List of drugs metabolized by various families of CYP enzymes.
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",isbn:"978-1-83969-057-0",printIsbn:"978-1-83969-056-3",pdfIsbn:"978-1-83969-058-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"5f388543a066b617d2c52bd4c027c272",bookSignature:"Prof. Christophe Hano and Dr. Jen-Tsung Chen",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10539.jpg",keywords:"Plant Description, Botany, Phylogeny, Genome, Phytochemical Analysis, Extraction, Phytochemical Diversity, Phytochemical Analysis, Extraction, Phytochemical Diversity, Biotechnological Production, Traditional Medicinal Uses",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 8th 2020",dateEndSecondStepPublish:"November 23rd 2020",dateEndThirdStepPublish:"January 22nd 2021",dateEndFourthStepPublish:"April 12th 2021",dateEndFifthStepPublish:"June 11th 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Assistant Professor at the University of Orleans at Research INRAE Lab LBLGC USC1328 and a member of the Cosm'ACTIFS Research Group (CNRS GDR3711). He authored and co-authored more than 100 scientific papers, reviews, and book chapters in internationally renowned journals.",coeditorOneBiosketch:"Dr. Jen-Tsung Chen is currently a professor at the National University of Kaohsiung in Taiwan. He teaches cell biology, genomics, proteomics, medicinal plant biotechnology, and plant tissue culture in college. Dr. Chen's research interests are bioactive compounds, chromatography techniques, in vitro culture, medicinal plants, phytochemicals, and plant biotechnology. He has published over 60 research papers, reviewed over 260 manuscripts, and edited at least 150 papers in international peer-review journals.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"313856",title:"Prof.",name:"Christophe",middleName:null,surname:"Hano",slug:"christophe-hano",fullName:"Christophe Hano",profilePictureURL:"https://mts.intechopen.com/storage/users/313856/images/system/313856.jpg",biography:"Dr. Christophe Hano (male, 1978), who completed his PhD in 2005 in Plant Physiology, Biochemistry and Molecular Biology, is now Assistant Professor at the University of Orleans at Research INRAE Lab LBLGC USC1328 and a member of the Cosm'ACTIFS Research Group (CNRS GDR3711). His research career has focused on applied plant metabolism and plant biotechnology. He has written more than 100 scientific papers, reviews and book chapters in internationally renowned journals and edited one book as well as a variety of journal topical issues on plant secondary metabolism, including polyphenols. He is Academic, Assistant Editor and/or Editorial Board Member of several renowned Q1 Journals in Plant Biochemistry and Biotechnology (including Plos ONE, Biomolecules, Plant Cell Tissue and Organ Culture, Frontiers in Plant Science, Cosmetics). He was reviewers for more than 500 papers for ca 35 International Journals, and recognized scientific expert for several national and international Institutions. Currently, he is developing research projects aimed at studying plant secondary metabolism to lead to the development of natural products with interests in pharmacology or cosmetics. His research focuses on the green extraction and analytical methods applied to plant polyphenols, elucidation of biosynthetic mechanisms of plant natural products and their exploitation by metabolic engineering approaches. He was a leader (project manager) in 6 scientific projects and major investigator in several more. In this context he conducts research projects in cooperation with industrial companies and he coordinates in the European Le Studium® Consortium Action on the bioproduction of bioactive extracts for cosmetic applications through plant cell in vitro cultures. In this context, he explores the potential of the Loire Valley Flora Area for cosmetic applications. 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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"70384",title:"Detoxification of Drug and Substance Abuse",doi:"10.5772/intechopen.90380",slug:"detoxification-of-drug-and-substance-abuse",body:'Detoxification is the process of disengaging a person from a specific psychoactive substance in a safe and effective manner. The choice of which strategy to use for detoxification can depend on many factors, involving clinical judgment, the user’s personal preference and circumstances, lifestyle and expectations, degree of dependence and concomitant health problems. Detoxification does not imply that a patient has been given the diagnosis of substance use disorder such as addiction, abuse, or misuse of medications. Although addiction may necessitate detoxification in order to begin drug rehabilitation treatment, there are many reasons that patients must undergo detoxification. Detoxification refers to a decrease in biological activity of a drug after it has been metabolized in the body. Biotransformation is a critically essential pathway for drug detoxification and elimination in humans. Biotransformation of drugs leads to termination or alteration of their biologic activity, otherwise most drugs would have a prolonged duration of action. Despite the fact that probably every organ in the human body is capable of metabolizing drugs but the liver and small intestine serves as the dominant sites of expression of the major drug metabolizing enzymes. Broad spectrums of enzymes are present in a human that can catalyze biotransformation reactions, and they have been classified precisely into Phase I and Phase II processes. Whereas Phase I represents oxidation, reduction, and hydrolytic reactions, Phase II involves conjugation of the drug with an endogenous molecule that generally increases the hydrophilicity of the adducted metabolite. Ultimately, all drug metabolites are excreted primarily through the urine or bile. Many endogenous and Xenobiotics are lipophilic. They can easily cross lipid bilayers & transported by lipoproteins. Metabolism of endogenous compounds and xenobiotics allows organisms to convert lipophilic compounds to more water soluble forms which facilitate excretion. Many xenobiotic compounds contain aromatic rings and heterocyclic ring structures that we are unable to degrade or recycle because those are structures are hydrophobic in nature.
Detoxification is a lot of intercessions planned for overseeing intense inebriation and withdrawal. Directed detoxification may forestall conceivably hazardous complexities that may show up if the patient was left untreated. Simultaneously, detoxification is a type of palliative consideration (diminishing the force of a turmoil) for the individuals who need to get abstinent or who must watch obligatory forbearance because of hospitalization or legitimate contribution. At long last, for certain patients it speaks to a point of first contact with the treatment framework and the initial step to recuperation. Treatment/restoration, then again, includes a group of stars of continuous remedial administrations at last proposed to advance recuperation for substance misuse patients.
The accord board based on existing meanings of detoxification as an expansive procedure with three fundamental segments that may happen simultaneously or as a progression of steps:
Assessment involves testing for the nearness of substances of maltreatment in the circulation system, estimating their focus, and screening for co-happening mental and physical conditions. Assessment additionally incorporates an exhaustive evaluation of the patient’s medicinal and mental conditions and social circumstance to help decide the proper degree of treatment following detoxification. Basically, the assessment fills in as the reason for the underlying substance misuse treatment plan once the patient has been pulled back effectively.
Adjustment incorporates the medicinal and psychosocial procedures of helping the patient through intense inebriation and withdrawal to the achievement of a therapeutically steady, completely upheld, sans substance state. This frequently is finished with the help of prescriptions, however in certain ways to deal with detoxification no drug is utilized. Adjustment incorporates acclimating patients with what’s in store in the treatment milieu and their job in treatment and recuperation. During this time experts likewise look for the inclusion of the patient’s family, bosses, and other huge individuals when fitting and with arrival of classification. Cultivating the patient’s entrance into treatment includes setting up the patient for section into substance misuse treatment by focusing on the significance of finishing the total substance misuse treatment continuum of care. For patients who have exhibited an example of finishing detoxification administrations and afterward neglecting to participate in substance misuse treatment, a composed treatment agreement may energize entrance into a continuum of substance misuse treatment and care. This agreement, which is not legitimately official, is intentionally marked by patients when they are steady enough to do as such toward the start of treatment. In it, the patient consents to take an interest in a proceeding with care plan, with subtleties and contacts built up before the completion of detoxification.
The cytochrome P450 (CYP) catalysts are otherwise called microsomal blended capacity oxidases. The CYP compounds are layer bound proteins, present in the smooth endoplasmic reticulum of liver and different tissues. They are the most significant chemicals for Phase I biotransformation of medications. These catalysts contain a heme prosthetic gathering, where heme gathering is the iron-porphyrin unit. The oxidizing site in these chemicals is the heme focus, and is liable for the oxidation of hydrophobic mixes to hydrophilic or progressively polar metabolites for resulting discharge.
There are in excess of 300 distinctive CYP catalysts, which have been assembled into a few families and subfamilies dependent on the amino-corrosive arrangement. Out of these, 18 CYP families have been distinguished in warm blooded creatures, containing significantly of families CYP1, CYP2 and CYP3. Some of the CYP enzymes and their respective drugs are given in Table 1.
S. No. | CYP enzyme | Drug metabolized |
---|---|---|
1 | 1A2 | Amitriptyline, clozapine |
2 | 2A6 | Acetaminophen, amodiaquine |
3 | 2C8 | Paclitaxel |
4 | 2C9 | Diclofenac, ibuprofen, phenytoin |
5 | 3A4 | Carbamazepine, erythromycin, zolpidem |
6 | 2E1 | Enflurane, halothane |
List of drugs metabolized by various families of CYP enzymes.
This section sets out the key aspects of the pharmacology of the opioids and other drugs used in detoxification, including the use of opioid agonists, partial agonists and opioid antagonists. The point of detoxification for a ward narcotic client is to kill the impacts of narcotic medications in a sheltered and viable way. Fitting organization of pharmacological operators assumes a significant job in improving the probability of a fruitful detoxification, while limiting the distress of withdrawal experienced by the administration client.
