Training mental health residents in tobacco and alcohol: Relationship with their clinical intervention. / Formación en tabaco y alcohol de residentes de salud mental: Relación con su intervención clínica.

The objective of this study is to describe how mental health professionals in training (residents) apply the brief intervention (5As) on the tobacco and alcohol consumption to their patients, and if this is related to the training received and/or their own consumption. This is a cross-sectional study in which a self-reported questionnaire was administered to first-year residents of mental health professionals in Catalonia (2016-2019) (psychiatrists, psychologists and nurses). We performed a descriptive analysis of the variables and we applied a chi-square test for the comparison of proportions. 154 professionals completed the questionnaire. Half of them had not received any university training on intervention in smoking (46.8%) or in alcohol consumption (53.2%). Those who had received it, advised, assessed and helped their patients to quit smoking more frequently (p = 0.008, p = 0.037 and p = 0.039, respectively). Those who had received training in alcohol intervention gave advice, performed assessments and offered help to quit/reduce alcohol among their patients more frequently (p < 0.001, p = 0.001, and p < 0.001, respectively). Residents usually helped more to quit or reduce alcohol than to quit tobacco (p < 0.001). 60.1% of them never or rarely helped their patients to stop smoking and 34.6% rarely helped in the case of alcohol. In general, nurses did more intervention for tobacco than alcohol use, regardless of the training received. The lack of training of professionals in tobacco and alcohol intervention at university is related to a lack of intervention on patients in their professional practice, regardless of their own consumption.

El objetivo del estudio es analizar la intervención breve 5As en tabaco y alcohol de los profesionales sanitarios residentes de salud mental y analizar su relación con la formación recibida y/o con su propio consumo. Se trata de un estudio transversal en el que se administró un cuestionario autoinformado a residentes de primer año de salud mental de Cataluña de 2016 a 2019 (médicos, psicólogos y enfermeras). Se realizó un análisis descriptivo de las variables y comparación de proporciones a través de pruebas chi-cuadrado. Contestaron 154 profesionales, la mitad no había recibido ninguna formación universitaria sobre intervención en tabaquismo (46,8%), ni en consumo de alcohol (53,2%). Los que sí la habían recibido, aconsejaban, evaluaban y ayudaban a dejar de fumar a sus pacientes con mayor frecuencia (p = 0,008, p = 0,037 y p = 0,039; respectivamente). Los que habían recibido formación en alcohol, aplicaban más consejo, evaluación y deshabituación sobre el alcohol a sus pacientes (p < 0,001; p = 0,001; y p < 0,001; respectivamente). En global, ayudaban más a dejar o reducir el alcohol que el tabaco (p < 0,001). Un 60,1% de todos ellos nunca o raramente ayudaba a sus pacientes a dejar de fumar y un 34,6% en el caso del alcohol. Las enfermeras intervenían más en tabaquismo que en alcohol, hubieran recibido o no formación universitaria. El estudio concluye que la poca formación universitaria recibida por los profesionales se asocia con una frecuencia baja de intervención sobre sus pacientes, sin que exista relación entre el nivel de intervención y su propio consumo.

Smoking cessation interventions in substance use disorders treatment centers of Catalonia: The abandoned addiction. / Intervenciones para dejar de fumar en los centros de atención a las drogodependencias de Cataluña: La adicción abandonada.

Substance use disorders (SUD) treatment centers are an optimal setting for delivering smoking cessation interventions (SCI). This study aimed to examine the adoption of SCI in SUD treatment centers in Catalonia (Spain) as well as to assess their managers' views on the appropriateness and feasibility of providing SCI. Managers directly in charge of SUD treatment centers (n = 57) answered a 30-item on-line questionnaire. Data was obtained of 50 centers (87.7% response rate). Forty-six per cent of the centers provided some kind of SCI, but only 4.8% of the new patients were treated for smoking cessation. Managers reported that 73.3% of mental health professionals working in SUD centers had not been trained in SCI. Sixty-four per cent of managers agreed that all health professionals should deliver SCI. Those centers offering SCI attended more patients and were more likely to have professionals trained in SCI than those not offering SCI. The implementation of SCI in SUD treatment centers in Catalonia was suboptimal. Continuing education and training should be provided for all health professionals working in SUD centers. Not systematically delivering SCI to patients in treatment for other SUD means missing opportunities to reduce health and economic costs while perpetuating a smoking culture.

