PMCID: PMC2621026
1: J Stud Alcohol Drugs. 2008 Nov;69(6):915-23.
Links
Substance-use problems: are uninsured workers at greater risk?
Waehrer GM, Zaloshnja E, Miller T, Galvin D.
Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland
20705-3111, USA. Waehrer@pire.org
OBJECTIVE: This study examined how problem drinking and drug use and their related
treatment received by workers varied by health insurance coverage and employment
characteristics. METHOD: We used National Survey on Drug Use and Health data on
civilian workers ages 18 years and older from the 2002 and 2003 public-use files.
Multivariate logistic regressions estimated the relationship between workers' uninsured
status and problem use, dependence, and treatment while controlling for worker
demographics, education, income, and job characteristics. RESULTS: Controlling for
differences in worker and workplace characteristics, uninsured workers were significantly
more likely than privately insured workers to be illicit drug users or heavy drinkers.
Among dependent workers, the lack of insurance was associated with a reduction in
treatment received for problem drinkers (odds ratio = 0.31, p = .13). By contrast, a
large, positive-albeit statistically nonsignificant-association between being uninsured and
receiving treatment prevailed among uninsured workers using illicit drugs. Workplace
substance-use policies were associated with a significant reduction in the odds of
treatment received or treatment needed among problem drinkers without insurance
coverage. Employee assistance programs were not good predictors of treatment received
among uninsured workers. CONCLUSIONS: Uninsured workers were more likely to be
heavy drinkers or illicit drug users than were workers with health insurance. Health
insurance coverage was not significantly associated with treatment received among
workers reporting problem use. Uninsured workers may be unable to benefit fully from
employee assistance programs' treatment and referral services, whose utility depends on
adequate behavioral health coverage for workers.
PMID: 18925350 [PubMed - indexed for MEDLINE]
1: Psychol Sci. 2008 Jan;19(1):7-11.
Links
Implicit prejudice toward injecting drug users predicts intentions to change jobs among
drug and alcohol nurses.
von Hippel W, Brener L, von Hippel C.
School of Physchology, University of Queensland, St. Lucia, Australia. billvh@psy.uq.edu.au
The meaning and importance of implicit prejudice is a source of considerable debate. One
way to advance this debate is to assess whether implicit prejudice can predict
independent variance, beyond that predicted by explicit prejudice, in meaningful and
unambiguous behaviors or behavioral intentions. In the current research, drug and
alcohol nurses reported their level of stress working with injecting drug users, their job
satisfaction, their explicit prejudice toward injecting drug users, and their intentions to
leave drug and alcohol nursing. The nurses also completed the Single Category Implicit
Association Test, which measured their implicit prejudice toward injecting drug users.
Analyses revealed that implicit prejudice was a significant mediator, beyond explicit
prejudice and job satisfaction, of the relation between job stress and intention to change
jobs.
PMID: 18181783 [PubMed - indexed for MEDLINE
PMID: 9048146 [PubMed - indexed for MEDLINE
PMID: 14670518 [PubMed - indexed for MEDLINE
1: Nurs Res. 2000 Mar-Apr;49(2):83-90.
Links
Workplace access, negative proscriptions, job strain, and substance use in registered
nurses.
Trinkoff AM, Zhou Q, Storr CL, Soeken KL.
Department of Behavioral and Community Health Nursing, University of Maryland, School of Nursing,
Baltimore 21201, USA. trinkoff@son.umaryland.edu
BACKGROUND: Both occupational conditions and individual factors have been shown as
contributors to the likelihood of substance use among health professionals. OBJECTIVES:
To assess the use of Winick's (1974) model for explaining nurses' substance use, which
asserts that groups with access to substances, freedom from negative proscriptions, and
role strain have an increased likelihood of drug dependence. METHODS: Data were
analyzed from the 3,600 working nurses participating in the Nurses Worklife and Health
Study, a nationally representative survey of registered nurses in the United States. A
structural equation model was tested fitting workplace access to substances (availability,
frequency of administration, and knowledge), freedom from negative proscriptions
(internal: religiosity; external: social network), and role strain (job demands and
depressive symptoms) to the frequency of past year alcohol, marijuana/cocaine, and
prescription-type drug use. RESULTS: Nurses were more likely to use substances when
workplace access to substances increased (p < 0.001), with social networks containing
more drug users, and when religiosity decreased (p < 0.001). Role strain (measured
through job demands and depressive symptoms) also was related to substance use.
