Global burden of disease from alcohol, illicit drugs and tobacco

Workforce Perspectives of Sustaining the Utilisation of a Harm Reduction Instrument in a Mental Health Residential Setting

PURPOSE

This exploratory study investigated worker experiences of utilising the Before During After (BDA) harm reduction instrument to engage well with service users in a residential mental health service setting. Stakeholder interviews were conducted with a purposive sample of two senior nurses and one senior allied health staff at the study site to explore the impacts of BDA implementation on their work after 3 years of its use. A thematic analysis was conducted, including two-level coding. Five major themes were discussed. Of particular interest, and the focus of this paper, are the themes of effect on service users and effect on staff. The study found improved engagement between staff and service users, reduced stigma and more holistic care that was collaborative. In regard to staff, it was found that staff knowledge and confidence increased in addressing harm reduction issues with consumers and this was sustained over 3 years. Use of the BDA clinical instrument and package was reported to enhance worker engagement, knowledge and confidence in dual diagnosis work with service users.

Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa

The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.

Community-based alcohol education intervention (THEATRE) study to reduce harmful effects of alcohol in rural Sri Lanka: design and adaptation of a mixed-methods stepped wedge cluster randomised control trial

INTRODUCTION

Alcohol consumption is a leading cause of mortality, morbidity and adverse social sequelae in Sri Lanka. Effective community-based, culturally adapted or context-specific interventions are required to minimise these harms. We designed a mixed-methods stepped wedge cluster randomised control trial of a complex alcohol intervention. This paper describes the initial trial protocol and subsequent modifications following COVID-19.

METHODS AND ANALYSIS

We aimed to recruit 20 villages (approximately n=4000) in rural Sri Lanka. The proposed intervention consisted of health screening clinics, alcohol brief intervention, participatory drama, film, and public health promotion materials to be delivered over 12 weeks.Following disruptions to the trial resulting from the Easter bombings in 2019, COVID-19 and a national financial crisis, we adapted the study in two main ways. First, the interventions were reconfigured for hybrid delivery. Second, a rolling pre-post study evaluating changes in alcohol use, mental health, social capital and financial stress as the primary outcome and implementation and ex-ante economic analysis as secondary outcomes.

ETHICS AND DISSEMINATION

The original study and amendments have been reviewed and granted ethical approval by Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and February 2022) and the University of Sydney (2019/006). Findings will be disseminated locally in collaboration with the community and stakeholders.The new hybrid approach may be more adaptable, scalable and generalisable than the planned intervention. The changes will allow a closer assessment of individual interventions while enabling the evaluation of this discontinuous event through a naturalistic trial design. This may assist other researchers facing similar disruptions to community-based studies.

TRIAL REGISTRATION

The trial is registered with the Sri Lanka Clinical Trials Registry; https://slctr.lk/trials/slctr-2018-037.

Supervisor Undermining, Social Isolation and Subordinates' Problematic Drinking: The Role of Depression and Perceived Drinking Norms

Findings regarding the mechanism underlying the impact of supervisor incivility on subordinate alcohol misuse remain equivocal. Specifically, some studies indicate that stress mediates the impact of supervisor incivility on subordinate alcohol misuse, while others, find no evidence for such an effect, suggesting the need to investigate other mechanisms. Extending Conservation of Resource (COR) theory and employing a longitudinal study design, this study examines two alternative mechanisms grounded on social isolation. The first suggests drinking as a resource-mobilizing response, with social isolation eliciting the perception of more permissive injunctive drinking norms, thus facilitating problematic drinking. The second suggests problematic drinking as a mode of coping with a negative emotional state elicited by social isolation, namely depression. Findings indicate that supervisor undermining's association with subsequent subordinate problematic drinking is serially mediated by social isolation and depression, with no support found for the first mechanism. Implications for research, practice and policy are discussed.

Most common principal diagnoses assigned to Australian emergency department presentations involving alcohol use: a multi-centre study

OBJECTIVES

Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia.

METHODS

Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area.

RESULTS

ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females.

CONCLUSIONS

Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide.

IMPLICATIONS FOR PUBLIC HEALTH

The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.

Inbred mouse strain differences in alcohol and nicotine addiction-related phenotypes from adolescence to adulthood

Understanding the genetic basis of a predisposition for nicotine and alcohol use across the lifespan is important for public health efforts because genetic contributions may change with age. However, parsing apart subtle genetic contributions to complex human behaviors is a challenge. Animal models provide the opportunity to study the effects of genetic background and age on drug-related phenotypes, while controlling important experimental variables such as amount and timing of drug exposure. Addiction research in inbred, or isogenic, mouse lines has demonstrated genetic contributions to nicotine and alcohol abuse- and addiction-related behaviors. This review summarizes inbred mouse strain differences in alcohol and nicotine addiction-related phenotypes including voluntary consumption/self-administration, initial sensitivity to the drug as measured by sedative, hypothermic, and ataxic effects, locomotor effects, conditioned place preference or place aversion, drug metabolism, and severity of withdrawal symptoms. This review also discusses how these alcohol and nicotine addiction-related phenotypes change from adolescence to adulthood.

Content analysis of Netflix and Amazon Prime Instant Video original films in the UK for alcohol, tobacco and junk food imagery

BACKGROUND

Exposure to alcohol, tobacco and high fat, sugar and salt (HFSS) food imagery is a significant risk factor for the uptake and regular use of these products in young people, and imagery are more frequently portrayed in video-on-demand (VOD) than in terrestrial television programmes. This study compared alcohol, tobacco and HFSS imagery in original films on Amazon Prime Instant Video and Netflix.

METHODS

Content analysis of 11 original films released by Amazon Prime and Netflix in 2017 using 5-minute interval coding of alcohol, tobacco and HFSS content. Proportions of intervals containing alcohol, tobacco and HFSS imagery were compared between services using the chi-square test.

RESULTS

Alcohol content appeared in 200 (41.7%) out of the total of 479 intervals coded, whereas tobacco and HFSS appeared in 129 (26.9%) and 169 (35.24%), respectively. Proportions were similar between Amazon Prime Instant Video and Netflix original films and were unrelated to film age classification.

CONCLUSIONS

Alcohol, tobacco and HFSS content likely to promote consumption among young people occurs frequently in original films shown by VOD services in the UK. Further studies are needed to investigate effective regulatory frameworks for VOD services to protect viewers from harmful or unwanted contents.

