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Fishman M, Wenzel K, Gauthier P, Borodovsky J, Murray O, Subramaniam G, Levy S, Fredyma E, McLeman B, Marsch LA. Engagement, initiation, and retention in medication treatment for opioid use disorder among young adults: A narrative review of challenges and opportunities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209352. [PMID: 38494051 DOI: 10.1016/j.josat.2024.209352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Opioid Use Disorder (OUD) is a catastrophic public health problem for young adults (YAs) and their families. While medication for OUD (MOUD) is safe, effective, and recognized as the standard of care, its' uptake and success have been limited in YAs compared to older adults. METHODS This narrative review summarizes the existing literature and highlights select studies regarding barriers to YA MOUD, potential explanations for those barriers, and strategies to overcome them. RESULTS Barriers are prominent along the entire cascade of care, including: treatment engagement and entry, MOUD initiation, and MOUD retention. Hypothesized explanations for barriers include: developmental vulnerability, inadequate treatment system capacity, stigma against MOUD, among others. Interventions to address barriers include: promotion of family involvement, increasing provider capacity, integration of MOUD into primary care, assertive outreach, and others. CONCLUSIONS Integrating an adapted version of family coaching from the Community Reinforcement Approach and Family Training (CRAFT) and other models into YA MOUD treatment serves as an example of an emerging novel practice that holds promise for broadening the funnel of engagement in treatment and initiation of MOUD, and enhancing treatment outcomes. This and other developmentally-informed approaches should be evaluated as part of a high-priority clinical and research agenda for improving OUD treatment for YAs.
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Affiliation(s)
- Marc Fishman
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA; Johns Hopkins University School of Medicine, Dept of Psychiatry, 3800 Frederick Avenue, Baltimore, MD 21229, USA.
| | - Kevin Wenzel
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA
| | - Phoebe Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Owen Murray
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, 301 North Stonestreet Ave, Bethesda, MD 20892, USA
| | - Sharon Levy
- Boston Children's Hospital, Division of Addiction Medicine, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Emma Fredyma
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
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Todd Arnedt J, Conroy DA, Stewart H, Yeagley E, Bowyer G, Bohnert KM, Ilgen MA. Cognitive behavioral therapy for insomnia to reduce cannabis use: Results from a pilot randomized controlled trial. Drug Alcohol Depend 2023; 246:109835. [PMID: 36940598 DOI: 10.1016/j.drugalcdep.2023.109835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Individuals with regular cannabis use demonstrate adverse health outcomes, yet infrequently seek treatment. Insomnia, a common co-occurring complaint, could be targeted to reduce cannabis use and improve functioning in these individuals. In an intervention development study, we refined and tested the preliminary efficacy of a telemedicine-delivered CBT for insomnia tailored to individuals with regular cannabis use for sleep (CBTi-CB-TM). METHODS In this single-blind randomized trial, fifty-seven adults (43 women, mean age 37.6 ± 12.8 years) with chronic insomnia and cannabis use for sleep ≥3 times/week received CBTi-CB-TM (n = 30) or sleep hygiene education (SHE-TM, n = 27). Participants completed self-reported assessments of insomnia (Insomnia Severity Index [ISI]) and cannabis use (Timeline Followback [TLFB] and daily diary data) at pre-treatment, post-treatment, and 8-week follow-up. RESULTS ISI scores improved significantly more in the CBTi-CB-TM compared to SHE-TM condition (β = -2.83, se=0.84, P = 0.004, d=0.81). At 8-week follow-up, 18/30 (60.0 %) CBTi-CB-TM compared to 4/27 (14.8 %) SHE-TM participants were in remission from insomnia (X2 =12.8, P = 0.0003). The TLFB showed a small reduction in past 30-day cannabis use for both conditions (β = -0.10, se=0.05, P = 0.026); CBTi-CB-TM participants demonstrated greater post-treatment reductions in the % of days cannabis was used within 2 h of bedtime (-29.1 ± 7.9 % fewer days vs. 2.6 ± 8.0 % more days, P = 0.008). CONCLUSIONS CBTi-CB-TM is feasible, acceptable, and demonstrated preliminary efficacy for improving sleep and cannabis-related outcomes among non-treatment-seeking individuals with regular cannabis use for sleep. Although sample characteristics limit generalizability, these findings support the need for adequately powered randomized controlled trials with longer follow-up periods.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Haylie Stewart
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Emily Yeagley
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Gabrielle Bowyer
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road Room B601, East Lansing, MI 48824, USA
| | - Mark A Ilgen
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Problem drinking recognition among UK military personnel: prevalence and associations. Soc Psychiatry Psychiatr Epidemiol 2023; 58:193-203. [PMID: 35661230 PMCID: PMC9922231 DOI: 10.1007/s00127-022-02306-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Despite the higher prevalence of problem drinking in the UK military compared to the general population, problem recognition appears to be low, and little is known about which groups are more likely to recognise a problem. This study examined prevalence of problem drinking recognition and its associations. METHODS We analysed data from 6400 regular serving and ex-serving personnel, collected in phase 3 (2014-2016) of the King's Centre for Military Health Research cohort study. MEASUREMENTS Participants provided sociodemographic, military, health and impairment, life experiences, problem drinking, and problem recognition information. Problem drinking was categorised as scores ≥ 16 in the AUDIT questionnaire. Associations with problem recognition were examined with weighted logistic regressions. FINDINGS Among personnel meeting criteria for problem drinking, 49% recognised the problem. Recognition was most strongly associated (ORs ≥ 2.50) with experiencing probable PTSD (AOR = 2.86, 95% CI = 1.64-5.07), social impairment due to physical or mental health problems (AOR = 2.69, 95% CI = 1.51-4.79), adverse life events (AOR = 2.84, 95% CI = 1.70-4.75), ever being arrested (AOR = 2.99, CI = 1.43-6.25) and reporting symptoms of alcohol dependence (AOR = 3.68, 95% CI = 2.33-5.82). To a lesser extent, recognition was also statistically significantly associated with experiencing psychosomatic symptoms, feeling less healthy, probable common mental health disorders, and increased scores on the AUDIT. CONCLUSION Half of UK military personnel experiencing problem drinking does not self-report their drinking behaviour as problematic. Greater problem drinking severity, poorer mental or physical health, and negative life experiences facilitate problem recognition.
