Substance Use and Associated Health Conditions throughout the Lifespan

Women Empowered to Connect With Addiction Resources and Engage in Evidence-Based Treatment (WE-CARE)-an mHealth Application for the Universal Screening of Alcohol, Substance Use, Depression, and Anxiety: Usability and Feasibility Study

BACKGROUND

Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment.

OBJECTIVE

In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age.

METHODS

We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app's usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women's reactions to the app.

RESULTS

A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as "at-risk" for substance use disorders contacted the free treatment clinic for further evaluation.

CONCLUSIONS

The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change.

On the pathway to health equity: Creating a harm reduction strategy for a large academic acute care hospital

An urban centre in southwestern Ontario continues to be faced with the extensive impacts of high rates of substance use. To more effectively meet the Quintuple Aim, in a way that authentically considers patients who use substances, the need for a cohesive, comprehensive organizational harm reduction strategy at the large academic acute care hospital providing community and regional healthcare services was clear. Community-based harm reduction expertise was leveraged to support the development work. Information gathered through literature review and interviews with patients, internal staff and leaders, partner healthcare agencies, and Canadian hospitals leading in harm reduction work provided key insights and supported the formulation of emerging recommendations that will be used to shape the acute care hospital's formal organizational harm reduction strategy.

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults

INTRODUCTION

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

METHODS

We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

RESULTS

We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

CONCLUSION

We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

Characteristics and quality of life of people living with comorbid disorders in substance use recovery residences

Background

Opioid use disorder (OUD) is associated with significant morbidity and mortality; however, research on physical and mental health comorbidities and health-related quality of life (HRQoL) among people taking medication for OUD (MOUD) and living in recovery residences is sparse. We investigated the prevalence of comorbidities and examined which EQ-5D-5L HRQoL dimensions are most affected by these comorbidities.

Methods

Data were collected from 358 residents living in 14 Texas-based recovery residences from April 2021 to June 2023. The EQ-5D-5L descriptive system comprises five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Each dimension has five levels of perceived problems, dichotomized into "No problems" (level 1) and "Any problems" (levels 2-5) for analyses. Cross-sectional analyses of residents' characteristics, comorbidities (categorized as mental health disorders or association with major body systems), and EQ-5D-5L dimensions were conducted using Chi-squared or Student t-tests. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

The mean [SD] age of residents was 36.0 [8.9]. Most residents were non-Hispanic White (68.7%), male (59.7%), unemployed (66.3%), and engaged in polysubstance use (75.4%). The most frequently reported comorbidities were mental health (26.5%), respiratory (26.3%), neurological (19.3%), cardiovascular (18.2%), and musculoskeletal (17.0%) disorders. The most reported HRQoL problems were anxiety/depression (75.8%) and pain/discomfort (53.2%). In the unadjusted regression models, all comorbidities, except mental health (negative association) and digestive (no association) disorders, were positively associated with HRQoL problems. The usual activities dimension was the most affected by comorbidities, followed by mobility and pain/discomfort. Increasing age was positively associated with cardiovascular disorders (aOR = 1.06; 95% CI = 1.03-1.10), musculoskeletal disorders (aOR = 1.03; 95% CI = 1.00-1.06), mobility problems (aOR = 1.05; 95% CI = 1.01-1.09), and pain/discomfort problems (aOR = 1.02; 95% CI = 1.00-1.05). Illicit drug use was positively associated with mobility problems (aOR = 3.36; 95% CI = 1.20-9.45). Neurological (aOR = 2.71; 95% CI = 1.38-5.33) and musculoskeletal (aOR = 2.57; 95% CI = 1.25-5.29) disorders were positively associated with pain/discomfort problems. MOUD duration was negatively associated with mental health disorders (aOR = 0.14; 95% CI = 0.08-0.22) but not HRQoL.

Conclusions

Comorbidities significantly predict HRQoL among individuals with OUD. Our findings highlight the need for an integrated care model to treat OUD and comorbidities to sustain recovery and improve health and HRQoL.

Education based on the theory of planned behavior to improve medication regimen adherence, hope and marital quality in patients with substance use disorder

BACKGROUND

Regarding the psychosocial aspect of treating those with substance use, it is crucial for them to exhibit a capacity for personal transformation, fully utilize their remaining capabilities, and eradicate societal discrimination. We aimed to assess the efficacy of educational instruction grounded in the theory of planned behavior (TPB) in enhancing adherence to medication regimens, fostering hope, and improving marital quality among people with substance use disorders.

METHODS

This study was conducted at the Rapid Addiction Closure Center in Fasa city, Iran, involving a sample of 140 patients undergoing addiction treatment with methadone and buprenorphine in 2021-2022. Subjects were randomly allocated to intervention and control groups. The intervention group participated in 15 weekly educational sessions, each lasting 50 to 55 min, covering topics such as quitting strategies, social support, problem solving, communication skills, and coping mechanisms. Data were collected using demographic questionnaires, TPB construct questionnaires, Miller's Hope Survey, and the Revised Dyadic Adjustment Scale.

RESULTS

The study included 140 individuals receiving treatment for addiction. No differences were seen among the two groups in education, occupation, marital status, and living conditions before the intervention. However, six months later, the intervention group showed improvements in attitude, subjective norms, perceived behavioral control, behavioral intention, medication regimen adherence, hope, and marital quality compared to controls.

CONCLUSION

The results indicate that family-based educational interventions grounded in TPB are effective in improving medication regimen adherence, hope, and marital quality among patients with substance use disorders. Significant increases in attitude, subjective norms, perceived behavioral control, and behavioral intention positively impacted medication regimen adherence in these patients.

Personality disorders and schizophrenia spectrum disorders in the Italian forensic psychiatric population: clinical features, pattern of violence and treatment

Starting in 2015, the Residencies for Execution of Security Measures (REMS) became the place of treatment and care for dangerous offenders who were acquitted due to a mental disorder in Italy. Schizophrenia spectrum disorders (SSD) and personality disorders (PD) are the most common psychiatric disorders among REMS patients. This study aimed to identify and describe potential clinical, therapeutic, and criminal-related differences in REMS patients with SSD and PD. A sample of 528 REMS patients extracted from a previous observational retrospective study underwent secondary analysis. The group of PD patients (n = 150) comprised more females (p < 0.001) and had a higher frequency of substance abuse (p < 0.001) than the SSD group (n = 378). The SSD group was more frequently admitted to the REMS due to homicide/attempted homicide (p < 0.001). Among SSD patients, we found a higher recognition of criminal irresponsibility (p < 0.001). Patients with PD were more likely to engage in violent behavior in the REMS than their SSD counterparts (p < 0.001). Patients with SSD were more likely to receive antipsychotic polypharmacy (p < 0.05) and a higher dose of antipsychotics (p < 0.001). These initial results provide empirical evidence to support the need for personalized forensic treatment paths.

Prevalence and Correlates of Alcohol and Drug Harms to Others: Findings From the 2020 U.S. National Alcohol Survey

OBJECTIVE

The purpose of this study was to measure the prevalence and overlap of secondhand harms from other people's use of alcohol, cannabis, opioids, or other drugs and examine sociodemographic and other correlates of these secondhand harms.

METHOD

This cross-sectional analysis used data from 7,799 respondents (51.6% female; 12.9% Black, 15.6% Hispanic/Latiné; mean age = 47.6 years) in the 2020 U.S. National Alcohol Survey. Secondhand harms included family/marriage difficulties, traffic accidents, vandalism, physical harm, and financial difficulties. Weighted prevalence estimates provided nationally representative estimates of these harms. Logistic regression assessed associations between individual characteristics and secondhand harms.

