A follow-up study of heroin addicts (VEdeTTE2): study design and protocol

BACKGROUND: In Italy, a large cohort study (VEdeTTE1) was conducted between 1998–2001 to evaluate the effectiveness of treatments in reducing mortality and increasing treatment retention among heroin addicts. The follow-up of this cohort (VEdeTTE2) was designed to evaluate the effectiveness of treatments on long-term outcomes, such as rehabilitation and social re-integration. The purpose of this paper is to describe the protocol of the VEdeTTE2 study, and to present the results of the pilot study carried out to assess the feasibility of the study and to improve study procedures. METHODS: The source population for the VEdeTTE2 study was the VEdeTTE1 cohort, from which a sample of 2,200 patients, traced two or more years after enrolment in the cohort, were asked to participate. An interview investigates drug use; overdose; family and social re-integration. Illegal activity are investigated separately in a questionnaire completed by the patient. Patients are also asked to provide a hair sample to test for heroin and cocaine use. Information on treatments and HIV, HBV and HCV morbidity are obtained from clinical records. A pilot phase was planned and carried out on 60 patients. RESULTS: The results of the pilot phase pointed out the validity of the procedures designed to limit attrition: the number of traced subjects was satisfactory (88%). Moreover, the pilot phase was very useful in identifying possible causes of delays and attrition, and flaws in the instruments. Improvements to the procedures and the instruments were subsequently implemented. Sensitivity of the biological test was quite good for heroin (78%) but lower for cocaine (42.3%), highlighting the need to obtain a hair sample from all patients. CONCLUSION: In drug addiction research, studies investigating health status and social re-integration of subjects at long-term follow-up are lacking. The VEdeTTE2 study aims to investigate these outcomes at long-term follow-up. Results of the pilot phase underline the importance of the pilot phase when planning a follow-up study

Understanding Organizational Evolution : Toward a Research Agenda using Generalized Darwinism

The terms ‘evolution’ and ‘coevolution’ are widely used in organization studies but rarely defined. Often it is unclear whether they refer to single entities or populations. When specific evolutionary processes are suggested, the labelling is often misleading. For example, in the debate over the roles of individual adaptation and competitive selection, the ‘selectionist’ position of Michael Hannan and John Freeman (1989), which emphasizes the role of selection and stress the limits of individual firm adaptability, is often described as ‘Darwinian’ whereas opposing views that emphasise adaptability are described as ‘Lamarckian’. But these labels are not strictly dichotomous. Scholars have shown that core Darwinian principles, resulting from abstract ontological communality rather than analogy, apply to social evolution. This opens up a research agenda using the principles of generalized Darwinism and the replicator-interactor framework to help understand the evolution of organizations. Some illustrations of the conceptual value of this approach are provided, including understanding the entwinement of selection and adaptation, the nature and role of organizational routines, the place of strategic choice and the growth of organizational complexity. The framework of generalized Darwinism also helps to bridge apparently divergent perspectives in the business strategy and organizational ecology literatures.Peer reviewedFinal Accepted Versio

A randomized trial of a pain management intervention for adults receiving substance use disorder treatment

Background and AimsChronic pain is difficult to treat in individuals with substance use disorders and, when not resolved, can have a negative impact on substance use disorder treatment outcomes. This study tested the efficacy of a psychosocial pain management intervention, ImPAT (improving pain during addiction treatment), that combines pain management with content related to managing pain without substance use.DesignSingle‐site, parallel‐groups randomized controlled trial comparing ImPAT to a supportive psychoeducational control (SPC) condition; follow‐up assessments occurred at 3, 6 and 12 months.SettingThe Ann Arbor VA Substance Use Disorder treatment program, USA.ParticipantsVeterans Health Administration patients {n = 129; mean [standard deviation (SD)], age = 51.7 (9.5); 115 of 129 (89%) male; ImPAT (n = 65); SPC (n = 64)}.InterventionImPAT combines principles of cognitive–behavioral therapy and acceptance‐based approaches to pain management with content related to avoiding the use of substances as a coping mechanism for pain. The SPC used a psychoeducational attention control treatment for alcoholism modified to cover other substances in addition to alcohol.MeasurementsPrimary: Pain intensity over 12 months; secondary: pain‐related functioning, frequency of alcohol and drug use over 12 months.FindingsPrimary: randomization to the ImPAT intervention versus SPC predicted significantly lower pain intensity {β [standard error (SE)] = −0.71 (0.29); 95% confidence interval (CI) = −1.29, −0.12}; secondary: relative to the SPC condition, those who received ImPAT also reported improved pain‐related functioning [β (SE) = 0.27 (0.11); 95% CI = 0.05, 0.49] and lower frequency of alcohol consumption [β (SE) = −0.77; 95% CI = −1.34, −0.20]. No differences were found between conditions on frequency of drug use over follow‐up.ConclusionsFor adults with pain who are enrolled in addictions treatment, receipt of a psychological pain management intervention (improving pain during addiction treatment) reduced pain and alcohol use and improves pain‐related functioning over 12 months relative to a matched‐attention control condition.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133564/1/add13349_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133564/2/add13349.pd