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Yoo R, Krawczyk N, Johns E, McCormack RP, Rotrosen J, Mijanovich T, Gelberg L, Doran KM. Association of substance use characteristics and future homelessness among emergency department patients with drug use or unhealthy alcohol use: Results from a linked data longitudinal cohort analysis. Subst Abus 2022; 43:1100-1109. [DOI: 10.1080/08897077.2022.2060445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ruth Yoo
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Eileen Johns
- NYC Center for Innovation through Data Intelligence, New York, NY, USA
| | - Ryan P. McCormack
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Tod Mijanovich
- Applied Statistics, Social Science, and Humanities, NYU Steinhardt School, New York, NY, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, The University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Kelly M. Doran
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Rojas-Jara C, Polanco-Carrasco R, Caycho-Rodríguez T, Acuña-Espinoza R, González-Serrano C, Roa-Méndez P, Rojas-Román A, Sepúlveda-López MA. Experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez: un análisis de la evidencia. UNIVERSITAS PSYCHOLOGICA 2021. [DOI: 10.11144/javeriana.upsy20.eaiu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
El objetivo de este estudio es la revisión de la evidencia actual sobre la relación entre la vivencia de experiencias adversas en la infancia y el posterior uso de drogas en la adolescencia y adultez, y sus características. La metodología utilizada fue una revisión sistemática de publicaciones científicas, entre el periodo 2013-2017, disponibles en la base de datos Scopus sobre experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez que arrojó un total de 69 publicaciones incluidas en el estudio. Las experiencias adversas en la infancia presentan una elevada relación con el uso y/o abuso de drogas en la adolescencia y adultez. El consumo de drogas en adolescentes y adultos expuestos a experiencias traumáticas en la infancia se da principalmente en hombres. Las drogas mayormente usadas son alcohol, tabaco, cannabis y fármacos no recetados y, en menor medida, opioides, cocaína y anfetaminas. Las drogas, en este sentido, cumplen el rol de barrera química para distanciar el dolor emocional que deriva del recuerdo de las experiencias traumáticas y su intensa carga psíquica. Se requieren acciones de promoción del buen trato en la infancia, así como el abordaje terapéutico temprano de niños expuestos a experiencias traumáticas.
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Scholes G. Problematic alcohol consumption in homeless Australians: A narrative review of the causes, barriers to receiving help and possible solutions. Health Promot J Austr 2019; 31:279-286. [PMID: 31446632 DOI: 10.1002/hpja.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Problematic alcohol consumption (PAC) affects one-third of homeless Australians, and it is expected that the rates will increase as the population ages. However, current policy does not recognise the importance of this problem. The aim of this narrative review was to examine the social determinants and other risk factors contributing to PAC in homeless Australians, the barriers to receiving help and possible solutions for the Australian context. METHODS PubMed and PsycINFO databases and Australian government websites were examined for the keywords "alcohol" and "homeless," and pertinent articles were selected for inclusion and for citation tracking of further relevant articles. RESULTS The causes of PAC in homeless Australians are multifactorial, and multidirectional, and include risk factors such as low socio-economic status, mental illness and having experienced trauma. There is significant stigma associated with both homelessness and PAC, which further isolates this group. Current policies to address PAC in the homeless are inadequate; however, there are a range of possible programs to reduce PAC in this group, and international harm reduction strategies have also shown success in improving outcomes for this group. CONCLUSION There are numerous social risk factors that influence the development of PAC in the homeless. The introduction of harm reduction strategies, programs to enhance motivation and personal skills, as well as better mental health treatment, would all fill important gaps in services for homeless Australians with PAC. SO WHAT?: Health professionals can be advised that there are many social determinants that influence PAC in homeless Australians. There are important structural barriers to providing this marginalised group with the services they require; however, there is scope for the introduction of new programs, including harm reduction strategies, to meet the fundamental needs of this group.
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Fajardo-Bullón F, Esnaola I, Anderson I, Benjaminsen L. Homelessness and self-rated health: evidence from a national survey of homeless people in Spain. BMC Public Health 2019; 19:1081. [PMID: 31399028 PMCID: PMC6688283 DOI: 10.1186/s12889-019-7380-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. METHOD The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. RESULTS Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. CONCLUSIONS These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.
