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Pastwa-Wojciechowska B, Guzińska K. The relationship between male prisoners' self-efficacy and their participation in addiction treatment. Alcohol 2024; 120:65-72. [PMID: 38163492 DOI: 10.1016/j.alcohol.2023.12.007] [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: 10/09/2020] [Revised: 10/21/2021] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
The purpose of this study was to attempt to verify the existence of a relationship between internal resources (self-esteem and self-efficacy) and motivation (decisional balance) to undergo treatment in prisoners with alcohol addiction participating in voluntary treatment as well as referred to obligatory addiction treatment based on a court decision. The study was carried out in penitentiary units in various parts of Poland in 2018-2019. Participants completed the Decision Balance Scale, Generalized Self-Efficacy Scale, and Multidimensional Self-Esteem Inventory twice - before and after addiction treatment. The study adopted the assumptions of the Transtheoretical Model developed by Prochaska and DiClemente (1984). There were no statistically significant differences between the group of prisoners referred for obligatory treatment and those undergoing voluntary therapy. At the end of the 3-month treatment, there was a significantly smaller number of arguments "for" drinking and less identity integration in both groups studied. The results obtained may indicate that after undergoing therapy, prisoners remain in a contemplation stage due to their inability to adapt therapeutic interactions to individual needs. It seems that changes in identity integration may be indicative of the crisis that is being experienced, which in effect may allow individuals with alcohol addiction to search for and achieve a potentially new, coherent image of themselves.
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Silcox J, Rapisarda SS, Hughto JMW, Vento S, Case P, Palacios WR, Zaragoza S, Shrestha S, Stopka TJ, Green TC. Views and experiences of involuntary civil commitment of people who use drugs in Massachusetts (Section 35). Drug Alcohol Depend 2024; 263:112391. [PMID: 39167986 DOI: 10.1016/j.drugalcdep.2024.112391] [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: 02/29/2024] [Revised: 06/28/2024] [Accepted: 08/03/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Involuntary civil commitment (ICC) is a court-mandated process to place people who use drugs (PWUD) into substance use treatment. Research on ICC effectiveness is mixed, but suggests that coercive drug treatment like ICC is harmful and can produce a number of adverse outcomes. We qualitatively examined the experiences and outcomes of ICC among PWUD in Massachusetts. METHODS Data for this analysis were collected between 2017 and 2023 as part of a mixed-methods study of Massachusetts residents who disclosed illicit drug use in the past 30-days. We examined the transcripts of 42 participants who completed in-depth interviews and self-reported ICC. Transcripts were coded and thematically analysed using inductive and deductive approaches to understand the diversity of ICC experiences. RESULTS Participants were predominantly male (57 %), white (71 %), age 31-40 (50 %), and stably housed (67 %). All participants experienced ICC at least once; half reported multiple ICCs. Participants highlighted perceptions of ICC for substance use treatment in Massachusetts. Themes surrounding ICC experience included: positive and negative treatment experience's, strategies for evading ICC, disrupting access to medications for opioid use disorder (MOUD), and contributing to continued substance use and risk following release. CONCLUSIONS PWUD experience farther-reaching health and social consequences beyond the immediate outcomes of an ICC. Findings suggest opportunities to amend ICC to facilitate more positive outcomes and experiences, such as providing sufficient access to MOUD and de-criminalizing the ICC processes. Policymakers, public health, and criminal justice professionals should consider possible unintended consequences of ICC on PWUD.
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Affiliation(s)
- Joseph Silcox
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; University of Massachusetts - Boston, Department of Sociology, Boston, MA, USA.
| | - Sabrina S Rapisarda
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; University of Massachusetts - Lowell, School of Criminology and Justice Studies, Lowell, MA, USA
| | - Jaclyn M W Hughto
- Brown University, Center for Health Promotion and Health Equity, Providence, RI, USA; Brown University School of Public Health, Departments of Behavioral and Social Sciences and Epidemiology, School of Public Health, Providence, RI, USA
| | - Stephanie Vento
- Brown University, Center for Health Promotion and Health Equity, Providence, RI, USA; The Sutherland School of Law, University College Dublin, Belfield, Dublin, Ireland
| | - Patricia Case
- Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| | - Wilson R Palacios
- University of Massachusetts - Lowell, School of Criminology and Justice Studies, Lowell, MA, USA
| | - Sofia Zaragoza
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Traci C Green
- The Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; Brown University Schools of Medicine and Public Health, Departments of Emergency Medicine and Epidemiology, Providence, RI, USA
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Fiellin DA. Treatment Failure Versus Failed Treatments: The Risks of Embracing Treatment Refractory Addiction. J Addict Med 2024; 18:480-482. [PMID: 39356618 DOI: 10.1097/adm.0000000000001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
ABSTRACT In this issue, Strain advocates for the field of addiction medicine to consider a new diagnostic signal-treatment-refractory addiction. Also in this issue, Nunes and McLellan support the concepts advanced by Strain. I provide an alternate view and propose that it is premature to create such a signal and that doing so could lead to unintended adverse consequences. My argument is based on 4 concerns: (1) the lack of neuroscientific correlates, (2) the profound impact that context has on what patients receive as "treatment," (3) the rare provision of sequentially stepped treatment, and (4) the potential for misuse of the signal. Addiction medicine should be cautious in introducing concepts such as treatment-refractory addiction to ensure that patients are not seen as "treatment failures." Our efforts should rather focus on the development of additional effective treatments, improving access to existing effective treatments and a creating a system that does not provide "failed treatments."
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Affiliation(s)
- David A Fiellin
- From the Department of Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; and Yale School of Public Health, New Haven, CT
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Wells M, Kelly PJ, Robson D, Haynes C, Hatton E, Larance B. Systematic review of treatment completion rates and correlates among young people accessing alcohol and other drug treatment. Drug Alcohol Depend 2024; 262:111376. [PMID: 38971027 DOI: 10.1016/j.drugalcdep.2024.111376] [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: 03/24/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND AIMS Treatment completion is associated with improved alcohol and other drug (AOD) treatment outcomes. Unfortunately, treatment disengagement is common, particularly among young people. We reviewed and synthesised research on AOD treatment completion and/or early disengagement among young people. METHODS We conducted a systematic review and meta-analysis of studies reporting on completion rates and/or early disengagement from psychosocial AOD treatment among adolescents and young adults. An overall estimated treatment completion rate was calculated using inverse-variance random effects meta-analysis, and random-effects meta-regression was used to identify between-study level moderators of completion rate. We completed a narrative review summarising literature on early treatment disengagement and within-study level correlates of treatment completion. Study quality was assessed using the EPHPP. RESULTS Of the 6158 studies screened, we retained 410 for full text review and included 98 studies in the review. Treatment completion rates were reported in 88 studies, and early disengagement rates were reported in 13. The estimated overall treatment completion rate was 59 % (95 % CI=57-61 %), with experimental studies reporting higher rates of completion than observational studies. There was limited evidence for demographic or substance-related correlates of treatment completion. Contingency management was associated with increased completion rates, as was family-based intervention. CONCLUSIONS Disengagement from AOD treatment among youth populations is common and contributes to poor treatment outcomes. Existing research has yielded little consensus on the factors associated with treatment completion. The use of contingency management strategies and involving family/social supports in treatment were identified as potential avenues for promoting ongoing treatment engagement.
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Affiliation(s)
- Megan Wells
- School of Psychology, University of Wollongong, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Australia
| | - Davina Robson
- School of Psychology, University of Wollongong, Australia; School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Australia
| | - Chloe Haynes
- School of Psychology, University of Wollongong, Australia
| | - Emma Hatton
- School of Psychology, University of Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Australia
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Mills JM, Davidson KM. The prison-based Therapeutic Community: Resident recommendations for program improvement. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209404. [PMID: 38768815 DOI: 10.1016/j.josat.2024.209404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION The prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants. METHODS To assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item "What can the TC do better?" Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program. RESULTS Residents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system. CONCLUSIONS Resident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback.
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Affiliation(s)
- Jack M Mills
- College of Criminology & Criminal Justice, Florida State University, Tallahassee, USA
| | - Kimberly M Davidson
- College of Criminology & Criminal Justice, Florida State University, Tallahassee, USA.
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Kisely S, Zirnsak T, Corderoy A, Ryan CJ, Brophy L. The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses. Aust N Z J Psychiatry 2024; 58:555-570. [PMID: 38650311 PMCID: PMC11193324 DOI: 10.1177/00048674241246436] [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] [Indexed: 04/25/2024]
Abstract
AIMS Community treatment orders have been introduced in many jurisdictions with increasing use over time. We conducted a rapid umbrella review to synthesise the quantitative and qualitative evidence from systematic reviews and/or meta-analyses of their potential harms and benefits. METHODS A systematic search of Medline, PubMed, Embase and PsycINFO for relevant systematic reviews and/or meta-analyses. Where available, participants on community treatment orders were compared with controls receiving voluntary psychiatric treatment. This review is registered with PROSPERO (CRD42023398767) and the Open Science Framework (https://osf.io/zeq35). RESULTS In all, 17 publications from 14 studies met the inclusion criteria. Quantitative synthesis of data from different systematic reviews was not possible. There were mixed findings on the effects of community treatment orders on health service use, and clinical, psychosocial or forensic outcomes. Whereas uncontrolled evidence suggested benefits, results were more equivocal from controlled studies and randomised controlled trials showed no effect. Any changes in health service use took several years to become apparent. There was evidence that better targeting of community treatment order use led to improved outcomes. Although there were other benefits, such as in mortality, findings were mostly rated as suggestive using predetermined and standardised criteria. Qualitative findings suggested that family members and clinicians were generally positive about the effect of community treatment orders but those subjected to them were more ambivalent. Any possible harms were under-researched, particularly in quantitative designs. CONCLUSIONS The evidence for the benefits of community treatment orders remains inconclusive. At the very least, use should be better targeted to people most likely to benefit. More quantitative research on harms is indicated.
