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Adolescent cannabis use disorder: Adaptive treatment for poor responders to initial treatment
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Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
ery had been achieved, the Semi- Structured Assessment for Drug Dependence and Alcoholism (SSADDA) Thai version was used to collect demographic data, illness history, and alcohol use/dependence. Mini International Neuropsychiatric Structured Interview (M.I.N.I) Lifetime Thai version was used to interview patients for other psychiatric illness. Laboratory findings and treatment data were collected from the Department’s Consultation Forms. Data were analyzed by using descriptive statistic, chisquare, and Mann-Whitney U test. Results: Of 53 patients, 31 (53.8%) had DTs. Abnormal levels of bicarbonate, creatinine, SGOT, having history of DTs, prolonged DTs duration, high maximum and average daily dosage of benzodiazepine were associated with DTs (p < 0.05). Patients with more severe DTs had longer DTs duration, higher maximum and average daily dosage of benzodiazepine than those with less severe DTs. Abnormal alkaline phosphatase level was associated with severity of delirium (p < 0.05), but not severity of alcohol withdrawal symptoms. Conclusions: The history of DTs, bicarbonate, creatinine, and SGOT level, the duration of DTs, maximum and average daily dosage of benzodiazepine were associated with the occurrence of DTs. Financial support: The US–Thai training grant (D43TW009087) co-funded by the Fogarty International Center (FIC), National Institute on Drug Abuse (NIDA) and National Human Genome Research Institute (NHGRI). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.274 Adolescent cannabis use disorder: Adaptive treatment for poor responders to initial treatment Yifrah Kaminer Psychiatry, University of CT School of Medicine, Farmington, CT, United States Aims: Examine retention and abstinence rates to a randomized continued care intervention of either 10 weeks of enhanced individual CBT or ACRA for adolescents with cannabis use disorders (CUD) who were poor responders to initial common MET/CBT-7 intervention. Methods: A total of 172 adolescents, 13-18 years of age, diagnosed with DSM- IV cannabis use disorder (CUD), enrolled in this intent-to-treat design, randomized, outpatient study. The initial treatment phase was composed of weekly MET/CBT-7 manualized intervention. Poor responders to initial treatment (defined as drop outs or positive to drug urinalysis at last session of attended) were randomized into 10 weekly sessions of either enhanced individual CBT or Adolescent community reinforcement approach (ACRA). All study participants regardless of response to treatment participated in periodic follow-ups composed of objective and subjective assessments starting at week 17. Results: One hundred and sixty one subjects engaged in at least one session of th MET/CBT-7 treatment. Retention rate was 83% and abstinence at the end of treatment was 50%. Eighty subjects met criteria for poor responders including the 17% dropouts. 75% of treatment completers who had positive urines for cannabis engaged in the continued care (phase II). Thirty seven percent completed phase II and 27% of completers of phase II achieved abstinence. Conclusions: Continued care for poor responders to initial treatment remains a therapeutic necessity and a clinical research challenge. In order to improve retention and abstinence rates various innovative adaptive treatment algorithms should be explored. One logical step may involve integrating incentives for improved
retention and abstinence according to efficacious contingency management design and schedule. Financial support: RO1 DA 03054-02 to Dr. Kaminer. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.275 Prevalence and correlates of hazardous alcohol use and co-occurring mental health problems in Nepal following the 2015 earthquakes Jeremy C. Kane 1,∗ , Nagendra Luitel 2 , Mark J.D. Jordans 3,4 , Brandon A. Kohrt 5 , M. Claire Greene 1 , Wietse A. Tol 1,6 1 Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States 2 Transcultural Psychosocial Organization, Kathmandu, Nepal 3 Research and Development, Healthnet TPO, Amsterdam, Netherlands 4 Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, United Kingdom 5 Duke Global Health Institute, Duke University, Durham, NC, United States 6 Peter C. Alderman Foundation, Bedford, NY, United States
Aims: The risk for harmful alcohol use increases following traumatic events and hazardous drinking is thought to be a negative coping mechanism for mental health symptoms associated with the event. Few studies have investigated alcohol use problems following disasters in low- and middle-income countries. This study assessed the prevalence of hazardous alcohol use and rates of comorbidity with depression, anxiety, and post-traumatic stress disorder (PTSD), among 513 adults affected by the 2015 earthquakes in Nepal. Methods: A three-stage cluster sampling design was used to randomly select 513 adults from three of the most heavily earthquake-affected districts in Nepal. The Alcohol Use Disorders Identification Test-Consumption was used to measure hazardous alcohol use. The Hopkins Symptom Checklist-25 and Post-traumatic Stress Disorder Checklist were used to assess depression/anxiety and PTSD, respectively. Results: Prevalence of hazardous alcohol use in the overall sample was 20.4%. Among only those who reported ever drinking (36.1% of the sample), 56.6% drank at hazardous levels. Among those who met criteria for hazardous alcohol use, 37.8% met criteria for depression, 35.3% for anxiety, and 3.2% for PTSD. Conclusions: Overall prevalence of alcohol use was low but rates of hazardous use were high among those who reported ever drinking. Hazardous use also commonly co-occurred with depression and anxiety symptoms. Interventions that address both mental health and alcohol use problems are warranted. Financial support: The study was supported by a grant from the International Medical Corps. Dr. Kane and Ms. Greene are supported by a NIDA training grant in Drug Dependence Epidemiology (PI: Furr-Holden; T32DA007292). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.276
