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Rosen AD, Javanbakht M, Shoptaw SJ, Seamans MJ, Lloyd-Smith JO, Gorbach PM. Association of current substance use treatment with future reduced methamphetamine use in an observational cohort of men who have sex with men in Los Angeles. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209228. [PMID: 37981239 PMCID: PMC10984139 DOI: 10.1016/j.josat.2023.209228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Methamphetamine use is highly prevalent among men who have sex with men (MSM), but knowledge of the long-term dynamics, and how they are affected by substance use treatment, is limited. This study aimed to describe trajectories of methamphetamine use among MSM, and to evaluate the impact of treatment for any kind of substance use on frequency of methamphetamine use. METHODS This analysis used data from a cohort of MSM in Los Angeles, CA, who participated in semi-annual study visits from 2014 to 2022. The study characterized trajectories of methamphetamine use using a continuous time multistate Markov model with three states. States were defined using self-reported frequency of methamphetamine use in the past six months: frequent (daily), occasional (weekly or less), and never. The model estimated the association between receiving treatment for any kind of substance use and changes in state of frequency of methamphetamine use. RESULTS This analysis included 2348 study visits among 285 individuals who were followed-up for an average of 4.4 years. Among participants who were in the frequent use state, 65 % (n = 26) of those who were receiving any kind of substance use treatment at a study visit had reduced their methamphetamine use at their next visit, compared to 33 % (n = 95) of those who were not receiving treatment. Controlling for age, race/ethnicity, and HIV-status, those who reported receiving current treatment for substance use were more likely to transition from occasional to no use (HR: 1.63, 95 % CI: 1.10-2.42) and frequent to occasional use (HR: 4.25, 95 % CI: 2.11-8.59) in comparison to those who did not report receiving current treatment for substance use. CONCLUSIONS Findings from this dynamic modeling study provide a new method for assessing longitudinal methamphetamine use outcomes and add important evidence outside of clinical trials that substance use treatment may reduce methamphetamine use.
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Affiliation(s)
- Allison D Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Steven J Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marissa J Seamans
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Tardelli VS, Berro LF, Gerra G, Tadonio L, Bisaga A, Fidalgo TM. Prescription psychostimulants for cocaine use disorder: A review from molecular basis to clinical approach. Addict Biol 2023; 28:e13271. [PMID: 37016755 PMCID: PMC10499006 DOI: 10.1111/adb.13271] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
Cocaine use is a public health concern in many countries worldwide, particularly in the Americas and Oceania. Overdose deaths involving stimulants, such as cocaine, have been increasing markedly in North America, especially with concurrent opioid involvement. To date, no pharmacological treatment is available to treat stimulant (including cocaine) use disorders. Prescription psychostimulants (PPs) could be useful to treat cocaine use disorder (CUD) as they share the pharmacological effects with cocaine, as evidenced by a recent meta-analysis that assessed 38 randomized clinical trials (RCTs). PPs were found to promote sustained abstinence and reduce drug use in patients with CUD. The aim of this paper is to provide a narrative review of the clinical pharmacology of PPs and comment on the current stage of evidence supporting PPs to treat CUD. We also propose a model of care that integrates PPs with evidence-based psychosocial interventions (such as cognitive-behavioural therapy [CBT] and contingency management [CM]), a harm reduction approach and case management with social support.
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Affiliation(s)
- Vitor S. Tardelli
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
- Translational Addiction Research Laboratory, Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Lais F. Berro
- Department of Psychiatry and Human Behavior, University of Mississipi Medical Center, Jackson, MS, USA
| | - Gilberto Gerra
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Leonardo Tadonio
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Adam Bisaga
- The Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
- Young Leaders Program from the National Academy of Medicine, Brazil
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Avalone L, King C, Popeo D, Perkel C, Abara CJ, Linn-Walton R, Gasca V, Vitagliano L, Barron C, Fattal O. Increased Attendance During Rapid Implementation of Telehealth for Substance Use Disorders During COVID-19 at the Largest Public Hospital System in the United States. Subst Use Misuse 2022; 57:1322-1327. [PMID: 35611875 DOI: 10.1080/10826084.2022.2079140] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to examine differences between; telehealth and in-person visits during COVID-19 and in a pre-COVID-19 reference period; COVID-19 televisit completion for patients with varying engagement in treatment during the reference period. METHODS Electronic medical record data were collected and analyzed with chi-squared or t-tests to compare patient demographics. Generalized estimating equations for estimating the odds of outcomes were used, controlling for demographics. RESULTS Patients were 3.34 and 1.74 times more likely to complete a telehealth visit (n = 11,839) compared with an in-person visit during (n = 7,917) and prior (n = 15,497) to COVID-19. For patients on buprenorphine, patients with no prior in-person visits during the pre-televisit period were 2.26 more likely to complete televisits compared with patients with two or more prior in-person visits. For all patients, those with two or more prior in-person visits in the reference period were 1.27 times more likely to complete a televisit compared with a patient with no in-person visits during the pre-televisit period. There was no significant difference when comparing with patients who had only one prior in-person visit to those patients with no prior visits. CONCLUSIONS In this study, outpatient substance use disorder (SUD) telehealth appointments were associated with higher odds of visit completion compared with in-person visits during and prior to COVID-19. Patients receiving buprenorphine, without prior in person visits, were more likely to attend if they did not have in-person visits prior to COVID-19. Regulators should consider permanently adopting telehealth flexibilities for SUD treatment once the federal emergency status has ended.
