions was sustained or would translate into help-seeking behaviour. A brief online biological education intervention did not alter stigma, but did promote a small increase in help-seeking intentions for depression among adolescents. This type of intervention may be a practical means for facilitating help-seeking among adolescents with current or future depression treatment needs.
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Depresión/psicología , Depresión/terapia , Educación en Salud , Conducta de Búsqueda de Ayuda , Autoimagen , Estigma Social , Adolescente , Adulto , Australia , Método Doble Ciego , Femenino , Humanos , Intención , Masculino , Salud Mental , Aceptación de la Atención de Salud/psicología , Personalidad , Factores Sociológicos , Adulto JovenRESUMEN
OBJECTIVE: To estimate the number of regular and dependent methamphetamine users in Australia. DESIGN: Indirect prevalence estimates were made for each year from 2002-03 to 2013-14. We applied multiplier methods to data on treatment episodes for amphetamines (eg, counselling, rehabilitation, detoxification) and amphetamine-related hospitalisations to estimate the numbers of regular (at least monthly) and dependent methamphetamine users for each year. Dependent users comprised a subgroup of those who used the drug regularly, so that estimates of the sizes of these two populations were not additive. RESULTS: We estimated that during 2013-14 there were 268 000 regular methamphetamine users (95% CI, 187 000-385 000) and 160 000 dependent users (95% CI, 110 000-232 000) aged 15-54 years in Australia. This equated to population rates of 2.09% (95% CI, 1.45-3.00%) for regular and 1.24% (95% CI, 0.85-1.81%) for dependent use. The rate of dependent use had increased since 2009-10 (when the rate was estimated to be 0.74%), and was higher than the previous peak (1.22% in 2006-07). The highest rates were consistently among those aged 25-34 years, in whom the rate of dependent use during 2012-2013 was estimated to be 1.50% (95% CI, 1.05-2.22%). There had also been an increase in the rate of dependent use among those aged 15-24 years (in 2012-13 reaching 1.14%; 95% CI, 0.80-1.69%). CONCLUSIONS: There have been increases over the past 12 years in the numbers of regular and dependent methamphetamine users in Australia. Our estimates suggest that the most recent numbers are the highest for this period, and that the increase has been most marked among young adults (those aged 15-34 years). IMPLICATIONS: There is an increasing need for health services to engage with people who have developed problems related to their methamphetamine use.
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Metanfetamina , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Australia , Humanos , Metanfetamina/administración & dosificación , Factores de TiempoRESUMEN
BACKGROUND: We analyzed population-based injury trends and the association between injury and alcohol consumption patterns in Thailand, a middle-income country undergoing rapid social change. METHODS: A nationwide cohort of 42 785 Thai adult Open University students, who were aged 15 to 87 years at enrolment, participated in cross-sectional assessments at baseline (2005) and 8 years later (2013). Incident non-fatal traffic and non-traffic injuries were recorded. Alcohol consumption patterns were categorized as follows: non-drinkers, occasional light drinkers, occasional heavy drinkers, regular drinkers, and ex-drinkers. Logistic regression was used to assess associations in 2005 and 2013 between injuries and alcohol consumption. We adjusted odds ratios (ORs) for socio-demographic factors, stress, health behaviors, and risk-taking behaviors. RESULTS: Incidence estimates in 2013 were standardized to the age structure of 2005: the standardized rates were 10% (95% confidence interval [CI], 9.32-9.89) for participants with at least one non-traffic injury and 5% (95% CI, 4.86-5.29) for those with at least one traffic injury. Both standardized incidences for non-traffic and traffic injuries were significantly lower than corresponding rates in 2005 (20% and 6%, respectively). Alcohol consumption was significantly associated with non-traffic injury in 2005, but the association disappeared in 2013. For example, non-traffic injury was associated with regular drinking (adjusted OR 1.17; 95% CI, 1.01-1.40) in 2005, but not in 2013 (adjusted OR 0.89; 95% CI, 0.73-1.10). In both survey years, traffic injury was not associated with occasional heavy drinking when adjusted for health and risk-taking behavior. CONCLUSIONS: We examined non-fatal injury and the health-risk transition in Thailand in 2005 and 2013. Our data revealed decreases in alcohol consumption and non-fatal injury in the Thai Cohort between 2005 and 2013. Alcohol-related injury in Thailand today could be amenable to preventive intervention.
