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1.
Lancet ; 395(10219): 226-239, 2020 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31791690

RESUMO

This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.


Assuntos
Alcoolismo/epidemiologia , Hepatopatias/epidemiologia , Hepatopatias/prevenção & controle , Obesidade/epidemiologia , Bebidas Alcoólicas/economia , Alcoolismo/complicações , Alcoolismo/terapia , Comércio , Redes Comunitárias/organização & administração , Comorbidade , Efeitos Psicossociais da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Legislação sobre Alimentos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Transplante de Fígado/estatística & dados numéricos , Obesidade/complicações , Pacotes de Assistência ao Paciente , Escócia , Reino Unido/epidemiologia
2.
Psychol Addict Behav ; 33(8): 659-668, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738072

RESUMO

The cardiovascular system is disrupted by chronic excessive alcohol use and often impaired in individuals with an alcohol use disorder (AUD). Less is known about cardiovascular recovery when an individual receives treatment for AUD. This observational study aimed to extend the growing body of evidence for cardiovascular biomarkers and intervention targets in the treatment of AUD. We examined cardiovascular function in 92 women before and after 12 weeks of cognitive-behavioral therapy (CBT) for AUD. Participants were recruited exclusively from a randomized clinical trial comparing group versus individual CBT treatment strategies (parent study); no control group of untreated, but treatment-seeking women was available. Demographic and drinking data were obtained from the parent study. Cardiovascular data were collected as part of this separate study, prior to and following the clinical trial. Mixed-model analyses revealed multiple within-person cardiovascular changes indicative of improving health from pre- to posttreatment, including reduced heart rate and vessel stiffness as well as increased heart rate variability and baroreflex sensitivity. These significant improvements remained when extent of drinking during treatment was included in the models, suggesting that active ingredients of AUD treatment may serve to benefit physical health over and above drinking reductions. Future studies should assess the time course of cardiovascular recovery during addiction treatment and the mechanisms by which evidence-based AUD treatments may benefit physical as well as mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo/terapia , Barorreflexo/fisiologia , Sistema Cardiovascular/fisiopatologia , Terapia Cognitivo-Comportamental , Frequência Cardíaca/fisiologia , Adulto , Alcoolismo/fisiopatologia , Alcoolismo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Presse Med ; 48(12): e361-e368, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31767250

RESUMO

BACKGROUND: Few studies of mental health or substance abuse have focused on rural life. This study aimed to evaluate the association between socio-demographic and clinical characteristics and the probability of rural alcoholic women seeking help on their own at a specialty treatment service. METHODS: This exploratory study used a cross-sectional design to collect data from alcoholic women upon admission to a French outpatient department. Multiple logistic regression models tested whether the socio-demographic and clinical characteristics of these women predicted the likelihood that they would seek treatment at a specialty service on their own. RESULTS: Among 50 rural alcoholic women, the probability of seeking help on their own at a specialty treatment service was 5.6 times greater (95% CI 1.2-25.7, P=0.03) for participants with a history of physical and/or sexual trauma and 5.1 times greater (95% CI 1.1-24, P=0.03) among women with no complementary health insurance. CONCLUSION: Increased knowledge of the specific characteristics of rural alcoholic women is needed to develop programs that will increase awareness of and access to specialty treatment services among these women.


Assuntos
Alcoolismo/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , População Rural/estatística & dados numéricos , Adulto , Alcoolismo/psicologia , Alcoolismo/terapia , Estudos Transversais , Feminino , França/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
4.
Behav Ther ; 50(6): 1030-1041, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31735239

RESUMO

Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d = -0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/terapia , Terapia Cognitivo-Comportamental , Adaptação Psicológica , Adulto , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo , Autoeficácia , Resultado do Tratamento
5.
BMC Public Health ; 19(1): 1350, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640647

RESUMO

BACKGROUND: Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. METHODS: The repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). RESULTS: The proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes. CONCLUSION: The study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.


Assuntos
Alcoolismo/terapia , Depressão/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde Mental , Adolescente , Adulto , Alcoolismo/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Seguro Saúde/organização & administração , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Adulto Jovem
6.
Int Rev Neurobiol ; 147: 219-267, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607356

RESUMO

There are vast literatures on the neural effects of alcohol and the neural effects of exercise. Simply put, exercise is associated with brain health, alcohol is not, and the mechanisms by which exercise benefits the brain directly counteract the mechanisms by which alcohol damages it. Although a degree of brain recovery naturally occurs upon cessation of alcohol consumption, effective treatments for alcohol-induced brain damage are badly needed, and exercise is an excellent candidate from a mechanistic standpoint. In this chapter, we cover the small but growing literature on the interactive neural effects of alcohol and exercise, and the capacity of exercise to repair alcohol-induced brain damage. Increasingly, exercise is being used as a component of treatment for alcohol use disorders (AUD), not because it reverses alcohol-induced brain damage, but because it represents a rewarding, alcohol-free activity that could reduce alcohol cravings and improve comorbid conditions such as anxiety and depression. It is important to bear in mind, however, that multiple studies attest to a counterintuitive positive relationship between alcohol intake and exercise. We therefore conclude with cautionary notes regarding the use of exercise to repair the brain after alcohol damage.