All narcotics, including heroin and methadone, are agonists that animate narcotic receptors. Numerous narcotic agonists are additionally endorsed for their pain relieving properties in torment the board, including morphine, codeine, dihydrocodeine, oxycodone, hydrocodone and fentanyl.
Buprenorphine is a partial agonist at the narcotic receptor subtype, which implies that the framework is not completely animated in any event, when every one of the receptors are involved. This lesser impact is the primary contributory system hidden buprenorphine’s better wellbeing profile when taken alone, since the edge for respiratory wretchedness is not come to in any event, when every one of the receptors are involved. As a fractional agonist, buprenorphine can likewise seem to go about as a rival (and all things considered may have been portrayed in more seasoned writing as a blended agonist-rival). In the event that buprenorphine is given to an individual who has taken a full agonist (for instance, heroin or methadone), it uproots the full agonist, because of buprenorphine’s higher proclivity at the narcotic receptor, however just incompletely animates these receptors.
An antagonist, for example, naltrexone or naloxone, ties to the receptor yet does not invigorate it. Naltrexone and naloxone have a high fondness with narcotic receptors, to such an extent that they will dislodge existing agonists and keep further agonists from official to the receptors. Along these lines if an agonist is available animating the receptor, for instance heroin or methadone, taking naltrexone or naloxone will stop this incitement, coming about in accelerated (sudden) withdrawal. Thus, naloxone is usually utilized in crisis drug to switch narcotic overdose, while the more drawn out acting naltrexone is recommended as an upkeep treatment to anticipate detoxified administration clients from backsliding to narcotic use.
This technique joins a quick, hastened withdrawal by naltrexone delivering serious withdrawal manifestations, with high portions of clonidine and benzodiazepines when the naltrexone to improve the side effects. While shortening withdrawal to 2–3 days, proof is missing of longer restraint or naltrexone maintenance [1].
In the course of the most recent a very long while there has been a lot of progress understanding the atomic and cell premise of practices identified with nicotine addiction, and this comprehension has prompted focused on tranquilize disclosure prompting new therapeutics for smoking discontinuance, for example, varenicline [2]. These advances show that basic investigations of the neurobiological premise of medication misuse can build our insight into why people become dependent and what drives continuous smoking, however can likewise prompt novel techniques for mediation to assist individuals with stopping and remain abstinent. The information that has been increased about the systems fundamental nicotine support has been applied to understanding different practices that drive continuous smoking. Focusing on the multimodal reason for nicotine admission may in this way bring about progressively compelling medicines for smoking suspension going ahead.
The antihypertensive, α2-adrenergic agonist medicate clonidine has been utilized to encourage narcotic withdrawal in both inpatient and outpatient settings for more than 25 years. It works by official to α2 autoreceptors in the locus coeruleus and smothering its hyperactivity during withdrawal. Portions of 0.4–1.2 mg/day or higher decrease a considerable lot of the autonomic parts of the narcotic withdrawal disorder, however side effects, for example, a sleeping disorder, torpidity, muscle throbs, and fretfulness may not be sufficiently taken care of. Contrasted and methadone-helped withdrawal, clonidine has progressively symptoms, particularly hypotension, however is less inclined to prompt post-withdrawal rebound [3, 4]. Dropouts are bound to happen ahead of schedule with clonidine and later with methadone. In an investigation of heroin detoxification, buprenorphine improved on maintenance, heroin use, and withdrawal seriousness than the clonidine gathering. Since clonidine has gentle pain relieving impacts, included absence of pain may not be required during the withdrawal time frame for therapeutic narcotic addicts.
There are 3 primary narcotic receptors: delta, kappa, and mu. They happen all through the CNS yet especially in territories and tracts related with torment recognition. Receptors are likewise situated in some tactile nerves, on pole cells, and in certain cells of the GI tract.
Narcotic receptors are animated by endogenous endorphins, which for the most part produce absence of pain and a feeling of prosperity. Narcotics are utilized remedially, principally as analgesics. Narcotics fluctuate in their receptor movement, and a few (e.g., buprenorphine) have consolidated agonist and foe activities. Mixes with unadulterated rival action (e.g., naloxone, naltrexone) are accessible.
Exogenous narcotics can be taken by practically any course: orally, intravenously, subcutaneously, rectally, through the nasal layers, or breathed in as smoke. Pinnacle impacts are come to around 10 min after IV infusion, 10–15 min after nasal insufflation, and 90–120 min after oral ingestion, despite the fact that opportunity to top impacts and length of impact shift extensively relying upon the particular medication. Synapse discharge from neurons is regularly gone before by depolarisation of the nerve terminal and Ca++ section through voltage-touchy Ca++ channels. Medications may hinder synapse discharge by an immediate impact on Ca++ channels to diminish Ca ++ passage, or by implication by expanding the outward K + current, in this way shortening repolarisation time and the term of the activity potential. Narcotics produce both of these impacts in light of the fact that narcotic receptors are obviously coupled through G-proteins legitimately to K+ channels and voltage-touchy Ca++ channels. Narcotics additionally collaborate with other intracellular effector components, the most significant being the adenylate cyclase framework.
Nicotine poisonous quality is frequently dismissed as far as helpful methodology regardless of most patients being smokers. The fundamental nicotine detoxification medications are considered beneath, yet likewise, clonidine can be considered as a second-line treatment. Tiagabine, baclofen, gabapentin, varenicline, mecamylamine (a non-particular NAch receptor foe) and topiramate have all been appeared in concentrates to effectively affect suspension.
Nicotine replacement treatment (NRT) ties to nicotine acetylcholinergic (NAch) receptors in the focal sensory system in a portion subordinate way. This diminishes the desire to smoke, withdrawal impacts and any reward from cigarettes if the client should backslide. It likewise gives a less destructive and less fortifying strategy for organization contrasted and smoking, and can improve end rates by 50–70%. The routine for detoxification treatment should begin 2 weeks before the end endeavor, as this has been demonstrated to be more successful than beginning treatment upon the arrival of suspension itself. NRT ought to be proceeded for at least 2 months, or for whatever length of time that vital. There is some proof that mental help is likewise valuable, as forbearance with NRT is higher on solution than when it is bought over the counter [5]. The slowest technique for conveying NRT is through transdermal patches. These come in differing portions, where higher dosages might be progressively advantageous for exceptionally subordinate smokers. Adequacy can be improved by utilizing patches related to a quicker conveyance technique. Biting gum, in portions of 2 and 4 mg, is a case of a quicker conveyance technique, as are inhalers, oral showers, sublingual tablets and capsules. The quickest conveyance technique is by nasal splash, which can supplant about a large portion of the blood nicotine levels of smoking inside 5–10 min [6]. All things being equal, NRT does not give nicotine as productively as smoking and does not copy the conduct ceremonies, which bargains its viability for cessation [7]. In the event that the client keeps on smoking during NRT, they may experience symptoms of nicotine poisonous quality, for example, queasiness, stomach torment, loose bowels, wooziness and palpitations, and mix-up these for nicotine withdrawal.
Nicotine receptor partial agonists check nicotine withdrawal side effects (by going about as an agonist) and lessen smoking fulfillment (by going about as an opponent), and might be valuable for improving long haul end. Varenicline is a particular fractional agonist for the a4-b2-NAch receptor with a moderate fondness for the 5-hydroxytryptamine-3 receptor. Cahill et al. [8] indicated varenicline improved long haul end by two to three times contrasted and fake treatment or bupropion, was as yet powerful at lower dosages which likewise decreased the symptoms of the medication, (for example, sickness). The suggested portion is 1 mg twice every day for 12 weeks, which is come to by continuously expanding the portion from 0.5 mg once day by day during the prior week smoking suspension starts. An additional 12 weeks of dosing can be utilized as backslide anticipation. It is hazy if these medicines are better than NRT and there have been unconfirmed connections between these medications and despondency with self-destructive speculation [9].
Nicotine ties to nicotinic cholinergic receptors, coming about at first, by means of activities on autonomic ganglia, in overwhelmingly thoughtful anxious incitement. With higher portions, parasympathetic incitement and afterward ganglionic and neuromuscular bar may happen. Direct impacts on the mind may likewise bring about heaving and seizures. Extensive proof focuses to contribution of oxidative stress (OS), receptive oxygen species, lipid peroxidation, DNA harm, and advantageous impact of cancer prevention agents. Beforehand, a proposal was progressed for cooperation of iminium metabolites which may work, by means of electron transfer (ET) with redox cycling, to deliver radical elements. The conjugated iminium usefulness is one of the less notable ET types. The cationic metabolites emerge from a few courses, including oxidation of nicotine itself, and protonation of myosmine which starts from nornicotine through demethylation of nicotine. Decrease possibilities, which are in the range manageable to ET in vivo, loan assurance to the hypothetical structure. Another metabolic course involves hydrolysis of nicotine iminium to an open-chain ketoamine that, thusly, experiences nitrosation to shape a harmful nitrosamine. Thusly, the nitrosamine fills in as a DNA alkylator which can likewise produce conjugated iminiums by assault on specific nitrogen of DNA bases. During the previous 14 years, the speculation has delighted in generous help. Expanding proof focuses to a job for OS in danger by nicotine involving significant body organs, including the lung, cardiovascular framework, focal sensory system, liver, kidney, testicles, ovary, pancreas, and throat.
