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Lodetti G, de Bitencourt RM, Rico EP. Classic psychedelics and the treatment for alcoholism. Prog Neuropsychopharmacol Biol Psychiatry 2024; 135:111129. [PMID: 39181308 DOI: 10.1016/j.pnpbp.2024.111129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
Alcohol is a harmful drug, and reducing its consumption is a significant challenge for users. Furthermore, alcohol dependence is often treatment-resistant, and no completely effective treatment model is available for chemical dependence. Classic psychedelics, such as LSD, psilocybin, and ayahuasca have been used in different clinical and pre-clinical trials, demonstrating promising pharmacotherapeutic effects in the treatment of treatment-resistant psychopathological conditions, such as addiction, especially related to alcohol dependence. In this work, we conducted a narrative review of the emerging research regarding the potential of psychedelics for alcohol use disorder treatment. Psychedelic substances have demonstrated potential for treating drug addiction, especially AUD, mostly by modulating neuroplasticity in the brain. Given that serotonergic psychedelics do not produce physical dependence or withdrawal symptoms with repeated use, they may be considered promising treatment options for managing drug use disorders. However, certain limitations could be found. Although many participants achieve positive results with only one treatment dose in clinical studies, great inter-individual variability exists in the duration of these effects. Therefore, further studies using different doses and experimental protocols should be conducted to enhance evidence about psychedelic substances.
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Affiliation(s)
- Guilherme Lodetti
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil
| | - Rafael Mariano de Bitencourt
- Behavioral Neuroscience Laboratory, University of Southern Santa Catarina (UNISUL), Tubarão, Santa Catarina, Brazil
| | - Eduardo Pacheco Rico
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil.
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Mogk J, Idu AE, Bobb JF, Key D, Wong ES, Palazzo L, Stefanik-Guizlo K, King D, Beatty T, Dorsey CN, Caldeiro RM, Garza McWethy A, Glass JE. Prescription Digital Therapeutics for Substance Use Disorder in Primary Care: Mixed Methods Evaluation of a Pilot Implementation Study. JMIR Form Res 2024; 8:e59088. [PMID: 39222348 PMCID: PMC11406110 DOI: 10.2196/59088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. OBJECTIVE This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. METHODS From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. RESULTS Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. CONCLUSIONS The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. TRIAL REGISTRATION ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045.
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Affiliation(s)
- Jessica Mogk
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Dustin Key
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Edwin S Wong
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Deborah King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Ryan M Caldeiro
- Mental Health and Wellness Services, Kaiser Permanente Washington, Renton, WA, United States
| | | | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Tilhou A, Baldwin M, Alves J. No Time to Wait: Leveraging Primary Care to Treat Stimulant Use Disorder. Am J Prev Med 2024; 67:464-469. [PMID: 38762205 PMCID: PMC11338722 DOI: 10.1016/j.amepre.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Alyssa Tilhou
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Marielle Baldwin
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Justin Alves
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
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Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:473-485. [PMID: 38494728 PMCID: PMC11179974 DOI: 10.1177/29767342241236028] [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] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
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Aljassem A, Spickler M, Kapur N. A path to recovery for overlooked populations and their unique challenges: integrating rehabilitation in palliative care for patients with substance use disorders. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1373857. [PMID: 38756191 PMCID: PMC11096464 DOI: 10.3389/fresc.2024.1373857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Palliative care is a growing medical specialty focusing on providing compassionate and holistic management for those facing life-threatening diseases. These patients frequently present with physical, functional, emotional, and psychosocial problems that require comprehensive interdisciplinary management. However, there is a substantial opportunity to improve care for patients in palliative care who also have a substance use disorder (SUD). These opportunities include direct provision of SUD treatments by specialist palliative care providers and the integration of physical medicine and rehabilitation services. The purpose of this article is to examine the misunderstood and underutilized interaction between palliative care and SUDs, as well as describing the unique opportunities provided by physical medicine and rehabilitation providers to achieve a patient's palliative care goals and optimize overall quality of life. Substance Use Disorder is a chronic, often relapsing, illness that is relevant to palliative care practice due to the potential for significant morbidity and mortality through organ failure, chronic infections, and overdose syndromes. In traditional palliative care practice, it has been observed that past or current SUD diagnoses are often left untreated, resulting in increased distress, and exacerbating an already complex medical situation. Furthermore, many of these patients also experience physical, functional, or psychosocial changes that, when left untreated, will worsen distress and quality of life. To provide more comprehensive and successful palliative care for patients with SUD, the authors recommend an increased emphasis on specialist palliative care training in SUD management, proactive integration of rehabilitation services into the palliative care team, and consistent advocacy for these steps in various arenas. Combined, these actions can improve the care team's ability to provide a holistic, patient-centered approach that can have substantial positive outcomes for patients, health systems, and society.
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Affiliation(s)
- Annas Aljassem
- Department of Physical Medicine and Rehabilitation, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
| | - Michael Spickler
- Department of Physical Medicine and Rehabilitation, Corwell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Nandita Kapur
- Department of Physical Medicine and Rehabilitation, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
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Tilhou AS, Dague L, Chachlani P, Burns M. Can telehealth expansion boost health care utilization specifically for patients with substance use disorders relative to patients with other types of chronic disease? PLoS One 2024; 19:e0299397. [PMID: 38557607 PMCID: PMC10984462 DOI: 10.1371/journal.pone.0299397] [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] [Received: 04/25/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high risk of poor outcomes. Telehealth expansion may boost utilization, but it is unclear whether telehealth can increase utilization for patients with SUDs beyond that expected for other chronic diseases amenable to remote treatment, like type 2 diabetes. This information is needed by health systems striving to improve SUD outcomes, specifically. This study compared the impact of telehealth expansion during the COVID-19 public health emergency (PHE) on utilization for patients with SUDs and diabetes. METHODS Using Wisconsin Medicaid administrative, enrollment and claims data 12/1/2018-12/31/2020, this cohort study included nonpregnant, nondisabled adults 19-64 years with SUDs (N = 17,336) or diabetes (N = 8,499). Outcomes included having a primary care visit in the week (any, and telehealth) for any diagnosis, or a SUD or diabetes diagnosis; and the weekly fraction of visits completed by telehealth. Logistic and fractional regression examined outcomes pre- and post-PHE. Covariates included age, sex, race, ethnicity, income, geography, and comorbid medical and psychotic disorders. RESULTS Post-PHE, patients with SUDs exhibited greater likelihood of telehealth utilization (percentage point difference (PPD) per person-week: 0.2; 95% CI: 0.001-0.003; p<0.001) and greater fractional telehealth use (PPD: 1.8; 95%CI: 0.002-0.033; p = 0.025) than patients with diabetes despite a larger overall drop in visits (PPD: -0.5; 95%CI: -0.007- -0.003; p<0.001). CONCLUSIONS Following telehealth expansion, patients with SUDs exhibited greater likelihood of telehealth utilization than patients with diabetes. This advantage lessened the substantial PHE-induced healthcare disruption experienced by patients with SUDs. Telehealth may boost utilization for patients with SUDs.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America
| | - Laura Dague
- Public Service & Administration, Texas A&M University, College Station, TX, United States of America
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin—Madison, Madison, WI, United States of America
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin—Madison, Madison, WI, United States of America
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Oster C, Hunter S, Schultz T, Harvey G, Lawless M, Battersby M. Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia. Drug Alcohol Rev 2024; 43:705-717. [PMID: 38098184 DOI: 10.1111/dar.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/20/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. METHODS A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. RESULTS Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). DISCUSSION AND CONCLUSIONS Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.
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Affiliation(s)
- Candice Oster
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Timothy Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Wolfe DM, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Dowson M, Palumbo A, Suschinsky K, Skidmore B, Bartram M, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Eves AP, Thavorn K. Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review. Front Public Health 2023; 11:1296239. [PMID: 38106884 PMCID: PMC10722420 DOI: 10.3389/fpubh.2023.1296239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. Methods A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. Results One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Discussion Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Systematic Review Registration Open Science Framework doi: 10.17605/OSF.IO/S849R.