The perceived social rejection of sexual minorities: Substance use and unprotected sexual intercourse

INTRODUCTION

This study presents associations between the perceived social rejection of sexual minorities and tobacco, alcohol and cannabis consumption and unprotected sexual intercourse in the capital of Greece, Athens. This is the first Greek study to evaluate the concept of the minority stress theory on sexual minorities' substance use and unprotected sexual intercourse. In addition, this is among the first international studies to examine whether periods of adverse economic conditions are associated with sexual minorities' substance use and unprotected sexual intercourse.

METHODS

Two-panel datasets covering the periods 2013-2014 and 2018-2019 were used to determine the perceived social rejection, that is, whether sexual minorities have been rejected by friends, treated unfairly in educational and/or workplace environments, treated negatively in social situations and received poor health and public services due to their sexuality.

RESULTS

The estimates indicate that perceived social rejection is associated with the increased consumption of tobacco (by 9.1%, P < 0.01), alcohol (by 7.1%, P < 0.01) and cannabis (by 12.5%, P < 0.01), as well as unprotected sexual intercourse (by 6.5%, P < 0.01). In the first three cases, the magnitude of the associations is stronger for men than women and there is increased cannabis consumption during periods of deteriorated economic conditions (by 5.5%, P < 0.01).

DISCUSSION AND CONCLUSIONS

In the European Union, reducing stigma, substance use, risky sexual behaviours and health inequalities for sexual minorities is a goal of public health. If minority stress is correlated with substance use and risky sexual behaviours leading to detrimental physical/mental health outcomes then prevention and support interventions should be designed.

Diverting people who use drugs from the criminal justice system: A systematic review of police-based diversion measures

BACKGROUND

Previous reviews of the effectiveness of measures to divert those who use drugs from the criminal justice system have focused mainly on post-conviction or post-sentence programs and report mixed results. The present systematic review synthesizes evidence on the effectiveness of police-based diversion measures in reducing criminal offenses and other harms related to drug use and then summarizes evidence from qualitative studies to identify facilitators and barriers associated with the implementation of such measures.

METHODS

Eight databases were searched to find evaluations of police-based diversion measures for drug-related offenders. Twenty-seven studies were identified. The vote-count method and the Maryland Scientific Method Scale were used to assess the impact of police-based diversion measures. Themes related to barriers or conditions facilitating the implementation of these measures were extracted from qualitative studies.

RESULTS

Evidence from quantitative studies indicates that in general police-based diversion measures are effective in preventing criminal offending and show promising results for improving participants' health and diminishing social costs as well as costs associated with processing drug-related offenses. There was insufficient evidence to draw conclusions about the effect of police-based diversion measures on drug use, drug accessibility, or changes in participants' socioeconomic conditions. Findings from qualitative studies suggest that program acceptance by police officers, constructive intersectoral collaboration, clear eligibility criteria, and timely access to services seem to facilitate the implementation and delivery of police-based diversion measures.

CONCLUSION

Police-based diversion measures can be effective in preventing drug-related criminal offenses and harm. Additional research is needed to evaluate their effect on participants' socioeconomic conditions and drug use as well as drug accessibility.

Smoking and snus use among Norwegian students: Demographic, personality and substance use characteristics

Background and aim:

Smoking rates are decreasing in Norway while the use of snus has increased. We aimed to investigate the co-occurrence of, and the socio-demographics, personality and substance use characteristics associated with, student smoking and snus use.

Methods:

Survey data were collected among students in higher education in Bergen, Norway in 2015 (N = 11,236, response rate 39.4%). Multinomial regression analyses comparing snus users and smokers to non-users and non-smokers, respectively, on demographic, personality and substance use variables were conducted. Regression analyses comparing current dual users to current smokers and current snus users and comparing daily smokers to daily snus users, on demographic, personality and substance use variables were also conducted.

Results:

In total 67.9% of ever snus users identified themselves as non-smokers (past and current). Several demographic, personality and substance use characteristics associated with smoking and snus use were identified (all = p < .05), some of which were common for both (e.g., use of cannabis) and some which were exclusively associated with either smoking (e.g., neuroticism) or snus use (e.g., extroversion).

Conclusion:

The current study contributes with several novel findings regarding traits associated with smoking and snus use. Though limited by a cross-sectional design, the current findings may suggest that the group of students using snus consists of a combination of previous smokers, students who would have smoked if snus was not available and a new segment who may not have used nicotine if snus was not available.

Youths' Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study

The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke's (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.

Association of Serotonergic Pathway Gene Polymorphisms With Behavioral Parameters in Patients With Opioid Dependence

Background and aims Opioid dependence is a chronic, relapsing substance use disorder with a multifactorial etiology, including a genetic component. Serotonin pathway gene polymorphisms have been an important focus of research for psychiatric disorders, including substance use disorders. This study aimed to identify the association of serotonin pathway gene polymorphisms with self-harm, depressive symptoms, impulsiveness, and aggression in patients with opioid dependence. Method The study group comprised 366 subjects with opioid dependence and 200 healthy volunteers. Patients were assessed for a history of self-harm, depressive symptoms, impulsiveness, and aggression using standard tools. Genomic DNA was used for genotyping of four polymorphisms - 5-HTTLPR, STin2 VNTR, TPH1 A218C, and TPH2 G703T. Results The short allele of 5-HTTLPR polymorphism showed a significant difference between cases (59.8%) and controls (40.1%) (p=0.001) and revealed an association with age at opioid dependence (p=0.033). There was a borderline significance of the short allele of 5-HTTLPR with the duration of opioid use (p=0.061) and non-plan impulsivity (p=0.076), suggesting a role of 5-HTTLPR in the susceptibility of opioid dependence. The other markers did not differ between cases and controls. However, the STin2A polymorphism revealed a significant association with anger scores, which may indicate its role in aggressive behavior. Conclusions The present study, the first of its kind, suggests an association of 5-HTTLPR polymorphism with opioid dependence and STin2A polymorphism with aggressive behavior among opioid-dependence patients, signifying the role of these markers in our patient population.

Changes in substance use and other reinforcing behaviours during the COVID-19 crisis in a general population cohort study of young Swiss men

BACKGROUND AND AIMS

There are concerns about the potential impact of the coronavirus disease (COVID-19) pandemic on substance use (SU) and other reinforcing behaviours (ORB). This paper investigates changes in SU and ORB among young men during the COVID-19 crisis (i.e. March-June 2020).

METHODS

Before and during the COVID-19 crisis, 2,344 young Swiss men completed questionnaires covering SU (i.e. alcohol, cigarettes, illegal cannabis), ORB (i.e. gaming, watching TV series, internet pornography) and sociodemographic and work-related characteristics (i.e. deterioration in the work situation, change in working hours, change in working hours from home, healthcare workers' and other professionals' contacts with potentially infected people, linguistic region, call up to military or civil protection unit, living situation, age).