Depressive symptoms were related directly and negatively to substance use (p < 0.01),
whereas job demands were related indirectly to substance use through depressive
symptoms. CONCLUSIONS: Winick's model has use in explaining nurses' substance use.
Research and preventive initiatives should consider the multidimensional aspects of
substance use in nurses.
PMID: 10768584 [PubMed - indexed for MEDLINE
1: Rev Epidemiol Sante Publique. 2000 Aug;48(4):363-73.
Links
[Two years follow-up of a heroin users cohort treated with high dosage buprenorphine.
Results of the SPESUB study (pharmacoepidemiologic follow-up of general practice
Subutex)]
[Article in French]
Duburcq A, Charpak Y, Blin P, Madec L.
EVAL, 43, boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France.
BACKGROUND: Since February 1996, French GPs are allowed to prescribe high dosage
buprenorphine for maintenance treatment of major opioid drug addiction. A prospective
cohort of major opioid addicts was initiated in order to assess patient outcomes: followup, retention rate in treatment, drug use, intravenous injection and social situation
evolution. METHODS: Each GP, known to be involved in drug user management, had to
include the first 10 opioid drug addict patients to whom he prescribed high dosage
buprenorphine, with a maximum inclusion period of 3 months. Patients were followed up
for two years and a regular standardized information was collected (usual data on drug
users and prescription modalities). RESULTS: Between May and July 1996, 919 patients
(664 men and 255 women, mean age: 30 years) were included by 101 GPs. They had a
long and serious history of drug addiction, important parallel consumption of cocaine,
codeine and other illicit drugs and psychiatric problems (28% of definite problems and
45% of probable) and frequent hepatic conditions (hepatitis B: 23%, hepatitis C: 21%).
Two years later, 55% of patients were still followed-up by the same GP and an additional
12% were followed by another GP or in a health care service (hospitalized or receiving
methadone in a specialized centre). 13% were not followed, but GPs were able to describe
their situation. 8% had been included by GPs who had dropped the study. Finally, 12% of
patients were lost to follow-up. Among the 508 patients still followed-up by the same GP
after 2 years, the substitution treatment rate was 84%. The dosage bracket had widened
(inclusion: mean dosage=7.8 mg +/-4.5, minimum=0.8, maximum=28, median=8; after
2 years: mean=7.6 mg +/-5.4, minimum=0.4, maximum=28, median=8) and the
duration of the prescription and dispensing had increased. Declaration of heroin intake in
the previous month had fell from 40% to 11% and declaration of drug intake from 53% to
20%. Social situation had improved on average (housing conditions and work). There
were 12 seroconversions for hepatitis B, 21 for hepatitis C and 4 for HIV. 14% of patients
had declared intravenous injection of high dosage buprenorphine in the previous month.
CONCLUSION: After two years of follow-up, 55% of patients were still followed-up by the
same GP and an additional 12% was followed by another GP or in a health care service.
Among patients still followed up by the same GP, a reduction of drug related harm
(seroconversions for hepatitis B, hepatitis C and HIV) was observed.
months
1: J Subst Abuse Treat. 2009 Jan;36(1):75-86. Epub 2008 Jul 26.
Links
Patient predictors of alcohol treatment outcome: a systematic review.
Adamson SJ, Sellman JD, Frampton CM.
National Addiction Centre (Aotearoa New Zealand), University of Otago, Christchurch, New Zealand.
Patient characteristics as predictors of alcohol use disorder treatment outcome were
examined on three levels, identifying whether or not variables were significant predictors
of drinking-related outcome in univariate analysis, in multivariate analysis, and in
multivariate analyses limited to studies including several "key predictors." Also, a model
was developed to predict total percentage of variance in treatment outcome accounted for
in each study using each of the key predictors and a range of methodological factors. The
most consistent univariate predictors were baseline alcohol consumption, dependence
severity, employment, gender, psychopathology rating, treatment history,
neuropsychological functioning, alcohol-related self-efficacy, motivation, socioeconomic
status/income, treatment goal, and religion. When these key predictors were combined
into multivariate analyses, baseline alcohol consumption and gender showed substantial
reductions in predictive consistency whereas the remaining variables were not greatly
affected. The most consistent predictors overall were dependence severity,
psychopathology ratings, alcohol-related self-efficacy, motivation, and treatment goal.
The two predictor variables most associated with greater variance accounted for in
predictive models, when controlling for broader methodological variables, were baseline
alcohol consumption and dependence severity. Few predictor variables were examined in
more than a third of studies reviewed, and few variables were found to be significant
predictors in a clear majority of studies. However, a subset of variables was identified,
which collectively could be considered to represent a consistent set of predictors. Too few
studies controlled for other important predictor variables. Attempts to synthesize findings
were often hampered by lack of agreement of the best measure for predictor variables.
