Search

This study examined demographic and psychosocial correlates associated with persistence/recurrence of and remission from at least one of ten DSM-5 substance use disorders (SUDs) and three substance-specific SUDs (i.e., alcohol, cannabis, and prescription opioids). Data were collected from structured diagnostic interviews and national prevalence estimates were derived from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. An estimated 25.4% of the U.S. population had at least one prior-to-past-year (prior) SUD. Among individuals with any prior SUDs, the prevalence of past-year substance use and DSM-5 symptomology was as follows: abstinence (14.2%), asymptomatic use (36.9%), symptomatic use (10.9%), and persistent/recurrent SUD (38.1%). Among individuals with prior SUDs, design-based multinomial logistic regression analysis revealed that young adulthood, higher educational attainment, higher personal income, never having been married, being divorced/separated/widowed, lack of lifetime substance use treatment, and stressful life events predicted significantly greater odds of past-year persistent/recurrent SUDs, relative to abstinence. In addition, remission from a prior tobacco use disorder decreased the probability of past-year persistent/recurrent SUD, relative to abstinence. Stressful life events were the only common correlates across the aggregation of all SUDs and each substance-specific SUD, but differences were found for specific stressful life events between drug classes. Nearly half (49%) of adults with prior DSM-5 SUDs continued to report past-year symptomatic substance use, while only one in seven individuals were abstinent. The findings suggest the value of examining remission associated with both substance-specific SUDs and aggregation of SUDs based on the shared and unique correlates of persistent/recurrent SUDs; this is especially true for stressful life events, which could be useful targets for enhancing clinical care and interventions.

Alcohol and other substance use by nurses potentially places patients, the public, and nurses themselves at risk for serious injury or death. Nursing students are also at risk for problems related to substance use. When viewed and treated as a chronic medical illness, treatment outcomes for substance use disorders are comparable with those of other diseases and can result in lasting benefits. Professional monitoring programs that employ an alternative-to-discipline approach have been shown to be effective in the treatment of health professionals with substance use disorders and are considered a standard for recovery, with high rates of completion and return to practice. It is the position of the Emergency Nurses Association and the International Nurses Society on Addictions that 1. health care facilities provide education to nurses and other employees regarding alcohol and other drug use and establish policies, procedures, and practices to promote safe, supportive, drug-free workplaces; 2. health care facilities and schools of nursing adopt alternative-to-discipline approaches to treating nurses and nursing students with substance use disorders, with stated goals of retention, rehabilitation, and reentry into safe, professional practice; 3. drug diversion, in the context of personal use, is viewed primarily as a symptom of a serious and treatable disease and not exclusively as a crime; and 4. nurses and nursing students are aware of the risks associated with substance use, impaired practice, and drug diversion and have the responsibility and means to report suspected or actual concerns.

PURPOSE This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)-attendance and spiritual awakening-and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), 1 month (T2), and 6-12 months postbaseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. Alcoholics Anonymous meeting attendance and alcohol consumption were measured using the Timeline Followback interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement Scale. RESULTS There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled. CONCLUSIONS Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample.

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

Alcoholics Anonymous (AA) is a mainstay for recovery from alcoholism, yet critical aspects of this program remain only partially understood, including the element of storytelling. Using qualitative research methods derived from narrative analysis, we examined a set of personal stories from the “Big Book” of AA and proposed a normative, structural model for these accounts. The overall storyline followed classical literary conventions for tragedy and comedy. Prototypical stages included: (1) first or early drinking, (2) alcoholic regression, (3) hitting bottom, (4) progress in the AA program, and (5) stable sobriety, embedded in a subjective, evaluative function over time.

We conducted a double-blind pilot study involving 11 alcohol- and nicotine-dependent patients randomized to receive either bupropion or placebo. Four of six patients on bupropion and one of five patients on placebo were abstinent from smoking at the end of medication phase. Those in the bupropion group reported significantly less craving (p < .02) and less exposure to cigarette smoke over time (expired carbon monoxide; p < .01). There were no serious adverse events and no main effects of medication group on either per subject or total number of adverse events. All those who completed treatment remained abstinent from alcohol.

