This study examined whether perceived barriers to smoking cessation mediate the relationship between tobacco dependence and withdrawal symptoms in African American smokers. 249 daily smokers completed measures of nicotine dependence, barriers to cessation, and withdrawal symptoms both while smoking and during abstinence. Statistical analysis found that the addiction-based barriers subscale significantly mediated the relationship between dependence and abstinence-induced withdrawal. This suggests that greater perceived addiction barriers predict lower smoking cessation success rates due to increased withdrawal severity. The findings have clinical implications for tailoring smoking cessation treatments.
This document discusses research on unassisted smoking cessation. It notes that the majority of ex-smokers quit unassisted, yet most smoking cessation research and programs focus on professionally or pharmacologically assisted methods. The document summarizes several studies conducted by the author and colleagues on unassisted cessation. It argues that unassisted cessation should be presented as a viable first-line option to smokers, rather than an afterthought, since it is how most smokers successfully quit. The document also questions the effectiveness and population-level impact of smoking cessation aids based on limitations of clinical trials and real-world use.
Presentation by Dr Susanne Stanley PhD and Lucia Ferguson - The Wellness Clinic: A model of integrated care for people with complex mental illness.
Presented at the Western Australian Mental Health Conference 2019.
This document discusses drug addiction, including its history and early medical models, definitions of substance abuse and addiction, basic processes like tolerance and physical dependence, and broad views on what causes addiction including substances, biology, personality, and family factors. It also covers addictive disorders and diagnosis, introduction to treatment including defining goals and evaluating outcomes, specific treatment stages and approaches, and concludes with resources and final words.
012012 v156 i2 cytisine increased smoking cessation in adultsGeorgi Daskalov
Cytisine, a partial nicotine receptor agonist, increased smoking cessation rates more than placebo in a randomized controlled trial of 740 adult smokers in Poland. Participants received a 25-day tapering course of cytisine or placebo along with minimal behavioral counseling. At 6-month and 12-month follow-ups, cytisine led to higher rates of smoking abstinence compared to placebo, with numbers needed to treat of 16 to 17. Cytisine was associated with more gastrointestinal side effects than placebo. While promising, further studies are still needed to confirm the findings, assess safety, and determine optimal dosing and cost-effectiveness before cytisine can be recommended for smoking cessation.
This document discusses research on unassisted smoking cessation. It notes that the majority of ex-smokers quit unassisted, yet most smoking cessation research and programs focus on professionally or pharmacologically assisted methods. The document summarizes several studies conducted by the author and colleagues on unassisted cessation. It argues that unassisted cessation should be presented as a viable first-line option to smokers, rather than an afterthought, since it is how most smokers successfully quit. The document also questions the effectiveness and population-level impact of smoking cessation aids based on limitations of clinical trials and real-world use.
Presentation by Dr Susanne Stanley PhD and Lucia Ferguson - The Wellness Clinic: A model of integrated care for people with complex mental illness.
Presented at the Western Australian Mental Health Conference 2019.
This document discusses drug addiction, including its history and early medical models, definitions of substance abuse and addiction, basic processes like tolerance and physical dependence, and broad views on what causes addiction including substances, biology, personality, and family factors. It also covers addictive disorders and diagnosis, introduction to treatment including defining goals and evaluating outcomes, specific treatment stages and approaches, and concludes with resources and final words.
012012 v156 i2 cytisine increased smoking cessation in adultsGeorgi Daskalov
Cytisine, a partial nicotine receptor agonist, increased smoking cessation rates more than placebo in a randomized controlled trial of 740 adult smokers in Poland. Participants received a 25-day tapering course of cytisine or placebo along with minimal behavioral counseling. At 6-month and 12-month follow-ups, cytisine led to higher rates of smoking abstinence compared to placebo, with numbers needed to treat of 16 to 17. Cytisine was associated with more gastrointestinal side effects than placebo. While promising, further studies are still needed to confirm the findings, assess safety, and determine optimal dosing and cost-effectiveness before cytisine can be recommended for smoking cessation.
The document discusses various forms of non-compliance with medication regimens, including forgetting to take medications, taking less than the recommended dose, and failing to fill prescriptions. It notes that non-compliance is a major cause of wasted medication and occurs in about 50% of patients. Reasons for non-compliance include medication costs, fear of side effects, distrust of doctors, and reluctance to acknowledge illness. Having multiple prescriptions can also increase non-compliance rates.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
An MS relapse is defined as new or worsening neurological symptoms that last at least 24 hours and occur at least 30 days after any previous symptoms. Symptoms develop over days or weeks and then stabilize and improve over weeks or months. Relapses are characterized by new symptoms, whereas worsening of old symptoms that vary daily are less likely to be relapses. If experiencing relapse symptoms, one should contact their MS nurse and see their neurologist to determine if steroid treatment is appropriate, considering the severity of symptoms and ability to do daily activities. Disease-modifying treatments may help reduce future relapses.
