To evaluate the clinical observation that the number of individuals seeking opioid detoxification from oxycodone was increasing at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ont; and to identify the characteristics of individuals seeking opioid detoxification at CAMH.
Retrospective analysis of patient health records.
Medical Withdrawal Management Service at CAMH.
All patients admitted for opioid detoxification between January 2000 and December 2004.
Number of opioid detoxification admissions each year; type, dose, and source of opioids; comorbid problems and symptoms.
There were 571 opioid detoxification admissions during the 5-year study period. The number of admissions increased steadily over the 5 years; in particular, the number of admissions related to controlled-release oxycodone increased substantially (3.8%, 8.3%, 20.8%, 30.6%, and 55.4% of the total opioid admissions in 2000 to 2004, respectively; chi(4)2= 105.5, P
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Cites: Drug Alcohol Depend. 2004 Feb 7;73(2):199-20714725960
The clinical characteristics of adolescents reporting methamphetamine as their primary drug of choice: an examination of youth admitted to inpatient substance-abuse treatment in northern British Columbia, Canada, 2001-2005.
We conducted a 5-year medical-chart review of all admissions to an inpatient adolescent substance-abuse program. Youth indicating methamphetamine as their primary drug of choice did not have worse dropout rates or a more severe baseline profile on 4 Addiction Severity Index subscales (Family/Social Conflict, Legal, Psychological, and Medical), compared to adolescents reporting another drug of choice.
Upon administering the South Oaks Gambling Screen to 328 clients with substance dependence problems in treatment facilities in Windsor, Ontario, it was found that high rates of pathological gambling occur comorbidity with substance dependence. Levels of problem and pathological gambling were found to be consistent with similar studies done in North America. Treatment professionals are urged to screen for pathological gambling when treating other addictions, as this growing cormorbid addiction can compound problems when undetected.
The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described.
First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms.
This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.
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Cites: Int Clin Psychopharmacol. 2004 Jan;19(1):1-715101563
For many years, clinicians, especially those working in rehabilitation centers for alcohol and drug users, have been preoccupied with clients presenting with dual diagnosis: substance abuse and legal problems. Comparative analyses of three groups of addicted men, 553 offenders and 499 nonoffenders in treatment for addiction problems and 103 addicted inmates were made to ascertain the biopsychosocial profile of these persons. Results showed that dual-diagnosis clients experienced more severe biopsychosocial problems than the nonoffending group of subjects. Offenders in prison experienced more social maladjustment than offenders in drug addiction treatment, they were less preoccupied by their drug consumption, and less motivated to change. Implications for treatment are discussed.
Correlations between population levels of prescription opioid use and prescription-opioid-related substance use treatment admissions in the USA and Canada since 2001.
Ethnicity and psychiatric comorbidity among alcohol-dependent persons who receive inpatient treatment: African Americans, Alaska natives, Caucasians, and Hispanics.
This study examined ethnic and gender differences of psychiatric comorbidity among alcohol dependent men and women from four ethnic groups: Alaska Native, Caucasians, African Americans, and Hispanics. The data were obtained through individual standardized interview; DSM-III-R diagnoses were obtained via a computer algorithm. The subjects included 1177 Caucasians, 361 African Americans, 93 Hispanics and 486 Alaska Natives. Significant ethnic differences were found in relation to age of onset of alcohol and multiple substance dependence and psychiatric comorbidity. Ethnic differences were also noted with regard to the health care utilization.
The objectives of the present paper were to determine the rate and factors associated with seeking readmission among the clients admitted to an inpatient medical withdrawal management program, Vancouver Detox (VD). All clients who were admitted to VD between July 1, 2003, and June 30, 2004, were included in the study, and were followed up for 1 year. Multinomial logistic regression was performed to investigate the potential risk factors associated with short-term (1 month) and long-term (2 to 12 months) requests for readmission simultaneously. The risk factor associated with short-term request for readmission was leaving VD against medical advice (AMA) during the index admission. Clients who reported to have hepatitis C virus (HCV) infection, whose primary preferred substance was alcohol, and those who were poly-drug users were more likely to request readmission in long-term. Clients with no fixed address were less likely to seek readmission between months 2 and 12.
Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA. douglas.novins@ucdenver.edu
Because of their broad geographic distribution, diverse ownership and operation, and funding instability, it is a challenge to develop a framework for studying substance abuse treatment programs serving American Indian and Alaska Native communities at a national level. This is further complicated by the historic reluctance of American Indian and Alaska Native communities to participate in research.
We developed a framework for studying these substance abuse treatment programs (n ˜ 293) at a national level as part of a study of attitudes toward, and use of, evidence-based treatments among substance abuse treatment programs serving AI/AN communities with the goal of assuring participation of a broad array of programs and the communities that they serve.
Because of the complexities of identifying specific substance abuse treatment programs, the sampling framework divides these programs into strata based on the American Indian and Alaska Native communities that they serve: (1) the 20 largest tribes (by population); (2) urban AI/AN clinics; (3) Alaska Native Health Corporations; (4) other Tribes; and (5) other regional programs unaffiliated with a specific AI/AN community. In addition, the recruitment framework was designed to be sensitive to likely concerns about participating in research.
This systematic approach for studying substance abuse and other clinical programs serving AI/AN communities assures the participation of diverse AI/AN programs and communities and may be useful in designing similar national studies.
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Cites: AIDS Educ Prev. 2002 Oct;14(5):401-1812413186
Cites: Cult Med Psychiatry. 2003 Sep;27(3):259-8914510095
Cites: Implement Sci. 2011;6:6321679438
Cites: Cancer Control. 2005 Nov;12 Suppl 2:70-616327753
Cites: Am J Public Health. 2006 Aug;96(8):1469-7716809606
Cites: Am Indian Alsk Native Ment Health Res. 1989;2(3):7-172490286
This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group.
We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year.
Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR=.96, 95% CL=.94, .99, P=.002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status.
The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.
