RESUMO
The mental health gap has been a persistent concern globally, especially in low and middle-income countries (LMIC). In an attempt to mitigate resource limitations, the psychiatric practice has been undergoing a paradigm shift into digitalized mental health interventions. One such innovation involves digital gaming utilizing the principles of 'gamification' to incorporate both the playfulness component of online gaming as well as the domain-targeted design of gaming elements. Digital gaming-based interventions have been to deliver psychotherapy, biofeedback, cognitive training and rehabilitation, as well as behavioural modification and social skills training. Research shows their utility in autism spectrum disorders, attention deficit disorders, schizophrenia, depression, anxiety disorders, post-traumatic stress, eating disorders, neurocognitive disorders and also to promote healthy aging. Though promising in scope, these interventions face pragmatic challenges for implementation in developing countries. Even though increased use of technology, internet penetration and growing digital literacy have enhanced their accessibility and feasibility, various factors like socio-cultural diversity, lack of standardization, poor infrastructural support, bandwidth issues and lack of practice can impair their use and acceptability. Keeping this in the background, this commentary critically discusses the scope, applications and challenges of digital gaming in mental healthcare delivery in one of the rapidly globalizing LMIC nations, India.
Assuntos
Comportamento Aditivo/psicologia , Comportamento Aditivo/terapia , Saúde Mental/estatística & dados numéricos , Jogos de Vídeo/psicologia , Comportamento Aditivo/reabilitação , Humanos , Índia , Saúde Mental/economia , PsicoterapiaRESUMO
Recovery capital (RC) is an emerging conceptual framework in the addiction field that pinpoints the internal and external (i.e., human, community, cultural, social, financial) resources individuals can draw on throughout the recovery process. The concept of RC was developed and applied primarily to individuals who have recovered from substance addiction. The aim of this study was to extend the RC conceptual framework to gambling disorder (GD)-which is classified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) as a behavioral addiction-and to identify and conceptualize RC resources implemented by individuals who have recovered from GD. Ninety-one individuals who reported a lifetime history of DSM-5 GD but who had not exceeded the DSM-5 GD threshold criteria in the previous year, were interviewed about the factors that helped them throughout their recovery. Directed content analyses identified 12 main RC resources that were classified under 4 RC domains: human capital (subjective well-being, self-efficacy, self-control skills, proactive coping skills, socioemotional skills, reconstruction skills), community capital (prorecovery environment, professional therapeutic milieu), social capital (recovering gamblers' peer group, friends without a GD, family), and financial capital (prorecovery financial state). These findings are the first step toward formulating a comprehensive conceptual model of RC applicable to GD. This study extends the RC and the gambling literature by presenting a holistic view of recovery from GD in many facets of life, and underscores the importance of observing strengths and resources in treating people with GD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Assuntos
Comportamento Aditivo/reabilitação , Jogo de Azar/reabilitação , Satisfação Pessoal , Autoeficácia , Autocontrole , Meio Social , Habilidades Sociais , Fatores Socioeconômicos , Adulto , Feminino , Humanos , Masculino , Modelos PsicológicosRESUMO
OBJECTIVE: We aimed to analyze sex differences in the DSM-5 criteria among patients admitted to their first treatment of alcohol use disorder (AUD). METHODS: Assessment of AUD was carried out using DSM-5 diagnostic criteria in a multicenter study (CohRTA) within the Spanish Network on Addictive Disorders. Further, baseline questionnaires including socio-demographics, family history, lifetime alcohol consumption and other substance use, as well as clinical and laboratory parameters were obtained during admission. RESULTS: 313 patients (74.8%M) were eligible; mean age at first AUD treatment was 48.8 years (standard deviation (SD): 9.9 years). Age at onset of alcohol use was 15.9 years (SD: 3.3 years) and age at starting regular alcohol consumption was 25.6 years (SD: 9.6 years). Almost 69.3% of patients were tobacco smokers and 61% had family history of AUD. Regarding other substance use, 7.7% were current cocaine users and 18.2% were cannabis users. Women started regular alcohol consumption later than men (p<,001) and used benzodiazepines more frequently (p=.013). According to DSM-5, 89.5% of cases had severe AUD (≥6 criteria). In the adjusted analysis (logistic regression), men were more likely to neglect major rules (OR=1.92, 95%CI: 1.06-3.48) and to have hazardous alcohol use (OR=3.00, 95%CI: 1.65-5.46). DISCUSSION: DSM-5 detects sex differences in patients seeking their first AUD treatment. Social impairment and risky alcohol use are significantly more frequent in men.
