Addiction Switzerland

BackgroundAlthough prior research has explored the roles of attachment styles and defense mechanisms in marital satisfaction, limited attention has been given to how these two factors interact. This study investigates the combined influence of attachment styles and defense mechanisms on marital satisfaction in Iranian couples.MethodsA total of 228 participants (114 couples) completed three online questionnaires: The Revised Adult Attachment Scale, the Marital Intimacy Needs Questionnaire, and the Defense Style Questionnaire. Hierarchical multiple regression with interaction terms was used to examine the moderating effects of attachment styles and defense mechanisms on marital satisfaction.ResultsAnalyses showed several connections between marital satisfaction and attachment styles as well as defense mechanisms. Notably, in the prediction of marital satisfaction, secure attachment enhanced marital satisfaction when paired with mature defense mechanisms.DiscussionOur findings highlight potential interactive effects of attachment styles and defense mechanisms in shaping marital satisfaction. The results emphasize the need for therapeutic interventions that integrate both attachment-based and defense-oriented approaches to enhance marital well-being.

Preventing mental disorders is important to avoiding clinical conditions. This study evaluated the efficacy of internet-based indicated prevention for anxiety and depressive disorders. In a three-arm randomized controlled trial, 566 adults with subthreshold anxiety (GAD-7 ≥ 5) and/or depressive symptoms (CES-D ≥ 16), but no clinical diagnosis in the past six months (MINI 6.0), were assigned to either an individually (IG-IMI, n = 186) or automatically (AG-IMI, n = 189) guided digital intervention, or waitlist control (WLC, n = 191). The digital intervention comprised 8 transdiagnostic, self-tailored, CBT-based sessions. The primary outcome was time to onset of any anxiety or depressive disorder over 12 months, assessed via blinded diagnostic interviews (MINI). AD/DD onset was 19.4% in IG-IMI, 14.8% in AG-IMI, and 30.9% in WLC. Cumulative incidence was 23.1% (IG-IMI), 20.7% (AG-IMI), and 36.0% (WLC; p < 0.001). Hazard ratios were 0.59 and 0.47; NNTs were 7.76 and 5.79. Both individually guided and automated interventions effectively reduced AD/DD incidence. Trial Registration: The study was preregistered in the German Clinical Trial Registration (DRKS00011099; https://drks.de/search/de/trial/DRKS00011099).

Digital interventions are promising for the prevention of substance use in young people. However, engagement with these interventions is often insufficient, and their full potential remains unrealized. Given the established link between engagement in digital interventions and their effectiveness, understanding user factors that influence involvement in eHealth and mobile health (mHealth) interventions is essential. This study aimed to identify factors influencing user engagement in a mobile phone-based life skills training program for substance use prevention among adolescents and to collect suggestions for program optimization. A qualitative study was conducted with 171 participants of the mHealth prevention SmartCoach (Pathmate Technologies) program. The program provided individualized text messages to foster life skills for 4 months and proved to be effective in preventing the onset of cigarette and cannabis use. Semistructured phone interviews were conducted with program participants to explore factors associated with program engagement and to gather suggestions for program optimization. Interviews were recorded, transcribed, and analyzed using thematic analysis with both inductive and deductive coding. The capability, opportunity, and motivation model of behavior change (COM-B) model and Theoretical Domains Framework (TDF) were used to assess behavioral influences. Key factors positively influencing program engagement included the timing of text messages, social influences and support, engaging and helpful content, and rewards (points and prizes). Conversely, barriers to engagement were identified as forgetfulness, short response time limits, limited time resources, lack of interest, concerns related to personal disclosure, and difficulty identifying with the challenge task type (posting). Suggestions for optimization included implementing reminders, providing better guidance for using tips, allowing personalization of message timing and content, extending time limits for tasks, and reducing the concerns related to personal disclosure. The study confirms the critical role of timing, content relevance, and social support in enhancing engagement with digital interventions. Specific recommendations for optimizing the SmartCoach program were derived, highlighting the importance of reminders, personalization, and addressing concerns related to personal disclosure.

Stigma remains a major barrier to accessing HIV care. We analysed the association between stigma and failed pillbox return, and described factors associated with stigma among adults living with HIV in rural Tanzania. From the Kilombero and Ulanga Antiretroviral Cohort we included newly diagnosed adults ≥15 years enrolled between June 2019 and September 2022 with a stigma assessment at 6-12 months and a clinical visit within 7 days. We assessed stigma using the adapted 7-item Berger questionnaire. Logistic and linear regression models were used to identify factors associated with stigma and to determine the association between stigma and depression with failed pillbox return. Among 241 participants (median age 37 years (IQR, 30-44) at enrolment), most were female (n = 170, 71%), WHO stage I (n = 132, 55%), had no pillbox at the clinical visit (n = 188, 78%), and remained in care at 2 years (n = 167, 69%). Participants with no pillbox had slightly higher stigma levels (9, IQR, 5-14) versus those who did (7, IQR, 4-13); this difference was not observed after adjustment (adjusted Odds Ratio 1.02 [95% CI 0.97, 1.07]; p = 0.38). Higher stigma was associated with higher depression (95% CI 0.48, 1.33, p < 0.01), HIV non-disclosure (95% CI 2.58, 8.33, p < 0.01) and higher education (p < 0.01). Higher Body Mass Index (p < 0.01) and advanced WHO stage (p < 0.01) were associated with lower stigma. Failed pillbox return was not associated with stigma. However, stigma was associated with depression, HIV non-disclosure and higher education. Stigma-reduction interventions focused on mental health and disclosure are urgently needed in rural areas.