RESULTS

Lifetime prevalence of secondhand harms from alcohol, cannabis, opioids, or other drugs was 34.2%, 5.5%, 7.6%, and 8.3%, respectively. There was substantial overlap among lifetime harms: Almost 30% of those reporting secondhand alcohol harms also reported secondhand drug harms. Significant correlates of secondhand substance harms included female sex (alcohol, other drugs); White (alcohol, opioids), American Indian/Alaska Native (opioids), and Black (cannabis) race/ethnicity; and separated/divorced/widowed marital status (opioids). Those reporting a family history of alcohol problems had significantly higher odds of reporting secondhand harms across substance types. Individuals who reported frequent cannabis use had higher odds of reporting secondhand alcohol and opioid harms compared to those with no cannabis use (aOR = 1.55; aOR = 2.38) but lower odds of reporting secondhand cannabis harms (aOR = 0.51).

CONCLUSIONS

Although less prevalent than secondhand alcohol harms, 14% of participants reported secondhand harms from someone else's drug use and frequently experienced secondhand harms attributed to multiple substances. Population-focused interventions are needed to reduce the total burden of alcohol and other drug use.

Substance Use and Mental Health Screening Within an Emergency Department-Based HIV Screening Program: Outcomes From 1 Year of Implementation

INTRODUCTION

The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program.

METHODS

Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse-Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]).

RESULTS

Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms.

CONCLUSIONS

Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services.

Addiction is a Dignity Disorder

Human dignity refers to the value of the human person. By clarifying distinctions within human dignity, we can conclude that, whereas a person's ontological dignity cannot be lost or diminished regardless of circumstance, a person's existential, moral, or social dignity can be impaired. We describe the state of impaired existential, moral, or social dignity as a dignity disorder, which is defined by the criteria of: impaired rationality; impaired will; impaired capacity to love; and impaired body. We further demonstrate how addiction can be characterized as a dignity disorder with the associated benefit of emphasizing a personalist approach to addiction treatment with the principal intent of promoting existential, moral, and social dignity, which entails: restoring agency, self-efficacy, and freedom of choice; reconciling the internal conflict of akrasia; restoring loving, disinterested relationships; and healing the dysfunctional neuroadaptations and medical sequelae of substance use. This nosology reveals that the distinction between addiction as a choice and addiction as a disease is a false dichotomy; rather, addiction represents an impairment in both body and spirit. By incorporating the criteria of love, this nosology also reveals that addiction is an issue of both personal and societal responsibility.

Association of physical activity, screen time and sleep with substance use in children and adolescents: a large sample cross-sectional study

Background

24-h movement guidelines (24-HMG) play an important role in various demographics such as early years, children, youth, and the older adult. Nevertheless, most existing research exploring the links between socioeconomic factors, dietary intake, and substance use with sleep patterns, physical activity (PA), and sedentary behavior (SB) has been conducted in high-income Western countries.

Purpose

Hence, this study seeks to investigate the relationship between adherence to the 24-HMG and smoking and alcohol use behaviors among children and adolescents in China.

Methods

A comprehensive survey, in collaboration with the Municipal Education Commission, was carried out across primary and middle schools in Shenzhen, China. Sleep duration was gauged using the Pittsburgh Sleep Quality Index (PSQI), screen time was assessed with items adapted from the Health Behavior of School-aged Children (HBSC) survey, and PA was measured using a single item adapted from the HBSC survey. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), considering p-values below 0.05 as statistically significant.

Results

Among the sample, 51.9% were boys and 48% were girls. Those who did not meet any guidelines had a higher probability of smoking (OR = 1.62 [95% CI: 1.03, 2.56], p = 0.037) among children and adolescents. Conversely, meeting one (OR = 0.94 [95% CI: 0.61, 1.52], p = 0.874) or two guidelines (OR = 0.84 [95% CI: 0.52, 1.34], p = 0.459) showed no significant impact. The data displayed an inverse correlation between the number of guidelines adhered to and the likelihood of alcohol use among children and adolescents: none (OR = 2.07, p < 0.001), one guideline (OR = 1.40, p = 0.006), and two guidelines (OR = 1.22, p = 0.106).

Conclusion

Not meeting guidelines elevates smoking and alcohol use risks in children and adolescents, whereas following more guidelines lowers these risks, highlighting the importance of guideline adherence in reducing substance use.

Social support networks of incarcerated women with opioid use disorder: Differences associated with jail-based substance use treatment

INTRODUCTION

Social support is a critical factor for women's engagement with substance use treatment and recovery, particularly for women with criminal-legal system involvement. However, less is known about the social support networks of incarcerated women, particularly as a function of service engagement. Thus, this paper aims to describe the structure, composition, and function of social support networks of women with opioid use disorder (OUD) incarcerated in jails; and compare network differences between women receiving jail-based substance use treatment and non-treatment participants.

METHODS

As part of a larger clinical trial under the NIDA-funded Justice Community Opioid Innovation Network (JCOIN), staff conducted an egocentric social network inventory with women who were randomly selected from eight jails in Kentucky, screened for OUD, and consented (N = 445). Women were asked to name people (alters) who provided them with support in the past 90 days and respond to questions about alters who were named. Bivariate comparisons examined differences in social networks among women who were currently receiving jail-based treatment (29.9 %, n = 133) and those who were incarcerated, but not receiving treatment (70.1 %, n = 312).

RESULTS

On average, women's social support networks consisted of 2.4 alters (range 1-9). Compared to women with OUD who were not receiving treatment, those in treatment were significantly more likely to name at least one alter who was in recovery (57.9 % vs. 43.9 %, p = .007) and less likely to name a partner (21.8 % vs. 37.8 %, p = .001) or someone who had recently used opioids (9.8 % vs. 24.7 %, p < .001). On average, women in treatment also felt significantly closer to their alters (4.70 vs. 4.55 out of 5, p = .021) and rated alters as fulfilling more types of social support functions (5.54 vs. 5.18 out of 6, p < .001) and recovery support functions (2.83 vs. 2.70 out of 3, p = .016).

CONCLUSION

Results suggest that women participating in jail-based substance use treatment reported more positive social support network attributes, including network function and composition. Future research should assess longitudinal changes in networks and associated differences in recovery outcomes as women are released to the community.

Substance Use-Related Alterations of Social Decision Making in a Longitudinal Cohort of Young Adults

BACKGROUND

Substance use disorders are associated with severe negative social and health-related outcomes. Evidence has accumulated that long-term substance use is associated with alterations in social interaction behavior, which likely contributes to the vicious cycle of substance use disorder. However, little is known about whether these social problems originate from contextual factors only or also from the substance use itself-in other words, if they are predisposed or substance induced.

METHODS

We studied the causation behind behavioral alterations of substance users over a 9-year period (ages 11-20 years) in an urban age cohort (N = 1002) with a high prevalence of substance use at age 20. We identified common substance use patterns using toxicological hair analysis, examined behavioral alterations with incentivized games, and used teacher assessments across different ages to determine the causes and effects that underlie substance use-related impairments in social interaction.

RESULTS

We found that opioid and stimulant users showed reduced prosocial behavior compared with nonusers, particularly in interpersonal trust and perspective taking (e.g., they were approximately 50% less likely to trust others). Our longitudinal analyses suggest a causal relationship between the nonmedical use of prescription opioids and impaired social behavior, whereas impairments among stimulant users seem to be partially predisposed. Moreover, women tended to be more severely affected by opioid use than men. However, no behavioral alterations were found among young adult cannabis or ecstasy users.

CONCLUSIONS

Highly addictive substances such as opioids can impair users' social behavior by undermining fundamental human interaction, thereby fueling a vicious cycle of substance use and social isolation.

Analyzing the Relationship Between Self-Efficacy in Protecting Against Substance Use and Loneliness in Adolescents: A Cross-Sectional Survey

PURPOSE

To analyze the relationship between self-efficacy in protecting against substance use and loneliness in adolescents.

METHOD

This descriptive, cross-sectional study comprised 400 adolescents. A Sociodemographic Data Form, Self-Efficacy for Adolescents Protecting Against Substance Abuse Scale (SEAPSAS), and Short-Form UCLA Loneliness Scale (ULS-8) were used for data collection. Regression analysis and Pearson correlation analysis, as well as descriptive statistics, were used in data analysis.