1: Subst Use Misuse. 2008;43(10):1464-75.
Links
Effectiveness of an outreach treatment program for inner city crack abusers: compliance,
outcome, and client satisfaction.
Henskens R, Garretsen H, Bongers I, Van Dijk A, Sturmans F.
Trimbos Institute, Utrecht, The Netherlands. RHenskens@trimbos.nl
In a randomized controlled trial the effectiveness of an outreach treatment program (OTP)
was compared with standard addiction care services for hard-drug addicts in Rotterdam
(The Netherlands). The study aimed at chronic, high-risk crack abusers who were
insufficiently engaged in standard addiction treatment services. Data were collected from
February 2000 to December 2001. A total of 124 subjects participated in the study at
baseline. Follow-up data were available for 94 subjects. Outcome measures included
treatment compliance, outcome, and satisfaction. Data were collected by means of
monthly registrations, EuropAsi interviews and an evaluation form. There was a high
compliance with OTP in the treatment group; the average length-of-stay was 6 months,
with visits three times a week. Although both groups were well represented in standard
care, participation was mainly based on methadone maintenance. Subjects treated in OTP
showed significant improvements in physical health, general living conditions, and
psychiatric status, but no change in employment, substance abuse, and legal status. The
control group remained almost unchanged. Clients of OTP reported feeling very satisfied
with their treatment. On-the-spot incentives and a positive relationship with the care
provider were directly associated with treatment retention. An outreach treatment
program, as conducted in this study, is associated with high compliance, general
improvement, and treatment satisfaction. Characteristics of this treatment modality are
(1) assertive outreach, (2) a mixed program with incentives, and (3) a strong focus on
individual-bound therapy. Further research is needed with larger groups and similar
conditions at baseline assessment
.
1: J Subst Abuse Treat. 2008 Apr;34(3):311-9. Epub 2007 Jul 5.
Links
Economic benefit of chemical dependency treatment to employers.
Jordan N, Grissom G, Alonzo G, Dietzen L, Sangsland S.
Mental Health Services and Policy Program, Department of Psychiatry and Behavioral Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Using assessment data from the Substance Abuse Treatment Support System, we
estimated the economic benefit of chemical dependency treatment to employers. A cohort
of individuals (N = 498) treated at Kaiser Permanente's Addiction Medicine programs in
Southern California completed assessments before and at least 30 days after treatment
began. Compared to intake, subsequent assessments indicated substantial reduction in
the number of patients who missed work, were late for work, were less productive than
usual at work, and/or had conflict with coworkers or management. The net economic
value of these improvements to their employers depended upon the utilization rate of the
benefit and the salary level of the employees receiving treatment. For a utilization rate of
0.9% and a mean annual salary of US$45,000, the net benefit of treatment was
US$1,538 for > or = 61 days of treatment. Based solely upon these employment-related
measures, without factoring in the medical cost offset or indirect benefits of treatment
that may help employees to maintain higher levels of productivity, employers break even
on an investment of US$30 per member per year for a chemical dependency treatment
benefit if the mean annual salary of the employees participating in treatment is
US$36,565.
: J Addict Dis. 2007;26(2):35-43. Links
Women physicians and addiction.
Wunsch MJ, Knisely JS, Cropsey KL, Campbell ED, Schnoll SH.
Edward Via Virginia College of Osteopathic Medicine, Discipline of Addiction Medicine, Blacksburg, VA,
24060, USA. mwunsch@vcom.vt.edu
Nine hundred and sixty-nine impaired physicians (125 women and 844 men) enrolled in
one of four state physician health programs were evaluated with comprehensive
psychosocial, psychiatric and substance abuse/dependence profiles. When compared to
male impaired physicians at time of entry to physician health programs, the 125 female
impaired physicians were younger (39.9 vs. 43.7 years; p < .0001), reported more
medical (48.7% vs. 34.4%; OR = 1.81) and psychiatric (76.5% vs. 63.9%; OR = 1.84)
problems at intake. They were more likely to report past (51.8% vs. 29.9%; OR = 2.51)
or current (11.4% vs. 4.8%; OR = 2.54) suicidal ideation, and more likely to have made a
suicide attempt under the influence (20.0% vs. 5.1%; OR = 4.64) or not under the
influence (14.0% vs. 1.7%; OR = 9.67) of a substance. Although alcohol was the primary
drug of abuse for all physicians studied, women physicians were more likely to abuse
sedative hypnotics than men (11.4 vs. 6.4; OR = 1.87). There were no gender differences
in employment problems (65.3% vs. 67.5%; ns) or legal problems (15% vs. 21%; OR =
.66) due to addiction. These findings suggest different characteristics between male and
female impaired physicians which may have implications for identification and treatment
of this population.