The non-medical use of anabolic androgenic steroids for the improvement of aesthetic and sports performance purposes has become a global substance use disorder, particularly among men in recreational sports. Health outcomes among people who are using anabolic androgenic steroids may be detrimental, yet healthcare services for these users are scarce. Therefore, the aim of this project was to conduct a quality assurance study to evaluate the feasibility of providing current best clinical practice for anabolic androgenic steroids users based on the published literature within a primary care practice in Zurich (Switzerland). A primary healthcare practice for current or past anabolic androgenic steroids use was established at the Arud Centre for Addiction Medicine in Zurich providing specialised medical care for this population. The reporting and methodology to evaluate feasibility of this quality assurance study follow a checklist for pilot studies. The primary feasibility outcomes for this study were satisfaction with the services received (customer satisfaction score), as well as loyalty towards the services (net promoter score). These customer metrics have been used successfully in the medical field to measure patient experiences, as well as infer future word-of-mouth advertisement (i.e. return and refer). Furthermore, the objective was to describe patient characteristics and substance use behaviours in a Swiss context. Patients could access these services in Zurich from 1 June 2023 onwards. The recruitment strategy was word-of-mouth advertising among anabolic androgenic steroids users and paper advertisement (i.e. flyers) about the healthcare service. Eligibility criteria were based on legal restrictions regarding doping laws and professional ethical principles of medicine. In an initial visit at the practice, a focused patient history was assessed, and patients received a physical, psychometric, instrumental as well as laboratory examination. Datasets are summarised using descriptive statistics. Overall, 34 eligible patients were seen over the period from June until December 2023. Excellent results regarding loyalty towards the service (net promoter score: 100; integer) as well as patient satisfaction with the received services (customer satisfaction score: 100%) were achieved. Patients were commonly young professional males (mean: 38.5 years, standard deviation: 8 years), with educational level beyond compulsory schooling. The main motivation for using anabolic androgenic steroids was aesthetic purposes. Acquisition of these substances occurred mostly through non-medical sources. Patterns of anabolic androgenic steroids use were complex with extensive polypharmacy and concomitant illicit substance use. Most patients suffered from side effects with multiple physical as well as mental health complications. Many abnormal findings were found regarding the physical as well as laboratory and instrumental examination, although mostly mild and transient, some possibly severe regarding health outcomes. With this first quality assurance study, we demonstrate that integration of current best clinical practice for anabolic androgenic steroids users in recreational sports appears to be feasible with high acceptance in a Swiss primary care practice. Furthermore, those patients may engage in high-risk behaviours and a high prevalence of comorbid medical conditions was demonstrated. Anabolic androgenic steroids users likely benefit from integrated medical care provided and coordinated in a primary health care setting. On the basis of the initial study results, these services were continued at a larger scale to further assess as well as mitigate health risks among this user population. Importantly, current doping legislation was demonstrated to be a major limitation to provision of adequate medical care for this user population, thus changes in legislation are crucial to avert this growing public health threat.

BackgroundThe positive influence of physical activities on a person’s physical and mental health has been proven many times. These findings were implemented in the regular exercise therapy offered within psychiatric hospitals in Switzerland. However, after leaving a psychiatric hospital, there are insufficient opportunities for individuals with psychiatric disorders to engage in sports. Therefore, voluntary sports groups for this specific population have been offered in Switzerland by the disability sports systems since 2015. Still, the perspective of individuals with psychiatric disorders as well as perceived barriers and facilitators for participating in these groups have neither been assessed nor included in the design of sports programs.MethodsThis study consists of 15 semi-structured interviews (N = 15) lasting up to one hour each with individuals with psychiatric disorders who participated in voluntary sports groups for this specific population in Switzerland. The results were analyzed employing Thematic Analysis using Nvivo.ResultsInterviewees named offer-specific (disability-related), emotional (social exchange), and rational motives (health) for their participation in voluntary sports groups for individuals with psychiatric disorders. In addition, intrapersonal (psychological/physical deficits), sociocultural (stigmatization), and structural (unsuitable location) factors were mentioned as possible inhibitors in the context of participation in voluntary sports groups for individuals with psychiatric disorders. Furthermore, participants experienced predominantly positive outcomes from participation.ConclusionIndividuals with psychiatric disorders benefit socially, physically, and psychologically from participating in voluntary sports groups for this specific population. However, participation is associated with barriers that need to be minimized in the future. Additionally, a large-scale survey is necessary to validate the results among the population.