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Robinson CSH, Claus ED, Calhoun V, Swartz M, Fokas K, Witkiewitz K. Association between empathy and drinking among a community sample of heavy drinkers: Sex differences and neural correlates. Addict Behav 2022; 132:107346. [PMID: 35533589 PMCID: PMC9547551 DOI: 10.1016/j.addbeh.2022.107346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
Alcohol use disorder (AUD) is a major health problem, yet most individuals with AUD do not perceive a need for formal treatment and do not receive treatment. The lack of treatment seeking among individuals with AUD may suggest a lack of self-awareness and insight into the seriousness of AUD related problems, as well as lack of empathy for the impact of one's drinking on others. Recent work has suggested that empathy may be impaired among individuals seeking treatment for AUD. Further these impairments may differ by sex such that males with lower empathy reported more drinking consequences and greater drinking intensity, but there was no association between empathy and drinking among females. The current study used regression analyses (alpha = 0.05) to examine the association between empathy (as measured by the four scales of the Interpersonal Reactivity Index), independent components of gray matter volume in regions associated with empathy, and drinking variables among non-treatment seeking drinkers with AUD (N = 136) and also examined these effects by sex. Results showed greater perspective taking was associated with less temporoparietal and frontotemporal gray matter volume (B(SE) = -0.912 (0.043), p = 0.034). An interaction between perspective taking and sex was associated with craving, such that higher perspective taking was associated with less craving for males only (B(SE) = -0.48 (0.243), p = 0.049; R2 = 0.087). Empathic concern was related to lower percent heavy drinking days for both males and females (B(SE) = -1.57 (0.743), p = 0.035; R2 = 0.11). The current study found empathy may be an important predictor of craving for males and frequency of heavy drinking for males and females. Future work should investigate whether empathy predicts treatment seeking.
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Affiliation(s)
- Charles S H Robinson
- The University of New Mexico, USA; The Mind Research Network, USA; The University of Chicago, USA.
| | - Eric D Claus
- The Mind Research Network, USA; The Pennsylvania State University, USA
| | - Vince Calhoun
- The Mind Research Network, USA; Georgia State University, USA
| | - Megan Swartz
- The University of New Mexico, USA; The Mind Research Network, USA
| | | | - Katie Witkiewitz
- The University of New Mexico, USA; The Mind Research Network, USA
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Correlates of cannabis use disorder in the United States: A comparison of logistic regression, classification trees, and random forests. J Psychiatr Res 2022; 151:590-597. [PMID: 35636037 DOI: 10.1016/j.jpsychires.2022.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
Although several recent studies have examined psychosocial and demographic correlates of cannabis use disorder (CUD) in adults, few, if any, recent studies have evaluated the performance of machine learning methods relative to standard logistic regression for identifying correlates of CUD. The present study used pooled data from the 2015-2018 National Survey on Drug Use and Health to evaluate psychosocial and demographic correlates of CUD in adults. In addition, we compared the performance of logistic regression, classification trees, and random forest methods in classifying CUD. When comparing the performance of each method on the test data set, classification trees (AUC = 0.84, 95%CI: 0.82, 0.85) and random forest (AUC = 0.83, 95%CI: 0.82, 8.05) performed similarly and superior to logistic regression (AUC = 0.77, 95%CI: 0.74, 0.79). Results of the random forests reveal that marital status, risk propensity, age, and cocaine dependence variables contributed most to node purity, whereas model accuracy would decrease significantly if county type, income, race, and education variables were excluded from the model. One possible approach to improving the efficiency, interpretability, and clinical insights of CUD correlates is the employment of machine learning techniques.
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6
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Lee WC, Chang HM, Huang MC, Pan CH, Su SS, Tsai SY, Chen CC, Kuo CJ. Increased medical utilization and psychiatric comorbidity following a new diagnosis of methamphetamine use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 48:245-254. [PMID: 34670448 DOI: 10.1080/00952990.2021.1979990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evidence of patterns of medical utilization and distribution of comorbidities among individuals using methamphetamine remains limited. OBJECTIVE This study aims to investigate changes in medical utilization and comorbidities before and after a diagnosis of methamphetamine use disorder. METHODS A total of 3321 cases (79% were male) of methamphetamine use disorder between January 1, 1996, and December 31, 2012, were identified from Psychiatric Inpatient Medical Claims database in Taiwan. Information was collected on demographics, diagnoses, and medical utilizations. The date of newly diagnosed with methamphetamine use disorder was defined as the baseline. Mirror-image study design was used to compare changes in medical utilization and comorbidities between the pre-baseline period (within 1 year before diagnosis) and the post-baseline period (within 1 year after diagnosis). Conditional logistic regression was used to estimate changes in medical utilization and comorbidities. RESULTS Most cases (77%) were first identified in a psychiatric department. There is a significant increase (P < .001) in psychiatric admission (odds ratio[OR] = 2.19), psychiatric emergency visits (OR = 1.31), and psychiatric outpatient visits (OR = 1.15) after diagnosis. Multivariable analysis revealed significantly increased risks (P < .001) of non-methamphetamine drug induced mental disorders (adjusted OR[aOR] = 29.47), schizophrenia (aOR = 2.62), bipolar disorder (aOR = 2.14), organic mental disorder (aOR = 1.82), and upper respiratory tract infection (aOR = 2.03) after diagnosis. CONCLUSIONS We found significant increases of medical utilization and psychiatric comorbidities after diagnosed with methamphetamine use disorder. These findings may reflect the problem of delayed diagnosis and treatment. Enhancement of early identification of methamphetamine use disorder in general practice is required for early intervention and decreased subsequent morbidities.
