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Oster C, Hunter S, Schultz T, Harvey G, Lawless M, Battersby M. Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia. Drug Alcohol Rev 2024; 43:705-717. [PMID: 38098184 DOI: 10.1111/dar.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/20/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. METHODS A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. RESULTS Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). DISCUSSION AND CONCLUSIONS Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.
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Affiliation(s)
- Candice Oster
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Timothy Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Hyland CJ, McDowell MJ, Bain PA, Huskamp HA, Busch AB. Integration of pharmacotherapy for alcohol use disorder treatment in primary care settings: A scoping review. J Subst Abuse Treat 2023; 144:108919. [PMID: 36332528 PMCID: PMC10321472 DOI: 10.1016/j.jsat.2022.108919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) represents the most prevalent addiction in the United States. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include pharmacotherapy (acamprosate, disulfiram, naltrexone). METHODS The team undertook a search across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science on May 21, 2021. Eligibility criteria included: patient population ≥ 18 years old, primary care-based setting, US-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies. We assessed study bias using a modified Oxford Centre for Evidence-based Medicine Rating Framework quality rating scheme. RESULTS The qualitative synthesis included forty-seven papers, representing 25 primary studies. Primary study sample sizes ranged from 24 to 830,825 participants and many (44 %) were randomized controlled trials. Most studies (80 %) included a nonpharmacologic intervention for AUD: 56 % with brief intervention, 40 % with motivational interviewing, and 12 % with motivational enhancement therapy. A plurality of studies (48 %) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acamprosate, and/or disulfiram. Of the 47 total studies included, 68 % assessed care initiation and engagement. Fewer studies (15 %) explored practices surrounding screening for or diagnosing AUD. Outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (53 % and 51 %, respectively). Many of these outcomes showed significant findings in favor of integrated care models for AUD. CONCLUSIONS The integration of AUD pharmacotherapy in primary care settings may be associated with improved process and outcome measures of care. Future research should seek to understand the varied experiences across care integration models.
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Affiliation(s)
- Colby J Hyland
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America.
| | - Michal J McDowell
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, United States of America
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States of America.
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America.
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America; McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States of America.
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Boucher LM, Shoemaker ES, Liddy CE, Leonard L, MacPherson PA, Presseau J, Martin A, Pineau D, Lalonde C, Diliso N, Lafleche T, Fitzgerald M, Kendall CE. "The Drug Use Unfortunately isn't all Bad": Chronic Disease Self-Management Complexity and Strategy Among Marginalized People Who Use Drugs. QUALITATIVE HEALTH RESEARCH 2022; 32:871-886. [PMID: 35324352 PMCID: PMC9189593 DOI: 10.1177/10497323221083353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Self-management programs improve health outcomes and self-management is recommended for chronic conditions. Yet chronic disease self-management supports have rarely been applied to people who use drugs (PWUD). Thus, our objective was to explore self-management experiences among marginalized PWUD. We used community-based participatory methods and conducted qualitative interviews. Participants self-identified as having long-term and past year experience using non-prescribed drugs, one other chronic condition, and socioeconomic marginalization. We analyzed the data using reflexive thematic analysis. Although many participants considered drug use a chronic health issue, self-medicating with non-prescribed drugs was also a key self-management strategy to address other health issues. Participants also described numerous other strategies, including cognitive and behavioral tactics. These findings highlight the need for a safe supply of pharmaceutical-grade drugs to support self-management among marginalized PWUD. Self-management supports should also be tailored to address relevant topics (e.g., harm reduction, withdrawal), include creative activities, and not hinder PWUD's agency.
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Affiliation(s)
- Lisa M. Boucher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Lisa M. Boucher, Elisabeth Bruyere Research Institute, 43 Bruyere Street, Annex E, Ottawa, ON K1N 5C7, Canada.