Los centros de tratamiento de drogodependencias son un recurso óptimo para realizar intervenciones para la cesación tabáquica (ICT). El objetivo de este estudio fue examinar la implementación de ICT en la Red de centros de Atención a las Drogodependencias (CAS) de Cataluña, así como evaluar las opiniones sobre la adecuación y viabilidad de la provisión de ICT. Los responsables de los CAS (n = 57) contestaron un cuestionario on-line compuesto por 30 ítems. Se obtuvieron datos de 50 centros (87,7% tasa de respuesta). El 46% de los CAS ofrecía algún tipo de ICT, pero sólo un 4,8% de los nuevos pacientes eran tratados para dejar de fumar. Además, los responsables informaron que el 73,3% de los profesionales que trabajaban en los CAS no había recibido formación en ICT. El 64% de los responsables estaba de acuerdo que todos los profesionales deberían realizar ICT. Aquellos centros que ofrecían ICT visitaban más pacientes y era más probable que tuviesen profesionales formados en ICT, comparado con los centros que no ofrecían ICT. La implementación de ICT en los CAS de Cataluña era subóptima. Se debería facilitar formación continuada a los profesionales de los CAS. No intervenir sobre el consumo de tabaco en pacientes en tratamiento por otras drogodependencias significa perder oportunidades para reducir costes en salud y económicos mientras perpetuamos una cultura fumadora.

One Year Clinical Correlates of EtG Positive Urine Screening in Alcohol-Dependent Patients: A Survival Analysis.

AIMS: Little evidence exists supporting the efficacy of regular alcohol urine screening (RAUS) in the management of alcohol dependence, despite recent improvements in urine biomarkers. In this study, we aimed at investigating 1 year, differential clinical correlates between a positive and a negative baseline urine ethyl glucuronide (EtG) screening. METHODS: Alcohol-dependent outpatients participating in a previous cross-sectional study where EtG and ethanol diagnostic performances were compared in a double blind design were included. After 1 year, the presence of relapse, the number of hospitalizations and whether patients had abandoned treatment or not were assessed from electronic medical records. A survival analysis was conducted to compare time to relapse between EtG negative and positive subjects. Regression models were performed to compare the mean number of days hospitalized between groups, the risk of being lost to follow-up and treatment expenses. RESULTS: Of note, 152 patients (mean age 52, 67% males) were included. The mean time to relapse was of 163 days in EtG positive subjects, compared to 329 days in those with a negative result. In the Cox-regression model, only EtG positivity yielded significant results, with a hazard ratio of 5:3 (95% CI: 3.1-9.1). EtG positive was also the only significant predictor of a greater number of hospitalization days and treatment expenses. Younger age was the only variable predicting a greater risk of treatment abandonment. CONCLUSION: RAUS with sensible biomarkers could improve clinicians' ability to assess patients' relapse risk. Further prospective studies will have to determine if this can be translated into a better prevention capacity. SHORT SUMMARY: Positive urine screenings, when conducted with highly sensible alcohol biomarkers, significantly indicate a greater risk of relapse in alcohol-dependent patients and have the capacity to predict a greater risk of hospitalization and greater treatment expenses.

Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review. / Metadona para el tratamiento de la dependencia de opioides de prescripción médica. Una revisión retrospectiva de historias clínicas.

Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.