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Affiliation(s)
- Wan-Chen Lee
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Ming-Chyi Huang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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7
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Dogan J, Stevens-Watkins D, Knighton JS, Wheeler P, Hargons C. Perceived need for drug treatment among African American male drug-using prisoners. J Subst Abuse Treat 2021; 120:108166. [PMID: 33298302 PMCID: PMC7733029 DOI: 10.1016/j.jsat.2020.108166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Since 2016, African Americans have experienced the largest increase in cocaine-related drug overdose deaths compared to other racial/ethnic groups. African American male prisoners who used drugs prior to incarceration are at an increased risk for relapse and overdose upon community re-entry. Using the Theory of Planned Behavior as a guiding framework, this study examined correlates of perceived need for treatment among 193 drug-using incarcerated African American men nearing release. Linear regression analyses revealed that the number of lifetime drug overdoses, severity of legal problems, and previous drug treatment significantly predicted a need for treatment. Further, more frequent drug use, specifically crack cocaine, in the month prior to incarceration predicted a higher perceived need for drug treatment. Implications suggest this population demonstrates a need for treatment, which may be exacerbated by re-entry stressors. Preventative measures, including culturally tailored treatment and transitional care from prison to community-based services, are necessary to reduce risk of relapse and overdose among this group.
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Affiliation(s)
- Jardin Dogan
- University of Kentucky, Department of Educational, School, and Counseling Psychology, , 36 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Danelle Stevens-Watkins
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Joi-Sheree Knighton
- Center for Forensic Psychiatry, Michigan Department of Health and Human Services (MDHHS), P.O. Box 2060, Ann Arbor, MI 48160, United States of America.
| | - Paris Wheeler
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Candice Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 239 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
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8
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Dillon PJ, Kedia SK, Isehunwa OO, Sharma M. Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study. Subst Abuse 2020; 14:1178221820940682. [PMID: 32922019 PMCID: PMC7457698 DOI: 10.1177/1178221820940682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this study was to explore perspectives on motivations for treatment engagement from substance use disorder (SUD) clients in a long-term residential rehabilitation program. DESIGN AND METHODS A convenience sample of 30 clients who were enrolled in a year-long SUD treatment program at a residential rehabilitation facility took part in in-depth interviews. Interview transcripts were analyzed using the directed content analysis approach. RESULTS Participant accounts indicated that their treatment engagement was motivated by factors that aligned with the six primary constructs of the Health Belief Model: (i) perceived susceptibility (eg, believing that their substance use required intervention and that they were prone to relapse), (ii) perceived severity (eg, substance use negatively impacted their health and harmed their close relationships), (iii) perceived benefits (eg, opportunities for a better life, reconnecting with family members and close friends, & avoiding legal consequences), (iv) perceived barriers (eg, the length of the treatment program), (v) cues to actions (eg, decisive moments, elements of the treatment program, & faith and spirituality), and (vi) self-efficacy in remaining abstinent (eg, treatment program provided them with skills and experiences to maintain long-term sobriety). DISCUSSION Our analysis indicates that participants' treatment engagement was linked to their beliefs regarding the severity of their substance use disorder, their treatment program's ability to help them avoid future relapse, and their own capability to act upon the strategies and resources provided by the treatment program. A theoretical understanding of these aspects can contribute to the future planning of precision interventions.
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Affiliation(s)
- Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Oluwaseyi O Isehunwa
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
| | - Manoj Sharma
- School of Public Health, University of Nevada, Las Vegas, NV, USA
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Moeller SJ, Platt JM, Wu M, Goodwin RD. Perception of treatment need among adults with substance use disorders: Longitudinal data from a representative sample of adults in the United States. Drug Alcohol Depend 2020; 209:107895. [PMID: 32078975 PMCID: PMC7418940 DOI: 10.1016/j.drugalcdep.2020.107895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Most individuals with substance use disorders (SUDs) do not seek treatment. Lack of perceived treatment need (PTN) is one contributing factor, but little is known about PTN over time. We estimated whether PTN changed over three years among those with SUDs in the United States and identified select variables, including sociodemographics and symptom burden, that predict malleability vs. stability of PTN. METHODS Data were from Waves 1 (collected 2001-2002) and 2 (collected 2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); 1695 adults who met DSM criteria for alcohol or non-alcohol SUD at Wave 1 and maintained ≥1 diagnostic symptom at Wave 2 were included. RESULTS Most individuals with SUDs (77.2%) did not perceive a need for treatment at Wave 1 baseline. Only about 1 in 8 individuals not perceiving a need for treatment in Wave 1 came to perceive a need in Wave 2 (adjusted odds ratio = 0.18, 99% confidence interval = 0.11-0.29). In contrast, about half the individuals who perceived a need for treatment in Wave 1 no longer did so in Wave 2, despite maintaining ≥1 SUD symptom. Married respondents, and respondents with more SUD symptoms, were more likely to transition from low- to high-PTN status three years later. Respondents with incomes >$35,000 were less likely to transition to high-PTN status three years later. CONCLUSIONS PTN was more likely to decline than increase over time. Low PTN appears to be stable among adults with SUDs in the United States, presenting a potentially enduring barrier to treatment-seeking.