RESULTS

Latent-change score models showed significant decreases of 17% for drinking volume and frequency of heavy episodic drinking, and a significant increase of 75% for time spent gaming and watching TV series. Subgroups showed greater relative increases. French-speaking participants, those who experienced a deterioration in their work situation and healthcare workers in contact with potentially infected people reported increased cigarette use. Those without children increased gaming, whereas those who worked fewer hours, experienced a deterioration in their work situation or were French-speaking did more gaming and watched more TV series. Those who lived alone or were German-speaking watched more internet pornography.

CONCLUSION

During the COVID-19 crisis, young Swiss men drank less alcohol and spent more time gaming and watching TV series. Changes in SU and ORB were not homogenous in the young Swiss men population.

Substance Use Disorders in Global Mental Health Delivery: Epidemiology, Treatment Gap, and Implementation of Evidence-Based Treatments

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Assess the treatment gap for patients with substance use disorders• Evaluate treatments and models of implementation for substance use disorders ABSTRACT: Substance use disorders (SUDs) account for substantial global morbidity, mortality, and financial and social burden, yet the majority of those suffering with SUDs in both low- and middle-income (LMICs) and high-income countries (HICs) never receive SUD treatment. Evidence-based SUD treatments are available, but access to treatment is severely limited. Stigma and legal discrimination against persons with SUDs continue to hinder public understanding of SUDs as treatable health conditions, and to impede global health efforts to improve treatment access and to reduce SUD prevalence and costs. Implementing SUD treatment in LMICs and HICs requires developing workforce capacity for treatment delivery. Capacity building is optimized when clinical expertise is partnered with regional community stakeholders and government in the context of a unified strategy to expand SUD treatment services. Workforce expansion for SUD treatment delivery harnesses community stakeholders to participate actively as family and peer supports, and as trained lay health workers. Longitudinal supervision of the workforce and appropriate incentives for service are required components of a sustainable, community-based model for SUD treatment. Implementation would benefit from research investigating the most effective and culturally adaptable models that can be delivered in diverse settings.

24-h Movement Guidelines and Substance Use among Adolescents: A School-Based Cross-Sectional Study

Children and youth are recommended to achieve at least 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and a sleep duration of 9–11 h/night for 11–13-year-olds or 8–10 h/night for 14–17-year-olds. Meeting the physical activity, screen time, and sleep duration recommendations have previously been associated with substance use among adolescents. However, previous research has mainly examined these factors individually rather than looking at how these indicators could concurrently relate to substance use in this age group. Therefore, this study examined the associations between meeting the 24-h movement guidelines for screen time, sleep duration, and physical activity (independent variables) with substance use outcomes including alcohol consumption, cannabis use, and cigarette smoking (dependent variables) among adolescents. Self-reported data from a cross-sectional and representative sample of 10,236 students (mean age = 15.1 years) in Ontario, Canada were analyzed. Logistic regression models stratified by gender were adjusted for potential confounders. Combinations of 24-h movement guidelines was differentially associated with substance use in boys and girls. Overall, findings showed that meeting 24-h movement guidelines is associated with lower odds of alcohol consumption, cannabis use, and cigarette smoking differentially with type of recommendation met and gender. Given that the associations between 24-h movement guidelines and substance use differ between boys and girls, future efforts should take this into consideration.

High educational attainment redresses the effect of occupational social class on health-related lifestyle: findings from four Spanish national health surveys

PURPOSE

Social determinants as occupational social class or educational attainment might influence health outcomes. This phenomenon is known as the social gradient of health and is related to a skewed distribution of health behaviours that might explain differences in morbidity and mortality between social groups. But social class and educational attainment differ in their nature and might have distinct effects on health. Here we study the combined effect of educational attainment and occupational social class on health-related lifestyle.

METHODS

We retrieved data from four large-scale, national representative Spanish surveys (n = 67,171). A latent class regression analysis was run to identify clusters of health-related lifestyle behaviours. Clusters were made according to sociodemographic factors, including a combined analysis of education and occupational social class.

RESULTS

Higher educational attainment and occupational social class were associated with a healthier lifestyle for both sexes. The combined analysis of education and social class indicated that women with secondary education showed a high risk combination of unhealthy behaviours, as men with middle, primary or no education.

CONCLUSIONS

Regardless of social class, a higher educational attainment redresses the effect of occupational social class on health-related behaviours. Our results suggest that education likely plays a crucial role in population health outcomes through its effects on lifestyle.

Barriers and Facilitators to Substance Use Disorder Treatment in Low-and Middle-Income Countries: A Qualitative Review Synthesis

BACKGROUND AND AIMS

One of the ways to address the treatment gap for substance use disorders is to understand the barriers and facilitators to treatment. This study aimed to synthesize the literature on barriers and facilitators of treatment in Low- and Middle-Income Countries (LMICs).

METHODS

We search Medline electronic database to identify English language peer reviewed empirical studies, both qualitative and quantitative which reported barriers and/or facilitators of treatment of substance use disorders.

RESULTS

Of 1389 titles, we selected 28 studies (14 were qualitative and 14 quantitative studies). The sample sizes of the qualitative studies ranged from 11 to 235. The majority of studies were from community or clinic settings. A wide range of barriers and facilitators were identified from the qualitative studies and were synthesized according to perceived susceptibility/seriousness, self-efficacy, perceived costs, perceived benefits, and cues to action. Most of the quantitative studies were community-based cross sectional-observational by design. Commonly identified barriers in these quantitative studies were perceived lack of problem or lack of need for treatment and low motivation whereas factors such as good family support and availability of effective treatment was found to facilitate substance use disorder treatment.

CONCLUSION

There are a wide range of barriers that hinder the substance use disorder treatment as well as certain factors that facilitate the treatment. Addressing them can help to minimize the treatment gap, which in turn can help in reducing the familial and social burden due to substance use disorders.

Adrenal gland response to endocrine disrupting chemicals in fishes, amphibians and reptiles: A comparative overview

The adrenal gland is an essential component of the body stress response; it is formed by two portions: a steroidogenic and a chromaffin tissue. Despite the anatomy of adrenal gland is different among classes of vertebrates, the hormones produced are almost the same. During stress, these hormones contribute to body homeostasis and maintenance of ion balance. The adrenal gland is very sensitive to toxic compounds, many of which behave like endocrine-disruptor chemicals (EDCs). They contribute to alter the endocrine system in wildlife and humans and are considered as possible responsible of the decline of several vertebrate ectotherms. Considering that EDCs regularly can be found in all environmental matrices, the aim of this review is to collect information about the impact of these chemical compounds on the adrenal gland of fishes, amphibians and reptiles. In particular, this review shows the different behavior of these "sentinel species" when they are exposed to stress condition. The data supplied in this review can help to further elucidate the role of EDCs and their harmful impact on the survival of these vertebrates.

