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Brown S, Barman-Adhikari A, Garcia K, Chassman S, Hsu HT, Petering R, Santa Maria D, Narendorf S, Shelton J, Bender K, Ferguson K. Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis. Addict Behav 2024; 150:107929. [PMID: 38056194 DOI: 10.1016/j.addbeh.2023.107929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Substance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics. METHODS From June 2016 to July 2017, 1,426 YEH (aged 18-26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership. RESULTS Four latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH. CONCLUSIONS These findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.
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Affiliation(s)
- Samantha Brown
- School of Social Work, Colorado State University, 450 W Pitkin St, Fort Collins, CO 80521, USA.
| | - Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Kevin Garcia
- School of Social Work, Colorado State University, 450 W Pitkin St, Fort Collins, CO 80521, USA
| | - Stephanie Chassman
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, 729 Clark Hall, Columbia, MO 65211, USA
| | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, 1503-1, Los Angeles, CA 90015, USA
| | - Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 591, Houston, TX 77030, USA
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd. #110HA, Houston, TX 77204-4013, USA
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, 2180 Third Ave., New York, NY 10035, USA
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, 411 N. Central Ave., #865, Phoenix, AZ 85004-0689, USA
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Nawaz A, Nielsen S, Mehmood T, Abdullah A, Ahmed A, Ullah W, Khan A. Prescription drug dependence with and without concurrent illicit drug use: a multicenter cross-sectional survey among an addiction treatment seeking population. Front Psychiatry 2023; 14:1133606. [PMID: 37324815 PMCID: PMC10267420 DOI: 10.3389/fpsyt.2023.1133606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Dependence on prescription drugs and illicit drugs imposes a global health and social burden. Despite accumulating evidence of prescription drugs and illicit drugs dependence, none of the systematized studies has explored the magnitude of this problem in Pakistan. The aim is to investigate the extent and associated factors of prescription drug dependence (PDD), as opposed to concomitant prescription drug dependence and illicit drug use (PIDU), within a sample of individuals seeking addiction treatment. Methods The cross sectional study was conducted on the sample recruited from three drug treatment centers in Pakistan. Face-to-face interviews were conducted with participants who met ICD-10 criteria for prescription drug dependence. Several aspects like substance use histories, negative health outcomes, patient attitude, pharmacy and physician practices also collected to predict the determinants of (PDD). Binomial logistic regression models examined the factors associated with PDD and PIDU. Results Of the 537 treatment seeking individuals interviewed at baseline, close to one third (178, 33.3%) met criteria for dependence on prescription drugs. The majority of the participants were male (93.3%), average age of 31 years, having urban residence (67.4%). Among participants who met criteria for dependence on prescription drugs (71.9%), reported benzodiazepines as the most frequently used drug, followed by narcotic analgesics (56.8%), cannabis/marijuana (45.5%), and heroin (41.5%). The patients reported alprazolam, buprenorphine, nalbuphine, and pentazocin use as alternatives to illicit drugs. PDD was significantly negatively associated with injectable route (OR = 0.281, 95% CI, 0.079-0.993) and psychotic symptoms (OR = 0.315, 95% CI, 0.100, 0.986). This implies that PDD is less likely to be associated with an injectable route and psychotic symptoms in contrast to PIDU. Pain, depression and sleep disorder were primary reasons for PDD. PDD was associated with the attitude that prescription drugs are safer than illicit drugs (OR = 4.057, 95%CI, 1.254-13.122) and PDD was associated with being on professional terms (i.e., having an established relationship) with pharmaceutical drugs retailers for acquisition of prescription drugs. Discussion and conclusion The study found benzodiazepine and opioid dependence in sub sample of addiction treatment seekers. The results have implications for drug policy and intervention strategies for preventing and treating drug use disorders.
