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Welsh JW, Dopp AR, Durham RM, Sitar SI, Passetti LL, Hunter SB, Godley MD, Winters KC. Narrative review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00140-0. [PMID: 38537736 DOI: 10.1016/j.jaac.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/24/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE In 2014, the U.S. National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018) updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices. METHOD The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research. RESULTS Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research. CONCLUSION These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.
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Li Y, Maina G, Mousavian G, Fang Y, Twum-Antwi B, Sherstobitoff J, Amoyaw J, Pandey M. Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241244680. [PMID: 38707894 PMCID: PMC11069246 DOI: 10.1177/29768357241244680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/15/2024] [Indexed: 05/07/2024]
Abstract
Introduction Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. Methods This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. Results After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. Conclusion From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.
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Affiliation(s)
- Yiyan Li
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Geoffrey Maina
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Ghazal Mousavian
- College of Graduate and Postdoctoral Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yiting Fang
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Barbara Twum-Antwi
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | | | - Jonathan Amoyaw
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
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Earlywine JJ, Bagley SM, Rodean J, Zima BT, Chadi N, Leslie DL, Hadland SE. Medications for Alcohol Use Disorder and Retention in Care in Medicaid-Enrolled Youth, 2014-2019. J Adolesc Health 2023; 73:845-851. [PMID: 37256254 PMCID: PMC10593088 DOI: 10.1016/j.jadohealth.2023.03.005] [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: 07/15/2022] [Revised: 12/27/2022] [Accepted: 03/14/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is a pediatric-onset condition needing timely, effective treatment. Medications for AUD are part of nationally recommended treatments for youth. This study measured receipt of medications and behavioral health services for AUD and subsequent retention in care. METHODS This retrospective cohort study used claims data from > 4.7 million publicly insured youth aged 13-22 years in 15 states from 2014-2019. Timely treatment was defined as receipt of medication (naltrexone, acamprosate, or disulfiram) and/or behavioral health services within 30 days of incident AUD diagnosis. Associations of age and other characteristics with timely treatment were identified using modified Poisson regression. Retention in care (i.e., no period ≥ 60 days without claims) was studied using Cox regression. RESULTS Among 14,194 youth with AUD, 10,851 (76.4%) received timely treatment. Only 2.1% of youth received medication (alone or in combination); nearly all (97.9%) received behavioral health services only. Older (aged 16-17 years) and younger adolescents (aged 13-15 years) were 0.13 (95% confidence interval [CI], 0.07-0.26) and 0.24 (95% CI, 0.11-0.51) times as likely, respectively, to receive medications than young adults aged ≥ 21 years. Median retention in care for youth receiving medications was 119 days (interquartile range, 54-321) compared with 108 days (interquartile range, 43-243) for behavioral health services alone (p = .126). Young adults aged ≥ 18 years were 1.12 (95% CI, 1.06-1.18) times as likely to discontinue treatment compared with adolescents aged < 18 years. DISCUSSION This study found that more than seven in 10 youth received AUD treatment but only two in 100 received medications. Future studies should further characterize the effectiveness of medications and determine whether low rates of receipt represent underuse.
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Affiliation(s)
- Joel J Earlywine
- Mathematica, Seattle, Washington; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Sarah M Bagley
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - Bonnie T Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Esteban J, Suárez-Relinque C, Jiménez TI. Effects of family therapy for substance abuse: A systematic review of recent research. FAMILY PROCESS 2023; 62:49-73. [PMID: 36564902 DOI: 10.1111/famp.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.
