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1.
Niger Postgrad Med J ; 26(4): 211-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621660

RESUMO

Introduction: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. Methods: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. Results: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. Conclusion: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.


Assuntos
/efeitos adversos , Transtornos Mentais/epidemiologia , Pacientes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Distribuição por Idade , Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Criança , Comorbidade/tendências , Estudos Transversais , Feminino , Hospitais Psiquiátricos , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Abuso de Maconha/epidemiologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pacientes/psicologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Adulto Jovem
2.
Neuropsychology ; 33(6): 757-759, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448944

RESUMO

OBJECTIVE: Cognitive, behavioral, emotional, and neural dysfunction have been associated with misuse of alcohol for centuries. METHOD: Multidisciplinary research efforts have shed much light on the profile of impaired and spared functions associated with excessive heavy drinking, with heterogeneity noted among alcoholic individuals. RESULTS: Myriad factors may moderate or mediate the untoward effects of misuse of alcohol and an individual's likelihood of initiation and maintenance of abstinence. CONCLUSIONS: In this special section, a number of leading experts in the field of alcohol and alcoholism provide systematic and critical reviews of published research pertaining to specific topics of interest spanning from brain-behavior relations to the latest theories on cognitive training and the bidirectional influences of social and emotional deficits and chronic pain to the initiation and maintenance of alcoholism. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Abstinência de Álcool/psicologia , Alcoolismo/psicologia , Disfunção Cognitiva/psicologia , Alcoolismo/fisiopatologia , Alcoolismo/reabilitação , Encéfalo/fisiopatologia , Cognição , Disfunção Cognitiva/fisiopatologia , Emoções , Humanos , Testes Neuropsicológicos
3.
Neuropsychology ; 33(6): 795-807, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448947

RESUMO

OBJECTIVE: Alcohol use disorder (AUD) and chronic pain are widespread conditions with extensive public health burden. This review seeks to describe neuroanatomical links and major mediating influences between AUD and chronic pain, in the service of identifying factors that predict the risk of chronic pain in precipitating or facilitating AUD. METHOD: We review the neural bases of pain and the influence of AUD on processes involved in pain perception. We propose potential mechanisms involved in the development of chronic pain in AUD, and we consider implications for pain management in recovery from AUD. RESULTS: Pain is a multidimensional and subjective experience that, in its acute form, is essential for survival, but in chronic form, pain is a disorder that negatively impacts quality of life. Neural substrates involved in initiating and maintaining chronic pain include dysfunction in descending pain pathways and reward network circuitry. AUD involves preoccupation or craving, intoxication, withdrawal, and negative affect. Neural substrates of AUD involve widespread mesocorticolimbic and cerebrocerebellar networks. Both conditions involve dysfunction of extended reward and oversight circuitry, particularly prefrontal cortex. CONCLUSIONS: The interrelationship between chronic pain and AUD resides in the intersection of etiological influences, mental experiences, and neurobiological processes. Characterization of the connection between brain and behavioral abnormalities in AUD's precipitation of chronic pain-and vice versa-allows for early detection and treatment of patients at risk for developing either or both of these conditions and for preemptive interventional approaches to reduce the risk of consequent vulnerabilities and harm. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo/fisiopatologia , Encéfalo/fisiopatologia , Dor Crônica/fisiopatologia , Alcoolismo/reabilitação , Córtex Cerebral/fisiopatologia , Dor Crônica/terapia , Fissura , Giro do Cíngulo/fisiopatologia , Humanos , Vias Neurais , Manejo da Dor , Córtex Pré-Frontal/fisiopatologia , Qualidade de Vida , Recompensa
4.
Neuropsychology ; 33(6): 822-841, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448949

