Substance Dependence

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Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study

Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study

Despite a higher prevalence of sexual risk behaviors among people with substance dependence than in the general population [7], little is known about disparities in sexual health care among these individuals. Commu- nication problems in the patient-clinician exchange may occur differentially across race/ethnicities and among patients with mental illness, thereby contributing to the disparities in contraceptive use and, subsequently, STIs and unintended pregnancy [37,43]. Primary care clini- cians in particular may feel discomfort in discussing these issues because of their sensitive nature and lack of training [44-46]. Despite the vast literature about racial disparities in medical care, little is known about dispar- ities specific to sexual health care [47]. One recent study of low income women found that blacks were more likely to report being pressured by their clinician to use contraceptives, compared to whites [47]. A series of stu- dies found that many African Americans who received family planning care felt discriminated against and held conspiracy beliefs about birth control (such as “birth control is a form of Black genocide”) [48].
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Camp Approach - an Effective, Alternate Inpatient Treatment Setting For Substance Dependence: A Report from India

Camp Approach - an Effective, Alternate Inpatient Treatment Setting For Substance Dependence: A Report from India

Researchers have voiced the need for development and availability of effective inpatient options for patients with substance dependence (Finney et al, 1996; Long et al, 1998) and increasing the effectiveness of interventions by the community reinforcement approach (Longabaugh, 1996). Although this study has certain limitations - small sample size, lack of structured instruments for measuring course and outcome, no interim follow-up on structured basis, lack of sound techniques for corroboration of information ob- tained (related to abstinence) etc., yet it provides an insight into a form of inpatient setting which, if not being more effective, is at least as effective as hospital based setting. Hence, camp approach is a viable and clinically effective mode of treatment for substance abuse in an inpatient setting. However, the profile of the patients attending the ‘camp’ and the ‘hospital’ was different on the parameters of age, employment, education, diagnosis, and comorbidity. This could have affected the treatment seeking pattern and outcome substantially and cannot be ignored. Hence, the study should, in perspective, be seen as preliminary and naturalistic.
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The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study

Of the 249 patients included in the SUBUSQOL cohort, 159 answered the EQS-C, which was sent 11.5 days (SD = 3.6 days) after study inclusion on average. Nine ques- tionnaires were returned because of incorrect addresses, and the 159 EQS-C forms were returned in a mean time of 17.1 days (13.7 days). The sociodemographic and clinical characteristics of the patients are presented in Table 1 for the entire sample and separately based on whether the EQS-C was answered. Most patients were male (76.1%) with a mean age of 39.5 years old (SD = 11.1). More than one-third of these patients were married (37%), and a minority reported a high-school or university-level education (17.7%). Of the 159 respondents, 71 (44.7%) sought care for alcohol depen- dence and 88 (55.3%) for opioid dependence according to the DSM-IV criteria. The mean duration of substance dependence was 14.6 (SD = 11.1) years. Nineteen patients required care while undergoing a legally mandated addiction treatment. Patients who responded to the satisfaction questionnaire were older than those who did not respond (P = 0.03); otherwise, the EQS-C nonresponders did not differ from the EQS-C
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Social group membership before treatment for substance dependence predicts early identification and engagement with treatment communities

Social group membership before treatment for substance dependence predicts early identification and engagement with treatment communities

Social relationships play a major role in recovery from substance dependence. To date, greater attention has been paid to the role of important individuals in a person’s life and their contribution to recovery following treatment. This study is the first to examine both individual and wider group-based social connections in the lead up to residential treatment for substance misuse in a therapeutic community (TC), and their influence both on a person’s readiness to engage with the treatment community and with a recovery pathway. Participants were 307 adults interviewed early in treatment about their individual- and group-based social relationships prior to treatment entry, their social identification with the TC, as ‘a user’ and a person ‘in recovery’, their current recovery capital and quality of life. Correlational analysis showed that only pre-treatment group-based, and not individual, relationships, were significantly associated with developing social identification with the TC early in treatment. Moreover, results of hierarchical regression analyses indicated that identification with the TC was best predicted by the extent to which they saw themselves as being in recovery. Finally, mediation analysis indicated that TC identification was the mechanism through which social group memberships prior to treatment commencement protected quality of life in the early phases of treatment. These findings highlight the protective role that group memberships play in building early identification with the TC and supporting well-being in a critical period of transitioning to treatment.
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A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care

