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1.
Subst Abus ; : 1-9, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32105582

RESUMO

Background: Patients with addiction often encounter negative attitudes from health care professionals, including medical doctors. Addiction medicine training might improve medical students' attitudes toward patients with addiction problems and change the way they think about addiction. We evaluated the effect of comprehensive addiction medicine training on students' attitudes and illness perceptions and explored which perceptions are most relevant for attitude development. Methods: In a quasi-experimental non-randomized study, fourth-year students (n = 296) participated in either addiction medicine training (intervention) or one of three other blocks (control). We used the Medical Condition Regards Scale to measure attitudes and the Illness Perception Questionnaire Addiction version for perceptions. We analyzed the effect of the intervention using repeated measures MANOVA. The contribution of illness perception to attitude was explored in the intervention group using linear regression analysis. Results: Addiction medicine training improved students' attitudes toward patients with addiction, compared to the control group. After the training, students expressed a less demoralized perception, a stronger perception of a coherent understanding of addiction, addiction as a cyclical condition, and attributed addiction more to psychological factors, compared to the control group. In the intervention group, attitude and emotional representation before training and illness coherence after the training were associated with attitude after the training. Conclusions: Addiction medicine training is effective in improving medical students' attitudes toward patients with addiction and changing their illness perceptions of addiction. The development of an understanding of addiction might be particularly relevant for attitude improvement. These findings underscore the relevance of addiction medicine training as part of medical curricula and argue for including aspects related to attitude development in the curriculum.

2.
J Subst Abuse Treat ; 99: 61-66, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30797395

RESUMO

BACKGROUND: Addiction is a context specific but common and devastating condition. Though several evidence-based treatments are available, many of them remain under-utilized, among others due to the lack of adequate training in addiction medicine (AM). AM Training needs may differ across countries because of difference in discipline and level of prior AM training or contextual factors like epidemiology and availability of treatment. For appropriate testing of training needs, reliability and validity are key issues. The aim of this study was to evaluate the psychometric properties of the AM-TNA Scale: an instrument specifically designed to develop the competence-based curriculum of the Indonesian AM course. METHODS: In a cross-sectional study in Indonesia, Ireland, Lithuania and the Netherlands the AM-TNA was distributed among a convenience sample of health professionals working in addiction care in The Netherlands, Lithuania, Indonesia and General Practitioners in-training in Ireland. 428 respondents completed the AM-TNA scale. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach's Alpha, ANOVA determined the discriminative validity. RESULTS: Validity: factor analysis revealed a two-factor structure: One on providing direct patient treatment and care (Factor 1: clinical) and one factor on facilitating/supporting direct patient treatment and care (Factor 2: non-clinical) AM competencies and a cumulative 76% explained variance. Reliability: Factor 1 α = 0.983 and Factor 2: α = 0.956, while overall reliability was (α = 0.986). The AM-TNA was able to differentiate training needs across groups of AM professionals on all 30 addiction medicine competencies (P = .001). CONCLUSIONS: In our study the AM-TNA scale had a strong two-factor structure and proofed to be a reliable and valid instrument. The next step should be the testing external validity, strengthening discriminant validity and assessing the re-test effect and measuring changes over time.