RESUMO

OBJECTIVE: Cognitive training is an effective means of improving performance in a range of populations. Whether it may serve to facilitate cognitive recovery and longer-term outcomes in persons with alcohol use disorders (AUDs) is unclear. Here, we review historical and current literature and offer perspectives for model development and potential implementation. METHOD: We considered a large literature regarding the nature of alcohol-related compromise, early efforts to clarify the nature of recovery and current models and methods underlying cognitive training paradigms. We then constructed a narrative review demonstrating evolving frameworks and empirical data informing the critical review of cognitive training methods as a means of mitigating compromise and facilitating functional outcomes. RESULTS: Cognitive improvement with abstinence is generally noted, but training protocols may enhance performance and generalize benefit to untrained, but highly similar, tasks. Transfer of training to dissimilar tasks and functional outcomes is uncommonly reported. It is noteworthy that some work suggests that clinician ratings for participants are improved. Inconsistency in sample characteristics, training protocols, and outcome measures constrain general conclusions while suggesting opportunities for study and development. CONCLUSIONS: Cognitive training protocols have shown benefit in a variety of populations but have been examined infrequently in persons with AUDs. This overview indicates significant opportunity for cognitive improvement and recovery and thus a strong potential role for training protocols. However, supportive data are not robustly obtained. We suggest that one step in bridging this gap is the implementation of a conceptual framework incorporating contextual, behavioral, and neurobiological variables. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo/reabilitação , Disfunção Cognitiva/reabilitação , Remediação Cognitiva , Alcoolismo/psicologia , Disfunção Cognitiva/psicologia , Humanos , Resultado do Tratamento
6.
Psychol Addict Behav ; 33(6): 511-519, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436446

RESUMO

Although computer delivered brief interventions (CDBIs) have been effective in reducing alcohol use, few studies have examined which components of CDBIs are most associated with drinking reductions. The current factorial trial deconstructed a brief alcohol intervention into component parts to identify main and interaction effects on drinking outcomes. Participants (N = 352) were randomly assigned to 1 of 16 possible combinations of four dichotomous (present vs. absent) CDBI components for which theoretical and empirical support was available: empathic reflections, motivational strategies, a spoken voice, and an animated narrator. We measured main and interaction effects of these components on the primary outcome of self-reported mean drinks per day at 1- and 3-month follow-up, as well as on secondary outcomes, including binge drinking, intentions to reduce drinking, and alcohol consequences. Participants reduced drinking across all alcohol use indices over the 3-month assessment period. These effects were stronger for participants who were exposed to motivational strategies, F = 7.7, p < .001. Empathic reflections, use of a spoken voice, and use of an animated narrator were not associated with reductions in alcohol use, either as main effects or in interaction with other factors. Results suggest that CDBIs using motivational strategies are effective in reducing alcohol use. However, empathic reflections and lifelike characteristics (e.g., narrator, voice) may operate differently in CDBIs than they do in person-delivered interventions. More research is needed to better understand how these (or other factors) may influence efficacy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo/reabilitação , Aconselhamento/métodos , Empatia , Retroalimentação , Motivação , Terapia Assistida por Computador/métodos , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Seguimentos , Humanos , Masculino , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-31261620

RESUMO

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.


Assuntos
Alcoolismo/reabilitação , Exercício , Cooperação do Paciente , Abandono do Hábito de Fumar/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Comorbidade , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Autoeficácia , Mensagem de Texto
8.
BMJ Case Rep ; 12(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308191

RESUMO

We present the preliminary data in an ongoing open-label safety and tolerability proof of concept study exploring the potential role for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in treating patients with alcohol use disorder. At this stage, seven participants have completed the full 8-week MDMA-assisted psychotherapy course, including two therapy sessions each with MDMA. This paper focuses on the safety and tolerability of the therapeutic course for the first four participants to complete treatment. Longer-term outcomes of drinking behaviour will be presented later when the full project data are published. Results show all four participants have successfully tolerated the treatment. There have been no serious adverse events related to MDMA, no unexpected physiological responses to the MDMA sessions or changes to blood results or electrocardiograms, measured before and after the 8-week course. We conclude that the treatment is well- tolerated and are making plans to expand the project into a randomised placebo-controlled study.