Objetivo: Analizar las diferencias de sexo en los criterios diagnósticos del DSM-5 de los pacientes que solicitan un tratamiento para el trastorno por uso de alcohol (TUA) por primera vez. Métodos: Pacientes incluidos entre enero 2014 y marzo 2016 en el estudio multicéntrico CohRTA de la Red de Trastornos Adictivos. El diagnóstico del TUA se realizó mediante el DSM-5. Además, se recogieron datos sociodemográficos, sobre el consumo de alcohol y otras sustancias, variables clínicas y una analítica general. Resultados: se incluyeron 313 pacientes (74,8% hombres); la edad al inicio del primer tratamiento fue de 48,8 años (desviación estándar (DE): 9,9 años), la edad al inicio del consumo de alcohol de 15,9 años (DE: 3,3 años) y la de inicio del consumo regular de 25,6 años (DE: 9,6 años). Un 69,3% de los pacientes eran fumadores y un 61% tenían antecedentes familiares de TUA. Un 7,7% eran consumidores de cocaína y un 18,2% de cannabis. Las mujeres iniciaron el consumo regular de alcohol más tarde que los hombres (p<,001) y usaban benzodiacepinas con mayor frecuencia (p=,013). Según el DSM-5, el 89,5% de los pacientes presentaban un TUA grave (≥6 criterios). En el análisis ajustado (regresión logística), los hombres tenían mayor probabilidad de presentar el criterio diagnóstico relacionado con el incumplimiento de los deberes fundamentales en el trabajo o en el hogar (OR=1,92, IC95%: 1,06-3,48) y el criterio diagnóstico de consumir alcohol en situaciones de riesgo físico (OR=3,00, IC95%: 1,65-5,46). Discusión: El DSM-5 detecta diferencias de sexo en pacientes que solicitan el primer tratamiento del TUA. El deterioro social y el consumo de alcohol de riesgo son significativamente más frecuentes en hombres.
Assuntos
Transtornos Relacionados ao Uso de Álcool/reabilitação , Comportamento Aditivo/reabilitação , Manual Diagnóstico e Estatístico de Transtornos Mentais , Assunção de Riscos , Idade de Início , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
In order to reconstruct the origin and development of neo-Pentecostal devices for the treatment of addictions in the City of Buenos Aires, Argentina, the article analytically puts into historical context the "therapeutic spiritualization" of addictive behavior undertaken by evangelical agents since the 1970s and explores the way in which the State and religious groups converge in the Recover Inclusion Program. Based on qualitative methodology and a sociological approach and carried out in 2015 and 2016, the study includes fourteen interviews with teachers, leaders and former users of the program, twelve interviews with state officials, participant observation in training courses and a corpus made up of documents related to both institutions. The emergent processes of political and religious institutionalization were analyzed according to three dimensions: a) charisma and its opposite, bureaucracy, b) the dynamic role of the second lines of leadership and c) the networked organization structures. It is concluded that points of convergence and analogies exist in the dynamics of evangelical and public institutionalization in addiction treatment.
Para reconstruir el origen y desarrollo de los dispositivos neopentecostales dirigidos al tratamiento de adicciones en la Ciudad de Buenos Aires, Argentina, el artículo periodiza analíticamente los impulsos de "espiritualización terapéutica" de la conducta adictiva que emprenden los agentes evangélicos a partir de la década de 1970 y explora el modo en que el Estado y los grupos religiosos convergen en el Programa Recuperar Inclusión. Desde una metodología cualitativa y un enfoque sociológico entre 2015 y 2016, se realizaron catorce entrevistas a profesores, dirigentes y ex usuarios del programa, doce entrevistas a responsables estatales, observación participante en los cursos de formación y se conformó un corpus de documentos relativo a ambas instituciones. Los procesos emergentes de institucionalización política y religiosa se analizaron de acuerdo a tres dimensiones: a) el carisma y su par opuesto, la burocracia, b) al rol dinamizador de las segundas líneas y c) las estructuras de organización en red. Se concluye que existen encuentros y analogías entre las dinámicas de institucionalización evangélica y pública en el tratamiento de las adicciones.