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Affiliation(s)
- Scott J. Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Melody Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
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10
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Han B, Lopez EI, McCance-Katz EF. Commentary on Harris et al. (2019): Increasing perceived need for substance use treatment among people with substance use disorders. Addiction 2019; 114:1460-1461. [PMID: 31240755 DOI: 10.1111/add.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Beth Han
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - Elizabeth I Lopez
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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Ameral V, Yule A, McKowen J, Bergman BG, Nargiso J, Kelly JF. A Naturalistic Evaluation of a Group Intervention for Parents of Youth with Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2019; 38:379-394. [PMID: 32863559 PMCID: PMC7451897 DOI: 10.1080/07347324.2019.1633978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Parents of youth with substance use disorders (SUDs) often play a vital role in successful treatment, yet little is known about interventions designed to help them cope with the stress of this role, especially as delivered in real-world settings. Evaluations of such interventions could potentially inform adaptations to enhance their clinical utility. Parents of youth with SUDs attending a clinician-led group based on the CRAFT model completed measures at intake, 4- and 8-weeks. Parents (n=545) attended an average of 3.7 sessions; 12% completed all 8 weeks. Analysis of demographic predictors of retention indicated that older parents attended more sessions on average. Overall stress did not change across time points (p>0.05). However, parents reported improvement in parent empowerment as measured by the Parent Empowerment Scale, a novel measure of parent empowerment in coping with their child's SUD (p<0.001). Clinician led evidence-informed group services may improve parents' perceived ability to help their child with their SUD. Low retention rates highlight the need to better understand the factors contributing to retention, and the potential value of adaptations to shorten the intervention. Programs serving youth with SUDs may wish to consider integrating such group services to support parents.
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Affiliation(s)
- Victoria Ameral
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130
- Department of Psychiatry, Boston University School of Medicine, 72 E Concord St., Boston, MA 02118
| | - Amy Yule
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
| | - James McKowen
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, Suite 601, Boston, MA 02114
| | - Jessica Nargiso
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
| | - John F Kelly
- Addiction Recovery Management Service, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, Suite 601, Boston, MA 02114
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Romo E, Ulbricht CM, Clark RE, Lapane KL. Correlates of specialty substance use treatment among adults with opioid use disorders. Addict Behav 2018; 86:96-103. [PMID: 29551551 DOI: 10.1016/j.addbeh.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/26/2018] [Accepted: 03/09/2018] [Indexed: 11/17/2022]
Abstract
AIMS To identify factors associated with the receipt of specialty substance use treatment among adults with opioid use disorders (OUD). DESIGN Cross-sectional study based on 2010-2014 National Surveys on Drug Use and Health (NSDUH). SETTING AND PARTICIPANTS Adults with a past-year OUD (n = 2488). The sample is representative of non-institutionalized US adults. MEASUREMENTS Past-year OUD was determined using DSM-IV criteria. Past-year specialty substance use treatment was defined as receiving treatment for drug use at any of the following locations: rehabilitation facilities, hospitals (inpatient only), outpatient mental health centers, private doctors' offices, or methadone clinics. Multivariable logistic regression models were used to measure the independent association between potential correlates and specialty substance use treatment receipt. FINDINGS Of adults with an OUD, 8.3% received past-year specialty substance use treatment. In a fully adjusted logistic regression model, the following factors were associated with increased odds of receiving specialty substance use treatment: ≥ 35 years old (adjusted Odds Ratio (aOR) = 2.55, 95% Confidence Interval (CI) = 1.04-6.26); unemployment (aOR = 1.92, 95% CI = 1.02-3.61); not in the labor force (aOR = 2.16, 95% CI = 1.15-4.06); never been married (aOR = 2.14, 95% CI = 1.04-4.39); arrested in past 12 months (aOR = 4.43, 95% CI = 2.45-7.99); opioid dependence (aOR = 3.82, 95% CI = 2.06-7.10); alcohol use disorder (aOR = 2.44, 95% CI = 1.44-4.11); and another drug use disorder (aOR = 3.22, 95% CI = 1.95-5.32). Living in a non-metropolitan county (aOR = 0.29, 95% CI = 0.12-0.68) and fair/poor health (aOR = 0.38, 95% CI = 0.17-0.86) were associated with decreased odds of receiving specialty substance use treatment. CONCLUSIONS These findings suggest a need for the following efforts: strategies to increase individuals' recognition of their need for OUD treatment, expansion of insurance coverage for substance use treatment, expansion of earlier intervention services, adoption of a chronic care approach to substance use treatment, and an expansion of treatment capacity for rural communities.
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Affiliation(s)
- Eric Romo
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Robin E Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Robinson CSH, Fokas K, Witkiewitz K. Relationship between empathic processing and drinking behavior in project MATCH. Addict Behav 2018; 77:180-186. [PMID: 29054077 DOI: 10.1016/j.addbeh.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/24/2017] [Accepted: 10/01/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Family relationships, social connectedness and a greater network of supportive others each predict better drinking outcomes among individuals with alcohol use disorder (AUD). The association between social factors and drinking may be related to the ability of individuals to take the perspectives of others' mental and emotional states, defined as empathic processing (EP). As such, it may be the case that EP is associated with social support (SS) and drinking behavior among individuals with AUD, yet few prior studies have attempted to define EP in an AUD sample. METHODS The current study was a secondary data analysis of Project MATCH (N=1726) using structural equation modeling to model EP as a latent factor. The study also sought to test the baseline associations between EP, SS, and drinking behavior, as well as sex differences in the associations between EP, SS, and drinking. It was hypothesized that EP would be positively associated with SS and negatively associated with drinking behavior. RESULTS Results suggested adequate model fit of the EP construct. Structural equation models indicated significant associations between EP, SS, and both drinking consequences and percent drinking days, but only for males. Males reported significantly lower EP and SS from friends, but more SS from family, compared to females. EP was not related to drinking among females. CONCLUSIONS The current study validated a model of EP in a treatment-seeking sample of individuals with alcohol use disorder. Future work may consider EP as a treatment-modifiable risk factor for drinking frequency and consequences in males.