Assuntos
Dissuasores de Álcool/administração & dosagem , Alcoolismo/reabilitação , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Psicoterapia/métodos , Adulto , Dissuasores de Álcool/efeitos adversos , Terapia Combinada , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Resultado do Tratamento
9.
Neuropsychiatr ; 33(3): 160-164, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31218547

RESUMO

This case report is about a 44-year-old woman with alcohol-related end-stage liver disease. Initial contact with the patient was made in the alcohol-outpatient clinic of the Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna. Due to a particularly poor general condition, Child Pugh Score C/MELD Score 20, the patient was admitted to ward 4A, with the clinical and scientific focus of treating patients with alcohol use disorder. The withdrawal process was complicated by a multitude of factors associated with end-stage liver disease. By explaining the theoretical background of possible somatic as well as psychiatric complications of end-stage liver disease and elaborating on treatment options a comprehensive overview of the psychiatric and somatic management of this patient population is given.


Assuntos
Alcoolismo/complicações , Alcoolismo/psicologia , Doença Hepática Terminal/complicações , Doença Hepática Terminal/terapia , Adulto , Alcoolismo/reabilitação , Doença Hepática Terminal/psicologia , Feminino , Humanos
10.
J Christ Nurs ; 36(3): 148-156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180959

RESUMO

Largely underutilized in North America, the use of medications to treat alcohol dependence is frequently a successful method of reducing alcohol craving and promoting abstinence. Recovery from alcohol addiction can be a complicated process, requiring nutritional, social, psychological, spiritual, and physical aspects of healing and self-directed behavioral change. Nurses can intervene in alcohol use disorder via screening, referrals, support of medical and behavioral treatments, and spiritual care that emphasizes hope, forgiveness, and relief from shame and guilt.


Assuntos
Alcoolismo/reabilitação , Dissuasores de Álcool/uso terapêutico , Alcoolismo/tratamento farmacológico , Alcoolismo/enfermagem , Fissura , Humanos , Naltrexona/uso terapêutico , Enfermagem na Comunidade de Fé
11.
Eur Addict Res ; 25(4): 198-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31117072

RESUMO

BACKGROUND: In police officers, posttraumatic stress disorder (PTSD) is associated with alcohol use disorder (AUD), but we lack data on the association between PTSD and other substance-related and addictive disorders. OBJECTIVES: We assessed whether PTSD could be a risk factor for different substance-related and addictive disorders in police officers, including alcohol, tobacco, cannabis, and gambling. METHOD: This cross-sectional study included all police officers admitted consecutively for alcohol to an inpatient ward dedicated to police officers (Le Courbat rehabilitation center, France; n= 133). Each patient completed self-administered questionnaires that assessed lifetime exposure to potentially traumatic events (Life Event Checklist for DSM-5), PTSD severity and diagnosis (PTSD Checklist for DSM-5), AUD severity (Alcohol Use Disorder Identification Test [AUDIT]), tobacco dependence (Fagerström test for Nicotine Dependence), cannabis dependence (Cannabis Abuse Screening test), and gambling disorder (Canadian Problem Gambling Index). RESULTS: Mean AUDIT score was 23.7 ± 8.0; 66.2% had an AUDIT score ≥20. Our sample comprised a high prevalence for PTSD (38.3%) and for substance-related and addictive disorders: tobacco dependence (68.4%), cannabis dependence (3.8%), and pathological gambling (3%). Patients with PTSD experienced higher lifetime exposure to traumatic experiences: physical assault, severe human suffering, sudden accidental death of another person, and other types of stressful events/experiences. In multiple linear regressions adjusted for age, sex, and marital status, PTSD was a significant predictor of the severity of AUD and tobacco use disorder, but not of the severity of cannabis use disorder nor gambling disorder. CONCLUSIONS: PTSD is common in police officers hospitalized for alcohol and associated with a higher severity of some addictive disorders (alcohol/tobacco). PTSD and its comorbid addictive disorders should be systematically screened and treated in this population.


