A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment.

Introduction: This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions. Materials and Methods: Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables. Results: The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG. Conclusion: The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

Is There an Association Between Salivary Cortisol and Dropping Out of Inpatient Substance Addiction Treatments? A Prospective Repeated Measures Study.

Several studies have found an association between salivary cortisol levels and dropping out of inpatient substance addiction treatment programs. The results are mixed due to variations in the study design and the lack of standardized routines for cortisol assessment. The aim of this study was to investigate whether there was (1) an association between salivary cortisol levels and dropping out from inpatient substance addiction treatments; (2) higher predictive validity for dropout in one of the cortisol indexes: Area Under the Curve with respect to ground (AUCG) or Daily Cortisol Slope (DCS); (3) an interaction effect with time for each cortisol index; and (4) different dropout rates for sex and patients in short-term versus long-term treatment programs. This was a prospective, repeated-measures observational study. Patients (n = 173) were recruited from 2 inpatient facilities in the central region of Norway between 2018 and 2021. Salivary cortisol was measured 4 times during the treatment period, with 8 samples collected over 2 consecutive days at each time point. Cortisol levels were calculated using the cortisol indices AUCG and DCS. Dropout was used as the outcome measure at each time point. Associations were calculated using a logistic linear regression. The results suggest a main effect of AUCG, whereby higher levels reduce dropout risk (OR = 0.92, P = .047). An interaction with time in treatment also revealed a higher dropout risk (OR = 1.09, P = .044) during week 4 of the treatment, depending on the AUCG. These results support using AUCG as the recommended index when assessing cortisol, and that the relationship between cortisol levels and length of treatment should be further investigated.

Protective Factors Against Psychological Distress Among Inpatients in Substance Use Treatment: A Cross-Sectional Study.

Several studies have found co-occurrence between substance abuse and mental health problems, as well as an association between treatment retention and psychological distress. The aim of this study was to investigate the association of possible protective factors with psychological distress. The present study tested physical activity, self-esteem and sense of coherence, and psychological distress level among inpatients in substance use treatment. The study design was cross-sectional and multicenter. Patients (N = 167) were recruited in 2018 from 10 Norwegian inpatient facilities. They self-reported on 3 validated measurement instruments: Rosenberg Self-Esteem Scale, Antonovsky's Sense of Coherence Scale, and frequency of physical activity. The Hopkins Symptom Checklist-10 was used as an outcome variable of psychological distress. The associations were investigated with multiple linear and logistic regression methods. The results suggested that high self-esteem and sense of coherence were protective factors against high levels of psychological distress: self-esteem (ß = -.39, P < .001) and sense of coherence (ß = -.352, P < .001). The results offer support for a salutogenic approach in substance use disorder (SUD) treatment by enhancing individuals' protective factors to reduce psychological distress.

Predictors of Dropout From Inpatient Substance Use Treatment: A Prospective Cohort Study.

INTRODUCTION: Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing challenge. The aim of this study was to identify demographic, substance use, and psychological factors that predict dropout from postdetoxification inpatient SUD treatment. MATERIALS AND METHODS: A total of 454 patients from 5 inpatient SUD centers in Central Norway were consecutively included in this naturalistic, prospective cohort study. RESULTS: A total of 132 patients (28%) did not complete the planned treatment stay (dropped out). Cox regression analysis showed that higher levels of intrinsic motivation for changing personal substance use reduced the dropout risk (adjusted hazard ratio [adjHR]: 0.62, 95% confidence interval [CI]: 0.48-0.79). Higher levels of mental distress were associated with an increased risk for dropout (adjHR: 1.48, 95% CI: 1.11-1.97). CONCLUSIONS: The role of mental health and motivation in reducing dropout risk from inpatient SUD treatment should be targeted in future prospective intervention studies.

Patient satisfaction with treatments and outcomes in residential addiction institutions.

