The role of contextual factors in avenues to recover from gambling disorder: a scoping review.

Introduction: Recovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions. Methods: A systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps-titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34). Results and discussion: Findings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made.

Patients' satisfaction with heroin-assisted treatment: a qualitative study.

BACKGROUND: Heroin-assisted treatment (HAT) involves supervised dispensing of medical heroin (diacetylmorphine) for people with opioid use disorder. Clinical evidence has demonstrated the effectiveness of HAT, but little is known about the self-reported satisfaction among the patients who receive this treatment. This study presents the first empirical findings about the patients' experiences of, and satisfaction with, HAT in the Norwegian context. METHODS: Qualitative in-depth interviews with 26 patients in HAT were carried out one to two months after their enrollment. Analysis sought to identify the main benefits and challenges that the research participants experienced with this treatment. An inductive thematic analysis was conducted to identify the main areas of benefits and challenges. The benefits were weighed against the challenges in order to assess the participants' overall level of treatment satisfaction. RESULTS: Analysis identified three different areas of experienced benefits and three areas of challenges of being in this treatment. It outlines how the participants' everyday lives are impacted by being in the treatment and how this, respectively, results from the treatment's medical, relational, or configurational dimensions. We found an overall high level of treatment satisfaction among the participants. The identification of experienced challenges reveals factors that reduce satisfaction and thus may hinder treatment retention and positive treatment outcomes. CONCLUSIONS: The study demonstrates a novel approach to qualitatively investigate patients' treatment satisfaction across different treatment dimensions. The findings have implications for clinical practice by pointing out key factors that inhibit and facilitate patients' satisfaction with HAT. The identified importance of the socio-environmental factors and relational aspect of the treatment has further implications for the provision of opioid agonist treatment in general.

The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions.

Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%-89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.

[Poor uptake of service provision at a drug-related emergency department ­ a qualitative study]. / Ubenyttet behandlingstilbud ved rusakuttmottak ­ en kvalitativ studie.

BACKGROUND: The patient pathway for follow-up after a drug overdose, which is an important part of Norway's national overdose strategy, started up on 1 January 2022. Four years earlier, a collaboration was initiated between the ambulance service and the drug-related emergency department at Oslo University Hospital with the same aim as this patient pathway: to provide emergency follow-up in the specialist health service after a drug overdose. Uptake of the follow-up provision was minimal, and the purpose of this study was to investigate the reasons behind this. MATERIAL AND METHOD: We used a case study design and carried out twelve qualitative interviews with representatives from the ambulance service, the drug-related emergency department and the service user group. A thematic analysis of the interviews was then conducted. RESULTS: The analysis revealed five thematic areas with different explanations for the poor uptake of the service provision. There was insufficient information about the provision, and the admission criteria were unclear. Communication issues between the ambulance service and the drug-related emergency department meant that the provision did not function as an emergency service. The service users' wishes after an overdose did not correspond fully with the provision, and uptake was sometimes associated with sanctions. INTERPRETATION: The results show that things could have been done differently at a local level, but also that the content of the patient pathway is unclear, and that general guidelines can lead to the provision being perceived as unsafe. The knowledge generated from this survey can help uncover areas that require improvement at a national level in the follow-up pathway after a drug overdose.

Governing by commissioning services - Implementing alcohol screening and brief interventions in hospital settings in Norway.

Norwegian health services have undergone marked logistical changes in organization and funding over recent decades. One significant change was the new public management-inspired commissioner's document, first issued in 2013 by the Norwegian Ministry of Health and Care Services, to establish medical and surgical departments' identification of patients with underlying substance abuse problems (Ministry of Health and Care Services, 2013). Herein, we investigate how multiple stakeholders and actors, who bear responsibility in regional and local health trusts, have responded to the commissioned services to establish routines for identifying alcohol and substance abuse problems among patients admitted to medical and surgical wards. First, an extensive literature search was conducted. Second, we conducted qualitative interviews with informants who have responsibility for applying the commissioner's document in regional health authorities and local hospitals. The study results demonstrate that responsible actors at all levels take establishing alcohol routines seriously, and that hospitals' self-assessment of their achievements on internal goals indicate that they have made satisfactory progress. Nevertheless, improvement is needed to meet the goal of discussing alcohol use with all patients admitted to medical and surgical wards within local health trusts. Recommendations for the next steps, based on these findings, include further research and training priorities.

