Alcohol Disorders in Military Veterans: An Evaluation with the Roy Adaptation Model

The purpose of this paper was to evaluate a role for the Roy adaptation model (RAM) for the nursing care of military veterans with alcohol use disorder. Parse’s criteria were used to critique the RAM. The RAM’s humanistic philosophy emphasizes the ability to develop new coping skills and adapt to complex environments. The framework can define physical, emotional, and social responses to stressors faced by veterans. The RAM could guide new research and practice initiatives that optimize the health of military veterans.

Dynamics of Ethanolic Intoxications between the 15th of March 2020 to the 15th of March 2021 in the Context of the Covid-19 Pandemic

In Romania, the consumption of alcoholic beverages has been and still is a cultural mechanism for socializing and reducing anxiety, regardless of age and gender. This paper evaluates the trends related to people diagnosed with acute intoxication (F10.0) and harmful use (F10.1) at the 'Elisabeta Doamna' Psychiatriy Hospital in Galati, during the pandemic, in the period between the 15th of March 2020 and the 15th of March 2021. We analysed the data base of discharges from the 'Elisabeta Doamna' Psychiatry Hospital from the 15th of March 2020 to the 15th of March 2021. ICD-10 (Classification of mental and behavioural disorders) was used for diagnosis of psychiatric disorders. We selected outpatients with the codes for acute intoxication (F10.0) and harmful use (F10.1) and excluded all patients with other psychiatric diagnoses. The data were statistically processed using: Microsoft Office-Excel, The jamovi project (2021) jamovi (Version 1.6) [Computer Software]. During the analysed period, there were 7614 discharges from the 'Elisabeta Doamna' Psychiatriy Hospital of which 1465 (20.08%) disorders were related to alcohol consumption. Disorders related to intoxication and alcohol use represent 13.14% (957 cases) of the total discharges and 65.46% of the total number of disorders related to alcohol. Disorders related to harmful use (F10.1) represent 30.31% (442 cases), and a percentage of 35.15% (515 cases) with disorders due to acute intoxication (F10.0) out of the total cases were related to alcohol consumption. From the view of the dispersion of the number of cases, there is a fluctuation in the tendency to follow the restrictions imposed by the authorities.

Changes in Drug Use Patterns during the COVID-19 Pandemic in Italy: Monitoring a Vulnerable Group by Hair Analysis

From 22 March until 18 May 2020, a complete lockdown in Italy was ordered as a countermeasure against the COVID-19 pandemic. Social isolation measures affect some populations more than others, and people with drug and/or alcohol disorders (SUDs) are more likely to be adversely affected. This study presents, for the first time, laboratory data on the use of alcohol and drugs in a high-risk population during Italy’s first wave of the COVID-19 pandemic. Thirty subjects with SUDs were monitored for the use of illicit drugs and alcohol every 3 months before, during and after the lockdown, by hair analysis. The number of samples positive for heroin, cocaine, MDMA and cannabis fell considerably during the lockdown and then resumed to pre-lockdown levels when the period of confinement was over. Interestingly, the consumption of benzodiazepines and alcohol followed the opposite trend; both the number of benzodiazepine-positive samples and the level of alcohol consumption increased and remained high, even at the end of the lockdown. The confinement measures produced significant changes in drug/alcohol use patterns, with a shift toward the use of substances that were more easily accessible, used as self-medication for negative feelings, and used to alleviate the effects of abstinence from drugs that were no longer readily available.

Diagnosed Opioid Use Disorder Among Older Adults: Complex Comorbidity and Management Challenges

In the face of a widespread opioid epidemic and many policy changes affecting opioid access and management, it is important to understand the prevalence and characteristics of diagnosed opioid use disorder in older people and their implications for effective management of this high-risk population. We examined these issues in an ~40% random sample of Medicare beneficiaries with Part D coverage. In 2017, .8% of beneficiaries ages 65+ were diagnosed with OUD (opioid abuse or dependence diagnoses), an increase from .5% in 2015. The late-2015 transition from ICD-9 to ICD-10 may have contributed to this change, but the rate also increased post-ICD-10 by 9.1% from 2016-2017. The profile of individuals diagnosed with OUD reveals a population with complex comorbidity and multiple health challenges: 45% were diagnosed with major depression, 7% with alcohol disorders, 45% with anxiety, 8% with hepatitis C, 26% with cancer, 38% with COPD and 19% with pneumonia (risk factors for opioid overdose), 56% with diabetes and 27% with heart failure. 97% were diagnosed with pain conditions, 85% received opioid prescriptions, and 38% received benzodiazepine prescriptions. These patients represent complex and potentially competing challenges in concurrent management of pain, opioid use disorder, multi-substance use and opioid use disorder. Development of effective, integrated care models to simultaneously address these interrelated problems in this high-risk population should be informed by a closer focus on their multiple needs and monitoring of the adequacy of health system response.