The document discusses strategies for preventing substance abuse and dependency. It outlines several symptoms of substance abuse and dependency according to the DSM-IV-TR, including impaired control over substance use and social/interpersonal problems from use. The most important prevention strategies discussed are early education programs in schools to teach youth about risks and support programs for parents. Effective treatment options include individual counseling, group therapy, outpatient programs, and short or long-term residential care.
This document summarizes research priorities and findings from the National Institute on Drug Abuse (NIDA) regarding the opioid crisis. It outlines NIDA's focus on alternative pain treatments, preventing opioid use disorder and overdoses, improving treatment for opioid use disorder, and implementing evidence-based solutions. Specific areas of research discussed include biomarkers for pain, abuse-deterrent drug formulations, non-medication pain treatments, universal prevention programs for adolescents, easier-to-use naloxone for overdose reversal, new formulations of addiction medications, increasing access to medication-assisted treatment, and using addiction medications earlier to prevent heroin overdoses and improve treatment retention.
Assessing the Appropriateness of Oral Ketamine in DepressionMichael Nguyen
Ketamine has shown promise for treatment-resistant depression based on its rapid antidepressant effects seen in clinical trials. However, the evidence for its use is still limited. A randomized controlled trial compared a single intravenous dose of ketamine (0.5 mg/kg over 40 minutes) to midazolam in 73 patients with treatment-resistant major depression. Ketamine produced significantly greater improvements in depression scores and response rates at 24 hours based on the primary and secondary outcomes. While adverse effects were common, they were transient. However, the study only assessed a single intravenous dose and longer-term safety and efficacy remain unknown. Overall, more research is still needed regarding appropriate dosing and administration routes before ketamine can be recommended for routine
Substance abuse and treatment final presentationTyler Guna
This document discusses substance abuse and treatment. It defines substance abuse as unstable drug use that causes significant problems over a period of 12 months. Most treatment programs in the US follow the Minnesota Model, which recognizes that drug users have lost control and need to relearn living without drugs. The Minnesota Model involves 4 steps - admitting there is a problem, entering treatment which can be inpatient or outpatient, undergoing therapy like counseling and meetings, and remaining sober with support from others by avoiding triggers and maintaining a healthy lifestyle. Effective treatment considers individual needs, is readily available, and monitors drug use during the program.
1) Tobacco smoking remains the leading preventable cause of disease and death worldwide. While smoking rates have decreased in developed countries, certain high risk groups have greater difficulty quitting.
2) Brief advice from doctors and other healthcare professionals on smoking cessation can more than double quit rates compared to no advice. Comprehensive treatment involving both behavioral support and pharmacotherapy is most effective for treating nicotine dependence.
3) Effective cessation medications include nicotine replacement therapy, varenicline, bupropion, and others depending on location. Behavioral support through counseling, telephone quitlines, internet programs, and motivational interviewing can also significantly increase success rates.
The disadvantage of MDMA or Ecstasy use has been reported to lead to clinical depression, confusion, panic attack ,anxiety, and sleep depravations. Other negative side effects of using Ecstasy involve:
This document discusses addictive behavior and the neurobiology of addiction. It defines addictive behavior as compulsive drug use despite negative consequences and craving effects beyond pain relief. It describes how drugs of abuse hijack the brain's reward system and lead to long-term changes in gene expression and neural plasticity through mechanisms like conditioning and memory formation. These changes help explain why addiction is persistent and why drug cues can trigger intense craving and relapse. The neurobiology of addiction involves dysregulation of the dopamine and other neurotransmitter systems in the brain's reward pathways.
This study evaluated the effectiveness of a novel intervention called Customized Adherence Enhancement (CAE) for improving medication adherence in patients with bipolar disorder. The study found that patients who responded well to the intervention ("Converters") showed improved medication attitudes and adherence after treatment and at 3-month follow-up, while patients who did not respond well ("Non-Converters") showed little improvement immediately after but some gradual attitude and adherence improvement over time. The results suggest targeting medication attitudes can improve adherence and that a more intensive intervention may be needed for the most non-adherent patients.
