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[PMID]:27775161
[Au] Autor:Tucker JA; Cheong J; Chandler SD; Lambert BH; Pietrzak B; Kwok H; Davies SL
[Ad] Endereço:Department of Health Education & Behavior, University of Florida, Gainesville, Florida.
[Ti] Título:Prospective Analysis of Behavioral Economic Predictors of Stable Moderation Drinking Among Problem Drinkers Attempting Natural Recovery.
[So] Source:Alcohol Clin Exp Res;40(12):2676-2684, 2016 Dec.
[Is] ISSN:1530-0277
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: As interventions have expanded beyond clinical treatment to include brief interventions for persons with less severe alcohol problems, predicting who can achieve stable moderation drinking has gained importance. Recent behavioral economic (BE) research on natural recovery has shown that active problem drinkers who allocate their monetary expenditures on alcohol and saving for the future over longer time horizons tend to have better subsequent recovery outcomes, including maintenance of stable moderation drinking. This study compared the predictive utility of this money-based "Alcohol-Savings Discretionary Expenditure" (ASDE) index with multiple BE analogue measures of behavioral impulsivity and self-control, which have seldom been investigated together, to predict outcomes of natural recovery attempts. METHODS: Community-dwelling problem drinkers, enrolled shortly after stopping abusive drinking without treatment, were followed prospectively for up to a year (N = 175 [75.4% male], M age = 50.65 years). They completed baseline assessments of preresolution drinking practices and problems, analogue behavioral choice tasks (Delay Discounting, Melioration-Maximization, and Alcohol Purchase Tasks), and a Timeline Followback interview including expenditures on alcohol compared to voluntary savings (ASDE index) during the preresolution year. RESULTS: Multinomial logistic regression models showed that, among the BE measures, only the ASDE index predicted stable moderation drinking compared to stable abstinence or unstable resolutions involving relapse. As hypothesized, stable moderation was associated with more balanced preresolution allocations to drinking and savings (odds ratio = 1.77, 95% confidence interval = 1.02 to 3.08, p < 0.05), suggesting it is associated with longer-term behavior regulation processes than abstinence. CONCLUSIONS: The ASDE's unique predictive utility may rest on its comprehensive representation of contextual elements to support this patterning of behavioral allocation. Stable low-risk drinking, but not abstinence, requires such regulatory processes.
[Mh] Termos MeSH primário: Consumo de Bebidas Alcoólicas/economia
[Mh] Termos MeSH secundário: Economia Comportamental
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Recidiva
Autocontrole
Temperança
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171208
[Lr] Data última revisão:
171208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1111/acer.13245


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[PMID]:28223731
[Au] Autor:Onishi Y; Kimura H; Hori T; Kishi S; Kamei H; Kurata N; Tsuboi C; Yamaguchi N; Takahashi M; Sunada S; Hirano M; Fujishiro H; Okada T; Ishigami M; Goto H; Ozaki N; Ogura Y
[Ad] Endereço:Yasuharu Onishi, Tomohide Hori, Hideya Kamei, Nobuhiko Kurata, Yasuhiro Ogura, Department of Transplantation Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
[Ti] Título:Risk of alcohol use relapse after liver transplantation for alcoholic liver disease.
[So] Source:World J Gastroenterol;23(5):869-875, 2017 Feb 07.