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
ery had been achieved, the Semi- Structured Assessment for Drug Dependence and Alcoholism (SSADDA) Thai version was used to collect demographic data, illness history, and alcohol use/dependence. Mini International Neuropsychiatric Structured Interview (M.I.N.I) Lifetime Thai version was used to interview patients for other psychiatric illness. Laboratory findings and treatment data were collected from the Department’s Consultation Forms. Data were analyzed by using descriptive statistic, chisquare, and Mann-Whitney U test. Results: Of 53 patients, 31 (53.8%) had DTs. Abnormal levels of bicarbonate, creatinine, SGOT, having history of DTs, prolonged DTs duration, high maximum and average daily dosage of benzodiazepine were associated with DTs (p < 0.05). Patients with more severe DTs had longer DTs duration, higher maximum and average daily dosage of benzodiazepine than those with less severe DTs. Abnormal alkaline phosphatase level was associated with severity of delirium (p < 0.05), but not severity of alcohol withdrawal symptoms. Conclusions: The history of DTs, bicarbonate, creatinine, and SGOT level, the duration of DTs, maximum and average daily dosage of benzodiazepine were associated with the occurrence of DTs. Financial support: The US–Thai training grant (D43TW009087) co-funded by the Fogarty International Center (FIC), National Institute on Drug Abuse (NIDA) and National Human Genome Research Institute (NHGRI). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.274 Adolescent cannabis use disorder: Adaptive treatment for poor responders to initial treatment Yifrah Kaminer Psychiatry, University of CT School of Medicine, Farmington, CT, United States Aims: Examine retention and abstinence rates to a randomized continued care intervention of either 10 weeks of enhanced individual CBT or ACRA for adolescents with cannabis use disorders (CUD) who were poor responders to initial common MET/CBT-7 intervention. Methods: A total of 172 adolescents, 13-18 years of age, diagnosed with DSM- IV cannabis use disorder (CUD), enrolled in this intent-to-treat design, randomized, outpatient study. The initial treatment phase was composed of weekly MET/CBT-7 manualized intervention. Poor responders to initial treatment (defined as drop outs or positive to drug urinalysis at last session of attended) were randomized into 10 weekly sessions of either enhanced individual CBT or Adolescent community reinforcement approach (ACRA). All study participants regardless of response to treatment participated in periodic follow-ups composed of objective and subjective assessments starting at week 17. Results: One hundred and sixty one subjects engaged in at least one session of th MET/CBT-7 treatment. Retention rate was 83% and abstinence at the end of treatment was 50%. Eighty subjects met criteria for poor responders including the 17% dropouts. 75% of treatment completers who had positive urines for cannabis engaged in the continued care (phase II). Thirty seven percent completed phase II and 27% of completers of phase II achieved abstinence. Conclusions: Continued care for poor responders to initial treatment remains a therapeutic necessity and a clinical research challenge. In order to improve retention and abstinence rates various innovative adaptive treatment algorithms should be explored. One logical step may involve integrating incentives for improved
retention and abstinence according to efficacious contingency management design and schedule. Financial support: RO1 DA 03054-02 to Dr. Kaminer. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.275 Prevalence and correlates of hazardous alcohol use and co-occurring mental health problems in Nepal following the 2015 earthquakes Jeremy C. Kane 1,∗ , Nagendra Luitel 2 , Mark J.D. Jordans 3,4 , Brandon A. Kohrt 5 , M. Claire Greene 1 , Wietse A. Tol 1,6 1 Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States 2 Transcultural Psychosocial Organization, Kathmandu, Nepal 3 Research and Development, Healthnet TPO, Amsterdam, Netherlands 4 Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, United Kingdom 5 Duke Global Health Institute, Duke University, Durham, NC, United States 6 Peter C. Alderman Foundation, Bedford, NY, United States
Aims: The risk for harmful alcohol use increases following traumatic events and hazardous drinking is thought to be a negative coping mechanism for mental health symptoms associated with the event. Few studies have investigated alcohol use problems following disasters in low- and middle-income countries. This study assessed the prevalence of hazardous alcohol use and rates of comorbidity with depression, anxiety, and post-traumatic stress disorder (PTSD), among 513 adults affected by the 2015 earthquakes in Nepal. Methods: A three-stage cluster sampling design was used to randomly select 513 adults from three of the most heavily earthquake-affected districts in Nepal. The Alcohol Use Disorders Identification Test-Consumption was used to measure hazardous alcohol use. The Hopkins Symptom Checklist-25 and Post-traumatic Stress Disorder Checklist were used to assess depression/anxiety and PTSD, respectively. Results: Prevalence of hazardous alcohol use in the overall sample was 20.4%. Among only those who reported ever drinking (36.1% of the sample), 56.6% drank at hazardous levels. Among those who met criteria for hazardous alcohol use, 37.8% met criteria for depression, 35.3% for anxiety, and 3.2% for PTSD. Conclusions: Overall prevalence of alcohol use was low but rates of hazardous use were high among those who reported ever drinking. Hazardous use also commonly co-occurred with depression and anxiety symptoms. Interventions that address both mental health and alcohol use problems are warranted. Financial support: The study was supported by a grant from the International Medical Corps. Dr. Kane and Ms. Greene are supported by a NIDA training grant in Drug Dependence Epidemiology (PI: Furr-Holden; T32DA007292). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.276