This document summarizes a study on racial and ethnic differences in medication adherence among patients newly prescribed antihypertensive medications. The study found that after controlling for factors like income and health status, black, Asian, and Hispanic patients were more likely than white patients to not fill their initial prescription or refill later prescriptions. However, differences in long-term adherence between white and non-white patients decreased when the model accounted for medication costs and use of mail-order pharmacies. The authors conclude that improving access to medications may help reduce persistent gaps in medication use between racial and ethnic groups.
Contrary to the hypothesis, patients seeing a cardiovascular specialist for uncontrolled hypertension were more likely to have their hypertension treatment intensified by their primary care provider. However, those seeing an unrelated specialist were less likely to have their treatment intensified. This suggests primary care providers still consider themselves responsible for hypertension management even when patients see specialists. The study analyzed over 15,000 patients and 70,000 visits from six primary care practices to determine the relationship between specialist care, patient characteristics, and likelihood of primary care providers intensifying hypertension treatment.
This document summarizes research on reducing criminal recidivism. It finds that incarceration has little to no effect or can slightly increase recidivism compared to probation. Intermediate sanctions like electronic monitoring also tend to show small decreases or no difference in recidivism compared to standard supervision. Treatment programs that target criminogenic needs using cognitive behavioral therapy and are properly implemented can reduce recidivism, especially for higher risk offenders. Cost-benefit analyses find that for every $1 spent on correctional programming, taxpayers save $5-7 on average due to reduced crime. Treatment programs for juveniles show the highest returns, with up to $31 saved for every $1 spent.
Here are the 11 DSM-5 criteria for substance use disorder filled in with the blank (___) replaced with "alcohol":
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused
Mechanisms Underlying Mindfulness-Based Addiction Treatment
versus Cognitive Behavioral Therapy and Usual Care for
Smoking Cessation
Claire Adams Spears1, Donald Hedeker2, Liang Li3, Cai Wu3, Natalie K. Anderson4, Sean C.
Houchins4, Christine Vinci5, Diana Stewart Hoover3, Jennifer Irvin Vidrine6, Paul M.
Cinciripini3, Andrew J. Waters7, and David W. Wetter8
1Georgia State University School of Public Health, Atlanta, GA
2The University of Chicago, Chicago, IL
3The University of Texas MD Anderson Cancer Center, Houston, TX
4The Catholic University of America, Washington, DC
5Rice University, Houston, TX
6Stephenson Cancer Center and The University of Oklahoma Health Sciences Center, Oklahoma
City, OK
7Uniformed Services University of the Health Sciences, Washington, DC
8University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT
Abstract
Objective—To examine cognitive and affective mechanisms underlying Mindfulness-Based
Addiction Treatment (MBAT) versus Cognitive Behavioral Therapy (CBT) and Usual Care (UC)
for smoking cessation.
Method—Participants in the parent study from which data were drawn (N = 412; 54.9% female;
48.2% African-American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual
income < $30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From
quit date through 26 weeks post-quit, participants completed measures of emotions, craving,
dependence, withdrawal, self-efficacy, and attentional bias. Biochemically-confirmed 7-day
smoking abstinence was assessed at 4 and 26 weeks post-quit. Although the parent study did not
find a significant treatment effect on abstinence, mixed-effects regression models were conducted
to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on
abstinence were tested.
Results—Participants receiving MBAT perceived greater volitional control over smoking and
evidenced lower volatility of anger than participants in both other treatments. However, there were
no other significant differences between MBAT and CBT. Compared to those receiving UC,
MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as
Corresponding Author: Claire Adams Spears, Ph.D., Assistant Professor, Division of Health Promotion & Behavior, School of Public
Health, Georgia State University; [email protected]; Phone: 404.413.9335.
HHS Public Access
Author manuscript
J Consult Clin Psychol. Author manuscript; available in PMC 2018 November 01.
Published in final edited form as:
J Consult Clin Psychol. 2017 November ; 85(11): 1029–1040. doi:10.1037/ccp0000229.
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well as higher self-efficacy for managing negative affect without smoking. Indirect effects of
MBAT versus UC on abstinence occurred through each of these mechanisms.
Conclusions—Whereas se ...
Drug addiction
Drug treatment intend to help those addicted stop compulsive drug seeking.
Takes different forms, last for different time and happen in a variety settings.
This document summarizes research being conducted by the National Institute on Drug Abuse (NIDA) related to tobacco. It discusses NIDA's focus on basic research including genetics and biomarkers of vulnerability to smoking. It also discusses NIDA's prevention research through the Adolescent Brain Cognitive Development study, as well as medication development, behavioral treatments, research on vulnerable populations, and integrated tobacco epidemiology through studies like the Monitoring the Future study and Population Assessment of Tobacco and Health study. The overall themes of NIDA research are described as understanding the neurobiology of all drugs of abuse and their effects on the brain.