Cocaine exerts its effects by interfering with the reabsorption of brain’s natural neurotransmitters such as dopamine. Cocaine makes chemical changes in the brain that may take time to reverse. A safe and secure environment monitored around the clock by staff members may provide the smoothest possible detox. Physically, the body may need to stabilize. Cocaine suppresses appetite and may cause unhealthy weight loss, for example. A balanced diet plan can help restore a healthy body weight. Physical exercise is also beneficial during detox as it releases natural endorphins as well as increases physical strength and stamina, boosting self-esteem and confidence levels. Yoga and meditation have been proven to help reduce stress, and increase energy and focus naturally. Propranolol for cocaine detoxification is just more viable than fake treatment if the clients are follower to the medicine. Amantadine and other dopamine receptor agonists were seen as not any more powerful than placebo. [10, 11] GABA-ergic medications might be a superior course of examination, as glutamate exhaustion is related with rehashed cocaine administration [12]. For instance, progesterone, tiagabine, topiramate and gabapentin were found to diminish cocaine use in clients with low withdrawal seriousness.
Modafinil builds histamine discharge by means of the orexinergic framework and is a feeble monoamine re-take-up inhibitor. Modafinil may upgrade glutamate and hinder GABA, and has been seen as better than fake treatment regarding higher restraint levels [13]. It is thought to go about as an ‘agonist substitution’, hindering the dopamine transporter and, to a flimsier degree, the noradrenaline transporter, expanding extracellular dopamine and noradrenaline. Studies show modafinil may improve electrotonic coupling, whereby the associations over hole intersections turned out to be progressively viable. For amphetamine detoxification, mirtazapine and amineptine were seen as incapable. Anyway it very well may be inferred that bupropion and modafinil might be useful as an extra to conduct treatments.
In detoxification for cannabis, anticonvulsants, for example, valproate semisodium and antidepressants, for example, bupropion, fluoxetine, mirtazapine and nefazodone have demonstrated little benefit [14, 15]. Yearnings are decreased, yet peevishness, uneasiness and tiredness are expanded. A significant issue in cannabis withdrawal is trouble dozing and has indicated this might be reduced with zolpidem. Examination into rimonabant, a cannabinoid receptor adversary, was ended because of unfortunate reactions. Some guarantee for cannabis detoxification has been appeared by oral tetrahydrocannabinol (THC or dronabinol) and lithium carbonate. A portion of 30–90 mg day by day of THC, especially when joined with lofexidine, has been appeared to lessen withdrawal manifestations, rest issues, uneasiness, longings and burdensome symptoms [16]. Dronabinol (δ-9-tetrahydrocannabinol) and lithium carbonate have been demonstrated to be helpful for reducing withdrawal [13]. Be that as it may, for unlawful medications including stimulants, cannabis and joy (MDMA), psychosocial treatments, for example, keyworking and possibility the executives remain the prescribed treatment. There is as yet a job for the clinician in the checking and treating of any emotional wellness issues, including psychosis, wretchedness or danger of suicide. Withdrawal manifestations from GHB and its forerunners (γ-butyrolactone, GBL and 1,4-butanediol, 1,4-CB) can incorporate serious neuropsychiatric issues and autonomic insecurity, which might be perilous and require escalated care. Less extreme yet continuing reactions incorporate a sleeping disorder, uneasiness and depression [17]. Ringer and Collins report pharmacological techniques to treat this incorporate the utilization of high portion benzodiazepines (for instance, 40–120 mg of diazepam), perhaps joined with baclofen or different narcotics like pentobarbital if there is no reaction to benzodiazepines. SSRIs ought to in a perfect world be maintained a strategic distance from in cocaine and amphetamine clients because of conceivable serotonin disorder, in spite of the fact that they are regularly utilized.
Cannabis inebriation is a disorder perceived in DSM-IV and ICD-10, with both mental and conduct (rapture, unwinding, expanded craving, weakened memory and focus), and physical (engine incoordination, tachycardia, orthostatic hypotension), indications. Inebriation is generally mellow and self-restricting, not requiring pharmacological treatment. The most serious impacts (tension, alarm, psychosis) are best treated symptomatically with a benzodiazepine or second-age (atypical) antipsychotic prescription. No medicine is affirmed explicitly for treatment of cannabis inebriation.
Concentrates with the particular CB1 receptor opponent/opposite agonist rimonabant propose that CB1 receptors intercede a considerable lot of the intense impacts of cannabis in people. In a twofold visually impaired, fake treatment controlled investigation of 63 solid men with a background marked by cannabis use, single oral portions of rimonabant delivered noteworthy portion ward bar of the abstract inebriation and tachycardia brought about by smoking a functioning (2.64% THC) or fake treatment (twofold visually impaired) cannabis cigarette 2 hours after the fact. The 90-mg portion delivered about 40% decreases in appraisals of “high” “stoned” and “tranquilize impact” (on 100-mm visual-simple scales) and a 60% decrease in pulse. Rimonabant alone delivered no huge physiological or mental impacts and did not influence top THC plasma focus or its time course.
This example of discoveries proposes that the watched lessening of cannabis impacts was explicitly due to CB1 receptor bar, and not to decrease in cerebrum THC fixation or checking impacts of rimonabant. CB receptor adversaries, for example, rimonabant may be valuable in treating intense cannabis inebriation, in the way that the mu-narcotic receptor (mOR) foes naloxone and naltrexone are utilized to treat sedative inebriation. Be that as it may, such meds are never again accessible for clinical use. Rimonant and comparable CB1 receptor rivals were pulled back from clinical advancement and use in view of mental reactions related with their long haul use.
Long haul endorsing of high portions of benzodiazepines (more than 30 mg of diazepam) can be destructive. Benzodiazepine reliance is normally treated in optional consideration, however may display close by other medication reliance. It is suggested that clients of methadone and benzodiazepines ought to experience detoxification from benzodiazepines first. Anyway there is proof that narcotic/benzodiazepine clients may have less withdrawal impacts if buprenorphine is utilized for detoxification. Benzodiazepine reliance is not just by means of rehash solution. They are additionally obtained and abused unlawfully and there might be some an incentive in “support” endorsing for high portion illegal clients before withdrawal. Solutions for benzodiazepines ought to be diminished gradually to the most minimal portion to control the reliance. There is no proof that week-on week-off (beat) dosing is successful. Reliance on high dosages may require authority treatment however can have a quicker pace of decrease, for example, lessening portions significantly more than about a month and a half, without a danger of seizures. Decrease of high portion use to a remedial portion level might be a helpful restorative goal in some needy clients. Medications, for example, zolpidem, or melatonin might be useful for any subsequent a sleeping disorder. The DH Drug Misuse and Dependence rules prescribe changing over all benzodiazepines to a proper portion of diazepam, which has a long half-life, and afterward decreasing the portion by an eighth at regular intervals. Phenobarbital can likewise be utilized along these lines. Different methodologies incorporate changing to a nonbenzodiazepine anxiolytic, or the solution of aide drugs, for example, antidepressants or anticonvulsants. For instance, pregabalin at higher dosages of 225–900 mg have been seen as powerful, and an ongoing Cochrane survey recognized carbamazepine as a potential extra to lessen withdrawal impacts. Flumazenil, the benzodiazepine enemy, additionally shows guarantee when given by moderate imbuement, and has the bit of leeway that both high and low portions can be detoxified similarly well, and patients feel well after the detoxification.
Detoxification of benzodiazepines has different therapeutic regimes depending on the patient’s condition. Some of the protocols are discussed below.
Need to institute a excellent therapeutic relationship between the general practitioner and the patient—the process of benzodiazepine weaning is often interminable and benzodiazepine doses may need to be continually negotiated.
Need to treat earnestly any clinically significant anxiety and depression with appropriate pharmacological or non-pharmacological methods. This is so as to diminish the degrees of nervousness and discouragement while the patient keeps on getting his/her standard benzodiazepine portion. There will be cutoff points to what can be accomplished at times in light of the fact that the nervousness and gloom indications might be a sign of benzodiazepine reliance.
Need to prescribe a dose of diazepam equivalent to their usual regime and maintain this dose for 1 week. The dose of diazepam can then be reduced by approximately 10–15% at weekly intervals until withdrawal symptoms develop. If withdrawal symptoms develop smaller decrements and longer intervals between dose reductions may be necessary. It may be very difficult for patients to discontinue the final few milligrams. Although complete cessation is preferable, a single daily dose of 2 mg diazepam is sometimes acceptable.
A few patients may turn out to be progressively upset with regards to step-wise decrease and it might become clear that they have under evaluated their portion. It is basic that the believing relationship is kept up and portions renegotiated by seriousness of withdrawal.