Group treatment for complex dissociative disorders: a randomized clinical trial.

BACKGROUND: Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. METHODS: Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. RESULTS: Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. CONCLUSION: In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. TRIAL REGISTRATION: Clinical Trials ( NCT02450617 ).

Vulnerability of personality disorder during the Covid-19 crises - a multicenter survey of treatment experiences among patients referred to treatment.

BACKGROUND: The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementation of treatment modifications was required for patients typically characterized by insecure attachment and vulnerability to separation. AIM: To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD. DESIGN: A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs. RESULTS: The response-rate was 12% (N = 133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly telephone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations. CONCLUSION: The survey confirms a radical modification from comprehensive group-based PD programs to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable concern about treatment progress.

The effect evaluation of Individual Placement and Support (IPS) for patients with substance use disorders: study protocol for a randomized controlled trial of IPS versus enhanced self-help.

BACKGROUND: Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. METHODS/DESIGN: The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. DISCUSSION: The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04289415 . Registered on February 28, 2020.

Stabilizing group treatment for childhood-abuse related PTSD: a randomized controlled trial.

Background: Patients with PTSD related to childhood-abuse often experience additional problems such as emotional dysregulation and interpersonal difficulties. Psychotherapy focused on stabilization of symptoms, emotion-regulation, and skills training has been suggested as a treatment for this patient population, either as preparation for further treatment or as a stand-alone intervention. Objective: The present study tests the efficacy of treatment using a group-protocol for stabilizing treatment delivered adjunct with conventional individual therapy. Methods: In a delayed-treatment design with switching replication, a clinically representative sample of 89 patients with PTSD and histories of childhood abuse were randomly assigned to either 20-week stabilizing group treatment or a corresponding waiting-period, both adjunct with conventional individual therapy. After the waiting-period, patients in the control condition were offered group treatment. The primary outcome was psychosocial functioning, measured with interview - assessed Global Assessment of Functioning (GAF), while secondary outcome was self-reported PTSD symptoms. These were measured before treatment, after treatment and at 6 months follow up. The trial was preregistered at Clinical Trials (NCT02450617). Results: We found large within-group effect sizes in both conditions on GAF and moderate effects on PTSD symptoms. Linear mixed-models did not indicate significant differences in treatment trajectories between conditions. Conclusion: Stabilizing group treatment focused on emotional-regulation and skills-training does not improve outcomes beyond individual-treatment alone, and should not be recommended as first-line treatment for this patient-group.