Behaviour change interventions to reduce risky substance use and improve mental health in children in care: the SOLID three-arm feasibility RCT

Background

Looked-after children and care leavers (henceforth children in care) are young people placed under the care of local authorities, often because of a history of family abuse and/or neglect. These young people have significantly increased risk of substance use and mental health problems compared with peers.

Aim

The Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol (SOLID) trial aimed to investigate the feasibility of a definitive randomised controlled trial comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol) in and improve the mental health of children in care aged 12–20 years.

Methods

The study consisted of two phases: (1) a formative phase that adapted the motivational enhancement therapy and social behaviour and network therapy interventions for use with children in care and (2) a three-arm pilot randomised controlled trial (comparing motivational enhancement therapy, social behaviour and network therapy and usual care), and a linked process and economic (return on investment) evaluation. Trial feasibility was compared with prespecified STOP/GO criteria.

Setting

Six local authority areas in the north-east of England.

Participants

Children in care (aged 12–20 years) who screened positive for drug and/or alcohol use within the last 12 months were eligible for the trial. The formative and process evaluations included children in care, carers, social workers, and drug and alcohol workers.

Outcome measures

The primary outcomes were recruitment and retention rates at 12 months’ follow-up. Baseline and 12-month follow-up questionnaires measured self-reported drug and alcohol use, mental health and health-related quality of life. The process evaluation considered acceptability and engagement with the interventions and trial procedures.

Results

Formative findings (n = 65) highlighted the need for interventions to increase the emphasis on therapeutic relationships, use creative methods of engagement and support the identification of treatment goals wider than substance misuse. Within the randomised controlled trial, of 860 participants screened, 211 (24.5%) met the inclusion criteria. One hundred and twelve (53%) of the 211 eligible children were recruited and randomised. Just 15 of the 76 (20%) participants allocated to intervention attended any of the motivational enhancement therapy of social behaviour and network therapy sessions, and 60 (54%) participants completed the 12-month follow-up. The screening and recruitment of children in care required significantly more time and resource investment by researchers and children’s services than planned. The process evaluation (n = 116) demonstrated that, despite participants engaging in risky substance use, they did not often acknowledge this nor felt that they needed help. Children in care had complex, chaotic lives and children’s services departments were less research mature and extremely stretched; this, coupled with the multiple steps in the intervention pathway and study protocol, resulted in low adherence to the intervention and the trial.

Conclusions

The SOLID trial demonstrated successful engagement with children in care to adapt the motivational enhancement therapy and social behaviour and network therapy interventions. However, the pilot randomised controlled trial found that a definitive trial is not feasible. The current screen, refer and treat pathway for children in care did not work. There is an urgent need to radically rethink how we deliver therapeutic services for children in care. A pragmatic evaluation design, coupled with additional research resource for children’s services, is needed to evaluate these novel models of care at scale.

Trial registration

This study is registered as PROSPERO CRD42018098974 and Current Controlled Trials ISRCTN80786829.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 13. See the NIHR Journals Library website for further project information.

Successes and failures in treatment of substance abuse: Treatment system perspectives and lessons from the European continent

Objective:

The article offers an inventory of controversial basic issues related to treatment responses and their sociocultural political context, highlighting policy failures and successes, with a focus on Europe. As a reference point for this assessment, serves a conceptual framework of an “ideal type of treatment system”, which is built upon the following normative assumptions: the objective of harm minimisation or preventing substance-use-related consequences, evidence-based decision making, securing equity and accessibility also from a user perspective as well as efficiency in terms of the diversity and choice of treatment options.

Method:

Five major issues of addiction treatment systems, as identified and exemplified by an expert survey among 14 countries conducted in 2014, served as a reference for discussing fundamental gaps between an assumed ideal type of treatment system and the treatment response in practice: (1) Resistance to change, consensus building and innovation, (2) Political influence and target group bias beyond evidence, (3) Assumptions about rationality and universal evidence, (4) Myths of addiction and ethical deficits and (5) The treatment gap and user perspectives.

Results/conclusions:

Recommendations relevant for politicians, system planners, and clinicians are formulated for each of the five issues, specifically focusing on embeddedness of treatment systems in macro-societal conditions, the abstinence paradigm and outcome diversity, ethnocentric biases of the “evidence credo”, learning from self-change as the major road to recovery, and questioning implicit conceptions of the “addict as a human being”. Furthermore, it is concluded that theories regarding the diffusion of innovation and knowledge exchange can inform future research.

Development and Validation of the Recognizing Addictive Disorders Scale: A Transdiagnostic Measure of Substance-Related and Other Addictive Disorders

OBJECTIVE

Substance use disorders and behavioral addictions commonly co-occur. However, few available self-report measures reliably and validly assess the full range of addictive conditions. The development and initial validation of a new measure-Recognizing Addictive Disorders (RADs) scale addresses a significant gap in the literature. Method: After items were generated and evaluated in Study 1, Study 2 (N = 300), applied exploratory factor analysis to the item pool using an online-based community sample. In Study 3 (N = 427), the factor structure was validated using an independent online-based community sample and confirmatory factor analysis. Results: The scale demonstrated good internal consistency (a = .92) and construct validity, including replication of the factor structure (χ2 (553) = 760.83, p < .001, CFI = .997, TLI = .997, RMSEA = .030) and correlation with a related transdiagnostic measure of addiction (r = .72). Discussion: Overall, results support the preliminary validity of a brief transdiagnostic measure of addiction that considers a diverse range of behaviors. For patients presenting to substance abuse treatment, this tool may be useful in identifying symptoms of other types of non-substance problems, which could ultimately aid in treatment planning.

Predictors of premature treatment termination in a large residential addiction medicine program

BACKGROUND

While inpatient programs are a common setting for addiction treatment, patients' premature termination is a major concern. Predicting premature treatment termination has the potential to substantially improve patient outcomes by identifying high-risk profiles and suggesting care paths that might reduce dropout. The current study examined the predictors of premature termination from an inpatient addiction medicine service.

METHODS

In 1082 patients admitted to a large inpatient addiction medicine service, we used intake assessments of severity of alcohol use disorder, illicit drug use disorder, post-traumatic stress disorder (PTSD), anxiety disorders, and major depressive disorder to predict planned termination (n = 922) or premature termination (n = 160). We used two complementary analytic approaches-traditional binary logistic regression and a data-driven latent profile analysis (LPA).