| | - Esther S. Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Clare E. Liddy
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lynne Leonard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul A. MacPherson
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, ON, Canada
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Dave Pineau
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Christine Lalonde
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Nic Diliso
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Terry Lafleche
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
- Sandy Hill Community Health Centre, Ottawa, ONCanada
| | - Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E. Kendall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Brookfield S, Selvey L, Maher L, Fitzgerald L. ‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211073911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Linda Selvey
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Lisa Fitzgerald
- School of Public Health, The University of Queensland, Brisbane, Australia
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Integration of primary care into the substance use disorder outpatient treatment setting. J Am Assoc Nurse Pract 2020; 33:652-660. [DOI: 10.1097/jxx.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
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The Role of Health Plans in Supporting Behavioral Health Integration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017. [PMID: 28646242 DOI: 10.1007/s10488-017-0812-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Health plan policies can influence delivery of integrated behavioral health and general medical care. This study provides national estimates for the prevalence of practices used by health plans that may support behavioral health integration. Results indicate that health plans employ financing and other policies likely to support integration. They also directly provide services that facilitate integration. Behavioral health contracting arrangements are associated with use of these policies. Delivery of integrated care requires systemic changes by both providers and payers thus health plans are key players in achieving this goal.
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Claborn K, Becker S, Ramsey S, Rich J, Friedmann PD. Mobile technology intervention to improve care coordination between HIV and substance use treatment providers: development, training, and evaluation protocol. Addict Sci Clin Pract 2017; 12:8. [PMID: 28288678 PMCID: PMC5348772 DOI: 10.1186/s13722-017-0073-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) with a substance use disorder (SUD) tend to receive inadequate medical care in part because of a siloed healthcare system in which HIV and substance use services are delivered separately. Ideal treatment requires an interdisciplinary, team-based coordinated care approach, but many structural and systemic barriers impede the integration of HIV and SUD services. The current protocol describes the development and preliminary evaluation of a care coordination intervention (CCI), consisting of a tablet-based mobile platform for HIV and SUD treatment providers, an interagency communication protocol, and a training protocol. We hypothesize that HIV and SUD treatment providers will find the CCI to be acceptable, and that after receipt of the CCI, providers will: exhibit higher retention in dual care among patients, report increased frequency and quality of communication, and report increased rates of relational coordination. Methods/design A three phase approach is used to refine and evaluate the CCI. Phase 1 consists of in-depth qualitative interviews with 8 key stakeholders as well as clinical audits of participating HIV and SUD treatment agencies. Phase 2 contains functionality testing of the mobile platform with frontline HIV and SUD treatment providers, followed by refinement of the CCI. Phase 3 consists of a pre-, post-test trial with 30 SUD and 30 HIV treatment providers. Data will be collected at the provider, organization, and patient levels. Providers will complete assessments at baseline, immediately post-training, and at 1-, 3-, and 6-months post-training. Organizational data will be collected at baseline, 1-, 3-, and 6-months post training, while patient data will be collected at baseline and 6-months post training. Discussion This study will develop and evaluate a CCI consisting of a tablet-based mobile platform for treatment providers, an interagency communication protocol, and a training protocol as a means of improving the integration of care for PLWH who have a SUD. Results have the potential to advance the field by bridging gaps in a fragmented healthcare system, and improving treatment efficiency, work flow, and communication among interdisciplinary providers from different treatment settings. Trial Registration: NCT02906215
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Affiliation(s)
- Kasey Claborn
- Department of Medicine, Division of General Internal Medicine, Rhode Island Hospital, 111 Plain Street, Providence, RI, 02903, USA. .,The Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI, 02912, USA.