Antecedentes: Los pacientes con trastorno de estrés postraumático (TEPT) asociado a abuso infantil con frecuencia experimentan problemas adicionales como desregulación emocional y dificultades interpersonales. Se ha propuesto a la psicoterapia enfocada en la estabilización de síntomas, la regulación emocional y el entrenamiento en habilidades como un tratamiento para esta población de pacientes, tanto como preparación para algún tratamiento adicional o como una intervención única.Objetivo: Este estudio evalúa la eficacia del tratamiento empleando un protocolo grupal para estabilización realizado junto con la terapia individual convencional.Métodos: El estudio contó con un diseño de inicio retrasado del tratamiento con entrecruzamiento de grupos. Los participantes de una muestra clínicamente representativa de 89 pacientes con TEPT y antecedente de abuso infantil fueron aleatorizados ya sea a un tratamiento grupal para estabilización de 20 semanas o a un tiempo de espera de igual duración. Ambos grupos recibieron terapia individual convencional. Luego del tiempo de espera, a los pacientes en el grupo de control se les ofreció el tratamiento grupal. El resultado principal fue el funcionamiento psicosocial, medido en una entrevista empleando la Evaluación Global de Funcionamiento (GAF, por sus siglas en inglés). El resultado secundario fueron los síntomas del TEPT auto-reportados. Estos fueron medidos antes del tratamiento, después del tratamiento y a los 6 meses de seguimiento. El ensayo clínico fue pre-registrado en "Clinical Trials" (NCT02450617).Resultados: Encontramos tamaños del efecto grandes dentro de los grupos en ambas condiciones con la GAF; además, encontramos tamaños del efecto moderados para los síntomas del TEPT. Los modelos mixtos lineales no mostraron diferencias significativas en las trayectorias del tratamiento entre ambas condiciones.Conclusiones: El tratamiento grupal para estabilización enfocado en la regulación emocional y en el entrenamiento de habilidades no mejoró los resultados clínicos más allá del tratamiento individual como monoterapia y no debería ser recomendado como un tratamiento de primera línea para este grupo de pacientes.

Quality of life among patients seeking treatment for substance use disorder, as measured with the EQ-5D-3L.

PURPOSE: There is a need to assess the quality of treatment for Substance Use Disorder (SUD), and document SUD patients' health-related quality of life (HRQoL). The study aims to describe Norwegian SUD patients' HRQoL as measured by EQ-5D, compared to a general population sample, and discuss the potential usefulness of the EQ-5D to monitor HRQoL for SUD patients. METHODS: One hundred seventy eight SUD patients (66.3% male) were administered the EQ-5D-3L at treatment start. Patients and general population samples were compared in terms of reported EQ-5D-3L health states, problems by dimension, UK index values, and EQ VAS scores. We investigated specific drug dependence, mental health disorders, sex, age, and education as predictors of EQ-5D-3L values and EQ VAS scores. Anxiety/depression dimension scores were compared to Hopkins symptom Checklist (HSCL-25) scores. RESULTS: 91.6% of the patient sample reported problems on the EQ-5D-3L, with 29.8% reporting extreme problem, compared to 39.8% and 3.0% in the general population sample. Mean index (EQ VAS) score among SUD patients was .59 (59.9) compared to .90 (84.1) in the general population. Regression analyses identified phobic anxiety and cocaine dependence as statistically significant predictors of higher EQ-5D-3L index scores. CONCLUSION: SUD patients report substantially reduced HRQoL, as measured using the EQ-5D-3L. The most frequently reported problems were for the anxiety/depression, pain/discomfort, and usual activities dimensions. The EQ-5D may be a useful and practical instrument for monitoring HRQoL in SUD patients.

Complementary horse-assisted therapy for substance use disorders: a randomized controlled trial.

BACKGROUND: Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs. METHODS: Fifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment. RESULTS: The multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some unforeseen challenges were encountered in the study: a high number of subjects transferred to another treatment, variable attendance at cHAT sessions, and long temporary exits. Nevertheless, 44% of participants in the cHAT group completed their treatment, compared with 32% in the TAU-only group; this observation encourages further investigation in a larger sample. CONCLUSIONS: Though no association was identified between cHAT and treatment retention or completion, our study may have been underpowered. Further work in a larger clinical population is needed; observational studies with repeated measures may also be useful for investigating whether cHAT increases retention in treatment or rates of completion, two important factors for successful SUD treatment. Trial registration The trial was registered and approved on 14 October 2011 by the Regional Committee for Medical and Health Research Ethics with registration number 2011/1642 and registered at ClinicalTrials.gov on 21 February 2013 with registration number NCT01795755.

Measuring Personality Problems in Patients With Substance Use Disorders: A Cross-Sample Validation.

Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications. Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems were compared among samples. Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population. Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.

