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Psychiatry and Clinical Neurosciences Oct 2023Disturbed interoception (i.e., the sensing, awareness, and regulation of internal body signals) has been found across several mental disorders, leading to the... (Review)
Review
Disturbed interoception (i.e., the sensing, awareness, and regulation of internal body signals) has been found across several mental disorders, leading to the development of interoception-based interventions (IBIs). Searching PubMed and PsycINFO, we conducted the first systematic review of randomized-controlled trials (RCTs) investigating the efficacy of behavioral IBIs at improving interoception and target symptoms of mental disorders in comparison to a non-interoception-based control condition [CRD42021297993]. Thirty-one RCTs fulfilled inclusion criteria. Across all studies, a pattern emerged with 20 (64.5%) RCTs demonstrating IBIs to be more efficacious at improving interoception compared to control conditions. The most promising results were found for post-traumatic stress disorder, irritable bowel syndrome, fibromyalgia and substance use disorders. Regarding symptom improvement, the evidence was inconclusive. The IBIs were heterogenous in their approach to improving interoception. The quality of RCTs was moderate to good. In conclusion, IBIs are potentially efficacious at improving interoception for some mental disorders. In terms of symptom reduction, the evidence is less promising. Future research on the efficacy of IBIs is needed.
Topics: Humans; Mental Health; Psychosocial Intervention; Interoception; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Randomized Controlled Trials as Topic
PubMed: 37421414
DOI: 10.1111/pcn.13576 -
The Western Journal of Emergency... Jul 2022The clinical model of screening, providing a brief psychosocial and/or pharmacological intervention, and directly referring patients to treatment (SBIRT) is a compelling... (Review)
Review
INTRODUCTION
The clinical model of screening, providing a brief psychosocial and/or pharmacological intervention, and directly referring patients to treatment (SBIRT) is a compelling model to address drug use among assault-injured individuals in the busy emergency department (ED) setting. Our objective in this study was to examine the current literature and determine ED-based strategies that have been reported that screen, directly refer to drug mis-use/addiction specialized treatment services, or initiate addiction treatment among individuals injured by non-partner assault in the United States.
METHODS
We conducted a systematic review of ED-based studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. OVID, MEDLINE, OVID Embase, OVID AMED, Web of Science-Core Collection, Cochrane CENTRAL, and CINAHL were systematically searched using keywords and Medical Subject Heading terms. Studies were excluded if they only involved intimate partner assault-injury, tobacco, or alcohol use. We categorized ED-based strategies as screening, direct referral, or treatment initiation.
RESULTS
Of the 2,076 non-duplicated studies identified, we included 26 full-text articles in the final analysis. Fourteen studies were cross-sectional, 11 were cohort, and one was case-control in design. The most common drug use screening instrument used was the National Institute on Drug Abuse Quick Screen Question. Cannabis was the most common drug detected upon screening.
CONCLUSION
Drug use, while highly prevalent, is a modifiable risk factor for non-partner assault-injury. The paucity of scientific studies is evidence for the need to intentionally address this area that remains a major challenge for the public's health. Future research is needed to evaluate ED-based interventions for drug use in this population.
Topics: Alcohol Drinking; Emergency Service, Hospital; Humans; Mass Screening; Referral and Consultation; Substance-Related Disorders; United States
PubMed: 35980419
DOI: 10.5811/westjem.2022.5.55475 -
Addiction (Abingdon, England) Oct 2022Parental substance use is a major public health and safeguarding concern. There have been a number of trials examining interventions targeting this risk factor. We aimed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
Parental substance use is a major public health and safeguarding concern. There have been a number of trials examining interventions targeting this risk factor. We aimed to estimate the effectiveness of psychosocial interventions at reducing parental substance use.
DESIGN
We used systematic methods to identify trials; pooling data using a random-effects model. Moderator analyses examined influence of parent gender, presence of child in treatment and intervention type.
SETTING
No restrictions on setting.
PARTICIPANTS
Substance using parents of children below the age of 21 years.
INTERVENTIONS
Psychosocial interventions including those that targeted drug and alcohol use only, and drug and alcohol use in combination with associated issues.
