Successful outcomes with low-threshold intervention for cannabis use disorders in Norway - an observational study.

AIMS: Cannabis is the most commonly used regulated drug by European youths. Yet, few cannabis-specific interventions have been examined in Europe. The Cannabis Cessation Program (CCP) was developed in Sweden in the 1990s and has been implemented in some Norwegian municipalities. The present study aimed to examine outcomes of this intervention in the Norwegian setting. METHOD: The respondents (N = 102) were recruited in four community-based CCPs in Norway. We examined their changes in cannabis use, other substance use, mental distress, well-being, sense of coherence (SoC), and social networks, from baseline (T0) to post-treatment (T1) and up to a 3-month follow-up period (T2). Changes were evaluated with pair-wise t-tests. RESULT: Seventy-six participants (75%) completed the 8-week program, according to plan. All participants reported a significant reduction in cannabis use at T1 (average reduction ~16 days per month) and at T2 (N = 59; ~13 days per month). Among those that completed the program, 67% was abstinent from cannabis at T1 and 37% was abstinent at T2. An intention-to-treat analysis showed that 50% (51/102) and 22% (22/102) were abstinent from cannabis use at T1 and T2, respectively. In parallel to abstinence, we observed a substantial reduction in mental distress and an increase in well-being and SoC. Respondents socialized with fewer friends with current substance use, but drug-free social networks were not expanded. CONCLUSION: Our findings suggested that the CCP was a valuable, low-threshold manual-based intervention for cannabis use disorders. It showed considerable potential for reducing individuals' cannabis use. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov no. NCT04989205. Registered 12 July 2021, i.e., the study was retrospectively registered.

Can a Smartphone App for Cannabis Cessation Gain a Broader User Group than Traditional Treatment Services?

BACKGROUND: Treatment demand for cannabis use disorders is increasing in Europe. Mobile phone- and internet-based interventions for cannabis users can possibly help meet the need. The purpose of this study was to examine whether a recently developed Norwegian Cannabis Cessation app reaches a broader or different user group compared to community-based Cannabis Cessation programs (CCP, Nordic abbreviation: HAP). METHOD: The app respondents (n = 148) were recruited through an online link in the app. A comparative sample (n = 102) was recruited in three municipally based CCPs in Norway. We examined whether app users differed from the CCP population in sociodemographics, substance use, mental health, and well-being. RESULT: The app group included more women than the CCP group (46% versus 26%, χ2 = 10.9, P = .001), but otherwise the groups were similar for sociodemographic variables. Severity of cannabis use did not differ between groups, but the app sample exhibited a higher depressiveness score on the Hopkins Symptom Checklist (mean difference, 0.24; 95% CI 0.04-0.44; P = .018) and lower perceived well-being (3.4 point lower score on the Outcome Rating Scale; 95% CI -5.7 to -1.2; P = .003). Well-being was negatively associated with being in the app group, being older, and having higher levels of mental distress, and was positively associated with the perceived ability to make changes ('self-efficacy of quitting'). CONCLUSION: The higher proportion of women in the app group indicated that the app did capture an expanded segment of the cannabis-using population. The app can be an alternative for those who are not yet prepared to seek treatment in formal healthcare services. The high level of depressive symptoms and lower levels of well-being among the app respondents suggest that some app users might need additional support.

Readiness to change among involuntarily and voluntarily admitted patients with substance use disorders.

BACKGROUND: Health care workers in the addiction field have long emphasised the importance of a patient's motivation on the outcome of treatments for substance use disorders (SUDs). Many patients entering treatment are not yet ready to make the changes required for recovery and are often unprepared or sometimes unwilling to modify their behaviour. The present study compared stages of readiness to change and readiness to seek help among patients with SUDs involuntarily and voluntarily admitted to treatment to investigate whether changes in the stages of readiness at admission predict drug control outcomes at follow-up. METHODS: This prospective study included 65 involuntarily and 137 voluntarily admitted patients treated in three addiction centres in Southern Norway. Patients were evaluated using the Europ-ASI, Readiness to Change Questionnaire (RTCQ), and Treatment Readiness Tool (TReaT). RESULTS: The involuntarily admitted patients had significantly lower levels of motivation to change than the voluntarily admitted patients at the time of admission (39% vs. 59%). The majority of both involuntarily and voluntarily admitted patients were in the highest stage (preparation) for readiness to seek help at admission and continued to be in this stage at discharge. The stage of readiness to change at admission did not predict abstinence at follow-up. The only significant predictor of ongoing drug use at 6 months was SUD severity at baseline. CONCLUSIONS: The majority of involuntarily admitted patients scored high on motivation to seek help. Their motivation was stable at a fairly high level during their stay, and even improved in some patients. Thus, they were approaching the motivation stage similar to the voluntarily admitted patients at the end of hospitalization. Therapists should focus on both motivating patients in treatment and adapting the treatment according to SUD severity. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00970372. Registered 1 September 2008, https://clinicaltrials.gov/ct2/show/NCT00970372. The trial was registered before the first participant was enrolled. The fist participant was enrolled September 02, 2009.

