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McGeough BL, Zemore SE, Dastur Z, Neilands TB, Lisha NE, Lunn MR, Obedin-Maliver J, Lubensky ME, Flentje A. Levels and outcomes of 12-step participation among sexual and gender minority subgroups. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209519. [PMID: 39260805 DOI: 10.1016/j.josat.2024.209519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/22/2024] [Accepted: 09/08/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Sexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes. METHODS We used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately. RESULTS Participants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model. CONCLUSIONS This study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.
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Affiliation(s)
- Briana L McGeough
- School of Social Welfare, University of Kansas, United States of America.
| | - Sarah E Zemore
- Alcohol Research Group, Emeryville, CA, United States of America
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, United States of America; Department of Obstetrics and Gynecology, Stanford University School of Medicine, United States of America
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, United States of America
| | - Nadra E Lisha
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, United States of America
| | - Mitchell R Lunn
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, United States of America; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, United States of America; Department of Epidemiology and Population Health, Stanford University School of Medicine, United States of America
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, United States of America; Department of Obstetrics and Gynecology, Stanford University School of Medicine, United States of America; Department of Epidemiology and Population Health, Stanford University School of Medicine, United States of America
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, United States of America; Department of Community Health Systems, School of Nursing, University of California, San Francisco, United States of America
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, United States of America; Department of Community Health Systems, School of Nursing, University of California, San Francisco, United States of America; Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, United States of America
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Burmester S, Krüger C, Franck J, Lindberg MH, Westman J. At the tipping point: Patient experiences of addiction to benzodiazepines and motivation to seek treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209508. [PMID: 39243978 DOI: 10.1016/j.josat.2024.209508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/16/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Addiction to benzodiazepines is a serious problem, and it is important to better understand how individuals can be motivated to quit. Few studies have investigated patients' perceptions and experiences of addiction to benzodiazepines and there is a need to better understand the influence of motivational factors on treatment seeking. METHODS In this qualitative study, nineteen adults undergoing treatment for addiction to benzodiazepines participated in semi-structured individual interviews which were analyzed using reflexive thematic analysis. RESULTS Participants both defined addiction in relation to and found motivation to quit using benzodiazepines in the negative effects they experienced. Three themes were identified relating to a patient's journey towards a "tipping point" where they were motivated to seek treatment. Participants described that as their addiction grew, benzodiazepine use became a constant mental preoccupation resulting in the need to procure more medication. Participants faced a crossroads as their benzodiazepines became less effective, and many entered a negative cycle of dose escalation and withdrawal symptoms. Participants also described many negative impacts on psychosocial and practical aspects of their daily lives as they lost control to benzodiazepines. CONCLUSIONS The results of this study provide insight to patient perspectives on benzodiazepine addiction and suggests that patients find motivation to quit when the consequences related to benzodiazepine use reach a tipping point. Motivation is of clinical importance in the decision to seek treatment, and by working to identify and cultivate individual motivational factors, healthcare providers may be able to help more patients recover from addiction to benzodiazepines.
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Affiliation(s)
- Sofia Burmester
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 141 52 Huddinge, Sweden; The Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Friskvårdsvägen 4, 112 81 Stockholm, Sweden.
| | - Cecilia Krüger
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 141 52 Huddinge, Sweden.
| | - Johan Franck
- The Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Friskvårdsvägen 4, 112 81 Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden.
| | - Mathilde Hedlund Lindberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 141 52 Huddinge, Sweden; Department of Medical Sciences, Psychiatry, Uppsala University, 751 85 Uppsala, Sweden.
| | - Jeanette Westman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 141 52 Huddinge, Sweden; Academic Primary Care Centre, Region Stockholm, Solnavägen 1E, 113 65 Stockholm, Sweden; Department of Health Care Sciences, Marie Cederschiöld University, Folkungagatan 127, 116 30 Stockholm, Sweden.
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Väisänen V, Linnaranta O, Sinervo T, Hietapakka L, Elovainio M. Healthcare use of young finnish adults with mental disorders - profiles and profile membership determinants. BMC PRIMARY CARE 2024; 25:238. [PMID: 38965514 PMCID: PMC11225417 DOI: 10.1186/s12875-024-02497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Comprehensive, timely, and integrated primary care services have been proposed as a response to the increased demand for mental health and substance use services especially among young people. However, little is known about the care utilization patterns of young people with mental and substance use disorders. Our aim was to characterize profiles of care use in young Finnish adults with mental or substance use disorders, and the potential factors associated with the service use profiles. METHODS Primary and specialized care visits of young adults (16-29 years) diagnosed with a psychiatric or a substance use disorder (n = 7714) were retrieved from the national health care register from years 2020 and 2021. K-Means clustering was used to detect different profiles based on the utilization of care services. Multinomial logistic regression was used to analyze the factors associated with different profiles of care use. RESULTS Five different profiles were identified: low care use (75%), and use of principally primary health care (11%), student health services (9%), psychiatric services (5%), or substance use services (1%). Female gender was associated with membership in the primary health care focused profiles (OR 2.58 and OR 1.99), and patients in the primary health care and student health services profiles were associated with a better continuity of care (OR 1.04 and OR 1.05). Substance use disorders were associated with psychiatric service use (OR: 2.51) and substance use services (OR: 58.91). Living in smaller municipalities was associated with lower service use when comparing to the largest city. CONCLUSIONS Young adults diagnosed with a psychiatric or a substance use disorder had remarkably different and heterogeneous care patterns. Most of the participants had low care utilization, indicating potential gaps in service use and care needs. Measures should be taken to ensure equal access to and availability of mental health services. The profiles that utilized the most services highlights the importance of integrated services and patient-oriented improvement of treatment.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland.
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Yliopistonranta 8 E, Kuopio, 70210, Finland.
| | - Outi Linnaranta
- Finnish Institute for Health and Welfare, Equality unit, Mental health team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Laura Hietapakka
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
- Faculty of Medicine, Research Program Unit, Department of Psychology, University of Helsinki, Haartmaninkatu 3, Helsinki, 00014, Finland
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Peddireddy SR, Livingston MD, Young AM, Freeman PR, Ibragimov U, Komro KA, Lofwall MR, Oser CB, Staton M, Cooper HLF. Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209262. [PMID: 38103835 PMCID: PMC10947911 DOI: 10.1016/j.josat.2023.209262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. METHODS The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. RESULTS The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. CONCLUSIONS There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA.
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Umedjon Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Michelle R Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carrie B Oser
- Department of Sociology, University of Kentucky College of Arts & Sciences, Lexington, KY, USA
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
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Dacosta-Sánchez D, Fernández-Calderón F, Díaz-Batanero C, Mancheño-Velasco C, Lozano ÓM. Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission. Eur Addict Res 2024; 30:80-93. [PMID: 38437822 DOI: 10.1159/000535689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/29/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. METHOD A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. RESULTS Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. DISCUSSION/CONCLUSION Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.
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Affiliation(s)
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | | | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Acuff SF, Ellis JD, Rabinowitz JA, Hochheimer M, Hobelmann JG, Huhn AS, Strickland JC. A brief measure of non-drug reinforcement: Association with treatment outcomes during initial substance use recovery. Drug Alcohol Depend 2024; 256:111092. [PMID: 38266572 PMCID: PMC10922801 DOI: 10.1016/j.drugalcdep.2024.111092] [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: 08/23/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Translational research demonstrates that drug use is inversely associated with availability and engagement with meaningful non-drug reinforcers. Evaluation of non-drug reinforcement in treatment-receiving clinical populations is limited, likely owing to the time intensive nature of existing measures. This study explores the association of non-drug reinforcers with treatment outcomes using a novel, brief measure of past month non-drug reinforcement quantifying three elements: relative frequency, access, and enjoyability. METHODS Respondents enrolled in substance use treatment (residential, intensive outpatient, and medically managed withdrawal) in clinics across the United States (N = 5481) completed standardized assessments of non-drug reinforcement and treatment outcomes (i.e., return to use and life satisfaction) one-month after treatment discharge. Non-drug reinforcement measures (availability, engagement, enjoyability) were used as predictors of return to use and life satisfaction using generalized linear models. RESULTS Non-drug reinforcement indices were associated with return to use and life satisfaction in unadjusted models (e.g., 12.4 % versus 58.3 % return to use for those with the highest and lowest availability, respectively). Consistent results were observed in models adjusted for sociodemographic variables and risk factors (i.e., sleep disturbance, anhedonia, stress). Comparisons by drug class generally showed lower non-drug reinforcement among patients reporting heroin or methamphetamine as their primary drug. CONCLUSIONS Results highlight the importance of non-drug reinforcement during the first month following treatment. Rapid measurement of non-drug reinforcement in stepped care settings may illuminate critical deficits in early stages of behavior change, identify those at greatest risk for return to use, and provide targets for treatment to improve recovery trajectories.
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Affiliation(s)
- Samuel F Acuff
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - J Gregory Hobelmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA.
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Wang D, Zhou Y, Chen S, Wu Q, He L, Wang Q, Hao Y, Liu Y, Peng P, Li M, Liu T, Ma Y. Employing Bayesian analysis to establish a cut-off point and assess stigma prevalence in substance use disorder: a comprehensive study of the Chinese version of the Substance Use Stigma Mechanism Scale. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02621-5. [PMID: 38411725 DOI: 10.1007/s00127-024-02621-5] [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: 08/04/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE In China, individuals with substance use disorders (SUD) face severe stigma, but reliable stigma assessment tool is lacking. Therefore, this study aimed to validate the Chinese version of the Substance Use Stigma Mechanism Scale (SU-SMS-C) and set its cut-off point. METHODS We recruited 1005 individuals with SUDs from Chinese rehabilitation centers. These participants completed a battery of questionnaires that included the SU-SMS-C, The Multidimensional Scale of Perceived Social Support (MSPSS), Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and Perceived Devaluation and Discrimination (PDD). Confirmatory factor analysis was used to assess the construct validity of the scale. Additionally, the Naive Bayes classifier was used to establish the cut-off point for the SU-SMS-C. We additionally explored the correlation between patient demographic characteristics and stigma. RESULTS A confirmatory factor analysis was utilized, revealing a second-order five-factor model. Based on the Naive Bayes classifier, the area under the receiver operating characteristic (AUCROC) of 0.746, the cut-off point for the SU-SMS-C was established at 44.5. The prevalence of stigma observed in the study population was 49.05%. Significant disparities were observed in the distribution of stigma across genders, with males experiencing more pronounced stigma than females. Moreover, patients consuming different primary substances reported diverse levels of stigma. Notably, those primarily using heroin endured a higher degree of stigma than users of other substances. CONCLUSION The study is the first to identify a cut-off point for the SU-SMS-C by Naive Bayes classifier, bridging a major gap in stigma measurement research. SU-SMS-C may help treat and manage SUDs by reducing stigma.
