30.9.13
25.9.13
Hispanic and Latino Recovery Population
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The National Hispanic and Latino ATTC releases its latest fact sheet entitled:
Support for Hispanic and Latino Recovery Population
Recovery from addiction is person-centered and culturally relevant to an individual's substance free lifestyle. Dona Dmitrovic, MHS ellaborates on how Hispanic and Latinos experience RECOVERY, especially as we celebrate September as the National Recovery Month.
You might access the following link for a downloadable copy of this fact sheet. The fact sheet is available in English and Spanish:
Also, if you want to learn more you may register for our nextwebinar:
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Webinar Registration
When: October 9th, 2013
Time: 1:00 PM EDT/10:00 AM PDT
Presenter: Dona Dmitrovic, MHS
Director of Consumer Affairs, Substance Use Disorders at Optum Behavioral Solutions.
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17.9.13
Chronic Care Management for Dependence on Alcohol and Other Drugs. The AHEAD Randomized Trial
Richard Saitz; Debbie M. Cheng; Michael Winter; Theresa W. Kim; Seville M. Meli; Don Allensworth-Davies; Christine A. Lloyd-Travaglini; Jeffrey H. SametJAMA. 2013;310(11):1156-1167. doi:10.1001/jama.2013.277609. PDF
Importance People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes.
Objective To determine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care.
Design, Setting, and Participants The AHEAD study, a randomized trial conducted among 563 people with alcohol and other drug dependence at a Boston, Massachusetts, hospital-based primary care practice. Participants were recruited from September 2006 to September 2008 from a freestanding residential detoxification unit and referrals from an urban teaching hospital and advertisements; 95% completed 12-month follow-up.
Interventions Participants were randomized to receive CCM (n=282) or no CCM (n=281). Chronic care management included longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (including mutual help). The no CCM (control) group received a primary care appointment and a list of treatment resources including a telephone number to arrange counseling.
Main Outcomes and Measures The primary outcome was self-reported abstinence from opioids, stimulants, or heavy drinking. Biomarkers were secondary outcomes.
Results There was no significant difference in abstinence from opioids, stimulants, or heavy drinking between the CCM (44%) and control (42%) groups (adjusted odds ratio, 0.84; 95% CI, 0.65-1.10; P=.21). No significant differences were found for secondary outcomes of addiction severity, health-related quality of life, or drug problems. No subgroup effects were found except among those with alcohol dependence, in whom CCM was associated with fewer alcohol problems (mean score, 10 vs 13; incidence rate ratio, 0.85; 95% CI, 0.72-1.00; P=.048).
Conclusions and Relevance Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation.
Problem solving styles among people who use alcohol and other drugs in South Africa
Addictive Behaviors
Available online 13 September 2013
The present study examines the relationship between problem-solving styles, socio-demographic variables and risk of alcohol and other drug (AOD)-related problems among a South African population. The Social Problem-Solving Inventory–Revised, Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were administered to a convenience sample of 1000 respondents. According to the ASSIST, 32% and 49% of respondents met criteria for moderate to high risk of alcohol use and illicit drug use respectively. After adjusting for the effects of other variables in the model, respondents who were of “Coloured” ancestry (PR = 1.20, 95% CI 1.0-1.4), male (PR = 1.19, 95% CI 1.04-1.37), older (PR = 1.01, 95% CI 1.00-1.02), who adopted an avoidance style of coping with problems (PR = 1.03, 95% CI 1.01-1.05) and who met criteria for depression (PR = 1.42, 95% CI 1.12-1.79) were more likely to be classified as having risky AOD use. This suggests that interventions to improve problem solving and provide people with cognitive strategies to cope better with their problems may hold promise for reducing risky AOD use.
15.9.13
Energy drinks and alcohol: research supported by industry may be downplaying harms
- Peter Miller, associate professor, School of Psychology,
- Deakin University, Geelong, Victoria, 3220, Australia
Concern is growing about the harms that may arise from heavy drinkers mixing alcohol with so called energy drinks to enable them to drink for longer and achieve higher levels of intoxication. On Friday and Saturday evenings, about 40% of people on Australian city streets are heavily intoxicated (breath alcohol concentrations (BAC) greater than 0.087 mg alcohol/100 ml) and nearly a quarter of these drinkers will have consumed more than two energy drinks.1 Data are lacking on energy drink use by alcohol drinkers in other countries but in samples, 73% of US college students2 and 85% of Italian college students3 reported consuming energy drinks mixed with alcohol in the past month.
