Introduction of a spirituality group in a community service for people with drinking problems

Aims: To explore the value of providing clients of a community service for people with drinking problems with an opportunity to explore matters of spirituality related to their recovery.

Methods: A spirituality group was introduced to a community treatment programme for people with drinking problems.

Results: The group ran for a period of 5 months, and attracted a small but enthusiastic group of clients. It explored matters of personal spirituality in the context of recovery from alcohol misuse. A number of discrete themes and processes emerged, which included significant issues not addressed elsewhere in treatment.

Conclusions: A spirituality group has a significant contribution to make in the treatment of drinking problems and is complementary to other medical, social and psychological treatments.     

Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study

The use of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) has increased dramatically in the past two decades. There has also been a marked increase in the abuse of prescribed opioids and in accidental opioid overdose. Misuse of prescribed opioids may link these trends, but has thus far only been studied in small clinical samples. We therefore sought to validate an administrative indicator of opioid misuse among large samples of recipients of COT and determine the demographic, clinical, and pharmacological risks associated with possible and probable opioid misuse. A total of 21,685 enrollees in commercial insurance plans and 10,159 in Arkansas Medicaid who had at least 90 days of continuous opioid use 2000–2005 were studied for one year. Criteria were developed for possible and probable opioid misuse using administrative claims data concerning excess days supplied of short-acting and long-acting opioids, opioid prescribers and opioid pharmacies. We estimated possible misuse at 24% of COT recipients in the commercially insured sample and 20% in the Medicaid sample and probable misuse at 6% in commercially insured and at 3% in Medicaid. Among non-modifiable factors, younger age, back pain, multiple pain complaints and substance abuse disorders identify patients at high risk for misuse. Among modifiable factors, treatment with high daily dose opioids (especially >120 mg MED per day) and short-acting Schedule II opioids appears to increase the risk of misuse. The consistency of the findings across diverse patient populations and the varying levels of misuse suggest that these results will generalize broadly, but await confirmation in other studies.     

National survey of alcohol treatment agencies in England: Characteristics of clients

Background: To map and contact all alcohol treatment services in England offering Tier 2, 3 and 4 interventions and describe the characteristics of their service-users.

Methods: A national cross-sectional survey of alcohol treatment providers in England, designed to gather information about the characteristics of clients referred, assessed, and treated in the financial 2003/4.

Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7 %) responded to the survey. The majority of clients were men, particularly within residential and non-statutory agencies. A higher proportion of residential clients were highly alcohol dependent, homeless and neurologically impaired, whereas, community clients were more likely to be offenders or to have mental health problems. Non-statutory services were more likely to see homeless clients, offenders, and clients with mental health problems and neurological deficits than statutory services who, typically, see a more dependent population.

Conclusions: Findings support the need for more specialist service provision for severely dependent offenders and dependent drinkers with serious mental illness. To aid future mapping of alcohol services, which allows areas of need to be identified, it is recommended that services have a monitoring system similar to that for drug misuse with the National Drug Treatment Monitoring System.     

Victory or defeat: narratives of recovery and chronic substance misuse revealed through the “Life as a Film”

ABSTRACT

Background

Recent “Life as a film” (LAAF) studies demonstrate a relationship between themes of agency and communion in life stories and substance misuse recovery, contrasting with theme deficits in addicted populations, suggesting pathways to positive identity change. The present study aims to elucidate other key constructs differentiating recovery and non-recovery to comprehensively model interactive narrative processes.     

Interventions with family caregivers for people with dementia: efficacy problems and potential solution

Family members are increasingly caring for relatives with dementia at home. It is well recognized that this is a stressful experience for carers. Treatment approaches that aim to alleviate this stress were introduced in the 1970s and later research began to evaluate their efficacy. Early studies using subjective ratings of satisfaction and usefulness demonstrated encouraging results. However, later studies using standardized measures of distress and burden, have not been able to demonstrate efficacy in a convincing way. There have been some positive significant changes; however, most findings have been poor, inconsistent and equivocal. This may be accounted for by the poor methodological rigour diluting the positive potential benefits of interventions for carers. This paper suggests that in order for the efficacy research to evolve, there needs to be a change in direction. It is vital that instead of repeating 'more of the same' studies, researchers need to prioritize the use of theoretically driven interventions and research design. This factor alone could provide the framework to influence the methodological issues that potentially dilute the demonstration of treatment efficacy. Without clearer evidence from research, guidance for practitioners about treatment for carers is ambiguous.     