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Affiliation(s)
- Dongfang Wang
- Department of Sport and Health Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Shubao Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuxia Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuzhu Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yueheng Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Pu Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Manyun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuejiao Ma
- Department of Child and Adolescent Psychiatry, Shenzhen Kangning Hospital, Shenzhen Institute of Mental Health, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen, Guangdong, 518020, China.
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Bosak J, Drainoni M, Bryer C, Goodman D, Messersmith L, Declercq E. 'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme. Health Expect 2024; 27:e13908. [PMID: 37920874 PMCID: PMC10726284 DOI: 10.1111/hex.13908] [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: 06/02/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. METHODS A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. RESULTS The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges. CONCLUSION These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. PATIENT CONTRIBUTION Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.
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Affiliation(s)
- Julie Bosak
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Mari‐Lynn Drainoni
- Department of Medicine, Section of Infectious DiseasesBoston University Aram V. Chobanian & Edward Avedisian School of MedicineBostonMassachusettsUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Cheri Bryer
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Daisy Goodman
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Lisa Messersmith
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Eugene Declercq
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
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Conner KR, Maisto SA, Abar B, Szafranski S, Chiang A, Hutchison M, Aldalur A, Stecker T. Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial. Addiction 2023; 118:2342-2351. [PMID: 37488997 PMCID: PMC10805959 DOI: 10.1111/add.16300] [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: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Szafranski
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Krendl AC, Perry BL. Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions. Psychol Sci Public Interest 2023; 24:90-126. [PMID: 37883667 DOI: 10.1177/15291006231198193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Substance dependence is a prevalent and urgent public health problem. In 2021, 60 million Americans reported abusing alcohol within the month prior to being surveyed, and nearly 20 million Americans reported using illegal drugs (e.g., heroin) or prescription drugs (e.g., opioids) for nonmedical reasons in the year before. Drug-involved overdose rates have been steadily increasing over the past 20 years. This increase has been primarily driven by opioid and stimulant use. Despite its prevalence, drug dependence is one of the most stigmatized health conditions. Stigma has myriad negative consequences for its targets, including limiting their access to employment and housing, disrupting interpersonal relationships, harming physical and mental health, and reducing help-seeking. However, because research on stigma toward people with substance use disorders (SUDs) is relatively sparse compared with research on stigma toward other mental illnesses, the field lacks a comprehensive understanding of the causes and consequences of SUD stigma. Moreover, it remains unclear how, if at all, these factors differ from other types of mental illness stigma. The goal of this review is to take stock of the literature on SUD stigma, providing a clear set of foundational principles and a blueprint for future research and translational activity.
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Affiliation(s)
- Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University Bloomington
| | - Brea L Perry
- Department of Sociology, Indiana University Bloomington
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Sypher I, Pavlo A, King J, Youins R, Shumake A, Lopez J, Haeny AM. What's race got to do with it? Factors contributing to self-change from cocaine use disorder among Black adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:208945. [PMID: 37654008 DOI: 10.1016/j.josat.2022.208945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 12/30/2022] [Indexed: 09/02/2023]
Abstract
INTRODUCTION A substantial number of people with substance use disorders recover without formal treatment, though we know little about the process of self-change among Black adults with cocaine use disorder (CUD) and whether racism contributes to the development of CUD and these adults' process of self-change. METHODS The study team conducted qualitative interviews with 29 Black adults using a narrative and phenomenological approach. At the time of the interview, all participants met criteria for DSM-5 CUD prior to the past year but did not meet criteria for CUD in the past year and reported that they reduced their cocaine use without formal treatment. Participants completed a qualitative interview followed by the UConn Racial/Ethnic Stress & Trauma Survey. Thematic analyses informed key themes from the qualitative interviews. RESULTS Qualitative analyses indicated several major factors that contributed to self-change from CUD: racial identity, responsibility to family, social regard, spirituality, turning point for change, and changing one's environment. These results highlight that self-change from CUD is a complex, ongoing, and multifaceted process. The identified themes align with several theories of recovery, including social control theory and the theory of stress and coping. Furthermore, the results suggest that experiences of racism are common among Black adults recovering from CUD, and that the multiple strategies employed for coping with racism may be consistent with the process of self-change. CONCLUSIONS This study shows that multiple race-related factors contribute to the development of, maintenance of, and self-change from CUD among Black adults. Better understanding these factors can help to inform drug treatment.
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Affiliation(s)
- Isaiah Sypher
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Anthony Pavlo
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Jaelen King
- Yale College, Yale University, New Haven, CT, United States of America.
| | - Richard Youins
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Amina Shumake
- Yale Divinity School, Yale University, New Haven, CT, United States of America.
| | - Joel Lopez
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Angela M Haeny
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
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12
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Malhotra A, Drexler K, Hsu M, Tang YL. Medication treatment for alcohol use disorder in special populations. Am J Addict 2023; 32:433-441. [PMID: 37551638 DOI: 10.1111/ajad.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Alcohol use disorder (AUD) is a significant public health concern, with underutilized effective treatments, particularly in special populations. This article summarizes the current evidence and guidelines for treating AUD in special populations. METHODS This article is a literature review that synthesizes the latest research on AUD treatment for special populations. We screened 242 articles and included 57 in our final review. RESULTS There are four food and Drug Administration-approved medications for AUD (MAUD): disulfiram, oral naltrexone, extended-release injectable naltrexone (XR-NTX), and acamprosate. Naltrexone and disulfiram have the potential to cause liver toxicity, and acamprosate should be avoided in patients with severe kidney disease. Psychosocial treatments should be considered first-line for pregnant and nursing patients. Naltrexone is contraindicated in patients on opioids, as it may precipitate acute withdrawal. For patients experiencing homelessness, nonabstinent treatment goals may be more practical, and XR-NTX should be considered to improve adherence. Limited evidence suggests medication can improve AUD treatment outcomes in adolescents and young adults. For patients with poor treatment response despite adequate medication adherence, switching to a different medication and augmentation with psychosocial treatments should be considered. DISCUSSION AND CONCLUSIONS Understanding the unique considerations for special populations with AUD is crucial, and addressing their special needs may improve their treatment outcomes. SCIENTIFIC SIGNIFICANCE Our study significantly contributes to the existing literature by summarizing crucial information for the treatment of AUD in special populations, highlighting distinct challenges, and emphasizing tailored approaches to improve overall health and well-being.
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Affiliation(s)
- Aniket Malhotra
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Karen Drexler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Michael Hsu
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
- Substance Abuse Treatment Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia, USA
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13
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Ahuja M, Stamey J, Cimilluca J, Al Skir K, Herndon MK, Baggett K, Sathiyasaleen T, Fernandopulle P. Association between chronic disease and substance use among older adults in Tennessee. J Public Health Res 2023; 12:22799036231193070. [PMID: 37636292 PMCID: PMC10460272 DOI: 10.1177/22799036231193070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/16/2023] [Indexed: 08/29/2023] Open
Abstract
Background Substance use and misuse have a negative impact on health care outcomes, specifically in the older adult population. Older adults are at risk due to several factors occurring toward the end of life such as changing family dynamics, loss of friends and loved ones, and chronic diseases. Substance use in older adults with chronic diseases in rural areas remains poorly studied. This study examines older adults greater than 55 of age in the state of Tennessee, U.S.A. Design and methods Data was extracted from the 2019 National Behavioral Risk Factor Surveillance System (BRFSS) with a subsample for the State of Tennessee (N = 6242) and individuals over age 55 (N = 3389). Results At least 33.7% (N = 1143) of older adults have a chronic disease, and 24.4% (N = 828) have at least two or more chronic diseases. Alcohol use in the past month was reported in 29.4% of older adults; however, chronic disease status was not associated with alcohol use. Marijuana use and smoking in the past month were significant for older adults with two or more chronic diseases. Low income and less high school education were associated with chronic disease and smoking. Conclusions Marijuana use and smoking were found to be significant in older adults with chronic disease, but not with alcohol use. Preventative measures such as screening tools, education, and providing resources to patients should be targeted to populations at risk to promote overall health outcomes.
