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Mazzeo SE, Weinstock M, Vashro TN, Henning T, Derrigo K. Mitigating Harms of Social Media for Adolescent Body Image and Eating Disorders: A Review. Psychol Res Behav Manag 2024; 17:2587-2601. [PMID: 38978847 PMCID: PMC11229793 DOI: 10.2147/prbm.s410600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024] Open
Abstract
Social media has negative effects on adolescent body image and disordered eating behaviors, yet adolescents are unlikely to discontinue engaging with these platforms. Thus, it is important to identify strategies that can reduce the harms of social media on adolescent mental health. This article reviews research on social media and adolescent body image, and discusses strategies to reduce risks associated with social media use. Topics covered include interventions aimed at mitigating social media's negative impacts, the body-positivity movement, and policies regulating adolescents' social media use. Overall, this review highlights specific factors (such as staffing, duration, modality, facilitator training, and cultural sensitivity) to consider when designing and implementing social media interventions targeting adolescents. This review also discusses psychosocial outcomes associated with body positivity on social media. Finally, policy efforts to reduce the negative impact of social media on adolescents' body image and eating behaviors are described. In sum, there is a strong need to conduct further research identifying optimal approaches to reduce the harms of social media for adolescent body image and eating behavior.
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Affiliation(s)
- Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Madison Weinstock
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Taryn Henning
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Karly Derrigo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Collins AB, Tan M, Smith M, Becker SJ. 'Everywhere I call, there's nothing available': Understanding the alcohol treatment landscape and needs among unstably housed people who use alcohol in Rhode Island. Drug Alcohol Rev 2024; 43:1235-1246. [PMID: 38623042 PMCID: PMC11223957 DOI: 10.1111/dar.13852] [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: 05/23/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Alcohol is a leading cause of morbidity and mortality in the United States and people who are unstably housed are disproportionately impacted by adverse alcohol-related health outcomes. Addressing the needs of unstably housed people with high-intensity alcohol use (i.e., heavy episodic use or binge drinking), including those whose goal is not abstinence, is critical to reducing harms among this population. This study explores the alcohol-related treatment and support needs among unstably housed people who use alcohol. METHODS Data collection included participant observation and semi-structured interviews (n = 25) with unstably housed people with high-intensity alcohol use. Data were analysed thematically, with attention to structural vulnerability and social-structural forces at shaping perceptions of and experiences with alcohol treatment. RESULTS Participants underscored how housing instability was critical in precipitating and maintaining heavy alcohol use, with alcohol often used to manage the stress and anxiety related to housing instability. While participants regularly engaged with alcohol treatment programs, program design and barriers to access undermined the effectiveness of these services for participants. Participants described the need for a range of program and service options across a continuum of care to be implemented to support participants in meeting their diverse needs and identified goals regarding alcohol use. DISCUSSION AND CONCLUSIONS Alcohol treatment and supports need to be modified so that they include a range of harm reduction and abstinence-based models to better meet people's diverse needs. Furthermore, treatment must be paired with permanent and affordable housing to address underlying drivers of alcohol-related harm for unstably housed people.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Michael Tan
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Megan Smith
- School of Social Work, Rhode Island College, Providence, USA
- House of Hope Community Development Corporation, Warwick, USA
- Warren Alpert Medical School, Providence, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, USA
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Spata A, Gupta I, Lear MK, Lunze K, Luoma JB. Substance use stigma: A systematic review of measures and their psychometric properties. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100237. [PMID: 38779475 PMCID: PMC11108807 DOI: 10.1016/j.dadr.2024.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/27/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
Background Instruments to measure substance use stigma are emerging, however little is known regarding their psychometric properties. While research has evolved to view substance use stigma as a context sensitive international phenomenon that is embedded within cultures, validated self-report measures are lacking and comprehensive reviews of the existing measures are extremely limited. In this systematic review of substance use stigma and shame measures, we aim to contextualize results from existing research, lay the groundwork for future measurement development research, and provide a thorough resource for research scientists currently designing studies to measure substance use stigma. Methods We searched three databases using Boolean search terms for psychometric evaluations of measures of substance use stigma and shame and evaluated the quality/psychometric properties using an adaptation of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review guidelines. Results We identified 18 measures of substance use stigma. Overall, most measures had minimal psychometric assessments and none of the measures met all domains of the COSMIN measure quality criteria. However, most studies reported satisfactory factor analyses and internal consistency scores. Conclusions Most measures of substance use stigma and shame had psychometric assessment across a limited range of criteria and no measures of structural substance use stigma were found. The most reported psychometric properties were structural validity and convergent validity. We suggest future researchers investigate test-retest reliability and cross-cultural validity for existing substance use stigma measures, as well as develop and evaluate novel measures assessing structural stigma of substance use.
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Affiliation(s)
- Angelica Spata
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, USA
| | - Ishita Gupta
- Dr. Rajendra Prasad Governmental Medical College, Tanda, India
| | - M. Kati Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, USA
| | - Karsten Lunze
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, MA, USA
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, USA
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De Leon AN, Dvorak RD, Perrotte JK, Klaver SJ, Peterson R, Magri TD, Burr EK, Leary AV, Aguilar B. The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults. ETHNICITY & HEALTH 2024:1-25. [PMID: 38714915 DOI: 10.1080/13557858.2024.2345916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/16/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking. DESIGN Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation. RESULTS Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy. CONCLUSIONS Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.
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Affiliation(s)
- Ardhys N De Leon
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Robert D Dvorak
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | | | - Samantha J Klaver
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Roselyn Peterson
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Tatiana D Magri
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Emily K Burr
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Angelina V Leary
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Bradley Aguilar
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Trinh CD, Girard R, Schick MR, Spillane NS. Positive psychological interventions on alcohol use and consequences: Pilot randomized trial in a young adult cannabis-using sample. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209241. [PMID: 38056630 DOI: 10.1016/j.josat.2023.209241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Young adults exhibit high rates of concurrent alcohol and cannabis use, which is associated with more negative alcohol-related consequences. Positive psychological interventions have successfully been leveraged to target alcohol, cannabis, and nicotine use, as well as substance use disorders, and may be a useful harm reduction approach to reduce alcohol-related consequences. This pilot study sought to generate effect sizes for two positive psychological interventions, Savoring and Three Good Things, on frequency of alcohol use, quantity of alcohol use, and alcohol-related consequences. METHODS The current study used data from a pilot study testing positive psychological interventions to reduce cannabis use and cannabis-related consequences in young adults (ages 18 to 25) who used cannabis at least once per week within the prior month (N = 50, Mage = 22.72, 72 % men, 40 % White). Participants reported baseline alcohol and cannabis use and alcohol-related consequences, then the study randomized them to complete a daily Savoring intervention, Three Good Things, or a control exercise, and completed daily text message surveys for two weeks (i.e., the intervention period) and a follow-up survey. RESULTS Analyses revealed no significant differences across experimental conditions on alcohol use frequency, alcohol use quantity, or alcohol-related consequences at baseline or follow-up. Paired samples t-tests demonstrated that participants in the Savoring group showed large, significant decreases in alcohol-related consequences (t[16] = 2.28, p = .04, gav = 0.54); no decreases occurred in frequency or quantity of alcohol use. The Three Good Things group showed no significant decreases in alcohol-related consequences, frequency of alcohol use, or quantity of alcohol use. CONCLUSIONS Results suggest that a larger scale clinical trial is warranted to determine whether Savoring and Three Good Things might function as harm reduction interventions to reduce alcohol-related consequences in young adults who concurrently use alcohol and cannabis. Future research should use a larger sample, a longer intervention administration period, and a longer follow-up period to examine these positive psychological interventions more rigorously.
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Affiliation(s)
- Catherine D Trinh
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA
| | - Rachel Girard
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA
| | - Melissa R Schick
- Yale School of Medicine, Division of Prevention and Community Research, New Haven, CT 06511, USA
| | - Nichea S Spillane
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA.
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Goldstein SC, Newberger NG, Schick MR, Ferguson JJ, Collins SE, Haeny AM, Weiss NH. A systematic meta-epidemiologic review on nonabstinence-inclusive interventions for substance use: inclusion of race/ethnicity and sex assigned at birth/gender. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-15. [PMID: 38411974 DOI: 10.1080/00952990.2024.2308087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
Background: Minoritized racial/ethnic and sex assigned at birth/gender groups experience disproportionate substance-related harm. Focusing on reducing substance-related harm without requiring abstinence is a promising approach.Objectives: The purpose of this meta-epidemiologic systematic review was to examine inclusion of racial/ethnic and sex assigned at birth/gender in published studies of nonabstinence-inclusive interventions for substance use.Methods: We systematically searched databases (PubMed and PsycINFO) on May 26, 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Articles were eligible for inclusion if they: 1) reported in English language, 2) had a primary goal of investigating a nonabstinence-inclusive intervention to address substance use, 3) used human subjects, and 4) only included adults aged 18 or older. Two coders screened initial articles and assessed eligibility criteria of full text articles. A third consensus rater reviewed all coding discrepancies. For the remaining full-length articles, an independent rater extracted information relevant to study goalsResults: The search strategy yielded 5,759 records. 235 included articles remained. Only 73 articles (31.1%) fully reported on both racial/ethnic and sex assigned at birth/gender, and only seven articles (3.0%) reported subgroup analyses examining treatment efficacy across minoritized groups. Nine articles (3.8%) mentioned inclusion and diversity regarding both racial/ethnic and sex assigned at birth/gender in their discussion and four articles (1.7%) broadly mentioned a lack of diversity in their limitationsConclusion: Findings highlight that little is known about nonabstinence-inclusive interventions to address substance use for individuals from minoritized racial/ethnic and sex assigned at birth/gender groups.
