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Quiroz Santos E, Stein LAR, Delaney DJ, Bassett SS, Rossi JS, van den Berg JJ. Screening, Brief Intervention and Referral to Treatment (SBIRT): An examination of health disparities. J Ethn Subst Abuse 2024:1-21. [PMID: 38967519 DOI: 10.1080/15332640.2024.2367234] [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: 07/06/2024]
Abstract
Risky substance use can lead to a variety of negative health outcomes, yet treatment is often underutilized by historically minoritized racial/ethnic groups. Screening, Brief Intervention and Referral to Treatment (SBIRT) is effective in changing substance use patterns across diverse settings and for diverse demographic groups. However, few studies have focused on whether individuals receive the appropriate level of care based on screening criteria. The purpose of this study was to investigate intervention match/mismatch and factors (e.g., service site, gender, race, ethnicity, age, socio-economic status) that predicted the likelihood of being matched/mismatched to an intervention. A sample of N = 3412 were available for analyses and logistic regressions were performed to examine the relationship between matching/mismatching to an intervention and other factors. Of participants, 2222 (65%) were matched to an intervention and 1190 (35%) were mismatched to an intervention. Being older, Hispanic, and receiving SBIRT by health-teams designed to reduce health disparities was related to increased odds of being mismatched. Exploratory results suggested that across predictors, individuals were more likely to receive a lesser intervention than their screening score indicated. Most clients were matched well to intervention as based on screening score. When mismatch occurred, a lower level of care was given. Staff may benefit from attending to more client engagement so that clients return for more intensive interventions; and agencies may need more resources to facilitate client access to services.
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Affiliation(s)
- Esther Quiroz Santos
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, Cranston, Rhode Island, USA
- Department of Behavioral & Social Sciences and Center for Alcohol & Addiction Studies, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Daniel J Delaney
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Shayna S Bassett
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph S Rossi
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jacob J van den Berg
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Gallant KC, Harris BR. Community Collaboration for Suicide and Overdose Prevention: Attitudes, Perceptions, and Practices of Community-Based Professionals and County Leadership in New York State. Community Ment Health J 2024; 60:859-868. [PMID: 38374308 DOI: 10.1007/s10597-024-01238-x] [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: 11/13/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
Deaths by overdose and suicide have been steadily rising, yet efforts to jointly address them have been limited despite shared risk and protective factors. The purpose of this study was to explore ways of jointly addressing these two significant public health issues at the community level. To accomplish this goal, we distributed an electronic survey via email to all 58 Local Mental Hygiene Directors (LMHDs) and 184 substance use and 57 suicide prevention coalition leads in New York State in March 2019 to better understand attitudes, perceptions, and practice of community-based overdose and suicide prevention. A total of 140 unique individuals completed the survey for a 47% usable response rate. Participants overwhelmingly reported that suicide and overdose are preventable and that individuals with risky substance use would benefit most from suicide prevention services compared to other populations. In addition, substance use prevention coalition leads reported less awareness of key suicide prevention programs than suicide prevention coalition leads and LMHDs; LMHDs were generally most familiar with suicide prevention programs. Finally, substance use and suicide prevention coalition leads were interested in collaborating to raise awareness, provide training, and implement community-based activities. These findings demonstrate a consensus among county leadership and substance use and suicide prevention coalition leads that suicide and overdose are prevalent in their communities and that increased collaboration to address these two public health issues is warranted. Results suggest a need for education, training, and technical assistance to support collaboration.
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Affiliation(s)
- Katharine C Gallant
- Public Health Research Department, NORC at the University of Chicago, Bethesda, MD, USA.
| | - Brett R Harris
- Public Health Research Department, NORC at the University of Chicago, Bethesda, MD, USA
- Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, NY, USA
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Kowalchuk A, Ostovar-Kermani TG, Schaper K, Grigoryan L, Hirth JM, Mejia MC, Spooner KK, Zoorob RJ. Factors associated with intention to implement SBI and SUD treatment: a survey of primary care clinicians in Texas enrolled in an online course. BMC PRIMARY CARE 2024; 25:192. [PMID: 38807054 PMCID: PMC11134618 DOI: 10.1186/s12875-024-02427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice. METHODS This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory of Planned Behavior and included measures of knowledge, subjective norms, and perceived behavioral controls related to SBI and SUD treatment. Intention to engage in SBI and SUD treatment was assessed as the outcome. RESULTS Of 645 participants included in this study, 59.5% were physicians. Knowledge was low, with less than half correctly reporting what was considered a standard drink (39.6%) and only 20% knew the correct number of alcoholic beverages considered risky drinking in 21-year-old non-pregnant women. Subjective norms, such as having colleagues within their practice support addressing SUDs, and perceived behavioral control such as having SUD screening routinized within clinic workflows, were positively associated with intention to implement SBI and SUD treatment in primary care settings. CONCLUSIONS Modifying knowledge gaps, subjective norms, and perceived behavioral control requires a multipronged interventional approach that blends accessible clinician training with systemic workplace enhancements and a collective shift in professional norms.
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Affiliation(s)
- Alicia Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA.
| | - Tiffany G Ostovar-Kermani
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Kylie Schaper
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Jacqueline M Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Maria Carmenza Mejia
- Department of Population Health and Social Medicine, Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, USA
| | - Kiara K Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
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Khazaee-Pool M, Naghibi SA, Pashaei T, Ponnet K. Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol. Addict Sci Clin Pract 2024; 19:40. [PMID: 38755676 PMCID: PMC11097512 DOI: 10.1186/s13722-024-00472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs. METHODS/DESIGN The present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants' perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique. DISCUSSION This is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Seyed Abolhassan Naghibi
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Department of Health Promotion and Education, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Jones M, Seel CJ, Dymond S. Electronic-Screening, Brief Intervention and Referral to Treatment (e-SBIRT) for Addictive Disorders: Systematic Review and Meta-Analysis. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241248926. [PMID: 38756012 DOI: 10.1177/29767342241248926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Addictive disorders are significant global public health burdens. Treatment uptake with these disorders is low and outcomes can be mixed. Electronic screening, brief intervention, and referral to treatment (e-SBIRT) programs have potential to improve uptake and treatment outcomes. To date, however, no prior review of the literature has been conducted to gauge the effectiveness of e-SBIRT for addictive disorders. METHODS We conducted a systematic review and meta-analysis of the literature concerning e-SBIRT for addictive disorders by surveying the MEDLINE, PubMed, Web of Science, Scopus, Embase, and PsycInfo databases on January 17, 2023. RESULTS Ten articles were included at analysis reporting evaluation of e-SBIRT interventions for substance use disorders including alcohol use in a variety of settings. No articles were identified regarding treatment for behavioral addictions such as disordered/harmful gambling. Meta-analysis found e-SBIRT to be effective at reducing drinking frequency in the short term only. e-SBIRT was not found to be advantageous over control conditions for abstinence or other treatment outcomes. We identified and described common components of e-SBIRT programs and assessed the quality of available evidence, which was generally poor. CONCLUSION The present findings suggest that research regarding e-SBIRT is concentrated exclusively on higher-risk substance use. There is a lack of consensus regarding the effectiveness of e-SBIRT for addictive disorders. Although common features exist, e-SBIRT designs are variable, which complicates identification of the most effective components. Overall, the quality of outcome evidence is low, and furthermore, high-quality experimental treatment evaluation research is needed.
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Affiliation(s)
- Matthew Jones
- School of Psychology, Swansea University, Swansea, UK
| | | | - Simon Dymond
- School of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
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Samuolis J, Osborne-Leute V. Web-based alcohol use and cannabis use screening, brief intervention, and referral to treatment: college students' experience and perceived norms. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-7. [PMID: 38713868 DOI: 10.1080/07448481.2024.2346352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/14/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVES The objectives were to examine students' experience, perceived student norms, and perceived campus norms regarding web-based SBIRT based on substance use risk level. PARTICIPANTS One hundred forty-three students completed an alcohol SBIRT program and survey, and 80 students completed a cannabis SBIRT program and survey. METHODS Undergraduates were recruited through campus-wide emails and a research management system. RESULTS The majority of students found the SBIRT programs to be understandable, comfortable, and useful. Students reporting moderate/high-risk alcohol use were less likely to believe the information in the SBIRT program (X2 (1, N = 143) = 16.334, p < .001). Students with moderate/high-risk cannabis use were less likely to indicate that students on campus would be open to taking the web-based SBIRT (X2 (1, N = 80) = 7.680, p = .006). CONCLUSIONS Understanding students' experience and perceived norms regarding web-based SBIRT can inform efforts to utilize this approach as part of campus prevention efforts.