A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care

Background: HCV treatment among people who inject drugs (PWID) is low. Education programs may be suitable strategies to improve patients ’ knowledge about their condition and to overcome barriers to access treatment. Methods: The Health Educational Program (HEP) consisted of patient workshops and educational videos and leaflets, and healthcare professionals ’ workshops. HEP was implemented at seven substance dependence treatment centers (STDC) in Portugal. The study comprised two cross-sectional evaluations conducted before and after HEP. At both evaluations, adult patients with confirmed HCV diagnosis and registered in the STDC were consecutively included. For patients that completed both evaluations, the overall knowledge score were calculated and compared with McNemar test. Linear regression modelling was used to evaluate factors associated with baseline knowledge. Rates of referral and attendance to referral specialist, treatment proposal, initiation and retention at both evaluations were also compared with McNemar test.
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Substance Abuse vs. Substance Dependence: Implications for the Management of the DUI Offender. William L. White, MA

Substance Abuse vs. Substance Dependence: Implications for the Management of the DUI Offender. William L. White, MA

Over the past three decades, the author has provided ongoing training to key stakeholders involved in the management of DUI offenders in the State of Illinois. Included among those key stakeholders are traffic court judges, states attorneys, probation officers, court social service workers, DUI evaluators, treatment specialists, and DUI hearing officers. One of the most consistent areas of interest expressed by these professionals is the distinction between substance use and substance dependence and whether placement in one or the other diagnostic category influences risk of DUI recidivism or approaches to management and treatment. The purpose of this paper is to provide answers to such questions that are brief and as clear as current research will allow.
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Achieving Effective Treatment of Patients With Chronic Psychotic Illness and Comorbid Substance Dependence

Achieving Effective Treatment of Patients With Chronic Psychotic Illness and Comorbid Substance Dependence

Objective: The changing effectiveness of a treatment program for dual-diagnosis pa- tients was evaluated over a 2-year period with the use of a sequential study group design. Method: The treatment outcome of 179 consecutively enrolled patients with chronic psy- chotic illness and comorbid substance dependence who entered a specialized day hospital dual-diagnosis treatment program from Sept. 1, 1994, to Aug. 31, 1996, was evaluated. The 24 months were divided into four successive 6-month periods for comparing the evolving ef- fectiveness of the program for groups of patients entering the day hospital during these four periods. Treatment attendance, hospital utilization, and twice weekly urine toxicology analy- ses were used as outcome measures. Results: The initial treatment engagement rate, de- fined as at least 2 days of attendance in the first month, increased significantly from group 1 to group 4, more than doubling. Thirty-day and 90-day treatment retention rates also sub- stantially increased from group 1 to group 4. More patients had no hospitalization in the 6 months after entering the day hospital program than in the 6 months before entering the day hospital program. Urine toxicology monitoring indicated that the patients in group 4 were more likely than those in group 1 to remain abstinent at follow-up. Conclusions: The evolving clinical effectiveness of a developing program can be quantified by using a se- quential group comparison design. The sequential outcome improvements may be related to the incremental contributions of assertive case management and skills training for re- lapse prevention.
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From policy to practice: implementing frontline community health services for substance dependence-study protocol

From policy to practice: implementing frontline community health services for substance dependence-study protocol

Methods/Design: Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.
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Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders

Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders

We examined the effects of substance dependence on health care use in both bivariate and multivari- able settings. For the multivariable regression models, we included variables that were selected a priori to be potentially associated with ED visits and hospital admis- sion [HF intervention (combined HF-ACT, HF-ICM, HF-CONG), need-level (HN vs. MN), employment, age, gender, ethnicity, education, age at first homelessness, mental disorders, chronic health conditions (3 or more), blood-borne infectious disease, prior health care utiliza- tion, having a regular doctor, and where one goes when sick]. In the model-building process, we chose all vari- ables that were significant in bivariate models (p ≤ 0.05). In addition, we forced several demographic variables and substance dependence into the multivariable models, regardless of significance in bivariate models. We tested the interaction term between HF intervention and sub- stance dependence, but did not include it in the final model due to nonsignificance (p  >  0.05). We also con- ducted two sub-analyses fitting NBR models: one for the association of daily substance use and ED use and hos- pitalization using a similar set of covariates; and another model examining the association of substance depend- ence on psychiatric hospitalization. All reported p values were two-sided. Rate ratios (RRs) obtained from the NBR models were reported as effect sizes. The missing values for covariates that ranged from zero to 2% were excluded from the analysis. IBM SPSS statistics (version 19.0, August 2010) and STATA 12 (StataCorp. 2011) were used to conduct these analyses.
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<p>Patient experiences with interdisciplinary treatment for substance dependence: an assessment of quality indicators based on two national surveys in Norway</p>