During the withdrawal organize, adjunctive medications, for instance, scholarly social treatment (CBT), loosening up treatment and planning in pressure the board have exhibited to be simply humbly effective. If downturn ascends during the withdrawal organize, the patient should be eagerly watched for reckless ideation. Stimulant treatment may ought to be considered. Mental interventions, for instance, CBT may be completed to address the scholarly signs of melancholy. Carbamazepine at a portion of 200–800 mg every day during withdrawal might be fruitful in averting benzodiazepine reuse despite the fact that it has no announced impact on the seriousness of withdrawal indications. Propranolol may help when substantial indications, for example, tremor and uneasiness are lessened. Cyproheptadine 4 mg daily is useful for rest unsettling influence or a sleeping disorder which is a typical element during detoxification.
Symptomatic help is fundamental for some patients in benzodiazepine withdrawal notwithstanding sedation, especially when muscle issues or gut manifestations are noticeable. Side effects ought to be treated on an as required premise, as per the specific side effect complex. Metoclopramide is recommended orally or IM at a portion of 10 mg at regular intervals as required for sickness as well as spewing. An acid neutralizer 15-20 ml orally is allowed at regular intervals as required for indigestion or heartburn. Propantheline 15 mg orally is allowed like clockwork as required for stomach issues. Kaolin blend 15–20 ml orally is allowed at regular intervals as required for the runs. Quinine sulfate 300 mg orally is given twice day by day as required for muscle spasms. In any case, overabundance quinine sulfate is dangerous to the heart. Paracetamol 1 g orally is given each 4–6 hours as required for cerebral pains and other minor torments. Increasingly extreme a throbbing painfulness can be treated with nonsteroidal calming drugs (NSAIDS, for example, Ibuprofen 400 mg orally at regular intervals as required gave there is no history of ulcers, gastritis or asthma. A cox-2 inhibitor, for example, Celecoxib is a suitable elective where there is a contra-sign for vague NSAIDS.
Benzodiazepines (BZD) are natural bases with a benzene ring and a seven part diazepine moiety; different side chains decide the strength, length of activity, metabolite movement, and pace of disposal for explicit operators. BZDs apply their impact by means of tweak of the gamma-aminobutyric corrosive A (GABA-A) receptor. Gamma-aminobutyric corrosive (GABA) is the boss inhibitory synapse of the focal sensory system.
The GABA-A receptor is made out of five subunits (alpha, beta, and gamma) orchestrated in different mixes. The organization of subunits decides the liking of the different xenobiotics that quandary to the receptor. Benzodiazepines tie at the interface of the alpha and gamma subunits and, when bound, lock the GABA-A receptor into an adaptation that builds its partiality for GABA. BZDs do not modify the amalgamation, discharge, or digestion of GABA yet rather potentiate its inhibitory activities by increasing receptor authoritative. This coupling builds the progression of chloride particles through the GABA particle channel, causing postsynaptic hyperpolarization and a diminished capacity to start an activity potential. The low occurrence of respiratory sadness with orally ingested BZDs has all the earmarks of being identified with the low thickness of restricting locales in the brainstem respiratory focus.
Withdrawal from liquor may not require pharmacological mediation, if the seriousness of reliance and withdrawal manifestations do not require it. In any case, thiamine enhancements might be important to keep away from the Wernicke-Korsakoff disorder. Those with liquor reliance will in general have a diminished dimension of thiamine in their eating regimen and ethanol can upset thiamine stockpiling and use. Notwithstanding the medicines sketched out beneath, it tends to be contended that different medications have a job in detoxification, for example, naltrexone, nalmefene, acamprosate, baclofen and disulfiram, despite the fact that these are progressively fit to backslide aversion [9]. Another treatment with a potential job in liquor detoxification is the psychotropic pain relieving nitrous oxide (PAN), which has been distinguished by a Cochrane survey for mellow to direct liquor withdrawal. This may have a quick remedial impact with negligible sedation (Table 2).
Alcohol is a lethal substance and its danger is identified with the amount and term of alcohol utilization. It can affect each organ in the body. In the mind, in a solitary drinking scene, expanding levels of liquor lead at first to incitement (experienced as joy), fervor and garrulity. At expanding fixations liquor creates sedation prompting uproars of unwinding, afterwards to slurred discourse, instability, loss of coordination, incontinence, trance state and eventually Alcohol reliance and unsafe liquor use demise through liquor harming, because of the sedation of the essential mind works on breathing and flow. The reliance delivering properties of liquor have been examined widely over the most recent 20 years. Liquor influences a wide scope of synapse frameworks in the mind, prompting the highlights of liquor reliance. The principle synapse frameworks influenced by liquor are gamma-aminobutyric corrosive (GABA), glutamate, dopamine and narcotic. The activity of liquor on GABA is like the impacts of different narcotics, for example, benzodiazepines and is answerable for liquor’s calming and anxiolytic properties. Glutamate is a major neurotransmitter responsible for brain stimulation, and alcohol affects glutamate through its inhibitory action on N-methyl D-aspartate (NMDA)-type glutamate receptors, producing amnesia (for example, blackouts) and sedation. Chronic alcohol consumption leads to the development of tolerance through a process of neuroadaptation: receptors in the brain gradually adapt to the effects of alcohol, to compensate for stimulation or sedation (Figure 1). This is experienced by the individual as the same amount of alcohol having less effect over time. This can lead to individual increasing alcohol consumption to achieve the desired psychoactive effects. The key neurotransmitters involved in tolerance are GABA and glutamate, with chronic alcohol intake associated with reduced GABA inhibitory function an increased NMDA-glutamatergic activity.
Progression of liver disease in chronic alcoholism.
This GABA—glutamate unevenness is adequate within the sight of liquor, which expands GABA and lessens NMDA-glutamate movement. Be that as it may, when the liquor subordinate individual quits drinking, the irregularity between these synapse frameworks brings about the cerebrum getting overactive following a couple of hours prompting horrendous withdrawal manifestations, for example, uneasiness, perspiring, longing for, seizures and mental trips. This can be hazardous in extreme cases and requires critical medicinal treatment. Rehashed withdrawal is additionally thought to underlie the lethal impact of liquor on neurons, prompting subjective disability and cerebrum harm. The impacts of liquor withdrawal can take up to between 3 months and 1 year to completely recuperate from (alluded to as the extended withdrawal disorder). That being said, the mind remains strangely delicate to liquor and, when drinking is continued, resistance and withdrawal can return inside a couple of days (known as restoration). This makes it amazingly hard for an individual who has created liquor reliance to come back to supported moderate drinking (Table 3).
S. No. | Substance of abuse | Detoxification process |
---|---|---|
1 | Opioids (morphine) | Clonidine-naltrexone detoxification, rapid opioid withdrawal under general anesthesia |
2 | Nicotine | Nicotine replacement therapy (NRT); e.g., tiagabine, baclofen, gabapentin, varenicline, mecamylamine. |
3 | Benzodiazepine | Flumazenil as an antidote. |
4 | Cannabis | Antagonist approach, e.g., rimonabant |
5 | Alcohol | Disulfiram |
6 | Cocaine | Bupropion |
7 | Amphetamine | Modafinil |
Summary of detoxification process of different substance of abuse.
Molecular structure of substance abuse and drugs used in detoxification.
Detoxification is not an end in itself, however a transitional state among reliance and restraint or decreased use. It can give a chance to restraint as a major aspect of the recuperation venture, yet for certain medications may build the danger of overdose and supported backslide. It is a harmony between the substance client’s needs and inclination, decision of medicine, strategies for organization, and the force of key working and psychosocial programs. Proof has appeared pharmacological treatment for substance abuse works; however that it should be joined with psychosocial treatment. We should now ask how we can best tailor built up medicines to suit the requirements of people in distinction conditions. Questions remain with respect to examinations between medicines, mixes of medications and ideal treatment regimens. Much consideration has been given to affirmed medicines, for example, methadone decreasing for narcotic reliance and benzodiazepines for liquor reliance, and more research is required into rising treatment potential outcomes, for example, oxytocin and flumazenil. Different medications for abuse are less all around inquired about, to some degree because of the administrative obstacles associated with setting up investigations of substances of abuse and controlled medications. Ebb and flow investigation into extra or elective medicines is not vigorous enough for significant survey bodies, which mean suggestion, are difficult to accomplish. The decision of which technique to use for detoxification can rely upon numerous elements, including clinical judgment, the client’s close to home inclination and conditions, way of life and desires, level of reliance and associative medical issues. Clinicians may need to tailor pharmacological medicines, for instance, in connection to danger of overdose if detoxification treatment can be occupied for infusion, or if there are any dangers to kids living with the client if the treatment can be brought home. For viable treatment plans, clients ought to be associated with their treatment decisions. The choice of medication for detoxification in case of opioid poisoning is very important. Methadone or buprenorphine should be offered as the first-line treatment in opioid detoxification.
