Traumatic experience in childhood or adolescence has a significant impact on the development of chronic mental and physical conditions in adulthood. Thus, it is very important for health ...professionals, especially primary care physicians to have an inventory in order to detect early trauma for planning appropriate treatment, such as the Early Trauma Inventory (ETI). The aim of this paper is to test the psychometric properties of the Slovenian translation of the short, self-rated version (ETISR-SF), and to further validate the instrument.
The research was done in two parts - qualitative and quantitative. In the qualitative part, a questionnaire was translated and culturally adapted using the Delphi method. For the quantitative part, 51 patients with substance use disorders hospitalized at the Centre for the Treatment of Drug Addictions were recruited, along with 133 controls. The psychometric properties of the questionnaire were checked. Internal consistency was calculated using Cronbach's alpha, test-retest reliability was examined graphically using a Bland-Altman plot. Discriminant validity between groups was gauged using the independent samples t-test.
Consensus in the Delphi study was reached in the second round. Cronbach's alpha varied between 0.60 - 0.85. Of the four domains, physical abuse had the lowest Cronbach's alpha. The test-retest reliability is high for all domains, with correlation coefficients ranging from 0.82 to 0.96. The non-clinical sample differed significantly from the clinical sample.
The Slovenian translation of ETISR-SF is a satisfactory instrument for the evaluation of trauma before the age of 18.
Benzodiazepines abuse in drug using population has become a large problem in many countries. The authors present the problem of use and misuse of benzodiazepines in drug using population in Slovenia ...and recommendations for prescribing benzodiazepines to patients in medicationassisted (substitution) treatment programmes for opioid addiction in Slovenia, including indications for prescribing and detoxification scheme.
Background: Substitution maintenance treatment is considered to be one of the most effective options for the management of heroin or other opioid drug addiction. It has expanded substantially in the ...European Union in the last decade. It is part of recognised medical practice approved by competent authorities. Research has shown that methadone maintenance treatment is more effective than detoxification programmes in promoting retention in drug treatment and abstinence from illicit drug use. The death rate of people with opioid dependence under methadone maintenance treatment is one third to one fourth the rate of those not under treatment. IDUs who do not enter treatment are up to six times more likely to become infected with HIV and fifteen times more with hepatitis C than injectors who enter and remain under treatment. Criminal behaviour is strongly reduced. Every Euro invested in the programmes may yield a return of between four and seven Euros in reduced drug-related crime, criminal justice costs and theft alone, and when including savings related to health care, total savings can exceed costs by a ratio of 1:12. Conclusions: Since 1995 eighteen Centres for the Prevention and Treatment of Drug Addiction have been established in the Republic of Slovenia. Centre for Treatment of Drug Addicts at the University Hospital of Psychiatry in Ljubljana was established in 2003. Substitution treatment with methadone was introduced in Slovenia in 1990, buprenorphine was registered in 2004 and SR morphine in 2005. Since 2007 buprenorphine-naloxone combination has been used as well. In 2008 there were 4429 patients treated in these outpatient centres, 3332 of them with substitution medications and additionally 542 in prisons. At the Centre for treatment of drug addiction 790 patients were treated in the outpatient clinic, 174 as inpatients and 70 in the day hospital.
To assess the ability to work and employability of individuals taking part in opioid substitution treatment programs (OSTP).
The study was composed of two surveys. In the first survey, 237 of 480 ...patients enrolled in OSTP responded to the questionnaire about their employment status, opinion about employment, and perception of assignments before and during OSTP. In the second survey, 66 of 100 employers responded to the questionnaire on the occurrence, perception, and management of addiction problems in their companies.
Unemployment rate in individuals enrolled in OSTP was 43.5% and decreased during OSTP by 10.5% (P=0.027). Irregular use of OSTP medications was the most important factor for unemployment (odds ratio, 2.44; P=0.016). OSTP was highly effective in achieving a positive change in patients' perception of different kinds of assignments previously perceived as beyond their abilities. Thus, perception of mentally demanding assignments (P<0.001), working at unfavorable hours (P<0.001), and forced work pace (P<0.001) represented much lower burden after entering OSTP. Only 6.6% of employers reported illicit drugs as being a problem at their companies and 79.1% believed they would not recognize a person under the influence of illicit drugs. In 93.0% of the cases, applicants for a job would have had lower chances if they had been drug users; the percentage was slightly higher for those taking part in OSTP (94.7%).