[Is] ISSN:2219-2840
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: To investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD). METHODS: The clinical records of 102 patients with ALD who were referred to Nagoya University Hospital for LT between May 2003 and March 2015 were retrospectively evaluated. History of alcohol intake was obtained from their clinical records and scored according to the High-Risk Alcoholism Relapse scale, which includes duration of heavy drinking, types and amount of alcohol usually consumed, and previous inpatient treatment history for alcoholism. All patients were assessed for eligibility for LT according to comprehensive criteria, including Child-Pugh score, Model for End-Stage Liver Disease score, and psychosocial criteria. RESULTS: Of the 102 patients with ALD referred for LT, seven (6.9%) underwent LT. One (14.3%) of these seven patients returned to heavy drinking, but that patient was able to successfully quit drinking following an immediate intervention, consisting of psychotherapeutic education and supportive psychotherapy, by a psychiatrist. A comparison between the transplantation/registration (T/R) group, consisting of the seven patients who underwent LT and 10 patients listed for deceased donor LT, and 50 patients who did not undergo LT and were not listed for deceased donor LT (non-T/R group), showed statistically significant differences in duration of abstinence period ( < 0.01), duration of heavy drinking ( < 0.05), adherence to medical treatment ( < 0.01), and declaration of abstinence ( < 0.05). CONCLUSION: Patients with ALD referred for LT require comprehensive evaluation, including evaluation of psychosocial criteria, to prevent alcoholic recidivism.
[Mh] Termos MeSH primário: Hepatopatias Alcoólicas/cirurgia
Transplante de Fígado
[Mh] Termos MeSH secundário: Adulto
Idoso
Consumo de Bebidas Alcoólicas/prevenção & controle
Consumo de Bebidas Alcoólicas/psicologia
Consumo de Bebidas Alcoólicas/terapia
Feminino
Seres Humanos
Hepatopatias Alcoólicas/psicologia
Transplante de Fígado/psicologia
Masculino
Meia-Idade
Psicologia
Psicoterapia
Recidiva
Estudos Retrospectivos
Fatores de Risco
Temperança/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE
[do] DOI:10.3748/wjg.v23.i5.869


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[PMID]:28123032
[Au] Autor:Caprioli D; Venniro M; Zhang M; Bossert JM; Warren BL; Hope BT; Shaham Y
[Ad] Endereço:Behavioral Neuroscience Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224 daniele.caprioli@uniroma1.it yavin.shaham@nih.gov.
[Ti] Título:Role of Dorsomedial Striatum Neuronal Ensembles in Incubation of Methamphetamine Craving after Voluntary Abstinence.
[So] Source:J Neurosci;37(4):1014-1027, 2017 Jan 25.
[Is] ISSN:1529-2401
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We recently developed a rat model of incubation of methamphetamine craving after choice-based voluntary abstinence. Here, we studied the role of dorsolateral striatum (DLS) and dorsomedial striatum (DMS) in this incubation. We trained rats to self-administer palatable food pellets (6 d, 6 h/d) and methamphetamine (12 d, 6 h/d). We then assessed relapse to methamphetamine seeking under extinction conditions after 1 and 21 abstinence days. Between tests, the rats underwent voluntary abstinence (using a discrete choice procedure between methamphetamine and food; 20 trials/d) for 19 d. We used in situ hybridization to measure the colabeling of the activity marker Fos with Drd1 and Drd2 in DMS and DLS after the tests. Based on the in situ hybridization colabeling results, we tested the causal role of DMS D and D family receptors, and DMS neuronal ensembles in "incubated" methamphetamine seeking, using selective dopamine receptor antagonists (SCH39166 or raclopride) and the Daun02 chemogenetic inactivation procedure, respectively. Methamphetamine seeking was higher after 21 d of voluntary abstinence than after 1 d (incubation of methamphetamine craving). The incubated response was associated with increased Fos expression in DMS but not in DLS; Fos was colabeled with both Drd1 and Drd2 DMS injections of SCH39166 or raclopride selectively decreased methamphetamine seeking after 21 abstinence days. In Fos-lacZ transgenic rats, selective inactivation of relapse test-activated Fos neurons in DMS on abstinence day 18 decreased incubated methamphetamine seeking on day 21. Results demonstrate a role of DMS dopamine D and D receptors in the incubation of methamphetamine craving after voluntary abstinence and that DMS neuronal ensembles mediate this incubation. SIGNIFICANCE STATEMENT: In human addicts, abstinence is often self-imposed and relapse can be triggered by exposure to drug-associated cues that induce drug craving. We recently developed a rat model of incubation of methamphetamine craving after choice-based voluntary abstinence. Here, we used classical pharmacology, in situ hybridization, immunohistochemistry, and the Daun02 inactivation procedure to demonstrate a critical role of dorsomedial striatum neuronal ensembles in this new form of incubation of drug craving.