Assuntos
Alcoolismo/complicações , Alcoolismo/terapia , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/terapia , Encéfalo/efeitos dos fármacos , Etanol/efeitos adversos , Terapia por Exercício/métodos , Humanos
7.
J Consult Clin Psychol ; 87(12): 1093-1105, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31599606

RESUMO

OBJECTIVE: This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. METHOD: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. RESULTS: CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. CONCLUSIONS: The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Alcoolismo/terapia , Humanos
8.
Lancet ; 394(10200): 781-792, 2019 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-31478502

RESUMO

Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/terapia , Alcoolismo/diagnóstico , Alcoolismo/genética , Efeitos Psicossociais da Doença , Feminino , Saúde Global , Humanos , Masculino , Programas de Rastreamento , Atenção Primária à Saúde/métodos
9.
Br J Hosp Med (Lond) ; 80(9): 500-506, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498680

RESUMO

Regular heavy consumption of alcohol is associated with a wide range of physical, psychological and social problems. All health-care clinicians should be able to screen for and detect problematic levels of alcohol consumption in their patients, and deliver an effective brief intervention. When patients with alcohol dependence are admitted to hospital there must be an assessment of whether medication is required to prevent withdrawal symptoms and potential delirium tremens and withdrawal seizures. Medically assisted alcohol withdrawal using a long-acting benzodiazepine such as chlordiazepoxide should be carefully monitored and titrated to effect, and the clinician should be aware of the risk of Wernicke-Korsakoff syndrome and other complications. Abstinence from alcohol is usually only the first step in treatment, and effective linkage to community alcohol services is an important step.


Assuntos
Delirium por Abstinência Alcoólica/prevenção & controle , Convulsões por Abstinência de Álcool/prevenção & controle , Alcoolismo/diagnóstico , Benzodiazepinas/uso terapêutico , Delirium por Abstinência Alcoólica/etiologia , Convulsões por Abstinência de Álcool/etiologia , Síndrome Alcóolica de Korsakoff/diagnóstico , Síndrome Alcóolica de Korsakoff/etiologia , Síndrome Alcóolica de Korsakoff/prevenção & controle , Síndrome Alcóolica de Korsakoff/terapia , Alcoolismo/complicações , Alcoolismo/terapia , Serviços Comunitários de Saúde Mental , Hospitalização , Humanos , Encaminhamento e Consulta , Medição de Risco , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/etiologia , Encefalopatia de Wernicke/prevenção & controle , Encefalopatia de Wernicke/terapia
10.
Artigo em Inglês | MEDLINE | ID: mdl-31500358

RESUMO

Within Canada, several specialized multi-service prevention programs work with highly vulnerable pregnant and early parenting women with substance use issues. Experiences of trauma, mental health, poverty, and other factors associated with the social determinants of health complete the picture. Program evaluations have demonstrated their value, but less has been said as to women's reasons for choosing to seek help from these programs, what they were hoping to gain, or what difference they believe has occurred as a result. The Co-creating Evidence project is a multi-year (2017-2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol or substance exposure. The evaluation uses a mixed methods design involving quarterly program output and "snapshot" client data, as well as in-person, semi-structured interviews and questionnaires with clients, program staff, and program partners. This article presents findings from interviews with women regarding why they sought help, how they used the services, and what they perceived to be the most significant change in their lives as a result. Obtaining help with substance use was the top theme for what women hoped to get from their participation in their program; however, women's reasons were often intertwined. Additional motivations included wanting information, support or assistance with: child welfare; pregnancy; housing; getting connected to health care or prenatal care; and opportunities for peer support. With respect to the most significant life change, themes included: reduced substance use; improved housing; stronger mother-child connection; and improved wellness and social connections. Findings demonstrated that vulnerable, marginalized pregnant and parenting women who are using substances will seek help when health and social care services are configured in such a way as to take into consideration and address their unique roles, responsibilities, and realities.