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Affiliation(s)
- Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Melissa R Schick
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Cole AB, Lopez SV, Armstrong CM, Gillson SL, Weiss N, Blair AL, Walls M. An Updated Narrative Review on the Role of Alcohol Among Indigenous Communities. CURRENT ADDICTION REPORTS 2023; 10:702-717. [PMID: 38645278 PMCID: PMC11027470 DOI: 10.1007/s40429-023-00520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 04/23/2024]
Abstract
Purpose of Review The role of alcohol varies considerably among Indigenous Peoples and is the backdrop of persistent stereotypes despite decades of research. This paper provides an updated narrative review on the alcohol literature among Indigenous communities, highlighting recent studies published since 2017. Recent Findings We examined published literature involving alcohol use rates, including abstinence; risk and protective factors; treatment; and recovery, as well as future directions for alcohol prevention and intervention efforts with Indigenous communities. Summary Evidence-based alcohol use prevention, intervention, and recovery strategies with Indigenous communities are outlined. Recommendations are provided for researchers, health providers, and public policy advocates to address and better understand alcohol use, treatment, prevention, and recovery among Indigenous Peoples. Specific recommendations include using community-based participatory research strategies and harm reduction approaches to prevent and treat alcohol use problems with Indigenous communities. Future research is needed to elucidate mechanisms of resilience and recovery from Alcohol Use Disorder and possible shifts in perceptions of alcohol use for Indigenous Peoples.
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Affiliation(s)
- Ashley B. Cole
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Susanna V. Lopez
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, 5310 E 31st St., Tulsa, OK 74135, USA
| | - Cassidy M. Armstrong
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | | | - Nicole Weiss
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 1915 South Street, Duluth, MN 55812, USA
| | - Alexandra L. Blair
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Melissa Walls
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 1915 South Street, Duluth, MN 55812, USA
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Frankeberger J, Gagnon K, Withers J, Hawk M. Harm Reduction Principles in a Street Medicine Program: A Qualitative Study. Cult Med Psychiatry 2023; 47:1005-1021. [PMID: 36229766 PMCID: PMC9560723 DOI: 10.1007/s11013-022-09807-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
There is ample evidence that homelessness is associated with high rates of morbidity and mortality. Street Medicine seeks to eliminate these disparities by providing healthcare on the streets to people who are unsheltered. While extant research describes health disparities for the unsheltered and programmatic approaches to addressing housing instability, there are few published studies describing how healthcare providers build and maintain relationships with patients on the street. This insight is central to specifying how street medicine differs from traditional forms of care and defining aspects of street medicine that contribute to successful patient engagement. Through a collaboration between Operation Safety Net (OSN), a street medicine provider in Pittsburgh, Pennsylvania, and [name redacted], an exploratory qualitative study was designed and implemented using harm reduction principles as a guiding framework. Qualitative interviews were conducted with eleven OSN street medicine providers and a thematic analysis using a deductive approach was used to analyze the data. Findings identified the ways that relational harm reduction was central to all aspects of patient care provided through this program. Major themes included: (1) individualism, or meeting patients where they are figuratively and literally; (2) humanism, which refers to valuing and holding true regard for patients; and (3) nonjudgmental care, in which providers do not hold negative attitudes toward patients and their decisions. These themes are consistent with relational principles of harm reduction. Challenges that were discussed also aligned with these principles and included frustration with systems providing care that did not meet patients' individualized needs, and pain and trauma experienced by providers upon losing patients for whom they genuinely cared. Understanding these relational principles of harm reduction may help providers operationalize ways to effectively engage and maintain homeless patients in care and subsequently bridge the gap to traditional models of care. This study may provide valuable insights to expand the street medicine field in research and applied clinical and community settings.
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Affiliation(s)
- Jessica Frankeberger
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, USA
| | - Kelly Gagnon
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, USA
| | - Jim Withers
- Operation Safety Net, Pittsburgh Mercy Health System, Pittsburgh, PA, USA
| | - Mary Hawk
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, USA.
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Richards DK, Greń JD, Pearson MR. Profiles of alcohol and cannabis protective behavioral strategies use across two large, multi-site college student samples of concurrent alcohol and cannabis users. Addict Behav 2023; 146:107789. [PMID: 37467629 PMCID: PMC10528137 DOI: 10.1016/j.addbeh.2023.107789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
Concurrent use of alcohol and cannabis among college students is common and confers greater harms than the use of either of these substances alone. Large and growing bodies of literature have demonstrated the independent utility of behaviors used before, during, after, or instead of alcohol and cannabis use that minimize related harms (i.e., protective behavioral strategies [PBS]). However, little is known about the relationship between alcohol and cannabis PBS and their joint influence on harms among college students who concurrently use alcohol and cannabis. In the present study, we used data from two large, multi-site samples of college students, and restricted analyses to those who reported at least one episode of alcohol and cannabis use in the past 30 days (Study 1: N = 1104[Mage = 20.3, SD = 3.8; 70.0 % female; 79.5 % white]; Study 2: N = 2034[Mage = 20.2, SD = 3.2; 69.1 % female; 76.6 % white]). A latent profile analysis supported a 4-profile solution that was largely consistent across samples: Profile 1 (low alcohol/cannabis PBS; 8.8-11.9 %), Profile 2 (average alcohol/cannabis PBS; 33.1-37.7 %), Profile 3 (average alcohol PBS/low cannabis PBS; 16.3-25.2 %), and Profile 4 (high alcohol/cannabis PBS; 29.8-37.2 %). Profile 4 reported the least alcohol/cannabis use, fewest negative alcohol-/cannabis-related consequences, and lowest alcohol/cannabis use severity. In contrast, Profile 1 was the opposite for alcohol-related outcomes, and Profile 3 was the opposite for cannabis-related outcomes. These findings are preliminary but may suggest that targeting both alcohol and cannabis PBS in intervention is generally beneficial except some groups at risk for a particular substance may benefit from increased focus on that substance in intervention.
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Affiliation(s)
- Dylan K Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA.
| | - Jakub D Greń
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA; Public Health Department, Institute of Psychiatry and Neurology in Warsaw, Jana III Sobieskiego 9, 02-957 Warsaw, Poland
| | - Matthew R Pearson
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA
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Dewabhrata W, Ahsan A, Bella A, Amalia N, Kusuma D, Pertiwi YBA. Mental Health, Environmental, and Socioeconomic Geographic Factors of Severe Drug Addiction: Analysis of Rehabilitation Center Data in Indonesia. Subst Abuse 2023; 17:11782218231203687. [PMID: 37822734 PMCID: PMC10563495 DOI: 10.1177/11782218231203687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
Background A growing number of recent literatures have attempted to document the factors related to drug use in different contexts, but limited studies analyzed the factors related to patient's severity level. Objective We aimed to examine the correlates of behavioral, environmental, socioeconomic, geographic factors, and severe drug addiction. Methods We used a sample of 6790 people who use drugs (PWUD) from rehabilitation centers during 2019 to 2020 in Indonesia. Data were obtained from Drugs Rehabilitation Information System (SIRENA) by the Indonesian National Narcotics Agency (BNN) during 2019 to 2020. SIRENA used the adapted version of WHO's Addiction Severity Index (ASI), which assesses patient's addiction severity level and relevant factors. A composite of the ASI factors is classified as "poor" or "serious" if its score is 4 or higher. The data was analyzed using logistic regression model to estimate correlations of severe drug addiction. Results We found a high prevalence (65.08%) of our sample reported having severe drug addiction, which needed intervention and support. Poor psychiatric condition (OR = 4.02, CI: 2.97-5.44), serious work-related issue (OR = 2.10, 1.75-2.51), poor medical condition (OR = 2.01, 1.32-3.06), and serious family and social problems (OR = 2.56, 2.15-3.05) were significantly associated with severe drug addiction. Male users had higher odds of severe drug addiction (OR = 1.81, 1.55-2.20), compared to female counterparts. Patients in urban areas had higher odds of severe drug addiction (OR = 1.19, 1.1-1.3) than those in rural. Those in less developed regions (eg, Sumatera, Kalimantan, and Sulawesi) had higher odds of severe drug addiction (OR = 2.33, 1.9-2.9), compared to those in the most developed region (eg, Java and Bali). Conclusion This evidence can help policymakers in refining the harm reduction policies in Indonesia and other countries with similar settings.
