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Marvin AF, Buckingham SL. "It's time for a change. I need to. I have to": Substance misuse recovery turning points of unhoused Alaskans. J Prev Interv Community 2024; 52:35-53. [PMID: 38622963 DOI: 10.1080/10852352.2024.2332124] [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] [Indexed: 04/17/2024]
Abstract
Substance misuse is a pernicious health concern for many unhoused people. A deep understanding of turning points - what propels someone to take concrete action toward addressing substance misuse - is needed to inform recovery policies and practices. This study sought to identify common elements in turning points among unhoused people vis-à-vis a phenomenological qualitative approach. Twenty people (Mage = 47.47, SD = 9.75; 50% female) who self-identified as being in recovery while unhoused participated in semi-structured interviews in Anchorage, Alaska, a community with high rates of both houselessness and substance misuse. Survival (life- and health-sustaining), individual (intrapersonal), and relational (interpersonal) motivations all shaped turning points. Limitations include the possible underrepresentation of individuals using a harm-reduction approach or capturing differences by housing type. Programs to address substance misuse should consider these motivations. Future research should identify and refine turning points and work to understand how they interact with change processes.
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Molander O, Bjureberg J, Sahlin H, Beijer U, Hellner C, Ljótsson B. Integrated cognitive behavioral treatment for substance use and depressive symptoms: a homeless case series and feasibility study. Pilot Feasibility Stud 2023; 9:76. [PMID: 37147667 PMCID: PMC10161417 DOI: 10.1186/s40814-023-01305-2] [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: 04/15/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Homelessness is associated with high prevalence of psychiatric disorders such as substance use disorders, including alcohol use disorder, and depression. METHODS This case series and feasibility trial evaluated a novel integrated cognitive behavioral treatment (ICBT), which was adapted specifically for homeless individuals and developed to treat substance use and depressive symptoms simultaneously. The ICBT was delivered among four homeless individuals enrolled in the Treatment First program (a social services program where treatment is offered in conjunction with temporary transitional housing), who had access to stable and sober housing milieus. RESULTS The ICBT was rated high in expectancy of improvement, credibility, and satisfaction, with few treatment-related adverse events, and fairly high treatment retention. At 12 months follow-up, three of four participants were not homeless anymore. Some participants experienced short-term reductions in substance use and/or depressive symptoms. CONCLUSIONS The study provided preliminary support that the ICBT can be a feasible and potentially effective treatment for homeless individuals with substance use and/or depressive symptoms. However, the delivery format within the Treatment First program was not feasible. The ICBT could be offered within the social services Housing First program instead (where permanent housing is offered before treatment), or to non-homeless individuals. TRIAL REGISTRATION The study was registered retrospectively at ClinicalTrials.gov (NCT05329181).
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Affiliation(s)
- Olof Molander
- PelarbackenErsta Diakoni, Social Welfare Office for the Homeless, City of Stockholm, Stockholm, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden.
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Ulla Beijer
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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Arnos D, Acevedo A. Homelessness and Gender: Differences in Characteristics and Comorbidity of Substance Use Disorders at Admission to Services. Subst Use Misuse 2023; 58:27-35. [PMID: 36519365 DOI: 10.1080/10826084.2022.2136491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Substance use disorders and homelessness are two closely related behavioral health issues. This study examines associations between homelessness and severity of substance use disorder (SUD) characteristics (inclusive of alcohol and other legal and illegal drugs) and presence of mental health comorbidity among individuals entering treatment for SUD. We also examine differences in SUD and mental health comorbidity by gender within a sample of clients experiencing homelessness upon admission to treatment. Methods: Using the 2017 Treatment Episodes Data Set, we used logistic regression models to examine the association between homelessness and indicators of severity (e.g., frequency of use, route of transmission) and the presence of mental health conditions, and to examine the association between gender and these dependent variables among only individuals experiencing homelessness at treatment admission. Results: After controlling for covariates, homelessness is significantly associated with increased odds of cocaine and methamphetamine use compared to all other substances, higher frequency of use, younger age of first use, use of more substances, injection drug use, and co-occurring mental health conditions. Female gender is inversely associated with younger age at first use and highly associated with co-occurring mental health conditions among those experiencing homelessness at admission to treatment. Conclusions: Individuals experiencing homelessness enter substance use services with different characteristics of substance use disorders, different patterns of use, and with higher rates of mental health comorbidity. Within homeless admissions, women have significant differences in substance use and higher likelihood of mental health comorbidity than men. Future research should focus on the specific treatment needs of individuals experiencing homelessness, and how the combination of homelessness and gender affects barriers and challenges to treatment.
