The Use of Motivational Interviewing (Mi) in Preventing Relapse on Methamphetamine Drug User

Methamphetamine (MA) is a potent stimulant with a high potential for abuse that can be smoked, inhaled, injected or taken orally. It is easily being relapse among drug abuse. Thus, this study aims to investigate the impact of drug addiction therapy utilizing the Motivational Interviewing (MI) approach. This is a qualitative study using interview sessions as a study design. The subject is a drug misuse client undergoing imprisonment in Kajang Prison, Selangor. Client’s progression was assessed through direct observations using the Mental State Examination (MSE), client records, and client speech changes. The study revealed that client has gained mental literacy and the client needs to change his behaviors so that the misery does not recur. The use of MI strategies in treatment sessions has been able to help clients eliminate ambiguities related to addictive behaviors, clients are confident to stay recovering and now have concrete plans to not re -addict in the future. The implications of the findings of this case study suggest the MI strategy is a treatment option that counselors can use in assisting drug abuse clients.

Attachment and Therapeutic Alliance in Substance Use Disorders: Initial Findings for Treatment in the Therapeutic Community

Background: There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. In contrast, a strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. However, insecure attachment has been observed to be linked with weaker therapeutic alliance strength. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. Furthermore, SUD patients were compared to healthy controls regarding attachment, personality and mood pathology.Methods: A total sample of 68 participants, 34 inpatients in SUD treatment and 34 age-gender and education adjusted controls, were investigated. Both groups filled in the Adult Attachment Scale (AAS), the Inventory of Personality Organization (IPO-16), and the Brief Symptom Inventory (BSI-18) questionnaires. Additionally, SUD patients filled in the Working Alliance Inventory (WAI-SR) and the adapted German version of the University of Rhode Island Change Assessment scale (FEVER).Results: In line with our assumptions, SUD patients exhibited a decreased amount of attachment security (AAS) which was related to higher personality (IPO-16) and mood pathology (BSI-18). Furthermore, correlational analysis revealed the WAI-SR dimension Bond being positively associated with more secure attachment. A strong task alliance was linked to the Action stage of change (FEVER) and decreased mood but not personality pathology.Conclusion: Our findings confirm the putative negative effect of attachment and personality pathology on therapy motivation and therapeutic alliance in addiction therapy as well as more specifically in therapeutic community treatment. Future research in enhanced samples might focus more on the long-term effects of the interaction of attachment, personality and therapeutic alliance variables.

Type D Personality, Stress Level, Life Satisfaction, and Alcohol Dependence in Older Men

Alcohol consumption among older adults is becoming an increasing public health problem due to the rapidly growing elderly population. There is a theory that Type D personality is positively correlated with alcohol dependence. The study aimed to assess the style of coping with stress, emotions and anxiety in elder men addicted to alcohol and the relationship between the above. The study included 170 men aged 60 years and older (mean age - 63 ± 3.1 years) addicted to alcohol staying in the Department of Alcohol Addiction Therapy for Men. They were tested with the questionnaire sheet and the following scales: Perceived Family Wealth (PFW), Family Affluence Scale (FAS), Cantril's Ladder of Life Scale, Satisfaction with Life Scale, Type D Personality Scale-14 (DS14), and the 10-item Perceived Stress Scale (PSS-10). The respondents' wealth on a scale of 1–5 points was assessed on avg. 3.1 ± 0.2. The above was confirmed by the results of the FAS scale study, where the respondents obtained an average of 3.9 ± 1.9 (min. 1, max. 8), which proves their average level of affluence. The evaluation of the satisfaction with life using Cantril's Ladder showed that the respondents were also satisfied with life on average (on average 5.5 ± 1.9). The assessment of life satisfaction using the Satisfaction with Life Scale (SWLS) scale allowed for the conclusion that the respondents were very dissatisfied with their lives (mean 17.2 ± 4.9). The evaluation of the measurement of perceived stress (PSS-10 scale) showed that the respondents obtained an average of 23.5 ± 3.7, and on the sten scale, a mean of 7.7 ± 0.98, which proves a high level of perceived stress. The study using the DS14 scale showed that the respondents were in the negative emotionality (NE) subscale - 17.4 ± 4.5 points, and in the HS scale - 16.2 ± 3.2, which proves that they can be classified as a Type D personality. The participants were very dissatisfied with their lives, with a high perceived stress and Type D personality.