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Affiliation(s)
- Manik Ahuja
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Jessica Stamey
- College of Nursing, East Tennessee State University, Johnson City, TN, USA
| | - Johanna Cimilluca
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Kawther Al Skir
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Mary K Herndon
- James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- University of Tennessee Medical Center, Knoxville, TN, USA
| | - Kathleen Baggett
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | | | - Praveen Fernandopulle
- James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Munier J, Shen S, Rahal D, Hanna A, Marty V, O'Neill P, Fanselow M, Spigelman I. Chronic intermittent ethanol exposure disrupts stress-related tripartite communication to impact affect-related behavioral selection in male rats. Neurobiol Stress 2023; 24:100539. [PMID: 37131490 PMCID: PMC10149313 DOI: 10.1016/j.ynstr.2023.100539] [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: 11/22/2022] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023] Open
Abstract
Alcohol use disorder (AUD) is characterized by loss of intake control, increased anxiety, and susceptibility to relapse inducing stressors. Both astrocytes and neurons contribute to behavioral and hormonal consequences of chronic intermittent ethanol (CIE) exposure in animal models. Details on how CIE disrupts hypothalamic neuro-glial communication, which mediates stress responses are lacking. We conducted a behavioral battery (grooming, open field, reactivity to a single, uncued foot-shock, intermittent-access two-bottle choice ethanol drinking) followed by Ca2+ imaging in ex-vivo slices of paraventricular nucleus of the hypothalamus (PVN) from male rats exposed to CIE vapor or air-exposed controls. Ca2+ signals were evaluated in response to norepinephrine (NE) with or without selective α-adrenergic receptor (αAR) or GluN2B-containing N-methyl-D-aspartate receptor (NMDAR) antagonists, followed by dexamethasone (DEX) to mock a pharmacological stress response. Expectedly, CIE rats had altered anxiety-like, rearing, grooming, and drinking behaviors. Importantly, NE-mediated reductions in Ca2+ event frequency were blunted in both CIE neurons and astrocytes. Administration of the selective α1AR antagonist, prazosin, reversed this CIE-induced dysfunction in both cell types. Additionally, the pharmacological stress protocol reversed the altered basal Ca2+ signaling profile of CIE astrocytes. Signaling changes in astrocytes in response to NE were correlated with anxiety-like behaviors, such as the grooming:rearing ratio, suggesting tripartite synaptic function plays a role in switching between exploratory and stress-coping behavior. These data show how CIE exposure causes persistent changes to PVN neuro-glial function and provides the groundwork for how these physiological changes manifest in behavioral selection.
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Affiliation(s)
- J.J. Munier
- Laboratory of Neuropharmacology, Section of Biosystems & Function, School of Dentistry, UCLA, United States
- Corresponding author.
| | - S. Shen
- Laboratory of Neuropharmacology, Section of Biosystems & Function, School of Dentistry, UCLA, United States
| | - D. Rahal
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, United States
| | - A. Hanna
- Laboratory of Neuropharmacology, Section of Biosystems & Function, School of Dentistry, UCLA, United States
| | - V.N. Marty
- Laboratory of Neuropharmacology, Section of Biosystems & Function, School of Dentistry, UCLA, United States
| | - P.R. O'Neill
- Hatos Center for Neuropharmacology, Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, UCLA, United States
| | - M.S. Fanselow
- Department of Psychology, College of Life Sciences, Department of Psychiatry & Biobehavioral Science, David Geffen School of Medicine, UCLA, United States
| | - I. Spigelman
- Laboratory of Neuropharmacology, Section of Biosystems & Function, School of Dentistry, UCLA, United States
- Corresponding author. Laboratory of Neuropharmacology, Section of Biosystems & Function, School of Dentistry, UCLA, 10833 Le Conte Avenue, 63-078 CHS, Los Angeles, CA, 90095-1668, United States.
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15
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Gooding NB, Williams JN, Williams RJ. The Differences Between Gamblers and Substance Users Who Seek Treatment. CANADIAN JOURNAL OF ADDICTION 2023. [DOI: 10.1097/cxa.0000000000000171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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16
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Mauro PM, Kaur N, Askari MS, Keyes KM. Alcohol or Drug Self-Help Use Among Adults in the United States: Age, Period, and Cohort Effects Between 2002 and 2018. Int J Ment Health Addict 2023:1-15. [PMID: 36785551 PMCID: PMC9907883 DOI: 10.1007/s11469-023-01012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
In the context of an ongoing and worsening drug overdose epidemic in the USA, increases in free support services like self-help groups may be expected. We estimated differences in self-help use by age, period, or cohort among people who may have needed treatment. We included N = 92,002 adults from the 2002-2018 National Surveys on Drug Use and Health who met past-year DSM-IV substance use disorder criteria or received alcohol/drug treatment in any location. We used hierarchical age-period-cohort (HAPC) modeling to estimate average age-period-cohort associations with self-help. Level-1 covariates included age, race and ethnicity, household income, and sex. We quantified level-2 variance components using the median odds ratio (MOR). We found small positive HAPC period effects for alcohol/drug self-help that were driven by alcohol-specific effects. Birth cohort differences were observed starting at age 48. Younger birth cohorts, especially among Black adults, were less likely to report self-help use than older birth cohorts. MOR was consistently elevated for cohort effects (MOR = 1.17; covariance parameter: 0.15; 95% CI [0.11, 0.23]) but not for period effects. Overall, self-help use did not increase in the context of substantial treatment needs and worsening overdose racialized disparities. Instead, cohort effects explained trends in alcohol/drug self-help. Findings could indicate that younger birth cohorts may need additional supports, especially services tailored for Black and Hispanic people. Supplementary Information The online version contains supplementary material available at 10.1007/s11469-023-01012-2.
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Affiliation(s)
- Pia M. Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Navdep Kaur
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Melanie S. Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
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Milanak ME, Witcraft SM, Park JY, Hassell K, McMahon T, Wilkerson AK. A Transdiagnostic group therapy for sleep and anxiety among adults with substance use disorders: Protocol and pilot investigation. Front Psychiatry 2023; 14:1160001. [PMID: 37065898 PMCID: PMC10090550 DOI: 10.3389/fpsyt.2023.1160001] [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: 02/06/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Treatment of substance use disorders (SUDs) is challenging with high rates of treatment dropout and relapse, particularly among individuals with comorbid psychiatric conditions. Anxiety and insomnia are prevalent among those with SUD and exacerbate poor treatment outcomes. Interventions that concurrently target anxiety and insomnia during the early stages of SUD treatment are lacking. To this end, we investigated the feasibility and preliminary effectiveness in a single-arm pilot trial of an empirically informed group transdiagnostic intervention, Transdiagnostic SUD Therapy, to concurrently reduce anxiety and improve sleep among adults receiving treatment for SUD. Specifically, we hypothesized that participants would evidence declines in anxiety and insomnia and improvements in sleep health, a holistic, multidimensional pattern of sleep-wakefulness that promotes wellbeing. A secondary aim was to describe the protocol for Transdiagnostic SUD Therapy and how it may be implemented into a real-world addiction treatment setting. Method Participants were 163 adults (Mage = 43.23; 95.1% White; 39.93% female) participating in an intensive outpatient program for SUD who attended at least three of four Transdiagnostic SUD Therapy sessions. Participants had diverse SUDs (58.3% alcohol use disorder, 19.0% opioid use disorder) and nearly a third of the sample met criteria for two SUDs and comorbid mental health diagnoses (28.9% anxiety disorder, 24.6% major depressive disorder). Results As anticipated, anxiety and insomnia reduced significantly across the 4-week intervention period from clinical to subclinical severity, and sleep health significantly improved (ps < 0.001). These statistically significant improvements following Transdiagnostic SUD Therapy demonstrated medium to large effects (ds > 0.5). Conclusion Transdiagnostic SUD Therapy is designed to be flexibly administered in "real-world" clinical settings and, preliminarily, appears to be effective in improving emotional and behavioral factors that increase risk for return to substance use and poor SUD treatment outcomes. Additional work is needed to replicate these findings, determine the feasibility of widespread uptake of Transdiagnostic SUD Therapy, and examine whether the treatment effects translate to improvement in substance use outcomes.
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Affiliation(s)
- Melissa E. Milanak
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Sara M. Witcraft
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jie Young Park
- Edward Via College of Osteopathic Medicine–Carolinas, Spartanburg, SC, United States
| | | | - Tierney McMahon
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Allison K. Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- *Correspondence: Allison K. Wilkerson,
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Votaw VR, Tuchman FR, Piccirillo ML, Schwebel FJ, Witkiewitz K. Examining Associations Between Negative Affect and Substance Use in Treatment-Seeking Samples: A Review of Studies Using Intensive Longitudinal Methods. CURRENT ADDICTION REPORTS 2022; 9:445-472. [PMID: 37063461 PMCID: PMC10101148 DOI: 10.1007/s40429-022-00441-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review Understanding dynamic relationships between negative affect and substance use disorder (SUD) outcomes, including craving, may help inform adaptive and personalized interventions. Recent studies using intensive longitudinal methods were reviewed to examine relationships between negative affect and the outcomes of either craving or substance use during and following SUD treatment. Recent Findings Results on associations between negative affect and craving/substance use were mixed and difficult to synthesize, given methodological differences across studies. The strength and direction of these relationships varied across outcomes, subgroups, contexts, and time course. Summary The current literature is mixed concerning negative affect and craving/substance use associations during and following SUD treatment. Researchers should increasingly recruit diverse individuals, for example, samples of varying racial and ethnic backgrounds and those reporting co-occurring disorders and polysubstance use. Experimental, qualitative, and person-specific methods will improve our understanding of relationships between negative affect and substance-related outcomes during SUD treatment.
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Affiliation(s)
- Victoria R Votaw
- Department of Psychology, University of New Mexico, Albuquerque, NM
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
| | - Felicia R Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM
- Department of Psychology, Northwestern University, Evanston, IL
| | | | - Frank J Schwebel
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM
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Mauro PM, Gutkind S, Rivera-Aguirre A, Gary D, Cerda M, Santos EC, Castillo-Carniglia A, Martins SS. Trends in cannabis or cocaine-related dependence and alcohol/drug treatment in Argentina, Chile, and Uruguay. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103810. [PMID: 35939947 PMCID: PMC9912990 DOI: 10.1016/j.drugpo.2022.103810] [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: 10/07/2021] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay. METHODS Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country. RESULTS Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only. CONCLUSION Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.
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Affiliation(s)
- Pia M Mauro
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA.
| | - Sarah Gutkind
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Ariadne Rivera-Aguirre
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
| | - Dahsan Gary
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Magdalena Cerda
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA
| | - Erica Chavez Santos
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA; University of Washington School of Public Health, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Alvaro Castillo-Carniglia
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Society and Health Research Center, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Badajoz 130, Room 1306, Las Condes, Santiago, Chile; Millennium Nucleus on Sociomedicine (SocioMed), Chile
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
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Christoffersen LAN, Mortensen EL, Sørensen HJ, Becker U, Osler M, Flensborg-Madsen T. Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment. Nord J Psychiatry 2022; 76:507-514. [PMID: 34873973 DOI: 10.1080/08039488.2021.2007999] [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] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD. METHODS The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors. RESULTS The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts. CONCLUSIONS The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.