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Affiliation(s)
- Wijaya Dewabhrata
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesian National Narcotics Agency (BNN), Ciamis Regency, West Java, Indonesia
| | - Abdilah Ahsan
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
- Lembaga Demografi, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adrianna Bella
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Nadira Amalia
- Lembaga Demografi, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, UK
| | - Yuyu Buono Ayuning Pertiwi
- Lembaga Demografi, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
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O'Logbon J, Wickersham A, Williamson C, Leightley D. The effectiveness of digital health technologies for reducing substance use among young people: a systematic review & meta-analysis. J Ment Health 2023:1-29. [PMID: 37664884 DOI: 10.1080/09638237.2023.2245902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Substance use amongst young people poses developmental and clinical challenges, necessitating early detection and treatment. Considering the widespread use of technology in young people, delivering interventions digitally may help to reduce and monitor their substance use. AIMS We conducted a systematic review and two meta-analyses to assess the effectiveness of digital interventions for reducing substance use (alcohol, smoking, and other substances) among young people aged 10 to 24 years old. METHOD Embase, Global Health, Medline, PsychINFO, Web of Science and reference lists of relevant papers were searched in November 2020. Studies were included if they quantitatively evaluated the effectiveness of digital health technologies for treating substance use. A narrative synthesis and meta-analysis were conducted. RESULTS Forty-two studies were included in the systematic review and 18 in the meta-analyses. Digital interventions showed small, but statistically significant reductions in weekly alcohol consumption compared to controls (SMD= -0.12, 95% CI= -0.17 to -0.06, I2=0%), but no overall effect was seen on 30-day smoking abstinence (OR = 1.12, 95% CI = 0.70 to 1.80, I2=81%). The effectiveness of digital interventions for reducing substance use is generally weak, however, promising results such as reducing alcohol use were seen. Large-scale studies should investigate the viability of digital interventions, collect user feedback, and determine cost-effectiveness. PRISMA/PROSPERO This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in November 2020 (CRD42020218442).
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Affiliation(s)
| | - Alice Wickersham
- Department of Psychological Medicine, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Charlotte Williamson
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Daniel Leightley
- Department of Psychological Medicine, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
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Puryear SB, Ayieko J, Hahn JA, Mucunguzi A, Owaraganise A, Schwab J, Balzer LB, Kwarisiima D, Charlebois ED, Cohen CR, Bukusi EA, Petersen ML, Havlir DV, Kamya MR, Chamie G. Universal HIV Testing and Treatment With Patient-Centered Care Improves ART Uptake and Viral Suppression Among Adults Reporting Hazardous Alcohol Use in Uganda and Kenya. J Acquir Immune Defic Syndr 2023; 94:37-45. [PMID: 37220015 PMCID: PMC10524467 DOI: 10.1097/qai.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Determine whether patient-centered, streamlined HIV care achieves higher antiretroviral therapy (ART) uptake and viral suppression than the standard treatment model for people with HIV (PWH) reporting hazardous alcohol use. DESIGN Community cluster-randomized trial. METHODS The Sustainable East Africa Research in Community Health trial (NCT01864603) compared an intervention of annual population HIV testing, universal ART, and patient-centered care with a control of baseline population testing with ART by country standard in 32 Kenyan and Ugandan communities. Adults (15 years or older) completed a baseline Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and were classified as no/nonhazardous (AUDIT-C 0-2 women/0-3 men) or hazardous alcohol use (≥3 women/≥4 men). We compared year 3 ART uptake and viral suppression of PWH reporting hazardous use between intervention and control arms. We compared alcohol use as a predictor of year 3 ART uptake and viral suppression among PWH, by arm. RESULTS Of 11,070 PWH with AUDIT-C measured, 1723 (16%) reported any alcohol use and 893 (8%) reported hazardous use. Among PWH reporting hazardous use, the intervention arm had higher ART uptake (96%) and suppression (87%) compared with control (74%, adjusted risk ratio [aRR] = 1.28, 95% CI: 1.19 to 1.38; and 72%, aRR = 1.20, 95% CI: 1.10 to 1.31, respectively). Within arm, hazardous alcohol use predicted lower ART uptake in control (aRR = 0.86, 95% CI: 0.78 to 0.96), but not intervention (aRR = 1.02, 95% CI: 1.00 to 1.04); use was not predictive of suppression in either arm. CONCLUSIONS The Sustainable East Africa Research in Community Health intervention improved ART uptake and viral suppression among PWH reporting hazardous alcohol use and eliminated gaps in ART uptake between PWH with hazardous and no/nonhazardous use. Patient-centered HIV care may decrease barriers to HIV care for PWH with hazardous alcohol use.
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Affiliation(s)
- Sarah B Puryear
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA
| | - James Ayieko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Judith A Hahn
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA
| | | | | | - Joshua Schwab
- Division of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Laura B Balzer
- Division of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA
| | | | - Edwin D Charlebois
- Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; and
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maya L Petersen
- Division of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Diane V Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA
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Slavin MN, West BS, Levin FR, El-Bassel N. Women with substance use disorders are highly impacted by the overturning of Roe v. Wade: Advocacy steps are urgently needed. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209052. [PMID: 37105267 PMCID: PMC10433178 DOI: 10.1016/j.josat.2023.209052] [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: 09/23/2022] [Revised: 12/22/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
The Supreme Court's ruling to overturn the 1973 Roe v. Wade verdict represents a major setback for women's reproductive freedoms in the United States. This ruling revokes constitutional protection for abortion rights and returns the decision to the states. Since this ruling in June 2022, numerous states have adopted total or near total abortion bans, with many of these bans offering no exception for rape, incest, or nonfatal maternal health risks. Legal experts also warn that this ruling can open the door to restrict contraceptive rights previously protected under the same implied constitutional right to privacy as abortion. Already, this decision has increased momentum for states to place restrictions on specific forms of contraception. Certain groups of women will be disproportionately harmed by these bans, such as women with substance use disorders (SUDs). Women with SUDs face unique barriers to sexual and reproductive health services that exist at the structural level (e.g., criminalization; costs and accessibility), interpersonal level (e.g., higher rates of intimate partner violence) and individual level (e.g., reduced reproductive autonomy). These synergistic barriers interact to produce lower contraceptive use, increased unintended pregnancy rates, and subsequently a greater need for abortion services among this population. This ruling will exacerbate the effects of these barriers on women with SUDs, resulting in even greater difficulties accessing contraceptive and abortion services, and ultimately increasing rates of criminalization among pregnant and parenting women with SUDs. This commentary describes these barriers and highlights potential advocacy steps that are urgently needed to assist reproductive-aged women with SUDs during these challenging times when essential health services are increasingly inaccessible.
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Affiliation(s)
| | - Brooke S West
- School of Social Work, Columbia University, New York, NY, USA
| | - Frances R Levin
- Columbia University, Vagelos College of Physicians and Surgeons, USA; New York State Psychiatric Institute, USA
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Moebes ZR, Card KG, Koenig B, Benoit C. Lower-risk substance use guidelines accessible by youth. Subst Abuse Treat Prev Policy 2023; 18:10. [PMID: 36782291 PMCID: PMC9926657 DOI: 10.1186/s13011-023-00516-3] [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: 10/19/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Lower-risk substance use guidelines (LRSUGs) are an evidence-based harm reduction strategy used to provide information to people who use drugs so they can reduce harms associated with substance use. OBJECTIVES This study aimed to identify LRSUGs accessible to youth and to characterize the recommendations within these guidelines. The overall goal is to identify gaps in current LRSUGs and to inform researchers and policymakers of the kinds of health information youth can access. METHODS We conducted a digital assessment using the Google search engine to identify LRSUGs that could be identified by youth when searching for official sources of information related to commonly used substances, including cannabis, caffeine, alcohol, hallucinogens, prescription opioids, nicotine, and/or prescription stimulants. LRSUGs were coded and data were extracted from them to identify gaps. RESULTS One hundred thirty LRSUGs were identified; most focused on alcohol (n = 40, 31%), cannabis (n = 30, 23%), and caffeine (n = 21, 16%). LRSUGs provided recommendations about dosing (n = 108, 83%), frequency of use (n = 72, 55%), and when to use (n = 86, 66%). Most LRSUGs were published by health (n = 51, 39%) and third-sector organizations (n = 41, 32%), followed by provincial/state (n = 18, 14%), government (n = 14, 11%), municipal (n = 4, 3%), and academic (n = 2, 2%) sources. Only 16% (n = 21) of LRSUGs were youth-specific and one-quarter (n = 32, 25%) of LRSUGs provided gender-specific recommendations. Most guidelines featured information on short (n = 76, 58%) and long-term (n = 69, 53%) negative effectives and positive effects of substances (n = 56, 43%). Less than half (n = 50, 38%) of LRSUGs cited evidence in support of the information they provided. CONCLUSIONS We identified several areas in the current LRSUGs for youth that need to be addressed. Among the gaps are a lack of LRSUGs developed specifically for youth, a lack of youth engagement in developing harm reduction strategies centered around them, and a lack of evidence-based LRSUGs. Youth-oriented, evidence-based LRSUGs are needed to better support youth who use substances and help them manage the negative effects of substance use.