The document discusses various forms of non-compliance with medication regimens, including forgetting to take medications, taking less than the recommended dose, and failing to fill prescriptions. It notes that non-compliance is a major cause of wasted medication and occurs in about 50% of patients. Reasons for non-compliance include medication costs, fear of side effects, distrust of doctors, and reluctance to acknowledge illness. Having multiple prescriptions can also increase non-compliance rates.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
An MS relapse is defined as new or worsening neurological symptoms that last at least 24 hours and occur at least 30 days after any previous symptoms. Symptoms develop over days or weeks and then stabilize and improve over weeks or months. Relapses are characterized by new symptoms, whereas worsening of old symptoms that vary daily are less likely to be relapses. If experiencing relapse symptoms, one should contact their MS nurse and see their neurologist to determine if steroid treatment is appropriate, considering the severity of symptoms and ability to do daily activities. Disease-modifying treatments may help reduce future relapses.
The document discusses strategies for preventing substance abuse and dependency. It outlines several symptoms of substance abuse and dependency according to the DSM-IV-TR, including impaired control over substance use and social/interpersonal problems from use. The most important prevention strategies discussed are early education programs in schools to teach youth about risks and support programs for parents. Effective treatment options include individual counseling, group therapy, outpatient programs, and short or long-term residential care.
This document summarizes research priorities and findings from the National Institute on Drug Abuse (NIDA) regarding the opioid crisis. It outlines NIDA's focus on alternative pain treatments, preventing opioid use disorder and overdoses, improving treatment for opioid use disorder, and implementing evidence-based solutions. Specific areas of research discussed include biomarkers for pain, abuse-deterrent drug formulations, non-medication pain treatments, universal prevention programs for adolescents, easier-to-use naloxone for overdose reversal, new formulations of addiction medications, increasing access to medication-assisted treatment, and using addiction medications earlier to prevent heroin overdoses and improve treatment retention.
Assessing the Appropriateness of Oral Ketamine in DepressionMichael Nguyen
Ketamine has shown promise for treatment-resistant depression based on its rapid antidepressant effects seen in clinical trials. However, the evidence for its use is still limited. A randomized controlled trial compared a single intravenous dose of ketamine (0.5 mg/kg over 40 minutes) to midazolam in 73 patients with treatment-resistant major depression. Ketamine produced significantly greater improvements in depression scores and response rates at 24 hours based on the primary and secondary outcomes. While adverse effects were common, they were transient. However, the study only assessed a single intravenous dose and longer-term safety and efficacy remain unknown. Overall, more research is still needed regarding appropriate dosing and administration routes before ketamine can be recommended for routine
Substance abuse and treatment final presentationTyler Guna
This document discusses substance abuse and treatment. It defines substance abuse as unstable drug use that causes significant problems over a period of 12 months. Most treatment programs in the US follow the Minnesota Model, which recognizes that drug users have lost control and need to relearn living without drugs. The Minnesota Model involves 4 steps - admitting there is a problem, entering treatment which can be inpatient or outpatient, undergoing therapy like counseling and meetings, and remaining sober with support from others by avoiding triggers and maintaining a healthy lifestyle. Effective treatment considers individual needs, is readily available, and monitors drug use during the program.
1) Tobacco smoking remains the leading preventable cause of disease and death worldwide. While smoking rates have decreased in developed countries, certain high risk groups have greater difficulty quitting.
2) Brief advice from doctors and other healthcare professionals on smoking cessation can more than double quit rates compared to no advice. Comprehensive treatment involving both behavioral support and pharmacotherapy is most effective for treating nicotine dependence.
3) Effective cessation medications include nicotine replacement therapy, varenicline, bupropion, and others depending on location. Behavioral support through counseling, telephone quitlines, internet programs, and motivational interviewing can also significantly increase success rates.
The disadvantage of MDMA or Ecstasy use has been reported to lead to clinical depression, confusion, panic attack ,anxiety, and sleep depravations. Other negative side effects of using Ecstasy involve:
This document discusses addictive behavior and the neurobiology of addiction. It defines addictive behavior as compulsive drug use despite negative consequences and craving effects beyond pain relief. It describes how drugs of abuse hijack the brain's reward system and lead to long-term changes in gene expression and neural plasticity through mechanisms like conditioning and memory formation. These changes help explain why addiction is persistent and why drug cues can trigger intense craving and relapse. The neurobiology of addiction involves dysregulation of the dopamine and other neurotransmitter systems in the brain's reward pathways.
