Suchergebnisse

<b><i>Background:</i></b> Abstinence-related self-efficacy and action-oriented motivation to change addictive behaviours have been demonstrated to be important predictors of post-treatment drinking. However, there are only a few studies that assess drinking outcomes through a long-term follow-up interval. <b><i>Objectives:</i></b> The purpose of this longitudinal observational study is to evaluate whether self-efficacy and motivation at a 1-year follow-up mediate the relationship of self-efficacy at discharge from residential treatment with drinking outcomes at 5-year follow-up. <b><i>Method:</i></b> Simple and serial multiple mediation analyses were conducted on data collected from 263 patients (174 men, 89 women) with severe alcohol use disorder (AUD). Self-efficacy was measured at discharge and 1-year follow-up, and motivation was also measured at 1-year follow-up. Abstinence, percent days of abstinence (PDA), and drinks per drinking day (DDD) were used as drinking outcomes at 5-year follow-up. Exploring the indirect paths provided details about the interrelationship between self-efficacy and motivation. <b><i>Results:</i></b> Self-efficacy at discharge predicted abstinence and PDA. The mediation models suggest that self-efficacy at discharge was associated with self-efficacy and motivation at 1-year follow-up, which in turn was related to better long-term drinking outcomes, in particular for abstinence and PDA at 5-year follow-up. No such effects were found for DDD. <b><i>Conclusions:</i></b> The results indicate that self-efficacy and motivation are interrelated in improving long-term abstinence and PDA following residential treatments and may play a substantial role in recovery from AUD.

<B>Fragestellung:</B> Konsummuster und spezifische Merkmale von Rauschtrinken und Cannabiskonsum. </P><P> <B>Methodik:</B> Mittels Telefoninterviews wurden 2842 junge Erwachsene befragt. </P><P> <B>Egebnisse:</B> Im Monat vor der Befragung konsumierten 40 % der jungen Erwachsenen Alkohol bis zur Betrunkenheit und/oder Cannabis. Zwei Drittel von ihnen waren reine Rauschtrinker oder reine Cannabiskonsumenten. Suchmittelkonsum hing mit Hedonismus und Risikobereitschaft, hochfrequenter Konsum zusätzlich mit Belastungen und geringem Gesundheitsbewusstsein zusammen. Männliche Rauschtrinker und Cannabiskonsumenten unterschieden sich nicht. Bei Frauen war eine erhöhte Risikobereitschaft spezifisch für niederfrequenten Cannabiskonsum, vermehrte Belastungen für hochfrequentes Rauschtrinken. </P><P> <B>Schlussfolgerungen:</B> Nur bei Frauen zeigten sich in Abhängigkeit von der Konsumfrequenz suchtmittelspezifische Merkmale.

Ziel: Ziel der Untersuchung war die Erarbeitung von theoretisch und empirisch fundierten Empfehlungen zur HIV-Prävention im sexuellen Risikoverhalten von Drogenkonsumentinnen. </P><P> Methodik: Mit einem standardisierten Interviewleitfaden wurden 146 Konsumentinnen harter Drogen zu Motiven und Bedingungen von sexuellem Risikoverhalten befragt. Erfasst wurden die Prävalenzen von sexuellen Risikokontakten bei festen Partnern, Gelegenheitspartnern und Freiern sowie mögliche Einflussfaktoren auf das Risikoverhalten. </P><P> Ergebnisse: 47 von 146 Konsumentinnen harter Drogen (32%) hatten im halben Jahr vor der Befragung sexuelle Risikokontakte. Drogenkonsumentinnen mit sexuellem Risikoverhalten unterschieden sich von Konsumentinnen ohne Risikoverhalten durch eine signifikant geringere Selbstwirksamkeitserwartung, eine geringere Ergebniserwartung, eine höhere Vulnerabilitätseinschätzung und eine geringere Wichtigkeit der persönlichen Gesundheit. </P><P> Schlussfolgerungen: Diese sozialkognitiven Variablen sind wichtige Ansatzpunkte für Präventionsmaßnahmen. Zusätzlich müssen bei Risikonkontakten mit festen Partnern, Gelegenheitspartnern und Freiern unterschiedliche, kontextbezogene Ansatzpunkte mit berücksichtigt werden.

