After decades of the American "war on drugs" and relentless prison expansion, political officials are finally challenging mass incarceration. Many point to an apparently promising solution to reduce ...the prison population: addiction treatment.InAddicted to Rehab, Bard College sociologist Allison McKim gives an in-depth and innovative ethnographic account of two such rehab programs for women, one located in the criminal justice system and one located in the private healthcare system-two very different ways of defining and treating addiction. McKim's book shows how addiction rehab reflects the race, class, and gender politics of the punitive turn. As a result, addiction has become a racialized category that has reorganized the link between punishment and welfare provision. While reformers hope that treatment will offer an alternative to punishment and help women, McKim argues that the framework of addiction further stigmatizes criminalized women and undermines our capacity to challenge gendered subordination. Her study ultimately reveals a two-tiered system, bifurcated by race and class.
Abstract
Drawing on ethnography and interviews with recovering men in the Twin Cities, Minnesota, this study explores how two dominant models of American rehab are racialized — coerced treatment ...theorizing addiction as criminal personality—and a more medicalized, voluntaristic model rooted in the brain disease paradigm. At the “carceral rehab” of “Arcadia House,” staff assumed its majority court-mandated, poor men of color would arrive resistant to reforming their “lifestyle addictions,” justifying treatment backed by (re)incarceration. In contrast, “Healing Bridges” offered its gentler, “medical-restorative rehab” to mostly white, middle-class patients who escaped incarceration despite substantial participation in drug-related crime. While both programs mobilized the colorblind logic that “addiction doesn’t discriminate,” local disparities routed recovering men into vastly different treatments, disproportionately criminalizing the addictions of the Black poor. In a racialized binary operating across the field, Arcadia’s clients of color were viewed as sicker and more out of control than Bridges’ white patients. While Arcadia’s clients required coercive state management, Bridges’ patients were understood as already possessing the capacity for self-management—reinforcing staff’s mission to empower the non-addict within. Distinctions between coerced and voluntary treatment were naturalized and mapped onto recovering men, reproducing race at the most intimate levels of self-making.
Several lines of evidence suggest that classic (5HT2A agonist) hallucinogens have clinically relevant effects in alcohol and drug addiction. Although recent studies have investigated the effects of ...psilocybin in various populations, there have been no studies on the efficacy of psilocybin for alcohol dependence. We conducted a single-group proof-of-concept study to quantify acute effects of psilocybin in alcohol-dependent participants and to provide preliminary outcome and safety data. Ten volunteers with DSM-IV alcohol dependence received orally administered psilocybin in one or two supervised sessions in addition to Motivational Enhancement Therapy and therapy sessions devoted to preparation for and debriefing from the psilocybin sessions. Participants’ responses to psilocybin were qualitatively similar to those described in other populations. Abstinence did not increase significantly in the first 4 weeks of treatment (when participants had not yet received psilocybin), but increased significantly following psilocybin administration (p < 0.05). Gains were largely maintained at follow-up to 36 weeks. The intensity of effects in the first psilocybin session (at week 4) strongly predicted change in drinking during weeks 5–8 (r = 0.76 to r = 0.89) and also predicted decreases in craving and increases in abstinence self-efficacy during week 5. There were no significant treatment-related adverse events. These preliminary findings provide a strong rationale for controlled trials with larger samples to investigate efficacy and mechanisms.
TRIAL REGISTRATION: NCT02061293
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Abstract Prior studies have identified that working in an addiction treatment unit with higher levels of organizational capacity is a factor associated with positive staff attitudes about ...evidence-based addiction treatment practices (EBPs). The study presented here explored whether staff perceptions about the organizational capacity of their treatment unit are also associated with staff experience of barriers to implementing EBPs. Multivariate regression methods examined the relationship between the clinical staff ( n = 510) and director ( n = 296) perceptions of organizational capacity (Texas Christian University Organizational Readiness for Change TCU ORC-staff and TCU ORC-director) and level of barriers experienced when implementing a new EBP controlling for a range of treatment unit characteristics, staff characteristics, and type of EBP implemented. For both samples, reporting higher levels of stress in their organizations was significantly associated with reporting higher levels of barriers when implementing a new EBP. For clinical staff only, experiencing lower levels of program needs in their organization, working in a program that had been in existence for a shorter period, and implementing motivational interviewing techniques compared with other EBPs were all factors significantly associated with experiencing lower levels of barriers with EBP implementation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The epidemic of addiction and overdose is real. Addiction among pain patients accounts for only a small proportion but a large number. Scientific opinion leaders can be most effective on two fronts, ...each relatively low-tech: dissemination and oversight of empirically established treatments, and promulgation of social-science-based strategies for population-level prevention.