La adicción a opioides de prescripción médica (OPM) está ahasta la fecha sobre su tratamiento se basan principalmente en el uso de buprenorfina. Sin embargo, la metadona puede considerarse como otra opción. El objetivo de nuestro estudio fue revisar las historias clínicas de todos los pacientes ingresados en una unidad de psiquiatría para la desintoxicación de OPM usando metadona entre el 2010 y el 2013. El periodo de evaluación finaliza a los 3 meses desde el alta médico. Pese a ser una revisión de historia clínicas, se evaluaron las características sociodemográficas de la muestra, así como las variables relacionadas con el tratamiento y la tasa de abstinencia durante el estudio. Se incluyeron 11 pacientes, mayoritariamente mujeres (81,8%), con una mediana de edad de 50 años. La mediana de duración de la dependencia fue de 8 años. Hubo una alta prevalencia de adicción a otras sustancias así como de comorbilidades psiquiátricas. Ocho pacientes fueron seguidos durante al menos 3 meses. De estos, 7 (87,5%) estuvieron abstinentes hasta el final del periodo evaluado por el estudio. Los resultados sugieren la necesidad de estudios de mayor rigor metodológico para la correcta evaluación de la metadona como un tratamiento potencialmente eficaz para la dependencia de los OPM.

Motivational interviewing for smoking cessation in a psychiatric day hospital: a feasibility study.

OBJECTIVE: Our main objective was to test the feasibility of adding motivational interviewing to the usual smoking cessation treatment for patients with psychiatric disorders attending a day hospital. METHODS: A total of 44 patients participated in the study: a comparison group of 25 patients, all of whom received the usual smoking cessation treatment (nicotine replacement therapy, 1 hour of weekly group therapy, and daily individual advice), and an intervention group of 19 patients who received the usual smoking cessation treatment plus up to four motivational interviewing sessions. Data included sociodemographics, psychiatric diagnosis, cigarette use, and engagement in treatment. Descriptive analyses were conducted, along with logistic regression to test for differences on abstinence and daily smoking rates. RESULTS: All 19 patients offered the motivational interviewing accepted it, and all of them completed at least one session (M = 2.53, SD = 0.234, Range = 1 to 4). At the end of treatment, four patients in the intervention group were abstinent (versus none in the comparison group), but this was not statistically significant. Both groups showed a mean daily reduction of eight cigarettes. After introducing all variables into the regression models, none reached significance. CONCLUSIONS: Adding motivational interviewing to usual smoking cessation treatment in a psychiatric day hospital seems feasible and acceptable. Further, more rigorous research is needed.

Quitline nurses' experiences in providing telephone-based smoking cessation help to mental health patients: A mixed methods study.

WHAT IS KNOWN ON THE SUBJECT?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The '061 QUIT-MENTAL study' evaluated the efficacy of a proactive telephone-based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non-mental health specialized nurses and other health professionals to provide evidence-based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While the training programme was successful in improving non-mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population. ABSTRACT: Introduction The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long-term viability. The 061 QUIT-MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone-based intervention addressed to mental health patients conducted by non-psychiatric specialized nurses. Aim We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method Mixed methods study: (1) Pre-post evaluation to assess self-reported knowledge, self-efficacy and opinions about smoking cessation. (2) In-depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population-based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population-based interventions to individuals with mental health disorders. Implications for Practice Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population.

Smoke-free policies in psychiatric services: identification of unmet needs.

INTRODUCTION: Smoke-free policies have been extended to enclosed workplaces in many countries; however, smoking continues to be commonly allowed on psychiatric premises. The aim of this study was to describe tobacco control strategies undertaken in psychiatric inpatient services and day centres in Spain. METHODS: This cross-sectional survey included all psychiatric service centres that offered public services in Catalonia, Spain (n=192). Managers responded to a questionnaire of 24 items that covered four dimensions, including clinical intervention, staff training and commitment, smoking area management and communication of smoke-free policies. RESULTS: A total of 186 managers (96.9%) completed the questionnaire. Results showed low tobacco control in psychiatric services: 41.0% usually intervened in patient tobacco use, 34.1% had interventional pharmacotherapy available and 38.9% had indoor smoking areas. Day centres showed the lowest implementation of tobacco control measures. Out of 186 managers, 47.3% stated that the staff had insufficient knowledge on smoking cessation interventions. CONCLUSIONS: The former Spanish partial law has not been sufficiently successful in promoting tobacco control in psychiatric services. There is room for improvement in tobacco control policies, specifically in smoking interventions, staff training and resource availability.

