Michael Krausz | UBC - Academia.edu (original) (raw)
Papers by Michael Krausz
International Journal of Environmental Research and Public Health
Chronic pain and substance use disorders are serious conditions that are prevalent among homeless... more Chronic pain and substance use disorders are serious conditions that are prevalent among homeless populations. The aim of this study was to examine the association between chronic pain and substance use among individuals experiencing homelessness and mental illness. We analyzed cross-sectional data from two sites of the At Home/Chez Soi study (Vancouver and Toronto) using bivariate statistics and multivariate logistic regression. Substance use and chronic pain parameters were assessed with the Maudsley Addiction Profile and purpose-designed short instruments. The sample comprised 828 participants. Mean age was 42.4 years and 54% reported chronic pain. In bivariate analysis, chronic pain was significantly associated with use of opioids and stimulants, daily substance use, polysubstance use and injecting as route of administration. In multivariate analysis, only daily substance use (OR: 1.46, 95% CI: 1.02–2.09) and injecting (OR: 1.81, 95% CI: 1.08–3.05) remained as significant associ...
Medicina
Background and Objectives: Now more than ever, there is an obvious need to reduce the overall bur... more Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised...
Objectives: This paper presents an analysis of the frequency and rates of substance use of 500 ho... more Objectives: This paper presents an analysis of the frequency and rates of substance use of 500 homeless individuals in three different geographic homeless populations in British Columbia, Canada: Vancouver, Victoria, and Prince George. Methods: The Maudsley Addiction Profile (MAP) was administered to measure substance use, and chi-squared tests were used to evaluate the significance level of substance use in each city. Results: The findings reveal a significant relationship between region and type of substance used. Alcohol use was significantly higher in Prince George, amphetamine and heroin use were higher in Vancouver and Victoria, and non-prescribed opioid use was lowest in Vancouver. Conclusion: The study suggests that substance use among the homeless varies based on the specific region and context; substance availability, demographic differences, and other factors clearly affect usage patterns. In order to effectively deliver substance use resources to homeless populations, lo...
Die Psychiatrie, 2015
Summary Background: Addiction and concurrent disorders give rise to a major burden of disease in ... more Summary Background: Addiction and concurrent disorders give rise to a major burden of disease in both North America and Europe. However, these two continents have some fundamental differences in regards to the health care system and its funding as well as the types of vulnerable subpopulations to serve. For example, while emergency rooms are often the only available care for patients in the US and Canada due to financial barriers or structural deficits, stepped care approaches and separate rehabilitation systems are more commonplace in Europe. These differences can be observed not only on a transatlantic but also on an intra-European level. These differing attitudes and policies impact on treatment paradigms such as harm reduction, abstinence-based or opioid maintenance treatments etc. Structural components and clinical pathways lead to dissimilarities in access to care services such as detoxification, rehabilitation and community services. The role of primary care as an important t...
Mental Health in Family Medicine, 2016
Contemporary Clinical Trials Communications, 2017
Addiction (Abingdon, England), 2017
Evidence supports the effectiveness of Housing First (HF) programmes for people who are experienc... more Evidence supports the effectiveness of Housing First (HF) programmes for people who are experiencing homelessness and mental illness; however, questions remain about its use in people with comorbid substance use disorders (SUD). The aim of this project was to test whether SUD modifies the effectiveness of an HF intervention. Secondary analysis of data from a randomized controlled trial of HF versus treatment-as-usual (TAU) with 24-month follow-up, comparing those with and without SUD at trial entry. Vancouver, Toronto, Winnipeg, Moncton and Montreal, Canada. A total of 2154 participants recruited from 2009 to 2013 and randomized to HF versus TAU (67% male, mean age 40.8 ± 11.2, 25% ethno-cultural minority). All were homeless and had a mental disorder at baseline; 35% reported symptoms consistent with SUD. Housing paired with Intensive Case Management or Assertive Community Treatment. Primary outcomes were days housed and community functioning. Secondary outcomes were general and hea...