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Affiliation(s)
- Charles S H Robinson
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, United States.
| | - Kathryn Fokas
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, United States
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, United States
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Davis JP, Bergman BG, Smith DC, Kelly JF. Testing a Matching Hypothesis for Emerging Adults in Project MATCH: During-Treatment and One-Year Outcomes. J Stud Alcohol Drugs 2017; 78:140-145. [PMID: 27936374 DOI: 10.15288/jsad.2017.78.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Compared with older adults, emerging adults (18-29 years old) entering treatment typically have less severe alcohol use consequences. Also, their unique clinical presentations (e.g., modest initial abstinence motivation) and developmental contexts (e.g., drinking-rich social networks) may make a straightforward implementation of treatments developed for adults less effective. Yet, this has seldom been examined empirically. This study was a secondary analysis of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) data examining (a) overall differences between emerging adults and older adults (≥30 years old) on outcomes during treatment and at 1-year follow-up, and (b) whether emerging adults had poorer outcomes on any of the three Project MATCH treatments in particular. METHOD Participants were 267 emerging adults and 1,459 older adults randomly assigned to individually delivered cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), or 12-step facilitation (TSF). Multilevel growth curve models tested differences on percentage of days abstinent (PDA) and drinks per drinking day (DDD) by age group and treatment assignment. RESULTS During treatment, compared with older adults, emerging adults reported more DDD but similar PDA. Further, emerging adults assigned to TSF had less PDA and more DDD than emerging adults and older adults assigned to CBT or MET during treatment (i.e., emerging adults in TSF has poorer outcomes initially), but this matching effect was not evident at 1-year follow-up. CONCLUSIONS This study is among the first to test age group differences across three psychosocial interventions shown to be efficacious treatments for alcohol use disorder. Although emerging adults generally did as well as their older counterparts, they may require a more developmentally sensitive approach to bolster TSF effects during treatment.
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Affiliation(s)
- Jordan P Davis
- University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Brandon G Bergman
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas C Smith
- University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Wu LT, Zhu H, Mannelli P, Swartz MS. Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States. Drug Alcohol Depend 2017; 177:153-162. [PMID: 28599214 PMCID: PMC5538354 DOI: 10.1016/j.drugalcdep.2017.03.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The increase in cannabis potency may have treatment implications for cannabis use disorder (CUD). Given the reported increase in prevalence of cannabis use among adults, there is a need to understand substance use treatment needs for CUD. METHODS We examined demographics and behavioral health indicators of adults aged ≥18 years that met criteria for past-year CUD (n=10,943) in the 2005-2013 National Surveys on Drug Use and Health. We determined prevalence and correlates of past-year treatment use for alcohol/drug, any drug, and cannabis use related problems, to inform treatment efforts for CUD. RESULTS The majority of adults with past-year CUD were young adults aged 18-25 or men, had low income, and did not attend college. Two-thirds of adults with CUD met criteria for cannabis dependence, which was comparatively common among younger adults, women, low-income or publicly insured adults, and college-educated adults. Nicotine dependence (40.92%) and alcohol (44.07%) or other drug use disorder (19.70%) were prevalent among adults with CUD. Overall, less than 13% of adults with CUD had received alcohol/drug use treatment the past year; only 7.8% received cannabis-specific treatment. There was no significant yearly variation in treatment use prevalence over 9 years. In particular, Asian-Americans, women, and college-educated adults underutilized cannabis-specific treatment. CONCLUSIONS This large sample of adults with CUD reveals pervasive underutilization of cannabis-related treatment, especially in women, married adults, and those with college education, despite a high proportion of comorbid behavioral health problems.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
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16
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Knudsen HK, Studts JL. Perceived Impacts of the Affordable Care Act: Perspectives of Buprenorphine Prescribers. J Psychoactive Drugs 2017; 49:111-121. [PMID: 28296579 DOI: 10.1080/02791072.2017.1295335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Affordable Care Act (ACA) has been heralded as a major policy change that is expected to transform the delivery of substance use disorder (SUD) treatment. Few studies have reported on the perceived impacts of ACA from the perspectives of SUD treatment providers, such as physicians who prescribe buprenorphine to patients with opioid use disorder. The present study describes buprenorphine prescribers' perceptions regarding impacts of the ACA on the delivery of buprenorphine and examines whether state-level approaches to implementing ACA are associated with its perceived impacts. Data are drawn from a national sample of current buprenorphine prescribers (n = 1,174) who were surveyed by mail. On average, buprenorphine prescribers reported ambivalence regarding the impacts of the ACA, as indicated by a mean of 2.75 (SD = 0.69) on a scale that ranged from 1 ("strongly disagree") to 5 ("strongly agree"). A multi-level mixed-effects regression model indicated that physicians practicing in states that were supportive of ACA, as indicated by adopting both the Medicaid expansion and implementing a state-based health insurance exchange, had more positive perceptions of the ACA than physicians in states that had declined both of these policies. This study suggests that state approaches to ACA may be associated with varied impacts.