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Affiliation(s)
- Jessica Esteban
- Facultad de Ciencias Sociales y Humanas, Campus de Teruel, Universidad de Zaragoza, Teruel, Spain
| | | | - Teresa I Jiménez
- Facultad de Ciencias Sociales y Humanas, Campus de Teruel, Universidad de Zaragoza, Teruel, Spain
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A Meta-Analysis of fMRI Studies of Youth Cannabis Use: Alterations in Executive Control, Social Cognition/Emotion Processing, and Reward Processing in Cannabis Using Youth. Brain Sci 2022; 12:brainsci12101281. [PMID: 36291215 PMCID: PMC9599849 DOI: 10.3390/brainsci12101281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Adolescent cannabis use (CU) is associated with adverse health outcomes and may be increasing in response to changing cannabis laws. Recent imaging studies have identified differences in brain activity between adult CU and controls that are more prominent in early onset users. Whether these differences are present in adolescent CU and relate to age/developmental stage, sex, or cannabis exposure is unknown. Methods: A systematic review and subsequent effect-size seed-based d mapping (SDM) meta-analysis were conducted to examine differences in blood-oxygen-level-dependent (BOLD) response during fMRI studies between CU and non-using typically developing (TD) youth. Supplemental analyses investigated differences in BOLD signal in CU and TD youth as a function of sex, psychiatric comorbidity, and the dose and severity of cannabis exposure. Results: From 1371 citations, 45 fMRI studies were identified for inclusion in the SDM meta-analysis. These studies compared BOLD response contrasts in 1216 CU and 1486 non-using TD participants. In primary meta-analyses stratified by cognitive paradigms, CU (compared to TD) youth showed greater activation in the rostral medial prefrontal cortex (rmPFC) and decreased activation in the dorsal mPFC (dmPFC) and dorsal anterior cingulate cortex (dACC) during executive control and social cognition/emotion processing, respectively. In meta-regression analyses and subgroup meta-analyses, sex, cannabis use disorder (CUD) severity, and psychiatric comorbidity were correlated with brain activation differences between CU and TD youth in mPFC and insular cortical regions. Activation differences in the caudate, thalamus, insula, dmPFC/dACC, and precentral and postcentral gyri varied as a function of the length of abstinence. Conclusions: Using an SDM meta-analytic approach, this report identified differences in neuronal response between CU and TD youth during executive control, emotion processing, and reward processing in cortical and subcortical brain regions that varied as a function of sex, CUD severity, psychiatric comorbidity, and length of abstinence. Whether aberrant brain function in CU youth is attributable to common predispositional factors, cannabis-induced neuroadaptive changes, or both warrants further investigation.
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Hsiung H, Patel K, Hundal H, Baccouche BM, Tsao KW. Preventing Substance Abuse in Adolescents: A Review of High-Impact Strategies. Cureus 2022; 14:e27361. [PMID: 36046301 PMCID: PMC9417217 DOI: 10.7759/cureus.27361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
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Treatment completion among justice-involved youth engaged in behavioral health treatment studies in the United States: A systematic review and meta-analysis. J Clin Transl Sci 2022; 6:e86. [PMID: 36003208 PMCID: PMC9389282 DOI: 10.1017/cts.2022.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Justice-involved youth (JIY) have high rates of behavioral health disorders, but few can access, much less complete, treatment in the community. Behavioral health treatment completion among JIY is poorly understood, even within treatment studies. Measurement, reporting, and rates of treatment completion vary across studies. This systematic review and meta-analysis synthesizes the literature on rates of treatment completion among JIY enrolled in research studies and identifies potential moderators. After systematically searching 6 electronic databases, data from 13 studies of 20 individual treatment groups were abstracted and coded. A meta-analysis examined individual prevalence estimates of treatment completion in research studies as well as moderator analyses. Prevalence effect sizes revealed high rates of treatment completion (pr = 82.6). However, analysis suggests a high likelihood that publication bias affected the results. Treatment groups that utilized family- or group-based treatment (pr = 87.8) were associated with higher rates of treatment completion compared to treatment groups utilizing individual treatment (pr = 61.1). Findings suggest that it is possible to achieve high rates of treatment completion for JIY, particularly within the context of family- and group-based interventions. However, these findings are limited by concerns about reporting of treatment completion and publication bias.
