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Tsutsumi S, Takano A, Usami T, Kumakura Y, Kanazawa Y, Takebayashi T, Sugiyama D, Matsumoto T. Risk and protective factors for early dropout from telephone monitoring for individuals with drug convictions in community mental health centers in Japan. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209347. [PMID: 38494050 DOI: 10.1016/j.josat.2024.209347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/27/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Individuals involved with the criminal justice system face challenges in receiving and maintaining substance use disorder (SUD) treatment and support. Although telephone monitoring (TM) could reduce these barriers, data on TM for community-dwelling individuals involved with the criminal justice system and research on individuals who drop out of TM are scarce. We examined the factors associated with dropping out early from the Voice Bridges Project, which provides TM for individuals on probation for drug-related convictions through community mental health centers in Japan. METHODS Participants (n = 546) were individuals aged ≥20 years with methamphetamine-related convictions who were on probation. Univariate analyses examine the associations between one-year follow-up status and baseline variables, and multivariate Cox proportional hazards regression analyses identify the risk and protective factors associated with dropping out. Stratified analyses report results based on sex and halfway-house residency. RESULTS The one-year dropout rate was 43.6 % (n = 238). Multivariate analysis identified two risk factors for dropping out-halfway-house residency and suicide attempts in the past year, and two protective factors-higher education and the current use of SUD services. Sex-stratified analyses showed that halfway-house residency was a risk factor for both men and women. Attempted suicide was a risk factor for women. Conversely, higher education and current use of SUD services were protective factors for men. CONCLUSIONS Our results identify unique risk factors for women, such as a recent history of suicide attempts, and distinctive protective factors for men, including higher education and current use of SUD services, emphasizing the importance of sex-specific approaches. Furthermore, the study reveals that irrespective of sex, vulnerable individuals, such as halfway-house residents, are at a higher risk of dropping out from TM.
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Affiliation(s)
- Shiori Tsutsumi
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan; Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan.
| | - Ayumi Takano
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan.
| | - Takashi Usami
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan; Kitakyushu Municipal Mental Health and Welfare Center, 1-7-1 Bashaku, Kokurakita Ward, Kitakyushu, Fukuoka, Japan
| | - Yousuke Kumakura
- Department of Neuropsychiatry, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuka Kanazawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan
| | - Toru Takebayashi
- Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan; Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan.
| | - Daisuke Sugiyama
- Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan; Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan; Faculty of Nursing and Medical Care, Keio University, 4411 Endo, Fujisawa-shi, Kanagawa, Japan.
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo, Japan.
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Wah TH, Ong AJX, Naidu KNC, Hanafi S, Tan K, Tan A, Ong TJJ, Ong E, Ho DWS, Subramaniam M, See MY, Tan RKJ. Navigating drug use, cessation, and recovery: a retrospective case notes review among sexual minority men at a community-based service in Singapore. Subst Abuse Treat Prev Policy 2024; 19:23. [PMID: 38627809 PMCID: PMC11020317 DOI: 10.1186/s13011-024-00605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process. METHODS Data were extracted from clinical records provided by The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data. RESULTS Data from beneficiaries (n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one's ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one's recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare. CONCLUSIONS The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies.
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Affiliation(s)
- Tzy Hyi Wah
- The Greenhouse Community Services Limited, Singapore, Singapore
| | | | - Kuhanesan N C Naidu
- The Greenhouse Community Services Limited, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, Singapore
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Syaza Hanafi
- The Greenhouse Community Services Limited, Singapore, Singapore
| | - Kelvin Tan
- The Greenhouse Community Services Limited, Singapore, Singapore
| | - Alaric Tan
- The Greenhouse Community Services Limited, Singapore, Singapore
| | | | - Eleanor Ong
- The Greenhouse Community Services Limited, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, Singapore
| | | | - Mythily Subramaniam
- The Greenhouse Community Services Limited, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Rayner Kay Jin Tan
- The Greenhouse Community Services Limited, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, Singapore.
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Kane L, Benson K, Stewart ZJ, Daughters SB. The impact of spiritual well-being and social support on substance use treatment outcomes within a sample of predominantly Black/African American adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209238. [PMID: 38061630 PMCID: PMC10947916 DOI: 10.1016/j.josat.2023.209238] [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: 04/12/2023] [Revised: 07/22/2023] [Accepted: 11/30/2023] [Indexed: 03/18/2024]
Abstract
INTRO Substance use and associated problems often return following treatment for substance use disorder (SUD), which disproportionally impact Black/African American (AA) individuals. Social support and spiritual well-being are sources of recovery capital identified as particularly important among Black/AA adults. Social support and spiritual well-being are also posited mechanisms in 12-step; thus, this study tested the effects of social support and spiritual well-being on substance use outcomes over time, distinct from 12-step involvement, among Black/AA adults post-SUD treatment. The study hypothesized that social support and spiritual well-being would demonstrate significant interactions with time, respectively, on substance use frequency and substance use consequences, above the effect of 12-step involvement. METHOD The study drew data from a study of 262 adults (95.4 % Black/AA) entering residential SUD treatment (NCT#01189552). Assessments were completed at pretreatment and at 3-, 6-, and 12-months posttreatment. Two generalized linear mixed models (GLMM) tested the effects of social support and spiritual well-being, above the effect of 12-step involvement, on substance use frequency and substance use consequences over the course of 12-months posttreatment. RESULTS Higher spiritual well-being predicted significantly less frequent substance use during recovery (β = 0.00, p = .03). Greater 12-step involvement predicted significantly fewer substance use consequences during recovery (β = 0.00, p = .02). In post hoc analyses the effect of spiritual well-being and 12-step involvement dissipated by 3.5- and 6.6-months posttreatment, respectively. The study found no significant effects of social support over time. DISCUSSION Spiritual well-being and 12-step involvement are associated with lower substance use and substance use consequences, respectively, in the early months of posttreatment recovery among Black/AA adults. These findings contribute to the growing recovery capital literature informing paths to recovery and sources of support outside of 12-step affiliation. However, these effects diminish over time.
