substance related disorder [keywords]
- Developing and Testing Twelve-Step Facilitation for Adolescents with Substance Use Disorder: Manual Development and Preliminary Outcomes. [Journal Article]
- Subst Abuse 2016.:55-64.
Adolescent substance use disorder treatment programs are often based on the 12-step philosophy of Alcoholics Anonymous and/or link adolescents to these free resources. Despite this, no studies have developed and rigorously tested a twelve-step facilitation (TSF) intervention for young people, leaving a significant evidence gap. This study describes the first systematic development of an outpatient adolescent TSF treatment. An integrated twelve-step facilitation (iTSF) treatment incorporated TSF, motivational enhancement therapy, and cognitive behavioral therapy elements and was developed in an iterative manner with weekly feedback provided by 36 adolescents (M age 17 years [SD = 1.4]; 52.8% white) with DSM-IV substance use disorder recruited from the community. Assessments were conducted at baseline and at three and six months. Participants completed 6 of 10 sessions on average (8 participants completed all 10). Notable treatment developments were the inclusion of "in-services" led by Marijuana Anonymous members, including parents in a portion of individual sessions to provide a rationale for TSF, and use of a Socratic therapeutic interaction style. Acceptability and feasibility of the treatment were excellent (treatment satisfaction was 4.29 [SD = 0.59] out of 5). In keeping with TSF theory, the intervention substantially increased 12-step participation, and greater participation related to greater abstinence. iTSF is a replicable manualized treatment that can be implemented and tested in outpatient settings. Given the widespread compatibility of iTSF with the current adolescent treatment, if found efficacious, iTSF could be relatively easily adopted, implemented, and sustained and could provide an evidence-based option that could undergird current practice.
- Clozapine users in Australia: their characteristics and experiences of care based on data from the 2010 National Survey of High Impact Psychosis. [JOURNAL ARTICLE]
- Epidemiol Psychiatr Sci 2016 Jul 18.:1-13.
Clozapine is the most effective medication for treatment refractory schizophrenia. However, descriptions of the mental health and comorbidity profile and care experiences of people on clozapine in routine clinical settings are scarce. Using data from the 2010 Australian Survey of High Impact Psychosis, we aimed to examine the proportion of people using clozapine, and to compare clozapine users with other antipsychotic users on demographic, mental health, adverse drug reaction, polypharmacy and treatment satisfaction variables.Data describing 1049 people with a diagnosis of schizophrenia or schizoaffective disorder, who reported taking any antipsychotic medication in the previous 4 weeks, were drawn from a representative Australian survey of people with psychotic disorders in contact with mental health services in the previous 12 months. We compared participants taking clozapine (n = 257, 22.4%) with those taking other antipsychotic medications, on a range of demographic, clinical and treatment-related indicators.One quarter of participants were on clozapine. Of participants with a chronic course of illness, only one third were on clozapine. After adjusting for diagnosis and illness chronicity, participants taking clozapine had significantly lower odds of current alcohol, cannabis and other drug use despite similar lifetime odds. Metabolic syndrome and diabetes were more common among people taking clozapine; chronic pain was less common. Psychotropic polypharmacy did not differ between groups.Consistent with international evidence of clozapine underutilisation, a large number of participants with chronic illness and high symptom burden were not taking clozapine. The lower probabilities of current substance use and chronic pain among clozapine users warrant further study.
- Carbonyl stress-induced 5-hydroxytriptamine secretion from RIN-14B, rat pancreatic islet tumor cells, via the activation of transient receptor potential ankyrin 1. [JOURNAL ARTICLE]
- Brain Res Bull 2016 Jul 13.
Methylglyoxal (MG), a highly reactive dicarbonyl substance, is known as an endogenous carbonyl stress-inducing substance related to various disease states. Irritable bowel syndrome (IBS) is one of the most frequently encountered gastrointestinal disorders and MG is considered to be its causal substance. An increased serum 5-hydroxytryptamine (5-HT) level is related to IBS symptoms and the majority of 5-HT originates from enterochromaffin (EC) cells in the intestine. Here we examine the mechanisms of MG-induced 5-HT secretion using RIN-14B cells derived from a rat pancreatic islet tumor since these cells are used as a model for EC cells. MG increased the intracellular Ca(2+) concentration ([Ca(2+)]i) and 5-HT secretion, both of which were inhibited by the removal of extracellular Ca(2+) and specific transient receptor potential ankyrin 1 (TRPA1) antagonists. MG elicited an inward current under voltage-clamped conditions. Prior application of MG evoked reciprocal suppression of subsequent [Ca(2+)]i responses to allylisothiocyanate, a TRPA1 agonist, and vice versa. Glyoxal, an analog of MG, also evoked [Ca(2+)]i and secretory responses but its potency was much lower than that of MG. The present results suggest that MG promotes 5-HT secretion through the activation of TRPA1 in RIN-14B cells. These results may indicate that TRPA1 is a promising target for the treatment of IBS and that the RIN-14B cell line is a useful model for investigation of IBS.