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Affiliation(s)
- Asma Nawaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tahir Mehmood
- School of Natural Sciences, National University of Science and Technology, Islamabad, Pakistan
| | | | - Ali Ahmed
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
| | - Waseem Ullah
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Ahmad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Papp LM, Kouros CD, Witt HK, Curtin JJ, Blumenstock SM, Barringer A. Real-time momentary mood as a predictor of college students' prescription drug misuse in daily life: Direct links and the moderating role of background mental health. Exp Clin Psychopharmacol 2022; 30:787-796. [PMID: 34110882 PMCID: PMC8660934 DOI: 10.1037/pha0000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present study addressed calls for research to identify real-time predictors of prescription drug misuse (Schepis et al., 2020) by testing young adults' momentary reports of their negative mood and positive mood as predictors of event-level misuse in daily life. We implemented a 28-day ecological momentary assessment (EMA) procedure that collected individuals' mood and other contextual experiences in moments preceding prescription drug misuse. Consistent with models of problematic substance use as a means to reduce negativity (Khantzian, 1997), results from hierarchical generalized linear modeling (HGLM) indicated within-person links between higher than usual negative mood and greater likelihood of prescription misuse in daily life. Contrary to the hypothesis, misuse was also more likely when preceded by elevated positive mood. We found consistent support for the hypothesized between-person effects, with prescription misuse in daily life associated with higher average levels of negative mood, and lower average levels of positive mood, across the reporting period. We further predicted that individuals reporting greater levels of social anxiety, depression, and externalizing symptoms would evidence stronger links between their momentary negative mood and prescription misuse. Partial support for this moderation hypothesis was found, with the positive within-person link between negative mood and prescription misuse significantly stronger among individuals higher (vs. lower) on social anxiety and depression. Results provide support for intricate connections between young adults' momentary mood, mental health symptoms, and prescription drug misuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Burke CW, Firmin ES, Wilens TE. Systematic review: Rates of psychopathology, substance misuse, and neuropsychological dysfunction among transitional age youth experiencing homelessness. Am J Addict 2022; 31:523-534. [PMID: 36036233 DOI: 10.1111/ajad.13340] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Transitional age youth experiencing homelessness (TAY-EH) bear a disproportionate burden of morbidity and mortality related to psychopathology, substance use disorders (SUD), and neuropsychological dysfunction. Prior reviews examining these conditions are now nearly a decade old, have focused on younger adolescent populations, or have utilized nonsystematic approaches. To our knowledge, no prior reviews have reported on all three of these domains in an integrated fashion. Here, we provide a contemporary, critical synthesis of the literature on the functioning of TAY-EH in North America within these three domains. METHODS Based upon PRISMA guidelines, a search of PubMed, Medline, and PsycInfo databases was conducted, including literature published between January 2015 and June 2021. RESULTS The initial search yielded 2024 citations; 104 underwent full text review and 32 met inclusion criteria, with a final aggregate sample size of 13,516. Studies revealed elevated rates of mood disorders, PTSD, anxiety disorders, and alcohol misuse. There is insufficient data to draw generalizable conclusions regarding neuropsychological functioning, other SUD, or other psychiatric diagnoses. No studies reported on co-occurrence of disorders among or between the domains of psychopathology, SUD, and neuropsychological dysfunction. Four studies used structured interviews for diagnoses, with the remainder relying upon brief screeners or self-report measures. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE To our knowledge, this is the first systematic review to provide integrated findings on psychopathology, SUD, and neuropsychological dysfunction among TAY-EH. Further research using structured, DSM-based tools is needed to characterize rates of single and co-occurring conditions to inform tailored treatment interventions.