Predicting Dropout from Inpatient Substance Use Disorder Treatment: A Prospective Validation Study of the OQ-Analyst.

BACKGROUND AND AIMS: There is an urgent need for tools allowing therapists to identify patients at risk of dropout. The OQ-Analyst, an increasingly popular computer-based system, is used to track patient progress and predict dropout. However, we have been unable to find empirical documentation regarding the ability of OQ-Analyst to predict dropout. The aim of the present study was to perform the first direct test of the ability of the OQ-Analyst to predict dropout. DESIGN: Patients were consecutively enlisted in a naturalistic, prospective, longitudinal clinical trial. As interventions based on feedback from the OQ-Analyst could alter the outcome and potentially render the prediction wrong, feedback was withheld from patients and therapists. SETTING: The study was carried out during 2011-2013 in an inpatient substance use disorder clinic in Oslo, Norway. PARTICIPANTS: Patients aged 18 to 28 years who met criteria for a principal diagnosis of mental or behavioural disorder due to psychoactive substance use (ICD 10; F10.2-F19.2). MEASUREMENTS: Red signal (predictions of high risk) from the Norwegian version of the OQ-Analyst were compared with dropouts identified using patient medical records as the standard for predictive accuracy. FINDINGS: A total of 40 patients completed 647 OQ assessments resulting in 46 red signals. There were 27 observed dropouts, only one of which followed after a red signal. Patients indicated by the OQ-Analyst as being at high risk of dropping out were no more likely to do so than those indicated as being at low risk. Random intercept logistic regression predicting dropout from a red signal was statistically nonsignificant. Bayes factor supports no association. CONCLUSIONS: The study does not support the predictive ability of the OQ-Analyst for the present patient population. In the absence of empirical evidence of predictive ability, it may be better not to assume such ability.

Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder: A Clinical Explorative Study.

BACKGROUND: Substance use disorders (SUDs) have been assumed to be rare in individuals with autism spectrum disorder (ASD). Recent research suggests that the rates of SUD among individuals with ASD may be higher than assumed although reliable data on the prevalence of SUD in ASD are lacking. Typical interventions for SUD may be particularly unsuitable for people with ASD but research on intervention and therapy are limited. METHODS: This study addresses ways of improving services for individuals with ASD and SUD by enhancing the competence of professionals in ordinary SUD outpatient clinics. Three therapists were given monthly ASD education and group supervision. The participants were ordinary referred patients who wanted to master their problems with alcohol or drugs. Four patients, all men diagnosed with ASD and intelligence quotient (IQ) ⩾ 70 completed the treatment. The participants were given cognitive behavioural therapy (CBT) modified for their ASD over a minimum of 10 sessions. The therapies lasted between 8 and 15 months. Standardised assessments were conducted pre- and post-treatment. RESULTS: Post-treatment, 2 participants had ended their drug and alcohol abuse completely, 1 had reduced his abuse, and 1 still had a heavy abuse of alcohol. Physical well-being was the most prevalent reported positive aspect of drug or alcohol use, whereas the experience of being left out from social interaction was the most frequent negative aspects of intoxication. CONCLUSIONS: CBT may represent a promising treatment option for individuals with ASD and SUD. The results suggest that patients' symptoms can be reduced by providing monthly ASD education and group supervision to therapists in ordinary SUD outpatient clinics. This group of patients need more sessions than other client groups, the therapy has to be adapted to ASD, ie, direct, individualised, and more extensive. Moreover, the patients need psychoeducation on ASD generally, social training, and support to organise several aspects of their lives and some patients need more support than can be provided in an outpatient clinic.

The Montreal Cognitive Assessment as a predictor of dropout from residential substance use disorder treatment.