[Mh] Termos MeSH primário: Corpo Estriado/fisiologia
Fissura/fisiologia
Ingestão de Alimentos/fisiologia
Metanfetamina/administração & dosagem
Neurônios/fisiologia
Temperança
[Mh] Termos MeSH secundário: Animais
Comportamento de Escolha/efeitos dos fármacos
Comportamento de Escolha/fisiologia
Corpo Estriado/efeitos dos fármacos
Fissura/efeitos dos fármacos
Comportamento de Procura de Droga/efeitos dos fármacos
Comportamento de Procura de Droga/fisiologia
Ingestão de Alimentos/efeitos dos fármacos
Ingestão de Alimentos/psicologia
Feminino
Injeções Intraventriculares
Masculino
Neurônios/efeitos dos fármacos
Ratos
Ratos Sprague-Dawley
Ratos Transgênicos
Autoadministração
Temperança/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
44RAL3456C (Methamphetamine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170127
[St] Status:MEDLINE
[do] DOI:10.1523/JNEUROSCI.3091-16.2016


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[PMID]:27718053
[Ti] Título:Ist das Abstinenzgebot noch relevant?.
[So] Source:Neuropsychiatr;30(3):169-172, 2016 Sep.
[Is] ISSN:0948-6259
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Abstinência de Álcool/psicologia
Alcoolismo/reabilitação
Temperança
[Mh] Termos MeSH secundário: Abstinência de Álcool/tendências
Consumo de Bebidas Alcoólicas/psicologia
Alcoolismo/diagnóstico
Alcoolismo/psicologia
Comparação Transcultural
Diagnóstico Precoce
Europa (Continente)
Seres Humanos
Cooperação do Paciente/psicologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; NEWS
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170406
[Lr] Data última revisão:
170406
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161009
[St] Status:MEDLINE


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[PMID]:27628590
[Au] Autor:Mericle AA; Karriker-Jaffe KJ; Gupta S; Sheridan DM; Polcin DL
[Ad] Endereço:Alcohol Research Group, Public Health Institute, Emeryville, CA, USA. americle@arg.org.
[Ti] Título:Distribution and Neighborhood Correlates of Sober Living House Locations in Los Angeles.
[So] Source:Am J Community Psychol;58(1-2):89-99, 2016 09.
[Is] ISSN:1573-2770
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Sober living houses (SLHs) are alcohol and drug-free living environments for individuals in recovery. The goal of this study was to map the distribution of SLHs in Los Angeles (LA) County, California (N = 260) and examine neighborhood correlates of SLH density. Locations of SLHs were geocoded and linked to tract-level Census data as well as to publicly available information on alcohol outlets and recovery resources. Neighborhoods with SLHs differed from neighborhoods without them on measures of socioeconomic disadvantage and accessibility of recovery resources. In multivariate, spatially lagged hurdle models stratified by monthly fees charged (less than $1400/month vs. $1400/month or greater), minority composition, and accessibility of treatment were associated with the presence of affordable SLHs. Accessibility of treatment was also associated with the number of affordable SLHs in those neighborhoods. Higher median housing value and accessibility of treatment were associated with whether a neighborhood had high-cost SLHs, and lower population density was associated with the number of high-cost SLHs in those neighborhoods. Neighborhood factors are associated with the availability of SLHs, and research is needed to better understand how these factors affect resident outcomes, as well as how SLHs may affect neighborhoods over time.