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Affiliation(s)
- Lea Arregui Nordahl Christoffersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Holger Jelling Sørensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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21
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Falker CG, Stefanovics EA, Rhee TG, Rosenheck RA. Women's Use of Substance Use Disorder Treatment Services: Rates, Correlates, and Comparisons to Men. Psychiatr Q 2022; 93:737-752. [PMID: 35661318 DOI: 10.1007/s11126-022-09989-0] [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] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
In spite of evidence of increasing prevalence of substance use disorders (SUDs) among women, there is little information on gender differences in SUD treatment use. Nationally representative survey data were used to compare specialized SUD treatment among women and men with past-year DSM-5 SUD diagnoses (N = 5,789, 42.8% women). An estimated 10.7% of women and 9.9% of men (p = 0.45) received SUD treatment. Those who received treatment among both men and women had more problems than others. Five variables were independently associated with receipt of past-year treatment in both women and men and while five others were independently associated with receipt of treatment for only one gender. Interaction analysis, however, revealed no statistically significant gender differences in any correlate of treatment receipt. Although men were more likely to have SUDs than women, there were no significant differences by gender in rates or correlates of service use.
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Affiliation(s)
- Caroline G Falker
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.,Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA.,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Taeho Greg Rhee
- Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA.,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Robert A Rosenheck
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA. .,Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA. .,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA. .,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.
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22
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Coelho SG, Tabri N, Kerman N, Lefebvre T, Longpre S, Williams RJ, Kim HS. The Perceived Causes of Problems with Substance Use, Gambling, and Other Behavioural Addictions from the Perspective of People with Lived Experience: a Mixed-Methods Investigation. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00900-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Conner KR, Abar B, Aldalur A, Chiang A, Hutchison M, Maisto SA, Stecker T. Alcohol-related consequences and the intention to seek care in treatment naïve women and men with severe alcohol use disorder. Addict Behav 2022; 131:107337. [PMID: 35483181 PMCID: PMC9717617 DOI: 10.1016/j.addbeh.2022.107337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/18/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research on treatment utilization for alcohol use disorder (AUD) is based primarily on clinical samples and community samples of low AUD severity that may not need formal care. Using a community sample of adults with untreated but severe AUD symptoms, we tested the hypothesis that alcohol-related consequences, but not alcohol consumption levels, are associated with the intention to seek AUD treatment, examined associations of specific types of alcohol-related consequences with intention, and explored sex differences in these associations. METHODS The sample was recruited using social media ads for a randomized controlled trial to test a brief intervention to promote AUD treatment seeking. This report is based on analysis of baseline data collected prior to treatment intervention. Multiple linear regressions examined associations of measures of alcohol consumption, alcohol-related consequences broadly, and specific alcohol-related consequences with the intention to seek treatment. Moderating effects of sex on associations were explored. RESULTS Subjects (n = 349) averaged 41 years of age, 48% were female, 6% were Latinx, 80% were white, 15% were Black, and 92% met criteria for severe AUD. Alcohol consumption measures were not associated with intention to seek treatment whereas interpersonal- and intrapersonal- consequences were associated with intention. Sex served as a moderator, with intrapersonal consequences (e.g., sad mood) showing a stronger association with intention in women and social responsibility consequences (particularly financial) associated with intention in men. CONCLUSION Select alcohol-related consequences may be keys to understanding increased intention to seek AUD treatment including intrapersonal consequences in women and financial consequences in men.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA.
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA.
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA.
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA.
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Room 431, Charleston, SC 29425, USA.
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24
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Krendl AC, Perry BL. Addiction onset and offset characteristics and public stigma toward people with common substance dependencies: A large national survey experiment. Drug Alcohol Depend 2022; 237:109503. [PMID: 35644088 DOI: 10.1016/j.drugalcdep.2022.109503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Drug-related overdose deaths topped 100,000 between 2020 and 2021. Opioids and stimulants are implicated as the primary drivers of this public health crisis. Stigma remains one of the primary barriers to treatment and recovery from substance use disorders. However, little is known about how stigma varies across different substance types, whether individuals are actively using or in recovery, and medical versus recreational onset. We examined these questions using data from the 2021 Shatterproof Addiction Stigma Index, the only nationally representative data available on this topic. Respondents (N = 7051) completed a vignette-based survey experiment to assess public stigma (social distance, prejudice, competence, and causal attributions) toward people with alcohol, opioid (following a prescription pain or recreational use onset), heroin, or methamphetamine dependencies. Vignette characters were described as active users or in recovery. Adjusting for covariates (e.g., race, age, gender), prejudice and desire for social distance were highest toward heroin and methamphetamine, and lowest toward alcohol dependence. The perceived onset of the dependency affected stigma. Specifically, prescription opioids with a recreational onset were more stigmatized than those with a medical onset. Moreover, individuals depicted as being in recovery were less stigmatized than those depicted as active users. Recovery status had the largest impact on prejudice and social distance toward methamphetamine, relative to other conditions. The nature and magnitude of substance dependency stigma differs across substance types and onset and offset conditions. Reducing stigma will require tailored strategies that consider the multidimensional nature of stigma toward people with addiction.
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Affiliation(s)
- Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
| | - Brea L Perry
- Department of Sociology, Indiana University, Bloomington, IN, USA
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25
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Smith JJ, Spanakis P, Gribble R, Stevelink SAM, Rona RJ, Fear NT, Goodwin L. Prevalence of at-risk drinking recognition: A systematic review and meta-analysis. Drug Alcohol Depend 2022; 235:109449. [PMID: 35461086 DOI: 10.1016/j.drugalcdep.2022.109449] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a prominent "treatment gap" in relation to at-risk drinking (ARD), whereby a minority of at-risk drinkers ever access treatment. Research suggests that recognition of problem drinking is a necessary precursor for help-seeking and treatment. OBJECTIVE This systematic review and meta-analysis aimed to estimate the prevalence of ARD recognition within those meeting criteria for ARD. METHOD PsycINFO, Web of Science, Scopus, and MEDLINE were searched using the terms: problem* AND (recogni* OR perceive* OR perception OR self-identif*) AND alcohol - to identify studies published in English between 2000 and 2022. Studies reported the frequency (weighted or unweighted) of participants meeting ARD criteria that also directly identified ARD, perceived a need for help, or endorsed a readiness to change. The prevalence of ARD recognition was estimated using a random-effects meta-analysis with 95% confidence intervals (CIs). RESULTS 17 studies were included which provided data for 33,349 participants with ARD. Most (n = 14) were US studies. ARD was self-identified via a single indicator in 7 studies, whereas recognition was assessed via stages of change in 4 studies and need for help in 6 studies. The pooled prevalence of ARD recognition was 31% (95% CI: 25%-36%), and subgroup analyses indicated alcohol use severity, measure of recognition, and population type to be significant sources of heterogeneity. CONCLUSIONS Most individuals with ARD fail to recognise their drinking problem so preventive approaches that promote recognition may be helpful. However, we must be cautious of how inconsistency in question framing affects self-reported problem recognition.
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Affiliation(s)
- Jessica J Smith
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom.