Assuntos
Poder Familiar/psicologia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Alcoolismo/terapia , Canadá , Feminino , Habitação , Humanos , Motivação , Gravidez , Avaliação de Programas e Projetos de Saúde
11.
J Consult Clin Psychol ; 87(9): 815-830, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31403817

RESUMO

OBJECTIVE: This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored. METHOD: Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months. RESULTS: Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]). CONCLUSIONS: Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Aculturação , Adaptação Psicológica , Alcoolismo/etnologia , Alcoolismo/terapia , Hispano-Americanos , Entrevista Motivacional/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
12.
Aust N Z J Public Health ; 43(5): 484-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31390112

RESUMO

OBJECTIVE: The aim of this literature review was to establish the economic burden of preventable disease in Australia in terms of attributable health care costs, other costs to government and reduced productivity. METHODS: A systematic review was conducted to establish the economic cost of preventable disease in Australia and ascertain the methods used to derive these estimates. Nine databases and the grey literature were searched, limited to the past 10 years, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to identify, screen and report on eligible studies. RESULTS: Eighteen studies were included. There were at least three studies examining the attributable costs and economic impact for each risk factor. The greatest costs were related to the productivity impacts of preventable risk factors. Estimates of the annual productivity loss that could be attributed to individual risk factors were between $840 million and $14.9 billion for obesity; up to $10.5 billion due to tobacco; between $1.1 billion and $6.8 billion for excess alcohol consumption; up to $15.6 billion due to physical inactivity and $561 million for individual dietary risk factors. Productivity impacts were included in 15 studies and the human capital approach was the method most often employed (14 studies) to calculate this. CONCLUSIONS: Substantial economic burden is caused by lifestyle-related risk factors. Implications for public health: The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors. New analysis of the economic burden of multiple risk factors concurrently is needed.


Assuntos
Alcoolismo/economia , Doença Crônica/economia , Doença Crônica/prevenção & controle , Assistência à Saúde/economia , Custos de Cuidados de Saúde , Doenças não Transmissíveis/economia , Obesidade/economia , Obesidade/prevenção & controle , Comportamento Sedentário , Fumar/economia , Alcoolismo/terapia , Austrália/epidemiologia , Doença Crônica/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Humanos , Estilo de Vida , Doenças não Transmissíveis/terapia , Obesidade/epidemiologia , Fumar/efeitos adversos
13.
Trials ; 20(1): 402, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277683

RESUMO

BACKGROUND: Alcohol use disorder (AUD) leads to a significant individual and societal burden. To achieve higher therapy success rates, therapeutic interventions still need to be improved. Most current neuroscientific conceptualizations of AUD focus on the imbalance between an enhanced automatic reaction to alcohol cues and impaired inhibition. Complementary to traditional relapse prevention strategies, novel computerized training interventions aim to directly alter these processes. This study tests a computerized alcohol-specific inhibition training in a large clinical sample and investigates its effects on behavioral, experimental and neurophysiological outcomes. It also analyzes whether variations in inhibition difficulty and/or endogenous cortisol levels during training impact these effects. METHODS: This is a double-blind, randomized controlled trial (RCT) with 246 inpatients with AUD participating. After baseline assessment, participants are randomly assigned to one of three computerized Go-NoGo-based inhibition training interventions (two alcohol-specific versions with different Go/NoGo ratios, or neutral control training) and one of two intervention times (morning/afternoon), resulting in six study arms. All patients perform six training sessions within 2 weeks. Endogenous cortisol is measured in 80 patients before and after the first training session. Inhibitory control and implicit associations towards alcohol are assessed pre and post training, at which point electroencephalography (EEG) is additionally measured in 60 patients. Patients' alcohol consumption and relevant psychological constructs (e.g., craving, self-efficacy, treatment motivation) are measured at discharge and at 3-, 6- and 12-month follow-ups. Fifty healthy participants are assessed (20 with EEG) at one time point as a healthy control group. DISCUSSION: This study investigates the effects of a computerized, alcohol-specific inhibition training for the first time in patients with AUD. Results should give insight into the effectiveness of this potential add-on to standard AUD treatment, including proximal and distal measures and effects on behavioral, experimental and neurophysiological measures. Information about working mechanisms and potential optimizations of this training are gathered through variations regarding difficulty of inhibition training and training time. This study may thus contribute to a deepened understanding of AUD and the improvement of its evidence-based treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02968537 . Registered on 18 November 2016.