Assuntos
Cristianismo , Terapias Espirituais , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Argentina , Comportamento Aditivo/reabilitação , Humanos , Fatores Sociológicos , Saúde da População UrbanaRESUMO
The truth of the adage, "An ounce of prevention is worth a pound of cure", is exemplified by the opioid crisis now facing the world. While the best way to rid society of drug addiction is to prevent it from occurring in the first place, this is highly unlikely in the near future given the many ways that individuals can be first exposed to some potentially addicting substance. When an addiction is established, the first treatment for it is detoxification, but the insidious nature of addiction is its propensity to relapse. Too often, detoxified addicts resume drug use despite knowing that they are exposing themselves to serious, sometimes fatal, consequences. In an attempt to ward off relapse following detoxification, drug treatment centers, clinics, rehabilitation facilities, half-way houses, etc., offer different types of programs to help addicts stay clean. Examples of such treatments are 12-step programs, cognitive behavioral therapy (CBT), faith-based programs, and so forth. In addition, narcotics like methadone and suboxone, are sometimes prescribed to control the cravings that drive relapse, but this approach simply substitutes one drug for another. We now hypothesize that the auditory system can be used as a sensory conduit to modify the hijacked brain reward system of recently-detoxified addicts. As a rationale for this hypothesis, we present evidence from basic science studies showing the effect of music (the sensory input) on the brain, and from clinical trials employing music in a variety of neurological conditions. We then summarize an IRB-approved randomized control trial we performed to determine if our sound intervention could reduce the probability of relapse in recently-detoxified subjects. We end with suggestions for further study.
Assuntos
Comportamento Aditivo/reabilitação , Musicoterapia/métodos , Reincidência/prevenção & controle , Prevenção Secundária/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Analgésicos Opioides/uso terapêutico , Encéfalo/fisiopatologia , Feminino , Florida , Humanos , Masculino , Metadona , Pessoa de Meia-Idade , Entorpecentes , Plasticidade Neuronal , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Projetos Piloto , Probabilidade , Qualidade de Vida , Recidiva , Recompensa , Adulto JovemRESUMO
RESUMEN Para reconstruir el origen y desarrollo de los dispositivos neopentecostales dirigidos al tratamiento de adicciones en la Ciudad de Buenos Aires, Argentina, el artículo periodiza analíticamente los impulsos de "espiritualización terapéutica" de la conducta adictiva que emprenden los agentes evangélicos a partir de la década de 1970 y explora el modo en que el Estado y los grupos religiosos convergen en el Programa Recuperar Inclusión. Desde una metodología cualitativa y un enfoque sociológico entre 2015 y 2016, se realizaron catorce entrevistas a profesores, dirigentes y ex usuarios del programa, doce entrevistas a responsables estatales, observación participante en los cursos de formación y se conformó un corpus de documentos relativo a ambas instituciones. Los procesos emergentes de institucionalización política y religiosa se analizaron de acuerdo a tres dimensiones: a) el carisma y su par opuesto, la burocracia, b) al rol dinamizador de las segundas líneas y c) las estructuras de organización en red. Se concluye que existen encuentros y analogías entre las dinámicas de institucionalización evangélica y pública en el tratamiento de las adicciones.
ABSTRACT In order to reconstruct the origin and development of neo-Pentecostal devices for the treatment of addictions in the City of Buenos Aires, Argentina, the article analytically puts into historical context the "therapeutic spiritualization" of addictive behavior undertaken by evangelical agents since the 1970s and explores the way in which the State and religious groups converge in the Recover Inclusion Program. Based on qualitative methodology and a sociological approach and carried out in 2015 and 2016, the study includes fourteen interviews with teachers, leaders and former users of the program, twelve interviews with state officials, participant observation in training courses and a corpus made up of documents related to both institutions. The emergent processes of political and religious institutionalization were analyzed according to three dimensions: a) charisma and its opposite, bureaucracy, b) the dynamic role of the second lines of leadership and c) the networked organization structures. It is concluded that points of convergence and analogies exist in the dynamics of evangelical and public institutionalization in addiction treatment.
Assuntos
Humanos , Cristianismo , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Terapias Espirituais , Argentina , Saúde da População Urbana , Comportamento Aditivo/reabilitação , Fatores SociológicosRESUMO
This paper reviews empirical studies conducted on the role of spirituality and religiosity (S/R) characteristics in 12-step recovery among program members followed up after substance abuse treatment and those assessed independent of formal treatment. Aspects of spiritual functioning that change in relation to program participation and those S/R characteristics that were found to mediate the association between program involvement and drinking-related outcomes are discussed. In addition, a review is provided of 12-step program studies investigating S/R-related predictors of clinical outcomes relevant to risk of relapse among members in long-term recovery. To further examine the role of S/R characteristics in recovery, a study was conducted on long-term AA members to assess the relationship of S/R characteristics and AA program involvement to craving for alcohol and emotional distress after controlling for relevant demographic variables. Feeling God's presence daily, believing in a higher power as a universal spirit, and serving as an AA sponsor were all predictive of positive outcomes.