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Affiliation(s)
- Louisa Kane
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America.
| | - Katherine Benson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| | - Zachary J Stewart
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
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Schweitzer EM, Urmanche A, Kong J, Hafezi S, Zhao J, Cooperman NA, Konova AB. The role of social connection in opioid use disorder treatment engagement. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:222-230. [PMID: 37384450 PMCID: PMC10755080 DOI: 10.1037/adb0000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Medications for opioid use disorder (OUD or MOUD) treatment combining pharmacotherapy with psychosocial support are effective for managing OUD. However, treatment engagement remains a challenge, with retention rates ∼30%-50%. Although social connection has been identified as important to recovery, it remains unclear whether and how social factors can bolster participation in treatment. METHOD Individuals receiving MOUD at three outpatient treatment programs (N = 82) and healthy community controls (N = 62) completed validated measures assessing social connection including (a) size, diversity, and embeddedness of social networks; (b) perceived social support and criticism within familial relationships; and (c) subjective social status. For those receiving MOUD, we also examined how aspects of social connection related to opioid (re)use and treatment engagement (medication adherence, group, and individual meeting attendance) assessed over ∼8 weeks/person. RESULTS Compared to controls, individuals receiving MOUD had smaller and less diverse and embedded social networks (Cohen's d > 0.4), and despite similar levels of perceived social support (d = 0.02), reported higher levels of social criticism (d = 0.6) and lower subjective social status (d = 0.5). Within the MOUD group, higher social network indices correlated specifically with higher therapeutic group attendance (Rs > 0.30), but not medication adherence, while higher levels of perceived criticism correlated with more frequent opioid use (R = 0.23). Results were mostly robust to control for sociodemographic variables, psychological distress/COVID-19, and treatment duration, but differed by MOUD type/program. CONCLUSIONS These findings highlight the potential importance of assessing an individual's social capital, promoting positive social connection, and continuing to assess the implementation and value of psychosocial support in MOUD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Adelya Urmanche
- University Behavioral Health Care & Brain Health Institute, Rutgers University-New Brunswick
| | - Julia Kong
- Department of Psychiatry, Rutgers University-New Brunswick
| | - Sahar Hafezi
- Department of Psychiatry, Rutgers University-New Brunswick
| | - Joshua Zhao
- Department of Psychiatry, Rutgers University-New Brunswick
| | | | - Anna B Konova
- Graduate Program in Neuroscience, Rutgers University-New Brunswick
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Ruan S, Wang X, Zhao C, Li Q, Li WM, Zhang G, Pan J, Yang X. Psychosocial Correlates of Motivation for Abstinence Among People Who Used Drugs After Community Rehabilitation Treatment in China: A Structural Equation Modelling. Psychol Res Behav Manag 2024; 17:39-50. [PMID: 38192274 PMCID: PMC10773245 DOI: 10.2147/prbm.s440876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
Background Enhancing abstinence motivation of drugs is an effective strategy for the rehabilitation of people who used drugs and prevention of drug use relapse. However, little is known about its risk and protective factors. This study aimed to examine the potential intrapersonal (ie, impulsivity, depression, anxiety, sleep quality) and interpersonal factors (ie, perceived social support) of abstinence motivation among people who completed the community rehabilitation treatment. Methods A total of 222 participants (mean age = 43; male = 89.2%) were recruited from eleven communities located in Wenzhou, China. Data were collected using a self-reported questionnaire in counselling room settings between April and June 2021. Results The proportions of participants with depression, anxiety, and poor sleep quality were 38.8%, 19.5%, and 21.2%, respectively. Age and family history of physical disease were significant background factors of abstinence motivation. Impulsivity, depressive symptoms, anxiety symptoms, and poor quality of sleep were negatively associated with abstinence motivation. Perceived social support from family and important others was positively associated with abstinence motivation. Structural equation modeling fitted the data well in which impulsivity and perceived social support were both associated with abstinence motivation indirectly through mental health problems. Conclusion The identified psychosocial factors should be addressed in community rehabilitation treatment and follow-up service to enhance abstinence motivation and the long-term effectiveness of the treatment.
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Affiliation(s)
- Songli Ruan
- Mental Health Education and Guidance Center of College Students, Henan University of Urban Construction, Pingdingshan, People’s Republic of China
| | - Xin Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Chengjia Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Qian Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Wing Ming Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Guohua Zhang
- Department of Psychiatry, The Affiliated Kangning Hospital, Wenzhou, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, People’s Republic of China
| | - Jianshe Pan
- Department of Psychiatry, The Affiliated Kangning Hospital, Wenzhou, People’s Republic of China
| | - Xue Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
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Kleinman MB, Hines AC, Anvari MS, Bradley VD, Shields A, Dean D, Abidogun TM, Jack HE, Magidson JF. "You rise up and then you start pulling people up with you": Patient experiences with a peer-delivered behavioral activation intervention to support methadone treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104234. [PMID: 37866292 PMCID: PMC10872983 DOI: 10.1016/j.drugpo.2023.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Although medications for opioid use disorder (MOUD) are efficacious treatments for opioid use disorder, retention remains low. Peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, may be particularly well-suited to support patients receiving MOUD. While PRSs are rarely trained in evidence-based behavioral interventions other than motivational interviewing, preliminary evidence suggests that peers can deliver brief behavioral interventions, such as behavioral activation, with efficacy and fidelity. This qualitative study sought to explore patient perspectives on receiving an adapted PRS-delivered behavioral activation intervention (Peer Activate) to support patients receiving methadone treatment. METHODS The sample (N = 26) included patients recently starting or demonstrating challenges with adherence at a community-based methadone treatment program who received the Peer Activate intervention in a pilot trial. Participants were invited to participate in in-depth, semi-structured interviews at study completion or discontinuation, assessing perceived acceptability and feasibility of Peer Activate, and stigma-related barriers. Interview transcripts were coded using codebook/template thematic analysis. RESULTS Analysis revealed the importance of two areas to promote intervention acceptability: 1) connection with intervention content and skill building, and 2) valued PRS-specific qualities. Intervention flexibility was found to promote feasibility of the intervention in the context of chaotic and challenging life circumstances. Additionally, participants described stigma towards substance use and methadone treatment as potential barriers to engaging in methadone treatment. CONCLUSION Results support the acceptability and feasibility to patients of this PRS-delivered behavioral activation intervention in the context of outpatient MOUD treatment among a low-income, majority racially minoritized patient population. Future intervention adaptation and implementation should focus on incorporating content related to relationships and interpersonal skills; balancing behavioral intervention content with system navigation support; maintaining flexibility; and further investigation of the impact of individual PRS attributes, including shared lived experiences, on intervention acceptability and shifts in stigma.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Abigail C Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alia Shields
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Dwayne Dean
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
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Jack HE, Anvari MS, Abidogun TM, Ochieng YA, Ciya N, Ndamase S, Rose AL, Kleinman MB, Myers B, Magidson JF. Applying a mutual capacity building model to inform peer provider programs in South Africa and the United States: A combined qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104144. [PMID: 37567035 PMCID: PMC10758300 DOI: 10.1016/j.drugpo.2023.104144] [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: 08/22/2022] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Globally, there is a treatment gap for substance use treatment and harm reduction services. As peer-delivered interventions expand to address this gap in both high-income countries (HICs) and low and middle-income countries (LMICs), they provide an opportunity to examine mutual capacity building, the bidirectional exchange of ideas between distinct settings to address common challenges. METHODS The aim of this study was to explore the perspectives of patients in Cape Town and Baltimore about the acceptability and feasibility of a peer-delivered intervention using a combined qualitative analysis across a HIC and LMIC. Semi-structured qualitative interviews were conducted with participants in pilot trials in Cape Town, South Africa and Baltimore, USA (n=55). Across both trials, participants received a peer-delivered behavioral intervention focused on problem solving strategies for medication adherence, behavioral activation, and other cognitive-behavioral skills. The datasets from each location were merged and analyzed jointly using thematic analysis to develop codes and themes. Transcripts were coded to theoretical saturation (n=21 from Baltimore, n=16 from Cape Town). RESULTS Participants highlighted what they valued about the peer-delivered intervention: 1) behavioral skills learned, 2) relationship with the peer, 3) ability to help others based on what they learned, 4) improved adherence to HIV or substance use medications, and 5) changes in substance use behaviors. In Baltimore, participants were typically more focused on their supportive relationship with the peer, which contrasted with many other relationships in their lives. In Cape Town, many participants highlighted the value of the skills they learned, such as mindfulness and activity scheduling. CONCLUSIONS Across sites, participants valued that the peer could support them to accomplish meaningful life goals beyond substance use recovery, such as building relationships or health. Differences between settings may highlight the importance of tailoring peer interventions to fill context-specific gaps in available services.
