| 1. |
- Grönbladh, Leif, 1947-
(författare)
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A National Swedish Methadone Program 1966-1989
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala.The aim of this thesis was to study the outcome of methadone treatment along various lines:• An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program.• Retention in treatment.Study subjects, methods and treatment goals: Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. Results: Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the occurrence of HIV infection among patients in long-term methadone treatment. The average one-year retention during 1967-1989 was 90% and cumulative retention showed that 29% were still in treatment 10 years after admission.Conclusion: The present results emphasise the importance of vocational rehabilitation and support in a treatment strategy based on long-term maintenance therapy.
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| 2. |
- Grönbladh, Leif, et al.
(författare)
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Adherence and social antecedents in relation to outcome in Methadone Maintenance Treatment (MMT)
- 2010
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Ingår i: Heroin Addiction and Related Clinical Problems. - 1592-1638. ; 12:2, s. 9-18
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Tidskriftsartikel (refereegranskat)abstract
- Numerous reports of the effectiveness of methadone in reducing opiate use as well as mortality, criminality, prostitution and the risk for HIV-infection have been published during the last forty years. However, poor adherence to treatment, continuing drug use and increasing rate of premature termination may lead to less than optimal outcome results or in too many cases death. The aim of this paper is to investigate which of the background variables, collected at the admission procedure, that can be used to tell which type of patient will adhere to the treatment regime and succeed or who will fail and who either need special considerations or ought not to be accepted for a methadone treatment (MMT). As much as 86 percent of the compliers in this study did benefit from the treatment and were rated as medium to very much improved according to CGI-I. The group not improved or worse had significantly more background problems such as school problems, a history of non-opioid abuse, many non-MMT treatment episodes, low age at drug debut and opioid debut than the group much or very much improved. Those moderately improved is usually situated somewhere in between the others.
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| 3. |
- Grönbladh, Leif, et al.
(författare)
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Heroinberoende
- 2015. - 2
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Ingår i: Beroendemedicin. - 9789144099859 ; , s. 211-223
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Grönbladh, Leif, et al.
(författare)
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Self-reported differences in side-effects for 110 heroin addicts during opioid addiction and during methadone treatment
- 2011
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Ingår i: Heroin addiction and related clinical problems. - 1592-1638. ; 13:4, s. 5-12
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Tidskriftsartikel (refereegranskat)abstract
- Although methadone maintenance treatment (MMT) has been shown to be effective, poor compliance is always a threat. It has often been pointed out that one variable that inevitably reduces adherence to treatment regimes is the negative side-effects of the treatment. This study examines seventeen known side-effects in a sample of 110 former opiate addicts consecutively admitted to methadone maintenance treatment. Self-reported side-effects were collected through a questionnaire. Despite the considerable increase, from 23 to 74% of the sample, in the proportion that reported individual side-effects between the period of opiate use and that of methadone treatment, the overall result was a significant decrease in eleven symptoms, no change in four and a substantial increase in only two. In some individuals a symptom that is liable to be problematic actually does become problematic, while the same symptom becomes less frequent in the group as a whole. Weight gain is the symptom that increases most in the whole group and needs to be constantly monitored. Other side-effects that remain high and need to be kept under review in clinical practice are nervousness, decreased libido, daytime drowsiness, constipation and perspiration.
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| 5. |
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| 6. |
- Kakko, Johan, et al.