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Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON, Canada
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- Informatics, Decision Enhancement, and Analytics Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alyssa Grant
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | | | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Gordon Garner
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Sarah Konefal
- Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada
| | - Amy Porath Eves
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Maxwell AM, Brucar LR, Zilverstand A. A systematic review of sex/gender differences in the multi-dimensional neurobiological mechanisms in addiction and their relevance to impulsivity. CURRENT ADDICTION REPORTS 2023; 10:770-792. [PMID: 39282614 PMCID: PMC11395779 DOI: 10.1007/s40429-023-00529-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 09/19/2024]
Abstract
Purpose of Review Addiction may be characterized along three functional domains: Approach Behavior, Executive Function, and Negative Emotionality. Constructs underlying impulsivity thought to be relevant in addiction map on to these three functional domains. The purpose of the present review was to evaluate the extant research regarding sex/gender differences in the multi-dimensional domains of addiction using human neuroimaging and discuss their relevance to impulsivity. Recent Findings Few papers over the past two decades have used human neuroimaging to test sex/gender differences in addiction. There is therefore a significant gap in the literature regarding sex/gender differences in the neurobiological mechanisms driving the multi-dimensionality of addiction and their implications to impulsivity. Summary Of the 34 reviewed papers, the orbitofrontal cortex/ventromedial prefrontal cortex (OFC/vmPFC) was the most frequently reported brain region to evidence a sex/gender difference during fMRI tasks probing Approach Behavior and Negative Emotionality. This finding suggests potential sex/gender-specific patterns of subjective valuation in substance misuse, driven by OFC/vmPFC dysregulation.
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Affiliation(s)
- Andrea M Maxwell
- Medical Scientist Training Program, University of Minnesota, Minneapolis, Minnesota, United States
- Graduate Program in Neuroscience, University of Minnesota, Minneapolis, Minnesota, United States
| | - Leyla R Brucar
- Graduate Program in Cognitive Sciences, University of Minnesota, Minneapolis, Minnesota, United States
| | - Anna Zilverstand
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, United States
- Medical Discovery Team on Addiction; University of Minnesota, Minneapolis, Minnesota, United States
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Mogk JM, Matson TE, Caldeiro RM, Garza Mcwethy AM, Beatty T, Sevey BC, Hsu CW, Glass JE. Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study. Addict Sci Clin Pract 2023; 18:27. [PMID: 37158931 PMCID: PMC10169300 DOI: 10.1186/s13722-023-00387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) are prevalent and often go untreated. Patients are commonly screened for AUD in primary care, but existing treatment programs are failing to meet demand. Digital therapeutics include novel mobile app-based treatment approaches which may be cost-effective treatment options to help fill treatment gaps. The goal of this study was to identify implementation needs and workflow design considerations for integrating digital therapeutics for AUD into primary care. METHODS We conducted qualitative interviews with clinicians, care delivery leaders, and implementation staff (n = 16) in an integrated healthcare delivery system in the United States. All participants had experience implementing digital therapeutics for depression or substance use disorders in primary care. Interviews were designed to gain insights into adaptations needed to optimize existing clinical processes, workflows, and implementation strategies for use with alcohol-focused digital therapeutics. Interviews were recorded and transcribed and then analyzed using a rapid analysis process and affinity diagramming. RESULTS Qualitative themes were well represented across health system staff roles. Participants were enthusiastic about digital therapeutics for AUD, anticipated high patient demand for such a resource, and made suggestions for successful implementation. Key insights regarding the implementation of digital therapeutics for AUD and unhealthy alcohol use from our data include: (1) implementation strategy selection must be driven by digital therapeutic design and target population characteristics, (2) implementation strategies should seek to minimize burden on clinicians given the large numbers of patients with AUD who are likely to be interested in and eligible for digital therapeutics, and (3) digital therapeutics should be offered alongside many other treatment options to accommodate individual patients' AUD severity and treatment goals. Participants also expressed confidence that previous implementation strategies used with other digital therapeutics such as clinician training, electronic health record supports, health coaching, and practice facilitation would be effective for the implementation of digital therapeutics for AUD. CONCLUSIONS The implementation of digital therapeutics for AUD would benefit from careful consideration of the target population. Optimal integration requires tailoring workflows to meet anticipated patient volume and designing workflow and implementation strategies to meet the unique needs of patients with varying AUD severity.
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Affiliation(s)
- Jessica M Mogk
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
| | - Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, USA
| | | | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Brandie C Sevey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Clarissa W Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
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Glass JE, Dorsey CN, Beatty T, Bobb JF, Wong ES, Palazzo L, King D, Mogk J, Stefanik-Guizlo K, Idu A, Key D, Fortney JC, Thomas R, McWethy AG, Caldeiro RM, Bradley KA. Study protocol for a factorial-randomized controlled trial evaluating the implementation, costs, effectiveness, and sustainment of digital therapeutics for substance use disorder in primary care (DIGITS Trial). Implement Sci 2023; 18:3. [PMID: 36726127 PMCID: PMC9893639 DOI: 10.1186/s13012-022-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Experts recommend that treatment for substance use disorder (SUD) be integrated into primary care. The Digital Therapeutics for Opioids and Other SUD (DIGITS) Trial tests strategies for implementing reSET® and reSET-O®, which are prescription digital therapeutics for SUD and opioid use disorder, respectively, that include the community reinforcement approach, contingency management, and fluency training to reinforce concept mastery. This purpose of this trial is to test whether two implementation strategies improve implementation success (Aim 1) and achieve better population-level cost effectiveness (Aim 2) over a standard implementation approach. METHODS/DESIGN The DIGITS Trial is a hybrid type III cluster-randomized trial. It examines outcomes of implementation strategies, rather than studying clinical outcomes of a digital therapeutic. It includes 22 primary care clinics from a healthcare system in Washington State and patients with unhealthy substance use who visit clinics during an active implementation period (up to one year). Primary care clinics implemented reSET and reSET-O using a multifaceted implementation strategy previously used by clinical leaders to roll-out smartphone apps ("standard implementation" including discrete strategies such as clinician training, electronic health record tools). Clinics were randomized as 21 sites in a 2x2 factorial design to receive up to two added implementation strategies: (1) practice facilitation, and/or (2) health coaching. Outcome data are derived from electronic health records and logs of digital therapeutic usage. Aim 1's primary outcomes include reach of the digital therapeutics to patients and fidelity of patients' use of the digital therapeutics to clinical recommendations. Substance use and engagement in SUD care are additional outcomes. In Aim 2, population-level cost effectiveness analysis will inform the economic benefit of the implementation strategies compared to standard implementation. Implementation is monitored using formative evaluation, and sustainment will be studied for up to one year using qualitative and quantitative research methods. DISCUSSION The DIGITS Trial uses an experimental design to test whether implementation strategies increase and improve the delivery of digital therapeutics for SUDs when embedded in a large healthcare system. It will provide data on the potential benefits and cost-effectiveness of alternative implementation strategies. CLINICALTRIALS gov Identifier: NCT05160233 (Submitted 12/3/2021). https://clinicaltrials.gov/ct2/show/NCT05160233.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA.
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Edwin S Wong
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, 3980 15th Ave. NE, Fourth Floor, Seattle, WA, 98195, USA
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation, 1660 S Columbian Way, WA, 98108, Seattle, USA
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Deborah King
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Jessica Mogk
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Kelsey Stefanik-Guizlo
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Abisola Idu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Dustin Key
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - John C Fortney
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation, 1660 S Columbian Way, WA, 98108, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Rosemarie Thomas
- Kaiser Permanente Washington Mental Health & Wellness Services, 1200 SW 27th St, Renton, WA, 98057, USA
| | - Angela Garza McWethy
- Kaiser Permanente Washington Mental Health & Wellness Services, 1200 SW 27th St, Renton, WA, 98057, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, 1200 SW 27th St, Renton, WA, 98057, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
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Polcin DL, Mericle AA, Braucht GS, Wittman FD. Moving Social Model Recovery Forward: Recent Research on Sober Living Houses. ALCOHOLISM TREATMENT QUARTERLY 2023; 41:173-186. [PMID: 37125214 PMCID: PMC10139742 DOI: 10.1080/07347324.2023.2167528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Social model recovery is a peer centered approach to alcohol and drug problems that is gaining increased attention. This approach is well-suited to services in residential settings and typically includes living in a shared alcohol- and drug-free living environment where residents give and receive personal and recovery support. Sober Living Houses (SLHs) are recovery residences that explicitly use a social model approach. This paper describes recent research on SLHs, including new measures designed to assess their social and physical environments. We conclude that our understanding of social model is rapidly evolving to include broader, more complex factors associated with outcomes.
