Effects on Smoking Cessation: Naltrexone Combined with a Cognitive Behavioral

A promising option in substance abuse treatment is the Community Reinforcement Approach (CRA). The opioid antagonist naltrexone (NTX) may work in combination with nicotine replacement therapy (NRT) to block the effects of smoking stimuli in abstinent smokers. Effects of lower doses than 50 mg/dd. have not been reported. A study was conducted in Amsterdam in 2000/2001 with the objective to explore the effects of the combination NTX (25/50-mg dd.), NRT, and CRA in terms of craving and abstinence. In a randomized open label, 2 × 2 between subjects design, 25 recovered spontaneous pneumothorax (SP) participants received 8 weeks of treatment. Due to side effects, only 3 participants were compliant in the 50-mg NTX condition. Craving significantly declined between each measurement and there was a significant interaction between decline in craving and craving measured at baseline. The abstinence rate in the CRA group was nearly double that in the non-psychosocial therapy group (46% vs. 25%; NS) at 3 months follow-up after treatment

Efficacy and tolerability of naltrexone in the treatment of alcohol dependence: oral versus injectable delivery

Oral naltrexone, an opioid antagonist, reduces relapse and heavy drinking in alcohol-dependent patients. However, oral delivery is associated with poor compliance and adverse events. To enhance treatment outcome and reduce side effects, injectable extended-release naltrexone formulations have been developed. Currently, there are no studies available directly comparing oral and injectable formulations of naltrexone in alcohol-dependent patients. This paper reviews the efficacy and adverse events of oral versus injectable extended-release naltrexone. Therefore, data were extracted from two recently published reviews about oral naltrexone in the treatment of alcohol dependence. Pooled outcomes were compared with reported outcomes of recent studies on injectable extended-release naltrexone. Injectable naltrexone seems to be effective in the management of alcohol dependence. Although inconclusive, the available results indicate that the expected advantages of injectable naltrexone over oral naltrexone still have to be proven. Randomized studies with direct comparisons of oral and injectable naltrexone are urgently neede

Reasons for entering treatment reported by initially treatment-resistant patients with substance use disorders

Many individuals with substance use disorders are resistant to entering formal treatment, despite the negative consequences that plague their own lives and the lives of concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) has been developed as an effective strategy for helping family members who are concerned about the alcohol/drug use of a loved one who refuses to seek treatment. The present study explored reasons and feelings that played a part in these resistant individuals' (identified patients [IPs]) decision to begin treatment. Written statements and feelings of 36 initially treatment-refusing IPs, who were engaged into treatment via their CRAFT-trained CSOs, were examined upon entering treatment. Self-report forms assessed three complementary domains about entering treatment: (1) feelings about coming for treatment, (2) important reasons for entering treatment, and (3) reasons for entering treatment narratives. It was shown that the occurrences of self-reported positive emotions and statements that expressed a positive wish for change outweighed negative feelings and statements. Although conceivably these CRAFT-exposed IPs may have provided different responses than other treatment-seeking populations, the current study's strong IP reports of positive feelings, reasons, and narrative statements regarding treatment entry nonetheless address potential concerns that treatment-refusing IPs might only enter treatment if felt coerced by family members and while experiencing salient negative feelings overall. Keywords: treatment-resistant, community reinforcement and family training, CRAFT, family, addiction, substance use disorder, recovery, evidence-base

Cross-Cultural Examination of the Community Reinforcement Approach Happiness Scale (CRA-HS): Testing measurement invariance in five countries

The Community Reinforcement Approach Happiness Scale (CRA-HS) is widely used for assessing the quality of life in addiction treatment, but the amount of research on the psychometric properties has been scant. The present study sought to (a) test for measurement invariance of the CRA-HS across college students (n = 3388) in five countries (i.e., United States, Spain, Argentina, Uruguay, and the Netherlands); (b) evaluate differences on the CRA-HS (i.e., latent mean differences) as a function of sex and country, and (c) compare criterion-related validity. Using multi-group confirmatory factor analyses, we found a shortened 10-item version of the CRA-HS to be invariant across sex, but only configural and metric invariance was found across countries. Across all countries, criterion-related validity of the CRA-HS scores across different countries emerged. Our findings serve as a foundation for future cross-cultural work testing models in which subjective well-being (i.e., happiness) is an important clinical/routine outcome among college students.Fil: Roozen, Hendrik G.. University of New Mexico; Estados UnidosFil: Bravo, Adrian J.. University of New Mexico; Estados UnidosFil: Pilatti, Angelina. Universidad Nacional de Córdoba. Instituto de Investigaciones Psicológicas. - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones Psicológicas; ArgentinaFil: Mezquita, Laura. Universitat Jaume I; EspañaFil: Vingerhoets, Ad. Tilburg University; Países BajosFil: Cross-cultural Addictions Study Team. No especifíca

Effects of multiple detoxifications on withdrawal symptoms, psychiatric distress and alcohol-craving in patients with an alcohol use disorder

Previous studies have shown an association between the number of withdrawal attempts and increased severity of withdrawal symptoms in patients with an alcohol use disorder (AUD). An underlying allostatic neuroadaptive response may negatively affect the withdrawal pathology after alcohol discontinuation. The objective of the present research is to examine the intensification of psychiatric distress, craving, and post-detoxification drinking outcomes, which may result from these neurobehavioral alternations. Fifty-two AUD inpatients were divided into two groups: <2 previous detoxifications and ≥2 previous detoxifications. Patients completed the Dutch version of the Severity of Withdrawal Scale (SWS), Depression Anxiety Stress Scales (DASS-21), VAS Craving, and Desires for Alcohol Questionnaire (DAQ). Linear mixed effects models were applied, controlling for the number of drinks consumed in the past 30 days and alcohol drinking history (years). Patients who had undergone ≥2 detoxifications reported statistically significantly higher scores on SWS withdrawal and DASS psychiatric symptoms. Also, craving patterns were different between groups, as shown by a statistically significant interaction effect for VAS craving for the time of day factor (morning vs. evening). No statistically significant group differences were found for DAQ scores and post-detoxification drinking outcomes. Due to relatively low 1-month follow-up rates our power was limited to detect such a difference. The present study contributes to the existing body of evidence that multiple detoxifications are associated with aggravated withdrawal/psychiatric pathology, and distinct diurnal patterns of VAS craving. Several clinical implications are discussed and alternative strategies are provided to manage repeated cycles of detoxifications

Cross-Cultural Examination of the Community Reinforcement Approach Happiness Scale (CRA-HS): Testing measurement invariance in five countries

The Community Reinforcement Approach Happiness Scale (CRA-HS) is widely used for assessing the quality of life in addiction treatment, but the amount of research on the psychometric properties has been scant. The present study sought to (a) test for measurement invariance of the CRA-HS across college students (n = 3388) in five countries (i.e., United States., Spain, Argentina, Uruguay, and the Netherlands); (b) evaluate differences on the CRA-HS (i.e., latent mean differences) as a function of sex and country, and (c) compare criterion-related validity. Using multi-group confirmatory factor analyses, we found a shortened 10-item version of the CRA-HS to be invariant across sex, but only configural and metric invariance was found across countries. Across all countries, criterion-related validity of the CRA-HS scores across different countries emerged. Our findings serve as a foundation for future cross-cultural work testing models in which subjective well-being (i.e., happiness) is an important clinical/routine outcome among college students