How do psychological characteristics of family members affected by substance use influence quality of life?

PURPOSE: Addiction is a major health stressor for families, representing an under-researched area with important policy implications. The current aim was to validate the Composite Codependency Scale, which captures the psychological characteristics of affected family members, and assess quality of life as mediated by family functioning. METHODS: Close relatives (n = 271) of patients in treatment for substance use disorder (SUD) participated in a 4-day psychoeducational program. We also recruited a general population sample (n = 393) via an online social media site. Data were analyzed using multigroup confirmatory factor analysis (MGCFA) and a latent regression model. Differences in subscale latent means were applied to ascertain how the scale discriminated the two populations. RESULTS: MGCFA yielded a shortened, nine-item partial scalar invariant scale (SCCS) that allowed comparison of latent means. The SCCS discriminated between family members and the general population, with family scoring higher on all three scale dimensions. By effect size, family had higher means (mean differences; 95% confidence intervals) for 'emotional suppression' (0.48; 0.36-0.59; p < 0.001; effect size, 0.92), 'interpersonal control' (0.47; 0.36-0.59; p < 0.001; effect size, 0.97), and 'self-sacrifice' (0.20; 0.10-0.29; p < 0.001; effect size, 0.43). Higher SCCS scores were associated with greater family dysfunction (ß = 1.00, 95% CI 0.63-1.36; p < 0.001) and worse quality of life (ß = - 0.23, 95% CI - 0.30 to - 0.16; p < 0.001), confirming the concurrent validity of the SCCS. CONCLUSION: When family members of people with addictions had the psychological characteristics of suppressing their emotions, believing they could fix others' problems, and neglecting their own for others' needs, they also had more family dysfunction and poorer quality of life. The SCCS offers a valid instrument for addressing the life situation of affected families. This scale can help clinicians focus on family members within health services, especially within SUD treatment services.

Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions.

BACKGROUND: Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act (NMHCA) calls for compulsory treatment for persons with "severe and life-threatening substance use disorder" if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. Mental distress is known to be high among SUD patients admitted to inpatient treatment. The purpose of this study is to describe changes in mental distress from admission to a 6-month follow-up in patients with SUDs, which underwent either voluntary or compulsory treatment. METHOD: This prospective study followed 202 hospitalized patients with SUDs who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). Levels of mental distress were assessed with SCL-90-R. Of 123 patients followed-up at 6 months, 97 (62 VA and 35 CA) had rated their mental distress at admission, discharge and follow-up. Sociodemographics and substance use severity were recorded with the use of The European Addiction Severity Index (EuropASI). We performed a regression analysis to examine factors associated with changes in psychiatric distress at the 6-month follow-up. RESULTS: The VA group exhibited higher mental distress than the CA group at admission, but both groups improved significantly during treatment. At the 6-month follow-up, the VA group continued to show reduced distress, but the CA group showed increases in mental distress to the levels observed before treatment. The deterioration appeared to be associated with higher scores that reflected paranoid ideas, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, and depression. Active substance use during follow-up was significantly associated with increased mental distress. CONCLUSION: In-patient treatment reduces mental distress for both CA and VA patients. The time after discharge seems critical especially for CA patients regarding active substance use and severe mental distress. A greater focus on continuing care initiatives to assist the CA patients after discharge is needed to maintain the reduction in mental distress during treatment. Continuing-care initiatives after discharge should be intensified to assist patients in maintaining the reduced mental distress achieved with treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT 00970372 December 02, 2016.

Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders.

