The enactive approach offers a distinctive view of how mental life relates to bodily activity at three levels: bodily self-regulation, sensorimotor coupling, and intersubjective interaction. This paper concentrates on the second level of sensorimotor coupling. An account is given of how the subjectively lived body and the living body of the organism are related (the body-body problem) via dynamic sensorimotor activity, and it is shown how this account helps to bridge the explanatory gap between consciousness and the brain. Arguments by O'Regan, Noe, and Myin that seek to account for the phenomenal character of perceptual consciousness in terms of ‘bodiliness’ and ‘grabbiness’ are considered. It is suggested that their account does not pay sufficient attention to two other key aspects of perceptual phenomenality: the autonomous nature of the experiencing self or agent, and the pre-reflective nature of bodily self-consciousness.

/pdf/sensorimotor-subjectivity-and-the-enactive-approach-to-1t10c71rgc.pdf

Sensorimotor subjectivity and the enactive approach to experience

Most of the estimated 125,000 injection drug users (IDUs) in Canada use illicit opioids and are outside treatment (i.e., methadone maintenance treatment). Empirical data suggest that illicit opioid users outside treatment are characterized by various health and social problem characteristics, including polydrug use, physical and mental morbidity, social marginalization, and crime. Although required for evidence-based programming, systematic information on this specific substance-user population is sparse in Canada to date. This article presents and compares key characteristics of population of illicit opioid users outside treatment in five cities across Canada (OPICAN cohort). Overall, the majority of OPICAN participants regularly used both a variety of illicit opioids and cocaine or crack, reported physical and mental health (e.g., mood disorder) problems, lacked permanent housing, were involved in crime, and had their “ideal” treatment not available to them. However, key local sample differences were shown, including patterns of heroin versus prescription opioid use and levels of additional cocaine versus crack use as well as indicators of social marginalization. Illicit opioid user population across Canada differ on key social, health, and drug use indicators that are crucial for interventions and are often demonstrated between larger and smaller city sites. Differentiated interventions are required.

/pdf/illicit-opioid-use-in-canada-comparing-social-health-and-ikpt6iv1kh.pdf

Illicit opioid use in Canada: Comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN study)

Methadone treatment for opiate dependent patients in general practice and specialist clinic settings: Outcomes at 2-year follow-up

https://scielo.isciii.es/pdf/gs/v23n3/revision.pdf

Evaluación del uso apropiado de procedimientos sanitarios mediante el método RAND: revisión de su aplicación en la literatura biomédica (1999–2004)

Los programas de tratamiento con metadona: situación real e ideal, definida por profesionales de Andalucía

With some 30 000 dependent persons, opiate addiction constitutes a major public health problem in Switzerland. The Swiss Federal Office of Public Health (FOPH) has long played a leading role in the prevention and treatment of opiate addiction and in research on effective means of containing the epidemic of opiate addiction and its consequences. Major milestones on that path have been the successive "Methadone reports" published by that Office and providing guidance on the care of opiate addiction with substitution treatment. In view of updating the recommendations for the appropriateness of substitution treatment for opiate addiction, in particular for the prescription of methadone, the FOPH commissioned a multi-component project involving the following elements. A survey of current attitudes and practices in Switzerland related to opiate substitution treatment Review of Swiss literature on methadone substitution treatment . Review of international literature on methadone substitution treatment National Methadone Substitution Conference Multidisciplinary expert panel to evaluate the appropriateness of substitution treatment. The present report documents the process and summarises the results of the latter element above. The RAND appropriateness method (RAM) was used to distil from literature-based evidence and systematically formulated expert opinion, areas where consensus exist on the appropriateness (or inappropriateness) of methadone maintenance treatment (MMT) and areas where disagreement or uncertainty persist and which should be further pursued. The major areas which were addressed by this report are Initial assessment of candidates for MMT Appropriate settings for initiation of MMT (general and special cases) Appropriateness of methadone supportive therapy Co-treatments and accompanying measures Dosage schedules and pharmacokinetic testing Withdrawal from MMT Miscellaneous questions Appropriateness of other (non-methadone) substitution treatment Summary statements for each of the above categories are derived from the panel meeting and presented in the report. In the "first round", agreement was observed for 31 % of the 553 theoretical scenarios evaluated. The "second round" rating, following discussion of divergent ratings, resulted in a much higher agreement among panellists, reaching 53 % of the 537 scenarios. Frank disagreement was encountered for 7 % of all scenarios. Overall 49 % of the clinical situations (scenarios) presented were considered appropriate. The areas where at least 50 % of the situations were considered appropriate were "initial assessment of candidates for MMT", the "appropriate settings for initiation of MMT", the "appropriate settings for methadone supportive treatment" and "Appropriateness of other (non-methadone) substitution treatment". The area where there was the least consensus on appropriateness concerned "appropriateness of withdrawal from MMT" (6 %). The report discusses the implications and limitations of the panel results and provides recommendations for the dissemination, application, and future use of the criteria for the appropriateness of MMT. The RAND Appropriateness Method proved to be an accepted and appreciated method to assess the appropriateness of methadone maintenance treatment for opiate addicts. In the next step, the results of the expert panel process must now be combined with those of the Swiss and international literature reviews and the survey of current attitudes and practices in Switzerland, to be synthesized into formal practice guidelines. Such guidelines should be disseminated to all concerned, promoted, used and rigorously evaluated for compliance and outcome.