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Affiliation(s)
- Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA
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13
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Hyland CJ, McDowell MJ, Bain PA, Huskamp HA, Busch AB. Integration of pharmacotherapy for alcohol use disorder treatment in primary care settings: A scoping review. J Subst Abuse Treat 2023; 144:108919. [PMID: 36332528 PMCID: PMC10321472 DOI: 10.1016/j.jsat.2022.108919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) represents the most prevalent addiction in the United States. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include pharmacotherapy (acamprosate, disulfiram, naltrexone). METHODS The team undertook a search across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science on May 21, 2021. Eligibility criteria included: patient population ≥ 18 years old, primary care-based setting, US-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies. We assessed study bias using a modified Oxford Centre for Evidence-based Medicine Rating Framework quality rating scheme. RESULTS The qualitative synthesis included forty-seven papers, representing 25 primary studies. Primary study sample sizes ranged from 24 to 830,825 participants and many (44 %) were randomized controlled trials. Most studies (80 %) included a nonpharmacologic intervention for AUD: 56 % with brief intervention, 40 % with motivational interviewing, and 12 % with motivational enhancement therapy. A plurality of studies (48 %) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acamprosate, and/or disulfiram. Of the 47 total studies included, 68 % assessed care initiation and engagement. Fewer studies (15 %) explored practices surrounding screening for or diagnosing AUD. Outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (53 % and 51 %, respectively). Many of these outcomes showed significant findings in favor of integrated care models for AUD. CONCLUSIONS The integration of AUD pharmacotherapy in primary care settings may be associated with improved process and outcome measures of care. Future research should seek to understand the varied experiences across care integration models.
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Affiliation(s)
- Colby J Hyland
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America.
| | - Michal J McDowell
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, United States of America
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States of America.
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America.
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America; McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States of America.
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14
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Luo Z, Roychoudhury C, Pompos WS, DiMaria J, Robinette CM, Gore PH, Roychoudhury R, Beecroft W. Prevention of 90-day inpatient detoxification readmission for opioid use disorder by a community-based life-changing individualized medically assisted evidence-based treatment (C.L.I.M.B.) program: A quasi-experimental study. PLoS One 2022; 17:e0278208. [PMID: 36520863 PMCID: PMC9754176 DOI: 10.1371/journal.pone.0278208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Evidence for community-based strategies to reduce inpatient detoxification readmission for opioid use disorder (OUD) is scant. A pilot program was designed to provide individualized structured treatment plans, including addressing prolonged withdrawal symptoms, family/systems assessment, and contingency management, to reduce readmission after the index inpatient detoxification. METHODS A non-randomized quasi-experimental design was used to compare the pilot facilities (treatment) and comparison facilities before and after the program started, i.e., a simple difference-in-differences (DID) strategy. Adults 18 years and older who met the Diagnostic and Statistical Manual of Mental Disorders version 5 criteria for OUD and had an inpatient detoxification admission at any OUD treatment facility in two study periods between 7/2016 and 3/2020 were included. Readmission for inpatient detoxification in 90-days after the index stay was the primary outcome, and partial hospitalization, intensive outpatient care, outpatient services, and medications for OUD were the secondary outcomes. Six statistical estimation methods were used to triangulate evidence and adjust for potential confounding factors between treatment and comparison groups. RESULTS A total of 2,320 unique patients in the pilot and comparison facilities with 2,443 index inpatient detoxification admissions in the pre- and post-periods were included. Compared with patients in comparison facilities, patients in the C.L.I.M.B. facilities had higher readmission in the pre-period (unadjusted readmission 17.0% vs. 10.6%), but similar rates in the post-period (12.3% vs. 10.6%) after the implementation of the pilot program. For 90-day readmission, all DID estimates were not statistically significant (adjusted estimates ranged from 6 to 9 percentage points difference favoring the C.L.I.M.B. program). There was no significant improvement in the secondary outcomes of utilizations in lower level of care and medications for OUD in C.L.I.M.B. facilities. CONCLUSIONS We found a reduction in readmission in the pilot facilities between the two periods, but the results were not statistically significant compared with the comparison facilities and the utilization of lower level of care services remained low. Even though providers in the pilot OUD treatment facilities actively worked with health plans to standardize care for patients with OUD, more strategies are needed to improve treatment engagement and retention after an inpatient detoxification.
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Affiliation(s)
- Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- * E-mail:
| | - Canopy Roychoudhury
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - William S. Pompos
- Behavioral Health Strategy & Planning, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - James DiMaria
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Cynthia M. Robinette
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Purva H. Gore
- Health Care Value Business Analytics Services, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Rohon Roychoudhury
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - William Beecroft
- Behavioral Health Strategy & Planning, Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
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15
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Wolfe D, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Suschinsky K, Skidmore B, Bartram M, Cohen K, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Porath A, Thavorn K. Service-level barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use: protocol for a scoping review. BMJ Open 2022; 12:e064578. [PMID: 36410826 PMCID: PMC9680171 DOI: 10.1136/bmjopen-2022-064578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, substance use health services for treatment of alcohol use disorder and problematic alcohol use (AUD/PAU) were fragmented and challenging to access. The pandemic magnified system weaknesses, often resulting in disruptions of treatment as alcohol use during the pandemic rose. When treatment services were available, utilisation was often low for various reasons. Virtual care was implemented to offset the drop in in-person care, however accessibility was not universal. Identification of the characteristics of treatment services for AUD/PAU that impact accessibility, as perceived by the individuals accessing or providing the services, will provide insights to enable improved access. We will perform a scoping review that will identify characteristics of services for treatment of AUD/PAU that have been identified as barriers to or facilitators of service access from the perspectives of these groups. METHODS AND ANALYSIS We will follow scoping review methodological guidance from the Joanna Briggs Institute. Using the OVID platform, we will search Ovid MEDLINE including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, APA PsychInfo, Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews and CINAHL (Ebsco Platform). Multiple reviewers will screen citations. We will seek studies reporting data collected from individuals with AUD/PAU or providers of treatment for AUD/PAU on service-level factors affecting access to care. We will map barriers to and facilitators of access to AUD/PAU treatment services identified in the relevant studies, stratified by service type and key measures of inequity across service users. ETHICS AND DISSEMINATION This research will enhance awareness of existing evidence regarding barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use. Findings will be disseminated through publications, conference presentations and a stakeholder meeting. As this is a scoping review of published literature, no ethics approval was required.
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Affiliation(s)
- Dianna Wolfe
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberly Corace
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | | | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alyssa Grant
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, Ontario, Canada
| | - Karen Cohen
- Canadian Psychological Association, Ottawa, Ontario, Canada
| | - Gord Garner
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | - Sarah Konefal
- Research, Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Amy Porath
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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16
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Challenges in Perinatal Drug Testing. Obstet Gynecol 2022; 140:163-166. [DOI: 10.1097/aog.0000000000004808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
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17
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Watson DP, Staton MD, Grella CE, Scott CK, Dennis ML. Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2022; 17:22. [PMID: 35303913 PMCID: PMC8931576 DOI: 10.1186/s13011-022-00449-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
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Affiliation(s)
- Dennis P. Watson
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Monte D. Staton
- grid.185648.60000 0001 2175 0319Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Christine E. Grella
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Christy K. Scott
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Michael L. Dennis
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761 USA
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18
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Brookfield S, Selvey L, Maher L, Fitzgerald L. ‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211073911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Linda Selvey
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Lisa Fitzgerald
- School of Public Health, The University of Queensland, Brisbane, Australia
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19
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Gottlieb A, Bakos-Block C, Langabeer JR, Champagne-Langabeer T. Sociodemographic and Clinical Characteristics Associated with Improvements in Quality of Life for Participants with Opioid Use Disorder. Healthcare (Basel) 2022; 10:healthcare10010167. [PMID: 35052330 PMCID: PMC8775674 DOI: 10.3390/healthcare10010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The Houston Emergency Opioid Engagement System was established to create an access pathway into long-term recovery for individuals with opioid use disorder. The program determines effectiveness across multiple dimensions, one of which is by measuring the participant’s reported quality of life (QoL) at the beginning of the program and at successive intervals. Methods: A visual analog scale was used to measure the change in QoL among participants after joining the program. We then identified sociodemographic and clinical characteristics associated with changes in QoL. Results: 71% of the participants (n = 494) experienced an increase in their QoL scores, with an average improvement of 15.8 ± 29 points out of a hundred. We identified 10 factors associated with a significant change in QoL. Participants who relapsed during treatment experienced minor increases in QoL, and participants who attended professional counseling experienced the largest increases in QoL compared with those who did not. Conclusions: Insight into significant factors associated with increases in QoL may inform programs on areas of focus. The inclusion of counseling and other services that address factors such as psychological distress were found to increase participants’ QoL and success in recovery.
