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1.
Psychiatr Prax ; 47(1): 22-28, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31910457

RESUMEN

INTRODUCTION: Over the last decade, methamphetamine use has spread rapidly in Europe, leading to a significant medical shortfall in many regions. To date, there are no standardized German-language therapy programs for qualified detoxification and motivation treatment. We have developed a therapy manual ("CrystalClean") over 15 therapy modules, which was evaluated in the present pilot study with regard to feasibility and acceptability. METHODS: Observational study with systematic interviews over 3 months on 31 patients with methamphetamine dependence. RESULTS: Acceptability of most modules was rated as high by both patients and therapists. In addition, the manual was considered to be well feasible in inpatient daily routine. However, contact terminations frequently occurred when switching to outpatient treatment. CONCLUSION: Results from our study point to a high acceptance of the manual for the accompaniment of qualified detoxification and motivation treatment in patients with methamphetamine dependence. Feasibility in the clinical setting can be improved by reducing the number of modules to the 12 best evaluated and by increasing the frequency of therapies.


Asunto(s)
Lenguaje , Metanfetamina , Trastornos Relacionados con Opioides/rehabilitación , Trastornos Relacionados con Sustancias/rehabilitación , Europa (Continente) , Estudios de Factibilidad , Alemania , Humanos , Motivación , Aceptación de la Atención de Salud , Proyectos Piloto , Traducción
2.
J Forensic Sci ; 65(1): 97-102, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31386191

RESUMEN

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.


Asunto(s)
Conducta de Elección , Prisioneros , Factores Sexuales , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Distribución por Edad , Consumo de Bebidas Alcohólicas , Cannabis , Cocaína , Cocaína Crack , Femenino , Heroína , Humanos , Masculino , Metanfetamina , Missouri/epidemiología , Medicamentos bajo Prescripción , Distribución por Sexo , Trastornos Relacionados con Sustancias/rehabilitación , Adulto Joven
3.
J Ment Health Policy Econ ; 22(3): 109-120, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31811754

RESUMEN

BACKGROUND: Recovery high schools (RHS) provide a supportive educational and therapeutic environment for students subsequent to treatment for substance use disorders (SUDs). Most students served by RHSs have concurrent mental health disorders and are at risk for school failure or dropout and substance use relapse. AIMS OF THE STUDY: The central question addressed is whether RHSs are economically efficient alternatives to other high school settings for students in recovery. The aim is to estimate the incremental cost-benefit of RHSs. METHODS: A quasi-experimental non-equivalent pretest-posttest comparison group design was used. We compared substance use and educational outcomes for adolescents who had received specialty SUD treatment; 143 who enrolled in an RHS were compared to 117 who enrolled in a non-RHS school. Groups were balanced by use of a propensity score to drop students who were not similar to those in the other group. The propensity score was also used as a covariate in multiple regression to estimate cost and outcome parameters and standard errors. To take account of uncertainties in impacts and shadow prices, we used Monte Carlo simulations to estimate the distribution of incremental benefits of RHS relative to non-RHS schooling. RESULTS: Two beneficial impacts of statistical and substantive importance were identified: increased probability of high school graduation and increased sobriety. RHS students had significantly (p<.05) less substance use during the study period -- at 12-month follow-up, 55% of RHS and 26% of comparison students reported 3 month abstinence from alcohol and drugs. Urinalysis confirmed abstinence from THC (cannabis) for 68% of RHS versus 37% of comparison students. RHS students' high school graduation rates were 21 to 25 percentage points higher than comparison students. Adopting a societal perspective, incremental benefits of RHSs were estimated by monetizing the increased probability of high school graduation and comparing it to incremental costs. Mean net benefits ranged from USD16.1 thousand to USD51.9 thousand per participant; benefit-to-cost ratios ranged from 3.0 to 7.2. DISCUSSION: Monetizing the benefits and the incremental costs of RHS relative to conventional schooling show substantial positive net benefits from RHS participation. Two factors lend credibility to the results. First, the RHS improvement in substance use indicates a mechanism through which the increased probability of high school graduation can plausibly occur. Second, the estimated increases in the probability of high school graduation were large and statistically significant. As the productivity gains from high school graduation are also large, the dominant benefit category is very plausible. Limitations include the non-randomized design; selection bias into the study conditions not fully controlled by the propensity scores; generalizability only to young people with treated behavioral health disorders; lack of estimates for direct monetization of reduced substance use among adolescents; possible attenuation of the value of education among individuals with behavioral health issues; and uncertainty in calculation of school costs. IMPLICATIONS FOR BEHAVIORAL HEALTH POLICIES: This research provides evidence that the recovery high school model provides cost beneficial support for high school students after primary SUD treatment. The students who enroll in RHSs typically have co-occurring mental health and substance use disorders, adding complexity to their continuing care. Funding policies recognizing the multiple systems of care (behavioral health, education, child and family services, juvenile justice) responsible for these young people are called for.


