Moloud RADFAR, Haleh GHAVAMI, Javad NAMAZPOOR, Hamid Reza KHALKHALI

Lapse and craving prevention in methadone maintenance treatment, applying continuous care model: a randomized clinical trial

Objective: Although, the lapse and relapse are synonymous with the return to substance use disorder but they have different meanings. Lapse is suddenly return to substance use but relapse is reuse of substance after substance use quitting. Lapse does not have to lead to relapse. Lapse is one of the major challenges in methadone maintenance treatment (MMT). Lapse is the stage that occurs before relapse. Craving is the most important factor for lapse after the treatment periods, too. The aim of this study was to determine the effectiveness of applying conti- nuous care model on lapse and craving prevention in patients on MMT. Methods: This parallel randomized con- trolled trial was conducted on 95 patients who were selected through the convenience sampling and randomly assigned to intervention (n=48) and control (n=47) groups. Continuous care model which consisted of four stages (orientation, sensitization, control and evaluation) was conducted on intervention group over a period of 3 months. At the end, two groups were compared. Craving Questionnaire and Lapse-and-Absence Check List were used to collect data. Results: At the end of third month, the mean of the lapse in the experimental group decreased to 1.57±1.1 times (from 2.07±0.89 times) and the mean of craving score decreased to 50.47±15.1 (from 53.73±13.58) that showed a significant difference comparing to the control group. Discussion: Continuous care model is effective to reduce lapse and craving in male patients on MMT. Therefore, it is suggested that this model should be imple- mented along with a medical treatment to prevent lapse and craving in male substance abuse disorder. (Anatolian Journal of Psychiatry 2019; 20(2):117-124)

Metadon sürdürüm tedavisinde, sürekli bakım modeli uygulanarak lapse ve aşermeyi önleme: Bir randomize klinik çalışma

Amaç: Tekrar madde kullanımı (lapse) ve depreşme (relapse), madde kullanım bozukluğuna geri dönüş ile eş anlamlı olmakla birlikte, farklı anlamlar taşır. Lapse aniden madde kullanımına geri dönmektir, ancak depreşme madde kullanımını bıraktıktan sonra madde kullanımının tekrarlanması anlamına gelir. Lapse, her zaman depreş- meye yol açmaz, ancak metadon sürdürüm tedavisindeki (MST) başlıca zorluklardan biridir. Lapse, depreşmeden önceki aşamadır. Ayrıca madde aşermesi, tedavi dönemlerinden sonra lapse için en önemli etkendir. Bu çalışma- nın amacı, MST hastalarında sürekli bakım modeli uygulamasının lapse ve aşermeyi önlemeye etkisini belirlemektir. Yöntem: Bu paralel randomize kontrollü çalışma, uygun örnekleme ve rastgele seçilerek müdahale (s=48) ve kontrol (s=47) gruplarına randomize olarak atanan, toplam 95 hasta üzerinde gerçekleştirildi. Üç aylık süre boyunca müdahale grubunda dört aşamadan (oryantasyon, duyarlılık, kontrol ve değerlendirme) oluşan sürekli bakım modeli uygulandı. Araştırmanın sonunda iki grup karşılaştırıldı. Veri toplanmasında Madde Aşerme Ölçeği, Lapse ve Ayık- lık Kontrol Listesi kullanıldı. Bulgular: Üçüncü ayın sonunda, deney grubundaki lapse ortalaması 2.07±0.89 kezden 1.57±1.1 keze düştü. Aşerme puan ortalaması 53.73±13.58’den 50.47±15.1'e düştü. Müdahale ve kontrol grubu arasındaki fark istatistiksel yönden anlamlı bulundu. Tartışma: Sürekli bakım modeli, MST hastalarında lapse ve aşermeyi azaltmada etkilidir. Bu nedenle, tekrar madde kullanımını ve aşermeyi önlemek için bu modelin tıbbi tedavi ile birlikte uygulanması önerilmektedir. (Anadolu Psikiyatri Derg 2019; 20(2):117-124)

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Bowser BP, Word CO, Seddon T. UnderstandingDrug Use and Abuse: A Global Perspective. UK: Palgrave Macmillan,2014.

Detels R, Gulliford M, Karim QA, Tan CC. OxfordTextbook of Global Public Health. Sixth ed., Oxford University Press,2015.

Warraq I. Why the West is Best: A Muslim Apo-state's Defense of Liberal Democracy. New York: Encounter Books,2011.

Şipka H, Vardar E. Evaluation of sleep quality ofearly buprenorphine/naloxone treatment in opioid addicted patients. Anatolian Journal of Psychiatry 2018;19(5):466-471.

Yeltepe Ercan H, Yargıç IL, Karagözoğlu C. Theeffects of regular exercise on anxiety, depression andqualityoflifeinadultalcoholanddrugdepen- dents in addiction treatment. Anatolian Journal of Psychiatry 2016;17(1):33-41.

ReiterMD.SubstanceAbuseandtheFamily.NewYork: Routledge,2015.

Fedotov Y. World Drug Report 2016 By UnitedNations Office on Drugs and Crime. New York, 2016.

Soyka M, Strehle J, Rehm J, Bühringer G,Wittchen HU. Six-year outcome of opioid main- tenance treatment in heroin-dependent patients: results from a naturalistic study in a nationally representative sample. Eur Addict Res 2017; 23(2):97-105.

Bart G. Maintenance medication for opiate addic-tion:thefoundationofrecovery.JAddictDis2012; 31(3):207-225.