3.
CNS Drugs ; 32(5): 437-442, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29651711

RESUMO

BACKGROUND: Gamma-hydroxybutyrate (GHB) dependence is associated with a severe, potentially lethal, withdrawal syndrome and relapse rates as high as 60% within 3 months of detoxification. Baclofen has been shown to decrease self-administration of GHB in mice and reduce relapse in a case series of GHB-dependent patients. Controlled studies on the effectiveness of baclofen to prevent relapse in GHB-dependent patients are lacking. AIM: The aim of this study was to assess effectiveness of baclofen in preventing relapse in GHB-dependent patients. METHODS: This was an out-patient, multicentre, open-label, non-randomized, controlled trial in GHB-dependent patients (n = 107) in the Netherlands. Treatment as usual (TAU, n = 70) was compared with TAU plus baclofen 45-60 mg/day for 3 months (n = 37). Outcome measures were rates of lapse (any use) and relapse (using GHB on average once a week or more), based on self-report. Side effects were monitored with a baclofen side-effects questionnaire. Treatment groups were compared using Chi square analyses, with both per-protocol (PP) and intention-to-treat (ITT) analyses. RESULTS: GHB-dependent patients treated with baclofen after detoxification showed no reduced lapse rates, but reduced relapse and dropout rates, compared with patients receiving TAU only (24 vs 50%). While both ITT and PP analyses revealed similar results, the effectiveness of baclofen prescribed PP was slightly higher than in ITT analysis. Patients reported overall limited side effects, with the most frequently reported being feeling tired (28%), sleepiness (14%) and feeling depressed (14%). No serious adverse events were reported. CONCLUSIONS: This study showed potential effectiveness of baclofen in preventing relapse in patients with GHB dependence after detoxification. Though promising, future studies with longer follow-up and a randomized double-blind design should confirm these findings before recommendations for clinical practice can be made. CLINICAL TRIAL REGISTRATION: Netherlands Trial Register with number NTR4528.


Assuntos
Baclofeno/uso terapêutico , Agonistas dos Receptores de GABA-B/uso terapêutico , Oxibato de Sódio , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adulto , Assistência Ambulatorial , Baclofeno/efeitos adversos , Feminino , Agonistas dos Receptores de GABA-B/efeitos adversos , Humanos , Masculino , Prevenção Secundária , Resultado do Tratamento
4.
J Psychosom Obstet Gynaecol ; 39(2): 96-104, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28279121

RESUMO

INTRODUCTION: Demoralization is a relatively neglected issue in which low morale and poor coping result from a stressor such as familial cancer risk. Female BRCA1/2 mutation carriers are highly susceptible for developing breast and ovarian cancer. The aim of this study was to evaluate demoralization in oophorectomized BRCA1/2 mutation carriers and its relation to quality of life. METHODS: This cross-sectional study examined 288 oophorectomized BRCA1/2 mutation carriers using the following standardized self-report measures: Demoralization Scale, EORTC Quality of Life Questionnaire-C30, State-Trait Anxiety Inventory and the Cancer Worry Scale. RESULTS: The mean score on the Demoralization Scale was 17.8 (SD 14.0). A clinically significant level of demoralization, defined as a score ≥30, was found in 45 BRCA1/2 mutation carriers (16%). Being highly demoralized was associated with a significantly lower quality of life, and higher levels of physical problems, anxiety and cancer worries. No demographic or clinical factors could predict higher levels of demoralization. CONCLUSIONS: Our findings established that a clear proportion of oophorectomized BRCA1/2 mutation carriers experience demoralization impacting on their well-being. Further research is needed to explore the natural trajectory of demoralization and the resultant need for support in these women.


Assuntos
Adaptação Psicológica , Moral , Neoplasias Ovarianas/prevenção & controle , Ovariectomia/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Proteína BRCA2/genética , Estudos Transversais , Feminino , Heterozigoto , Humanos , Pessoa de Meia-Idade , Ubiquitina-Proteína Ligases/genética
6.
Subst Abus ; 38(4): 483-487, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28718723

RESUMO

BACKGROUND: Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. METHODS: A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology. RESULTS: We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. CONCLUSIONS: Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.


Assuntos
Medicina do Vício/educação , Competência Clínica , Educação Médica Continuada/normas , Educação de Pós-Graduação em Medicina/normas , Educação Médica/normas , Prova Pericial , Currículo , Conhecimentos, Atitudes e Prática em Saúde , Humanos
7.
Res Dev Disabil ; 63: 151-159, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27133469