RESULTS

Mean ULS-8 total score was 17.94 (SD = 5.07) and mean SEAPSAS total score was 68.78 (SD = 17.59). A weak significant negative relationship was found between mean ULS-8 total score and mean SEAPSAS subdimensions and total score. As a result of regression analysis, it was determined that ULS-8 total score negatively affected mean SEAPSAS total score by 24.9% (R2 = 0.249; B = -1.713; p < 0.001).

CONCLUSION

Loneliness in adolescents, which was observed to negatively impact self-efficacy in protecting against substance use, should be addressed by psychiatric nurses through prevention activities and support programs and services, such as early detection and intervention. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 29-36.].

The path from mood symptoms to substance use: A longitudinal examination in individuals with and at risk for bipolar spectrum disorders

BACKGROUND

Adolescent substance use poses a critical public health challenge, intertwined with risk-taking behavior, criminality, functional impairment, and comorbid mental and physical health issues. Adolescents with bipolar spectrum disorders (BSD) exhibit heightened susceptibility to substance use, necessitating a nuanced exploration of the bipolar-substance use relationship.

METHODS

This study addressed gaps in the literature by employing a prospective, longitudinal design with 443 Philadelphia-area adolescents, tracking BSD symptoms and substance use. We predicted that BSD symptoms would be associated with increases in substance use, and that these effects would be more pronounced for individuals with a BSD and those with high reward sensitivity.

RESULTS

Hypomanic symptoms predicted subsequent substance use, with a stronger association observed in individuals diagnosed with BSD. Contrary to expectations, depressive symptoms did not exhibit a similar relationship. Although the hypothesized moderating role of reward sensitivity was not supported, higher reward sensitivity predicted increased substance use.

LIMITATIONS

Symptoms and substance use are only captured for the month prior to each session due to the assessment timeline. This highlights the benefits of frequent assessments over a shorter time frame to monitor real-time changes. Alternative classification methods for reward sensitivity, such as brain or behavior-based assessments, might yield different results.

CONCLUSIONS

This study's contributions include evaluating substance use broadly, utilizing a longitudinal design for temporal clarity, and shifting the focus from substance use predicting mood symptoms to the inverse. The findings underscore the need for continued exploration of mood symptom predictors of substance use, emphasizing the role of reward sensitivity.

Therapeutic alliance in the treatment of adolescent substance misuse: a systematic review

BACKGROUND

Therapeutic alliance has been found to play an influential role in predicting outcomes for adults and adolescents in psychotherapy. However, thus far, the information concerning the impact of therapeutic alliance on outcomes for adolescents in treatment for substance misuse has not yet been critically synthesised.

METHODS

In accordance with PRISMA guidelines, the current review aimed to systematically collate published research investigating the association between alliance and outcomes for adolescents undergoing substance misuse treatment. Database searching produced 1083 records, with 16 studies meeting eligibility criteria.

RESULTS

Twelve out of the 16 studies (75%) reported significant alliance-outcome relationships, whereby higher alliance ratings predicted better treatment outcomes, as well as improved engagement and retention in treatment. In addition, the review explored the conditions whereby alliances better predict outcomes, with reference to the alliance rater, the timing of the alliance rating and comorbid diagnoses. These results, however, largely remain inconclusive.

CONCLUSIONS

The evidence as it stands demonstrates the importance of the therapeutic alliance in predicting outcomes for adolescents in substance misuse treatments. The implications of the review's findings and recommendations for future research are discussed.

HIV status and substance use disorder treatment need and utilization among adults in the United States, 2015-2019: Implications for healthcare service provision and integration

INTRODUCTION

Substance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status.

METHODS

We included participants from the 2015-2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income.

RESULTS

Overall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08-3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07-4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20-0.77).

CONCLUSIONS

Despite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.

Validation of an ultra-short global quality of life scale in a large population-based health survey

INTRODUCTION

Quality of life (QoL) assessment is essential in health-related research and clinical settings, offering insights into individuals' well-being and functioning. This study validated the Essential QoL-3 (EQoL-3), an ultra-short scale assessing essential dimensions of QoL, for use in epidemiological research and clinical settings.

METHODS

Data from a 2021 national survey in Norway (N = 17,487) were used. Three items on the EQoL-3 assess life satisfaction, happiness, and meaningfulness on a 0-10 scale. Discriminant validity was assessed by comparing the EQoL-3 with the Satisfaction with Life Scale (SWLS) and by examining latent mean differences between individuals with adverse life experiences (ALE+) and those without such experiences (ALE-). Convergent validity was evaluated through latent regression analyses comparing the EQoL-3 with a perceived mastery scale and a mental distress scale.

RESULTS

The discriminant validity of the EQoL-3 was less than optimal when compared with the SWLS. Nonetheless, a multigroup confirmatory factor analysis revealed that the EQoL-3 score was 1.42 (95% CI = 1.33-1.50, p < 0.001) lower in the ALE+ group compared to the ALE- group, providing support for discriminant validity. Convergent validity was established with a positive association between EQoL-3 and mastery (β = 1.75, 95% CI = 1.70-1.80, p < 0.001) and a negative association between the EQoL-3 and mental distress (β = -2.64, 95% CI = -2.71/-2.59, p < 0.001).

CONCLUSIONS

The EQoL-3 is a reliable measure of QoL. Its streamlined nature facilitates quick administration, making it a valuable tool for clinicians and researchers in diverse settings. Its inclusion of the eudaimonic dimension, as well as its exclusion of health items in the measure itself, distinguishes it from traditional HQoL measures, making it suitable for mental health and substance use disorder research.

Prevalence and Sociodemographic Correlates of Smoking among Schoolchildren in Albania

Smoking among children remains a critical public health issue, with millions of minors engaging in tobacco use, leading to addiction and long-term health consequences. Our objective was to assess the prevalence and sociodemographic distribution of smoking habits among Albanian children. A cross-sectional study was conducted in Albania in 2022, including a nationwide representative sample of 5454 schoolchildren aged 11, 13, and 15 years (N = 5454; ≈52% girls; response rate: 96%). Data on smoking habits were gathered, along with sociodemographic factors of schoolchildren. Binary logistic regression was used to assess the associations of smoking variables with sociodemographic factors. The prevalence of smoking variables was 12% for lifetime cigarette smoking, 7% for current cigarette smoking, 20% for lifetime smoking of e-cigarettes, and 13% for current smoking of e-cigarettes. Independent positive correlates of both cigarette and e-cigarette smoking included male gender, age 15, and pertinence to more affluent families (all p < 0.01). The prevalence of smoking among Albanian children is seemingly high, which should be a cause of serious concern to decisionmakers and policymakers in this transitional country. Albania should immediately consider the implementation of expanded comprehensive tobacco control measures, which will save lives, reduce illness, and help reduce the economic burden associated with tobacco-related illness.

Prevalence and associated factors of cigarette smoking and substance use among university entrance test-taking students: A GIS-based study

BACKGROUND

Numerous studies have examined substance use and smoking behavior among adolescents and university students. However, little is known about these behaviors among students undergoing university entrance tests, a critical transition period from adolescence to adulthood. The entrance test can significantly affect students' mental health, potentially leading to substance use. This study aims to investigate the prevalence of cigarette smoking and substance use among students taking these exams and the associated factors.

METHODS

A cross-sectional survey was carried out on September 4th and 11th, 2022 to collect data from 1,480 university entrance test-taking students using a convenience sampling technique. Chi-square tests and logistic regression were conducted using SPSS software. Besides, GIS mapping was used to visualize the distribution of substance use and smoking behavior across districts via ArcGIS.