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Affiliation(s)
- Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Yvonne A Ochieng
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Nonceba Ciya
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Sibabalwe Ndamase
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland College Park, USA
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Pavlacic JM, Witcraft SM, Allan NP, Gros DF. Anxiety sensitivity and social support in veterans with emotional disorders. J Clin Psychol 2023; 79:2337-2350. [PMID: 37310172 PMCID: PMC10527913 DOI: 10.1002/jclp.23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE An understanding of the incremental value of social support in predicting psychopathology above transdiagnostic risk factors could speak to the benefit of leveraging social factors into existing, evidence-based interventions in veterans with emotional disorders. This cross-sectional study aimed to expand our understanding of associations between domains of anxiety sensitivity and facets of psychopathology in veterans with emotional disorders. We also determined whether social support predicted psychopathology above anxiety sensitivity domains and combat exposure and explored these relationships with a path model. METHODS One hundred and fifty-six treatment-seeking veterans with emotional disorders completed diagnostic interviews and assessments of demographics, social support, symptom measures (e.g., PTSD, depression, anxiety, and stress), and transdiagnostic risk factors (i.e., anxiety sensitivity). After data screening, 150 were included in regressions. RESULTS Using regression analyses with cross-sectional data, cognitive anxiety sensitivity concerns predicted PTSD and depression above combat exposure. Cognitive and physical concerns predicted anxiety, and cognitive and social concerns predicted stress. Above combat exposure and anxiety sensitivity, social support predicted PTSD and depression. CONCLUSION Focusing on social support in tandem with transdiagnostic mechanisms in clinical samples is critical. These findings inform transdiagnostic interventions and recommendations related to incorporation of assessment of transdiagnostic factors in clinical contexts.
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Affiliation(s)
- Jeffrey M. Pavlacic
- Mental Health Service, Ralph H. Johnson, VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychology & Behavioral, Sciences, Medical University of South, Carolina, Charleston, South Carolina, USA
| | - Sara M. Witcraft
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P. Allan
- Department of Psychiatry and Behavioral, Health, Ohio State University, Columbus, Ohio, USA
- VA Center of Excellence for Suicide, Prevention, VA Finger Lakes Healthcare, System, Canandaigua, New York, USA
| | - Daniel F. Gros
- Mental Health Service, Ralph H. Johnson, VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychology & Behavioral, Sciences, Medical University of South, Carolina, Charleston, South Carolina, USA
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Slocum S, Paquette CE, Pollini RA. Drug treatment perspectives and experiences among family and friends of people who use illicit opioids: A mixed methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209023. [PMID: 36940779 DOI: 10.1016/j.josat.2023.209023] [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: 07/15/2022] [Revised: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION Increasing evidence-based treatment for opioid use disorder (OUD) is key to reducing opioid-related morbidity and mortality. Family and close friends of people with OUD can play an important role in motivating and facilitating their loved ones' treatment. We examined evolving knowledge about OUD and its treatment among family and close friends of people who use illicit opioids and their experiences navigating the treatment system. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids in the past 30 days, and had a close relationship with someone who currently uses illicit opioids. Recruitment leveraged a nonprofit support network for family members of persons with a substance use disorder (SUD). We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22, April-July 2018) informed the development of a quantitative survey (N = 260, February-July 2020). Attitudes and experiences related to OUD treatment constituted an emergent theme in qualitative interviews, which informed a section of the subsequent survey. RESULTS Both qualitative and quantitative data indicated support groups were instrumental in increasing OUD knowledge and influencing attitudes toward treatment options. Regarding how best to motivate drug treatment engagement, some participants favored what they referred to as a "tough love" approach that typically included a preference for abstinence-based treatment, while others favored a positive reinforcement approach focused on enhancing treatment motivation. Loved ones' treatment preferences and scientific evidence played a minor role in determining preferred treatment modalities, and only 38 % of survey participants believed that using medications for OUD is more effective than treatment without medications. A majority (57 %) agreed that finding a drug treatment slot or bed was either somewhat or very difficult, and that once in the system treatment was costly and involved multiple returns to treatment after relapse. CONCLUSIONS Support groups appear to be important forums for gaining knowledge about OUD, negotiating strategies to motivate their loved ones' entry into treatment, and forming preferences for treatment modalities. Participants emphasized the influence of other group members more so than their loved ones' preferences or empirical evidence of effectiveness with regard to choosing treatment programs and approaches.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States of America; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States of America.