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How to Enhance the Motivation for Drug Detoxification: Consciousness Guidance and Behaviour Restriction of Family Intergenerational Ethics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010366. [PMID: 35010627 PMCID: PMC8744547 DOI: 10.3390/ijerph19010366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
Assisting substance users to recover from the behaviour of drug addiction and maintain long-term rehabilitation is a long and complicated process, in which the motivation to undergo drug rehabilitation plays a decisive role. So far, the cultural connotation of family and its mechanism of promoting behavioural change of substance users have not been fully explored. Through in-depth interviews with 15 drug rehabilitants, among which there were 7 women and 8 men, it is found that the motivation for drug rehabilitation is stimulated under the guidance and restriction of family ethics based on obligation and responsibility, which is mainly reflected in the longitudinal intergenerational responsibility. On the one hand, negative consequences such as intergenerational liability deficit and reputation damage lead substance users to reflect on ethical values. On the other hand, disciplines such as intergenerational responsibility and obligation and mutual assistance can correct the actual behaviour of substance users in ethical practice. In contrast to Western countries, which focus on external environmental factors such as family function, family relationships and family support, the motivation for drug rehabilitation in China places more emphasis on their identity and role as family members and corresponding responsibilities, which provides inspiration for developing social work services for substance users from family cultural norms.
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Randall J, York JA. Lessons Learned from the Impact of Adolescents’ Internet Use Disorders on Adolescents’ Substance Use Disorders. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2021. [DOI: 10.1080/1067828x.2021.1967247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeff Randall
- Medical University of South Carolina, Charleston, SC, USA
| | - Janet A. York
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
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Efficacy and acceptability of a second dose of ecological executive skills training for children with ADHD: a randomized controlled study and follow-up. Eur Child Adolesc Psychiatry 2021; 30:921-935. [PMID: 32596788 DOI: 10.1007/s00787-020-01571-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/01/2020] [Indexed: 01/18/2023]
Abstract
To explore the efficacy and acceptability of a second dose of the 12-session ecological executive skills training (EEST) 1 year after the initial training in children with ADHD. A total of 97 children (aged 6-12) with ADHD who finished the first dose for about 1 year were recruited in the current study. 70 children who agreed to participate the second dose were randomized to the second dose or waitlist group. Both groups were followed up 1 year after the second dose. Executive function, core symptoms were assessed at the time of pre-intervention first dose, pre-intervention second dose, post-intervention second dose and follow-up 1 year after second dose (phase 0-3). For the immediate efficacy, the improvements in the second dose group were greater than the waitlist group on planning by Stockings of Cambridge and delay aversion by Cambridge gambling task (P = 0.02-0.04, η2 = 0.07-0.08). The parent rating of symptoms assessed by ADHD-RS-IV of the second dose group were also greater than the waitlist group rated by self-report. For long term efficacy, Linear mixed model indicated that there was significant time effect for both groups between phase 3 and phase 1, phase 1 and phase 0 on Behavior Rating Scales of Executive Function and ADHD-RS-IV (F = 2.849-21.560, P = 0.001-0.048). The compliance rate was 94.3% for the second dose group and 49% for waitlist group. A second dose of EEST program might bring further efficacy of EF and core symptoms for children with ADHD and it was well accepted.
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Nayak SM, Huhn AS, Bergeria CL, Strain EC, Dunn KE. Familial perceptions of appropriate treatment types and goals for a family member who has opioid use disorder. Drug Alcohol Depend 2021; 221:108649. [PMID: 33640679 DOI: 10.1016/j.drugalcdep.2021.108649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite effective, evidence-based medications for opioid use disorder (MOUD), these treatments remain underutilized. This may be due to multiple reasons. Family members may impact patient decision-making when choosing an opioid use disorder (OUD) treatment. While there has been work on patient preferences and attitudes towards opioid use disorder (OUD) treatment, to date, there has been minimal work assessing the attitudes of family member towards OUD treatment and recovery. METHODS Participants were ≥ 18 years of age and endorsed having a first-degree family member with past-year treatment for OUD. Participants were recruited via online crowdsourcing and were asked a number of questions regarding their desired outcomes for OUD treatment, and their familiarity, approval, and perceived effectiveness of various OUD treatment options. RESULTS The most commonly reported desired treatment outcome (50 %) was for family members to never use any kind of opioid, including maintenance therapies or opioid analgesics. Mean familiarity ratings for MOUD (rated 0-100) were relatively low, with naltrexone being the least familiar (32.3). Among those who endorsed a familiarity rating of at least 30 for a given treatment, mean approval and effectiveness ratings were relatively low-buprenorphine (approve 55.1; effective 54.1), methadone (approve 51.9; effective 49.3), naltrexone (approve 61.6; effective 55.9). These were lower than approval and effectiveness ratings for all non-MOUD treatments queried. CONCLUSIONS These findings highlight a need for clinicians and researchers to engage with family members' regarding their preferences and understanding of treatment, and to better understand how this might impact patient engagement with treatment.