[Mh] Termos MeSH primário: Alcoolismo/reabilitação
Casas para Recuperação
Distribuição Espacial da População
Fatores Sociológicos
Transtornos Relacionados ao Uso de Substâncias/psicologia
Transtornos Relacionados ao Uso de Substâncias/reabilitação
Temperança/psicologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Bebidas Alcoólicas/provisão & distribuição
Alcoolismo/economia
Alcoolismo/psicologia
Feminino
Casas para Recuperação/economia
Acesso aos Serviços de Saúde/economia
Seres Humanos
Los Angeles
Masculino
Meia-Idade
Grupos de Autoajuda/economia
Grupos de Autoajuda/estatística & dados numéricos
Fatores Socioeconômicos
Transtornos Relacionados ao Uso de Substâncias/economia
Temperança/economia
Populações Vulneráveis/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171121
[Lr] Data última revisão:
171121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160916
[St] Status:MEDLINE
[do] DOI:10.1002/ajcp.12084


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[PMID]:27627782
[Au] Autor:Garbutt JC; Kampov-Polevoy AB; Kalka-Juhl LS; Gallop RJ
[Ad] Endereço:Department of Psychiatry, University of North Carolina at Chapel Hill2Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill.
[Ti] Título:Association of the Sweet-Liking Phenotype and Craving for Alcohol With the Response to Naltrexone Treatment in Alcohol Dependence: A Randomized Clinical Trial.
[So] Source:JAMA Psychiatry;73(10):1056-1063, 2016 Oct 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Identification of moderators of the response to naltrexone hydrochloride treatment for alcohol dependence could improve clinical care for patients with alcohol use disorders. Objective: To investigate the preliminary finding that the sweet-liking (SL) phenotype interacts with a high level of craving for alcohol and is associated with an improved response to naltrexone in alcohol dependence. Design, Setting, and Participants: This 12-week double-blind, randomized, placebo-controlled clinical trial was conducted from February 1, 2010, to April 30, 2012, in an academic outpatient medical center. Eighty actively drinking patients were randomized by the SL (n = 22) or the sweet-disliking (SDL) (n = 58) phenotype and by pretreatment high (n = 40) or low (n = 40) craving for alcohol, with high craving defined as greater than the median. Patients and staff were blinded to categorization. Patients were excluded for unstable medical or psychiatric illness, including dependence on drugs other than nicotine. Four patients (2 in the placebo arm and 2 in the naltrexone arm) stopped medication therapy because of adverse effects. Data were analyzed from January 15, 2013, to May 15, 2016, based on intention to treat. Interventions: Oral naltrexone hydrochloride, 50 mg/d, or daily placebo with weekly to biweekly brief counseling. Main Outcomes and Measures: The a priori hypothesis tested SL/SDL phenotype, pretreatment craving, and their interaction as moderators of frequency of abstinent and heavy drinking days during treatment, assessed with the timeline follow-back method. Results: Eighty patients were randomized (57 men [71%]; 23 women [29%]; mean [SD] age, 47.0 [8.6] years). A nonsignificant effect of naltrexone on heavy drinking was noted (4.8 fewer heavy drinking days; Cohen d = 0.45; 95% CI, -0.01 to 0.90; F1,67 = 3.52; P = .07). The SL phenotype moderated the effect of naltrexone on heavy drinking (6.1 fewer heavy drinking days; Cohen d = 0.58; 95% CI, 0.12-1.03; F1,67 = 5.65; P = .02) and abstinence (10.0 more abstinent days; Cohen d = 0.57; 95% CI, 0.11-1.02; F1,67 = 5.36; P = .02), and high craving moderated heavy drinking (7.1 fewer heavy drinking days; Cohen d = 0.66; 95% CI, 0.20-1.11; F1,67 = 7.37; P = .008). The combination of the SL phenotype and high craving was associated with a strong response to naltrexone, with 17.1 fewer heavy drinking days (Cohen d = 1.07; 95% CI, 0.58-1.54; F1,67 = 19.33; P < .001) and 28.8 more abstinent days (Cohen d = 0.72; 95% CI, 0.25-1.17; F1,67 = 8.73; P = .004) compared with placebo. Conclusions and Relevance: The SL phenotype and a high craving for alcohol independently and particularly in combination are associated with a positive response to naltrexone. The SL/SDL phenotype and a high craving for alcohol merit further investigation as factors to identify patients with alcohol dependence who are responsive to naltrexone. Trial Registration: clinicaltrials.gov Identifier: NCT01296646.