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Affiliation(s)
- Assaf Gottlieb
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
| | - Christine Bakos-Block
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
| | - James R. Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
- McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
- Correspondence:
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20
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Frost MC, Matson TE, Richards JE, Lee AK, Achtmeyer CE, Bradley KA, Williams EC. Barriers and facilitators to changing drinking and receiving alcohol-related care: Interviews with Veterans Health Administration primary care patients who indicated interest but did not enroll in an alcohol care management intervention trial. Subst Abus 2022; 43:1197-1206. [PMID: 35657656 PMCID: PMC9555295 DOI: 10.1080/08897077.2022.2074602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Most people with alcohol use disorder do not receive treatment, and primary care (PC)-based management of alcohol use disorder is a key strategy to close this gap. Understanding PC patients' perspectives on changing drinking and receiving alcohol-related care is important for this goal, particularly among those who decline alcohol-related care. This study examined perspectives on barriers and facilitators to changing drinking and receiving alcohol-related care among Veterans Health Administration (VA) PC patients who indicated interest but did not enroll in the Choosing Healthier drinking Options In primary CarE trial (CHOICE), which tested a PC-based alcohol care management intervention. Methods: VA PC patients with frequent heavy drinking who indicated interest in CHOICE but did not enroll were invited to participate. Twenty-seven patients completed in-person, semi-structured interviews. Interview transcripts were analyzed using iterative deductive and inductive content analysis. Results: Participants were mostly men (96%) and White (59%), and the mean age was 48. Seventy-four percent met criteria for alcohol use disorder, and the median number of past-week standard drinks was 41.5. Participants reported fewer alcohol-related problems, lower importance of/readiness to change drinking, and higher confidence in their ability to change than patients who enrolled in the CHOICE trial. Barriers fell into 5 domains: drinking fulfills need(s); reducing drinking or treatment is not needed; treatment is not effective/not acceptable; alcohol-related stigma; and practical barriers. Facilitators fell into 4 domains: reasons to change drinking; social support; treatment is acceptable/meets patients' needs; and practical facilitators. Participants discussed how Veteran identity and military experiences impacted drinking and willingness to receive care, which amplified multiple barriers/facilitators. Conclusions: This study identified barriers and facilitators to changing drinking and receiving alcohol-related care among VA PC patients who indicated interest but did not enroll in an alcohol care management trial. Findings can inform patient-centered interventions and support clinicians in engaging patients in care.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108,Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195
| | - Theresa E. Matson
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108,Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195,Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101
| | - Julie E. Richards
- Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195,Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101
| | - Amy K. Lee
- Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101
| | - Carol E. Achtmeyer
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108
| | - Katharine A. Bradley
- Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195,Kaiser Permanente Washington Health Research Institute,
1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE
Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D)
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs
(VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA
98108,Department of Health Systems and Population Health,
University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA
98195
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21
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Kowalchuk A, Gonzalez SJ, Mejia MC, Zoorob RJ. Substance Use Disorders. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Glass JE, Tiffany B, Matson TE, Lim C, Gundersen G, Kimbel K, Hartzler AL, Curran GM, McWethy AG, Caldeiro RM, Bradley KA. Approaches for implementing digital interventions for alcohol use disorders in primary care: A qualitative, user-centered design study. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221135264. [PMID: 37091101 PMCID: PMC9924279 DOI: 10.1177/26334895221135264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Digital interventions, such as smartphone apps, can be effective in treating alcohol use disorders (AUD). However, efforts to integrate digital interventions into primary care have been challenging. To inform successful implementation, we sought to understand how patients and clinicians preferred to use apps in routine primary care. Methods This study combined user-centered design and qualitative research methods, interviewing 18 primary care patients with AUD and nine primary care clinicians on topics such as prior experiences with digital tools, and design preferences regarding approaches for offering apps for AUD in primary care. Interviews were recorded and transcribed for template analysis whereby a priori codes were based on interview topics and refined through iterative coding. New codes and cross-cutting themes emerged from the data. Results Patient participants with AUD indicated they would be more likely to engage in treatment if primary care team members were involved in their use of apps. They also preferred to see clinicians “invested” and recommended that clinicians ask about app use and progress during follow-up appointments or check-ins. Clinician participants valued the opportunity to offer apps to their patients but noted that workflows would need to be tailored to individual patient needs. Time pressures, implementation complexity, and lack of appropriate staffing were cited as barriers. Clinicians proposed concrete solutions (e.g., education, tools, and staffing models) that could improve their ability to use apps within the constraints of primary care and suggested that some patients could potentially use apps without clinician support. Conclusions A user-centered approach to engaging patients in digital alcohol interventions in primary care may require personalized support for both initiation and follow-up. Meeting patients’ needs likely require increased staffing and efficient workflows in primary care. Health systems should consider offering multiple pathways for enrolling patients in apps to accommodate individual preferences and contextual barriers. Plain Language Summary Healthcare systems have begun using app-based treatments to help patients manage their health conditions, including alcohol use disorders. Some apps have been tested in research studies and appear to be effective. However, it is difficult for healthcare teams to offer apps to patients. Clinicians must engage in new activities that they have not done before, such as “teaching” patients to use apps and checking in on their use of the apps. Identifying how to use apps in routine healthcare is critical to their successful implementation. This study interviewed 27 people, including healthcare providers and patients in primary care, to uncover the most optimal ways to offer apps to patients with alcohol use disorders. The interviews combined the use of qualitative research methods and user-centered design. Results suggest that to use to address alcohol use disorders, primary care teams should be prepared to offer personalized support to patients. Both patient and clinician interviewees said that the steps required to use apps must be intuitive and simple. Patients could gain more benefits if clinicians introduced the apps and guided patients to use them, as opposed to making apps available for patients to download and use on their own. However, the exact approach to offering apps would depend on a given patient’s preferences and the extent that staffing was available in the clinic to support patients. Health systems should be prepared to offer and support patients in their use of apps, which should accommodate patient preferences and the constraints of the clinic.
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Affiliation(s)
- Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brooks Tiffany
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Catherine Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea L. Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | | | - Ryan M. Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, USA
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23
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Barry DT, Oberleitner DE, Beitel M, Oberleitner LMS, Gazzola MG, Eller A, Madden LM, Zheng X, Bergman E, Tamberelli JF. A Student Walks into Class … Vignettes to Identify Substance Use Disorder Models of Illness among College Students. Subst Use Misuse 2022; 57:1523-1533. [PMID: 35787230 DOI: 10.1080/10826084.2022.2091787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students. METHODS Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness. RESULTS Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition. CONCLUSIONS Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut, USA
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Anthony Eller
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaoying Zheng
- APT Foundation, Inc, New Haven, Connecticut, USA.,Yale University, New Haven, Connecticut, USA
| | - Emma Bergman
- APT Foundation, Inc, New Haven, Connecticut, USA.,Quinnipiac School of Medicine, Hamden, Connecticut, USA
| | - Joseph F Tamberelli
- APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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24
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Clark A, Lanzillotta-Rangeley J, Stem J. "If You Could Wave a Magic Wand": Treatment Barriers in the Rural Midwest. Subst Abuse 2021; 15:11782218211053343. [PMID: 34924756 PMCID: PMC8679048 DOI: 10.1177/11782218211053343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The multigenerational health considerations and negative economic impacts related to the opioid epidemic are many. Increasing numbers of opioid-related fatalities are bolstered by barriers related to access to evidence-based treatment. Ohio is ranked second in the country for number of opioid-related deaths, and for many their treatment needs remain unmet due to impaired access to effective treatment, in rural, medically underserved areas of the state. PURPOSE The goal of this study was to assess opioid use disorder treatment barriers in order to increase access to evidence-based treatment, wrap around services, and harm reduction efforts to support the reintegration of persons with substance use disorder back into society and subsequently reduce opioid fatalities in a rural, medically underserved region of Ohio. METHODS As part of a larger mixed-methods study design where a community health survey was randomly distributed to residents in a rural county in Ohio, this study used qualitative methods to triangulate findings. To supplement the data received from the surveys, 20persons with a diagnosed opioid use disorder (OUD) took part in focus group sessions guided by trained researchers. The sessions were transcribed, and the data was analyzed using Braun and Clarke's thematic analysis method. RESULTS Three major themes emerged from the data: epigenetics and exposure, management of disease including re-integration into society, and disease process. The participant data created insight regarding the need to recognize OUD as a chronic condition that must be addressed with integrated components of medical, behavioral, and mental health morbidities throughout the lifespan and across generations. CONCLUSIONS Findings from this study support the need for targeted interventions for integrated care and improved wrap around services such as transportation, sober living, and employment.