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Affiliation(s)
- Sandeep M Nayak
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Andrew S Huhn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly E Dunn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bagley SM, Hadland SE, Schoenberger SF, Gai MJ, Topp D, Hallett E, Ashe E, Samet JH, Walley AY. Integrating substance use care into primary care for adolescents and young adults: Lessons learned. J Subst Abuse Treat 2021; 129:108376. [PMID: 34080547 DOI: 10.1016/j.jsat.2021.108376] [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: 09/03/2020] [Revised: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Substance use disorders are common chronic conditions that often begin and develop during adolescence and young adulthood, yet the delivery of primary care is not developmentally tailored for youth who use substances. Very few primary care-based substance use treatment programs exist in the United States for adolescents and young adults and no clear guidance is available about how to provide substance use treatment in primary care. METHODS We conducted a retrospective evaluation from July 2016 to December 2018 of a newly established primary care-based, multidisciplinary, outpatient program for youth who use substances. Components of the program include primary care, addiction treatment, harm reduction, naloxone distribution, psychotherapy, recovery support, and navigation addressing social determinants of health. We report the following patient characteristics and outcomes: demographics; proportion with substance use and mental health diagnoses; receipt of medications for opioid use disorder; retention in care at three, six, nine, and 12 months; and re-engagement in medical care. RESULTS From July 2016 through December 2018, 148 patients had at least one visit. Demographic characteristics included: median age 21 years; 40.5% female; 94.0% spoke primarily English; 18.3% Black, 14.9% Hispanic, and 60.8% white. One-third of patients (33.8%) were homeless or housing insecure. The most common substance use disorder was opioid use disorder (60.8%), followed by nicotine (37.2%), cannabis (20.9%), and alcohol (18.2%). Overall, 29.7% of patients had depression, 32.4% had anxiety disorder, and 18.9% had post-traumatic stress disorder. Retention in care was 29.7% at six months and 12.2% at 12 months. Among the 90 patients with OUD, 90.0% received medication for OUD, and 35.5% and 15.5% of patients with OUD were retained at six and 12 months, respectively. For patients lost to follow-up (no contact during a three-month period), the median time to re-engagement was 4.8 months, and 33.3% (37/111) of patients re-engaged. The most common reason for re-engagement was to access mental health treatment (59.5%) and primary care (51.4%). CONCLUSIONS Youth who sought care in a primary care-based substance use program presented most commonly with opioid, nicotine, cannabis, and alcohol use disorders. Co-morbid mental health diagnoses were common. While continuous retention at 12 months was low, one in three of the patients who fell out of care re-engaged. For youth receiving substance use care integrated into primary care, key components for pursing optimal retention in substance use treatment are a flexible model that anticipates the need for the treatment of mental health disorders and the use of re-engagement strategies.
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Affiliation(s)
- Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA 02119, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America.