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Paired Housing or a Socially-Paired Context Decreases Ethanol Conditioned Place Preference in Male Rats. Brain Sci 2022; 12:brainsci12111485. [DOI: 10.3390/brainsci12111485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Alcohol abuse dramatically affects individuals’ lives nationwide. The 2020 National Survey on Drug Use and Health (NSDUH) estimated that 10.2% of Americans suffer from alcohol use disorder. Although social support has been shown to aid in general addiction prevention and rehabilitation, the benefits of social support are not entirely understood. The present study sought to compare the benefits of social interaction on the conditioned ethanol approach behavior in rats through a conditioned place preference (CPP) paradigm in which a drug is paired with one of two distinct contexts. In experiment 1A, rats were single-housed and received conditioning trials in which ethanol was paired with the less preferred context. In experiment 1B, rats underwent procedures identical to experiment 1A, but were pair-housed throughout the paradigm. In experiment 1C, rats were single-housed, but concurrently conditioned to a socially-paired context and an ethanol-paired context. By comparing the time spent between the ethanol-paired environment and the saline-paired or socially-paired environment, we extrapolated the extent of ethanol approach behavior in the pair-housed, single-housed, and concurrently conditioned rats. Our results revealed that social interaction, both in pair-housed animals or concurrently socially-conditioned animals, diminished the ethanol approach behavior, which highlights the importance of social support in addiction prevention, treatment, and recovery programs.
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Tsai TY, Wang TY, Tseng HH, Chen KC, Chiu CJ, Chen PS, Yang YK. Correlation between loneliness, personality traits, and treatment outcomes in patients with methamphetamine use disorder. Sci Rep 2022; 12:8629. [PMID: 35606379 PMCID: PMC9126870 DOI: 10.1038/s41598-022-11901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/22/2022] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate whether loneliness and personality traits correlate with the treatment outcome of methamphetamine use disorder. In this 1-year longitudinal study, a total 106 participants (98 males, 8 females), with a mean age 36.3 ± 9.6 years were enrolled. We measured UCLA Loneliness Scale and Tridimensional Personality Questionnaire at baseline, while craving level at baseline, week 12, 24, 36, and 48. Urinary methamphetamine tests were given 17 times. For the evaluation of the data, multiple linear regression and generalized linear mixed models were used. The baseline results showed lower levels of the harm avoidance trait and higher levels of loneliness were significantly associated with higher craving levels (p=0.04 and 0.04). Moreover, loneliness was not only positively associated with craving levels (B=0.05, p<0.01) but with urinary methamphetamine positive results (B= 0.08, p=0.03) during one-year treatment. The findings suggested that loneliness was associated with poor methamphetamine treatment outcome (greater craving levels and higher proportion of positive methamphetamine urine tests) and lower harm avoidance traits are associated with higher craving levels.
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Simsek M, Yucebas S, Ogel K. Behavioral changes observed in substance users in Turkey during the COVID-19 pandemic. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2069609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Oles W, Alexander M, Kumar N, Howell B, O'Connor PG, Madden LM, Barry DT. Characterizing the social support and functioning of a low-threshold medication for opioid use disorder treatment cohort at intake. BMC Psychiatry 2022; 22:236. [PMID: 35366844 PMCID: PMC8976510 DOI: 10.1186/s12888-022-03884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite the growing morbidity and mortality rates associated with opioid use disorder, a large gap still exists between treatment need and capacity. Low-threshold clinics utilizing medication for opioid use disorder (MOUD) treatment can increase treatment access but are understudied, and little is known about how patient demographic characteristics are associated with their social support and functioning in these settings. METHODS We used multivariate regression to estimate associations between demographic characteristics and self-reported social support or functioning indicators among patients receiving MOUD in a low-threshold clinic using several validated instruments administered at intake: Behavior and Symptom Identification Scale, Brief Pain Inventory, and Life Events Checklist for DSM-5. Patients initiating MOUD treatment between April 1 and December 31, 2017, with complete surveys were included (N=582). RESULTS Patients were primarily male (62%), aged 34 or older (53%), non-Hispanic White (79%), separated or not married (86%), and unemployed (64%). Over 20% did not live in a house or apartment in the past month. Women were more likely to "get along" with people outside their family or in social situations and to identify their partner as their source of support. Women, non-White, and older patients were at higher risk of social functioning-disrupting events (physical/sexual assaults or experiencing chronic pain), while employment and housing were protective against exposure to these trauma-related events. However, employment and housing also decreased the odds of talking with others about substance use. The aforementioned results were obtained from multivariate logistic regression models and were significant to p<0.05. CONCLUSIONS Variation in support and functioning by demographic characteristics suggests that treatment facilities may benefit from adopting strategies that take baseline disparities in support and functioning into account.
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Affiliation(s)
- William Oles
- Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT, USA
| | - Marcus Alexander
- Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT, USA.
| | - Navin Kumar
- Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT, USA
- Department of Sociology, Yale University, New Haven, CT, USA
| | - Benjamin Howell
- Section of General Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
- VA Connecticut Healthcare System, New Haven, CT, USA
| | - Patrick G O'Connor
- Section of Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Lynn M Madden
- Section of Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Guan M, Han JY, Shah DV, Gustafson DH. Exploring the Role of Social Support in Promoting Patient Participation in Health Care among Women with Breast Cancer. HEALTH COMMUNICATION 2021; 36:1581-1589. [PMID: 32500731 PMCID: PMC7718291 DOI: 10.1080/10410236.2020.1773704] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Scholars have adopted Street's (2003) ecological model of communication in medical encounters to investigate the factors promoting patient participation in health care. However, factors demonstrated in the ecological model were bounded in the context of medical care primarily focusing on health care providers and patients. Social factors, such as patients' relationships and supportive communication with others outside the context of health care remain relatively unexplored. To expand the purview of our understanding of factors that influence patient participation, this research integrated social support literature into the research on physician-patient communication and proposed a model which described a process through which social support can enhance patient participation in health care. The data analyzed in this study were a part of two larger clinical trials in which 661 women with breast cancer were recruited from three cancer institutions in the United States. The results from structural equation modeling analysis from cross-sectional and longitudinal data provided strong evidence for the hypotheses predicting that perceived social support was positively associated with health information competence, which in turn fully mediated the association between social support and patient participation in health care. Theoretical and practical implications are discussed.