Assuntos
Alcoolismo/diagnóstico , Comportamento Aditivo/psicologia , Polícia/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Tabagismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Canadá/epidemiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Polícia/psicologia , Prevalência , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , Tabagismo/epidemiologia
12.
Artigo em Russo | MEDLINE | ID: mdl-31089098

RESUMO

AIM: To study the efficacy of medical rehabilitation outpatient program 'Point of Soberness' with the use of prolonged injectable naltrexone for alcohol dependent parents of minor children. MATERIAL AND METHODS: One hundred and seventeen patients with severe disease form without remissions were enrolled in the study. All patients were parents at risk of deprivation of parental rights. RESULTS AND CONCLUSION: A complex approach, used during the rehabilitation, helped 87% of patients to maintain social and professional status and finish treatment program. More than 95% of patients retained their parental rights. The 'Point of Soberness' program allows achievement of remission of alcohol dependence and retaining parental rights.


Assuntos
Alcoolismo , Antagonistas de Entorpecentes , Adulto , Alcoolismo/reabilitação , Criança , Humanos , Naltrexona , Antagonistas de Entorpecentes/uso terapêutico , Relações Pais-Filho , Pais
14.
Artigo em Inglês | MEDLINE | ID: mdl-30823386

RESUMO

Excessive use of alcohol has been identified as a major risk factor for diseases, injury conditions and increased mortality. The aims of this study were to estimate the frequency of success (abstinence and no alcohol related hospitalization) at 6- and 12-month follow-up after hospital discharge, and to identify the predictors of success. In 2009, a total of 1040 patients at their first admission in one of the 12 Residential Alcohol Abuse Rehabilitation Units (RAARUs) participating in the CORRAL (COordinamento of Residenzialità Riabilitative ALcologiche) project were included in the study. Several socio-demographic and clinical variables, and the number of treatments' strategies during the rehabilitation were collected. Information on alcohol abstinence and no alcohol related hospitalization was assessed through a phone interview using a health worker-administered structured questionnaire at six and 12 months after discharge. An inverse probability weighted, repeated measures Poisson regression model with robust variance was applied to estimate the association between patients' characteristics and the study's outcomes, accounting for non-responders status. The frequencies of abstinence and non-alcohol related hospitalization were 68.38% and 90.73% at six months, respectively, and 68.65% and 87.6% at 12 months, respectively. Patients that were already abstainers in the month before RAARUs' admission have an increased probability of being abstainers after discharge (relative risk: RR 1.20, 95% confidence interval: 95%CI 1.08⁻1.33) and of having an alcohol related hospitalization at 12 months. Subjects undergoing more than four treatment strategies (RR 1.19; 95% CI 1.01⁻1.40) had a higher abstinence probability and lower probability of no alcohol related hospitalizations after 12 months. Finally, patients with dual diagnosis (co-occurrence of alcohol abuse/dependence and psychiatric disorders) have a decreased probability of not being hospitalized for alcohol-related problems (RR 0.95; 95% CI 0.91⁻0.99). The results of this study suggest that specific attention should be paid to the intensity of treatment, with particular regard to a multidisciplinary rehabilitation in order to respond to the complexity of alcohol dependent patients.


Assuntos
Alcoolismo/reabilitação , Tratamento Domiciliar/estatística & dados numéricos , Adulto , Abstinência de Álcool/estatística & dados numéricos , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Tratamento Domiciliar/métodos , Tratamento Domiciliar/organização & administração , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Inquéritos e Questionários
15.
J Addict Nurs ; 30(1): 57-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30830001

RESUMO

OBJECTIVE: The purpose of the study was to determine if there was a significant difference between veterans who received treatment voluntarily versus involuntarily in regard to length of sobriety. METHOD: A sample of 120 veterans being treated for alcohol use disorder in a residential rehabilitation treatment program was used for this study. Veterans who were admitted under recommendation by court order (n = 60) were matched with veterans who were admitted without recommendation of court order (n = 60). Success of the program was determined by the number of days of sobriety postdischarge. RESULTS: The study revealed that there was no significant difference between types of motivation for residential treatment (i.e., voluntary vs. involuntary treatment) and length of sobriety for veterans with alcohol use disorder posttreatment. CONCLUSIONS: Findings revealed that there was no significant relationship when comparing types of motivation for treatment in a residential treatment program for veterans in regard to length of sobriety posttreatment. Therefore, a veteran's motivation for treatment may not necessarily be an accurate indicator of treatment outcomes (i.e., length of sobriety posttreatment) for residential treatment settings.