RESULTS

The study found a 10% prevalence of current tobacco smoking and 4% substance use. Females (OR = 1.98; 95% CI: 1.38-2.85), urban residence (OR = 2.03; 95% CI: 1.42-2.88), repeater (OR = 1.45; 95% CI: 1.02-2.06), anxiety (OR = 1.55, 95% CI: 1.10-2.19), burnout (OR = 1.51, 95% CI: 1.00-2.12), and suicidal behavior (OR = 1.57; 95% CI: 1.03-2.40) were the significant factors for cigarette use. Whereas the urban residence (OR = 1.91; 95% CI: 1.11-3.31), anxiety (OR = 2.47, 95% CI: 1.45-4.20), and suicidal behavior (OR = 2.76; 95% CI: 1.55-4.92) significantly increased the risk of substance use. GIS analysis revealed males varied in substance use and females in tobacco smoking by district. Repeat test-takers were associated with district variations in both smoking and substance use.

CONCLUSIONS

Educational institutions, public health authorities, and policymakers must implement mental health support and substance use prevention programs for students. Integrating mental health education, providing resources, and enforcing regulations can promote healthier coping strategies and reduce substance use risks among students.

Expectations and needs of people with illicit substance use disorders in general practice: a qualitative study in Belgium

BACKGROUND

People who use illicit drugs cumulate medical and psychosocial vulnerabilities, justifying a rounded health approach. Both caregivers and patients can form barriers to accessing care, leading to inadequate care. This study aimed to identify the needs and expectations of such patients in general practice.

METHODS

Qualitative research was conducted using semi-structured interviews with 23 people with illicit substance use disorder in Brussels in 2020. Multicentric recruitment was conducted to obtain a heterogeneous mix of sociodemographic profiles and care trajectories. Thematic analysis was performed using RQDA package software.

RESULTS

Participants highlighted several vulnerabilities. These include the presence of significant self-stigmatization and guilt, sometimes to the extent of self-dehumanization, even after years of care, and overdoses masking suicide attempts and early memory disorders. Multiple substance use, smoking in almost all participants, and misuse of benzodiazepines were also noted. The majority of participants expressed the need for an open-minded, non-stigmatizing and empathic GP with a holistic approach that could guide them throughout their life course. The competencies of the GPs in the field of addiction seemed secondary to the participants. Knowledge and good collaboration with the mental health network were assets.

CONCLUSION

Participants expressed the need for GPs with good interpersonal skills, including a non-stigmatizing attitude. The care coordinator role of the GP was highlighted as a key element, as it was a holistic approach focusing on global health (including the social determinants of health) and not only on substance use disorders.

Impact of the COVID-19 Pandemic on Youth Substance Use and Substance-Related Risk Factors and Outcomes: Implications for Prevention, Treatment, and Policy

Youth substance use and substance use disorders (SUD) are major public health issues associated with significant societal cost. The coronavirus SARS-CoV-2 (COVID-19) pandemic and pandemic-related lockdowns, school closures, and social distancing dramatically impacted the daily lives of young people worldwide, resulting in major disruptions to normal developmental trajectories and complex (and at times opposing effects) on different SUD risk and protective factors, which contributed to inconsistent outcomes. During the COVID-19 pandemic, substance use prevalence rates decreased in the general population of US youth, but increased for certain vulnerable subgroups. Additionally, overdose deaths related to fentanyl rose significantly among US youth.

How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders?

BACKGROUND

Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown.

METHODS

Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share").

RESULTS

The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only.

CONCLUSIONS

Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.

Long-term trends in beverage-specific drinking in the National Alcohol Surveys: Differences by sex, age, and race and ethnicity

BACKGROUND

Despite substantial declines in underage drinking and binge drinking, alcohol consumption has increased in the past 30 years. This study examined how beverage-specific drinking patterns varied by sex, age, and race and ethnicity from 1979 to 2020.

METHODS

Secondary data analysis was conducted on pooled data from the National Alcohol Survey series from 1979 to 2020 of a sample of U.S. adults ages 18 years or older. Total and beverage-specific volume were calculated from graduated frequency questions on reported beverage type, which included beer, wine, and spirits. Sex-stratified analyses focused on descriptive trends of each alcohol measure over time and by age and race and ethnicity. Time-varying effect models were also conducted to identify subgroups at higher risk for increased consumption over time.

RESULTS

Women's drinking increased, with alcohol volume rising substantially from 2000 to 2020; the largest increase was among women 30 and older. Men's alcohol volume also rose over this period but remained below the levels of 1979 and 1984, with older adults increasing their consumption those 18-29 decreased their drinking. Beverage-specific trends showed some similarities by gender: in 2020, wine volume was at its highest level for both women and men, while spirits volume also was at its highest level for men and in women was tied with the 1979 peak in spirits consumption. Increases were also found among Black men and women and Latina women from 2000 to 2020.

CONCLUSIONS

Given the increases in alcohol volume, particularly among women and older age groups, alcohol policy, interventions, and education should consider ways to reduce harms associated with alcohol use among these groups. Continued monitoring of beverage-specific drinking patterns is needed to track policy-relevant changes.

Delay discounting is associated with addiction and mental health measures while controlling for health behaviors and health barriers in a large US sample

Background

Excessive discounting of future rewards [delay discounting (DD)] may be a transdiagnostic process and treatment target underlying behavioral health outcomes, including trauma, depression, anxiety, and problematic substance use. However, multiple health behaviors and barriers are also related to these outcomes, including social media usage, adverse childhood experiences (ACEs), sleep quality, healthcare access, housing status, and exercise. To extend research examining DD as transdiagnostic process, we recruited a large, heterogenous sample to examine the association between DD, problematic substance use, and mental health outcomes while controlling for certain health behaviors and health barriers.

Method

In a cross-sectional online survey of 3992 US residents, we administered validated measures of PTSD, depression, anxiety, and problematic alcohol, stimulant, and opioid use. Using linear or ordinal logistic models, scores for each outcome were regressed onto DD while controlling for demographics, health behaviors, and health barriers.

Results

Including only DD and demographics, DD was associated with each outcome at low effect sizes (ƒ2 = .013, OR range = 1.08-1.16). Except for opioid ASSIST scores, these relationships held when controlling for social media usage, sleep, housing status, healthcare access, ACEs, physical exercise, and demographic variables (ƒ2 = .002, OR range = 1.03-1.12), increasing confidence that DD concurrently and directly relates to four of these five clinical outcomes.

Discussion

These findings support the conceptualization of DD as a transdiagnostic process underlying certain psychopathologies and suggest targeting DD in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.

The Use of Nonmonetary Outcomes in Health-Related Delay Discounting Research: Review and Recommendations

Delay discounting (DD) refers to the tendency to devalue an outcome as a function of its delay. Most contemporary human DD research uses hypothetical money to assess individual rates of DD. However, nonmonetary outcomes such as food, substances of misuse, and sexual outcomes have been used as well, and have advantages because of their connections to health. This article reviews the literature on the use of nonmonetary outcomes of food, drugs, and sexual outcomes in relation to health and reinforcer pathologies such as substance use disorders, obesity, and sexual risk behaviors, respectively, and makes a case for their use in discounting research. First, food, substances, and sex may be more ecologically valid outcomes than money in terms of their connections to health problems and reinforcer pathologies. Second, consistent trends in commodity-specific (i.e., domain) effects, in which nonmonetary outcomes are discounted more steeply than money, enhance variation in discounting values. Third, commodity-specific changes in discounting with treatments designed to change health choices are described. Finally, methodological trends such as test-retest reliability, magnitude effects, the use of hypothetical versus real outcomes, and age-related effects are discussed in relation to the three outcome types and compared to trends with monetary discounting. Limitations that center around individual preferences, nonsystematic data, and deprivation are discussed. We argue that researchers can enhance their DD research, especially those related to health problems and reinforcer pathologies, with the use of nonmonetary outcomes. Recommendations for future directions of research are delineated.

Bidirectional relationships between nicotine vaping and maladaptive eating behaviors among young adults

Background

Past research indicates that young adult cigarette smokers are at risk of engaging in maladaptive eating behaviors (MEBs); however, whether this relationship extends to nicotine vaping is unclear. The current study assessed bidirectional associations between four types of MEBs and nicotine vaping among young adults.