[Mh] Termos MeSH primário: Alcoolismo/genética
Alcoolismo/reabilitação
Fissura/efeitos dos fármacos
Fissura/fisiologia
Naltrexona/uso terapêutico
Fenótipo
Paladar/genética
[Mh] Termos MeSH secundário: Adulto
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Meia-Idade
Temperança
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
5S6W795CQM (Naltrexone)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170501
[Lr] Data última revisão:
170501
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160915
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2016.2157


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[PMID]:27618169
[Au] Autor:Schmid P; Widmann B; Jekel A; Nelles U; Fritschi T; Uhlmann C
[Ad] Endereço:Zentrum für Psychiatrie Südwürttemberg, Suchtabteilung Ravensburg, Klinik 1 für Psychiatrie und Psychotherapie, Universität Ulm.
[Ti] Título:[Conceptual and Cognitive Restructuring?]
[Ti] Título:Konzeptionelle und kognitive Umstrukturierung?.
[So] Source:Psychiatr Prax;43(8):441-443, 2016 Nov.
[Is] ISSN:1439-0876
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:In the treatment of patients with alcohol dependence it is next to physical detoxification under protected conditions to promoting abstinence motivation. Further the need of crisis interventions is derived from the clinical practise. To be able to become fairer to all groups of treatment as well as the different demands, the addiction admission station was restructured. Pre-post-evaluation. It was found that the door was closed up significantly less often after the restructuring. In the residence time structure an increase appeared in the descriptive values with the more than 7-day stays. It is to be able to hold successfully the optional closed door highly significantly more often open.
[Mh] Termos MeSH primário: Alcoolismo/psicologia
Alcoolismo/reabilitação
Terapia Cognitiva/métodos
Terapia Cognitiva/organização & administração
Formação de Conceito
Unidade Hospitalar de Psiquiatria/organização & administração
Temperança/psicologia
[Mh] Termos MeSH secundário: Adulto
Agressão/psicologia
Internação Compulsória de Doente Mental
Intervenção na Crise/métodos
Intervenção na Crise/organização & administração
Feminino
Alemanha
Reestruturação Hospitalar/organização & administração
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Motivação
Avaliação de Processos e Resultados (Cuidados de Saúde)
Equipe de Assistência ao Paciente/organização & administração
Satisfação do Paciente
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160913
[St] Status:MEDLINE


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[PMID]:27449273
[Au] Autor:Crist RC; Doyle GA; Kampman KM; Berrettini WH
[Ad] Endereço:Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA. Electronic address: crist@mail.med.upenn.edu.
[Ti] Título:A delta-opioid receptor genetic variant is associated with abstinence prior to and during cocaine dependence treatment.
[So] Source:Drug Alcohol Depend;166:268-71, 2016 Sep 01.
[Is] ISSN:1879-0046
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: An intronic polymorphism in the delta-opioid receptor gene (OPRD1) was previously associated with cocaine dependence in African-Americans. However, it is not known if the polymorphism (rs678849) is associated with dependence-related phenotypes within the cocaine dependent population. METHODS: Cocaine and alcohol dependent subjects were randomized to either topiramate or placebo. Abstinence from cocaine use was confirmed by urine drug screens for benzoylecgonine three times per week. Cocaine withdrawal and craving were assessed at randomization using the Cocaine Selective Severity Assessment (CSSA) and Minnesota Cocaine Craving Scale (MCCS), respectively. Subjects were also interviewed using the Addiction Severity Index (ASI). Genotype at rs678849 was determined for 105 African-American subjects and compared to cocaine abstinence, as well as scores for CSSA, MCCS, and ASI. RESULTS: African-American patients with the C/T or T/T genotypes (n=40) were more likely to be abstinent at the first urine drug screen and more likely to be abstinent for the week prior to randomization compared to patients with the C/C genotype (n=65). Subjects carrying the T allele were also more likely to have abstinent weeks over the course of the trial compared to those with the C/C genotype (RR=1.88, 95% CI=1.59-2.22, p=0.0035). No effects of rs678849 genotype on withdrawal, craving, or addiction severity were observed. CONCLUSIONS: A polymorphism in OPRD1 appears to be associated with both cocaine dependence and cocaine use during treatment in African-Americans. Follow-up studies to confirm the effect on cocaine use are warranted.