Appropriateness of methadone maintenance treatment for opiate addiction: evaluation by an expert panel. Commentaries. Authors' reply

With some 30,000 dependent persons, opiate addiction constitutes a major public health problem in Switzerland. The Swiss Federal Office of Public Health (FOPH) has long played a leading role in the prevention and treatment of opiate addiction and in research on effective means of containing the epidemic of opiate addiction and its consequences. Major milestones on that path have been the successive "Methadone reports" published by that Office and providing guidance on the care of opiate addiction with substitution treatment. In view of updating the recommendations for the appropriateness of substitution treatment for opiate addiction, in particular for the prescription of methadone, the FOPH commissioned a multi-component project involving the following elements. A survey of current attitudes and practices in Switzerland related to opiate substitution treatment Review of Swiss literature on methadone substitution treatment Review of international literature on methadone substitution treatment National Methadone Substitution Conference Multidisciplinary expert panel to evaluate the appropriateness of substitution treatment. The present report documents the process and summarises the results of the latter element above. The RAND appropriateness method (RAM) was used to distil from literature-based evidence and systematically formulated expert opinion, areas where consensus exist on the appropriateness (or inappropriateness) of methadone maintenance treatment (MMT) and areas where disagreement or uncertainty persist and which should be further pursued. The major areas which were addressed by this report are Initial assessment of candidates for MMT Appropriate settings for initiation of MMT (general and special cases) Appropriateness of methadone supportive therapy Co-treatments and accompanying measures Dosage schedules and pharmacokinetic testing Withdrawal from MMT Miscellaneous questions Appropriateness of other (non-methadone) substitution treatment Summary statements for each of the above categories are derived from the panel meeting and presented in the report. In the "first round", agreement was observed for 31% of the 553 theoretical scenarios evaluated. The "second round" rating, following discussion of divergent ratings, resulted in a much higher agreement among panellists, reaching 53% of the 537 scenarios. Frank disagreement was encountered for 7% of all scenarios. Overall 49% of the clinical situations (scenarios) presented were considered appropriate. The areas where at least 50% of the situations were considered appropriate were "initial assessment of candidates for MMT", the "appropriate settings for initiation of MMT", the "appropriate settings for methadone supportive treatment" and "Appropriateness of other (non-methadone) substitution treatment". The area where there was the least consensus on appropriateness concerned "appropriateness of withdrawal from MMT" (6%). The report discusses the implications and limitations of the panel results and provides recommendations for the dissemination, application, and future use of the criteria for the appropriateness of MMT. The RAND Appropriateness Method proved to be an accepted and appreciated method to assess the appropriateness of methadone maintenance treatment for opiate addicts. In the next step, the results of the expert panel process must now be combined with those of the Swiss and international literature reviews and the survey of current attitudes and practices in Switzerland, to be synthesized into formal practice guidelines. Such guidelines should be disseminated to all concerned, promoted, used and rigorously evaluated for compliance and outcome.

/pdf/appropriateness-of-methadone-maintenance-treatment-for-1knj44ouey.pdf

Appropriateness of methadone maintenance treatment for opiate addiction: evaluation by an expert panel

We are grateful to the editors of SPM for having invited comments on our report and to the distinguished commentators for their thoughtful remarks. We appreciate the opportunity that is given us here to respond. The remarks of van den Brink, Davoli and Perucci, Verthein et al. and Monteiro are mostly complimentary of, and largely complementary to, our report and, in that sense, do not require extensive replies. The criticisms of Newman will be dealt with in more detail. Van den Brink’s comments are generally supportive of our approach and conclusions, though he does regret certain absences in the paper. It is correct that stage of illness (as opposed to stage of treatment) and treatment objectives are not explicitly included, as such. This is because we felt that the modular approach in our scenarios allows the therapists to implicitly consider illness severity and the therapeutic response to targeted problems. Van den Brink has correctly made the conceptual distinction between cure and care. However, it is important to emphasise that in real life, even if cure is the eventual goal, care (i.e., MMT) may be used for different reasons on the difficult pathway leading to abstinence. Physical examination and blood tests are not listed in our list of initial assessments, though they could very well have been. The reason, as van den Brink understands, is because in our system the first level of treatment is with the primary care physician and it is assumed that this assessment has been done if the patient’s condition and physician’s need for information requires. Physical examination and blood tests were thus considered to be part of usual care and left out of the framework of the specific criteria examined. As can be seen from the actual ratings, all the elements we identified for initial assessment were considered appropriate by the expert panel. A further element that van den Brink misses is substitution with other opioids. There are at least two reasons for this 1. more than 90% of maintenance/substitution is based on methadone, and 2. the other substances are more generally used in case of failure of methadone.

Authors’ reply to commentators

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Christopher Eastus

Author Tools

Chat about Author

Papers

Appropriateness of methadone maintenance treatment for opiate addiction: evaluation by an expert panel. Commentaries. Authors' reply

Appropriateness of methadone maintenance treatment for opiate addiction: evaluation by an expert panel

Authors’ reply to commentators