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Affiliation(s)
- Fernando Fajardo-Bullón
- Department of Development and Educational Psychology. Faculty of Education, University of Extremadura, Badajoz, Spain
| | - Igor Esnaola
- Department of Development and Educational Psychology. Faculty of Education (Avenida de Tolosa, 20018, San Sebastián), University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Lars Benjaminsen
- The Danish Center for Social Science Research, København, Denmark
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Asana OO, Ayvaci ER, Pollio DE, Hong BA, North CS. Associations of alcohol use disorder, alcohol use, housing, and service use in a homeless sample of 255 individuals followed over 2 years. Subst Abus 2018; 39:497-504. [PMID: 29595364 DOI: 10.1080/08897077.2018.1449169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Homeless individuals with alcohol use disorders have multiple comorbidities and therefore various service needs. Despite need for services, homeless individuals face numerous barriers to treatment. Little is known about the associations of specific services in relation to homelessness in the context of alcohol problems. The current study analyzed 2-year prospective longitudinal data on a homeless sample, examining relationships between alcohol use disorder, alcohol use, housing status, and service use over time. METHODS Two hundred fifty-five of 400 individuals recruited systematically from shelters and street locations completed 3 annual assessments (69% completion). Data on lifetime and current psychiatric disorders, housing status, and past-year service use were obtained and merged with service use data gathered from local agencies. Generalized estimating equation (GEE) models were created to predict dependent outcome variables of stable housing, alcohol use, and service use in both follow-up years. RESULTS Lifetime alcohol use disorder was positively associated with substance and medical service use. Alcohol problems did not hinder attainment of stable housing, and placement in housing did not necessarily increase risk for alcohol use. Stable housing was negatively associated with psychiatric and substance service use. In the second year, when alcohol use was finally associated with receiving substance services, it appears that these services provided a gateway to psychiatric services. The psychiatric services in turn appeared to provide a gateway to medical services. CONCLUSIONS Alcohol use behaved differently compared with lifetime alcohol use disorder in relation to service use. Lack of association between alcohol use and housing supports Housing First policy. Obtaining housing may have ameliorative effects on mental health, diminishing perceived need for psychiatric services. Services may also be more accessible during homelessness. Obtaining substance treatment may provide a gateway for those who use alcohol after becoming homeless to connect with psychiatric and medical services, informing policy and practice.
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Affiliation(s)
- Olubunmi O Asana
- a Department of Psychiatry , New York University Langone Health , New York , New York , USA
| | - Emine R Ayvaci
- b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - David E Pollio
- c Department of Social Work , The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Barry A Hong
- d Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Carol S North
- b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA.,e The Altshuler Center for Education & Research , Metrocare Services , Dallas , Texas , USA
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Mills KL. The importance of providing trauma-informed care in alcohol and other drug services. Drug Alcohol Rev 2016; 34:231-3. [PMID: 25944454 DOI: 10.1111/dar.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katherine L Mills
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Fielder AL, Mikocka-Walus A, McCallum S, Stewart B, Alvaro P, Esterman A. Pilot CBT trial for anxiety in alcohol use disorders treatment. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-05-2015-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to test the effectiveness of a self-directed cognitive behavioural therapy (CBT) booklet allowing immediate access to treatment for anxiety during alcohol use disorder (AUD) interventions.
Design/methodology/approach
– Parallel pilot randomised controlled trial: 69 individuals in AUD treatment, continued to receive treatment alone (control: n=29) or in addition, a self-directed, four week CBT booklet to manage anxiety (intervention: n=40). Primary outcome measures were changes in state (SAnx) and trait anxiety (TAnx) at four weeks. Secondary outcome measures were changes in adaptive (ACop), maladaptive (MCop) coping and quality of life (QoL, physical (PHQoL), psychological (PSQoL), social (SQoL), environment (EQoL)) at four weeks.
Findings
– Participants had significantly higher SAnx (p
<
0.01) and TAnx (p
<
0.01) baseline scores compared to the general population. There were no statistically significant group changes in SAnx or TAnx (p
>
0.05). Control group allocation predicted improvement in ACop (p
<
0.01), MCop (p
<
0.05), PHQoL (p
<
0.01), PSQoL (p
<
0.05) and SQoL (p
<
0.01); CBT group allocation predicted improvement in EQoL (p=0.05). All effect sizes were small to moderate (Cohen’s d
<
0.50). Percentage of book completion did not determine changes in anxiety, coping or quality of life.
Originality/value
– A four week self-directed CBT booklet did not significantly reduce anxiety during AUD treatment. Larger sample sizes will determine the most suitable treatment delivery mode for this type of CBT.
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Hamilton M. Reflecting on the interface between alcohol and other drug use, parenting and the outcomes for children in the modern state. Drug Alcohol Rev 2015; 34:1-3. [DOI: 10.1111/dar.12245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Margaret Hamilton
- School of Population & Global Health; University of Melbourne; Australia
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