1: Occup Med. 2002 Jan-Mar;17(1):91-104, v. Links
Medications in the treatment of addiction: workplace issues.
Krejci J, Ziedonis D.
University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School,
Picscataway, USA.
Despite resistance from some treatment providers, medications play an increasingly
important role in the treatment of substance dependence disorders. Goals of
pharmacotherapy are discussed in terms of a four-stage model of treatment: acute
withdrawal, protracted withdrawal, abstinence, and maintenance. The greatest
controversy centers on the use of medications during the abstinence and maintenance
phases of recovery. Particularly controversial, despite considerable supporting scientific
data, is the lon -term use of agonists such as methadone. Occupational physicians and
other non-prescribing staff can play a crucial role by supporting the responsible use of
medications, maintaining contact with other medical and psychosocial treatment
providers, enlisting support for medication compliance in patients' personal and
professional support systems, advocating for comprehensive and humane patient care,
and being alert to signs of medication misuse
1: J Subst Abuse Treat. 1999 Apr;16(3):247-53.
Links
Work dysfunction and addiction. Common roots.
Comerford AW.
New Hope Foundation, Marlboro, NJ 07746, USA.
A review of the literature identified similarities in the self-efficacy roots of substance
abuse and vocational dysfunction, along with a potential benefit to providing vocational
interventions as part of substance abuse treatment. Based upon the evidence presented,
the author recommends the use of social cognitive counseling; using client functioning
and level of care to guide vocational interventions; closely monitoring clients who are
working; providing for ongoing social support; and committing to the availability of longterm aftercare and crisis intervention counseling to insure developmental gains are not
lost
1: Behav Healthc. 2006 Jul;26(7):46, 48. Links
A personal story of addiction at work.
Poznanovich B.
Addiction Intervention Resources Inc. poznanovich0706@behavioral.net
PMID: 16915893 [PubMed - indexed for MEDLINE]
1: Addiction. 2002 Mar;97(3):249-52.
Links
Have we evaluated addiction treatment correctly? Implications from a chronic care
perspective.
McLellan AT.
PMID: 11964098 [PubMed - indexed for MEDLINE]
1: J Addict Dis. 2007;26 Suppl 1:51-64. Links
The role of the TCI-R (Temperament Character Inventory) in individualized treatment
plannning in a population of addicted professionals.
Angres DH, Nielsen AK.
Resurrection Addiction Services, Oak Park, IL 60304, USA. dangres@reshealthcare.org
This article discusses a multi-faceted treatment paradigm used to service professionals
with addictive disorders. Individualized treatment plans are developed based on a
multitude of factors including administration of the TCI-R (Temperament Character
Inventory), MCMI-III (Millon Clinical Multiaxial Inventory) and the WASI (Wechsler
Abbreviated Scale of Intelligence). Treatment goals include specific therapeutic
interventions and patient and therapist-directed tasks related to enhanced development of
the character dimensions of Self-Directedness, Cooperativeness and Self-Transcendence,
as measured on Cloninger's TCI-R inventory.
1: Subst Use Misuse. 2004;39(13-14):2621-3. Links
Comment on:
Subst Use Misuse. 2004;39(13-14):2325-53.
Addressing persistent and intractable employment problems in individuals with histories of
drug addiction.
Dillon EM.
Johns Hopkins University, Baltimore, Maryland, USA.
J Addict Dis. 2003;22(2):15-29. Links
Employee benefits managers' opinions about addiction treatment.
McFarland BH, Lierman WK, Penner NR, McCamant LE, Zani BG.
Department of Psychiatry, Oregon Health & Science University, Portland, OR 97201, USA.
mcfarlab@ohsu.edu
Employee benefits managers arrange addictive disease treatment insurance coverage for
the majority of people in the United States but little is known about these decisionmakers. Managers were surveyed to learn their opinions about addiction treatment.