RESUMO

BACKGROUND AND AIMS: Individuals with mild or borderline intellectual disability (MBID) are at risk of substance use (SU). At present, it is unclear which strategy is the best for assessing SU in individuals with MBID. This study compares three strategies, namely self-report, collateral-report, and biomarker analysis. METHODS AND PROCEDURES: In a sample of 112 participants with MBID from six Dutch facilities providing care to individuals with intellectual disabilities, willingness to participate, SU rates, and agreement between the three strategies were explored. The Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q; self-report) assesses lifetime use, use in the previous month, and recent use of tobacco, alcohol, cannabis, and stimulants. The Substance use and misuse in Intellectual Disability - Collateral-report questionnaire (SumID-CR; collateral-report) assesses staff members' report of participants' SU over the same reference periods as the SumID-Q. Biomarkers for SU, such as cotinine (metabolite of nicotine), ethanol, tetrahydrocannabinol (THC), and its metabolite THCCOOH, benzoylecgonine (metabolite of cocaine), and amphetamines were assessed in urine, hair, and sweat patches. RESULTS: Willingness to provide biomarker samples was significantly lower compared to willingness to complete the SumID-Q (p<0.001). Most participants reported smoking, drinking alcohol, and using cannabis at least once in their lives, and about a fifth had ever used stimulants. Collateralreported lifetime use was significantly lower. However, self-reported past month and recent SU rates did not differ significantly from the rates from collateral-reports or biomarkers, with the exception of lower alcohol use rates found in biomarker analysis. The agreement between self-report and biomarker analysis was substantial (kappas 0.60-0.89), except for alcohol use (kappa 0.06). Disagreement between SumID-Q and biomarkers concerned mainly over-reporting of the SumID-Q. The agreement between SumID-CR and biomarker analysis was moderate to substantial (kappas 0.48 - 0.88), again with the exception of alcohol (kappa 0.02). CONCLUSIONS AND IMPLICATIONS: In this study, the three strategies that were used to assess SU in individuals with MBID differed significantly in participation rates, but not in SU rates. Several explanations for the better-than-expected performance of self- and collateral-reports are presented. We conclude that for individuals with MBID, self-report combined with collateralreport can be used to assess current SU, and this combination may contribute to collaborative, early intervention efforts to reduce SU and its related harms in this vulnerable group.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Deficiência Intelectual/epidemiologia , Fumar Maconha/epidemiologia , Autorrelato , Fumar/epidemiologia , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/metabolismo , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/metabolismo , Anfetaminas/metabolismo , Biomarcadores , Cocaína/análogos & derivados , Cocaína/metabolismo , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/metabolismo , Cotinina/metabolismo , Dronabinol/metabolismo , Etanol/metabolismo , Feminino , Cabelo/química , Humanos , Deficiência Intelectual/psicologia , Masculino , Fumar Maconha/metabolismo , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Índice de Gravidade de Doença , Fumar/metabolismo , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Suor/química , Urina/química , Adulto Jovem
8.
Res Dev Disabil ; 63: 160-166, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27836581

RESUMO

BACKGROUND AND AIMS: Adolescents with Intellectual Disability (ID) are at risk for tobacco and alcohol use, yet little or no prevention programs are available for this group. 'Prepared on time' is an e-learning program based on the attitude - social influence - efficacy model originally developed for fifth and sixth grades of mainstream primary schools. The goals of this study were (1) to examine the lifetime use of tobacco and alcohol among this target group and (2) to gain a first impression of the efficacy of 'Prepared on time' among 12-16-year old students with moderate or mild ID (MMID). METHODS AND PROCEDURES: Students form three secondary special-needs schools were assigned to the experimental (e-learning) group (n=37) or the control group (n=36). Pre-intervention and follow-up data (3 weeks after completion) were gathered using semi-structured interviews inquiring about substance use among students with MMID and the behavioral determinants of attitude, subjective norm, modelling, intention, and knowledge. RESULTS: The lifetime tobacco use and alcohol consumption rates in our sample were 25% and 59%, respectively. The e-learning program had a positive effect on the influence of modelling of classmates and friends. No significant effects were found on other behavioral determinants and knowledge. CONCLUSIONS AND IMPLICATIONS: A substantial proportion of adolescents with MMID in secondary special-needs schools use tobacco or alcohol. This study showed that an e-learning prevention program can be feasible for adolescents with MMID.