Assuntos
Alcoólicos Anônimos , Comportamento Aditivo/psicologia , Comportamento Aditivo/reabilitação , Espiritualidade , HumanosRESUMO
Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes.
Assuntos
Comportamento Aditivo/epidemiologia , Perdão , Culpa , Espiritualidade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Comportamento Aditivo/psicologia , Comportamento Aditivo/reabilitação , Comorbidade , Métodos Epidemiológicos , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/psicologia , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Reino Unido , Adulto JovemRESUMO
High rates of substance use and related problems have been long recognized as critical health issues for Native American adolescents. Unfortunately, no manualized interventions address the specific needs of Native American adolescents in a culturally appropriate manner. In 2006, the Cherokee Nation partnered with the University of Colorado to employ a community-based participatory research process to develop an intervention for Native American adolescents with substance use problems. The resulting intervention, Walking On, is an explicit blend of traditional Cherokee healing and spirituality with science-based practices such as cognitive behavioral therapy and contingency management and is designed to address the specific needs and worldviews of Native American adolescents with substance use problems and their families. Each individual and family session includes a brief assessment, a skill-building component, and a ceremony. A Weekly Circle (multifamily group) promotes sobriety and builds a community of healing. Early pilot study results suggest that Walking On is feasible for use in tribal substance abuse treatment programs. While Walking On shows early promise, the intervention will require further study to examine its efficacy.
Assuntos
Comportamento do Adolescente/etnologia , Comportamento Aditivo/reabilitação , Serviços de Saúde Comunitária , Usuários de Drogas/psicologia , Indígenas Norte-Americanos/psicologia , Grupos Minoritários/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Comportamento Aditivo/etnologia , Comportamento Aditivo/psicologia , Comportamento Ritualístico , Terapia Cognitivo-Comportamental , Colorado , Terapia Combinada , Pesquisa Participativa Baseada na Comunidade , Características Culturais , Prestação Integrada de Cuidados de Saúde , Humanos , Medicina Tradicional , Desenvolvimento de Programas , Terapias Espirituais , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do TratamentoRESUMO
OBJECTIVE: To review the evolution of the paradigm of recovery in addiction and its implications. METHOD: A systematic literature review was conducted using the MEDLINE and PsychInfo databases over the past 10 years and key references from the retrieved literature. FINDINGS: The historical evolution of the concept of recovery has been shaped by several driving forces, including consumer experience, the need to better define our treatment outcome and parallel elaboration of the concepts of health, quality of life, and chronic disorders. Similarities and differences with the concept of "recovery" in mental health and other biomedical fields are identified.The empirical basis is growing in support of various proposed attributions and features of recovery along with the temporal benchmarks involved. The various forms of recovery, such as "natural," "transformational," or "medication-assisted," describe a choice of pathways to a common goal.The management implications are far-reaching and call for system shifts from acute stabilization to sustained recovery, including the growth of alternative institutions, and roles complementary to mutual help. Tools for the sustenance of recovery, including educational kits, recovery workbooks, and e-recovery initiatives, are developing. CONCLUSIONS: Although first-person accounts of recovery abound, a more systematic empirical investigation of the concept has just begun, including demographic and cultural differences. Management implications are derived from the experience with other "mainstream" chronic disorders with treatment providing stabilization and initiation of recovery and a range of long-term resources becoming available to sustain it.