| | | | - Rachael Gribble
- Department of Psychological Medicine, King's College London, London, United Kingdom; King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Sharon A M Stevelink
- Department of Psychological Medicine, King's College London, London, United Kingdom; King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Roberto J Rona
- Department of Psychological Medicine, King's College London, London, United Kingdom; King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, United Kingdom; Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Laura Goodwin
- Division of Health Research, Lancaster University, Lancaster, United Kingdom; Liverpool Centre for Alcohol Research, Liverpool Centre for Alcohol Research, Liverpool Health Partners, Liverpool, United Kingdom
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26
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Evans-Polce RJ, Kcomt L, Veliz PT, Boyd CJ, McCabe SE. Mental health-related quality of life by sex and sexual identity among U.S. adults with alcohol and tobacco use disorder. J Psychiatr Res 2022; 149:136-144. [PMID: 35276630 PMCID: PMC10712285 DOI: 10.1016/j.jpsychires.2022.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Alcohol use disorder (AUD) and tobacco use disorder (TUD) are more severe among some sexual minority subgroups. It is less understood whether mental health indicators also differ by sexual identity among those with more severe forms of AUD and TUD. We examined differences in mental health-related QoL by sex-specific sexual identity subgroup among those meeting criteria for moderate-to-severe AUD or moderate-to-severe TUD. METHODS We analyzed data from the National Epidemiologic Study of Alcohol and Related Conditions-III (2012-2013; n = 36,309). Our analyses focused on those meeting criteria for past-year moderate-to-severe AUD (n = 2341) and past-year moderate-to-severe TUD (n = 3675). Using multivariable linear regression, we examined associations of sex-specific sexual identity subgroups with mental health-related QoL, while controlling for (a) sociodemographic characteristics, (b) disorder severity, and (c) risk and protective factors (adverse childhood experiences, parental history of substance misuse, stressful life events, and social support). RESULTS Among those with past-year moderate-to-severe AUD, gay men and heterosexual, bisexual, and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual men in fully adjusted models. Among those with past-year moderate-to-severe TUD, gay men and heterosexual and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual women. Bisexual and heterosexual women were not significantly different in fully adjusted models. DISCUSSION Clinicians should consider the variability in mental health-related QoL among those with moderate-to-severe AUD and TUD particularly for women and sexual minorities. Consideration of current and past stressors and the degree of social support may be beneficial when conducting assessments and forming treatment plans.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Philip T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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27
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Amundsen EJ, Bretteville-Jensen AL, Rossow I. Patients admitted to treatment for substance use disorder in Norway: a population-based case-control study of socio-demographic correlates and comparative analyses across substance use disorders. BMC Public Health 2022; 22:792. [PMID: 35443672 PMCID: PMC9020072 DOI: 10.1186/s12889-022-13199-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs. Methods A national population-based case–control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009–2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers. Results Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit – as compared to licit – SUDs were younger (mean quotient = 0.72 [0.71–0.72]), more often had low education level (RR = 1.68 [1.63–1.73]), were less often in paid work (RR = 0.74 [0.72–0.76]) and had lower income (mean quotient = 0.61 [0.60–0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation. Conclusion Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13199-5.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway
| | - Ingeborg Rossow
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, POB 222 Skøyen, 0213, Oslo, Norway
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28
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Burchgart B, Akosile W. Comparing treatment and substance use in case-managed and non-case managed clients receiving opiate replacement therapy with a co-existing mental illness: a cross-sectional study. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2047804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Brook Burchgart
- BMBS, Masters of Psychiatry, Franzcp, Cert Addiction Psychiatry. Bachelor of Occupational Therapy (UQ), Addiction & General Adult Psychiatrist in Full-time Private Practice, Consultant Psychiatrist and Addiction Medicine Specialist, Gold Coast, Australia
| | - Wole Akosile
- Consultant Psychiatrist and Addiction Medicine Specialist, Consultant Psychiatrist and Addiction Medicine Specialist, New Farm Clinic, Senior Lecturer, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Blakey SM, Dillon KH, Wagner HR, Simpson TL, Beckham JC, Calhoun PS, Elbogen EB. Psychosocial well-being among veterans with posttraumatic stress disorder and substance use disorder. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2022; 14:421-430. [PMID: 33661689 PMCID: PMC8417144 DOI: 10.1037/tra0001018] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Concurrent posttraumatic stress disorder and substance use disorder (PTSD/SUD) in U.S. military veterans represents an urgent public health issue associated with significant clinical challenges. Although previous research has shown that veterans with PTSD/SUD endorse more psychosocial risk factors and fewer protective factors than veterans with neither or only one of these disorders, no study has applied a comprehensive framework to characterize the vocational, financial, and social well-being of veterans with PTSD/SUD. Furthermore, it is not fully known how well-being among veterans with PTSD/SUD compares to that of veterans with posttraumatic stress disorder (PTSD) only, substance use disorder (SUD) only, or neither disorder. METHOD This cross-sectional observational study analyzed data from the National Post-Deployment Adjustment Survey, which recruited a random national sample of U.S. veterans who served on/after September 11, 2001. Participants (weighted N = 1,102) self-reported sociodemographic, clinical, and military background information in addition to aspects of their vocational, financial, and social well-being. RESULTS Veterans with PTSD/SUD were particularly likely to report lifetime experiences of homelessness, violent behavior, suicidal ideation, and suicide attempts. Veterans with PTSD/SUD reported worse social well-being than the PTSD-only, SUD-only, and neither-disorder groups. They also reported worse vocational and financial well-being than veterans with SUD only or with neither disorder but did not significantly differ from the PTSD-only group on vocational or financial well-being. CONCLUSIONS The findings underscore the importance of assessing multiple aspects of well-being in veterans with PTSD and/or SUD. The findings also point to promising treatment targets to improve psychosocial functioning and overall quality of life among veterans with PTSD and/or SUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Shannon M. Blakey
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
| | - Kirsten H. Dillon
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - H. Ryan Wagner
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - Tracy L. Simpson
- VA Puget Sound Health Care System, Seattle Division; Seattle, WA,VA Center of Excellence for Substance Addiction Treatment and Education; Seattle, WA,University of Washington, Department of Psychiatry and Behavioral Sciences; Seattle, WA
| | - Jean C. Beckham
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - Patrick S. Calhoun
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - Eric B. Elbogen
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC,VA National Center on Homelessness Among Veterans; Tampa, FL
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30
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Specht S, Schwarzkopf L, Braun-Michl B, Seitz NN, Wildner M, Kraus L. Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 2016. BMC Public Health 2022; 22:320. [PMID: 35168578 PMCID: PMC8848644 DOI: 10.1186/s12889-022-12744-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/09/2022] [Indexed: 01/12/2023] Open
Abstract
Background The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns. Methods Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18–81 years for AUD (n = 46,706) and 18–70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization. Results Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order. Conclusions Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12744-6.
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Affiliation(s)
- Sara Specht
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.
| | - Larissa Schwarzkopf
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany
| | - Barbara Braun-Michl
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany
| | - Nicki-Nils Seitz
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany
| | - Manfred Wildner
- Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.,Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764, Oberschleißheim, Germany
| | - Ludwig Kraus
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Department of Public Health Science, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-106 91, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Izabella utca 46, 1064, Budapest, Hungary
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Farhoudian A, Razaghi E, Hooshyari Z, Noroozi A, Pilevari A, Mokri A, Mohammadi MR, Malekinejad M. Barriers and Facilitators to Substance Use Disorder Treatment: An Overview of Systematic Reviews. Subst Abuse 2022; 16:11782218221118462. [PMID: 36062252 PMCID: PMC9434658 DOI: 10.1177/11782218221118462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
objective: This investigation explored the barriers and facilitators to substance use
disorder (SUD) treatment in the integrated paradigm. methods: A search technique for barriers and facilitators of SUD treatment was applied
to the PubMed and Web of Science databases to identify relevant systematic
reviews. The eligibility criteria included systematic review (SR) or SR plus
meta-analysis (MA) articles published before the end of 2021, human
research, and the English language. Each of the 12 relevant review articles
met the inclusion criteria. AMSTAR was utilised to evaluate the
methodological quality of the systematic reviews. results: Two authors analysed 12 SR/SR-MA articles to identify barriers or
facilitators of SUD treatment. The cumulative summary results of these 12
evaluations revealed that barriers and facilitators may be classified into 3
levels: individual, social and structural. By analysing these review papers,
37 structural barriers, 21 individual barriers and 19 social barriers were
uncovered, along with 15 structural facilitators, 9 social facilitators and
3 individual facilitators. conclusions: The majority of barriers indicated in the review articles included in this
analysis are structural, as are the majority of facilitators. Consequently,
the design of macro models for the treatment of substance use disorders may
yield various outcomes and potentially affect society and individual
levels.
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Affiliation(s)
- Ali Farhoudian
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Emran Razaghi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science, Tehran, Iran
| | - Azam Pilevari
- Department of Sociology, Kharazmi University, Karaj, Iran
| | - Azarakhsh Mokri
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Malekinejad
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Bommersbach TJ, Jegede O, Na PJ, Stefanovics EA, Rhee TG, Rosenheck RA. Treatment of substance use disorders among black and white adults: rates, correlates, and racial discrimination. J Addict Dis 2021; 40:345-356. [PMID: 34747323 DOI: 10.1080/10550887.2021.1997038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Racial disparities in access to psychiatric treatment are well documented, but less is known about disparities in use of substance use disorder (SUD) treatment. OBJECTIVES To compare Black and White individuals with SUDs on overall differences and correlates of SUD treatment receipt. METHODS Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), we compared Black (n = 1,312 unweighted) and White (n = 3,076 unweighted) adults with past-year SUDs on proportions who received SUD treatment and on sociodemographic and clinical correlates of receiving treatment. Due to large samples, effect sizes, rather than p-values, were used to identify substantial differences between racial groups. Multivariate analyses were used to identify independent differentiating factors. RESULTS Black individuals with past-year SUDs were no less likely to receive treatment than White individuals (10.1% versus 11.3%; p = 0.24). Bivariate analyses demonstrated similar correlates of treatment receipt between racial groups, including sociodemographic disadvantage, racial discrimination, criminal justice involvement, low social support, multimorbidity of SUDs and psychiatric disorders, and prior SUD treatment. Multivariate analyses demonstrated that low income, unemployment, and criminal justice involvement had a significantly stronger association with receiving treatment for Whites, while parental problems with alcohol was more strongly associated with treatment among Black individuals (p < 0.05). CONCLUSION Recognizing methodological limitations, our findings are encouraging suggesting that Black individuals with SUDs are not less likely than White individuals to receive treatment and have few differences in correlates of receiving treatment. However, treatment receipt was low for both groups and remains a major unmet challenge.
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Affiliation(s)
| | | | - Peter J Na
- Yale University School of Medicine, New Haven, CT, USA
| | - Elina A Stefanovics
- Yale University School of Medicine, New Haven, CT, USA.,U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
| | - Taeho Greg Rhee
- Yale University School of Medicine, New Haven, CT, USA.,U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Robert A Rosenheck
- Yale University School of Medicine, New Haven, CT, USA.,U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
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Venegas A, Donato S, Meredith LR, Ray LA. Understanding low treatment seeking rates for alcohol use disorder: A narrative review of the literature and opportunities for improvement. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:664-679. [PMID: 34464542 PMCID: PMC9059657 DOI: 10.1080/00952990.2021.1969658] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Despite a well-documented global burden of disease attributable to alcohol use disorder (AUD), treatment seeking rates remain low. In this qualitative literature review, we address treatment seeking for AUD from a host of perspectives and summarize the literature on key factors. First, we summarize the rates of alcohol treatment seeking across various epidemiological surveys, spanning decades. Second, we discuss the definition of treatment seeking and 'what' is typically considered formal treatment. Third, we consider timing and discuss 'when' individuals are most likely to seek treatment. Fourth, we review the literature on 'who' is most likely to seek treatment, including demographic and clinical correlates. Fifth, we address the critical question of 'why' so few people receive clinical services for AUD, relative to the number of individuals affected by the disorder, and review barriers to treatment seeking at the treatment- and person-levels of analysis. Finally, we identify opportunities to improve treatment seeking rates by focusing on tangible points of intervention. Specifically, we recommend a host of adaptations to models of care including efforts to make treatment more appealing across stages of AUD severity, accept a range of health-enhancing drinking goals as opposed to an abstinence-only model, educate providers and consumers about evidence-based behavioral and pharmacological treatments, and incentivize the delivery of evidence-based services.