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Affiliation(s)
- Diane Arnos
- School of Public Health, University of California, Berkeley, California, USA
| | - Andrea Acevedo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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Choi NG, DiNitto DM, Marti CN, Choi BY. Demographic and Clinical Correlates of Treatment Completion among Older Adults with Heroin and Prescription Opioid Use Disorders. J Psychoactive Drugs 2022; 54:440-451. [PMID: 34818983 PMCID: PMC9130343 DOI: 10.1080/02791072.2021.2009068] [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: 04/30/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022]
Abstract
In this study using 2015-2018 Treatment Episode Data Set-Discharge (TEDS-D) cases age 55+ for heroin (N = 101,524) or prescription opioids (PO; N = 25,510) as the primary substance, we examined treatment completion rates and correlates. We fit separate logistic regression models for heroin and PO cases with treatment completion status (completed vs. discontinued due to dropout/termination/other reasons) for each treatment setting (detoxification, residential rehabilitation, and outpatient) as the dependent variable. Results show that detoxification cases had the highest completion rates and outpatient cases had the lowest (14.8% for heroin and 24.0% for PO cases). A consistently significant correlate of treatment completion was legal system referral for heroin cases and having a bachelor's degree for PO cases. Medication-assisted therapy was associated with higher odds of completing residential treatment for both types of opioids but lower odds of completing detoxification and outpatient treatment. Treatment duration >30 days tended to have higher odds of completion. PO cases age 65+ had higher odds of completing residential treatment than cases age 55-64. Racial/ethnic minorities tended to have lower odds of outpatient treatment completion. Study findings underscore the importance of helping older adults complete treatment, especially those who are racial/ethnic minorities and receiving outpatient treatment.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78702, USA
| | - Diana M. DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78702, USA
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78702, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131 & Bayhealth Medical Center, Dover, DE, 19901, USA
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Logan TK, McLouth CJ, Cole J. Examining Recovery Status Trends over 7-Years for Men and Women Clients of a Substance Use Disorder Recovery Housing Program. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221083654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adults who are homeless and/or involved in the criminal justice system have significantly higher risks of substance use disorders (SUD)s and they may have increased difficulty initiating and maintaining traditional SUD treatments. To address the needs of adults with SUDs who are homeless/criminal justice system involved the Recovery Kentucky programs were established. This study examined outcomes for this recovery housing program among an unduplicated statewide sample of men ( n=672) and women ( n = 732) clients who entered the Recovery Kentucky program and who were followed-up about 12 months after program entry across a 7-year period. Low, but similar rates of problem alcohol or illicit drug use at follow-up were found across the 7-year period. Men had higher rates of return to use than women. Further, about 40% of the clients had at least one recovery status vulnerability factor at follow-up each year of the study with no differences by gender.