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Affiliation(s)
- Mengfei Guan
- Department of Communication, University of Arkansas
| | - Jeong Yeob Han
- Department of Advertising & Public Relations, University of Georgia
| | - Dhavan V Shah
- School of Journalism and Mass Communication and Center for Health Enhancement Systems Studies, University of Wisconsin-Madison
| | - David H Gustafson
- Department of Industrial and Systems Engineering and Center for Health Enhancement Systems Studies, University of Wisconsin-Madison
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Maina G, Marshall K, Sherstobitof J. Untangling the Complexities of Substance Use Initiation and Recovery: Client Reflections on Opioid Use Prevention and Recovery From a Social-Ecological Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211050372. [PMID: 34675526 PMCID: PMC8524687 DOI: 10.1177/11782218211050372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
Background: In Canada, the rate of opioid use, opioid use disorder (OUD), and associated
mortality and morbidity are higher among Indigenous Peoples than the general
population. Indigenous Peoples on medications for opioid use disorders
(MOUD) often face distinct barriers that hinder their clinical progress,
leading to treatment attrition. Methods: We used a social-ecological model to inquire into clients’ experiences with a
history of treatment failure for OUD. We used exploratory qualitative
research to engage 22 clients with a history of OUD treatment dropouts and
who are currently on MOUD. In-depth, semi-structured interviews lasting an
average of 30 minutes were conducted on-site. Results: We identified 4 themes from the study: (a) risk for substance use; (b)
factors sustaining substance use; (c) factors leading to treatment, and (d)
treatment failure and re-enrollment. Conclusion: Using a socio-ecological model helps to understand factors that influence an
individual’s risk for OUD, decision to pursue treatment, and treatment
outcomes. Furthermore, social ecological model also creates possibilities to
develop supportive, multilevel interventions to prevent OUD risks and
support for clients on MOUD. Such interventions include mitigating adverse
childhood experiences, supporting families, and creating safe community
environments.
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Shen NT, Kaplan A, Fahoum K, Basu E, Shenoy A, Wahid N, Ivatorov A, Pisa J, Salajegheh A, Dawod E, Rosenblatt R, Fortune B, Safford M, Brown RS. Identification of Quantifiable Predictors of Relapse in Patients with Alcohol-Associated Liver Disease. Hepatol Commun 2021; 5:1156-1164. [PMID: 34278166 PMCID: PMC8279469 DOI: 10.1002/hep4.1704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 12/24/2022] Open
Abstract
Abstinence in patients with alcohol-associated liver disease (ALD) reduces mortality. Most predictors of relapse are not quantifiable, preventing objective analysis of relapse risk and targeted intervention to improve clinical outcomes. We prospectively enrolled patients with ALD from November 2016 to December 2019 and administered a survey with two previously published scales to assess insight into alcohol-use disorder (Hanil Alcohol Insight Scale [HAIS]) and social support (Community Assessment Inventory Scale [CAIS]). Relapse was assessed using surveys and metabolite testing. Unadjusted and prespecified adjusted regression analyses identified predictors of relapse. We enrolled 81% of eligible patients (n = 136), of whom 58 had follow-up data available at the time of analysis. Over a median follow-up of 1 year (interquartile range: 0.5-1.4), 10 patients relapsed (17%). Patients who relapsed were more likely to continue drinking despite either a diagnosis of liver disease or a decompensating event, and were less likely to have been transplanted (all P < 0.05). In unadjusted regression, the HAIS and the "support inside the home" subcategory of the CAIS were predictive of relapse, with odds ratio (OR) = 0.84 (95% confidence interval 0.72-0.97) and 0.85 (0.74-0.97). In adjusted regression, the HAIS was no longer significant, with adjusted OR = 0.70 (0.49-1.00, P = 0.05), whereas the "support inside the home' subcategory of CAIS remained significant, with adjusted OR = 0.69 (0.51-0.92, P = 0.01). Conclusions: Risk factors for relapse in patients with ALD were identified and quantified prospectively, suggesting opportunities to objectively identify patients at risk for relapse as well as to intervene to prevent relapse.
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Affiliation(s)
- Nicole T. Shen
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Alyson Kaplan
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Khalid Fahoum
- Department of MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Elora Basu
- Department of MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Akhil Shenoy
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Nabeel Wahid
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Amanda Ivatorov
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Joseph Pisa
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | | | - Enad Dawod
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Russell Rosenblatt
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Brett Fortune
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
| | - Monika Safford
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Robert S. Brown
- Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNYUSA
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Ndimbii J, Guise A, Igonya EK, Owiti F, Strathdee S, Rhodes T. Qualitative Analysis of Community Support to Methadone Access in Kenya. Subst Use Misuse 2021; 56:1312-1319. [PMID: 34027819 PMCID: PMC10708729 DOI: 10.1080/10826084.2021.1922450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methadone, as part of Medically Assisted Therapy (MAT) for treatment of opioid dependence and supporting HIV prevention and treatment, has been recently introduced in Kenya. Few low income settings have implemented methadone, so there is little evidence to guide ongoing scale-up across the region. We specifically consider the role of community level access barriers and support. OBJECTIVES To inform ongoing MAT implementation we implemented a qualitative study to understand access barriers and enablers at a community level. METHODS We conducted 30 semi-structured interviews with people who use drugs accessing MAT, supplemented by interviews with 2 stakeholders, linked to participant observation in a community drop in center within one urban area in Kenya. We used thematic analysis. RESULTS We developed five themes to express experiences of factors enabling and disabling MAT access and how community support can address these: 1) time, travel and economic hardship; 2) managing methadone and contingencies of life, 3) peer support among MAT clients as treatment ambassadors, 4) family relations, and 5)outreach project contributions. Crosscutting themes address managing socioeconomic constraints and gender inequities. CONCLUSIONS People who use drugs experience and manage socio-economic constraints and gender inequities in accessing MAT with the support of local communities. We discuss how these access barriers could be addressed through strengthening the participation of networks of people who use drugs in drug treatment and supporting community projects working with people who use drugs. We also explore potential for how socio-economic constraints could be managed within an integrated health and social care response.
