Addiction
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Multicenter Study
Heterogeneous dose-response and college student drinking: examining problem risks related to low drinking levels.
Previous research demonstrates that the number of problems related to each additional drink consumed on any drinking occasion, dose-response, varies non-linearly across average drinking quantities. We test predictions from a dynamic model of drinking behavior that locates this heterogeneity in drinkers' efforts to equilibrate between costs and benefits of use. ⋯ Among US college students, all drinkers exhibit greater risks for physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) when drinking greater amounts of alcohol, but heavier drinkers (those who consume more on average) exhibit fewer problems for each additional drink consumed (less dose-response) than light and moderate drinkers. Light and moderate drinkers exhibit greater dose-response, with three drinks per occasion associated with the greatest number of problems.
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Randomized Controlled Trial Multicenter Study
Opioid treatment at release from jail using extended-release naltrexone: a pilot proof-of-concept randomized effectiveness trial.
Relapse to addiction following incarceration is common. We estimated the feasibility and effectiveness of extended-release naltrexone (XR-NTX) as relapse prevention among opioid-dependent male adults leaving a large urban jail. ⋯ Extended-release naltrexone is associated with significantly lower rates of opioid relapse among men in the United States following release from jail when compared with a no medication treatment-as-usual condition.
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Randomized Controlled Trial Comparative Study
An exploratory short-term double-blind randomized trial of varenicline versus nicotine patch for smoking cessation in women.
Within a parent study examining ovarian hormone effects on smoking cessation in women, we conducted an exploratory short-term trial of varenicline versus transdermal nicotine patch. ⋯ In an exploratory 4-week head-to-head trial in female smokers, varenicline, compared with nicotine patch, more than doubled the odds of end-of-treatment abstinence, although this diminished somewhat at post-treatment follow-up.
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The World Health Organization (WHO), and a growing number of other organizations, have adopted the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system in order to both assess the quality of research evidence and develop clinical practice guidelines. In 2009 WHO published a guideline on psychosocially assisted pharmacological treatment of opioid dependence, based on the results of Cochrane Reviews summarized using the GRADE methodology. The main features of this system are an a priori definition of outcomes and their relevance, and distinction between the quality of evidence (also referred to as confidence in the estimate of intervention effect) and the strength of recommendations. We consider how successful this approach has been. ⋯ An explicit stepwise process of moving from evaluation of the quality of evidence to the definition of the strength of recommendations is important in providing practical and clear clinical guidance for practitioners and policy-makers in addiction.