Assuntos
Alcoolismo/reabilitação , Tratamento Involuntário/legislação & jurisprudência , Motivação/fisiologia , Tratamento Domiciliar/legislação & jurisprudência , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Veteranos
16.
Cien Saude Colet ; 24(2): 641-648, 2019 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-30726396

RESUMO

This work sought to determine the association between stressful events, spirituality, program participation and alcohol consumption in participants of the AA 12-step program. The study used a descriptive correlation and predictive method. The population was comprised by members from AA, Mexico. A simple random sampling by clusters was performed, the sample consisted of 72 AA participants with 95% CI. The Spiritual Perspective Scale and the Social Readjustment Rating Scale were used. Stressful events are negatively and significantly related to alcohol consumption (rs = -0.316, p = 0.007), this indicates that the higher the number of stressors, the lower the number of days without alcohol consumption; participation in the program was positively and significantly related to alcohol consumption (rs = 0.776, p = 0.001), which indicates that greater years of participation means greater number of days without alcohol consumption. Spirituality showed no significant relationship (p > 0.05), there is also a significant effect of participation in the program and age on alcohol consumption (R2 = 65.2%, p = 0.001). Participation in the AA program is related to and has an effect on the number of days without alcohol consumption.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/reabilitação , Espiritualidade , Estresse Psicológico/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos Anônimos , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade
17.
Traffic Inj Prev ; 20(1): 15-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30715916

RESUMO

OBJECTIVES: The Alcohol Use Disorders Identification Test (AUDIT) is used to assess the level of alcohol use/misuse and to inform the intensity of intervention delivered within screening, brief intervention, and referral to treatment (SBIRT) programs. Policy initiatives are recommending delivery of SBIRT within health care settings to reduce alcohol misuse and prevent alcohol-impaired driving. Recent reports are considering extending delivery of SBIRT to criminal justice settings. One consideration in implementing SBIRT delivery is the question of resource utilization; the amount of effort required in delivering the 4 different intensities of intervention in SBIRT: Alcohol education, simple advice, brief counseling and continued monitoring, and brief counseling and referral to specialist (from least to most intense in terms of delivery time, the skill level of the provider, and personnel resources). METHODS: In order to inform expectations about intervention intensity, this article describes the AUDIT scores from 982 adults recently arrested for alcohol-impaired driving. The distribution of scores is extrapolated to state rates for individuals arrested for alcohol-impaired driving by intervention level. RESULTS: Though alcohol education was the most common intervention category, about one quarter of the sample scored in a range corresponding with the more intensive interventions using the brief counseling, continued monitoring for ongoing alcohol use, and/or referral to specialist for diagnostic evaluation and treatment. CONCLUSIONS: This article provides local distribution of AUDIT scores and state estimates for the number of individuals scoring in each level of risk (AUDIT risk zone) and corresponding intervention type. Routine criminal justice practice is well positioned to deliver alcohol screening, education, simple advice, and continued alcohol monitoring, making delivery of SBIRT feasible for the majority of alcohol-impaired drivers. Challenges to implementing the full range of SBIRT services include resource demands of brief counseling, identifying the appropriate providers within a criminal justice context, and availability of community providers for referral to diagnostic and specialty care. Solutions may vary by state due to differences in population density and incidence rates of alcohol-impaired driving.