<p>Patient experiences with interdisciplinary treatment for substance dependence: an assessment of quality indicators based on two national surveys in Norway</p>

Purpose: The quality of health care is often measured using quality indicators, which can be utilized to compare the performance of health-care providers. Conducting comparisons in a meaningful and fair way requires the quality indicators to be adjusted for patient char- acteristics and other individual-level factors. The aims of the study were to develop and test a case-mix adjustment model for quality indicators based on patient-experience surveys among inpatients receiving interdisciplinary treatment for substance dependence, and to establish whether the quality indicators discriminate between health care providers. Patients and methods: Data were collected through two national surveys involving inpa- tients receiving residential treatment in Norway in 2013 and 2014. The same questionnaire was used in both surveys, and comprised three patient-experience scales. The scales are reported as national quality indicators, and associations between the scales and patient characteristics were tested through multilevel modeling to establish a case-mix model. The intraclass correlation coef fi cient was computed to assess the amount of variation at the hospital-trust level. Results: The intraclass correlation coef fi cient for the patient-reported experience scales varied from 2.3% for “ treatment and personnel ” to 8.1% for “ milieu ” . Multivariate multilevel regression analyses showed that alcohol reported as the most frequently used substance, gender and age were signi fi cantly associated with two of the three scales. The length of stay at the institution, pressure to be admitted for treatment, and self-perceived health were signi fi cantly related to all three scales. Explained variance at the individual level was approximately 7% for all three scales.
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Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs

Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs

It is clear that effective services for chronic substance abusing women can have significant economic benefits. A recent review which included twenty-four research re- views and forty-three research trials of evidence-based treatments for substance abusing patients with comorbid psychiatric disorders [63] found that the effectiveness of treatment varies by type (combination) of co-occurring disorder [65]. Further, depending on the nature of the diagnosis, stability in recovery may be contingent upon addressing the substance abuse early on while improve- ment of non-substance related disorders may precede improvement of substance use symptoms. Generally, treatment planning for patients with comorbid sub- stance use and psychiatric disorders is more effective when effective therapeutic modalities (i.e., psychother- apy, pharmacotherapy and behavioral treatments) are combined [66, 67]. Unfortunately, none of the research reviewed assessed changes in patient hospitalization. Fur- ther research on the clinical outcomes of interventions for individuals with comorbid substance dependence and psychiatric disorders should attempt to incorporate re- source use measures into assessment batteries [66].
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The Relationship Between Alexithymia, Wellness, and Substance Dependence

The Relationship Between Alexithymia, Wellness, and Substance Dependence

A demographic questionnaire asking respondents their age, culture of origin, gender, and socioeconomic level was included with the WEL and TAS-20 instruments. Research suggests that alexithymia occurs cross-culturally and in both male and female populations (Taylor, et al., 1997). Preliminary cross-culture and gender validity of the instrument specific to substance dependence has been demonstrated in Poland (Ziolkowski, Gruss, & Rybakowski, 1995), the United States (Haviland, Hendryx, Cummings, Shaw, & MacMurray , 1991), and Finland (Kauhnen, Julkunen, & Salonen, 1992). Research also suggests that the TAS-20 and the alexithymia construct are not culturally bound, but effective in diverse cultural settings such as populations in Japan, Africa, the Middle East, and Australia (Taylor et al.). Because the
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Patient experiences questionnaire for interdisciplinary treatment for substance dependence (PEQ ITSD): reliability and validity following a national survey in Norway

Patient experiences questionnaire for interdisciplinary treatment for substance dependence (PEQ ITSD): reliability and validity following a national survey in Norway