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Affiliation(s)
- Colin W Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth S Firmin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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5
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Ellis MS, Buttram ME, Kasper ZA. Nonmedical use of gabapentin and opioid agonist medications in treatment-seeking individuals with opioid use disorder. Drug Alcohol Depend 2022; 234:109400. [PMID: 35290917 DOI: 10.1016/j.drugalcdep.2022.109400] [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: 11/18/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND As prescriptions for gabapentin have increased in recent years, nonmedical use and risk of adverse outcomes (e.g., hospitalizations and overdose) have been identified, particularly in association with opioids, including opioid agonist medications (OAMs) buprenorphine and methadone. However, there is a lack of systematic, nationwide data assessing the relationship between the nonmedical use of gabapentin and OAMs. METHODS Data were sourced from two nationwide opioid surveillance programs of treatment-seeking individuals with opioid use disorder (OUD). Both programs utilized an identical serial, cross sectional survey of 12,792 new entrants to one of 163 substance use treatment programs for OUD in 46 states and the District of Columbia from January 2019 to December 2020. RESULTS Past month nonmedical use of gabapentin was endorsed by 9.3% of the sample. Of those using gabapentin nonmedically, 64.1% also endorsed nonmedical use of an OAM, including concomitant use of methadone (35.3%), and buprenorphine (49.0%). Concomitant nonmedical use of gabapentin and OAMs was more prevalent (versus nonmedical use of gabapentin alone) in the Southern region, among those living in a street dwelling, those with chronic pain and healthcare professionals. CONCLUSIONS Nonmedical use of gabapentin in people with OUD appears to frequently coincide with nonmedical use of OAMs. As prescriptions and off-label use of gabapentin increase, provider education should include the risks of concomitant gabapentin and OAM use, particularly amongst buprenorphine prescribers. Future research should investigate motivations (e.g., OUD self-management) for nonmedical use of gabapentin and OAMs within the context of OUD treatment access and retention.
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Affiliation(s)
- Matthew S Ellis
- Washington University in St. Louis, School of Medicine. Department of Psychiatry, St. Louis, MO, USA.
| | - Mance E Buttram
- University of Arkansas, Department of Health, Human Performance & Recreation, Fayetteville, AR, USA
| | - Zachary A Kasper
- Washington University in St. Louis, School of Medicine. Department of Psychiatry, St. Louis, MO, USA
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6
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Werb D, Scheim AI, Soipe A, Aeby S, Rammohan I, Fischer B, Hadland SE, Marshall BDL. Health harms of non-medical prescription opioid use: A systematic review. Drug Alcohol Rev 2022; 41:941-952. [PMID: 35437841 PMCID: PMC9064965 DOI: 10.1111/dar.13441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
ISSUES Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken. APPROACH We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality. KEY FINDINGS Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%). IMPLICATIONS A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault. DISCUSSION AND CONCLUSIONS Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.
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Affiliation(s)
- Dan Werb
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ayorinde Soipe
- Department of Epidemiology, Brown University School of Public Health, Providence, USA.,Division of Nephrology, Department of Medicine, State University of New York, New York, USA
| | - Samantha Aeby
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
| | - Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, USA.,Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
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7
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Tinland A, Loubiere S, Cantiello M, Boucekine M, Girard V, Taylor O, Auquier P. Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death. BMC Public Health 2021; 21:1294. [PMID: 34215235 PMCID: PMC8254224 DOI: 10.1186/s12889-021-11310-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Homeless people face large excess mortality in comparison with the general population, but little is known about the effect of housing interventions like Housing First (HF) on their mortality. Aims of the study 1) to explore 2-years mortality among homeless people with severe mental illness (SMI) included in French HF randomized controlled trial (RCT). 2) To examine causes of death among homeless participants. Methods For 703 participants of HF RCT: 353 in experimental group (HF) and 350 in control group (Treatment As Usual - TAU), any proof of life or death and causes of death were collected with a thorough retrospective investigation among relatives, institutions and administrative databases. Data collection took place from March to June 2017. Results 4.8% (n = 34) of the study participants died over the study period. Mean age of death was 40.9 (+/− 11.4) years. The overall 2-years mortality rate was 0.065 in the HF group (n = 23) versus 0.034 in the TAU group (n = 11). Mortality was associated with medications for opioid use disorder in multivariate Cox analysis (HR: 2.37, 95%CI 1.15–5.04, p = 0.025). Those in HF group seem to be more at risk of death compared to TAU group, mainly during the first 6 months of being housed, although the difference did not reach significance (HR: 0.49, 95%CI 0.24–1.01, p = 0.054). Violent deaths occurred in 52.2% of HF group’s deaths versus 18.2% of TAU group’s deaths, this excess being explained by 34.8% (n = 8) deaths by overdoses in HF group versus none in TAU group. Limitations 1) 8.7% (n = 2) people in HF group died before HF intervention but were analyzed in intention-to-treat. 2) No proof of life or death has been found for only 0.6% in HF group (n = 2) but for 9.5% people in TAU group (n = 33) that could be anonymous deaths. 3) Undetermined causes represented 8.7% of deaths in HF group versus 36.4% in TAU group. 4) The small number of events (deaths) in the study population is a limitation for statistical analysis. Conclusions Due to important limitations, we cannot conclude on HF effect on mortality, but our results nevertheless confirm that the vulnerability of long-term homeless people with SMI persists after accessing independent housing. Earlier intervention in the pathways of homelessness should be considered, alongside active specific support for addictions. Trial registration Ethics Committee Sud Mediterrannée V n° 11.050: trial number 2011-A00668–33: 28/07/2011. Clinicaltrials ID NCT01570712: 4/4/2012.