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Affiliation(s)
- Zakkaery R. Moebes
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
| | - Kiffer G. Card
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
- grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Brett Koenig
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
| | - Cecilia Benoit
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
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15
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Forchuk C, Serrato J, Scott L. Identifying barriers and facilitators for implementing harm reduction strategies for methamphetamine use into hospital settings. FRONTIERS IN HEALTH SERVICES 2023; 3:1113891. [PMID: 36926504 PMCID: PMC10012827 DOI: 10.3389/frhs.2023.1113891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Harm reduction strategies for substance use disorder are not currently offered in Canadian hospitals. Previous research has suggested that substance use may continue to occur which can lead to further complications such as new infections. Harm reduction strategies may be a solution to this issue. This secondary analysis aims to explore the current barriers and potential facilitators for implementing harm reduction into the hospital from the perspective of health care and service providers. METHOD Primary data was collected from 31 health care and service providers who participated in a series of virtual focus groups and one-to-one interviews regarding their perspectives on harm reduction. All staff were recruited from hospitals in Southwestern Ontario, Canada from February 2021 to December 2021. Health care and service professionals completed a one-time individual interview or a virtual focus group using an open-ended qualitative interview survey. Qualitative data was transcribed verbatim and analyzed using an ethnographic thematic approach. Themes and subthemes were identified and coded based on responses. FINDINGS Attitude and Knowledge, Pragmatics, and Safety/Reduction of Harm were identified as the core themes. Attitudinal barriers such as stigma and lack of acceptance were reported but education, openness and community support were regarded as potential facilitators. Cost, space, time and availability of substances on site were regarded as Pragmatic barriers but potential facilitators such as organizational support, flexible harm reduction services and a specialized team were identified. Policy and liability were perceived as both a barrier and a potential facilitator. Safety and impact of substances on treatment were considered as both a barrier and a potential facilitator but sharps boxes and continuity of care were regarded as potential facilitators. DISCUSSION Although barriers in implementing harm reduction in hospital settings exist, there are opportunities to facilitate change. As identified in this study, feasible and achievable solutions are available. Education on harm reduction for staff was considered to be a key clinical implication in facilitating harm reduction implementation.
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Affiliation(s)
- Cheryl Forchuk
- Mental Health Nursing Research Alliance, Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jonathan Serrato
- Mental Health Nursing Research Alliance, Lawson Health Research Institute, London, ON, Canada
| | - Leanne Scott
- Mental Health Nursing Research Alliance, Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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16
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Sensoy Bahar O, Nabunya P, Nabayinda J, Witte S, Kiyingi J, Nsubuga E, Schriger S, Nattabi J, Mayo-Wilson LJ, Nakigudde J, Tozan Y, Ssewamala FM. "I decided in my heart I have to complete the sessions": A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda. PLoS One 2023; 18:e0280138. [PMID: 36634037 PMCID: PMC9836279 DOI: 10.1371/journal.pone.0280138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. METHODS We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018-2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. RESULTS The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. DISCUSSION AND CONCLUSIONS Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. CLINICAL TRIAL REGISTRATION NCT03583541.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- * E-mail:
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Josephine Nabayinda
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Susan Witte
- Columbia University School of Social Work, New York City, NY, United States of America
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Edward Nsubuga
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Simone Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jennifer Nattabi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yesim Tozan
- School of Global Public Health, New York University, New York City, NY, United States of America
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
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D’Ambrozio G, Cosgrove L, Lilly S, McCarthy T. Harm Reduction, Humanistic Psychology, and the CRPD. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221136240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Harm reduction, which was initially developed as a public health response to illicit drug use, has relevance to the prescription of psychotropic medication. Indeed, focusing on the agency of people who use drugs—licit or illicit—facilitates a more authentic engagement with treatment. In this paper, we show how the framework of harm reduction is congruent with the guiding principles of both humanistic psychology and the Convention on the Rights of Persons with Disabilities (CRPD). Moreover, applying a harm reduction model to psychotropic drug use raises awareness that there are risks to taking these medications, risks which are frequently glossed over because of the emphasis on medication adherence and compliance. We provide case examples of organizations that take a person-centered (vs. medication-centered) approach to people experiencing mental health crises. In their unique ways, these organizations embody the principles of harm reduction and the humanistic impulse that informs the CRPD.
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Ignacio M, Sense-Wilson S, Lucero D, Crowder R, Lee JJ, Gavin AR, Mitchell FM, Spencer M. Assessing alcohol and other drug prevention needs among Indigenous youth ages 13-17: Developing a culturally grounded Indigenous youth harm reduction intervention. J Ethn Subst Abuse 2022:1-20. [PMID: 36129774 DOI: 10.1080/15332640.2022.2123877] [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: 10/14/2022]
Abstract
Perceptions of alcohol and other drug (AOD) use, harm reduction, and culture were examined among 10 U.S. Indigenous youth 13-17 years of age. Key findings were contextualized within the four constructs of Indigenous relationality: (a) youth understand the harms of AOD use (people); (b) youth appreciate non-abstinence-based education (ideas); (c) youth need safe spaces to talk about the impacts of AOD use (place); and (d) youth desire to help prevent AOD harms for themselves and others (cosmos). Findings from this community-based participatory study serve as the theoretical foundation to support the development of an Indigenous youth harm reduction intervention to prevent AOD use and related harms among urban Indigenous youth in the Pacific Northwest.
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Affiliation(s)
- Matt Ignacio
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Tucson, Arizona
| | | | | | - Rana Crowder
- School of Social Work, University of Washington, Seattle, Washington
| | - Jane J Lee
- School of Social Work, University of Washington, Seattle, Washington
| | - Amelia R Gavin
- School of Social Work, University of Washington, Seattle, Washington
| | - Felicia M Mitchell
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Tucson, Arizona
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, Arizona
| | - Mike Spencer
- School of Social Work, University of Washington, Seattle, Washington
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19
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Goldstein SC, Spillane NS, Nalven T, Weiss NH. Harm reduction acceptability and feasibility in a North American indigenous reserve community. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3607-3624. [PMID: 35420216 PMCID: PMC9464673 DOI: 10.1002/jcop.22859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
AIMS The present study assessed community and culturally specific alcohol-related harm among North American Indigenous (NAI) individuals, as well as the acceptability and feasibility of harm reduction approaches in one reserve-based NAI community. METHODS Participants lived on or near a NAI reserve in Canada. Semi-structured focus groups were conducted with health care workers (N = 8, 75% NAI) and community members (N = 9, 100% NAI). Self-report questionnaires were administered that measured acceptability and feasibility of harm reduction strategies. RESULTS Conventional content analysis revealed loss of culture as culturally specific alcohol-related harm. Health care workers rated harm reduction approaches to be acceptable and feasible, while community participants were more mixed. Majority of participants felt that some harm reduction strategies could provide opportunities for individuals who use alcohol to connect to Indigenous culture and traditions. However, there were mixed findings on whether harm reduction strategies are consistent with Indigenous cultural traditions and values. CONCLUSION Future research is needed to evaluate potential utility of harm-reduction approaches for NAI communities.
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Affiliation(s)
- Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Tessa Nalven
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Kendrick CT, MacEntee K, Wilson CL, Flicker S. Staying safe: how young women who trade sex in Toronto navigate risk and harm reduction. CULTURE, HEALTH & SEXUALITY 2022; 24:920-934. [PMID: 33819132 DOI: 10.1080/13691058.2021.1900603] [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: 08/04/2020] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Abstract
Celling Sex was a community-based participatory research project that used a strengths-based approach to explore the agentic harm reduction practices employed by young women who trade sex and learn about their experience accessing health and social services. Fifteen racially diverse young women participated in interviews. They described how they tried to stay safe and advice for others. Each participant also individually made a brief digital video (cellphilm) to tell their story. Participants were invited to a private screening at which cellphilms were screened and common themes identified. The interviews and cellphilms were subsequently coded according to these themes. Participants identified a number of trading risks including: physical risks (unwanted pregnancy, STIs, and violence), social risks (racism and fetishisation), and mental health risks. To mitigate these concerns, participants detailed the harm reduction strategies they used which included use of technology, screening measures, boundary setting, and actively incorporating sexual health protections. Young women who trade sex are keenly aware of the risks inherent in transactional relationships and proactively negotiate and navigate harm reduction strategies in the context of deep systemic barriers. Further intervention may be necessary for them to actualise these strategies and access important forms of health and social support.
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Affiliation(s)
| | - Katie MacEntee
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada
| | - Ciann L Wilson
- Community Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sarah Flicker
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada
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Sensoy Bahar O, Nabunya P, Nabayinda J, Witte SS, Kiyingi J, Mayo-Wilson LJ, Filippone P, Yang LS, Nakigudde J, Tozan Y, Ssewamala FM. "I expected little, although I learned a lot": perceived benefits of participating in HIV risk reduction sessions among women engaged in sex work in Uganda. BMC Womens Health 2022; 22:162. [PMID: 35562821 PMCID: PMC9100307 DOI: 10.1186/s12905-022-01759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The global HIV burden remains a public health concern. Women engaged in sex work (WESW) are at higher risk of acquiring HIV compared to the general adult population. Uganda reports high rates of HIV prevalence among WESW. While WESW in Uganda have long been the subject of surveillance studies, they have not been targeted by theory-informed HIV prevention intervention approaches. In this study, we explored the perceived benefits of an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda. METHODS As part of a larger randomized clinical trial, we conducted semi-structured in-depth interviews with 20 WESW selected using a stratified purposive sampling. All interviews were conducted in Luganda, language spoken in the study area, and audio-recorded. They were transcribed verbatim and translated to English. Thematic analysis was used to analyze the data. RESULTS WESW's narratives focused on: (1) condom use; (2) alcohol/drug consumption; (3) PrEP use; (4) "handling" customers; and (5) "massaging" customers. WESW agreed that male condom was one of the important learning points for them and planned to continue using them while female condoms were received with mixed reactions. Many women appreciated receiving information about the risks of consuming alcohol and drugs, and discussed how they reduced/ eliminated their consumption. PrEP information was appreciated though identified by fewer WESW. Handling a client was discussed as a helpful strategy for safer sex through improved ability to convince customers to use condoms or avoiding sex. Massaging was also beneficial to avoid penetrative sex, but similar to female condom, massaging also yielded mixed perceptions. CONCLUSION WESW found the intervention beneficial and described ways in which it improved their ability to engage in safer sex and stay healthy. The fact that WESW identified other strategies beyond condom use as helpful underlines the importance of adopting a comprehensive approach to behavioral interventions targeting HIV prevention even when combined with other interventions. Additionally, WESW's narratives suggest that incorporating the tenets of social cognitive theory and harm reduction approaches in HIV prevention among this population can result in risk behavior change.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Susan S Witte
- Columbia University School of Social Work, New York City, NY, USA
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Prema Filippone
- Columbia University School of Social Work, New York City, NY, USA
| | | | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yesim Tozan
- School of Global Public Health, New York University, New York City, NY, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA
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22
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Woolf-King SE, Firkey M, Foley JD, Bricker J, Hahn JA, Asiago-Reddy E, Wikier J, Moskal D, Sheinfil AZ, Ramos J, Maisto SA. Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers. AIDS Behav 2022; 26:3029-3044. [PMID: 35303190 PMCID: PMC8931450 DOI: 10.1007/s10461-022-03649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.