Assuntos
Educação Especial , Conhecimentos, Atitudes e Prática em Saúde , Deficiência Intelectual/psicologia , Internet , Prevenção do Hábito de Fumar , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Consumo de Álcool por Menores/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Grupo Associado , Projetos Piloto , Serviços de Saúde Escolar , Instituições Acadêmicas , Índice de Gravidade de Doença , Fumar/epidemiologia , Consumo de Álcool por Menores/estatística & dados numéricos
9.
Drug Alcohol Depend ; 170: 164-173, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27923198

RESUMO

BACKGROUND AND AIMS: Gamma-hydroxybutyrate (GHB) detoxification procedures have been insufficiently studied for effectiveness and safety. Based on case reports, benzodiazepines are generally regarded as first-choice agents in GHB detoxification. Detoxification by titration and tapering (DeTiTap) with pharmaceutical GHB in an open-label consecutive case series of 23 GHB-dependent patients showed to be feasible, effective and safe. This study further explored the feasibility, effectiveness and safety of this detoxification procedure in a large group of patients. METHOD: A large observational multicenter study was carried out in six addiction treatment centers in the Netherlands. GHB-dependent inpatients (229 unique patients, 274 admissions) were titrated on and tapered off with pharmaceutical GHB. RESULTS: Successful detoxification was achieved in 85% of cases. Detoxification was carried out in 12.5days in most patients. The DeTiTap procedure proved to be feasible and significantly reduced the experienced withdrawal symptoms and craving (p≤0.001). Several symptoms were found to influence the course of subjective withdrawal symptoms. During detoxification, psychological symptoms such as depression, anxiety, and stress decreased (p≤0.05). The main complications were hypertension and anxiety. Six patients were sent to the general hospital for observation, but all six were able to continue detoxification in the addiction treatment centers. Most patients (69%) relapsed within three months after detoxification. CONCLUSIONS: The DeTiTap procedure using pharmaceutical GHB seems a safe alternative to benzodiazepines as a GHB detoxification procedure. However, the high relapse rates warrant further investigation.


Assuntos
Oxibato de Sódio/uso terapêutico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adulto , Benzodiazepinas/uso terapêutico , Fissura/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Países Baixos , Psicoterapia , Recidiva , Oxibato de Sódio/administração & dosagem , Resultado do Tratamento , Adulto Jovem
10.
Psychiatry Res ; 247: 182-193, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27918968

RESUMO

Treatment dropout is an important concern in eating disorder treatments as it has negative implications for patients' outcome, clinicians' motivation, and research studies. Our main objective was to conduct an exploratory study on treatment dropout in a two-part web-based cognitive behavioral therapy with asynchronous therapeutic support. The analysis included 205 female patients with eating disorders. Reasons for dropout, treatment experiences, and predictors of dropout were analyzed. Overall treatment dropout was 37.6%, with 18.5% early dropout (before or during treatment part 1) and 19.0% late dropout (after part 1 or during part 2). Almost half of the participants identified personal circumstances as reason for dropout. The other participants mostly reported reasons related to the online delivery or treatment protocol. Predictors of early dropout included reporting less vigor and smoking at baseline and a longer average duration per completed treatment module of part 1. Late dropout was predicted by reporting less vigor at baseline and uncertainty about recommendation of the treatment to others after completion of treatment part 1. Generally, the web-based treatment and online therapeutic support were evaluated positively, although dropouts rated the treatment as significantly less helpful and effective than completers did.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Pacientes Desistentes do Tratamento/psicologia , Adulto , Feminino , Humanos , Internet , Motivação
11.
PLoS One ; 11(11): e0164262, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27824872