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Yimsaard P, Mootz JJ, Rungnirundorn T, Janamnuaysook R, Samitpol K, Phanuphak N, Wainberg ML. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed-method pre-implementation study using the Consolidated Framework for Implementation Research. Addiction 2024; 119:863-874. [PMID: 38168887 PMCID: PMC11009091 DOI: 10.1111/add.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. DESIGN A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews. SETTING The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand. PARTICIPANTS In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. MEASUREMENTS Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. FINDINGS Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. CONCLUSION Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer J. Mootz
- Columbia University Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Fisher S, Benner K, Huang H, Day E. Substance Use Screening, Brief Intervention, and Referral to Treatment in Urban Settings: Barriers and Facilitators to Implementation With Minoritized Youth. THE JOURNAL OF SCHOOL HEALTH 2024; 94:299-307. [PMID: 38239183 PMCID: PMC10939917 DOI: 10.1111/josh.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Substance use in minoritized youth is associated with negative long-term health and life outcomes. The present study explores perspectives of school stakeholders at urban minority-serving schools regarding integration of an evidence-based intervention, screening, brief intervention, and referral to treatment (SBIRT) into existing school prevention models. METHODS Twenty-two participants were interviewed using the Consolidated Framework for Implementation Research to identify barriers and facilitators to SBIRT implementation. Qualitative data were transcribed, coded, and analyzed. RESULTS Four major themes related to barriers to SBIRT implementation included: lack of training, unclear role expectations, student confidentiality, and punitive school climates. The 3 major facilitators included: the feasibility of the intervention, its fit within multi-tiered systems of support, and the districts increasing collaboration with community mental health providers. These major themes along with other minor themes are discussed. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY SBIRT implementation within low-income, minority-serving schools may reduce substance use disparities among minoritized youth, improving health and life outcomes. Recommendations addressed training, school climate, and student engagement, highlighting a collaborative and supportive approach involving all stakeholders. CONCLUSIONS While SBIRT implementation has barriers and facilitators, overall, school staff were optimistic about implementation. In light of these findings, additional research should embed SBIRT in these settings.
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Affiliation(s)
- Sycarah Fisher
- Department of Educational Psychology, University of Georgia, Athens, GA USA
| | - Kalea Benner
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | | | - Elizabeth Day
- Department of Educational Psychology, University of Georgia, Athens, GA USA
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Byhoff E, Dinh DH, Lucas JA, Marino M, Heintzman J. Mental Health Care Use by Ethnicity and Preferred Language in a National Cohort of Community Health Center Patients. Psychiatr Serv 2024; 75:363-368. [PMID: 37880967 PMCID: PMC10984775 DOI: 10.1176/appi.ps.20220585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Disparities in U.S. mental health care by race and ethnicity have long been documented. The authors sought to compare specialty mental health service use among non-Hispanic White, English-preferring Hispanic, and Spanish-preferring Hispanic patients who accessed care in community health centers (CHCs). METHODS Retrospective electronic medical records data were extracted for patients ages ≥18 years who received care in 2012-2020 at a national CHC network. Zero-inflated Poisson regression models were used to estimate the likelihood of receiving mental health services, which was compared with expected annual rates of mental health service use. RESULTS Of the 1,498,655 patients who received care at a CHC during the study, 14.4% (N=215,098) received any specialty mental health services. English- and Spanish-preferring Hispanic patients were less likely to have had a mental health visit (OR=0.69, 95% CI=0.61-0.77, and OR=0.65, 95% CI=0.54-0.78, respectively). Compared with non-Hispanic White patients, Spanish-preferring Hispanic patients had an estimated annualized rate of 0.59 (95% CI=0.46-0.76) mental health visits. CONCLUSIONS Among patients who were likely to receive specialty mental health services, Spanish-preferring patients had a significantly lower rate of mental health care use. Although overall access to mental health care is improving, unequal access to recurring specialty mental health care remains among patients who do not prefer to use English.
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Affiliation(s)
- Elena Byhoff
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Dang H Dinh
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Jennifer A Lucas
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Miguel Marino
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - John Heintzman
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
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Berger L, Topitzes J, Di Paolo M. Training Master of Social Work Students in Brief Intervention for Unhealthy Alcohol Use: Results of a Validated Adherence Assessment. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:299-306. [PMID: 38258841 DOI: 10.1177/29767342231214407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Many social workers receive limited training in working with clients engaged in unhealthy substance use. As a result, national organizations and agencies such as the Council on Social Work Education and individual social work programs are beginning to address this need by incorporating training into higher education social work programs. The purpose of this study was to examine Master of Social Work (MSW) students' adherence to a brief intervention protocol for unhealthy alcohol use. METHODS A total of 91 MSW students consented to the assessment of their digital, audio-recorded class assignment by independent raters. RESULTS Although 90% of MSW student participants were found to be overall adherent to the protocol, gaps in training quality were also identified. CONCLUSIONS Lessons learned for addressing the gaps are discussed, along with future directions for teaching and learning in social work related to substance use.
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Affiliation(s)
- Lisa Berger
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - James Topitzes
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michelle Di Paolo
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Dionisi T, Di Sario G, De Mori L, Spagnolo G, Antonelli M, Tarli C, Sestito L, Mancarella FA, Ferrarese D, Mirijello A, Vassallo GA, Gasbarrini A, Addolorato G. Current treatments of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:127-152. [PMID: 38555114 DOI: 10.1016/bs.irn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Emerging treatments for alcohol dependence reveal an intricate interplay of neurobiological, psychological, and circumstantial factors that contribute to Alcohol Use Disorder (AUD). The approved strategies balancing these factors involve extensive manipulations of neurotransmitter systems such as GABA, Glutamate, Dopamine, Serotonin, and Acetylcholine. Innovative developments are engaging mechanisms such as GABA reuptake inhibition and allosteric modulation. Closer scrutiny is placed on the role of Glutamate in chronic alcohol consumption, with treatments like NMDA receptor antagonists and antiglutamatergic medications showing significant promise. Complementing these neurobiological approaches is the progressive shift towards Personalized Medicine. This strategy emphasizes unique genetic, epigenetic and physiological factors, employing pharmacogenomic principles to optimize treatment response. Concurrently, psychological therapies have become an integral part of the treatment landscape, tackling the cognitive-behavioral dimension of addiction. In instances of AUD comorbidity with other psychiatric disorders, Personalized Medicine becomes pivotal, ensuring treatment and prognosis are closely defined by individual characteristics, as exemplified by Lesch Typology models. Given the high global prevalence and wide distribution of AUD, a persistent necessity exists for development and improvement of treatments. Current research efforts are steadily paving paths towards more sophisticated, effective typology-based treatments: a testament to the recognized imperative for enhanced treatment strategies. The potential encapsulated within the ongoing research suggests a promising future where the clinical relevance of current strategies is not just maintained but significantly improved to effectively counter alcohol dependence.
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Affiliation(s)
- Tommaso Dionisi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Giovanna Di Sario
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Lorenzo De Mori
- Department of Neuroscience, Section of Psychiatry, Catholic University of Rome, Rome, Italy
| | - Giorgia Spagnolo
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Mariangela Antonelli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Sestito
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Antonio Mancarella
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Ferrarese
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | | | - Antonio Gasbarrini
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy.
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Pautrat M, Barbier E, Lebeau JP. Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review. Prev Med Rep 2024; 38:102610. [PMID: 38375183 PMCID: PMC10874871 DOI: 10.1016/j.pmedr.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Substance use disorders substantially contribute to the global burden of disease. Early detection in primary care is recommended, and numerous screening tests are available. However, barriers to addictive disorder screening exist and the feasibility of using these tests in primary care is unclear. This study aims to identify available addictive disorder screening tests whose feasibility has been evaluated in primary care. This systematic literature review was performed using Pubmed, PsycINFO, and the Cochrane Library databases. The search strategy included four research topics: addictive disorders, screening, primary care, and feasibility. Selection criteria included published studies evaluating the feasibility of an addictive disorder screening test in primary care. Data were extracted for each included article, and each analyzed screening test. Of the 4911 articles selected, 20 were included and 16 screening tests were studied. Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time. Patient feasibility was measured using criteria including "ease of use", comprehension, or format preference. Self-administered formats were preferred, especially electronic versions. Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders. Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference. The criteria synthesized in this review could serve as a basis for screening test feasibility studies in primary care given the absence of feasibility study guidelines.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
| | | | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
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Ellick KL, Kroelinger CD, Chang K, McGown M, McReynolds M, Velonis AJ, Bronson E, Riehle-Colarusso T, Pliska E, Akbarali S, Mueller T, Dronamraju R, Cox S, Barfield WD. Increasing access to quality care for pregnant and postpartum people with opioid use disorder: Coordination of services, provider awareness and training, extended postpartum coverage, and perinatal quality collaboratives. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209208. [PMID: 37939904 PMCID: PMC10711679 DOI: 10.1016/j.josat.2023.209208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Fifteen states participating in the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC) developed action plan goals and activities to address the rise in opioid use disorder (OUD) among birthing persons. In a separate initiative, Perinatal Quality Collaboratives (PQCs) from 12 states participating in Centers for Disease Control and Prevention (CDC)-supported activities hosted trainings to improve the provision of OUD services and implement protocols for screening and treatment in delivery facilities. METHODS This descriptive study synthesizes qualitative data extracted from 15 OMNI LC state action plans, excerpts from qualitative interviews conducted with OMNI LC state teams, and quantitative data from quarterly project performance monitoring reports from 12 CDC-funded PQCs implementing quality improvement activities to address clinical service gaps for pregnant and postpartum people with OUD. Qualitative data were deidentified, coded as barriers or facilitators, then aggregated into emergent themes. Count data are presented for quantitative results. RESULTS The OMNI LC states identified a lack of coordinated care among providers, stigma toward people with OUD, discontinued insurance coverage, and inconsistencies in screening and treating birthing people with OUD as barriers to accessing quality care. State-identified facilitators for access to quality care included: 1) improving engagement and communication between providers and other partners to integrate medical and behavioral health services post-discharge, and facilitate improved patient care postpartum; 2) training providers to prescribe medications for OUD, and to address bias and reduce patient stigma; 3) extending Medicaid coverage up to one year postpartum to increase access to and continuity of services; and 4) implementing screening, brief intervention, and referral to treatment (SBIRT) in clinical practice. PQCs demonstrated that increased provider trainings to treat OUD, improvements in implementation of standardized protocols, and use of evidence-based tools can facilitate access to and coordination of services in delivery facilities. CONCLUSION State-identified facilitators for increasing access to care include coordinating integrated services, extending postpartum coverage, and provider trainings to improve screening and treatment. PQCs provide a platform for identifying emerging areas for quality improvement initiatives and implementing clinical best practices to provide comprehensive, quality perinatal care for birthing populations.