Drug and alcohol dependence, Jul 1, 2016
There is controversy about which outcome parameters should be employed to assess substance use tr... more There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant. We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors. The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for terminat...
e-Mental Health, 2016
Access to mental health services is, due to current epidemiology, extremely limited. For some are... more Access to mental health services is, due to current epidemiology, extremely limited. For some areas addressing the special needs of mental health clients, access to experts seems to be nearly impossible. In developed countries, typical explanations include a lack of funding and limited numbers of experts as well as their regional distribution. Building capacity in specialist areas and developing accessibility are two challenges for the health-care system globally.
Psychiatrische Praxis, 1995
The controversy caused by the debate on treatment and substitution strategies in drug addiction i... more The controversy caused by the debate on treatment and substitution strategies in drug addiction is unchanged. This is particularly true concerning the use of codein-based drugs in the substitution of heroin abusers. However, only a few studies on the effects of this old and widely used method of substitution have been carried out. This article presents one retrospective and prospective study on the effects of the codein-based substitution in heroin abusers (n = 416). With respect to the issues addressed by this study such as somatic and psychic health, social integration, delinquincy and consumption patterns, patients as well as clinicians report an improvement in general health and fewer of the problems usually associated with heroin abuse, similar to the results from substitution treatment elsewhere.
Substance Abuse, 1997
In a study of 50 long‐term heroin addicts in Hamburg with an average usage period of 17.4 years, ... more In a study of 50 long‐term heroin addicts in Hamburg with an average usage period of 17.4 years, it was found that heroin usage patterns differed in the course of addiction. It appeared that two‐thirds of the sample had had longer periods of uncontrolled heroin use that were interrupted by phases of abstinence or by phases of controlled use. Almost all of them use different drugs. Currently, as well as in the course of their addiction, they use numerous other drugs in an uncontrolled way, especially benzodiazepines. Long‐term heroin addicts on the whole have less treatment experience than persons in the reference studies. The percentage of treatment dropouts is as high among them as among the persons surveyed in other studies. Completed treatment correlated with better results with regard to the duration of abstinence following treatment. The level of information regarding the pending treatment was low among long‐term heroin addicts.
Social Psychiatry and Psychiatric Epidemiology, 2013
This study used an experimental design to examine longitudinal changes in subjective quality of l... more This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants' level of need. Participants (n = 497) were stratified by level of need ("high" or "moderate") and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level. Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU. Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.
Mental Health and Substance Use, 2013
ABSTRACT The paper allows a better understanding of the role of childhood maltreatment among pati... more ABSTRACT The paper allows a better understanding of the role of childhood maltreatment among patients with severe opiate addiction and explores its association with current psychological distress. A cross-sectional survey was carried out on a purposive sample (n = 87) of adult intravenous opiate users participating in the North American Opiate Medication Initiative study – the first of its kind in North America, who responded affirmatively to a question on childhood maltreatment. Each participant was assessed in the areas of childhood maltreatment (Childhood Trauma Questionnaire, Short Form), current post-traumatic stress disorder (PTSD Checklist, civilian version; PCL-C), and current psychological distress (Symptom Checklist; SCL-90). 87/125 individuals responded (response rate of 69.6%). Within this subsample, the mean age was 38 years, with women making up 41.4% of the participants of the sample. The prevalence of childhood maltreatment (both abuse and neglect) was 72.9%; of these, 45.9%, 41.2%, and 40% of the participants reported moderate-to-extreme emotional, physical, and sexual abuse, respectively. Those with self-reported exposure to childhood maltreatment, abuse, or neglect had significantly more severe current reported symptoms related to post-traumatic stress, anxiety, and paranoid ideation compared to participants who reported little (or no childhood) maltreatment. A childhood history of maltreatment, both abuse and neglect, is associated with a complex psychological state among chronic intravenous drug users and must be kept in mind when addressing anyone receiving treatment in a comprehensive addiction treatment program.