It should take into account whether the service user is receiving maintenance treatment with methadone or buprenorphine if so, opioid detoxification should normally be started with the same medication. Lofexidine may be considered for people who have made an informed and clinically appropriate decision not to use methadone or buprenorphine for detoxification or who have made an informed and clinically appropriate decision to detoxify within a short time period with mild or uncertain dependence (including young people). Clonidine should not be used routinely in opioid detoxification.
Dihydrocodeine should not be used routinely in opioid detoxification.
Dosage and duration of detoxification has a crucial role. When determining the starting dose, duration and regimen (for example, linear or stepped) of opioid detoxification, healthcare professionals, in severity of dependence (particular caution should be exercised where there is uncertainty about dependence) stability of the service user (including polydrug and alcohol use, and comorbid mental health problems), pharmacology of the chosen detoxification medication and any adjunctive medication. The duration of opioid detoxification should normally be up to 4 weeks in an inpatient/residential setting and up to 12 weeks in a community setting. In the course of the most recent a very long while there has been a lot of progress understanding the atomic and cell premise of practices identified with nicotine addiction, and this comprehension has prompted focused on tranquilize disclosure prompting new therapeutics for smoking discontinuance, for example, varenicline. These advances show that basic investigations of the neurobiological premise of medication misuse can build our insight into why people become dependent and what drives continuous smoking, however can likewise prompt novel techniques for mediation to assist individuals with stopping and remain abstinent. The information that has been increased about the systems fundamental nicotine support has been applied to understanding different practices that drive continuous smoking. Focusing on the multimodal reason for nicotine admission may in this way bring about progressively compelling medicines for smoking suspension going ahead. Restraint of synapse discharge is viewed as the significant system of activity liable for the clinical impacts of narcotics. By the by, notwithstanding broad examination, comprehension of the cell activities of morphine and different narcotics is inadequate. This is astounding for a gathering of medications with such amazing impacts, and is an impression of the unpredictability of the instruments associated with synapse discharge. Affirmation of current speculations with respect to components of narcotic hindrance of synapse discharge must anticipate the use of progressively refined methods. Ongoing progresses in the atomic science of narcotic receptors guarantee critical propels in narcotic pharmacology and should help disclosure of narcotics with increasingly specific activities.
The authors declare no conflict of interest.
Nowadays, organizations are facing a lot of challenges when competing in various sectors of the global market such as economics, technology, and labor. One of the crucial strategies for an organization to gain competitive advantage is exploitation of training. In particular, training is an important function for an organization to cultivate employees’ explicit and implicit knowledge, skills, and abilities and transfer employees into the valuable resources of an organization. This function is not only linked to improvement of business performance but also an effective determinant in shaping employee attitudes, which are critical variables to influence job performance [1]. According to the literature, job satisfaction is defined as “a pleasurable emotional state resulting from the appraisal of one’s job or job experiences” ([2], p. 94). It is one of the major job attitudes to affect employees’ behaviors and shows a strong relationship with other affective outcomes such as learning motivation, turnover rate, and firm performance [3].
\nSince training and job satisfaction are two important variables which individually produces impacts on firm performance, this chapter aims to elaborate training in organization toward job satisfaction. This chapter is organized in four sections. The first section describes how to plan and carry out an effective training program. It begins by discussing the definition of training and the meaning of learning. Next, a training effectiveness model is constructed to present a whole picture about the factors which influence the training outcomes. Elucidation will be provided for each part of the model which includes individual characteristics, organizational characteristics, and task characteristics, followed by needs assessment, training design, and training evaluation. The second section focuses on job satisfaction in which the fundamental concepts are introduced. This is followed by discussion of the impacts of job satisfaction on job performance. The third section describes job training satisfaction and how it contributes to job satisfaction, job performance, and other work-related attitudes. The final section is Conclusions.
\nWhat is training? Training refers to “a planned effort by a company to facilitate employees’ learning of job-related competencies” ([4], p. 5). It is also defined as “a planned and systematic effort to modify or develop knowledge, skills and attitudes through learning experiences to achieve effective performance in an activity or a range of activities” ([5], p. 41). Training is the major means to be used by organizations to cultivate employee competence to reach the appropriate required levels. It is also an important business strategy for organizations to cope with a variety of forces affecting the workplace [6, 7]. It is stated that training is organized and used by an organization as a business strategy to help employees develop and acquire competence, which includes knowledge, skills, behaviors, and attitudes that are critical for successful job performance. Typically, training can be distinguished by two basic types of locations where it is conducted, i.e., off-the-job and on-the-job. Off-the-job training provides learning opportunities on a variety of topics at a site other than where the work is actually done, whereas on-the-job training (OJT) occurs in the work setting itself [6]. With the assistance of modern technology, online training can be realized as well [8]. No matter which sites or ways the training is conducted, the key to effective training is to activate learning to occur.
\nIn most of the textbooks, learning is defined as an effect of experience on behavior [9]. It is related to a process of change in behavior that is due to experience. Actually, all learning involves two processes: one is an external interaction process between the learner and his or her social, cultural, and material environment, and the other is an internal psychological process of elaboration and acquisition in which new impulses are connected with the results of prior learning [10]. However, if the outputs of learning process (either through external or internal) only produce change in people’s behavior, such a definition cannot be satisfied by many researchers [9]. Therefore, learning has also been defined as “a relatively permanent change in human capabilities that is not a result of growth processes” ([4], p. 140). Based on this definition, learning can bring out three different outcomes. The first one is the content dimension, which refers to knowledge, understanding, skills, abilities, and attitudes. The second one is the incentive dimension which includes emotion, feelings, motivation, and volition. The final one is the social dimension, which involves interaction, communication, and cooperation [10]. Learning, thus, can be further referred to as a process that is “seen” through changes in knowledge, skills, attitudes, behaviors, emotion managing ability, communication style, and more during training and generalization to the transfer context.
\nTraditionally, in the workplace, learning occurs through formal training and development. All formal learning activities are designed with specific learning objectives to cultivate employees in lifelong processes for ongoing development and acquisition of competencies to meet the challenges that the organization faces from its internal and external environment [8]. Typically, such learning is activated through direct instruction, which engage learners in lectures, discussions, simulations, role-plays, and other structured activities [11]. With technological advancement and intense competition, training scholars have claimed that employees must extend their learning outside the formal classroom or work settings to ensure competencies are maximized [12]. Thus, informal learning becomes important because it represents the most part of learning occurring in organizations. Watkins and Marsick characterized informal learning as a process “based on learning from experience, embedded in the organizational context, oriented to a focus on action; governed by non-routine conditions; concerned with tacit dimensions that must be made explicit; delimited by the nature of the task, the way in which the problems are framed, and the work capacity of the individual underlying the task; and enhanced by proactivity, critical reflectivity, and creativity” ([13], p. 287). It is unstructured and occurs outside a learning institution [11].
\n\nFigure 1 shows the relationships between training and learning. Training, either off-the-job, on-the-job, or online, involves transferring expertise and knowledge from experts who have it to novices who need it [14]. Both training and learning activities consist of a process of knowledge sharing, which is an element of reciprocity and is a giving-taking exchange process of information or assistance to others [15]. Knowledge sharing between employees and across teams allows an organization to exploit existing knowledge-based resources and has been identified as a positive force in creating innovative organizations [15–17].
\nThe relationships between training and learning.
In a competitive environment, while employee training and learning have become an increasingly important strategic issue for organizations [8], the core concern is how to help the company and trainees receive benefits from the training activities? The related questions include “what kind of factors that may affect the success and effectiveness of training” and “what/how trainers can do to make training program effective?” Training effectiveness, according to Noe ([4], p. 216), refers to “the benefits that the company and trainees receive from training.” It focuses on understanding the whole learning system to determine why learners learn or do not. It also explains why the learning results happen and assists training designers to make troubleshooting to improve training [18]. Thus, theoretically, training effectiveness is the study of the individual, training, and organizational characteristics that influence the training process before, during, and after training [18]. Training effectiveness differs from the training evaluation. Training effectiveness is a theoretical approach to understand learning outcomes, whereas training evaluation is a methodological approach to measure these learning outcomes [18]. A summarized model of training effectiveness is presented in Figure 2 [19]. Figure 2 shows the factors that impact the training outcomes and job performance and the relationships between them. Three major topics will be discussed, that is, needs assessment before training (shaded with gray color), program design and delivery during training (shaded with orange color), and training evaluation after training (shaded with pink color).
\nThe comprehensive model of training effectiveness.
Effective training practices involving the use of a training design process begin with a needs assessment [4, 8, 18]. A need is a measureable gap between two conditions—what currently is and what should be [20]. In order to define the gap of need in training, a complete assessment process should be conducted to figure out problem areas, issues, or difficulties that should be resolved [20]. Thus, a training needs assessment refers to the process used to determine whether training is necessary and why specific training activities are required [4, 8]. In most contexts, a needs assessment focuses on gaps rather than solutions [20]. Theoretically, it involves three levels of analysis: organizational analysis, person analysis, and task analysis. Organizational characteristics, individual characteristics, and task characteristics are factors to be considered for three levels of analysis in the beginning of training design. The purpose of these levels of analysis is to realize the gaps in current training programs and further to collect information for program design and problem-solving [4, 8].