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Affiliation(s)
- TK Logan
- University of Kentucky, Lexington, KY, USA
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A longitudinal cross-sectional analysis of substance use treatment trends for individuals experiencing homelessness, criminal justice involvement, both, or neither - United States, 2006-2018. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100174. [PMID: 35382494 PMCID: PMC8979492 DOI: 10.1016/j.lana.2021.100174] [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] [Indexed: 11/29/2022]
Abstract
Background Individuals experiencing homelessness or criminal justice involvement (CJI) have higher rates of substance use than the general public. Despite documented barriers to accessing treatment, few studies have compared substance use treatment patterns between these groups. Methods This paper uses data from the Treatment Episode Dataset-Admissions between 2006 to 2018 to describe characteristics and trends in substance use treatment admissions indicating homelessness (n=2,524,413), CJI (4,764,750), both (509,902), or neither (8,950,797) in the United States. We used multivariable logistic regression to examine trends independent of demographic differences between groups. Findings Between 2006 and 2018, the proportion of treatment admissions related to heroin increased across all groups. Methamphetamine-related admissions rose substantially for individuals experiencing homelessness, CJI, or both. By 2018, 27·8% (95% CI: 27·4-28·2%) of admissions for individuals experiencing both were methamphetamine-related and 16·7% (95% CI: 16·3-17·0%) were heroin-related. Conversely, among individuals experiencing neither, 7·5% (95% CI: 7·4-7·5%) of admissions were methamphetamine-related and 33·6% (95% CI: 33·4-33·7%) were heroin-related. Individuals experiencing both homelessness and CJI received lower rates of medications for opioid use disorder (OUD) (8·3%; 95% CI: 8·2-8·3%) compared to individuals experiencing neither (36·4%; 95% CI: 36·4-36·4%). Interpretation Community treatment facilities should be supported to provide medications for OUD and accommodate rising rates of methamphetamine and polysubstance-related treatment admissions in populations experiencing complex social drivers of health such as homelessness, CJI, or both. Funding National Institute of General Medical Sciences and National Institute of Diabetes and Digestive and Kidney Diseases.
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Nyamathi A, Salem BE, Shin SS, Jones AA, Garfin DR, Yadav K, Chang AH, White K, Morisky D. Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults. Nurs Res 2021; 70:433-442. [PMID: 34380979 PMCID: PMC8563379 DOI: 10.1097/nnr.0000000000000545] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults. OBJECTIVES We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment. METHODS We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety. RESULTS The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (<50 years old) were less likely to complete 3HP treatment compared to those who were older. Neither drug use, depression, nor anxiety was associated with 3HP treatment completion. Decrease in anxiety was observed at 3 months, but not at 6 months, compared to baseline. DISCUSSION To our knowledge, the pilot study is the first to evaluate an effective RN/CHW-delivered, community-based intervention, which can reduce the burden of active TB for homeless adults.
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The association of opioid use disorder and homelessness nationally in the veterans health administration. Drug Alcohol Depend 2021; 223:108714. [PMID: 33865213 DOI: 10.1016/j.drugalcdep.2021.108714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is a major risk factor for homelessness, but the specific association of opioid use disorder (OUD) and homelessness in the context of their shared risk factors has not been the focus of prior studies. We used national data from the United States Veterans Health Administration (VHA) to examine the association of OUD and homelessness in the context of shared risk factors. METHODS In this cross-sectional analysis of veterans who received VHA care during Fiscal Year 2012 (N = 5,450,078), we compared the prevalence of OUD and other sociodemographic, and clinical factors among homeless and non-homeless veterans. We estimated the odds ratio for homelessness associated with OUD alone, and after adjusting for other factors through multivariate logistic regression. RESULTS Homeless veterans had substantially higher prevalence of OUD than other VHA patients (7.7 % Vs 0.6 %) and OUD was associated with 13 times higher unadjusted odds of homelessness (Odds Ratio [OR] 13.36, 95 % CI 13.09-13.62), which decreased with adjustment for sociodemographic factors (black race, mean income and age), other SUD, medical, and psychiatric diagnoses (final OR 1.57, 95 % CI 1.53-1.61). Other SUDs (alcohol, cannabis, cocaine, and hallucinogens) showed similar or slightly higher odds of homelessness as OUD in the final model. CONCLUSIONS OUD was strongly associated with homelessness among US veterans although this association was largely but not entirely attenuated by shared sociodemographic and co-morbid risk factors including several other SUDs. Treatment of homeless veterans with OUD should address socio-economic vulnerabilities and other co-morbidities in addition to treatments for OUD.