Nursing care of older people: a personal construct theory perspective

This paper outlines the use of the repertory grid technique, with nurses caring for elderly residents, and residents of a nursing home. The method focuses on the individuality of each person's attempt at making sense of her/his caring world. Previous papers have focused on a discussion of the repertory grid technique as a research method and tool for psychiatric nurses, an overview of studies using this technique with nurses and social workers, and applications of personal construct theory (from which the technique is derived) to nursing research. A paper by Rawlinson described content analysis of the role constructs elicited from the nurses. In this study, content analysis of caring constructs elicited by nurses and residents was also undertaken, and the results are presented. Additionally, principal component analysis of the repertory grids was carried out, and three examples are presented. This combined analysis provides an in-depth insight into nurses' perceptions of caring for others; perceptions which guide their caring behaviours. This information can be used by individual nurses to review their caring practice.     

Nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users

Abstract

The purpose of this study was to examine nonfatal overdose events experienced among a sample of recreational drug users. We sought to determine predictors of nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users. In addition, we examined the substance(s) used at the last overdose event. Methods: Participants were 637 recreational illicit drug users (had used illicit drugs other than marijuana, in a club or party setting), aged 19 or older, from Victoria or Vancouver, British Columbia, Canada. Data were obtained in structured interviews conducted from 2008 to 2012 as part of the Canadian Recreation Drug Use Survey (CRDUS). Results: In the 12 months prior to interview, 19.3% (n?=?123) of the participants had experienced an overdose. In multivariate analysis, younger age, unstable housing, and usually consuming eight or more drinks containing alcohol, when drinking, significantly increased overdose risk. In addition, polysubstance use was reported by 67.5% (n?=?83) participants at their last overdose event. Conclusions: Intervention and prevention measures seeking to reduce overdoses among recreational drug users should not only address illicit drug use but also alcohol and polysubstance use. In addition, measures may target those who usually consume high amounts of alcohol when drinking are younger and who experience housing instability.     

Medication overuse and drug addiction: a narrative review from addiction perspective

Chronic headache is particularly prevalent in migraineurs and it can progress to a condition known as medication overuse headache (MOH). MOH is a secondary headache caused by overuse of analgesics or other medications such as triptans to abort acute migraine attacks. The worsening of headache symptoms associated with medication overuse (MO) generally ameliorates following interruption of regular medication use, although the primary headache symptoms remain unaffected. MO patients may also develop certain behaviors such as ritualized drug administration, psychological drug attachment, and withdrawal symptoms that have been suggested to correlate with drug addiction. Although several reviews have been performed on this topic, to the authors best knowledge none of them have examined this topic from the addiction point of view. Therefore, we aimed to identify features in MO and drug addiction that may correlate. We initiate the review by introducing the classes of analgesics and medications that can cause MOH and those with high risk to produce MO. We further compare differences between sensitization resulting from MO and from drug addiction, the neuronal pathways that may be involved, and the genetic susceptibility that may overlap between the two conditions. Finally, ICHD recommendations to treat MOH will be provided herein.     

Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review

Title. Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: systematic review. Aim. This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Background. Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Data sources. Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Review methods. Results from studies using meta‐analysis, randomized and non‐randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Results. Fifty‐four studies were included: one systematic review with meta‐analysis, 30 randomized controlled trials and 23 non‐experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long‐term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. Conclusion. These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups.     

Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists

Abstract

Purpose: Our aim was to describe experiences of using Nintendo Wii Fit? for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients’ physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings.

• Implications for Rehabilitation

• Nintendo Wii Fit? can be used as a fun and challenging way to perform balance exercises.

• The competitive content embedded in the games triggers continued playing and exercising.

• The positive effect on balance control can improve standing and walking in everyday activities.