- Implicit Alcohol Approach and Avoidance Tendencies Predict Future Drinking in Problem Drinkers. [JOURNAL ARTICLE]
- Alcohol Clin Exp Res 2016 Jul 15.
Addiction is characterized by compulsive drug seeking and substance use, yet many individuals break free of these patterns and change their behavior. Traditional candidate predictors of behavior change/persistence rely on self-reports of factors such as readiness to change. However, explicit measures only characterize top-down influences on behavior. The incentive sensitization model of addition suggests that more implicit, automatic processes, such as the tendency to approach substance cues, play a major role in behavior.We examined implicit alcohol approach and avoidance tendencies using a reaction time (RT) task in a sample of problem drinkers with alcohol use disorder (AUD) seeking to reduce heavy drinking. We measured alcohol approach and avoidance tendencies at baseline and at outcome, 12 weeks later. We asked whether alcohol approach and avoidance tendencies (i) changed over time, (ii) related to current drinking, and (iii) predicted changes in drinking from baseline to outcome.Approach and avoidance tendencies did not significantly change over time, nor did they correlate with current drinking, but these tendencies at baseline did predict drinking weeks later. Faster alcohol approach was associated with greater overall drinking at outcome, and faster alcohol avoidance predicted fewer drinking days per week at outcome. Exploratory analyses examined the relationship between approach and avoidance and traditional explicit measures including appraisals of alcohol and motivation to change. Implicit approach tendencies were largely distinct from explicit measures, and approach and avoidance tendencies explained unique variance in outcome drinking.The current findings suggest that implicit alcohol approach and avoidance tendencies assessed via a simple reaction time task can predict relative changes in drinking weeks later. Given that many explicit measures typically used in treatment studies fail to predict who will change, approach and avoidance tendencies are promising candidates to understand individual differences in treatment responses.
- Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study. [JOURNAL ARTICLE]
- Psychiatry Res 2016 Jun 17.:174-181.
Opioid-dependent patients show a high rate of psychiatric comorbidities. The prevalence and characteristics of patients with dual diagnosis have not been well established in Spanish opioid agonist treatment (OAT) programmes. Thus, 621 opioid-dependent patients enrolled in OAT programmes were assessed, using the EuropASI questionnaire, for psychiatric comorbidities, which were detected in 67% of patients (anxiety 53%, mood disorders 48%, sleep disorders 41%, substance-related disorders 36%). In addition, compared with patients without a dual diagnosis, patients with dual pathology were significantly older, used benzodiazepines and cannabis in significantly greater percentages, and showed significantly more frequent infectious and non-infectious comorbidities, worse overall working status, a lower proportion of drivers and higher levels of severity regarding medical, employment, alcohol, legal, family and psychological issues. Therefore, the data showed a very high prevalence of psychiatric comorbidity in opioid-dependent patients receiving OAT in Spain and several problems frequently associated with patients with dual diagnosis. Physicians treating opioid-dependent patients should be aware of these facts to correctly identify and manage patients with a dual diagnosis.
- Current Viewpoints on DSM-5 in Japan. [JOURNAL ARTICLE]
- Psychiatry Clin Neurosci 2016 Jul 14.
The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, and its official Japanese version was published in 2014. The Japanese Government uses classifications from the Tenth Revision of the International Classification of Diseases (ICD-10) to categorize disorders and determine treatment fees. However, since the publication of the DSM-III, the use of the DSM system has become prevalent in research and educational settings in Japan. In addition to traditional psychiatry, both the ICD and the DSM are taught by many Japanese medical schools, and virtually all clinical research and trials refer to the DSM to define targeted disorders. Amid the current backdrop in which the reputation of the DSM-5 is being established, the editorial board of Psychiatry and Clinical Neurosciences has asked Japanese experts across 12 specialties to examine the structure of DSM-5, neurodevelopmental disorders, schizophrenia spectrum disorders, major depression, bipolar disorders, obsessive-compulsive disorders, somatic symptom disorder, eating disorders substance-related and addictive disorders, gender dysphoria, and neurocognitive disorders . Although opinions were only obtained from these selected experts, we believe that we have succeeded, to a certain extent, in presenting views that are representative of each specialty.
- Mitigation Strategies for Opioid Abuse. [Comment, Letter]
- N Engl J Med 2016 Jul 7; 375(1):95-6.
- Mitigation Strategies for Opioid Abuse. [Comment, Letter]
- N Engl J Med 2016 Jul 7; 375(1):95.
- Mitigation Strategies for Opioid Abuse. [Comment, Letter]
- N Engl J Med 2016 Jul 7; 375(1):96.
- THE CLASSIFICATION OF ANXIETY AND FEAR-RELATED DISORDERS IN THE ICD-11. [REVIEW, JOURNAL ARTICLE]
- Depress Anxiety 2016 Jul 13.
Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide (http://gcp.network) and clinic-based field trials implemented globally at participating field study centers.