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Arnold TD, Lin L(A, Cotton BP, Bryson WC, Polenick CA. Gender Differences in Patterns and Correlates of Continued Substance Use among Patients in Methadone Maintenance Treatment. Subst Use Misuse 2021; 56:529-538. [PMID: 33645425 PMCID: PMC8279751 DOI: 10.1080/10826084.2021.1887242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Continued substance use is common during opioid use disorder (OUD) treatment. There are still inconsistencies in how continued substance use and concurrent patterns of substance use among patients with OUD varies by gender. There is still more to learn regarding how factors associated with continued and concurrent use might differ for men and women in methadone maintenance treatment (MMT). Methods: This cross-sectional study examined predictors of concurrent substance use subgroups among patients receiving MMT. The sample included 341 (n = 161 women) MMT patients aged 18 and older from opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a survey assessing sociodemographic and clinical characteristics including past-month substance use. Latent class analyses were conducted by gender to identify groups based on substance use and determine predictors of those classes. Results: Three-class solutions were the optimal fit for both men and women. For both genders, the first subgroup was characterized as Unlikely Users (59.8% women, 52.8% men). Classes 2 and 3 among women were Cannabis/Opioid Users (23.7%) and Stimulant/Opioid Users (13.0%). Among men, Classes 2 and 3 consisted of Alcohol/Cannabis Users (21.9%) and Cannabis/Stimulant/Opioid Users (25.3%). Ever using Suboxone (buprenorphine/naloxone) and depression/anxiety symptoms were significantly linked to substance use group among women, whereas homelessness and employment status were significantly associated with substance use group among men. Conclusions: This study furthers understanding of gender differences in factors associated with continued substance use and distinctive patterns of concurrent substance use that may guide tailored treatments among patients MMT.
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Affiliation(s)
- Tomorrow D. Arnold
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Department of Psychology, University of Tennessee, Chattanooga, TN 37403
| | - Lewei (Allison) Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109
| | - Brandi P. Cotton
- College of Nursing, University of Rhode Island, Kingston, RI 02881
| | - William C. Bryson
- Department of Psychiatry, Oregon Health and Sciences University, Portland, OR, USA
| | - Courtney A. Polenick
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
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Villegas C, Ibabe I, Arnoso A. People at risk of social exclusion: mental health, structural-economic factors and sociocultural factors ( Personas en riesgo de exclusión social: salud mental, factores económico-estructurales y socio-culturales). INTERNATIONAL JOURNAL OF SOCIAL PSYCHOLOGY 2020. [DOI: 10.1080/02134748.2020.1840235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Izaskun Ibabe
- Universidad del País Vasco / Euskal Herriko Unibertsitatea
| | - Ainara Arnoso
- Universidad del País Vasco / Euskal Herriko Unibertsitatea
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de Espíndola MI, Bedendo A, da Silva EA, Noto AR. Interpersonal relationships and drug use over time among homeless people: a qualitative study. BMC Public Health 2020; 20:1746. [PMID: 33213421 PMCID: PMC7678275 DOI: 10.1186/s12889-020-09880-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/11/2020] [Indexed: 05/30/2023] Open
Abstract
Background Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users. Method We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis. Results Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use. Conclusion The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12889-020-09880-2.