European Psychiatry, 2002
International Journal of Environmental Research and Public Health
Chronic pain and substance use disorders are serious conditions that are prevalent among homeless... more Chronic pain and substance use disorders are serious conditions that are prevalent among homeless populations. The aim of this study was to examine the association between chronic pain and substance use among individuals experiencing homelessness and mental illness. We analyzed cross-sectional data from two sites of the At Home/Chez Soi study (Vancouver and Toronto) using bivariate statistics and multivariate logistic regression. Substance use and chronic pain parameters were assessed with the Maudsley Addiction Profile and purpose-designed short instruments. The sample comprised 828 participants. Mean age was 42.4 years and 54% reported chronic pain. In bivariate analysis, chronic pain was significantly associated with use of opioids and stimulants, daily substance use, polysubstance use and injecting as route of administration. In multivariate analysis, only daily substance use (OR: 1.46, 95% CI: 1.02–2.09) and injecting (OR: 1.81, 95% CI: 1.08–3.05) remained as significant associ...
Medicina
Background and Objectives: Now more than ever, there is an obvious need to reduce the overall bur... more Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised...
Objectives: This paper presents an analysis of the frequency and rates of substance use of 500 ho... more Objectives: This paper presents an analysis of the frequency and rates of substance use of 500 homeless individuals in three different geographic homeless populations in British Columbia, Canada: Vancouver, Victoria, and Prince George. Methods: The Maudsley Addiction Profile (MAP) was administered to measure substance use, and chi-squared tests were used to evaluate the significance level of substance use in each city. Results: The findings reveal a significant relationship between region and type of substance used. Alcohol use was significantly higher in Prince George, amphetamine and heroin use were higher in Vancouver and Victoria, and non-prescribed opioid use was lowest in Vancouver. Conclusion: The study suggests that substance use among the homeless varies based on the specific region and context; substance availability, demographic differences, and other factors clearly affect usage patterns. In order to effectively deliver substance use resources to homeless populations, lo...
Die Psychiatrie, 2015
Summary Background: Addiction and concurrent disorders give rise to a major burden of disease in ... more Summary Background: Addiction and concurrent disorders give rise to a major burden of disease in both North America and Europe. However, these two continents have some fundamental differences in regards to the health care system and its funding as well as the types of vulnerable subpopulations to serve. For example, while emergency rooms are often the only available care for patients in the US and Canada due to financial barriers or structural deficits, stepped care approaches and separate rehabilitation systems are more commonplace in Europe. These differences can be observed not only on a transatlantic but also on an intra-European level. These differing attitudes and policies impact on treatment paradigms such as harm reduction, abstinence-based or opioid maintenance treatments etc. Structural components and clinical pathways lead to dissimilarities in access to care services such as detoxification, rehabilitation and community services. The role of primary care as an important t...
Mental Health in Family Medicine, 2016
Contemporary Clinical Trials Communications, 2017
Addiction (Abingdon, England), 2017
Evidence supports the effectiveness of Housing First (HF) programmes for people who are experienc... more Evidence supports the effectiveness of Housing First (HF) programmes for people who are experiencing homelessness and mental illness; however, questions remain about its use in people with comorbid substance use disorders (SUD). The aim of this project was to test whether SUD modifies the effectiveness of an HF intervention. Secondary analysis of data from a randomized controlled trial of HF versus treatment-as-usual (TAU) with 24-month follow-up, comparing those with and without SUD at trial entry. Vancouver, Toronto, Winnipeg, Moncton and Montreal, Canada. A total of 2154 participants recruited from 2009 to 2013 and randomized to HF versus TAU (67% male, mean age 40.8 ± 11.2, 25% ethno-cultural minority). All were homeless and had a mental disorder at baseline; 35% reported symptoms consistent with SUD. Housing paired with Intensive Case Management or Assertive Community Treatment. Primary outcomes were days housed and community functioning. Secondary outcomes were general and hea...