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Affiliation(s)
| | - Andy Guise
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Emmy Kageha Igonya
- School of Medicine, University of Nairobi, Nairobi, Kenya
- Kenya & African Population and Health Research Center, Nairobi, Kenya
| | - Frederick Owiti
- School of Medicine, University of Nairobi, Nairobi, Kenya
- Kenya & African Population and Health Research Center, Nairobi, Kenya
| | - Steffanie Strathdee
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
- University of New South Wales, Syndey, Australia
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Pernice FM, Price MH, Rice K. Why We Come: Clubhouse Members Seek Connection, Purpose and Meaning. Community Ment Health J 2021; 57:446-456. [PMID: 32671506 DOI: 10.1007/s10597-020-00685-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
Approximately 4.5% of U.S. adults live with a serious mental illness (SMI) (Substance Abuse and Mental Health Services Administration, 2018). Creating a place for people seeking structure, connection, and purpose following psychiatric hospitalization or for mental health recovery is difficult given several factors associated with illness trajectories, lack of community-based support programs, and reliance on traditional models of care. Using semi-structured interviews, the current study examined the reasons people attend community programs referred to as psychosocial "clubhouses." Interviews with 140 people across 10 clubhouse programs in one state were conducted. Qualitative analyses revealed that social connections and the need to reduce social isolation were driving forces for attending. Further, individuals noted that the "structure" of engaging in meaningful activities and roles was a main reason for participating. Authors discuss the continued need for community models that provide a "place" for all people to successfully engage and recover from psychiatric illnesses.
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Affiliation(s)
| | - Megan H Price
- Wayne State University, 333 College of Education, Detroit, MI, 48202, USA
| | - Kevin Rice
- Fountain House New York, 425 West 47th Street, New York, NY, 10036, USA
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Benville JR, Compton P, Giordano NA, Cheatle MD. Perceived social support in patients with chronic pain with and without opioid use disorder and role of medication for opioid use disorder. Drug Alcohol Depend 2021; 221:108619. [PMID: 33667781 PMCID: PMC8796693 DOI: 10.1016/j.drugalcdep.2021.108619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND A significant predictor of treatment outcomes for patients with chronic non-cancer pain (CNCP) and opioid use disorder (OUD) is the degree and quality of social support they receive. Specifically, in patients with CNCP and on long-term opioid therapy, the development of OUD tends to be associated with losses in social support, while engagement in treatment for OUD improves support networks. Delivery of the evidence-based OUD treatment medications, methadone and buprenorphine, occurs in clinical environments which patently differ with respect to social support resources. The aims of this study were to describe perceived social support in patients with CNCP without OUD (no-OUD), with OUD and on buprenorphine (OUD-BP), and with OUD and on methadone (OUD-methadone). METHODS Using the Duke Social Support Index (DSSI), perceived social support in a sample of Caucasian patients with CNCP and on opioid therapy was compared between no-OUDs (n = 834), OUD-methadone (n = 83) and OUD-BP (n = 99) therapy. Average DSSI scores were compared across groups and a linear regression model computed to describe association between group and perceived social support. RESULTS No difference was observed in DSSI scores between no-OUDs and OUD-methadone, however scores were lower among OUD-BP participants than those receiving methadone (x = -5.2; 95% CI: -7.5, -2.9) and (x = -6.5, 95% CI: -8.2, -4.9). CONCLUSIONS Patients with CNCP and OUD on methadone therapy endorse levels of social support comparable to those without OUD, however those on buprenorphine therapy report significantly less support, bringing implications for OUD treatment outcomes.
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Affiliation(s)
- Julia R Benville
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 500, Philadelphia, PA, 19104, United States; Department of Psychiatry, NYU School of Medicine, Bellevue Hospital, 462 First Avenue, Room A842, New York, NY 10016, United States.
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Claire Fagin Hall, Room 402, Philadelphia, PA, 19104, United States.
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, United States.
| | - Martin D Cheatle
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 500, Philadelphia, PA, 19104, United States.
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Novak P, Bloodworth R, Green K, Chen J. Local Health Department Activities to Reduce Emergency Department Visits for Substance Use Disorders. J Healthc Qual 2020; 41:134-145. [PMID: 31094946 PMCID: PMC6527127 DOI: 10.1097/jhq.0000000000000161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions.
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Affiliation(s)
- Priscilla Novak
- Department of Health Services Administration , School of Public Health, University of Maryland, College Park, MD, Also Agency for Healthcare Research and Quality (employee), , Cell: (571) 201-5165
| | - Robin Bloodworth
- Department of Health Services Administration , School of Public Health, University of Maryland College Park, MD Also Patient Centered Outcomes Research Institute (employee)
| | - Kerry Green
- Department of Behavioral and Community Health , School of Public Health, University of Maryland, College Park, MD
| | - Jie Chen
- Department of Health Services Administration , School of Public Health, University of Maryland, College Park, MD
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Patel P, Kaiser BN, Meade CS, Giusto A, Ayuku D, Puffer E. Problematic alcohol use among fathers in Kenya: Poverty, people, and practices as barriers and facilitators to help acceptance. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 75:102576. [PMID: 31743859 PMCID: PMC7050447 DOI: 10.1016/j.drugpo.2019.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/06/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Kenya, the prevalence of alcohol use disorder (AUD) is close to 6%, but a notable treatment gap persists. AUD is especially pronounced among men, leading to negative consequences at both individual and family levels. This study examines the experiences of problem-drinking fathers in Kenya regarding previous treatment-seeking related to alcohol use. Experiences and dynamics of the family are also explored as they pertain to treatment-seeking experiences. METHODS In Eldoret, Kenya, semi-structured qualitative interviews were conducted with 11 families with a male exhibiting problem drinking, his spouse, and one child. Thematic content analysis was used to examine themes related to barriers and facilitators to treatment. RESULTS Participants only reported informal help received from family and community members; they exhibited little awareness of available formal treatments. Families were both deeply affected by alcohol use and actively involved in help-seeking. Indeed, fathers' experiences are described as help-accepting rather than help-seeking. Three overarching themes emerged from the results: poverty, people, and practices. Poverty could be a motivator to accept help to support one's family financially, but stress from lack of work also drove drinking behaviours. People were also crucial as both barriers and facilitators of help-accepting. Negative help strategies or peer influence deterred fathers from accepting help to quit. Positive motivation, social support, and stigma against drinking were motivators. Practices that were culturally salient, such as religiosity and gender roles, facilitated help acceptance. Overall, most help efforts were short-term and only lead to very short-term behaviour change. CONCLUSION Families and communities are active in help provision for problem-drinking men in Kenya, though results confirm remaining need for effective interventions. Future interventions could benefit from recognizing the role of family to aid in treatment-engagement and attending to the importance of poverty, people, and practices in designing treatment strategies.