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Affiliation(s)
- Marília Ignácio de Espíndola
- NEPSIS - Research Center on Health and Substance Use, Sao Paulo, Brazil. .,Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1° Andar, Vila Clementino, SP, 04023062, Sao Paulo, Brazil.
| | - André Bedendo
- NEPSIS - Research Center on Health and Substance Use, Sao Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1° Andar, Vila Clementino, SP, 04023062, Sao Paulo, Brazil
| | - Eroy Aparecida da Silva
- NEPSIS - Research Center on Health and Substance Use, Sao Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1° Andar, Vila Clementino, SP, 04023062, Sao Paulo, Brazil
| | - Ana Regina Noto
- NEPSIS - Research Center on Health and Substance Use, Sao Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1° Andar, Vila Clementino, SP, 04023062, Sao Paulo, Brazil
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Profiles of Clinical Need Among Homeless Individuals with Dual Diagnoses. Community Ment Health J 2019; 55:1305-1312. [PMID: 31236735 DOI: 10.1007/s10597-019-00432-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
This study explored patterns of clinical need among homeless individuals with dual diagnoses, and explored whether certain profiles are characteristic of different demographic groups. Data were drawn from two larger studies conducted with dually diagnosed, homeless individuals (n = 373). Hierarchical cluster analysis identified four subgroups: (1) Clinically least severe, characterized by less frequent psychological symptoms and no history of physical or sexual abuse; (2) Moderate clinical needs, including shorter history of substance use and less frequent psychological symptoms, but symptoms consistent with severe mental illness; (3) Clinically severe, with frequent anxiety, depression, past and recent physical or sexual abuse, and long history of substance use; (4) Least frequent psychological symptoms, but frequent history of physical or sexual abuse and long history of drug use. Women veterans were mostly likely to be classified in cluster 3, and male civilians in cluster 2. Subgroups of homeless individuals with dual diagnoses demonstrated different clusters of clinical needs, having implications for service delivery to the population.
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Affiliation(s)
- Andrew M. Byrne
- California Polytechnic State University, San Luis Obispo, USA
| | - Min Kim
- Korea Disabled People’s Development Institute, Seoul, Korea
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Kim M, Byrne AM, Jeon J. Predictors of treatment participation rate of substance use disorders among Whites and African Americans. J Ethn Subst Abuse 2019; 20:211-224. [PMID: 31113296 DOI: 10.1080/15332640.2019.1612300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Low treatment participation impedes successful treatment completion and reduces treatment effectiveness. This study explored relationships among treatment participation rate and individuals' symptom severities and employment statuses. A sample of 106 individuals with substance use disorders was recruited for cross-sectional investigation. Individuals who were employed at baseline or had lower symptom severities of baseline alcohol, drug use, and psychiatric issues had significantly higher treatment participation rates. Service providers should pay more attention to individuals' symptom severities and employment to encourage treatment participation. Integrated interventions including vocational services and illness management and recovery intervention could be provided to reduce individuals' symptom severities and increase employability. Implications of participation in substance abuse treatment are discussed.
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Affiliation(s)
- Min Kim
- Human Resource Evaluation, Incheon National University, Incheon, South Korea
| | | | - Jihye Jeon
- Incheon National University, Yeonsu-gu, Incheon, South Korea
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Factors associated with Quitline and pharmacotherapy utilisation among low-socioeconomic status smokers. Addict Behav 2019; 89:113-120. [PMID: 30290299 DOI: 10.1016/j.addbeh.2018.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/22/2022]
Abstract
AIMS To examine factors associated with Quitline and pharmacotherapy utilisation in low socioeconomic status (low-SES) smokers enrolled in a smoking cessation trial. METHODS Baseline data was used from a large-scale smoking cessation randomised controlled trial (RCT). Logistic regression models were used to examine predictors of treatment utilisation prior to entering the RCT and perceived effectiveness of past and future use. RESULTS A total of 1047 smokers consented and prior to enrolment 92% had previously tried to quit smoking, 86% had ever used quit support, 83% had used pharmacotherapy at least once and 38% had ever utilised Quitline. For those who had used pharmacotherapies, 71% used NRT, of which 21% had used dual NRT products. In the last 12-months, 27% utilised Quitline and 50% utilised NRT. Ever use of Quitline was negatively associated with self-efficacy to quit (OR: 0.80; 95% CI: 0.68, 0.94 p < .01) and positively associated with being diagnosed with a mental health condition (OR: 1.50; 95% CI: 1.01, 2.25 p < .05). Recent use of NRT was positively associated with mental health condition (OR: 1.39; 95% CI: 1.02, 1.90 p < .05) and negatively associated with alcohol consumption (OR: 0.69; 95% CI: 0.52, 0.92 p < .01). CONCLUSION Past use of Quitline and pharmacotherapy treatment was associated with self-efficacy to quit, sociodemographic variables, mental health conditions and alcohol consumption. Community-based strategies that target smoking, mental health and drug and alcohol problems may overcome some of the barriers that prevent low-SES populations from engaging with smoking cessation support.