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Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and ...mortality.
We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge.
Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios AOR 0.16; 95% CI, 0.04-0.65; P = .01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02-0.53; P < .001), and death (adjusted hazard ratio AHR, 0.20; 95% CI, 0.05-0.56; P = .001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09-0.98; P = .04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01-0.73; P = .02), and death (AHR, 0.20; 95% CI, 0.01-0.94; P = .04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73.
In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.
In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the ...quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits.
This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0-4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots.
The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001).
For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers.
Ketamine is a dissociative anaesthetic drug which acts on the central nervous system chiefly through antagonism of the n-methyl-d-aspartate (NMDA) receptor. Recently, ketamine has attracted attention ...as a rapid-acting anti-depressant but other studies have also reported its efficacy in reducing problematic alcohol and drug use. This review explores the preclinical and clinical research into ketamine's ability to treat addiction. Despite methodological limitations and the relative infancy of the field, results thus far are promising. Ketamine has been shown to effectively prolong abstinence from alcohol and heroin in detoxified alcoholics and heroin dependent individuals, respectively. Moreover, ketamine reduced craving for and self-administration of cocaine in non-treatment seeking cocaine users. However, further randomised controlled trials are urgently needed to confirm ketamine's efficacy. Possible mechanisms by which ketamine may work within addiction include: enhancement of neuroplasticity and neurogenesis, disruption of relevant functional neural networks, treating depressive symptoms, blocking reconsolidation of drug-related memories, provoking mystical experiences and enhancing psychological therapy efficacy. Identifying the mechanisms by which ketamine exerts its therapeutic effects in addiction, from the many possible candidates, is crucial for advancing this treatment and may have broader implications understanding other psychedelic therapies. In conclusion, ketamine shows great promise as a treatment for various addictions, but well-controlled research is urgently needed.
This article is part of the Special Issue entitled ‘Psychedelics: New Doors, Altered Perceptions’.
•Preliminary evidence suggests that ketamine may be effective in addiction.•Potential interacting mechanisms are enhancing neurogenesis and psychological therapies.•Ketamine may reduce depressive symptoms in a risky window for addiction relapse.
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GEOZS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
A considerable portion of the opioid epidemic has been driven by physician-prescribed opioids for pain management. Thus, policies to address the epidemic must consider not only the resources ...available to manage addiction but those to manage acute and chronic pain as well. For the period 2017 to 2019, the authors sought to describe the distribution, by state, of indicators of the supply of resources to address pain and addiction (graduate medical education subspecialty training in pain and addiction, number of board-certified pain and addiction specialists, number of opioid treatment centers), as well as indicators of the demands for those services (opioid prescriptions, opioid overdose deaths), to identify states that seem to suffer from a mismatch between supply and demand. It was also sought to examine the relationships between these treatment resources and indicators of the magnitude of the opioid epidemic, through an exploratory correlational analysis. The resulting model may inform public policy by suggesting areas in need of greater graduate medical education training and more pain and addiction specialists and by suggesting hypotheses about the impact of these specialists on outcome that are worthy of further study.
•Psychedelics may be a promising alternative in the treatment of SUD.•The set and setting are critical for the success of the treatments with psychedelics.•Psychedelics seem more effective when used ...as an adjunct therapy with psychotherapy.•The beneficial effects observed in some studies were partial and temporary.
Substance use disorder (SUD) is a global public health concern that affects millions of people worldwide. Considering current research, addiction has been noted as the last stage of a chronic disease that may impair brain reward circuit responses and affects personal and social life. Treatments for SUD face challenges including availability and limited pharmacological response, often resulting in low retention of patients. A growing number of studies from the ‘psychedelic renaissance’ have highlighted the therapeutic potential of psychedelics for several psychiatric disorders, including SUD. In this non-systematic review we discuss past and current clinical and observational studies with classic (LSD, DMT, psilocybin and mescaline) and non-classic (ibogaine, ketamine, MDMA, salvinorin A and THC) psychedelics for the treatment of SUD published until December 2021. Although results are still inconclusive for LSD, DMT, mescaline, MDMA and Salvinorin A, in general, the literature presents moderate evidence on the controlled use of psilocybin and ketamine for Alcohol Use Disorder, ketamine for management of opiate and alcohol withdrawal, and THC preparations for reducing withdrawal symptoms in Cannabis and possibly in Opioid Use Disorder. Importantly, studies suggest that psychedelics should be more effective when employed as an adjunct therapy. Extensive research is warranted to further elucidate the role of psychedelics in the treatment of SUD.
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