\nIn Figure 2, the first factor is organizational characteristics. Organizational characteristics include organizational structure, business strategies, support of managers for training activities, training resources, organizational procedures, reward systems, culture, and climate [4, 8, 18, 21]. Each variable plays a very critical role to impact training effectiveness. For example, Facteau et al. [22] found that intrinsic and compliance incentives, organizational commitment, and social support for training are able to predict trainees’ pretraining motivation. Motivation is the key determinant of the choices individuals make to engage in, attend to, and persist in learning activities, which will affect learning performance [3]. Because organizational analysis is concerned with identifying whether (1) training fits the company’s strategic objectives; (2) training supports the company’s culture, climate, and policies; and (3) the company has the budget, time, and expertise to carry out training, this analysis is usually conducted in the first place [4]. Several major questions will be assessed in this analysis: “How does the training relate to business objectives?” “How does training support business strategy?” “What are the threats to the talent base?” “How does the training impact day-to-day workplace dynamics?” “What are the costs and expected benefits of the training?” [4, 8].
\nAnother factor, individual characteristics, includes cognitive ability, attitudes, locus of control, personality, anxiety, age, self-efficacy, expectations, job involvement, pretraining motivation, need for achievement, independence, and more [18, 19, 23]. A large number of studies have been demonstrating how individual differences influence transfer of learning and learning performance, which further impacts on training effectiveness [7, 24]. For example, Noe showed that individuals with an internal locus of control had more positive attitudes toward training since they viewed training as a means to help them receive tangible benefits [25]. Mathieu et al. proposed that trainees with high achievement motivation were more motivated to learn and perform well in the training program [26]. Klein et al. found that the learners with high learning goal orientation (LGO) would be significantly related to the factor of motivation to learn [27]. Macey and Schneider claimed that four individual characteristics like positive affectivity, proactive personality, conscientiousness, and autotelic personality were more likely to have greater psychological availability to learn and also perceived learning activities being more meaningful such that they are likely to participate actively in the training activities [28]. In addition, many researches have suggested that learning is negatively related to aging [24]. Also, three of the big five factors—conscientiousness, neuroticism (emotional stability), and openness to experience—significantly impact learning, training, and transfer outcomes [29]. Since employees’ individual characteristics make huge impacts on learning performance, personal analysis helps to identify employees’ characteristics and readiness for training and recognize who needs training and who will perform well in the training program.
\nThe third factor, task characteristics, consists of the knowledge, skills, and abilities required to complete the tasks, the equipment, and environment that the employee works in, time constraints for a task, safety considerations, or performance standards [4]. Thus, for task-level assessment, it involves checking specific duties and responsibilities assigned to various jobs and the types of skills and knowledge needed to perform each task [8]. In other words, the major purpose of task analysis is to collect job-related information to identify the task and the training that employees will require in terms knowledge, skills, and abilities. This analysis should be conducted only after the organizational analysis because it is a time-consuming process to gather and summarize data from persons in different layers of the company [4]. Several questions will be addressed in this analysis. For example, what kinds of responsibilities are to be assigned to the job? What are the skills or knowledge needed for successful performance? What are the implications of mistakes? What tasks should employees be trained [4, 8]?
\nAfter identifying the gaps and training objectives through the needs assessment, the next step is the design and delivery of the training itself [8]. Program design is rooted in learning theories and refers to “the organization and coordination of the training program” ([4], p. 172). More specifically, “it is a process for helping to create effective training in an efficient manner. It is a system that helps designers ask the right questions, make the right decision, and produce a useful and useable product as the situation requires and allows” [30]. Thus, the purpose of a program design is to make learning occur and training effective. Research has indicated that each element of training design process is related to the quality of training. Researchers such as Baldwin et al. and Klein et al. presented that training design with organizational characteristics and individual characteristics together influences trainees’ motivation to learn and, motivation to transfer, and real training transfer [27, 31]. Latif presented a model of training effectiveness which points out that training satisfaction comes from trainees’ feeling of satisfaction with training session, training content, trainers, and learning transfer [1]. Noe et al. also showed that technology-based and face-to-face learning methods and contextual factors such as organizational climate, interpersonal dynamics, and individual differences are able to promote psychological engagement in learning, which is a crucial factor to enhance the effectiveness of training, development, and related learning activities [7].
\nTraining methodology was also found to be an important factor in the equation of job training satisfaction [32]. Compared to other training methods, on-the-job training is one of the oldest, most widely used training methods in the workplace. It can be useful for training newly hired employees, orienting promoted or transferred employees to the new job positions, upgrading employees’ competencies when new technology is used, and delivering cross-culture training to employees who are assigned to work overseas [4]. Since OJT occurs at or near the workplace using actual equipment and tools, most of the time, trainees are highly motivated to learn and can be customized to the experiences and abilities [4]. Although there are many advantages, OJT is informal or unstructured in nature and has received serious criticism such as incomplete and unpredictable [33]. Thus, structured on-the-job training (S-OJT) was proposed by Jacobs and McGiffin [34]. In contrast to informal and unstructured OJT, structured OJT adopts a planned approach to train and develop employees’ competencies [33]. Many research results indicated that S-OJT is superior to unstructured on-the-job training in terms of having lower training cost, enhancing skills acquisition, and removing learning anxieties [6].
\nIn the past, a large portion of the research in program design has paid great attention to traditional instructional design (ISD) model, which includes conducting a needs assessment, setting the objectives of training, identifying evaluation criteria, selecting appropriate trainers and training methods, making meaningful materials, and properly coordinating and arranging training delivery. In addition, it involves ensuring training transfer, offering a good training site, and providing opportunities for practice and feedback [4, 7]. Although the traditional instructional design brings a lot of benefits to enhance training effectiveness, it is more instructor-oriented where lecture proceeds with adding sophisticated elements and feedback loop with interaction and communication [35]. Some scholars have recently claimed that instructor-oriented design is deemed to be disadvantageous for effective learning. They argued that the learners in instructor-centered program may be passive in learning activities and seldom grasp the significance or realize the intricacies of the model from the instructors during the training [16, 35]. Thus, it has been claimed that the instructional design model needs to be modified or adapted to better fit the learner-centered learning, particularly technology-based learning [16, 36].
\nWhat is learner-centered learning? Learner-centered learning involves the balance between instructor and learner shifting the roles, so that the learners take on the responsibility to learn and the instructor becomes more of a facilitator [37, 38]. In this learning paradigm, instead of transferring factual knowledge to the learners, the instructor focuses more on creating a learning environment and providing learning opportunities that empower learners to construct knowledge for themselves [39]. Attention, in this paradigm, is given not only to what the learners learn but also to how they learn and whether they are able to retain and apply the knowledge or not [36]. More specifically, the instructor with the role of facilitator utilizes multiple teaching methods beyond traditional lecturing to help the learners actively participate in learning [35].
\nThus, several tips for delivering the training with the learner-centered approach are described as follows [36]. First, at the beginning of the training, the trainer involves learners into decision-making process for choosing the course textbook. Second, after choosing the textbooks, the trainer invites learners to pick up the topics which they are interested in and also fit personal needs. In this way, the learners would take responsibility for learning by themselves. Third, the class will be run like a discussion session. The trainer gives training materials before the class and asks them to read in advance. Following the Shor’s suggestion that the trainer controls his/her “authoritative academic voice” [40], the trainer says as little as necessary and focuses on determining what they are interested in, what they have troubles with and what they want to talk about. The trainer offers questions, comments, structures, and academic knowledge while patiently listening to trainees’ thoughts and ideas. The trainer and the learners learn from each other through interaction. Fourth, Weimer suggested that the careful design of assignments which help students effectively use the power they are given is the key component of sharing power to the learners [41]. Thus, the trainer needs to structure the assignments well and allows the trainees to make choices about the ways to complete the projects, for example, by conducting interview or submitting a real lesson activity.
\nThree critical issues must be considered in the designing and delivering stage [8]. The first one is interference. Interference occurs “when prior training, learning, or established habits act as block or obstacle in the learning process” ([8], p. 391). That is, someone who has more experience in behaving in a certain way will have more difficulties in changing the way he/she responds when encountering a situation. Therefore, when designing the training, the trainers need to be aware of this issue. The second one is transfer design [8]. Transfer refers to whether the trainee or learner can actually perform the new skills or use the new knowledge on the job [4]. Transfer design, thus, is defined as the ability to transfer learning to the job and to which the training instruction matches the job requirements [42]. In order to ensure that the organizations are able to receive benefit from training, Lim and Johnson suggested that training design, content, and instructional strategies must be related to the objective of transfer, whether near or far transfer [43]. In other words, transfer mechanisms such as climate for transfer, management and peer support, opportunity to perform, training awareness, and using self-management strategies need to be included in the design of a training program for maximizing transfer [4, 21, 44]. The third one is the needs of adult learners. It is said that the ways of children’s learning are different from those of adults. Several assumptions were proposed by Malcolm Knowles [45]: (1) adults have the need to know why they learn, (2) adults have the need to be self-managed, (3) adults bring more work-related experiences into the learning context than children or teenagers, (4) adults learn with a problem-centered approach, and (5) adults are motivated to learn by getting both extrinsic and intrinsic motivators. Since most of the job-related training is targeted for employees whose age is over 18, the training program must meet the needs of these adult learners in order to enhance training effectiveness.