Subjects were 131 people (61 percent female, 94 percent white, average age 46, average
of 14 years in the human resources field). Managers were asked to rank health benefits
(physical health, dental, alcohol-drug, vision, mental health, employee assistance
program, and pharmaceuticals) on 15 dimensions. Managers ranked alcohol-drug abuse
treatment worst on fiveitems and second to the worst on another four of the 15
dimensions. On the item considered most important by the managers, respondents noted
that employees often (2.8) ask for improved physical health benefits but rarely do so for
alcohol and drug (4.1) benefits (p < .001). Education of workers and payers will be
needed to change opinions about treatment of addictive disorders.
1: J Behav Health Serv Res. 2007 Jul;34(3):290-308. Epub 2007 Jul 20.
Links
Substance abuse treatment participation and employment outcomes for public disability
beneficiaries with substance use disorders.
Brucker DL.
Maine Office of Substance Abuse, 11 SHS, Augusta, ME 04333, USA. debra.brucker@maine.gov
Quantitative research methods are used to examine the interaction among public
disability benefit receipt, substance abuse, participation in substance abuse treatment,
and employment among US adults. Using cross-sectional data from the 2002 and 2003
Survey on Drug Abuse and Health, the results demonstrate that disability beneficiaries
who have substance use disorders are more likely to access treatment than persons with
substance use disorders who are not beneficiaries. Results could not confirm, however,
that those beneficiaries who access treatment are more likely to return to employment
than those who do not access treatment.
1: Alcohol. 2000 Aug;22(1):1-5.
Links
The recovery from alcohol problems over the life course: the Lundby longitudinal study,
Sweden.
Ojesjö L.
Department of Clinical Neuroscience, Magnus Huss Clinic, Karolinska Institute, S-171 76, Stockholm,
Sweden. leif.ojesjo@cspo.sll.se
The aim of this paper is to 'look behind the statistics' and to study alcohol-related
problems over time and to portray the recovery (treated and untreated) from these
problems over the life course in a subset of 41 males, defined as DSM-IV alcoholics from
the Lundby general population project.The subjects were interviewed with semi-structured
interviews by a psychiatrist. There was only minimal attrition. An analysis was made of
the distribution of alcohol-related problems among the current alcoholic group compared
to the recovered one at follow-up. Due to the limited number of subjects the calculations
were mainly descriptive.The dominant problems were medical (64% vs. 25%), mental
(45% vs. 17%), family (27% vs. 0%) and work (18% vs. 8%). The overall functioning
assessed by the GAF scale implied a change from continuous to transient symptoms and
problems in the recovered group. The subjects' attributions of reasons for recovery were
social stabilization (84%), treatment (58%), family and peer pressure (58%) and medical
complications (33%).It is argued that the qualitative findings might be used to
complement the large statistical investigations in order to understand how to link alcoholrelated problems and social consequences to the life course studies.
1: J Stud Alcohol Drugs. 2008 Nov;69(6):915-23.
Links
Substance-use problems: are uninsured workers at greater risk?
Waehrer GM, Zaloshnja E, Miller T, Galvin D.
Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland
20705-3111, USA. Waehrer@pire.org
OBJECTIVE: This study examined how problem drinking and drug use and their related
treatment received by workers varied by health insurance coverage and employment
characteristics. METHOD: We used National Survey on Drug Use and Health data on
civilian workers ages 18 years and older from the 2002 and 2003 public-use files.
Multivariate logistic regressions estimated the relationship between workers' uninsured
status and problem use, dependence, and treatment while controlling for worker
demographics, education, income, and job characteristics. RESULTS: Controlling for
differences in worker and workplace characteristics, uninsured workers were significantly
more likely than privately insured workers to be illicit drug users or heavy drinkers.
Among dependent workers, the lack of insurance was associated with a reduction in
treatment received for problem drinkers (odds ratio = 0.31, p = .13). By contrast, a
large, positive-albeit statistically nonsignificant-association between being uninsured and
receiving treatment prevailed among uninsured workers using illicit drugs. Workplace
substance-use policies were associated with a significant reduction in the odds of
treatment received or treatment needed among problem drinkers without insurance
coverage. Employee assistance programs were not good predictors of treatment received
among uninsured workers. CONCLUSIONS: Uninsured workers were more likely to be
heavy drinkers or illicit drug users than were workers with health insurance. Health
insurance coverage was not significantly associated with treatment received among
workers reporting problem use. Uninsured workers may be unable to benefit fully from
employee assistance programs' treatment and referral services, whose utility depends on
adequate behavioral health coverage for workers.
PMID: 18925350 [PubMed - indexed for MEDLINE]
1: J Public Health Policy. 2007;28(1):102-17. Links
Substance abuse and the uninsured worker in the United States.
Galvin DM, Miller TR, Spicer RS, Waehrer GM.