BACKGROUND: Perceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient's internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily. METHODS: This study included patients admitted to combined substance use disorder and psychiatry wards in three publicly funded treatment centres in Norway in the period 2009-2011. Participants included 63 patients that were admitted involuntarily, pursuant to the Norwegian Public Health Act, and 129 patients that were admitted voluntarily. All participants completed the Perceived Coercion Questionnaire. Sociodemographic variables were determined with the European Addiction Severity Index. The range of psychopathological symptoms was evaluated with the Symptom Checklist-90-R. Independent sample t-tests, the chi-squared test, and Fisher's exact test were used to detect statistically significant differences between groups. RESULTS: Scores on the Perceived Coercion Questionnaire showed that patients admitted voluntarily and those admitted involuntarily experienced similar levels of perceived coercion. Those admitted voluntarily reported higher levels of perceived coercion from internal sources, and those admitted involuntarily perceived significantly higher coercion from legal sources. No differences between groups were found with the other tests. CONCLUSIONS: Our results suggested that assumptions about involuntary admissions should be evaluated carefully to determine how best to alleviate counterproductive feelings of coercion when a coerced admission is planned. Informing and collaborating with the patient will most likely facilitate a better experience during admission and treatment. Moreover, the patient is more likely to experience a better recovery process.

Standardised detoxification in cases of polydrug use. / Standardisert avrusning ved blandingsmisbruk.

BACKGROUND: In recent decades the pattern of substance use among patients admitted for detoxification has changed from predominantly single-substance use to simultaneous multi-substance use. The evidence base for pharmacological treatment of polydrug users remains inadequate. MATERIAL AND METHOD: A non-experimental cohort study was conducted with 284 polydrug users in the Detoxification Unit of Sørlandet Hospital in 2013. The therapeutic approach was standardised, and was based on social therapy and symptomatic treatment of withdrawal symptoms with valproate and clonidine as key medications. RESULTS: Three quarters of the patients were male and they had used more than three different substances on average. The average age was 39 years. In total, 75 % of patients completed the detoxification programme, and for 95 % detoxification occurred without complications. In 89 % of cases, the standard treatment protocol was followed. There was a weak but significant correlation between treatment discontinuation and the number of substances used (OR = 1.42, p < 0.05). In terms of complications, 1.1 % experienced delirium tremens, 1.1 % epileptic seizures and 1.4 % substance-induced psychosis. Transfer to a somatic ward was necessary for 2.1 % of patients, and to a psychiatric ward for 1.4 %. INTERPRETATION: The completion rate in this study was considerably higher than in previous detoxification studies, and the complication rate was lower. In view of the good results observed and the high degree of standardised treatment, the regimen can be considered a safe treatment option for other detoxification units.

Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: results from compulsorily and voluntarily admitted patients.

BACKGROUND: Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act calls for mandated treatment for persons with "severe and life-threatening substance use disorder" if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. This study aims to examine substance use-related outcomes at 6 months following inpatient treatment and to analyse factors associated with improved outcomes and abstinence. METHOD: This prospective study followed 202 hospitalized patients with SUD who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographic and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at 6 months of follow-up. RESULTS: The frequency of use of a preferred substance showed marked improvement for both VA and CA patients (61 and 37 %, respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53 % of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose in the past 6 months and lower abstinence rates (24 % versus 50 %) at follow-up. A lower severity of drug use at intake (non-injection drug use), voluntary treatment modality, and higher treatment involvement during follow-up all were significant factors associated with abstinence at 6 months after treatment. CONCLUSION: Voluntary treatment for SUD generally yielded better outcomes; nevertheless, we also found improved outcomes for CA patients. It is important to keep in mind that in reality, the alternative to CA treatment is no treatment at all and instead a continuation of life-threatening drug use behaviours. Our observed outcomes for CA patients support the continuation of CA treatment.

Assessing alcohol use and smoking among patients admitted to the medical ward.

BACKGROUND: The objective of the study was to investigate the incidence of risky alcohol consumption in patients admitted to medical wards, and to examine possible differences in how smoking habits and alcohol consumption are assessed and monitored by health personnel. MATERIAL AND METHOD: The study was conducted on medical wards at Southern Norway Hospital Trust in autumn 2013. Out of 998 patients who were successively admitted, 536 were included in the analysis. A questionnaire was used to survey smoking and risky alcohol consumption, and to determine whether patients could remember being asked and advised about these during their hospitalisation period. RESULTS: Fifty patients (9.3%) fulfilled the criteria for risky alcohol consumption. A lower percentage reported having been asked about their drinking habits than about their smoking habits (44% versus 62%, p < 0.001). Compared to those who smoked, a lower percentage of those with risky alcohol consumption reported that they had been recommended to reduce their consumption or quit; 10% vs. 29% (p = 0.009). INTERPRETATION: The patients' experience was that they were asked less about their alcohol consumption than about smoking. They also reported receiving less health-promoting advice in relation to alcohol. Doctors should be more conscious of including alcohol consumption when taking regular case histories.

Quality of life improved following in-patient substance use disorder treatment.