This paper presents the German version of the Short Understanding of Substance Abuse Scale (SUSS) [Humphreys et al.: Psychol Addict Behav 1996;10:38–44], the Verständnis von Störungen durch Substanzkonsum (VSS), and evaluates its psychometric properties. The VSS assesses clinicians' beliefs about the nature and treatment of substance use disorders, particularly their endorsement of psychosocial and disease orientation. The VSS was administered to 160 treatment staff members at 12 substance use disorder treatment programs in the German-speaking part of Switzerland. Because the confirmatory factor analysis of the VSS did not completely replicate the factorial structure of the SUSS, an exploratory factor analysis was undertaken. This analysis identified two factors: the Psychosocial model factor and a slightly different Disease model factor. The VSS Disease and Psychosocial subscales showed convergent and discriminant validity, as well as sufficient reliability.

<B>Fragestellung:</B> Analyse von Ansatzpunkten für die HBV/HCV-Präventionsempfehlungen für das sexuelle Risikoverhalten von Drogenkonsumentinnen. </P><P> <B>Methodik:</B> Einschätzungen zu HBV/HCV und HIV von 146 Befragten wurden verglichen und ihr Zusammenhang mit dem sexuellen Risikoverhalten analysiert. </P><P> <B>Resultate:</B> HBV/HCV-Infektionen wurden als weniger schwerwiegend eingeschätzt und die Schutzmotivation und der Wissensstand bezüglich HBV/HCV waren geringer ausgeprägt als bei HIV. Personen mit geringerer Selbstwirksamkeit, Schutzmotivation und geringerem Wissen hinsichtlich HBV/HCV hatten häufiger sexuelles Risikoverhalten. </P><P> <B>Schlussfolgerungen:</B> Selbstwirksamkeit und Schutzmotivation sind Ansatzpunkte für die HBV/HCV- und HIV-Prävention. Für HBV/HCV muss zudem das Problembewusstsein erhöht und der Wissensstand verbessert werden.

Abstract. Aim: In the research and treatment of Substance Use Disorders (SUDs), craving for alcohol, nicotine, and drugs is an important concept associated with addictive processes, including relapse after treatment. The 12-item Mannheimer Craving Scale (MaCS) has been proved to be an economic, reliable, and valid self-rating instrument across several substances in German samples. The aim of this study was to examine its psychometric characteristics in a Swiss German sample. Method: Overall, 166 patients were recruited from an inpatient SUD treatment program at the University Hospital of Psychiatry in Bern, Switzerland. Results: The internal consistency was high and the test-retest reliability was satisfactory. The total scale and three specific analogue craving measures were highly correlated. Principal component analysis extracted two factors, explaining 62 % of the total variance, and these factors were confirmed through confirmatory factor analysis. However, the two factors correlated highly, and several items loaded on both factors, so that the factor structure was inconclusive. Conclusions: The psychometric characteristics of the MaCS in a Swiss German sample are as good as those characteristics of the German version, suggesting that it is a valid and reliable measure. The MaCS factor structure must be examined on a larger sample that integrates a broader range of SUDs and their severities.

Fragestellung: Der Erfassung subjektiv empfundenen Alkoholverlangens (Craving) kommt eine wichtige Rolle in der Einschätzung der Rückfallgefährdung zu. Mann & Ackermann (2000) haben an einer deutschen Stichprobe Reliabilität und Validität der Obsessive Compulsive Drinking Scale (OCDS-G; Anton, Moak & Latham, 1995 ) vorgestellt. Um deren Verwendbarkeit in der deutschsprachigen Schweiz zu überprüfen, wurden die psychometrischen Kennwerte der OCDS-G an einer Schweizer Stichprobe alkoholabhängiger Patienten untersucht. Methodik: Insgesamt 153 Patienten füllten eine Woche nach ihrem Eintritt in ein stationäres, qualifiziertes Entzugsprogramm die OCDS-G aus. Davon füllten 30 Patienten die OCDS-G erneut vor Austritt aus. Ergebnisse: Die beiden Unterskalen "Gedanken" und "Handlungen" konnten durch die Hauptkomponentenanalyse zwar knapp bestätigt werden und zwei Drittel der Varianz erklären, aber die Ergebnisse der konfirmatorischen Faktorenanalyse legen eher eine Einfaktorenlösung nahe. Für die Gesamtskala ergab sich eine sehr gute innere Konsistenz, gute Test-Retest-Reliabilität und substanzielle Korrelationen mit dem Schweregrad der Abhängigkeit und deren Konsequenzen. Schlussfolgerungen: Für die OCDS-G ergeben sich in einer Deutschschweizer Stichprobe alkoholabhängiger Patienten gute psychometrische Kennwerte, so dass sie sich auch für die Anwendung in Klinik und Forschung sowie für internationale Vergleiche (z. B. Wirksamkeits- und Verlaufsstudien) eignet.