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Shoptaw S, Li MJ, Javanbakht M, Ragsdale A, Goodman-Meza D, Gorbach PM. Frequency of reported methamphetamine use linked to prevalence of clinical conditions, sexual risk behaviors, and social adversity in diverse men who have sex with men in Los Angeles. Drug Alcohol Depend 2022; 232:109320. [PMID: 35093681 PMCID: PMC8885921 DOI: 10.1016/j.drugalcdep.2022.109320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study tested the hypothesis that reported frequency of methamphetamine use is significantly associated with measures of social adversity, sexual risk behaviors, chronic health conditions, bacterial STIs and HIV-related factors among diverse men who have sex with men (MSM). METHODS Data were 2428 visits from 515 mSTUDY participants (261 people living with HIV; 254 HIV-negative). mSTUDY is an ongoing longitudinal study of racially/ethnically diverse MSM in Los Angeles County. Logistic regression with random intercepts modeled associations between self-reported past 6-month methamphetamine use (none, monthly or less, weekly or more) with reported adverse social outcomes (unemployment, housing instability, intimate partner violence), sexual risk behaviors, chronic health conditions, and biomarkers of bacterial STIs (chlamydia, gonorrhea, or syphilis) and detectable HIV viral load (among HIV-positive). Models controlled for confirmed HIV-serostatus. RESULTS Prevalence of reported monthly or less methamphetamine use was 19%; weekly or more use was 18%. Multivariable models showed escalating odds of adverse social outcomes and sexual risk behaviors (p's < 0.001) with increased methamphetamine use frequency. Frequency of methamphetamine use associated with increased odds of a positive bacterial STI test (p < .001), detectable viral load (in HIV-positive participants) (p < .001), renal condition (p = .047), neurological condition (p = .008), and psychological condition (p = .001). CONCLUSIONS Findings show cross-sectional links between reported methamphetamine use frequency and adverse social and health outcomes among MSM in Los Angeles and suggest there may be fewer social and physical health harms corresponding to less frequent use of methamphetamine in this group.
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Affiliation(s)
- Steve Shoptaw
- David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles, United States; David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | - Michael J. Li
- David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles
| | - Marjan Javanbakht
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
| | - Amy Ragsdale
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
| | - David Goodman-Meza
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles
| | - Pamina M. Gorbach
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
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Expanding the continuum of substance use disorder treatment: Nonabstinence approaches. Clin Psychol Rev 2022; 91:102110. [PMID: 34864497 PMCID: PMC8815796 DOI: 10.1016/j.cpr.2021.102110] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD - especially drug use disorders - as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. We describe the development of nonabstinence approaches within the historical context of SUD treatment in the United States, review theoretical and empirical rationales for nonabstinence SUD treatment, and review existing models of nonabstinence psychosocial treatment for SUD among adults to identify gaps in the literature and directions for future research. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
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Zhao J, Stockwell T, Pauly B, Wettlaufer A, Chow C. Participation in Canadian Managed Alcohol Programs and Associated Probabilities of Emergency Room Presentation, Hospitalization and Death: A Retrospective Cohort Study. Alcohol Alcohol 2022; 57:246-260. [PMID: 34999760 DOI: 10.1093/alcalc/agab078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Managed Alcohol Programs (MAPs) are designed to improve health and housing outcomes for unstably housed people with an alcohol use disorder (AUD). The present study assesses the association of MAP participation with healthcare and mortality outcomes. METHODS A retrospective cohort study assessed health outcomes for 205 MAP participants and 128 controls recruited from five Canadian cities in 2006-2017. Survival and negative binomial regression models were used to calculate hazard ratios (HR) of death and emergency room (ER) visits and hospital bed days (HBDs). Covariates included age, sex, AUD severity and housing stability score. RESULTS In fully adjusted models, compared with times outside MAPs, participants had significantly reduced risk of mortality (HR = 0.37, P = 0.0001) and ER attendance (HR = 0.74, P = 0.0002), and fewer HBDs yearly (10.40 vs 20.08, P = 0.0184). Over the 12 years, people enrolled in a MAP at some point had significantly fewer HBDs per year than controls after MAP enrolment (12.78 vs 20.08, P = 0.0001) but not significantly different rates of death or ER presentation. MAP participants had significantly more alcohol-related but significantly fewer nonalcohol-related ER presentations than controls. CONCLUSION Attendance at a MAP was associated with reduced risk of mortality or morbidity and less hospital utilization for individuals with unstable housing and severe AUDs. MAPs are a promising approach to reduce mortality risk and time spent in hospital for people with an AUD and experiencing homelessness.
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Affiliation(s)
- Jinhui Zhao
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Tim Stockwell
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Bernie Pauly
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Ashley Wettlaufer
- Centre for Addiction & Mental Health, Institute for Mental Health Policy Research, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
| | - Clifton Chow
- Vancouver Coastal Health Authority, 200-520 West 6th Avenue, Vancouver, BC V5Z 4H5, Canada
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26
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Flannigan K, Odell B, Rizvi I, Murphy L, Pei J. Complementary therapies in substance use recovery with pregnant women and girls. WOMEN'S HEALTH 2022; 18:17455057221126807. [PMID: 36173262 PMCID: PMC9528000 DOI: 10.1177/17455057221126807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Supporting women and girls who are pregnant and experiencing substance use challenges is a high priority for researchers, clinicians, and policymakers. Complementary therapies (CTs) can be effective forms of treatment in some contexts and populations; however, research on the use of CTs in substance use recovery with pregnant women and girls is scarce. To fill this gap, we conducted a mixed methods study using survey data collected at a women’s recovery center in Canada. Our objectives were to describe CTs provided at the program; identify what CTs are perceived by participants as most/least positive; and explore factors that may impact participant experiences with CTs. Methods: We analyzed feedback responses from 255 women and girls ( Mage = 27.5 years, range 15–64) using Pearson chi-square tests, logistic regression, and inductive content analysis. Results: The most frequently provided CTs were yoga, energy-related activities (e.g. reiki, reflexology), and meditation. Among the most common CTs, participants provided the highest endorsements for massage and physical activity, and the lowest endorsements for yoga and drumming. Across CTs, whether participants looked forward to an activity contributed significantly to whether they found it helpful, would like to do it again, and planned to continue engaging in the activity after leaving the program. Four broad contextual factors were identified that may impact experiences and perspectives about CTs: (1) goodness of fit, (2) self-awareness, (3) growth, and (4) healing and holistic wellbeing. Conclusions: This study provides novel evidence on the potential impacts of CTs in substance use treatment for pregnant women and girls, and important contextual factors to consider when implementing these approaches.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
| | - Bryce Odell
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Imad Rizvi
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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Belisle LA, Solano-Patricio EDC. Harm reduction: a public health approach to prison drug use. Int J Prison Health 2021; 18:458-472. [PMID: 34962726 DOI: 10.1108/ijph-06-2021-0053] [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: 11/17/2022]
Abstract
PURPOSE As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs. DESIGN/METHODOLOGY/APPROACH This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution. FINDINGS A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community. ORIGINALITY/VALUE Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations' rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.