Epidemiological studies show that drinkers who consume energy drinks are more likely to record a higher breath alcohol concentration than those who do not.4 They are also more likely to report drinking more alcohol5; engaging in aggressive acts1; being injured1 6; symptoms of alcohol dependence7; having driven while drunk or been a passenger in a car with an alcohol impaired driver1; and having taken sexual advantage of, or having been taken advantage of, by another person.
Programa Nacional Integral contra las Adicciones (PRONADIC)
Martes 10 de Septiembre del 2013.
2. Introducción.
Ponente: Dr. Fernando Cano Valle. Comisionado Nacional Contra las Adicciones
3. Panorama general de las adicciones en México y el mundo: un problema de salud pública y de salud personal con implicaciones familiares y del entorno.
Ponente: Dr. Víctor Manuel Guisa Cruz. Coordinador de Asesores.
4. El Observatorio Mexicano del tabaco, alcohol y drogas: información para la toma de decisiones.
Ponente: Mtro. Raúl Martín Del Campo. Director General del CENADIC.
5. Fundamentos conceptuales, estructurales y metodológicos de la respuesta sectorial organizada para contender contra las adicciones.
Ponente: Dr. Leoncio Lara Sáenz. Director General de Coordinación y Cooperación en Adicciones.
6. El Programa Nacional Integral contra las Adicciones: propósitos, objetivos, estrategias y líneas de acción.
Ponente: Dr. José de Jesús Villalpando Casas. Director General de Programas en Adicciones.
7. Implementación intersectorial del PRONADIC a nivel federal, estatal y local: infraestructura y recursos humanos.
Ponente: Lic. Martín Mosqueda Ventura. Director de Coordinación de los Programas Nacionales en Adicciones.
8. Nuevas áreas de desarrollo del PRONADIC.
Dr. José de Jesús Villalpando Casas. Director General de Programas en Adicciones.
Mtra. María José Martínez Ruiz. Directora de la Oficina Nacional para el Control del Consumo de Alcohol y Drogas Ilícitas.
9. El enfoque médico integral para la prevención del consumo y el abuso de sustancias adictivas, su diagnóstico y tratamiento.
Ponente: Dr. Mario González Zavala. Subdirector de área.
10. Preguntas y Comentarios.
13.9.13
5a Reunión Ordinaria - CONADIC
http://www.almomento.mx/se-analizan-propuestas-para-la-atencion-integral-de-las-adicciones/
Se analizan propuestas para la atención integral de las adicciones
CIUDAD DE MÉXICO, 12 de septiembre (Al Momento Noticias).- La Secretaria de Salud, Mercedes Juan, en su calidad de presidenta del Consejo Nacional contra las Adicciones, presidió la 5ª Reunión Ordinaria de este organismo, donde se analizaron las propuestas de acción en materia de prevención, atención, tratamiento y reinserción social, de las personas que tienen adicciones.
Acompañada por el Comisionado Nacional contra las Adicciones, Fernando Cano Valle, consejeros estatales y representantes de las diferentes organizaciones de la sociedad civil que integran este Consejo, la titular de Salud enfatizó que el tema de las adicciones es una de las tareas más importantes de salud, por lo que es parte fundamental de los ejes rectores que integran el Plan Nacional de Desarrollo.
Asimismo, precisó que se trabajará coordinadamente con la Secretaría de Gobernación a través de la Comisión Intersectorial para la Prevención Social de la Violencia y la Delincuencia, donde se integra el CONADIC como pieza clave para su combate.
Durante la quinta Reunión Ordinaria del Consejo Nacional Contra las Adicciones se analizaron las propuestas de acción en materia de prevención, atención, tratamiento y reinserción social, de las personas que tienen adicciones.
Fernando Cano Valle, titular de CONADIC, presentó algunas de las acciones que conformarán el Programa Nacional contra las Adicciones, que tiene como objetivo proporcionar servicios eficaces, oportunos y de calidad a todas las personas con algún tipo de adicción.
Reiteró que los principios del CONADIC se fundamentan en la dignidad e integridad de las personas con adicciones, con el máximo respeto a sus derechos humanos y que continuará el estudio de los daños a la salud que ocasiona la mariguana, para que con base a la evidencia científica se elaboren las políticas públicas en la materia.