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Affiliation(s)
- Aurélie Tinland
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France. .,Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.
| | - Sandrine Loubiere
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Matthieu Cantiello
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Vincent Girard
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Owen Taylor
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
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8
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Tucker JS, Kennedy DP, Osilla KC, Golinelli D. Motivational network intervention to reduce substance use and increase supportive connections among formerly homeless emerging adults transitioning to housing: study protocol for a pilot randomized controlled trial. Addict Sci Clin Pract 2021; 16:18. [PMID: 33726809 PMCID: PMC7968154 DOI: 10.1186/s13722-021-00227-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies indicate high rates of substance use among youth experiencing homelessness (YEH). Further, the social networks of YEH, although multi-dimensional in composition, are largely comprised of other YEH, substance users, and individuals who do not provide the youth with tangible or emotional support. For YEH who have the opportunity to enter a housing program, helping them to reduce their substance use and strengthen their prosocial supportive connections during this critical transition period may increase their stability and reduce their risk of re-entering homelessness. The goal of this study is to pilot test a brief motivational network intervention (MNI), delivered by case managers, to help former YEH who have recently transitioned to a housing program reduce their substance use and strengthen their prosocial supportive connections. METHODS/DESIGN Up to 60 residents of housing programs in the Los Angeles area will be randomized to receive four sessions of usual case manager support or four sessions of case manager support + MNI. Each MNI session consists of three parts: (1) identifying two goals that are most important for the resident over the next year (e.g., get or keep a job, finish or stay in school, reduce substance use); (2) a network interview with the resident to capture network data pertaining to their interactions in the past 2 weeks; and (3) a discussion between the case manager and the resident of the resulting network visualizations, conducted in a Motivational Interviewing (MI) style, and what role the resident's network may play in reaching their most important goals over the next year. DISCUSSION This study addresses a critical gap by pilot testing a computer-assisted MNI, delivered using MI techniques, that can help case managers work with recent YEH to reduce substance use and increase permanent supportive connections during the critical transitional period from homelessness to housing. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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9
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D'Amico EJ, Davis JP, Tucker JS, Seelam R, Stein BD. Opioid misuse during late adolescence and its effects on risk behaviors, social functioning, health, and emerging adult roles. Addict Behav 2021; 113:106696. [PMID: 33264695 DOI: 10.1016/j.addbeh.2020.106696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/04/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022]
Abstract
Opioid misuse has emerged in recent years as a major public health concern in the United States, particularly for adolescents and emerging young adults. We examined the association of opioid misuse from ages 18 to 20 with four domains at age 21-22: risk behaviors and consequences; health; social functioning; and emerging adult roles. Participants were surveyed annually from 2008 through 2019. The sample includes N = 2880 youth from waves 8-11. The sample was approximately 18 years old at wave 8; 54% female, 46% Hispanic, 20% white, 20% Asian, 2% Black, and 11% multiracial. Opioid misuse was low in this general sample of young adults, with about 4% reporting misuse from age 18-20. We used latent growth curve modeling to examine how misuse from ages 18-20 was associated with functioning at age 21-22. Adolescents who reported opioid misuse at age 18 also reported more negative consequences from alcohol and cannabis use and greater odds of other prescription drug misuse at age 21-22 than those with no misuse. Those reporting opioid misuse at age 18 were also more likely to engage in sexual risk behaviors, report delinquent behavior, and have a higher likelihood of experiencing sexual victimization and engaging in sexual perpetration at age 21-22 than those with no misuse. Neither the intercept nor slope of opioid misuse was associated with depression, anxiety, physical health or ailments, satisfaction with friends, romantic relationship functioning, or emerging adult roles at wave 11. Findings highlight the importance of screening and brief intervention for adolescents reporting opioid misuse.
