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Auteur H. ALHO
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Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland / J. REHM ; M. X. REHM ; H. ALHO ; A. ALLAMANI ; H. J. AUBIN ; G. BÜHRINGER ; J. B. DAEPPEN ; U. FRICK ; A. GUAL ; N. HEATHER in International Journal of Alcohol and Drug Research, Vol.2, n°2 (2013)
in International Journal of Alcohol and Drug Research > Vol.2, n°2 (2013) . - 53-67
Titre : Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland Type de document : Périodique Auteurs : J. REHM ; M. X. REHM ; H. ALHO ; A. ALLAMANI ; H. J. AUBIN ; G. BÜHRINGER ; J. B. DAEPPEN ; U. FRICK ; A. GUAL ; N. HEATHER Année de publication : 2013 Article en page(s) : 53-67 Langues : Anglais Mots-clés : Thésaurus Géographique
EUROPE ; UNION EUROPEENNE ; ISLANDE ; NORVEGE ; SUISSE
ALCOOL ; DEPENDANCE ; TRAITEMENT ; RECOMMANDATION ; COMPARAISON ; PRATIQUE PROFESSIONNELLE ; ENTRETIEN ; REDUCTION DE CONSOMMATION ; ABSTINENCE ; SEVRAGE
Discipline : TRA Traitement et prise en charge / Treatment and care Domaine : Alcool / Alcohol Résumé : Aim: To describe guidelines and common practices for alcohol dependence treatment in Europe.
Design: Systematic and qualitative review; for each country, guidelines were identified via systematic literature research, followed by interviews with treatment experts.
Setting: European Union (EU) countries plus Iceland, Norway, and Switzerland.
Participants: Experts in alcohol dependence treatments and treatment systems.
Measure: Semi-structured questionnaire for interviews.
Findings: While fewer than half of EU countries have formal national guidelines for alcohol dependence treatment, a majority of these countries have guidelines by professional organizations such as psychiatric or neuropsychopharmacologic societies, and several are currently developing such guidelines. Abstinence is the usual treatment goal, but the majority of countries accept reduction of drinking as an intermediate or secondary goal, in practice even more than in the guidelines. Psychotherapy, mainly cognitive-behavioral approaches, motivational interviewing, and family therapy, is the most common treatment for relapse prevention, in part accompanied by pharmacotherapy (disulfiram, acamprosate and naltrexone being used most often).
Conclusions: There are differences in treatment for alcohol dependence in Europe. The introduction of reduction of drinking as one treatment goal may attract more patients.
Sous-type de document : Revue de la littérature / Literature review Affiliation : Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health, Toronto, Canada Lien : http://dx.doi.org/10.7895/ijadr.v2i2.89 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=73214[article]Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study / M. AALTO
Titre : Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study Type de document : Périodique Auteurs : M. AALTO ; SEPPÄ K. ; P. MATTILA ; MUSTONEN H. ; RUUTH K. ; HYVÄRINEN H. ; PULKKINEN H. ; H. ALHO ; SILLANAUKEE P. Année de publication : 2001 Importance : 224-230 Note générale : Alcohol and Alcoholism, 2001, 36, (3), 224-230 Langues : Anglais Mots-clés : Thésaurus TOXIBASE
DEPISTAGE ; INTERVENTION ; SEXE MASCULIN ; ABUS ; ALCOOL ; EFFICACITE ; MEDECIN GENERALISTE
Discipline : TRA Traitement et prise en charge / Treatment and care Domaine : Alcool / Alcohol Résumé :
The aim of this research was to evaluate the effectiveness of long- term brief intervention in routine general practice. In five primary care out-patient clinics in a Finnish town, 296 male early-phase heavy drinkers consulting a general practitioner (GP) for various reasons were identified. Control group C (n = 88) was informed of the risks of drinking after the screening and were advised at the subsequent feedback about 2 weeks later to reduce their drinking. Groups A (n = 109) and B (n = 99) were offered in addition seven and three brief intervention sessions, respectively. All GPs took part, whether or not they indicated a special interest. The main outcome measures were differences between beginning and end-point at 3 years in self-reported alcohol consumption, mean corpuscular volume (MCV), and serum carbohydrate- deficient transferrin, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase. There were no statistically significant differences between study groups A, B and C in mean changes in outcome measures. Within all the groups, MCV decreased. Depending on the outcome measure used and the study group analysed, clinically significant reduction of drinking was found in 25-53% of the subjects. In routine general practice, giving additional sessions of brief intervention may not be as effective as in special research conditions. Factors reducing the effectiveness of brief intervention programmes should be investigated, so that primary health care staff can be better supported in their efforts. (Author' s abstract)
Affiliation : Alcohol Research Centre, National Public Health Institute, Helsinki Finlande. Finland. Centre Emetteur : 13 OFDT Cote : A02020 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=56373Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients / E. LAUNONEN ; H. ALHO ; E. KOTOVIRTA ; I. WALLACE ; K. SIMOJOKI in International Journal of Drug Policy, Vol.26, n°9 (September 2015)
in International Journal of Drug Policy > Vol.26, n°9 (September 2015) . - 875-882
Titre : Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients Type de document : Périodique Auteurs : E. LAUNONEN ; H. ALHO ; E. KOTOVIRTA ; I. WALLACE ; K. SIMOJOKI Année de publication : 2015 Article en page(s) : 875-882 Langues : Anglais Mots-clés : Thésaurus Géographique
PRODUIT DE SUBSTITUTION ; TRAITEMENT DE MAINTENANCE ; USAGE DETOURNE ; BUPRENORPHINE ; METHADONE ; ABUS ; FACTEUR PREDICTIF ; ETUDE TRANSVERSALE
Discipline : EPI Epidémiologie / Epidemiology Domaine : Autres substances addictives / Other substances ; Drogues illicites / Illicit drugs Résumé : Background: Diversion (i.e. selling or giving away) of opioid maintenance treatment (OMT) medications is a challenge that concerns many units providing OMT worldwide and tools for prevention are needed. The object of this study was to examine the prevalence and predictors for diversion of the OMT medications buprenorphine-naloxone (BNX) and methadone (MET) among Finnish OMT patients.
