The Effect of Melatonin Upon Postacute Withdrawal Among Males in a Residential Treatment Program (M-PAWS): A Randomized, Double-blind, Placebo-controlled Trial.

OBJECTIVE: Assess the effect of melatonin (5 mg) compared with placebo as an adjuvant treatment along with current behavioral and pharmacotherapy for 28 days on weekly self-reported severity of anxiety, depression, stress, and sleep complaints, and also how sleep is affecting daily life in males 18 years of age and older in recovery from substance use at a residential program in south-western Pennsylvania. BACKGROUND: Individuals in recovery experience a variety of symptoms including, but are not limited to, anxiety, depression, sleep difficulties, and stress. In the U.S., melatonin is a readily available nutraceutical that is used to alleviate sleep difficulties. Studies also suggest that melatonin may also have anxiolytic and antidepressive actions alone, as well as in those with co-morbid insomnia. Observation of clinicians treating individuals during and/or post drug cessation indicated that melatonin is commonly provided specifically to alleviate sleep difficulties with little evidence regarding efficacy in this population. The paucity of evidence as well as observation of clinical practices provided the rationale for this randomized clinical trial. METHODS: A single-center, randomized, double-blind, placebo-controlled, parallel-group trial was conducted. Seventy individuals were enrolled, block-randomized with an allocation ratio of 1:1. Intention-to-treat analysis was performed for all primary outcome measures. Primary outcome measures were assessed with the Generalized Anxiety Disorder Scale (GAD-7), Personal Health Questionnaire Depression Scale (PHQ-8), Perceived Stress Scale (PSS-14), and Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-1). Secondary outcome measures were to acquire participant characteristics, determine adherence, and document adverse events. RESULTS: No statistically significant between-group differences were detected for baseline characteristics. Even though the proportion of individuals reporting an adverse event between groups was not significantly different, the frequency of reported adverse events was greater in the melatonin group. Intention-to-treat analysis for all the measured outcomes revealed no statistically significant between-group differences for same day comparisons. CONCLUSIONS: The diversity of medication regimens, and also the services provided by the residential treatment site add to the complexity of assessing the efficacy of melatonin on the measured outcomes. Given these limitations, there exists insufficient evidence to suggest that the effect of melatonin and placebo on the outcomes were significantly different.

Adherence With Therapeutic Regimens: Behavioral and Pharmacoeconomic Perspectives.

There is an extensive literature regarding nonadherence with both therapeutic regimens and medication. This literature includes reviews of empirical research regarding the factors associated with nonadherence. Health care system, provider, and patient factors as well as the nature of the illness and therapeutic regimen all effect adherence rates. Different behavioral models for adherence counseling such as the Health Belief Model, the Theory of Reasoned Action, the Medication Interest Model, and Motivational Interviewing have also been reported in the research literature. This article will discuss the development of a brief model for patient counseling with specific techniques illustrated for pharmacists based on empirical findings that have demonstrated effectiveness in the adherence research literature. In addition, the article will address the measurement of the economic impact of medication nonadherence and propose a framework for assessing the cost-effectiveness of pharmacist counseling to increase adherence. The problem of nonadherence has significant effects upon health care expenditures through increase in physician's visits, emergency department incidents, rehospitalizations, and nursing home readmissions. Thus, the overall goal is to assist the pharmacist in developing a brief adherence counseling program in community pharmacy and evaluating the economic feasibility of the intervention demonstrating the value-added proposition of pharmacist intervention.

Adherence with antidepressant medication.

Nonadherence with antidepressant medications is a well-documented factor in treatment failure. This article uses the literature to build a collaborative counseling model to increase antidepressant adherence. Studies may be warranted to determine whether specific antidepressants, when used as part of a collaborative strategy, can improve long-term adherence rates.

Managing the aftermath of medication errors: managed care's role.

OBJECTIVE: To discuss managed care's role in managing an organization's response to a medication error and to provide specific recommendations for that response. DATA SOURCES: Published articles and reports related to crisis management, service failure, public relations, ethics, psychology, management, marketing, health care, and law. Review of the literature on crisis management and service failure was extensive. ProQuest and MEDLINE databases were searched. Search terms were medication error, medical error, and organizational crisis. STUDY SELECTION: Studies were selected on the basis of their relevance to practitioners. DATA SYNTHESIS: Medication errors place practitioners, pharmacies, and health care organizations under severe emotional, physical, and financial stress. Managed poorly, a medication error can have disastrous consequences for all involved. When the response is managed correctly, a medication error presents a challenge, but one that is survivable and potentially instructive. Managed care should develop and disseminate best practices for responding to errors and lead the development and adoption of technologies and systems designed to curtail the number of errors and reduce the costs associated with those errors. Effectively responding to a medication error allows the pharmacy organization to maintain or resume its core activities while minimizing stakeholders' losses. The lessons learned in the process of managing the aftermath of a medication error should be incorporated into ongoing quality improvement programs. CONCLUSION: Based on the literature review and the ideas presented, specific recommendations for responding to catastrophic medication errors are made. Following those recommendations would allow those in the health care system--managed care organizations and individual practitioners--to improve their image and do good at the same time.

Attitudes and knowledge concerning alcohol abuse: curriculum implications.

This study presents data regarding social work practitioner experiences, attitudes and knowledge about alcoholism. A standardized instrument was used to survey BSWs and MSWs (N = 105) at three sites in Canada. Significant findings were: (a) these practitioners had low levels of knowledge about alcoholism as measured on the Alcohol Knowledge Scale (AKS), and (b) professional experiences, not personal ones, shaped their knowledge. The latter included whether they had participated in any post graduate coursework/continuing education or conducted research with this population. Implications are directed toward curriculum development for educators and practitioners working in this field.