The purpose of this study was to assess a 4-month inpatient treatment program based on integrated models for patients with substance use and psychiatric disorders (dual diagnosis patients). On admission and at the 1-year follow-up, a consecutive sample of 118 dual diagnosis patients who entered the program were assessed by interview. Eighty-four patients (70.6%) completed the 1-year follow-up interview, reporting less frequent substance use, less severe psychiatric symptoms, a lower rehospitalization rate, and better housing conditions than on admission. Patients diagnosed with a comorbid personality disorder had a better improvement in the frequency of drinking and were less likely to be rehospitalized than patients with schizophrenia or depression. The results suggest that the integrated inpatient program may be a promising treatment approach for dual diagnosis patients. The results await replication in controlled studies that need to include an assessment of outpatient treatment following inpatient programs.

AbstractAimsDrinking goal has emerged as a promising predictor variable for alcohol-related outcomes. Many patients with alcohol use disorder (AUD) choose another drinking goal than abstinence after residential AUD treatment program. We aimed to examine the effects of an abstinent drinking goal (ADG) and conditional abstinence drinking goal (CADG) 6 months after residential treatment on drinking outcomes in patients with severe AUD and investigate the effectiveness of telephone-based (TEL) or text message-based (TEX) continuing care according to the individual drinking goal.MethodsA total of 240 patients from two specialized residential treatment programs for AUD were included in the study. Patients were randomly assigned to high-frequency (nine contacts) or low-frequency (two contacts) TEL, TEX (nine contacts), or control group (no contact) from treatment discharge to the 6-month follow-up.ResultsPatients with an ADG were significantly more often abstinent (58%) at the 6-month follow-up compared to patients with a CADG (32.1%), and in the case of relapse, showed a significantly longer time to the first drink. Patients with a CADG of the high-frequency TEL showed a tendency to be more abstinent at the 6-month follow-up and reported significantly higher alcohol-related self-efficacy compared to the CADG patients of the control group.ConclusionsPatients with CADG are more vulnerable to relapse, and therefore may benefit more from high-frequency telephone contacts to deal with alcohol-related problems and reach their goal. In the case of relapse, the high-frequent contacts may help patients stay connected to health services, preventing chronification and facilitating recovery from AUD.

<b><i>Aims:</i></b> This review provides evidence of which interventions need to be part of effective outpatient integrated treatment for patients with comorbid schizophrenia and substance use disorders. <b><i>Methods:</i></b> A total of 14 randomized controlled trials were included. Effect sizes are provided to assess the magnitude of the treatments' efficacy. <b><i>Results:</i></b> Despite the studies' heterogeneity, we can conclude that certain programs (e.g. Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness ) and specific interventions (e.g. motivational interviewing, family interventions) seem to be effective. Moreover, programs integrating multiple interventions are more likely to be positively related to better outcomes than single interventions. Finally, the lack of difference between effect sizes of assertive community treatment compared to case management suggests that a lower caseload is not necessary for positive treatment outcomes. <b><i>Conclusion:</i></b> Integrated treatment seems advantageous, although effect sizes are mostly modest. More homogeneous and qualitative sound studies are needed.

<i>Background:</i> About half of all schizophrenic patients have a co-occurring substance use disorder, leading to poorer social and functional outcomes than obtained in non-abusing patients. To improve outcomes, integrated treatments have been designed that address the two conditions simultaneously. Results are, however, conflicting because the available effect studies are hampered by various methodological issues, among which are heterogeneous patient samples. <i>Methods:</i> In this comparative study, two well-described patient samples diagnosed with schizophrenia and co-morbid substance abuse disorders either received an integrated treatment (IDDT) or treatment as usual (TAU). <i>Results:</i> Patients in the IDDT condition showed significant reductions in illicit drug and alcohol use, improvements on all psychiatric symptom domains, reported higher quality of life and improved on social and community functioning. In contrast, patients' improvements in the TAU group were moderate and limited to a few substance use and psychiatric outcomes. The TAU group had significantly higher dropout rates 6 and 12 months after baseline, suggesting that the IDDT programme was more successful in committing patients. <i>Conclusions:</i> Our results suggest that an integrated approach to schizophrenic patients and co-morbid substance use disorders is superior to standard treatment and may be considered as the treatment of choice for this patient group.