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Affiliation(s)
- Kecia L Ellick
- CDC Foundation (CDCF), 600 Peachtree St. NE #1000, Atlanta, GA 30308, United States of America
| | - Charlan D Kroelinger
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America.
| | - Karen Chang
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Molly McGown
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America; Access Community Health Network, 600 W. Fulton St., Chicago, IL 60661, United States of America
| | - Matthew McReynolds
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America
| | - Alisa J Velonis
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America
| | - Emily Bronson
- CDC Foundation (CDCF), 600 Peachtree St. NE #1000, Atlanta, GA 30308, United States of America
| | - Tiffany Riehle-Colarusso
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Ellen Pliska
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Sanaa Akbarali
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Trish Mueller
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Ramya Dronamraju
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Shanna Cox
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Wanda D Barfield
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
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Hightower T, Stucke S, Specht K, Bertolani J, Malone C, Dhanyamraju K, Rivera N, Rodriguez R. Alcohol Misuse Screening Performance Improvement Initiative. J Trauma Nurs 2024; 31:30-33. [PMID: 38193489 DOI: 10.1097/jtn.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND A trauma registry review of our trauma center's alcohol misuse screening compliance noted inconsistent screening and data collection methods, putting our American College of Surgeons trauma center reverification at risk for a deficiency. OBJECTIVE The objective of this study was to evaluate an alcohol misuse screening improvement initiative on screening compliance in trauma patients. METHODS This before and after analysis of a quality improvement initiative to improve alcohol misuse screening was conducted from 2019 to 2021 at a Southwestern U.S. Level II trauma center on admitted trauma patients aged 13 years and older. The multicomponent initiative included a change in the screening instrument and timing of application, implementing electronic medical record documentation screens, and educating staff. The primary outcome measure was screening adherence. RESULTS A total of n = 4,734 patients were included in the study period. Alcohol misuse screening improved from 2.9% to 87.4% and remained sustained for over a year after the initiative's implementation. CONCLUSION The performance improvement initiative improved the alcohol misuse screening process, resulting in consistent screenings exceeding the American College of Surgeons standards of 80% for verified trauma centers.
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Affiliation(s)
- Todd Hightower
- Trauma Services, Sunrise Hospital and Medical Center, Las Vegas, Nevada (Mr Hightower and Mss Bertolani and Malone); Trauma Services, Sunrise Hospital and Medical Center and Department of General Surgery, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada (Drs Stucke, Rivera, and Rodriguez); and Department of General Surgery, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada (Drs Specht and Dhanyamraju)
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Anderson RE, Nickell AE, Piggott DM, Boros AP, Delahanty DL. A comparison of two strategies to assess sexual violence: general vs. specialised trauma screening strategies in two high-risk substance use health disparity samples. Eur J Psychotraumatol 2023; 14:2287331. [PMID: 38095602 PMCID: PMC10732194 DOI: 10.1080/20008066.2023.2287331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023] Open
Abstract
Background/Objective: Using two different high-risk samples, the present study compared and contrasted two different strategies/questionnaire types for assessing a history of sexual violence: a general trauma screening vs. specialised behaviourally-specific questionnaires.Methods: Sample 1 included 91 men and women seeking detoxification treatment services in a publicly funded, urban clinic who completed a trauma and substance use questionnaire battery during treatment. Sample 2 included 310 women at a rural college who completed a trauma and religious coping questionnaire battery for course credit. All participants completed both types of questionnaires: One general trauma screening questionnaire (i.e. the Life Events Checklist [LEC]) and two behaviourally-specific specialised questionnaires (i.e. the 2007 Sexual Experiences Survey [SES] and the Childhood Trauma Questionnaire [CTQ]).Results: There were large differences in the cases identified by the behaviourally-specific questionnaires (SES and CTQ) compared to the general trauma screening questionnaire (the LEC) in both samples but few differences in the prevalence rates of sexual violence detected by each questionnaire type. In the detoxification sample, the differences were especially notable for men. Follow-up analyses indicated that degree of traumatisation impacted results likely by increasing participant's willingness to endorse face-valid items on the LEC.Conclusions: For men, the behaviourally-specific questionnaires (SES/CTQ) were necessary to identify cases. For those with more severe trauma histories, the LEC was equivalent to the SES/CTQ in identifying a similar number of sexual violence cases. Thus, clinicians and researchers should consider the population when selecting assessments to identify sexual violence history.
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Affiliation(s)
- RaeAnn E. Anderson
- Psychology, University of North Dakota, Grand Forks, ND, USA
- Oriana House Inc., Akron, OH, USA
| | - Anne E. Nickell
- Psychology, University of North Dakota, Grand Forks, ND, USA
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Calihan JB, Levy S. Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics. Psychiatr Clin North Am 2023; 46:749-760. [PMID: 37879836 DOI: 10.1016/j.psc.2023.03.001] [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] [Indexed: 10/27/2023]
Abstract
Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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Bonar EE, Goldstick JE, Tan CY, Bourque C, Carter PM, Duval ER, McAfee J, Walton MA. A remote brief intervention plus social media messaging for cannabis use among emerging adults: A pilot randomized controlled trial in emergency department patients. Addict Behav 2023; 147:107829. [PMID: 37598642 DOI: 10.1016/j.addbeh.2023.107829] [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: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Interventions addressing cannabis use among emerging adults (ages 18-25) are currently needed to prevent negative outcomes. Emergency Department (ED) visits provide an opportunity to initiate interventions. In this pilot study, we created a brief intervention (BI), extended with private social media messaging for emerging adult ED patients who use cannabis regularly. Study aims were to examine intervention feasibility, acceptability, and descriptive outcomes. METHODS We recruited and randomized N = 58 emerging adults (M age 21.5 years, 65.5% female) who used cannabis from an ED in-person and remotely after their ED visit (given COVID-19 restrictions). Participants randomized to the intervention (N = 30) received a Motivational Interviewing-based BI and 4 weeks of health coaching via private social media; control participants received a resource brochure and entertaining social media messaging. Follow-ups occurred at 1-month and 3-months. RESULTS Most intervention participants liked the BI (95.8%), found it helpful to discuss cannabis use in the BI (91.7%), and liked interacting with coaches on social media (86.3%). Social media content (e.g., video clips, images/still pictures/memes) were highly rated. Descriptively, the intervention group showed theory-consistent changes in importance of and intentions to change cannabis (increases vs. decrease/stability in control group), whereas findings for cannabis consumption/consequences were mixed. CONCLUSIONS This BI paired with social media messaging was acceptable in a sample of emerging adults from an ED who used cannabis regularly. Despite feasibility challenges due to COVID-19, this intervention warrants future investigation with a larger sample and longer follow-up period, with attention to the changing cannabis landscape when measuring outcomes.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA.
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Burlington Building, 325 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA.
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
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Turner S, Allen VM, Graves L, Tanguay R, Green CR, Cook JL. Guideline No. 443a: Opioid Use Throughout Women's Lifespan: Fertility, Contraception, Chronic Pain, and Menopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102143. [PMID: 37977720 DOI: 10.1016/j.jogc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To provide health care providers with the best evidence on opioid use and women's health. Areas of focus include general patterns of opioid use and safety of use; care of women who use opioids; stigma, screening, brief intervention, and referral to treatment; hormonal regulation; reproductive health, including contraception and fertility; sexual function; perimenopausal and menopausal symptoms; and chronic pelvic pain syndromes. TARGET POPULATION The target population includes all women currently using or contemplating using opioids. OUTCOMES Open, evidence-informed dialogue about opioid use will lead to improvements in patient care and overall health. BENEFITS, HARMS, AND COSTS Exploring opioid use through a trauma-informed approach offers the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Therefore, health care providers and patients must understand the potential role of opioids in women's health (both positive and negative) to ensure informed decision-making. EVIDENCE A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, illicit drugs, fertility, pregnancy, breastfeeding, and aging. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care providers who care for women. TWEETABLE ABSTRACT Opioid use can affect female reproductive function; health care providers and patients must understand the potential role of opioids in women's health to ensure informed decision-making. SUMMARY STATEMENTS RECOMMENDATIONS.
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Kierski K, Maupin E. Screening and therapeutic recommendations for patients with alcohol use disorder. JAAPA 2023; 36:17-22. [PMID: 37820080 DOI: 10.1097/01.jaa.0000979456.51155.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
ABSTRACT Alcohol use disorder (AUD) is the most prevalent substance use disorder worldwide. Early screening can identify patients at risk for developing AUD, creating opportunities for prevention and early intervention. This article encourages the use of AUD screening tools, explores AUD treatments, and aims to equip clinicians with evidence-based strategies to prevent and manage AUD.