     

Affected family member coping with a relative with alcohol and/or other drug misuse: A cross‐sectional survey questionnaire

Families have a crucial role supporting a relative with alcohol and/or other drug misuse, but the role has adverse implications for family members’ coping, which in turn, affects their ability and willingness to support the relative. The aim of this study was to assess the coping behaviours of affected family members of relatives with alcohol and/or other drug misuse and to assess if there was a relationship between the level of coping and family member type and support‐giving experience. A cross‐sectional survey design was used, and 90 respondents completed the questionnaire. Results suggest the following associations: that ‘Other’ family members made more frequent use of maladaptive coping strategies than intimate partners (P = 0.012); family members whose role had a negative effect on their physical health made more frequent use of maladaptive coping strategies than those whose role did not have this effect (P = 0.014); and family members whose role had a negative effect on their ability to socialise used maladaptive coping strategies more often than those whose role did not have this effect (P = 0.003). Engaged and tolerant‐inactive maladaptive coping strategies had a significantly greater adverse influence on family members’ physical health and/or socialising than withdrawal coping strategies. Affected family members should be supported to use adaptive coping strategies to mitigate the detrimental effects of their support‐giving role and to sustain them in this crucial support‐giving role. Family and friends, mental health nurses, and other clinicians in the alcohol and other drug field have an important role in supporting family members in this context.     

Retention of adolescents with substance dependence and coexisting mental health disorders in outpatient alcohol and drug group therapy

The aim of this study was to investigate characteristics that might enhance retention among adolescents attending outpatient alcohol and drug group therapy within a youth mental health setting. An important goal was to provide information for nurses and other clinicians who work with adolescents with coexisting substance use and mental health disorders. A retrospective file audit reviewed the files of 64 adolescents who attended a weekly alcohol and drug group between 2002 and 2004. Five characteristics were shown to have a significant impact on enhancing participant group retention. These were Māori and Pacific Island ethnicity, past or current legal charges, youth drug court (YDC) involvement, having a diagnosis of cannabis dependence, and a diagnosis of conduct disorder. Logistic regression found that YDC involvement on its own significantly predicted treatment retention. In an area of limited research, the findings from this study expand the literature on enhancing treatment retention for a vulnerable and hard-to-engage adolescent group with complex treatment needs, and highlight the need for further investigation of the potential role of the YDC. From a practice perspective, the findings support group therapy interventions as a cost-effective treatment modality for assisting adolescents with coexisting substance use and mental health issues, including those with conduct disorder and YDC involvement.     

From policeman to drug user: a personal perspective on the use of khat

Most countries drug strategies comprise a combination of drug treatment, drug enforcement, and drug prevention. While there has been a tendency in public policy documents over the last few years to emphasise the importance of basing policy on evidence of need and impact, in fact, the evidential basis across these three domains is highly skewed with most evidence being focused on drug treatment, some evidence focused on drug prevention, and relatively little evidence focused specifically on the impact of drug law enforcement. In this article, we report on drug users’ views of major drug enforcement operations in their local area. The three drug enforcement operations we were looking at were carried out by the police in three different geographical areas. In each area, we interviewed a snowball sample of local heroin users to establish their views and experience of both the specific operations that had occurred in the recent past and their overall assessment of the impact of police activity in their local area. Most of those interviewed who had been involved in a drug raid described the experience as shocking, upsetting, and profoundly unsettling. However, according to the drug users interviewed, police activity had little sustained impact on the price, purity, and/or availability of illegal drugs locally. The article concludes by considering the policy implications of this research.     

“I don’t stress about it like I used to”: Perceptions of non-problematic sleep amongst people in residential treatment for substance use disorders

Background: Sleep problems are common amongst people who use alcohol and other drugs, but treatment options are limited. This paper explores how people in residential treatment for alcohol and other drug problems perceived and described ‘non-problematic’ sleep to provide insights that might inform sleep interventions for this population.

Methods: Qualitative interviews were conducted with 28 residents (19 women, 9 men; ages 24–83 years) in two residential drug and alcohol treatment centres in England during 2014/15. Interviews were audio-recorded, transcribed, and coded. Accounts of non-problematic sleep were then analysed inductively.

Results: Non-problematic sleep comprised three linked components: i. personal sleep patterns and routines; ii. sleep perceptions; and iii. sleep metacognitions. Some participants reported they slept well; others described their sleep as problematic but improving. Participants believed that sleep improved naturally with residential treatment and abstinence, but perceptions of ‘good’ sleep varied greatly. Participants used a range of metacognitive strategies (e.g. downgrading the importance of sleep; adapting their sleeping patterns; and focusing on sleep quality alongside sleep quantity) to manage sleep problems and render them non-problematic.