Methods: A cross-sectional study was conducted among all Finnish OMT patients of whom 60% (n = 1508) participated. The data were collected by anonymous questionnaires distributed through all OMT units in Finland. To evaluate predictors for diversion, we used binominal regression analysis with unadjusted and adjusted ORs. Selling and/or giving away of OMT medication was used as a dependent variable and explanatory variables were gender, age, duration of OMT, type of OMT medication and dose, dispensation method of OMT medication, place of residence and intravenous use of any intoxicating drugs during the past six months.
Results: Of all 1508 respondents, 7% (n = 100) had sold and 12% (n = 169) had given their OMT medication to others, 57% for money and 23% in exchange for other drugs. In multivariate analysis, predictors associated with diversion were BNX as OMT medication (OR 2.76, 95% CI 1.76-4.33), low (<9.0 mg/day) BNX dose (OR 1.74, 95% CI 1.01-2.98), intravenous use of intoxicating drugs during the past six months (OR 4.48, 95% CI 3.13-6.43) and increasing length of OMT (OR 1.01, 95% CI 1.01-1.02). Age, place of residence or unsupervised pharmacy distribution of BNX were not associated with diversion.
Conclusions: In order to reduce diversion, more interventions are needed to support patients to stop concurrent substance abuse. Increasing control measures, for example, increased supervision, are unlikely to prevent diversion. Given that sub-optimal dosing of BNX increases the risk of diversion, more attention should be paid to providing patients with an optimal medical dose.
We examine the predictors for diversion among all Finnish OMT patients (n = 1508).
Of all respondents, 7% had sold and 12% had given away their own OMT medication.
More diversion is associated with BNX medication and its low (<9.0 mg) daily dose.
Most diversion occurs among patients who use intoxicating drugs intravenously.
Focus on these predictors is essential when aiming to reduce diversion within OMT.
Affiliation : Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki University, Finland Cote : Abonnement Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=76228[article]Methadone vs. buprenorphine/naloxone during early opioid substitution treatment: a naturalistic comparison of cognitive performance relative to healthy controls / RAPELI P.
Titre : Methadone vs. buprenorphine/naloxone during early opioid substitution treatment: a naturalistic comparison of cognitive performance relative to healthy controls Titre traduit : (Méthadone vs. buprénorphine/naloxone lors d'un traitement de substitution précoce : une comparaison de la performance cognitive à celle de témoins sains.) Type de document : Périodique Auteurs : RAPELI P. ; FABRITIUS C. ; H. ALHO ; SALASPURO M. ; WAHLBECK K. ; KALSKA H. Année de publication : 2007 Importance : 1-10 Note générale : BMC Clinical Pharmacology, 2007, 7, (5), 1-10 Langues : Français Mots-clés : Thésaurus TOXIBASE
TRAITEMENT DE MAINTENANCE ; PERFORMANCE ; BUPRENORPHINE ; METHADONE ; SUBSTITUTION ; COGNITION ; OPIACES ; TEST ; COMPARAISON
Discipline : TRA Traitement et prise en charge / Treatment and care Domaine : Drogues illicites / Illicit drugs Résumé :
BACKGROUND: Both methadone- and buprenorphine-treated opioid-dependent patients frequently show cognitive deficits in attention, working memory, and verbal memory. However, no study has compared these patient groups with each other during early opioid substitution treatment (OST). Therefore, we investigated attention, working memory, and verbal memory of opioid-dependent patients within six weeks after the introduction of OST in a naturalistic setting and compared to those of healthy controls. METHODS: The sample included 16 methadone-, 17 buprenorphine/naloxone-treated patients, and 17 healthy controls matched for sex and age. In both groups buprenorphine was the main opioid of abuse during the recent month. Benzodiazepine codependence, recent use, and comedication were also common in both patient groups. Analysis of variance was used to study the overall group effect in each cognitive test. Pair-wise group comparisons were made, when appropriate RESULTS: Methadone-treated patients, as a group, had significantly slower simple reaction time (RT) compared to buprenorphine/naloxone-treated patients. In Go/NoGo RT methadone patients were significantly slower than controls. Both patient groups were significantly debilitated compared to controls in working memory and verbal list learning. Only