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Affiliation(s)
- Kathleen Kierski
- At the time this article was written, Kathleen Kierski was a student in the PA program at Wingate (N.C.) University. She now practices at WakeMed Hospital in Raleigh, N.C. Elizabeth Maupin is an associate professor in the PA program at Wingate University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Turner S, Allen VM, Graves L, Tanguay R, Green CR, Cook JL. Directive clinique n o 443a : Opioïdes aux différentes étapes de la vie des femmes : Fertilité, contraception, douleur chronique et ménopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102145. [PMID: 37977725 DOI: 10.1016/j.jogc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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Gutierrez F. Standardized Models for Identification and Intervention for Emergency Department Patients at Risk for Alcohol Use Disorder. Crit Care Nurs Q 2023; 46:241-254. [PMID: 37226916 DOI: 10.1097/cnq.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Alcohol use disorder (AUD) is chronic, lasting a person's lifetime. An increase in driving under the influence of alcohol, as well as emergency department (ED) visits, has been reported. The Alcohol Use Disorder Identification Test Consumption (AUDIT-C) is utilized to assess hazardous drinking. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model assists in early intervention and referral for treatment. The Transtheoretical Model standardized instrument assesses individual readiness to change. These tools may be used by nurses and nonphysicians in the ED to help reduce alcohol use and the consequences of its use.
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Affiliation(s)
- Felipe Gutierrez
- UCLA PhD Graduate, Los Angeles, California & Scripps Health Case Manager
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22
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Kim J, Yeom CW, Kim H, Jung D, Kim HJ, Jo H, Koh SB, Hahm BJ. A Novel Screening, Brief Intervention, and Referral to Treatment (SBIRT) Based Model for Mental Health in Occupational Health Implemented on Smartphone and Web-Based Platforms: Development Study With Results From an Epidemiologic Survey. J Korean Med Sci 2023; 38:e146. [PMID: 37191849 DOI: 10.3346/jkms.2023.38.e146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/02/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND While the importance of mental health is well-recognized in the field of occupational health, implementation of effective strategies in the workplace has been limited by gaps in infrastructure, program comprehensiveness, coverage, and adherence. The authors developed a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model based occupational mental health intervention, and implemented in a web-based format with a smartphone application. METHODS The SBIRT-based intervention was developed by a multidisciplinary team, including occupational health physicians, nurses, psychiatrists, and software developers. The following mental health areas were included, based on outcomes of an epidemiological survey conducted: insomnia, depression, anxiety, problematic alcohol use, and suicidal risk. The viability of the two-step evaluation process utilizing a combination of the brief version and the full-length version of the questionnaire was examined using responses from the survey. The intervention was adjusted according to the survey results and expert opinions. RESULTS The epidemiological survey included 346 employees who completed the long-form version of mental health scales. These data were the used to confirm the diagnostic value of using a combination of short-form and long-form version of the scales for screening in the SBIRT model. The model uses a smartphone application for screening, provision of psychoeducation, and for surveillance. The universal methods of the model ensure it can be implemented by all occupational managers, regardless of their specialization in mental health. In addition to the two-step screening procedure to identify employees at-risk for mental health problems, the model includes a stepped care approach, based on risk stratification, to promote mental health education, management, and follow-up for continuous care. CONCLUSION The SBIRT model-based intervention provides an easy-to-implement approach for the management of mental health in the workplace. Further studies are required to examine the effectiveness and feasibility of the model.
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Affiliation(s)
- Jaehyun Kim
- Department of Psychiatry, Korea Army Training Center District Hospital, Nonsan, Korea
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Chan-Woo Yeom
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Hwang Kim
- Department of Design, Ulsan National Institute of Science and Technology (UNIST), Ulsan, Korea
| | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Jo
- Artificial Intelligence Big Data Medical Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Bong-Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Korea.
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Leibowitz GS, Turner W, Bruckenthal P, Mezzatesta M, Ramsey KS, Dyer ME. Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program. Public Health Rep 2023; 138:42S-47S. [PMID: 37226953 PMCID: PMC10226063 DOI: 10.1177/00333549231170216] [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] [Indexed: 05/26/2023] Open
Abstract
The COVID-19 pandemic has placed an unprecedented burden on patients, health care providers, and communities and has been particularly challenging for medically underserved populations impacted by the social determinants of health, as well as people with co-occurring mental health and substance use risks. This case study examines outcomes and lessons learned from a multisite low-threshold medication-assisted treatment (MAT) program at a federally qualified health center in partnership with a large suburban public university in New York to integrate and train Health Resources & Services Administration Behavioral Health Workforce Education and Training-funded graduate student trainees in social work and nursing in screening, brief intervention, and referral to treatment and patient care coordination, including social determinants of health and medical and behavioral comorbidities. The MAT program for the treatment of opioid use disorder has a low threshold for entry that is accessible and affordable, reduces barriers to care, and uses a harm reduction approach. Outcome data showed an average 70% retention rate in the MAT program and reductions in substance use. And, while more than 73% of patients reported being somewhat or definitely impacted by the pandemic, most patients endorsed the effectiveness of telemedicine and telebehavioral health, such that 86% indicated the pandemic did not affect the quality of their health care. The main implementation lessons learned were the importance of increasing the capacity of primary care and health care centers to deliver integrated care, using cross-disciplinary practicum experiences to enhance trainee competencies, and addressing the social determinants of health among populations with social vulnerabilities and chronic medical conditions.
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Affiliation(s)
- George S Leibowitz
- Schools of Social Welfare and Nursing, Stony Brook University, Stony Brook, NY, USA
| | - Win Turner
- Schools of Social Welfare and Nursing, Stony Brook University, Stony Brook, NY, USA
| | - Patricia Bruckenthal
- Schools of Social Welfare and Nursing, Stony Brook University, Stony Brook, NY, USA
| | | | - Kelly S Ramsey
- Office of Addiction Services and Supports, Albany, NY, USA
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Croskey O, Clark MK. Individualized diet conversation in primary care: A pilot intervention. Nurse Pract 2023; 48:38-46. [PMID: 36975749 DOI: 10.1097/01.npr.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Most primary care providers do not routinely discuss nutrition and diet with their patients, largely due to lack of time, inadequate resources, and perceived complexity of the topic. This article describes development and implementation of a brief protocol for systematically assessing and discussing diet during routine primary care visits to increase the frequency of these conversations and improve patient health outcomes. METHODS The authors developed a protocol for assessing both nutrition and stage of change as well as a guide for engaging in patient-led conversations about nutrition. The protocol was modeled after Screening, Brief Intervention, and Referral to Treatment and informed by the Dietary Guidelines for Americans, the Transtheoretical Model of Behavior Change, and principles of motivational interviewing. It was implemented over three months at a rural health clinic staffed by one NP. RESULTS The protocol and conversation guide were easy to use with minimal training and seamlessly incorporated into clinic workflow. The likelihood of making diet changes increased significantly following the diet conversation, with persons who initially scored lower in readiness to change ultimately reporting significantly greater increases. CONCLUSION A protocol for assessing diet and engaging patients in a stage of change-appropriate diet conversation can be efficiently integrated into a single primary care visit and increase patients' intent to change their diet. Further investigation is needed to evaluate the protocol more completely and in multiple clinics.
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Pautrat M, Renard C, Riffault V, Ciolfi D, Edeline A, Breton H, Brunault P, Lebeau JP. Cross-analyzing addiction specialist and patient opinions and experiences about addictive disorder screening in primary care to identify interaction-related obstacles: a qualitative study. Subst Abuse Treat Prev Policy 2023; 18:12. [PMID: 36803797 PMCID: PMC9938560 DOI: 10.1186/s13011-023-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/04/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Promptly identifying individuals with addictive disorders reduces mortality and morbidity and improves quality of life. Although screening in primary care with the Screening, Brief Intervention and Referral Treatment strategy has been recommended since 2008, it remains underutilized. This may be due to barriers including lack of time, patient reluctance or perhaps the timing and approach for discussing addiction with their patients. OBJECTIVE This study aims to explore and cross-analyze patient and addiction specialist experiences and opinions about early addictive disorder screening in primary care to identify interaction-related screening obstacles. DESIGN AND PARTICIPANTS Qualitative study with purposive maximum variation sampling among nine addiction specialists and eight individuals with addiction disorders conducted between April 2017 and November 2019 in Val-de-Loire, France. MAIN MEASURES Using a grounded theory approach, verbatim data was collected from face-to-face interviews with addiction specialists and individuals with addiction disorders. These interviews explored their opinions and experiences with addiction screening in primary care. Initially, two independent investigators analyzed the coded verbatim according to the data triangulation principle. Secondly, convergences and divergences between addiction specialist and addict verbatim categories were identified, analyzed, and conceptualized. KEY RESULTS Four main interaction-related obstacles to early addictive disorder screening in primary care were identified and conceptualized: the new concepts of shared self-censorship and the patient's personal red line, issues not addressed during consultations, and opposition between how physicians and patients would like to approach addictive disorder screening. CONCLUSIONS To continue analysis of addictive disorder screening dynamics, further studies to examine the perspectives of all those involved in primary care are required. The information revealed from these studies will provide ideas to help patients and caregivers start discussing addiction and to help implement a collaborative team-based care approach. TRIAL REGISTRATION This study is registered with the Commission Nationale de l'Informatique et des Libertés (CNIL) under No. 2017-093.
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Affiliation(s)
- Maxime Pautrat
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France.