Assuntos
Alcoolismo/reabilitação , Comportamento Aditivo/reabilitação , Objetivos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Alcoólicos Anônimos , Alcoolismo/psicologia , Atitude Frente a Saúde , Comportamento Aditivo/psicologia , Benchmarking , Feminino , Humanos , Masculino , Motivação , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Qualidade de Vida/psicologia , Ajustamento Social , Apoio Social , Espiritualidade , Transtornos Relacionados ao Uso de Substâncias/psicologia , Temperança , Adulto JovemRESUMO
INTRODUCTION AND AIMS: Drug craving is considered to be an essential component of substance dependence. We aimed to characterise drug-dependent inpatients reporting continuous absence of subjective spontaneous drug craving. DESIGN AND METHODS: This is a 3 year chart-review study designed to compare drug-dependent inpatients who did not report craving everyday (non-cravers) and their counterparts who did (cravers). All participants were recruited consecutively and completed a 14 day detoxification treatment. Craving was defined as a desire to use the main detoxification substance. This substance was chosen by patients, who completed a craving visual analogue scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory daily. The Temperament and Character Inventory and the Addiction Severity Index were also used. RESULTS: Of the 195 patients who completed the detoxification treatment, 45 (23.1%) were non-cravers and 32 (16.4%) were cravers. The main detoxification substances were alcohol, benzodiazepines, cannabis, cocaine, heroin and methadone. Non-cravers named methadone as the main detoxification substance more frequently than cravers, and benzoylecgonine was less frequently present in their urine at treatment entry. A decreased score on the Temperament and Character Inventory dimension of harm avoidance (i.e. trait anxiety) was the only independent predictor of absence of craving (odds ratio = 1.16, 95% confidence interval = 1.03-1.31). During admission, non-cravers had lower Beck Depression Inventory and State-Trait Anxiety Inventory scores than cravers. These differences were not accounted for by pharmacological treatment. DISCUSSION AND CONCLUSIONS: Drug -dependent inpatients who report absence of craving are characterised by relatively low levels of depression and anxiety throughout detoxification treatment, and relatively low levels of trait anxiety.
Assuntos
Comportamento Aditivo/reabilitação , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Comportamento Aditivo/tratamento farmacológico , Comportamento Aditivo/psicologia , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Prontuários Médicos , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Medição da Dor , Escalas de Graduação Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Fatores de TempoRESUMO
Psychotherapy process research continues to be important in identifying within session client and therapist behaviors related to outcome. Motivational Interviewing (MI) assumes that the type of client language elicited within session is important. Client behavior was coded from 61 MI sessions with marijuana dependent adults. Sessions were coded for client language using the Client Language and Commitment Scale. Client statements indicating desire and reasons for change were significantly predictive of marijuana treatment outcome through the 34-month follow-up above and beyond baseline levels of marijuana use or motivation for change. Commitment language was not associated with outcomes. These findings suggest specific types of client language statements predict marijuana treatment outcome and are durable to a 34-month follow-up.
Assuntos
Comportamento Aditivo , Entrevista Psicológica , Abuso de Maconha , Motivação , Adulto , Comportamento Aditivo/psicologia , Comportamento Aditivo/reabilitação , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Seguimentos , Humanos , Masculino , Abuso de Maconha/psicologia , Abuso de Maconha/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde , Psicoterapia/métodos , Resultado do TratamentoRESUMO
Spirituality is a topic of increasing interest to clinicians and researchers interested in addiction because its perceived role in the promotion of meaningfulness in the recovery from addiction. Our review of the literature evaluates different domains relative to the relation between addiction, religion, and psychiatric treatment. Spirituality as a protective or precipitating factor for substance use and as a key component of recovery will be debated. Illustrations of its potential and limitations as a component of treatment will be presented. Types of investigation and integration of this dimension in an eventual therapeutic process strictly respecting the needs and specificities of each one will be discussed.
Assuntos
Comportamento Aditivo/psicologia , Comportamento Aditivo/reabilitação , Espiritualidade , Feminino , Humanos , Masculino , Literatura de Revisão como AssuntoRESUMO
Some adolescents show a greater response to treatment than others. We examined the extent to which amount of treatment content received was associated with certain patient characteristics (e.g., readiness to change) and severity of substance involvement at 6-month follow-up. Adolescents (N = 107) recruited from outpatient addiction treatment reported at follow-up on the extent to which treatment addressed addictive behaviors (e.g., getting motivated to change) and other concerns (e.g., depression). Contrary to prediction, readiness to change did not predict amount of treatment content received, but greater number of inpatient days during follow-up predicted greater endorsement of addictive behaviors content. At 6 months, more addictive behaviors content received was associated with fewer alcohol symptoms. For both alcohol and marijuana, greater endorsement of treatment content related to other concerns was associated with greater substance involvement at 6 months, suggesting the importance of evaluating and addressing other concerns because youth may present with problems in multiple domains.