This study evaluated the effectiveness of a novel intervention called Customized Adherence Enhancement (CAE) for improving medication adherence in patients with bipolar disorder. The study found that patients who responded well to the intervention ("Converters") showed improved medication attitudes and adherence after treatment and at 3-month follow-up, while patients who did not respond well ("Non-Converters") showed little improvement immediately after but some gradual attitude and adherence improvement over time. The results suggest targeting medication attitudes can improve adherence and that a more intensive intervention may be needed for the most non-adherent patients.
This document summarizes a study on racial and ethnic differences in medication adherence among patients newly prescribed antihypertensive medications. The study found that after controlling for factors like income and health status, black, Asian, and Hispanic patients were more likely than white patients to not fill their initial prescription or refill later prescriptions. However, differences in long-term adherence between white and non-white patients decreased when the model accounted for medication costs and use of mail-order pharmacies. The authors conclude that improving access to medications may help reduce persistent gaps in medication use between racial and ethnic groups.
Contrary to the hypothesis, patients seeing a cardiovascular specialist for uncontrolled hypertension were more likely to have their hypertension treatment intensified by their primary care provider. However, those seeing an unrelated specialist were less likely to have their treatment intensified. This suggests primary care providers still consider themselves responsible for hypertension management even when patients see specialists. The study analyzed over 15,000 patients and 70,000 visits from six primary care practices to determine the relationship between specialist care, patient characteristics, and likelihood of primary care providers intensifying hypertension treatment.
This document summarizes research on reducing criminal recidivism. It finds that incarceration has little to no effect or can slightly increase recidivism compared to probation. Intermediate sanctions like electronic monitoring also tend to show small decreases or no difference in recidivism compared to standard supervision. Treatment programs that target criminogenic needs using cognitive behavioral therapy and are properly implemented can reduce recidivism, especially for higher risk offenders. Cost-benefit analyses find that for every $1 spent on correctional programming, taxpayers save $5-7 on average due to reduced crime. Treatment programs for juveniles show the highest returns, with up to $31 saved for every $1 spent.
Here are the 11 DSM-5 criteria for substance use disorder filled in with the blank (___) replaced with "alcohol":
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused
Mechanisms Underlying Mindfulness-Based Addiction Treatment
versus Cognitive Behavioral Therapy and Usual Care for
Smoking Cessation
Claire Adams Spears1, Donald Hedeker2, Liang Li3, Cai Wu3, Natalie K. Anderson4, Sean C.
Houchins4, Christine Vinci5, Diana Stewart Hoover3, Jennifer Irvin Vidrine6, Paul M.
Cinciripini3, Andrew J. Waters7, and David W. Wetter8
1Georgia State University School of Public Health, Atlanta, GA
2The University of Chicago, Chicago, IL
3The University of Texas MD Anderson Cancer Center, Houston, TX
4The Catholic University of America, Washington, DC
5Rice University, Houston, TX
6Stephenson Cancer Center and The University of Oklahoma Health Sciences Center, Oklahoma
City, OK
7Uniformed Services University of the Health Sciences, Washington, DC
8University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT
Abstract
Objective—To examine cognitive and affective mechanisms underlying Mindfulness-Based
Addiction Treatment (MBAT) versus Cognitive Behavioral Therapy (CBT) and Usual Care (UC)
for smoking cessation.
Method—Participants in the parent study from which data were drawn (N = 412; 54.9% female;
48.2% African-American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual
income < $30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From
quit date through 26 weeks post-quit, participants completed measures of emotions, craving,
dependence, withdrawal, self-efficacy, and attentional bias. Biochemically-confirmed 7-day
smoking abstinence was assessed at 4 and 26 weeks post-quit. Although the parent study did not
find a significant treatment effect on abstinence, mixed-effects regression models were conducted
to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on
abstinence were tested.
Results—Participants receiving MBAT perceived greater volitional control over smoking and
evidenced lower volatility of anger than participants in both other treatments. However, there were
no other significant differences between MBAT and CBT. Compared to those receiving UC,
MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as
Corresponding Author: Claire Adams Spears, Ph.D., Assistant Professor, Division of Health Promotion & Behavior, School of Public
Health, Georgia State University; [email protected]; Phone: 404.413.9335.
HHS Public Access
Author manuscript
J Consult Clin Psychol. Author manuscript; available in PMC 2018 November 01.
Published in final edited form as:
J Consult Clin Psychol. 2017 November ; 85(11): 1029–1040. doi:10.1037/ccp0000229.
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well as higher self-efficacy for managing negative affect without smoking. Indirect effects of
MBAT versus UC on abstinence occurred through each of these mechanisms.