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Consumo de Bebidas Alcohólicas/epidemiología , Heridas y Lesiones/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tailandia/epidemiología , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Understanding methamphetamine associated psychotic (MAP) symptom typologies could aid in identifying individuals at risk of progressing to schizophrenia and guide early intervention. METHODS: Latent class analysis (LCA) of psychotic symptoms collected from 40 (n = 40) methamphetamine dependent individuals with a history of psychotic symptoms but no history of a primary psychotic disorder. RESULTS: Three typologies were identified. In one, persecutory delusions dominated (Type 1), in another persecutory delusions were accompanied by hallucinations (Type 2), and in the third a high frequency of all the assessed hallucinatory and delusional symptoms was observed (Type 3). DISCUSSION AND CONCLUSION: MAP is a heterogeneous syndrome with positive symptom typologies. SCIENTIFIC SIGNIFICANCE: This study represents the first attempt at identifying typologies of MAP and highlights the potential utility of LCA in future large-scale studies.
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Trastornos Relacionados con Anfetaminas/diagnóstico , Trastornos Relacionados con Anfetaminas/psicología , Deluciones/complicaciones , Alucinaciones/complicaciones , Metanfetamina/efectos adversos , Psicosis Inducidas por Sustancias/diagnóstico , Adulto , Trastornos Relacionados con Anfetaminas/complicaciones , Deluciones/psicología , Femenino , Alucinaciones/psicología , Humanos , Masculino , Psicosis Inducidas por Sustancias/complicaciones , Psicosis Inducidas por Sustancias/psicología , Evaluación de Síntomas , Victoria , Adulto JovenRESUMEN
BACKGROUND: Heavy alcohol consumption is an established risk factor for non-communicable diseases (NCDs) but few studies have investigated drinking and disease risk in middle income, non-western countries. We report on the relationship between alcohol consumption and NCDs in Thailand. METHODS: A nationwide cross sectional survey was conducted of 87,151 Thai adult open university students aged 15 to 87 years (mean age 30.5 years) who were recruited into the Thai Cohort Study. Participants were categorized as never having drunk alcohol (n = 22,527), as being occasional drinkers who drank infrequently but heavily (4+ glasses/occasion - occasional heavy drinkers, n = 24,152) or drank infrequently and less heavily (<4 glasses/occasion - occasional light drinkers, n = 26,861). Current regular drinkers were subdivided into those who either drank heavily (4 + glasses per occasion - regular heavy drinkers, n = 3,675) or those who drank less (<4 glasses/occasion -regular light drinkers, n = 490). There were 7,548 ex-drinkers in the study. Outcomes were lifetime diagnoses of self-reported NCDs and obesity (body mass index ≥ 25). RESULTS: Most women were never drinkers (40 % among females) or occasional light drinkers (39 %), in contrast to men (11 % and 22 %, respectively). Alcohol consumption was associated with urban in-migration and other recognized risks for NCDs (sedentary lifestyle and poor diet). After adjustment for these factors the odds ratios (ORs) for several NCDs outcomes - high cholesterol, hypertension, and liver disease - were significantly elevated among both occasional heavy drinkers (1.2 to 1.5) and regular heavy drinkers (1.5 to 2.0) relative to never drinkers. CONCLUSIONS: Heavy alcohol consumption of 4 or more glasses per occasion, even if the occasions were infrequent, was associated with elevated risk of NCDs in Thailand. These results highlight the need for strategies in Thailand to reduce the quantity of alcohol consumed to prevent alcohol-related disease. Thailand is fortunate that most of the female population is culturally protected from drinking and this national public good should be endorsed and supported.