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Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Griffith Criminology Institute (GCI), Griffith University, Mount Gravatt, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Tessa Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Amy Corderoy
- Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Christopher James Ryan
- Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, NSW, Australia
- Specialty of Psychiatry, University of Sydney, Sydney, NSW, Australia
- Department of Psychiatry, St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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Oser CB, Moody MD, Hansen AC, Stevens-Watkins D, Staton M, Bunting AM. Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach. Drug Alcohol Depend 2024; 260:111326. [PMID: 38733734 DOI: 10.1016/j.drugalcdep.2024.111326] [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: 07/20/2023] [Revised: 04/01/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.
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Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, United States.
| | - Myles D Moody
- Department of Sociology, The University of Alabama at Birmingham, Heritage Hall, Room 460, 1401 University Blvd, Birmingham, AL 35233, United States
| | - Anna C Hansen
- Department of Sociology, College of Medicine, University of Kentucky, 1519 Patterson Office Tower, Lexington, KY 40506, United States
| | - Danelle Stevens-Watkins
- Department of Counseling Psychology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 251c Dickey Hall, Lexington, KY 40506, United States
| | - Michele Staton
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 117 Medical Behavioral Science Building, Lexington, KY 40506, United States
| | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, United States
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Chen CY, Hsieh TW, Rei W, Huang CH, Wang SC. Association between socioeconomic and motherhood characteristics with receiving community-based treatment services among justice-involved young female drug users: a retrospective cohort study in Taiwan. Harm Reduct J 2024; 21:109. [PMID: 38840179 PMCID: PMC11151603 DOI: 10.1186/s12954-024-01010-0] [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: 11/14/2023] [Accepted: 04/23/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Drug-involved individuals who contact treatment services in Taiwan are mostly driven by criminal justice systems either as an alternative or adjunct to criminal sanctions for a drug offence. With a focus on justice-involved young female drug users, the present study examines the extent to which socioeconomic and motherhood characteristics are associated with receiving deferred prosecution, a scheme diverting drug offenders to community-based addiction treatment. METHODS We identified a cohort of 5869 women under the age of 30 arrested for using Schedule II drugs (primarily amphetamine-like stimulants) from the 2011-2017 National Police Criminal Records in Taiwan. Information concerning socioeconomic characteristics, pregnancy and live birth history, and deferred prosecution was obtained through linkage with the 2006-2019 National Health Insurance, birth registration, and deferred prosecution datasets. Multinomial logistic regression was used to evaluate the association with stratification by recidivism status. RESULTS Within six months of arrest, 21% of first-time offenders (n = 2645) received deferred prosecution and 23% received correction-based rehabilitation; the corresponding estimates for recidivists (n = 3224) were 6% and 15%, respectively. Among first-time offenders, low/unstable income was associated with lower odds of deferred prosecution (adjusted odds ratio [aOR] = 0.71; 95% CI: 0.58, 0.88). For recidivists, those with low/unstable income (aOR = 1.58) or unemployment (aOR = 1.58) had higher odds of correction-based rehabilitation; being pregnant at arrest was linked with reduced odds of deferred prosecution (aOR = 0.31, 95% CI: 0.13, 0.71) and correction-based rehabilitation (aOR = 0.50, 95% CI: 0.32, 0.77). CONCLUSIONS For the young women arrested for drug offences, disadvantaged socioeconomic conditions were generally unfavored by the diversion to treatment in the community. Childbearing upon arrest may lower not only the odds of receiving medical treatment but also correctional intervention. The criminal prosecution policy and process should be informed by female drug offenders' need for treatment and recovery.
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Affiliation(s)
- Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
| | - Tan-Wen Hsieh
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Wenmay Rei
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | | | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
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Giang LM, Trang NT, Hoe HD, Anh NH, Thuy DTT, Bart G. "If they get out of drug rehab centers, they're on their own": Opportunities and challenges for people released from compulsory drug rehabilitation centers to communities in Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104443. [PMID: 38743963 PMCID: PMC11213659 DOI: 10.1016/j.drugpo.2024.104443] [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: 12/20/2023] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Compulsory drug rehabilitation is a major governmental response to illicit drug use in Vietnam and other countries in Asia. Long-term compulsory rehabilitation is associated with negative health, social and economic outcomes. The transition to community-based services for people released from compulsory drug rehabilitation has been problematic not only in Vietnam. This study utilized the WHO Health System Building Blocks Framework to examine the opportunities and challenges for people with substance use disorders (SUD) who are released from compulsory drug rehabilitation back into the community. METHODS Between October 2021 and August 2022, we interviewed people with SUD who had recently returned from or were preparing to leave compulsory drug rehabilitation (n = 25), their family members (n = 20) and professionals working in the field of drug rehabilitation (n = 28) across three cities in Vietnam. Additionally, we conducted a review of policy documents to complement the interview data. RESULTS The study identified opportunities and challenges within Vietnam's drug rehabilitation system concerning leadership and governance, financing, workforce, information systems and service delivery for people with SUD. Key opportunities include a legal framework that emphasizes community-based support for people with SUD, a government-funded national network of lay social workers, and ongoing efforts to connect people to community-based services. We found significant challenges caused by the lack of clear instructions for implementing supportive policies, inadequate funding for community-based services, persisting stigma from providers towards people with SUD and unavailability of community-based drug treatment other than methadone. CONCLUSION Vietnam continues with compulsory drug rehabilitation yet endorses recovery-oriented policies to address substance use issues. Substantial challenges hinder the effective implementation of these policies. Our study recommends reinforcing existing policies and enhancing recovery-oriented community-based services by improving the quality of data collection, building capacity of lay social workers who facilitate linkages to services and expanding community-based drug treatment options.
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Affiliation(s)
- Le Minh Giang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Nguyen Thu Trang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam.
| | - Han Dinh Hoe
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Nguyen Huu Anh
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Dinh Thi Thanh Thuy
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Gavin Bart
- Division of Addiction Medicine, Hennepin Healthcare and University of Minnesota Medical School, United States
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Guta A, Gagnon M, German D, Buchman DZ, Strike CJ. Resisting Inadequate Care is Not Irrational, and Coercive Treatment is Not an Appropriate Response to the Drug Toxicity Crises. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:42-45. [PMID: 38635440 DOI: 10.1080/15265161.2024.2327287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Adrian Guta
- School of Social Work, University of Windsor
| | | | | | | | - Carol J Strike
- Dalla Lana School of Public Health, University of Toronto
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Oesterle TS, Bormann NL, Ochal DA, Arndt S, Breitinger SA. Transitioning Virtual-Only Group Therapy for Substance Use Disorder Patients to a Hybrid Model. Subst Abuse Rehabil 2024; 15:73-78. [PMID: 38681859 PMCID: PMC11055515 DOI: 10.2147/sar.s460024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed. Patients and Methods Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181-255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure. Results A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demographics; however, the overall IOP sample for 2020-2022, from which the sample was derived, was 29.8% female, and 64.1% were 18-40 years of age. For completed treatment, hybrid group exposure relative to virtual-only had a univariate odds ratio of 1.88 (95% CI: 1.50-2.41, p < 0.001). No significant difference was seen across IOP sites. Conclusion These results describe a novel hybrid group approach to virtual care for SUDs with outcome data not previously documented in the literature. While virtual treatment delivery can increase access, these results suggest a benefit is derived from including an in-person option. Further research is needed to identify how an in-person component may change dynamics and if it can be replicated in virtual-only models.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Pedroso JMG, Araujo CNDP, Corradi-Webster CM. The joy and pain of being a harm reduction worker: a qualitative study of the meanings about harm reduction in Brazil. Harm Reduct J 2024; 21:56. [PMID: 38439094 PMCID: PMC10910711 DOI: 10.1186/s12954-024-00962-7] [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: 05/22/2023] [Accepted: 02/11/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Although harm reduction is highlighted as an effective intervention for alcohol and drug use, a funding gap for harm reduction interventions has been identified, mainly in low- and middle-income countries. In these countries, tensions between abstinence and harm reduction models have impaired the shift from punitive practices to evidence-based interventions committed to guaranteeing the human rights of people who use drugs. Since 2015, the Brazilian government has adopted a more punitive and abstinence-focused drug policy that jeopardizes the care of people who use alcohol and other drugs and the comprehension of the harm reduction workers' perspective in relation to their practice. Therefore, this study aimed to comprehend the meanings constructed by Brazilian harm reduction workers regarding their practices with vulnerable populations amidst a context of political tension. METHODS We conducted 15 in-depth semi-structured qualitative interviews with harm reduction workers employed in public health services for at least 6 months. Data were analyzed using thematic analysis. RESULTS The thematic axis "The joy and pain of being a harm reduction worker in Brazil" was constructed and divided into four major themes: (1) Invisibility of harm reduction work; (2) Black, poor, and people who use drugs: identification with the service users; (3) Between advocacy and profession: harm reduction as a political act; (4) Small achievements matter. Despite the perceived invisibility of harm reduction workers in the public health and alcohol and drug fields, valuing small achievements and advocacy were important resources to deal with political tension and punitive strategies in Brazil. The findings also highlight the important role of harm reduction workers due to their personal characteristics and understanding of drug use behavior, which bring the target audience closer to actions within the public health system. CONCLUSION There is an urgent need to acknowledge harm reduction based on peer support as a professional category that deserves adequate financial support and workplace benefits. Additionally, expanding evidence-based harm reduction interventions and community-based voluntary drug use treatment centers should be prioritized by public policies to address the human rights violations experienced by people who use drugs.