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Affiliation(s)
- Linsey Ann Belisle
- Department of Criminal Justice and Social Work, University of Houston - Downtown, Houston, Texas, USA
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Kerman N, Polillo A, Bardwell G, Gran-Ruaz S, Savage C, Felteau C, Tsemberis S. Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review. Drug Alcohol Depend 2021; 228:109052. [PMID: 34601279 DOI: 10.1016/j.drugalcdep.2021.109052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Harm reduction is a central tenet of Housing First. As the intervention has been shown to stably house people experiencing chronic homelessness across the lifespan with complex behavioural health needs, it is critical to understand the harm reduction outcomes and practices in Housing First. METHODS A systematic review following PRISMA guidelines was conducted of five databases: PsycINFO, MEDLINE, Embase, CINAHL, and Google Scholar. Harm reduction outcomes and practices in Housing First were examined in four domains: substance-related harms, viral health, sexual health, and harm reduction service use. RESULTS A total of 35 articles were included in the review, 23 of which examined harm reduction outcomes and 12 of which investigated harm reduction practices in Housing First. Harm reduction outcome studies focused mostly on nonspecific substance use problems, with Housing First being found to have minimal effects in this domain. More severe harms, such as delirium tremens and substance use-related deaths, have been minimally explored, though preliminary evidence is promising. Viral health, sexual health, and harm reduction service use outcomes were the focus of few studies. Research on harm reduction practices highlighted that Housing First providers experience both flexibility and ambiguity in their work using a harm reduction approach, and the importance of empathetic working relationships for engagement in harm reduction work. CONCLUSIONS Harm reduction outcomes in Housing First remain underexamined and any conclusions of the intervention's impacts in this domain would be premature. Effective harm reduction practices in Housing First require strong working relationships between staff and tenants.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada; University of British Columbia, Department of Medicine, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sophia Gran-Ruaz
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
| | - Cathi Savage
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Charlie Felteau
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Sam Tsemberis
- Pathways Housing First Institute, 1328 2nd Street, Santa Monica, CA, 90403, United States
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29
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Rawls E, Wolkowicz NR, Ham LS, Lamm C. Negative urgency as a risk factor for hazardous alcohol use: Dual influences of cognitive control and reinforcement processing. Neuropsychologia 2021; 161:108009. [PMID: 34454939 PMCID: PMC8488007 DOI: 10.1016/j.neuropsychologia.2021.108009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 01/16/2023]
Abstract
Negative Urgency (NU) is a prominent risk factor for hazardous alcohol use. While research has helped elucidate how NU relates to neurobiological functioning with respect to alcohol use, no known work has contextualized such functioning within existing neurobiological theories in addiction. Therefore, we elucidated mechanisms contributing to the NU-hazardous alcohol use relationship by combining NU theories with neurobiological dual models of addiction, which posit addiction is related to cognitive control and reinforcement processing. Fifty-five undergraduates self-reported NU and hazardous alcohol use. We recorded EEG while participants performed a reinforced flanker task. We measured cognitive control using N2 activation time-locked to the incongruent flanker stimulus, and we measured reinforcement processing using the feedback-related negativity (FRN) time-locked to better-than-expected negative reinforcement feedback. We modeled hazardous drinking using hierarchical regression, with NU, N2, and FRN plus their interactions as predictors. The regression model significantly predicted hazardous alcohol use, and the three-way interaction (NU × N2 × FRN) significantly improved model fit. In the context of inefficient processing (i.e., larger N2s and FRNs), NU demonstrated a strong relationship with hazardous alcohol use. In the context of efficient processing (i.e., smaller N2s and FRNs), NU was unrelated to hazardous alcohol use. Control analyses ruled out the potential impact of other impulsivity subscales, individual differences in dimensional negative affect or anxiety, and use of substances other than alcohol, and post hoc specificity analyses showed that this effect was driven primarily by heavy drinking, rather than frequency of drinking. This analysis provides preliminary evidence that brain mechanisms of cognitive control and reinforcement processing influence the relationship between NU and hazardous alcohol use, and confirms a specific influence of negative reinforcement processing. Future clinical research could leverage these neurobiological moderators for substance misuse treatment.
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Affiliation(s)
- Eric Rawls
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA.
| | | | - Lindsay S Ham
- Department of Psychological Science, University of Arkansas, USA
| | - Connie Lamm
- Department of Psychological Science, University of Arkansas, USA
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30
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Abatemarco DJ, Gannon M, Short VL, Baxter J, Metzker KM, Reid L, Catov JM. Mindfulness in Pregnancy: A Brief Intervention for Women at Risk. Matern Child Health J 2021; 25:1875-1883. [PMID: 34618309 DOI: 10.1007/s10995-021-03243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The U.S. has the highest rate of preterm birth (PTB), of all developed countries, especially among African American women. Social determinants of health and inequalities in health outcomes are understudied areas. The intersectionality of race and socioeconomic status has been shown to contribute to chronic stress, stress has been shown to be associated with PTB, yet the mechanisms that affect pregnancy outcomes have not been explicit. Mindfulness-based Interventions that address stress reduction during pregnancy may improve quality of life during pregnancy, perhaps enhancing resilience, and be on the pathway to reducing the risk of negative pregnancy outcomes such as PTB. METHODS We over-enrolled African American women and those covered by Medicaid to reach women at higher risk for PTB and included women in substance use treatment. Participants were enrolled in a 6-week mindfulness in pregnancy (MIP) intervention at the obstetric clinic. Sociodemographic characteristics and psychosocial assessments were obtained at three time points. RESULTS We enrolled 35 women who self-identified as: non-white, Medicaid recipients, aged 25-35 years, with high school or less education. We found reductions in perceived stress, pregnancy specific stress, trait anxiety and depression and increases in mindfulness that sustained post-intervention at 2 and 7 months. DISCUSSION Social determinants and stress in particular have been associated with negative birth outcomes. This paper describes a brief intervention and results of MIP tailored to women who have significantly more stress due to race, poverty, homelessness, substance use treatment and other comorbid health risks including PTB.
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Affiliation(s)
- Diane J Abatemarco
- Maternal Addiction Treatment, Education and Research (MATER), Departments of Obstetrics, Gynecology, and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, 1233 Locust St, Suite 401, Philadelphia, PA, 19107, USA.
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Vanessa L Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, USA
| | - Jason Baxter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, USA
| | | | - Lindsay Reid
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Janet M Catov
- Departments of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, USA
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Rodda SN. A Systematic Review of Internet Delivered Interventions for Gambling: Prevention, Harm Reduction and Early Intervention. J Gambl Stud 2021; 38:967-991. [PMID: 34515903 DOI: 10.1007/s10899-021-10070-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
Internet delivered interventions are accessible and easy to access and can be used to deliver brief interventions. These interventions can be tailored according to individual need for the prevention and minimisation of gambling harm or early intervention for those that are displaying some signs of problems. The objective of this review was to summarise the existing literature on the effectiveness of prevention, harm reduction and early intervention programs when delivered online. A systematic review was conducted for peer-reviewed studies that evaluated internet delivered interventions for the prevention, harm reduction or early intervention for gambling problems. Four electronic databases were consulted in the past 20 years (2000-2020) resulting in a total of 15 included studies. Across identified studies just one study provided prevention with 7 harm reduction and 7 early interventions. The quality of the literature was variable with just 8 randomised controlled trials with the remainder matched controls or longitudinal cohort studies. The target group was predominantly gamblers accessing betting and casino websites (n = 8). Studies administered four types of interventions which included personalised and normative feedback, limit setting, self-directed cognitive and behavioural therapy and self-exclusion. These were delivered via customer gaming accounts, email, and self-learning packages. The available literature shows promise in the effectiveness of internet delivered interventions. However, the limited number of studies included in this review highlight significant lost opportunities to leverage technology in the prevention and reduction of gambling harm.
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Affiliation(s)
- Simone N Rodda
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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32
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Rosansky JA, Rosenberg H. Intervene to moderate pandemic drinking by university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021:1-4. [PMID: 34232848 DOI: 10.1080/07448481.2021.1942888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
Increases and decreases in university students' drinking during and after the pandemic will be influenced by multiple factors, including their access to alcohol, COVID-related stress, social support, and whether they live with parents or on campus. Many will engage in elevated drinking, especially upon return to the campus environment. It is our view that abstinence-oriented advice and interventions are unlikely to attract and assist the full range of pandemic drinkers. This viewpoint outlines advantages of supporting moderate drinking, provides examples of self-assessment methods that could enhance motivation to change, and describes self-initiated tactics that university students can employ to moderate their drinking. Students who have a more serious drinking problem or find it difficult to limit or quit drinking on their own may be encouraged to seek professional counseling or attend a mutual help group, either on campus or at home, depending on where they are residing.
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Affiliation(s)
- Joseph A Rosansky
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
- Department of Psychiatry, Cambridge Health Alliance Harvard Medical School, Boston, Massachusetts, USA
| | - Harold Rosenberg
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
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Ooms M, Roozen HG, Willering JH, Zijlstra WP, de Waart R, Goudriaan AE. Effects of Multiple Detoxifications on Withdrawal Symptoms, Psychiatric Distress and Alcohol-Craving in Patients with an Alcohol Use Disorder. Behav Med 2021; 47:296-310. [PMID: 32396039 DOI: 10.1080/08964289.2020.1760777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous studies have shown an association between the number of withdrawal attempts and increased severity of withdrawal symptoms in patients with an alcohol use disorder (AUD). An underlying allostatic neuroadaptive response may negatively affect the withdrawal pathology after alcohol discontinuation. The objective of the present research is to examine the intensification of psychiatric distress, craving, and post-detoxification drinking outcomes, which may result from these neurobehavioral alternations. Fifty-two AUD inpatients were divided into two groups: <2 previous detoxifications and ≥2 previous detoxifications. Patients completed the Dutch version of the Severity of Withdrawal Scale (SWS), Depression Anxiety Stress Scales (DASS-21), VAS Craving, and Desires for Alcohol Questionnaire (DAQ). Linear mixed effects models were applied, controlling for the number of drinks consumed in the past 30 days and alcohol drinking history (years). Patients who had undergone ≥2 detoxifications reported statistically significantly higher scores on SWS withdrawal and DASS psychiatric symptoms. Also, craving patterns were different between groups, as shown by a statistically significant interaction effect for VAS craving for the time of day factor (morning vs. evening). No statistically significant group differences were found for DAQ scores and post-detoxification drinking outcomes. Due to relatively low 1-month follow-up rates our power was limited to detect such a difference. The present study contributes to the existing body of evidence that multiple detoxifications are associated with aggravated withdrawal/psychiatric pathology, and distinct diurnal patterns of VAS craving. Several clinical implications are discussed and alternative strategies are provided to manage repeated cycles of detoxifications.