Assuntos
Abstinência de Álcool/psicologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoólicos/psicologia , Alcoolismo/terapia , Aprendizagem , Motivação , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/fisiopatologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/sangue , Alcoolismo/fisiopatologia , Alcoolismo/psicologia , Biomarcadores/sangue , Encéfalo/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Suíça , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Alcohol Alcohol ; 54(5): 551-558, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31361815

RESUMO

AIM: The aim of this randomized controlled trial was to examine the impact of daily supportive text messages over a 6-month treatment period on mood and alcohol consumption in individuals with a dual diagnosis of alcohol use disorder (AUD) and depression following completion of an inpatient treatment programme. METHOD: Ninety-five adult participants with AUD and comorbid depression were recruited into this randomized control trial, which took place after completing a 30-day rehabilitation programme. The intervention group (n = 47) received twice-daily supportive text messages over 6-months while control participants (n = 48) had treatment as usual for a 6-month period, with an added 6-month post-treatment follow-up for both groups. Drinking history in the previous 90 days as well as symptoms of depression, anxiety and stress were measured at baseline, 3- and 6-month treatment points and 6-month post treatment follow up. RESULTS: Depression scores (P = 0.02) and perceived stress scores (P < 0.01) were significantly reduced at 3-month treatment point in the intervention group relative to control participants with small to medium effect. The intervention group also showed a significantly greater reduction in units per drinking day from baseline to 6-month treatment point compared to the control group with a medium effect size (P = 0.03). There were no differences in drinking or mood measures at 6-month post treatment follow-up. CONCLUSIONS: Supportive text messages provide an early initial benefit in decreasing symptoms of depression and stress, with a further positive impact on alcohol consumption following a longer treatment period. Benefits did not persist six months after the intervention ended.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/terapia , Depressão/epidemiologia , Depressão/terapia , Recuperação de Função Fisiológica , Mensagem de Texto , Adulto , Alcoolismo/psicologia , Comorbidade , Depressão/psicologia , Diagnóstico Duplo (Psiquiatria) , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
15.
Am J Nurs ; 119(7): 68-69, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31232784
16.
BMC Public Health ; 19(1): 727, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185955

RESUMO

BACKGROUND: A physically active lifestyle contributes to the prevention of lifestyle diseases, promotion of physical health, and reduction of pain, among other benefits. Being physically active also promotes mental health for many individuals, in the form of improved mood, increased self-efficacy and reduced risk of depression. Alcohol-dependent individuals may experience a better quality of life when supplementing their treatment with physical exercise. This study aimed to evaluate the effect of exercise on Quality of Life among patients with alcohol use disorder in a large randomized controlled trial. METHODS: The study had three arms: Patients were allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise two days a week of one hour each, (C) treatment as usual and individual physical exercise minimum two days a week. Duration of the intervention was six months. Data on values of Quality of Life were collected at baseline (before treatment start and at time of enrollment in the study), and at follow-up (at six months after enrollment in the study) using the EQ-5D questionnaire and the EQ-VAS. The sample consisted of 117 consecutive patients, and the follow-up rate was 66.6%. Intention-to-treat analyses were conducted to evaluate the effect of exercise on quality of life. RESULTS: Although not statistically significant, a substantial portion of the participants in the individual exercise condition reported that they had no pain or discomfort (one of the five quality of life dimensions measured by EQ-5D questionnaire) compared to the controls at follow-up. No difference was found between the groups regarding the EQ-VAS. CONCLUSION: The exercise intervention had no effect on quality of life for patients with alcohol use disorder, nor was quality of life improved across the total sample. More research in how to improve quality of life for patients with alcohol use disorder is needed. TRIAL REGISTRATION: ISRCTN74889852 (retrospectively registered, date: 16/05/2013).


Assuntos
Alcoolismo/psicologia , Alcoolismo/terapia , Terapia por Exercício/métodos , Exercício/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Inquéritos e Questionários , Resultado do Tratamento
17.
Alcohol Alcohol ; 54(4): 386-395, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31206165

RESUMO

AIMS: The aims of this study were to: examine differences in alcoholic cardiomyopathy (ACM) prevalence, temporal trends and the distribution of socio-demographic factors and comorbidities by sex; and investigate differences in selected inpatient outcomes between women and men with ACM. METHODS: We used the 2002-2014 Nationwide Inpatient Sample databases. Overall and sex-specific rates of ACM were estimated across sociodemographic, clinical, and hospital characteristics. Joinpoint regression was used to estimate temporal trends (annual percent change [APC]) of ACM-related hospitalization by sex and race/ethnicity. Adjusted odds ratios (AOR) representing associations between sex and selected ACM outcomes were calculated using survey logistic regression. RESULTS: The rate of ACM among all inpatient men and women was 128 per 100,000 and 17 per 100,000 hospitalizations, respectively. Among women, the rate of ACM remained unchanged during the study period, while for men, there was 1.2% annual reduction from 2002-2010 (APC -1.3, 95% CI: -1.7, -0.8). Women with ACM were more likely than men with ACM to experience depression (AOR=2.24, 95% CI: 2.06-2.43) and anxiety (AOR=1.94, 95% CI: 1.75-2.15), while men with ACM were 21% and 24% more likely than women with ACM to experience 'any heart failure (HF)' and HF with reduced ejection fraction respectively. One in 1,471 hospitalizations were related to ACM with a male-to-female ratio of 8:1. CONCLUSION: Individuals with ACM are at increased likelihood of adverse outcomes. Women with ACM are at increased risk of depression and anxiety, while men are at increased risk of HF.