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Affiliation(s)
- João Maurício Gimenes Pedroso
- Psychology Department, Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-900, Brazil.
- Central Paulista University Center - UNICEP, São Carlos, SP, 13563-470, Brazil.
| | - Cristiana Nelise de Paula Araujo
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32608, USA
| | - Clarissa Mendonça Corradi-Webster
- Psychology Department, Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-900, Brazil
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Hawkins C, Kealy D. Readiness and Personality Disorders: Considering Patients' Readiness for Change and Our System's Readiness for Patients. Harv Rev Psychiatry 2024; 32:70-75. [PMID: 38452287 DOI: 10.1097/hrp.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
ABSTRACT The culture around personality disorder treatment has changed drastically in the past generation. While once perceived as effectively untreatable, there are now numerous evidence-based treatment approaches for personality disorders (especially borderline personality disorder). The questions, however, of who should be matched to which treatment approach, and when, remain largely unanswered. In other areas of psychiatry, particularly substance use disorders and eating disorders, assessing patient treatment readiness is viewed as indispensable for treatment planning. Despite this, relatively little research has been done with respect to readiness and personality disorder treatment. In this article, we propose multiple explanations for why this may be the case, relating to both the unique features of personality disorders and the current cultural landscape around their treatment. While patients with personality disorders often face cruel stigmatization, and much more work needs to be done to expand access to care (i.e., our system's readiness for patients), even gold-standard treatment options are unlikely to work if a patient is not ready for treatment. Further study of readiness in the context of personality disorders could help more effectively match patients to the right treatment, at the right time. Such research could also aid development of strategies to enhance patient readiness.
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Affiliation(s)
- Connor Hawkins
- From Department of Psychiatry, University of British Columbia (Drs. Hawkins and Kealy); Vancouver Coastal Health, British Columbia, CA (Dr. Hawkins)
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Tomlin J, Meise E, Wegner J, Völlm B. Mandatory substance use treatment for justice-involved persons in Germany: a systematic review of reoffending, treatment and the recurrence of substance use outcomes. Front Psychiatry 2024; 14:1217561. [PMID: 38375516 PMCID: PMC10876065 DOI: 10.3389/fpsyt.2023.1217561] [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: 05/05/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and effectiveness of this disposal abound. Very little attention has been paid in the international literature to patients receiving mandatory treatment in Germany. This systematic review synthesises research on patients receiving substance use treatment in forensic hospitals under §64 of the German Penal Code with regard to three primary outcomes: treatment completion, reoffending, and the recurrence of substance use. Forty-five publications reporting on 36 studies were reviewed; publication dates ranged from 1988 to 2023. On average, 47% of patients did not successfully complete treatment, compared to 45% who did. Average follow-up reconviction rates were higher than in mentally ill and general offender populations as reported elsewhere. Approximately half of all patients reused substances during treatment. Suggestions for future research, including a focus on strength- and recovery-based indicators, and harmonising routine outcomes measurements, are given.
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Affiliation(s)
- Jack Tomlin
- School of Law and Criminology, University of Greenwich, London, United Kingdom
| | - Esther Meise
- Department of Forensic Psychiatry, University Medicine, Rostock, Germany
| | - Juliane Wegner
- Institut für Medienforschung, University of Rostock, Rostock, Germany
| | - Birgit Völlm
- Department of Forensic Psychiatry, University Medicine, Rostock, Germany
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15
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Cochran P, Chindavong PS, Edelenbos J, Chiou A, Trulson HF, Garg R, Parker RW. The impact of civil commitment laws for substance use disorder on opioid overdose deaths. Front Psychiatry 2024; 15:1283169. [PMID: 38370563 PMCID: PMC10869443 DOI: 10.3389/fpsyt.2024.1283169] [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: 08/25/2023] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Our study analyzed the impact of civil commitment (CC) laws for substance use disorder (SUD) on opioid overdose death rates (OODR) in the U.S. from 2010-21. Methods We used a retrospective study design using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset to analyze overdose death rates from any opioid during 2010-21 using ICD-10 codes. We used t-tests and two-way ANOVA to compare the OODR between the U.S. states with the law as compared to those without by using GraphPad Prism 10.0. Results We found no significant difference in the annual mean age-adjusted OODR from 2010-21 between U.S. states with and without CC SUD laws. During the pre-COVID era (2010-19), the presence or absence of CC SUD law had no difference in age-adjusted OODR. However, in the post-COVID era (2020-21), there was a significant increase in OODR in states with a CC SUD law compared to states without the law (p = 0.032). We also found that OODR increased at a faster rate post-COVID among both the states with CC SUD laws (p < 0.001) and the states without the law (p = 0.019). Conclusion We found higher age-adjusted OODR in states with a CC SUD law which could be due to the laws being enacted in response to the opioid crisis or physicians' opposition to or unawareness of the law's existence leading to underutilization. Recent enactment of CC SUD law(s), a lack of a central database for recording relapse rates, and disparities in opioid overdose rate reductions uncovers multiple variables potentially influencing OODR. Thus, further investigation is needed to analyze the factors influencing OODRs and long-term effects of the CC SUD laws.
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Nakhaee N, Karamouzian M, Sharifi H, Malekshahi K, Moaddeb KA, Vahidzadeh A, Iranpour A. The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104325. [PMID: 38232440 DOI: 10.1016/j.drugpo.2024.104325] [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: 08/19/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND In Iran, people living with substance use disorders who engage in public drug use may be subjected to court-mandated treatment in compulsory drug detention and rehabilitation centers (CDDRC). This study aims to assess residential CDDRC's effectiveness in promoting sustained abstinence among people who use drugs (PWUD) in Kerman, Iran. METHODS Between October 1, 2021, and September 30, 2022, 1,083 adult male PWUD with a diagnosis of substance use disorders and a history of engagement in public drug use were admitted to the CDDRC in Kerman. They were followed-up for 12 months after discharge. The relationship between baseline variables and abstinence, assessed using rapid urine tests, was examined using crude logistic regression models. RESULTS Most PWUD were 30 or older (n = 876, 80.9 %) and had a history of previous CDDRC admission (n = 638, 58.9 %). At the end of the 12-month follow-up, only 2.6 % (95 % confidence intervals: 1.7-3.7) were abstinent. Individuals with limited education (Odds ratio [OR] = 3.43; 1.50-7.95) and those with a prior history of admission to the CDDRC (OR = 3.73; 1.55-9.89) had increased odds of relapse. CONCLUSIONS The effectiveness of CDDRC in promoting abstinence among the participants was minimal. This highlights the necessity of reassessing support and investment in these interventions and considering more evidence-informed alternative approaches in Iran.
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Affiliation(s)
- Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | - Abedin Iranpour
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Boness CL, Kataria K, Morris J. Should we embrace the term 'preaddiction'? Neuropsychopharmacology 2024; 49:495-496. [PMID: 37968450 PMCID: PMC10789777 DOI: 10.1038/s41386-023-01764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Cassandra L Boness
- University of New Mexico Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA.
| | - Kanak Kataria
- Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - James Morris
- Centre for Addictive Behaviours Research, London South Bank University, London, UK
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18
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Stenersen MR, Peltier M, McKee SA. The criminal justice system in alcohol use treatment: a nationwide analysis of racial disparities in treatment referral and completion. Alcohol Alcohol 2024; 59:agad092. [PMID: 38266072 PMCID: PMC10807701 DOI: 10.1093/alcalc/agad092] [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: 05/01/2023] [Revised: 09/13/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Alcohol use and the criminal justice (CJ) system have long been integrally connected in the United States and have both disproportionally impacted Communities of Color. Despite this connection, scholarly literature has largely focused on substance use as a whole, and little literature has examined the influence of race on CJ referral to alcohol treatment and treatment outcomes. METHODS A total of 749,349 cases from the treatment episodes dataset discharge were used in the current study. A series of ANOVA and logistic regression analyses were conducted to examine the impact of race on (i) likelihood of referral to alcohol treatment by the CJ system and (ii) the association between CJ referral and treatment completion. RESULTS Results revealed significant disparities in both who is referred to alcohol treatment by the CJ system and the association of that referral to treatment completion. Notably, American Indian/Alaska Native people were significantly more likely than people of all other races to be referred by the CJ system. However, American Indian/Alaska Native people showed the smallest association between CJ referral and treatment completion. CONCLUSIONS Contrary to previous literature, findings showed that referral of and positive association between CJ referral and treatment completion are not equal across people of different races. Taken together, these results highlight continued racial inequities in the role of the CJ system in alcohol treatment and the unique potential for non-CJ-related treatment to best serve people combatting alcohol use disorder.