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Affiliation(s)
- Angela Clark
- College of Nursing, University of Cincinnati,
Cincinnati, OH, USA
| | | | - Jack Stem
- College of Nursing, University of Cincinnati,
Cincinnati, OH, USA
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25
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Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention. Addict Sci Clin Pract 2021; 16:51. [PMID: 34362445 PMCID: PMC8343892 DOI: 10.1186/s13722-021-00259-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is invested in expanding access to medication treatment for opioid use disorder (MOUD) to save lives. Access varies across VHA facilities and, thus, requires implementation strategies to promote system-wide adoption of MOUD. We conducted a 12-month study employing external facilitation that targeted MOUD treatment among low-adopting VHA facilities. In this study, we sought to evaluate the patterns of perceived barriers over 1 year of external implementation facilitation using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Methods We randomly selected eight VHA facilities from the bottom quartile of the proportion of Veterans with an OUD diagnosis receiving MOUD (< 21%). The 1-year external implementation intervention included developmental evaluation to tailor the facilitation, an on-site visit, and monthly facilitation calls. Facilitators recorded detailed notes for each call on a structured template. Qualitative data was analyzed by coding and mapping barriers to the constructs in the i-PARIHS framework (Innovation, Recipients, Context). We identified emerging themes within each construct by month. Results Barriers related to the Innovation, such as provider perception of the need for MOUD in their setting, were minimal throughout the 12-month study. Barriers related to Recipients were predominant and fluctuated over time. Recipient barriers were common during the initial months when providers did not have the training and waivers necessary to prescribe MOUD. Once additional providers (Recipients) were trained and waivered to prescribe MOUD, Recipient barriers dropped and then resurfaced as the facilities worked to expand MOUD prescribing to other clinics. Context barriers, such as restrictions on which clinics could prescribe MOUD and fragmented communication across clinics regarding the management of patients receiving MOUD, emerged more prominently in the middle of the study. Conclusions VHA facilities participating in 12-month external facilitation interventions experienced fluctuations in barriers to MOUD prescribing with contextual barriers emerging after a facilitated reduction in recipient- level barriers. Adoption of MOUD prescribing in low-adopting VHA facilities requires continual reassessment, monitoring, and readjustment of implementation strategies over time to meet challenges. Although i-PARIHS was useful in categorizing most barriers, the lack of conceptual clarity was a concern for some constructs. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00259-1.
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26
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Neighbors CJ, Hussain S, O'Grady M, Manseau M, Choi S, Hu X, Burke C, Lincourt P. Predictive validity of the New York State Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) for continuous engagement in treatment among individuals recommended for outpatient care. J Subst Abuse Treat 2021; 131:108559. [PMID: 34272131 DOI: 10.1016/j.jsat.2021.108559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/26/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The New York State (NYS) Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) was launched in 2015 to determine the most appropriate level of care for individuals seeking addiction treatment. However, research has not studied its predictive validity. We examined the predictive validity of the LOCADTR recommendation for outpatient treatment by determining whether those who entered a level of care (LOC) concordant with the LOCADTR recommendation differed in continuous engagement in treatment compared to those who entered a discordant LOC. METHODS The study combined data from two NYS administrative sources, the LOCADTR database and a treatment registry. The study examined characteristics of the clients who entered concordant and discordant LOCs as well as tested for differences in continuous engagement of clients who entered discordant care compared to a propensity score-matched comparison group of clients who entered the concordant LOC. RESULTS Among clients for whom the LOCADTR recommended the outpatient LOC, concordant clients who entered the outpatient LOC were more likely to be retained in care than discordant clients who entered the inpatient LOC (aOR = 0.53; 95% CI = 0.36, 0.77). We did not observe statistical differences in continuous engagement among clients who were recommended for outpatient and entered that LOC versus those who entered the outpatient rehabilitation LOC instead (aOR = 1.08; 95% CI = 0.90, 1.30). CONCLUSION This study provides support for predictive validity of recommendations stemming from the LOCADTR. Clients, treatment providers, and payers benefited from a tool that provides clear guidance and predictively valid recommendations for treatment placement. The study found that clients were more likely to be retained in treatment for 6 months or longer if admitted to outpatient care, as recommended by the LOCADTR algorithm, rather than to inpatient treatment. One factor accounting for the longer engagement in outpatient care is the low level of continuity of care among patients being discharged from inpatient treatment.
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Affiliation(s)
- Charles J Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Megan O'Grady
- Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Marc Manseau
- New York State Office of Addiction Services and Supports, Albany, NY, USA; Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Xiaojing Hu
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Constance Burke
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Pat Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
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Glass JE, Matson TE, Lim C, Hartzler AL, Kimbel K, Lee AK, Beatty T, Parrish R, Caldeiro RM, Garza McWethy A, Curran GM, Bradley KA. Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives. J Med Internet Res 2021; 23:e25866. [PMID: 34255666 PMCID: PMC8293157 DOI: 10.2196/25866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Catherine Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rebecca Parrish
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Angela Garza McWethy
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, United States
| | - Geoffrey M Curran
- University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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28
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Whitman L, Olesker W. Introduction - Addiction: A Ubiquitous Problem. PSYCHOANALYTIC STUDY OF THE CHILD 2021. [DOI: 10.1080/00797308.2020.1859302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laura Whitman
- Faculty, Columbia Center for Psychoanalytic Training and Research
- Faculty, Psychoanalytic Association of New York
- Clinical Assistant Professor of Psychiatry, Columbia University Irving Medical Center
| | - Wendy Olesker
- Faculty, Psychoanalytic Association of New York
- Training and Supervising Analyst, The New York Psychoanalytic Institute; Faculty, New York University
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29
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Nguemeni Tiako MJ, Sweeney L. The Government's Involvement in Prenatal Drug Testing May Be Toxic. Matern Child Health J 2021; 26:761-763. [PMID: 33392931 DOI: 10.1007/s10995-020-03110-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
In 25 U.S. states, healthcare professionals are mandated to report pregnant people for substance use to child protection service (CPS) agencies. This practice is not evidence-based, and we believe it harms the patient-provider relationship, opposes reproductive autonomy, and contributes to racial disparities in CPS referrals and their outcomes. Black patients are more often screened and reported than white patients for prenatal substance use; besides the impact on their obstetric care, this may be a barrier to seeking treatment for substance use disorders. Furthermore, strict, punitive state-level policies are associated with greater odds of neonatal abstinence syndrome. The treatment of substance use disorders in pregnancy under the Child Abuse Prevention and Treatment Act opposes robust evidence understanding substance use disorders as chronic illnesses. Among non-pregnant people seeking healthcare, substance use is not a "reportable offense." This double marginalization of pregnant patients limits their autonomy and unduly exposes them to the criminal-legal system. Given disparities in prenatal drug screening, Black pregnant patients are at greater risk of such double-jeopardy. Public health and medical organizations have released policy statements against states' punitive laws, but little has changed. Healthcare providers and institutions should prioritize evidence-based care to benefit the health and wellbeing of birthing person and their infant and combat "legal" interference at the clinic and public-health scale.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Yale School of Medicine, 367 Cedar Street, New Haven, CT, 06511, USA.
- Department of Emergency Medicine, Center for Emergency Care and Policy Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Lena Sweeney
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, USA
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30
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Hadland SE, Yule AM, Levy SJ, Hallett E, Silverstein M, Bagley SM. Evidence-Based Treatment of Young Adults With Substance Use Disorders. Pediatrics 2021; 147:S204-S214. [PMID: 33386323 PMCID: PMC7879425 DOI: 10.1542/peds.2020-023523d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among adolescents and young adults, in this special article, we review principles of care related to SUD treatment of young adults. SUDs are most commonly diagnosed during young adulthood, but most of the evidence guiding the treatment of this population has been obtained from older adult study participants. Extrapolating evidence from older populations, the expert group asserted the following principles for SUD treatment: It is important that clinicians who work with young adults effectively identify and address SUD to avert long-term addiction and its associated adverse health outcomes. Young adults receiving addiction treatment should have access to a broad range of evidence-based assessment, psychosocial and pharmacologic treatments, harm reduction interventions, and recovery services. These evidence-based approaches should be tailored to young adults' needs and provided in the least restrictive environment possible. Young adults should enter care voluntarily; civil commitment to treatment should be a last resort. In many settings, compulsory treatment does not use evidence-based approaches; thus, when treatment is involuntary, it should reflect recognized standards of care. Continuous engagement with young adults, particularly during periods of relapse, should be considered a goal of treatment and can be supported by care that is patient-centered and focused on the young adult's goals. Lastly, substance use treatments for young adults should be held to the same evidence and quality standards as those for other chronic health conditions.
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Affiliation(s)
- Scott E Hadland
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Amy M Yule
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sharon J Levy
- Departments of Psychiatry and Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
- Adolescent Substance Use and Addiction Program and Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Eliza Hallett
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Michael Silverstein
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Sarah M Bagley
- Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
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31
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Małkiewicz MA, Małecki A, Toborek M, Szarmach A, Winklewski PJ. Substances of abuse and the blood brain barrier: Interactions with physical exercise. Neurosci Biobehav Rev 2020; 119:204-216. [PMID: 33038347 DOI: 10.1016/j.neubiorev.2020.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/22/2020] [Accepted: 09/25/2020] [Indexed: 12/22/2022]
Abstract
Substance use disorders pose a common medical, social and financial problem. Among the pathomechanisms of substance use disorders, the disruption and increased permeability of the blood-brain barrier has been recently revealed. Physical exercise appears to be a relatively inexpensive and feasible way to implement behavioral therapy counteracting the blood-brain barrier impairment. Concomitantly, there are also studies supporting a potential protective role of selected substances of abuse in maintaining the blood-brain barrier integrity. In this review, we aim to provide a summary on the modulatory influence of physical exercise, a non-pharmacological intervention, on the blood-brain barrier alterations caused by substances of abuse. Further studies are needed to understand the precise mechanisms that underlie various effects of physical exercise in substance use disorders.