Asunto(s)
Éxito Académico , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/estadística & datos numéricos , Estudiantes/psicología , Trastornos Relacionados con Sustancias/terapia , Adolescente , Conducta del Adolescente/psicología , Niño , Enfermedad Crónica , Análisis Costo-Beneficio , Humanos , Estudios Longitudinales , Estudios Prospectivos , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Trastornos Relacionados con Sustancias/rehabilitación
4.
J Forensic Nurs ; 15(4): 231-241, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31764527

RESUMEN

INTRODUCTION: Clients on methadone maintenance treatment (MMT) have high attrition rates that are attributed to personal and system-related factors. To develop supportive interventions for these clients, it is imperative to understand social demographic characteristics and challenges that clients in the MMT program face. OBJECTIVES: This article aims to describe (a) the sociodemographic characteristics and clinical profiles of clients in a MMT program, (b) factors that impact their positive clinical outcomes, and (c) the study's implications for practice. METHODS: A retrospective review of 101 randomly selected electronic medical records representing one third of all the records were examined for sociodemographic characteristics, clinical profiles, and outcomes. Descriptive statistics were used to analyze these variables. Interviews with 18 healthcare providers focusing on their experiences of caring for clients in the MMT program were analyzed thematically. RESULTS: The average age of clients on MMT is 35.5 years. Clients had early exposure to alcohol and drugs, and at the time of enrollment to the program, they presented with complex healthcare needs, borne from chronic use, and exposure to adverse traumatic events. Personal and systemic factors impact clients' recovery. These include poverty, homelessness, and inadequate healthcare services. Understanding sociodemographic characteristics, clinical profiles, and clients' challenges is central to the development of supportive interventions that enhance retention to care and recovery.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Centros de Tratamiento de Abuso de Sustancias , Adulto , Distribución por Edad , Canadá/epidemiología , Femenino , Necesidades y Demandas de Servicios de Salud , Personas sin Hogar , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Medio Social , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitación , Adulto Joven
5.
BMC Health Serv Res ; 19(1): 687, 2019 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-31601199

RESUMEN

BACKGROUND: Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities. METHODS: EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis. DISCUSSION: This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs. TRIAL REGISTRATION: Clinical Trials.gov # NCT03369678 (registration date November 18, 2017).


Asunto(s)
Prestación de Atención de Salud/normas , Servicio de Urgencia en Hospital/normas , Equidad en Salud/organización & administración , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Colombia Británica , Protocolos Clínicos , Servicio de Urgencia en Hospital/organización & administración , Humanos , Indios Norteamericanos/estadística & datos numéricos , Análisis de Series de Tiempo Interrumpido , Servicios de Salud Mental/normas , Servicios de Salud Mental/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Racismo/estadística & datos numéricos , Trastornos Relacionados con Sustancias/rehabilitación , Violencia/estadística & datos numéricos
6.
Physiol Rev ; 99(4): 2115-2140, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31507244

RESUMEN

Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.


Asunto(s)
Conducta Adictiva , Encéfalo/fisiopatología , Consumidores de Drogas/psicología , Recompensa , Trastornos Relacionados con Sustancias/fisiopatología , Trastornos Relacionados con Sustancias/psicología , Animales , Encéfalo/metabolismo , Neuronas Dopaminérgicas/metabolismo , Humanos , Vías Nerviosas/metabolismo , Vías Nerviosas/fisiopatología , Plasticidad Neuronal , Factores de Riesgo , Trastornos Relacionados con Sustancias/metabolismo , Trastornos Relacionados con Sustancias/rehabilitación
7.
BMC Health Serv Res ; 19(1): 656, 2019 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-31500620