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Affiliation(s)
- Madeline R Stenersen
- Department of Psychology, Saint Louis University, Saint Louis, MO 63108, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, United States
| | - MacKenzie Peltier
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, United States
- Mental Health Service Line, VA Connecticut Healthcare System, West Haven, CT 06516, United States
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, United States
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Kozelka EE. Living the Process: Examining the Continuum of Coercion and Care in Tijuana's Community-Based Rehabilitation Centers. Cult Med Psychiatry 2023; 47:937-960. [PMID: 37022536 DOI: 10.1007/s11013-023-09822-8] [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] [Accepted: 03/13/2023] [Indexed: 04/07/2023]
Abstract
In Mexico, community-based, non-biomedical treatment models for substance use are legally recognized in national drug policy, monitored by state-level Departments of Health, and in some cases publicly funded. Academic research on centers that utilize these forms of treatment have focused primarily on documenting their rapid spread and describing their institutional practices, particularly human rights abuses and lack of established biomedical efficacy. In Tijuana, these community-based therapeutic models are shaped by conceptions of health and illness from the local cultural context of the United States-Mexico border zone in ways that do not cleanly match western, biomedical notions of the illness "addiction." In this article, I examine treatment ethics by exploring the contextually understood need for coerced treatment (i.e., why centers are locked) along with experiences of compulsion in a women's 12 Step center. These discussions highlight the contested therapeutic value of coercion from multiple perspectives. Utilizing engaged listening around local care practices marks a path for global mental health researchers to understand and sit with difference in order to communicate across opposing viewpoints in the service of mental health equity and best care practices.
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Affiliation(s)
- Ellen E Kozelka
- Department of Anthropology, Dartmouth College, 3 Tuck Drive, 316 Silsby Hall, Hanover, NH, 03755, USA.
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20
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Carroll JJ, Cummins ER, Formica SW, Green TC, Bagley SM, Beletsky L, Rosenbloom D, Xuan Z, Walley AY. The police paradox: A qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104160. [PMID: 37597344 DOI: 10.1016/j.drugpo.2023.104160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Post-overdose outreach has emerged in the United States as an increasingly common response to non-fatal overdose. This qualitative study investigates the implementation of such programs through public health-public safety partnerships in Massachusetts. METHODS We conducted semi-structured interviews with post-overdose outreach team members, overdose survivors, and family members who received outreach. Interview transcripts were inductively analyzed to identify emergent themes and subsequently organized within the framework of Ecological Systems Theory. RESULTS Forty-nine interviews were conducted, including 15 police officers (80% male, 100% non-Hispanic White); 23 public health partners (48% male, 87% non-Hispanic White); 8 overdose survivors who received outreach services and 3 parents of survivors who received services (collectively 27% male, 64% non-Hispanic White). Implementation factors identified across all levels (macrosystem, exosystem, mesosystem, and microsystem) of Ecological Systems Theory included key program facilitators, such as access to police data and funding (macro), interagency collaboration (exo), shared recognition of community needs (exo), supportive relationships among team members (meso), and program champions (micro). Common barriers included inherent contradictions between policing and public health mandates (macro), poor local treatment and service capacity (exo), divergent staff views of program goals (exo), overdose survivors' prior negative experiences with law enforcement (meso), difficulty locating overdose survivors (meso), and police officers' lack of qualifications or training in providing psycho-social services (micro). CONCLUSIONS Most post-overdose outreach programs in this study were dependent on funding and data-sharing partnerships, which police agencies largely controlled. Yet, police participation, especially during outreach visits presented numerous challenges for engaging overdose survivors and establishing non-coercive linkages with evidence-based services, which may undermine the public health goals of these programs. These findings should inform state and federal efforts to expand the role of law enforcement in behavioral health initiatives.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC 27605, United States; Department of Medicine, Brown University, 222 Richmond St., Providence, RI 02903, United States.
| | - Emily R Cummins
- Ariadne Labs, Harvard T.H. Chan School of Public Health, 405 Park Drive, Boston, MA 02215, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc., 84 Mill St., Lincoln, MA 01773, United States
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South Street MS 035, Waltham, MA 02453, United States
| | - Sarah M Bagley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and the Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Health in Justice Action Lab, Northeastern University, 416 Huntington Ave, Boston, MA 02115, United States
| | - David Rosenbloom
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
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21
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Alibudbud R. Addressing an opportune time to revise the Philippine Comprehensive Dangerous Drugs Act of 2002. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100857. [PMID: 37520161 PMCID: PMC10382915 DOI: 10.1016/j.lanwpc.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
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Radfar N, Radfar SR, Mohammadi F, Azimi A, Amirkafi A, Tehrani-Banihashemi A. Retention rate in methadone maintenance treatment and factors associated among referred patients from the compulsory residential centers compared to voluntary patients. Front Psychiatry 2023; 14:1139307. [PMID: 37304442 PMCID: PMC10248436 DOI: 10.3389/fpsyt.2023.1139307] [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] [Received: 01/06/2023] [Accepted: 04/11/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Compulsory treatment has decades of history in Iran; both before and after the Islamic Revolution, but there are many debates regarding its efficacy and effectiveness. Retention Rate is one of the best indices to estimate the efficacy of treatment. This study will compare Retention Rate among people referred from compulsory treatment centers and volunteer participants. Methods This was a retrospective (historical) cohort study that has been conducted among people who were taking methadone maintenance treatment (MMT). The study sample was selected from the MMT centers that admit both referral patients from compulsory centers and voluntary patients. All newly admitted patients from March 2017 to March 2018 were enrolled and followed up until March 2019. Results A total of 105 participants were recruited for the study. All were males with a mean age of 36.6 ± 7.9 years. Fifty-six percent of individuals were referred from compulsory residential centers. The total one-year retention rate of participants in this study was 15.84%. The one-year retention rate for the patients referred from compulsory residential centers and the non-referred patients was 12.28 and 20.45%, respectively (value of p = 0.128). Among the other studied factors, only marital status was significantly associated with MMT retention (p = 0.023). Conclusion Although the average treatment adherence time for non-referred patients was about 60 days higher than those referred from compulsory residential centers, this study found no significant differences in retention days and a one-year retention rate. Further studies with larger sample sizes and longer follow-ups are needed to explore the efficacy of compulsory treatment methods in Iran.
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Affiliation(s)
- Niayesh Radfar
- Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
- Integrated Substance Abuse Programs Department, University of California, Los Angeles, CA, United States
| | - Faezeh Mohammadi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Azimi
- Department of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amirkafi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Slocum S, Paquette CE, Walley AY, Pollini RA. Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104074. [PMID: 37244144 DOI: 10.1016/j.drugpo.2023.104074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. RESULTS While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. CONCLUSIONS Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States.
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O'Brien D, Hudson-Breen R. "Grasping at straws," experiences of Canadian parents using involuntary stabilization for a youth's substance use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104055. [PMID: 37182351 DOI: 10.1016/j.drugpo.2023.104055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND In Canada, involuntary stabilization programs are used to apprehend and confine youth who use drugs for the purpose of stabilization, assessment, and discharge planning. In the Canadian province of Alberta, the Protection of Children Using Drugs (PChAD) act allows parents to apply for involuntary stabilization of their children for up to 15 days. Given that research on involuntary stabilization programs is scarce, this qualitative study was designed to explore parents' experiences with PChAD and their perceptions of the program's benefits and drawbacks. METHODS We conducted semi-structured interviews with 18 parents who had used PChAD for their children between 2007-2018. Interviews were conducted between 2019-2020 and were analyzed inductively using Interpretive Phenomenological Analysis. RESULTS Most parents sought involuntary stabilization because they were desperate to protect their child's health and safety, or to motivate them to reduce their substance use. Many also felt lost and overwhelmed because their child was unwilling to attend voluntary treatment, and they lacked professional guidance as to how to care for their child. Consequently, many parents used involuntary stabilization because they did not know what else to do. While some parents were grateful to have their child temporarily safe, many were disappointed because involuntary stabilization had little impact on their child's substance use. Parents also felt they did not receive sufficient support in coordinating their child's care following involuntary stabilization. Parents identified several risks of involuntary stabilization, such as angering the youth and undermining trust, and exposing them to negative peer influences. IMPLICATIONS It is important for policymakers and clinicians to carefully consider whether the immediate benefits of keeping youth safe are worth the potential risks. Efforts are needed to provide families with greater guidance and support, and to ensure coordinated access to a continuum of voluntary services, including treatment and harm reduction.