RESULTS

Binary logistic regression revealed that alcohol use severity, illicit drug use severity, and PTSD severity significantly predicted termination status, although alcohol use severity notably exhibited an inverse relationship. The LPA revealed four distinct profiles, with one profile exhibiting a significantly higher rate of premature termination and another exhibiting a significantly lower rate of premature termination. The high-risk profile was characterized by high drug severity, high comorbid psychopathology (PTSD, depression, and anxiety symptoms), but low alcohol severity. The low-risk profile was characterized by high alcohol severity, but low drug use and low comorbid psychopathology.

CONCLUSIONS

These results provide converging evidence that illicit drug severity and psychiatric severity, and particularly PTSD, were associated with premature termination. Moreover, the LPA revealed distinct latent subgroups of patients with meaningfully higher and lower risk of premature termination, suggesting that addiction services should develop strategies for identifying high-risk individuals or develop care paths for high-risk symptom clusters. Approaches that are trauma-informed or otherwise focus on the management of comorbid psychiatric conditions may be particularly appropriate for reducing premature termination.

Cortisol as a Biomarker of Alcohol Use in Combat Veterans: A Literature Review and Framework for Future Research

Objective: Alcohol use and alcohol use disorders (AUDs) are an increasing concern among veterans, particularly those from recent conflicts in Iraq and Afghanistan. The study of biomarkers in alcohol use and AUD has moved to enhancing the understanding of the development and maintenance of AUDs, as well as investigating its association with clinical severity and potential predictors of treatment response. Cortisol, a glucocorticoid known as a stress hormone, has been linked with both stress and trauma, as well as increased alcohol suppression effects. Method/Results: The present review summarizes existing literature and presents suggestions for future research to evaluate whether cortisol may be a possible biomarker of alcohol use disorder risk in combat veterans. Specifically, aspects of combat deployments and high levels of PTSD, coupled with the stress of reintegration may dysregulate cortisol and increase risk to AUD. There may also be bidirectional impacts, such that alcohol is used as a coping mechanism and can dysregulate hypothalamic pituitary adrenal (HPA) axis functioning and cortisol. Conclusions: In the context of this framework, cortisol may serve as a biomarker for the development of AUD, as well as a biomarker of risk or relapse. This review ends with both theoretical and clinical implications, as well as directions for future research.

Designing an Optimum Fiscal Policy for Tobacco to Maximise the Tax Revenue, Social Savings and the Net Monetary Benefits in Sri Lanka

BACKGROUND

Fiscal policy targeting tobacco control is identified as the most effective strategy for rapid control of tobacco use. An optimum fiscal policy to estimate the percentage taxation that will maximise the government tax revenue, social savings and the net monetary benefit has not been empirically designed before in Sri Lanka.

METHODS

A model was developed using Microsoft Excel 2016, utilizing up-to-date published evidence on the cigarette sales, current fiscal policy, social cost of tobacco use, consumer response and the price elasticity of cigarettes. Univariate estimates on the expected revenue from tobacco tax, average annual social savings and the net monetary benefit were predicted for different levels of tobacco taxation. A deterministic sensitivity analysis was performed covering all possibilities. The percentage taxation maximizing the government tax revenue and the net monetary benefit were identified.

RESULTS

It was estimated that a further 30% tax increase from the 2019 baseline will generate approximately LKR 3544 million per year of additional tax revenue for the government while saving LKR 28 069 million per annum as social savings. A fiscal elevation of 50% will produce identical annual tax revenue to that of 2018, while securing a social saving of more than LKR 47 600 million per annum. The maximum net monetary benefit is achievable at an overnight tax increase of 90% from the baseline, however with a short-term compromise in tax revenue.

CONCLUSION

The well-defined thresholds take tobacco taxation advocacy in Sri Lanka a step forward and will assist the government in taking an informed decision on its fiscal policy for cigarettes.

Assessing the European impact of alcohol misuse and illicit drug dependence research: clinical practice guidelines and evidence-base policy

BACKGROUND

Despite alcohol and illicit drug dependence being one of the most common diagnoses in Europe, there is heterogeneity of research evidence used in policy and practice.

OBJECTIVE

We sought to (1) evaluate European research outputs on alcohol misuse and drug addiction in 2002-2018 in the Web of Science, (2) compare these with their burden of disease and (3) determine their impact in several ways.

METHODS

A bibliometric research was undertaken including an assessment of the citation counts, the influence of research on members of national health advisory committees, and their contribution to the evidence base of clinical practice guidelines (CPGs).

FINDINGS

There were 3201 analysed references cited in 28 CPGs across 11 European Countries on alcohol misuse and illicit drug abuse. Research conducted in the USA dominated both sets of CPGs, while many European countries were overcited relative to their research presence. The illicit drug research appeared to be adequate relative to the evidence of harm in Europe. However, alcohol misuse research appeared grossly inadequate to the harm it causes by a factor of 20.

CONCLUSIONS

The volume of research on illicit drug addiction is commensurate to the European burden, whereas alcohol misuse is far below what is needed to curb a significant source of harm.

CLINICAL IMPLICATIONS

The research asymmetries call for attention to the causes of the problem. Development of research-based solutions to a serious social harm is needed, including minimum pricing and collaborative work to harmonise efforts on disease management and treatment practices across European countries.

Construction workers' alcohol use, knowledge, perceptions of risk and workplace norms

INTRODUCTION AND AIMS

Globally, there is growing concern regarding workers' alcohol use and its implications for health, wellbeing and workplace safety. Male-dominated industries are more susceptible to risky alcohol consumption and its associated harms. This paper investigated the patterns, prevalence and predictors of risky drinking among construction workers.

DESIGN AND METHODS

Male construction workers (n = 511) completed a survey measuring alcohol-related measures including Alcohol Use Disorders Identification Test - Concise (AUDIT-C), which was compared with population data. Hierarchical multiple regression examined alcohol-related knowledge, perception of risk to workplace safety, psychological distress, job stress, general health, quality of life and workplace alcohol culture variables as predictors of risky drinking.

RESULTS

Prevalence of risky drinking was higher than the national average, particularly for younger (<25 years) and mid-aged (45-54 years) workers. One in six construction workers reported workmates being visibly affected by alcohol in the workplace. Key predictors of risky drinking were perception of alcohol-related risks to workplace safety, general health, alcohol knowledge and descriptive norms regarding workmates' alcohol use.