- Department of General Practice, Tours Regional University Hospital, Tours, France.
| | - Caroline Renard
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Vincent Riffault
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - David Ciolfi
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Agathe Edeline
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Hervé Breton
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Paul Brunault
- Department of General Practice, Tours Regional University Hospital, Tours, France
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Qualipsy EE 1901, University of Tours, Tours, France
- Équipe de Liaison et de Soins en Addictologie, CHRU de Tours, Service d'Addictologie Universitaire, Tours, France
| | - Jean Pierre Lebeau
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
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Alsubaie S. Psychosocial Life Aspects among Substance Misuse Clients who are at Rehabilitation Phase: A Narrative Review. Health Psychol Res 2023; 11:66174. [PMID: 36777809 PMCID: PMC9907330 DOI: 10.52965/001c.66174] [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: 01/29/2023] Open
Abstract
Objective The present study aimed at exploring the psychosocial life aspects among substance misuse clients through conducting a review of the literature related to the research topic. A scoping search in the literature revealed the significant lack of both local, regional and international studies exploring the psychosocial life aspects among substance misuse clients who are at the rehabilitation stage. Method A comprehensive literature search was performed using the keywords: "psychosocial, "psychological", "social", "life", "rehabilitation" and "substance misuse". The search process was performed in the following electronic databases "MEDLINE, PubMed, CINAHL, PsycINFO". Full text articles, published in English during the period between 2016 and 2021 were included in the literature. Results A total of 7 studies were found to be in relation with the topic addressed in this study, which is the psychosocial life aspects of substance misuse clients at rehabilitation phase. The results showed that there is a significant weakness of psychosocial life aspects among substance misuse clients, in addition to a significant lack of both educational and training program that aim at enhancing and improving the psychosocial life aspects among substance misuse clients who are at the rehabilitation phase. Conclusion The study concluded that there should be concise and clear measurement tools to be used in assessing the psychosocial life aspects of substance misuse clients who are the rehabilitation phase.
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Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Weisner CM, Satre DD, Grant RW, Elson J, Ross TB, Awsare S, Lu Y, Metz VE, Sterling SA. Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study. BMJ Open 2023; 13:e064088. [PMID: 36657762 PMCID: PMC9853251 DOI: 10.1136/bmjopen-2022-064088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D). DESIGN A population-based observational study using electronic health records data. SETTING An integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care. PARTICIPANTS Adult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017. MAIN OUTCOME MEASURES We examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and 'controlled HbA1c' (HbA1c<8%) at 18-month follow-up. RESULTS For patients with hypertension, those who received BI had a modest but significant additional -0.06 reduction in drinks/drinking day (95% CI -0.11 to -0.01) and additional -0.30 reduction in drinks/week (95% CI -0.59 to -0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined. CONCLUSIONS Alcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI's long-term public health impact.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joseph Elson
- Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Reilly J, Meurk C, Heffernan E, Sara G. Substance use disorder screening and brief intervention in routine clinical practice in specialist adult mental health services: A systematic review. Aust N Z J Psychiatry 2023; 57:793-810. [PMID: 36632829 DOI: 10.1177/00048674221148394] [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: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders co-occurring with other mental health disorders are common and harmful. Clinical guidelines often recommend substance use screening and brief intervention though evidence about screening practice in mental health services is limited. This systematic review of routine clinical practice in adult mental health services aims to identify (a) proportions of screening and brief intervention, (b) how they are practised and (c) their outcomes. METHODS We searched MEDLINE, PsycINFO and Embase and relevant Cochrane databases for articles until 31 July 2021 reporting on adults in English, regardless of geographical location. Backward snowball methods were used to locate additional articles. Screening, brief intervention and mental health services were defined. Data were extracted and variables compared related to setting, period, patient cohort, substances routine substance use disorder care pathways, and study quality was assessed. RESULTS We identified 17 articles reporting routine screening within adult mental health services. Studies in community settings mainly reported on screening for alcohol and other substance use disorders, while studies from inpatient settings reported mainly on tobacco. There was marked variation in methods and screening proportions. Only two studies reported on brief intervention. CONCLUSION This systematic review shows marked variation in mental health services routine screening practices with early focus on alcohol but more recently tobacco screening. We suggest approaches to enhancing implementation of screening and brief intervention in routine care, particularly using electronic health records.
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Affiliation(s)
- John Reilly
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Carla Meurk
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Grant Sara
- NSW Ministry of Health, St Leonards, NSW, Australia
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Calihan JB, Levy S. Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics. Child Adolesc Psychiatr Clin N Am 2023; 32:115-126. [PMID: 36410898 DOI: 10.1016/j.chc.2022.08.002] [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] [Indexed: 11/28/2022]
Abstract
Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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McGovern MP, Dunn J, Bonnell LN, Leibowitz G, Waddell E, Rose G, Littenberg B. The Association Between Depression and Substance Use Among Primary Care Patients With Comorbid Medical and Behavioral Health Conditions. J Prim Care Community Health 2023; 14:21501319231200302. [PMID: 37728047 PMCID: PMC10515515 DOI: 10.1177/21501319231200302] [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: 06/08/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION The scope of primary care increasingly encompasses patient behavioral health problems, manifest typically through depression screening and treatment. Although substance use is highly comorbid with depression, it is not commonly identified and addressed in the primary care context. This study aimed to examine the association between the likelihood of substance use disorder and increased depression severity, both cross-sectionally and longitudinally, among a sample of 2409 patients from 41 geographically dispersed and diverse primary care clinics across the US. METHODS This is secondary analysis of data obtained from a multi-site parent study of integrated behavioral health in primary care, among patients with both chronic medical and behavioral health conditions. Patient reported outcome surveys were gathered from patients at 3 time points. The primary care practices were blind to which of their patients completed surveys. Included were standardized measures of depression severity (Patient Health Questionnaire-9) [PHQ-9] and substance use disorder likelihood (Global Appraisal of Individual Needs-Short Screener [GSS]). RESULTS Four percent of the study population screened positive for substance use disorder. PHQ-9 scores indicated depression among 43% of all patients. There was a significant association between the likelihood of substance use disorder and depression initially, at a 9-month follow-up, and over time. These associations remained significant after adjusting for age, gender, race, ethnicity, education, income, and other patient and contextual characteristics. CONCLUSIONS The findings suggest that substance use disorder is associated with depression severity cross-sectionally and over time. Primary care clinics and health systems might consider implementing substance use screening in addition to the more common screening strategies for depression. Especially for patients with severe depression or those who do not respond to frontline depression treatments, the undermining presence of a substance use disorder should be explored.
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Affiliation(s)
| | - Julia Dunn
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Gail Rose
- University of Vermont, Burlington, VT, USA
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Reist C, Petiwala I, Latimer J, Raffaelli SB, Chiang M, Eisenberg D, Campbell S. Collaborative mental health care: A narrative review. Medicine (Baltimore) 2022; 101:e32554. [PMID: 36595989 PMCID: PMC9803502 DOI: 10.1097/md.0000000000032554] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The Collaborative Care model is a systematic strategy for treating behavioral health conditions in primary care through the integration of care managers and psychiatric consultants. Several randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses. Large healthcare systems and organizations have begun to adopt Collaborative Care initiatives and are seeing improved treatment outcomes and provider and patient satisfaction. This review discusses current research on the effectiveness and cost-efficiency of Collaborative Care. In addition, this paper discusses its ability to adapt to specific patient populations, such as geriatrics, students, substance use, and women with perinatal depression, as well as the significance of measurement-based care and mental health screening in achieving improved clinical outcomes. Current data suggests that Collaborative Care may significantly improve patient outcomes and time-to-treatment in all reviewed settings, and successfully adapts to special patient populations. Despite the high upfront implementation burden of launching a Collaborative Care model program, these costs are generally offset by long term healthcare savings.
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Affiliation(s)
- Christopher Reist
- University of California, Irvine, Irvine, CA
- Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | | | | | | | - Maurice Chiang
- Carbon Health Technologies, Inc, Oakland, CA
- * Correspondence: Maurice Chiang, Carbon Health Technologies, Inc. 2100 Franklin Street, Suite 355, Oakland CA 94612 (e-mail: )
| | | | - Scott Campbell
- Department of Psychiatry & Behavioral Neurosciences, Cedars-Sinai Medical Care Foundation, Los Angeles, CA
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Vongsirimas N, Kesornsri S, Sitthimongkol Y, Thanoi W, Klainin-Yobas P. Evaluating psychometric properties of the Thai-version Alcohol Smoking and Substance Involvement Screening Test (ASSIST). JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2153756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Mushi D, Moshiro C, Hanlon C, Francis JM, Teferra S. Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022; 17:50. [PMID: 35794580 PMCID: PMC9258127 DOI: 10.1186/s13011-022-00479-x] [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] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers. Design A cross-sectional survey Setting Outpatient services in the six governmental primary health care facilities in Moshi district council in Tanzania. Participants A total of 1604 adults were screened for alcohol use disorder (AUD) using the Alcohol Use Disorder Identification Test (AUDIT). Participants scoring 8 or above then provided details about their help-seeking behavior and barriers to seeking care. Participants’ records were reviewed to assess the screening and management of AUD. Results In the last 12 months, 60.7% reported alcohol use, and heavy episodic drinking (HED) was reported by 37.3%. AUD (AUDIT ≥ 8) was present in 23.9%. Males were more likely to have HED (aPR = 1.43;95% CI:1.3 to 1.4) or AUD (aPR = 2.9; 95% CI 1.9 to 4.2). Both HED and AUD increased with age. Only one participant (0.3%) had documented AUD screening and management. Only 5% of participants screening positive for AUD had sought help. Reasons for not seeking care were thinking that the problem would get better by itself (55.0%), wanting to handle the problem alone (42.0%), or not being bothered by the problem (40.0%). Conclusion While reported alcohol use, HED, and AUD are common among patients presenting to primary healthcare facilities in northern Tanzania, help-seeking behavior and detection are very low. Not screening for AUD in primary health care is a missed opportunity for early detection and management. There is an urgent need to develop interventions to increase the detection of AUD by health care providers, while also addressing help-seeking behavior and barriers to seeking care.