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany Street, Room 2055, Boston, MA 02119, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Samantha F Schoenberger
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America
| | - Mam Jarra Gai
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America
| | - Deric Topp
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America
| | - Eliza Hallett
- Center for the Urban Child and Healthy Family, Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Erin Ashe
- Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, United States of America
| | - Jeffrey H Samet
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States of America; Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America
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Witt DR, Patten CA. Treatment of Tobacco Use Disorder and Mood Disorders in Adolescents. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0216-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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More A, Jackson B, Dimmock JA, Thornton AL, Colthart A, Furzer BJ. Exercise in the Treatment of Youth Substance Use Disorders: Review and Recommendations. Front Psychol 2017; 8:1839. [PMID: 29089915 PMCID: PMC5651015 DOI: 10.3389/fpsyg.2017.01839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/03/2017] [Indexed: 01/26/2023] Open
Abstract
Substance use disorders among youth represent a significant public health concern. It is well established that regular exercise provides important physical and mental health benefits; however, evidence for the role of exercise as an adjunct component within substance use disorder treatment is scarce. In this review, we identify factors associated with the development and persistence of substance use disorders among youth, identify current treatment modalities, and present evidence to support the efficacy of incorporating exercise participation during rehabilitation. We also provide a series of recommendations for future research that explores the feasibility and effectiveness of exercise participation as a complement to substance use disorder treatment among youth.
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Affiliation(s)
- Alissa More
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Perth, WA, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Perth, WA, Australia
| | - James A Dimmock
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Perth, WA, Australia
| | - Ashleigh L Thornton
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Perth, WA, Australia
| | - Allan Colthart
- Drug and Alcohol Youth Service, Mental Health Commission and Mission Australia, Perth, WA, Australia
| | - Bonnie J Furzer
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Perth, WA, Australia
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Livesey CMW, Rostain AL. Involving Parents/Family in Treatment during the Transition from Late Adolescence to Young Adulthood: Rationale, Strategies, Ethics, and Legal Issues. Child Adolesc Psychiatr Clin N Am 2017; 26:199-216. [PMID: 28314451 DOI: 10.1016/j.chc.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The progression from adolescence to adulthood is a time of tremendous change, characterized by issues of identity formation, autonomy, and shifting relationship dynamics. The family is embedded in all aspects of this transition and serves as both a protective support and a limiting factor, a complicated duality that raises psychological, ethical, and legal issues. This article discusses the influence of familial factors and provides assessment strategies for evaluating the family in relation to treatment of transitional age youth. It is increasingly evident that family engagement is a significant contributor to outcomes for transitional age youth seeking mental health treatment.
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Affiliation(s)
- Cecilia M W Livesey
- Department of Psychiatry, The University of Pennsylvania Health System, 3535 Market Street, Room 4039, Philadelphia, PA 19104, USA
| | - Anthony L Rostain
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 2007, Philadelphia, PA 19104, USA.
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Horigian VE, Anderson AR, Szapocznik J. Taking Brief Strategic Family Therapy from Bench to Trench: Evidence Generation Across Translational Phases. FAMILY PROCESS 2016; 55:529-42. [PMID: 27412949 PMCID: PMC6878974 DOI: 10.1111/famp.12233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
In this article, we review the research evidence generated over 40 years on Brief Strategic Family Therapy illustrating the NIH stages of intervention development and highlighting the translational process. Basic research (Stage 0) led to the discovery of the characteristics of the population and the nature of the problems that needed to be addressed. This step informed the selection of an intervention model that addressed the problems presented by the population, but in a fashion that was congruent with the population's culture, defined in terms of its value orientations. From this basic research, an intervention that integrated structural and strategic elements was selected and refined through testing (Stage I). The second stage of translation (Stage II) included efficacy trials of a specialized engagement module that responded to challenges to the provision of services. It also included several other efficacy trials that documented the effects of the intervention, mostly in research settings or with research therapists. Stages III/IV in the translational process led to the testing of the effectiveness of the intervention in real-world settings with community therapists and some oversight from the developer. This work revealed that an implementation/organizational intervention was required to achieve fidelity and sustainability of the intervention in real-world settings. The work is currently in Stage V in which new model development led to an implementation intervention that can ensure fidelity and sustainability. Future research will evaluate the effectiveness of the current implementation model in increasing adoption, fidelity, and long-term sustainability in real-world settings.
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Affiliation(s)
- Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL.
| | - Austen R Anderson
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
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