Methods

1,303 young adults (20.5 ± 2.3 years; 63 % female) from a public, urban university were recruited and completed online surveys at six-month intervals from spring 2021 (W1) to spring 2023 (W5). Past 30-day nicotine vaping and four types of MEBs (susceptibility to external cues, emotional eating, routine restraint, and compensatory restraint) were evaluated.

Results

Longitudinal cross-lagged models examined the bidirectional relationships between past 30-day nicotine vaping and each type of MEB across five waves. Nicotine vaping predicted both susceptibility to external cues (β = 0.10, p <.05; Wave 2 to 3) and emotional eating (β = 0.08, p <.05; Wave 1 to 2). A significant cross-lag regression (Wave 4 to 5) showed nicotine vaping predicted to routine restraint (β = 0.08, p <.05), and routine restraint predicted to nicotine vaping (β = 0.12, p <.05).

Conclusions

Results indicated that nicotine vaping predicted MEBs; however, the type of MEB differed across waves, which may have been due to the COVID-19 pandemic context. Nicotine vaping predicted to MEBs reflecting vulnerability to the external environment and emotion regulation during a period of heightened restrictions, whereas later when pandemic restrictions had ceased nicotine vaping predicted only to routine restraint. Integrating research and practice on nicotine vaping and MEBs may inform public health efforts to decrease co-occurring health-risks in young adulthood.

The Role of Family Functioning in the Prevention of Depressive Symptoms and Drug Use Among Hispanic Youth

Background

There is an established link between depression and drug use among adolescents. This relationship holds true for Hispanic youth, for whom familial relationships are especially impactful toward health outcomes.

Purpose

Our purpose was to examine the relationships between family functioning and adolescent and parent depressive symptoms, and the indirect effects of depressive symptoms on the relationship between family functioning and adolescent drug use.

Methods

Participants were 231 Hispanic adolescents (52.9% female, Mage=13.90±1.37) and their parents (93.0% female, Mage=43.24±6.64) enrolled in an RCT. Data on depressive symptoms, drug use, and family functioning were collected and a latent variable was specified using four indicators of family functioning (positive parenting, monitoring, communication, and involvement). A structural equation model approach was utilized.

Results

Youth family functioning predicted youths' depressive symptoms which predicted their own drug use. Youths' depressive symptoms mediated the relationship between youth family functioning and drug use.

Discussion

Findings suggest that adolescents' perceptions of family functioning plays a role in preventing depressive symptoms and drug use among Hispanic youth.

Translation to Health Education Practice

Teaching students of the role that family support and depressive symptoms play in the manifestation of drug use may be an effective approach to preventing drug use.

Exercise capacity, lung and respiratory muscle function in substance use disorders

BACKGROUND

Substance use disorder (SUD) causes conditions such as cognitive and behavioral disorders, anxiety, depression, and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics. The current study aimed to investigate the lung function, respiratory muscle strength, and exercise capacity in patients with SUD.

METHODS

One hundred-eighty three patients with SUD, a total of 119 healthy controls, 54 of whom were cigarette smokers and 65 of whom were non-smokers were included in the study. Spirometric tests, respiratory muscle strength (MIP and MEP), and the 6-Minute Walk Test (6-MWT) were assessed. The III National Health and Nutrition Examination Survey were used to evaluate respiratory symptoms in patients with SUD and cigarette smokers.

RESULTS

86.3% of the SUD patients included in the study were using heroin, 9.2% were cannabis, and 5.5% were spice. The most common symptom in both SUD patients and cigarette smokers was shortness of breath, wheezing, and sputum production. After post-hoc tests, the FVC (p = 0.002), FVC (%predicted) (p < 0.0001), FEV1 (p = 0.002), FEV1 (%predicted) (p < 0.0001), FEV1/FVC (%) (p < 0.0001), PEF (p < 0.0001) and FEF%25-75 (p < 0.0001) lung function parameters were significantly lower in SUD patients than non-smokers. In addition, it was found that MIP (p < 0.0001), MIP (%predicted) (p < 0.0001), MEP (p < 0.0001), and MEP (%predicted) (p < 0.0001) values of SUD patients were significantly lower than non-smokers.

CONCLUSION

The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath, wheezing, and sputum production. In addition, respiratory muscle strength and exercise capacity were decreased in SUD patients compared to non-smokers.

Prompt access to outpatient care post-incarceration among adults with a history of substance use: Predisposing, enabling, and need-based factors

INTRODUCTION

As expanded Medicaid coverage reduces financial barriers to receiving health care among formerly incarcerated adults, more information is needed to understand the factors that predict prompt use of health care after release among insured adults with a history of substance use. This study's aim was to estimate the associations between characteristics suggested by the Andersen behavioral model of health service use and measures of health care use during the immediate reentry period and in the presence of Medicaid coverage.

METHODS

In this retrospective cohort study, we linked individual-level data from multiple Wisconsin agencies. The sample included individuals aged 18-64 released from a Wisconsin State Correctional Facility between April 2014 and June 2017 to a community in the state who enrolled in Medicaid within one month of release and had a history of substance use. We grouped predictors of outpatient care into variable domains within the Andersen model: predisposing- individual socio-demographic characteristics; enabling characteristics including area-level socio-economic resources, area-level health care supply, and characteristics of the incarceration and release; and need-based- pre-release health conditions. We used a model selection algorithm to select a subset of variable domains and estimated the association between the variables in these domains and two outcomes: any outpatient visit within 30 days of release from a state correctional facility, and receipt of medication for opioid use disorder within 30 days of release.

RESULTS

The size and sign of many of the estimated associations differed for our two outcomes. Race was associated with both outcomes, Black individuals being 12.1 p.p. (95 % CI, 8.7-15.4, P < .001) less likely than White individuals to have an outpatient visit within 30 days of release and 1.3 p.p. (95 % CI, 0.48-2.1, P = .002) less likely to receive MOUD within 30 days of release. Chronic pre-release health conditions were positively associated with the likelihood of post-release health care use.

CONCLUSIONS

Conditional on health insurance coverage, meaningful differences in post-incarceration outpatient care use still exist across adults leaving prison with a history of substance use. These findings can help guide the development of care transition interventions including the prioritization of subgroups that may warrant particular attention.

Drug use and COVID-19 testing, vaccination, and infection among underserved, minority communities in Miami, Florida

The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49-0.81; p<0.001). PWUD presented with greater difficulties accessing COVID-19 testing, greater vaccine hesitancy, and lower odds of vaccination. Testing and immunization plans that are tailored to the needs of PWUD and consider access, trust-building campaigns, and education may be needed.

Prevalence of consumption of illicit drugs and associated factors from a nationwide epidemiological survey: The Singapore Health and Lifestyle Survey

Introduction

The primary aims of the current nationwide study were to establish the lifetime and 12-month prevalence of consumption of illicit drugs and its correlates in the general population of Singapore.

Method

A representative sample of 6509 Singapore residents (Singapore citizens and permanent residents) aged between 15 and 65 years were randomly selected for participation. Questionnaires were administered to assess the consumption of illicit drugs and collect information on correlates. All analyses were weighted to produce prevalence estimates for the consumption of drugs and other measured outcomes. Rao-Scott chi-square test and logistic regression analyses were performed to determine the association of sociodemographic and clinical characteristics with lifetime consumption of illicit drugs.

Results

The study was completed with a response rate of 73.2%. The lifetime prevalence of consuming illegal drugs was 2.3% (95% confidence interval [CI] 1.9-2.8) (n=180). Compared to individuals aged 15-34, those aged 50-65 (odds ratio [OR] 0.3, 95% CI 0.2-0.7) had lower odds of lifetime drug consumption. Current smokers (OR 4.7, 95% CI 2.7-8.3) and ex-smokers (OR 5.9, 95% CI 3.2-11.1) had significantly higher odds of lifetime drug consumption than non-smokers. Individuals with hazardous alcohol use (OR 3.3, 95% CI 1.7-6.5) had higher odds of lifetime drug consumption than those without hazardous alcohol use.