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Bakos-Block CR, Al Rawwad T, Cardenas-Turanzas M, Champagne-Langabeer T. Contact based intervention reduces stigma among pharmacy students. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1471-1477. [PMID: 36402691 DOI: 10.1016/j.cptl.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/15/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Interventions to reduce the stigma of substance use disorders by health professionals often include didactic instruction combined with an interactive component that includes a guest speaker in recovery. Few interactive studies have focused on pharmacy students. Community pharmacists are moving to the front lines to battle the opioid epidemic; therefore, pharmacy students should be included in interventions aimed at reducing stigma by health professionals. METHODS This study examined the effects of a contact-based interactive intervention delivered by a peer recovery support specialist on perceived stigma of opioid use disorder among third-year pharmacy students (N = 115) enrolled in an integrative psychiatry course. Stigma was measured using the Brief Opioid Stigma Scale. RESULTS Our study found significant differences in students' perceived stigma, both with their personal beliefs and their beliefs regarding the public, supporting the use of interactive presentations by peer recovery support specialists to decrease perceived stigma of opioid use disorder by health professionals. CONCLUSIONS This type of intervention for pharmacy students shows promise in reducing substance use disorder stigma and should be further explored.
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Affiliation(s)
- Christine R Bakos-Block
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, United States.
| | - Tamara Al Rawwad
- University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX 78539, United States.
| | - Marylou Cardenas-Turanzas
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, United States.
| | - Tiffany Champagne-Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, United States.
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Reif S, Brolin M, Beyene TM, D’Agostino N, Stewart MT, Horgan CM. Payment and Financing for Substance Use Screening and Brief Intervention for Adolescents and Adults in Health, School, and Community Settings. J Adolesc Health 2022; 71:S73-S82. [PMID: 36122974 PMCID: PMC9945348 DOI: 10.1016/j.jadohealth.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 10/14/2022]
Abstract
Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address unhealthy substance use. With SBI services expanding beyond healthcare settings (e.g., schools, community organizations) and reaching younger populations, sustainability efforts must consider payment and financing. This narrative review incorporated rapid scoping review methods and a search of the gray literature to determine payment and financing approaches for SBI with adolescents and to describe related barriers and facilitators for its sustainability. We sought information relevant to adolescents and settings in which they receive SBI, but also reviewed sources with an adult focus. Few peer-reviewed articles met inclusion criteria, and those mostly highlighted healthcare settings. School-based settings were better described in the gray literature; little was found about community settings. SBI is mostly paid through grant funding and public and commercial insurance; school-based settings use a range of approaches including grants, public insurance, and other public funding. We call upon researchers and providers to describe the payment and financing of SBI, to inform how the uptake of SBI may be practicable and sustainable. The increasing activation and use of insurance billing codes, and the expansion of SBI beyond healthcare, is encouraging to address unhealthy substance use by adolescents.
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Affiliation(s)
- Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Mary Brolin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Tiginesh M. Beyene
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Nicole D’Agostino
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Maureen T. Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Constance M. Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Latiolais E, Morse C, Warnke K, Forest S. Implementing SBIRT to Address Maternal Marijuana Use. Neonatal Netw 2022; 41:263-272. [PMID: 36002279 DOI: 10.1891/nn-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
A quality improvement project conducted at 3 Texas hospitals to implement a new systematic process to address maternal marijuana use among breastfeeding mothers. The new process was created using the evidence-based Screening, Brief Intervention, Referral to Treatment (SBIRT) model to address maternal marijuana use. Nurses screened all postpartum mothers for marijuana use at each of the 3 hospitals. Mothers who reported ever using marijuana were advised to abstain while breastfeeding and given educational materials and a treatment referral card. Among all 3 hospitals, the mean nurses' adherence to the SBIRT process was 69 percent, exceeding the project aim of 50 percent adherence. SBIRT, which has been used extensively with other populations and settings, was easily translated into practice for use with postpartum mothers who reported using marijuana. A systematic process using SBIRT may help mitigate the risk of harm for infants of mothers who use marijuana.
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McAfee NW, Schumacher JA, Madson MB, Villarosa-Hurlocker MC, Williams DC. The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1236-1246. [PMID: 35320126 DOI: 10.1097/acm.0000000000004674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. METHOD The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. RESULTS Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. CONCLUSIONS SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.
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Affiliation(s)
- Nicholas W McAfee
- N.W. McAfee is assistant professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi; ORCID: 0000-0002-7992-9124
| | - Julie A Schumacher
- J.A. Schumacher is professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael B Madson
- M.B. Madson is professor, School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi; ORCID: 0000-0002-2025-8856
| | - Margo C Villarosa-Hurlocker
- M.C. Villarosa-Hurlocker is assistant professor, Department of Psychology, University of New Mexico, Albuquerque, New Mexico; ORCID: 0000-0002-9744-8551
| | - Daniel C Williams
- D.C. Williams is associate professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Doherty E, Wiggers J, Nathan N, Hall A, Wolfenden L, Tully B, Elliott EJ, Attia J, Dunlop AJ, Symonds I, Tsang TW, Reeves P, McFadyen T, Wynne O, Kingsland M. Iterative delivery of an implementation support package to increase and sustain the routine provision of antenatal care addressing alcohol consumption during pregnancy: study protocol for a stepped-wedge cluster trial. BMJ Open 2022; 12:e063486. [PMID: 35882461 PMCID: PMC9330336 DOI: 10.1136/bmjopen-2022-063486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antenatal care addressing alcohol consumption during pregnancy is not routinely delivered in maternity services. Although a number of implementation trials have reported significant increases in such care, the majority of women still did not receive all recommended care elements, and improvements dissipated over time. This study aims to assess the effectiveness of an iteratively developed and delivered implementation support package in: (1) increasing the proportion of pregnant women who receive antenatal care addressing alcohol consumption and (2) sustaining the rate of care over time. METHODS AND ANALYSIS A stepped-wedge cluster trial will be conducted as a second phase of a previous trial. All public maternity services within three sectors of a local health district in Australia will receive an implementation support package that was developed based on an assessment of outcomes and learnings following the initial trial. The package will consist of evidence-based strategies to support increases in care provision (remind clinicians; facilitation; conduct educational meetings) and sustainment (develop a formal implementation blueprint; purposely re-examine the implementation; conduct ongoing training). Measurement of outcomes will occur via surveys with women who attend antenatal appointments each week. Primary outcomes will be the proportion of women who report being asked about alcohol consumption at subsequent antenatal appointments; and receiving complete care (advice and referral) relative to alcohol risk at initial and subsequent antenatal appointments. Economic and process evaluation measures will also be reported. ETHICS AND DISSEMINATION Ethical approval was obtained through the Hunter New England (16/11/16/4.07, 16/10/19/5.15) and University of Newcastle Human Research Ethics Committees (H-2017-0032, H-2016-0422) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health service decision makers to inform the feasibility of conducting additional cycles to further improve antenatal care addressing alcohol consumption as well as at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12622000295741).
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Affiliation(s)
- Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Adrian John Dunlop
- Drug and Alcohol Clinical Services Research, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Tameka McFadyen
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Thurru Indigenous Health Unit, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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Sahker E, Luo Y, Sakata M, Toyomoto R, Hwang C, Yoshida K, Watanabe N, Furukawa TA. Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis. J Gen Intern Med 2022; 37:2041-2049. [PMID: 35419744 PMCID: PMC9198157 DOI: 10.1007/s11606-022-07543-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The efficacy of brief intervention (BI) for unhealthy drug use in outpatient medical care has not been sufficiently substantiated through meta-analysis despite its ongoing global delivery. This study aims to determine the efficacy of BI for unhealthy drug use and the expected length of effects, and describe subgroup analyses by outpatient setting. METHODS Trials comparing BI with usual care controls were retrieved through four databases up to January 13, 2021. Two reviewers independently screened, selected, and extracted data. Primary outcomes included drug use frequency (days used) and severity on validated scales at 4-8 months and were analyzed using random-effects model meta-analysis. RESULTS In total, 20 studies with 9182 randomized patients were included. There was insufficient evidence to support the efficacy of BI for unhealthy drug use among all outpatient medical care settings for use frequency (SMD = -0.07, 95% CI = -0.17, 0.02, p = 0.12, I2 = 37%, high certainty of evidence) and severity (SMD = -0.27, 95% CI = -0.78, 0.24, p = 0.30, I2 = 98%, low certainty of evidence). However, post hoc subgroup analyses uncovered significant effects for use frequency by setting (interaction p = 0.02), with significant small effects only in emergency departments (SMD = -0.15, 95% CI = -0.25, -0.04, p < 0.01). Primary care, student health, women's health, and HIV primary care subgroups were nonsignificant. Primary care BI revealed nonsignificant greater average use in the treatment group compared to usual care. DISCUSSION BI for unhealthy drug use lacks evidence of efficacy among all outpatient medical settings. However, small effects found in emergency departments may indicate incremental benefits for some patients. Clinical decisions for SBI or specialty treatment program referrals should be carefully considered accounting for these small effects in emergency departments. REGISTRATION PROSPERO (CRD42020157733).