RESUMEN

BACKGROUND: In Thailand, two community-based drug treatment approaches are common. The first one is the traditional community-based treatment program (FAST) which brings the principles of community therapy as a guideline for treatment. The second one is the military hospital-based drug treatment program (PMK), derived from the basic military training, the Buddhist Twelve Steps, CBT and the Minnesota Rehabilitation Model. This study aimed to investigate and compare the efficacy of PMK vs. FAST. METHOD: The experiment was conducted from January-March 2016 at the rehabilitation center for patients with drug addiction in Thailand. Quasi-experimental methods were introduced, and ASSIST, WHOQOL-BRIEF-THAI and self-efficacy interview form were applied. After completing the drug rehabilitation program at a total duration of 120 days, the researcher continued at follow up times at 3 and 6 months. RESULTS: Compared with baseline scores, both programs significantly reduced the severity of drugs and increased self-efficacy at 6-month follow-up. PMK had better improved scores in the relationship and environment dimensions of quality of life at 3-month follow-up (P = 0.026, 0.006). The mean quality of life scores in PMK at 3 and 6 months showed better results than mean scores at baseline (P = < 0.001). CONCLUSION: Both community-based programs in Thailand significantly reduced the severity of drugs and increased self-efficacy scores at 6-month follow-up. PMK and FAST has not shown any significant difference in treatment outcome results in the aspects of self-efficacy and reduced severity of drugs used. However, PMK had significant positive effects on the quality of life.


Asunto(s)
Calidad de Vida , Autoeficacia , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Hospitales Militares , Humanos , Masculino , Persona de Mediana Edad , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/psicología , Tailandia , Resultado del Tratamiento
9.
BMC Med ; 17(1): 161, 2019 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-31412884

RESUMEN

BACKGROUND: Cannabis is the most commonly used illicit substance amongst people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis. METHODS: CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at least one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045. RESULTS: Five hundred fifty-one participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99, 382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group; however, the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group. CONCLUSIONS: Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered.


Asunto(s)
Terapia Conductista/métodos , Cannabis , Trastornos Psicóticos/terapia , Trastornos Relacionados con Sustancias/rehabilitación , Adolescente , Adulto , Terapia Conductista/economía , Cannabis/efectos adversos , Condicionamiento Operante , Análisis Costo-Beneficio , Inglaterra , Femenino , Humanos , Masculino , Motivación , Adulto Joven
11.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artículo en Inglés | MEDLINE | ID: mdl-31352378

RESUMEN

A 45-year-old man, a regular cocaine user, presented with confusion and unusual behaviour to the emergency room. On examination he was unable to perform simple tasks or follow commands. He was treated for possible central nervous system infection. MRI of the brain showed multiple bilateral T2 hyperintense periventricular and deep white matter foci, best appreciated on FLAIR with contrast enhancement. He continued deteriorating, eventually becoming catatonic with extensor posturing and increased tone, requiring intensive therapy unit management. Repeat MRIs were also noted to show worsening changes. He was treated for a presumed inflammatory leucoencephalopathy with intravenous methylprednisolone, immunoglobulins, as well as plasmapheresis. After 2 weeks, the patient started to show clinical improvement with eventual transfer to a rehabilitation hospital. A year after his first presentation, the patient scored 30 out of 30 on the MMSE and his neurological examination was normal.


Asunto(s)
Cocaína/efectos adversos , Confusión/inducido químicamente , Leucoencefalopatías/fisiopatología , Trastornos Mentales/inducido químicamente , Trastornos Relacionados con Sustancias/fisiopatología , Sustancia Blanca/patología , Confusión/fisiopatología , Electroencefalografía , Humanos , Inmunoglobulinas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Leucoencefalopatías/inducido químicamente , Leucoencefalopatías/terapia , Imagen por Resonancia Magnética , Masculino , Trastornos Mentales/fisiopatología , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Plasmaféresis , Trastornos Relacionados con Sustancias/rehabilitación , Trastornos Relacionados con Sustancias/terapia , Resultado del Tratamiento
12.
Artículo en Inglés | MEDLINE | ID: mdl-31261620

RESUMEN

Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.


Asunto(s)
Alcoholismo/rehabilitación , Ejercicio , Cooperación del Paciente , Cese del Hábito de Fumar/métodos , Trastornos Relacionados con Sustancias/rehabilitación , Comorbilidad , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Estado Nutricional , Autoeficacia , Mensaje de Texto
13.
Cien Saude Colet ; 24(5): 1585-1596, 2019 May 30.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31166494

RESUMEN

Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.