RESUMO

BACKGROUND: Addiction, or substance dependence, is nowadays considered a chronic relapsing condition. However, perceptions of addiction vary widely, also among healthcare professionals. Perceptions of addiction are thought to contribute to attitude and stigma towards patients with addiction. However, studies into perceptions of addiction among healthcare professionals are limited and instruments for reliable assessment of their perceptions are lacking. The Illness Perception Questionnaire (IPQ) is widely used to evaluate perceptions of illness. The aim of this study was to evaluate the psychometric properties of the IPQ: factor structure, internal consistency, and discriminant validity, when applied to evaluate healthcare professionals' perceptions of addiction. METHODS: Participants were 1072 healthcare professionals in training and master students from the Netherlands and Indonesia, recruited from various addiction-training programs. The revised version of the IPQ was adapted to measure perceptions of addiction (IPQ-A). Maximum likelihood method was used to explore the best-fit IPQ factor structure. Internal consistency was evaluated for the final factors. The final factor structure was used to assess discriminant validity of the IPQ, by comparing illness perceptions of addiction between 1) medical students from the Netherlands and Indonesia, 2) medical students psychology students and educational science students from the Netherlands, and 3) participants with different training levels: medical students versus medical doctors. RESULTS: Factor analysis revealed an eight-factor structure for the perception subscale (demoralization, timeline chronic, consequences, personal control, treatment control, illness coherence, timeline cyclical emotional representations) and a four-factor structure for the attribution subscale (psychological attributions, risk factors, smoking/alcohol, overwork). Internal reliability was acceptable to good. The IPQ-A was able to detect differences in perceptions between healthcare professionals from different cultural and educational background and level of training. CONCLUSIONS: The IPQ-A is a valid and reliable instrument to assess healthcare professionals' perceptions of addiction.


Assuntos
Comportamento Aditivo/psicologia , Pessoal de Saúde/psicologia , Percepção/fisiologia , Psicometria/métodos , Adulto , Doença Crônica/psicologia , Emoções/fisiologia , Análise Fatorial , Feminino , Humanos , Indonésia , Funções Verossimilhança , Masculino , Países Baixos , Reprodutibilidade dos Testes , Percepção Social , Inquéritos e Questionários , Adulto Jovem
13.
J Psychoactive Drugs ; 47(5): 393-400, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26397714

RESUMO

The aims of this study were to examine the relationship between motivation for treatment and for change, and to explore their role in the prediction of treatment completion. The sample was composed of 560 predominantly polydrug-using inpatients with co-occurring psychiatric disorders. Motivation for treatment was assessed with the Motivation for Treatment Scales, and motivation for change was measured with the Readiness to Change Questionnaire. Patients indicated strong motivation to change illegal drug and alcohol use. In initial factor analysis, motivation for treatment and for change did not load on the same factors, confirming that these are distinct domains. Four categories were discerned with respect to readiness for treatment and for change, with low agreement between the two. In performing survival analysis, we found that being in readiness category 4 (RT↑RC↑) was associated with a greater chance of remaining in treatment for a period of 105 days without premature attrition (Log Rank chi-sq=5.000; p=0.02). To a limited extent, intake measures of motivation can be used to predict attrition from treatment. Clinicians can use motivation assessment both for clinical purposes and in the prediction of those who need extra monitoring due to increased risk of premature attrition.


Assuntos
Transtornos Mentais/psicologia , Motivação , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/terapia
14.
Am J Addict ; 24(6): 515-22, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26073849

RESUMO

BACKGROUND AND OBJECTIVES: Sleep problems and substance use are strongly linked. Sleep problems play a role in the etiology of substance use, but also may be a result of it. After detoxification, sleep problems may worsen leading to relapse. Nowadays, most substance dependence treatment programs aim at recovery rather than total abstinence, and in that view health-related quality of life (HRQL) is a relevant construct. This article describes the association between self-perceived sleep problems and HRQL in a naturalistic population of polydrug-using inpatients. METHODS: At the start of treatment, 388 polydrug-using inpatients completed questionnaires concerning their sleep quality and HRQL. Three categories were established based on reported sleep problems: patients without sleep problems (21.6%), those with clinically relevant sleep problems (34.5%), and patients with sleep disorders (43.8%). RESULTS: Mean grades for quality of sleep were M = 7.3 (sd 1.7), M = 6.6 (sd 1.7) and M = 5.3 (sd 1.9) for the three categories, respectively. In addition, patients in the disorder category perceived a lower HRQL than those in the other categories. In the explanation of HRQL, both sleep problems and sleep disorders added significantly to the model when controlling for baseline characteristics. DISCUSSION AND CONCLUSIONS: Our findings stress the need for clinicians to pay attention to the quality of sleep of recovering polydrug users, since this may play an important role in the recovery process. Monitoring sleep during treatment is advocated. This study adds to the knowledge about the way HRQL and sleep are related in a naturalistic sample of substance-dependent patients.