12.9.13
Brief intervention and decrease of alcohol consumption among women: a systematic review
Brief intervention and decrease of alcohol consumption among women: a systematic review
http://www.substanceabusepolicy.com/content/8/1/31/abstract
Abstract (provisional)
11.9.13
Characterizing Gender Differences in Treatment Seekers
Article first published online: 9 AUG 2013
Background
Available evidence suggests women may be more vulnerable to the effects of chronic alcohol consumption than men. The few investigations of gender differences in treatment-seeking populations have often involved study samples restricted by selection criteria (e.g., age, education). The current study examined gender differences in a heterogeneous sample of individuals seeking treatment for a substance use disorder. We examined alcohol drinking levels, age at drinking milestones (e.g., first drink, first intoxication), and progression from milestones to alcohol problems or treatment. Additionally, family history, spousal alcoholism, and nicotine use were analyzed.
Methods
Participants included men (n = 274) and women (n = 257) in substance abuse treatment facilities. Participants completed inventories quantifying affect, intellectual ability, and drinking consequences. A family tree for substance use and personal histories for alcohol and nicotine use, including chronicity, frequency, and regularity, were collected.
Results
Telescoping was not observed when progression from drinking milestones to alcoholism or alcohol problems was compared between men and women. In contrast, when considered as progression to treatment, marked telescoping effects were detected, with women entering treatment more rapidly by approximately 4 years. Familial differences included a greater proportion of women reporting alcoholic parents (73% women; 61% men) and alcoholic spouses (58% women; 38% men). Smoking behaviors were similar between genders; however, men reporting higher levels of alcohol consumption reported greater intensity of chronic smoking. Smoking and drinking behaviors were correlated among men, but not women. Rates of pretreatment drug problems were equivalent between genders.
Conclusions
When contrasted with the available literature, our data were only partially supportive of gender-contingent telescoping. While women did not experience alcohol problems or alcoholism earlier than men, they progressed to treatment more quickly. These results highlight the importance of carefully considering the sample and specific outcome variables when interpreting gender differences.
10.9.13
Repeated Diagnoses of Lifetime Alcohol Use Disorders in a Prospective Study
Article first published online: 22 AUG 2013
Background
Prior research indicates that assessments of lifetime alcohol use disorders (AUDs) show low sensitivity and are unreliable when assessed by a single, retrospective interview. This study sought to replicate and extend previous research by calculating the lifetime prevalence rate of AUDs using both single retrospective assessments of lifetime diagnosis and repeated assessments of both lifetime and past-year diagnoses over a 16-year period within the same high-risk sample. In addition, this study examined factors that contributed to the consistency in reporting lifetime AUDs over time.
Methods
Using prospective data, the reliability and validity of lifetime estimates of alcohol dependence and AUD were examined in several ways. Data were drawn from a cohort of young adults at high and low risk for alcoholism, originally ascertained as first-time college freshmen (N = 489 at baseline) at a large, public university and assessed over 16 years.
Results
Compared with using a single, lifetime retrospective assessment of DSM-III disorders assessed at approximately age 34, lifetime estimates derived from using multiple, prospective assessments of both past-year and lifetime AUD were substantially higher (25% single lifetime vs. 41% cumulative past-year vs. 46% cumulative lifetime). This pattern of findings was also found when conducting these comparisons at the symptom level. Further, these results suggest that some factors (e.g., symptoms endorsed, prior consistency in reporting of a lifetime AUD, and family history status) are associated with the consistency in reporting lifetime AUDs over time.
Conclusions
Based on these findings, lifetime diagnoses using a single measurement occasion should be interpreted with considerable caution given they appear to produce potentially large prevalence underestimates. These results provide further insight into the extent and nature of the reliability and validity problem with lifetime AUDs.
9.9.13
The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) in the Assessment of Alcohol Use Disorders Among Acute Injury Patients
Article first published online: 22 AUG 2013
Background
The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief alcohol screening test and a candidate for inclusion in recommended screening and brief intervention protocols for acute injury patients. The objective of the current study was to examine the performance of the AUDIT-C to risk stratify injury patients with regard to their probability of having an alcohol use disorder.