| | - Sara Becker
- The Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI, 02912, USA.,Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Box G-121-5, Providence, RI, 02912, USA
| | - Susan Ramsey
- Department of Medicine, Division of General Internal Medicine, Rhode Island Hospital, 111 Plain Street, Providence, RI, 02903, USA.,The Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Josiah Rich
- The Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI, 02912, USA.,Miriam Hospital, Providence, RI, 02906, USA
| | - Peter D Friedmann
- Office of Research, Department of Medicine, University of Massachusetts - Baystate and Baystate Health, Springfield, MA, USA
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[Management of alcohol use disorders in ambulatory care: Which follow-up and for how long?]. Encephale 2016; 42:67-73. [PMID: 26796554 DOI: 10.1016/j.encep.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alcohol consumption with its addictive potential may lead to physical and psychological dependence as well as systemic toxicity all of which have serious detrimental health outcomes in terms of morbimortality. Despite the harmful potential of alcohol use disorders, the disease is often not properly managed, especially in ambulatory care. Psychiatric and general practitioners in ambulatory care are first in line to detect and manage patients with excessive alcohol consumption. However, this is still often regarded as an acute medical condition and its management is generally considered only over the short-term. On the contrary, alcohol dependence has been defined as a primary chronic disease of the brain reward, motivation, memory and related circuitry, involving the signalling pathway of neurotransmitters such as dopamine, opioid peptides, and gamma-aminobutyric acid. Thus, it should be regarded in terms of long-term management as are other chronic diseases. OBJECTIVE To propose a standard pathway for the management of alcohol dependence in ambulatory care in terms of duration of treatment and follow-up. METHODS Given the lack of official recommendations from health authorities which may help ambulatory care physicians in long-term management of patients with alcohol dependence, we performed a review and analysis of the most recent literature regarding the long-term management of other chronic diseases (diabetes, bipolar disorders, and depression) drawing a parallel with alcohol dependence. RESULTS Alcohol dependence shares many characteristics with other chronic diseases, including a prolonged duration, intermittent acute and chronic exacerbations, and need for prolonged and often-lifelong care. In all cases, this requires sustained psychosocial changes from the patient. Patient motivation is also a major issue and should always be taken into consideration by psychiatric and general practitioners in ambulatory care. In chronic diseases, such as diabetes, bipolar disorders, or depression, psychosocial and motivational interventions have been effective to improve the patient's emotional functioning and to prevent or delay relapses. Such interventions help patients to accept their disease and to promote long-term therapeutic plans based on treatment adherence, behavioural changes, self-management and self-efficacy. The management of alcohol-dependence in ambulatory care should be addressed similarly. Therapeutic monitoring may be initiated to manage alcohol use disorders, including alcohol dependence, especially when the patient is unwilling or unready for alcohol withdrawal (i.e. using the strategy of reduction of alcohol consumption, which is considered a possible intermediate step toward abstinence). CONCLUSION Alcohol dependence needs long-term medical supervision, and the therapeutic success depends on the initiation of sustained monitoring at the time of diagnosis (initiating phase with several consultations over 2-4 weeks) with psychosocial and motivational interventions in order to address all the patient uncertainties, to involve him/her in a proactive disease management plan, and to insure adherence to treatment, behavioural changes and new lifestyle. A close monitoring (once a month during the first 6 months) during a consolidation phase is necessary. Finally, a regular monitoring should be maintained overtime after 6-12 months in order to insure that the patient maintains a minimal consumption during the first year, to consolidate the patient's motivation, to abstain in at risk situations, and to maintain a controlled consumption or abstinence.
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Underner M. Le tabagisme est-il une maladie chronique ? Oui. Rev Mal Respir 2015; 32:663-7. [DOI: 10.1016/j.rmr.2015.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022]
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Love J, Zatzick D. Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey. Psychiatr Serv 2014; 65:918-23. [PMID: 24733143 PMCID: PMC4256134 DOI: 10.1176/appi.ps.201300399] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers. METHODS Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD. RESULTS There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention. CONCLUSIONS Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.
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Affiliation(s)
- Jeff Love
- The authors are with the Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle. Send correspondence to Dr. Zatzick (e-mail: ). A preliminary version of this paper was presented at the annual meeting of the American Psychiatric Association, San Francisco, May 18-22, 2013
| | - Douglas Zatzick
- The authors are with the Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle. Send correspondence to Dr. Zatzick (e-mail: ). A preliminary version of this paper was presented at the annual meeting of the American Psychiatric Association, San Francisco, May 18-22, 2013
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Association of recent incarceration with traumatic injury, substance use-related health consequences, and health care utilization. J Addict Med 2014; 8:66-72. [PMID: 24365804 DOI: 10.1097/adm.0000000000000009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The higher risk of death among recently released inmates relative to the general population may be because of the higher prevalence of substance dependence among inmates or an independent effect of incarceration. We explored the effects of recent incarceration on health outcomes that may be intermediate markers for mortality. METHODS Longitudinal multivariable regression analyses were conducted on interview data (baseline, 3-, 6-, and 12-month follow-up) from alcohol- and/or drug-dependent individuals (n = 553) participating in a randomized clinical trial to test the effectiveness of chronic disease management for substance dependence in primary care. The main independent variable was recent incarceration (spending ≥1 night in jail or prison in the past 3 months). The 3 main outcomes of this study were any traumatic injury, substance use-related health consequences, and health care utilization--defined as hospitalization (excluding addiction treatment or detoxification) and/or emergency department visit. RESULTS Recent incarceration was not significantly associated with traumatic injury (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI]: 0.65-1.49) or health care utilization (AOR = 0.88; 95% CI: 0.64-1.20). However, recent incarceration was associated with higher odds for substance use-related health consequences (AOR = 1.42; 95% CI: 1.02-1.98). CONCLUSIONS Among people with alcohol and/or drug dependence, recent incarceration was significantly associated with substance use-related health consequences but not injury or health care utilization after adjustment for covariates. These findings suggest that substance use-related health consequences may be part of the explanation for the increased risk of death faced by former inmates.