Drug and alcohol dependence, Jul 1, 2016
There is controversy about which outcome parameters should be employed to assess substance use tr... more There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant. We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors. The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for terminat...
e-Mental Health, 2016
Access to mental health services is, due to current epidemiology, extremely limited. For some are... more Access to mental health services is, due to current epidemiology, extremely limited. For some areas addressing the special needs of mental health clients, access to experts seems to be nearly impossible. In developed countries, typical explanations include a lack of funding and limited numbers of experts as well as their regional distribution. Building capacity in specialist areas and developing accessibility are two challenges for the health-care system globally.
Psychiatrische Praxis, 1995
The controversy caused by the debate on treatment and substitution strategies in drug addiction i... more The controversy caused by the debate on treatment and substitution strategies in drug addiction is unchanged. This is particularly true concerning the use of codein-based drugs in the substitution of heroin abusers. However, only a few studies on the effects of this old and widely used method of substitution have been carried out. This article presents one retrospective and prospective study on the effects of the codein-based substitution in heroin abusers (n = 416). With respect to the issues addressed by this study such as somatic and psychic health, social integration, delinquincy and consumption patterns, patients as well as clinicians report an improvement in general health and fewer of the problems usually associated with heroin abuse, similar to the results from substitution treatment elsewhere.
Substance Abuse, 1997
In a study of 50 long‐term heroin addicts in Hamburg with an average usage period of 17.4 years, ... more In a study of 50 long‐term heroin addicts in Hamburg with an average usage period of 17.4 years, it was found that heroin usage patterns differed in the course of addiction. It appeared that two‐thirds of the sample had had longer periods of uncontrolled heroin use that were interrupted by phases of abstinence or by phases of controlled use. Almost all of them use different drugs. Currently, as well as in the course of their addiction, they use numerous other drugs in an uncontrolled way, especially benzodiazepines. Long‐term heroin addicts on the whole have less treatment experience than persons in the reference studies. The percentage of treatment dropouts is as high among them as among the persons surveyed in other studies. Completed treatment correlated with better results with regard to the duration of abstinence following treatment. The level of information regarding the pending treatment was low among long‐term heroin addicts.
Social Psychiatry and Psychiatric Epidemiology, 2013
This study used an experimental design to examine longitudinal changes in subjective quality of l... more This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants' level of need. Participants (n = 497) were stratified by level of need ("high" or "moderate") and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level. Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU. Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.
Mental Health and Substance Use, 2013
ABSTRACT The paper allows a better understanding of the role of childhood maltreatment among pati... more ABSTRACT The paper allows a better understanding of the role of childhood maltreatment among patients with severe opiate addiction and explores its association with current psychological distress. A cross-sectional survey was carried out on a purposive sample (n = 87) of adult intravenous opiate users participating in the North American Opiate Medication Initiative study – the first of its kind in North America, who responded affirmatively to a question on childhood maltreatment. Each participant was assessed in the areas of childhood maltreatment (Childhood Trauma Questionnaire, Short Form), current post-traumatic stress disorder (PTSD Checklist, civilian version; PCL-C), and current psychological distress (Symptom Checklist; SCL-90). 87/125 individuals responded (response rate of 69.6%). Within this subsample, the mean age was 38 years, with women making up 41.4% of the participants of the sample. The prevalence of childhood maltreatment (both abuse and neglect) was 72.9%; of these, 45.9%, 41.2%, and 40% of the participants reported moderate-to-extreme emotional, physical, and sexual abuse, respectively. Those with self-reported exposure to childhood maltreatment, abuse, or neglect had significantly more severe current reported symptoms related to post-traumatic stress, anxiety, and paranoid ideation compared to participants who reported little (or no childhood) maltreatment. A childhood history of maltreatment, both abuse and neglect, is associated with a complex psychological state among chronic intravenous drug users and must be kept in mind when addressing anyone receiving treatment in a comprehensive addiction treatment program.
European Psychiatry, 2002