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Consumo de Bebidas Alcohólicas/efectos adversos , Trastornos Relacionados con Alcohol/complicaciones , Etanol/efectos adversos , Hipercolesterolemia/etiología , Hipertensión/etiología , Hepatopatías/etiología , Obesidad/etiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Intoxicación Alcohólica , Alcoholismo/complicaciones , Alcoholismo/epidemiología , Índice de Masa Corporal , Estudios de Cohortes , Estudios Transversales , Emigración e Inmigración , Etanol/administración & dosificación , Femenino , Humanos , Hipercolesterolemia/epidemiología , Hipertensión/epidemiología , Estilo de Vida , Hepatopatías/epidemiología , Masculino , Obesidad/epidemiología , Oportunidad Relativa , Factores de Riesgo , Factores Sexuales , Tailandia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The use of amphetamine-type stimulants (ATS) places a large burden on health services. OBJECTIVE: The aim was to evaluate the effectiveness of a self-guided Web-based intervention ("breakingtheice") for ATS users over 6 months via a free-to-access site. METHODS: We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing 3 modules derived from cognitive behavioral therapy and motivation enhancement. The main outcome was self-reported ATS use in the past 3 months assessed at 3- and 6-month follow-ups using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Secondary outcomes were help-seeking intentions (general help-seeking questionnaire), actual help seeking (actual help-seeking questionnaire), psychological distress (Kessler 10), polydrug use (ASSIST), quality of life (European Health Interview Survey), days out of role, and readiness to change. Follow-up data were evaluated using an intention-to-treat (ITT) analysis with a group by time interaction. RESULTS: We randomized 160 people (intervention: n=81; control: n=79). At 6 months, 38 of 81 (47%) intervention and 41 of 79 (52%) control participants provided data. ATS scores significantly declined for both groups, but the interaction effect was not significant. There were significant ITT time by group interactions for actual help seeking (rate ratio [RR] 2.16; d=0.45) and help-seeking intentions (RR 1.17; d=0.32), with help seeking increasing for the intervention group and declining for the control group. There were also significant interactions for days completely (RR 0.50) and partially (RR 0.74) out of role favoring the intervention group. However, 37% (30/81) of the intervention group did not complete even 1 module. CONCLUSIONS: This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role, but it did not reduce ATS use. Thus, this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment, but a substantial minority remained disengaged. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307 (Archived by WebCite at http://www.webcitation.org/6Y0PGGp8q).
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Anfetaminas , Estimulantes del Sistema Nervioso Central , Internet , Trastornos Relacionados con Sustancias/prevención & control , Adulto , Anfetamina , Terapia Cognitivo-Conductual , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Aceptación de la Atención de Salud , Calidad de Vida , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Recently, Marczinski and colleagues (2013) showed that energy drinks combined with alcohol augment a person's desire to drink more alcohol relative to drinking alcohol alone. The current study replicates the findings of Marczinski and colleagues (2013) using a robust measure of alcohol craving. METHODS: Seventy-five participants aged 18 to 30 years were assigned to an alcohol only or alcohol+energy drink condition in a double-blind randomized pre- versus posttest experiment. Participants received a cocktail containing either 60 ml of vodka and a Red Bull(®) Silver Edition energy drink (alcohol+energy drink condition) or 60 ml of vodka with a soda water vehicle (alcohol-only condition); both cocktails contained 200 ml of fruit drink. The primary outcome measure was the Alcohol Urge Questionnaire taken at pretest and at 20 minutes (posttest). Other measures taken at posttest were the Biphasic Alcohol Effects Questionnaire, the Drug Effects Questionnaire, and breath alcohol concentration (BAC). RESULTS: The alcohol+energy drink condition showed a greater pre- versus posttest increase in urge to drink alcohol compared with the alcohol-only condition (B = 3.24, p = 0.021, d = 0.44). Participants in the alcohol+energy drink condition had significantly higher ratings on liking the cocktail and wanting to drink more of the cocktail, and lower BACs, than the alcohol-only condition. When examined at specific BACs, the effect of the energy drink on the pre- to posttest increase in urge to drink was largest and only significant at BACs of 0.04-0.05 (cf. < 0.04 g/dl).There were no significant differences in stimulation, sedation, feeling the effects of the cocktail, or feeling high. CONCLUSIONS: Combining energy drinks with alcohol increased the urge to drink alcohol relative to drinking alcohol alone. More research is needed to understand what factors mediate this effect and whether it increases subsequent alcohol consumption.