Assuntos
Qualidade de Vida , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Inquéritos e Questionários , Adulto Jovem
15.
Am J Drug Alcohol Abuse ; 41(4): 309-16, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26087226

RESUMO

BACKGROUND: Web-based alcohol interventions have demonstrated efficacy in randomized controlled trials. However, most studies have involved self-help interventions without therapeutic support. OBJECTIVES: To examine the results of a 3-month web-based alcohol treatment program using intensive, asynchronous (non-simultaneous) therapeutic support ( www.alcoholdebaas.nl ) at 9-month follow-up assessment. METHODS: This study reports the follow-up results of 144 problem drinking participants who received a web-based alcohol treatment program. We investigated whether the intervention effects at treatment completion (3 months) continued to exist at 6 and 9 months of follow-up. The primary outcome measure was weekly alcohol consumption. Repeated measures analysis with a mixed model approach was used to address loss to follow-up. RESULTS: Weekly alcohol consumption significantly improved between baseline and 9 months (F(1,74) = 85.6, p < 0.001). Post-hoc tests revealed that the reduction occurred during the first 3 months (from 39.9-11.4 standard units a week). Although alcohol consumption had risen to 19.5 units per week at 9 months, it still decreased by more than 20 units compared to baseline drinking. Significant improvements with medium to large effect sizes were found on the secondary outcomes (depression, general health, and quality of life) at 9 months. CONCLUSION: The web-based alcohol treatment with intensive asynchronous therapeutic support has been shown to be effective in reducing alcohol consumption and improving health status at post treatment assessments. The present study showed that most of these improvements were sustained after 9 months. Despite the lack of a control group and the high dropout rate, our findings suggest that web-based treatment can achieve relevant health gains in the long term.


Assuntos
Alcoolismo/terapia , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia/métodos , Resultado do Tratamento , Adulto Jovem
16.
Eur Addict Res ; 21(5): 223-39, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25966903

RESUMO

BACKGROUND: Over the past decade, addiction medicine training curricula have been developed to prepare physicians to work with substance use disorder patients. This review paper aimed at (1) summarizing scientific publications that outline the content of addiction medicine curricula and (2) evaluating the evidence for efficacy for training in addiction medicine. METHODS: We carried out a literature search on articles about addiction medicine training initiatives across the world, using PubMed, PsychINFO and EMBASE with the following search terms 'substance abuse, addiction medicine, education and training.' RESULTS: We found 29 articles on addiction medicine curricula at various academic levels. Nine studies reported on the need for addiction medicine training, 9 described addiction medicine curricula at various academic levels, and 11 described efficacy on addiction medicine curricula. CONCLUSIONS: Several key competences in addiction medicine were identified. Efficacy studies show that even short addiction medicine training programs can be effective in improving knowledge, skills and attitudes related to addiction medicine. A more uniform approach to addiction medicine training in terms of content and accreditation is discussed.


Assuntos
Currículo , Educação Médica/organização & administração , Transtornos Relacionados ao Uso de Substâncias , Competência Clínica , Humanos , Avaliação de Programas e Projetos de Saúde
17.
BMC Psychiatry ; 15: 51, 2015 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-25884223

RESUMO

BACKGROUND: Addiction constitutes a major public health problem, and despite treatment, relapse rates remain very high. Preliminary findings suggest that Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based treatment for PTSD, may also reduce craving and relapse rates when applied in substance abuse. This study aims to determine the feasibility, efficacy and effectiveness of EMDR when added to treatment as usual (TAU) for addiction in alcohol dependent outpatients, compared to TAU only. METHODS/DESIGN: A single blinded study in which 100 adult patients with a primary DSM-IV-TR diagnosis of alcohol dependence or abuse receiving treatment in one of six Dutch outpatient addiction care facility sites, will be enrolled. After baseline assessment participants will be allocated to one of two treatment conditions (allocation ratio of 1:1) using a stratified (per site, per care pathway), blocked randomization procedure. The intervention consists of EMDR (seven weekly 90 minute sessions) + TAU or TAU only. Assessments are scheduled pre-treatment (t0), post-treatment (t0 + eight weeks), and one and six months post treatment. The effects of both treatment arms are compared on indices of (a) drinking behavior, (b) mediators, moderators and predictors of treatment outcome, (c) quality of life and d) safety, acceptability and feasibility of treatment. Repeated measures ANOVA's will be conducted using an intention-to-treat and per-protocol approach. Multiple imputation will be used to deal with missing values when possible. DISCUSSION: This study adapts and extends the standard EMDR treatment for traumatized patients for use with patients with alcohol use disorders without psychological trauma. TRIAL REGISTRATION: ClinicalTrial.gov: NCT01828866.