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Affiliation(s)
- Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Suzanna Donato
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lindsay R Meredith
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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Krasnova A, Diaz JE, Philbin MM, Mauro PM. Disparities in substance use disorder treatment use and perceived need by sexual identity and gender among adults in the United States. Drug Alcohol Depend 2021; 226:108828. [PMID: 34325282 PMCID: PMC8477369 DOI: 10.1016/j.drugalcdep.2021.108828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use disorder (SUD) treatment use is low in the United States. We assessed differences in treatment use and perceived need by sexual identity (i.e., lesbian, gay, bisexual, heterosexual) and gender among adults with a past-year SUD. METHODS We pooled data from the 2015-2019 National Survey on Drug Use and Health for adults (18+) who met past-year DSM-IV SUD criteria and self-reported sexual identity (n = 21,926). Weighted multivariable logistic regressions estimated odds of past-year: 1) any SUD treatment; 2) specialty SUD treatment; 3) perceived SUD treatment need by sexual identity, stratified by gender and adjusted for socio-demographics. RESULTS Any past-year SUD treatment use was low among adult men (heterosexual [10.4 %], gay [15.5 %], and bisexual [7.1 %]) and women (heterosexual [9.9 %], gay/lesbian [11.9 %], and bisexual [13.2 %]). Patterns were similar for specialty SUD treatment and perceived treatment need. Adjusted odds of any SUD treatment use were higher among gay men (aOR = 1.65 [95 % Confidence Interval 1.10-2.46]) and bisexual women (aOR = 1.31 [1.01-1.69]) than their heterosexual peers. Compared to their heterosexual counterparts, adjusted odds of perceived SUD treatment need were higher among bisexual women (aOR = 1.65 [1.22-2.25]), gay men (aOR = 1.76 [1.09-2.84]), and bisexual men (aOR = 2.39 [1.35-4.24]). CONCLUSIONS Most adults with SUD did not receive treatment. Gay men and bisexual women were more likely to receive treatment and reported higher perceived SUD treatment need than heterosexual peers. Facilitating treatment access and engagement is needed to reduce unmet needs among marginalized people who perceive SUD treatment need.
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Affiliation(s)
- Anna Krasnova
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - José E Diaz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Chang C, Wang TJ, Chen MJ, Liang SY, Wu SF, Bai MJ. Factors influencing readiness to change in patients with alcoholic liver disease: A cross-sectional study. J Psychiatr Ment Health Nurs 2021; 28:344-355. [PMID: 32667735 DOI: 10.1111/jpm.12677] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 06/19/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Readiness to change has been documented as a factor affecting alcohol treatment attendance, engagement and outcome. Knowledge regarding readiness to change and its influencing factors in patients with alcoholic liver diseases will inform the development of relevant interventions to help these patients to successfully stop drinking. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The scores in all three dimensions of readiness, recognition, ambivalence and taking steps, were low. For the recognition stage, age, drinking severity and stigma are important factors to be considered. For the ambivalence stage, age and drinking severity are important influencing factors. For the taking steps stage, drinking refusal self-efficacy and depression should be the focus. Instead of negative associations, we found that age and drinking severity, self-stigma and depression were positively associated with readiness to change. Patients who are younger and have higher drinking severity, higher self-stigma, higher self-efficacy and severe depression are more likely to change alcohol use. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Age, drinking severity, self-stigma, drinking refusal self-efficacy and depression are important factors to be considered when mental health nurses try to increase psychological preparedness for changing alcohol use in patients with alcoholic liver diseases. Different factors must be considered for patients in different stages of readiness to change. Different alcohol treatments are needed for different patient populations. ABSTRACT: Introduction Readiness to change (RC) refers to the willingness or psychological preparedness for changing alcohol use. Knowledge regarding factors influencing RC is crucial for developing alcohol treatment plans. Aims The study's purpose was to investigate RC and its influencing factors in patients with alcoholic liver disease (ALD). The factors explored include demographics, disease characteristics, drinking severity, self-stigma, depression, social support and self-efficacy. Method This is a cross-sectional study using self-reported questionnaires. Results Eighty-seven patients with ALD were recruited. Their scores in all three dimensions of readiness, recognition, ambivalence and taking steps, were low. Self-stigma, age and drinking severity explained 32.3% variation in recognition. Drinking severity and age explained 21.5% variation in ambivalence. Self-efficacy, depression and age explained 19.3% variation in taking steps. Discussion Instead of negative associations, we found that age, drinking severity, self-stigma and depression were positively associated with RC. Younger patients with higher drinking severity, higher self-stigma, higher self-efficacy and severe depression are more likely to change alcohol use. Implications for practice Mental health nurses should consider factors such as age, drinking severity, self-stigma, self-efficacy and depression, while trying to increase patients' RC. More specifically, strategies to increase self-efficacy and interventions to support coping are needed. Relevance statement Many ALD patients needing treatment for problematic alcohol use can be effectively managed in primary care with appropriate specialist support. An experienced specialist mental health nurse can play this role. Mental health nurses are important members of alcohol addiction treatment teams. Traditionally, most nurses working in alcohol therapy services have been mental health specialists and work in a partnership model with physicians and other healthcare professionals. The influencing factors found in this study can further inform mental health nurses to recognize and work more effectively with ALD patients' alcohol problems.
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Affiliation(s)
- Chi Chang
- Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ming-Jong Bai
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
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Ray LA, Grodin EN, Leggio L, Bechtholt AJ, Becker H, Ewing SWF, Jentsch JD, King AC, Mason BJ, O’Malley S, MacKillop J, Heilig M, Koob GF. The future of translational research on alcohol use disorder. Addict Biol 2021; 26:e12903. [PMID: 32286721 PMCID: PMC7554164 DOI: 10.1111/adb.12903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
In March 2019, a scientific meeting was held at the University of California, Los Angeles (UCLA) Luskin Center to discuss approaches to expedite the translation of neurobiological insights to advances in the treatment of alcohol use disorder (AUD). A guiding theme that emerged was that while translational research in AUD is clearly a challenge, it is also a field ripe with opportunities. Herein, we seek to summarize and disseminate the recommendations for the future of translational AUD research using four sections. First, we briefly review the current landscape of AUD treatment including the available evidence-based treatments and their uptake in clinical settings. Second, we discuss AUD treatment development efforts from a translational science viewpoint. We review current hurdles to treatment development as well as opportunities for mechanism-informed treatment. Third, we consider models of translational science and public health impact. Together, these critical insights serve as the bases for a series of recommendations and future directions. Towards the goal of improving clinical care and population health for AUD, scientists are tasked with bolstering the clinical applicability of their research findings so as to expedite the translation of knowledge into patient care.
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Affiliation(s)
- Lara A. Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Erica N. Grodin
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD; Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Anita J. Bechtholt
- National Institute on Alcohol Abuse and Alcoholism, Division of Treatment and Recovery Research, National Institutes of Health, Bethesda, MD, USA
| | - Howard Becker
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Science; Department of Neuroscience, Medical University of South Carolina; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Sarah W. Feldstein Ewing
- Oregon Health and Science University, Department of Child and Adolescent Psychiatry, Portland, Oregon, USA
| | - J. David Jentsch
- Binghamton University, Department of Psychology, Binghamton, NY, USA
| | - Andrea C. King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Barbara J. Mason
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, USA
| | | | - James MacKillop
- McMaster University and St. Joseph’s Healthcare Hamilton, Peter Boris Center for Addictions Research, Hamilton, ON, CAN
| | - Markus Heilig
- Linkoping University, Center for Social and Affective Neuroscience, Linkoping, Sweden
| | - George F. Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA; National Institute on Drug Abuse, Baltimore, MD, USA
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Baskerville WA, Nieto SJ, Ho D, Towns B, Grodin EN, Li C, Burnette E, Donato S, Ray LA. Baseline Drinking Patterns in Non-Treatment Seeking Problem Drinkers. Alcohol Alcohol 2021; 56:57-63. [PMID: 33016306 PMCID: PMC7768624 DOI: 10.1093/alcalc/agaa098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Natural processes of change have been documented in treatment-seekers who begin to reduce their drinking in anticipation of treatment. The study examined whether non-treatment-seeking problem drinkers would engage in drinking reduction in anticipation of participating in a research study. METHODS Non-treatment-seeking problem drinkers (n = 935) were culled from five behavioral pharmacology studies. Participants reported on their alcohol use during the past 30 days using the Timeline Followback. Cluster analysis identified distinct groups/clusters based on drinking patterns over the 30-day pre-visit period. The identified clusters were compared on demographic and clinical measures. RESULTS Three distinct clusters were identified (a) heavy-decreasing drinking group (n = 255, 27.27%); (b) a moderate-stable drinking group (n = 353, 37.75%) and (c) low-stable drinking group (n = 327, 34.97%). The three clusters differed significantly on a host of measures including pre-visit drinking (age at first drink, drinking days, drinks per week, drinks per drinking day), alcohol use severity, alcohol craving, readiness for change, depression and anxiety levels. These differences were alcohol dose-dependent such that the heavier drinking group reported the highest levels on all constructs, followed by the moderate group, and the low drinking group last. CONCLUSIONS Baseline drinking patterns of non-treatment-seekers were generally stable and pre-visit reductions were only observed among the heavy drinking group. This generally stable pattern stands in contrast to previous reports for treatment-seeking samples. Nevertheless, the heavier drinking group, which is most similar to treatment-seekers, displayed pre-study drinking reduction. Overall, naturalistic processes of change may pose less of a threat to randomization and testing in this population.