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Affiliation(s)
- Hannah K Knudsen
- a Associate Professor, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,b Associate Professor, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Jamie L Studts
- b Associate Professor, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
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17
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Verissimo ADO, Grella CE. Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems. J Subst Abuse Treat 2017; 75:54-61. [PMID: 28237055 DOI: 10.1016/j.jsat.2016.12.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/18/2016] [Accepted: 12/03/2016] [Indexed: 12/19/2022]
Abstract
This study examines reasons why people do not seek help for alcohol or drug problems by gender and race/ethnicity using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey. Multivariate models were fit for 3 barriers to seeking help (structural, attitudinal, and readiness for change) for either alcohol or drug problems, controlling for socio-demographic characteristics and problem severity. Predicted probabilities were generated to evaluate gender differences by racial/ethnic subgroups. Over three quarters of the samples endorsed attitudinal barriers related to either alcohol or drug use. Generally, women were less likely to endorse attitudinal barriers for alcohol problems. African Americans and Latina/os were less likely than Whites to endorse attitudinal barriers for alcohol problems, Latina/os were less likely than Whites to endorse readiness for change barriers for alcohol and drug problems, however, African Americans were more likely to endorse structural barriers for alcohol problems. Comparisons within racial/ethnic subgroups by gender revealed more complex findings, although across all racial/ethnic groups women endorsed attitudinal barriers for alcohol problems more than men. Study findings suggest the need to tailor interventions to increase access to help for alcohol and drug problems that take into consideration both attitudinal and structural barriers and how these vary across groups.
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Affiliation(s)
- Angie Denisse Otiniano Verissimo
- Department of Health Science, California State University, San Bernardino, 5500 University Parkway, San Bernardino, CA 92407, USA.
| | - Christine E Grella
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025-7535, USA.
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18
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Merrin GJ, Davis JP, Berry D, D'Amico EJ, Dumas TM. The longitudinal associations between substance use, crime, and social risk among emerging adults: A longitudinal within and between-person latent variables analysis. Drug Alcohol Depend 2016; 165:71-8. [PMID: 27242288 DOI: 10.1016/j.drugalcdep.2016.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The reciprocal relationship between crime and substance use is well known. However, when examining this relationship, no study to date has disaggregated between- and within-person effects, which represents a more methodologically sound and developmentally-appropriate analytic approach. Further, few studies have considered the role of social risk (e.g., deviant peers, high-risk living situations) in the aforementioned relationship. We examined these associations in a group of individuals with heightened vulnerability to substance use, crime and social risk: emerging adults (aged 18-25 years) in substance use treatment. METHODS Participants were 3479 emerging adults who had entered treatment. We used auto-regressive latent growth models with structured residuals (ALT-SR) to examine the within-person cross-lagged association between crime and substance use and whether social risk contributed to this association. A taxonomy of nested models was used to determine the structural form of the data, within-person cross-lagged associations, and between-person associations. RESULTS In contrast to the extant literature on cross-lagged relations between crime and substance use, we found little evidence of such relations once between- and within-person relations were plausibly disaggregated. Yet, our results indicated that within-person increases in social risk were predictive of subsequent increases in crime and substance use. Post-hoc analyses revealed a mediation effect of social risk between crime and substance use. CONCLUSIONS Findings suggest the need to re-think the association between crime and substance use among emerging adults. Individuals that remain connected to high-risk social environments after finishing treatment may represent a group that could use more specialized, tailored treatments.
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Affiliation(s)
- Gabriel J Merrin
- University of Illinois at Urbana-Champaign, Department of Educational Psychology, United States.
| | - Jordan P Davis
- University of Illinois at Urbana-Champaign, School of Social work, United States
| | - Daniel Berry
- University of Illinois at Urbana-Champaign, Department of Educational Psychology, United States
| | | | - Tara M Dumas
- Huron University College at Western University, London, Ontario, Canada
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Common Mental Disorder Diagnosis and Need for Treatment are Not the Same: Findings from the NEMESIS Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:572-581. [DOI: 10.1007/s10488-016-0745-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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Mericle AA, Arria AM, Meyers K, Cacciola J, Winters KC, Kirby K. National Trends in Adolescent Substance Use Disorders and Treatment Availability: 2003-2010. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015; 24:255-263. [PMID: 26388683 DOI: 10.1080/1067828x.2013.829008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examines trends in adolescent substance use disorders (SUDs) and treatment utilization in the US using data from the National Household Survey on Drug Use and Health (NSDUH) and data from the National Survey of Substance Abuse Treatment Services (N-SSATS). Results indicate an overall decrease in the percent of adolescents meeting past year criteria for an alcohol or illicit drug disorder between 2003 and 2010, but the percent of adolescents meeting criteria who had not received any treatment in the past year was substantial and has remained stable since 2003. In 2010, less than 30% of facilities participating in the N-SSATS survey indicated that they offered special programming for adolescents, reflecting an overall decrease since 2003.
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Affiliation(s)
| | | | | | - John Cacciola
- Treatment Research Institute ; University of Pennsylvania
| | - Ken C Winters
- Treatment Research Institute ; University of Minnesota
| | - Kim Kirby
- Treatment Research Institute ; University of Pennsylvania
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21
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Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug Alcohol Depend 2015; 149:136-44. [PMID: 25725934 PMCID: PMC4789763 DOI: 10.1016/j.drugalcdep.2015.01.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about to what extent treatment-seeking behavior varies across individuals with alcohol abuse, alcohol dependence, drug abuse, and drug dependence. METHODS The sample included respondents from the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who reported a lifetime diagnosis alcohol abuse, alcohol dependence, drug abuse, or drug dependence. Unadjusted and adjusted hazard ratios are presented for time to first treatment contact by sociodemographic characteristics and comorbid psychiatric disorders. Individuals were censored from the analyses if their condition remitted prior to seeking treatment. RESULTS In the first year after disorder onset, rates of treatment-seeking were 13% for drug dependence, 5% for alcohol dependence, 2% for drug abuse, and 1% for alcohol abuse. The lifetime probability of seeking treatment among individuals who did not remit was also highest for drug dependence (90%), followed by drug abuse (60%), alcohol dependence (54%), and alcohol abuse (16%). Having had previous treatment contact for a substance use disorder (SUD) increased the probability of seeking treatment for another SUD. By contrast, an early age of SUD onset, belonging to an older cohort, and a higher level of education decreased the lifetime probability of treatment contact for SUD. The role of comorbid mental disorders was more complex, with some disorders increasing and other decreasing the probability of seeking treatment. CONCLUSIONS Given high rates of SUD and their substantial health and economic burden, these patterns suggest the need for innovative approaches to increase treatment access for individuals with SUD.