Assuntos
Alcoolismo/reabilitação , Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/prevenção & controle , Assistência Ambulatorial/métodos , Análise de Variância , Doença Crônica , Protocolos Clínicos , Terapia Combinada , Fissura , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
18.
AIDS ; 29(3): 385-8, 2015 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-25834861

RESUMO

Opioid use may affect HIV infection through altered expression of HIV co-receptors. This was examined in Indonesia among antiretroviral therapy-naive HIV patients, many of whom use drugs. C-C chemokine receptor type 5 (CCR5) expression on CD4+ cells was higher in heroin (P = 0.007), methadone (P = 0.024) and former opioid users (P = 0.003) compared to nonusers, whereas production of RANTES and other CCR5 ligands was similar or lower. This suggests that opioids can affect HIV susceptibility through up-regulation of CCR5 or down-regulation of its ligands.


Assuntos
Linfócitos T CD4-Positivos/química , Linfócitos T CD4-Positivos/efeitos dos fármacos , Quimiocina CCL5/análise , Dependência de Heroína/imunologia , Transtornos Relacionados ao Uso de Opioides/imunologia , Receptores CCR5/análise , Receptores de HIV/análise , Adulto , Feminino , Humanos , Indonésia , Masculino
19.
Psychiatry Res ; 226(1): 328-32, 2015 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-25687377

RESUMO

Traumatic experiences have been linked with substance use disorders (SUD) and may be an important factor in the perpetuation of SUD, even in the absence of posttraumatic stress disorder (PTSD) symptoms. The purpose of the current study was to examine the relationship between childhood trauma and substance use severity in 192 SUD inpatients. Childhood trauma was assessed using the Traumatic Experiences Checklist (TEC). With variables derived from this measure in addition to PTSD symptoms, two regression models were created with alcohol use or drug use severity as dependent variables. Alcohol severity was explained by PTSD symptoms as well as the age of trauma. Drug severity was explained solely by PTSD symptoms. The clinical value of assessing childhood trauma in determining the addiction severity appears to be limited in comparison with PTSD symptoms.


Assuntos
Alcoolismo/psicologia , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Programas de Rastreamento/métodos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Alcoolismo/epidemiologia , Criança , Abuso Sexual na Infância , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Análise de Regressão , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Índices de Gravidade do Trauma
20.
Psychol Assess ; 27(2): 513-23, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25558965

RESUMO

The study aims to validate the shortened version of the Person's Relating to Others Questionnaire (PROQ3), a measure of negative and maladaptive relating to others, for data collection via the Internet across 4 national samples. The psychometric properties of the Internet-administered (IN) format of the PROQ3 in 4,802 participants (169 British; 360 Irish; 1,110 Dutch; and 3,163 Greek) were compared with that of the standard-written (SW) version in 1918 participants (338 British, 403 Irish, 204 Dutch, and 973 Greek), in respect of its measurement and structural equivalence. Internal consistency, as estimated by alpha coefficient and item-to-scale homogeneity, were consistently acceptable across nationality and modality. There was agreement in regard to the interscale correlations across nationality and modality. Lower mean scores for the British sample in the SW format, and lower mean scores for the Irish sample in the IN format were found. The structural equivalence across modality and nationality was also supported: A consistent 8-factor underlying structure, as supported by a multiple group factor analysis, and an octagonal higher order, as supported by a 3-way multidimensional scaling procedure, were found. It was concluded that the PROQ3 can be administered via the Internet with maintained psychometric properties for clinicians to screen people with interpersonal relating deficiencies and for researchers to collect data.


Assuntos
Internet , Relações Interpessoais , Inquéritos e Questionários , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Adulto Jovem
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