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Affiliation(s)
- Puja Patel
- Duke Global Health Institute, Duke University, Durham, NC, USA; Psychology, University of North Carolina Greensboro, Greensboro, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Duke University, Durham, NC, USA; Anthropology, University of California San Diego, La Jolla, CA, USA
| | - Christina S Meade
- Duke Global Health Institute, Duke University, Durham, NC, USA; Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Ali Giusto
- Duke Global Health Institute, Duke University, Durham, NC, USA; Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - David Ayuku
- Behavioral Sciences, Moi University, Eldoret, Kenya
| | - Eve Puffer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Psychology and Neuroscience, Duke University, Durham, NC, USA
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Shiraly R, Taghva M. Factors Associated with Sustained Remission among Chronic Opioid Users. ADDICTION & HEALTH 2019; 10:86-94. [PMID: 31069032 PMCID: PMC6494988 DOI: 10.22122/ahj.v10i2.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Chronic opioid use is a major public health problem with significant morbidity. The aim of this study was to investigate factors associated with sustained remission among a sample of Iranian chronic opioid users in Shiraz, Iran. Methods This was a cross-sectional study to evaluate sustained remission among chronic opiate users aged 20-60 years. Participants included two groups: 365 people who have been in sustained remission for the past year, and 187 persons who did not achieve remission for the past one year. Then, demographic and factors related to drug use pattern and previous treatments were compared between two groups. Pearson chi-square test was used for univariate analysis and backward stepwise logistic regression was used to estimate adjusted odds ratios (AORs). Findings Our findings showed that sustained remission was associated with Narcotic Anonymous (NA) participation [AOR = 3.28, 95% confidence interval (CI): 2.19-4.89, P < 0.001], male gender (AOR = 2.53, 95% CI: 1.45-4.43, P = 0.001), younger age of onset (AOR = 1.63, 95% CI: 1.03-2.58, P = 0.037), higher total years of opioid use (AOR = 2.13, 95% CI: 1.42-3.19, P < 0.001), no history of imprisonment (AOR = 2.11, 95% CI: 1.16-3.85, P = 0.015), and family support (AOR = 2.58, 95% CI: 1.33-5.01, P = 0.005). Conclusion Participation in self-help groups can be a suitable alternative in predicting sustained remission among chronic opiate users. Chronic opioid users should be encouraged by the physicians who are involved in the treatment of drug addiction to participate in NA programs.
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Affiliation(s)
- Ramin Shiraly
- Assistant Professor, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Taghva
- Resident, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Khuong LQ, Vu TVT, Huynh VAN, Thai TT. Psychometric properties of the medical outcomes study: social support survey among methadone maintenance patients in Ho Chi Minh City, Vietnam: a validation study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:8. [PMID: 29444687 PMCID: PMC5813430 DOI: 10.1186/s13011-018-0147-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/11/2018] [Indexed: 01/28/2023]
Abstract
Background Social support plays a crucial role in the treatment and recovery process of patients engaging in methadone maintenance treatment (MMT). However, there is a paucity of research about social support among MMT patients, possibly due to a lack of appropriate measuring tools. This study aimed to evaluate the psychometric properties of the Vietnamese version of the Medical Outcomes Study: Social Support Survey (MOS-SSS) among MMT patients. Methods A cross-sectional survey of 300 patients was conducted in a methadone clinic in Ho Chi Minh City, Vietnam. MMT patients who agreed to participate in the study completed a face-to-face interview in a private room. The MOS-SSS was translated into Vietnamese using standard forward-backward process. Internal consistency was measured by Cronbach’s alpha. The intra-class correlation coefficient was used to determine the test-retest reliability of the MOS-SSS in 75 participants two weeks after the first survey. Concurrent validity of the MOS-SSS was evaluated by correlations with the Multidimensional Scale of Perceived Social Support (MSPSS) and the Perceived Stigma of Addiction Scale (PSAS). Construct validity was investigated by confirmatory factor analysis. Results The MOS-SSS had good internal consistency with Cronbach’s alpha from 0.95 to 0.97 for the four subscales and 0.97 for the overall scale. The two-week test-retest reliability was at moderate level with intra-class correlation coefficients of 0.61–0.73 for the four subscales and 0.76 for the overall scale. Strong significant correlations between the MOS-SSS and the MSPSS (r = 0.77; p < 0.001) and the PSAS (r = − 0.76; p < 0.001) indicated good concurrent validity. Construct validity of the MOS-SSS was established since a final four-factor model fitted the data well with Comparative Fit Index (0.97), Tucker-Lewis Index (0.97), Standardized Root Mean Square Residual (0.03) and Root Mean Square Error of Approximation (0.068; 90% CI = 0.059–0.077). Conclusions The MOS-SSS is a reliable and valid tool for measuring social support in Vietnamese MMT patients. Further studies among methadone patients at different stages of their treatment and among those from different areas of Vietnam are needed. Electronic supplementary material The online version of this article (10.1186/s13011-018-0147-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Long Quynh Khuong
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam
| | - Tuong-Vi Thi Vu
- South Vietnam HIV- Addiction Technology Transfer Center, Ho Chi Minh City University of Medicine and Pharmacy, 15th Floor, Central Building, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Van-Anh Ngoc Huynh
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam
| | - Truc Thanh Thai
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam. .,Training and Scientific Research, University Medical Center, 215 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.
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Maher DP, Cohen SP. Opioid Reduction Following Interventional Procedures for Chronic Pain: A Synthesis of the Evidence. Anesth Analg 2017; 125:1658-1666. [PMID: 28719427 DOI: 10.1213/ane.0000000000002276] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The past decade has witnessed the tremendous growth of procedures to treat chronic pain, which has resulted in increased third-party scrutiny. Although most of these procedures appear to be associated with significant pain relief, at least in the short and intermediate term, their ability to improve secondary outcome measures, including function and work status is less clear-cut. One of these secondary outcome measures that has garnered substantial interest in the pain and general medical communities is whether interventions can reduce opioid intake, which is associated with significant risks that in most cases outweigh the benefits in the long term. In the article, we examine whether procedural interventions for chronic pain can reduce opioid intake. Most studies that have examined analgesic reduction as a secondary outcome measure have not separated opioid and nonopioid analgesics, and, among those studies that have, few have demonstrated between-group differences. Reasons for failure to demonstrate opioid reduction can be broadly classified into procedural, design-related, clinical, psychosocial, biological, and pharmacological categories, all of which are discussed. In the future, clinical trials in which this outcome is examined should be designed to evaluate this, at least on a preliminary basis.