Asunto(s)
Motivación , Terapia Ocupacional/métodos , Trastornos Relacionados con Sustancias/rehabilitación , Grupos Focales , Humanos , Entrevistas como Asunto , Grupo de Atención al Paciente/organización & administración , Portugal , Comunidad Terapéutica
14.
Artículo en Inglés | MEDLINE | ID: mdl-31159227

RESUMEN

This study adopts the perspective of the Self-Determination Theory to look at the psychological experience of drug users and their decisions to take drugs or not, with particular emphasis on the concept of relatedness. To achieve this objective, a qualitative methodology was employed to explore the experiences of these drug users regarding how they take drugs and/or relapse. Theory-driven thematic analysis was employed to identify themes related to this topic. Results show that one's psychological need for relatedness is an important determinant of whether one will take drugs or not, via the interaction mechanisms that exist in dimensions of affiliation and intimacy. While drug taking is a result of the modeling behavior existing in affiliated relationships, it is also a coping strategy for the ultimate satisfaction of psychological needs when human relatedness disappears. The implication is that significant others can develop unconditionally warm, caring, and empathetic supportive relationships with drug users, so as to enhance their fulfillment of psychological needs and reduce the risk of drug relapse.


Asunto(s)
Motivación , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitación , Adaptación Psicológica , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Autonomía Personal , Satisfacción Personal , Investigación Cualitativa , Recurrencia , Adulto Joven
15.
J Addict Nurs ; 30(2): 78-86, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31162209

RESUMEN

There are approximately 3.1 million nurses in the Unites States (U.S. Census Bureau, 2016), and approximately 8% of them experience substance use disorders (Kunyk, 2015). Nurses with impaired practice are referred to peer assistance programs as they seek rehabilitation. As of 2016, 348 nurses in Texas Peer Assistance Program for Nurses were actively participating in the program for substance-abuse-related offenses. Over the last 6 years (2010-2016), 1,553 nurses were referred to Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. These represent 2% of the population of nurses in Texas. The average age of participants was 40.1 years. Women represented 75% of participants, and 76% were registered nurses. About 41% successfully completed the program without relapsing, and 32% reported at least one relapse. Varieties of drugs were abused including prescription drugs and illegal drugs. Opioids were the most frequently abused class of drugs, followed by alcohol and stimulants. Most nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical-surgical units, and home health care had the highest prevalence of impaired practice. Psychiatric comorbidity was not significantly associated with relapse, but self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of abstinent days. Men were also more likely to be employed while in the program.


Asunto(s)
Enfermeras y Enfermeros/estadística & datos numéricos , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tratamiento de Sustitución de Opiáceos , Inhabilitación Profesional/estadística & datos numéricos , Derivación y Consulta , Estudios Retrospectivos , Texas , Resultado del Tratamiento , Adulto Joven
17.
Australas Psychiatry ; 27(4): 378-382, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31179714

RESUMEN

OBJECTIVES: This paper considers the impact of having a diagnosis of substance use disorder on the utilisation of compulsory orders under the Victorian Mental Health Act (2014). METHODS: We analysed the subsequent treatment episodes over 2 years of people who had been on a community treatment order for at least 3 months and determined the odds of a further treatment order if there was a diagnosis of substance use at or about the time the index community treatment order ended. RESULTS: An additional diagnosis of a substance use disorder was coded in 47.7% and was associated with significantly increased odds of a subsequent treatment order in the following 2 years for those with a main diagnosis of schizophrenia (AOR = 3.03, p<0.001) and 'other' disorders (AOR = 11.60, p=0.002). Those with a main diagnosis of mood disorder had a significant increase in odds for an inpatient treatment order if there was an additional substance use disorder diagnosis (AOR = 3.81, p=0.006). CONCLUSIONS: Having an additional diagnosis of substance use disorder was associated with increased likelihood of being placed on an order. This study supports greater emphasis being given to treatment of substance use concurrently with that of mental illness.


Asunto(s)
Servicios Comunitarios de Salud Mental/legislación & jurisprudencia , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Trastornos del Humor/epidemiología , Esquizofrenia/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Internación Compulsoria del Enfermo Mental , Hospitalización/estadística & datos numéricos , Humanos , Trastornos del Humor/rehabilitación , Modelos de Riesgos Proporcionales , Esquizofrenia/rehabilitación , Trastornos Relacionados con Sustancias/rehabilitación , Victoria/epidemiología
18.
Rev Gaucha Enferm ; 40: e20180062, 2019 Jun 10.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31188983

RESUMEN

OBJECTIVE: To understand the motives behind the actions of harm reducers when working with drug users. METHOD: Qualitative research conducted in the municipality in Rio Grande do Sul (RS), Brazil, in May 2017, by means of phenomenological interviews with 17 harm reducers. We analyzed and interpreted the data using the social phenomenology of Alfred Schütz. RESULTS: Data analysis led to the following three categories: expectation of changes in the user's sphere of life, motivation at work from the recognition of their actions, and relationship with others as a life-learning experience. CONCLUSION: The reasons harm reducers work with drug users are related to the family, search for a home, employment, access to health care, rights, and stigma, as well as the positive results of their work, personal satisfaction, and learning with drug users.