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Cardiomiopatia Alcoólica/diagnóstico , Cardiomiopatia Alcoólica/epidemiologia , Caracteres Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/terapia , Cardiomiopatia Alcoólica/terapia , Estudos Transversais , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Rev Med Liege ; 74(5-6): 294-299, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-31206269

RESUMO

Alcohol dependence is a chronic and multifactorial disease with well-identified neurobiological substrates and a high relapse rate. Personalized psychological and pharmacological therapeutic interventions may improve its prognosis, although stigmatization of the disease may contribute to a deep treatment gap.


Assuntos
Alcoolismo , Alcoolismo/terapia , Doença Crônica , Humanos , Recidiva
19.
Int J Prison Health ; 15(2): 105-113, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31172855

RESUMO

PURPOSE: Many studies show that incarcerated populations have higher rates of problem drug use than the general population. The purpose of this paper is to analyse trends in addiction treatment demand in prisons in Ireland from 2009 to 2014 using available national surveillance data in order to identify any implications for practice and policy. DESIGN/METHODOLOGY/APPROACH: National surveillance data on treatment episodes for problem drug and alcohol use from 2009 to 2014, collected annually by the National Drug Treatment Reporting System (NDTRS), were analysed. FINDINGS: In total, 6 per cent of all treatment episodes recorded by the NDTRS between 2009 and 2014 were from prison services. The number of prison service treatment episodes increased from 964 in 2009 to 1,063 in 2014. Opiates were the main reason for treatment, followed by alcohol, cocaine and cannabis. The majority (94-98 per cent) of treatment episodes involved males (median age of 29 years) and low educational attainment, with 79.5-85.1 per cent leaving school before completion of second level. The percentage of treatment episodes with a history of ever injecting drugs increased from 20.9 per cent in 2009 to 31.0 per cent in 2014. PRACTICAL IMPLICATIONS: This study can help policy development and service planning in addiction treatment in prison as it provides an insight into the potential needs of incarcerated populations. It also provides a baseline from which to measure any changes in provision of treatment in prison over time. ORIGINALITY/VALUE: This is the first study to analyse treatment episodes in prison using routine surveillance data in Ireland. Analysis of these data can provide useful information, not currently available elsewhere.


Assuntos
Comportamento Aditivo/terapia , Prisões/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Idoso , Alcoolismo/epidemiologia , Alcoolismo/terapia , Comportamento Aditivo/epidemiologia , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
20.
Eur Addict Res ; 25(4): 182-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039565

RESUMO

AIMS: Two main therapeutic programs were offered to patients suffering from alcohol use disorders (AUDs): avoid the alcohol by abstinence or controlling their consumption. After information and motivational sessions, the patient chooses his own therapeutic plan. However, patients with AUD exhibit poor decision-making. The purpose of this study was to investigate the decision-making in AUD by comparing patients who chose to reduce and control their consumption to those who chose abstinence program. METHODS: Sixty-seven subjects with alcohol use disorder were included (AUD group) for treatment, choosing either a relapse prevention program (RPP) or a harm reduction program (HRP). Patients were compared to a healthy control group (n = 31). Cognitive skills were assessed through the Montreal Cognitive Assessment test, the National Adult Reading Test, the Trail Making Test and the Iowa Gambling Task (IGT). RESULTS: Thirty-seven patients with AUD chose the RPP while 30 followed a HRP. The AUD group performed worse than controls on the IGT. The RPP group had significantly lower performance than both HRP and control groups (these later groups being not statistically different). No correlation was observed between the available clinical, cognitive and intellectual measures. CONCLUSION: This study confirms that the decision-making process of patients with an alcohol use disorder is impaired. However, the 2 groups differ on the IGT scores, despite comparable clinical and cognitive profiles. The patients' decision-making abilities could be a useful guide when developing therapeutic programs.


Assuntos
Abstinência de Álcool , Alcoolismo/terapia , Tomada de Decisões , Redução do Dano , Comportamento Aditivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
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