Development of a virtual reality simulation for exposure based addiction therapy

After the success of virtual reality (VR) applications in supporting exposure-based and psychoeducational cognitive behavioural therapy for various mental illnesses, the technology is also gaining traction in addiction medicine. This paper will describe the concept behind a custom-developed VR simulation for this application with a particular emphasis on alcohol-related addictive disorders. Using Unreal Engine 4, an exposure simulation and a scenario for learning and applying coping strategies were developed for the Oculus Quest. Because of the common association of supermarkets with the procurement of alcohol among addicts, a small shop was implemented as initial scenario. Since the feeling of presence is an important parameter in the quality assessment of a simulation, the degree of immersion was evaluated in initial practical tests after development. In surveys with ten healthy testers, the majority showed a feeling of immersion. Cybersickness and unrealistic collision physics were identified as disruptive factors to the extent of immersion. This work provides the basis for a novel concept for addiction therapy which focusses on a fusion of playful psychoeducation, adjustable exposure, and the internalization of coping strategies with the help of multisensory biofeedback as well as the documentation of the objective physiological measurements for assessment of therapy success. The aim is to best possible address the specific requirements for clinical and home use in terms of self-containment, immersion, and ease of use. To evaluate and exploit the scientific potential of this concept scientific studies and technical improvements to both simulation and hardware are required.

Virtual Therapeutics – Requirements to deliver value with virtual reality and biofeedback applications for alcohol addiction therapy

The application of virtual reality (VR) as a supportive tool in psychotherapy has gained great popularity in recent years. Especially for addiction therapy, a combination of virtual exposure and learning or training coping skills by using biofeedback has a high potential to improve conventional therapy. To add value, the new therapy system has to meet the needs of patients and practitioners likewise. Added values consistently named by experts included, but were not limited to, new possibilities of creating individual exposition or coping scenarios, enhanced psychoeducation, a shorter duration of treatment, telemedical aspects, the possibility of measuring and predicting craving and finally an improvement in abstinence. Besides literature research, we evaluated existing technical solutions in the field of virtual addiction treatment, surveyed experts and evolved a concept that led to a first prototype. The prototype consists of a wireless VR headset and a wireless multi-sensor system for measuring the physiological reaction to stimuli or the effectiveness of coping strategies by means of biofeedback. For further studies we developed both, a virtual exposure and a coping scenario and tested the hardware and software in a pilot study in order to elaborate factors that could negatively affect the therapy adherence, the effectiveness of exposition (immersion) and possible hurdles in practical use. Cybersickness and the lack of haptic feedback turned out to be the main limiting factors. Concepts for the next iteration of the therapy system will reflect these points for upcoming clinical studies. In our proof of concept, we demonstrated that virtual therapy can be implemented with a reasonable effort of time and costs. The combination of software and hardware, that supplements the traditional therapeutic approach, lays the foundation for upcoming clinical use and trials to prove the better outcome of VR enhanced addiction therapy.

Histochemical characteristics of nitrergic neuronal system during acute alcohol intoxication and nNOS blockage in the rat lateral septum

Annotation. Alcohol is a one of the most frequently consumed substances of abuse, which can cause addiction or alcohol use disorders (AUDs). Alcohol addiction leads to decrease of the life quality of patients and considerable economic burden. Neuronal mechanisms of addiction are intensively studied. One of the most important systems involved in this process is a brain reward system that includes lateral septum (LS). Additionally alcohol consumption changes activity of the neurotransmitter systems including the nitric oxide (NO). Recent studies for blockage of nitric oxide synthase (NOS) for cocaine addiction and late stages of AUDs demonstrated that a group of the substances known as blockers of NOS can be referred to as candidates for alcohol addiction therapy. The aim of our research was to investigate histochemical characteristics of NO-system in LS, its response to acute alcohol intoxication including or excluding neuronal NOS (nNOS) blockage with selective inhibitor – 7-nitroindazole (7-NI). This study involved three experimental groups of animals (control group (n=4), group with acute alcohol intoxication (n=4), group of nNOS blockage with acute alcohol intoxication (n=4)). For statistical analysis, one-way Kruskal-Wallis test was implemented to reveal differences between groups (Matlab, Mathworks). We have identified NOS-positive structures in LS consisting of big neurons, medium/small neurons and nerve fibers. Acute alcohol intoxication activated subpopulations of NOS-positive medium/small neurons and nerve fibers. Moreover, we determined that ethanol-induced changes can be blocked with selective nNOS inhibitor 7-NI.

Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients’ access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient’s likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.