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Gordon AJ, Bertholet N, McNeely J, Starrels JL, Tetrault JM, Walley AY. 2013 Update in addiction medicine for the generalist. Addict Sci Clin Pract 2013; 8:18. [PMID: 24499640 PMCID: PMC3819258 DOI: 10.1186/1940-0640-8-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and medical care. The authors discuss each selected articles' merits, limitations, conclusions, and implication to advancing addiction screening, assessment, and treatment of addiction in generalist physician practice environments.
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Affiliation(s)
- Adam J Gordon
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Joanna L Starrels
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Morse DS, Cerulli C, Bedell P, Wilson JL, Thomas K, Mittal M, Lamberti JS, Williams G, Silverstein J, Mukherjee A, Walck D, Chin N. Meeting health and psychological needs of women in drug treatment court. J Subst Abuse Treat 2013; 46:150-7. [PMID: 24074850 DOI: 10.1016/j.jsat.2013.08.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/09/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
Abstract
We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: (1) intrapersonal challenges participants termed an "evil cycle" of relapse, recidivism, trauma, and life challenges; (2) interpersonal context of parenting and stigma involving features of this "evil cycle"; (3) institutions with logistical barriers to legal and medical assistance; (4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model.
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Affiliation(s)
- Diane S Morse
- Departments of Psychiatry and Medicine, University of Rochester School of Medicine, Women's Initiative Supporting Health, Center for Community Health, Rochester, NY 14642, USA.
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Saitz R, Cheng DM, Winter M, Kim TW, Meli SM, Allensworth-Davies D, Lloyd-Travaglini CA, Samet JH. Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial. JAMA 2013; 310:1156-67. [PMID: 24045740 PMCID: PMC3902022 DOI: 10.1001/jama.2013.277609] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes. OBJECTIVE To determine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care. DESIGN, SETTING, AND PARTICIPANTS The AHEAD study, a randomized trial conducted among 563 people with alcohol and other drug dependence at a Boston, Massachusetts, hospital-based primary care practice. Participants were recruited from September 2006 to September 2008 from a freestanding residential detoxification unit and referrals from an urban teaching hospital and advertisements; 95% completed 12-month follow-up. INTERVENTIONS Participants were randomized to receive CCM (n=282) or no CCM (n=281). Chronic care management included longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (including mutual help). The no CCM (control) group received a primary care appointment and a list of treatment resources including a telephone number to arrange counseling. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported abstinence from opioids, stimulants, or heavy drinking. Biomarkers were secondary outcomes. RESULTS There was no significant difference in abstinence from opioids, stimulants, or heavy drinking between the CCM (44%) and control (42%) groups (adjusted odds ratio, 0.84; 95% CI, 0.65-1.10; P=.21). No significant differences were found for secondary outcomes of addiction severity, health-related quality of life, or drug problems. No subgroup effects were found except among those with alcohol dependence, in whom CCM was associated with fewer alcohol problems (mean score, 10 vs 13; incidence rate ratio, 0.85; 95% CI, 0.72-1.00; P=.048). CONCLUSIONS AND RELEVANCE Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00278447.
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Affiliation(s)
- Richard Saitz
- Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts 02118-2335, USA.
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Walley AY, Tetrault JM, Friedmann PD. Integration of substance use treatment and medical care: a special issue of JSAT. J Subst Abuse Treat 2012; 43:377-81. [PMID: 23079197 DOI: 10.1016/j.jsat.2012.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/07/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, MA 02118, USA
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