Conclusions—Whereas se ...
Drug addiction
Drug treatment intend to help those addicted stop compulsive drug seeking.
Takes different forms, last for different time and happen in a variety settings.
This document summarizes research being conducted by the National Institute on Drug Abuse (NIDA) related to tobacco. It discusses NIDA's focus on basic research including genetics and biomarkers of vulnerability to smoking. It also discusses NIDA's prevention research through the Adolescent Brain Cognitive Development study, as well as medication development, behavioral treatments, research on vulnerable populations, and integrated tobacco epidemiology through studies like the Monitoring the Future study and Population Assessment of Tobacco and Health study. The overall themes of NIDA research are described as understanding the neurobiology of all drugs of abuse and their effects on the brain.
PROFESSOR JONATHAN CHICK - ANTIPATHY OR NAIVETY: 12-STEP FACILITATION IN UK H...iCAADEvents
When 300 English addiction treatment workers were surveyed, 9% said they used the 12-Step model and only a third felt that their clients were suited to AA or NA. Less than half would recommend trying a meeting. The NHS survey of the UK population found that of people who reported serious concern about their drinking some had had counselling, but very few had ever attended a mutual aid group This presentation traces some myths and barriers and proposes changes for colleagues and su erers.
A Look at a Consumer Peer Based Program with Jill Williams, MDsfary
From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”).
Having peers who have succeeded in recovering from tobacco dependence talk to smokers with mental illness offers advantages. Advantages of using peer counselors include reduced language and cultural barriers, increased trust and lowered defenses, and low cost. Peer counselors are often rated highly by other consumers and there is an added benefit in the modeling that comes from seeing peers do well and return to work. We have promoted community based advocacy and education through the CHOICES Program (Consumers Helping Others Improve their Condition by Ending Smoking). CHOICES employs mental health peer counselors known as Consumer Tobacco Advocates (CTA) to deliver the vital message to smokers with mental illness that addressing tobacco use is important and to motivate them to seek treatment. The philosophy of CHOICES is to bring information to smokers with mental illness about the harm of tobacco, as well as the benefits of quitting and possibilities of treatment. Additional goals are to enhance advocacy and education about addressing tobacco in mental health treatment settings through strong partnerships with a consumer advocacy organization (Mental Health America) and state government (New Jersey Division of Mental Health Services).
Participants will be able to:
- Understand the benefits of using peer counselors to disseminate health education information and increase demand for tobacco services
- Examine existing community relationships and partnerships that will help promote culture change in mental health systems.
- Understand how materials like newsletters and websites increase the reach of peer counselors
- Become familiar with CHOICES, a peer delivered tobacco dependence education and intervention program in New Jersey
This document discusses substance dependence disorder. It begins by outlining the diagnostic criteria according to the DSM-IV, including tolerance, withdrawal symptoms, and impairment. It then discusses epidemiology, finding higher rates in males and those aged 18-25. Comorbidity is also common, especially with other psychiatric disorders in youth. Treatment approaches are suggested, notably motivational interviewing which has been shown as effective as other programs.
This study examined factors affecting adherence to Suboxone treatment among 50 African American patients through a retrospective chart review. The results showed significantly negative correlations between adherence and concurrent use of opioids, cocaine, and alcohol. Surprisingly, PTSD showed a positive correlation with adherence, contradicting other studies. No correlation was found between adherence and unemployment. The study concluded that while mental health issues and unemployment may impact adherence, the small sample size likely influenced the results. Larger studies are still needed to fully understand factors affecting Suboxone adherence in minority groups.
This document discusses medication non-compliance in chronic mental illnesses. It notes that non-compliance is the number one cause of increasing disability in these illnesses. It outlines reasons for non-compliance including disease factors like poor insight and treatment factors like side effects. Consequences of non-compliance include relapse and worsening of symptoms over time. The document recommends strategies like psychoeducation, family support, and long-acting injectable medications to improve medication adherence.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
This document provides an overview of addiction and substance use. It defines addiction as a chronic disease involving brain circuits, genetics, environment and life experiences. It discusses types of addiction including substance and behavioral addiction. Common addictions include tobacco, alcohol, drugs, gambling, food, video games and internet. The document reviews prevalence data on addiction from various sources. It also discusses treatment approaches for behavioral and substance use disorders including detox, individual therapy, group therapy and rehabilitation programs. Recent studies on substance use during the COVID-19 pandemic are also summarized.
