Outpatient versus inpatient opioid detoxification: A randomized controlled trial

Day, Ed; Strang, John

doi:10.1016/j.jsat.2010.08.007

Cited by 48 publications

(30 citation statements)

References 36 publications

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“…Generally, drug-dependent patients start substance abuse treatment with detoxification. However, more than 50% of patients do not complete detoxification treatment (Franken & Hendriks, 1999; Hättenschwiler, Rüesch, & Hell, 2000; Day & Strang, 2011) and usually relapse to drug use soon afterwards (Gossop, Green, Phillips, & Bradley, 1987; Gossop, Stewart, Browne, & Marsden, 2002). It is therefore critical to understand the psychological processes underlying treatment drop-out and relapse so that more effective interventions can be developed.…”

mentioning

confidence: 99%

Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study.

Marhe

Waters

Wetering

et al. 2013

Journal of Consulting and Clinical Psychology

128

114

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Objective Relapse is a major problem in drug addiction treatment. Both drug craving and drug-related cognitions (e.g., attentional bias and implicit attitudes to drugs) may contribute to relapse. Using ecological momentary assessments (EMA), we examined whether craving and cognitions assessed during drug detoxification treatment were associated with relapse. Method Participants were 68 heroin-dependent inpatients undergoing clinical detoxification at an addiction treatment center. Participants carried around a personal digital assistant (PDA) for 1-week. Participants completed up to 4 random assessments (RAs) per day. They also completed an assessment when they experienced a temptation to use drugs (TA). At each assessment, participants reported their craving and attitudes to drugs. Implicit cognitions were assessed with a drug Stroop task (attentional bias) and an Implicit Association Test (implicit attitudes). Results Individuals who relapsed during the study week exhibited a larger attentional bias and more positive implicit attitudes to drugs than non-relapsers at TAs (but not RAs). In addition, compared to non-relapsers, relapsers reported higher levels of craving and more positive explicit attitudes to drugs at TAs compared to RAs. Additional within-subject analyses revealed that attentional bias for drugs at TAs increased before relapse. Conclusions Drug-related cognitive processes assessed using EMA were associated with relapse during drug detoxification. Real-time assessment of craving and cognitions may help to identify individuals at risk of relapse, and when they are at risk of relapse.

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mentioning

confidence: 99%

Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study.

Marhe

Waters

Wetering

et al. 2013

Journal of Consulting and Clinical Psychology

128

114

View full text Add to dashboard Cite

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“…The following example illustrates how different staff attitudes across settings can have implications for the conduct and results of a trial. An RCT of inpatient versus outpatient opioid detoxification was undertaken because previous trials had methodological limitations-the key one being that different medication regimens had been used in each setting, so the opportunity to study the impact of setting on the likelihood of success had been missed [ 22 ]. The newer trial therefore aimed to administer the same medical treatment regimen, for the same period, in an inpatient and an outpatient setting.…”

Section: Resultsmentioning

confidence: 99%

Randomised trials comparing different healthcare settings: an exploratory review of the impact of pre-trial preferences on participation, and discussion of other methodological challenges

Corbett

Watson

Eastwood

2016

BMC Health Serv Res

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BackgroundWe recently published a systematic review of different healthcare settings (such as outpatient, community or home) for administering intravenous chemotherapy, and concluded that performing conventionally designed randomised trials was difficult. The main problems were achieving adequate trial accrual rates and recruiting a study population which adequately represented the target population of interest. These issues stemmed from the fact that potential participants may have had pre-trial perceptions about the trial settings they may be allocated; such preferences will sometimes be strong enough for patients to decline an invitation to participate in a trial. A patient preference trial design (in which patients can choose, or be randomised to, an intervention) may have obviated these recruitment issues, although none of the trials used such a design.MethodsIn order to gain a better understanding of the broader prevalence and extent of these preference issues (and any other methodological challenges), we undertook an exploratory review of settings trials in any area of healthcare treatment research. We searched The Cochrane Library and Google Scholar and used snowballing methods to identify trials comparing different healthcare settings.ResultsTrial accrual was affected by patient preferences for a setting in 15 of the 16 identified studies; birth setting trials were the most markedly affected, with between 68 % and 85 % of eligible women declining to participate specifically because of preference for a particular healthcare setting. Recruitment into substance abuse and chemotherapy setting studies was also notably affected by preferences. Only four trials used a preference design: the proportion of eligible patients choosing to participate via a preference group ranged from between 33 % and 67 %.ConclusionsIn trials of healthcare settings, accrual may be seriously affected by patient preferences. The use of trial designs which incorporate a preference component should therefore strongly be considered. When designing such trials, investigators should consider settings to be complex interventions, which are likely to have linked components which may be difficult to control for. Careful thought is also needed regarding the choice of comparator settings and the most appropriate outcome measures to be used.

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“…Research with larger numbers of IPs is needed, but it may be that CRAFT and TEnT are best delivered in the context of a treatment program that offers full services to IPs, making transfer to community services unnecessary. Others have reported limited success executing similar transfers of substance using populations (about 10% to 20%; Chutaupe et al, 2001; Kimber et al, 2008; McCusker et al, 1995). The rates of transfer that we achieved are similar to those in studies of Screening, Brief Intervention and Referral to Treatment (SBIRT; Babor et al, 2007).…”

Section: Discussionmentioning

confidence: 98%

Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?

Kirby¹,

Benishek²,

Kerwin³

et al. 2017

Psychology of Addictive Behaviors

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Background Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved-one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all six components of CRAFT are necessary. Methods In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12–14 sessions of the full CRAFT intervention, 4–6 sessions focused on Treatment Entry Training (TEnT), or 12–14 sessions of Alanon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO’s mood and functioning. Data were collected at baseline and 4-, 6-, and 9- months post-baseline. Results We found significant reductions in time to treatment entry (X2(2)=8.89, p=.01) and greater treatment entry rates for CRAFT (62%; OR=2.7, 95% CI=1.1–6.9) and TEnT (63%; OR=2.9, 95% CI=1.2–7.5) compared to ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR=1.1, 95% CI=0.4–2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277)=13.47, p<.0001). Similarly, CSO mood and functioning did not differ between the three conditions, but improved over time (p<.0001 for all significant measures). Conclusions We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT.

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Outpatient versus inpatient opioid detoxification: A randomized controlled trial

Cited by 48 publications

References 36 publications

Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study.

Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study.

Randomised trials comparing different healthcare settings: an exploratory review of the impact of pre-trial preferences on participation, and discussion of other methodological challenges

Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?

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