Motivational interview for schizophrenia patients and alcohol abuse

The co-occurrence of schizophrenia and alcohol use disorders often leads to poor treatment retention and adherence. There are very few reports of efficient approaches to treat alcohol abuse in patients with schizophrenia. The purpose of this work was to review the benefits of motivational interview (MI) for alcohol disorders in patients with schizophrenia, and if it can be use in default or if there are some adaptations for this specific population. The authors did a non-systematic review of the literature with the words “motivational interview”, “schizophrenia”, “alcohol”. A case report from 2017 shows a 42 years old man in which was valued the patient's narrative and opinions with support and understanding, that lead to a increase in motivation of abstinence. Reflective listening and summarizing were very important to help with the consciousness of the disease. A study from 2007 with 60 patients shows that they tolerate the shorter sessions (20–30 min) better than longer sessions, because of the difficult time focusing for an extended period of time. More sessions are advantageous because it takes some time for patients to learn how to respond. Other study from 2003 with 30 patients shows that subjects randomized to the MI intervention had a significant reduction in drinking days and an increase in abstinence rates when compared to subjects receiving educational treatment. A blind randomised controlled trial from 2010 with 327 patients shows that integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse does reduce the amount of substance used for at least one year after completion of therapy. In conclusion there are evidence of the use of motivational interview in patients with schizophrenia. And the improve is bigger if there is an adaptation to this specific population. More studies are still needed in this aera.

Características sociodemográficas e psicossociais de trabalhadores relacionadas ao uso de álcool

Introdução: O consumo abusivo de álcool acompanha os indivíduos durante a idade economicamente ativa, sendo a causa de diversos problemas no ambiente de trabalho. Objetivos: Este estudo teve como objetivo avaliar a relação entre o consumo de álcool e características sociodemográficas e psicossociais de trabalhadores do setor metalúrgico. Metodologia: Foram selecionados, por conveniência, 104 dos 120 trabalhadores de uma empresa de médio porte do setor metalúrgico, sendo que, deste total dezesseis foram excluídos por não estarem presentes nos dias das entrevistas ou por falta de disponibilidade no dia da aplicação dos testes. Os instrumentos utilizados na coleta de dados foram: (1) o AUDIT (Alcohol Disorders Identification Test) para avaliar o padrão de consumo de álcool e comparar os funcionários usuários e não usuários de álcool; (2) a área médica do ASI6 (Addiction Severity Index 6), para associar outras questões de saúde com o uso de álcool; (3) o URICA (University of Rhode Island Change Assessment Scale), para analisar o estágio de motivação para mudança dos usuários de risco e (4) questionário de dados sociodemográficos e questões sobre o álcool, para descrever a amostra. Resultados: Os resultados demonstram que, quanto ao padrão de uso de álcool, 75% dos participantes pontuaram como uso de baixo risco de álcool, 21,2% como uso nocivo e 3,8% como dependência. Observou-se que a maioria da amostra afirmou ter consumido álcool nos últimos meses (61 trabalhadores/ 58,7%). Conclusão: Como a maioria dos funcionários entrevistados fazia uso de álcool e, destes, a maior parte fazia uso episódico excessivo do álcool, padrão denominado de binge drink, fica evidenciada a necessidade das empresas de investirem em programas de prevenção e tratamento, reduzindo os riscos de acidentes de trabalho e problemas como absenteísmo e queda de produtividade.

CAN HEARING AIDS DELAY THE ONSET OF ALZHEIMER’S AND OTHER AGE-RELATED CONDITIONS AMONG ADULTS WITH HEARING LOSS?

In this study, we examined the association between hearing aids (HAs) and the onset of Alzheimer’s disease or dementia; depression or anxiety; drug or alcohol disorders; and falls among adults aged 50 and older with hearing loss (HL). We performed a retrospective study of 176,716 adults (50+) with HL diagnoses using a national, insurance claims data (2008-2016). We used Kaplan Meier curves to examine disease-free survival and Cox regression models to examine the risk-adjusted association between HAs and time to diagnosis of 4 age-related/HL-associated conditions within 3 years of HL diagnosis. Large gender and racial/ethnic differences exist in HAs use. Approximately 11.3% of women vs. 14.5% of men used HAs (95% CI Difference: -0.04, -0.03). About 14.1% of Whites (95% CI: 0.14, 0.14) vs. 9.5% of Blacks (95% CI: 0.09, 0.10) and 7.8% of Hispanics (95% CI: 0.07, 0.08) used HAs. The risk-adjusted hazard ratios of being diagnosed with Alzheimer’s disease or dementia, depression or anxiety, drug/alcohol disorders, and injurious falls within 3 years after HL diagnosis, for those who used HA vs. those who did not, were lower by 0.82 (95% CI: 0.76-0.88), 0.92 (95% CI: 0.89-0.95), 0.91 (95% CI:0.80-1.04), and 0.86 (95% CI: 0.81-0.92), respectively. Use of HAs is associated with delayed onset of Alzheimer’s, dementia, depression, anxiety, and injurious falls among adults 50 years of age and older with HL. This is important because HL are increasingly common among older adults and early HL diagnosis and use of HAs may prevent or delay physical and mental decline.