Factors associated with neurofeedback and mindfulness-based combination therapy for patients with substance use disorder: A multicenter study

Background and objectives Substance use disorder (SUD) has become a major concern in public health globally, and there is an urgent need to develop an integrated psychosocial intervention. The aims of the current study are to test the efficacy of the integrated treatment with neurofeedback and mindfulness-based therapy for SUD and identify the predictors of the efficacy. Methods This study included 110 participants with SUD into the analysis. Outcome of measures includes demographic characteristics, severity of dependence, quality of life, symptoms of depression, and anxiety. Independent t test is used to estimate the change of scores at baseline and three months follow-up. Generalized estimating equations are applied to analyze the effect of predictors on the scores of dependence severity over time by controlling for the effects of demographic characteristics. Results A total of 22 (20 %) participants were comorbid with major mental disorder (MMD). The decrement of the severity in dependence, anxiety, and depression after treatment are identified. Improved scores of qualities of life in generic, psychological, social, and environmental domains are also noticed. After controlling for the effects of demographic characteristics, the predictors of poorer outcome are comorbid with MMD, lower quality of life, and higher level of depression and anxiety. Conclusion The present study implicates the efficacy of integrated therapy. Early identification of predictors is beneficial for healthcare workers to improve the treatment efficacy. (AU)

Factors impeding switching from methadone to buprenorphine in heroin users receiving methadone maintenance therapy - A naturalistic cohort study.

INTRODUCTION: Switching from methadone to buprenorphine/naloxone remains a challenge for heroin users receiving methadone maintenance treatment (MMT). The present study aimed to investigate the predictors for failed switching from methadone to buprenorphine/naloxone among patients receiving MMT. METHODS: This 5-year retrospective study included 168 individuals (138 males and 30 females) with opioid dependence who attempted to switch from methadone to buprenorphine/naloxone at our MMT clinics in Taiwan. We excluded patients with psychiatric comorbidity and other substance use disorders except nicotine. A univariate Cox proportional hazards regression model (Cox model) was used to estimate the potential factors of subsequent failed switching, followed by a multivariate Cox model to identify significant predictors after adjusting for other covariates. RESULTS: Seventy of the 168 participants (41.7%) failed switching from methadone to buprenorphine/naloxone. After forward selection in the Cox hazard regression model, a greater average dose of methadone (HR = 1.02; P = 0.01), greater maximal maintenance dose of MMT (HR = 1.02; P < 0.001), greater average dose of buprenorphine (HR = 1.10; P = 0.021), and lower average attendance rate during the three months before switching (HR = 0.09; P = 0.002) were significantly associated with failed switching. CONCLUSIONS: This study with limited participants showed that dose of methadone, dose of buprenorphine, and attendance rates were significantly associated with failed switching. Clinicians should discuss with their patients about tapering the dose of methadone and improving their attendance if they want to switch from methadone to buprenorphine. Further studies are necessary to verify whether our findings generalize to other populations.

Predictors of sleep disturbance in heroin users receiving methadone maintenance therapy: a naturalistic study in Taiwan.

INTRODUCTION: Sleep disturbance is a major health concern for heroin users receiving methadone maintenance treatment (MMT). The present study was aimed to investigate the predictors for new-onset clinically predominant sleep disturbance (CPSD) among heroin users receiving MMT. METHODS: This 2-year retrospective study included 152 individuals (127 males and 25 females) with heroin use disorder who visited our MMT clinics for the first time. A univariate Cox proportional hazards regression model (Cox model) was used to estimate the potential factors of subsequent CPSD, followed by a multivariate Cox model to identify significant predictors of CPSD after adjusting for other covariates. RESULTS: Twenty-nine (19.1%) participants developed CPSD during the 2-year period. After forward selection in the Cox model, earlier age at onset of heroin exposure (OR=0.95; P=0.044), lower attendance rate (OR =0.04; P=0.03), greater maximum dose of methadone (OR =1.01; P=0.022), and shorter time to maximum methadone dose (OR =0.98; P=0.007) were significantly associated with new-onset CPSD. CONCLUSION: We identified predictors that were significantly associated with new-onset CPSD, and clinicians should be aware of sleep disturbance in heroin users receiving MMT with these risk factors. Future studies are necessary to verify our findings and extend the applicability.

Factors affecting the dose of methadone among patients receiving methadone maintenance therapy in Taiwan.

BACKGROUND: Methadone maintenance treatment (MMT) has been shown to be an effective therapeutic strategy for opioid users. This study aimed to investigate the predictive effect of clinically predominant sleep disturbance (CPSD) on the dose of methadone among opiate users receiving MMT during a follow-up period of 6 years in Taiwan. METHODS: This retrospective study included 1,290 individuals with opioid dependence who visited our MMT clinic for the first time. Generalized estimating equations were used to analyze the effect of CPSD on the daily dose of methadone by controlling for the effects of demographic and MMT characteristics. RESULTS: A total of 469 (36.4%) participants were comorbid with CPSD. After controlling for the effects of demographic and MMT characteristics, the participants comorbid with CPSD had a higher dose of daily methadone than those without CPSD (estimate: 7.03, p < .001). Furthermore, younger age (estimate: -1.22, p < .001), older age at initial MMT (estimate: .44, p < .001), lower educational level (estimate: -.90, p = .003) and lower attendance rates (estimate: -.14, p = .033) are significantly related to higher doses of daily methadone. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Our study provided a naturalistic observation of the cohort for long period, along with a large sample size which could reflect clinical practice in the real world. We reported that a higher daily dose of methadone was significantly associated with CPSD after controlling for the effects of other factors. CPSD should be routinely surveyed among heroin users receiving MMT. (Am J Addict 2018;27:225-230).