BACKGROUND: Cognitive function is a challenge for many SUD patients, and residential SUD treatment is cognitively demanding. Treatment retention is a predictor for success in SUD treatment, and the literature links low cognitive function to increased dropout rates. In our study we investigate cognitive function and dropout in a residential SUD treatment setting, also accounting for psychological distress. METHODS: We screened a cohort (N = 142) of inpatients for cognitive function (MoCA®) and psychological distress (SCL-10) and calculated the relative risk for dropping out if over versus under the respective cut-off values (<26 and >1.85), and sex, and age-group (<23 years). We also employed a logistic regression with dropout as outcome and MoCA- and SCL-10 scores, and age and days before testing as input. RESULTS: Dropout risk was higher (RR = 1.70) if scoring below MoCA cut-off, and for those younger than 23 years (RR = 2.36). The other variables did not influence dropout risk. MoCA raw scores, age, and SCL-10 were associated with dropout (p < .05); with lower symptoms of psychological distress predicting increased dropout. The interaction between MoCA and SCL-10 scores was not significant (p = .26). CONCLUSIONS: SUD patients should routinely be screened for cognitive impairment, as it predicts dropout. Screenings should be ensued by appropriate adaptations to treatment and further assessment. The MoCA is a useful screening tool for this, independent of psychological distress. Future studies should replicate our findings, investigate specific interventions, and establish SUD population norms for the MoCA.

Measuring cognitive impairment in young adults with polysubstance use disorder with MoCA or BRIEF-A - The significance of psychiatric symptoms.

INTRODUCTION: Chronic polysubstance use disorder (PSUD) is associated with cognitive impairments. These impairments affect the quality of life, occupational functioning, and the ability to benefit from therapy. Psychological distress also affects neurocognitive status, and impaired neurocognition characterizes several psychiatric conditions. Neurocognitive assessment is thus of importance but faces several interpretive challenges. One is disentangling the link between psychological distress and cognitive impairment. This paper investigates the associations between psychological distress and two cognitive screening tools, the Montreal Cognitive Assessment (MoCA) and the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) in young adults with PSUD. MATERIAL AND METHODS: This study included 104 patients with PSUD recruited from the Norwegian Stayer study. Participants completed the MoCA, a self-report measure of executive functioning (EF), the BRIEF-A, and the Symptom Checklist 90 Revised, a measure of psychiatric symptoms (SCL-90-R). Cognitive impairment was diagnosed in accordance with previously published cutoff scores for the MoCA and BRIEF-A. Correlation analysis and multiple logistic regression were used to evaluate the association between cognitive impairment identified with the MoCA or BRIEF-A and psychological distress. RESULTS: More than a third (34.6%) of patients scored below the threshold for cognitive impairment on the MoCA. On the BRIEF-A, 63.2% of participants reported executive problems that exceeded what was expected based on previously published norms. SCL-90-R scores were, as expected, elevated when compared with normative scores. Logistic regression analysis demonstrated a significant association between cognitive impairment identified by the BRIEF-A and scores on the SCL-90-R Global Severity Index (OR = 17.3, 95% CI: 4.4-68.8, p < 0.001) and age (OR = 0.7, 95% CI: 0.6-0.9, p = 0.003). Cognitive impairment identified by the MoCA was not significantly associated with demographic variables or SCL-90-R GSI score in multiple regression analysis. CONCLUSIONS: Our study indicated that the MoCA is a measure of cognitive impairment that is independent of psychological distress, as measured with the SCL-90-R, whereas the BRIEF-A Global Executive Composite is strongly associated with distress. This suggests the need to interpret BRIEF-A results within a broad differential diagnostic context, where the assessment of psychological distress is included. The findings support that performance-based assessment such as the MoCA could reduce the impact of psychological distress in cognitive screening.

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders.