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1. Perceived Barriers to Smoking Cessation
Mediates Tobacco Dependence and
Withdrawal in a Primarily African
American Sample
Anika Suddath & Thomas Rutner
Department of Preventive Medicine, USC
1
2. Tobacco Related Race Disparities
African Americans are affected disproportionately
American Lung Association, 2010
Figure from NHIS data
2
3. Dependence and Withdrawal
• More heavily dependent smokers experience more
severe withdrawal symptoms
• Withdrawal Symptoms
– anger, anxiety, craving, difficulty concentrating,
hunger, impatience, and restlessness
Shiffman (1989) Psycho Pharm
Hughes et al., (1991) Arch Gen Psychiatry
3
4. Withdrawal and Cessation Success
• Severe withdrawal symptoms cause poorer cessation
success rates
• Previous cognitive mechanisms
– Depression
– Anxiety
Patten and Martin (1996) Ann Behav Med
4
5. Perceived Barriers
Internal: “feeling less in control of your moods”
External: “no encouragement or help from friends”
Addiction: “thinking of never being able to smoke again”
Perceived barriers predict smoking cessation rates
Macnee & Talsma (1995)
Nursing Research
5
6. Hypothesis
Perceived barriers to cessation act as a cognitive
pathway to mediate the relationship between
dependence and acute tobacco withdrawal
Dependence Barriers Withdrawal
6
7. Participants
249 daily smokers
• non-treatment seeking
• > 10 cig/day for past 2
years
• no use of non-cigarette
tobacco or nicotine
products
Age (SD) 47.2 (11.1)
Sex 45.6% Female
Race 90.4% African American
Cigs/day 14.9 (6.6)
Years
Smoked
27.8 (12.1)
Quit
Attempts
4.6 (9.8)
7
14. Acknowledgments
Raina D. Pang, PhD
Adam M. Leventhal, PhD
Matthew G. Kirkpatrick, PhD
Claudia Aguirre, BA
Mariel S. Bello, BS
Matthew D. Stone, BA
Health, Emotion & Addiction
Laboratory
14
15. Disclosure
Funding Sources
• National Institute on Drug
Abuse
– K01-DA040043
• American Cancer Society
– RSG-13-163-01
• Undergraduate Research
Associates Program, USC
15
Industry Funding
• N/A
Off-Label Medication Use
• N/A
Conflict of Interest Statement
• The authors report no conflicts
of interest
Editor's Notes
I’m Thomas Rutner and we’re undergraduate fellows from the University of Southern California here to present our talk on the mediational affect of Perceived Barriers to Smoking cessation from tobacco Dependence to withdrawal in African Americans.
So let’s begin.
In the 50 years since the original surgeon general report on its dangers, cigarette smoking has dropped drastically to about 20% of the adult population in the United States. However, smoking remains the leading cause of cancer and is the cause of nearly 400 thousand premature deaths annually. Many groups also remain disproportionately at risk. One of these is the African American population, which has been shown to have higher rates of lung cancer and lower successful cessation rates compared to other smoking populations. This graph comes from National Health Interview Survey which shows that African-Americans have consistently had lower successful cessation rates than both white and Hispanic populations since 1965. In addition, the population remains understudied in tobacco literature, which has led us to make this group be the focus of our study.
Given the ubiquitous information regarding the danger of smoking, many highly dependent smokers express a desire to quit, but find themselves unable to do so. Previous studies have shown that more heavily dependent smokers experience more severe withdrawal symptoms. This is problematic because withdrawal symptoms have been shown to directly correlate to smokers having greater difficulty quitting. These symptoms which we measured include anger, anxiety, craving, difficulty concentrating, hunger, impatience, and restlessness.
So as I mentioned, more severe symptoms have been shown to result in poorer cessation success, which leads a lot of study today being devoted to reducing these symptoms. The goal is that finding ways to reduce these symptoms may help the final 20% of the population quit smoking. With that in mind, our literature search showed that previous studies have considered how depression, anxiety, and other mental conditions can act as cognitive mechanisms to affect smoking cessation, but have yet to consider perceived barriers as one of these potential cognitive mechanisms.
Anika
Perceived barriers to cessation acts as a cognitive appraisal which underlies a smoker’s self confidence in quitting. It’s important to think of these barriers not as current obstacles in a smoker’s life; rather as perceived or possible obstacles which may hinder a smoker during a future cessation attempt. These obstacles fall into three distinct categories internal, external and addiction which are related to three distinct bodies of literature associated with smoking cessation. For example, if a smoker believes that feeling less in control of her mood would hinder her ability to quit, that would be an internal barrier. As an individual develops a higher dependency to tobacco, say they smoke a cigarette as soon as they wake up in the morning, with their cup of coffee, with every meal and with their friends, cigarettes become a more integral part of the smoker’s life, thus when thinking about a quit attempt a more highly dependent smoker may perceive no encouragement or help from their friends as a larger hindrance to a successful quit attempt. When compared to a less dependent smoker, let’s say someone who smokes once a week, not having that help or encouragement from their friends may not seem as big of an obstacle in their quit success. Interestingly, addiction based barriers such ast thinking of never being able to smoke again, or other pharmacological and behavioral withdrawal symptoms are some of the most commonly reported perceived barriers to quitting. Furthermore, perceived barriers have also been found to independently predict the success or relapse rate of a smoking cessation attempt.