Asunto(s)
Consumidores de Drogas , Reducción del Daño , Entrevista Psicológica , Motivación , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Brasil , Empleo/psicología , Familia , Femenino , Accesibilidad a los Servicios de Salud , Vivienda , Humanos , Masculino , Persona de Mediana Edad , Satisfacción Personal , Investigación Cualitativa , Estigma Social , Trabajadores Sociales/psicología , Adulto Joven
19.
Expert Opin Drug Saf ; 18(8): 753-758, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31177863

RESUMEN

Objectives: Z-Drugs (ZDs) have been developed to limit benzodiazepines (BZDs) abuse for sleep disorders. Data on the liver toxicity of zolpidem (ZLM) are lacking or anecdotal. The authors evaluated the presence of drug-induced liver injury (DILI) among a cohort of high-dose ZLM abusers. Methods: Retrospective study analyzing clinical records of 1112 consecutive patients admitted for BZDs detoxification from 2003 to 2018. Inclusion criteria: age >18 y.o.; ZLM abuse/dependence; high-dose ZDs abuse. Exclusion criteria: missing lab data; lack of informed consent. Main outcome was the presence of DILI measured as elevation of ALT/AST levels >250 U/l. Results: A total of 107 patients met the eligibility criteria. Liver enzymes alterations were present in 9.3% (95% CI 4.6-16.5%); one patient (0.9%, 95% CI 0.0-2.8%) showed DILI criteria. BMI significantly influenced transaminases levels. No correlations between duration nor doses of ZLM abuse and transaminases levels were found. Conclusion: The present study shows a very low prevalence of DILI among high-dose ZLM abusers. The prevalence of hypertransaminasemia was in line with general population. On one hand ZLM has a substantially safe liver profile but on the other hand ZLM abuse and dependence, especially at very high doses, represents an emerging problem.


Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Fármacos Inductores del Sueño/administración & dosificación , Trastornos Relacionados con Sustancias/complicaciones , Zolpidem/administración & dosificación , Adulto , Alanina Transaminasa/metabolismo , Aspartato Aminotransferasas/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Fármacos Inductores del Sueño/efectos adversos , Trastornos Relacionados con Sustancias/rehabilitación , Zolpidem/efectos adversos
20.
Early Interv Psychiatry ; 13 Suppl 1: 20-28, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31243907

RESUMEN

AIM: In many parts of the world, there is growing concern about youth homelessness. Homeless youth are particularly vulnerable to psychological distress, substance use and mental disorders, and premature mortality caused by suicide and drug overdose. However, their access to and use of mental health care is very limited. METHODS: The Réseau d'intervention de proximité auprès des jeunes (RIPAJ), a Montreal network of over 20 community stakeholders providing a wide array of cohesive services, was created to ease homeless youth's access to mental health and psychosocial services. Its philosophy is that there should be no "wrong door" or "wrong timing" for youth seeking help. In 2014, the network partnered with the pan-Canadian transformational research initiative, ACCESS Esprits ouverts. RESULTS: Created through this partnership, ACCESS Esprits ouverts RIPAJ has been promoting early identification through outreach activities targeting homeless youth and agencies that serve them. An ACCESS Clinician was hired to promote and rapidly respond to help-seeking and referrals. By strengthening connections within RIPAJ and using system navigation, the site is working to facilitate youth's access to timely appropriate care and eliminate age-based transitions between services. A notable feature of our program, that is not usually evident in homelessness services, has been the engagement of the youth in service planning and design and the encouragement of contact with families and/or friends. CONCLUSION: Challenges remain including eliminating any remaining age-related transitions of care between adolescent and adult services; and the sustainability of services transformation and network coordination. Nonetheless, this program serves as an example of an innovative, much-needed, community-oriented model for improving access to mental health care for homeless youth.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Jóvenes sin Hogar/psicología , Comunicación Interdisciplinaria , Colaboración Intersectorial , Servicios de Salud Mental/organización & administración , Mejoramiento de la Calidad/organización & administración , Servicios Urbanos de Salud/organización & administración , Adolescente , Niño , Femenino , Investigación sobre Servicios de Salud/organización & administración , Humanos , Masculino , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Grupo de Atención al Paciente/organización & administración , Quebec , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitación , Adulto Joven
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