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Affiliation(s)
- Marta A Małkiewicz
- Applied Cognitive Neuroscience Lab, Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland.
| | - Andrzej Małecki
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Michal Toborek
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Biochemistry and Molecular Biology, University of Miami, Miami, USA
| | - Arkadiusz Szarmach
- 2-nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Paweł J Winklewski
- 2-nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland; Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland
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32
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Developing interagency collaboration to address the opioid epidemic: A scoping review of joint criminal justice and healthcare initiatives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102849. [PMID: 32653668 DOI: 10.1016/j.drugpo.2020.102849] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/23/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND With the current opioid epidemic impacting well over half of all counties across the United States, initiatives that encourage interagency collaboration between first responder organizations appear necessary to comprehensively address this crisis. Police, fire, and emergency medical services (EMS) are in a unique position to identify substance users and provide necessary resources to initiate treatment, yet there is not sufficient evidence of joint collaborative programs between law enforcement/first responders and healthcare providers. METHODS In this scoping review we examine the current state of joint criminal justice and healthcare interventions, specifically, opioid and substance use pre-arrest initiatives via emergency first responders and police officers. We relied on data from the last 10 years across three major databases to assess the extent of criminal justice (CJ) and healthcare collaborations as a response to individuals with opioid use disorder (OUD). We specifically focused on interventional programs between criminal justice first responders (pre-arrest) and healthcare providers where specific outcomes were documented. RESULTS We identified only a small number (6) of studies involving interventions that met this criteria, suggesting very limited study of joint interagency collaboration between law enforcement first responders and healthcare providers. Most had small samples, none were in the southern states, and all but one were initiated within the last 5 years. CONCLUSIONS Although studies describing joint efforts of early intercept criminal justice responses and healthcare interventions were few, existing studies suggest that such programs were effective at improving treatment referral and retention outcomes. Greater resources are needed to encourage criminal justice and healthcare collaboration and policies, making it easier to share data, refer patients, and coordinate care for individuals with OUD.
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Atkins DN, Durrance CP. State Policies That Treat Prenatal Substance Use As Child Abuse Or Neglect Fail To Achieve Their Intended Goals. Health Aff (Millwood) 2020; 39:756-763. [DOI: 10.1377/hlthaff.2019.00785] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Danielle N. Atkins
- Danielle N. Atkins is an assistant professor of health management and informatics at the University of Central Florida, in Orlando
| | - Christine Piette Durrance
- Christine Piette Durrance is an associate professor of public policy at the University of North Carolina at Chapel Hill
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Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction 2020; 115:668-678. [PMID: 31642124 PMCID: PMC7725424 DOI: 10.1111/add.14836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
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Patients With Substance Use Disorders Leaving Against Medical Advice: Strategies for Improvement. J Addict Med 2020; 12:421-423. [PMID: 29939874 DOI: 10.1097/adm.0000000000000432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: In this issue of the Journal of Addiction Medicine, 2 studies fill an important gap in knowledge by examining predictors of leaving against medical advice from inpatient withdrawal management settings. The studies identify important risk factors for leaving against medical advice and highlight important areas for inpatient withdrawal management. These include the use of substance specific standardized protocols and initiation of opioid agonist treatment instead of opioid detoxification given harms associated with opioid withdrawal. Further need for increased training in addiction medicine for primary care physicians, and use of inpatient addiction medicine consult services as part of early intervention for substance withdrawal are also discussed.
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Kowalchuk A, Gonzalez SJ, Mejia MC, Zoorob RJ. Substance Use Disorders. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Warrington JS, Brett A, Foster H, Brandon J, Francis-Fath S, Joseph M, Fung M. Driving Access to Care: Use of Mobile Units for Urine Specimen Collection During the Coronavirus Disease-19 (COVID-19) Pandemic. Acad Pathol 2020; 7:2374289520953557. [PMID: 32989424 PMCID: PMC7502679 DOI: 10.1177/2374289520953557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022] Open
Abstract
Patients with substance use disorders (SUD) are at increased risk of both coronavirus disease-19 complications as well as exacerbations of their current conditions due to social distancing and isolation. Innovations that provide increased access to support substance use disorder patients may mitigate long-term sequelae associated with continued or renewed drug use. To improve patient access during the coronavirus disease-19 pandemic, we deployed a mobile unit to enable access to urine drug testing where needed for patients suffering from substance use disorder. Over a 3-week pilot program, 54 patients received urine drug testing across 5 providers and 8 zip codes. The mobile unit was cost-effective, demonstrating a volume-dependent 19% lower cost compared to pre-coronavirus disease-19 patient service centers in a similar geographic region. The mobile unit was well-received by patients and providers with an average of 9 out of 10 satisfaction scores and allowed for access to urine drug testing for 67% patients who would not have received testing during this time frame. No statistically significant differences were found in substance use positivity rates in comparison to pre-coronavirus disease findings; however, some shifts in use included higher rates of fentanyl and opioid positivity and reductions in tetrahydrocannabinol and cocaine use in the mobile collections setting. Deployment of mobile collection services during the coronavirus disease-19 pandemic has shown to be an effective mechanism for supporting patients suffering from substance use disorder, allowing for access to care of this often stigmatized, vulnerable population.
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Affiliation(s)
- Jill S Warrington
- Aspenti Health, South Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Robert Larner College of Medicine, University of Vermont Medical Center, VT, USA
| | | | | | | | | | - Michael Joseph
- Aspenti Health, South Burlington, VT, USA
- True Vector Management Consulting, Milton, VT, USA
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, Robert Larner College of Medicine, University of Vermont Medical Center, VT, USA
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Abstract
This chapter describes recent clinical trials for opioid use disorder (OUD), an area that has rapidly accelerated in response to the opioid overdose crisis in the USA and newly appropriated funding. Trials involve a wide range of compounds including cannabinoids and psychedelics, new and existing compounds targeting domains emerging from addiction neuroscience, agents repurposed from other indications, and novel strategies including vaccines, enzymes, and other biologicals. In parallel, new formulations of existing compounds offer immediate promise, as do a variety of web-based interventions and smartphone-delivered apps. Trials focused on implementing existing effective interventions in mainstream healthcare settings, and others focused on special populations, e.g., adolescents, criminal justice, pregnant women, native Americans, etc., have the potential to vastly expand treatment in the near term. Given the range of ongoing and recent trials, this chapter is not intended to be an exhaustive review but rather to present an overview of approaches within the framework of the opioid treatment cascade and the context of current OUD pharmacotherapies.