Conclusion

This is the first nationwide study to examine the prevalence of illicit drug consumption in the general population of Singapore. The results highlight the need to increase awareness of drug consumption in Singapore, especially among parents, teachers, healthcare workers and others who work with young people.

Hospital admissions among patients with Comorbid Substance Use disorders: a secondary analysis of predictors from the NavSTAR Trial

BACKGROUND

Individuals with substance use disorders (SUDs) frequently use acute hospital services. The Navigation Services to Avoid Rehospitalization (NavSTAR) trial found that a patient navigation intervention for hospitalized patients with comorbid SUDs reduced subsequent inpatient admissions compared to treatment-as-usual (TAU).

METHODS

This secondary analysis extends previous findings from the NavSTAR trial by examining whether selected patient characteristics independently predicted hospital service utilization and moderated the effect of the NavSTAR intervention. Participants were 400 medical/surgical hospital patients with comorbid SUDs. We analyzed 30- and 90-day inpatient readmissions (one or more readmissions) and cumulative incidence of inpatient admissions through 12 months using multivariable logistic and negative binomial regression, respectively.

RESULTS

Consistent with primary findings and controlling for patient factors, NavSTAR participants were less likely than TAU participants to be readmitted within 30 (P = 0.001) and 90 (P = 0.03) days and had fewer total readmissions over 12 months (P = 0.008). Hospitalization in the previous year (P < 0.001) was associated with cumulative readmissions over 12 months, whereas Medicaid insurance (P = 0.03) and index diagnoses of infection (P = 0.001) and injuries, poisonings, or procedural complications (P = 0.004) were associated with fewer readmissions. None of the selected covariates moderated the effect of the NavSTAR intervention.

CONCLUSIONS

Previous findings showed that patient navigation could reduce repeat hospital admissions among patients with comorbid SUDs. Several patient factors were independently associated with readmission. Future research should investigate risk factors for hospital readmission among patients with comorbid SUDs to optimize interventions.

TRIAL REGISTRATION

NIH ClinicalTrials.gov NCT02599818, Registered November 9, 2015 https://classic.

CLINICALTRIALS

gov/ct2/show/NCT02599818 .

Integrative Pharmacology in the Treatment of Substance Use Disorders

The detrimental physical, mental, and socioeconomic effects of substance use disorders (SUDs) have been apparent to the medical community for decades. However, it has become increasingly urgent in recent years to develop novel pharmacotherapies to treat SUDs. Currently, practitioners typically rely on monotherapy. Monotherapy has been shown to be superior to no treatment at all for most substance classes. However, many randomized controlled trials (RCTs) have revealed that monotherapy leads to poorer outcomes when compared with combination treatment in all specialties of medicine. The results of RCTs suggest that monotherapy frequently fails since multiple dysregulated pathways, enzymes, neurotransmitters, and receptors are involved in the pathophysiology of SUDs. As such, research is urgently needed to determine how various neurobiological mechanisms can be targeted by novel combination treatments to create increasingly specific yet exceedingly comprehensive approaches to SUD treatment. This article aims to review the neurobiology that integrates many pathophysiologic mechanisms and discuss integrative pharmacology developments that may ultimately improve clinical outcomes for patients with SUDs. Many neurobiological mechanisms are known to be involved in SUDs including dopaminergic, nicotinic, N-methyl-D-aspartate (NMDA), and kynurenic acid (KYNA) mechanisms. Emerging evidence indicates that KYNA, a tryptophan metabolite, modulates all these major pathophysiologic mechanisms. Therefore, achieving KYNA homeostasis by harmonizing integrative pathophysiology and pharmacology could prove to be a better therapeutic approach for SUDs. We propose KYNA-NMDA-α7nAChRcentric pathophysiology, the "conductor of the orchestra," as a novel approach to treat many SUDs concurrently. KYNA-NMDA-α7nAChR pathophysiology may be the "command center" of neuropsychiatry. To date, extant RCTs have shown equivocal findings across comparison conditions, possibly because investigators targeted single pathophysiologic mechanisms, hit wrong targets in underlying pathophysiologic mechanisms, and tested inadequate monotherapy treatment. We provide examples of potential combination treatments that simultaneously target multiple pathophysiologic mechanisms in addition to KYNA. Kynurenine pathway metabolism demonstrates the greatest potential as a target for neuropsychiatric diseases. The investigational medications with the most evidence include memantine, galantamine, and N-acetylcysteine. Future RCTs are warranted with novel combination treatments for SUDs. Multicenter RCTs with integrative pharmacology offer a promising, potentially fruitful avenue to develop novel therapeutics for the treatment of SUDs.

A Moderated Mediation Model of Age-Related Decline in Selective Executive Functions and Quality of Life in Men with Substance Use Disorder

Objective

It is known from earlier literature that substance use is associated with diminished executive functioning and decreased quality of life (QoL). The study extended this knowledge by assessing whether selective executive function components would mediate the association between age and QoL domains in young men with substance use disorder and whether family history of substance use would moderate these mediated associations.

Method

A sample of 212 young inpatient men with substance use disorder (105 positive family history and 107 negative family history of substance use disorder) was selected from drug units/wards of government sector hospitals.

Results

The participants with positive family history compared to those with negative family history scored significantly lower on all QoL domains except physical QoL. Mediation analyses revealed that only inhibition but not flexibility mediated the negative association of age with psychological, social, and environmental QoL. Furthermore, family history of substance use moderated all the significant mediated associations with stronger indirect negative associations in participants having a family history of substance use disorder compared to those with no such history.

Conclusions

It is concluded that inhibitory control, which is vulnerable to aging, substance use, and family history of substance use, is an important factor related to QoL in young substance abuser men.

Can telehealth expansion boost health care utilization specifically for patients with substance use disorders relative to patients with other types of chronic disease?

OBJECTIVE

Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high risk of poor outcomes. Telehealth expansion may boost utilization, but it is unclear whether telehealth can increase utilization for patients with SUDs beyond that expected for other chronic diseases amenable to remote treatment, like type 2 diabetes. This information is needed by health systems striving to improve SUD outcomes, specifically. This study compared the impact of telehealth expansion during the COVID-19 public health emergency (PHE) on utilization for patients with SUDs and diabetes.

METHODS

Using Wisconsin Medicaid administrative, enrollment and claims data 12/1/2018-12/31/2020, this cohort study included nonpregnant, nondisabled adults 19-64 years with SUDs (N = 17,336) or diabetes (N = 8,499). Outcomes included having a primary care visit in the week (any, and telehealth) for any diagnosis, or a SUD or diabetes diagnosis; and the weekly fraction of visits completed by telehealth. Logistic and fractional regression examined outcomes pre- and post-PHE. Covariates included age, sex, race, ethnicity, income, geography, and comorbid medical and psychotic disorders.

RESULTS

Post-PHE, patients with SUDs exhibited greater likelihood of telehealth utilization (percentage point difference (PPD) per person-week: 0.2; 95% CI: 0.001-0.003; p<0.001) and greater fractional telehealth use (PPD: 1.8; 95%CI: 0.002-0.033; p = 0.025) than patients with diabetes despite a larger overall drop in visits (PPD: -0.5; 95%CI: -0.007- -0.003; p<0.001).

CONCLUSIONS

Following telehealth expansion, patients with SUDs exhibited greater likelihood of telehealth utilization than patients with diabetes. This advantage lessened the substantial PHE-induced healthcare disruption experienced by patients with SUDs. Telehealth may boost utilization for patients with SUDs.