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Affiliation(s)
- Martha Ooms
- Centrum voor Transculturele Psychiatrie (CTP) Veldzicht, Balkbrug, ZG, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, The University of New Mexico (UNM), Albuquerque, NM, USA
| | - Juul H Willering
- Altrecht Centrum Psychodiagnostiek, Centrum Psychodiagnostiek, Zeist, WB, The Netherlands
| | - Wobbe P Zijlstra
- CITO, Department of Psychometrics and Research, Arnhem, CM, The Netherlands
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Rowell-Cunsolo TL, Bellerose M, Hart C. Access to Harm Reduction Treatment Among Formerly Incarcerated Individuals During the COVID-19 Era. Health Secur 2021; 19:S95-S101. [PMID: 34101494 PMCID: PMC8236556 DOI: 10.1089/hs.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tawandra L Rowell-Cunsolo
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
| | - Meghan Bellerose
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
| | - Carl Hart
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
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Pauly B, King V, Smith A, Tranquilli-Doherty S, Wishart M, Vallance K, Stockwell T, Sutherland C. Breaking the cycle of survival drinking: insights from a non-residential, peer-initiated and peer-run managed alcohol program. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1764500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Vashti King
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Ashley Smith
- St. Paul's Maternity Care, St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | - Kate Vallance
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Tim Stockwell
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
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McKendy L, Biro SM, Miron M, Keown LA. Understanding overdose incidents in Canadian federal custody. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103131. [PMID: 33558166 DOI: 10.1016/j.drugpo.2021.103131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND While the community effects of the opioid-related drug crisis in Canada are well documented, limited detailed data is available on overdose trends among custodial populations. Given that this crisis has disproportionate impacts on justice involved persons, research is needed to understand the implications of this crisis within institutional settings. METHODS We examined all overdose incidents that occurred between the 2012/2013 and 2018/2019 fiscal years in a federal correctional institution in Canada. An incident report search was conducted to identify overdose related incidents during this period. Information about the incident and characteristics of the victim was collected from incident reports, investigations, and victim case files. RESULTS Over the period under examination, overdose incidents steadily increased (i.e., from 40 in 2012/2013, to 110 non-fatal incidents in 2018/2019), although there was considerable regional and institutional variation. The number of incidents involving opioids, particularly fentanyl, increased both in raw numbers and as a percentage of overall incidents (i.e., from 3% in 2012/2013 to 47% in 2017/2018, and 34% of non-fatal incidents in 2018/2019). Other substances continue to contribute to overdose incidents; in fact, non-opioid prescription medications (i.e., non-illicit medications such as anti-convulsant drugs and anti-depressants) remain the most common among intentional non-fatal incidents. Relative to the general in-custody population, victims of overdose incidents tended to be younger and were more likely to be serving a determinate sentence, be on a repeat federal sentence, and be serving time for robbery. Mental health conditions and histories of substance use were common. CONCLUSION The effects of the overdose crisis are pronounced within certain Canadian federal institutions, illustrated by a growing number of fentanyl-related incidents. Institutional variation and variation in incidents (e.g., substance and intentionality) highlight diversity in drug activities among this custodial population and the need for multi-faceted responses that are reflective of local situations.
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Affiliation(s)
- Laura McKendy
- Research Branch, Correctional Service of Canada, 340 Laurier Ave. W., Ottawa, Ontario, K1A 0P9 Canada.
| | - Stephanie M Biro
- Research Branch, Correctional Service of Canada, 340 Laurier Ave. W., Ottawa, Ontario, K1A 0P9 Canada
| | - Magda Miron
- Research Branch, Correctional Service of Canada, 340 Laurier Ave. W., Ottawa, Ontario, K1A 0P9 Canada
| | - Leslie Anne Keown
- Research Branch, Correctional Service of Canada, 340 Laurier Ave. W., Ottawa, Ontario, K1A 0P9 Canada
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Bagot KS, Kaminer Y. Abstinence vs. Harm Reduction for Youth with Substance Use Disorders: “You Can’t Always Get What You Want”. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676610666200327164503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kara S. Bagot
- The Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - Yifrah Kaminer
- Departments of Psychiatry and Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
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Bishop AS, Fleming CM, Nurius PS. Substance Use Profiles Among Gang-Involved Youth: Social Ecology Implications for Service Approaches. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105600. [PMID: 33184526 PMCID: PMC7654736 DOI: 10.1016/j.childyouth.2020.105600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Substance use is a frequently cited health risk behavior in the youth gang literature, yet little is known about how substance use patterns vary among gang-involved youth or the social ecological factors that contribute to potential variation. Developing relevant and effective service approaches will require an understanding of this variation and the malleable factors that are likely to promote or inhibit particular patterns of use. Using latent class analysis, we identified four substance use classes within a school-based sample of gang-involved youth (n = 2,770): Non-Users (38%), Past Users (15%), Casual Users (27%), and Frequent Multi-Users (21%). These classes were distinguished by substance type, frequency of use, and source of access. Demographic and substance use-specific ecological factors across the family, peer, school, and neighborhood contexts were found to significantly differentiate these classes. Specifically, acceptance of use by parents, friends, and neighbors, along with a lack of family rules and high accessibility in the neighborhood, significantly differentiated use patterns. Findings highlight the need for service approaches that are responsive to the unique needs of individuals and their environments. Implications for practice are discussed, including the potential utility of applying a harm reduction service framework to address youth gang substance use.
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Affiliation(s)
- Asia S. Bishop
- School of Social Work, University of Washington 4101, 15 Avenue N.E., Seattle, Washington, 98105, United States of America
| | - Christopher M. Fleming
- Prevention Science Institute, University of Oregon, 1600 Millrace Drive, Eugene, Oregon, 97403, United States of America
| | - Paula S. Nurius
- School of Social Work, University of Washington 4101, 15 Avenue N.E., Seattle, Washington, 98105, United States of America
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Christie GIG, Cheetham A, Lubman DI. Interventions for Alcohol and Drug Use Disorders in Young People: 10 Key Evidence-Based Approaches to Inform Service Delivery. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00336-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Individual differences in distress, impulsivity, and coping motives for use as predictors of problematic ecstasy use. Addict Behav 2020; 108:106397. [PMID: 32353691 DOI: 10.1016/j.addbeh.2020.106397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/16/2020] [Accepted: 03/14/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ecstasy users who report problematic use of ecstasy experience adverse social, psychological, and health-related consequences not reported by non-problem users. Relatively little is known about the risk factors for the development of problematic ecstasy use. Such information would be valuable for targeted intervention, prevention, and education AIMS: The current study aimed to fill this gap by investigating several hypothesised risk factors for problematic use and the relationships between them. METHODS Self-reported impulsivity, psychological distress, sex, and coping motives for ecstasy use were investigated as predictors of problematic ecstasy use in a cross-sectional online survey. RESULTS The sample consisted of 483 individuals (60.5% male, 38.3% female, 1.2% other) aged 18-62 years, reporting ecstasy use on an average of 59.7 occasions (SD = 167.8). Both higher self-reported impulsivity and psychological distress predicted problem ecstasy use, and both these relationships were partially mediated by coping motives. When these variables were examined in a combined mediation model accounting for their covariance, psychological distress still predicted problematic use partially via an effect on coping motives, while impulsivity showed only a direct effect on problem use. No sex differences in problem ecstasy use were observed. CONCLUSIONS Increased trait impulsivity and psychological distress appear to confer greater risk of problematic ecstasy use. Targeting these factors, as well as coping motives for ecstasy use, may be useful in efforts to prevent and reduce problematic ecstasy use among those who use the drug.
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PARK JUNYEONG, ROUHANI SABA, BELETSKY LEO, VINCENT LOUISE, SALONER BRENDAN, SHERMAN SUSANG. Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework. Milbank Q 2020; 98:700-746. [PMID: 32808709 PMCID: PMC7482387 DOI: 10.1111/1468-0009.12470] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. CONTEXT Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. METHODS In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. FINDINGS De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. CONCLUSIONS Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.
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Affiliation(s)
| | | | - LEO BELETSKY
- School of Law and Bouvé College of Health SciencesNortheastern University
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Matalí JL, Pérez-Racana A, Flores E, Lleras M, Goti J, Kaminer Y. Goal commitment evolution in a Spanish adolescent sample with cannabis use disorder. Addict Behav 2020; 107:106388. [PMID: 32208323 DOI: 10.1016/j.addbeh.2020.106388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The treatment of adolescents with Cannabis Use Disorder (CUD) presents a variety of challenges. The identification of a patient's treatment goal might be an important predictor of cannabis consumption and a key factor when designing the intervention. This paper aims to present the psychometric properties of the Spanish version of the Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire in adolescent consumers of cannabis and to report the association of goal commitment with the treatment outcome. METHOD A sample of 115 adolescents between 13 and 18 years old with CUD in outpatient treatment were evaluated. Psychometric properties including exploratory and confirmatory factor analysis, predictive validity, reliability and stability over time were analyzed. RESULTS ASAGC shows good psychometric properties, with excellent reliability (Cronbach's α of >0.95 for both subscales, Abstinence and Harm Reduction) at baseline and 3 and 6 months (>0.95 for both subscales) and good stability at 3 and 6 months (K = 0.572 and 0.659). Higher scores in Commitment to abstinence at baseline are associated with lower scores of THC in urine at 3 and 6 months (p < .001). CONCLUSION The ASAGC is a useful tool to study treatment commitment in adolescents that present a CUD. Abstinence commitment is a reliable prognostic factor. However, adolescents committed to HR remain a therapeutic challenge.