AIM: The objective of the present study was to investigate associations between patients' satisfaction with different domains of inpatient substance use treatment and their perceived treatment outcome. The primary purpose was to identify domains of treatment satisfaction most strongly associated with a positive treatment outcome. DESIGN: Data were based on a survey among 188 patients with alcohol and/or illicit substance use disorders completing a three-six-month inpatient stay at one of two public clinics in Central Norway. The survey was carried out shortly before discharge. The 15-item questionnaire covered ratings of staff and programme factors, and services received for medical and mental problems and ancillary services. The outcome score was based on items measuring perceived substance use improvements and benefit of treatment. RESULTS: A significant proportion of patients were dissatisfied with the support provided for housing, financial issues and employment. Confidence in staff competence was the domain of treatment satisfaction most strongly associated with the outcome score. Furthermore, patients were more likely to report a positive outcome when they were actively involved in the treatment, as indicated by satisfaction with opportunities to affect treatment plans. CONCLUSION: Our results suggest that patient-experienced improvements are connected to confidence in staff competence and user involvement. The findings may be interpreted as supporting a collaborative relationship between patients and counsellors.

Treatment stage associated changes in cellular and molecular microbial markers during the production of drinking water at the Vansjø water works.

The production of a drinking water that meets current aesthetic, microbiological and chemical standards, generally requires a combination of mechanical purification and disinfection in a multi-component treatment chain. Treatment choices and optimisation of water processing is best informed by using markers (including microbiological parameters) which indicate how each stage contributes to the production of the potable water. The present study combines culture-based and a number of culture-independent analyses to indicate what is happening at each stage of a state-of-the-art water treatment chain at Vansjø near the city of Moss in Norway. We show that particularly clarification with flotation and post-chlorination have profound and positive effects on water quality with respect to the removal and inactivation of microbes. Post-chlorination achieved better disinfection of the water than UV-treatment and was of paramount importance, as the penultimate step filtration through granular activated shed microbes to the water. Cloning and sequencing showed that some clones present in the raw water were detected at all stages in the treatment process, perhaps providing examples of microbes breaching physically all barriers in the treatment process. Results from the study should be useful in the improvement and maintenance of the treatment process at the Vansjø plant and others.

Identification and phylogeny of the small eukaryote population of raw and drinking waters.

Culture-dependent and -independent methods were used to investigate the small eukaryote composition of raw and finished waters in the Norwegian cities of Oslo, Tromsø, Fredrikstad and Oppegård. Probes with general applicability to the 18S rRNA genes of the small eukaryote consortium were used for PCR-denaturing gradient gel electrophoresis (DGGE), and in the generation of clone libraries using the TOPO™ cloning and sequencing system. The chosen probes invariably gave a single band in agarose gel electrophoresis, indicating amplification of an area of similar size. DGGE and cloning analyses resolved the bands into components representing many unique amplicons. Diversity and composition in the collection were studied by DNA-sequencing, and visual examination of DGGE patterns. The cloning approach enabled the putative identification of a total of approximately 100 unique small eukaryotes. The major fraction of these represented ciliated and flagellated protozoal species. This was in keeping with the findings from protozoal cultivation. DNA from a number of multicellular eukaryotes was also detected. Amoebal and fungal DNA was rarely found. The latter may indicate a low incidence or a bias in the analysis technique. The population of small eukaryotes appears typical for pristine waters and no primary pathogens were detected by culture-independent techniques. However, the potentially pathogenic protozoa Acanthamoeba castellanii was grown on one occasion from Oslo's drinking water. DGGE allowed the identification of fewer amplicons (by excision and sequencing of bands) than by the cloning-transformation approach. The DGGE analysis revealed clear similarities between the compositions of the raw and treated waters, indicating that cells or DNA in the raw water pass through the treatment trains. Protozoal culture and heterotrophic plate count analysis consistently revealed viable cells in both raw and treated waters in Oslo. This indicates that a fraction of the clone library represents eukaryotic species surviving the treatment trains. The analyses here presented represent the first published study of the general small eukaryotic fraction of the Capital's drinking water, and those of three other Norwegian cities. We suggest that DGGE profiles may have a value in judging physical treatment efficacy (removal of cells), but that direct cloning and sequencing studies is more amenable for characterization of uncultured microbes.

Microbial quality and nutritional aspects of Norwegian brand waters.