OSTP in Slovenia was effective in increasing both employability and OSTP patients' ability to work. To facilitate complete rehabilitation, particularly in obtaining employment for the patients, the process must involve the society as a whole.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of this analysis was to evaluate perceived barriers related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). C‐SCOPE ...was a study consisting of a self‐administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and the United States between April and May 2017. A 5‐point Likert scale (1 = not a barrier, 3 = moderate barrier, 5 = extreme barrier) was used to measure responses to perceived barriers for HCV testing, evaluation and treatment across the domains of the health system, clinic and patient. Among the 203 physicians enrolled (40% USA, 45% Europe, 14% Australia/Canada), 21% were addiction medicine specialists, 29% psychiatrists and 69% were metro/urban. OAT physicians in this study reported poor access to on‐site venepuncture (35%), point‐of‐care HCV testing (16%), and noninvasive liver disease assessment (25%). Only 30% of OAT physicians reported personally treating HCV infection. Major perceived health system barriers to HCV management included the lack of funding for noninvasive liver disease testing, long wait times to see an HCV specialist, lack of funding for new HCV therapies, and reimbursement restrictions based on drug/alcohol use. Major perceived clinic barriers included the lack of peer support programmes and/or HCV case managers to facilitate linkage to care, the need to refer people off‐site for noninvasive liver disease staging, the lack of support for on‐site phlebotomy and the lack of on‐site delivery of HCV therapy. This study highlights several important modifiable barriers to enhance HCV testing, evaluation and treatment among PWID attending OAT clinics.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Since the recognition of hepatitis C virus in 1989 it has been clear that intravenous drug users are at highest risk for acquiring the infection due to parenteral mode of its transmission. Hepatitis ...C virus is the main cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. In Slovenia, the strategy for the complex management of hepatitis C virus infection has been established in 1997 and 1999. Nowadays, simple and accessible diagnostic tools are available to diagnose the infection and the treatment of chronic hepatitis is successful in 48–95 %. Due to several preventive strategies the prevalence of hepatitis C virus infection among intravenous drug users on substitution treatment has decreased from 50–60 % at the beginning of the nineties to 16.5 % actually infected in 2006. To improve the detection of the infected drug users, their further follow up and management by the hepatitis specialists, the Slovenian national consensus guidelines for the management of hepatitis C virus infection in drug users have been set up in 2007. They comprise the stepwise diagnostic and treatment procedures as well as counselling all being performed in close cooperation between the hepatitis specialists and therapists in drug addiction treatment programmes.
The term dual diagnosis is used to describe the comorbid condition of substance use disorder and other mental disorder. The prevalence of substance use disorders is higher among patients with other ...mental disorders than in general population. Regarding prognosis in the treatment of patients with comorbid disorders, both disorders have a poorer outcome when undertreated. There are four models explaining aetiology of dual diagnosis: common factor models, secondary substance use disorder models, secondary psychiatric disorder models and bidirectional models. Differentiation between primary psychotic disorders that co-occur with substance use and substance induced psychosis is generally difficult, but it is important for understanding the course of illness and effective treatment planning. Three treatment approaches are used in patients with comorbid substance use disorder and another mental disorder: parallel, sequentional and integrative– the last one supposed to be more effective than others. Therapeutic approaches in the treatment of patients with dual diagnosis include psychoeducation, motivational interventions, cognitive–behavioural therapy, social skills training and psycho-pharmacotherapy.
ABSTRACT
Aims Evaluation of the efficacy, safety and acceptability of slow‐release oral morphine (SROM) in opioid addicts intolerant to methadone or with inadequate withdrawal suppression.