[Mh] Termos MeSH primário: Afroamericanos/genética
Intoxicação Alcoólica/genética
Intoxicação Alcoólica/reabilitação
Transtornos Relacionados ao Uso de Cocaína/genética
Transtornos Relacionados ao Uso de Cocaína/reabilitação
Frutose/análogos & derivados
Variação Genética/genética
Receptores Opioides delta/genética
Temperança
[Mh] Termos MeSH secundário: Adulto
Alelos
Feminino
Seguimentos
Frutose/uso terapêutico
Genótipo
Seres Humanos
Masculino
Meia-Idade
Fenótipo
Polimorfismo Genético/genética
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (OPRD1 protein, human); 0 (Receptors, Opioid, delta); 0H73WJJ391 (topiramate); 30237-26-4 (Fructose)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160725
[St] Status:MEDLINE


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[PMID]:27394934
[Au] Autor:Morley KC; Logge W; Pearson SA; Baillie A; Haber PS
[Ad] Endereço:NHMRC Centre for Excellence in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, NSW 2006, Australia. Electronic address: kirsten.morley@sydney.edu.au.
[Ti] Título:National trends in alcohol pharmacotherapy: Findings from an Australian claims database.
[So] Source:Drug Alcohol Depend;166:254-7, 2016 Sep 01.
[Is] ISSN:1879-0046
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although the efficacy of alcohol pharmacotherapy has been widely investigated, little is known about real-world prescription patterns. Population-based dispensing data can provide an understanding of prescription patterns and characteristics of treatment in nonexperimental settings. METHODS: A retrospective cohort study of patients (aged 15-84) treated with acamprosate or naltrexone between July 2009 and June 2013 was conducted using dispensing claims from the Australian Pharmaceutical benefits Scheme Database. Only individuals with prescriptions from September 2009 onwards were included. RESULTS: We identified 61,904 individuals (40% female, 32% in 35-44 age bracket,) with a total number of 198,247 dispensings. There were 23,452 naltrexone-treated and 38,452 acamprosate-treated patients. For naltrexone, 42% of initial dispenses were followed by a second dispense with only 25% receiving at least 3 months of treatment. For acamprosate, 28% of dispenses were followed by a third dispense with only 15% receiving at least 3 months of treatment. Patients in older age groups were more likely to be dispensed a repeat script than those in younger age groups (e.g., for the 75-84 vs 15-24 age bracket OR's=2.27 and 2.98 for naltrexone and acamprosate respectively). CONCLUSION: Current national guidelines in Australia recommend alcohol pharmacotherapy for a minimum period of 3 months yet only 15-25% are receive this duration of treatment. Naltrexone-treated patients were more likely to return for a second and third dispense than acamprosate-treated patients. Prevalence and prescribing patterns change with age.
[Mh] Termos MeSH primário: Dissuasores de Álcool/uso terapêutico
Alcoolismo/reabilitação
Revisão da Utilização de Seguros/estatística & dados numéricos
Naltrexona/uso terapêutico
Taurina/análogos & derivados
[Mh] Termos MeSH secundário: Adulto
Austrália
Esquema de Medicação
Feminino
Fidelidade a Diretrizes
Seres Humanos
Masculino
Cooperação do Paciente/estatística & dados numéricos
Estudos Retrospectivos
Taurina/uso terapêutico
Temperança
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Alcohol Deterrents); 1EQV5MLY3D (Taurine); 5S6W795CQM (Naltrexone); N4K14YGM3J (acamprosate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160711
[St] Status:MEDLINE


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[PMID]:27332703
[Au] Autor:Weisner CM; Chi FW; Lu Y; Ross TB; Wood SB; Hinman A; Pating D; Satre D; Sterling SA
[Ad] Endereço:Department of Psychiatry, University of California, San Francisco2Division of Research, Kaiser Permanente Northern California, Oakland.