The Differential Role of Perceived Same-Gender and Gender-Neutral Norms in Emerging Adult Risk Behavior

Background: Normative perceptions are strongly related to risk behaviors among emerging adults but the role of gender-specific normative perceptions remain unclear. Objectives: The current study examined the differential effects of same-gender and gender-neutral normative perceptions on self-reported substance use and sexual risk behavior. College students (n = 389, ages 18-25) reported binge drinking, cannabis use and prescription drug misuse, sexual risk behavior, and the perceived frequency of these behaviors by both the average- and same-gender adult. Results: Binge drinking was positively associated with same-gender norms only, whereas cannabis use and sexual risk behavior were also positively associated with gender-neutral norms perceptions. For binge drinking only, same-gender norms explained more variance in behavior than gender-neutral norms. Conclusions: Findings indicate perceptions of same-gender norms play a particularly important role in binge drinking during this developmental period. Interventions targeting emerging adult risk behavior should include within-group normative perceptions related to demographic and social group characteristics.

Medication utilization in traumatic brain injury patients-insights from a population-based matched cohort study

Introduction

Traumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medications prescribed to address pain and somatic conditions in a population-based cohort of TBI patients, and to compare this to a sex- and age-matched cohort. We also examined how patient factors such as sex, age, and TBI severity were associated with medication use.

Methods

We assessed Swedish nationwide registers to include all individuals treated for TBI in hospitals or specialist outpatient care between 2006 and 2012. We examined dispensed prescriptions for eight different non-psychotropic medication classes for the 12 months before, and 12 months after, the TBI. We applied a fixed-effects model to compare TBI patients with the matched population cohort. We also stratified TBI patients by sex, age, TBI severity and carried out comparisons using a generalized linear model.

Results

We identified 239,425 individuals with an incident TBI and 239,425 matched individuals. TBI patients were more likely to use any medication [Odds ratio (OR) = 2.03, 95% Confidence Interval (CI) = 2.00-2.05], to present with polypharmacy (OR = 1.96, 95% CI = 1.90-2.02), and to use each of the eight medication classes before their TBI, as compared to the matched population cohort. Following the TBI, TBI patients were more likely to use any medication (OR = 1.83, 95% CI = 1.80-1.86), to present with polypharmacy (OR = 1.74, 95% CI = 1.67-1.80), and to use all medication classes, although differences were attenuated. However, differences increased for antibiotics/antivirals (OR = 2.02, 95% CI = 1.99-2.05) and NSAIDs/antirheumatics (OR = 1.62, 95% CI = 1.59-1.65) post-TBI. We also found that females and older patients were more likely to use medications after their TBI than males and younger patients, respectively. Patients with more severe TBIs demonstrated increased use of antibiotics/ antivirals and NSAIDs/antirheumatics than those with less severe TBIs.

Discussion

Taken together, our results point to poor overall health in TBI patients, suggesting that medical follow-up should be routine, particularly in females with TBI, and include a review of medication use to address potential polypharmacy.

Pathways to substance use: Examining conduct problems and parenting behaviors from preschool to adolescence

While many studies have identified risk and protective factors of substance use (SU), few have assessed the reciprocal associations of child conduct problems (CP) and parenting practices and behaviors in the prediction of SU across development. A greater understanding of how these factors relate over time is needed to improve the timing of targeted prevention efforts. This study examined how child CP, parenting behaviors, and parents' own antisocial behavior relate from preschool to adolescence and eventuate in SU. Participants included 706 youth (70.6% male; 89.7% white) enrolled in the Michigan Longitudinal Study. Data from waves 1 (ages 3-5), 2 (ages 6-8), 3 (ages 9-11), 4 (ages 12-14), and 5 (ages 15-17) were included. A random intercept cross-lagged panel model (RI-CLPM) examined reciprocal associations between parenting practices, parents' antisocial behavior, and child CP over time (waves 1-4) and how these factors contribute to adolescent alcohol, cigarette, and marijuana use (wave 5). At the within-person level, negative parenting and parents' own antisocial behavior had a strong influence in late childhood/early adolescence. Only child CP emerged as a significant predictor of SU. Results highlight the importance of early intervention and the potential influence of parenting and child factors throughout development in the prevention of SU.

Caring for Patients With Opioid Misuse or Substance Use Disorders in Hospice: A National Survey

Background: Opioid misuse and substance use disorders (SUDs) including opioid use disorder (OUD) are common and negatively impact quality of life. Hospice clinicians' experiences with these conditions have not been well described. Objectives: We sought to explore hospice clinicians' knowledge, practices, and comfort caring for patients with opioid misuse (e.g., a pattern of unsanctioned opioid use escalation, or concurrent illicit substance use) and SUDs. Design: We recruited hospice clinicians in the United States via national hospice and palliative care organizations to complete an online survey designed by the study authors and pilot tested with an interdisciplinary group of current/former hospice clinicians. Results: One hundred seventy-five clinicians (40% nurses, 40% physicians, 16% nurse practitioners) responded to the survey; most had cared for two or more hospice patients with opioid misuse or SUD in the past month. The majority felt confident identifying opioid misuse (94%) and taking SUD histories (79%). Most (62%) felt it is their role to treat hospice patients for SUD, though 56% lacked comfort in using buprenorphine for OUD treatment. While the majority felt it is their role to treat pain in hospice patients with SUDs (94%) and that hospice can help patients with SUDs (94%), many were not comfortable managing pain in patients taking buprenorphine (45%) or naltrexone (49%) for SUDs. Most felt comfortable managing pain in patients taking methadone for SUD (73%). Conclusions: Opioid misuse and SUD are common in hospice. Though clinicians are comfortable taking relevant histories, they feel less comfortable managing patients' opioid misuse or SUD, or these patients' pain.

Substance use disorder in young adults with stroke: clinical characteristics and outcome

OBJECTIVE

Stroke incidence among young adults has risen in the last decade. This research attempts to determine the effect of substance use disorder (SUD) on the clinical characteristics of stroke, mortality, outcome after IV thrombolysis, and functional dependency after 1 month among young adults.

METHODS

Through a retrospective study, data were extracted from the electronic medical records of stroke in young adults admitted to intensive care units in Kasr Al-Ainy Hospital (February 2018-January 2021). The National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale were documented at the onset and after 1 month.

RESULTS

The study included 225 young adults with stroke (median age of 40, IQR: 34-44). Only 93 young adults (41%) met the criteria of SUD. Anabolic steroid use disorder was significantly associated with cerebral venous thrombosis (P-value = 0.02), while heroin use disorder was significantly associated with a hemorrhagic stroke (P-value = 0.01). Patients with tramadol, cannabis, and cocaine use disorders had significantly more frequent strokes in the posterior than the anterior circulation. Patients with heroin use disorders had significantly higher mortality than those without heroin use disorders (P-value = 0.01). The risk of poor outcomes was doubled by alcohol or heroin use disorder, while it was tripled by cocaine use disorder (P-value = 0.01 for each).

CONCLUSION

Forty-one percent of young adults diagnosed with a stroke had SUD, with a relatively higher posterior circulation involvement. Increased mortality was associated with heroin use disorder more than other substances. Poor stroke outcome was associated with alcohol, heroin, and cocaine use disorders.

Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial

BACKGROUND

People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. Although dialectical behavioral therapy is effective for SUDs, it is often difficult to access. Self-guided, internet-delivered dialectical behavioral therapy (iDBT) allows for expanded availability, but few studies have rigorously evaluated it in individuals with SUDs.

OBJECTIVE

This study examines the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, acceptable, and engaging to people with SUDs. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time.

METHODS

A 12-week, single-blinded, parallel-arm, randomized controlled trial was implemented, with assessments at baseline and at 4 (acute), 8, and 12 weeks (follow-up). A total of 72 community adults aged 18 to 64 years were randomized. The immediate group (n=38) received access to iDBT at baseline, and the delayed group (n=34) received access after 4 weeks. The intervention (Pocket Skills 2.0) was a self-guided iDBT via a website, with immediate access to all content, additional text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed using self-report questionnaires.