Pacific Institute for Research and Evaluation, Calverton, MD 20705, USA. Miller@pire.org
Although millions of US workers lack health insurance, the relationship of insurance
coverage with substance abuse and access to workplace treatment services remains
unexplored. Our analysis shows uninsured workers have higher rates of heavy drinking
and illicit drug use than insured workers. Young and part-time workers are, moreover,
less likely to have insurance coverage than workers with lower substance abuse risks.
Compared to the insured, uninsured workers have less access to employee assistance
programs (EAPs) and less drug and alcohol testing by employers. The effectiveness of
workplace substance abuse programs and policies designed for insured populations is
untested among uninsured workers. Issues include EAP effectiveness with referrals to
public treatment and the return on investment for adding coverage of substance abuse
treatment. Workers in countries with universal health insurance but inadequate treatment
capacity may face similar problems to uninsured workers in the US.
1: Subst Use Misuse. 2007;42(7):1035-54.
Links
Factors for employment: a case-control study of fully employed and unemployed heroin
users.
Koo DJ, Chitwood DD, Sánchez J.
Department of Criminal Justice, California State University, Fullerton, USA.
The purpose of this article is to characterize fully employed users of heroin, compare them
with their unemployed counterparts, and identify demographic, human, and social capital
and drug misuse factors that are differentially associated with full employment. A nested
case-control research design was used to identify 122 fully employed users (cases) and
466 unemployed users (controls) from a larger study of African American, Hispanic, and
non-Hispanic White men and women who were active heroin injectors and sniffers and
recruited from the streets of Miami-Dade County, Florida, between July 1997 and
February 2000. Multivariate logistic regression techniques were used to analyze data from
the Modified AIDS Risk Behavior Questionnaire. Findings indicated that employed users
were more likely to possess human capital and social capital and less likely to use crack
cocaine than unemployed users. Intervention to increase and sustain the employability of
persons who misuse heroin is essential. Protocols that enhance human capital and social
capital and reduce the misuse of drugs will benefit programs that seek to improve the
employment status of persons who misuse heroin. The study's limitations are noted
1: JAMA. 1999 Oct 13;282(14):1320-1.
Illicit drug users not idle; report says 70% go to work.
Links
Marwick C.
PMID: 10527165 [PubMed - indexed for MEDLINE]
1: Rev Epidemiol Sante Publique. 2000 Aug;48(4):363-73.
Links
[Two years follow-up of a heroin users cohort treated with high dosage buprenorphine.
Results of the SPESUB study (pharmacoepidemiologic follow-up of general practice
Subutex)]
[Article in French]
Duburcq A, Charpak Y, Blin P, Madec L.
EVAL, 43, boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France.
BACKGROUND: Since February 1996, French GPs are allowed to prescribe high dosage
buprenorphine for maintenance treatment of major opioid drug addiction. A prospective
cohort of major opioid addicts was initiated in order to assess patient outcomes: followup, retention rate in treatment, drug use, intravenous injection and social situation
evolution. METHODS: Each GP, known to be involved in drug user management, had to
include the first 10 opioid drug addict patients to whom he prescribed high dosage
buprenorphine, with a maximum inclusion period of 3 months. Patients were followed up
for two years and a regular standardized information was collected (usual data on drug
users and prescription modalities). RESULTS: Between May and July 1996, 919 patients
(664 men and 255 women, mean age: 30 years) were included by 101 GPs. They had a
long and serious history of drug addiction, important parallel consumption of cocaine,
codeine and other illicit drugs and psychiatric problems (28% of definite problems and
45% of probable) and frequent hepatic conditions (hepatitis B: 23%, hepatitis C: 21%).
Two years later, 55% of patients were still followed-up by the same GP and an additional
12% were followed by another GP or in a health care service (hospitalized or receiving
methadone in a specialized centre). 13% were not followed, but GPs were able to describe
their situation. 8% had been included by GPs who had dropped the study. Finally, 12% of
patients were lost to follow-up. Among the 508 patients still followed-up by the same GP
after 2 years, the substitution treatment rate was 84%. The dosage bracket had widened
(inclusion: mean dosage=7.8 mg +/-4.5, minimum=0.8, maximum=28, median=8; after
2 years: mean=7.6 mg +/-5.4, minimum=0.4, maximum=28, median=8) and the
duration of the prescription and dispensing had increased. Declaration of heroin intake in
the previous month had fell from 40% to 11% and declaration of drug intake from 53% to
20%. Social situation had improved on average (housing conditions and work). There
were 12 seroconversions for hepatitis B, 21 for hepatitis C and 4 for HIV. 14% of patients
had declared intravenous injection of high dosage buprenorphine in the previous month.