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Affiliation(s)
| | - Steven J Nieto
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Diana Ho
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brandon Towns
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Caesar Li
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Burnette
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Suzanna Donato
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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38
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Benz MB, Cabrera KB, Kline N, Bishop LS, Palm Reed K. Fear of Stigma Mediates the Relationship between Internalized Stigma and Treatment-Seeking among Individuals with Substance Use Problems. Subst Use Misuse 2021; 56:808-818. [PMID: 33726616 DOI: 10.1080/10826084.2021.1899224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite the high prevalence and significant health consequences of substance use disorders, rates of treatment seeking are low. Identifying as an "addict" caries a mainstream connotation that the individual is blameworthy, which contributes to unique stressors and stigma that shape how they are viewed and treated. While substantial literature demonstrates this stigmatizing perspective may serve as a barrier to treatment-seeking, other studies present discrepant findings. The current study seeks to examine the role of fear of stigma and anticipation of being stigmatized in the relationship between internalized stigma and help-seeking for substance use disorders. OBJECTIVE We examined substance use-related stigma, fear of stigma, and treatment-seeking behaviors in a national sample of young adults with a history of problematic substance use. METHODS Participants (N = 171) completed an online, anonymous survey. RESULTS When controlling for enacted stigma and severity of alcohol and other drug use problems, more fear of stigma significantly mediated the relationship between higher internalized stigma and more help-seeking intentions. The sequentially mediated paths between internalized stigma and both help-seeking intentions and previous behaviors through fear of stigma and anticipated stigma were not significant. CONCLUSIONS Findings highlight the importance of fear of substance-related stigma as one mechanism by which internalized stigma may motivate individuals to seek treatment for substance use problems.
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Affiliation(s)
- Madeline B Benz
- Psychology Department, Clark University, Worcester, Massachusetts, USA
| | - Korine B Cabrera
- Psychology Department, Clark University, Worcester, Massachusetts, USA
| | - Nora Kline
- Psychology Department, Clark University, Worcester, Massachusetts, USA
| | - Lia S Bishop
- Psychology Department, Clark University, Worcester, Massachusetts, USA
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E Rudolph A, Fernau DJ, Tobin KE, Latkin C. Individual and social network correlates of recent treatment for substance use disorders among persons who use drugs in Baltimore, MD (2014 - 2017). Drug Alcohol Depend 2020; 217:108278. [PMID: 32949885 PMCID: PMC7736566 DOI: 10.1016/j.drugalcdep.2020.108278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This analysis examined individual and network correlates of treatment enrollment for substance use disorders (SUDs) in the past 6 months and whether these factors varied by type(s) of drug(s) used and type of SUD treatment received. METHODS Between 2014 and 2017, 330 Baltimore residents who reported using heroin, crack, and/or cocaine in the past 6 months completed a survey to assess demographics, substance use, recent SUD treatment enrollment, and information about their network members. The primary outcome was recent enrollment in any type of SUD treatment (i.e., methadone maintenance, detox, residential, outpatient, and meetings/self-help) vs. none. Using logistic regression, recent SUD treatment enrollment was regressed on individual and network characteristics. RESULTS Overall, 214 were enrolled in some form of SUD treatment in the past 6 months (56.6% Methadone Maintenance, 29.8% Detox, 25.9% Residential, 47.8% Outpatient, and 90.7% Meetings/Self-Help). The median number of network members listed was 4.0 (interquartile range: 4-6). In the adjusted model, the odds of SUD treatment enrollment increased with each additional network member who was currently enrolled in SUD treatment (Adjusted Odds Ratio [AOR]:2.22; 95%CI:1.47-3.33). The odds of SUD treatment enrollment decreased by 35% for each additional network member who used heroin, crack, and/or cocaine and could provide them with social support (AOR:0.65; 95%CI:0.48-1.88). CONCLUSIONS Our findings suggest a complex link between the intersecting roles of network members and SUD treatment outcomes among persons who use drugs and the importance of collecting detailed social network information on the different domains of social support provided.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Philadelphia PA 19122, USA.
| | - Deborah J Fernau
- Department of Epidemiology, Boston University School of Public Health, Talbot Building 715 Albany St., Boston University, Boston, MA 02118, USA
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
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Yangyuen S, Kanato M, Mahaweerawat C, Mahaweerawat U. The Perceived Stigma of Addiction and Treatment Utilization among Cannabis Addicts in Thailand. Indian J Community Med 2020; 45:492-496. [PMID: 33623208 PMCID: PMC7877418 DOI: 10.4103/ijcm.ijcm_532_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
Context: A major social problem among clients with substance use disorders is stigmatization related to health conditions, which contributes to poor mental and physical health circumstances and becomes hazardous to substance abuse treatment. Meanwhile, decreased stigmatization among cannabis users might occur because some people use cannabis without experiencing harm or believe it to be a harmless substance and might not be receiving treatment. Several studies have investigated stigma toward substance use disorder and treatment. However, less is known about how stigmatization influences treatment. Aims: To investigate the association between the perceived stigma of addiction and treatment utilization among cannabis addicts. Materials and Methods: A cross-sectional design was conducted with consecutive sampling techniques among 977 cannabis users recruited from all 7 compulsory drug detention centers in Thailand. The data were collected by standardized interviewers with a structured interviewing questionnaire. Binary logistic regression was applied to determine the effect of perceived stigma of treatment utilization. Results: Most clients were male (84.5%), had a family history of drug problems (54.5%), and had a history of mental health problems (5.1%). Most of them reported moderate-to-high levels of perceived stigma (87.2%) and received treatment (28.9%). Greater perceived stigma was associated with decreased treatment for cannabis abuse. Conclusions: The perceived stigma of addiction is a barrier to cannabis abuse treatment utilization. Thus, a better understanding of stigma could reduce its negative impact on seeking and engaging in treatment.
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Affiliation(s)
- Suneerat Yangyuen
- Department of Occupational Health and Safety, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand
| | - Manop Kanato
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Udomsak Mahaweerawat
- Department of Occupational Health and Safety, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand
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Krimphove MJ, Chen X, Marchese M, Friedlander DF, Fields AC, Roa L, Pucheril D, Kibel AS, Melnitchouk N, Urman RD, Kluth LA, Dasgupta P, Trinh QD. Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures. BMC Surg 2020; 20:235. [PMID: 33054733 PMCID: PMC7557098 DOI: 10.1186/s12893-020-00879-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rise in deaths attributed to opioid drugs has become a major public health problem in the United States and in the world. Minimally invasive surgery (MIS) is associated with a faster postoperative recovery and our aim was to investigate if the use of MIS was associated with lower odds of prolonged opioid prescriptions after major procedures. METHODS Retrospective study using the IBM Watson Health Marketscan® Commerical Claims and Encounters Database investigating opioid-naïve cancer patients aged 18-64 who underwent open versus MIS radical prostatectomy (RP), partial colectomy (PC) or hysterectomy (HYS) from 2012 to 2017. Propensity weighted logistic regression analyses were used to estimate the independent effect of surgical approach on prolonged opioid prescriptions, defined as prescriptions within 91-180 days of surgery. RESULTS Overall, 6838 patients underwent RP (MIS 85.5%), 4480 patients underwent PC (MIS 61.6%) and 1620 patients underwent HYS (MIS 41.8%). Approximately 70-80% of all patients had perioperative opioid prescriptions. In the weighted model, patients undergoing MIS were significantly less likely to have prolonged opioid prescriptions in all three surgery types (Odds Ratio [OR] 0.737, 95% Confidence Interval [CI] 0.595-0.914, p = 0.006; OR 0.728, 95% CI 0.600-0.882, p = 0.001; OR 0.655, 95% CI 0.466-0.920, p = 0.015, respectively). CONCLUSION The use of the MIS was associated with lower odds of prolonged opioid prescription in all procedures examined. While additional studies such as clinical trials are needed for further confirmation, our findings need to be considered for patient counseling as postoperative differences between approaches do exist.
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Affiliation(s)
- Marieke J Krimphove
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Xi Chen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - David F Friedlander
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Adam C Fields
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Daniel Pucheril
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA
| | - Nelya Melnitchouk
- Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Prokar Dasgupta
- Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, UK
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St., ASB II-3, Boston, MA, 02115, USA.
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Amini-Rarani M, Khedmati Morasae E, Pashaei T, Moeeni M. Redemption from plight: a qualitative study on reasons behind treatment decisions among Iranian male opioid users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:57. [PMID: 32771025 PMCID: PMC7414986 DOI: 10.1186/s13011-020-00299-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Opioid use remains a significant cause of harm to individual health. Perceived motives are of the main factors that help lead a patient into seeking treatment voluntarily to obviate that harm. The current study expands on the literature by exploring when and how male users of opioids become motivated to voluntarily seek treatment services. METHODS In a qualitative study in Isfahan city from January 2018 to March 2019, 55 male participants who had already started a variety of treatment services to withdraw their dependence on opioids were recruited. Selection of participants was based on a maximum variation purposive sampling strategy. Each participant took part in a unstructured interview to identify his motives for seeking opioid use treatment. Interviews were undertaken in eight different treatment centers. An inductive thematic analysis method was used to analyze the interviews. RESULTS The findings highlight that Iranian male opioid users have different motivations to seek treatment. To be precise, the findings illuminate three global themes and six themes as treatment-seeking motives among the participants including; motives related to family (reason for family and reason of family), quality of life (adverse effects on personal lifestyle and health) and economic motives (financial failure and job failure). CONCLUSIONS The findings can improve our understanding of the motives for seeking treatment from the perspective of opioid patients who entered themselves into treatment. Particularly, these findings could help policymakers and treatment providers to better understand opioid-use patient's perceived concerns and fears as motives for treatment-seeking.
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Affiliation(s)
- Mostafa Amini-Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Tahereh Pashaei
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maryam Moeeni
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Hezar-Jerib Ave, Isfahan, 81746 73461, Iran.