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Affiliation(s)
- Ethan Sahker
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan. .,Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Chiyoung Hwang
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Metz VE, Weisner C, Satre DD, Campbell CI, Elson J, Ross TB, Lu Y, Sterling SA. Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care. Drug Alcohol Depend 2022; 235:109458. [PMID: 35453082 PMCID: PMC10122418 DOI: 10.1016/j.drugalcdep.2022.109458] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking. METHODS We fit marginal structural models with inverse probability weighting to estimate the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT. We examined effects of ABI with and without adjusting for receipt of specialty alcohol use disorder (AUD) treatment, and whether effects varied by patient demographic characteristics and alcohol use patterns. RESULTS Receiving ABI resulted in significantly greater reductions in heavy drinking days (mean difference [95% CI] = -0.26 [-0.45, -0.08]), drinking days per week (-0.04 [-0.07, -0.01]), drinks per drinking day (-0.05 [-0.08, -0.02]) and drinks per week (-0.16 [-0.27, -0.04]). Effects of ABI on 12-month drinking outcomes varied by baseline consumption level, age group and whether patients already had an AUD, with better improvement in those who were drinking at levels exceeding only daily limits, younger, and without an AUD. CONCLUSIONS Systematic ABI in adult primary care has the potential to reduce drinking among people with unhealthy drinking considerably on both an individual and population level. More research is needed to help optimize ABI, in particular tailoring it to diverse sub-populations, and studying its long-term public health impact.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA; Department of Psychiatry, Weill Institute of Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Joseph Elson
- The Permanente Medical Group, 1600 Owens Street, San Francisco, CA 94158, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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Directive clinique n o 425b : Le cannabis aux différentes périodes de la vie des femmes - Partie 2 : Grossesse, période postnatale et allaitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:445-454.e1. [PMID: 35400522 DOI: 10.1016/j.jogc.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIF Fournir aux fournisseurs de soins les meilleures données probantes sur l'utilisation de cannabis et la santé des femmes. Les domaines d'intérêt sont le dépistage, la dépendance et le sevrage; la communication et la tenue de dossier; la grossesse (y compris les issues fœtales et maternelles); la gestion de la douleur maternelle; les soins postnataux (y compris la fumée secondaire et la parentalité); et l'allaitement. POPULATION CIBLE Femmes enceintes, allaitantes ou qui planifient une grossesse. BéNéFICES, RISQUES ET COûTS: Discuter de l'utilisation de cannabis avec les femmes enceintes, allaitantes ou qui planifient une grossesse les aide à faire des choix éclairés. D'après des données probantes limitées, il faut éviter l'utilisation de cannabis pendant la grossesse ou l'allaitement, ou réduire la consommation au maximum si l'abstention n'est pas un objectif atteignable, étant donné l'absence de données sur l'innocuité et le suivi à long terme des grossesses et nourrissons exposés au cannabis. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed et Cochrane Library pour extraire des articles sur l'utilisation de cannabis pendant la grossesse et l'allaitement publiés entre le 1er janvier 2018 et le 5 février 2021. Les termes de recherche ont été déterminés à partir de termes de recherche MeSH, de mots clés et de leurs variantes : cannabis, cannabinoids, cannabidiol, CBD, THC, marijuana, edible, pregnancy, pregnant, prenatal, perinatal, postnatal, breastfeed, breastfed, lactation, nursing, fetus, fetal, neonatal, newborn et child. Les auteurs ont inclus toutes les publications des types suivants : essais cliniques, études observationnelles, revues (y compris les revues systématiques et les méta-analyses), directives cliniques et déclarations de conférences de consensus. Les principaux critères d'inclusion étaient les femmes enceintes et allaitantes, comme population cible, et l'exposition au cannabis, comme intervention d'intérêt. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins de santé qui prodiguent des soins aux femmes en âge de procréer. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Directive clinique n o 425a : Le cannabis aux différentes périodes de la vie des femmes - Partie 1 : Fertilité, contraception, ménopause et douleur pelvienne. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:420-435.e4. [PMID: 35400520 DOI: 10.1016/j.jogc.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIF Fournir aux fournisseurs de soins de santé les meilleures données probantes sur l'utilisation de cannabis et la santé des femmes. Les domaines d'intérêt sont : les profils généraux d'utilisation du cannabis ainsi que la sécurité de la consommation; les soins aux femmes qui utilisent le cannabis; la stigmatisation; le dépistage, l'intervention brève et l'orientation vers le traitement; les effets sur la régulation hormonale; la santé reproductive, y compris la contraception et la fertilité; la fonction sexuelle; les effets sur les symptômes périménopausiques et postménopausiques; et l'utilisation dans le traitement des syndromes de douleur pelvienne chronique. POPULATION CIBLE La population cible comprend toutes les femmes qui consomment ou utilisent du cannabis ou qui envisagent de le faire. RéSULTATS: Un dialogue ouvert et fondé sur des données probantes relativement à l'utilisation et la consommation de cannabis, dialogue qui mènera à l'amélioration des soins aux patientes. BéNéFICES, RISQUES ET COûTS: L'exploration de l'utilisation et de la consommation de cannabis par une approche basée sur la connaissance des traumatismes donne l'occasion au fournisseur de soins et à la patiente de créer une solide alliance thérapeutique collaborative. Cette alliance permet aux femmes de faire des choix éclairés sur leurs propres soins. Elle facilite également le diagnostic et le traitement possible des troubles de l'usage du cannabis. Il ne faut pas stigmatiser la consommation, car la stigmatisation nuit à l'alliance thérapeutique (c'est-à-dire le partenariat entre la patiente et le fournisseur de soins). Plusieurs effets indésirables de la consommation de cannabis peuvent être confondus avec d'autres problèmes de santé. À l'heure actuelle, l'utilisation du cannabis pour traiter les problèmes de santé féminine n'est pas financée par le secteur public; par conséquent, les utilisatrices doivent assumer les coûts directs. Les coûts indirects de l'utilisation de cannabis sont inconnus. Ainsi, les fournisseurs de soins et les patientes doivent comprendre le rôle du cannabis dans les problèmes de santé féminine de sorte que les femmes puissent prendre des décisions éclairées. DONNéES PROBANTES: Des recherches ont été effectuées dans PubMed, Embase et la littérature grise pour recenser des études publiées entre le 1er janvier 2018 et le 18 février 2021 concernant l'utilisation du cannabis et ses effets sur l'infertilité, la contraception, les symptômes périménopausiques et postménopausiques et la douleur pelvienne. Toutes les publications des types suivants ont été incluses : essais cliniques, études observationnelles, revues (y compris les revues systématiques et les méta-analyses), directives cliniques et déclarations de conférences de consensus. Un survol des publications a été effectué pour en confirmer la pertinence. Les termes de recherche ont été définis à l'aide des termes MeSH (Medical Subject Headings) et mots clés (et variantes) suivants : cannabis, cannabinoids, marijuana, dexanabinol, dronabinol et tetrahydrocannabinol. À ces termes ont été combinés les termes suivants afin de cerner la santé des femmes : estrogen, estradiol, medroxyprogesterone acetate, vaginal contraception, oral contraceptives, fertilization, amenorrhea, oligomenorrhea, pelvic pain, dysmenorrhea, endometriosis, interstitial cystitis, vulvodynia et menopause. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant l'approche d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins de santé qui prodiguent des soins aux femmes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Focus on Rural Adolescent Cannabis Use and Abuse: Ignored Epidemiologic Trends, Unique Risks, Long-Term Concerns, and Hope. CNS Spectr 2022; 28:277-280. [PMID: 35387706 DOI: 10.1017/s1092852922000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractCannabis-related issues for adolescents and young adults are emerging from the shadow of rural opioid addiction and deaths. The rural pediatric population has multiple risk factors putting them at increased risk for adverse consequences with the expansion of cannabis legalization across the United States. Research in this area is rich but scattered across professional disciplines. Differences in demographics and cultures between rural and urban youth are gaining attention. Epidemiological factors relevant to rurality as a risk for cannabis and other substance use are considered for formulating clinical care, public policymakers, and future research. Race, culture, community stability, basic demographics of age, gender, educational status, and demands for more and better, accessible services for rural, nonmetropolitan areas comprise factors for consideration and are detailed. Research findings provide direction for policymakers and clinicians for prevention and intervention efforts to improve care for rural populations, validating and expanding upon insights gained to date.
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Gainey S, Muzzy W, Dooley M, Lauerer J, Pelic C, Rheingold AA, Holmes-Maybank K, Smith G. Outcomes and lessons learned from an interprofessional student training program in Screening, Brief Intervention, and Referral to Treatment (SBIRT) at an academic health sciences center. NURSE EDUCATION TODAY 2022; 111:105323. [PMID: 35278939 DOI: 10.1016/j.nedt.2022.105323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a public health intervention to address overuse and risky use of alcohol and illegal substances. In order to increase SBIRT in clinical practice, training should start with future health care provider students and faculty. The main objective of this program was to improve and enhance the training of health professions students to provide competent screening, brief intervention and referral to treatment for persons who have or are at-risk for substance use disorder. This paper shares the results of an SBIRT training program at an academic health sciences center for undergraduate nursing, graduate nursing, and medical students. DESIGN, SETTING AND PARTICIPANTS 1229 undergraduate and graduate nursing students, medical students, faculty and preceptors at an academic medical center completed SBIRT coursework integrated into their existing curriculum. Coursework utilized an online learning platform as well as in-person skills training experiences. METHODS An interprofessional team collaborated to create an online SBIRT curriculum consisting of 5 primary modules (total 3 h) and an SBIRT Booster module (0.5 h). The team also developed pre- and post-module quizzes and satisfaction surveys to measure changes in knowledge, confidence, and satisfaction; as well as simulations, videos, a screening tool, a provider pocket card, and an online resource library to support learning. Faculty and preceptors were trained in the program to model skills and answer student questions. A motivational interviewing specialist provided the in-person skills training sessions. RESULTS A sustainable interprofessional SBIRT training program demonstrated gains in knowledge, confidence, and skills across all programs. The team used clinical opportunities and simulation with education to promote clinical proficiency. CONCLUSIONS Interprofessional training mirrors real world clinical situations and encourages all providers to implement SBIRT in practice and decrease poor outcomes associated with substance use disorders.