[Ti] Título:Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial.
[So] Source:JAMA Psychiatry;73(8):804-14, 2016 Aug 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record and a patient activation approach. OBJECTIVE: To examine the effects of an intervention aiming to link patients receiving addiction treatment with health care. DESIGN, SETTING, AND PARTICIPANTS: A nonrandomized clinical trial evaluating the LINKAGE intervention vs usual care by applying an alternating 3-month off-and-on design over 30 months. Participants were recruited from an outpatient addiction treatment clinic in a large health system between April 7, 2011, and October 2, 2013. INTERVENTIONS: Six group-based, manual-guided sessions on patient engagement in health care and the use of health information technology resources in the electronic health record, as well as facilitated communication with physicians, vs usual care. MAIN OUTCOMES AND MEASURES: Primary outcomes, measured at 6 months after enrollment, were patient activation (by interview using the Patient Activation Measure), patient engagement in health care (by interview and electronic health record), and alcohol, drug, and depression outcomes (by interview using the Addiction Severity Index for alcohol and drug outcomes and Patient Health Questionnaire (PHQ) for depression). RESULTS: A total of 503 patients were recruited and assigned to the LINKAGE (n = 252) or usual care (n = 251) conditions, with no differences in baseline characteristics between conditions. The mean (SD) age of the patients was 42.5 (11.8) years, 31.0% (n = 156) were female, and 455 (90.5%) completed the 6-month interview. Compared with usual care participants, LINKAGE participants showed an increase in the mean number of log-in days (incidence rate ratio, 1.53; 95% CI, 1.19-1.97; P = .001). Similar results were found across types of patient portal use (communicating by email, viewing laboratory test results and information, and obtaining medical advice). LINKAGE participants were more likely to talk with their physicians about addiction problems (odds ratio, 2.30; 95% CI, 1.52-3.49; P < .001). Although 6-month abstinence rates were high for both conditions (≥70.0% for both) and depression symptoms improved (the proportion with scores ≥15 on the 9-item PHQ dropped from 15.1% [38 of 252] to 8.0% [18 of 225] among LINKAGE participants), there were no differences between conditions. Those who received all intervention components had significantly better alcohol and other drug outcomes than those who received fewer intervention components. CONCLUSIONS AND RELEVANCE: Findings support the feasibility and effectiveness of the LINKAGE intervention in helping patients receiving addiction treatment engage in health care and increase communication with their physicians. The intervention did not affect short-term abstinence or depression outcomes. Understanding if the LINKAGE intervention helps prevent relapse and manage long-term recovery will be important. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01621711.
[Mh] Termos MeSH primário: Alcoolismo/reabilitação
Acesso aos Serviços de Saúde
Encaminhamento e Consulta
Centros de Tratamento de Abuso de Substâncias
Transtornos Relacionados ao Uso de Substâncias/reabilitação
[Mh] Termos MeSH secundário: Adulto
Alcoolismo/epidemiologia
Alcoolismo/psicologia
Terapia Combinada
Comorbidade
Registros Eletrônicos de Saúde
Estudos de Viabilidade
Feminino
Seres Humanos
Comunicação Interdisciplinar
Colaboração Intersetorial
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Participação do Paciente
Recidiva
São Francisco
Transtornos Relacionados ao Uso de Substâncias/epidemiologia
Transtornos Relacionados ao Uso de Substâncias/psicologia
Temperança
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160623
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2016.0970



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