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Affiliation(s)
- Carlos Blanco
- New York State Psychiatric Institute, New York, NY, USA.
| | - Miren Iza
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | | | - Enrique Baca-García
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, USA
| | - Mark Olfson
- New York State Psychiatric Institute, New York, NY, USA
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22
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Chapman C, Slade T, Hunt C, Teesson M. Delay to first treatment contact for alcohol use disorder. Drug Alcohol Depend 2015; 147:116-21. [PMID: 25533894 DOI: 10.1016/j.drugalcdep.2014.11.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study explored the patterns and correlates of time to first treatment contact among people with alcohol use disorder (AUD) in Australia. Specifically it examined the relationship between sex, birth cohort, onset of AUD symptoms, severity, comorbidity, symptom type and time to first treatment contact (treatment delay) among those with alcohol abuse and dependence in a large population sample. METHODS Data came from the 2007 Australian National Survey of Mental Health and Wellbeing (N=8841). A modified version of the World Health Organization's Composite International Diagnostic Interview was used to determine the presence and age of onset of DSM-IV AUD and other mental disorders and the age at which respondents first sought treatment for alcohol or other drug-related problems. RESULTS Median time to first treatment contact for an AUD was 18 years (14 years dependence, 23 years abuse). Projected lifetime treatment rates were 78.1% for alcohol dependence and 27.5% for abuse. Those with earlier onset and from older cohorts reported longer delay and were less likely to ever seek treatment compared to those with later onset or from more recent cohorts. Those with comorbid anxiety but not mood disorder, or who reported alcohol-related role disruption or recurrent interpersonal problems were more likely to ever seek treatment and reported shorter delay compared to those who did not report these symptoms. CONCLUSIONS Treatment delay for alcohol use disorder in Australia is substantial. Those with earlier onset and those with comorbid mood disorder should be a target for earlier treatment.
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Affiliation(s)
- Cath Chapman
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Tim Slade
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, NSW 2006, Australia
| | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia
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23
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Wu LT, Blazer DG. Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders. Psychol Med 2015; 45:481-494. [PMID: 25066115 PMCID: PMC4272661 DOI: 10.1017/s0033291714001330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. METHOD We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. RESULTS NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. CONCLUSIONS Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.
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Affiliation(s)
- L.-T. Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - D. G. Blazer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
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Paljärvi T, Martikainen P, Leinonen T, Pensola T, Mäkelä P. Non-employment histories of middle-aged men and women who died from alcohol-related causes: a longitudinal retrospective study. PLoS One 2014; 9:e98620. [PMID: 24874518 PMCID: PMC4038621 DOI: 10.1371/journal.pone.0098620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/06/2014] [Indexed: 11/23/2022] Open
Abstract
Background Long-term patterning of non-employment among problem drinkers is poorly understood. We determined the level and timing of non-employment, and the relative contribution of various types of non-employment among middle-aged persons who died of alcohol-related causes. Methods We conducted a longitudinal retrospective register-based study of Finnish men and women aged 45–64 years who died of alcohol-related causes (n = 15 552) or other causes (n = 39 166) in the period 2000–07, or who survived (n = 204 422) until the end of 2007. We traced back the number of days in employment and non-employment for up to 17 years before death or before the end of the study period for the survivors. Results The majority (≥56%) of persons who died of alcohol-related causes were in employment up to ten years before death. Over the 17-year period before death, those who died of alcohol-related causes were in employment on average two years less (mean 6.3 years, 95%CI 6.2–6.4) than those dying of other causes (8.2, 8.1–8.3), and five years less than survivors (11.6, 11.5–11.7), when sex and age were adjusted for. The relative role of various types of non-employment differed markedly across the two mortality groups. Among those who died of alcohol-related causes, unemployment accounted for 54% of the total burden of non-employment, in comparison with 29% among those who died of other causes. In contrast, disability pension accounted for 41% of the total burden of non-employment among those who died of alcohol-related causes, but 65% among those who died of other causes. Conclusions The results indicate the feasibility of preventing movement out of employment among middle-aged men and women with severe alcohol-related harm, provided that they are identified early on during their working careers and offered effective interventions.
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Affiliation(s)
- Tapio Paljärvi
- Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland
- * E-mail:
| | | | - Taina Leinonen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Tiina Pensola
- Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Pia Mäkelä
- Alcohol and Drugs Unit, National Institute for Health and Welfare, Helsinki, Finland
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A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature. Prim Health Care Res Dev 2014; 16:492-505. [PMID: 24818752 DOI: 10.1017/s1463423614000164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM This article presents a conceptual model to help facilitate the transition from primary care to specialty substance use disorder (SUD) care for appropriate patients. BACKGROUND Substance misuse is a common health condition among patients presenting to primary care settings and may complicate the treatment of chronic health conditions such as diabetes and hypertension. It is therefore critical that primary care providers be prepared to identify and determine appropriate treatment options for patients presenting with substance misuse. METHODS We conducted a narrative review that occurred in three stages: literature review of health care transition models, identification of conceptual domains common across care transition models, and identification of SUD-specific model elements. Findings The conceptual model presented describes patient, provider, and system-level facilitators and barriers to the transition process, and includes intervention strategies that can be utilized by primary care clinics to potentially improve the process of transitioning patients from primary care to SUD care. Recognizing that primary care clinics vary in available resources, we present three examples of care practices along an intensity continuum from low (counseling and referral) to moderate (telephone monitoring) to high (intensive case management) resource demands for adoption. We also provide a list of common outcomes clinics might consider when evaluating the impact of care transition practices in this patient population; these include process outcomes such as patients' increased knowledge of available treatment resources, and health outcomes such as patients' reduced substance use and better quality of life.