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Vipler S, Hayashi K, Milloy MJ, Wood E, Nosova E, Kerr T, Ti L. Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:27. [PMID: 29976225 PMCID: PMC6034285 DOI: 10.1186/s13011-018-0164-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/26/2018] [Indexed: 12/21/2022]
Abstract
Background For many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. However, little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Using data derived from two prospective cohorts of PWUD, we conducted a longitudinal data analysis of factors associated with use of withdrawal management services. Methods Individuals participating in two cohorts of PWUD were prospectively followed between December 2005 and May 2016 in Vancouver, Canada. Bivariate and multivariate generalized estimating equations were used to examine factors associated with use of withdrawal management services. Results Out of a total of 2001 participants, 339 (16.9%) individuals reported having been to a withdrawal management centre in the previous 6 months at some point during the study period. In multivariate analyses, male sex (adjusted odds ratio [AOR]: 1.62, 95% Confidence Interval [CI]: 1.17–2.24), homelessness (AOR: 1.86, 95% CI: 1.45–2.38), binge use of any substance (AOR: 1.34, 95% CI: 1.08–1.67), having attended a supervised injection facility (AOR: 1.66, 95% CI: 1.3–2.11), and having accessed other addiction medicine treatment or supports (other than withdrawal management services or opioid agonist therapy; AOR: 3.34, 95% CI: 2.64–4.22) were positively associated with having accessed withdrawal management services, whereas older age (AOR: 0.81, 95% CI: 0.7–0.94) was negatively associated with the outcome. Conclusions This study identified specific factors associated with accessing withdrawal management services. Current evidence suggests a need to re-examine the provision of withdrawal management services. Consideration needs to be given to redesigning access to care and bridging to evidence-based addiction treatment, particularly for highly vulnerable subpopulations, identified in this study as females and older people.
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Affiliation(s)
- Sharon Vipler
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Family Practice, University of British Columbia, 320 - 5950 University Boulevard, Vancouver, BC, V6T 1Z6, Canada
| | - Kanna Hayashi
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - M-J Milloy
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Guerrero EG, Song A, Henwood B, Kong Y, Kim T. Response to culturally competent drug treatment among homeless persons with different living arrangements. EVALUATION AND PROGRAM PLANNING 2018; 66:63-69. [PMID: 29049917 DOI: 10.1016/j.evalprogplan.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
This study investigated the association between program cultural competence and homeless individuals' drug use after treatment in Los Angeles County, California. Los Angeles County has the largest and most diverse population of homeless individuals in the nation. We randomly selected for analysis 52 drug-treatment programs and 2158 participants who identified as homeless in the Los Angeles County Participant Reporting System in 2011. We included their living arrangements (indoors and stable, indoors and unstable, and outdoors) and individual and program characteristics (particularly whether their programs used six culturally competent practices) in multilevel regression analyses. The outcome was days of primary drug use at discharge.Results showed that higher levels of staff personal involvement in minority communities (IRR=0.437; 95% CI=0.222, 0.861) and outreach to minority communities (IRR = 0.406; 95% CI=0.213, 0.771) were associated with fewer days of drug use at discharge. Homeless individuals living outdoors used their primary drug more often than any other group. Yet, compared to individuals with other living arrangements, when outdoor homeless individuals were treated by programs with the highest community resources and linkages (IRR=0.364; 95% CI=0.157, 0.844), they reported the fewest days of drug use. We discuss implications for program evaluation and community engagement policies and practices.