Methods
Participants (n = 1,004) were from a multisite Australian acute injury study. Stratum-specific likelihood ratio (SSLR) analysis was used to examine the performance of previously recommended AUDIT-C risk zones based on a dichotomous cut-point (0 to 3, 4 to 12) and risk zones derived from SSLR analysis to estimate the probability of a current alcohol use disorder.
Results
Almost a quarter (23%) of patients met criteria for a current alcohol use disorder. SSLR analysis identified multiple AUDIT-C risk zones (0 to 3, 4 to 5, 6, 7 to 8, 9 to 12) with a wide range of posttest probabilities of alcohol use disorder, from 5 to 68%. The area under receiver operating characteristic curve (AUROC) score was 0.82 for the derived AUDIT-C zones and 0.70 for the recommended AUDIT-C zones. A comparison between AUROCs revealed that overall the derived zones performed significantly better than the recommended zones in being able to discriminate between patients with and without alcohol use disorder.
Conclusions
The findings of SSLR analysis can be used to improve estimates of the probability of alcohol use disorder in acute injury patients based on AUDIT-C scores. In turn, this information can inform clinical interventions and the development of screening and intervention protocols in a range of settings.
8.9.13
Underage Drinking: An Evolutionary Concept Analysis
Underage drinking is a major cause of morbidity and mortality for American youths and young adults. The negative consequences of underage drinking range from academic problems to intentional and unintentional injuries, acts directed toward self or others, and death. Nurses, regardless of practice settings, are on the frontline of defense. The take-home message is to delay/deter the first drink of alcohol.
Maintaining Sobriety and Recovery
William J. Lorman
Nursing Clinics of North America, Vol 48(3):437-444
Recovery is a continuous, progressive process of improvement whereby a person with a substance use disorder first becomes sober and then begins a lifelong commitment to improve his or her health, live a self-directed life, and strive to reach full potential. The nurse plays an important role in the beginning stages of this process by helping the patient identify relapse risk factors along with providing psychoeducational, psychotherapeutic, and psychopharmacologic interventions to decrease the risk of relapse and direct the patient down a path of self-efficacy, personal health, and productive citizenship.
7.9.13
Nursing and Addictions
Nursing and Addictions
Albert Rundio Jr.
Addictions affects individuals of all walks of life. I was first exposed to addictions when I was working as an orderly in an acute care hospital's emergency department in southern New Jersey. Following completion of nursing school, I was further exposed to addictions as an emergency nurse. My first management position was an emergency department supervisor in an urban emergency department. Here is where I really became more familiar with addictions and the effects on individuals' and others' lives. I really did not understand the disease at that time. I knew it was a disease, but that was about it. My role in the hospital’s emergency department was to make certain that individuals were stable medically; fed; clean; and had medical clearance for referral to a treatment center. Once medical clearance was obtained, I would then consult two of my nurses, who were in recovery, so that they could get the patient to a treatment center.
September 2013 | Vol. 48, No. 3
Alcoholics anonymous and twelve-step recovery: A model based on social and cognitive neuroscience
http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.2013.12106.x/abstract
Background
In the course of achieving abstinence from alcohol, longstanding members of Alcoholics Anonymous (AA) typically experience a change in their addiction-related attitudes and behaviors. These changes are reflective of physiologically grounded mechanisms which can be investigated within the disciplines of social and cognitive neuroscience.
Objective
This article is designed to examine recent findings associated with these disciplines that may shed light on the mechanisms underlying this change.
Method
Literature review and hypothesis development.
Results
Pertinent aspects of the neural impact of drugs of abuse are summarized. After this, research regarding specific brain sites, elucidated primarily by imaging techniques, is reviewed relative to the following: Mirroring and mentalizing are described in relation to experimentally modeled studies on empathy and mutuality, which may parallel the experiences of social interaction and influence on AA members. Integration and retrieval of memories acquired in a setting like AA are described, and are related to studies on storytelling, models of self-schema development, and value formation. A model for ascription to a Higher Power is presented.
Conclusion
The phenomena associated with AA reflect greater complexity than the empirical studies on which this article is based, and certainly require further elucidation. Despite this substantial limitation in currently available findings, there is heuristic value in considering the relationship between the brain-based and clinical phenomena described here.
Scientific Significance
There are opportunities for the study of neuroscientific correlates of Twelve-Step-based recovery, and these can potentially enhance our understanding of related clinical phenomena.
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