Assuntos
Comportamento Aditivo/reabilitação , Centros de Tratamento de Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Comportamento do Adolescente/psicologia , Alcoolismo/psicologia , Alcoolismo/reabilitação , Comportamento Aditivo/psicologia , Feminino , Seguimentos , Humanos , Masculino , Abuso de Maconha/reabilitação , Estudos Prospectivos , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do TratamentoRESUMO
Data from three outpatient studies of treatment of marijuana dependence were used to test whether behavior change parallels stage movement in the transtheoretical model of change (TMC). This study examined one putative assumption of the TMC: individuals remaining in the preaction stages of change (i.e., precontemplation and contemplation) across time would show little change in their marijuana use. The University of Rhode Island Change Assessment (URICA) measure and two recent stage assignment algorithms were utilized to assess TMC stage status at baseline and end of treatment. The primary analyses employed paired-sample t tests of statistical equivalence and sign tests, and 34 out of the 36 tests demonstrated that individuals remaining in the preaction stages of change over the treatment period showed clinically important and statistically significant treatment outcomes. Clinicians and researchers should exercise caution in their use of URICA-based indices as meaningful markers of the recovery process. Better methods to measure stage status and test the TMC are needed if the model is to be used to guide substance abuse interventions.
Assuntos
Comportamento Aditivo/reabilitação , Abuso de Maconha/reabilitação , Modelos Psicológicos , Escalas de Graduação Psiquiátrica , Adulto , Algoritmos , Ensaios Clínicos como Assunto , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Psicometria , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice. A preliminary understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources, which will be delineated: namely, physiology, psychology, and cross-cultural sources. Furthermore, the impact of spirituality on mental health and addiction in different cultural and clinical settings is explicated regarding both beneficial and compromising outcomes. Illustrations of its application in addiction and general psychiatry are given: in meditative practices, Alcoholics Anonymous, and treatment programs for addiction singly and comorbid with major mental illness. Given its prominence in Alcoholics Anonymous and related Twelve-Step groups, spirituality plays an important role in the rehabilitation of many substance-dependent people. The issue of spirituality, however, is prominent within contemporary culture as well in the form of theistic orientation, as evidenced in a probability sampling of American adults, among whom 95% of respondents reply positively when asked if they believe in "God or a universal spirit." Responses to a follow-up on this question suggest that this belief affects the daily lives of the majority (51%) of those sampled, as they indicated that they had talked to someone about God or some aspect of their faith or spirituality within the previous 24 h (Gallup, 2002).
Assuntos
Alcoolismo/reabilitação , Comportamento Aditivo/reabilitação , Psiquiatria/métodos , Espiritualidade , Alcoólicos Anônimos , Humanos , Meditação , Psicologia/métodosRESUMO
Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal. A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioral norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives. The mechanisms underlying the attribution of new meaning in AA are considered by recourse to the models of positive psychology and social network support; both models have been found to be associated with constructive health outcomes in a variety of contexts. By drawing on available empirical research, it is possible to define the diagnosis of addiction and the criteria for recovery in spiritually oriented terms.
Assuntos
Alcoolismo/reabilitação , Comportamento Aditivo/reabilitação , Modelos Psicológicos , Religião e Medicina , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alcoólicos Anônimos , Comportamento Aditivo/psicologia , Pesquisa Empírica , Humanos , Cooperação do Paciente/psicologia , Prevenção Secundária , Apoio Social , TemperançaRESUMO
The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.
Assuntos
Alcoolismo/reabilitação , Comportamento Aditivo/reabilitação , Autoimagem , Espiritualidade , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alcoólicos Anônimos , Estudos de Coortes , Estudos Transversais , Hospitais Gerais , Humanos , Metadona/uso terapêutico , Unidade Hospitalar de Psiquiatria , Psicometria , Tratamento Domiciliar , Prevenção Secundária , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Temperança/psicologia , Comunidade TerapêuticaRESUMO
AIMS: To examine the acute effects of a guided relaxation routine (body scan) on desire to smoke and tobacco withdrawal symptoms in overnight abstinent smokers. DESIGN: Experimental. PARTICIPANTS: Thirty individuals reporting to smoke 10 or more cigarettes daily for at least 3 years. INTERVENTION: Participants were assigned randomly to complete a 10-minute body scan (experimental group n = 15) or listen to a natural history passage for 10 minutes (control group n = 15). MEASUREMENT: Ratings of strength of desire to smoke and smoking withdrawal symptoms were assessed at baseline, immediately after the interventions, and 5, 10 and 15 minutes post-intervention. FINDINGS: There was a significant group x time interaction for strength of desire to smoke. The mean desire to smoke rating was significantly lower in the body scan group relative to the control group immediately after the intervention, and 5 minutes post-intervention. The body scan group also reported lower ratings of irritability, tension and restlessness, relative to the controls. CONCLUSION: A brief body scan intervention reduces strength of desire to smoke and some tobacco withdrawal symptoms in temporarily abstaining smokers. The body scan may be beneficial as a technique for managing cigarette cravings and withdrawal.