CONCLUSION: After two years of follow-up, 55% of patients were still followed-up by the
same GP and an additional 12% was followed by another GP or in a health care service.
Among patients still followed up by the same GP, a reduction of drug related harm
(seroconversions for hepatitis B, hepatitis C and HIV) was observed.
1: Am J Psychiatry. 2009 Apr;166(4):398-404.
Links
Mental illness, work, and income support programs.
Danziger S, Frank RG, Meara E.
PMID: 19339364 [PubMed - indexed for MEDLINE]
1: Rev Mal Respir. 2008 Dec;25(10):1343-4, quiz 1344.
Links
[Marijuana abuse and employment, an underrated problem]
[Article in French]
Dewitte JD.
Centre de consultations hospitalières de tabacologie, CHU, Brest, France. jeandominique.dewitte@chu-brest.fr
PMID: 19107030 [PubMed - indexed for MEDLINE]
1: J Stud Alcohol Drugs. 2008 Nov;69(6):885-95.
Links
Characteristics of first-time alcohol treatment seekers: the COMBINE Study.
Locastro JS, Potter JS, Donovan DM, Couper D, Pope KW.
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, and
Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA. joseph.locastro@va.gov
OBJECTIVE: The current study compared alcoholics who entered treatment for the first
time with those who had reported one or more prior treatment experiences using a large
sample (N = 1,362) of alcoholics who entered the National Institute on Alcohol Abuse and
Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions)
Study of pharmacological and behavioral treatment efficacy. METHOD: Participants were
categorized into three prior-treatment groups: (1) treatment naive (n = 691, 50.73%),
(2) one to two prior treatments (n = 380, 27.90%), or (3) three or more prior treatments
(n = 291, 21.37%). Groups were compared at baseline on multiple drinking and
psychosocial variables. RESULTS: The treatment-naive group was more likely to be
female, educated, married, and employed. They reported the lowest levels of drinks per
drinking day, average drinks per day, alcohol dependence, craving, and alcohol-related
consequences; but, they had the oldest age at onset of alcohol problems. Both the
treatment-naive group and the one-to-two prior-treatment group had lower percentage
days abstinent within the prior 30 days, compared with the three-or-more group (22%
and 25% vs 32%, respectively). The treatment-naive group reported the least
commitment to an abstinence goal (43% vs 70% and 80%, respectively) and the lowest
mean number of Alcoholics Anonymous meetings attended (0.86 vs 3.10 vs 6.91,
respectively). They also reported fewer psychological symptoms, less distress, and higher
levels of quality of life on physical, emotional, and environmental domains, as well as
social relationships. CONCLUSIONS: Results suggest that a greater understanding of
treatment-naive versus treatment-experienced clients may provide a better profile of
help-seeking behavior and may suggest different approaches to treatment.
1: Healthc Manage Forum. 2008 Summer;21(2):58-9. Links
Do health executives have the right to discipline employees for drug use if their habits have
no apparent effect on their job performance?
[Article in English, French]
Jaeger HF.
PMID: 18795558 [PubMed - indexed for MEDLINE]
1: Subst Abus. 2008;29(3):71-9. Links
Follow-up study of crack cocaine users: situation of the patients after 2, 5, and 12 years.
Dias AC, Ribeiro M, Dunn J, Sesso R, Laranjeira R.
UNIAD, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
andreaabead@uol.com.br
The purpose of this study was to follow-up 131 crack users and examine drug use,
treatment experience, employment status, and mortality at 2, 5, and 12 years.
Consecutive crack dependent patients were re-interviewed in 1995-1996, 1998-1999, and
2005-2006. Of those subjects not using cocaine at 2 years, 19 (63%) were still abstinent
at 5 years. Almost half of the users were abstinent at the same period. The abstinent
group was still the most prevalent at 12 years. Twenty-seven (20.6%) patients had died
by the 12-year follow-up, with homicide being the most common cause (n = 16). After
2000, however, it declined sharply with only 2 deaths in 7 years. There was a progressive
movement toward abstinence over the follow-up period, with the evidence that once
abstinence had been achieved it was maintained. On the other hand, the mortality rate
was extremely high and probably more related with socioeconomic factors instead of the
drug use itself.
1: Drug Alcohol Depend. 2007 Mar 16;87(2-3):194-201. Epub 2006 Sep 22.
Links
Women-only and mixed-gender drug abuse treatment programs: service needs, utilization
and outcomes.