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Myers B, Kline TL, Doherty IA, Carney T, Wechsberg WM. Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa. BMC Psychiatry 2014; 14:100. [PMID: 24708789 PMCID: PMC3977683 DOI: 10.1186/1471-244x-14-100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/31/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Initiation of treatment for substance use disorders is low among young women from disadvantaged communities in Cape Town, South Africa. Yet little is known about the factors that influence perceived need for treatment (a determinant of treatment entry) within this population. METHODS Baseline data on 720 young, drug-using women, collected as part of a randomized field experiment were analyzed to identify predisposing, enabling and health need factors associated with perceived need for treatment. RESULTS Overall, 46.0% of our sample perceived a need for treatment. Of these participants, 92.4% wanted treatment for their substance use problems but only 50.1% knew where to access services. In multivariable logistic regression analyses, we found significant main effects for ethnicity (AOR = 1.54, 95% CI = 1.05-1.65), income (AOR = 0.96, 95% CI = 0.93-0.99), anxiety (AOR = 1.22, 95% CI = 1.05-1.45), and not having family members with drug problems (AOR = 1.45, 95% CI = 1.05-2.04) on perceived need for treatment. When the sample was stratified by methamphetamine use, income (AOR = 0.87, 95% CI = 0.79-0.96), awareness of treatment services (AOR =1.84, 95% CI = 1.03-3.27), anxiety (AOR =1.41, 95% CI = 1.06-1.87) and physical health status (AOR = 6.29, 95% CI = 1.56-25.64) were significantly associated with perceived need for treatment among those who were methamphetamine-negative. No variables were significantly associated with perceived need for treatment among participants who were methamphetamine-positive. CONCLUSIONS A sizeable proportion of young women who could benefit from substance use treatment do not believe they need treatment, highlighting the need for interventions that enhance perceived need for treatment in this population. Findings also show that interventions that link women who perceive a need for treatment to service providers are needed. Such interventions should address barriers that limit young women's use of services for substance use disorders.
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Affiliation(s)
- Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Tracy L Kline
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Irene A Doherty
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Tara Carney
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA,Gillings Global School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA,Psychology in the Public Interest, North Carolina State University, Raleigh, North Carolina, USA,Psychiatry and Behavioral Sciences, Duke University School of Medicine, Raleigh, North Carolina, USA
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Chi FW, Weisner C, Grella CE, Hser YI, Moore C, Mertens J. Does age at first treatment episode make a difference in outcomes over 11 years? J Subst Abuse Treat 2014; 46:482-90. [PMID: 24462221 PMCID: PMC3940137 DOI: 10.1016/j.jsat.2013.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/26/2013] [Accepted: 12/09/2013] [Indexed: 12/29/2022]
Abstract
This study examines the associations between age at first substance use treatment entry and trajectory of outcomes over 11 years. We found significant differences in individual and treatment characteristics between adult intakes first treated during young adulthood (25 years or younger) and those first treated at an older age. Compared to their first treated older age counterparts matched on demographics and dependence type, those who entered first treatment during young adulthood had on average an earlier onset for substance use but a shorter duration between first substance use and first treatment entry; they also had worse alcohol and other drug outcomes 11 years post treatment entry. While subsequent substance use treatment and 12-step meeting attendance are important for both age groups in maintaining positive outcomes, relationships varied by age group. Findings underline the importance of different continuing care management strategies for those entering first treatment at different developmental stages.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612.
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612; Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143
| | - Christine E Grella
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025
| | - Charles Moore
- Kaiser Permanente Chemical Dependency Recovery Program, Sacramento, CA 95821-6237
| | - Jennifer Mertens
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
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Ding Y, He N, Shoptaw S, Gao M, Detels R. Severity of club drug dependence and perceived need for treatment among a sample of adult club drug users in Shanghai, China. Soc Psychiatry Psychiatr Epidemiol 2014; 49:395-404. [PMID: 23715971 PMCID: PMC3797173 DOI: 10.1007/s00127-013-0713-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/15/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Examine the severity of club drug dependence and perceived need for treatment, and further identify their determinants among a sample of club drug users in Shanghai, China. METHODS Two hundred and seventy-six club drug users were recruited using respondent-driven sampling (RDS). Severity of dependence on club drugs was measured using the Severity of Dependence Scale (SDS). RESULTS 69.9% reported dependence on club drugs (i.e., SDS ≥ 4) and 36.6% reported severe dependence (i.e., SDS ≥ 6). One-eighth (12.7%) perceived need for drug treatment. Severe dependence on club drugs was more likely among those who reported recent use of ecstasy and those who had more depressive symptoms, but less likely among those reporting recent use of methamphetamine. Perceived need for treatment was more likely among those who lived with a spouse or boy/girlfriend, but less likely among those had prior drug treatment experience and more severe club drug dependence. CONCLUSIONS Our findings suggest that educational activities should be implemented to raise public awareness about the powerful addictive properties of club drugs, along with efforts to reduce stigma towards drug abuse and psychiatric disorders. Programs to motivate drug users to seek treatment and encourage treatment linkage are urgently needed.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China,Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Steven Shoptaw
- Department of Family Medicine and Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Roger Detels
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA,Correspondence to Roger Detels, Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, 90095-1772, USA;
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