Tobacco cessation among smokers under substance use treatment for alcohol and/or cannabis: study protocol and pilot study.

BACKGROUND: Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic. METHODS: Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users' Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.). DISCUSSION: The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200-250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies. Trial registration The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].

Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards.

BACKGROUND AND AIM: Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge. METHODS: Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation. RESULTS: Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05). CONCLUSIONS: A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.

Analysis of the Consequences of the COVID-19 Pandemic on People with Severe Mental Disorders.

For people with severe mental disorders (SMDs) the COVID-19 pandemic may pose a number of risks. These include the loss of needed care, a higher probability of infection, and the worsening of their mental health. To analyze the pandemic's impact on care received, relapses, loss of employment, and adherence to preventive guidelines in SMD sufferers, a multicenter retrospective cohort study was carried out comparing 185 patients diagnosed with SMD and 85 with common disorders. The results showed that during lockdown, there was a significant reduction in face-to-face psychotherapeutic, nursing, and occupational therapy interventions. In the same period, telematic interventions were introduced which, although subsequently reduced, now continue to be used to a greater extent than before the pandemic. Employment decreased significantly (13% vs. 9.2%; χ2 = 126.228 p < 0.001). The percentage of people with SMD following preventive guidelines was significantly lower for both hand washing (56.2% vs. 75.3%; χ2 = 9.360, p = 0.002) and social distancing (47% vs. 63.5; χ2 = 6.423 p = 0.011). In conclusion, the COVID-19 pandemic has led to a reduction in the interventions that are needed for the recovery of people with SMDs, together with a significant loss of employment and an increased risk of contagion due to less adherence to preventive guidelines. In the future, appropriate attention to these people's needs must be guaranteed.

Attentional Bias, Alcohol Craving, and Anxiety Implications of the Virtual Reality Cue-Exposure Therapy in Severe Alcohol Use Disorder: A Case Report.

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed.

[Assessing coping strategies in alcoholics: Comparison while controlling for personality disorders, cognitive impairment and benzodiazepine misuse]. / Estrategias de afrontamiento en enfermos alcohólicos. Diferencias según el consumo de benzodiacepinas, los trastornos de la personalidad y el deterioro cognitivo.

INTRODUCTION: Better coping skills are related to greater capacity for dealing with stressful situations. This relationship could be relevant for the prevention of alcohol-misuse relapse. Relapse rate is higher among severe alcoholics. The current study examines whether this may be due to a lack of coping skills in those cases. The COPE (Coping Orientations to Problems Experienced) is a questionnaire used for assessing coping strategies. METHOD: COPE scores of 216 alcohol inpatients are compared while controlling for personality disorders (PDs), cognitive impairment (CI) and benzodiazepine misuse (BM). RESULTS: Patients with PDs score higher on the scales of Humor, Venting emotions, Substance use and Use of instrumental support. However, there are no differences in COPE scores attributable to CI or BM. CONCLUSIONS: Alcoholics with Personality disorders use maladaptive coping strategies. Patients presenting CI or BM have low capacity for introspection and are unable to properly evaluate their own abilities, so that they tend to give a socially favorable but unrealistic image of themselves. Longitudinal studies are needed to evaluate the predictive validity of the coping skills before training alcoholics, who are especially difficult to assess due to their lower capacity for objective self-observation.

Predictors of Changes in Alcohol Craving Levels during a Virtual Reality Cue Exposure Treatment among Patients with Alcohol Use Disorder.