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Affiliation(s)
- Esther Blessing
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
| | - Sanya Virani
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - John Rotrosen
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Osborne-Leute V, Pugatch M, Hruschak V. Social work: Addressing substance use in the 21st century. Subst Abus 2019; 40:435-440. [PMID: 31746677 DOI: 10.1080/08897077.2019.1690090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Marianne Pugatch
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Valerie Hruschak
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Patel KK, Jones PG, Ellerbeck EF, Buchanan DM, Chan PS, Pacheco CM, Moneta G, Spertus JA, Smolderen KG. Underutilization of Evidence-Based Smoking Cessation Support Strategies Despite High Smoking Addiction Burden in Peripheral Artery Disease Specialty Care: Insights from the International PORTRAIT Registry. J Am Heart Assoc 2019; 7:e010076. [PMID: 30371269 PMCID: PMC6474973 DOI: 10.1161/jaha.118.010076] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Smoking is the most important risk factor for peripheral artery disease (PAD). Smoking cessation is key in PAD management. We aimed to examine smoking rates and smoking cessation interventions offered to patients with PAD consulting a vascular specialty clinic; and assess changes in smoking behavior over the year following initial visit. Methods and Results A total of 1272 patients with PAD and new or worsening claudication were enrolled at 16 vascular specialty clinics (2011–2015, PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry). Interviews collected smoking status and cessation interventions at baseline, 3, 6, and 12 months. Among smokers, transition state models analyzed smoking transitions at each time point and identified factors associated with quitting and relapse. On presentation, 474 (37.3%) patients were active, 660 (51.9%) former, and 138 (10.8%) never smokers. Among active smokers, only 16% were referred to cessation counseling and 11% were prescribed pharmacologic treatment. At 3 months, the probability of quitting smoking was 21%; among those continuing to smoke at 3 months, the probability of quitting during the next 9 months varied between 11% and 12% (P<0.001). The probability of relapse among initial quitters was 36%. At 12 months, 72% of all smokers continued to smoke. Conclusions More than one third of patients with claudication consulting a PAD provider are active smokers and few received evidence‐based cessation interventions. Patients appear to be most likely to quit early in their treatment course, but many quickly relapse and 72% of all patients smoking at baseline are still smoking at 12 months. Better strategies are needed to provide continuous cessation support. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
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Affiliation(s)
- Krishna K. Patel
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Philip G. Jones
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | - Donna M. Buchanan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Paul S. Chan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | | | - John A. Spertus
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Kim G. Smolderen
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
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Gonzales-Castaneda R, McKay JR, Steinberg J, Winters KC, Yu CH(A, Valdovinos IC, Casillas JM, McCarthy KC. Testing mediational processes of substance use relapse among youth who participated in a mobile texting aftercare project. Subst Abus 2019; 43:1-12. [PMID: 31638878 PMCID: PMC7174140 DOI: 10.1080/08897077.2019.1671941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a study that measured the impact of an aftercare intervention on primary substance use relapse among youth who completed treatment in Los Angeles County for SUDs. The aftercare intervention, Project ESQYIR-Educating and Supporting inQuisitive Youth In Recovery, utilized text messaging to monitor relapse and recovery processes, provide feedback, reminders, support, and education among youth from SUD specialty settings during the initial 3-month period following treatment completion. Method: Mediational modeling informed by Baron and Kenny was used to examine the extent to which select recovery processes including participation in extracurricular activities and self-help, were impacted by the texting intervention, and if such processes helped sustain recovery and prevent primary substance use relapse. The data come from a two-group randomized controlled pilot study testing the initial efficacy of a mobile health texting aftercare intervention among 80 youth (Mage= 20.7, SD = 3.5, range: 14-26 years) who volunteered to participate after completing SUD treatment between 2012 and 2013. Results: Among the two recovery processes examined in the mediational modeling, only involvement in extracurricular activities mediated the effects of the texting aftercare intervention on reductions in primary substance use relapse; not self-help participation. Conclusion: Findings from this pilot study offer greater understanding about potential recovery-related mechanisms of action of mobile aftercare interventions. Mobile texting was found to promote increased engagement in recovery-related behaviors such as participation in extracurricular activities, which mediated the effects of the mobile aftercare intervention on decreasing primary substance use relapse. Findings suggest mobile approaches may be effective for increasing adherence to a wide-array of recovery behavioral regiments among youth populations challenged by complex behavioral issues.
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Affiliation(s)
- Rachel Gonzales-Castaneda
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA
- Azusa Pacific University, Psychology Department, Azusa, CA
| | - James R. McKay
- University of Pennsylvania, Center on the Continuum of Care in the Addictions, Philadelphia, PA
| | - Jane Steinberg
- Azusa Pacific University, Psychology Department, Azusa, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Muzyk A, Smothers ZPW, Collins K, MacEachern M, Wu LT. Pharmacists' attitudes toward dispensing naloxone and medications for opioid use disorder: A scoping review of the literature. Subst Abus 2019; 40:476-483. [PMID: 31418645 PMCID: PMC6920531 DOI: 10.1080/08897077.2019.1616349] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Pharmacists are on the frontline caring for patients at risk of an opioid overdose and for patients with an opioid use disorder (OUD). Dispensing naloxone and medications for OUD and counseling patients about these medications are ways pharmacists can provide care. Key to pharmacists' involvement is their willingness to take on these practice responsibilities. Methods: The purpose of this scoping review is to identify, evaluate, and summarize published literature describing pharmacists' attitudes toward naloxone and medications for OUD, i.e., methadone, buprenorphine, and naltrexone. All searches were performed on December 7, 2018, in 5 databases: Embase.com, PubMed.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Central Register of Controlled Trials via Wiley, and Clarivate Web of Science. Articles included original research conducted in the United States, described attitude-related language toward naloxone and medications for OUD, and pharmacists. Results: A total of 1323 articles were retrieved, 7 were included. Five studies reported on pharmacists' attitudes toward naloxone dispensing, 1 study reported on attitudes toward naloxone, buprenorphine, and buprenorphine/naloxone, and 1 reported on attitudes toward buprenorphine/naloxone. Respondents were diverse, including pharmacists from different practice specialties. Studies found that pharmacists agreed with a naloxone standing order, believed that naloxone should be dispensed to individuals at risk of an opioid overdose, and were supportive of dispensing buprenorphine. A minority of pharmacists expressed negative attitudes. Barriers cited to implementation included education and training, workflow, and management support. Conclusions: Pharmacists were positive in their attitudes toward increased practice responsibilities for patients at risk of an opioid overdose or with an OUD. Pharmacists must receive education and training to be current in their understanding of OUD medications, and they must be supported in order to provide effective care to this patient population.
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Affiliation(s)
- Andrew Muzyk
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Zachary P W Smothers
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn Collins
- Doctor of Pharmacy Program, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Wallace PM, Warrier S, Kahn MJ, Welsh C, Fischer M. Developing an opioid curriculum for medical students: A consensus report from a national symposium. Subst Abus 2019; 41:425-431. [DOI: 10.1080/08897077.2019.1635971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paul M. Wallace
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sarita Warrier
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Marc J. Kahn
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Office of the Dean, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Melissa Fischer
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Abstract
The United States opioid epidemic is a nationwide public health crisis. Initially driven by increased consumption and availability of pharmaceutical opioids, an increasing number of opioid overdoses are now related to heroin and illicitly manufactured fentanyl and fentanyl analogs. Addressing this epidemic requires addressing the stigma associated with opioid use disorders and its treatment, improving access to efficacious treatment options, specifically methadone and buprenorphine, and reducing opioid overdose fatalities with distribution of the opioid antagonist and overdose reversal agent naloxone.
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Affiliation(s)
- Jennifer Lyden
- Denver Health and Hospital Authority, Denver, CO, United States; Department of Medicine, University of Colorado School of Medicine, Denver, CO, United States.
| | - Ingrid A Binswanger
- Department of Medicine, University of Colorado School of Medicine, Denver, CO, United States; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States; Colorado Permanente Medical Group, Aurora, CO, United States
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Hawkins EJ, Danner AN, Malte CA, Painter JM, Lott AM, Baer JS. Feasibility of a care management approach for complex substance use disorders and high acute services utilization. J Subst Abuse Treat 2018; 92:100-108. [PMID: 30032938 PMCID: PMC9809937 DOI: 10.1016/j.jsat.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/27/2018] [Accepted: 07/03/2018] [Indexed: 01/05/2023]
Abstract
Although care management approaches have potential to improve clinical outcomes and reduce healthcare costs, little is known about the feasibility of these interventions in patients with complex substance use disorders (SUDs), which are characterized by psychosocial, psychological and/or medical needs and high acute healthcare utilization. We assessed the feasibility of recruitment, treatment engagement, compliance with follow-up assessments, and patients' use of a care management model (CMM) at one medical center. This pilot study enrolled patients with complex SUDs and high healthcare utilization in a prospective, 1-year open trial of a CMM adapted for specific needs of this patient population. Patients completed baseline assessment, monthly assessments of treatment progress and follow-up assessments at 6- and 12-months. Patients' use of CMM services were abstracted from medical records. Of 33 eligible patients approached, 23 (69.6%) men enrolled in the study. Approximately 59.1% of patients attended a CMM visit in ≥8 of 12 months enrolled. Patients completed monthly assessments in 4.9 (SD = 3.1) of 12 months enrolled, and 68.2% and 41.0% completed 6- and 12-month follow-up assessments, respectively. The most common CMM service delivered was care coordination/case management, followed by supportive counseling, motivational interviewing, and medication management. Recruitment and engagement results suggest that use of CMM for complex SUDs and high healthcare utilization is feasible. More robust outreach services may be needed to increase engagement among those who did not engage or lost contact with the CMM team. Additional research is needed to evaluate if CMM enhances retention, improves outcomes and reduces acute healthcare utilization of patients with complex SUDs.
