BACKGROUND: Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients' preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. METHODS: An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. RESULTS: N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. DISCUSSION: Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients' preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders.

/pdf/patient-preferences-and-shared-decision-making-in-the-4wev2fggmc.pdf

Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature.

Pharmacotherapy for amphetamine dependence: A systematic review.

Issues. Psychostimulant dependence is a chronic, relapsing condition which is highly treatment refractory. No medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Agonist strategies have attracted limited attention. Approach. Successful examples of agonist pharmacotherapy in the treatment of heroin and nicotine dependence are first considered. Agonist pharmacological approaches to the treatment of psychostimulant dependence are then examined, based on the dopamine receptor agonist and indirect dopamine agonist strategies. Finally, the potential extension of the concept of agonist pharmacotherapy to include the novel non-amphetamine-type stimulant, modafinil, is discussed. Conclusions. Agonist approaches appear to be viable with risks outweighed by benefits in carefully selected, monitored and motivated patients. On the other hand, the effectiveness of indirect agonists such as dexamphetamine and methylphenidate are not established. Further r...

https://onlinelibrary.wiley.com/doi/pdf/10.1080/09595230801927372

The principles of agonist pharmacotherapy for psychostimulant dependence

Relationship between perceived improvement and treatment satisfaction among clients of a methadone maintenance program.

We surveyed 150 methadone maintenance treatment (MMT) program patients about willingness to use, and perceived efficacy of, conventional and unconventional nonpharmacological stress-related treatments. Although levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were high, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. Dimensions of psychiatric distress-but not demographic or MMT characteristics-predicted treatment willingness for conventional therapies and treatment willingness and perceived efficacy for unconventional therapies. These findings are likely to have implications for resource and program planning in MMT programs.

/pdf/conventional-and-unconventional-treatments-for-stress-among-26aa7fgt5f.pdf

Conventional and unconventional treatments for stress among methadone-maintained patients: treatment willingness and perceived efficacy.

Introduction: Buprenorphine is being used increasingly as an alternative treatment to methadone in the treatment of heroin misuse.Aim: We sought to obtain patients' views regarding the two medications and test the hypothesis that buprenorphine has a better reputation and is therefore preferred by patients.Method: Patients receiving treatment in Cornwall, UK were asked to complete a 34‐item questionnaire.Results: One‐hundred‐and‐thirty‐five questionnaires were returned. Methadone was considered superior in the domain relating to mental health, but buprenorphine was judged as better in other domains. The ease with which buprenorphine is diverted was highlighted. Overall, methadone was preferred, so refuting our hypothesis, but the differences were marginal.Discussion: Patient preference alone does not justify the increased of cost of buprenorphine. However, for the sake of increasing patient choice it would seem important that it is available.

Patients' views of treatment: methadone vs. buprenorphine

Background: In the UK dexamphetamine has been used widely as a treatment for amphetamine users. We sought to study the effects of illicit amphetamine use on pregnancy, and to evaluate the safety an...

Dexamphetamine substitute‐prescribing in pregnancy: a 10‐year retrospective audit

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Patients' views of treatment: methadone vs. buprenorphine

Dexamphetamine substitute‐prescribing in pregnancy: a 10‐year retrospective audit