DISCUSSION AND CONCLUSIONS

These findings provide useful insights into the patterns and predictors of risky drinking in construction and can inform future preventive programs and interventions in high-risk workplaces. In addition to tailoring programs to both young and mid-aged workers, this work highlights the importance of implementing strategies to increase awareness of risks to workplace safety; and the adoption of norms that inhibit the social acceptability of risky drinking behaviour in the wider workplace.

Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: a qualitative study

PURPOSE

Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario.

METHODS

Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding.

RESULTS

The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings.

CONCLUSIONS

Given the turmoil in clients' lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities.

Innovations in pre-doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with substance use disorders (SUD). Historically, SUD were seen as a criminal issue and access to treatment was limited, but that paradigm is shifting and substance abuse is now being recognized as a disease state and the management of patients with SUD is increasingly within the healthcare system starting with primary healthcare settings including dental facilities. In a new training initiative, first-year dental students (DDS1) attended a 90-minute SBIRT training. An Attitudes and Opinion Survey (AOS) consisting of 8 questions that separately assesses DDS1 attitudes toward alcohol and drug use disorders was utilized to evaluate the training. Assenting DDS1 anonymously completed the AOS before and following the training. Over 3 years, we analyzed changes in the AOS of 230 DDS1 using Chi-squared test for bivariate comparison. We then applied a Bonferroni correction to the P-values. Response rate was 95.5%. The SBIRT training improved DDS1 attitudes and opinions toward patients with SUD with respect to all AOS questions. There was a statistically significant improvement (P < 0.003) in DDS1 attitudes and opinions with respect to whether other patients care suffers because of time and resources spent on patients with SUD and whether the SBIRT training provided adequate education to prepare DDS1 to manage patients with SUD. SBIRT training is relevant to dental education. It fills an important educational gap and is a suitable model for other dental schools.

Social Drinking Contexts and Their Influence on Problematic Drinking at Age 30

Aims: Understanding the social contexts in which problematic drinking occurs can inform prevention strategies. In this article, we investigate gender-specific social contexts associated with problematic drinking and depression among adults aged 30 years. Because depression has been consistently linked with harmful alcohol consumption, we will also examine its association with drinking contexts. Methods: We used data from 2490 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exploratory and confirmatory factor analyses were used to identify latent constructs of drinking contexts stratified by gender, with subsequent regression analysis to assess the role of these contexts in problematic drinking (measured using the Alcohol Use Disorders Identification Test). Results: Six distinct drinking contexts were identified, which differed by gender, three for men and three for women. For both men and women, "social drinking", was associated with problematic drinking. "Home drinking" was also common to men and women but associations with problematic drinking differed, being risky only among men. "Daytime drinking" (women) was associated with risk but "work-related drinking" (men) was not. Both "home drinking" (men) and "daytime drinking" (women) were linked to depression symptoms. Conclusion: Specific contexts appeared to be associated with problematic drinking for both sexes. Among both men and women, "social drinking" was associated with problematic drinking. Both "home drinking" (men) and "daytime drinking" (women) contexts, were associated with problematic drinking and depressive symptoms. Targeted alcohol-focused interventions need to address co-occurring mental health issues.

The prevalence of major mental illness, substance misuse and homelessness in Irish prisoners: systematic review and meta-analyses

AimsTo systematically review studies from Irish prisons that estimate the prevalence of major mental illness, alcohol and substance misuse, and homelessness at the time of committal.

METHODS

Healthcare databases were searched for studies quantifying the point prevalence for each outcome of interest. Searches were augmented by scanning of bibliographies and searches of governmental and non-governmental websites. Proportional meta-analyses were completed for each outcome.

RESULTS

We found eight, six and five studies quantifying the point prevalence of major mental illness, substance misuse, and homelessness respectively. Considerable heterogeneity was found for each subgroup (except psychosis where substantial heterogeneity was observed) and random effects models were used to calculate pooled percentages. The pooled percentage for psychotic disorder was 3.6% [95% confidence interval (CI) 3.0-4.2%], for affective disorder 4.3% (95% CI 2.1-7.1%), for alcohol use disorder 28.3% (95% CI 19.9-37.4%), for substance use disorder 50.9% (95% CI 37.6-64.2%) and for those who were homeless on committal 17.4% (95% CI 8.7-28.4%).

CONCLUSIONS

Estimates for the prevalence of psychotic illness and substance abuse amongst Irish prisoners are in keeping with international estimates of morbidity in prisons, whilst those for affective disorders are lower. The prevalence of homelessness in committal to Irish prisons is higher than some international estimates. Rates for psychoses, alcohol and substance misuse as well as homelessness in Irish prisons are significantly higher than the general population prevalence of these vulnerabilities. A need for service development is discussed.

Substance use and sociodemographic correlates among adolescents in a low-income sub Saharan setting

BACKGROUND

The present study investigated the social and behavioral correlates of substance use, specifically bang or cocaine or similar drugs among a school-based sample of adolescents in a low-income urban setting.

METHODS

The study utilized data on 2,176 school-attending adolescents aged 11-16 years in Dar es Salaam (DES) to examine social and behavioral correlates for lifetime substance use. The correlates under investigation included, demographic - age and gender; social - poverty, parent-adolescent relationship; behavioral - truancy, aggressive behavior, injury risk; psychological - depression and suicide ideation. Bivariate and multivariate analyses were then carried out on several variables identified from the 2006 Tanzanian Global School-based Health Survey (GSHS) questionnaire.

RESULTS

Approximately seven percent of school-attending adolescents (n=144) reported having used an illicit substance at least once during their lifetime. After adding significantly associated covariates into a logistic regression model, we found that only truancy [OR= 2.29 (CI=1.07 - 4.90)], suicide ideation [OR=4.36 (2.32 - 8.19)] and parents who had checked their adolescents' homework (OR=0.56 (CI=0.32 - 1.00)] were significantly associated with reported substance use.

CONCLUSIONS

Our results suggest that health promotion programs should simultaneously target multiple factors associated with substance use behaviors among school-attending adolescents in Dar es Salaam. They should take into account the range of psychosocial characteristics of school-attending adolescents which may be impacted by or result from substance use.

Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men

We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals.