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Affiliation(s)
- Dermot P Maher
- From the *Department of Anesthesiology & Critical Care Medicine and †Departments of Anesthesiology & Critical Care Medicine, Neurology, and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Bethesda, Maryland; and ‡Departments of Anesthesiology and Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Cooper S, Campbell G, Larance B, Murnion B, Nielsen S. Perceived stigma and social support in treatment for pharmaceutical opioid dependence. Drug Alcohol Rev 2017; 37:262-272. [DOI: 10.1111/dar.12601] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/29/2017] [Accepted: 07/31/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Sasha Cooper
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Bridin Murnion
- Drug Health Services, Royal Prince Alfred Hospital; Sydney Local Health District; Sydney Australia
- Faculty of Medicine; University of Sydney; Sydney Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
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Woo J, Bhalerao A, Bawor M, Bhatt M, Dennis B, Mouravska N, Zielinski L, Samaan Z. "Don't Judge a Book Its Cover": A Qualitative Study of Methadone Patients' Experiences of Stigma. Subst Abuse 2017; 11:1178221816685087. [PMID: 28469424 PMCID: PMC5398333 DOI: 10.1177/1178221816685087] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT. METHODS Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes. RESULTS In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies. DISCUSSION AND CONCLUSION Stigma is a widespread and serious issue that adversely affects MMT patients' quality of life and treatment. More efforts are needed to combat MMT-related stigma.
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Affiliation(s)
- Julia Woo
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anuja Bhalerao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Brittany Dennis
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Natalia Mouravska
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Zielinski
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
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Cooper S, Nielsen S. Stigma and Social Support in Pharmaceutical Opioid Treatment Populations: a Scoping Review. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9719-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Souza JD, Villar Luis MA, Ventura CA, Barbosa SP, Santos CBD. Perception of social support: a comparative study between men with and without substance-related disorders. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.966343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | - Cláudia Benedita dos Santos
- Department of Maternal Infant Nursing and Public Health, Ribeirão Preto College of Nursing/WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Aguilar-Gaxiola S, Ahmed S, Franco Z, Kissack A, Gabriel D, Hurd T, Ziegahn L, Bates NJ, Calhoun K, Carter-Edwards L, Corbie-Smith G, Eder MM, Ferrans C, Hacker K, Rumala BB, Strelnick AH, Wallerstein N. Towards a unified taxonomy of health indicators: academic health centers and communities working together to improve population health. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:564-72. [PMID: 24556775 PMCID: PMC4124598 DOI: 10.1097/acm.0000000000000198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public's health and reducing health disparities, the CTSA Consortium's Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators.The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy's application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health.
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Affiliation(s)
- Sergio Aguilar-Gaxiola
- Dr. Aguilar-Gaxiola is professor of clinical internal medicine; director, Center for Reducing Health Disparities; director, Community Engagement Program, Clinical and Translational Science Center; and codirector, Latino Aging Research and Resource Center, University of California, Davis School of Medicine, Sacramento, California. Dr. Ahmed is senior associate dean for community engagement; director, Community Engagement Key Function, Clinical and Translational Science Institute of Southeast Wisconsin; professor, Department of Family and Community Medicine; professor, Institute for Health and Society; and director, Healthier Wisconsin Partnership Program, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Franco is assistant professor, Community Engagement Key Function, Clinical and Translational Science Institute of Southeast Wisconsin, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Ms. Kissack is program manager, Community Engagement Key Function, Clinical and Translational Science Institute of Southeast Wisconsin, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Ms. Gabriel is data integration and interoperability manager, Biomedical Informatics, Clinical and Translational Science Center, University of California, Davis School of Medicine, Sacramento, California. Dr. Hurd is associate professor of surgery, Division of Surgical Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Dr. Ziegahn is community engagement and research program manager, Clinical and Translational Science Center, University of California Davis School of Medicine, Sacramento, California. Dr. Bates is senior evaluation specialist, Evaluation and Tracking Program, Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois. Ms. Calhoun is clinical research associate and cofacilitator, Community Engagement Program, Michi
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Kaiser S. Psychiatric and addiction consultation for patients in critical care. Crit Care Nurs Clin North Am 2012; 24:9-26. [PMID: 22405709 DOI: 10.1016/j.ccell.2011.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Practicing within the paradigm of compartmentalized specially treatment without a collaborative practice is ineffective for the chemical dependency and dual diagnosis population. Chemical dependency is not well understood as a disease, evidenced by barriers cited from the 2005 Survey on Drug Use and Health. Recovery from addiction and dual diagnosis logically demands an integrated and science-based treatment approach with unified standards for care and improved educational standards for preparation of care providers. Consultation and collaboration with addiction and psychiatric specialists is needed to establish consistency in standards for treatment and holistic care, essential for comorbidity. Continued learning and research about the complexity of the addiction process and comorbidity will provide continued accurate information about the harmful effects of alcoholism and drug abuse which in turn will empower individuals to make informed choices and result in better treatment and social policies.
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Schwartz RP, Kelly SM, O'Grady KE, Mitchell SG, Brown BS. Antecedents and correlates of methadone treatment entry: a comparison of out-of-treatment and in-treatment cohorts. Drug Alcohol Depend 2011; 115:23-9. [PMID: 21126830 PMCID: PMC3059350 DOI: 10.1016/j.drugalcdep.2010.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/09/2010] [Accepted: 10/01/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The majority of opioid-dependent individuals in the US in need of drug treatment are not receiving it. It would be useful to understand the characteristics of individuals entering and failing to enter methadone treatment. METHODS Participants were opioid-dependent adults in Baltimore Maryland recruited from new admissions to one of six methadone treatment programs (n=351) and from the streets from among non-treatment seekers (n=164). At study enrollment, participants were administered the Addiction Severity Index, AIDS Risk Assessment, Community Assessment Inventory, Attitudes toward Methadone Scale, Motivation for Treatment Scale and a urine drug test. A series of logistic regression analyses were conducted to determine the best model to predict treatment entry. RESULTS The final logistic regression analysis showed that predictors of treatment entry included: being African-American, being on parole or probation, having lower rates of self-reported cocaine use and criminal activity, higher employment functioning, and greater perceptions of support from family and community for behavioral change. In addition, in-treatment participants were more likely to have a more extensive prior history of drug abuse treatment, greater desire to seek help in coping with their drug problem, and more positive view of methadone. CONCLUSIONS The distinctions between those entering and those not pursuing MTP entry have significance for the structure of outreach programs and reaffirm the need to supplement the current practices of voluntary and coerced treatment entry with one of encouraged treatment entry through outreach.
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Affiliation(s)
- Robert P Schwartz
- Friends Research Institute, Inc. 1040 Park Avenue, Suite 103, Baltimore, MD 21201 USA.
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