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Affiliation(s)
- Sarah Gainey
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, United States of America.
| | - Wendy Muzzy
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, United States of America
| | - Mary Dooley
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425, United States of America
| | - Joy Lauerer
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425, United States of America
| | - Christopher Pelic
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, United States of America
| | - Alyssa A Rheingold
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, United States of America; College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425, United States of America
| | - Keri Holmes-Maybank
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, United States of America
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425, United States of America
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Robert M, Graves LE, Allen VM, Dama S, Gabrys RL, Tanguay RL, Turner SD, Green CR, Cook JL. Guideline No. 425a: Cannabis Use Throughout Women's Lifespans - Part 1: Fertility, Contraception, Menopause, and Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:407-419.e4. [PMID: 35400519 DOI: 10.1016/j.jogc.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide health care providers with the best evidence on cannabis use with respect to women's health. Areas of focus include general patterns of cannabis use as well as safety of use; care for women who use cannabis; stigma; screening, brief intervention, and referral to treatment; impact on hormonal regulation; reproductive health, including contraception and fertility; sexual function; effects on perimenopausal and menopausal symptoms; and use in chronic pelvic pain syndromes. TARGET POPULATION The target population includes all women currently using or contemplating using cannabis. OUTCOMES Open, evidence-informed dialogue about cannabis use, which will lead to improvement in patient care. BENEFITS, HARMS, AND COSTS Exploring cannabis use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of cannabis use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Multiple side effects of cannabis use may be mistaken for other disorders. Currently, use of cannabis to treat women's health issues is not covered by public funding; as a result, individual users must pay the direct cost. The indirect costs of cannabis use are unknown. Thus, health care providers and patients must understand the role of cannabis in women's health issues, so that women can make knowledgeable decisions. EVIDENCE PubMed, EMBASE, and grey literature were searched to identify studies of "cannabis use and effect on infertility, contraception, perimenopause and menopausal symptoms, and pelvic pain" published between January 1, 2018 and February 18, 2021. All clinical trials, observational studies, reviews (including systematic reviews and meta-analyses), guidelines, and conference consensus statements were included. Publications were screened for relevance. The search terms were developed using the Medical Subject Headings (MeSH) terms and keywords (and variants), including cannabis, cannabinoids, marijuana, dexanabinol, dronabinol, tetrahydrocannabinol; the specific terms to capture women's health were estrogen, estradiol, medroxyprogesterone acetate, vaginal contraception, oral contraceptives, fertilization, amenorrhea, oligomenorrhea, pelvic pain, dysmenorrhea, endometriosis, interstitial cystitis, vulvodynia, and menopause. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All heath care providers who care for women. SUMMARY STATEMENTS RECOMMENDATIONS.
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Graves LE, Robert M, Allen VM, Dama S, Gabrys RL, Tanguay RL, Turner SD, Green CR, Cook JL. Guideline No. 425b: Cannabis Use Throughout Women's Lifespans - Part 2: Pregnancy, the Postnatal Period, and Breastfeeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:436-444.e1. [PMID: 35400521 DOI: 10.1016/j.jogc.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To provide health care providers with the best evidence on cannabis use and women's health. Areas of focus include screening, dependence, and withdrawal; communication and documentation; pregnancy (including maternal and fetal outcomes); maternal pain control; postpartum care (including second-hand smoking and parenting); and breastfeeding. TARGET POPULATION The target population includes women who are planning a pregnancy, pregnant, or breastfeeding. BENEFITS, HARMS, AND COSTS Discussing cannabis use with women who are planning a pregnancy, pregnant, or breastfeeding allows them to make informed choices about their cannabis use. Based on the limited evidence, cannabis use in pregnancy or while breastfeeding should be avoided, or reduced as much as possible if abstaining is not feasible, given the absence of safety and long-term follow up data on cannabis-exposed pregnancies and infants. EVIDENCE PubMed and Cochrane Library databases were searched for articles relevant to cannabis use during pregnancy and breastfeeding published between January 1, 2018, and February 5, 2021. The search terms were developed using the MeSH terms and keywords and their variants, including cannabis, cannabinoids, cannabidiol, CBD, THC, marijuana, edible, pregnancy, pregnant, prenatal, perinatal, postnatal, breastfeed, breastfed, lactation, nursing, fetus, fetal, neonatal, newborn, and child. In terms of publication type, all clinical trials, observational studies, reviews (including systematic reviews and meta-analyses), guidelines, and conference consensus statements were included. The main inclusion criteria were pregnant and breastfeeding women as the target population, and exposure to cannabis as the intervention of interest. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care providers who care for women of reproductive age. SUMMARY STATEMENTS RECOMMENDATIONS.
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Dauber S, Hammond C, Hogue A, Henderson C, Nugent J, Ford V, Brown J, Scott L, Ondersma S. Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: A Qualitative Description of Intervention Development (Preprint). JMIR Form Res 2022; 6:e37865. [PMID: 36346648 PMCID: PMC9682454 DOI: 10.2196/37865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e-SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. OBJECTIVE This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e-SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e-SBI-HV prototype and describe the e-SBI-HV prototype. METHODS Adaptation of the original e-SBI into the e-SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e-SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. RESULTS The e-SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor-client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e-SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. CONCLUSIONS This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e-SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e-SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e-SBI-HV.
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Giusto AM, Ayuku D, Puffer ES. Learn, Engage, Act, Dedicate (LEAD): development and feasibility testing of a task-shifted intervention to improve alcohol use, depression and family engagement for fathers. Int J Ment Health Syst 2022; 16:16. [PMID: 35246218 PMCID: PMC8896316 DOI: 10.1186/s13033-022-00522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men's depression, alcohol use, and family problems commonly co-occur to create of cluster of mental health problems. Yet, few treatments exist to address these problems, especially in low and middle-income countries (LMICs). This paper describes the development and initial feasibility and acceptability of a novel task-shifted intervention to address this cluster of men's mental health problems with a focus on engaging and retaining men in treatment. METHODS The intervention, Learn, Engage, Act, Dedicate (LEAD), is based in behavioral activation blended with motivational interviewing and was pilot tested in Kenya. To develop LEAD, we engaged in a community-engaged multi-step, collaborative process with local Kenyan stakeholders. LEAD was piloted with nine fathers reporting problem drinking. To assess initial feasibility and acceptability, recruitment and participation were tracked and descriptive statistics were generated given engagement of men was key for proof of concept. Semi-structured interviews were conducted with participants and analyzed using thematic content analysis. RESULTS The development process resulted in a weekly 5-session intervention rooted in behavioral activation, motivational interviewing, and masculinity discussion strategies. These approaches were combined and adapted to fit contextually salient constructs, such as the importance of the man as provider, and streamlined for lay providers. Feasibility and acceptability results were promising with high attendance, acceptability of delivery and intervention content, and perceived intervention helpfulness. CONCLUSION Results describe an acceptable task-shifted treatment that may engage men in care and addresses a cluster of common mental health problems among men in ways that consider social determinants like masculinity. Findings set the stage for a larger trial. Trial registration ISRCTN, ISRCTN130380278. Registered 7 October 2019-Retrospectively registered, http://www.isrctn.com/ISRCTN13038027.
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Affiliation(s)
- Ali M Giusto
- Duke University Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA. .,Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA. .,Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, 40 Haven Ave., #171, New York, NY, 10032, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya
| | - Eve S Puffer
- Duke University Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA.,Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA
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Gimenez PV, Lichtenberger A, Cremonte M, Cherpitel CJ, Peltzer RI, Conde K. Efficacy of Brief Intervention for Alcohol Consumption during Pregnancy in Argentinean Women: A Randomized Controlled Trial. Subst Use Misuse 2022; 57:674-683. [PMID: 35258400 PMCID: PMC8967783 DOI: 10.1080/10826084.2022.2026967] [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: 10/18/2022]
Abstract
INTRODUCTION Although Brief Intervention (BI) has proven to reduce alcohol consumption during pregnancy in high income countries, there is no evidence from the Southern Cone of America. Thus, we conducted a study to assess BI efficacy among Argentinean pregnant women. METHOD AND MATERIALS We collected data on pregnant women receiving prenatal care at the public health system in Mar del Plata, Argentina. Women with less than 26 weeks of gestation (n = 486) were randomized to brief advice (BA) or BI. Three months later they were re-assessed; women with more than 26 weeks of gestation constituted a screening only control group (SC) (n = 154). Self-reported quantity and frequency of alcohol consumption, frequency of binge drinking, and related problems after three months were used as outcomes. We performed generalized estimating equations and clinical significance analyses. Also, we obtained newborn health indicators from the city's health system database to use as objective outcomes. Women who did not participate in any of the three former conditions were randomly selected to constitute a non-screening control group (NSC) (n = 150). We compared objective outcomes among BI, BA, and NSC groups using the Wilcoxon rank test. RESULTS In comparison with SC, BI and BA reduced alcohol consumption, without differences between the latter two. Newborns of women who received BI and BA had better health indicators compared with the NSC group. CONCLUSIONS performing either a BI or BA reduces alcohol consumption among Argentinean pregnant women and might lead to healthier newborns.
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Affiliation(s)
- Paula Victoria Gimenez
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | - Aldana Lichtenberger
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | - Mariana Cremonte
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | | | - Raquel Inés Peltzer
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | - Karina Conde
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
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