\nEvaluation is an integral part and the final stage of most instructional design (ID) models [46]. Theoretically, it is a systematic process of collecting data in an effort to measure and determine success or failure of a training program with regard to content and design [18, 47]. Two questions intend to be answered in the evaluation process, that is, whether (1) training objectives are achieved in the learning process and (2) accomplishment of those objectives results in enhanced job performance [48]. Thus, evaluation can be divided into two categories, formative evaluation and summative evaluation [46, 49, 50]. Formative evaluation is an evaluation with the purpose to improve design and development to enhance learning, whereas summative evaluation is intended to determine whether the training program is worthy or effective [51, 52]. Besides, Campbell stressed that the most important and fundamental thing is whether trainees have learned the materials covered in training or not [53].
\nTraditionally, Kirkpatrick’s model was one of the first efforts to create a framework for training evaluation. It is also the simplest method to understand training effectiveness [18, 54]. According to Kirkpatrick, training can be evaluated at four levels. Level 1 is the “reactions” criteria, which evaluates trainees’ affective and attitudinal perceptions to a training program, including facilities, trainers, and content. For the “reactions” criteria, evaluation is performed via a questionnaire completed by trainees or self-reported regarding perceived learning gains [55]. Level 2 is the “learning” criteria, which evaluates the extent to which trainees have learned the training materials covered in training and acquired knowledge, skills, attitudes, and behavior from a training program. Learning outcomes are typically measured by using various forms of knowledge tests such as pencil-and-paper test or by immediate post-training measures of performance and skill demonstration in the training context [56]. Level 3 is the “behavior” criteria. It refers to as transfer criteria and evaluates the extent to which trainees have applied the learned competencies on the job. For behavioral criteria, evaluation is assessed by self-ratings, supervisor ratings, or objective performance indicators [56–58]. Level 4 is the “results” criteria, which evaluates the extent to which the training program has improved business outcomes and to increase organizational-level profits [47]. Although this kind of assessment is the most difficult to be obtained, it is highly desirable for the organizations. Most of the time, “results” are operationalized by productivity gains, reduced costs related to employee turnover, increased customer satisfaction, enhancing employee commitment, or increase in profitability [57, 58].
\nAlthough Kirkpatrick’s framework is the most accepted approach for training evaluation, it has been criticized by many scholars. One of the criticisms is that the criteria used for evaluation in Kirkpatrick’s framework do not relate to the training needs, the learning objectives, and strategic goals of the organizations [4]. The second one is the lack of relationship between reaction, learning, behavior, and results’ criteria [55]. As a result, both training practitioners and academic researchers have developed a more comprehensive model for training criteria. For example, Kraiger et al. attempted to expand the original Kirkpatrick model by linking the learning outcomes with training evaluation [48]. Based on Kraiger et al.’s proposition, three categories of learning outcomes, that is, cognitive, skill-based, and affective outcomes, should be included in evaluation [48, 59]. Specifically, cognitive outcomes are used to determine the degree to which trainees are familiar with principles, facts, techniques, procedures, or processes emphasized in the training program. It includes verbal knowledge, knowledge organization, and cognitive strategies. Skill-based outcomes, including skill learning and skill transfer, are used to assess the level of technical or motor skills and behaviors. Affective outcomes include both attitudinal and motivational change, which also involves disposition, motivation to learn, self-efficacy, tolerance for diversity, safety attitudes, customer service orientation, and goal setting [4, 48].
\nAmong three categories of learning outcomes, affective outcomes have attracted a lot of attentions in different research areas such as education, psychology, and organizational behavior. The scholars are particularly interested in the issue regarding whether self-efficacy or motivation to learn can be changed through training and how different training methods impact self-efficacy and motivation to learn. For example, Gist found that a training method comprising cognitive modeling with practice and reinforcement generated significantly higher participant self-efficacy than a method involving only lecture and practice [60]. Torkzadeh and Dyke suggested that training significantly improved Internet self-efficacy for trainees, both males and females [61]. Combs and Luthans stated that the diversity training enhanced trainees’ diversity self-efficacy [62]. Huang and Jacobs claimed that structured on-the-job training could generate higher self-efficacy to achieve training outcomes than classroom training with lecture only, especially for trainees with lower general self-efficacy (GSE) [63]. Huang and Jao reported that structured on-the-job training could generate higher trainees’ motivation to learn than classroom training [64].
\nAmong thousands of attitudes, job satisfaction is one of important work-related attitudes in the work environment [3]. Specifically, job satisfaction refers to the degree to which the feeling of satisfaction is derived from the employees’ perceptions toward different facets of their tasks or jobs [65, 66]. In other words, job satisfaction is a pleasurable or positive emotional state emerging as the result of appraising one’s job or job experiences and as the fulfillment or gratification of certain needs that are associated with one’s work [3, 67, 68]. Simply put, job satisfaction is the combination of feelings, beliefs, and behavioral intentions that workers hold a relation to their current jobs [3, 69]. The employees’ job satisfaction is measurable and can be changed [3]. A popular way to explain job satisfaction has been the person-environment fit paradigm, which suggests that the more a person’s work environment is fulfilling one’s needs, personality, values, or personal characteristics, the greater the degree of job satisfaction is [70].
\nWhile tackling the issue of job satisfaction, some typical questions were raised by researchers. For example, why are some employees more satisfied than others? What kinds of work tasks are especially satisfying? How to design a task to make employees feel satisfied? Colquitt et al. claimed that values play a key role in explaining job satisfaction [2]. What is value? Values are “the things that people consciously or unconsciously want to seek or attain” ([2], p. 94). Thus, value-percept theory argues that “job satisfaction depends on whether the employee perceives that his or her job supplies the things that he or she values” ([2], p. 94). Based on the value-percept theory, the dissatisfaction of employees can be expressed as follows:
\nwhere Vwant refers to how much of a value an employee wants, Vhave is the value the job supplies, and Vimportance reflects the importance of the value to the employee. It can be seen that, although the difference between Vwant and Vhave causes the dissatisfaction, it is the importance of the value that will either magnify or minimize the dissatisfaction [2]. In the value-percept theory, five specific facets of satisfaction, i.e., pay satisfaction, promotion satisfaction, supervision satisfaction, coworker satisfaction, and satisfaction with the work itself, must be met in order to achieve overall job satisfaction.
\nWhile explaining job satisfaction from the perspective of value-percept theory, personal characteristics make the issue of “the things that each employee wants to pursue and feels important in the workplace” complicated. Personal characteristics include personality disposition, attitudes, self-efficacy, self-esteem, motivation, gender, communication style, emotions, and more [3, 71]. Since each employee is independent and unique, the value of things an employee wants and their importance differ from one to another. Such differences cause the variance in dissatisfaction. Personal characteristics offer the explanation to the question of why some employees are more satisfied than others. Take personality as an example. If the employees’ score is high on the neuroticism scale in a personality measurement, they are likely to carry a rather negative view toward the world. This makes them more likely be nervous, anxious, depressed, and insecure in general, especially in the workplace. Conversely, the employees who have higher scores on the conscientiousness and extraversion scales tend to be responsible, organized, gregarious, and sociable, and it is more likely they will be satisfied with their work [3]. Hence, personality traits of neuroticism, extraversion, and conscientiousness displayed appreciable correlations with the employees’ job satisfaction [72].
\nBesides personal characteristics, situational characteristics also influence job satisfaction, which can explain what kinds of work tasks are especially satisfying. The situational factors include pay, opportunities for promotion, administration style, coworker, and working conditions [73]. For employees, a job is not “just a job.” Instead, it is a collection of tasks, relationships, and rewards. Any job-related conditions happened in the workplace may influence their emotion, which further impacts how they judge and perceive toward their job [3]. Therefore, in order for employees to have job satisfaction, the situational factors need to be carefully considered. For example, is the pay commensurate with the job duties? Is the pay secure? Are the promotions frequent, fair, and based on ability? Is the supervisor competent, polite, and a good communicator? Are the coworkers responsible, helpful, and interesting? Is the work challenging, interesting, respected? If it is yes to all the above questions, then it is highly possible that employees would be satisfied with their job [2].