The microbiological quality of the five leading brands of Norwegian bottled still waters was investigated. All brands were free for the enteric indicator organisms and named pathogens whose absence is demanded in current quality directives. The relatively nutrient-poor agar R2A revealed large heterogeneous bacterial populations which grew slowly, or not at all, on clinical media specified for use in substrate-utilization approaches to identification. The main approach used for identification was cultivation of microbes on R2A, followed by amplification and partial sequencing of 16S rDNA genes. The identity of the heterotrophic plate count of the brands differed significantly to that found in many other similar studies with respect to the dominating species. The bacterial flora was dominated by beta- and alphaproteobacteria most of which were psychrotolerant. Several brands contained Sphingomonas and large populations of Methylobacterium species which have been associated with a variety of opportunistic infections of immunocompromised hosts. Analysis of the isolated strains' nutritional capabilities using the Biolog GN2® system, gave in most instances low positive scores, and strain identifications using the system were generally inconclusive. Measures of assimilable organic carbon in the water revealed that some brands contained levels higher than those which have been associated with biological stability and restricted or no growth of heterotrophs in distribution systems. The relationship between assimilable organic carbon and R2A plate counts was significant and moderately positive for bottled waters. Assimilable organic carbon correlated strongly with the survival time of Escherichia coli when introduced into bottles as a contaminant. Those brands having high values (~100 µg/L) supported protracted survival, but not growth of E. coli, whereas E. coli quickly became nonculturable in brands with low values. Thus measures of assimilable organic carbon may have a particular value in predicting the survival of this and nutritionally similar species of hygienic relevance. Only small numbers of fungi were found. However, one isolate (Aureobasidium pullulans) has been associated with infections of humans.

Visible foliar injury and infrared imaging show that daylength affects short-term recovery after ozone stress in Trifolium subterraneum.

Tropospheric ozone is a major air pollutant affecting plants worldwide. Plants in northern regions can display more ozone injury than plants at lower latitudes despite lower ozone levels. Larger ozone influx and shorter nights have been suggested as possible causes. However, the effects of the dim light present during northern summer nights have not been investigated. Young Trifolium subterraneum plants kept in environmentally controlled growth rooms under long day (10 h bright light, 14 h dim light) or short day (10 h bright light, 14 h darkness) conditions were exposed to 6 h of 70 ppb ozone during daytime for three consecutive days. Leaves were visually inspected and imaged in vivo using thermal imaging before and after the daily exposure. In long-day-treated plants, visible foliar injury within 1 week after exposure was more severe. Multivariate statistical analyses showed that the leaves of ozone-exposed long-day-treated plants were also warmer with more homogeneous temperature distributions than exposed short day and control plants, suggesting reduced transpiration. Temperature disruptions were not restricted to areas displaying visible damage and occurred even in leaves with only slight visible injury. Ozone did not affect the leaf temperature of short-day-treated plants. As all factors influencing ozone influx were the same for long- and short-day-treated plants, only the dim nocturnal light could account for the different ozone sensitivities. Thus, the twilight summer nights at high latitudes may have a negative effect on repair and defence processes activated after ozone exposure, thereby enhancing sensitivity.

Effects of the Nordic photoperiod on ozone sensitivity and repair in different clover species studied using infrared imaging.

Plants in Nordic regions can be more ozone sensitive at a given ozone concentration than plants at lower latitudes. A recent study shows that the Nordic summer photoperiod, particularly the dim nighttime light, can increase visible foliar injury and alter leaf transpiration in subterranean clover. Effects of photoperiod on the ozone sensitivity of white and red clover cultivars adapted to Nordic conditions were investigated. Although ozone induced visible foliar injury and leaf transpirational changes in white clover, the effects were independent of photoperiod. In red clover, ozone combined with a long photoperiod with dim nights (8 nights) induced more severe visible injuries than with a short photoperiod. Furthermore, transpirational changes in red clover depended on photoperiod. Thus, a long photoperiod can increase ozone sensitivity differently in clover cultivars with different degrees of adaptation to northern conditions, suggesting that ozone indices used in risk analysis should take this effect into account.