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Affiliation(s)
- Daniel O'Brien
- University of Alberta, Faculty of Education, Department of Educational Psychology 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Rebecca Hudson-Breen
- University of Alberta, Faculty of Education, Department of Educational Psychology 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada
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Loyal JP, Lavergne MR, Shirmaleki M, Fischer B, Kaoser R, Makolewksi J, Small W. Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:257-268. [PMID: 36200433 PMCID: PMC10037746 DOI: 10.1177/07067437221128477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Involuntary psychiatric hospitalization occurs when someone with a serious mental disorder requires treatment without their consent. Trends vary globally, and currently, there is limited data on involuntary hospitalization in Canada. We examine involuntary hospitalization trends in British Columbia, Canada, and describe the social and clinical characteristics of people ages 15 and older who were involuntarily hospitalized between 2008/2009 and 2017/2018. METHOD We used population-based linked administrative data to examine and compare trends in involuntary and voluntary hospitalizations for mental and substance use disorders. We described patient characteristics (sex/gender, age, health authority, income, urbanity/rurality, and primary diagnosis) and tracked the count of involuntarily hospitalized people over time by diagnosis. Finally, we examined population-based prevalence over time by age and sex/gender. RESULTS Involuntary hospitalizations among British Columbians ages 15 and older rose from 14,195 to 23,531 (65.7%) between 2008/2009 and 2017/2018. Apprehensions involving police increased from 3,502 to 8,009 (128.7%). Meanwhile, voluntary admissions remained relatively stable, with a minimal increase from 17,651 in 2008/2009 to 17,751 in 2017/2018 (0.5%). The most common diagnosis for involuntary patients in 2017/2018 was mood disorders (25.1%), followed by schizophrenia (22.3%), and substance use disorders (18.8%). From 2008/2009 to 2017/2018, the greatest increase was observed for substance use disorders (139%). Over time, population-based prevalence increased most rapidly among women ages 15-24 (162%) and men ages 15-34 (81%) and 85 and older (106%). CONCLUSION Findings highlight the need to strengthen the voluntary care system for mental health and substance use, especially for younger adults, and people who use substances. They also signal a need for closer examination of the use of involuntary treatment for substance use disorders, as well as further research exploring forces driving police involvement and its implications.
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Affiliation(s)
- Jackson P Loyal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia
| | - M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mehdi Shirmaleki
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Ridhwana Kaoser
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jack Makolewksi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia
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New Psychoactive Substances: Major Groups, Laboratory Testing Challenges, Public Health Concerns, and Community-Based Solutions. J CHEM-NY 2023. [DOI: 10.1155/2023/5852315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Across communities worldwide, various new psychoactive substances (NPSs) continue to emerge, which worsens the challenges to global mental health, drug rules, and public health risks, as well as combats their usage. Specifically, the vast number of NPSs that are currently available, coupled with the rate at which new ones emerge worldwide, increasingly challenges both forensic and clinical testing strategies. The well-established NPS detection techniques include immunoassays, colorimetric tests, mass spectrometric techniques, chromatographic techniques, and hyphenated types. Nonetheless, mitigating drug abuse and NPS usage is achievable through extensive community-based initiatives, with increased focus on harm reduction. Clinically validated and reliable testing of NPS from human samples, along with community-driven solution, such as harm reduction, will be of great importance, especially in combating their prevalence and the use of other illicit synthetic substances. There is a need for continued literature synthesis to reiterate the importance of NPS, given the continuous emergence of illicit substances in the recent years. All these are discussed in this overview, as we performed another look into NPS, from differentiating the major groups and identifying with laboratory testing challenges to community-based initiatives.
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Goodyear T, Jenkins E, Knight R, Sedgemore KO, White M, Culham T, Fast D. Autonomy and (In)Capacity to Consent in Adolescent Substance Use Treatment and Care. J Adolesc Health 2023; 72:179-181. [PMID: 36496336 DOI: 10.1016/j.jadohealth.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Trevor Goodyear
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kali-Olt Sedgemore
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; 'Namgis First Nation, Alert Bay, British Columbia, Canada; Coalition of Peers Dismantling the Drug War, Vancouver, British Columbia, Canada
| | - Melissa White
- Mental Health & Substance Use Network, Interior Health, British Columbia, Canada
| | - Tania Culham
- Three Bridges Community Health Centre, Vancouver, British Columbia, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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28
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Rhodes T, Kyaw KWY, Harris M. Precarious Lives, Precarious Treatments: Making Drug Treatment Work in Northern Myanmar. Med Anthropol 2023; 42:4-20. [PMID: 36306464 DOI: 10.1080/01459740.2022.2133706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We explore how precarious livelihoods intersect with precarious treatments for heroin dependency in a setting affected by longstanding conflicts and an illicit drug economy as well as by recent events of pandemic and political change. Working with 33 qualitative interviews with people who inject drugs in Kachin State, northern Myanmar, we explore how drug dependency treatment, especially methadone substitution, is made to work in efforts to sustain everyday livelihoods. Our analysis attends to the work that is done to enable therapeutic trajectories to emerge as "generous constraints" in precarity. We trace methadone substitution as an emergent intervention of livelihood survival.
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Affiliation(s)
- Tim Rhodes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Khine Wut Yee Kyaw
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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29
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Lee KSK, Bullen LM, Zheng C, Dawson A, Munro A, Conigrave KM. Beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal clients to involuntary drug and alcohol treatment: A qualitative study. Drug Alcohol Rev 2023; 42:169-180. [PMID: 36194535 PMCID: PMC10947027 DOI: 10.1111/dar.13549] [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: 10/01/2021] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Involuntary drug and alcohol treatment occurs in many countries and its role is often controversial. This can be a particular concern in relation to First Nations or other culturally distinct populations. This study explores beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in New South Wales (NSW), Australia. METHODS The Involuntary Drug and Alcohol Treatment program (IDAT) is legislated by the NSW Drug and Alcohol Treatment Act 2007. There are two IDAT units-in urban (Sydney, four beds) and regional NSW (Orange, eight beds). NSW Health drug and alcohol clinicians who had referred clients to IDAT between 2016 and 2018 were invited to participate in a semi-structured 1:1 interview. Eleven clinicians (n = 2, male) from six local health districts (urban through to remote) agreed to participate. A descriptive qualitative analysis of responses was conducted. RESULTS Two key themes summarised the beliefs and attitudes that clinicians reported influencing them when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in NSW: (i) dilemma between saving someone's life and being culturally safe; and (ii) need for holistic wrap-around care. DISCUSSION AND CONCLUSIONS Almost all clinicians were worried that being in IDAT would further erode their Aboriginal client's autonomy and be retraumatising. Strategies are needed to support the involvement of Aboriginal-specific services in IDAT processes and ensure local support options for clients on discharge. Future research should examine the effectiveness, acceptability and feasibility of involuntary drug and alcohol treatment programs.
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Affiliation(s)
- K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Lynette M. Bullen
- Involuntary Drug and Alcohol Treatment UnitWestern NSW Local Health DistrictOrangeAustralia
| | - Catherine Zheng
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology SydneySydneyAustralia
| | - Alice Munro
- Research OfficeWestern NSW Local Health DistrictOrangeAustralia
| | - Katherine M. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyAustralia
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Zaller ND, Gorvine MM, Ross J, Mitchell SG, Taxman FS, Farabee D. Providing substance use disorder treatment in correctional settings: knowledge gaps and proposed research priorities-overview and commentary. Addict Sci Clin Pract 2022; 17:69. [PMID: 36482490 PMCID: PMC9733039 DOI: 10.1186/s13722-022-00351-0] [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: 03/28/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
This manuscript is the product of the authors' discussions, literature overview, and consultation with experts in the field, and identifies important gaps in the evidence base for substance use disorder (SUD) treatment effectiveness within criminal justice (CJ) settings. Lacking from the extant literature are longitudinal investigations of treatment related outcomes during and after incarceration. Such studies could provide rich contextual data about treatment delivery and effectiveness across the CJ continuum, and would provide important insight into individual characteristics (e.g., motivation, treatment modality preferences, treatment completion rates, etc.) as well as institutional and environmental factors (e.g., appropriate staffing, space limitations for individual treatment sessions, distribution of medications, etc.). We also identified the importance of reproducibility within CJ research, and the unfortunate reality of too many single studies conducted in single (or relatively few) correctional facilities. Some of this has been because the studies designed to produce that evidence are not prioritized for funding, which has continually placed researchers in a position where we cannot make firm conclusions or recommendations based on available evidence. The importance of replicating the foundational studies in this field cannot be overstated. We hope this article spurs other researchers to join in the healthy process of questioning the existing state of the CJ-based SUD treatment research, what should be re-examined, and how we can lay a stronger foundation for the future.
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Affiliation(s)
- Nickolas D Zaller
- University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA.
| | - Margaret M Gorvine
- University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
| | - Jon Ross
- TASC, Inc. (Treatment Alternatives for Safe Communities), Chicago, IL, USA
| | | | - Faye S Taxman
- George Mason University, Schar School of Policy and Government, Fairfax, VA, USA
| | - David Farabee
- New York University, School of Medicine, New York, NY, USA
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31
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Wheeldon J, Heidt J. Cannabis, Coerced Care, and a Rights-Based Approach to Community Support. Health Hum Rights 2022; 24:115-119. [PMID: 36579311 PMCID: PMC9790941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Johannes Wheeldon
- An adjunct professor at Norwich University, Northfield, United States
| | - Jon Heidt
- An associate professor of criminology at the University of the Fraser Valley, Abbotsford, Canada
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Parker CM, Miranda-Miller OE, Albizu-García C. Involuntary Civil Commitment for Substance Use Disorders in Puerto Rico: Neglected Rights Violations and Implications for Legal Reform. Health Hum Rights 2022; 24:59-70. [PMID: 36579313 PMCID: PMC9790954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Laws facilitating the involuntary civil commitment (ICC) of people with substance use disorders vary considerably internationally and across the United States. Puerto Rico, a colonial territory of the United States since 1898, currently harbors the most punitive ICC legislation in the country. It is the only place in the United States where self-sufficient adults who pose no grave danger to themselves or others can be involuntarily committed to restrictive residential facilities for over a year at a time without ever being assessed by a health care professional. The involuntary commitment of otherwise-able citizens-many of whom have never been diagnosed with a substance use disorder-continues to be ignored nationally and internationally. In this paper, we specify how Puerto Rican ICC law and procedures systematically violate rights and liberties that are supposed to be guaranteed by Puerto Rico's Mental Health Act, the US Federal Supreme Court, and the Universal Declaration of Human Rights. To ensure that Puerto Rico's ICC procedures conform to prevailing local, national, and international standards, we propose a series of legislative reforms. Finally, we highlight the importance of addressing the preponderance of poorly constructed ICC laws both within the United States and internationally.