BACKGROUND/OBJECTIVE: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). METHOD: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. RESULTS: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ2 = 13.818; p = 0.003) but not within the TAU group (χ2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. CONCLUSIONS: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment.

[Impact of a training in brief intervention. Differences in the hospital approach of tobacco and alcohol consumption]. / Impacto de la formación en intervención breve. Diferencias en el abordaje hospitalario del consumo de tabaco y alcohol.

OBJECTIVE: To evaluate th e impact of a training intervention To evaluate the impact of a training intervention for health care professionals on inpatients' smoking and alcohol consumption and to compare the hospital intervention for the two substances. METHODS: Through two parallel studies, we compared, using auto-administered questionnaires, the referred clinical behaviour on smoking of 66 health care professionals and the intervention received by 169 patients, with the clinical behaviour on hazardous drinking of other 38 professionals and other 118 patients from different hospital wards before and after attending a training in brief intervention on smoking cessation and hazardous alcohol drinking respectively. RESULTS: We only found slight differences between alcohol and tobacco concerning professionals' behaviour. Professionals declared to assist more often patients with alcohol risk consumption than smoking (36.4% vs 10.9% [p<.0001]) although with patients those differences haven't been confirmed. They just told to have been asked more often about alcohol consumption than about smoking (43.6% vs 30.8% [p<.05]). There were no differences after the training sessions. DISCUSSION: Before and after training, health professionals hardly intervene in patients with alcohol or tobacco consumption even we observed higher detection and assist for alcohol risk consumption. It is necessary to examine other barriers to the application of the knowledge gained.

Identifying Triggers of Alcohol Craving to Develop Effective Virtual Environments for Cue Exposure Therapy.

Background: Many studies have indicated that alcohol craving is a core mechanism in the acquisition, maintenance, and precipitation of relapse in alcohol use disorder (AUD). A common treatment approach in AUD is cue exposure therapy (CET). New technologies like virtual reality (VR) have the potential to enhance the effectiveness of CET by creating realistic scenarios in naturalistic environments. In this study, we aimed to determine relevant triggers of alcohol craving in patients with AUD. Methods: We enrolled 75 outpatients diagnosed with AUD according to the DSM-5 criteria Participants completed the Alcohol Use Disorder Identification Test and a self-administered questionnaire to assess alcohol craving. The variables included in the craving questionnaire were as follows: presence of others, situations, time of the day, day of the week, mood, and type of alcoholic beverage. Results: Greater levels of alcohol craving were seen in many situations, including being at a party, in a restaurant, in a bar or pub, and at home. Drinking alone and drinking with two or more friends were equally associated with higher levels of craving. Drinking at night and drinking at weekends also emerged as triggers for alcohol craving. Emotional states like anxiety or tension, sadness, stress, frustration, or irritability were highly associated with urges to drink alcohol. The alcoholic drinks most highly associated with increased levels of craving were beer, wine, and whisky. Gender and age implications were discussed. Conclusion: This study is part of a larger project aiming to develop and validate CET based on VR technology for patients with AUD who are resistant to classical treatment. The identified triggers have been used to develop relevant VR environments for CET, and further research is ongoing to implement our findings.

Cue-Elicited Anxiety and Alcohol Craving as Indicators of the Validity of ALCO-VR Software: A Virtual Reality Study.