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Medication for opioid use disorder treatment and specialty outpatient substance use treatment outcomes: Differences in retention and completion among opioid-related discharges in 2016. J Subst Abuse Treat 2020; 114:108028. [PMID: 32527510 DOI: 10.1016/j.jsat.2020.108028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/11/2020] [Accepted: 05/06/2020] [Indexed: 11/21/2022]
Abstract
Opioid medication treatment access is a public health priority aimed to improve opioid use treatment outcomes. However, Medicaid does not cover all forms of MOUD, particularly methadone, in many states. We examined associations between medication for opioid use disorder (MOUD) plans and substance use treatment discharge reason (e.g., completed treatment, dropped out of treatment) as well as treatment retention (i.e., length of stay), and estimated whether these relationships were modified by state Medicaid methadone coverage. Data from the 2016 Treatment Episode Data Set for Discharges (TEDS-D) included 152,196 opioid-related treatment episodes from 47 states using relative risk regression with state clustering. Discharges involving MOUD had higher treatment retention for >180 days (aRR: 1.60, 95% CI: 1.29, 1.99) and >365 days (aRR: 2.64, 95% CI: 2.00, 3.49) but lower treatment completion (aRR: 0.46, 95% CI: 0.38, 0.57). There was no evidence that state Medicaid methadone coverage modified any of these relationships. Focusing on treatment completion alone may obscure health benefits associated with longer MOUD treatment retention.
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Sayre M, Lapham GT, Lee AK, Oliver M, Bobb JF, Caldeiro RM, Bradley KA. Routine Assessment of Symptoms of Substance Use Disorders in Primary Care: Prevalence and Severity of Reported Symptoms. J Gen Intern Med 2020; 35:1111-1119. [PMID: 31974903 PMCID: PMC7174482 DOI: 10.1007/s11606-020-05650-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/10/2019] [Accepted: 12/10/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Most patients with substance use disorders (SUDs) never receive treatment and SUDs are under-recognized in primary care (PC) where patients can be treated or linked to treatment. Asking PC patients to directly report SUD symptoms on questionnaires might help identify SUDs but to our knowledge, this approach is previously untested. OBJECTIVE To describe the prevalence and severity of DSM-5 SUD symptoms reported by PC patients as part of routine care. DESIGN Cross-sectional study using secondary data. PARTICIPANTS A total of 241,265 adult patients who visited one of 25 PC sites in an integrated health system in Washington state and had alcohol, cannabis, or other drug use screening documented in their EHRs (March 2015-July 2018) were included in main analyses if they had a positive screen for high-risk substance use defined as AUDIT-C score 7-12 points, or report of past-year daily cannabis use or any other drug use. MAIN MEASURES The main outcome was number of SUD symptoms based on Diagnostic and Statistical Manual, 5th edition (DSM-5), reported on Symptom Checklists (0-11) for alcohol or other drugs: 2-3 mild; 4-5 moderate; 6-11 severe. RESULTS Of screened patients, 16,776 (5.7%) reported high-risk use of alcohol (2.4%), cannabis (3.9%), and/or other drugs (1.7%), and 65.0-69.9% of those completed Symptom Checklists. Of those with high-risk alcohol use, 52.5% (95% CI 50.9-54.0%) reported ≥ 2 symptoms consistent with mild-severe alcohol use disorders. Of those reporting daily cannabis use, 29.8% (28.6-30.9%) reported ≥ 2 symptoms consistent with mild-severe SUDs. Of those reporting any other drug use, 37.5% (35.7-39.3%) reported ≥ 2 symptoms consistent with mild-severe SUDs. CONCLUSIONS AND RELEVANCE Many PC patients who screened positive for high-risk substance use reported symptoms consistent with DSM-5 SUDs on self-report Symptom Checklists. Use of SUD Symptom Checklists could support PC providers in making SUD diagnoses and initiating discussions of substance use.
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Affiliation(s)
- Mikko Sayre
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
- Columbia-Bassett Program at Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA.
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 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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Transdiagnostic or Disorder Specific? Indicators of Substance and Behavioral Addictions Nominated by People with Lived Experience. J Clin Med 2020; 9:jcm9020334. [PMID: 31991652 PMCID: PMC7073953 DOI: 10.3390/jcm9020334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
Using a transdiagnostic perspective, the present research examined the prominent indicators of substance (alcohol, cocaine, marijuana, tobacco) and behavioral (gambling, video games, sex, shopping, work, eating) addictions nominated by people with lived experiences. Specifically, we aimed to explore whether the perceived most important indicators nominated were consistent across the 10 addictions or differed based on the specific addiction. Additionally, we explored gender differences in the perceived most important indicators across addictive behaviors. A large online sample of adults recruited from a Canadian province (n = 3503) were asked to describe the most important signs or symptoms of problems with these substances and behaviors. Open-ended responses were analyzed among a subsample of 2603 respondents (n = 1562 in the past year) who disclosed that they had personally experienced a problem with at least one addiction listed above. Content analyses revealed that dependence (e.g., craving, impairments in control) and patterns of use (e.g., frequency) were the most commonly perceived indicators for both substance and behavioral addictions, accounting for over half of all the qualitative responses. Differences were also found between substance and behavioral addictions regarding the proportion of the most important signs nominated. Consistent with the syndrome model of addiction, unique indicators were also found for specific addictive behaviors, with the greatest proportion of unique indicators found for eating. Supplemental analyses found that perceived indicators across addictions were generally gender invariant. Results provide some support for a transdiagnostic conceptualization of substance and behavioral addictions. Implications for the study, prevention, and treatment of addictions are discussed.
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Receiving addiction treatment in the US: Do patient demographics, drug of choice, or substance use disorder severity matter? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 75:102583. [DOI: 10.1016/j.drugpo.2019.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022]
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Vilsaint CL, Hoffman LA, Kelly JF. Perceived discrimination in addiction recovery: Assessing the prevalence, nature, and correlates using a novel measure in a U.S. National sample. Drug Alcohol Depend 2020; 206:107667. [PMID: 31780300 PMCID: PMC6980305 DOI: 10.1016/j.drugalcdep.2019.107667] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alcohol and other drug (AOD) problems are among the most stigmatized conditions globally diminishing help-seeking due to fear of discrimination. Discrimination is common also among people already in AOD recovery, but little is known about the prevalence and nature of perceived discrimination. Greater knowledge would inform treatment and policy. METHOD Nationally representative cross-sectional sample of U.S. adults who reported resolving an AOD problem (final weighted sample n = 2002). Participants were asked, "Since resolving your problem with alcohol or drugs, how frequently have the following occurred because someone knew about your alcohol or drug history?". MEASURES Item response models yielded two types of discrimination: 1. Micro discrimination (personal slights) 2. Macro discrimination (violations of personal rights); psychological distress, quality of life, and recovery capital. RESULTS About one quarter of participants reported some type of micro discrimination (e.g., held to a higher standard) with slightly less reporting a violation of personal rights (e.g., couldn't get a job). After adjusting for addiction severity and years since problem resolution, greater micro and macro discrimination were associated with higher psychological distress (β = .45, 95% CI = .35,.55 and β = .59, 95% CI = .45,.73), lower quality of life (β =-.41, 95% CI=-.57,-.26 and β =-.49, 95% CI=-.76,-.21) and recovery capital (β =-.33, 95% CI=-.54,-.12 and β =-.68, 95% CI=-.97,-.40) respectively. CONCLUSIONS Despite being in recovery, different types of discrimination are experienced. These are associated with increased distress, and lower quality of life and recovery capital. Prospective studies are needed to help clarify the exact nature and impact of such discrimination on AOD problem recurrence.
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O'Grady MA, Lincourt P, Hussain S, Gilmer E, Neighbors CJ. An instrument for assessing progress in substance use disorder treatment: a pilot study of initial reliability and factor structure of the Treatment Progress Assessment-8. J Addict Dis 2019; 38:49-54. [PMID: 31870228 DOI: 10.1080/10550887.2019.1695512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
New instruments are needed to assist substance use disorder (SUD) clinics in monitoring client treatment progress. This paper describes the development of an 8-item monitoring tool and results from a pilot to understand the tool's structure and reliability. 393 clients completed the tool upon treatment entry. A factor analysis resulted in a 2-factor solution: SUD symptoms and treatment progress. Multiple regression analyses showed that clients in inpatient detoxification had lower scores than those in less intensive levels of care. Acceptable internal consistency reliability was found. This study shows promise for the tool and sets the stage for future validation work.
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Affiliation(s)
- Megan A O'Grady
- Division of Health Services Research, Center on Addiction, New York, USA
| | - Patricia Lincourt
- Addiction Treatment and Recovery, New York State Office of Alcoholism and Substance Abuse Services, New York, USA
| | - Shazia Hussain
- Practice Innovation and Care Management, New York State Office of Alcoholism and Substance Abuse Services, New York, USA
| | - Evan Gilmer
- Division of Health Services Research, Center on Addiction, New York, USA
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Batty EJ, Brown RL. Psychosocial resources and strains and health services use among adult illicit drug users from the Miami-Dade community. J Addict Dis 2019; 38:42-48. [PMID: 31741426 DOI: 10.1080/10550887.2019.1690930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study builds on previous research concerning the associations of positive and negative dimensions of the self-concept and social relationships, respectively, with medical treatment seeking actions by modeling potentially positive and negative effects simultaneously. Using data from the first wave of a large community study including adult (20-93) drug users (n = 318), multivariate linear regression analysis presents the effects of psychosocial resources on drug users' medical treatment seeking in six progressive models. Social resources such as family support, family conflict, and friend support account for variation in medical treatment seeking actions in adult drug users. Dimensions of the self-concept, including perception of powerlessness and self-esteem also influence medical treatment seeking actions in adult drug users. Moderation tests reveal that the presence of family problems related to drug use is associated with a lower likelihood of taking treatment-seeking action in the context of greater family support. This study assessed how positive and negative dimensions of social relationships and the self-concept can jointly influence medical treatment seeking actions. Implications for medical treatment seeking action research are discussed.
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Affiliation(s)
- Evan J Batty
- Department of Sociology, University of Kentucky, 1522 Patterson Office Tower, Lexington, KY, USA
| | - Robyn Lewis Brown
- Department of Sociology, University of Kentucky, 1522 Patterson Office Tower, Lexington, KY, USA
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