Design ...Prospective, open, non‐comparative multi‐centre study.
Setting Twelve out‐patient Centres for Prevention and Treatment of Drug Addiction in Slovenia.
Participants Male and female opioid addicts (age >18 years) under methadone maintenance therapy requiring a change of treatment in order to continue more effectively with maintenance.
Interventions Maintenance therapy with methadone was switched to once‐daily SROM.
Measurements Efficacy evaluations were based on the reduction of side effects and on the degree of suppression of opiate craving, signs and symptoms of withdrawal. In addition, self‐reported somatic and psychic symptoms (SCL‐27) as well as World Health Organization quality of life‐related (WHO QOL) parameters were monitored.
Findings Thirty‐nine subjects intolerant to methadone and 28 subjects showing inadequate withdrawal suppression under methadone ≥90 mg/day were included as two separate groups in the efficacy analyses. Treatment was switched easily from methadone to SROM on a 1 : 8 ratio. Four‐week SROM treatment resulted in significant reduction of side effects reported under methadone. Signs and symptoms of opioid withdrawal as well as craving for opiates were improved significantly in patients with inadequate response to methadone. Physical and psychological wellbeing improved significantly under SROM treatment. SROM was tolerated very well.
Conclusions Maintenance treatment with SROM appears to be a clinically useful alternative treatment in subjects not tolerating methadone or with inadequate withdrawal suppression.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
This study evaluated competency related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT).
C-SCOPE is a study consisting of a ...self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and USA between April-May 2017. A 7-point scale was used to measure < average competence (score >4 of 7) related to HCV testing, management and treatment.
Among 203 physicians (40% USA, 45% Europe, 14% Australia/Canada) 21% were addiction medicine specialists, 29% psychiatrists, and 70% were metro/urban mean PWID managed, 51; years of experience, 11. The majority perceived HCV testing (82%) and treatment (85%) among PWID as important. The minority reported < average competence with respect to regular screening (12%) and interpretation of HCV test results (14%), while greater proportions reported < average competence in advising patients about new HCV therapies (28%), knowledge of new treatments (37%), and treatment/management of HCV (40%). In adjusted analysis, factors independently associated with < average self-reported competency related to the ability to treat HCV and manage side effects included fewer years in medical practice, fewer numbers of patients treated for HCV infection in the past six months, not having obtained information on screening, diagnosing or treatment of HCV, not having attended any training on HCV in the past year, and not having read or consulted AASLD/IDSA, EASL or other guidelines for HCV.
Physicians treating HCV infection among PWID attending OAT clinics recognized the importance of HCV testing and treatment. However, self-perceived competency related to HCV management and treatment was low, highlighting the importance of improved HCV education and training among physicians practicing in clinics offering OAT.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
This study describes the validation process for the Slovenian version of the Drug Addiction Treatment Efficacy Questionnaire (DATEQ).
DATEQ was constructed from the questionnaires used at the Centre ...for the Treatment of Drug Addiction, Ljubljana University Psychiatric Hospital, and within the network of Centres for the Prevention and Treatment of Drug Addiction in Slovenia during the past 14 years. The Slovenian version of the DATEQ was translated to English using the 'forward-backward' procedure by its authors and their co-workers. The validation process included 100 male and female patients with established addiction to illicit drugs who had been prescribed opioid substitution therapy. The DATEQ questionnaire was used in the study, together with clinical evaluation to measure psychological state and to evaluate the efficacy of treatment in the last year. To determinate the validity of DATEQ the correlation with the clinical assessments of the outcome was calculated using one-way ANOVA.
The F value was 44.4, p<0.001 (sum of squares: between groups 210.4, df=2, within groups 229.7, df=97, total 440.1, df=99). At the cut-off 4 the sensitivity is 81% and specificity 83%.
The validation process for the Slovenian DATEQ version shows metric properties similar to those found in international studies of similar questionnaires, suggesting that it measures the same constructs, in the same way and as similar questionnaires. However, the relatively low sensitivity and specificity suggests caution when using DATEQ as the only measure of outcome.
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