BACKGROUND: This study is part of a larger project aiming to develop a virtual reality (VR) software to be implemented as a clinical tool for patients diagnosed with alcohol use disorder (AUD). The study is based on previous research in which we identified factors that elicit craving for alcohol in a sample of AUD patients, and which led to the development of a virtual reality software to be used in cue exposure treatments of alcohol use disorder (ALCO-VR). The main objective of this study was to test the effectiveness of ALCO-VR to elicit cue-induced craving and anxiety responses among social drinkers (SD) and AUD patients. Our secondary objective was to explore which responses (cue-induced craving or anxiety) can best differentiate between AUD patients and the SD group. METHOD: Twenty-seven individuals (13 AUD patients and 14 SD) participated in this study after giving written informed consent. Their anxiety and alcohol craving levels were measured by different instruments at different stages of the procedure. The VR equipment consisted of Oculus Rift technology, and the software consisted of the ALCO-VR platform. RESULTS: Our data indicate that the ALCO-VR software can elicit responses of anxiety and alcohol craving, especially in the group of AUD patients. The cue-induced anxiety response differentiated AUD patients and the SD group better than the cue-induced craving response. CONCLUSIONS: The general interest in applying new technologies to the assessment and treatment of mental health disorders has led to the development of immersive real-life simulations based on the advantages of VR technology. Our study concluded that the ALCO-VR software can elicit anxiety and craving responses and that cue-induced anxiety responses can distinguish between AUD and SD groups better than cue-induced craving. The data on craving and anxiety were assessed consistently by different instruments. In addition, we consider that ALCO-VR is able to ecologically assess cue-induced anxiety and alcohol craving levels during exposure to VR alcohol-related environments.

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial.

BACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, ß = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03230955 . Registered on 24 July 2017.

Using the temperament and character inventory (TCI) to predict outcome after inpatient detoxification during 100 days of outpatient treatment.

AIMS: The aim was to evaluate TCI (Temperament and Character Inventory) scales in identifying personality traits for predicting adherence to outpatient treatments and the relapse of alcohol consumption by alcoholic patients. METHODS: Follow-up of 89 alcoholic patients during the 100-day outpatient treatment after their release from the hospital detoxification unit. The detoxification treatment and the follow-up take place in the same hospital unit. RESULTS: Of the patients, 34.8% abandoned the treatment and 31.5% relapsed. The patients who abandoned treatment had lower scores on the Cooperativeness scale. The length of time until the abandonment of the treatment was greater for those with scores >50 for the Self-directedness or Cooperativeness scales. Patients with scores >50 on the Persistence scale were more often abstinent; however, they took the same time to relapse. CONCLUSIONS: Higher scores on the TCI personality scales of Persistence, Self-directedness and Cooperativeness predict a better therapeutic evolution, especially with regard to adherence during outpatient treatment after detoxification.

[Alcohol-dependent patients with benzodiazepine abuse: its relation to personality disorders and neuropsychological impairment]. / Consumo de tranquilizantes en pacientes alcohólicos y su relación con los trastornos de personalidad y el deterioro neuropsicológico.

BACKGROUND AND OBJECTIVE: Alcohol and drug dependent patients present a higher psychiatric comorbidity, which increases according to the number of drugs. Moreover, there are complications from the treatment and the prognosis is aggravated. We aimed to observe the differences regarding personality disorders (PD) and cognitive deterioration between alcohol dependent patients and patients who were benzodiazepine dependent as well. PATIENTS AND METHOD: Transversal study. Comparison between benzodiazepine-abusers (BZD+) and non-abusers (BZD-) from a cohort of 401 alcoholic inpatients under detoxification treatment. RESULTS: 28.1% of patients had benzodiazepine abuse or dependence (n=113). There was a higher proportion of women and PD within the BZD+ group (50.4% and 25.7%) than in the BZD- group (20.1% and 15.6%). They were of similar age -mean (standard deviation): 48,2 (10) versus 47,4 (10) years- and presented a smaller frequency, although not significant, of neuropsychological deterioration (19% versus 26%). This difference was stronger in women (8.8% versus 36.2%) than in men (30.4% versus 23%). CONCLUSIONS: Benzodiazepine consumption predominates in women and in patients with PD. In women it tends to occur before alcohol addiction and is related to a PD, decreasing alcohol consumption and the frequency of cognitive deterioration. This deterioration is more frequent in men because of higher alcohol consumption, since benzodiazepines are taken later when deterioration has already started, to diminish withdrawal symptoms.