Buprenorphine (Suboxone®, Subutex®), a partial mu opioid agonist, has been shown to be a relatively safe and effective form of pharmacotherapy for the treatment of opioid dependence. Since its introduction and approval, however, few clinicians have described specific programs or approaches to long-term opioid maintenance therapy with buprenorphine, and fewer still have examined this phenomenon from the perspective of patient satisfaction. Here we describe a quality improvement project for a monthly buprenorphine clinic for opioid maintenance therapy, and have included demographic and clinical characteristics of the participants. Based on patient satisfaction survey results and supporting clinical data, respondents showed high levels of patient satisfaction, attendance, and treatment adherence in a multidisciplinary buprenorphine clinic for opioid maintenance therapy in an outpatient addictions treatment program.

Evidence from multiple lines of research supports the effectiveness and practical importance of Alcoholics Anonymous and Narcotics Anonymous. Conference presenters discussed the relationship between 12-Step participation and abstinence among various populations, including adolescents, women, and urban drug users. Insight from the arts and humanities placed empirical findings in a holistic context.

Background: The purpose of this study was to examine relationships between genetic markers of central serotonin (5-HT) and dopamine function, and risk for post-treatment relapse, in a sample of alcohol-dependent patients. Methods: The study included 154 patients from addiction treatment programs in Poland, who met DSM-IV criteria for alcohol dependence. After assessing demographics, severity of alcohol use, suicidality, impulsivity, depression, hopelessness, and severity of alcohol use at baseline, patients were followed for approximately 1 year to evaluate treatment outcomes. Genetic polymorphisms in several genes (TPH2, SLC6A4, HTR1A, HTR2A, COMT, and BDNF) were tested as predictors of relapse (defined as any drinking during follow-up) while controlling for baseline measures. Results: Of 154 eligible patients, 123 (80%) completed follow-up and 48% (n = 59) of these individuals relapsed. Patients with the Val allele in the Val66Met BDNF polymorphism and the Met allele in the Val158Met COMT polymorphism were more likely to relapse. Only the BDNF Val ⁄ Val genotype predicted post-treatment relapse [odds ratio (OR) = 2.62; p = 0.019], and time to relapse (OR = 2.57; p = 0.002), after adjusting for baseline measures and other significant genetic markers. When the analysis was restricted to patients with a family history of alcohol dependence (n = 73), the associations between the BDNF Val ⁄ Val genotype and relapse (OR = 5.76, p = 0.0045) and time to relapse (hazard ratio = 4.93, p = 0.001) were even stronger. Conclusions: The Val66Met BDNF gene polymorphism was associated with a higher risk and earlier occurrence of relapse among patients treated for alcohol dependence. The study suggests a relationship between genetic markers and treatment outcomes in alcohol dependence. Because a large number of statistical tests were conducted for this study and the literature on genetics and relapse is so novel, the results should be considered as hypothesis generating and need to be replicated in independent studies.

Background: Subjective and objective measures of poor sleep in alcoholic insomniacs predict relapse to drinking. Nonalcoholic insomniacs underestimate their total sleep time (TST) and overestimate their sleep onset latency (SOL) and wake time after sleep onset (WASO) compared with polysomnography (PSG). This study evaluated 3 hypotheses: (1) subjective SOL would predict frequency of future drinking; (2) participants would overestimate SOL and WASO and underestimate TST; and (3) higher amounts of over- and underestimates of sleep at baseline would predict worse drinking outcomes prospectively. Methods: Participants (N 5 18), mean age 44.6 years (13.2), underwent an adaptation night and then 2 nights of PSG 3 weeks apart. They also provided morning estimates of SOL, WASO, TST, and sleep efficiency (SE). Following the baseline PSG, participants were followed over 12 weeks. A 2-way ANOVA (nightmethod of measuring sleep) compared results and regression analyses predicted drinking. Drinking outcomes were defined as number of days drinking (DD) and number of heavydrinking days (HDD) during 2 consecutive 6-week follow-up periods. Results: Most participants (72%) overestimated SOL by a mean of 21.3 (36) minutes compared with PSG [F(1, 14) 5 7.1, po0.03]. Unexpectedly, 89% underestimated WASO by a mean difference of 48.7 (49) minutes [F(1, 14) 5 15.6, po0.01]. Drinking during the first 6-week study period was predicted by both subjective estimates of WASO and their accuracy, whereas drinking during the second 6-week period was predicted by both subjective estimations of sleep and rapid eye movement sleep latency. Conclusion: Greater subjective accuracy of wakefulness at night provided by the patient predicted drinking during the study. Unlike nonalcoholic insomniacs, this alcoholic sample significantly underestimated WASO compared with PSG values. The predictive ability of sleep parameters depended on the selected measure of drinking outcomes and when outcomes were measured. Subjective sleep