(författare)
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A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence : A randomized controlled trial
- 2007
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Ingår i: American Journal of Psychiatry. - 0002-953X .- 1535-7228. ; 164:5, s. 797-803
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Both methadone and buprenorphine are effective therapy for heroin dependence. Efficacy is best documented for methadone maintenance therapy, but safety concerns limit its use. Buprenorphine offers lower overdose risk and improved access, but efficacy may be lower. The authors compared adaptive, buprenorphine-based stepped care to optimal methadone maintenance treatment. METHOD: This randomized controlled trial was undertaken 2004-2006. It consisted of a 24-day uniform double-blind induction phase followed by single-blind flexible dosing based on structured clinical criteria, for a total of 6 months. Ninety-six self-referred subjects with heroin dependence were randomly assigned to methadone or to stepped treatment initiated with buprenorphine/naloxone and escalated to methadone if needed. All subjects received intensive behavioral treatment. Primary outcome was retention in treatment. Secondary outcomes were completer analyses of problem severity (Addiction Severity Index) and proportion of urine samples free of illicit drugs. RESULTS: Overall, 6-month retention was 78%. Stepped treatment and methadone maintenance therapy outcomes were virtually identical. Among completers of stepped therapy, 46% remained on buprenorphine/naloxone. Proportion of urine samples free of illicit opiates increased over time and ultimately reached approximately 80% in both arms. Problem severity decreased significantly and uniformly in both arms. CONCLUSIONS: A stepped treatment of heroin dependence as described here appears equally efficacious compared to optimally delivered methadone maintenance therapy. Together with prior data on the advantageous safety of buprenorphine, this suggests that broad implementation of strategies using buprenorphine as first-line treatment should be considered.
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| 7. |
- Nehlin, Christina Gordh, et al.
(författare)
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Alcohol and Drug Use, Smoking, and Gambling Among Psychiatric Outpatients : A 1-Year Prevalence Study
- 2013
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Ingår i: Substance Abuse. - : Informa UK Limited. - 0889-7077 .- 1573-6733 .- 1547-0164. ; 34:2, s. 162-168
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Studies of alcohol habits in general psychiatric populations are scarce. The objective was to investigate alcohol and drug use, smoking, and gambling in a clinical sample of psychiatric outpatients. A further aim was to study age and gender differences in the rates of these habits. Methods: Data were collected among psychiatric outpatients with mainly mood (47%) and anxiety (35%) disorders. A questionnaire package was distributed, including AUDIT (Alcohol Use Disorders Identification Test), DUDIT (Drug Use Disorders Identification Test), tobacco items, and gambling items. Two major drinking categories were formed: Nonhazardous alcohol use (NH) and Alcohol use above hazardous levels (AH). Results: In total, 2160 patients (65% females) responded to the questionnaire package. The AH rate was high among psychiatric outpatients (28.4%), particularly among young females (46.6%). Young female patients also reported a high prevalence of problematic drug use (13.8%). Problematic drug use, daily smoking, and problematic gambling were frequent. The unhealthy habits were linked to AH. Conclusions: Alcohol and drug use, smoking, and gambling are all highly prevalent among psychiatric outpatients. Young females are in particular need of attention. Interventions should be tailored for co-occurring psychiatric disorders and applied within routine psychiatric care.
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| 8. |
- Nehlin, Christina, 1958-, et al.
(författare)
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Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients
- 2012
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Ingår i: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 31:4, s. 544-549
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and aimsStaff attitudes are an important factor in the successful implementation of systematic alcohol strategies and policies. The forms and extent of training needed to improve therapeutic attitude among psychiatric staff to problem drinking are unclear. The aim of the investigation was to study the knowledge and attitudes of psychiatric staff toward problem drinking patients. A further aim was to investigate whether a short three-hour training is sufficient to improve knowledge and therapeutic attitude toward problem drinking.Design and methodsA tailored training model for psychiatric staff (non-physicians) was carried out at a medium size university clinic. Participants were medical (nurses and psychiatric aides) and non-medical staff (psychologists and social workers). The training consisted of a two-hour workshop and a one-hour follow-up session. Knowledge and attitudes were measured at baseline and follow-up by a questionnaire including vignettes assessment and the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ).Results In total, 115 persons completed the questionnaire (follow-up rate 83.5 %). The distribution was even (50 % for the medical and 50 % for the non-medical staff). After training, the non-medical staff estimated vignette case severity higher than before. Both staff groups estimated their capacity to help a patient with complex problems higher after training. Role adequacy was higher in both subgroups after training. Medical staff scored Work satisfaction higher after the training. Discussion and conclusionsThree hours of tailored training for psychiatric staff improve their knowledge and therapeutic attitude to problem drinking patients.
