Sunday, November 8, 2015

Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users

Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help.

The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO.

Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined.

Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety. Additionally, significant improvements were found within specific subgroups of participants, including females, males, service users reporting alcohol dependence, opiate and crack dependence, and those seeking support for other substances that may be less well represented in the substance misuse sector.

Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.

Table 1

The main substances of dependence (N=19).

Substance		n (%)
Alcohol		210 (53.4)
Non-opiate (and opiate substitute) or crack
	Amphetamines	11 (11.0)
	Cannabis	46 (11.7)
	Cocaine	16 (4.1)
	Diazepam	7 (7.0)
	Dihydrocodeine	2 (0.5)
	Etizolam	1 (0.3)
	GBL	1 (0.3)
	Ketamine	2 (0.5)
	Khat	2 (0.5)
	Mephedrone	3 (0.8)
	Temazepam	1 (0.3)
	Tramadol	2 (0.5)
	Zopiclon	1 (0.3)
	Total	95 (24.2)
Opiate (and opiate substitute) or crack
	Buprenorphine	5 (1.3)
	Crack	12 (3.1)
	Heroin	52 (1.2)
	Methadone	18 (4.6)
	Suboxone	1 (0.3)
	Total	88 (22.4)

Full article at: http://goo.gl/qBjDbp

By: Sarah Elison, BSc (Hons), MSc, MPhil, PhD,^#1 Glyn Davies, BSc (Hons), MSc (Econ),¹ and Jonathan Ward, BA (Econ), MSc, DClinPsy¹

¹Breaking Free Online, Manchester, United Kingdom

Sarah Elison, Breaking Free Online, 274 Deansgate, Manchester, M3 4JB, United Kingdom, Phone: 44 0161 834 ext 4647, Fax: 44 0161 834 4647, Email: moc.puorgeerfgnikaerb@nosiles.

More at: https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Wednesday, October 21, 2015

Personal Network Recovery Enablers and Relapse Risks for Women with Substance Dependence

We examined the experiences of women in treatment for substance dependence and their treatment providers about personal networks and recovery. We conducted six focus groups at three women’s intensive substance abuse treatment programs. Four coders used thematic analysis to guide the data coding and an iterative process to identify major themes. Coders identified social network characteristics that enabled and impeded recovery and a reciprocal relationship between internal states, relationship management, and recovery. Although women described adding individuals to their networks, they also described managing existing relationships through distancing from or isolating some members to diminish their negative impact on recovery. Treatment providers identified similar themes but focused more on contextual barriers than the women. The focus of interventions with this population should be on both internal barriers to personal network change such as mistrust and fear, and helping women develop skills for managing enduring network relationships...

The aims of this study were to identify the qualities of the salient relationships in women’s personal networks that served as either recovery enablers or risks for relapse, and to identify barriers to making changes in personal network relationships to facilitate recovery. These data reflected the ambivalent nature of relationships and network change for these women. Changes in personal networks involved fear and loss that were sometimes unaddressed by treatment providers. In addition, even substance abusing friends and family and those who enabled substance use in the past were described by participants as providing important support and maintaining some positive involvement with women.

Whereas traditional 12-step-oriented treatment models emphasize changing people and places, these data indicated that such changes might be very difficult for socioeconomically disadvantaged women to achieve. Zelvin (1999), using a relational approach to women and addiction, conceptualized women’s relationship problems as “maladaptive attempts to connect rather than the failure to separate” (p. 9) and suggested that women’s relational focus should be viewed as a strength to promote more positive relationships in recovery. Substance abuse treatment providers hear many client narratives describing negative relationships with partners, families, and friends. These narratives lead them to conclude that these network relationships are more of a liability than a potential resource in recovery. Providers might then miss opportunities to educate and coach women in ways to change and adapt network relationships toward being more supportive of recovery...

Full article at: http://goo.gl/kxo4nt

By: Suzanne Brown,1 Elizabeth M. Tracy,2 MinKyoung Jun,3 Hyunyong Park,2 and Meeyoung O. Min2

¹Wayne State University, Detroit, Michigan, USA

²Case Western Reserve University, Cleveland, Ohio, USA

³Gyeonggido Family and Women’s Research Institute, Suwon, South Korea

Corresponding Author: Suzanne Brown, School of Social Work, Wayne State University, 4756 Cass Avenue, Detroit, MI 48202, USA. Email:ude.enyaw@nworb.ennazus