Outpatient medical detoxification has become an increasingly common form of treatment for mild to moderate alcohol withdrawal, yet few studies have examined this phenomenon from the patient's perspective. Therefore, we reviewed Patient Satisfaction Survey (PSS) results from each of 57 alcohol-dependent patients who successfully completed a course of outpatient detoxification from among 64 who initiated such treatment in conjunction with an intensive day treatment program (89%). Those who completed detoxification were asked to evaluate specific aspects of clinical care. On a 5-point Likert scale, subjects responded to statements related to safety, comfort, information and instructions about medications, availability of the nurse, and participation in the day treatment program. Additional qualitative feedback was sought through two open-ended questions to determine what was viewed as most helpful, and suggestions for program improvement. High rates of completion and patient satisfaction were realized with o...

Completion rates for outpatient opioid detoxification with clonidine generally range from 20-40%, but few studies have examined the correlates of successful completion. Of 29 consecutive patients, we compared those who completed detoxification with clonidine (n=12) to those who did not (n=17). Patients who completed treatment were significantly (p< 0.05) more likely to depend on opioids other than heroin, have private health insurance, and report low levels of subjective withdrawal symptoms. Patients with two or three of these characteristics were about seven times more likely to complete treatment than patients with none or one. Although it may not detoxify most opioid-dependent patients, clonidine will likely play a continued role in selected patients when a non-narcotic agent is desirable. The study findings may help target patients who could benefit the most from outpatient clonidine detoxification.

Based on gender, we compared demographics, clinical characteristics, and completion rates for outpatient detoxification from alcohol, using oxazepam in conjunction with an intensive day treatment program. Among 64 consecutive patients, nearly half were female. Women were significantly more likely than men to be Medicaid recipients, to have received past mental health treatment, and to have used illicit substances in the four weeks prior to detoxification. Despite these added risk factors, there were no clinical differences noted between men and women in terms of severity of alcohol withdrawal, completion rates for outpatient detoxification, length of detoxification in days, total oxazepam dose in mg/kg, or transition to continued substance abuse treatment. Overall, 89% of patients completed detoxification. These findings suggest that the clinical course of alcohol withdrawal is similar between women and men, and that women can achieve high rates of completion with outpatient detoxification when administer...

Alcohol misuse is a global health risk, and Alcoholics Anonymous (AA) is the largest and most popular mutual-help program for individuals with alcohol-related problems. In recent years, researchers and clinicians have become increasingly interested in specific mechanisms of action that may contribute to positive outcomes through involvement with this 12-step program for recovery, yet few have applied a theoretical framework to these efforts. We examined the phenomena of alcoholism and recovery in AA, using the nursing Theory of Human Relatedness (THR). THR addresses a pervasive human concern: "establishing and maintaining relatedness to others, objects, environments, society and self." The theory describes four states of relatedness (connectedness, disconnectedness, parallelism, and enmeshment) and four relatedness competencies (sense of belonging, reciprocity, mutuality, and synchrony). Both alcoholism and recovery in AA can be viewed primarily in terms of relatedness. In active alcoholism, an individual's involvement with alcohol (enmeshment) can limit, impair, or preclude healthy or adaptive relatedness toward virtually all other referents, including self. As a program of recovery, each of the 12 Steps of Alcoholics Anonymous addresses an individual's relatedness to one or more identified referents while simultaneously enhancing and expanding each of the four relatedness competencies. THR provides a theoretical framework to help direct patient care, research, and education and has the potential to serve as a unifying theory in the study of alcoholism and recovery in AA.