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"We know the streets:" race, place, and the politics of harm reduction. Health Place 2020; 64:102376. [PMID: 32838893 DOI: 10.1016/j.healthplace.2020.102376] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
This paper explores how a peer-and street-based naloxone distribution program (Bmore POWER) reshapes narratives and practices around drug use and harm reduction in an urban context with an enduring opioid epidemic. Data collection included observations of Bmore POWER outreach events and interviews with peers. Bmore POWER members create a sense of community responsibility around overdose prevention and reconfigure overdose hotspots from places of ambivalence to places of grassroots action. It expands a harm reduction approach to Black communities that have not traditionally embraced it and that have been underserved by drug treatment programs. Policy makers should consider ways to use peers grounded in specific communities to expand other aspects of harm reduction, such as syringe and support services.
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Liu S, Zhang RY, Kishimoto T. Analysis and prospect of clinical psychology based on topic models: hot research topics and scientific trends in the latest decades. PSYCHOL HEALTH MED 2020; 26:395-407. [PMID: 32156155 DOI: 10.1080/13548506.2020.1738019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The popularity of research topics in clinical psychology has always been changing over time. In this study, we use Latent Dirichlet Allocation (LDA), a well-established statistical modeling approach in machine learning, to extract hot research topics in published review articles in clinical psychology. In Study 1, we use LDA to extract existing topics between 1981 to 2018 from the review articles published on three premium journals in clinical psychology. Results provide stable information about all topics and their proportions. In Study 2, we use a dynamic variant of LDA to identify the development of hot topics from 2007 to 2018. Results show that meta-analysis, psychotherapy, professional development, and depression constantly stay as hot topics all over the 12 years. We also find that behavior intervention has a clear rising trend since 2007. Our results provide a comprehensive summary of the popularity of research topics in clinical psychology in the last couple of years, and the results here can help clinical researchers form a structured view of past research and plan future research directions.
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Affiliation(s)
- Shuang Liu
- Department of Social Psychology, Nankai University, Tianjing, P.R. China
| | - Ru-Yuan Zhang
- Center for Magnetic Resonance Research, University of Minnesota at Twin Cities, Minneapolis, MN, USA
| | - Tomoko Kishimoto
- Department of Social Psychology, Nankai University, Tianjing, P.R. China
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Pauly B, Brown M, Evans J, Gray E, Schiff R, Ivsins A, Krysowaty B, Vallance K, Stockwell T. "There is a Place": impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness. Harm Reduct J 2019; 16:70. [PMID: 31842903 PMCID: PMC6916004 DOI: 10.1186/s12954-019-0332-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/29/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). METHODS We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of "messy", "ordered" and "social arenas" maps that provide insight into the social worlds of participants and the impact of MAPs. RESULTS Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. CONCLUSIONS In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.
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Affiliation(s)
- B. Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC V8P 5C2 Canada
| | - M. Brown
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC V8P 5C2 Canada
| | - J. Evans
- Department of Earth and Atmospheric Sciences, University of Alberta, 1-26 Earth Sciences Building, Edmonton, AB T6G 2E9 Canada
| | - E. Gray
- School of Social Work, MacEwan University, 9-505 Robbins Building, Box 1796, 10700-104 Avenue, Edmonton, AB T5J 2P2 Canada
| | - R. Schiff
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - A. Ivsins
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - B. Krysowaty
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - K. Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - T. Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
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Szelest I, Motluk L, Jennens H, Lagassé J, Tailleur M, Salvalaggio G. Technology to support relational care for people who use drugs at home: Literature review and key informant content. Healthc Manage Forum 2019; 32:213-217. [PMID: 31091991 DOI: 10.1177/0840470419836266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Canada's opioid crisis is a public health emergency that disproportionately affects people who use drugs alone at home, requiring the mobilization of health systems to implement timely, effective, and innovative programs. The purpose of this review is to provide a synthesis of recent literature relating to technology-enabled harm reduction strategies. The results of the literature review are corroborated with key informants, including family members of people who use drugs and policy-makers in the area of opioid use. Based on this, it is recommended that technology-enabled support programs for people who use drugs at home must deliver support at whatever point the person is along their drug use continuum, must transfer frontline relational skills, must be co-developed with community members and service providers, and must deliver predictable and reliable services that are safe from stigma.
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Affiliation(s)
- Izabela Szelest
- 1 South Okanagan Similkameen Division of Family Practice, Penticton, British Columbia, Canada
| | - Lori Motluk
- 2 North & South Okanagan Hospitals and Community Integrated Services, Interior Health, Penticton, British Columbia, Canada
| | - Helen Jennens
- 3 Moms Stop the Harm, Kelowna, British Columbia, Canada
| | - Jeannine Lagassé
- 4 Nova Scotia Department of Health and Wellness, Office of the Associate Deputy Minister, Halifax, Nova Scotia, Canada
| | - Martin Tailleur
- 5 Strategic Information Management Technology Services Branch, Alberta Health, Edmonton, Alberta, Canada
| | - Ginetta Salvalaggio
- 6 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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"Beyond Safer Injecting"-Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112032. [PMID: 31181648 PMCID: PMC6603933 DOI: 10.3390/ijerph16112032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Health and social issues in aging populations of people who inject drugs (PWID) tend to aggregate, despite risky injecting practices decreasing with age. Identifying needs and avenues of support is becoming increasingly important. We described the health and social situation among clients of a long-running supervised injecting facility (SIF) in Sydney, Australia. An interviewer-administered survey (n = 182) assessed current housing status, employment, physical and mental health, incarceration history, drug use, engagement in drug treatment, health service utilization, and willingness to accept support. Results were compared to the information provided at initial visit. Up to half of the participants transitioned between lower- and higher-risk health and social indicators over time. Willingness to accept support was greatest amongst those with higher self-perceived need. Support for mental health was a low priority, despite the high self-reporting of mental health issues. SIF clients are open to support for health and social issues, despite ongoing active drug use. Lower-threshold services such as SIFs are well-positioned to recognize and respond to deteriorating health and social issues for PWID. Facilitating care and treatment remains a challenge when the services to which people are being referred are higher-threshold with a more rigid approach.
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Collins SE, Clifasefi SL, Nelson LA, Stanton J, Goldstein SC, Taylor EM, Hoffmann G, King VL, Hatsukami AS, Cunningham ZL, Taylor E, Mayberry N, Malone DK, Jackson TR. Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:24-33. [PMID: 30851620 PMCID: PMC6488431 DOI: 10.1016/j.drugpo.2019.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/05/2018] [Accepted: 01/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. METHODS People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. RESULTS Compared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). CONCLUSION A low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.
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Affiliation(s)
| | | | | | - Joey Stanton
- University of Washington, United States; Downtown Emergency Service Center, United States
| | | | | | | | | | | | | | | | | | | | - T Ron Jackson
- University of Washington, United States; Evergreen Treatment Services - REACH
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Kaminer Y, Ohannessian CM, Burke RH. Goal commitment predicts cannabis use for adolescents in treatment. Subst Abus 2019; 40:496-500. [PMID: 30810498 DOI: 10.1080/08897077.2019.1573207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Commitment to change is an innovative potential mediator and mechanism of behavior change (MOBC) that has not been examined in adolescents with cannabis use. The Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire is a reliable and valid 2-scale measure developed to assess the adolescent's commitment to either abstinence or harm reduction model for adolescents, which in addition to decrease in negative consequences includes consumption reduction as a stated treatment goal. The objective of this paper is to examine the ASAGC's ability to predict adolescent substance use treatment outcome. Methods: During Sessions 3 and 9 of a 10-week treatment program, therapists completed the ASAGC for 170 adolescents 13-18 years of age with alcohol use disorders, the majority of whom (82%) were diagnosed with co-occurring cannabis use disorder (CUD). Results: Logistic regression analyses assessing goal commitment regarding cannabis use at Session 3 indicated that commitment to both abstinence and harm reduction predicted cannabis use at Session 3. However, only commitment to abstinence predicted later cannabis use (assessed at Session 9 and during aftercare). When goal commitment at Session 9 was examined, only commitment to abstinence predicted cannabis use, concurrently and longitudinally. These results indicated that adolescents who had higher scores for commitment to abstinence were less likely to be positive for cannabis use. In contrast, harm reduction was not a significant predictor of cannabis use. Conclusions: Findings demonstrate that goal commitment consistently predicts cannabis use treatment outcome. Commitment to abstinence specifically is a salient predictor for concurrent and future cannabis use. Further prospective study is necessary to determine whether harm reduction may be an attainable goal for some youth given normative delayed neurodevelopmental processes of inhibitive behaviors.
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Affiliation(s)
- Yifrah Kaminer
- Alcohol Research Center and Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Christine M Ohannessian
- Alcohol Research Center and Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, Connecticut, USA.,Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Rebecca H Burke
- Alcohol Research Center and Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
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Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan. AIDS Behav 2019; 23:1-14. [PMID: 30194502 DOI: 10.1007/s10461-018-2268-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.
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