methadone patients were inferior to controls in story recall. In simple RT and delayed story recall buprenorphine/naloxone patients with current benzodiazepine medication (n = 13) were superior to methadone patients with current benzodiazepine medication (n = 13). When methadone patients were divided into two groups according to their mean dose, the patient group with a low dose (mean 40 mg, n = 8) showed significantly faster simple RT than the high dose group (mean 67 mg, n = 8). CONCLUSION: Deficits in attention may only be present in methadone-treated early phase OST patients and may be dose-dependent. Working memory deficit is common in both patient groups. Verbal memory deficit may be more pronounced in methadone-treated patients than in buprenorphine/naloxone-treated patients. In sum, to preserve cognitive function in early OST, the use of buprenorphine/naloxone may be more preferable to methadone use of, at least if buprenorphine has been recently abused and when benzodiazepine comedication is used. Longitudinal studies are needed to investigate if the better performance of buprenorphine/naloxone-treated patients is a relatively permanent effect or reflects "only" transient opioid switching effect. (Author' s abstract)
Refs biblio. : 56 Affiliation : Unit for Drug Dependence, Department of Psychiatry, Helsinki University Central Hospital, Helsinki. Email : firstname.lastname@example.org Finlande. Finland. Numéro Toxibase : 1302392 Centre Emetteur : 13 OFDT Cote : A03501 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=53015A retrospective evaluation of patients switched from buprenorphine (Subutex) to the buprenorphine/naloxone combination (Suboxone) / SIMOJOKI K. in Substance Abuse Treatment, Prevention, and Policy, Vol.3, n°16 (2008)
in Substance Abuse Treatment, Prevention, and Policy > Vol.3, n°16 (2008) . - 6 p.
Titre : A retrospective evaluation of patients switched from buprenorphine (Subutex) to the buprenorphine/naloxone combination (Suboxone) Type de document : Périodique Auteurs : SIMOJOKI K. ; VORMA H. ; H. ALHO Année de publication : 2008 Article en page(s) : 6 p. Langues : Anglais Mots-clés : Thésaurus TOXIBASE
BUPRENORPHINE ; NALOXONE ; ETUDE RETROSPECTIVE ; SUBSTITUTION ; TRAITEMENT DE MAINTENANCE ; POSOLOGIE
Discipline : TRA Traitement et prise en charge / Treatment and care Domaine : Drogues illicites / Illicit drugs Résumé : BACKGROUND: In Finland, buprenorphine (Subutex) is the most abused opioid. In order to curb this problem, many treatment centres transferred (forced transfer) their buprenorphine patients to the buprenorphine plus naloxone (Suboxone) combination product in late 2003. METHODS: Data from a retrospective study involving five different treatment centers, examining the effects of switching patients to Suboxone, were gathered from 64 opioid-dependent patients who had undergone the medication transfer. RESULTS: Most patients (90.6%) switched to Suboxone at the same dose of buprenorphine that they had been receiving as Subutex (average 22 mg). The majority of these patients (71.9%) were maintained at the same dose of Suboxone throughout the 4-week study period. During the first 4 weeks, 50% of the patients reported adverse events and at the four month time point, 26.6% reported adverse events. However, due to adverse events one patient only discontinued treatment with Suboxone during the 4-week study period, and five during the four month follow-up period. Of the 26 patients in the follow-up period, Suboxone was misused intravenously once each by 4 patients and twice by 1 patient. These 5 patients all reported that injecting Suboxone was like injecting "nothing" with any euphoria, or that it was a bad experience. CONCLUSION: We conclude that when patients are transferred from high doses (> 22 mg) of buprenorphine to the combination product, dose adjustments may be necessary especially in the later phase of the treatment. We recommend that a transfer from Subutex to Suboxone should be carefully discussed and planned in advance with the patients and after the transfer adverse events should be regularly monitored. With regard of buprenorphine IV abuse, the combination product seems to have a less abuse potential than buprenorphine alone. (Author' s abstract) Refs biblio. : 6 Affiliation : Espoo Treatment and Rehabilitation Center, A-clinic Foundation, Espoo, Finland Centre Emetteur : 13 OFDT Lien : http://www.substanceabusepolicy.com/content/3/1/16 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=51757[article]