Anika
While no study to our knowledge has investigated perceived barriers as cognitive mechanism between tobacco dependence and tobacco withdrawal, prior theory does supports this pathway. Therefore we hypothesize that perceived barriers to a cessation attempt act as a cognitive pathway to mediate the relationship between dependence and acute tobacco withdrawal
Anika
Our study includes 249 non-treatment seeking daily cigarette smokers
In order to participate the participants must have been smoking 10 cigarettes a day or more for the past two year, be 18 years or older, fluent in English in order to complete our surveys, they could not have a current DSM_IV mood disorder or non-nicotine substance dependence, they could not use be using any other tobacco or nicotine products, and our female participants could not be currently pregnant or had a child within the past 6 months.
The average age of our participants was 47 years old, about 46% were female. 90.4% were African American, our study is not comprised exclusively of African Americans because it is part of a larger ongoing study where we are collecting data for a control group comprised of European Americans, for our smoking statistics the average number of cigarettes smoked per day was 15, years smoked was 28, and lifetime quit attempts was 4.6.
Anika
In our study design, after an initial phone screening to determine their eligibility, participants were scheduled for their baseline session, which was followed by two experimental session that were randomized and counterbalanced. If a participant was in randomization scheme A they
During the baseline or initial session we measured each smoker’s dependence and perceived barriers. To assess nicotine dependence severity we used the fagerstrom test of nicotine dependence which is a well-validated and widely used measure for this purpose. The barriers to cessation scale measures the degree to which perceived barriers may hinder the smoker during a future cessation attempt. The barriers are broken down into 3 subscales internal, external and addiction, where the participants must rate whether each item would be not a barrier to large barrier in hindering them during a future quit attempt. During each of the experimental sessions we used the minnesota nicotine withdrawal scale which measures withdrawal symptoms experienced so far today on a scale from none to severe. In our dataset we used the difference score between the non-deprived and deprived sessions to model abstinence induced withdrawal symptoms
So for our statistical analysis we used Process Macro for SPSS as our mediational pathway. To do so we labeled an A path which is the path of the predictor to the mediator, in our case the from Nicotine Dependence to the Perceived Barriers, and then a B path from the mediator to the outcome while controlling for the predictor, so the Perceived Barriers to Withdrawal Symptoms. After doing this, the model determines the indirect or mediational effect by multiplying paths A and B. After running this model for all the subscales, we controlled for depression, anxiety, gender, and smoking statistics, and the only one that was significant was the BCS Addiction as a mediational pathway.
So in this graphic to display our pathways we see we do have a significant direct path, which is the predictor to the outcome, or in our case FTND to the MNWS. But we also see that we have a significant A path and B path in order to end with a significant mediational effect. When we take this indirect effect and divide it by the total effect we see, we end up with a proportion mediated by of 30.7%. And so this shows that increased nicotine dependence predicts increased perceived addiction based barriers to cessation which in turn predicts more severe withdrawal symptoms during acute abstinence.
Which leads us to our conclusion, once again, that addiction based barriers represent a significant mediator between tobacco dependence and withdrawal symptoms. By extension, this also shows that these barriers could affect a smoker’s ability to quit, which has a number of clinical implications for the future. There is potential for the use of this information in treatment programs which do not currently appraise their patients’ perceived barriers to smoking cessation. We hope that this may help the treatment programs reach the last, most treatment-resistant, group of smokers.
The scope of our current study does lead to some future directions. We’re limited in our study to only include non-treatment seeking smokers and only being able to analyze the effect of acute abstinence of about 16 hours. Both of these traits make extrapolation from our findings to the overall smoking population difficult as treatment-seeking smokers or long-term abstinence effects may report differently. A future study may be able to examine these effects in a longitudinal study to even better inform treatment programs. As a final note, we did not have enough European American participants to make any conclusions between races and further study of this population would make these comparisons possible. However, the results are still promising and provide some clarity on how perceived barriers affect quit attempts in the smoking population at large, not just African-Americans.