Sex Differences in the Effect of Alcohol Drinking on Myelinated Axons in the Anterior Cingulate Cortex of Adolescent Rats

Cognitive deficits associated with teenage drinking may be due to disrupted myelination of prefrontal circuits. To better understand how alcohol affects myelination, male and female Wistar rats (n = 7-9/sex/treatment) underwent two weeks of intermittent operant self-administration of sweetened alcohol or sweetened water early in adolescence (postnatal days 28-42) and we tested for macro- and microstructural changes to myelin. We previously reported data from the males of this study showing that alcohol drinking reduced myelinated fiber density in layers II-V of the anterior cingulate division of the medial prefrontal cortex (Cg1); herein, we show that myelinated fiber density was not significantly altered by alcohol in females. Alcohol drinking patterns were similar in both sexes, but males were in a pre-pubertal state for a larger proportion of the alcohol exposure period, which may have contributed to the differential effects on myelinated fiber density. To gain more insight into how alcohol impacts myelinated axons, brain sections from a subset of these animals (n = 6/sex/treatment) were used for microstructural analyses of the nodes of Ranvier. Confocal analysis of nodal domains, flanked by immunofluorescent-labeled contactin-associated protein (Caspr) clusters, indicated that alcohol drinking reduced nodal length-to-width ratios in layers II/III of the Cg1 in both sexes. Despite sex differences in the underlying cause (larger diameter axons after alcohol in males vs. shorter nodal lengths after alcohol in females), reduced nodal ratios could have important implications for the speed and integrity of neural transmission along these axons in both males and females. Alcohol-induced changes to myelinated axonal populations in the Cg1 may contribute to long-lasting changes in prefrontal function associated with early onset drinking.

Treatment-resistant depression as risk factor for substance use disorders-a nation-wide register-based cohort study

BACKGROUND AND AIMS

Treatment-resistant depression (TRD) is common among patients with major depressive disorder (MDD). MDD may increase the risk for developing substance use disorders (SUD). The aim of this study was to investigate the risk for developing SUD among patients with TRD compared with other depressed patients.

DESIGN

Observational cohort study.

SETTING

Nation-wide governmental health registers in Sweden.

PARTICIPANTS

All patients aged 18-69 years with an MDD diagnosis in specialized health care who had received at least one antidepressant prescription during 2006-14 were identified. Patients with at least three treatment trials within a single depressive episode were classified with TRD.

MEASUREMENTS

Patients with TRD were compared with the whole MDD cohort regarding risk for obtaining a SUD diagnosis or medication using survival analyses adjusted for socio-demographics and comorbidities.

FINDINGS

Of 121 669 MDD patients, 13% were classified with TRD. Among the patients without any history of SUD, patients with TRD had a risk increase for any SUD both ≤ 1 and > 1 year after antidepressant initiation [> 1 year hazard ratio (HR) = 1.4; 95% confidence interval (CI) = 1.3-1.5]. Risks were elevated for the subcategories of opioid (HR = 1.9, 95% CI = 1.4-2.5) and sedative SUD (HR = 2.7, 95% CI = 2.2-3.2). Patients with a history of SUD had a risk increase for any SUD ≤ 1 year after start of treatment (HR = 1.2, 95% CI = 1.1-1.4), and both ≤ 1 year and > 1 year for sedative (> 1 year HR = 2.0, 95% CI = 1.3-3.0) and multiple substance SUD (HR = 1.9, 95% CI = 1.4-2.5).

CONCLUSIONS

Patients with treatment-resistant depression may be at greater risk for substance use disorders compared with other patients with major depressive disorder. Patterns may differ for patients with and without a history of substance use disorders, and for different categories of substance use disorder.

Widowhood and Alcohol, Tobacco, and Other Drug Use Among Older Adults in India

Objective

We sought to assess how widowhood among older adults in India was associated with alcohol consumption, smoking, and use of chewing tobacco or other drugs.

Method

Data were collected in 2011 from 9,852 adults aged 60 and older from seven regionally diverse states in India. Regression analyses provided estimates of the relationship between widowhood and having smoked cigarettes, consumed alcohol, or used chewed tobacco or other drugs in the past month among men, adjusting for demographic and socioeconomic factors. We also estimated the relationship between widowhood and past-month substance use among women.

Results

Recently widowed men (within 0-4 years) were 1.76 times (95% confidence interval [CI] 1.01-3.09, p < .05) more likely to have consumed alcohol and 1.62 times (95% CI 1.01-2.59, p < .05) more likely to have used chewing tobacco or other drugs as compared with married men. Women widowed for any length of time were 1.37 times (95% CI 1.11-1.69, p < .01) more likely to have used chewing tobacco or other drugs.

Discussion

Interventions aimed at reducing use of chewing tobacco or other drugs among older adults in India should consider focusing on recently widowed men and women widowed for any amount of time.

Barriers and facilitators of maintained smoking abstinence following release from smoke-free prisons: A qualitative enquiry

BACKGROUND

The prevalence of smoking among people entering prisons is high. Despite increasing adoption of prison smoke-free policies, relapse to smoking after release from prison is nearly universal, and policy to effectively mitigate this is largely absent. Informed by a risk environment framework, we aimed to identify key barriers and facilitators to maintaining smoking abstinence among former smokers released from smoke-free prisons.

METHOD

Twenty-one people released from smoke-free prisons in Queensland, Australia, were followed up from a larger survey of 114 former prisoners. Semi-structured interviews were used to explore the perceived barriers and facilitators of maintained smoking abstinence.

FINDINGS

Identified barriers to continued abstinence included pre-release intention to resume smoking; normalisation of smoking in home or social environments, resumption of smoking as a symbolic act of freedom and resistance from and to a restrictive environment; a perception that smoking provides stress relief to their difficult lives, and the use of tobacco/smoking to cope with cravings experienced on release for illicit substances. A number of interviewees were unable to provide clear reflective reasons for relapse. For those who did manage to remain abstinent for a period of time, identified facilitators included an awareness of the health and financial benefits of smoking abstinence, the use of intrinsic motivation, distraction from nicotine cravings using alternative activities, and social support from family and peers.

DISCUSSION

Interventions promoting continued smoking abstinence among people exiting smoke-free prisons should focus on targeting the perceived individual- and environmental-level barriers to maintained smoking abstinence while simultaneously promoting perceived facilitators, so as to reduce smoking-related health and economic disparities in this marginalised population.