Alcohol use disorders and their related consequences continue to be among the nation's most prevalent and persistent healthcare problems across the lifespan. The vast majority of treatment facilities for substance use disorders in the United States report using some form of 12-step facilitation to help direct their patients to mutual help groups such as Alcoholics Anonymous (AA). Yet, many students in various healthcare disciplines may lack familiarity and direct experience with this readily accessible and potentially lifesaving, low-cost resource. AA has a long-standing tradition of extending an open invitation to professionals and providing educational materials about this worldwide program of recovery. The purpose of this article is to describe an experiential, interdisciplinary approach that has been used to teach undergraduate psychology students about AA. Associated activities included (a) selected readings, (b) attendance at an open AA meeting, (c) the formulation of thoughtful questions by the students, and (d) a single, interactive didactic session. Undergraduate psychology students responded positively when principles of experiential learning were applied to educational activities related to AA.

It is the position of the International Nurses Society on Addictions and the Emergency Nurses Association that nurses in all practice settings be prepared to deliver screening, brief intervention, and referral to treatment, or SBIRT, to identify and effectively respond to alcohol use and related disorders across the lifespan.

In order to increase safe access to buprenorphine treatment for patients with opioid dependence, it is the position of the International Nurses Society on Addictions (IntNSA) that the Drug Addiction Treatment Act of 2000 (DATA 2000) be amended to allow for the prescribing of buprenorphine by qualified advanced practice nurses who have both prescriptive authority and specialty certification in addictions nursing.

Suicidal behavior has been recognized as an increasing problem among alcohol-dependent subjects. The aim of the study was to identify correlates of impulsive and non-impulsive suicide attempts among a treated population of alcohol-dependent patients.A total of 154 patients with alcohol dependence consecutively admitted for addiction treatment participated in the study. Suicidal behavior was assessed together with severity of alcohol dependence, childhood abuse, impulsivity, and family history. A stop-signal procedure was used as a behavioral measure of impulsivity.Lifetime suicide attempts were reported by 43% of patients in alcohol treatment; of which 62% were impulsive. Compared to patients without a suicide attempt, those with a non-impulsive attempt were more likely to have a history of sexual abuse (OR=7.17), a family history of suicide (OR=4.09), and higher scores on a personality measure of impulsiveness (OR=2.27). The only significant factor that distinguished patients with impulsive suicide attempts from patients without a suicide attempt and from patients with a non-impulsive suicide attempt was a higher level of behavioral impulsivity (OR=1.84-2.42).Retrospective self-report of suicide attempts and family history. Lack of diagnostic measure.

Background: Insomnia and other sleep disturbances are common, persistent, and associated with relapse in alcohol-dependent patients. The purpose of this pilot study was to compare gabapentin versus placebo for the treatment of insomnia and prevention of relapse in alcohol-dependent patients. Methods: Twenty-one subjects, including 10 women who met study criteria for alcohol dependence and insomnia and expressed a desire to abstain from alcohol, were recruited to the study. During a 1 to 2 week placebo lead-in and screening phase, a complete medical history, physical exam, blood tests, urine drug test, and structured interviews were performed to determine eligibility and patterns of alcohol use and sleep. Insomnia due to intoxication or acute withdrawal, psychiatric or medical illness, medications, and other sleep disorders were ruled out. Subjects were then randomized to either placebo (n = 11) or gabapentin (n = 10) for 6 weeks and titrated over a 10-day period to 1,500 mg or 5 pills at bedtime. After a 4-day taper, subjects were reassessed 6 weeks after ending treatment. Results: Gabapentin significantly delayed the onset to heavy drinking, an effect which persisted for 6 weeks after treatment ended. Insomnia improved in both treatment groups during the medication phase, but gabapentin had no differential effects on sleep as measured by either subjective report or polysomnography. Conclusion: Because gabapentin is a short-acting medication that was taken only at nighttime in this study, it may possibly exert a nocturnal effect that prevents relapse to heavy drinking by a physiological mechanism not measured in this pilot study.

We report here on the feasibility of implementing a semiautomated performance improvement system—Patient Feedback (PF)—that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.