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Affiliation(s)
- Lynsey Avalone
- NYC Health + Hospitals/Office of Behavioral Health, New York, New York, USA
| | - Carla King
- NYC Health + Hospitals/Office of Behavioral Health, New York, New York, USA
| | - Dennis Popeo
- NYC Health + Hospitals/Bellevue, New York, New York, USA
| | - Charles Perkel
- NYC Health + Hospitals/Coney Island, New York, New York, USA
| | - Chidinma J Abara
- NYC Health + Hospitals/Office of Population Health, New York, New York, USA
| | | | - Vladimir Gasca
- NYC Health + Hospitals/Elmhurst, New York, New York, USA
| | - Laurie Vitagliano
- NYC Health + Hospitals/Queens, Mt. Sinai Ichan School of Medicine, New York, New York, USA
| | - Charles Barron
- NYC Health + Hospitals/Office of Behavioral Health, New York, New York, USA
| | - Omar Fattal
- NYC Health + Hospitals/Office of Behavioral Health, New York University Grossman School of Medicine, New York, New York, USA
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The Effects of Drug Camp in Treatment of Methamphetamine Use with a New Behavioral Change Model: A Quasi-Experimental Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kelly JF, Hoffman L, Vilsaint C, Weiss R, Nierenberg A, Hoeppner B. Peer support for mood disorder: Characteristics and benefits from attending the Depression and Bipolar Support Alliance mutual-help organization. J Affect Disord 2019; 255:127-135. [PMID: 31150942 PMCID: PMC6591033 DOI: 10.1016/j.jad.2019.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/08/2019] [Accepted: 05/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mood disorders (MDs) are pervasive and debilitating psychiatric conditions. Many helpful psychological and psychopharmacological treatments exist, but MD's prevalence and chronicity often means relying purely on professional care can create financial strain on individuals and healthcare systems. Also, many individuals respond only partially to professionally-delivered medical/pharmacological interventions or are unable to tolerate or adhere to them. Peer-led mutual-help organizations (MHOs) have emerged and grown in the U.S. to extend and potentiate professional efforts or otherwise address needs unmet by professional care. The Depression and Bipolar Support Alliance (DBSA) is the largest of these, but beyond observational evidence, little is known about participation or benefits. Greater knowledge could inform the field regarding clinical and public health utility of peer-driven efforts. METHOD Community-based cross-sectional comparative investigation of MD individuals attending (N = 202) or not attending (N = 105) DBSA. Measures included demographics, clinical characteristics and clinical service use, and indices of symptomatology, functioning, quality of life (QOL), and psychological well-being. RESULTS Compared to non-DBSA participants, DBSA participants were more likely to be male and white and trended toward greater religious affiliation (p = 0.05). DBSA participants attended meetings about twice per month with two-thirds attending for more than one year. The DBSA cohort had a much higher proportion with bipolar I disorder and reported more lifetime and past 90-day use of acute, intensive, medical services and medications. There were no between-group differences on indices of QOL or psychological well-being, but within the DBSA group, greater DBSA attendance and involvement was associated with greater QOL and well-being, and less functional impairment. LIMITATIONS Cross-sectional design and regional sampling frame with unknown generalizability to national DBSA membership. CONCLUSION Given the grave impact of MDs and that DBSA is freely available it may fill an important clinical and public health need by attracting and engaging MD individuals with greater functional instability and impairment. The positive association found between greater active DBSA participation and improvements in functioning and well-being, while promising, requires longitudinal investigation to formally establish the causal direction of effects.
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Affiliation(s)
- John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | - Lauren Hoffman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | - Corrie Vilsaint
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | | | - Andrew Nierenberg
- Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School
| | - Bettina Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
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Wendt DC, Hallgren KA, Daley DC, Donovan DM. Predictors and Outcomes of Twelve-Step Sponsorship of Stimulant Users: Secondary Analyses of a Multisite Randomized Clinical Trial. J Stud Alcohol Drugs 2017; 78:287-295. [PMID: 28317510 DOI: 10.15288/jsad.2017.78.287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This secondary data analysis explored predictors and outcomes of having a 12-step sponsor among individuals receiving treatment for stimulant use disorders, inclusive of four types of 12-step groups (Narcotics Anonymous, Alcoholics Anonymous, Cocaine Anonymous, and Crystal Meth Anonymous). METHOD For a multisite randomized clinical trial, participants (N = 471; 59% women) were recruited among adult patients in 10 U.S. community treatment programs. Participants were randomized into treatment as usual (TAU) or a 12-step facilitation (TSF) intervention: Stimulant Abuser Groups to Engage in 12-Step (STAGE-12). Logistic regression analyses explored the extent to which participants obtained sponsors, including the extent to which treatment condition and other predictors (12-step experiences, expectations, and beliefs) were associated with having a sponsor. The relationship between end-of-treatment sponsorship and follow-up substance use outcomes was also tested. RESULTS Participants were more likely to have a sponsor at the end of treatment and 3-month follow-up, with the STAGE-12 condition having higher sponsorship rates. Twelve-step meeting attendance and literature reading during the treatment period predicted having a sponsor at the end of treatment. Sponsorship at the end of treatment predicted a higher likelihood of abstinence from stimulant use and having no drug-related problems at follow-up. CONCLUSIONS This study extends previous research on sponsorship, which has mostly focused on alcohol use disorders, by indicating that sponsorship is associated with positive outcomes for those seeking treatment from stimulant use disorders. It also suggests that sponsorship rates can be improved for those seeking treatment from stimulant use disorders through a short-term TSF intervention.
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Affiliation(s)
- Dennis C Wendt
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Dennis C Daley
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis M Donovan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
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