Niv N, Hser YI.
Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs,
University of California, Los Angeles, CA 90025, USA. noosha23@yahoo.com
OBJECTIVES: This prospective longitudinal study examined service needs, utilization and
outcomes for 189 women in women-only (WO) programs and 871 women in mixedgender (MG) programs. METHODS: The Addiction Severity Index was administered at
both intake and the 9-month follow-up interview to assess clients' problem severity and
outcomes, and the Treatment Service Review was given at the 3-month interview to
measure service utilization. Treatment completion and arrests were based on official
records. RESULTS: Compared to women in MG programs, women in WO programs were
more likely to be White, less educated, physically abused in the past 30 days and in
residential treatment (as opposed to outpatient treatment). Women in WO programs also
had greater problem severity in a number of domains including alcohol, drug, family,
medical and psychiatric. They utilized more treatment services and had better drug and
legal outcomes at follow-up compared to women in MG programs. Program type was not
predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol,
employment, family, medical and psychiatric). CONCLUSIONS: The greater problem
severity of women treated in WO programs and their better drug and legal outcomes
suggest that these specialized services are filling an important gap in addiction services.
1: Drug Alcohol Rev. 2006 May;25(3):249-58.
Links
Long-term follow-up of people with co-existing psychiatric and substance use disorders:
patterns of use and outcomes.
Greig RL, Baker A, Lewin TJ, Webster RA, Carr VJ.
Centre for Mental Health Studies, University of Newcastle, Australia.
The aims of this study were to document long-term patterns of substance use among
people with co-existing psychiatric and substance use disorders and to explore differences
in psychosocial outcomes for groups with different substance use outcome profiles
(persistent hazardous, intermittent hazardous and non-hazardous users). An opportunistic
long-term (4 - 6 years) follow-up interview was conducted with participants from a
previous study who were recruited during their inpatient admission at a public psychiatric
hospital in Newcastle, New South Wales, Australia. Follow-up data were obtained from 47
people from the original study and combined with their existing baseline, 6-month and
12-month data. The follow-up interview included demographic variables and measures of
substance use, psychiatric symptomatology and a range of psychosocial variables.
Alcohol, cannabis and amphetamines were the most commonly misused substances.
Persistent hazardous users experienced poorer outcomes in the domains of social
functioning and psychiatric symptomatology, including depression, than intermittently
hazardous or non-hazardous users. An unusually high mortality rate of 10% among the
males in the original sample (12/120) was an unexpected finding, particularly as this was
likely to be an underestimate. Given the differences in outcomes between groups with
varied gradations of substance use, a harm minimisation approach for research and
practice among people with co-existing psychiatric and substance use disorders is
endorsed.
1: Am J Drug Alcohol Abuse. 2009;35(3):138-44.
Links
Personality disorder factors predict recovery of employment functioning among treated
cocaine abusers.
McMahon RC, Enders C.
University of Miami, Coral Gables, Florida 33124, USA. MCM7798@Bellsouth.net
BACKGROUND: Identifying treatments that produce specific benefits in nondrug
psychosocial functioning areas such as employment functioning has been illusive.
Examination of dimensions of clinical status that moderate such effects may be useful in
planning more effective interventions. OBJECTIVES: The purpose of this study is to
determine if life stress and four dimensions of personality and psychopathology previously
found to predict early post-treatment relapse in diverse groups of substance abusers,
predict less recovery in employment functioning among 240 cocaine dependent males
after completion of residential treatment. METHODS: Latent growth curve analysis was
used to determine if antisocial, avoidant, dependent, paranoid-delusional personality
dimensions, and life event stress predict employment problem severity evident at drug
treatment discharge and change in employment problems over three 3-month follow-up
intervals. RESULTS: Individuals with higher employment severity at intake and those who
spent less time in treatment tended to have greater employment problems at the
predischarge. Two covariates were significant predictors of the linear growth component,
and the set of covariates explained approximately 18% of the variation in the linear
growth rates. Individuals with higher paranoid/delusional scores and lower educational
attainment experienced less improvement in their employment status over follow-up.
CONCLUSIONS: Current findings appear consistent with those of McLellan and colleagues
who found that greater psychiatric severity predicts poor response to treatment across
multiple psychosocial outcomes including employment status. CLINICAL SIGNIFICANCE:
More intensive and long-term psychiatric treatment and vocational-educational
rehabilitative services may be required for improvement in employment functioning
among those with relatively severe psychopathology.
PMID: 19462296 [PubMed - in process]