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/reabilitação , Intervenção Médica Precoce/organização & administração , Implementação de Plano de Saúde/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Condução de Veículo , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pesquisa , Medição de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos
19.
Drug Test Anal ; 11(6): 859-869, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30618164

RESUMO

Direct and indirect biomarkers are widely applied for the determination of alcohol consumption. They help to assess past or present alcohol consumption. Depending on the window of detection and sensitivity of the investigated marker, punctual alcohol consumption may remain undetected. In this study, different sampling strategies for the intermediary long-term marker phosphatidylethanol (PEth) are evaluated and compared to the determination of the short-term markers ethyl glucuronide (EtG) and ethyl sulfate (EtS) in urine. Samples from 19 patients undergoing alcohol use disorder treatment were collected during the withdrawal treatment and successive rehabilitation (33 ± 26 days (range: 3-74 days)). With liquid chromatography-tandem mass spectrometry (LC-MS/MS) EtG and EtS in urine, PEth in blood, PEth in dried blood spot (DBS) from venous blood, and PEth in DBS from capillary blood were quantified and compared. The use of volumetric capillary DBS, prepared from 20 µL of blood, provided the same results as the use of venous DBS (95% ± 10%, R2 0.9899 for PEth 16:0/18:1). Capillary DBS sampling has the advantage that it can be performed without venipuncture. The use of PEth in DBS proved to prevent post-sampling degradation, providing a longer detection in comparison to PEth in liquid blood, which only showed 67% ± 24% of the PEth DBS 16:0/18:1 concentration. When compared with EtG and EtS in urine, PEth monitoring proved to be advantageous for the detection of relapse situations, as the accumulation of PEth in blood prolongs the detectability. In conclusion, volumetric capillary DBS sampling for PEth is a simple and useful tool for compliance monitoring, and avoids hematocrit issues.


Assuntos
Alcoolismo/sangue , Alcoolismo/urina , Glucuronatos/urina , Glicerofosfolipídeos/sangue , Ésteres do Ácido Sulfúrico/urina , Adulto , Idoso , Alcoolismo/reabilitação , Alcoolismo/terapia , Biomarcadores/sangue , Biomarcadores/urina , Cromatografia Líquida/métodos , Teste em Amostras de Sangue Seco/métodos , Feminino , Humanos , Limite de Detecção , Masculino , Pessoa de Meia-Idade , Espectrometria de Massas em Tandem/métodos , Adulto Jovem
20.
Drug Alcohol Depend ; 194: 288-295, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30469100

RESUMO

BACKGROUND: Alcohol use is risky for patients with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) infection, but alcohol use disorder (AUD) treatment is underutilized in these populations. Comorbid drug use disorders (DUD) are common, but their influence on AUD treatment receipt is understudied. We evaluated the association between DUD and AUD treatment receipt in two national samples of patients with AUD, those with HIV and those with HCV, in the U.S. Veterans Health Administration. METHODS: Samples included patients with AUD and HCV and/or HIV among positive alcohol screens (AUDIT-C≥5) documented 10/01/09-5/30/13 in the national electronic health record. Poisson regression models estimated incidence rate ratios for receiving specialty treatment (stop codes) and pharmacotherapy (filled prescription for naltrexone, disulfiram, acamprosate, or topiramate) within 365 days of positive alcohol screening for patients with DUD versus those without. Models were clustered on patient and adjusted for potential confounders. RESULTS: Among 22,039 patients with HCV/AUD, 45.2% (N = 9,964) had DUD, which was associated with receiving specialty treatment [adjusted incidence rate ratio: 1.89 (95% confidence interval 1.82-1.96)] and pharmacotherapy [aIRR: 1.50 (1.37-1.65)]. Among 1,834 patients with HIV/AUD, 56.9% (N = 1,043) had DUD, which was associated with receiving specialty treatment [aIRR: 1.94 (1.68-2.24)], but not pharmacotherapy. CONCLUSIONS: Rates of AUD treatment receipt among patients with AUD and HCV and/or HIV were low overall, but likelihood of treatment receipt was generally higher among those with comorbid DUD. Future research should investigate mechanisms underlying these associations, such as enhanced readiness for treatment or differential provider prescribing or referral practices.


Assuntos
Alcoolismo/complicações , Alcoolismo/reabilitação , Infecções por HIV/complicações , Hepatite C/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Medicina Baseada em Evidências , Feminino , Hospitais de Veteranos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Resultado do Tratamento , Estados Unidos , United States Department of Veterans Affairs , Adulto Jovem
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