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Consumo de Bebidas Alcohólicas/psicología , Ansia/efectos de los fármacos , Bebidas Energéticas/efectos adversos , Adolescente , Adulto , Pruebas Respiratorias , Método Doble Ciego , Sinergismo Farmacológico , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND: Alcohol policies and interventions seek to curtail risky single-occasion drinking (RSOD) and the negative health and public order consequences. Yet RSOD behaviors are not easily defined since people can drink excessively at a variety of locations and drink a range of products. The current study examines the presence and correlates of different typologies or classes of drinking behavior on 1 Saturday night to facilitate a nuanced policy response to harmful drinking. METHODS: Data from 1,883 adults aged 18 to 30 were collected using an online survey. Latent class analysis was used to categorize respondents into mutually exclusive classes based on the quantity, type, and unit cost of alcohol consumed plus location of alcohol consumption on the past Saturday night. Significant correlates and predictors of latent class membership were then identified using regression analysis. RESULTS: Seven distinct classes were identified that represent qualitatively distinct profiles of Saturday night drinking behavior among young adults. Multivariate analyses indicated that alcohol risk (measured using the Alcohol Use Disorder Identification Test), age, and recent (past 12 months) stimulant use were strong predictors of heavier drinking. The heaviest drinkers also consumed some of the cheapest alcohol and consumed alcohol at multiple locations over the course of the night. CONCLUSIONS: Given the large degree of heterogeneity among drinking behaviors, policy makers need to be cognizant that alcohol type and drinking location-specific policies may be less effective in targeting some groups of the population.
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Consumo de Bebidas Alcohólicas/epidemiología , Adolescente , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/psicología , Bebidas Alcohólicas/economía , Bebidas Alcohólicas/estadística & datos numéricos , Alcoholismo/epidemiología , Alcoholismo/psicología , Australia/epidemiología , Recolección de Datos , Femenino , Humanos , Masculino , Análisis Multivariante , Sexo , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation. DESIGN: A prospective cohort study. SETTING: Prisons in Queensland and Western Australia. PARTICIPANTS: Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. MEASUREMENTS: Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. FINDINGS: During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). CONCLUSIONS: Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.
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Metanfetamina , Prisioneros , Trastornos Relacionados con Sustancias , Humanos , Prisiones , Estudios de Cohortes , Estudios Prospectivos , Heroína , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Fumar , HospitalizaciónRESUMEN
INTRODUCTION: There is little knowledge of the perspectives of people who use methamphetamine and have participated in clinical trials, and none for interventions not intended to address abstinence. A better understanding of these experiences could lead to more patient centred clinical trial design. This study seeks to understand the experiences of people who completed a clinical trial of lisdexamfetamine for the treatment of acute methamphetamine withdrawal. METHODS: Thematic analysis of open-ended, semi-structured interviews with eight people who participated in an inpatient clinical trial of lisdexamfetamine for acute methamphetamine withdrawal. Interviews were conducted between days 3 and 6 of admission to an inner-city Sydney hospital. RESULTS: Participants described how research procedures, the research setting, and the investigational product affected their experiences while enrolled in a clinical trial. Of particular importance to participants were transparent and low burden trial procedures, a welcoming trial environment, trusting relationships and effective communication, which were linked with the participants' subsequent decision to remain enrolled in the trial. DISCUSSION: The experiences of participants in this clinical trial can be distilled into four meta-themes: agency, caring-trust, safety, and communication. Participants spontaneously linked these experiences with a capacity to remain enrolled in the study. By considering the experiences of trial participants in clinical trial design, researchers can improve the experiences of future trial participants and facilitate their choice to remain enrolled in clinical trials.