Background: The four-dimensional ('4-D') model has been proposed as a theoretical framework to understand and delineate trauma-related dissociative experiences, categorizing symptoms into trauma-related altered states of consciousness (TRASC) and normal waking consciousness (NWC), which occur along four dimensions: time, thought, body and emotion. Objective: The main aim of the present study was to evaluate the validity of this model in patients with post-traumatic stress disorder (PTSD), with and without comorbid dissociative disorders. Method: The predictions of the 4-D model were tested in 142 patients with PTSD, with (N = 46) and without (N = 96) comorbid dissociative disorders. Results: As predicted by the 4-D model, experiences of TRASC were less frequent and more specifically related to other measures of dissociation, dissociative disorder comorbidity and a history of childhood sexual abuse compared to experiences of NWC. The predicted lower intercorrelation of TRASC was not supported. Conclusion: The 4-D model represents a promising framework for understanding dissociation across trauma-related disorders.

Antecedentes: El 'modelo 4-D' ha sido propuesto como un marco teórico para entender y delinear las experiencias disociativas relacionadas al trauma, categorizando los síntomas en estados alterados de conciencia relacionados al trauma (TRASC en su sigla en inglés) y la conciencia en vigilia normal (NWC en sus siglas en inglés), que ocurren a lo largo de cuatro dimensiones: (1) tiempo; (2) pensamiento; (3) cuerpo; y (4) emoción. El principal objetivo del presente estudio fue evaluar la validez de este modelo en pacientes con Trastorno de Estrés Postraumático (TEPT), con y sin trastornos disociativos comórbidos.Métodos: Los predictores del modelo 4-D fueron probados en 142 pacientes con TEPT, con (N=46) y sin (N=96) trastornos disociativos comórbidos.Resultados: Como predice el modelo 4-D, las experiencias de los TRASC fueron menos frecuentes y más específicamente relacionados a otras medidas de disociación, comorbilidad del trastorno disociativo y una historia de abuso sexual infantil en comparación a las experiencias de NWC. La predicción de la intercorrelación más baja de los TRASC no fue confirmada.Conclusión: El modelo 4-D representa un prometedor marco para el entendimiento de la disociación de forma transversal en los trastornos relacionados al trauma.

More Than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy.

Inclusion of horse-assisted therapy (HAT) in substance use disorder (SUD) treatment is rarely reported. Our previous studies show improved treatment retention and the importance of the patient-horse relationship. This qualitative study used thematic analysis, within a social constructionist framework, to explore how eight patients experienced contextual aspects of HAT's contribution to their SUD treatment. Participants described HAT as a "break from usual treatment". However, four interrelated aspects of this experience, namely "change of focus", "activity", "identity", and "motivation," suggest HAT is more than just a break from usual SUD treatment. The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the "patient/self" receiving treatment for a problem. The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader SUD policy and treatment practices warrants further study.

Autism Spectrum Disorder and Co-occurring Substance Use Disorder - A Systematic Review.

OBJECTIVE: Patients with co-occurring autism spectrum disorders (ASD) and substance use disorder (SUD) require special attention from clinical services. Screening for this co-occurrence is not generally an integral part of routine clinical assessments, and failure to identify and understand this group of patients may contribute to a worsening of their symptoms and/or an increase in drug abuse. Thus, there is a need to review the evidence base on patients with co-occurring ASD and SUD in order to enhance clinical practice and future research. METHODS: We reviewed all identified papers on patients with co-occurring ASD and SUD. The focus of the review was on epidemiology, patient characteristics, function of drug use, and the effect of current interventions. RESULTS: A total of 18 papers were included in the analysis. Eleven papers were based on epidemiological studies, although only one study reported the prevalence of ASD in an SUD population. Two papers explored the role of personality, three papers studied subgroups of individuals serving prison for violent or sexual crimes, and one paper explored the function of drugs in the ASD patient group. There were no studies testing specific treatment interventions. CONCLUSIONS: In most of the treatment settings studied, there were relatively few patients with co-occurring ASD and SUD, but due to differences in study samples it was difficult to establish a general prevalence rate. The one consistent finding was the lack of focused treatment studies. There is clearly a need for research on interventions that take account of the special needs of this patient group.