202 research outputs found
Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT)
No full textAbstract not available.John Marsden , Brian Eastwood, Robert Ali, Pete Burkinshaw, Gagandeep Chohan, Alex Copello, Daniel Burn, Michael Kelleher, Luke Mitcheson, Steve Taylor, Nick Wilson, Chris Whiteley, Edward Da
A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units : study protocol for a randomized controlled trial
No full textBackground:
Substance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention.
Methods/Design:
This randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention.
Discussion:
This pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care
Italian families living with relatives with alcohol or drugs problems
No full textPurpose: To examine the overall impact of alcohol and drug problems on a sample of Italian family members. Sample: About 113 family members affected by and concerned about the problem drinking or drug-taking of close relatives recruited from the North (N1⁄437), the Centre (N1⁄426) and the South (N1⁄450) of Italy. Measurements: Family Member Impact scale (FMI), Symptom Rating Test (SRT), Coping Questionnaire (CQ) and Hopefulness–Hopelessness scale (HOPE). Findings: There is a high level of impact on family members; the greater the impact, the higher the symptom levels; and the greater both the impact and symptoms are, the more types of coping behaviour are used. Multiple regression showed that the most important variables relating to overall symptom levels reported by family members were total coping, gender and impact. These data lend further support to the Stress-Strain-Coping-Support model (Orford et al., 2005a, b)
Start Over and Survive : A Brief Intervention For Substance Abuse in Early Psychosis
No full textOver the last decade, brief intervention for alcohol problems has become a well-validated and accepted treatment, with bried interventions frequently showing equivalence in terms of outcome to more extended treatments (Bien et al, 1993). A recent review of this studies found that heavy drinkers who received interventions of less than 1 h were almost twice as likely to moderate their drinking over the following 6-12 months as did those not receiving intervention (Wilk etal, 1997).Some studies have used motivational interviewing (MI) strategies (Monti et al, 1999); others have simply given information ajnd advice to reduce drinking (Fleming et al, 1997). Leaflets or information on strategies to assist in the attempt or follow-up sessions are sometimes provided (Fleming et al, 1997). In general practice research, provision of one or more follow-up sessions increases the reliability of intake reductions across studies (Poikolainen, 1999)
What was useful about that session? Clients' and therapists' comments after sessions in the UK. Alcohol Treatment Trial (UKATT)
No full textAim: The aim of this study was to report and contrast the aspects of two therapies considered by clients and therapists to be most and least useful.
Method: In the Uk Alcohol Treatment (UKATT), 742 clients were treated by 49 therapists with up to three sessions of motivational enhancement therapy (MET) or up to eight sessions of social behaviour and network therapy (SBNT). After each treatment session, clients and therapists were asked to independently complete two sentences, one inviting a statement about the 'most useful' and other about the 'least useful' thing that had happened during the session.
Results: The proportion of 'most useful' sentences completed was greater than the proportion of 'least useful' and equality so for MET and SBNT. The content of comments was significantly different for the two treatments: more comments on social aspects followed SBNT and more motivational comments followed MET, with larger numbers of comments following both treatments that were more general. Clients more often completed 'most useful' sentences than therapists and less often completed 'least useful sentences. There were a number of differences in the content of their comments: notably more 'most useful'client comments about talking to their therapists, and more therapist comments about client engagement.
Conclusions: MET and SBNT left distinct impressions on the participants immediately following treatment sessions, adding to the evidence that they are different treatments, and hence deepening the mystery about why outcomes followisng the two treatments were so similar (UKATT Research Team. (2005) Br Med J 331:541-58)
Substance Misuse and Psychosis in Context: The Influences of Families and Social Networks
No full text
Commentary on Roozen et al. (2010): Involving families in addiction treatment-the way forward
No full textAssertive Community Treatment for People With Alcohol Dependence: A Pilot Randomized Controlled Trial
No full textAims: A pilot randomized controlled trial (RCT) to assess the feasibility and potential efficacy of assertive community treatment (ACT) in adults with alcohol dependence.
Methods: Single blind, individually randomized, pilot RCT of 12 months of ACT plus treatment as usual (TAU) versus TAU alone in adults (age 18+ years) with alcohol dependence and a history of previous unsuccessful alcohol treatment attending specialist community alcohol treatment services. ACT aimed to actively engage participants for 12 months with assertive, regular, minimum weekly
contact. ACT was combined with TAU. TAU comprised access to the full range of services provided by the community teams. Primary outcome is mean drinks per drinking day and percent days abstinent
at 12 months follow up. Analysis of covariance was conducted using 80% confidence intervals, appropriate in the context of a pilot trial.
Results: A total of 94 participants were randomized, 45 in ACT and 49 in TAU. Follow-up was achieved with 98 and 88%, respectively at 12 months. Those in ACT had better treatment engagement,
and were more often seen in their homes or local community than TAU participants. At 12 months the ACT group had more problems related to drinking and lower quality of life than TAU
but no differences in drinking measures. The ACT group had a higher percentage of days abstinent but lower quality of life at 6 months. The ACT group had less unplanned healthcare use than TAU.
Conclusions: An trial of ACT was feasible to implement in an alcohol dependent treatment population.
Trial registration: ISRCTN2277553
Assertive Community Treatment for alcohol dependence (ACTAD): study protocol for a randomised controlled trial
No full textBackground
Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT), a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this.
Methods/Design
In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one of two conditions: (1) ACT plus care as usual, or (2) care as usual. Those allocated to the ACT plus care as usual will receive the same treatment that is routinely provided by services, plus a trained key worker who will provide ACT. ACT comprises intensive and assertive contact at least once a week, over 50% of contacts in the participant's home or local community, and comprehensive case management across social and health care, for a period of one year. All participants will be followed up at 6 months and 12 months to assess outcome post randomisation. The primary outcome measures will be alcohol consumption: mean drinks per drinking day and percentage of days abstinent measured by the Time Line Follow Back interview. Secondary outcome measures will include severity of alcohol dependence, alcohol related problems, motivation to change, social network involvement, quality of life, therapeutic relationship and service use. Other outcome variables are treatment engagement including completion of assessment, detoxification and aftercare.
Discussion
Results of this trial will help clarify the potential beneficial effects of ACT for people with alcohol dependence and provide information to design a definitive trial
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