RESULTS

iDBT was perceived as a credible and acceptable treatment. In terms of feasibility, 94% (68/72) of the participants started iDBT, 13% (9/68) were early dropouts, 35% (24/68) used it for the recommended 8 days in the first month, and 50% (34/68) were still active 4 weeks later. On average, the participants used iDBT for 2 hours and 24 minutes across 10 separate days. In the acute period, no greater benefit was found for the immediate group on substance dependence, although we did find lower depression (b=-2.46; P=.02) and anxiety (b=-2.22; P=.02). At follow-up, there were greater benefits in terms of reduced alcohol (b=-2.00; P=.02) and nonalcoholic substance (b=-3.74; P=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence in the acute (b=-1.73; P<.001) and follow-up period (b=-2.09; P<.001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotional dysregulation, and functional disability.

CONCLUSIONS

iDBT is a feasible and acceptable intervention for patients with SUDs, although methods for improving engagement are warranted. Although results did not support efficacy for the primary outcome at 4 weeks, findings support reductions in substance dependence and other mental health concerns at 12 weeks. Notwithstanding the limitations of this study, the results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440.

Predictive factors of substance misuse and abuse in South Korean adolescents: a secondary data analysis of the 2021 Youth Risk Behavior Web-based Survey

PURPOSE

This study aimed to identify the general characteristics and health behaviors of students with non-therapeutic substance use.

METHODS

This secondary data analysis used data from the 17th Korea Youth Risk Behavior Web-based Survey (2021). Analyses of the 54,848 adolescents used descriptive statistics, the Rao-Scott χ2 test, and logistic regression.

RESULTS

The risk factors for substance use among students were anxiety, loneliness, living separately from family, suicidal ideation, e-cigarette use, and high stress.

CONCLUSION

The findings help identify the risk factors for non-therapeutic drug use among adolescents. Since South Korea does not have a drug prevention program for its adolescent population, an educational plan based on these findings could help prevent adolescent substance abuse.

Evidence-Based Assessment of Substance Use Disorder

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

Functional Domains of Substance Use and their Implications to Trauma: A Systematic Review of Neuroimaging Studies

Substance use disorder (SUD) is a significant health problem, and trauma exposure is a known risk factor for the escalation of substance use. However, the shared neural mechanisms through which trauma is associated with substance use are still unknown. Therefore, we systematically review neuroimaging studies focusing on three domains that may contribute to the overlapping mechanisms of SUD and trauma-reward salience, negative emotionality, and inhibition. Using PRISMA guidelines, we identified 45 studies utilizing tasks measuring these domains in alcohol, tobacco, and cannabis use groups. Greater reward, lesser regulation of inhibitory processes, and mixed findings of negative emotionality processes in individuals who use substances versus controls were found. Specifically, greater orbitofrontal cortex, ventral tegmental area, striatum, amygdala, and hippocampal activation was found in response to reward-related tasks, and reduced activation was found in the inferior frontal gyrus and hippocampus in response to inhibition-related tasks. Importantly, no studies in trauma-exposed individuals met our review criteria. Future studies examining the role of trauma-related factors are needed, and more studies should explore inhibition- and negative-emotionality domains in individuals who use substances to uncover clinically significant alterations in these domains that place an individual at greater risk for developing a SUD.

Personalized online intervention based on a risk algorithm for the universal prevention of anxiety disorders: Design and development of the prevANS intervention

Objective

To describe the design and development of prevANS, a personalized online intervention for the universal prevention of anxiety disorders based on a predictive risk algorithm. A user-centered approach was followed, considering the feedback of potential users and mental health professionals.

Methods

The study had three phases: (a) designing the intervention based on existing scientific literature; (b) piloting and evaluating the beta version involving potential users and health professionals; and (c) refining the intervention based on participants' suggestions. This iterative process aimed to refine the prevANS intervention before testing in a randomized controlled trial.

Results

The prevANS intervention provides personalized anxiety risk reports and components tailored to individuals' needs. Participants at low risk receive psychoeducation had access to a set of tools enhance protective factors. Moderate/high-risk individuals also receive cognitive-behavioral training. Both groups have access to a reward system and forum. Results from the design evaluation indicate that the prevANS interface is attractive and user-friendly and the psychoeducational materials helpful and engaging. The cognitive-behavioral training module received positive feedback. Participants suggested changes related to usability, content clarity, attractiveness, and engagement, which were implemented afterwards.

Conclusions

This article describes the development of a personalized intervention for preventing anxiety disorders using a validated risk prediction algorithm. The prevANS intervention was designed based on current scientific literature by a team of experts employing a user-centered approach. Research on the effectiveness of information and communication technologies in mental health prevention interventions considering user needs and preferences is warranted.

Motivational interviewing for substance use reduction

BACKGROUND

Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues.

OBJECTIVES

To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment.

SEARCH METHODS

We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022.

SELECTION CRITERIA

We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up).

MAIN RESULTS

We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision.

AUTHORS' CONCLUSIONS

Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.

Operating an overdose prevention site within a temporary emergency shelter during the COVID-19 pandemic

SETTING

A temporary emergency shelter was established inside the Commonwealth Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate health risks among people experiencing homelessness.

INTERVENTION

A non-profit organization, Boyle Street Community Services, opened an overdose prevention site (OPS) between February and March 2022 inside the temporary emergency shelter. People accessed the shelter-based OPS to consume unregulated drugs (via injection, intranasally, or orally), receive medical aid, access sterile drug use equipment, and be connected to additional health and social supports, without leaving the shelter. We conducted short interviewer-administered surveys with OPS participants to examine participant views and identify suggested improvements.

OUTCOMES

The shelter-based OPS was accessed a total of 1346 times by 174 unique people. Fentanyl was the most common self-reported drug consumed (59%) and most consumption (99% of episodes) was by injection. OPS staff responded to 66 overdoses and reported no deaths. Survey respondents reported that the shelter-based OPS was convenient, with no need to forfeit their shelter spot or find transportation to another OPS. Respondents indicated that the OPS felt safe and accessible and reported that it reduced drug use in other shelter areas. Participants identified the OPS' exclusion of inhalation as a limitation.

IMPLICATIONS

People who use unregulated drugs and are experiencing homelessness are at a higher risk of negative health outcomes, which COVID-19 exacerbated. Integrating temporary shelter/housing and harm reduction services may be an innovative way to lower barriers, increase accessibility, and improve well-being for this structurally vulnerable population. Future operators should consider incorporating inhalation services to further reduce service gaps.

Associations between adverse childhood experiences and substance use: A meta-analysis

BACKGROUND

Adverse childhood experiences (ACEs) can be associated with negative health outcomes such as substance use. However, extant literature assessing this association is mixed.

OBJECTIVE

The present meta-analysis was conducted to obtain a pooled effect size for the association between ACEs and substance use (i.e., smoking, problematic alcohol use, heavy alcohol use, illicit drug use, and cannabis use).

PARTICIPANTS AND SETTING

The present meta-analyses included 102 studies (N = 901,864), where 42.32 % of participants were male, and the mean age was 30.91 years.

METHODS

Searches were conducted in MEDLINE, Embase, and PsycINFO in August 2021 and moderators were examined. Inclusion criteria included studies that measured ACEs prior to age 18 and substance use, and were published in English. All analyses were completed in Comprehensive Meta-Analysis Software, Version 3.0 (Borenstein et al., 2009).

RESULTS

Pooled effect sizes between ACEs and smoking [OR = 1.803 (95 % CI 1.588, 2.048)], problematic alcohol use [OR = 1.812 (95 % CI 1.606, 2.044)], heavy alcohol use [OR = 1.537 (95 % CI 1.344, 1.758)], cannabis use [OR = 1.453 (95 % CI 1.184, 1.786)] and illicit drug use [OR = 1.695 (95 % CI 1.530, 1.878)] were significant. Significant moderators contribute to the understanding of the association between ACEs and substance use, and are discussed extensively.

CONCLUSIONS

ACEs confer risk for substance use and trauma-informed approaches to substance use treatment should be considered. Study limitations and implications are discussed.