BackgroundSubstance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time.Methods/designIn a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome – persistence of or desistance from SUD.DiscussionThere are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in addiction treatment for longer than 1 year. We are confident that the Youth in Transition study will further our understanding of determinants and consequences of persistent SUD among high-risk adolescents during the critical transition from adolescence to young adulthood.Trial registrationThe Netherlands National Trial Register Trial NL7928. Date of registration January 17, 2019.
Non-attendance in mental healthcare is a substantial problem. Research hasshown that sending a short message service (SMS) reminder could reduce non-attendance by 50 percent in general health services and by 25 percent in mental health institutions. However, no studies exist on the effect of sending SMS reminders in mental healthcare for addiction. Objectives: To examine the influence of SMS reminders on non-attendance in mental health care for addiction and to examine whether different effects occur between appointments for intake or for treatment. Methods. In a specialized institution for addictioncare in the north of the Netherlands 193.474 appointments of outpatient patients, representing 12.797 unique patients, were analyzed for non-attendance and related to registered SMS reminders. Results: Non-attendance was statistically significantly lower for appointments of patients who had received an SMS reminder (20.5%) than for appointments of patients who had not received a reminder (21.9%). Effects were found to be greater for intakeappointments in several analyses. Conclusions: Sending an SMS reminder is associated with a statistically significant lower non-attendance at appointments by patients with a substance use disorder, but the differences have hardly any clinical significance. Special characteristics of the population of patients with substance use disorders may explain this small clinical effect.
This study examined patient and appointment factors as predictors of nonattendance in addiction mental health services. Data were collected from the electronic files of 7,641 patients treated for a substance use disorder in outpatient clinics of an addiction mental health organization in the Netherlands. Negative binomial regression analyses revealed that cocaine use, poly substance use, limitations in interpersonal functioning, presence of anxiety disorder and cluster C personality disorder, age, level of education, source of income, and planning consistency were associated with nonattendance.
Alcohol use disorder (AUD) is a major problem. In the USA alone there are 15 million people with an AUD and more than 950,000 Dutch people drink excessively. Worldwide, 3-8% of all deaths and 5% of all illnesses and injuries are attributable to AUD. Care faces challenges. For example, more than half of AUD patients relapse within a year of treatment. A solution for this is the use of Cue-Exposure-Therapy (CET). Clients are exposed to triggers through objects, people and environments that arouse craving. Virtual Reality (VRET) is used to experience these triggers in a realistic, safe, and personalized way. In this way, coping skills are trained to counteract alcohol cravings. The effectiveness of VRET has been (clinically) proven. However, the advent of AR technologies raises the question of exploring possibilities of Augmented-Reality-Exposure-Therapy (ARET). ARET enjoys the same benefits as VRET (such as a realistic safe experience). But because AR integrates virtual components into the real environment, with the body visible, it presumably evokes a different type of experience. This may increase the ecological validity of CET in treatment. In addition, ARET is cheaper to develop (fewer virtual elements) and clients/clinics have easier access to AR (via smartphone/tablet). In addition, new AR glasses are being developed, which solve disadvantages such as a smartphone screen that is too small. Despite the demand from practitioners, ARET has never been developed and researched around addiction. In this project, the first ARET prototype is developed around AUD in the treatment of alcohol addiction. The prototype is being developed based on Volumetric-Captured-Digital-Humans and made accessible for AR glasses, tablets and smartphones. The prototype will be based on RECOVRY, a VRET around AUD developed by the consortium. A prototype test among (ex)AUD clients will provide insight into needs and points for improvement from patient and care provider and into the effect of ARET compared to VRET.
Significant Others, family care, substance abuse, addiction, substance use disorder, Concerned significant others of a person with substance use disorder face psychological, social and financial problems caused by the subtance abuse of their loved one. Tradionally health care orginizations focus on the person with substance use disorder and pay less attention to their concerned significant other. In the Netherlands there is less information available about concerned significant others of persons with substance abuse. To develop a family care aproach for the significant other it's necessary to provide insight in the charasteristics of the concerned significant others of persons with substance use disorder.
It is essential to look for new forms of care, with an emphasis on Prevention, Relocation and Replacement (Health & Care Knowledge and Innovation Agenda 2020-2030). Especially when it comes to Alcohol Use Disorder (AUD). Globally, more than 5% of all illness and injury are attributable to AUD. Treatment is challenging; 47-75% of AUD patients who are clinically detoxified relapse within one year. Recovry aims to prevent an unhealthy lifestyle due to (alcohol) addiction by developing and testing a Virtual Reality (VR) self-prevention tool (relocating and replacing care treatment). Although research shows that VR is used successfully in health care and in the treatment of alcohol addiction, especially through the creation of presence, it has not been tested for effectiveness and implementation (as an adjuvant in a clinical post-detoxification phase of an AUD- therapy). The question of whether virtual-humans should be used in a VR treatment and whether 3600 recorded VR or computer generated (CG) VR should be selected before. The use of a virtual human in VR has expected advantages (more effect) but also disadvantages (more costs). The expected advantages and disadvantages of 360o VR (cheaper, faster, more personal) and CG VR (more flexible and interactive) also cause choice and implementation problems. Recovry is the first project in which a VR tool is (further) developed in which an AUD treatment can (and will) be tested for the effect and effectiveness of adding virtual humans in CG and 360o VR environments as part of preventive care for patients with an AUD. This project thus serves as a prelude to cooperation in the Netherlands around a more effective implementation of VR in the (self) care system and thus the active and independent integration of former AUD patients in society (“more people, less patients”).