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Affiliation(s)
- Caroline M. Parker
- A presidential fellow of medical anthropology at the Department of Social Anthropology at the University of Manchester, United Kingdom.,Please address correspondence to Caroline M. Parker. .
| | | | - Carmen Albizu-García
- A physician and a professor of health services research at the Graduate School of Public Health at the University of Puerto Rico, San Juan, Puerto Rico
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Reader SW, Walton GH, Linder SH. Review and inventory of 911 Good Samaritan Law Provisions in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103896. [PMID: 36343430 DOI: 10.1016/j.drugpo.2022.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND 911 Good Samaritan Laws (GSLs) confer limited legal immunity to bystanders in possession of controlled substances who report emergency overdoses. While these laws may decrease opioid overdose mortality, current literature reduces GSLs to a small number of variables, overlooking substantial differences in implementation and statutory context which dramatically alter their applicability. METHODS We identified all state GSLs and their legislative history, characterizing features into four categories using a novel framework: breadth of protected activities, burden placed on Good Samaritans, strength of protection, and exemption in coverage. When protections depended on the nature of the controlled substance, heroin served as a common point of comparison. RESULTS GSLs vary substantially across states and time. Protections depend on the quantity of substances involved and may extend to the person experiencing the overdose or persons reporting their own overdose. Protected offenses range from possession of controlled substances to drug-induced homicide. In some states, Good Samaritans must complete substance use treatment or administer naloxone to retain protections. Immunity ranges from protection from arrest to merely procedural protections at trial, and may even exclude persons in possession of opioids. Exemptions target persons engaging in chronic substance use, such as persons invoking protection multiple times or previously reporting an overdose. CONCLUSION States offer Good Samaritans substantially different protections even when the statutes confer nominally comparable immunities. Accommodating this heterogeneity will enhance the validity of future studies into these laws and their efficacy.
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Affiliation(s)
- Shane W Reader
- School of Public Health, University of Texas Health Science Center at Houston, United States.
| | - Gretchen H Walton
- School of Public Health, University of Texas Health Science Center at Houston, United States
| | - Stephen H Linder
- School of Public Health, University of Texas Health Science Center at Houston, United States
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Schumm J, Wong C, Okrant E, Tharp JA, Embree J, Lester N. Factor Structure of the Brief Addiction Monitor in a Non-Veteran Substance Use Disorder Outpatient Treatment Sample. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100125. [PMID: 36844173 PMCID: PMC9948935 DOI: 10.1016/j.dadr.2022.100125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Background The Brief Addiction Monitor (BAM) was developed as a comprehensive substance use disorder (SUD) outcome metric to fill a gap in quality measurement. Research to date has only examined the psychometric performance of this measure in veteran SUD populations. The purpose of the current research is to examine the factor structure and validity in a non-veteran SUD population. Methods Non-veteran patients admitted to a SUD treatment program (N = 2,227) completed BAM at intake. After confirmatory factor analysis (CFA) was performed to evaluate the measurement model validity of previously defined latent structures, exploratory factor analysis (EFA) was used to assess the factor structure and psychometric properties of the BAM within the full sample and within subgroups, specifically racial, referral source (mandated vs. not), and primary SUD diagnosis. Results Exploratory factor analyses in the full sample supported a 4-factor model (representing Stressors, Alcohol Use, Risk Factors, and Protective Factors) derived from 13 items. Subsequent EFAs conducted separately in each subgroup revealed variability in the number of resulting factors and pattern matrices. The internal consistency also varied among factors and between subgroups; in general, reliability was greatest for the Alcohol Use scale and either poor or questionable for pattern matrices resulting in scales reflecting Risk or Protective Factors. Conclusion Findings from our study suggest that the BAM might not be a reliable and valid instrument for all populations. More research is needed to develop and validate tools that are clinically meaningful and allow clinicians to track recovery progress over time.
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Affiliation(s)
- Jeremiah Schumm
- School of Professional Psychology, College of Health, Education, and Human Services, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH, 45435,Samaritan Behavioral Health, Inc./OneFifteen, Inc., 707 S Edwin C Moses Blvd, Dayton, OH, 45417,Correspondence should be addressed to Jeremiah A. Schumm, Wright State University, School of Professional Psychology, 3640 Colonel Glenn Highway, Dayton, OH, 45435-0001
| | - Celeste Wong
- Verily, LLC, 269 E Grand Ave, South San Francisco, CA, 94080
| | | | - Jordan A. Tharp
- Verily, LLC, 269 E Grand Ave, South San Francisco, CA, 94080
| | - Jared Embree
- OneFifteen, Inc., 6636 Longshore St Suite 200, Dublin, OH, 43017
| | - Natalie Lester
- Verily, LLC, 269 E Grand Ave, South San Francisco, CA, 94080,OneFifteen, Inc., 6636 Longshore St Suite 200, Dublin, OH, 43017
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35
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Seto MC, Healey LV, Ahmed AG. Legally Mandated, Formally Pressured, or Voluntary Anger Treatment: Associations With Treatment Recommendations, Refusal, and Completion. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20012-NP20039. [PMID: 34715763 DOI: 10.1177/08862605211050100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Legally mandated treatment is common in the criminal justice system, for example, for anger management, substance misuse, and intimate partner violence. Past studies have compared voluntary and legally mandated treatment participants but have not distinguished a third, in-between group that is formally pressured to participate in treatment, but not mandated by the criminal justice system. The current study aimed to assess differences on individual characteristics (e.g., sociodemographic and psychiatric) and baseline measures of psychopathology (e.g., anger, aggression, and depression) across three levels of voluntariness and to determine whether voluntariness was associated with treatment recommendation, refusal, and completion at an outpatient anger treatment clinic. Data were retrospectively gathered from the clinical charts of 405 participants. Referrals were classified as voluntary (e.g., self-referred, 61%), formally pressured (e.g., required by work, 14%), or legally mandated (e.g., court order, 25%). Legally mandated participants were younger, more likely to have substance use disorder, less likely to be women, to have a high school education, or to be on psychiatric medications compared to the other two groups. Voluntary participants scored higher on measures of self-reported anger, depression, and stress than the legally mandated participants. Legally mandated participants in particular presented with non-clinical levels of anger and aggression. Level of voluntariness did not affect the decision to recommend individual or group therapy after an intake assessment, but legally mandated participants were significantly more likely (OR = 2.30) than voluntary participants to refuse recommended treatment. Level of voluntariness did not have a significant association with treatment completion. Findings support our distinction between legally mandated and formally pressured participants, but do not support previous research that suggests legally mandated individuals have lower attrition rates in similar treatment programs. The study has implications for the criminal justice system and for anger treatment programs who admit participants with varying levels of voluntariness.
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36
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Shearer RD, Winkelman TNA, Khatri UG. State level variation in substance use treatment admissions among criminal legal-referred individuals. Drug Alcohol Depend 2022; 240:109651. [PMID: 36228467 DOI: 10.1016/j.drugalcdep.2022.109651] [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: 05/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Individuals involved in the criminal legal system face unique challenges to accessing substance use disorder (SUD) treatment, yet state-level variation in referrals for treatment remains largely unknown. To address disparities in the overdose crisis among individuals with criminal legal involvement, it is important to understand variation in SUD treatment across states. METHODS We conducted a retrospective comparison of substance use treatment referrals from the criminal legal system and other sources across participating states. Using data from the 2018-2019 Treatment Episode Dataset-Admissions, we characterized treatment referral rates from the criminal legal system, the substances most commonly leading to treatment, and rates of treatment with medication for opioid use disorder (MOUD) across states. RESULTS Across all states, criminal legal referral rates were higher than non-criminal legal rates. Criminal-legal referral rates, adjusted for state overdose deaths, were highest in the Northeast and Midwest. Methamphetamine use was the most common substance leading to treatment referral from the criminal legal system in 24 states while opioid use was the most common reason for non-criminal legal referrals in 34 states. In over half the states analyzed, fewer than 10% of opioid treatment referrals from the criminal legal system received MOUD. In almost all states, MOUD was more common in treatment referred from non-criminal legal settings. CONCLUSION State-specific policies and practices shape drug policy and the SUD treatment landscape for people with criminal legal involvement. Standards and ongoing monitoring for substance use treatment referrals from the criminal-legal system should be considered by federal agencies charged with addressing the ongoing overdose crisis.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7th St, Minneapolis, MN 55415, USA
| | - Utsha G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1620, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1077, New York, NY 10029, USA.
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Holland A, Stevens A, Harris M, Lewer D, Sumnall H, Stewart D, Gilvarry E, Wiseman A, Howkins J, McManus J, Shorter GW, Nicholls J, Scott J, Thomas K, Reid L, Day E, Horsley J, Measham F, Rae M, Fenton K, Hickman M. Analysis of the UK Government's 10-Year Drugs Strategy-a resource for practitioners and policymakers. J Public Health (Oxf) 2022:6779883. [PMID: 36309802 DOI: 10.1093/pubmed/fdac114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put 'people, health and human rights at the centre'. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue.