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Affiliation(s)
- Eric J. Hawkins
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Healthcare System, Seattle, WA,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Seattle, WA,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA,Department of Psychology, University of Washington, Seattle, WA
| | - Anissa N. Danner
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Healthcare System, Seattle, WA,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Seattle, WA
| | - Carol A. Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Healthcare System, Seattle, WA,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Seattle, WA
| | | | - Aline M.K. Lott
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Healthcare System, Seattle, WA,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Seattle, WA
| | - John S. Baer
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Healthcare System, Seattle, WA,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Seattle, WA,Department of Psychology, University of Washington, Seattle, WA
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Bradley KA, Bobb JF, Ludman EJ, Chavez LJ, Saxon AJ, Merrill JO, Williams EC, Hawkins EJ, Caldeiro RM, Achtmeyer CE, Greenberg DM, Lapham GT, Richards JE, Lee AK, Kivlahan DR. Alcohol-Related Nurse Care Management in Primary Care: A Randomized Clinical Trial. JAMA Intern Med 2018; 178:613-621. [PMID: 29582088 PMCID: PMC5885256 DOI: 10.1001/jamainternmed.2018.0388] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Experts recommend that alcohol use disorders (AUDs) be managed in primary care, but effective approaches are unclear. OBJECTIVE To test whether 12 months of alcohol care management, compared with usual care, improved drinking outcomes among patients with or at high risk for AUDs. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at 3 Veterans Affairs (VA) primary care clinics. Between October 11, 2011, and September 30, 2014, the study enrolled 304 outpatients who reported heavy drinking (≥4 drinks per day for women and ≥5 drinks per day for men). INTERVENTIONS Nurse care managers offered outreach and engagement, repeated brief counseling using motivational interviewing and shared decision making about treatment options, and nurse practitioner-prescribed AUD medications (if desired), supported by an interdisciplinary team (CHOICE intervention). The comparison was usual primary care. MAIN OUTCOMES AND MEASURES Primary outcomes, assessed by blinded telephone interviewers at 12 months, were percentage of heavy drinking days in the prior 28 days measured by timeline follow-back interviews and a binary good drinking outcome, defined as abstinence or drinking below recommended limits in the prior 28 days (according to timeline follow-back interviews) and no alcohol-related symptoms in the past 3 months as measured by the Short Inventory of Problems. RESULTS Of 304 participants, 275 (90%) were male, 206 (68%) were white, and the mean (SD) age was 51.4 (13.8) years. At baseline, both the CHOICE intervention (n = 150) and usual care (n = 154) groups reported heavy drinking on 61% of days (95% CI, 56%-66%). During the 12-month intervention, 137 of 150 patients in the intervention group (91%) had at least 1 nurse visit, and 77 of 150 (51%) had at least 6 nurse visits. A greater proportion of patients in the intervention group than in the usual care group received alcohol-related care: 42% (95% CI, 35%-49%; 63 of 150 patients) vs 26% (95% CI, 19%-35%; 40 of 154 patients). Alcohol-related care included more AUD medication use: 32% (95% CI, 26%-39%; 48 of 150 patients in the intervention group) vs 8% (95% CI, 5%-13%; 13 of 154 patients in the usual care group). No significant differences in primary outcomes were observed at 12 months between patients in both groups. The percentages of heavy drinking days were 39% (95% CI, 32%-47%) and 35% (95% CI, 28%-42%), and the percentages of patients with a good drinking outcome were 15% (95% CI, 9%-22%; 18 of 124 patients) and 20% (95 % CI, 14%-28%; 27 of 134 patients), in the intervention and usual care groups, respectively (P = .32-.44). Findings at 3 months were similar. CONCLUSIONS AND RELEVANCE The CHOICE intervention did not decrease heavy drinking or related problems despite increased engagement in alcohol-related care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01400581.
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Affiliation(s)
- Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Medicine, University of Washington, Seattle.,Department of Health Services, University of Washington, Seattle.,Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Evette J Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Laura J Chavez
- Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus.,Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - Emily C Williams
- Department of Health Services, University of Washington, Seattle.,Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Eric J Hawkins
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ryan M Caldeiro
- Behavioral Health Support Services, Kaiser Foundation Health Plan of Washington, Seattle
| | - Carol E Achtmeyer
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,General Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Diane M Greenberg
- General Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Innovative Programs Research Group, School of Social Work, University of Washington, Seattle
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Health Services, University of Washington, Seattle
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Health Services, University of Washington, Seattle
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Daniel R Kivlahan
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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47
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Weinstein N, Przybylski AK, Murayama K. A prospective study of the motivational and health dynamics of Internet Gaming Disorder. PeerJ 2017; 5:e3838. [PMID: 28975056 PMCID: PMC5624294 DOI: 10.7717/peerj.3838] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/01/2017] [Indexed: 12/03/2022] Open
Abstract
The American Psychiatric Association has identified Internet Gaming Disorder (IGD) as a potential psychiatric condition and called for research to investigate its etiology, stability, and impacts on health and behavior. The present study recruited 5,777 American adults and applied self-determination theory to examine how motivational factors influence, and are influenced by, IGD and health across a six month period. Following a preregistered analysis plan, results confirmed our hypotheses that IGD criteria are moderately stable and that they and basic psychological need satisfaction have a reciprocal relationship over time. Results also showed need satisfaction promoted health and served as a protective factor against IGD. Contrary to what was hypothesized, results provided no evidence directly linking IGD to health over time. Exploratory analyses suggested that IGD may have indirect effects on health by way of its impact on basic needs. Implications are discussed in terms of existing gaming addiction and motivational frameworks.
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Affiliation(s)
| | - Andrew K. Przybylski
- Oxford Internet Institute, University of Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, United Kingdom
| | - Kou Murayama
- School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom
- Kochi University of Technology, Japan
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48
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Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091030. [PMID: 28885557 PMCID: PMC5615567 DOI: 10.3390/ijerph14091030] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/22/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
Alcohol use is a major cause of disability and death worldwide. To improve prevention and treatment addressing unhealthy alcohol use, experts recommend that alcohol-related care be integrated into primary care (PC). However, few healthcare systems do so. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). Here, we describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. Across the three sites (N = 74,225 PC patients), alcohol screening increased from 8.9% of patients pre-implementation to 62% post-implementation (p < 0.0001), with a corresponding increase in assessment for alcohol use disorders (AUD) from 1.2 to 75 patients per 10,000 seen (p < 0.0001). Increases were sustained over a year later, with screening at 84.5% and an assessment rate of 81 patients per 10,000 seen across all sites. In addition, there was a 50% increase in the number of new AUD diagnoses (p = 0.0002), and a non-statistically significant 54% increase in treatment within 14 days of new diagnoses (p = 0.083). The pilot informed an ongoing stepped-wedge trial in the remaining 22 PC sites.
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49
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Upshur CC, Jenkins D, Weinreb L, Gelberg L, Orvek EA. Homeless women's service use, barriers, and motivation for participating in substance use treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:252-262. [PMID: 28806101 PMCID: PMC6088786 DOI: 10.1080/00952990.2017.1357183] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/16/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Homeless women are at high risk for substance use disorder (SUD), and are a growing proportion of the homeless population. However, homeless women experience barriers to engaging in substance use services. OBJECTIVES Among homeless women with SUD, to explore service use, motivation to change, service barriers, and willingness to have substance use and mental health problems addressed in primary health care. METHODS Women with SUD were sampled from 11 Health Care for the Homeless (HCH) primary care clinics in 9 states, yielding 241 with either an alcohol or drug use disorder who then completed questions about SUD services. RESULTS Over 60% of women with dual alcohol and drug use disorders used some type of SUD service in the past year, while 52% with a drug only disorder, and 44% with an alcohol only disorder used services. The most mentioned barrier to service use was depression, but cost, wait time, where to find treatment, and facilities located too far away, were also frequently noted. A large proportion across all groups indicated high motivation for treatment and willingness to discuss their SUD in a primary care setting. CONCLUSION There are continued barriers to SUD service use for homeless women despite high motivation for treatment, and willingness to be asked about SUD and mental health problems in primary care. HCH primary care sites should more systematically ask about SUD and mental health issues and address women's expressed need for support groups and alternative therapies to more holistically address their SUD needs.
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Affiliation(s)
- Carole C. Upshur
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester MA 01655 USA
- Department of Quantitative Methods, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester MA 01655 USA
| | - Darlene Jenkins
- National Health Care for the Homeless Council, 604 Gallating Ave. Suite 106, Nashville, TN 37206 USA
| | - Linda Weinreb
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester MA 01655 USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, and Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024 USA
| | - Elizabeth Aaker Orvek
- Department of Quantitative Methods, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester MA 01655 USA
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50
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Saitz R, Daaleman TP. Now is the Time to Address Substance Use Disorders in Primary Care. Ann Fam Med 2017; 15:306-308. [PMID: 28694263 PMCID: PMC5505446 DOI: 10.1370/afm.2111] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/18/2017] [Accepted: 06/18/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Richard Saitz
- Boston University School of Public Health, Boston, Massachusetts
| | - Timothy P Daaleman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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