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Affiliation(s)
- Erick G Guerrero
- Suzanne Dworak-Peck School of Social Work, and Marshall School of Business, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Ahyoung Song
- Department of Social Welfare, Gachon University, Seongnam, South Korea.
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, and Marshall School of Business, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, Fullerton, CA, 92834, USA.
| | - Tina Kim
- Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, Alhambra, CA, 91803, USA.
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Abstract
Housing options for people exiting homelessness and seeking recovery from substance use disorders are limited. Policies tend to favor low-demand models such as housing first and permanent supportive housing that do not require abstinence, but offer immediate housing placement based on consumer choice and separate housing from clinical services. While these models have proven effective in promoting housing retention, especially among individuals with a primary diagnosis of mental illness, evidence to support positive outcomes related to people with a primary or co-occurring substance use disorder are mixed. Recovery housing models provide abstinence-focused environments and integrated peer support embedded within a recovery framework. Various models exist along a continuum from fully peer-run to clinically staffed residences. However, this continuum is typically separate from the homeless services system, and many barriers to integration persist. Recent national dialogues have begun to explore opportunities to integrate housing and substance use recovery approaches to meet the needs of people who need both types of support. This perspective paper argues that recovery housing is essential for supporting some homeless individuals and families. Within a comprehensive continuum based on choice, both recovery housing and low-demand models can support housing retention, reduce homelessness, promote recovery, and foster self-determination.
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Krupski A, Graves MC, Bumgardner K, Roy-Byrne P. Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net Clinics. J Subst Abuse Treat 2015; 58:84-9. [PMID: 26153073 DOI: 10.1016/j.jsat.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The present study of homeless non-treatment-seeking problem drug users was designed to complement and extend previous studies which focused exclusively on treatment-seeking homeless problem drug users. METHOD Data were available for 866 primary care patients with drug problems, 30% homeless and 70% housed. RESULTS In the 2 years prior to baseline, homeless participants had less chronic medical co-morbidity than problem drug users who were housed yet were significantly more likely to have used emergency department services, to have used them more frequently, and at higher cost. Compared to their housed counterparts, homeless participants were also more likely to have been admitted to specialized chemical dependency treatment and/or detoxification services, to have been arrested for a felony or gross misdemeanor, and to report having psychiatric problems in the prior 30 days. CONCLUSIONS Additional support may be necessary for homeless patients presenting in primary care to benefit from substance abuse treatment given their more severe drug use problems coupled with their co-morbid health, psychiatric, and psychosocial problems.
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Affiliation(s)
- Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA.
| | - Meredith C Graves
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Kristin Bumgardner
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA
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Pombo S, da Costa NF, Figueira ML, Ismail F, Lesch OM. Multidimensional alcoholism typologies: could they guide clinical practice? Results from a 3-month prospective study. Int J Psychiatry Clin Pract 2015; 19:137-47. [PMID: 25666860 DOI: 10.3109/13651501.2015.1016972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The current nosological classifications may describe a syndrome of "alcoholism" that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. METHOD This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. RESULTS The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. CONCLUSIONS Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.
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Affiliation(s)
- Samuel Pombo
- Department of Neuroscience, Psychiatric Service and Medical Psychology, Santa Maria University Hospital , Lisbon , Portugal
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Hossain R, Coren E. Service Engagement in Interventions for Street-Connected Children and Young People: A Summary of Evidence Supplementing a Recent Cochrane–Campbell Review. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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