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Affiliation(s)
- Adam Holland
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Alex Stevens
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, CT2 7NZ
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Dan Lewer
- Public Health Specialty Registrar, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, L3 5UX, UK
| | - Daniel Stewart
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Eilish Gilvarry
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, NE1 7RU, UK
| | - Alice Wiseman
- Association of Directors of Public Health, London, EC4Y 0HA, UK
| | - Joshua Howkins
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Jim McManus
- Association of Directors of Public Health, London, EC4Y 0HA, UK
| | | | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, Bath, BA2 7AY
| | - Kyla Thomas
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | - Edward Day
- Institute of Mental Health, University of Birmingham, Birmingham, B15 2TT
| | - Jason Horsley
- National Institute for Health Research Evaluation Trials and Studies Coordinating Centre, University of Southampton, Southampton, SO17 1BJ, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, L69 3BX
| | - Maggie Rae
- Epidemiological and Public Health Section, Royal Society of Medicine, London, W1G 0AE, UK
| | | | - Matthew Hickman
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
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38
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Ali R, Stevens M. Moving toward Voluntary Community-Based Treatment for Drug Use and Dependence. Health Hum Rights 2022; 24:183-187. [PMID: 35747280 PMCID: PMC9212818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Robert Ali
- Associate professor at the School of Biomedicine, University of Adelaide, Australia, as well as a member of the Australian National Advisory Council on Alcohol and Drugs, the Cochrane Alcohol and Drug Group editorial board, and the World Health Organization Expert Advisory Panel on Drug Dependence and Alcohol Problems.,Please address correspondence to Robert Ali. .
| | - Matthew Stevens
- Research fellow at the School of Biomedicine, University of Adelaide, Australia
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Vuong T, Gillies M, Larney S, Montebello M, Ritter A. The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls. Addiction 2022; 117:1589-1597. [PMID: 34817096 DOI: 10.1111/add.15755] [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: 07/16/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Many nations have provisions for involuntary treatment of alcohol dependence where the person is at serious risk of harm to themselves. To date, there has been little thorough evaluation of its effectiveness. This study aimed to determine if there were differences between involuntary and voluntary treatment for alcohol dependence on subsequent emergency and hospital care. DESIGN A retrospective cohort design using linked routinely collected administrative data on health-care utilization. SETTING Hospital and community-based alcohol treatment, New South Wales, Australia. PARTICIPANTS A total of 231 patients who were involuntarily treated for alcohol dependence and 231 matched controls who received treatment as usual within the period May 2012 to April 2018. INTERVENTION AND COMPARATOR Involuntary treatment comprised a 28-day mandated hospital admission which included supervised withdrawal, comprehensive assessment, rehabilitation and support followed by voluntary aftercare support for up to 6 months. Treatment as usual comprised three not mutually exclusive forms of intensive voluntary alcohol treatment: withdrawal management, rehabilitation and pharmacotherapies for alcohol dependence. MEASUREMENTS Outcome measures: changes in the number of emergency department (ED) visits and number of unplanned hospital admissions 12 months before and 12 months after completion of index treatment. FINDINGS Both groups showed a reduction in ED visits (incidence rate ratio (IRR) = 0.56, 95% credible intervals (CrI) = 0.39-0.78) and unplanned hospital admissions (IRR = 0.49, 95% CrI = 0.37-0.65). There was no statistically significant difference between the two groups (IRR = 0.77, 95% CrI = 0.58-1.03 for ED visits and IRR = 0.79, 95% CrI = 0.62-1.01 for hospital admissions). The Bayes factors were 0.925 and 0.936 for ED visits and unplanned hospital admissions, respectively, interpreted as weak evidence in support of the null hypothesis of no difference between the interventions. CONCLUSIONS Involuntary treatment of alcohol dependence was associated with reduced health service utilization in the year following treatment, and the outcomes did not differ from those of a matched control group.
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Affiliation(s)
- Thu Vuong
- Drug Policy Modelling Program, SPRC, UNSW Sydney, Sydney, NSW, Australia
| | - Malcolm Gillies
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.,Département de médecine famille et de médicine d'urgence, Université de Montréal, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mark Montebello
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.,Northern Sydney Local Health District, Drug and Alcohol Services, University of Sydney, NSW, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, SPRC, UNSW Sydney, Sydney, NSW, Australia
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Doyle MF, Guthrie J, Butler T, Shakeshaft A, Conigrave K, Williams M. Opportunities for intervention for alcohol and other drug use problems for men before prison: a qualitative study. Health Promot J Austr 2022; 34:570-578. [PMID: 35570751 DOI: 10.1002/hpja.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/05/2022] Open
Abstract
Research into opportunities for prevention including health promotion information about alcohol and other drugs (AoD) harms for people who go to prison is sparce. This is despite there being ample research reporting how much and how frequently AoD have been used by people who go to prison. This paper describes results from a qualitative thematic analysis of interviews with 31 men in a Sydney prison, about where they first received health promotion information about AoD-related harms and their first ever treatment episode. No participant receiving education on AoD harms or treatment support services in primary or high school. Only one participant received their first treatment episode through a health service in his case a doctor and none reported being screened for AoD use at a health service. Twenty-seven participants had their first session with a trained professional through the criminal justice system. Pro-active screening in health services for AoD use disorders and referral to appropriate health services is needed.
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Affiliation(s)
- Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol Central Clinical School, Faculty of Medicine and Health The University of Sydney Camperdown, NSW
| | - Jill Guthrie
- National Centre for Epidemiology & Population Health, The Australian National University, Canberra, ACT
| | - Tony Butler
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW
| | - Anthony Shakeshaft
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW
| | - Katherine Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and Health, The University of Sydney & Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW
| | - Megan Williams
- National Centre for Cultural Competence and Sydney Institute of Criminology, The University of Sydney
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Xavier J, Greer A, Crabtree A, Buxton JA. Police officers’ perceptions of their role at overdose events: a qualitative study. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2070057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane A. Buxton
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Stoicescu C, Lataire Q, Peters K, Amon JJ, Kamarulzaman A, Ali R, Aramrattana A, Escartin IC, Feria MI, Kaur S, Sarasvita R, Nugraha S. End compulsory drug treatment in the Asia-Pacific region. Lancet 2022; 399:419-421. [PMID: 35032436 DOI: 10.1016/s0140-6736(22)00003-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Claudia Stoicescu
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Quinten Lataire
- UNAIDS, Regional Support Team, Asia and the Pacific, Bangkok, Thailand
| | - Karen Peters
- The United Nations Office on Drugs and Crime (UNODC) Regional Office for Southeast Asia and the Pacific, Bangkok, Thailand
| | - Joseph J Amon
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
| | | | - Robert Ali
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Apinun Aramrattana
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Sangeeth Kaur
- Centre of Excellence for Research in AIDS (CERIA), University Malaya, Kuala Lumpur, Malaysia
| | - Riza Sarasvita
- Indonesia National Narcotics Board, East Jakarta, Indonesia
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Tran MTN, Luong QH. Community harm reduction initiatives: Essential investments for illicit drug prevention and control in the future. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100373. [PMID: 35024663 PMCID: PMC8749285 DOI: 10.1016/j.lanwpc.2021.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Mai Thi Ngoc Tran
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Training and Research on Substance Abuse -HIV, Hanoi Medical University, Vietnam
- Nursing and Midwifery Faculty, Hanoi Medical University, Vietnam
| | - Quang Hung Luong
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
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Des Jarlais DC, Feelemyer J, McKnight C, Knudtson K, Glick SN. Is your syringe services program cost-saving to society? A methodological case study. Harm Reduct J 2021; 18:126. [PMID: 34876135 PMCID: PMC8650283 DOI: 10.1186/s12954-021-00575-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there is a general acceptance among public health officials and policy-makers that syringe services programs can be effective in reducing HIV transmission among persons who inject drugs, local syringe services programs are often asked to provide economic justifications for their activities. A cost-effectiveness study, estimating the cost of preventing one HIV infection, would be the preferred methods for addressing this economic question, but few local syringe services programs have the needed data, staff and epidemiologic modeling resources needed for a cost-effectiveness study. We present a method for estimating a threshold value for the number of HIV infections prevented above which the program will be cost-saving to society. An intervention is considered "cost-saving" when it leads to a desirable health outcome a lower cost than the alternative. METHODS The research literature on the effectiveness of syringe services programs in controlling HIV transmission among persons who inject drugs and guidelines for syringe services program that are "functioning very well" were used to estimate the cost-saving threshold at which a syringe services program becomes cost-saving through preventing HIV infections versus lifetime treatment of HIV. Three steps are involved: (1) determining if HIV transmission in the local persons who inject drugs (PWID) population is being controlled, (2) determining if the local syringe services program is functioning very well, and then (3) dividing the annual budget of the syringe services program by the lifetime cost of treating a single HIV infection. RESULTS A syringe services program in an area with controlled HIV transmission (with HIV incidence of 1/100 person-years or less), functioning very well (with high syringe coverage, linkages to other services, and monitoring the local drug use situation), and an annual budget of $500,000 would need to prevent only 3 new HIV infections per year to be cost-saving. CONCLUSIONS Given the high costs of treating HIV infections, syringe services programs that are operating according to very good practices ("functioning very well") and in communities in which HIV transmission is being controlled among persons who inject drugs, will almost certainly be cost-saving to society.