BACKGROUND: Quality of life (QoL) is increasingly recognized as central to the broad construct of recovery in patients with substance use disorders (SUD). However, few longitudinal studies have evaluated changes in QoL after SUD treatment and included patients with SUD that were compulsorily hospitalized. This study aimed to describe QoL among in-patients admitted either voluntarily or compulsorily to hospitalization and to examine patterns and predictors of QoL at admission and at 6 months post treatment. METHODS: This prospective study followed 202 hospitalized patients with SUD that were admitted voluntarily (N=137) or compulsorily (N=65). A generic QoL questionnaire (QoL-5) was used to assess QoL domains. Regression analysis was conducted to identify associations with QoL at baseline and to examine predictors of change in QoL at a 6-month follow-up. RESULTS: The majority of patients had seriously impaired QoL. Low QoL at baseline was associated with a high psychiatric symptom burden. Fifty-eight percent of patients experienced a positive QoL change at follow-up. Although the improvement in QoL was significant, it was considered modest (a mean 0.06 improvement in QoL-5 scores at follow-up; 95% confidence interval: 0.03 - 0.09; p<0.001). Patients admitted voluntarily and compulsorily showed QoL improvements of similar magnitude. Female gender was associated with a large, clinically relevant improvement in QoL at follow-up. CONCLUSIONS: In-patient SUD treatment improved QoL at six month follow-up. These findings showed that QoL measurements were useful for providing evidence of therapeutic benefit in the SUD field.

Patients who terminate OMT--how do they fare?

BACKGROUND: OMT tends to involve treatment over an extended period of time. Some OMT patients terminate the treatment. There is a need for more knowledge about how these persons do following treatment. MATERIAL AND METHOD: We undertook a retrospective review of patient records at Sørlandet Hospital in Kristiansand for patients who had undergone OMT in the period 1998-2009. Data from 103 discharged patients were included in the study, registered on two occasions--31 December 2009 and 30 June 2011. RESULTS: Of the 469 patients who started their OMT during the period of study, altogether 103 patients (22%) terminated the treatment. One-half of the 103 patients who terminated their treatment did so because they no longer wanted OMT or failed to report to the hospital. The others terminated the treatment because they wanted medication from their GP other than OMT (n = 11), because they considered themselves to be no longer addicted and in need of treatment (n = 19) or because they maintained a considerable substance use (n = 21). Seven patients wanted a planned tapering-off of OMT drugs. The status for these 103 discharged patients as of 31 December 2009 (median 1,034 days after discharge) was: uncontrolled substance use: 30%; dead: 17%; other medication from GP: 14%; psychiatric treatment: 12%; imprisoned: 8%; OMT in another county: 2%; drug-free without maintenance treatment: 11%; unknown: 6%. Eighteen months later, altogether 36 of them had changed their status. The group with uncontrolled substance use (n = 31) had undergone the greatest change--altogether 14 were back in OMT, ten continued their substance use and four had died. INTERPRETATION: The OMT patients who terminated the treatment had a high rate of mortality. Approximately 10 % of those discharged lived stable drug-free lives without OMT medication during the period of observation.

Motivational intervention to enhance post-detoxification 12-Step group affiliation: a randomized controlled trial.

AIMS: To compare a motivational intervention (MI) focused on increasing involvement in 12-Step groups (TSGs; e.g. Alcoholics Anonymous) versus brief advice (BA) to attend TSGs. DESIGN: Patients were assigned randomly to either the MI or BA condition, and followed-up at 6 months after discharge. SETTING AND PARTICIPANTS: One hundred and forty substance use disorder (SUD) patients undergoing in-patient detoxification (detox) in Norway. MEASUREMENTS: The primary outcome was TSG affiliation measured with the Alcoholics Anonymous Affiliation Scale (AAAS), which combines meeting attendance and TSG involvement. Substance use and problem severity were also measured. FINDINGS: At 6 months after treatment, compared with the BA group, the MI group had higher TSG affiliation [0.91 point higher AAAS score; 95% confidence interval (CI) = 0.04 to 1.78; P = 0.041]. The MI group reported 3.5 fewer days of alcohol use (2.1 versus 5.6 days; 95% CI = -6.5 to -0.6; P = 0.020) and 4.0 fewer days of drug use (3.8 versus 7.8 days; 95% CI = -7.5 to -0.4; P = 0.028); however, abstinence rates and severity scores did not differ between conditions. Analyses controlling for duration of in-patient treatment did not alter the results. CONCLUSIONS: A motivational intervention in an in-patient detox ward was more successful than brief advice in terms of patient engagement in 12-Step groups and reduced substance use at 6 months after discharge. There is a potential benefit of adding a maintenance-focused element to standard detox.