MEASUREMENTS
Frequency of alcohol use and frequency of drug use.
FINDINGS
We included eight unique studies with a total of 703 participants. Psychosocial interventions were more effective at reducing the frequency of parental alcohol use than comparison conditions at 6-month [standardized mean difference (SMD) = - 0.32, 95% confidence interval (CI) = -0.51 to -0.13, P = 0.001] and 12-month follow-up (SMD = -0.25, 95% CI = -0.47 to -0.03, P = 0.02) and frequency of parental drug use at 12 months only (SMD = -0.21, 95% CI = -0.41 to -0.01, P = 0.04). Integrated interventions which combined both parenting and substance use targeted components were effective at reducing the frequency of alcohol use (6 months: SMD = -0.56, 95% CI = -0.96 to -0.016, P = 0.006; 12 months: SMD = -0.42, 95% CI = -0.82 to -0.03, P = 0.04) and drug use (6 months: SMD = -0.39, 95% CI = -0.75 to -0.03, P = 0.04; 12 months: SMD = -0.43, 95% CI = -0.80 to -0.07, P = 0.02). Interventions targeting only substance use or parenting skills were not effective at reducing frequency of alcohol or drug use at either time-point.
CONCLUSION
Psychosocial interventions should target both parenting and substance use in an integrated intervention.
Topics: Alcohol Drinking; Female; Humans; Male; Parenting; Parents; Psychosocial Intervention; Substance-Related Disorders; Treatment Outcome
PubMed: 35188313
DOI: 10.1111/add.15846 -
Substance Abuse Treatment, Prevention,... Apr 2017There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD)... (Review)
Review
BACKGROUND
There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care.
METHODS
We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised.
RESULTS
We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians' primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning.
CONCLUSION
Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable.
Topics: Delivery of Health Care, Integrated; Humans; Mental Health Services; Program Development; Substance-Related Disorders
PubMed: 28388954
DOI: 10.1186/s13011-017-0104-7 -
Drug and Alcohol Dependence Dec 2021Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this. (Review)
Review
BACKGROUND
Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this.
METHODS
A systematic review of all available evidence was carried out to document and interpret the frequency and severity of alcohol and other substance use during the Covid-19 pandemic and their relationship to demographic and mental health variables that may suggest further clinical implications. Peer reviewed articles in MEDLINE, Embase, PsycINFO, CINAHL complete and Sociological Abstracts were searched from December 2019 until November 2020.
RESULTS
The search and screening identified 45 articles from 513 deduplicated records. The evidence suggests a mixed picture for alcohol use. Overall, there was a trend towards increased alcohol consumption. The proportion of people consuming alcohol during the pandemic ranged from 21.7% to 72.9% in general population samples. Unlike alcohol use, there was a clear trend towards increased use of other substances use during the COVID-19 pandemic. The proportion of people consuming other substances during the pandemic ranged from 3.6% to 17.5% in the general population. Mental health factors were the most common correlates or triggers for increased use of both alcohol and other substances.
CONCLUSION
There is an increased need for treatment for alcohol and other substance use related problems during the pandemic. Increased targeting and evidence-based interventions will also be important in the period which follows this pandemic, to improve the quality of life for individuals and families, but also to prevent additional costs to society and health systems.
Topics: COVID-19; Humans; Pandemics; Quality of Life; SARS-CoV-2; Substance-Related Disorders
PubMed: 34749198
DOI: 10.1016/j.drugalcdep.2021.109150 -
Prevention Science : the Official... May 2024Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and... (Meta-Analysis)
Meta-Analysis Review
Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.