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Affiliation(s)
- Don C Des Jarlais
- Epidemiology, Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 7th Floor, New York, NY, 10003, USA.
| | - Jonathan Feelemyer
- Epidemiology, Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 7th Floor, New York, NY, 10003, USA
| | - Courtney McKnight
- Epidemiology, Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 7th Floor, New York, NY, 10003, USA
| | - Kelly Knudtson
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Prevalence and risk factors for opioid related mortality among probation clients in an American city. J Subst Abuse Treat 2021; 137:108712. [DOI: 10.1016/j.jsat.2021.108712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
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Marshall T, Hancock M, Kinnard EN, Olson K, Abba-Aji A, Rittenbach K, Stea JN, Tanguay R, Vohra S. Treatment options and shared decision-making in the treatment of opioid use disorder: A scoping review. J Subst Abuse Treat 2021; 135:108646. [PMID: 34810044 DOI: 10.1016/j.jsat.2021.108646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shared decision-making (SDM) is an approach to clinical decision-making that includes patients' values and preferences during health-related decisions. Previous research suggests that SDM may be beneficial in the treatment of substance use disorders; however, the impact of SDM in the treatment of opioid use disorder (OUD) remains unclear. OBJECTIVES To identify relevant peer-reviewed literature related to SDM in the treatment of adults with OUD, and to summarize the main findings according to patient outcomes. METHODS The research team conducted a scoping review. The team searched five electronic health databases from database inception until September 2019 using MeSH and keywords related to SDM. The team included only peer-reviewed studies where adults (≥18 years) with OUD were provided a choice and/or allowed input into their treatment plan. Two independent reviewers screened, extracted, and assessed the quality of included studies. RESULTS Fourteen studies (n = 1748 participants) met inclusion criteria, including seven randomized controlled trials, three non-randomized controlled trials, two observational studies, and one qualitative study. Treatment options included: patient regulated methadone dosing vs. fixed dosing (n = 4 studies), optional vs. mandatory counseling (n = 4 studies), home vs. office buprenorphine inductions (n = 2 studies), and inpatient vs. outpatient treatment (n = 1 study). None of the studies measured SDM with a validated instrument. Seven of 14 studies reported at least one improved patient outcome. CONCLUSIONS The review found few studies that explored whether providing treatment options and/or encouraging participation in decision-making are beneficial for adults with OUD. Preliminary evidence suggests that SDM may be promising for this population. However, the field needs more research on person-centered care and SDM.
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Affiliation(s)
- Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Myles Hancock
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth N Kinnard
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States of America
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Katherine Rittenbach
- Addiction and Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada; Department of Psychology, University of Calgary, Alberta, Canada
| | - Jonathan N Stea
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Robert Tanguay
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Sunita Vohra
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Walt G, Porteny T, McGregor AJ, Ladin K. Clinician's experiences with involuntary commitment for substance use disorder: A qualitative study of moral distress. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103465. [PMID: 34619444 DOI: 10.1016/j.drugpo.2021.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Petitions for involuntary commitment of people living with a substance use disorder (SUD) have almost doubled since 2011 in Massachusetts through the policy Section 35. However, the efficacy of this controversial policy remains unclear, and clinicians differ on whether it ought to be used. This study examines how clinicians decide whether to use Section 35 and their experiences of moral distress, the negative feeling that occurs when a clinician is required to pursue a treatment option against their moral judgement due to institutional constraints, associated with its use. METHODS Qualitative semi-structured interviews with clinicians in Massachusetts were conducted between December 2019 and February 2020 and continued until thematic saturation. Thematic and narrative analysis was conducted with recorded and transcribed interviews. RESULTS Among 21 clinicians, most (77%) experienced some or high moral distress when utilizing Section 35 for involuntary commitment, with clinicians working in emergency departments experiencing less distress than those working in SUD clinics. Clinicians with low moral distress referenced successful patient anecdotes and held an abstinence-based view of SUD, while clinicians with high moral distress were concerned by systemic treatment failures and understood SUD through a nuanced and harm reduction-oriented view. Clinicians across professional settings were concerned by the involvement of law enforcement and criminal justice settings in the Section 35 process. Clinicians employed a variety of strategies to cope with moral distress, including team-based decision-making and viewing the petition as a last resort. Barriers to utilizing Section 35 included restrictive court hours and lack of post-section aftercare services. CONCLUSION Widespread distress associated with use of involuntary commitment and inconsistent approaches to its use highlight the need for better care coordination and guidance on best practices for utilization of this policy.
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Affiliation(s)
- Galya Walt
- Department of Community Health, Tufts University, Medford, MA, USA; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, MA, USA
| | - Thalia Porteny
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, MA, USA; Department of Occupational Therapy, Tufts University, Medford, MA, USA
| | | | - Keren Ladin
- Department of Community Health, Tufts University, Medford, MA, USA; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, MA, USA; Department of Occupational Therapy, Tufts University, Medford, MA, USA.
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Meanings constructed by family members about coerced treatment for alcohol and drug use in Brazil. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103466. [PMID: 34619445 DOI: 10.1016/j.drugpo.2021.103466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In Brazil, regarding drug and alcohol treatment, there is an emphasis on financing long-term residential treatment and a lack of community-based approaches, leading to a burden on families. Therefore, family members increasingly seek coerced treatment even though there are reports of human rights violations in this context. This study aims to describe the meanings constructed by family members regarding coerced treatment of people who use alcohol and other drugs. METHODS We conducted 15 interviews with the family members of people who use alcohol and other drugs and had requested coerced treatment. The interviews were recorded, transcribed and analyzed using reflexive thematic analysis. RESULTS Through analysis, five major themes regarding the use of coerced treatment were constructed: (1) as protection for people from the dangers related to the use of alcohol and other drugs; (2) as punishment, aiming to prevent the return to drug use; (3) as a guarantee of abstinence; (4) as a consequence of the loss of autonomy to decide what was best for themselves; and (5) as time for the reorganization of the family members' lives. The lack of emotional support in relation to their concerns regarding the health and safety of the person using drugs, the prohibitionist discourse and the emphasis on abstinence shared in the decision to seek coerced treatment, and the lack of knowledge about voluntary treatments contributed to family members requesting coerced treatment more than once. CONCLUSION This study highlights the importance of the need for public policies that expand evidence-based voluntary approaches, especially community-based services, and promote the disclosure of these services to eliminate coerced treatment. Health care providers should support the feelings of family members and provide guidelines related to other treatment options, making families feel genuinely included as partners in the care of people who use drugs.
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Vo AT, Magana C, Hickman M, Borquez A, Beletsky L, Martin NK, Cepeda JA. Assessing HIV and overdose risks for people who use drugs exposed to compulsory drug abstinence programs (CDAP): A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103401. [PMID: 34389218 PMCID: PMC9027650 DOI: 10.1016/j.drugpo.2021.103401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/06/2021] [Accepted: 07/21/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Evidence supports integrating drug use treatment, harm reduction, and HIV prevention services to address dual epidemics of drug use disorders and HIV. These dual epidemics have spurred a rise in legally-enforced compulsory drug abstinence programs (CDAP), despite limited evidence on its effectiveness. We conducted a systematic review and meta-analysis evaluating the association between CDAP exposure and HIV and overdose-related risk. METHODS We searched PubMed, EBSCOhost and Sociological Abstracts for studies that contained an individual-level association between CDAP exposure and related HIV or overdose risks, with no date restrictions. Meta-analyses were conducted on data abstracted from eligible studies, using pooled random-effects models and I-squared statistics. We assessed quality of the studies across 14 criteria for observational studies. RESULTS Out of 2,226 abstracts screened, we included 8 studies (5253 individuals/776 events) across China, Mexico, Thailand, Norway, and the United States. All but two were cross-sectional analyses, limiting strength of observed associations. In the two studies that reported association between CDAP and HIV seropositivity or receptive syringe sharing, findings were inconsistent and did not indicate that those with exposure to CDAP had increased odds of HIV or syringe sharing. However, we found the odds of experiencing non-fatal overdose in lifetime and in the last 6-12 months were 2.02 (95% CI 0.22 - 18.86, p = 0.16) to 3.67 times higher (95% CI 0.21 - 62.88, p = 0.39), respectively, among those with CDAP exposure than those without. CONCLUSION Research assessing HIV risk associated with CDAP is scant and inconclusive, while evidence of robust associations between CDAP and overdose risk continues to mount. More rigorous, longitudinal studies are needed to evaluate the causal relationships between CDAP and these health outcomes. Aside from the growing evidence base on collateral harms, ethical considerations dictate that voluntary, evidence-based drug treatment should be prioritized to address the drivers of excess morbidity and mortality among people who use drugs.
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Affiliation(s)
- Anh T Vo
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA.
| | - Christopher Magana
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA
| | | | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA; Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA; Population Health Sciences, University of Bristol, UK
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Roshanpajouh M, Mirkazemi R, Zanganeh AM, Rezazadeh M, Jalali Z, Olfat MB. A Comprehensive, Systematic, and Integrated (CSI) Model Based on Drug Court: as a New Approach Toward Organizing and Managing Homeless Addicts in Iran. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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