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, 669 W 34th St, Los Angeles, CA 90089, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
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10
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Ali MM, Sutherland H, Rosenoff E. Comorbid Health Conditions and Treatment Utilization among Individuals with Opioid Use Disorder Experiencing Homelessness. Subst Use Misuse 2021; 56:571-574. [PMID: 33637031 DOI: 10.1080/10826084.2021.1884723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People experiencing homelessness have been particularly hard hit by the opioid crisis. This epidemic has also impacted individuals experiencing homelessness in ways that are distinct from how it has impacted individuals with stable housing. However, not much is known about comorbid health conditions and health services utilization among adults with opioid use disorder (OUD) who are experiencing homelessness. METHOD A retrospective observational cohort study was conducted utilizing a large national all-payer electronic health record database. The sample for the analysis is comprised of 2,080 individuals with OUD who had an ICD-10 Z code of homelessness (Z59.0), and the comparison group includes 980 individuals with OUD covered under Medicaid who were matched on age and gender to the homeless population. RESULTS Higher rates of mental health conditions such as bipolar disorder (48%) and schizophrenia (22%) were present among individuals with OUD experiencing homelessness compared to individuals with OUD covered under Medicaid not experiencing homelessness (26% and 8%, respectively). In addition, higher rates of alcohol (44%) and stimulant abuse (30%) were also present among the patients compared to the comparison group (29% and 9%, respectively). Utilization of buprenorphine for OUD and treatment for mental health conditions were low among the patients experiencing homelessness. CONCLUSION Underlying mental health conditions and polysubstance use contribute toward making individuals experiencing homelessness more susceptible to adverse health outcomes associated with OUD. Health policy initiatives directed toward treatment engagement might benefit from an emphasis on addressing housing instability that many individuals with OUD might be experiencing.
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Affiliation(s)
- Mir M Ali
- Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, DC, USA
| | - Harper Sutherland
- Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, DC, USA
| | - Emily Rosenoff
- Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, DC, USA
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Tucker JS, D'Amico EJ, Pedersen ER, Rodriguez A, Garvey R. Study protocol for a group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among young adults experiencing homelessness. Addict Sci Clin Pract 2020; 15:26. [PMID: 32723349 PMCID: PMC7390162 DOI: 10.1186/s13722-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/17/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. METHODS/DESIGN In a cluster-cross-over randomized controlled trial, 18-25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. DISCUSSION This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered).
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.,Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, United States
| | - Rick Garvey
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
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Beharry MS, Christensen R. Homelessness in Pediatric Populations: Strategies for Prevention, Assistance, and Advocacy. Pediatr Clin North Am 2020; 67:357-372. [PMID: 32122565 DOI: 10.1016/j.pcl.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent data indicate that homelessness among pediatric and adolescent populations is significantly higher than previous studies and point-in-time counts indicate. Pediatricians and other health care providers often see children and youth who are at risk of or are currently experiencing homelessness, but may not be aware of their status. This article summarizes current definitions of homelessness and data on common health issues for pediatric patients. Information on how to recognize and help those experiencing homelessness as well as areas for continued advocacy is shared.
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Affiliation(s)
- Meera S Beharry
- Adolescent Medicine, McLane Children's Medical Center, McLane Children's Specialty Clinic, Baylor Scott and White, 1901 SW H.K. Dodgen Loop, MS-CK-300, Building 300, Temple, TX 76502, USA; Texas A&M Health Science Center (Affiliate), Temple, TX, USA.
| | - Randal Christensen
- Randal Christensen Consulting, LLC, 2654 W Horizon Ridge Parkway Suite B5-113, Henderson, NV 89052, USA. https://twitter.com/AskMeWhyIHurt
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