Scherbauma N, Kluwiga J, Specka M, Krause D,Mergeta B, Finkbeinera T, et al. Group psycho- therapy for opiate addicts in methadone main- tenance treatment–a controlled trial. Eur Addict Res 2005;11:163-171.

McKay JR, Lynch KG, Shepard DS, Pettinati HM.The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24- month outcomes. Arch Gen Psychiatry 2005; 62(2):199-207.

Vaziryan M, Yazdi S, Mostashary G, Sham-salizadeh N, Abedin A. Guidelines for the preven- tion and treatment of drug abuse, especially for physicians. Health MoHaMEDo, Tehran: Iran Institute of Psychiatry,2005.

Mokri A, Noroozi A. Protocol on Management ofOpioid Dependence with Methadone. A Mokri, A Noroozi(Eds.),OfficeofMentalHealthSaa,Office of Substance Abuse Prevention and Treatment, third ed., Tehran: Departement of Treatment; 2014.

Aslinejhad MA, Moshki M, Alimardani MS, Tava-kolizadehJ.Theeffectivenessofbehavioralgroup therapy and cognitive-behavioral group therapy on the laps rate and persistence in the treatment of patients with opioid dependency under the treatment of MMT. J Kermanshah Univ Med Sci 2013;17(2):103-112.

Skinner MD, Aubin H-J. Craving's place in addic-tion theory: contributions of the major models. Neuroscience & Biobehavioral Reviews 2010; 34(4):606-623.

Chehri A, Mirzaee F, Khazaie H, Rezaei O,Ekhtiari H, Mokri A, et al. Comparison of craving for opioid in opioid-dependent individuals and people under methadone maintenance treatment. J Kermanshah Univ Med Sci 2014; 17(11):718- 726.

Badger GJ, Bickel WK, Giordano LA, Jacobs EA,Loewenstein G, Marsch L. Altered states: The impact of immediate craving on the valuation of current and future opioids. J Health Econ 2007; 26(5):865-876.

Roozen HG, de Waart R, van der Windt DA, vandenBrinkW,deJongCA,KerkhofAJ.Asystema- tic review of the effectiveness of naltrexone in the maintenance treatment of opioid and alcohol dependence. Eur Neuropsychopharmacol 2006; 16(5):311-323.

Ahmadi F. Design and evaluation of a continuouscare model in the management of patients with chronic coronary artery disease. Iran, Tarbiat Modares University, Nursing Department,2002.

Ghavami H, Ahmadi F, Meamarian R, EntezamiH, Faghih Zadeh S. Effectiveness of applying continuous care model on diabetic patients body mass index and weight. Quarterly of Horizon of Medical Sciences. 2006;12(2):10-16.

OtaghiM,BastamiM,BorjiM,TayebiA,AzamiM.The Effect of continuous care model on the sleep quality of hemodialysis patients. Nephro-Urology Monthly 2016;8(3).

Ahmadi F, Ghofranipour F, Abedi H, Arefi S,Faghihi-zadehS.Effectofcontinuousconsultation care model on re hospitalization and chest painin patients with coronary artery disease. J Qazvin Univ Med Sci 2005;35(9):99-103. GhavamiH,AhmadiF,EntezamiH,Meamarian R.Theeffectofcontinuouscaremodelondiabeticpatients’ blood pressure. IJME 2006;6(2):87-95.

Sadeghi S, Alavi FF, Ahmadi F, Karimi Z, Baba-tabar HD, Ebadi A, et al. Effect of applying conti- nuous care model on quality of life in heart failure patients. Journal of Behavioral Sciences 2009; 3(1):9-13.

Aslani J, Zebardast J, Mahmoudi H, Naderi Z,Mehdizadeh S, Ebadi A. Influence of continuous care model on quality of life in chemical warfare victimswithbronchiolitisobliterans.KowsarMedJ 2009;14(2):101-107.

KhankeH,AnjomaniyanV,AhmadiF,Fallahhi KM, Rahgozar M, Ranjbar M. Continuous Careeffect on quality of life in schizophrenic patients discharged from hospital Sina Hamadan. Nursing Research 2010; 4(15):60-70.

Rahimi A, Ahmadi F, Gholyaf M. Effects ofapplying continuous care model on blood tests in hemodialysis patients. Tehran Uni Medi J 2008; 66(1):43-51.

Sadeghi H, Azizzadeh Forouzi M, Haghdust A A,Mohammad Alizadeh S. Effect of implementing continuous care model on sleep quality of hemo- dialysis patients. Journal of Intensive Care Nursing 2010;3(1):13-8.

Salehi Fadardi J, Barerfan Z. The effect of drugs-attention control training program on drug-related attentional bias and improving other indices of recovery. Studies in Education & Psychology 2011;2(11):29-56.

Ilgen MA, Hu KU, Moos RH, McKellar J. Con-tinuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders. Psychiatr Serv 2008;59(9):982-988.

Ayu AP, Schellekens AF, Iskandar S, Pinxten L,De Jong CA. Effectiveness and organization of addiction medicine training across the globe. Eur Addict Res 2015;21(5):223-239.

Reimer J, Wright N, Somaini L, Roncero C,Maremmani I, McKeganey N, et al. The impact of misuse and diversion of opioid substitution treat- ment medicines: evidence review and expertcon- sensus. Eur Addict Res 2016;22(2):99-106.

Ögel K, Bilici R, Güvenç Bahadir G, Maçkan A,Orhan N, Tuna O. The effectiveness of the tobacco, alcohol and drug dependence treatment program (SAMBA) on drug users in probation. Anatolian Journal of Psychiatry 2016; 17(4):270- 277.