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| 9. |
- Nehlin Gordh, Christina, 1958-
(författare)
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Alcohol Use and Secondary Prevention in Psychiatric Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although alcohol plays an important role in psychiatric morbidity, there is a general lack of strategies within psychiatric care to intervene at alcohol problems in an early stage (secondary prevention). The aim of this thesis was to increase knowledge of adequate forms of secondary alcohol prevention in psychiatric care. The capacity of three brief screening instruments was investigated in a psychiatric outpatient sample (n=1811). The results indicate that the HED (heavy episodic drinking) screener, strongly recommended for health care settings, is not sufficiently sensitive in a psychiatric setting. Instead, the full AUDIT (Alcohol Use Disorders Identification Test) is recommended.The knowledge and attitudes of psychiatric staff members to problem-drinking patients were studied and the effects of a three-hour training course were investigated. Confidence in self-perceived capacity to intervene in more severe alcohol problems was raised among all staff after training. Awareness of early signs of problem drinking was raised among psychologists and social workers. The therapeutic attitude of the psychiatric staff was higher when compared with primary care staff.Two forms of brief intervention were delivered by clinical psychiatric staff. At 12 months, 29% of all participants had improved their drinking habits, moving from hazardous to non-hazardous level (21%) or from harmful to hazardous level (8%). In the improved group, mean AUDIT score was reduced from 11.0 points at baseline to 5.5 points. Differences in outcome between the two interventions could not be identified.Nine high-risk drinking young female psychiatric patients were interviewed, focusing on reasons for excessive drinking and factors facilitating a change in drinking habits. Alcohol played an important role in the lives of the young women. It made them feel social and helped them deal with unbearable emotions. It was also used as a means of self-harm, representing the first stage in an escalating self-harm process. They expressed a need for help from their caregivers in addressing the underlying reasons for drinking.Secondary alcohol prevention strategies including appropriate screening methods, staff training and the elaboration of tailored interventions are urgently needed in psychiatric care. The findings of this thesis can be used when forming such strategies.
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| 10. |
- Nehlin Gordh, Christina, 1958-, et al.
(författare)
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Brief alcohol intervention in a psychiatric outpatient setting : A randomized controlled study
- 2012
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Ingår i: Addiction Science & Clinical Practice. - : Springer Science and Business Media LLC. - 1940-0640. ; 7:23
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Tidskriftsartikel (refereegranskat)abstract
- Background:Although brief alcohol intervention (BI) is widely studied, studies from psychiatric outpatient settings are rare. The aim of this study was to investigate the effects of two variants of BI in psychiatric outpatients. By using clinical psychiatric staff to perform the interventions, we sought to collect information of the usefulness of BI in the clinical setting.Methods: Psychiatric outpatients with Alcohol Use Disorders Identification Test (AUDIT) scores indicating hazardous or harmful drinking were invited to participate in the study. The outpatients were randomized to minimal (assessment, feedback, and an informational leaflet) or BI (personalized advice added). Measurements were performed at baseline and at six and 12 months after the intervention. The primary outcome was change in AUDIT score at the 12-month follow-up.Results: In all, 150 patients were enrolled and received either a minimal intervention (n = 68) or BI (n = 82). At 12 months, there was a small reduction in AUDIT score in both groups, with no significant differences in outcome between groups. At 12-month follow-up, 21% of participants had improved from a hazardous AUDIT score level to a nonhazardous level, and 8% had improved from a harmful level to a hazardous level (8%).Conclusions: Brief alcohol interventions may result in a reduction of AUDIT score to a small extent in psychiatric patients with hazardous or harmful alcohol use. Results suggest that BI may be of some value in the psychiatric outpatient setting. Still, more profound forms of alcohol interventions with risky-drinking psychiatric patients need elaboration.
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