Kick the habit! Implementation of rapid detoxification in the treatment of opioid dependence

Contains fulltext : 76759.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 26 maart 2009Promotores : Jong, C.A.J. de, Staak, C.P.F. van der Co-promotor : Krabbe, P.F.M.122 p

De behandeling van GHB-afhankelijkheid

Contains fulltext : 174051.pdf (publisher's version ) (Open Access)GHB is een populaire drug. Gebruik leidt snel tot afhankelijkheid, die lastig is te behandelen doordat veel patiënten terugvallen. Door aandacht voor de psychosociale effecten van het gebruik wordt verwacht dat de effectiviteit van de behandeling toeneemt.3 p

Patients improvements measured with the Pleasant Activities List and the Community Reinforcement Approach Happiness Scale: Preliminary results

Item does not contain fulltextObjectives: In general, patients with ongoing substance use disorders are associated with a reduced level of engagement in nonsubstance-related pleasant activities and impaired well-being. The aim of this study is to evaluate the value of the Pleasant Activities List (PAL) and Community Reinforcement Approach (CRA) Happiness Scale to detect changes in a clinical outpatient sample of alcohol-dependent individuals. Methods: By means of a pretreatment and posttreatment design, 34 actively drinking alcohol-dependent participants were consecutively enrolled in this study and referred to a 6-week outpatient CRA program that was focused on sustained abstinence. The PAL and the CRA Happiness Scale were administered to examine the value of both instruments in relation to treatment outcome. Results: The results indicate that both instruments were characterized by overall satisfactory internal consistencies and yielded robust improvements on virtually all subscales and thus were considered highly “sensitive” to detect changes between baseline and 1 month follow-up measurement. Moreover, the moderate and in general positive relationships among the subscales of the PAL and the Happiness Scale support the notion that the increase in rewarding activities is associated with improvements on well being and quality of life. Conclusions: Owing to the relatively low response costs, both instruments seem to be viable to adopt in program evaluations.8 p

EDOCRA II: Implementatie van snelle detoxificatie van opiaten

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Standaarden bieden houvast aan alle zorgverleners

Contains fulltext : 174053.pdf (publisher's version ) (Open Access)Ondersteuning bij diagnostiek en behandeling bij stoornissen in het middelengebruik. Richtlijnen en zorgstandaarden geven handvatten om effectief het gesprek aan te gaan met (weinig gemotiveerde) verslaafden, om samen te werken met naasten, en om effectieve interventies aan te bieden. Een overzicht van het aanbod. Verslavingszorginstellingen, beroepsgroepen en verzekeraars werken samen met patiëntvertegenwoordigers aan goede verslavingszorg en preventie. Zij hebben daarvoor zorgstandaarden en richtlijnen ontwikkeld of herzien.3 p

Treatment consumption and treatment re-enrollment in GHB-dependent patients in the Netherlands

Contains fulltext : 174055.pdf (publisher's version ) (Open Access)Background: The objective of this study was to assess treatment consumption and re-enrollment in treatment in patients with gamma-hydroxybutyrate (GHB)-dependence in Dutch Addiction Treatment Centers (ATCs) in comparison with other addictions. Methods: A cohort-study using nationwide administrative data from regular Dutch ATCs associated with the Dutch National Alcohol and Drugs Information System (LADIS), covering an estimated 95% of ATCs. We selected in- and out-patients with alcohol, drug and/or behavioral addictions with a first treatment episode in 2008-2011 and consecutive treatments until 2013 (n = 71,679). Patients still in treatment at that date (n = 3686; 5.1%), forensic patients (n = 1949; 2.7%) and deceased patients (n = 570; 0.8%) were excluded, leaving 65,474 patients (91.3%). Of those, 596 (0.9%) patients had GHB dependence. We analyzed number of treatment contacts, treatment duration, admissions and admission duration of the first treatment episode, and re-enrollment (defined as having started a second treatment episode in the study period). Results: GHB-dependent patients showed the highest number of treatment contacts, duration of treatment and chance of being admitted. Re-enrollment rates were 2-5 times higher in GHB-dependent patients than other patients with adjusted HR of other addictions ranging from 0.18 (95% confidence interval [CI]: 0.15-0.21) to 0.53 (95% CI: 0.47-0.61). Conclusions: This study demonstrates high levels of treatment consumption and high rates of treatment re-enrollment in GHB-dependent patients. These findings highlight the urgency of developing effective relapse prevention interventions for GHB-dependent patients.6 p

