The latest medical research on Addiction Medicine

This paper documents the methods used to assess the implementation costs of the APPRAISE alcohol brief intervention (ABI) delivered to male remand prisoners across two study sites in Scotland and North East England.

We first developed a comprehensive taxonomy of the activities constituting the APPRIASE ABI. Next, data were collected for each activity about the study staff and the subject time spent, in addition to the other resources used and unit costs.

From the pilot data collection it was possible to construct a narrative, for both study sites, for how the intervention was delivered and the time required for each activity. The ABI was delivered by Change Grow Live and Humankind intervention staff and staff salaries were obtained from both organizations to calculate the staff delivery costs for each site. Other costs, such as the printing of materials, were estimated based on APPRAISE study records. Due to the ongoing Covid-19 restrictions and limited access to prison resources and staff, there were significant deviations from the initial study protocols. As a result, we document the costs of implementing the ABI as delivered rather than as planned.

This paper provides the first estimates of the implementation costs of an ABI delivered in criminal justice setting in the UK. Although these costs are from a pilot implementation that was heavily impacted by the Covid-19 pandemic, this paper nonetheless provides useful, policy-relevant information on the potential costs of providing ABI to remand prisoners. It also serves as a methodological template, guidance, and proof of concept for future micro-costing studies of ABIs in criminal justice settings.

Problematic pornography use (PPU) can be a manifestation of compulsive sexual behavior disorder (CSBD). Studies investigating PPU confirm approach-avoidance tendencies in response to pornographic stimuli in this population. This study show indications of the significance of the efficacy of imaginal retraining, a variant of approach bias modification, as an intervention for PPU.

A total of 274 participants (86.5% male; mean age = 30.65, SD = 10.13) with self-reported PPU were randomized to imaginal retraining (instruction video) or a waitlist control group. Assessments were conducted online at baseline and after the six-week intervention period. The primary outcome was a reduction in problematic pornography use. Compulsive sexual behavior, sexual desire, depressiveness, and satisfaction with the intervention served as secondary outcomes.

Retention was low (51.7%), but comparable between groups. The retraining was performed at least once a week (the per-protocol [PP] criterion) by 51.4% of participants. The PP analyses of 111 participants showed a significant reduction in problematic pornography use (primary outcome) in the intervention compared to the control group. The intention-to-treat analyses (ITT), however, did not corroborate this result. Despite low adherence, participants rated their satisfaction with the intervention positively.

Imaginal retraining can function as a low-threshold self-help intervention for PPU to overcome help-seeking barriers and may reduce PPU in a subgroup of users. Low adherence limits the results of this trial. Given the need for low-threshold interventions for PPU and/or CSBD, further research should focus on increasing adherence and should evaluate retraining for clinical groups. Modifications to augment efficacy are suggested.

Theories suggest that experiences of negative and positive affect are important precursors to alcohol and illicit substance use. Research utilizing ecological momentary assessments (EMA) has generally supported the relation between momentary experiences of positive affect, but not negative affect, and subsequent substance use. Unfortunately, most of these studies have focused on alcohol use and not other substance use. The goal of this paper was to further explore the relation between momentary affect and use of both alcohol and illicit substances within a population of individuals with a history of substance use. Additionally, this study aimed to understand whether the relations between affect and substance use would vary depending on the timing of EMA assessments of affect prior to substance use.

Participants with a history of heavy substance use (N = 59) completed EMA's measuring affect and substance use using random prompts 4 times a day for 14 days.

We found that positive affect was significantly related to later engagement in drinking, illicit substance use, and marijuana use. Moreover, timing of the affect was important. When affect was assessed in the last hour prior to substance use, relative to 7 hours prior, the relation between positive affect and illicit substance use was stronger. Negative affect was related to a lower likelihood of subsequent marijuana use, but more so when it was measured a few hours versus several hours before the use.

This study further supported the relation between positive affect and both alcohol and illicit substance use.