Conclusions: Metacognitive strategies that focus on changing perceptions of sleep can potentially inform sleep interventions for people with a history of alcohol and other drug use.     

Do medical treatments increase the risk of substance abuse in older people with dementia

Abstract

The current study aims to determine the association between medical treatments and the risk of substance abuse in the elderly with dementia. The research was conducted on Malaysian elderly who were demented and non-institutionalized. The study was a national cross sectional survey that included 1210 non-institutionalized Malaysian elderly with dementia. The Multiple Logistic Regression Model was applied to predict the risk of substance abuse in respondents. The prevalence of substance abuse was approximately 57.9% among subjects. Furthermore, medical treatment (OR?=?1.88, 95% CI: 1.37–2.59), ethnic non-Malay (OR?=?1.44, 95% CI: 1.12–1.84) and male sex (OR?=?4.64; 95% CI: 3.42–6.29) significantly increased substance abuse after adjusting for socio-demographic factors. The results showed that age, marital status and educational level did not predict significantly the risk of substance abuse in samples (p?>?0.05). It was concluded that male sex, medical treatment and ethnic non-Malay can increase the risk of substance abuse in the older people with dementia.     

Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners

Aim: The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners’ perspectives on the practices that constitute high quality hip fracture rehabilitation.

Methods: Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners’ perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach.

Results: Seven themes emerged: objectives of care; first 72?h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration.

Conclusions: Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners’ perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes.

• Implications for Rehabilitation

• This study highlights occupational and physiotherapy therapy practitioners’ perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation.

• While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers.

• Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.

     

Chemotherapy-induced nausea and vomiting in routine practice: a European perspective

Goals of work The aim of this study was to evaluate the occurrence of chemotherapy-induced nausea and vomiting (CINV) and its effect on patients ability to carry out daily life activities following moderately to highly emetogenic, first-cycle chemotherapy in routine practice in cancer centers of four different European countries.Patients and methods This was a prospective, cross-sectional, nonrandomized, self-assessment study in 249 patients enrolled from cancer centers in Spain, Austria, Germany, and Switzerland. The study population consisted of 78% women, with a mean age of 54. Breast, lung, and ovarian cancers made up 75% of all cancers in the study. Patients received a mean of 2.0 chemotherapy agents and 2.5 antiemetic drugs.Main results A total of 450 emetic episodes experienced by 243 patients was recorded over 5 days following chemotherapy, with an average of 1.8 episodes per patient (range: 0–28). A higher percentage of patients (38%) suffered from delayed compared to acute emesis (13%). Between 42% and 52% of all patients suffered from nausea (visual analogue scale 5 mm) on any one day, peaking at day 3. Using the Functional Living Index for Emesis (FLIE) questionnaire, 75% of patients with nausea and 50% with vomiting reported a negative impact of these conditions on performance of daily living.Conclusions CINV remains a significant problem in routine practice, particularly in the delayed phase posttreatment. Overall, CINV had a negative impact on patients daily life.     

Key components of drug treatment provision for young people: a Delphi approach

To date, most drug treatment services have dealt with adult clients, often stretching their services to include a younger age group. As drug services specifically for young people are being developed, there is scant evidence of the effectiveness of treatment provision on which to draw. Consequently, policy makers, service commissioners, and service providers face the problem of trying to make decisions in a situation where there is little information concerning the key components of accessible and effective services for young drug users. The current authoritative guidance is contained within the Health Advisory Service (HAS) Report (1996), and the subsequent Health Advisory Service (HAS) Review (2001). The HAS Report and the HAS Review were generated by consensus methodologies based on eliciting expert opinion. The aim of this study was to obtain information by using a different, and arguably more rigorous, method to the consensus methodologies used in the HAS Report and the HAS Review. A Delphi consensus methodology was used in this study in order to corroborate (or otherwise) the current HAS guidance, and thus better inform service provision. The Delphi panel was mainly in agreement with the recommendations of the HAS Report and the HAS Review, but placed less weight on physiological and pharmaceutical interventions and more emphasis on interventions that may lead to social integration. The implications with regard to future service development are discussed in light of the findings of this Delphi study.