\nThe needs of employees toward the work itself can be further realized through job characteristic theory. In other words, this theory helps to answer the question of how to design a task to make employees feel satisfied. Job characteristic theory suggested that job dimensions such as task identify, task significance, skill variety, autonomy, and feedback impact employees’ satisfaction with the work itself [3, 74]. Among these dimensions, skill variety, task identities, and task significance together produce a sense of meaningfulness of work, which reflects the extent the work tasks fit in the employees’ value and beliefs. The dimension of autonomy allows employees to experience the responsibility for outcomes of the work. Responsibility for outcomes refers to the extent the employees feel that they are responsible for the quality of the work. Providing either positive or negative feedback to employees make them have the opportunities to know the actual results of the work activities. Knowledge of results means that employees know how well or poorly they are doing. Thus, research suggests that the higher the three psychological states, the higher the working motivation, which leads to higher job satisfaction. An employee who has a high level of job satisfaction holds positive feelings toward his or her job, while he/she may hold negative feelings if he/she has a low level of job satisfaction [3].
\nThe next question to be answered is “does job satisfaction really matter?” This question can be answered through elaborating the relationship between job satisfaction and job performance, job commitment, organizational citizenship behavior (OCB), absenteeism, and turnover.
\nFirst, a number of researchers have been curious about the relationships between job satisfaction and job performance. For this question, many people may intuitively believe that job satisfaction is an important factor to impact job performance. Their presumption is that happy workers are more likely to be productive workers. However, at the early stage, the results indicated that job satisfaction was not meaningfully associated with job performance [75]. Till recently, studies showed that job satisfaction was moderately correlated with task performance. In other words, job satisfaction did predict job performance [2]. The satisfied employees who held positive feelings toward their work did a better job to fulfill the duties [76], to increase creativity in job [77], to enhance decision-making and problem-solving ability [78], and furthermore, to strengthen the memory and recall ability [79].
\nSecond, job satisfaction is interrelated to job commitment. Commitment is defined as that an employee identifies with a particular organization and its goals and wishes to remain as a member [3]. Commitment can be divided into three types, i.e., affective commitment, continuance commitment, and normative commitment, which are emotional-based, cost-based, and obligation-based, respectively [2]. Research found that job satisfaction was strongly correlated with affective and normative commitment but not correlated with continuance commitment [80]. Thus, the employees who have positively affective reaction to their jobs will be committed to their job and feel an obligation to remain in the organization [80–84].
\nThird, job satisfaction is moderately positive related to organizational citizenship behavior [2, 85]. OCB has been defined as “individual behavior that is discretionary, not directly or explicitly recognized by the formal reward system, and that in the aggregate promotes the effective functioning of the organization” ([86, 87], p. 4). Williams and Anderson found that the cognitive component of job satisfaction predicted the emergence of OCB [88], which was also supported by Moorman’s study [89]. Therefore, the satisfied employees would like to engage in more work-related behaviors to offer help to coworkers and increase desire to interact with others. OCB is extremely important for the employees to contact with the customers since it leads to improved customer evaluation of service quality [90].
\nFinally, job satisfaction reduces job turnover and absenteeism [91, 92]. Turnover refers to “…the voluntary and involuntary permanent withdrawal from an organization” ([93], p. 72). Since actual turnover behavior is difficult to measure, Lingard suggested using turnover intention as a predictor of actual turnover behavior [94]. Karatepe et al. found that job satisfaction was a negative association with turnover intention [95]. As to absenteeism, it refers to “unscheduled employee absences from the workplace” ([96], p. 144). Vroom found that low levels of job satisfaction contributed to higher absenteeism rates [97], and such a finding was confirmed by Clegg [98]. In addition, Drago and Wooden conducted a survey of 601 workers from Australia, New Zealand, Canada, and the USA and found that absenteeism was lower while employees’ job satisfaction was high [99]. The relationship between job satisfaction and turnover was stronger than between satisfaction and absenteeism [3].
\nThe concept of job training satisfaction was proposed by Schmidt [32]. He combined the definitions of job training and job satisfaction into one of the affective outcomes, called job training satisfaction (JTS). As mentioned above, training involves employees acquiring knowledge and learning skills that they will be able to apply on the job immediately [8]. Job satisfaction involves how an employee feels and what he/she thinks about the job [2]. Job training satisfaction, thus, is defined as “…how people feel about aspects of the job training they receive. Job training satisfaction is the extent to which people like or dislike the set of planned activities or dislike the set of planned activities organized to develop the knowledge, skills, and attitudes required to effectively a given tasks or job” ([32], p. 483). According to Schmidt, the definition of job training satisfaction has several key components [100]. First, the focus of evaluation is on-the-job training as a whole, rather than on a single part of training activities such as a training course, trainers, facilities, or training content. Second, it refers to a pleasurable or positive emotional state resulting from each element and the whole process before and after the job training, such as fulfillment of needs, enhancing motivation to learn, or satisfied with the transferring the learned competencies to the job. Third, the subjects of evaluation target on the trainees where formal or planned training activities are offered by the organization rather than the informal learning effort endeavors by the employees themselves. When measuring job training satisfaction, not only the employees’ feelings about the job training are measured but also the training activities offered by the organization are examined [32, 101].
\nIn the past, the impact of training on job satisfaction was not emphasized until it was found that job satisfaction tended to be higher where workplace training was held in organizations [102]. In order to explore the relationships between these two variables, Schmidt conducted a survey of job training and satisfaction for employees in customer and technical service department in nine major organizations in the USA and Canada to address how job training satisfaction impacts on job satisfaction [32]. According to his findings, job training satisfaction was not only highly correlated with job satisfaction but also significantly related to the time spent in training, training methodology, and content. However, it was not related to age, gender, and race/ethnicity. Extended researches have been carried out to explore the impact of job training satisfaction on other work attitudes. Huang and Su found that there is a negative relationship between job training satisfaction and turnover intentions [103]. It is stated that, when employees are satisfied with job training, they are more likely to stay in the organization and have lower turnover intentions. The research results have also indicated that the relationship between job training satisfaction and turnover intentions can be mediated by job satisfaction. Mansour et al. showed that there is a positive relation between job training satisfaction and normative commitment [100]. Moreover, job training satisfaction was found to be positively related to organizational citizenship behavior [104, 105], organizational commitment (OC), and job involvement (JI) [105]. The relationship between JTS and OCB can also be partially mediated by OC and JI [105]. From these research results, job training satisfaction is found to be able to enhance employees’ work attitudes such as job satisfaction, commitment, job involvement, and organizational citizenship behavior, which leads to the increase of job performance.
\nBased on the above discussion, a revised comprehensive model of training effectiveness is proposed and shown in Figure 3. According to Schmidt’s definition, job training satisfaction measures the employees’ feelings about the whole job training activities such as identifying the training needs, designing the training program, delivering training contents, activating learning occurring, and assessing training evaluation. Thus, different from the original model shown in Figure 2, the variable of job training satisfaction was inserted after the variable of training transfer to influence job satisfaction and job performance. That is, if the learners are able to perceive positively toward training program, to learn the job required knowledge, skill, abilities, and attitudes through training, and to succeed in transferring the learned competencies to real workplace, their satisfaction level toward training program must be high. For instance, on-the-job training, especially structured OJT, has been perceived as an effective training approach to achieve transfer of training owing to its occurrence at or near the workplace using actual facilities, enhancing skills acquisition, and removing learning anxieties [6, 33]. This allows the employees to be able to perform the job well and, in turn, feel satisfied with the training. Such high satisfaction toward job training leads to high level of job satisfaction and further results in high job performance but low turnover intention. These findings are interesting and valuable. Jones et al. ever mentioned that training can have an indirect effect on performance if it increases job satisfaction by making it easier for employees to perform the job or feel more valued [96]. From a series of studies, the impact of training on job satisfaction, job performance, and turnover intention has been confirmed. The variable of job training satisfaction can serve as a predictor to the employees’ job satisfaction, job performance, and turnover intentions.
\nThe revised comprehensive model of training effectiveness with insertion of job training satisfaction and job satisfaction.
The central thesis of this chapter is to present how job training plays a role in influencing the employees’ job training satisfaction, which then impacts job satisfaction and subsequently affects job performance and turnover intentions. Although training is a critical strategy to help organizations gain competitive advantages and its purpose is to help employees learn job-related competencies, job training satisfaction cannot be achieved without a well-prepared and designed training program. That is, at the beginning of the training program design, it is necessary to carry out a needs assessment to make the learning occur, which consists of organizational analysis, person analysis, and task analysis. While conducting training design and delivery during training, the learner-centered learning paradigm which has been emphasized recently may be considered as a preferred approach owing to its increasing learners’ learning motivation and learning engagement. After training, the training effectiveness is evaluated by assessing not only learning performance of knowledge, skills, and job-related behaviors but also affective outcomes such as self-efficacy, attitude, and motivation. Research has indicated that possessing a pleasurable or positive emotional state with the whole job training program, employees will have higher job satisfaction and job performance. Other job attitudes such as organizational citizenship behavior, affective commitment, and normative commitment will increase, while turnover intention and absenteeism will decrease. In this chapter, the comprehensive model of training effectiveness was modified by inserting the job training satisfaction after training transfer. This not only better elaborate the relationship among training, job satisfaction, and job performance but also serves as a reminder for the human resource practitioners who should always bear in mind how to make the trainees satisfied with the training when designing and delivering a training program.
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