When are fakers also drinkers? A self-control view of emotional labor and alcohol consumption among U.S. service workers

Some employees tend to drink more alcohol than other employees, with costs to personal and organizational well-being. Based on a self-control framework, we propose that emotional labor with customers-effortfully amplifying, faking, and suppressing emotional expressions (i.e., surface acting)-predicts alcohol consumption, and that this relationship varies depending on job expectations for self-control (i.e., autonomy) and personal self-control traits (i.e., impulsivity). We test these predictions with data drawn from a national probability sample of U.S. workers, focusing on employees with daily contact with outsiders (N = 1,592). The alcohol outcomes included heavy drinking and drinking after work. Overall, surface acting was robustly related to heavy drinking, even after controlling for demographics, job demands, and negative affectivity, consistent with an explanation of impaired self-control. Surface acting predicted drinking after work only for employees with low self-control jobs or traits; this effect was exacerbated for those with service encounters (i.e., customers and the public) and buffered for those with service relationships (i.e., patients, students, and clients). We discuss what these results mean for emotional labor and propose directions for helping the large segment of U.S. employees in public facing occupations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

"Working on Wellness:" protocol for a worksite health promotion capacity-building program for employers

Background

In the United States, worksite wellness programs are more often offered by larger employers. The Massachusetts Working on Wellness (WoW) program is an innovative, statewide capacity-building model designed to increase the number of smaller employers (200 or fewer workers) adopting health promotion initiatives. This article describes the WoW program design and approaches to recruitment, implementation, and evaluation.

Methods/design

WoW provides employer training, technical assistance and seed funding, utilizing a Wellness Program Development framework based on recognized good practices. For-profit employers with 200 employees or fewer are eligible for and encouraged to apply for a Massachusetts Small Business Wellness Tax Credit. During the phase described in this paper, employer organizations applied to the program and committed to designating a champion responsible for program implementation. Interventions were to include policy and environmental supports, as well as those targeting individual behavior change through raising awareness and education. Supports provided to employers included seed grants for qualifying activities (up to $10,000 with matching required), community linkages, data collection and organization-specific feedback tools, an on-line curriculum supplemented with technical assistance, and an expert webinar series. Data collection at multiple time points, from the initial application through program completion, provides information for evaluation of recruitment, planned and completed activities.

Discussion

This model is grounded in literature on good practices as well as in local knowledge about Massachusetts employers. It does not directly address the influence of working conditions, which can affect both worker participation and health behaviors. Implementation may be less successful with some organizations, such as those with many workers who are part-time or geographically distributed rather than in a centralized physical location. Program evaluation will assess the extent to which WoW achieves its goals. The data are expected to increase understanding of the needs of smaller employers and industries not traditionally implementing employee wellness programs.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6405-1) contains supplementary material, which is available to authorized users.

Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders

Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions.

Effectiveness of pharmacotherapy for smoking cessation: protocol for umbrella review and quality assessment of systematic reviews

BACKGROUND

In the long term, smoking cessation can decrease the risk of cancer, stroke, and heart attacks and improve overall survival. The aim of the proposed umbrella review is to summarize existing systematic reviews that assessed the effects of pharmacological interventions for smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews.

METHODS

Databases such as the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHIL PsychINFO Web of Science, Conference Papers Index, Scopus, and Google Scholar will be used to retrieve reviews. Systematic reviews which included only randomized control trials will be considered in this review. The primary outcome will be prolonged abstinence from smoking for a minimum of 6 months follow-up, and the secondary outcome will be point abstinence rate from smoking of less than 6 months follow-up but more than 7 days. Methodological quality of the included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, which contains 16 domains. Two authors will screen the titles and abstracts of all reviews obtained by the search strategy, assess the full text of selected articles for inclusion, and extract data independently. The quality appraisal will be also assessed by two authors (AM, CC) independently, and Cohen's Kappa statistic will be used to assess inter-ratter agreement. The findings of the study will be narrated qualitatively to describe the effect of different pharmacotherapy on smoking cessation.

DISCUSSION

The World Health Organization recommends treatment of tobacco dependence as one approach in its comprehensive tobacco control policy. To date, many trials and systematic reviews have been conducted to assess the effectiveness of pharmacotherapy for smoking cessation. Therefore, the findings of the umbrella review will improve clinical decision-making and be used as a baseline for future studies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017080906.

Do Callous-Unemotional Traits and Conduct Disorder Symptoms Predict the Onset and Development of Adolescent Substance Use?

Despite strong evidence of the relationship between conduct disorder (CD) symptoms and substance use, it is unclear how callous-unemotional (CU) traits predict substance use over and above CD symptoms, and their potential interaction. This study used data from 753 participants followed from grade 7 to 2-years post-high school. Latent growth curve models showed that CU traits predicted the onset of cigarette use, alcohol misuse, and a substance use composite at grade 7 only when no CD symptoms were present. Among those without CD symptoms, boys showed greater change in the odds of using cigarettes, and were more likely to misuse alcohol or use any substance at grade 7 than girls. However, CD symptoms, CU traits, and their interaction did not predict the linear rates of growth of substance use over time. Thus, CU traits may uniquely predict adolescent substance use when CD symptoms are not present. This research has implications for predicting onset of adolescent substance use and for incorporating the assessment of CU traits into interventions targeting adolescent substance use.

Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial

OBJECTIVES

Interventions addressing the individual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common, previous studies have suggested variable effectiveness by subgroups of students. An exploratory study was undertaken to examine the differential effectiveness of a universal school-based resilience intervention on adolescent substance use and protective factors according to their sociodemographic and previous substance use.

DESIGN

Secondary analysis of data from a cluster-randomised controlled trial.

SETTING

32 Australian secondary schools.

PARTICIPANTS

Cohort of grade 7 students (n=3155) followed up in grade 10 (aged 15-16 years; 2014; n=2105).

INTERVENTION

Three-year universal school-based intervention implemented by school staff that targeted a range of student resilience protective factors (2012-2014).

MEASUREMENTS

Primary outcomes included: tobacco (recent, number of cigarettes) and alcohol (recent, 'risk' and number of drinks) use, and secondary outcomes included: marijuana (recent) and other illicit substance (recent) use, and aggregate individual and environmental protective factor scores. Generalised and linear mixed models examined interactions between treatment and student subgroups (gender; socioeconomic disadvantage (low/high); geographic location (major city/inner regional/outer regional-remote); and previous substance use (non-user/user)) at follow-up (36 models).

RESULTS

Analysis of student follow-up data showed no differential intervention effect for any substance use or protective factor outcome for any subgroup, with the exception of one differential effect found by socioeconomic status for the outcome of mean number of cigarettes smoked by recent smokers (p=0.003). There was no evidence of an intervention effect within the low (mean difference (MD) -12.89, 95% CI -26.00 to 0.23) or high (MD 16.36, 95% CI -1.03 to 33.76) socioeconomic subgroups.

CONCLUSIONS

No evidence of an intervention effect on substance use and protective factors was found according to student subgroups defined by sociodemographic characteristics or previous substance use.

TRIAL REGISTRATION NUMBER

ACTRN12611000606987.