The data for this study was collected as part of the na- tional patient experience program in Norway. It was the first national survey of patient experiences of interdiscip- linary treatment for substance dependence. The PEQ- ITSD was designed for use among inpatients, and fo- cuses on topics patients have reported to be important. The questionnaire was developed after a thorough re- view of the literature, meetings in an expert group, inter- views with patients and results from a pilot survey. The testing and evaluation of the PEQ-ITSD showed that the questionnaire comprised three scales with excellent in- ternal consistency reliability, test-retest reliability and construct validity. Furthermore, the questionnaire showed good acceptability given the high response rate and low proportion of item missing.
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Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America

Up to 79% of respondents perceived that they had had enough or complete improvement in their condition with the entrance to the TC, and less than 2% did not feel any improvement. These findings are different from those reported by Fernandez et al. [22], who found that only 54% of users had perceived some degree of im- provement and 46% had not felt any improvement or deterioration in his health. These could be explained by differences in the users or the number of sample that had each of the studies. Other reasons may be how the improvement was evaluated if just by asking the patient or following them until they relapse or how long was the period of abstinence. These differences mainly exist be- cause there are no standardized measures of treatment success of substance use which could limit the compari- sons between the results of different studies about man- agement of drug addictions. Another explanation could be the selection bias because only users who were active in the program were interviewed, but not those who abandoned the program. All these explanations could modify the proportion of users feeling any improvement in their condition.
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Attitudes And Beliefs Towards Medication-Assisted Treatment (mat) For Substance Dependence And Abuse Among Fishermen In Eastern Malaysia: Determining Barriers And Facilitators To Mat Scale-Up

Attitudes And Beliefs Towards Medication-Assisted Treatment (mat) For Substance Dependence And Abuse Among Fishermen In Eastern Malaysia: Determining Barriers And Facilitators To Mat Scale-Up

Subjects were questioned about whether they had used a bomoh, a Malay shaman, to treat their drug use problems. Many showed disdain for bomohs, laughing at the question of whether they would use their services, and several noted that they did not trust bomohs. Five fishermen said they had sought treatment from a bomoh to address their addiction (or that their families had sought this treatment on their behalf). However, two of the men who had consulted a bomoh as drug treatment were convinced that bomohs could not cure substance use problems. One fisherman who had consulted a bomoh explained that the treatment cleansed his body by inducing vomiting but that the treatment did not have the power to rid him of his drug cravings. Asked if he would go to a bomoh again he replied, “No way. Because I have methadone.” Another said it was hard to say whether the treatment worked because despite having a healthy body, “once we remember them [drugs], it’s gonna be hard.”
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Insula and Orbitofrontal Cortical Morphology in Substance Dependence Is Modulated by Sex

Insula and Orbitofrontal Cortical Morphology in Substance Dependence Is Modulated by Sex

Limitations of this study are a modest sample size, an in- ability to determine causality, and an inability to isolate the effects of a single drug. Tobacco and alcohol use is common among stimulant-dependent SDI. A subsample analysis com- paring 16 SDI with alcohol dependence to 12 SDI without al- cohol dependence revealed no differ- ences in cortical thickness. We cannot exclude the possibility that other drugs influenced the findings. Seven of 28 controls used nicotine, which may have reduced our sensitivity. We did not as- sess post-traumatic stress disorder and anxiety disorder, which could also in- fluence morphometry.
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Neuroscience of psychoactive substance use and dependence   WHO 2004 pdf

Neuroscience of psychoactive substance use and dependence WHO 2004 pdf

Substitution therapy is defined as the administration under medical supervision of a prescribed psychoactive substance – pharmacologically related to the one producing dependence – to people with substance dependence, for achieving defined treatment aims (usually improved health and well-being). Substitution therapy is widely used in the management of opioid dependence and is often referred to as “opioid substitution treatment,” “opioid replacement therapy”, or “opioid pharmacotherapy”. Agents suitable for substitution therapy of opioid dependence are those with some opioid properties, so that they have the capacity to prevent the emergence of withdrawal symptoms and reduce craving. At the same time they diminish the effects of heroin or other opioid drugs because they bind to opioid receptors in the brain. In general, it is desirable for opioid substitution drugs to have a longer duration of action than the drug they are replacing so as to delay the emergence of withdrawal and reduce the frequency of administration. As a result there is less disruption of normal life activities from the need to obtain and administer drugs, thereby facilitating rehabilitation efforts. Whereas non-prescribed opioids are usually injected or inhaled by drug users, these prescribed medicines are usually administered orally in the form of a solution or a tablet. Agents used in substitution therapy can also be prescribed in decreasing doses over short periods of time (usually less than one month) for detoxification purposes. Substitution maintenance treatment is associated with prescription of relatively stable doses of opioid agonists (e.g. methadone and buprenorphine) over a long period of time (usually more than 6 months). The mechanisms of action of opioid substitution maintenance therapy include prevention of disruption of molecular, cellular and physiological events and, in fact, normalization of those functions already disrupted by chronic use of usually short-acting opiates such as heroin. The context of delivery of substitution therapy has important implications for the quality of the interventions, both to maintain adequate control and to ensure responsible prescribing. Since 1970, methadone maintenance treatment has grown substantially to become the dominant form of opioid substitution treatment globally. Because the treatment was initially controversial, it has been more rigorously evaluated than any other treatment for opioid dependence. The weight of evidence for benefits is substantial.
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History of Substance in Philosophy