GHB

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Treatment delivery of the community reinforcement approach in outpatient addiction treatment

Item does not contain fulltextObjective: Treatment model adherence is an important predictor of treatment outcome. In clinical practice evidence-based treatments are delivered in widely varying degrees. This study examines which Community Reinforcement Approach (CRA) procedures are delivered by addiction care therapists and how this is associated with therapist characteristics. Method: The study integrated two observational designs. Firstly, using a prospective design, 24 therapists registered every CRA procedure delivered during every patient contact over a six month period. Secondly, using a cross-sectional design, personal characteristics of 69 therapists were assessed including their self-reported delivery of CRA procedures and their perceptions with regard to the meaningfulness and complexity of these procedures. Results: The number of CRA procedures delivered varied substantially among therapists both at session and patient level. More experienced therapists and those that had received advanced training previously, delivered more CRA procedures. Finally, the delivery of CRA procedures was positively associated with experienced meaningfulness and negatively associated with difficulty. Conclusions: The results confirm the relation between treatment delivery and experienced meaningfulness and difficulty of CRA procedures and provides support for advanced training to enhance the delivery of a wider range of CRA procedures.6 p

Good psychometric properties of the Addiction version of the revised Illness Perception Questionnaire for health care professionals

Contains fulltext : 161796pub.pdf (publisher's version ) (Open Access)Background: Addiction, or substance dependence, is nowadays considered a chronic relapsing condition. However, perceptions of addiction vary widely, also among healthcare professionals. Perceptions of addiction are thought to contribute to attitude and stigma towards patients with addiction. However, studies into perceptions of addiction among healthcare professionals are limited and instruments for reliable assessment of their perceptions are lacking. The Illness Perception Questionnaire (IPQ) is widely used to evaluate perceptions of illness. The aim of this study was to evaluate the psychometric properties of the IPQ: factor structure, internal consistency, and discriminant validity, when applied to evaluate healthcare professionals perceptions of addiction. Methods: Participants were 1072 healthcare professionals in training and master students from the Netherlands and Indonesia, recruited from various addiction-training programs. The revised version of the IPQ was adapted to measure perceptions of addiction (IPQ-A). Maximum likelihood method was used to explore the best-fit IPQ factor structure. Internal consistency was evaluated for the final factors. The final factor structure was used to assess discriminant validity of the IPQ, by comparing illness perceptions of addiction between 1) medical students from the Netherlands and Indonesia, 2) medical students psychology students and educational science students from the Netherlands, and 3) participants with different training levels: medical students versus medical doctors. Results: Factor analysis revealed an eight-factor structure for the perception subscale (demoralization, timeline chronic, consequences, personal control, treatment control, illness coherence, timeline cyclical emotional representations) and a four-factor structure for the attribution subscale (psychological attributions, risk factors, smoking/alcohol, overwork). Internal reliability was acceptable to good. The IPQ-A was able to detect differences in perceptions between healthcare professionals from different cultural and educational background and level of training. Conclusions: The IPQ-A is a valid and reliable instrument to assess healthcare professionals' perceptions of addiction.15 p

Clinicians' perceptions for indicating and contra-indicating integrated treatment for SUD and comorbid PTSD, a vignette study

Background: Posttraumatic Stress Disorder (PTSD) is more common in patients with Substance Use Disorder (SUD) than in the general population. Although international guidelines recommend integrated treatment clinicians are still hesitant in offering integrated treatment and more concrete recommendations are needed. This study aims to contribute to a practice-based guideline through the exploration of practice-based decision criteria to determine the indication and treatment of SUD and PTSD. Methods: A vignette study to explore the views of experienced clinicians on the treatment of SUD and PTSD. Results: Thirty-one experienced clinicians working in Dutch addiction care facilities filled in 15 vignettes resulting in 465 scored vignettes. Respondents did not report any contra-indications for integrated treatment and the perceived relationship between SUD and PTSD was found to be an important factor in the indication of integrated treatment. Conclusions: For integrated treatment to be offered to all eligible patients more training and schooling in trauma treatment and comorbid psychopathology is needed for all disciplines involved. Inpatient treatment options are necessary when patients need external support due to psychiatric or physical vulnerabilities. Further research into the effect of the relationship between SUD and PTSD on treatment execution and effectiveness is needed and can contribute to future treatment guidelines