Topics: Humans; Attention Deficit Disorder with Hyperactivity; Substance-Related Disorders; Child; Adolescent; Female; Parents; Child, Preschool; Male
PubMed: 37976008
DOI: 10.1007/s11121-023-01605-2 -
Journal of Substance Abuse Treatment Apr 2011A range of innovative computer-based interventions for psychiatric disorders have been developed and are promising for drug use disorders due to reduced cost and greater... (Comparative Study)
Comparative Study Review
A range of innovative computer-based interventions for psychiatric disorders have been developed and are promising for drug use disorders due to reduced cost and greater availability compared to traditional treatment. Electronic searches were conducted from 1966 to November 19, 2009, using MEDLINE, Psychlit, and EMBASE. Four hundred sixty-eight nonduplicate records were identified. Two reviewers classified abstracts for study inclusion, resulting in 12 studies of moderate quality. Eleven studies were pilot or full-scale trials compared to a control condition. Interventions showed high acceptability despite substantial variation in type and amount of treatment. Compared to treatment-as-usual, computer-based interventions led to less substance use and higher motivation to change, better retention, and greater knowledge of presented information. Computer-based interventions for drug use disorders have the potential to dramatically expand and alter the landscape of treatment. Evaluation of Internet- and telephone-based delivery that allows for treatment-on-demand in patients' own environment is needed.
Topics: Health Knowledge, Attitudes, Practice; Humans; Internet; Motivation; Substance-Related Disorders; Therapy, Computer-Assisted
PubMed: 21185683
DOI: 10.1016/j.jsat.2010.11.002 -
Obesity Reviews : An Official Journal... Dec 2017Emerging research suggests that rates of food addiction are high among individuals seeking bariatric surgery, but little is known about associated features and the... (Review)
Review
Emerging research suggests that rates of food addiction are high among individuals seeking bariatric surgery, but little is known about associated features and the prognostic significance of pre-operative food addiction. Thus, this article provides a systematic review and synthesis of the literature on food addiction and bariatric surgery. Articles were identified through PubMed and SCOPUS databases, resulting in a total of 19 studies which assessed food addiction among pre-bariatric and/or post-bariatric surgery patients using the Yale Food Addiction Scale. Most studies were cross-sectional, and only two studies prospectively measured food addiction both pre-operatively and post-operatively. The presence of pre-surgical food addiction was not associated with pre-surgical weight or post-surgical weight outcomes, yet pre-surgical food addiction was related to broad levels of psychopathology. The relationship between food addiction and substance misuse among individuals undergoing bariatric surgery is mixed. In addition, very few studies have attempted to validate the construct of food addiction among bariatric surgery patients. Results should be interpreted with caution due to the methodological limitations and small sample sizes reported in most studies. Future rigorous research with larger and more diverse samples should prospectively examine the clinical utility and validity of the food addiction construct following bariatric surgery.
Topics: Bariatric Surgery; Food Addiction; Humans; Obesity; Psychometrics; Substance-Related Disorders; Validation Studies as Topic; Weight Loss
PubMed: 28948684
DOI: 10.1111/obr.12600 -
Injury Prevention : Journal of the... Aug 2022Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite...
BACKGROUND
Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries.
METHODS
This systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses.
RESULTS
A total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies.
CONCLUSIONS
AOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies .
PROSPERO REGISTRATION NUMBER
CRD42020188746.
Topics: Accidental Falls; Alcohol Drinking; Hospitals; Humans; Prevalence; Substance-Related Disorders
PubMed: 35508365
DOI: 10.1136/injuryprev-2021-044513 -
The Cochrane Database of Systematic... May 2011There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred, semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective.
OBJECTIVES
To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions.
SEARCH STRATEGY
We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO.
SELECTION CRITERIA
Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction.
DATA COLLECTION AND ANALYSIS
Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no-treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta-analyses separately for post-intervention, short, medium and long follow-ups.
MAIN RESULTS
We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post-intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow-up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow-up, the effect was not significant SMD 0.06 (95% CI-0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow-up post-intervention, short and medium follow up. MI did better than assessment and feedback for medium follow-up SMD 0.38 (95% CI 0.10 to 0.66). For short follow-up, there was no significant effect . For other active intervention there were no significant effects for either follow-up.There was not enough data to conclude about effects of MI on the secondary outcomes.
AUTHORS' CONCLUSIONS
MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Topics: Alcohol-Related Disorders; Humans; Interview, Psychological; Motivation; Patient Acceptance of Health Care; Patient-Centered Care; Substance-Related Disorders; Terminology as Topic; Treatment Outcome
PubMed: 21563163
DOI: 10.1002/14651858.CD008063.pub2