History of Substance in Philosophy

question of what is real. Are dream object genuine, in the route in which unmistakable substances, for example, seats and trees are? Are numbers genuine? Alternately would it be a good idea for them to be depicted as close to reflections? Is the tallness of a man a reality in the same sense in which he is a reality, or is it only a part of something more concrete, a minor quality that has subsidiary as opposed to significant being and couldn’t exist with the exception of as ascribed to something else? This inquiry is some way or another troublesome, however numerous metaphysicians have related thoughts of substance, quality, and connection; they have contended that lone what is significant genuinely exists, albeit each substance has qualities and stands in connection to differ- ent substances. Along these lines, a tree is tall and it’s decisively 50 yards north of that wall. Troubles start, when illustrations like these are considered important. Expect for the minute that an individual tree what may be known as a solid existent fits the bill for the title of substance; it is only the kind of thing that has qualities and stands in rela- tions. Unless there were substances in this sense, no attributes could be genuine: the tallness of the tree would not exist unless the tree existed. The inquiry can now be raised what the tree would be in the event that it were denied of every one of its quali- ties and remained in no relations. The idea of a substance in this kind of transcenden- talism is that of a thing that exists without anyone else’s input, aside from any ascribes it might happen to have; the trouble with this thought is to know how to apply it. Any solid thing one chooses to embody the idea of substance turns out practically speaking to answer a specific portrayal; this implies in actuality that it can’t be talked about se- parated from its attributes. It in this manner, substances are not any more essential creatures than are qualities and relations; without the previous one couldn’t have the last mentioned, however similarly without the last one couldn’t have the previous. This negate Descartes demonstrate and the bundle theory hypothesis. Ibuanyidanda tries to give a solution to the problem of substance and accident.
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The substance in styles

The substance in styles

– Short implied volatility in rates (selling delta-hedged swaption straddles) and FX markets (selling delta-hedged straddles) Defining investment styles.. Styles are a way of understand[r]

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Auto dependence structure of arch models: tail dependence coefficients

Auto dependence structure of arch models: tail dependence coefficients

Although auto-correlation of squared returns provides a satisfactory qualitative explanation for volatility clustering, and for Mandelbrot’s observation cited above, it does not always easily provide answers to questions related to the multi-variate distribution functions associated to the process, like for example the behavior of conditional quantiles at lags greater than 1 for a GARCH(1, 1) - cf. [9]. Motivated by recent developments in risk-management (see Embrechts, McNeil and Strau- mann [12],), we propose to study auto-dependence in time-series from the point of view of alternative, copula-based, dependence measures like rank-correlations, concordance measures or, in this paper, tail dependence coefficients. Indeed, as in risk-management, where linear correlation is the natural dependence measure for multi-variate normal, or more generally elliptic, linear models, but is less suitable for non-linear models or for more general classes of multi-variate distributions, we ar- gue that autocorrelations, while adequate for linear processes, should, for non-linear processes like the GARCH, be supplemented by other measures of auto-dependence. As a further motivation to consider alternative auto-dependence measures in time series, linear autocorrelations are not always defined: in the case of a stationary GARCH only for a limited parameter range, and not at all if the i.i.d. innovations which drive the process do not posses a finite variance. Similarly, if one is interested in the squared process they should at least have a finite fourth moment. (This does not preclude studying sample autocorrelation functions of such processes; cf. [4] and its references).
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